bluuebunny/crossref_metadata_2025 huggingface dataset:
Are Transition Countries Overbanked? The Effect of Institutions on Bank Market Entry
Authors: Hainz Christa
Published: May 2004

The popular notion that transition countries are overbanked is challenged in this paper. We study the decision for market entry and the optimal number of banks in a Salop model. We show that the amount of collateral, which is necessary to solve the moral hazard problem of finance, depends on the distance between bank and firm as well as the quality of the institutional environment. We analyze how the number of banks decreases as the institutional environment improves. Moreover, we find that market entry is insufficient because new entrants do not consider thoroughly the positive effects of their entry decision on social welfare.
The Pro‐Life Argument from Substantial Identity: A Defence
Authors: Lee Patrick
Published: May 2004

This article defends the following argument: what makes you and I valuable so that it is wrong to kill us now is what we are (essentially). But we are essentially physical organisms, who, embryology reveals, came to be at conception/fertilisation. I reply to the objection to this argument (as found in Dean Stretton, Judith Thomson, and Jeffrey Reiman), which holds that we came to be at one time, but became valuable as a subject of rights only some time later, in virtue of an acquired characteristic. I argue against this position that the difference between a basic, natural capacity and some degree of development of such a capacity is a mere difference in degree, that this position logically implies the denial of equal personal dignity, and that the selection of the required degree of development of a capacity is necessarily arbitrary.
Essential Properties and the Right to Life: A Response to Lee
Authors: Stretton Dean
Published: May 2004

In ‘The Pro‐Life Argument from Substantial Identity: A Defence’, Patrick Lee argues that the right to life is an essential property of those that possess it. On his view, the right arises from one's ‘basic’ or ‘natural’ capacity for higher mental functions: since human organisms have this capacity essentially, they have a right to life essentially. Lee criticises an alternative view, on which the right to life arises from one's ‘developed’ capacity for higher mental functions (or development of some other accidental property). I argue that his criticisms of this alternative view are misguided or self‐defeating, and that there are good reasons to hold we have a right to life accidentally rather than essentially.
Aging, Public Budgets, and the Need for Policy Reform
Authors: Elmeskov Jørgen
Published: May 2004

Projections show that, without policy changes, population aging will lead to unsustainable developments in public budgets. Various policy options to address this challenge are reviewed. Particular emphasis is given to the incentives to retire early and the programs that generate these incentives. The requirements for labor markets to absorb an added supply of older workers are discussed.
Reform of European Merger Policy
Authors: Lyons Bruce R.
Published: May 2004

The paper highlights the main drivers for merger policy reform in the European Union, including the consequences of the recent appeal court reverses. It discusses some of the substantive and procedural issues that the reform package should address, and outlines the reforms in progress. The author concludes that much of the reform package will be beneficial, but some important opportunities have been missed in this inevitably patchwork process.
The Changing Finnish Democracy: Stronger Parliamentary Accountability, Coalescing Political Parties and Weaker External Constraints
Authors: Raunio Tapio
Published: May 2004

Examining constitutional and political developments since the Second World War, this article shows that Finland has moved from a system dominated by the president toward a normal parliamentary democracy. Government formation is now based on partisan negotiations and the president is almost completely excluded from the policy process in domestic matters. The chain of delegation from the voters to the civil servants is thus now simpler than before and subject to fewer external constraints. In fact, Finland is probably the only West European country where parliamentary democracy has become less constrained since the 1980s. Leadership by presidents has effectively been replaced with leadership by strong majority governments, which have ruled, without much effective opposition, since the early 1980s. The stronger role of parties in shaping public policy stands in contrast to the weakening of the parties among the electorate. The ability of political parties to effectively align preferences is increasingly in doubt, as indicated by the transforming cleavage structure, lower turnout and declining party membership.
Iceland: Searching for Democracy along Three Dimensions of Citizen Control
Authors: Kristjánsson Svanur
Published: May 2004

This article scrutinises delegation and accountability in Iceland. In a healthy democracy, the representatives serve the wishes and interests of the main principal, the people. In an ailing democracy, the agents of the people primarily serve themselves.

The main conclusions are as follows. First, the semi‐presidential constitutional framework places the voters in a central role. They vote in two systems, electing MPs in the parliamentary system and the president by a national vote. The open primary, adopted by the main political parties, gives the voters the opportunity to participate in the selection of candidates in parliamentary elections. The central role of the voters is, however, often made difficult by the fluctuation and complexity of this dual system of representation. Second, citizen control through party organisations and party membership has all but disappeared. Instead, political parties cater to the fickle electorate and produce government policy aiming at economic stability and economic growth. Third, external constraints – the political presidency, judicial activism and Iceland's membership of the European Economic Area – all weigh in and sometimes override decisions reached by the parliamentary system of government.

The final conclusion is that the Icelandic system of governance has become a rather messy and complicated political arrangement, thereby resembling the situation in other modern democracies.
Sweden: Democratic Reforms and Partisan Decline in an Emerging Separation‐of‐Powers System1
Authors: Bergman Torbjörn
Published: May 2004

Early in the twentieth century, parliamentary democracy developed within an 1809 constitution based on separation of powers. By the mid‐1970s, the last remnants of this constitution had disappeared. After that, measures such as more openness in candidate nominations, positive preference voting and more scrutiny by parliamentarians were introduced to strengthen the democratic chain. But a weakening of political parties and an increased importance of external constraints are again moving Sweden towards ade factoseparation‐of‐powers system. There is once again a considerable discrepancy between the written constitutional framework and the ‘working constitution’. In particular, local and supranational constraints on national policy making provide reason for a reconsideration of the constitutional framework.
A Single EU Seat in the IMF?
Authors: Smaghi Lorenzo Bini
Published: May 2004

This article examines the rationale for consolidating EU Member States' position in the International Monetary Fund (IMF). Although a substantial amount of co‐ordination already takes place, particularly on issues related to the euro area and the single monetary and exchange rate policy, co‐operation between EU countries in the IMF remains a relatively new phenomenon and divergences still prevail. The current institutional set‐up, whereby the 15 EU countries are spread in nine constituencies, undermines effectiveness. Al though there is scope for further improving co‐operation, there are natural limits to what can be achieved within the existing co‐operation frame work. A single EU constituency would enable EU Member States to have a strong impact on IMF policies, potentially as strong as that of the US. However, this may not be an objective for all EU countries in the current conjuncture.
Negotiating Transparency: The Role of Institutions
Authors: Bjurulf Bo , Elgström Ole
Published: May 2004

On 30 May 2001, a new regulation on public access to EU documents was presented and was heralded in the European press as a breakthrough for transparency. We argue that a focus on institutions can cast light on the negotiation processes that led to this decision, and explain the final–for realist negotiation theory puzzling–outcome. We demonstrate the importance of institutions in EU negotiations by detailing actor interests and strategies in the transparency case, and by tracing and analysing the negotiation process that resulted in the regulation. The institutions that receive particular attention are: agenda‐shaping rules, decision‐making procedures and voting rules, informal norms, time tables and deadlines, and intervention by institutional actors.
Eastern European Attitudes to Integration with Western Europe
Authors: Caplanova Anetta , Orviska Marta , Hudson John
Published: May 2004

This article examines attitudes to membership of the EU and Nato amongst countries in central and eastern Europe. Sample survey data are obtained from the Eurobarometer surveys of transition and EU candidate countries. The empirical results suggest that support for membership increases with socio‐economic variables such as in come and education, reflecting self‐interest. But attitudinal variables are also important and, in particular, confidence in the free market economy impacts positively on support for membership. Support for EU membership is not a mirror image of that for Nato, with the differences appearing to revolve around self‐interest.
Accounting, Auditing and Corporate Governance of European Listed Countries: EU Policy Developments Before and After Enron
Authors: Dewing Ian P. , Russell Peter O.
Published: May 2004

This article provides an overview of EU policy developments in accounting, auditing and corporate governance before and after the collapse of Enron. For EU policy‐makers the article identifies areas for both encouragement and concern. It concludes that considerable progress has been made towards the harmonization of accounting, auditing and corporate governance within the context of the Financial Services Action Plan. However, it can be argued that, to achieve this, the EU has given too much ground to US hegemony, whether by embracing US practice masquerading as international ‘best practice’, or being forced to accept US practice where the US chooses to act unilaterally.
Competition Policy in Central Eastern Europe in the Light of EU Accession
Authors: Hölscher Jens , Stephan Johannes
Published: May 2004

This study reviews the progress made in EU accession candidates on competition policy. The analysis shows that institution‐building and legislation are well under way and that anti‐trust practice is not too lax. Due to the diversity among the accession countries under review, the study finds that the strictly rule‐based frame work of the EU might not be the most favourable solution for some candidates: firstly, the small and open economies of most candidates make it particularly difficult to define the ‘relevant market’ in competition cases. Secondly, the traditionally intense vertical integration of production in accession states calls for a reassessment of ‘vertical restraints’. The policy implications of this study suggest that the EU competition task force should take a proactive, case‐by‐case approachvis‐à‐visits new members.
Europeanization of Central Government Administration in the Nordic States
Authors: Lægreid Per , Steinthorsson Runolfur Smari , Thorhallsson Baldur
Published: May 2004

This article examines the Europeanization of public administration in the Nordic countries, and explores the changes in central administration due to EU and European Economic Area (EEA)membership. The focus is on Sweden and Finland, which have recently joined the European Union, and Norway and Iceland, whose participation in European integration is based on the EEA agreement. The database is a survey conducted in all ministerial departments and directorates in the Nordic countries. There are significant differences in the adaptation patterns between EU members and EEA members, but also important differences between countries with the same form of affiliation to the EU. The adaptation pattern of the EEA member ship of Norway and Iceland seems to follow a somewhat different path. To understand this, we have to add structural factors such as the size of the public administration. The institutional context of the domestic administrative tradition and strategy also has to be taken into account.
Is the European Union in Need of a Competence Catalogue? Insights from Comparative Federalism
Authors: Swenden Wilfried
Published: May 2004

This article assesses the value of a detailed and rigid catalogue of competencies for curbing the process of European centralization and increasing the overall legitimacy of the EU. The article first details the reasons, and the actors who put the search for a catalogue of competencies on to the European agenda. Drawing from comparative federalism, it then lists five arguments why a detailed and rigid competence catalogue is neither feasible nor desirable. Finally, alternatives are provided leading to competence delimitation by other means. The main arguments are illustrated with reference to the European Convention's draft Constitutional Treaty.
The Incidental Fortress: The Single European Market and World Trade
Authors: Young Alasdair R.
Published: May 2004

The European Union's role in international trade contains two significant contradictions: first, although its trade policy, with some notable exceptions, is generally fairly liberal, it has been the respondent in a number of high‐profile trade disputes; second, al though a champion of multilateralism, the EU has had problems complying with World Trade Organization (WTO) judgments. I argue that these contradictions in the EU's trading persona are due to the internal dynamics of European policy‐making, which create ‘regulatory peaks’ where the member governments' rules diverge, and render the resulting rules difficult to alter.
Normative Dynamics and Strategic Interests in the EU's External Identity
Authors: Youngs Richard
Published: May 2004

Focus on the ideational dimensions of the EU's international presence has unduly diverted attention away from the persistence of power politics instrumentalism. De spite general recognition that these elements co‐exist, analysis of EU external policies can benefit from a more precise exploration of how strategic calculation invests a broadly normative agenda with notable characteristics. The article demonstrates this in relation to the promotion of human rights. This sheds light on the way in which security concerns and normative values inform each other, and cautions against neglect of the strategic specificities to identity‐representation dynamics.
How much is enough and who says so?
Authors: Kelleher Con J. , Pleil Andreas M. , Reese Pat Ray , Burgess Somali Misra , Brodish Paul H.
Published: May 2004

Background  One of the challenges of health‐related quality of life research is to translate statistically significant health‐related quality of life changes into interpretable clinical or medically important ones.

Objective  To calculate the minimal important difference of the King's Health Questionnaire, a condition‐specific health‐related quality of life questionnaire for the assessment of men and women with lower urinary tract dysfunction.

Methods  The King's Health Questionnaire was administered to patients suffering from overactive bladder enrolled in two multinational studies. Minimal important differences were calculated using an anchor‐based approach with both a global rating of patient‐perceived treatment benefit and one of perceived disease impact. A distribution‐based method using effect size was calculated for comparison purposes.

Results  Minimal important difference values varied slightly with each method. Using the anchor‐based approach, the King's Health Questionnaire minimal important difference ranged between 5–10 points when the calculation factored out patients who reported no change and 6–12 points for patients who experienced a small improvement. The effect size method indicated a minimal important difference of 5 to 6 points for a small effect and 10 to 15 points for a medium effect.

Conclusions  In the case of the King's Health Questionnaire, the anchor‐based approaches and the distribution‐based approach provide similar results. A change from baseline of at least 5 points on King's Health Questionnaire domains indicates a change that is meaningful to patients and is indicative of a clinically meaningful improvement in health‐related quality of life after treatment. Convergence of the estimates using different approaches should give us confidence in the values derived for the quality of life domains measured by the King's Health Questionnaire.
Soy, fat and other dietary factors in relation to premenstrual symptoms in Japanese women
Authors: Nagata Chisato , Hirokawa Kumi , Shimizu Natsuki , Shimizu Hiroyuki
Published: May 2004

Objective  To evaluate the relations of intakes of soy, fat and other dietary components to premenstrual symptoms.

Design  Cross sectional study.

Setting  Three colleges and two nursing schools.

Population  One hundred and eighty‐nine Japanese women aged 19 to 34 years.

Methods  Intakes of nutrients and foods, including soy products and isoflavones, were estimated by a semiquantitative food frequency questionnaire. Change in menstrual cycle symptoms were assessed by the Moos Menstrual Distress Questionnaire (MDQ).

Main outcome measures  Spearman rank correlation of soy and other dietary factors with changes in MDQ scores between the follicular and the premenstrual phases after controlling for age, marital status, exercise, smoking status, age at menarche and number of days of bleeding.

Results  Neither soy product nor isoflavone intake was significantly associated with change in MDQ score in the premenstrual phase. Intakes of total, saturated and monounsaturated fats were significantly correlated with change in scores for total MDQ and subscale ‘pain’ in the premenstrual phase after controlling for the covariates. Intake of cereals/potatoes/starches was significantly inversely correlated with a change in total MDQ score in the premenstrual phase.

Conclusions  High intake of fats and low intake of foods with high concentration of carbohydrate may be associated with premenstrual symptoms.
A pilot study for a randomised controlled trial of waterbirth versus land birth
Authors: Woodward Joanne , Kelly Susan M.
Published: May 2004

Objectives  To assess the feasibility of undertaking an adequately powered multicentre study comparing waterbirth with land birth. To assess whether women are willing to participate in such a trial and whether participation has a negative effect on their birthing experience.

Design  A randomised controlled trial (RCT) with ‘preference arm’.

Setting  District general hospital with 3600 deliveries annually.

Population  Women with no pregnancy complications and no anticipated problems for labour/delivery.

Methods  Women were recruited and randomised between 36 and 40 weeks of gestation. Comparison of randomised and ‘preference arm’ to assess any impact of randomisation on women's birthing experience.

Main outcome measures  Data were collected at delivery concerning the labour, the pool water and baby's condition at birth and six weeks of age. The main outcome measures are means and standard deviation of cord O2, CO2, haemoglobin, haematocrit and base excess; medians and ranges of time to first breathe and cord pH; bacterial growth from pool water samples and neonatal swabs; and maternal satisfaction.

Results  Eighty women participated—60 women were randomised. Twenty women participated in a non‐randomised ‘preference arm’. The babies randomised to a waterbirth demonstrated a significantly lower umbilical artery pCO2 (P= 0.003); however, it is recognised that this study is underpowered. Women were willing to participate and randomisation did not appear to alter satisfaction.

Conclusion  This small study has shown that a RCT is feasible and demonstrated outcome measures, which can be successfully collected in an average delivery suite.
Deterioration in cord blood gas status during the second stage of labour is more rapid in the second twin than in the first twin
Authors: Leung Tak‐Yeung , Lok Ingrid Hung , Tam Wing‐Hung , Leung Tse‐Ngong , Lau Tze‐Kin
Published: May 2004

Objective  To compare in twin pregnancy the rate of deterioration in umbilical blood gas status during the second stage of labour, and to investigate whether the duration of the first twin's delivery has any effect on the blood gas status of the second twin.

Design  A retrospective study.

Setting  Department of Obstetrics and Gynaecology in a university teaching hospital.

Population  Twin pregnancies with both of the twins delivered by normal cephalic vaginal mode, at or beyond 34 weeks of gestation, over a period of seven years. Twins with any maternal or fetal complications including discordant growth, intrauterine growth restriction, intrauterine death, fetal malformations, fetal distress, pre‐eclampsia and diabetes were excluded.

Methods  The first twins' second stage was defined as from the start of maternal pushing to his/her delivery, while the second twins' second stage started after the delivery of the first twin and ended by his/her delivery. The total duration of the second stage was the sum of the above two intervals. The correlations between the first twins' umbilical cord blood gas parameters and the duration of their own second stage, the second twins' umbilical cord blood gas parameters and the duration of their own second stage, as well as that of the total second stage, were studied.

Main outcome measures  The changes of umbilical arterial pH of each twin with the duration of the corresponding second stage of labour, and the difference among them.

Results  A total of 51 cases were reviewed. The median gestation at delivery was 37 weeks. The median duration of first twins' second stage was 10 minutes (range 1–75) while that of the second twins' was 10 minutes (range 3–26). The first twins' second stage was inversely correlated with their arterial pH, venous pH and base excess [BE] (P < 0.01). Both the second twins' second stage and the total second stage were inversely correlated with both of their arterial and venous pH and BE (P < 0.01). However, further multiple regression analysis suggested that the correlation of the total second stage with the second twins' cord blood parameters could be solely explained by their own second stage. The rate of reduction in the second twins' arterial pH was 4.95 × 10−3 per minute, and was significantly faster than that of the first twins', which was 1.55 × 10−3 per minute (P < 0.05).

Conclusions  During normal vaginal delivery, the umbilical cord blood gas status of both the first and the second twins deteriorated with the duration of their corresponding second stages, but the effects are greater in the latter. Furthermore, the duration of the first twins' second stage does not affect the blood gas status of the second twins'. These observations support the postulation of a diminished uteroplacental exchange function after the delivery of the first twin. Close monitoring and expeditious delivery of the second twins are important.
Ultrasonographic occiput position in early labour in the prediction of caesarean section
Authors: Akmal Serap , Kametas Nikos , Tsoi Elly , Howard Richard , Nicolaides Kypros H.
Published: May 2004

Objective  To investigate the value of ultrasonographically determined occiput position in the early stages of the active phase of labour, in addition to traditional maternal, fetal and labour‐related characteristics, in the prediction of the likelihood of caesarean section.

Design  Prospective observational study.

Setting  District general hospital in the UK.

Population  Six hundred and one singleton pregnancies with cephalic presentation in active labour at term with cervical dilatation of 3–5 cm.

Methods  Transabdominal sonography to determine fetal occiput position was carried out by an appropriately trained sonographer immediately before or after the routine clinical examination by the attending midwife or obstetrician.

Main outcome measure  Caesarean section.

Results  Delivery was vaginal in 514 (86%) cases and by caesarean section in 87 (14%). The fetal occiput position was posterior in 209 (35%) cases and in this group the incidence of caesarean section was 19% (40 cases), compared with 11% (47 of 392) in the non‐occiput posterior group. Multiple regression analysis revealed that significant independent contribution in the prediction of caesarean section was provided by maternal age (OR 1.1, 95% CI 1.0–1.2), Afro‐Caribbean origin (OR 2.4, 95% CI 1.2–4.6), height (OR 0.93, 95% CI 0.89–0.97), parity (OR 0.2, 95% CI 0.1–0.4), type of labour (OR 2.2, 95% CI 1.3–3.8), gestation (OR 1.4, 95% CI 1.1–1.7), fetal head descent (OR 0.6, 95% CI 0.4–0.9), occiput posterior position (OR 2.2, 95% CI 1.3–3.7) and male gender (OR 2.0, 95% CI 1.2–3.5).

Conclusions  The risk of caesarean section can be estimated during the early stage of active labour by the sonographically determined occiput position, in addition to traditional maternal, fetal and labour‐related characteristics.
The effectiveness of GnRHa with and without ‘add‐back’ therapy in treating premenstrual syndrome: a meta analysis
Authors: Wyatt Katrina M. , Dimmock Paul W. , Ismail Khaled M.K. , Jones Peter W. , O'Brien P.M. Shaughn
Published: May 2004

Objective  To determine the effectiveness of gonadotrophin‐releasing hormone analogues (GnRHa) with and without hormonal add‐back therapy in the management of premenstrual syndrome.

Design  Randomised controlled trials were identified by searching multiple databases.

Setting  Exeter and North Devon Research and Development Support Unit and Keele University Academic Unit of Obstetrics and Gynaecology.

Population  Women with pre‐diagnosed premenstrual syndrome and/or premenstrual dysphoric disorder.

Methods  A meta‐analysis of published randomised placebo‐controlled trials assessing the use of GnRHa in the management of premenstrual syndrome. The standardised mean difference for each individual study and subsequently an overall standardised mean difference were calculated after demonstrating the consistency or homogeneity of the study results.

Main outcome measures  Overall improvement in premenstrual symptomatology and effectiveness of GnRHa with additional hormonal add‐back therapy were the main outcome measures assessed in this analysis. A secondary analysis was performed to assess the effectiveness of GnRHa in treating physical and emotional symptoms.

Results  Overall standardised mean difference for all trials that assessed the efficacy of GnRHa was −1.19 (95% confidence interval [CI] −1.88 to −0.51). The equivalent odds ratio was 8.66 (95% CI 2.52 to 30.26) in favour of GnRHa. GnRHa were more efficacious for physical than behavioural symptoms, although the difference was not statistically significant. The addition of hormonal add‐back therapy to GnRHa did not appear to reduce the efficacy of GnRHa alone; standardised mean difference 0.12 (95% CI −0.35 to 0.58).

Conclusions  GnRHa appear to be an effective treatment in the management of premenstrual syndrome. The addition of hormonal add‐back therapy to reduce side effects does not reduce efficacy.
Blood pressure and urinalysis are often omitted in women who have suffered pre‐eclampsia at their six‐week postnatal check
Authors: Samwiil Lisa , Mercer Cath , Jarrett Patricia , O'Malley Sheila ,   For the Genetics of Pre‐eclampsia Collaborative Study (GOPEC) Research Midwives
Published: May 2004

Women with pregnancies complicated by pre‐eclampsia were visited between six weeks and three months postpartum and were asked to recall if they had their blood pressure and urine tested at their six‐week postnatal check. Of 257 audit participants across 21 maternity units in the United Kingdom over the period 1st June 2001 to 31st May 2002, 93% (n= 238) recalled having had their blood pressure taken and 28% (n equals; 73) recalled having had their urine tested. A significant proportion of women were not being screened for unresolved pre‐eclampsia at their six‐week routine postnatal examination.
Overactive bladder: prevalence, risk factors and relation to stress incontinence in middle‐aged women
Authors: Teleman Pia M. , Lidfeldt Jonas , Nerbrand Christina , Samsioe Göran , Mattiasson Anders ,   the WHILA study group
Published: May 2004

Objective  To investigate the prevalence of and factors associated with overactive bladder in middle‐aged women.

Design  Cross sectional population‐based study.

Setting  Southern Sweden and the Women's Health in the Lund Area study (WHILA 1995–2000) where 6917 (64% of the invited) women, 50–59 years old in 1995, participated.

Population  From the WHILA study, 1500 women reporting troublesome urinary incontinence (INCONT‐1) and 1500 without incontinence (CONT‐1) were selected by computerised randomisation and received the Bristol Female Lower Urinary Tract Symptoms (BFLUTS) questionnaire in January 2001.

Methods  Overactive bladder was defined in two versions using the ICS definition of 2002 as either urgency alone (OAB‐1) or urgency combined with frequency more than eight times per day and/or nocturia twice or more per night (OAB‐2). Risk factors were analysed by multiple logistic regression analyses.

Main outcome measures  Prevalence figures and odds ratios with corresponding 95% confidence intervals.

Results  The prevalence of OAB‐1 was 46.9% in the INCONT‐1 and 16.7% in the CONT‐1 group, and that of OAB‐2 was 21.6% and 8.1%, respectively. Most urgency occurred in combination with stress incontinence (i.e. as mixed incontinence). The overlap between stress and urge symptoms increased with the frequency of stress incontinence episodes (P < 0.001). Metabolic risk factors were body mass index (BMI) ≥ 30 for OAB‐1, OAB‐2 and stress incontinence, positive metabolic screening for OAB‐1, family history of diabetes for OAB‐2 and elevation of BMI ≥ 25% since the age of 25 for stress incontinence. Stress incontinence was associated with the current use of hormonal replacement therapy.

Conclusions  Overactive bladder and stress incontinence are intimately associated with each other. Both OAB and stress incontinence are associated with abnormal metabolic factors, mainly increased BMI.
Increased levels of gangliosides in the plasma and ascitic fluid of patients with advanced ovarian cancer
Authors: Santin Alessandro D. , Ravindranath Mepur H. , Bellone Stefania , Muthugounder Sakunthala , Palmieri Michela , O'Brien Timothy J. , Roman Juan , Cannon Martin J. , Pecorelli Sergio
Published: May 2004

Objectives  To assess the expression of total gangliosides in primary ovarian cancer cell lines, ascitic fluid and plasma of advanced ovarian cancer patients.

Design  A prospective study.

Setting  The Department of Obstetrics and Gynecology at the University of Arkansas for Medical Sciences and the Laboratory of Glycolipid Immunotherapy, John Wayne Cancer Institute.

Population  Twenty‐two women diagnosed with advanced ovarian cancer and seven normal female controls.

Methods  Total gangliosides shedding from primary ovarian cancer cell lines were measured by estimating lipid‐associated sialic acids (LASAs test) and compared with the ganglioside levels shed by primary cervical and uterine cancer cell lines. In addition, plasma and ascitic samples from advanced ovarian cancer patients were collected at the time of surgery and analysed for the presence of total gangliosides.

Main outcome measures  Levels of total ganglioside in plasma and ascites fluid samples drawn from ovarian cancer patients, relative to total gangliosides levels in plasma from normal female controls.

Results  All primary ovarian tumours secreted high levels of total gangliosides (mean 4 mg/mL, range between 2.7 and 4.8 mg/mL/105 cells/24 h) when compared with primary cervical cancers (mean 1.4 mg/mL, range between 0.7 and 2.2 mg/mL/105 cells/24 h) (P < 0.008) and uterine carcinoma cell lines (mean 1.4 mg/mL, range between 1.3 and 1.6 mg/mL/105 cells/24 h) (P < .004). Elevated levels of total gangliosides were detected in the plasma [mean (SD) 31 (12) mg/mL, range between 18 and 57 mg/mL] (P < .001), and in the peritoneal fluid [mean (SD) 27 (9) mg/mL, range between 14 and 40 mg/mL] (P < .003) of ovarian cancer patients when compared with the levels detectable in the plasma samples of normal female controls tested [mean (SD) 15 (2) mg/mL, range between 12 and 18 mg/mL].

Conclusions  Increased serum levels of total gangliosides may reflect shedding or release of gangliosides from the surface of ovarian tumour cells. Secretion of gangliosides may play an important role in the inhibition of anti‐tumour immune function commonly observed in advanced ovarian cancer.
VEGF expression in the placenta from pregnancies complicated by hypertensive disorders
Authors: Sgambati Eleonora , Marini Mirca , Zappoli Thyrion Giorgia D. , Parretti Elena , Mello Giorgio , Orlando Claudio , Simi Lisa , Tricarico Carmela , Gheri Gherardo , Brizzi Enzo
Published: May 2004

Objective  To determine the expression of VEGF in the placental tissue from pregnancies complicated by hypertension disorders of different clinical severity.

Design  Prospective cohort study.

Setting  Polyclinic of Careggi, University of Florence, Italy.

Sample  Placentas from women with gestational hypertension (n= 20), pre‐eclampsia (n= 20) and pre‐eclampsia with HELLP syndrome (n= 20) and from normotensive women (n= 20), as control group (gestational age comprised between 35 and 38 weeks).

Methods  An immunohistochemical technique and a quantitative analysis to measure mRNA levels (RT‐PCR) were employed.

Main outcome measures  Intensity of immunoreactivity and mRNA levels in the placental components. Differences between the data.

Results  VEGF immunoreactivity was observable in all the placental components in the gestational hypertension cases as in the control ones. In the cases with pre‐eclampsia and pre‐eclampsia with HELLP syndrome, some placental components were not immunoreactive. However, the VEGF positive components of all the pathological groups showed a higher intensity of reactivity with respect to that of the control group. The levels of VEGF mRNA were higher in the gestational hypertension cases and lower in the cases of pre‐eclampsia with HELLP syndrome with respect to the control ones; in the cases of pre‐eclampsia, the levels were the same as the control ones.

Conclusion  The different expression of VEGF in the placenta of the pathological cases is probably related to haemodynamic changes that take place in these disorders, in order to attempt restoration of a normal uteroplacental flow.
Teenage antenatal clinics may reduce the rate of preterm birth: a prospective study
Authors: Quinlivan Julie A. , Evans Sharon F.
Published: May 2004

Objective  To examine whether teenage antenatal clinics reduce the incidence of preterm birth.

Design  A multicentre prospective study was performed.

Setting  Three Australian hospitals with maternity services.

Population  Consecutive teenage patients (N= 731) were approached at their first or second antenatal visit.

Methods  Cases were women attending multidisciplinary teenage antenatal clinics and controls attended general hospital‐based antenatal clinics. Teenage antenatal clinics involved multidisciplinary care and included guidelines to screen and treat all patients for infectious and social pathology. General antenatal clinic care was in accordance with Australian standards.

Main outcome measures  Preterm birth, newborn biometry adjusted for gestational age, breastfeeding and contraception plans at discharge.

Results  Consent was obtained from 651 (89%) patients. Teenage pregnancy clinic patients were significantly less likely to present with threatened preterm labour (OR 0.45; 95% CI 0.29–0.68), preterm, prelabour, prolonged rupture of membranes (OR 0.34; 95% CI 0.18–0.63) or deliver preterm (OR 0.40; 95% CI 0.25–0.62) compared with those from general clinics. However, there was no independent effect of clinic care upon newborn biometry outcomes. Clinic care did not significantly alter rates of initiation of breastfeeding in hospital. However, significantly more of the teenage antenatal clinic mothers were discharged on contraception (OR 1.58; 95% CI 1.07–2.25).

Conclusion  Teenage‐specific antenatal clinics may reduce the rate of preterm birth.
Perinatal HIV‐1 transmission among low income women participants in the HIV/AIDS Control Program in Southern Brazil: a cohort study
Authors: Kreitchmann Regis , Fuchs Sandra Costa , Suffert Theodoro , Preussler Gisele
Published: May 2004

Objective  To determine the rate and factors associated with perinatal transmission among women infected with HIV‐1.

Design  Cohort study.

Setting  Centro Municipal de Atendimento em DST/AIDS is a major reference centre for HIV treatment in Porto Alegre city, southern Brazil.

Population  Pregnant and puerperal women infected with HIV‐1.

Methods  Women were enrolled during pregnancy and seen monthly at the antenatal care centre. Those detected at delivery that presented at the centre within the first 10 days of postpartum were included. Maternal, obstetric and infant‐related characteristics were ascertained and testing for CD4 cell count, HIV PCR/RNA assay, anti‐HCV, HBSAg and syphilis were performed. Antiretrovirals and formula were provided free of charge following Brazilian guidelines.

Main outcome measure  HIV‐1 infection status in the infant.

Results  Perinatal transmission was assessed in 343 children (95% of the whole sample). Overall, the transmission rate was 3.2% (95% CI: 1.7–5.8%). Perinatal transmission rates increased with maternal viral load (≥10,000 copies/mL; RR: 11.27; 95% CI: 1.38–92.23). In multivariate analyses, the only independent risk factor for perinatal transmission was the maternal viral load at baseline (OR = 2.72 per log increase in the number of copies; 95% CI: 1.17–6.50).

Conclusion  Perinatal transmission rate was low among HIV‐1 infected women in clinical care and on antiretroviral therapy despite poor socio‐economic conditions. Viral load level was the only independent predictor of perinatal transmission. It is possible to prevent HIV‐1 perinatal transmission in a developing country if we provide antiretrovirals and formula.
Are women's expectations and preferences for intrapartum care affected by the model of care on offer?
Authors: Hundley Vanora , Ryan Mandy
Published: May 2004

Objective  To investigate the effect of service provision on consumer preferences, in particular, whether women who have access to systems of care which offer particular attributes (such as continuity of carer) value these attributes more highly than women for whom the attributes are not a realistic option.

Design  Simple rating scales and a discrete choice experiment were used to assess the importance to women of different aspects of intrapartum care.

Sample and setting  The sample consisted of 301 women at low obstetric risk, identified from three geographical areas, each with a different system of maternity care provision.

Methods  Midwives gave an anonymous, self‐complete questionnaire to the women at the booking visit. Categorical data from the rating scales were analysed using the χ2 test. Analysis of the discrete choice experiment was conducted using random effect probit regression.

Main outcome measures  Women's preference for different attributes of intrapartum care.

Results  From the rating scales, it appeared that women in the area with least continuity rated this aspect of care significantly lower than women in other areas (P= 0.007). Although the discrete choice experiment appeared to confirm this, the difference was not statistically significant.

Conclusions  The findings from this study suggest that the systems of care on offer do influence women's preferences for aspects of intrapartum care. Women in areas where continuity of carer was a realistic option appeared to value this aspect of care more highly. The tendency for preferences to be influenced not only by previous experience of a service but also by knowledge of its availability has important implications for the inclusion of consumers' values in deciding whether to introduce innovations in care. It has been suggested that greater consumer involvement may be a useful means of challenging the accepted view of what is important in health services and of facilitating change. However, the findings from this study suggest that consumer views may have the opposite effect. If consumers do prefer what they know, then a policy of tailoring health services to local preferences will simply reinforce current provision of services, reinforcing existing inequalities in the provision of care.
Outcome after a high number (4–10) of repeated caesarean sections
Authors: Juntunen Kaisa , Mäkäräinen Leo , Kirkinen Pertti
Published: May 2004

Objective  To evaluate outcomes in caesarean sections repeated several times.

Population  Sixty‐four women had had four or more (up to 10) caesarean sections.

Methods  The outcomes of these operations N= 149, study group) were compared with other caesarean sections.

Results  A quarter of the women in the study group complained of low abdominal pains during the late pregnancy. A thin or fenestrated isthmic myometrial layer was observed in 55% of their operations. Abnormal placentation with an increased risk of major operative complications occurred more often in the study group. No differences in post‐operative complications or perinatal outcome emerged between the groups.

Conclusion  Thus, no definitive upper limit for the number of caesarean sections per individual woman can be given.
Ovarian cancer detected non‐invasively by contrast‐enhanced power Doppler ultrasound
Authors: D'Arcy T.J. , Jayaram V. , Lynch M. , Soutter W.P. , Cosgrove D.O. , Harvey C.J. , Patel N.
Published: May 2004

Overall, about one‐third of women operated upon because of suspected ovarian cancer turn out to have benign disease. This proportion will be even higher when the tumours are small. A more accurate method of determining which are malignant would reduce the number of unnecessary referrals to the cancer centre and increase the scope for conservative management. This pilot study of ultrasound and intravenous microbubble contrast in 20 women with small ovarian tumours enabled the identification of all four malignant lesions with good inter‐observer agreement. These preliminary findings suggest that intravenous contrast improves the ultrasound identification of small ovarian malignancies and may provide an accurate way of selecting women who require to be referred urgently for surgery under the auspices of a gynaecological oncologist. The remainder might be considered for laparoscopic surgery or even for observation in some cases.
SURUSS in perspective
Authors: Wald N.J. , Rodeck C. , Hackshaw A.K. , Rudnicka A.
Published: May 2004

Background  Until the publication of the Serum Urine and Ultrasound Screening Study (SURUSS) report, it was difficult to compare the different antenatal screening tests for Down's Syndrome because of variations in study designs. We here present the main results from SURUSS, updated to take account of recent information on nuchal translucency in Down's Syndrome pregnancies, and discuss their implications.

Methods  SURUSS was a prospective study of 47,053 singleton pregnancies (including 101 pregnancies with Down's Syndrome) conducted in 25 maternity units. Nuchal translucency measurements were taken. Serum and urine samples collected between 9 and 13 weeks, and again between 14 and 20 weeks of pregnancy were stored. Samples from each affected pregnancy and five matched controls were tested for currently used or suggested biochemical Down's Syndrome screening markers. Pregnancies were followed up to determine the presence or absence of Down's Syndrome. For an 85% Down's Syndrome detection rate, the false‐positive rate for the Integrated test (nuchal translucency and pregnancy associated plasma protein‐A [PAPP‐A] at 11 completed weeks of pregnancy, and α‐fetoprotein, unconjugated oestriol [uE3], free β or total human chorionic gondaotrophin (hCG) and inhibin‐A in the early second trimester) was 0.9%, the Serum integrated test (without nuchal translucency) 2.7%, the Combined test (nuchal translucency with free β‐hCG and PAPP‐A at 11 weeks) 4.3%, the Quadruple test (α‐fetoprotein, uE3, free β or total hCG and inhibin‐A) 6.2%, and nuchal translucency at 11 weeks, 15.2%. All tests included maternal age. Using the Integrated test at an 85% detection rate, there would be six diagnostic procedure‐related unaffected fetal losses following amniocentesis per 100,000 women screened compared with 35 using the Combined test or 45 with the Quadruple test.

Conclusions  The Integrated test offers the most effective and safe method of screening for women who attend in the first trimester. The next best test is the Serum integrated test. The Quadruple test is the best test for women who first attend in the second trimester. There is no justification for retaining the Double (α‐fetoprotein and hCG) or Triple (α‐fetoprotein, uE3, and hCG) tests, or nuchal translucency alone (with or without maternal age) in antenatal screening for Down's Syndrome.
Sense of coherence is a sensitive measure for changes in subjects with Parkinson's disease during 1 year
Authors: Caap‐Ahlgren Marianne , Dehlin Ove
Published: May 2004

To investigate subjective and objective changes in function in subjects with Parkinson's disease (PD) home visits with interviews were performed with a 1‐year interval. Depressive symptoms were rated with the Geriatric Depression Scale, subjective health with the generic SF‐36 scale and the disease‐specific PDQ‐8 scale; objective changes were assessed according to the Hoehn and Yahr scale; insomnia was rated with an eight‐item questionnaire and the sense of coherence (SOC) was determined with the short version of that scale. A total of 91 subjects (39 women and 52 men with a mean age of 70 years) living at home, most of them moderately to severely disabled, were interviewed. Time since diagnosis was <2 years for 13%, 2–10 years for 55%, and >10 years for 32%. During the studied year the subjects‘ status declined significantly as shown by changes in both the PDQ‐8 and the Hoehn and Yahr scales. The most striking finding was a pronounced decrease in the SOC scale (p < 0.0001). This indicates that the subjects’ ability to handle stress‐related problems secondary to the progress of disease might have decreased. In order to optimize nursing care for subjects with PD, in addition to medical treatment, an assessment of the SOC could aid nursing staff in evaluating subjects’ ability to handle their life situation.