49 The symptoms begin at rest when the person is lying or sitting and are relieved by movement such as walking or stretching. The condition is present in 5% to 10% of the general population. It has been said to be the “most common and least diagnosed” sleep disorder.50 Diagnosis relies essentially on the interview with the physician.51 Restless legs may be caused by polyneu- ropathy, arthritis, Inhibitors,research,lifescience,medical positional discomfort and ischemia, neuroleptic exposure, or cramps. Objective measures include polysomnography, with EMG electrodes placed at the level

of the anterior tibialis muscles on both legs, and the suggested immobilization test (SIT) to provoke the restless legs symptoms. In the SIT, the patient is required not to move for 1 h while measures of leg movement and movement intensity are monitored. In 80% Inhibitors,research,lifescience,medical of patients, polysomnography will show periodic limb movements while awake and sensory discomfort may rise during the SIT. Periodic limb movements in sleep are repetitive movements that primarily involve the legs, especially during non-REM sleep. When http://www.selleckchem.com/products/Paclitaxel(Taxol).html patients report sleep-wake complaints, they are said to suffer from

periodic limb movement disorder. Movements Inhibitors,research,lifescience,medical are counted if they last 0.5 to 5 s and occur in a series of four or more at intervals of 5 to 90 s. The EMG amplitude of the nocturnal limb movements must be 25% or more of the baseline EMG amplitude while awake. The Inhibitors,research,lifescience,medical severity of the condition is determined by the periodic limb movement index (number of periodic movements per hour of sleep). The periodic limb movement

arousal index is the number of periodic limb movements associated with EEG arousals per hour of sleep. Periodic limb movement disorder is defined as mild (5 to 25 periodic limb movements occur per hour of sleep), moderate (25 to 50 movements per hour of sleep), or severe (more than 50 periodic limb movements per hour of sleep or more than 25 associated Inhibitors,research,lifescience,medical with arousals per hour of sleep). The pathophysiology of periodic movements has been related to iron deficiency, which itself is related to dopaminergic dysfunction, which has led to the recent publication of dopaminergic-centered therapeutic standards,52 dopamine agonists giving positive results. With the exception of anticholinergics, Parkinsonian medications benefit the condition. from Sleep apnea-lypopnea syndromes ani the upper airway resistance syndrome Two clinical entities constitute the essential part of breathing disorders during sleep: sleep apnea-hypopnea syndromes and the upper airway resistance syndrome.53 Obstructive sleep apnea affects up to 4% of middle-aged male adults, but may also affect women. The generally obese heavily snoring male patient stops or reduces (by more than 50%) breathing between 10 s to 1 min. Efforts to breathe arouse the patient, leading to an extremely fragmented sleep and excessive daytime sleepiness.

A total Icotinib cell line of 10 participants would provide an 80% probability of detecting

a difference of 10 cmH2O in maximal inspiratory pressure at a two-sided 5% significance level. We anticipated that a substantial proportion of these critically ill participants would die or receive a tracheostomy. We therefore increased the recruited Modulators sample to 20 participants per group to allow for this. All participants with follow-up data were analysed according to their group allocation, ie, using the intentionto-treat principle. Statistical significance was considered as p < 0.05, therefore mean between-group differences and 95% confidence intervals are presented for maximal inspiratory pressure, the index of Tobin, and weaning time. The Kappa test was used to evaluate the agreement between the evaluators of maximal inspiratory pressure. Total intubation time was analysed using a Kaplan-Meier curve. In the event of death, tracheostomy, or self-extubation, participants were excluded from the independent t-tests of between-group differences buy PR-171 and were treated as censored cases in the survival analysis. During the recruitment period, 198 patients were screened, of whom 67 were eligible and monitored daily to assess readiness

to start weaning. Of the 67, 20 were tracheostomised, 5 died, and 1 was transferred to another centre before the start of weaning. The remaining 41 were randomised: 21 to the experimental group and 20 to the control group. The baseline characteristics, ie, on the day weaning started, of the two groups are presented in Table 1 and in the first two columns of Table 2. Four participants in each group died before extubation. Three participants

in the experimental group and two in the control group were tracheostomised before extubation. The intensive care unit Thalidomide had a total of 24 beds, with 8 of these dedicated to postoperative patients. The physiotherapy team comprised 11 physiotherapists working in three shifts, all with expertise in intensive care, of which two have doctoral and six have masters qualifications. Consistency between the physiotherapists for the assessment of maximal inspiratory pressure was good, with a Kappa value of 0.68. Participants in the experimental group underwent training on all days during their weaning period. The average training load of the participants in the experimental group increased from 3 cmH2O initially to 20 cmH2O at the end of the weaning period. Group data for all outcomes at the start of weaning and at extubation for the experimental and control groups are presented in Table 2 while individual data are presented in Table 3 (see eAddenda for Table 3). Maximal inspiratory pressure increased significantly more in the treatment group than the control group (MD 7.6 cmH2O, 95% CI 5.8 to 9.4). The index of Tobin increased (ie, worsened) in both groups over the weaning period, but the increase was attenuated significantly by the inspiratory muscle training (MD 8.3 br/min/L, 95% CI 2.9 to 13.7).

However, taken together with the finding (reported elsewhere [20]) that anthelminthics during pregnancy had little effect NVP-BGJ398 cell line on infant responses to cCFP and TT in this study, these results suggest that maternal helminth infection may not be the major explanation for the poor efficacy of BCG immunisation in the tropics. Subsequent acquisition of helminths by the infant may

be a different story [17]. Tetanus immunisation during pregnancy was associated with enhanced IFN-γ, IL-13 and (to some extent) IL-5 responses following tetanus immunisation of the offspring. These results accord with the earlier report of Gill and colleagues [41] and show that priming of the infant response to TT can be influenced by immunisation of the mother. This antigen-specific

effect may result from transfer of TT across the placenta within an immune complex, utilising the immunoglobulin receptor systems involved in transfer of Epigenetic inhibitor supplier maternal antibody to the fetus [42], [43] and [44]. Fetal exposure to antigen can result in tolerisation, but immune complexes are potent activators of the immune system, and this may explain why priming occurred in this case. The lower response to tetanus immunisation in HIV-exposed-uninfected infants may have resulted from reduced transfer of maternal antibody and antigen in this group [45] and [46]. By contrast, Libraries presence of a maternal BCG scar showed a negative association with infant type 2 cytokine response, and (to some extent) IFN-γ response to cCFP following BCG immunisation. This may have been a non-specific effect since maternal BCG scar was also associated with reductions in these cytokine responses to PHA (data not shown). The association was not explained until by adjusting for potential confounding factors, and suggests an immunological interaction between

mother and infant related to maternal mycobacterial exposure or infection. There is evidence for sensitisation to mycobacterial antigens in utero in mouse models and in humans [47] and [48], but tolerisation is also a possibility, and would accord with the lower response to mycobacterial antigen observed in Malawian, compared to British, infants following BCG immunisation [10]. It may be important to investigate the role of maternal mycobacterial infection, and maternal immune responses to mycobacteria, in the infant response to BCG. Current infant malaria and infant HIV infection were associated with broad reductions in IFN-γ, IL-5 and IL-13 responses. These findings were in keeping with the recognised immunosuppressive effects of these pathogens and thus, incidentally, demonstrate the ability of this immuno-epidemiological approach to detect important effects. They contrast with the IL-10-restricted effects of maternal M. perstans.

Results: Analysis of covariance controlling for the effects of tricyclic antidepressant treatment (≥100 mg) and smoking habit showed that PSDEP had an increased concentration of plasma NE. The previously found correlation between plasma NE and AVP was still present after correcting for the effects of confounding variables. Conclusions: The results suggest an increased activity of the sympathetic nervous system in PSDEP that may act as a specific

mechanism for increased vasopressinergic activation. This supports the view of PSDEP as a distinct Inhibitors,research,lifescience,medical subcategory of major depression. Keywords: norepinephrine, psychotic depression, smoking, tricyclic antidepressant, vasopressin Introduction This study on norepinephrine (NE) in psychotic depression (PSDEP) is part of a series of investigations within the same patient sample that aimed to develop an improved differentiation of subcategories of depression, and to detect neurobiological markers of these subcategories and of depression at large. The neurobiological focus of these studies is on vasopressinergic mechanisms Inhibitors,research,lifescience,medical in depression [Goekoop et al. 2010] and its subcategories [Goekoop and Wiegant, 2009; Goekoop

et al. 2011]. The present study tests if PSDEP is characterized by a specifically high Inhibitors,research,lifescience,medical noradrenergic activation next to the increased noradrenergic–vasopressinergic coupling, selleck compound evidence of which has been found previously in a comparison with non-PSDEP [Goekoop et al. 2011]. We hypothesized the plasma concentration of NE to be increased as a mechanism associated with the positively correlating plasma vasopressin (AVP) and NE concentrations

in PSDEP [Goekoop et al. 2011]. The potential role of increased release of NE next to the increased NE–AVP correlation in Inhibitors,research,lifescience,medical PSDEP may be seen Inhibitors,research,lifescience,medical in the context of the vasopressinergic mechanisms in animal models of depression [Aguilera et al. 2008; Landgraf, 2006] and noradrenergic mechanisms involved in the hypothalamus–pituitary–adrenal (HPA) axis. The role of NE in stimulating the HPA axis has been studied extensively [Al-Damluji, 1993]. In human subjects noradrenergic agents stimulate the release of adrenocorticotroph hormone (ACTH) via an α-1 receptor in the brain at the level of the paraventricular nucleus (PVN) tuclazepam of the hypothalamus, and not at the peripheral level of the pituitary [Al-Damluji, 1993]. Though such noradrenergic stimulation of the PVN in rats and mice involves the synthesis of both corticotropin-releasing hormone [Day et al. 1999] and AVP in the parvocellular neurons [Vacher et al. 2002], the resulting release of ACTH depends particularly on the release of AVP [Al-Damluji, 1993]. We hypothesize that the increased noradrenergic activation suggested by the correlating plasma NE and AVP concentrations in PSDEP involves a centrally increased release of plasma NE. The correlation between central and plasma NE [Esler et al. 1995; Kelly and Cooper, 1997; Ziegler et al.

L’arrivée sur le marché du dabigatran (Pradaxa®), du rivaroxaban (Xarelto®) et de l’apixaban (Eliquis®) est sans aucun doute un véritable progrès pour les patients. Le comprimé remplace l’injection post-opératoire d’HBPM en chirurgie de la prothèse de hanche et de genou. Chez les patients traités pour une fibrillation atriale, l’efficacité antithrombotique

des NACO est au moins comparable à celle des AVK. Ils sont surtout mieux tolérés (diminution des hémorragies majeures intracrâniennes pour l’ensemble des NACO, et intracrâniennes pour l’apixaban et le dabigatran 110 mg). Seul le dabigatran 150 mg a montré une supériorité sur la warfarine pour les AVC ischémiques sous réserve des limitations méthodologiques (essai en ouvert). Enfin, on peut maintenant traiter une thrombose veineuse et/ou une embolie pulmonaire dès le diagnostic avec une double prise orale de rivaroxaban… Beaucoup d’enthousiasme émerge de la part des

utilisateurs, Crenolanib et notamment des équipes de cardiologie et de neurologie, qui envisagent le remplacement progressif des Osimertinib manufacturer AVK et de leur cortège d’effets indésirables… Pourtant, ces avantages sont contrebalancés par un certain nombre d’inconvénients pour la pratique quotidienne. Des complications pourraient survenir rapidement si l’on ne définit pas mieux la gestion péri-procédurale de ces nouveaux agents. Déjà, des accidents hémorragiques ont été rapportés [1], [2] and [3]. L’analyse rétrospective par Healey et al. des données de l’étude RE-LY (dabigatran versus warfarine chez des patients porteurs d’une arythmie complète par fibrillation atriale) montre que durant les deux ans de suivi, environ 25 % d’entre eux ont bénéficié d’une procédure invasive, allant de la pose de pacemaker à la chirurgie majeure en passant par l’endoscopie digestive [4]. C’est une proportion Modulators importante de patients traités par des doses thérapeutiques de NACO qui est concernée. Il est donc essentiel de prévoir cet afflux de patients (par projection, d’ores et déjà 25 000 par an en France) et de définir une conduite à about tenir. Que faire devant une dose thérapeutique de ces

médicaments chez un patient traité pour une fibrillation atriale, une thrombose veineuse profonde ou une embolie pulmonaire ? Les excellents résultats obtenus avec le dabigatran (étude RE-LY) [5], le rivaroxaban (étude ROCKET-AF) [6] et l’apixaban (étude ARISTOTLE) [7] comparés aux AVK dans l’arythmie complète par fibrillation atriale, et ceux du rivaroxaban pour le traitement des thromboses veineuses et de l’embolie pulmonaire (études EINSTEIN-DVT et EINSTEIN-PE) [8] and [9], suivis de l’obtention d’autorisations de mise sur le marché, vont très certainement conduire à une augmentation très conséquente du volume de prescription des NACO. Une réflexion s’est établie au sein du Groupe d’intérêt en hémostase péri-opératoire (GIHP), à l’initiative de Pierre Sie et Pierre Albaladejo [10] and [11]. Un certain nombre d’idées sont résumées ci-dessous.

Employees helped fulfill patients’ dying wishes and adjust and cope with their new health status. Employees were able to relate to patient and family needs, even if they fell outside of their defined professional roles or outside of organizational regulations. They listened and addressed personal preferences and religious beliefs. For instance: “A little boy fell off a lawnmower and his arm had been cut off … this was a very nasty complete amputation. We had the

limb in a cooler and the surgeon took a look at it and said to the father: ‘I can’t put Inhibitors,research,lifescience,medical that back on because this kid will be frustrated with it and he will be better off with a prosthesis …’ As they were leaving, the Selleckchem GSK2656157 father picked up the cooler and I said: ‘You can just leave that here’, and he

said: ‘No, I’m taking that’, and I said: ‘Why don’t you let me take care of it and I’ll clean up the cooler and bring it to you?’ He said: ‘No, I’m taking it’, and Inhibitors,research,lifescience,medical I said: ‘Could you tell me what you’re going to do with it?’ And he said: ‘Those are the five little fingers that I kissed and wrapped around my fingers and I’m not going to let you throw them away’. Another nurse and I said simultaneously: ‘What cooler?’ I Inhibitors,research,lifescience,medical said that we have some things to do over here and you just go out in the hall and we’ll have someone take you to surgery. I think even if I had known that I would have got fired (for doing that),

it wouldn’t mean anything to me.” As these nurses understood the value of the son’s limb for the father, they decided to do what they believed to Inhibitors,research,lifescience,medical be the right thing, even though it meant risking their jobs. This is an example of nurses putting patients’ and family members’ wishes above standard hospital policy Inhibitors,research,lifescience,medical that mandates that any tissue taken from patients has to be retained and given to pathology, and employing mindful value-based action. It also illustrates the complexity of human and organizational needs facing health care workers on a daily basis and the emergence and interpretation of meaning in context. Feeling Part of Organization and Team Another value that emerged as significant was the feeling of teamwork and togetherness. When team members taught each other, cared about one another, and pulled together in times of need, they felt fulfilled and that they belonged Resveratrol to a community of practice. As one interviewee said, “When we are at our best … we’re all clicking together as the teamwork aspect, everybody supporting each other, and that’s how we get through those days”. Teamwork, which included shared responsibility and goals, commitment to others, compromise/sacrifice, and caring, was considered to be a motivating factor that sustained individuals through difficult day-to-day work and personal crises.

Results of these studies showed that the vaccine to be immunogenic and safe. The NADFC therefore issued marketing authorization and Bio Farma’s seasonal influenza vaccine Flubio® Libraries became the first licensed product of the WHO technology transfer initiative in June 2009. Some 165,000 doses were produced for commercial

distribution signaling pathway focusing principally on mass immunization of Hajj pilgrims. Until such time as Bio Farma is able to produce its own seasonal (and ultimately pandemic) antigen, bulk seasonal vaccine supplies will continue to be imported from Biken Institute in Japan, for which a commercial agreement has been signed. The majority of the critical equipment for the preparation of seed lots, upstream process and quality control in pilot scale has been received. In 2008, Bio Farma started the preliminary development of the upstream process for seasonal influenza vaccine, and by April 2009 had produced three batches of seasonal bulk antigen derived from A/Solomon Islands/3/2006 IVR-145 seed strain at 1 000 egg scale. A Technical

Collaboration and License Agreement was signed between Bio Farma and Biken Institute Dasatinib in vitro of Japan in December 2009 for the transfer of influenza vaccine upstream production process. This was implemented through the training of Bio Farma staff at the Biken campus and follow-up training in Indonesia (see Section 4 below). Technology transfer of concentrated bulk preparation comprises the upstream process technology and quality control of seasonal influenza vaccine, i.e. seed preparation and virus cultivation up to the inactivation processes. In July 2009, following the onset of the A(H1N1) influenza pandemic, Bio Farma switched its attention to the development of a vaccine against this novel strain and by November 2010 a total of 20 lots had been

produced (Table 1). Of the latest nine batches of A(H1N1) derived from A/California/7/2009 (H1N1)v-like NYMC 179A, the first three were used to familiarize Bio Farma operators with the process. Thanks to this experience and hands-on guidance from Biken experts, the next batches showed increasing consistency (Table 2), and it is expected that by early 2011, three consecutive and consistent batches will have been produced to be formulated as monovalent already pandemic ready-filled bulk. Within its overall influenza pandemic preparedness plan, the Indonesian Ministry of Health decided to set up a manufacturing facility for egg-based influenza vaccines against wild-type influenza virus strains. The project comprises the whole manufacturing process including bulk antigen production, formulation, filling, laboratory quality control facilities, as well as an independent chicken farm to produce embryonated eggs. Significant progress had made in the physical execution of the BSL3+ building within the Bio Farma complex in Bandung.

Although brucella endocarditis is an uncommon complication, it remains the main cause of brucellosis-related mortality. Here we report the clinical and transesophageal echocardiographic findings of an interesting case with brucella endocarditis of an aortic root pseudoaneurysm following Bentall operation. Case A 40-year-old veterinarian with bicuspid aortic valve developed type A aortic root dissection following hypertensive crisis and underwent Bentall operation a year Inhibitors,research,lifescience,medical ago. His past medical history was positive for an episode of treated brucellosis. Four months after the operation, he complained of fever, malaise, arthralgia of the left hip joint, anorexia and weight loss.

The erythrocyte sedimentation rate was 103, Wright = 1/1280 and 2-mercaptoethanol (2ME) = 1/320. Combination antibiotic therapy with rifampin 900 mg/day per os (PO), doxycycline 200 mg/day PO and ciprofloxacin was started and continued for 6 months resulted in disappearance of his symptoms. Then after he was well untill about 14 days prior to his recent admission, when he again Inhibitors,research,lifescience,medical developed hip pain, fever, shortness of breath, profound fatigue and weakness. The erythrocyte sedimentation rate was elevated, his 2ME increased from 1/320 to 1/640. Because of recurrence of brucella symptoms, a transthoracic

echocardiogram was done which showed a competent non-stenotic prosthetic Inhibitors,research,lifescience,medical aortic valve with no vegetation. The mitral and tricuspid valves were normal; however, there was question of vegetations attached to the inner surface of the Dacron wall. BACTEC blood cultures × 5 were obtained and he was empirically started on multiple antibiotics

Inhibitors,research,lifescience,medical including doxycycline. At this time the patient was transferred to our university hospital. His chest X-ray showed mild cardiomegaly and blunting of right costophrenic angle. Sinus tachycardia, left anterior hemiblock and non-specific ST-T wave changes in lateral leads were found in Inhibitors,research,lifescience,medical his initial electrocardiogram. An emergency transesophageal echocardiogram and color Doppler mapping revealed the Protease Inhibitor Library manufacturer detachment of valve-conduit from the through annulus and the mitral-aortic intervalvular fibrosa and a large aortic pseudoaneurysm with multiple sessile and mobile vegetations attached to its Dacron walls (Fig. 1 and ​and2,2, Supplementary movie 1). Fig. 1 Transesophageal echocardiographic findings of the left ventricular outflow tract and the ascending aorta. A: Mid-esophageal long axis view revealing the detachment of the aortic valve-conduit from the annulus and the mitral-aortic intervalvular fibrosa … Fig. 2 Long axis views of the ascending aorta showing the compression of the aortic Dacron graft as the blood enters the pseudoaneurysm. Multiple vegetations are visible too. C: compression, PA: pseudoaneurysm, V: vegetations. The prosthetic aortic valve appeared to have normal motion and to be free of any vegetation.

Malignant transformation of primary or substitutional bladder epithelium is relatively rare, with an approximate risk of 1.2% in patients treated with augmentation cystoplasty.1

Malignant tumors may develop over long periods, usually more than 10 years, in augmented Modulators bladders.1 However, these malignant tumors are frequently aggressive and cause the death in nearly 50% of patients.2 Bladder tumors after augmentation cystoplasty are generally adenocarcinoma most commonly located in the region of enterovesical PD0325901 nmr anastomosis,5 in which urothelial cells at the site of the anastomosis may be susceptible to intestinal metaplasia. Previous reports have shown that urothelial cells at the enterovesical junction acquire characteristic of the enteric epithelium in an experimental canine model of augmentation cystoplasty.6 Furthermore, a variety of gene aberrations have been found in the region of enterovesical anastomosis in patients treated with ileocystoplasty, such as chromosomal numerical abnormalities in chromosomes 18, 9, and

8,7 and p53 mutations. 8 These findings suggest that multiple factors JAK inhibitor are involved in the bladder carcinogenesis after cystoplasty. Intestinal carcinogenesis is known to be a multistep process called adenoma-carcinoma sequence, progressing from adenoma to adenocarcinoma, involving various oncogenic factors.4 Our case newly demonstrated adenoma-carcinoma sequence histopathologically in the bladder after augmentation cystoplasty. Our findings suggest that multistep carcinogenesis develops in the region of enterovesical anastomosis after cystoplasty as the intestinal carcinogenesis. Late diagnosis of the diseases at an advanced stage accounts for the poor prognosis of patients with malignancies after cystoplasty.2 In our case, the malignancy was fortunately

discovered at the stage of tubulovillous adenoma, and a good prognosis was achieved. Our experience in the current case suggests that detection at the early stage of carcinogenesis improves patient prognosis in malignancies after augmentation cystoplasty. Carcinogenesis in the bladder after augmentation cystoplasty may be a multistep process, progressing adenoma to adenocarcinoma, and detection at the early stage of carcinogenesis would be important Bay 11-7085 for patient prognosis. The authors of this article have no conflict of interest. “
“Initially thought to be a malignancy affecting the pediatric and young adult population, recent studies have identified Xp11 translocation renal cell carcinoma (TRCC) in older adults. Incidence ranges from 0.95% to 5% of all adult renal cell carcinomas (RCCs).1 Considering that RCC is more prevalent in adults than children, Xp11 TRCC in adults represents a greater number of tumors as a whole than Xp11 TRCC in children. Compared with its more indolent presentation in the pediatric population, older adults usually present with advanced stage and distant metastasis.

45 The men in this study were also found to internalize and deny their grief, or attempt to distract themselves rather than speaking about their loss.47 Johnsson and Puddifoot51 had slightly different findings: they evaluated an all-male cohort and showed that grief responses were at a similar level to those of women after miscarriage. In general, these findings support the idea that fathers also experience grief after perinatal loss, but it is assumed that reactions are generally less intense. Coping mechanisms differ from those of women, it is thought that these differences in grieving may often contribute to misunderstanding Inhibitors,research,lifescience,medical and conflicts

in the relationship. It would certainly seem that one of the greatest

challenges in these situations Inhibitors,research,lifescience,medical would be to provide support for a partner whilst trying to cope with grief. In summary, it has been shown that the greatest risk to a relationship is presented by unequal or noncongruent grieving processes between partners.52,53 Clinical implications after perinatal loss Although it is widely recognized that perinatal loss can lead to psychiatric disorders and CG, only a small number of the women who have experienced miscarriage receive routine follow-up psychological support.54 As interventions Inhibitors,research,lifescience,medical typically aim to alleviate depressive symptoms, there seems to be little on offer for the prevention of development of CG.55 If intervention is offered, it generally begins early,

often immediately after the loss when the patient is still under hospital observation. Normally, psychological aftercare will involve programs of counseling, whilst manualized interventions are rare and are seldom based on evaluated Inhibitors,research,lifescience,medical intervention programs. The current literature highlights a number of methodical challenges to this system. Reviews and meta-analyses of general bereavement interventions have shown that although effectiveness Inhibitors,research,lifescience,medical of bereavement interventions is often assumed, empirical evidence yields inconclusive results. It has even been claimed by some reviewers that there is no strong evidence that these interventions are at all effective.56,57 Although bereavement interventions appear to be effective if aimed high-risk groups Non-specific serine/threonine protein kinase or at those whose grieving process has Ceritinib supplier already complicated,57-59 interventions aimed solely at preventing grief seem to have inconsistent support.60 Only a few randomized controlled studies have been carried out for women after prenatal loss, and most of these have been limited by being aimed at outcomes of depression and psychiatric disorder rather than grief itself.61-63 One exception to this was an intervention to prevent grief after perinatal loss specifically aimed at women following a stillbirth. This program began before hospital discharge and continued over a period of 4 to 6 months.