Birth Trauma: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

BIRTH TRAUMA A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2004 by ICON Group International, Inc. Copyright 2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Birth Trauma: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-497-00141-1 1. Birth Trauma-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International, Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on birth trauma. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON BIRTH TRAUMA......................................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Birth Trauma ................................................................................ 4 The National Library of Medicine: PubMed .................................................................................. 8 CHAPTER 2. ALTERNATIVE MEDICINE AND BIRTH TRAUMA ........................................................ 19 Overview...................................................................................................................................... 19 National Center for Complementary and Alternative Medicine.................................................. 19 Additional Web Resources ........................................................................................................... 22 General References ....................................................................................................................... 23 CHAPTER 3. DISSERTATIONS ON BIRTH TRAUMA .......................................................................... 25 Overview...................................................................................................................................... 25 Dissertations on Birth Trauma .................................................................................................... 25 Keeping Current .......................................................................................................................... 25 CHAPTER 4. BOOKS ON BIRTH TRAUMA ......................................................................................... 27 Overview...................................................................................................................................... 27 Chapters on Birth Trauma ........................................................................................................... 27 APPENDIX A. PHYSICIAN RESOURCES ............................................................................................ 33 Overview...................................................................................................................................... 33 NIH Guidelines............................................................................................................................ 33 NIH Databases............................................................................................................................. 35 Other Commercial Databases....................................................................................................... 37 APPENDIX B. PATIENT RESOURCES ................................................................................................. 39 Overview...................................................................................................................................... 39 Patient Guideline Sources............................................................................................................ 39 Finding Associations.................................................................................................................... 41 APPENDIX C. FINDING MEDICAL LIBRARIES .................................................................................. 43 Overview...................................................................................................................................... 43 Preparation................................................................................................................................... 43 Finding a Local Medical Library.................................................................................................. 43 Medical Libraries in the U.S. and Canada ................................................................................... 43 ONLINE GLOSSARIES.................................................................................................................. 49 Online Dictionary Directories ..................................................................................................... 49 BIRTH TRAUMA DICTIONARY................................................................................................. 51 INDEX ................................................................................................................................................ 71

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with birth trauma is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about birth trauma, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to birth trauma, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on birth trauma. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to birth trauma, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on birth trauma. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON BIRTH TRAUMA Overview In this chapter, we will show you how to locate peer-reviewed references and studies on birth trauma.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and birth trauma, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “birth trauma” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Impact of Self-Monitoring of Blood Glucose on Self-Efficacy and Pregnancy Outcomes in Women with Diet-Controlled Gestational Diabetes Source: Diabetes Educator. 28(3): 435-443. May-June 2002. Contact: Available from American Association of Diabetes Educators. 100 West Monroe Street, 4th Floor, Chicago, IL 60603-1901. (312) 424-2426. Summary: This article reports on a study undertaken to examine the effects of selfmonitoring of blood glucose (SMBG) on feelings of self-efficacy, dietary compliance, and pregnancy outcomes in women with diet-controlled gestational diabetes mellitus (GDM). The study included 58 women with GDM and a fasting blood glucose level less than 95 milligrams per deciliter (mg/dL) who were randomly assigned to 2 groups. The experimental group measured their blood glucose levels 4 times daily using a

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reflectance meter with memory. Metabolic status was assessed in the control group by periodic monitoring at prenatal visits. Otherwise the management protocol was identical for both groups. The Diabetes Empowerment Scale was completed at study entry and at 37 weeks gestation to assess feelings of self-efficacy. Dietary compliance was assessed at each visit. Both groups of women achieved excellent glucose control; only 1 woman in each group required insulin therapy. There were no significant differences with regard to feelings of self-efficacy, dietary compliance, birth weight, gestational age at delivery, Apgar scores, and neonatal complications. Rates of macrosomia (large size baby), delivery by cesarean section, and occurrence of birth trauma were similar. The authors conclude that SMBG appears to have little effect on maternal feelings of self-efficacy, dietary compliance, or pregnancy outcomes in women with diet-controlled GDM. 7 tables. 20 references.

Federally Funded Research on Birth Trauma The U.S. Government supports a variety of research studies relating to birth trauma. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to birth trauma. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore birth trauma. The following is typical of the type of information found when searching the CRISP database for birth trauma: •

Project Title: CLINICAL MEASURES TO LOWER GENITAL TRACT TRAUMA AT BIRTH Principal Investigator & Institution: Albers, Leah L.; None; University of New Mexico Albuquerque Controller's Office Albuquerque, Nm 87131 Timing: Fiscal Year 2002; Project Start 01-AUG-2001; Project End 30-APR-2005 Summary: (provided by applicant): Over 3 million women deliver vaginally each year in the United States, and most experience trauma to the genital tract with birth. This trauma can cause short and long term problems for new mothers, including pain and other functional impairments. Although lowering the rate of childbirth trauma would benefit many women, preventive measures have not been fully explicated. One factor, which may influence rates of childbirth trauma, is the hand maneuvers used by the birth attendant for perineal management late in the second stage of labor (the pushing or expulsive phase). Beyond limiting the routine use of episiotomies, no evidence supports any specific recommendations or perineal management immediately prior to vaginal birth. This study will assess the effects of techniques used by nurse-midwives on rates of

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Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

Studies

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spontaneous lacerations to the birth canal. A randomized trial of 1200 low-risk women will compare three strategies on the likelihood of an intact perineum after birth, with control for confounding variables (maternal age and parity, birth position, style of pushing, size and position of baby at birth, length of second stage, and epidural analgesia). The perineal care measures are 1) warm compresses to the perineum, 2) perineal massage with lubricants, and 3) no touching, that is hands off the perineum until crowning and expulsion of the baby. Patients will be recruited in six ambulatory clinics staffed by certified nurse midwives in Albuquerque, NM. Healthy gravidas at term will be randomized in labor. In second stage labor a staff midwife will perform one of the three-perineal management techniques (list above) prior to vaginal birth. After birth all perineal trauma will be documented by physical exam, and other clinical data recorded. Medical records will also be reviewed at hospital discharge and at the 4-6 weeks office visit to identify any complications/ adverse experiences. This study will identify whether any technique is superior for trauma reduction, and will generate evidence to inform the practice of all clinicians who work with childbearing women: nurses, nurse-midwives, family physicians, and obstetricians. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: FUNCTIONAL INCONTINENCE

TISSUE

ENGINEERING

FOR

STRESS

Principal Investigator & Institution: Cannon, Tracy W.; Urology; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2003; Project Start 01-MAY-2003; Project End 30-APR-2007 Summary: (provided by applicant): Utilizing techniques developed in our laboratory, we propose to mount a systematic in vitro and in vivo physiological and biomechanical analysis of muscle stem cell based tissue engineering treatment of stress urinary incontinence (SUI). SUI is a significant medical problem affecting approximately 25 million American women 1. Despite the high prevalence of SUI, there is very little treatment-oriented research utilizing tissue engineering techniques. Using such techniques, we propose to develop a truly physiologic sling, not from synthetic or cadaveric tissue, but rather an engineered, functional stem cell muscle scaffold that can be implanted to repair a damaged urethral sphincter.Hypothesis: 1) Muscle Derived Stem Cells (MDSC) improve the mechanical properties of small intestinal submucosa (SIS) scaffold in vitro. 2) MDSC/SIS suburethral sling improves continence in an in vivo rat model of SUI.The Key Aims of this grant include: 1) Establish the mechanisms underlying the alterations in biaxial mechanical properties of MDSC-seeded SIS: a) Establish the feasibility of seeding MDSC to SIS; b) Establish the long-term persistence of MDSC on SIS; and c) Evaluate the compliance properties of SIS alone and MDSC/SIS in vitro and in vivo with comprehensive mechanical testing at different time points. 2) Evaluate the contractile properties of MDSC/SIS: a) Test muscle and neurally evoked contractile properties of MDSC/SIS based on seeding different densities of MDSC onto SIS and culturing for 7 days; b) Using the best seeding density from 2a, test muscle and neurally evoked contractility properties of MDSC/SIS, culture in vitro at different time points; and c) Using the best seeding density from 2a, test muscle and neurally evoked contractility properties of MDSC/SIS cultured in vivo and at different time points. 3) Assess the functional outcome of MDSC/SIS versus SIS suburethral sling placement following simulated birth trauma: a) Assess the effect of SIS or MDSC/SIS suburethral slings on micturition during continuous cystometry; b) Assess the effect of SIS or MDSC/SIS on leak point pressure (LPP) using the reliable and sensitive vertical tilt intravesical pressure clamp method; c) Evaluate the immunohistology of implanted SIS

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and MDSC/SIS suburethral slings; and d) Retest the mechanical properties as well as muscle and neurally evoked contractile properties of MDSC/SIS suburethral slings following LPP testing for correlative purposes. By reengineering the deficient urinary sphincter through functional tissue engineering, we plan to significantly improve the treatment of SUI. We want to strongly emphasize that our research is in complete compliance with the federal guidelines on embryonic stem cell research. These stem cells have not been obtained from embryos (animal or human) or cell lines of embryonic stem cells. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MENTORED DEVELOPMENT AW

PATIENT-ORIENTED

RESEARCH

CAREER

Principal Investigator & Institution: Mathews, Carol A.; Psychiatry; University of California San Diego La Jolla, Ca 920930934 Timing: Fiscal Year 2002; Project Start 15-JUN-2000; Project End 31-MAY-2005 Summary: (Adapted from the applicant's abstract): The applicant's goal for this CAP award is to develop the multidisciplinary skills necessary to become expert in integrating complex genetic and clinical information in order to more fully characterize complex genetic neuropsychiatric disorders. Her developmental plans include focused research aimed at integrating clinical and genetic studies, as well as a program of course work, research seminars, and structured mentoring. Her research agenda is aimed at characterizing TS and its associated comorbitities from both clinical and genetic perspectives. Specifically, she will investigate potential correlations between genetic haplotypes and clinical variables such as symptom clusters and particular environmental variables in TS and TS spectrum disorders. This proposal has specific aims: 1) to expand the clinical data collected for the genetic study of TS for additional clinical and epidemiological investigations. a) to carefully characterize the phenomenology of TS by collecting specific information on a variety of clinical variables, and to evaluate the extent of comorbid disorders such as obsessive compulsive disorder (OCD) in the study sample. b) to evaluate the presence and extent of selected environmental variables (such as birth trauma) hypothesized to influence the course of TS; 2) to evaluate the relationship of high risk haplotypes and the presence or absence of specific environmental factors to specific clinical variables, such as presence or absence of comorbid disorders or symptom severity; 3) to identify and collect a sample of individuals with TS-spectrum disorders (such as chronic motor tic disorder), and to characterize these disorders with regard to associated comorbidities, associated environmental factors, and presence or absence of high risk TS aplotypes; and 4) to collect a sample of subjects with TS and TS-spectrum disorders from additional populations in order to formally assess relationships between genetic, environmental, and clinical factors identified in this study. The specific aims will be achieved by analyzing and correlating clinical and genetic information gathered from two genetically isolated populations, the Central Valley of Costa Rica and individuals of Ashkenazi Jewish descent in the United States. Clinical information will be collected in a systematic way, and will be expanded to include information on symptom types and severity, presence and severity of number of specific comorbidities, and presence of specific environmental factors postulated to be associated with TS. An additional study sample will be collected to investigate the role of these variables on TS spectrum disorders. Clinical and genetic information will be analyzed and correlations explored using a variety of statistical measures. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

Studies

•

Project Title: MOLECULAR INCONTINENCE

MECHANISM

FEMALE

STRESS

7

URINARY

Principal Investigator & Institution: Lue, Tom F.; Professor of Urology; Urology; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 941222747 Timing: Fiscal Year 2002; Project Start 01-DEC-1996; Project End 30-NOV-2002 Summary: (Adapted from the Applicant's Abstract): In the past 1 and 1/2 years, supported by grant 1 R55DK51374, we have modified and tested the feasibility of developing a reproducible rat model to study female stress urinary incontinence. We have studied the effect of pregnancy and delivery on the ultrastructure and function of the continence mechanism. We also modified our model by using pregnant rats and placed a intravaginal balloon under traction to direct the force to the levators and perineum to simulate the human situation. The information we have gained strongly support our opinion that the continence mechanism in the rats is similar to that of humans. We therefore propose to study the molecular mechanism involved in the pathogenesis of female stress urinary incontinence. We hypothesize that birth trauma, hormonal deficiency (menopause) and old age affect the gene and protein expression of several growth factors (IGF system, FGF, NGF, TGF, PDGF) and receptors (adrenergic, muscarinic and estrogen) which in turn change the structure and function of the continence mechanism. The hypothesis will be tested by completing the following specific aims: 1. To study and compare the functional, ultrastructural, cellular and molecular changes of the continence mechanism a). during pregnancy and after spontaneous delivery, b) after oxytocin-induced delivery and c) after delivery by cesarean section. 2. To examine the functional, ultrastructural, cellular and molecular changes of the continence mechanism after repeated birth trauma. 3. To examine the functional, ultrastructural, cellular and molecular changes of the continence mechanism after simulated birth trauma and bilateral ovariectomy. 4. To determine the functional, ultrastructural, cellular and molecular changes of the continence mechanism after combined simulated birth trauma, ovariectomy and aging. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NEUROTROPHINS, INCONTINENCE

HORMONES

AND

POSTPAROUS

Principal Investigator & Institution: Smith, Peter G.; Professor; Molecular & Integrative Phys; University of Kansas Medical Center Msn 1039 Kansas City, Ks 66160 Timing: Fiscal Year 2002; Project Start 01-APR-2000; Project End 31-MAR-2005 Summary: (Adapted from Applicant's Description): Traumatic labor and vaginal delivery during childbirth can produce permanent dysfunction of the pelvic musculature, in many cases leading to urinary and fecal incontinence. Damage to the pelvic nerves and failure to achieve complete reinnervation account for much of the deficit. Factors that modulate regrowth of damaged axons therefore may influence functional recovery. The investigators have shown recently that smooth muscle of the reproductive tract, which shares many similarities with urethral and anal sphincter smooth muscle, undergoes dramatic changes in innervation as a consequence of hormonal fluctuations. Elevated plasma estrogen results in marked reductions in numbers of sympathetic nerves, while other neuronal populations are unaffected. Preliminary data suggest that these changes are related to decreased nerve growth factor (NGF) synthesis. The investigators hypothesize that the high levels of estrogen in periparous females result in depressed neurotrophin synthesis in pelvic smooth muscle. Accordingly, sympathetic nerves, whose presence is essential for normal sphincter

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contractile tone, fail to regenerate to their full potential after nerve injury. In Specific Aim 1, the investigators will determine the effects of estrogen and pregnancy on protein and mRNA levels of NGF and the related neurotrophin, NT3, in urethral and anal sphincter smooth muscle using in situ hybridization, quantitative competitive polymerase chain reaction, immunohistochemistry and enzyme-linked immunoassays. In the second aim, they will use quantitative in situ hybridization and immunohistochemistry to determine the extent to which estrogen and pregnancy influence expression of the neurotrophin receptors trkA and p75NTR, which mediate the sympathetic nerve response to NGF and NT3. In aim 3, they will use immunohistochemistry to examine the effects of estrogen and pregnancy on the normal innervation of the urethral and anal sphincter smooth muscles. Aim 4 will employ immunohistochemistry and physiological and pharmacological measurements of urethral and anal smooth muscle contractile function to assess the effects of estrogen on sphincter reinnervation following a noradrenergic neurotoxin lesion with 6hydroxydopamine, or pelvic distension to simulate childbirth trauma, and these will be compared with injury of normal delivery. The fifth aim uses collagen gel co-cultures of sphincter smooth muscle and sympathetic ganglia in the presence of selective neutralizing antibodies to ascertain the roles of neurotrophins in modulating sympathetic neurite sprouting toward smooth muscle of estrogen-treated or pregnant rats. These studies should provide important new information on how hormones may affect neurotrophin synthesis by smooth muscle of the organs of continence, and how this in turn may alter sympathetic reinnervation of sphincters after axonal damage due to traumatic vaginal delivery, thus leading to urinary and fecal incontinence. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.3 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with birth trauma, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “birth trauma” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for birth trauma (hyperlinks lead to article summaries): •

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A case of scrotal birth trauma: sonographic evaluation. Author(s): Weinberg B, Rodriguez LR, Diakoumakis EE. Source: Journal of Clinical Ultrasound : Jcu. 1990 November-December; 18(9): 737-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2174928

PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

Studies

9

•

Anxiety associated with birth trauma. Author(s): Gemmette EV. Source: Psychological Reports. 1982 June; 50(3 Pt 1): 942. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7111561

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Birth trauma among liveborn infants in Mulago Hospital, Uganda. Author(s): Mukasa GK. Source: East Afr Med J. 1993 July; 70(7): 438-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8293703

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Birth trauma and brain damage. Author(s): Geirsson RT. Source: Baillieres Clin Obstet Gynaecol. 1988 March; 2(1): 195-212. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3046800

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Birth trauma and intracranial aneurysm. Author(s): Scheller JM. Source: Journal of Neurosurgery. 1993 December; 79(6): 964-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8246067

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Birth trauma and nasal septal deformity in neonates. Author(s): Saim L, Said H. Source: J Singapore Paediatr Soc. 1992; 34(3-4): 199-204. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1305661

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Birth trauma and the cervical spine. Author(s): Jones L. Source: Archives of Disease in Childhood. 1970 February; 45(239): 147. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5440190

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Birth trauma and the pelvic floor: lessons from the developing world. Author(s): Wall LL. Source: Journal of Women's Health / the Official Publication of the Society for the Advancement of Women's Health Research. 1999 March; 8(2): 149-55. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10100128

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Birth trauma causing nasal vestibular stenosis. Author(s): Jablon JH, Hoffman JF. Source: Archives of Otolaryngology--Head & Neck Surgery. 1997 September; 123(9): 1004-6. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9305255

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Birth trauma in insulin-dependent diabetic pregnancies. Author(s): Mimouni F, Miodovnik M, Rosenn B, Khoury J, Siddiqi TA. Source: American Journal of Perinatology. 1992 May; 9(3): 205-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1575844

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Birth trauma in the head and neck. Author(s): Hughes CA, Harley EH, Milmoe G, Bala R, Martorella A. Source: Archives of Otolaryngology--Head & Neck Surgery. 1999 February; 125(2): 1939. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10037286

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Birth trauma to muscles in babies born by breech delivery and its possible fatal consequences. Author(s): Ralis ZA. Source: Archives of Disease in Childhood. 1975 January; 50(1): 4-13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1124942

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Birth trauma to the cervical spine and vertebral arteries. Author(s): Jones EL, Cameron AH, Smith WT. Source: The Journal of Pathology. 1970 February; 100(2): Piv. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5420771

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Birth trauma. Author(s): Schullinger JN. Source: Pediatric Clinics of North America. 1993 December; 40(6): 1351-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8255629

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Birth trauma. Author(s): Murphy P. Source: Nurs Times. 1993 September 29-October 5; 89(39): 50-1. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8415102

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Birth trauma. Author(s): Valman HB. Source: British Medical Journal. 1979 December 15; 2(6204): 1566-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=534870

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Birth trauma. Author(s): Gresham EL. Source: Pediatric Clinics of North America. 1975 May; 22(2): 317-28. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1091907

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Birth trauma. A five-year review of incidence and associated perinatal factors. Author(s): Perlow JH, Wigton T, Hart J, Strassner HT, Nageotte MP, Wolk BM. Source: J Reprod Med. 1996 October; 41(10): 754-60. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8913978

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Birth trauma: in the eye of the beholder. Author(s): Beck CT. Source: Nursing Research. 2004 January-February; 53(1): 28-35. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14726774

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Birth trauma: incidence and predisposing factors. Author(s): Levine MG, Holroyde J, Woods JR Jr, Siddiqi TA, Scott M, Miodovnik M. Source: Obstetrics and Gynecology. 1984 June; 63(6): 792-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6728359

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Birth trauma: short and long term effects of forceps delivery compared with spontaneous delivery on various pelvic floor parameters. Author(s): Meyer S, Hohlfeld P, Achtari C, Russolo A, De Grandi P. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2000 November; 107(11): 1360-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11117762

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Brachial plexus impairment--a birth trauma? Author(s): Slooff AC, Ubachs JM. Source: American Journal of Obstetrics and Gynecology. 1993 July; 169(1): 230. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8333463

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Certain causes of neonatal death. V. Cerebral birth trauma. Author(s): Fedrick J, Butler NR. Source: Biology of the Neonate. 1971; 18(5): 321-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5163610

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Corneal birth trauma managed with a contact lens. Author(s): Stein RM, Cohen EJ, Calhoun JH, Fendick M, Reinecke RD. Source: American Journal of Ophthalmology. 1987 April 15; 103(4): 596-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3565522

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Corneal birth trauma: a cause for sensory exotropia. Author(s): Gnanaraj L, Rao VJ. Source: Eye (London, England). 2000 October; 14 Pt 5: 791-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11116710

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Craniocerebral birth trauma caused by vacuum extraction: a case of growing skull fracture as a perinatal complication. Author(s): Papaefthymiou G, Oberbauer R, Pendl G. Source: Child's Nervous System : Chns : Official Journal of the International Society for Pediatric Neurosurgery. 1996 February; 12(2): 117-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8674080

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Does cesarean section decrease the incidence of major birth trauma? Author(s): Puza S, Roth N, Macones GA, Mennuti MT, Morgan MA. Source: Journal of Perinatology : Official Journal of the California Perinatal Association. 1998 January-February; 18(1): 9-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9527937

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Epidural hematoma of the newborn due to birth trauma. Author(s): Gama CH, Fenichel GM. Source: Pediatric Neurology. 1985 January-February; 1(1): 52-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3880390

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Eversion of upper lids secondary to birth trauma. Author(s): Rainin EA. Source: Archives of Ophthalmology. 1976 February; 94(2): 330-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1252183

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Extradural hemorrhage in the newborn as a result of birth trauma. Author(s): Takagi T, Nagai R, Wakabayashi S, Mizawa I, Hayashi K. Source: Childs Brain. 1978; 4(5): 306-18. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=657885

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Fractured clavicle and birth trauma. Author(s): Pun TC, Lee CP, Lao TT. Source: American Journal of Obstetrics and Gynecology. 1998 May; 178(5): 1104-5. Erratum In: Am J Obstet Gynecol 1999 August; 181(2): 510. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9609595

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Fractured clavicle and Erb's palsy unrelated to birth trauma. Author(s): Peleg D, Hasnin J, Shalev E. Source: American Journal of Obstetrics and Gynecology. 1997 November; 177(5): 103840. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9396889

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Gestational diabetes and birth trauma. Author(s): Hunter DJ, Milner R. Source: American Journal of Obstetrics and Gynecology. 1985 August 1; 152(7 Pt 1): 9189. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4025442

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Hematoma of the liver due to birth trauma. Author(s): Smulewicz JJ, Tafreshi MM. Source: Journal of the National Medical Association. 1975 May; 67(3): 214-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1142458

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Infant rib fracture--birth trauma or non-accidental injury. Author(s): Barry PW, Hocking MD. Source: Archives of Disease in Childhood. 1993 February; 68(2): 250. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8481052

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Intracranial arterial aneurysm due to birth trauma. Case report. Author(s): Piatt JH Jr, Clunie DA. Source: Journal of Neurosurgery. 1992 November; 77(5): 799-803. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1457008

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Intracranial birth trauma in vaginal breech delivery: the continued importance of injury to the occipital bone. Author(s): Wigglesworth JS, Husemeyer RP. Source: British Journal of Obstetrics and Gynaecology. 1977 September; 84(9): 684-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=911720

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Is birth trauma responsible for idiopathic perforation of the biliary tract in infancy? Author(s): Topuzlu Tekant G, Yigit U, Bulut M. Source: Turk J Pediatr. 1994 July-September; 36(3): 263-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7974819

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Is macrosomia predictable, and are shoulder dystocia and birth trauma preventable? Author(s): Gonen R, Spiegel D, Abend M. Source: Obstetrics and Gynecology. 1996 October; 88(4 Pt 1): 526-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8841211

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Is permanent congenital facial palsy caused by birth trauma? Author(s): Laing JH, Harrison DH, Jones BM, Laing GJ. Source: Archives of Disease in Childhood. 1996 January; 74(1): 56-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8660050

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Long-term prognosis for the infant with severe birth trauma. Author(s): Donn SM, Faix RG. Source: Clin Perinatol. 1983 June; 10(2): 507-20. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6352153

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Management of facial palsy caused by birth trauma. Author(s): Bergman I, May M, Wessel HB, Stool SE. Source: The Laryngoscope. 1986 April; 96(4): 381-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3959696

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Neonatal rib fracture: birth trauma or child abuse? Author(s): Rizzolo PJ, Coleman PR. Source: The Journal of Family Practice. 1989 November; 29(5): 561-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2809530

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Neonatal skeletal fractures. Birth trauma or child abuse? Author(s): Cumming WA. Source: J Can Assoc Radiol. 1979 March; 30(1): 30-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=429433

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Neonatal skull depression unassociated with birth trauma. Author(s): Eisenberg D, Kirchner SG, Perrin EC. Source: Ajr. American Journal of Roentgenology. 1984 November; 143(5): 1063-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6333148

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Neurologic birth trauma. Intracranial, spinal cord, and brachial plexus injury. Author(s): Medlock MD, Hanigan WC. Source: Clin Perinatol. 1997 December; 24(4): 845-57. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9395866

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Obstructed labor injury complex: obstetric fistula formation and the multifaceted morbidity of maternal birth trauma in the developing world. Author(s): Arrowsmith S, Hamlin EC, Wall LL. Source: Obstetrical & Gynecological Survey. 1996 September; 51(9): 568-74. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8873157

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Outcome after later combined brachial plexus and shoulder surgery after birth trauma. Author(s): Grossman JA, Price AE, Tidwell MA, Ramos LE, Alfonso I, Yaylali I. Source: The Journal of Bone and Joint Surgery. British Volume. 2003 November; 85(8): 1166-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14653601

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Pattern of external birth trauma in southwestern Saudi Arabia. Author(s): Benjamin B, Khan MR. Source: The Journal of Trauma. 1993 November; 35(5): 737-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8230339

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Posterior cervical torticollis caused by birth trauma. Author(s): Jona JZ. Source: Journal of Pediatric Surgery. 1995 October; 30(10): 1526-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8786514

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Posterior fossa subdural hemorrhage in the newborn as a result of birth trauma. Author(s): Takagi T, Fukuoka H, Wakabayashi S, Nagai H, Shibata T. Source: Childs Brain. 1982; 9(2): 102-13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7094671

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Postpartum depression vs. post birth trauma. Author(s): Lindstrom K. Source: The Birth Gazette. 1996 Summer; 12(3): 12-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9015964

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Prophylactic insulin treatment of gestational diabetes reduces the incidence of macrosomia, operative delivery, and birth trauma. Author(s): Coustan DR, Imarah J. Source: American Journal of Obstetrics and Gynecology. 1984 December 1; 150(7): 83642. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6391174

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Radiologic imaging of severe cervical spinal cord birth trauma. Author(s): de Vries E, Robben SG, van den Anker JN. Source: European Journal of Pediatrics. 1995 March; 154(3): 230-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7758524

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Radiological case of the month. Rib fractures produced by birth trauma. Author(s): Hartmann RW Jr. Source: Archives of Pediatrics & Adolescent Medicine. 1997 September; 151(9): 947-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9308875

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Shoulder dystocia and birth trauma in gestational diabetes: a five-year experience. Author(s): Keller JD, Lopez-Zeno JA, Dooley SL, Socol ML. Source: American Journal of Obstetrics and Gynecology. 1991 October; 165(4 Pt 1): 92830. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1951556

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Sonographic evaluation of spinal cord birth trauma with pathologic correlation. Author(s): Babyn PS, Chuang SH, Daneman A, Davidson GS. Source: Ajr. American Journal of Roentgenology. 1988 October; 151(4): 763-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3048069

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Taking birth trauma seriously. Author(s): Riedlinger T, Riedlinger J. Source: Medical Hypotheses. 1986 January; 19(1): 15-25. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3634902

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The conceptualization, measurement, and validation of transient mechanical birth trauma. Author(s): Pressler JL, Hepworth JT. Source: Clinical Nursing Research. 2000 August; 9(3): 317-38. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11276622

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The immediate and long-term outcome of obstetric birth trauma. I. Brachial plexus paralysis. Author(s): Gordon M, Rich H, Deutschberger J, Green M. Source: American Journal of Obstetrics and Gynecology. 1973 September 1; 117(1): 51-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4722378

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The management of corneal birth trauma. Author(s): Hofmann RF, Paul TO, Pentelei-Molnar J. Source: Journal of Pediatric Ophthalmology and Strabismus. 1981 January-February; 18(1): 45-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7241296

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The prevention of mechanical birth trauma by means of computer aided simulation of delivery by means of nuclear magnetic resonance imaging and finite element analysis. Author(s): Melchert F, Wischnik A, Nalepa E. Source: Journal of Obstetrics and Gynaecology : the Journal of the Institute of Obstetrics and Gynaecology. 1995 April; 21(2): 195-207. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8556581

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Thrombosis of the middle cerebral artery associated with birth trauma. Author(s): Roessmann U, Miller RT. Source: Neurology. 1980 August; 30(8): 889-92. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7191074

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Unexpected birth trauma with near fatal consequences. Author(s): Hartman BJ, Van Der Zee DC, Duval EL. Source: European Journal of Emergency Medicine : Official Journal of the European Society for Emergency Medicine. 2000 June; 7(2): 151-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11132078

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Unexpected reduction in the incidence of birth trauma and birth asphyxia related to instrumental deliveries during the study period: was this the Hawthorne effect? Author(s): Leung WC, Lam HS, Lam KW, To M, Lee CP. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2003 March; 110(3): 319-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12628276

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Very preterm birth, birth trauma, and the risk of anorexia nervosa among girls. Author(s): Cnattingius S, Hultman CM, Dahl M, Sparen P. Source: Archives of General Psychiatry. 1999 July; 56(7): 634-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10401509

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CHAPTER TRAUMA

2.

ALTERNATIVE

MEDICINE

AND

BIRTH

Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to birth trauma. At the conclusion of this chapter, we will provide additional sources.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to birth trauma and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “birth trauma” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to birth trauma: •

Birth trauma: its effect on the urine continence mechanisms. Author(s): Meyer S, de Grandi P, Kuntzer T, Hurlimann P, Schmidt N. Source: Gynakologisch-Geburtshilfliche Rundschau. 1993; 33(4): 236-42. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8130660

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Early parental experiences of obstetric brachial plexus palsy. Author(s): Bellew M, Kay SP. Source: Journal of Hand Surgery (Edinburgh, Lothian). 2003 August; 28(4): 339-46. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12849945

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Effects of auditory stimulation on heart rate in premature infants as a function of level of arousal, probability of CNS damage, and conceptional age. Author(s): Schulman CA.

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Source: Developmental Psychobiology. 1969; 2(3): 172-83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5407666 •

Fracture of the clavicle in the newborn following normal labor and delivery. Author(s): Kaplan B, Rabinerson D, Avrech OM, Carmi N, Steinberg DM, Merlob P. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 1998 October; 63(1): 15-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9849706

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How septum deformations in newborns occur. Author(s): Kawalski H, Spiewak P. Source: International Journal of Pediatric Otorhinolaryngology. 1998 June 1; 44(1): 23-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9720676

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Lactation, nutrition and fertility and the secretion of prolactin and gonadotrophins in Mopan Mayan women. Author(s): Fink AE, Fink G, Wilson H, Bennie J, Carroll S, Dick H. Source: Journal of Biosocial Science. 1992 January; 24(1): 35-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1737813

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Management of obstetric brachial plexus lesions: state of the art and future developments. Author(s): van Ouwerkerk WJ, van der Sluijs JA, Nollet F, Barkhof F, Slooff AC. Source: Child's Nervous System : Chns : Official Journal of the International Society for Pediatric Neurosurgery. 2000 November; 16(10-11): 638-44. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11151713

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Maternal and infant complications in high and normal weight infants by method of delivery. Author(s): Gregory KD, Henry OA, Ramicone E, Chan LS, Platt LD. Source: Obstetrics and Gynecology. 1998 October; 92(4 Pt 1): 507-13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9764620

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Neglected spinal cord, brain stem and musculoskeletal injuries stemming from birth trauma. Author(s): Gottlieb MS. Source: Journal of Manipulative and Physiological Therapeutics. 1993 October; 16(8): 537-43. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8263433

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Obstetrical lesions of the brachial plexus. Natural history in 34 personal cases. Author(s): Rossi LN, Vassella F, Mumenthaler M.

Alternative Medicine 21

Source: European Neurology. 1982 January-February; 21(1): 1-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7094945 •

Outcome of 306 twin deliveries according to first twin presentation and method of delivery. Author(s): Grisaru D, Fuchs S, Kupferminc MJ, Har-Toov J, Niv J, Lessing JB. Source: American Journal of Perinatology. 2000; 17(6): 303-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11144312

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Perineal massage to prevent perineal trauma during pregnancy. Author(s): Sa'adah S. Source: The Journal of Family Practice. 1999 July; 48(7): 494-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10428240

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Practices that minimize trauma to the genital tract in childbirth: a systematic review of the literature. Author(s): Renfrew MJ, Hannah W, Albers L, Floyd E. Source: Birth (Berkeley, Calif.). 1998 September; 25(3): 143-60. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9767217

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Randomised controlled trial of swaddling versus massage in the management of excessive crying in infants with cerebral injuries. Author(s): Ohgi S, Akiyama T, Arisawa K, Shigemori K. Source: Archives of Disease in Childhood. 2004 March; 89(3): 212-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14977692

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Resuscitation of the newborn. Author(s): Finster M. Source: Acta Anaesthesiologica Scandinavica. Supplementum. 1969; 37: 86-93. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4393039

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Role of the spiritual churches in antenatal clinic default in Calabar, Nigeria. Author(s): Etuk SJ, Itam IH, Asuquo EE. Source: East Afr Med J. 1999 November; 76(11): 639-43. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10734525

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Sequelae of cerebral birth injury in infants treated by acupressure. Author(s): Wang ZP. Source: J Tradit Chin Med. 1988 March; 8(1): 19-22. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3393014

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Sternomastoid tumor of infancy. Author(s): Thomsen JR, Koltai PJ. Source: The Annals of Otology, Rhinology, and Laryngology. 1989 December; 98(12 Pt 1): 955-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2589764

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Structural normalization in infants and children with particular reference to disturbances of the central nervous system. Author(s): Woods RH. Source: J Am Osteopath Assoc. 1973 May; 72(9): 903-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4488506

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Sudden infant death syndrome: a literature review with chiropractic implications. Author(s): Banks BD, Beck RW, Columbus M, Gold PM, Kinsinger FS, Lalonde MA. Source: Journal of Manipulative and Physiological Therapeutics. 1987 October; 10(5): 246-52. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3320251

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Tackling birth trauma with cranio-sacral therapy. Author(s): Turney J. Source: Pract Midwife. 2002 March; 5(3): 17-9. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11915417

•

Traumatic vertebrobasilar occlusive disease in childhood. Author(s): Zimmerman AW, Kumar AJ, Gadoth N, Hodges FJ 3rd. Source: Neurology. 1978 February; 28(2): 185-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=563999

•

Treating psychosomatic disorders related to birth trauma. Author(s): Lake F. Source: Journal of Psychosomatic Research. 1978; 22(4): 227-38. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=368327

Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

•

AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats

•

Chinese Medicine: http://www.newcenturynutrition.com/

•

drkoop.com: http://www.drkoop.com/InteractiveMedicine/IndexC.html

Alternative Medicine 23

•

Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

•

Google: http://directory.google.com/Top/Health/Alternative/

•

Healthnotes: http://www.healthnotes.com/

•

MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine

•

Open Directory Project: http://dmoz.org/Health/Alternative/

•

HealthGate: http://www.tnp.com/

•

WebMDHealth: http://my.webmd.com/drugs_and_herbs

•

WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

•

Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

The following is a specific Web list relating to birth trauma; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

General Overview Diabetes Mellitus Source: Integrative Medicine Communications; www.drkoop.com

•

Alternative Therapy Myotherapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,931,00.html Radiance Breathwork Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/r.html

General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.

25

CHAPTER 3. DISSERTATIONS ON BIRTH TRAUMA Overview In this chapter, we will give you a bibliography on recent dissertations relating to birth trauma. We will also provide you with information on how to use the Internet to stay current on dissertations. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical dissertations that use the generic term “birth trauma” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on birth trauma, we have not necessarily excluded nonmedical dissertations in this bibliography.

Dissertations on Birth Trauma ProQuest Digital Dissertations, the largest archive of academic dissertations available, is located at the following Web address: http://wwwlib.umi.com/dissertations. From this archive, we have compiled the following list covering dissertations devoted to birth trauma. You will see that the information provided includes the dissertation’s title, its author, and the institution with which the author is associated. The following covers recent dissertations found when using this search procedure: •

RANK, IBSEN, AND O'NEILL: BIRTH TRAUMA AND CREATIVE WILL IN SELECTED DRAMAS (RANK OTTO, IBSEN HENRIK, O'NEILL EUGENE, NORWAY) by VOIGT, MAUREEN FRANCES, PHD from The Ohio State University, 1992, 278 pages http://wwwlib.umi.com/dissertations/fullcit/9219040

Keeping Current Ask the medical librarian at your library if it has full and unlimited access to the ProQuest Digital Dissertations database. From the library, you should be able to do more complete searches via http://wwwlib.umi.com/dissertations.

27

CHAPTER 4. BOOKS ON BIRTH TRAUMA Overview This chapter provides bibliographic book references relating to birth trauma. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on birth trauma include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Chapters on Birth Trauma In order to find chapters that specifically relate to birth trauma, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and birth trauma using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “birth trauma” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on birth trauma: •

Pregnancy in Preexisting Diabetes Source: in Harris, M.I., et al., eds., for the National Diabetes Data Group (NDDG). Diabetes in America. 2nd ed. Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. 1995. p. 719-733. Contact: Available from National Diabetes Information Clearinghouse (NDIC). 1 Information Way, Bethesda, MD 20892-3560. (800) 860-8747 or (301) 654-3327. Fax (301) 634-0716. E-mail: [email protected]. Also available at http://www.niddk.nih.gov/. PRICE: Full-text book and chapter available online at no charge; book may be purchased for $20.00. Order number: DM-96 (book). Summary: This chapter on pregnancy in preexisting diabetes is from a compilation and assessment of data on diabetes and its complications in the United States. Data from birth certificates in the United States indicate that maternal diabetes (preexisting and gestational) complicates 2 to 3 percent of all pregnancies, but the author cautions that these data may underestimate the true prevalence of maternal diabetes in pregnancy.

28

Birth Trauma

Prevalence rates for pregestational diabetes appear to be in the range of 0.1 percent to 0.3 percent of all pregnancies. These pregnancies are at risk for both maternal and fetal complications. Fetal complications of maternal diabetes can arise from the effects of maternal diabetes on early fetal development and include spontaneous abortions and major congenital malformations. In the absence of special preconceptional diabetes management, spontaneous abortions occur in 7 to 17 percent of diabetic pregnancies and major malformations occur in 7 to 13 percent. Rates of both complications are highest in women with the most marked hyperglycemia during the first trimester, and the rates of malformations appear to be decreasing in countries and medical centers where standards of diabetes care result in improved maternal blood glucose control prior to and during early pregnancy. The most prominent fetal complications that can arise during the second and third trimesters are stillbirth and macrosomia (an excessively large infant). Macrosomia appears to be the most frequent fetal complication, affecting 10 to 33 percent of infants, depending on the defining criteria. Macrosomia increases the risk of birth trauma and has been associated with a longterm risk of obesity in offspring. Maternal risks in diabetic pregnancies are greatest in the presence of preexisting microvascular disease (retinopathy and nephropathy). Diabetic retinopathy is present in 15 to 66 percent of women early in pregnancy, and the retinopathy frequently worsens during gestation, especially when severe background or proliferative changes are present early on. Laser photocoagulation therapy prior to pregnancy can reduce the risk that proliferative retinopathy will worsen during gestation. Overt diabetic nephropathy is present before pregnancy in 5 to 10 percent of patients; of these, two-thirds manifest hypertensive disorders during gestation. Overt diabetic nephropathy in mothers increases the prevalence of intrauterine growth retardation and prematurity in infants; fetal morbidity and mortality increase as well. The longterm impact of pregnancy on diabetic retinopathy and nephropathy in mothers is not known. 9 figures. 5 tables. 81 references. (AA-M). •

Sensorineural Hearing Loss in Children: Etiology and Pathology Source: in Martin, F.N.; Greer Clark, J., eds. Hearing Care for Children. Needham Heights, MA: Allyn and Bacon. 1996. p. 73-91. Contact: Available from Allyn and Bacon. 160 Gould Street, Needham Heights, MA 02194-2310. (800) 278-3525; Fax (617) 455-7024; E-mail: [email protected]; http://www.abacon.com. PRICE: $59.00 plus shipping and handling. ISBN: 0131247026. Summary: This chapter on the etiology and pathology of sensorineural hearing loss is from a textbook that focuses on the provision of hearing care for children with hearing loss. Topics covered include the etiologies of congenital hearing loss, including ototoxic drugs, teratogenic drugs, viral infections (maternal rubella, cytomegalovirus, herpes simplex, HIV), toxoplasmosis, erythroblastosis fetalis, and prematurity and birth trauma; the etiologies of acquired hearing loss, including bacterial infections, syphilis, viral diseases, neoplastic disorders (cancer), traumatic injury, acoustic trauma, metabolic disorders, and sudden deafness; monitoring dynamic sensorineural hearing loss in children; and medical diagnosis and treatment strategies. The authors emphasize that health care cost containment and the medical and legal implications of missed or delayed diagnosis of sensorineural hearing loss in children are critical issues for the pediatric otolaryngologist. 3 tables. 134 references. (AA-M).

•

Long-Term Outcome of Infants of Diabetic Mothers Source: in Reece, E.A.; Coustan, D.R., eds. Diabetes Mellitus in Pregnancy. 2nd ed. New York, NY: Churchill Livingstone. 1995. p. 379-388.

Books

29

Contact: Available from Churchill Livingstone. 300 Lighting Way, Secaucus, NJ 07094. (800) 553-5426. PRICE: $92.00. ISBN: 0443089795. Summary: This chapter, from a medical textbook on diabetes mellitus in pregnancy, describes the long-term outcome of infants of mothers with diabetes. The authors remind readers that the infant of the mother with diabetes eventually becomes the child, the adolescent, and the adult offspring of the mother with diabetes. The legacy of the diabetic intrauterine environment, acquired during gestation, cannot be ignored. The authors consider the long-range anatomic and functional changes that result from development in a diabetic uterine environment in four areas: growth, glucose homeostasis, neurologic and psychological development, and miscellaneous. Growth rate, height, and development as they relate to obesity are excessive during the latter stages of gestation and are also excessive during childhood and early adulthood. Because of genetic and environmental factors, glucose tolerance is more likely to be abnormal than that observed in offspring of nondiabetic women. Offspring of high-risk pregnancies often have neurologic defects, which are usually relatively minor, but which may be significant causes of morbidity. And there are long-term sequelae of congenital structure abnormalities and residual of birth trauma, especially if the abnormalities are severe enough to be recognized during the newborn period. 3 figures. 2 tables. 85 references. •

Evaluation and Management of Urinary Fistulas Source: in Carlin, B.I. and Leong, F.C., eds. Female Pelvic Health and Reconstructive Surgery. New York, NY: Marcel Dekker, Inc. 2003. p. 363-380. Contact: Available from Marcel Dekker, Inc. 270 Madison Avenue, New York, NY 10016. (212) 696-9000. Fax (212) 685-4540. Website: www.dekker.com. PRICE: $185.00 plus shipping and handling. ISBN: 0824708229. Summary: Urinary fistulas (abnormal openings or passageways between the bladder or urinary tract and the vagina, typically) have been recognized in the literature for centuries as a distressing problem that results most commonly from birth trauma or urogynecological surgery. This chapter on the evaluation and management of urinary fistulas is from a textbook that provides comprehensive, authoritative coverage of female pelvic health and reconstructive surgery. The authors discuss the etiology, diagnosis, and surgical management of the most common urinary fistulas: vesicovaginal (between bladder and vagina), urethrovaginal (between urethra and vagina), and ureterovaginal (between ureter and vagina). 5 figures. 72 references.

31

APPENDICES

33

APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute4: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

•

National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

•

National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

•

National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

•

National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

•

National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

•

National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

•

National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

4

These publications are typically written by one or more of the various NIH Institutes.

34

Birth Trauma

•

National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

•

National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

•

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

•

National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

•

National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

•

National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

•

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

•

National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

•

National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

•

National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

•

National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

•

National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

•

National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

•

Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

•

National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

•

National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

•

Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

•

Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

Physician Resources

35

NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.5 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:6 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

•

HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

•

NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

•

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

•

Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

•

Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

•

Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

•

Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

•

Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

•

Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

•

MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

5

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 6 See http://www.nlm.nih.gov/databases/databases.html.

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Birth Trauma

•

Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

•

Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html

The NLM Gateway7 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.8 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “birth trauma” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 3602 106 891 8 59 4666

HSTAT9 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.10 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.11 Simply search by “birth trauma” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

7

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

8

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 9 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 10 11

The HSTAT URL is http://hstat.nlm.nih.gov/.

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.

Physician Resources

37

Coffee Break: Tutorials for Biologists12 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.13 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.14 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

•

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

12 Adapted 13

from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 14 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

39

APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on birth trauma can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to birth trauma. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to birth trauma. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “birth trauma”:

40

Birth Trauma

Attention Deficit Disorder with Hyperactivity http://www.nlm.nih.gov/medlineplus/attentiondeficitdisorderwithhyperactivity.t ml Birth Defects http://www.nlm.nih.gov/medlineplus/birthdefects.html Head and Brain Injuries http://www.nlm.nih.gov/medlineplus/headandbraininjuries.html Health Statistics http://www.nlm.nih.gov/medlineplus/healthstatistics.html Infant and Toddler Health http://www.nlm.nih.gov/medlineplus/infantandtoddlerhealth.html You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The NIH Search Utility The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to birth trauma. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

•

Family Village: http://www.familyvillage.wisc.edu/specific.htm

•

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

•

Med Help International: http://www.medhelp.org/HealthTopics/A.html

•

Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

•

Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

•

WebMDHealth: http://my.webmd.com/health_topics

Patient Resources

41

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to birth trauma. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with birth trauma. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about birth trauma. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “birth trauma” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “birth trauma”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “birth trauma” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months.

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Birth Trauma

The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “birth trauma” (or a synonym) into the search box, and click “Submit Query.”

43

APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.15

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

15

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)16: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

•

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

•

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

•

California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

•

California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

•

California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

•

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

•

California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

•

California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

•

California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

•

California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

•

California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

•

California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

•

Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

•

Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

•

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

16

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

Finding Medical Libraries

45

•

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

•

Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

•

Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

•

Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

•

Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

•

Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

•

Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

•

Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

•

Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

•

Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

•

Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

•

Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

•

Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

•

Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

•

Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

•

Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

•

Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

•

Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

•

Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

•

Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

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•

Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

•

Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

•

Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

•

Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

•

Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

•

Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

•

Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

•

Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

•

Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

•

Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

•

Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

•

Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

•

Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

•

Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

•

Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

•

Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

•

National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

•

National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

•

National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

Finding Medical Libraries

47

•

Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

•

New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

•

New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

•

New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

•

New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

•

New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

•

New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

•

New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

•

New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

•

Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

•

Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

•

Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

•

Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

•

Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

•

Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

•

Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

•

Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

•

Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

•

Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

•

Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

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•

South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

•

Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

•

Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

•

Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

49

ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

•

MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

•

Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

•

Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

•

On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

•

Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

•

Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a).

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

•

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

•

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

•

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

51

BIRTH TRAUMA DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abscess: A localized, circumscribed collection of pus. [NIH] Acoustic: Having to do with sound or hearing. [NIH] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Amenorrhea: Absence of menstruation. [NIH] Amino Acid Sequence: The order of amino acids as they occur in a polypeptide chain. This is referred to as the primary structure of proteins. It is of fundamental importance in determining protein conformation. [NIH] Amniotic Fluid: Amniotic cavity fluid which is produced by the amnion and fetal lungs and kidneys. [NIH] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Aneurysm: A sac formed by the dilatation of the wall of an artery, a vein, or the heart. [NIH] Annealing: The spontaneous alignment of two single DNA strands to form a double helix. [NIH]

Anomalies: Birth defects; abnormalities. [NIH] Anorexia: Lack or loss of appetite for food. Appetite is psychologic, dependent on memory and associations. Anorexia can be brought about by unattractive food, surroundings, or company. [NIH] Anorexia Nervosa: The chief symptoms are inability to eat, weight loss, and amenorrhea. [NIH]

Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH]

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Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Anus: The opening of the rectum to the outside of the body. [NIH] Aqueous: Having to do with water. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH] Asphyxia: A pathological condition caused by lack of oxygen, manifested in impending or actual cessation of life. [NIH] Auditory: Pertaining to the sense of hearing. [EU] Axilla: The underarm or armpit. [NIH] Axons: Nerve fibers that are capable of rapidly conducting impulses away from the neuron cell body. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacterial Infections: Infections by bacteria, general or unspecified. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Bilateral: Affecting both the right and left side of body. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Bile duct: A tube through which bile passes in and out of the liver. [NIH] Biliary: Having to do with the liver, bile ducts, and/or gallbladder. [NIH] Biliary Tract: The gallbladder and its ducts. [NIH] Biological therapy: Treatment to stimulate or restore the ability of the immune system to fight infection and disease. Also used to lessen side effects that may be caused by some cancer treatments. Also known as immunotherapy, biotherapy, or biological response modifier (BRM) therapy. [NIH] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH]

Dictionary 53

Birth Certificates: Official certifications by a physician recording the individual's birth date, place of birth, parentage and other required identifying data which are filed with the local registrar of vital statistics. [NIH] Bladder: The organ that stores urine. [NIH] Blood Glucose: Glucose in blood. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Brachial: All the nerves from the arm are ripped from the spinal cord. [NIH] Brachial Plexus: The large network of nerve fibers which distributes the innervation of the upper extremity. The brachial plexus extends from the neck into the axilla. In humans, the nerves of the plexus usually originate from the lower cervical and the first thoracic spinal cord segments (C5-C8 and T1), but variations are not uncommon. [NIH] Brain Stem: The part of the brain that connects the cerebral hemispheres with the spinal cord. It consists of the mesencephalon, pons, and medulla oblongata. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Division: The fission of a cell. [NIH] Cell Survival: The span of viability of a cell characterized by the capacity to perform certain functions such as metabolism, growth, reproduction, some form of responsiveness, and adaptability. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebral Arteries: The arteries supplying the cerebral cortex. [NIH] Cerebral hemispheres: The two halves of the cerebrum, the part of the brain that controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. The right hemisphere controls muscle movement on the left side of the body, and the left hemisphere controls muscle movement on the right side of the body. [NIH] Cerebrum: The largest part of the brain. It is divided into two hemispheres, or halves, called the cerebral hemispheres. The cerebrum controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. [NIH] Cervical: Relating to the neck, or to the neck of any organ or structure. Cervical lymph nodes are located in the neck; cervical cancer refers to cancer of the uterine cervix, which is the lower, narrow end (the "neck") of the uterus. [NIH] Cervix: The lower, narrow end of the uterus that forms a canal between the uterus and vagina. [NIH] Cesarean Section: Extraction of the fetus by means of abdominal hysterotomy. [NIH]

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Chiropractic: A system of treating bodily disorders by manipulation of the spine and other parts, based on the belief that the cause is the abnormal functioning of a nerve. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Clamp: A u-shaped steel rod used with a pin or wire for skeletal traction in the treatment of certain fractures. [NIH] Clavicle: A long bone of the shoulder girdle. [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements,

Dictionary 55

megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Compliance: Distensibility measure of a chamber such as the lungs (lung compliance) or bladder. Compliance is expressed as a change in volume per unit change in pressure. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Conception: The onset of pregnancy, marked by implantation of the blastocyst; the formation of a viable zygote. [EU] Confounding: Extraneous variables resulting in outcome effects that obscure or exaggerate the "true" effect of an intervention. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Continence: The ability to hold in a bowel movement or urine. [NIH] Contractility: Capacity for becoming short in response to a suitable stimulus. [EU] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Control group: In a clinical trial, the group that does not receive the new treatment being studied. This group is compared to the group that receives the new treatment, to see if the new treatment works. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Cytomegalovirus: A genus of the family Herpesviridae, subfamily Betaherpesvirinae, infecting the salivary glands, liver, spleen, lungs, eyes, and other organs, in which they produce characteristically enlarged cells with intranuclear inclusions. Infection with Cytomegalovirus is also seen as an opportunistic infection in AIDS. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Denaturation: Rupture of the hydrogen bonds by heating a DNA solution and then cooling it rapidly causes the two complementary strands to separate. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diabetic Retinopathy: Retinopathy associated with diabetes mellitus, which may be of the background type, progressively characterized by microaneurysms, interretinal punctuate macular edema, or of the proliferative type, characterized by neovascularization of the retina and optic disk, which may project into the vitreous, proliferation of fibrous tissue, vitreous hemorrhage, and retinal detachment. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU]

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Duct: A tube through which body fluids pass. [NIH] Dystocia: Difficult childbirth or labor. [NIH] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Elastin: The protein that gives flexibility to tissues. [NIH] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Embryo Transfer: Removal of a mammalian embryo from one environment and replacement in the same or a new environment. The embryo is usually in the pre-nidation phase, i.e., a blastocyst. The process includes embryo or blastocyst transplantation or transfer after in vitro fertilization and transfer of the inner cell mass of the blastocyst. It is not used for transfer of differentiated embryonic tissue, e.g., germ layer cells. [NIH] Endocrine Glands: Ductless glands that secrete substances which are released directly into the circulation and which influence metabolism and other body functions. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Epidemiological: Relating to, or involving epidemiology. [EU] Epidural: The space between the wall of the spinal canal and the covering of the spinal cord. An epidural injection is given into this space. [NIH] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Estrogen: One of the two female sex hormones. [NIH] Eukaryotic Cells: Cells of the higher organisms, containing a true nucleus bounded by a nuclear membrane. [NIH] Exotropia: A form of ocular misalignment where the visual axes diverge inappropriately. For example, medial rectus muscle weakness may produce this condition as the affected eye will deviate laterally upon attempted forward gaze. An exotropia occurs due to the relatively unopposed force exerted on the eye by the lateral rectus muscle, which pulls the eye in an outward direction. [NIH] Extraction: The process or act of pulling or drawing out. [EU] Extravasation: A discharge or escape, as of blood, from a vessel into the tissues. [EU] Extremity: A limb; an arm or leg (membrum); sometimes applied specifically to a hand or foot. [EU] Facial: Of or pertaining to the face. [EU] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH]

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Fecal Incontinence: Failure of voluntary control of the anal sphincters, with involuntary passage of feces and flatus. [NIH] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Fertilization in Vitro: Fertilization of an egg outside the body when the egg is normally fertilized in the body. [NIH] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Finite Element Analysis: A computer based method of simulating or analyzing the behavior of structures or components. [NIH] Fistula: Abnormal communication most commonly seen between two internal organs, or between an internal organ and the surface of the body. [NIH] Flatus: Gas passed through the rectum. [NIH] Fossa: A cavity, depression, or pit. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Genetic testing: Analyzing DNA to look for a genetic alteration that may indicate an increased risk for developing a specific disease or disorder. [NIH] Genital: Pertaining to the genitalia. [EU] Gestation: The period of development of the young in viviparous animals, from the time of fertilization of the ovum until birth. [EU] Gestational: Psychosis attributable to or occurring during pregnancy. [NIH] Gestational Age: Age of the conceptus. In humans, this may be assessed by medical history, physical examination, early immunologic pregnancy tests, radiography, ultrasonography, and amniotic fluid analysis. [NIH] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glucose Intolerance: A pathological state in which the fasting plasma glucose level is less than 140 mg per deciliter and the 30-, 60-, or 90-minute plasma glucose concentration following a glucose tolerance test exceeds 200 mg per deciliter. This condition is seen frequently in diabetes mellitus but also occurs with other diseases. [NIH] Glucose tolerance: The power of the normal liver to absorb and store large quantities of glucose and the effectiveness of intestinal absorption of glucose. The glucose tolerance test is a metabolic test of carbohydrate tolerance that measures active insulin, a hepatic function based on the ability of the liver to absorb glucose. The test consists of ingesting 100 grams of glucose into a fasting stomach; blood sugar should return to normal in 2 to 21 hours after ingestion. [NIH]

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Glucose Tolerance Test: Determination of whole blood or plasma sugar in a fasting state before and at prescribed intervals (usually 1/2 hr, 1 hr, 3 hr, 4 hr) after taking a specified amount (usually 100 gm orally) of glucose. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Gravidity: Pregnancy; the condition of being pregnant, without regard to the outcome. [EU] Growth factors: Substances made by the body that function to regulate cell division and cell survival. Some growth factors are also produced in the laboratory and used in biological therapy. [NIH] Haplotypes: The genetic constitution of individuals with respect to one member of a pair of allelic genes, or sets of genes that are closely linked and tend to be inherited together such as those of the major histocompatibility complex. [NIH] Hematoma: An extravasation of blood localized in an organ, space, or tissue. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hepatic: Refers to the liver. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Herpes: Any inflammatory skin disease caused by a herpesvirus and characterized by the formation of clusters of small vesicles. When used alone, the term may refer to herpes simplex or to herpes zoster. [EU] Herpes Zoster: Acute vesicular inflammation. [NIH] Homeostasis: The processes whereby the internal environment of an organism tends to remain balanced and stable. [NIH] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hybrid: Cross fertilization between two varieties or, more usually, two species of vines, see also crossing. [NIH] Hybridization: The genetic process of crossbreeding to produce a hybrid. Hybrid nucleic acids can be formed by nucleic acid hybridization of DNA and RNA molecules. Protein hybridization allows for hybrid proteins to be formed from polypeptide chains. [NIH] Hydroxylysine: A hydroxylated derivative of the amino acid lysine that is present in certain collagens. [NIH] Hydroxyproline: A hydroxylated form of the imino acid proline. A deficiency in ascorbic acid can result in impaired hydroxyproline formation. [NIH] Hyperglycemia: Abnormally high blood sugar. [NIH] Hysterotomy: An incision in the uterus, performed through either the abdomen or the vagina. [NIH] Idiopathic: Describes a disease of unknown cause. [NIH] Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunohistochemistry: Histochemical localization of immunoreactive substances using labeled antibodies as reagents. [NIH]

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Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] In situ: In the natural or normal place; confined to the site of origin without invasion of neighbouring tissues. [EU] In Situ Hybridization: A technique that localizes specific nucleic acid sequences within intact chromosomes, eukaryotic cells, or bacterial cells through the use of specific nucleic acid-labeled probes. [NIH] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incontinence: Inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the rectum (fecal incontinence). [NIH] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infancy: The period of complete dependency prior to the acquisition of competence in walking, talking, and self-feeding. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Ingestion: Taking into the body by mouth [NIH] Innervation: 1. The distribution or supply of nerves to a part. 2. The supply of nervous energy or of nerve stimulus sent to a part. [EU] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Insulin-dependent diabetes mellitus: A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes. [NIH] Intestinal: Having to do with the intestines. [NIH] Intestines: The section of the alimentary canal from the stomach to the anus. It includes the large intestine and small intestine. [NIH] Intracranial Aneurysm: A saclike dilatation of the walls of a blood vessel, usually an artery. [NIH]

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Intravesical: Within the bladder. [NIH] Involuntary: Reaction occurring without intention or volition. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Lacerations: Torn, ragged, mangled wounds. [NIH] Lactation: The period of the secretion of milk. [EU] Lens: The transparent, double convex (outward curve on both sides) structure suspended between the aqueous and vitreous; helps to focus light on the retina. [NIH] Lesion: An area of abnormal tissue change. [NIH] Lipid: Fat. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Localization: The process of determining or marking the location or site of a lesion or disease. May also refer to the process of keeping a lesion or disease in a specific location or site. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Lubricants: Oily or slippery substances. [NIH] Lutein Cells: The cells of the corpus luteum which are derived from the granulosa cells and the theca cells of the Graafian follicle. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]

Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphatic system: The tissues and organs that produce, store, and carry white blood cells that fight infection and other diseases. This system includes the bone marrow, spleen, thymus, lymph nodes and a network of thin tubes that carry lymph and white blood cells. These tubes branch, like blood vessels, into all the tissues of the body. [NIH] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Magnetic Resonance Imaging: Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. [NIH] Major Histocompatibility Complex: The genetic region which contains the loci of genes which determine the structure of the serologically defined (SD) and lymphocyte-defined (LD) transplantation antigens, genes which control the structure of the immune responseassociated (Ia) antigens, the immune response (Ir) genes which control the ability of an animal to respond immunologically to antigenic stimuli, and genes which determine the structure and/or level of the first four components of complement. [NIH] Manifest: Being the part or aspect of a phenomenon that is directly observable : concretely expressed in behaviour. [EU]

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Medial: Lying near the midsaggital plane of the body; opposed to lateral. [NIH] Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Menopause: Permanent cessation of menstruation. [NIH] Menstruation: The normal physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus. [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Metabolic disorder: A condition in which normal metabolic processes are disrupted, usually because of a missing enzyme. [NIH] Microorganism: An organism that can be seen only through a microscope. Microorganisms include bacteria, protozoa, algae, and fungi. Although viruses are not considered living organisms, they are sometimes classified as microorganisms. [NIH] Micturition: The passage of urine; urination. [EU] Middle Cerebral Artery: The largest and most complex of the cerebral arteries. Branches of the middle cerebral artery supply the insular region, motor and premotor areas, and large regions of the association cortex. [NIH] Midwifery: The practice of assisting women in childbirth. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Mucosa: A mucous membrane, or tunica mucosa. [EU] Musculature: The muscular apparatus of the body, or of any part of it. [EU] Neonatal: Pertaining to the first four weeks after birth. [EU] Nephropathy: Disease of the kidneys. [EU] Nerve Fibers: Slender processes of neurons, especially the prolonged axons that conduct nerve impulses. [NIH] Nerve Growth Factor: Nerve growth factor is the first of a series of neurotrophic factors that were found to influence the growth and differentiation of sympathetic and sensory neurons. It is comprised of alpha, beta, and gamma subunits. The beta subunit is responsible for its growth stimulating activity. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Neurologic: Having to do with nerves or the nervous system. [NIH] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neurotoxin: A substance that is poisonous to nerve tissue. [NIH]

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Neurotrophins: A nerve growth factor. [NIH] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH] Nuclear magnetic resonance imaging: NMRI. A procedure in which a magnet linked to a computer is used to create detailed pictures of areas inside the body. Also called magnetic resonance imaging (MRI). [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleic acid: Either of two types of macromolecule (DNA or RNA) formed by polymerization of nucleotides. Nucleic acids are found in all living cells and contain the information (genetic code) for the transfer of genetic information from one generation to the next. [NIH] Nucleic Acid Hybridization: The process whereby two single-stranded polynucleotides form a double-stranded molecule, with hydrogen bonding between the complementary bases in the two strains. [NIH] Nurse Midwives: Professional nurses who have received postgraduate training in midwifery. [NIH] Ocular: 1. Of, pertaining to, or affecting the eye. 2. Eyepiece. [EU] Optic Disk: The portion of the optic nerve seen in the fundus with the ophthalmoscope. It is formed by the meeting of all the retinal ganglion cell axons as they enter the optic nerve. [NIH]

Otolaryngologist: A doctor who specializes in treating diseases of the ear, nose, and throat. Also called an ENT doctor. [NIH] Ototoxic: Having a deleterious effect upon the eighth nerve, or upon the organs of hearing and balance. [EU] Ovariectomy: The surgical removal of one or both ovaries. [NIH] Ovaries: The pair of female reproductive glands in which the ova, or eggs, are formed. The ovaries are located in the pelvis, one on each side of the uterus. [NIH] Ovum: A female germ cell extruded from the ovary at ovulation. [NIH] Oxytocin: A nonapeptide posterior pituitary hormone that causes uterine contractions and stimulates lactation. [NIH] Palsy: Disease of the peripheral nervous system occurring usually after many years of increased lead absorption. [NIH] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Paralysis: Loss of ability to move all or part of the body. [NIH] Parity: The number of offspring a female has borne. It is contrasted with gravidity, which refers to the number of pregnancies, regardless of outcome. [NIH]

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Parturition: The act or process of given birth to a child. [EU] Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pelvic: Pertaining to the pelvis. [EU] Pelvis: The lower part of the abdomen, located between the hip bones. [NIH] Perforation: 1. The act of boring or piercing through a part. 2. A hole made through a part or substance. [EU] Perinatal: Pertaining to or occurring in the period shortly before and after birth; variously defined as beginning with completion of the twentieth to twenty-eighth week of gestation and ending 7 to 28 days after birth. [EU] Perineal: Pertaining to the perineum. [EU] Perineum: The area between the anus and the sex organs. [NIH] Peripheral Nervous System: The nervous system outside of the brain and spinal cord. The peripheral nervous system has autonomic and somatic divisions. The autonomic nervous system includes the enteric, parasympathetic, and sympathetic subdivisions. The somatic nervous system includes the cranial and spinal nerves and their ganglia and the peripheral sensory receptors. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Photocoagulation: Using a special strong beam of light (laser) to seal off bleeding blood vessels such as in the eye. The laser can also burn away blood vessels that should not have grown in the eye. This is the main treatment for diabetic retinopathy. [NIH] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasma cells: A type of white blood cell that produces antibodies. [NIH] Plexus: A network or tangle; a general term for a network of lymphatic vessels, nerves, or veins. [EU] Pneumonia: Inflammation of the lungs. [NIH] Polymerase: An enzyme which catalyses the synthesis of DNA using a single DNA strand as a template. The polymerase copies the template in the 5'-3'direction provided that sufficient quantities of free nucleotides, dATP and dTTP are present. [NIH] Polymerase Chain Reaction: In vitro method for producing large amounts of specific DNA or RNA fragments of defined length and sequence from small amounts of short oligonucleotide flanking sequences (primers). The essential steps include thermal denaturation of the double-stranded target molecules, annealing of the primers to their complementary sequences, and extension of the annealed primers by enzymatic synthesis

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with DNA polymerase. The reaction is efficient, specific, and extremely sensitive. Uses for the reaction include disease diagnosis, detection of difficult-to-isolate pathogens, mutation analysis, genetic testing, DNA sequencing, and analyzing evolutionary relationships. [NIH] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Pons: The part of the central nervous system lying between the medulla oblongata and the mesencephalon, ventral to the cerebellum, and consisting of a pars dorsalis and a pars ventralis. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postnatal: Occurring after birth, with reference to the newborn. [EU] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Pregnancy Outcome: Results of conception and ensuing pregnancy, including live birth, stillbirth, spontaneous abortion, induced abortion. The outcome may follow natural or artificial insemination or any of the various reproduction techniques, such as embryo transfer or fertilization in vitro. [NIH] Pregnancy Tests: Tests to determine whether or not an individual is pregnant. [NIH] Prenatal: Existing or occurring before birth, with reference to the fetus. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH] Prolactin: Pituitary lactogenic hormone. A polypeptide hormone with a molecular weight of about 23,000. It is essential in the induction of lactation in mammals at parturition and is synergistic with estrogen. The hormone also brings about the release of progesterone from lutein cells, which renders the uterine mucosa suited for the embedding of the ovum should fertilization occur. [NIH] Proliferative Retinopathy: A disease of the small blood vessels of the retina of the eye. [NIH] Proline: A non-essential amino acid that is synthesized from glutamic acid. It is an essential component of collagen and is important for proper functioning of joints and tendons. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH]

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Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Psychosomatic: Pertaining to the mind-body relationship; having bodily symptoms of psychic, emotional, or mental origin; called also psychophysiologic. [EU] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Radioactive: Giving off radiation. [NIH] Radiography: Examination of any part of the body for diagnostic purposes by means of roentgen rays, recording the image on a sensitized surface (such as photographic film). [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Refraction: A test to determine the best eyeglasses or contact lenses to correct a refractive error (myopia, hyperopia, or astigmatism). [NIH] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Retina: The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outer-most layer is pigmented, whereas the inner nine layers are transparent. [NIH] Retinal: 1. Pertaining to the retina. 2. The aldehyde of retinol, derived by the oxidative enzymatic splitting of absorbed dietary carotene, and having vitamin A activity. In the retina, retinal combines with opsins to form visual pigments. One isomer, 11-cis retinal combines with opsin in the rods (scotopsin) to form rhodopsin, or visual purple. Another, all-trans retinal (trans-r.); visual yellow; xanthopsin) results from the bleaching of rhodopsin by light, in which the 11-cis form is converted to the all-trans form. Retinal also combines with opsins in the cones (photopsins) to form the three pigments responsible for colour vision. Called also retinal, and retinene1. [EU] Retinopathy: 1. Retinitis (= inflammation of the retina). 2. Retinosis (= degenerative, noninflammatory condition of the retina). [EU] Rod: A reception for vision, located in the retina. [NIH] Rubella: An acute, usually benign, infectious disease caused by a togavirus and most often affecting children and nonimmune young adults, in which the virus enters the respiratory tract via droplet nuclei and spreads to the lymphatic system. It is characterized by a slight cold, sore throat, and fever, followed by enlargement of the postauricular, suboccipital, and cervical lymph nodes, and the appearances of a fine pink rash that begins on the head and spreads to become generalized. Called also German measles, roetln, röteln, and three-day measles, and rubeola in French and Spanish. [EU] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU]

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Septal: An abscess occurring at the root of the tooth on the proximal surface. [NIH] Septum: A dividing wall or partition; a general term for such a structure. The term is often used alone to refer to the septal area or to the septum pellucidum. [EU] Septum Pellucidum: A triangular double membrane separating the anterior horns of the lateral ventricles of the brain. It is situated in the median plane and bounded by the corpus callosum and the body and columns of the fornix. [NIH] Sequencing: The determination of the order of nucleotides in a DNA or RNA chain. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]

Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Skull: The skeleton of the head including the bones of the face and the bones enclosing the brain. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

Sneezing: Sudden, forceful, involuntary expulsion of air from the nose and mouth caused by irritation to the mucous membranes of the upper respiratory tract. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Sphincter: A ringlike band of muscle fibres that constricts a passage or closes a natural orifice; called also musculus sphincter. [EU] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spirochete: Lyme disease. [NIH] Spleen: An organ that is part of the lymphatic system. The spleen produces lymphocytes, filters the blood, stores blood cells, and destroys old blood cells. It is located on the left side of the abdomen near the stomach. [NIH] Spontaneous Abortion: The non-induced birth of an embryo or of fetus prior to the stage of viability at about 20 weeks of gestation. [NIH] Steel: A tough, malleable, iron-based alloy containing up to, but no more than, two percent carbon and often other metals. It is used in medicine and dentistry in implants and instrumentation. [NIH] Stem Cells: Relatively undifferentiated cells of the same lineage (family type) that retain the ability to divide and cycle throughout postnatal life to provide cells that can become specialized and take the place of those that die or are lost. [NIH] Stenosis: Narrowing or stricture of a duct or canal. [EU] Stillbirth: The birth of a dead fetus or baby. [NIH] Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other

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excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Strand: DNA normally exists in the bacterial nucleus in a helix, in which two strands are coiled together. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stress urinary: Leakage of urine caused by actions--such as coughing, laughing, sneezing, running, or lifting--that place pressure on the bladder from inside the body. Stress urinary incontinence can result from either a fallen bladder or weak sphincter muscles. [NIH] Stricture: The abnormal narrowing of a body opening. Also called stenosis. [NIH] Substance P: An eleven-amino acid neurotransmitter that appears in both the central and peripheral nervous systems. It is involved in transmission of pain, causes rapid contractions of the gastrointestinal smooth muscle, and modulates inflammatory and immune responses. [NIH]

Synapse: The region where the processes of two neurons come into close contiguity, and the nervous impulse passes from one to the other; the fibers of the two are intermeshed, but, according to the general view, there is no direct contiguity. [NIH] Synergistic: Acting together; enhancing the effect of another force or agent. [EU] Syphilis: A contagious venereal disease caused by the spirochete Treponema pallidum. [NIH]

Teratogenic: Tending to produce anomalies of formation, or teratism (= anomaly of formation or development : condition of a monster). [EU] Thermal: Pertaining to or characterized by heat. [EU] Thoracic: Having to do with the chest. [NIH] Tic: An involuntary compulsive, repetitive, stereotyped movement, resembling a purposeful movement because it is coordinated and involves muscles in their normal synergistic relationships; tics usually involve the face and shoulders. [EU] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tolerance: 1. The ability to endure unusually large doses of a drug or toxin. 2. Acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU] Tone: 1. The normal degree of vigour and tension; in muscle, the resistance to passive elongation or stretch; tonus. 2. A particular quality of sound or of voice. 3. To make permanent, or to change, the colour of silver stain by chemical treatment, usually with a heavy metal. [EU] Tonus: A state of slight tension usually present in muscles even when they are not undergoing active contraction. [NIH] Torticollis: Wryneck; a contracted state of the cervical muscles, producing twisting of the neck and an unnatural position of the head. [EU] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicology: The science concerned with the detection, chemical composition, and

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pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxoplasmosis: The acquired form of infection by Toxoplasma gondii in animals and man. [NIH]

Traction: The act of pulling. [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Ultrasonography: The visualization of deep structures of the body by recording the reflections of echoes of pulses of ultrasonic waves directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1.6 to 10 megahertz. [NIH] Ureters: Tubes that carry urine from the kidneys to the bladder. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urinary Fistula: An abnormal passage in any organ of the urinary tract or between urinary organs and other organs. [NIH] Urinary tract: The organs of the body that produce and discharge urine. These include the kidneys, ureters, bladder, and urethra. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Uterine Contraction: Contraction of the uterine muscle. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH] Vaginal: Of or having to do with the vagina, the birth canal. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venereal: Pertaining or related to or transmitted by sexual contact. [EU] Vertebrae: A bony unit of the segmented spinal column. [NIH] Vertebral: Of or pertaining to a vertebra. [EU] Vestibular: Pertaining to or toward a vestibule. In dental anatomy, used to refer to the tooth surface directed toward the vestibule of the mouth. [EU] Vestibule: A small, oval, bony chamber of the labyrinth. The vestibule contains the utricle and saccule, organs which are part of the balancing apparatus of the ear. [NIH] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH]

Dictionary 69

Viral: Pertaining to, caused by, or of the nature of virus. [EU] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Vital Statistics: Used for general articles concerning statistics of births, deaths, marriages, etc. [NIH] Vitreous: Glasslike or hyaline; often used alone to designate the vitreous body of the eye (corpus vitreum). [EU] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH]

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INDEX A Abdominal, 51, 53, 62 Abscess, 51, 66 Acoustic, 28, 51 Adrenergic, 7, 51, 56 Algorithms, 51, 52 Alternative medicine, 51 Amenorrhea, 51 Amino Acid Sequence, 51 Amniotic Fluid, 51, 57 Anal, 7, 51, 57 Anatomical, 51, 59 Aneurysm, 13, 51 Annealing, 51, 63 Anomalies, 51, 67 Anorexia, 17, 51 Anorexia Nervosa, 17, 51 Antibacterial, 51, 66 Antibiotic, 51, 66 Antibodies, 8, 51, 58, 63 Antigen, 51, 52, 54, 59 Anus, 51, 52, 53, 59, 63 Aqueous, 52, 60 Arterial, 13, 52, 64 Arteries, 10, 52, 53 Artery, 51, 52, 59, 61 Asphyxia, 17, 52 Auditory, 19, 52 Axilla, 52, 53 Axons, 7, 52, 61, 62 B Bacteria, 51, 52, 57, 61, 66, 68 Bacterial Infections, 28, 52 Base, 52, 60 Benign, 52, 65 Bilateral, 7, 52 Bile, 52, 57, 60 Bile duct, 52 Biliary, 13, 52 Biliary Tract, 13, 52 Biological therapy, 52, 58 Biotechnology, 8, 35, 52 Birth Certificates, 27, 53 Bladder, 29, 53, 55, 59, 60, 67, 68 Blood Glucose, 3, 28, 53, 59 Blood vessel, 53, 59, 60, 63, 64, 66 Bowel, 51, 53, 55, 67 Bowel Movement, 53, 55, 67

Brachial, 11, 14, 16, 19, 20, 53 Brachial Plexus, 14, 19, 20, 53 Brain Stem, 20, 53 C Carbohydrate, 53, 57 Cell, 5, 52, 53, 54, 56, 58, 60, 62, 63 Cell Division, 52, 53, 58, 63 Cell Survival, 53, 58 Central Nervous System, 22, 53, 57, 64 Cerebral, 11, 21, 53, 56, 61 Cerebral Arteries, 53, 61 Cerebral hemispheres, 53 Cerebrum, 53 Cervical, 9, 10, 15, 53, 65, 67 Cervix, 53 Cesarean Section, 4, 7, 12, 53 Chiropractic, 22, 54 Chronic, 6, 54, 59 Clamp, 5, 54 Clavicle, 12, 20, 54 Clinical trial, 4, 35, 54, 55, 64, 65 Cloning, 52, 54 Collagen, 8, 54, 64 Complement, 54, 60 Complementary and alternative medicine, 19, 23, 54 Complementary medicine, 19, 54 Compliance, 3, 5, 55 Computational Biology, 35, 55 Conception, 55, 57, 64 Confounding, 5, 55 Connective Tissue, 54, 55, 57, 60 Continence, 5, 7, 8, 19, 55 Contractility, 5, 55 Contraindications, ii, 55 Control group, 4, 55 Cortex, 53, 55, 61, 64 Cytomegalovirus, 28, 55 D Degenerative, 55, 65 Denaturation, 55, 63 Diabetes Mellitus, 3, 23, 28, 29, 55, 57 Diabetic Retinopathy, 28, 55, 63 Diagnostic procedure, 55 Digestion, 52, 53, 55, 60, 67 Direct, iii, 7, 55, 65, 67 Duct, 56, 65, 66 Dystocia, 13, 16, 56

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E Edema, 55, 56 Efficacy, 3, 56 Elastin, 54, 56 Embryo, 56, 59, 64, 66 Embryo Transfer, 56, 64 Endocrine Glands, 56 Environmental Health, 34, 36, 56 Enzymatic, 54, 56, 63, 65 Enzyme, 8, 56, 61, 63, 69 Epidemiological, 6, 56 Epidural, 5, 12, 56 Epinephrine, 51, 56, 62 Estrogen, 7, 56, 64 Eukaryotic Cells, 56, 59 Exotropia, 11, 56 Extraction, 12, 53, 56 Extravasation, 56, 58 Extremity, 53, 56 F Facial, 13, 14, 56 Family Planning, 35, 56 Fecal Incontinence, 7, 57, 59 Feces, 57, 67 Fertilization in Vitro, 57, 64 Fetus, 53, 57, 64, 66, 68 Finite Element Analysis, 16, 57 Fistula, 14, 57 Flatus, 57 Fossa, 15, 57 G Gallbladder, 51, 52, 57 Ganglia, 8, 57, 61, 63 Gene, 7, 52, 57 Genetic testing, 57, 64 Genital, 4, 21, 57 Gestation, 4, 28, 29, 57, 63, 66 Gestational, 3, 13, 15, 16, 27, 57 Gestational Age, 4, 57 Gland, 57, 60, 62, 65, 66 Glucose, 3, 29, 53, 55, 57, 58, 59 Glucose Intolerance, 55, 57 Glucose tolerance, 29, 57 Glucose Tolerance Test, 57, 58 Governing Board, 58, 64 Gravidity, 58, 62 Growth factors, 7, 58 H Haplotypes, 6, 58 Hematoma, 12, 13, 58 Hemorrhage, 12, 15, 55, 58 Hepatic, 57, 58

Heredity, 57, 58 Herpes, 28, 58 Herpes Zoster, 58 Homeostasis, 29, 58 Hormonal, 7, 58 Hormone, 56, 58, 59, 62, 64 Hybrid, 58 Hybridization, 8, 58 Hydroxylysine, 54, 58 Hydroxyproline, 54, 58 Hyperglycemia, 28, 58 Hysterotomy, 53, 58 I Idiopathic, 13, 58 Immune system, 52, 58, 68 Immunohistochemistry, 8, 58 Immunologic, 57, 59 Impairment, 11, 59 In situ, 8, 59 In Situ Hybridization, 8, 59 In vitro, 5, 56, 59, 63 In vivo, 5, 59 Incontinence, 5, 7, 8, 59, 67 Induction, 59, 64 Infancy, 13, 22, 59 Infection, 52, 55, 59, 60, 68 Inflammation, 58, 59, 63, 65 Ingestion, 57, 59 Innervation, 7, 53, 59 Insulin, 4, 10, 15, 57, 59 Insulin-dependent diabetes mellitus, 59 Intestinal, 5, 57, 59 Intestines, 51, 57, 59 Intracranial Aneurysm, 9, 59 Intravesical, 5, 60 Involuntary, 57, 60, 66, 67 K Kb, 34, 60 L Lacerations, 5, 60 Lactation, 20, 60, 62, 64 Lens, 11, 60 Lesion, 8, 60 Lipid, 59, 60 Liver, 13, 51, 52, 55, 57, 58, 60 Localization, 58, 60 Localized, 51, 58, 59, 60, 63 Lubricants, 5, 60 Lutein Cells, 60, 64 Lymph, 53, 60, 65 Lymph node, 53, 60, 65 Lymphatic, 59, 60, 63, 65, 66

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Lymphatic system, 60, 65, 66 Lymphoid, 51, 60 M Magnetic Resonance Imaging, 60, 62 Major Histocompatibility Complex, 58, 60 Manifest, 28, 60 Medial, 56, 61 Mediate, 8, 61 MEDLINE, 35, 61 Memory, 4, 51, 61 Meninges, 53, 61 Menopause, 7, 61 Menstruation, 51, 61 Mental, iv, 4, 34, 36, 61, 65 Metabolic disorder, 28, 61 Microorganism, 61, 69 Micturition, 5, 61 Middle Cerebral Artery, 17, 61 Midwifery, 61, 62 Molecular, 7, 35, 37, 52, 55, 61, 64 Monitor, 61, 62 Mucosa, 61, 64 Musculature, 7, 61 N Neonatal, 4, 11, 14, 61 Nephropathy, 28, 61 Nerve Fibers, 53, 61 Nerve Growth Factor, 7, 61, 62 Nervous System, 12, 20, 53, 61, 63 Neurologic, 14, 29, 61 Neuronal, 7, 61 Neurons, 57, 61, 67 Neurotoxin, 8, 61 Neurotrophins, 8, 62 Norepinephrine, 51, 62 Nuclear, 16, 56, 62 Nuclear magnetic resonance imaging, 16, 62 Nuclei, 60, 62, 65 Nucleic acid, 58, 59, 62 Nucleic Acid Hybridization, 58, 62 Nurse Midwives, 5, 62 O Ocular, 56, 62 Optic Disk, 55, 62 Otolaryngologist, 28, 62 Ototoxic, 28, 62 Ovariectomy, 7, 62 Ovaries, 62 Ovum, 57, 62, 64 Oxytocin, 7, 62

P Palsy, 12, 13, 14, 19, 62 Pancreas, 51, 59, 62 Paralysis, 16, 62 Parity, 5, 62 Parturition, 63, 64 Pathologic, 16, 63 Pelvic, 7, 9, 11, 29, 63 Pelvis, 62, 63, 68 Perforation, 13, 63 Perinatal, 11, 12, 63 Perineal, 4, 21, 63 Perineum, 5, 7, 63 Peripheral Nervous System, 62, 63, 67 Pharmacologic, 63, 68 Photocoagulation, 28, 63 Physical Examination, 57, 63 Physiologic, 5, 61, 63 Plants, 57, 62, 63 Plasma, 7, 51, 57, 58, 63 Plasma cells, 51, 63 Plexus, 11, 16, 53, 63 Pneumonia, 55, 63 Polymerase, 8, 63 Polymerase Chain Reaction, 8, 63 Polypeptide, 51, 54, 58, 64 Pons, 53, 64 Posterior, 15, 51, 62, 64 Postnatal, 64, 66 Practice Guidelines, 36, 64 Pregnancy Outcome, 3, 64 Pregnancy Tests, 57, 64 Prenatal, 4, 56, 64 Prevalence, 5, 27, 64 Progesterone, 64 Prolactin, 20, 64 Proliferative Retinopathy, 28, 64 Proline, 54, 58, 64 Protein S, 52, 64 Proteins, 51, 52, 54, 58, 63, 64 Protocol, 4, 64 Proximal, 65, 66 Psychic, 61, 65 Psychosomatic, 22, 65 Public Policy, 35, 65 R Radioactive, 62, 65 Radiography, 57, 65 Randomized, 5, 56, 65 Rectum, 52, 53, 57, 59, 65 Refer, 1, 54, 58, 60, 65, 66, 68 Refraction, 65, 66

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Regimen, 56, 65 Retina, 55, 60, 64, 65 Retinal, 55, 62, 65 Retinopathy, 28, 55, 65 Rod, 54, 65 Rubella, 28, 65 S Salivary, 55, 65 Salivary glands, 55, 65 Screening, 54, 65 Secretion, 20, 59, 60, 65 Septal, 9, 66 Septum, 20, 66 Septum Pellucidum, 66 Sequencing, 64, 66 Shock, 66, 68 Skeletal, 14, 54, 66 Skeleton, 66 Skull, 12, 14, 66 Smooth muscle, 7, 66, 67 Sneezing, 66, 67 Specialist, 41, 66 Spectrum, 6, 66 Sphincter, 5, 7, 66, 67 Spinal cord, 14, 15, 16, 20, 53, 56, 61, 63, 66 Spirochete, 66, 67 Spleen, 55, 60, 66 Spontaneous Abortion, 28, 64, 66 Steel, 54, 66 Stem Cells, 5, 66 Stenosis, 9, 66, 67 Stillbirth, 28, 64, 66 Stimulus, 55, 59, 66 Stomach, 51, 57, 58, 59, 66, 67 Stool, 14, 59, 67 Strand, 63, 67 Stress, 5, 7, 67 Stress urinary, 5, 7, 67 Stricture, 66, 67 Substance P, 65, 67 Synapse, 51, 67 Synergistic, 64, 67 Syphilis, 28, 67 T Teratogenic, 28, 67

Thermal, 63, 67 Thoracic, 53, 67 Tic, 6, 67 Tissue, 5, 52, 55, 56, 58, 60, 61, 65, 67 Tolerance, 57, 67 Tone, 8, 67 Tonus, 67 Torticollis, 15, 67 Toxic, iv, 67, 68 Toxicology, 36, 67 Toxoplasmosis, 28, 68 Traction, 7, 54, 68 Transfection, 52, 68 Trauma, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 19, 20, 21, 22, 23, 28, 29, 68 Tryptophan, 54, 68 U Ultrasonography, 57, 68 Ureters, 68 Urethra, 29, 68 Urinary, 6, 7, 29, 59, 67, 68 Urinary Fistula, 29, 68 Urinary tract, 29, 68 Urine, 19, 53, 55, 59, 61, 67, 68 Uterine Contraction, 62, 68 Uterus, 53, 58, 61, 62, 64, 68 V Vaccine, 64, 68 Vagina, 29, 53, 58, 61, 68 Vaginal, 4, 7, 13, 68 Vein, 51, 62, 68 Venereal, 67, 68 Vertebrae, 66, 68 Vertebral, 10, 68 Vestibular, 9, 68 Vestibule, 68 Veterinary Medicine, 35, 68 Viral, 28, 69 Virus, 65, 69 Vital Statistics, 53, 69 Vitreous, 55, 60, 65, 69 Vitro, 5, 69 Vivo, 5, 69 X X-ray, 62, 69

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