bluuebunny/crossref_metadata_2025 huggingface dataset:
Many NK cell receptors activate ERK2 and JNK1 to trigger microtubule organizing center and granule polarization and cytotoxicity
Authors: Chen Xi , Trivedi Prachi P. , Ge Baoxue , Krzewski Konrad , Strominger Jack L.
Published: March 2007

Natural killer (NK) cells are components of the innate immune system that recognize and kill tumor or virus-infected target cells through specific NK activating receptor/ligand interactions. Lymphocyte function-associated antigen (LFA)-1 and its ligand ICAM-1 are also required to initiate conjugation and actin cytoskeletal remodeling. The NK activating receptors, many of which are expressed on a single NK cell, signal the polarization of the microtubule organizing center (MTOC) together with cytolytic granules to the synapse with target cells. After ligation of any one of these receptors, Src family kinases initiate activation of two signal pathways, the phosphoinositide-3 kinase → ERK2 and the phospholipase Cγ → JNK1 pathways. Both are required for polarization of the MTOC and cytolytic granules, a prerequisite for killing the targets. Crosslinking of CD28, NKG2D, NKp30, NKp46, NKG2C/CD94, or 2B4 leads to the phosphorylation of both ERK2 and JNK1, although they use different proximal signaling modules. Thus, many, if not all, activating receptors stimulate these two distal pathways, independent of the proximal signaling module used. By contrast, CD2, DNAM-1, and β1-integrin crosslinking do not activate either pathway; they may be costimulatory molecules or have another function in the synapse.
Discovering transcriptional regulatory regions in
Drosophila
by a nonalignment method for phylogenetic footprinting
Authors: Sosinsky Alona , Honig Barry , Mann Richard S. , Califano Andrea
Published: March 2007

The functional annotation of the nonprotein-coding DNA of eukaryotic genomes is a problem of central importance. Phylogenetic footprinting methods, which attempt to identify functional regulatory regions by comparing orthologous genomic sequences of evolutionarily related species, have shown promising results. The main advantage of this class of approaches is that they do not require any knowledge of the regulating transcription factors. Here we describe a method called Enhancer Detection using only Genomic Information (EDGI), which integrates a traditional motif-discovery algorithm with a local permutation-clustering algorithm. Together, they can identify large regulatory elements (e.g., enhancers) as evolutionarily conserved order-independent clusters of short conserved motifs. We show that EDGI can distinguish between established sets of known enhancers and nonenhancers with 88% accuracy, rivaling predictions by methods that rely on the knowledge of the regulating transcription factors and their DNA-binding specificities. We tested EDGI's performance on a set of
Drosophila
genomes. Our results demonstrate that comparative genomic analysis of multiple closely related species has substantial power to identify key functional elements without additional biological knowledge.
Molecular basis of MAPK-activated protein kinase 2:p38 assembly
Authors: White Andre , Pargellis Christopher A. , Studts Joey M. , Werneburg Brian G. , Farmer Bennett T.
Published: March 2007

p38 MAPK and MAPK-activated protein kinase 2 (MK2) are key components of signaling pathways leading to many cellular responses, notably the proinflammatory cytokine production. The physical association of p38α isoform and MK2 is believed to be physiologically important for this signaling. We report the 2.7-Å resolution crystal structure of the unphosphorylated complex between p38α and MK2. These protein kinases bind “head-to-head,” present their respective active sites on approximately the same side of the heterodimer, and form extensive intermolecular interactions. Among these interactions, the MK2 Ile-366–Ala-390, which includes the bipartite nuclear localization signal, binds to the p38α-docking region. This binding supports the involvement of noncatalytic regions to the tight binding of the MK2:p38α binary assembly. The MK2 residues 345–365, containing the nuclear export signal, block access to the p38α active site. Some regulatory phosphorylation regions of both protein kinases engage in multiple interactions with one another in this complex. This structure gives new insights into the regulation of the protein kinases p38α and MK2, aids in the better understanding of their known cellular and biochemical studies, and provides a basis for understanding other regulatory protein–protein interactions involving signal transduction proteins.
Cervical phIGFBP‐1 in the evaluation of the risk of preterm delivery
Authors: MARIA PATERNOSTER DELIA , MURESAN DANA , VITULO ANNA , SERENA ANDREA , BATTAGLIARIN GIUSEPPE , DELL'AVANZO MARINELLA , NICOLINI UMBERTO
Published: March 2007

Background. To evaluate the accuracy of the decidual phosphorylated isoform of insulin‐like growth factor binding protein‐1 in endocervical secretions to predict premature delivery in symptomatic and asymptomatic pregnant women. Methods. The study included 332 pregnant women: 109 symptomatic patients (study group) and 223 asymptomatic women (control group). For all women, qualitative and quantitative assessment of the decidual phosphorylated isoform of insulin‐like growth factor binding protein‐1 in endocervical secretions was carried out, but the quantitative assay was finally performed in 282 of 332. Student's test, the φ2 test, and Fisher's exact test were used as appropriate. Results. The phosphorylated insulin‐like growth factor binding protein‐1 qualitative test was positive in 35 of 301 women (11.6%) and 11 (31.4%) of them delivered before 37 weeks; in the remaining 266 women with a negative test, there were 11 (4.7%) premature deliveries (relative risk=5.8; 95% CI=3.3–10.3). The mean values of quantitative phosphorylated isoform of insulin‐like growth factor binding protein‐1 were 56.9 µg/l (95% CI=40.7–73.1) in cases of a positive qualitative test and 6.1 µg/l (95% CI=4.0–8.3; p = 0.0001) in women with a negative result. The sensitivity, specificity, positive predictive value, and negative predictive value for phosphorylated isoform of insulin‐like growth factor binding protein‐1 test in symptomatic patients were 69.2%, 90.5%, 50%, and 95.6% respectively, while in the asymptomatic patients they were 22.2%, 91.8%, 11.8%, and 96% respectively. Conclusions. The phosphorylated isoform of insulin‐like growth factor binding protein‐1 in cervical secretions is a potential specific marker for preterm delivery occurring before 37 weeks. This test may have an important role in the management of women presenting with symptoms suggestive of preterm labour.
A survey of knowledge, attitude and practice of malaria management among pregnant women from two health care facilities in Nigeria
Authors: ENATO EHIJIE F. O. , OKHAMAFE AUGUSTINE O. , OKPERE EUGENE E.
Published: March 2007

Background. Malaria remains one of the most important causes of maternal and child morbidity and mortality in sub‐Saharan Africa, despite the availability of effective interventions. The objective of this study was to assess the knowledge, attitude and practice of malaria management among pregnant women attending antenatal clinics in Nigeria. Methods. A cross‐sectional study was undertaken on a sample of 867 pregnant women attending antenatal clinics in 2 health care facilities in Edo State, Nigeria, using a self‐administered questionnaire. Results. Of the respondents, 87% said that they had undergone at least 1 episode of malaria during their current pregnancy. Most respondents (89%) attributed malaria to bites from infected mosquitoes, while 75% consider malaria an important health risk during pregnancy. However, knowledge of the consequences of malaria during pregnancy was poor, especially the risk posed to the fetus. Overall, the mean knowledge score on a scale of ‘0–7’ was 3.5 (median 4.0). Respondents had poor belief in the effectiveness and use of insecticide‐treated bed nets and intermittent preventive therapy, in preventing malaria during pregnancy. Conclusions. This study has revealed that malaria is perceived as a common health problem among pregnant women attending these 2 health care facilities, and that knowledge, attitude and practice of its management is poor. Efforts should be made to improve anti‐malarial intervention during pregnancy, to ensure that the goals of the Roll Back Malaria Initiative are achieved in Nigeria.
Maternal smoking does not affect fetal size as measured in the mid‐second trimester
Authors: BERGSJØ PER , BAKKETEIG LEIV S. , LINDMARK GUNILLA
Published: March 2007

Background. Cigarette smoking during pregnancy is causally related to birthweight, but we do not know whether fetal growth restriction is a continuous process or, if not, at what stage of pregnancy it affects weight gain. Material and methods. A random sample of para 1 and 2 mothers, drawn from the population of pregnant women in Bergen and Trondheim, Norway, and Uppsala, Sweden, were examined by a detailed questionnaire concerning smoking habits, menstrual history and pregnancy dating, and subjected to morphometric sonography of their fetuses in or around week 17. Of the 547 study participants, 31.9% were smokers. Gestational age was primarily determined by the last menstrual period [LMP], except in those with irregular cycles, and in 30 cases (6.6% of those with regular cycles) in whom the biparietal diameter [BPD]‐determined age deviated >14 days from the LMP‐based date. Results. The analysis did not reveal any statistically significant differences between the fetuses of non‐smokers, light smokers (0–9 cigarettes per day) and heavy (10+ cigarettes per day) smokers, regarding BPD, mean abdominal diameter [MAD] femur length [FL], and a ‘body contour index’: [BPD+FL]÷MAD. Conclusion. Tobacco‐induced fetal growth restriction probably begins after gestational week 17.
Impact of subclinical chorioamnionitis on maternal and neonatal outcomes
Authors: MIYAZAKI KEN , FURUHASHI MADOKA , MATSUO KEITARO , MINAMI KOJIRO , YOSHIDA KANA , KUNO NAOHIKO , ISHIKAWA KAORU
Published: March 2007

Background. Chorioamnionitis is considered to be one of the main causes of preterm labor and has been associated with an adverse perinatal outcome in preterm infants. The controversy about the benefits/risks of delaying labor is a critical issue concerning the management of chorioamnionitis. Methods. The database between July 2001 and March 2006 was reviewed for women with singleton pregnancies between 22 and 28 weeks of gestation and with chorioamnionitis diagnosed on admission by amniotic fluid neutrophil elastase level. Women were classified according to the severity of chorioamnionitis (group A, amniotic fluid neutrophil elastase level of 0.15–1 µg/ml; B, 1–10 µg/ml; and C, ≥10 µg/ml). During expectant management, serum C‐reactive protein levels monitored the remission and aggravation of chorioamnionitis. Following deliveries, placentas were examined for histologic chorioamnionitis. Results. One hundred women were enrolled (group A, 38; B, 34; C, 28). The latency period until delivery was significantly longer in group A than in groups B and C. C‐reactive protein levels just before delivery were higher than those on admission in 61% of the overall cases. Histologic chorioamnionitis and funisitis were manifested in 90.4% and 65.5%, respectively. Intrauterine fetal demise (4 cases) and neonatal and postneonatal deaths during admission (10 cases) were observed. Bronchopulmonary dysplasia was the most common major morbidity noted in groups B and C. Conclusion. Chorioamnionitis could be controlled but is hard to cure. Higher levels of amniotic fluid neutrophil elastase are associated with a shorter interval from admission to delivery in women with subclinical chorioamnionitis.
Characterization of surgically transposed ovaries in integrated PET/CT scan in patients with cervical cancer
Authors: HOON CHUNG HYUN , JUN KANG WON , WEON KIM JAE , PARK NOH‐HYUN , SONG YONG‐SANG , CHUNG JUNE‐KEY , KANG SOON‐BEOM , LEE HYO‐PYO
Published: March 2007

Background. The purpose of this study was to determine the ovarian findings on integrated positron emission tomography/computed tomography scans during follow‐up in cervical cancer patients with ovarian transposition. Method. We retrospectively reviewed the clinical data and integrated 18F‐fluorodeoxyglucose positron emission tomography/computed tomography of women with ovarian transposition during radical hysterectomy for cervical cancer between December 2003 and March 2006. Results. Eighty‐four premenopausal women had ovarian transposition performed during the study period. Twelve positron emission tomography/computed tomography scans from 11 patients were registered for the current study and three women were diagnosed with metastasis: two in lung and one in pelvis. Two patients complained of menopausal symptoms during follow‐up, and the hormonal tests were consistent with it. In the current study, an integrated positron emission tomography/computed tomography scan detected one patient with right lower abdominal mass with increased 18F‐fluorodeoxyglucose uptake, which was identified as a transposed right ovary. Clinical information of ovarian transposition was helpful in interpretation of the lesion. In the patient, transposed ovary was associated with increased fluorodeoxyglucose uptake, with standard uptake values ranging from 3.7 to 5.5. Other positron emission tomography/computed tomography scans did not show abnormal uptake of 18F‐fluorodeoxyglucose. Conclusions. Transposed ovary in premenopausal women may appear on integrated positron emission tomography/computed tomography scan as a mass with increased 18F‐fluorodeoxyglucose uptake, which may be associated with preserved ovarian function. Clinical information regarding transposition should be noted in order not to interpret these as recurrent or metastatic lesions.
Accuracy of HPV testing of vaginal smear obtained with a novel self‐sampling device
Authors: STENVALL HARRIET , WIKSTRÖM INGRID , BACKLUND INGRID , WILANDER ERIK
Published: March 2007

Background. Most of women diagnosed as having cervical cancer have not participated in organized cytological screening. Aim. A study was conducted to evaluate the accuracy of human papilloma virus testing by self‐collected vaginal samples in comparison to regular cytological screening. The agreement of hybrid capture 2 assay and polymerase chain reaction assay for detection of human papilloma virus DNA in self‐collected vaginal samples and clinician‐obtained cervical smears was investigated. Method. Forty‐three women aged 23–58 years admitted for further examination due to previous positive cytology in the organized screening participated in self‐collecting of vaginal samples with a novel self‐sampling device. During the visit a clinician also collected a cervical smear using a cytobrush. The vaginal samples collected with the self‐sampling device were analyzed for high‐risk human papilloma virus with the hybrid capture 2 assay technique and the cervical smears were Pap‐stained, examined cytologically and after that reanalyzed for human papilloma virus DNA using a polymerase chain reaction assay. Result. The vaginal samples were positive for high‐risk human papilloma virus in 37% of the cases using hybrid capture 2 assay. Twelve of the 43 Pap smears showed positive cytology (ASCUS‐CIN 3), of which 4 showed CIN 2–3. When polymerase chain reaction assay was performed, human papilloma virus DNA was detected in 40% of the glass slides. The agreement between cytology and the two human papilloma virus testing techniques was 67–74% (kappa 0.27–0.45) and the agreement between the two human papilloma virus tests was 70% (kappa 0.36). Conclusion. Testing for high‐risk human papilloma virus can identify more women at risk of developing cervical cancer than cytology irrespective of the sampling method. Furthermore, offering a self‐sampling device for collection of vaginal smear seems to be a useful screening tool for cervical cancer among women not responding to an invitation for smear sampling.
Menstrual disorders and associated factors among adolescent girls visiting a youth clinic
Authors: WIKSTEN‐ALMSTRÖMER MARIANNE , LINDÉN HIRSCHBERG ANGELICA , HAGENFELDT KERSTIN
Published: March 2007

Background. Menstrual disturbances are common among teenagers and are often explained by immaturity of the hypothalamic‐pituitary‐gonadal axis. However, little is known about the underlying causes. The aim of this study was to evaluate endocrine mechanisms of menstrual disturbances and associated factors among adolescent girls visiting a Swedish youth clinic. Methods. All adolescent girls visiting the youth clinic during a five‐year period due to menstrual disturbances, except those with primary amenorrhea, were included in this retrospective study. These 203 girls were evaluated in a standardized manner by the same gynecologist. One third also met a psychologist and/or a dietician at the clinic. Results. Secondary amenorrhea was diagnosed in 117 girls (58%) and oligomenorrhea in 86 girls (42%). Menarcheal age was 13 in both groups. Hypothalamic inhibition of the gonadal axis was more frequent in the girls with secondary amenorrhea, whereas a hyperandrogenic hormonal pattern as a feature of polycystic ovary syndrome was more common in the oligomenorrheic girls. Different types of eating disorders were diagnosed in 68% of the amenorrheic girls and in 38% of the oligomenorrheic girls. Conclusions. We found hypothalamic amenorrhea and hyperandrogenism to be frequent endocrine mechanisms of menstrual disorders in teenagers. Concomitant eating disorder was highly frequent and secondary amenorrhea was associated with anorectic behavior. It is important to evaluate endocrine patterns and eating behavior in adolescents with menstrual disturbances to ensure adequate medical care and treatment.
A comparison of high‐ versus low‐intensity, high‐frequency transcutaneous electric nerve stimulation for painful postpartum uterine contractions
Authors: FAGEVIK OLSÉN MONIKA , ELDEN HELEN , DAHMÉN JANSON EVA , LILJA HÅKAN , STENER‐VICTORIN ELISABET
Published: March 2007

Background.Breast‐feeding in the postpartum period is known to induce intense uterine contractions with pain in the lower abdomen.Aims.The primary aim of this study was to compare the effects of high and low intensity, high frequency Transcutaneous Electric Nerve Stimulation (TENS) on pain and discomfort of postpartum uterine contractions. The secondary aim was to evaluate discomfort experienced from the stimulation itself.Methods.Twenty‐one newly delivered women participated in this single‐blind trial, 12 women received high intensity, high‐frequency TENS (HI TENS) and 9 women received low intensity, high‐frequency TENS (LI TENS). The electrodes were placed abdominally on each side of the uterus. Stimulation was done during one minute. Visual analogue scales were used to evaluate the intensity of the pain before and after stimulation. A verbal scale was used to estimate sensation of discomfort before, during and after stimulation.Results.The median decrease in pain ratings before and after treatment by VAS was larger in the HI TENS group −49mm (95% CI −66.5– − 33.2) than in the LI TENS group −21mm (95% CI −39.0– − 20.0). The reduction of pain was most pronounced in the HI TENS group (median difference 28 (95% CI was 14.0–53.0). Furthermore, the HI TENS group experienced significantly less discomfort of the uterine contractions after stimulation (p < 0.01) but they also experienced more discomfort of the stimulation than women in the LI TENS group (p < 0.01).Conclusion.The women treated with HI TENS, experienced significantly less postpartum pain and discomfort to those treated with LI TENS even though the discomfort from the stimulation with HI TENS was greater.
Emergency obstetric hysterectomy
Authors: DASKALAKIS GEORGE , ANASTASAKIS ELEFTHERIOS , PAPANTONIOU NIKOLAOS , MESOGITIS SPYROS , THEODORA MARIANA , ANTSAKLIS ARIS
Published: March 2007

Background. All cases of obstetric hysterectomies that were performed in our hospital during a seven‐year study period were reviewed in order to evaluate the incidence, indications, risk factors, and complications associated with emergency obstetric hysterectomy. Methods. Medical records of 45 patients who had undergone emergency hysterectomy were scrutinized and evaluated retrospectively. Maternal age, parity, gestational age, indication for hysterectomy, the type of operation performed, estimated blood loss, amount of blood transfused, complications, and hospitalization period were noted and evaluated. The main outcome measures were the factors associated with obstetric hysterectomy as well as the indications for the procedure. Results. During the study period there were 32,338 deliveries and 9,601 of them (29.7%) were by cesarean section. In this period, 45 emergency hysterectomies were performed, with an incidence of 1 in 2,526 vaginal deliveries and 1 in 267 cesarean sections. All of them were due to massive postpartum hemorrhage. The most common underlying pathologies was placenta accreta (51.1%) and placenta previa (26.7%). There was no maternal mortality. Conclusions. Obstetric hysterectomy is a necessary life‐saving procedure. Abnormal placentation is the leading cause of emergency hysterectomy when obstetric practice is characterized by a high cesarean section rate. Therefore, every attempt should be made to reduce the cesarean section rate by performing this procedure only for valid clinical indications.
Obstetric brachial plexus palsy: a prospective study on risk factors related to manual assistance during the second stage of labor
Authors: MOLLBERG MARGARETA , WENNERGREN MARGARETA , BAGER BÖRJE , LADFORS LARS , HAGBERG HENRIK
Published: March 2007

Background. To evaluate the association between obstetric brachial plexus palsy and obstetrical maneuvers during the second stage of delivery. Methods. Prospective population‐based case control study. Cases of obstetric brachial plexus palsy were compared with a randomly selected control group with regard to obstetric management. Results. Five or more obstetrical maneuvers were used to deliver the infants in 82% in the obstetric brachial plexus palsy group versus 1.8% in the controls. Risk factors independently associated with obstetric brachial plexus palsy were force applied when downward traction was imposed on the fetal head (odds ratio 15.2; 95% confidence interval 8.4–27.7). The incidence of obstetric brachial plexus palsy in the infants in the population was 3.3‰. At 18 months of age 16.1% (incidence of 0.05%) of children had residual functional deficits and downward traction with substantial force was applied in all these cases. Conclusions. Forceful downward traction applied to the head after the fetal third rotation represents an important risk factor of obstetric brachial plexus palsy in vaginal deliveries in cephalic presentation.
Where is the aorta? Is it worth palpating the aorta prior to laparoscopy?
Authors: POLYZOS DIMITRIOS , PAPADOPOULOS NIKOLAOS , CHAPMAN LYNNE , PAPALAMPROS PANOS , VARELA VASILIKI , GAMBADAURO PIETRO , MAGOS ADAM
Published: March 2007

Background. Injury to major retroperitoneal vessels is the most catastrophic complication of laparoscopy. Knowledge of the site of the aortic bifurcation prior to inserting the umbilical port would be expected to reduce the risk of this type of injury. The aim of the study is to determine the feasibility of identifying the aortic bifurcation by palpation prior to the operation. Methods. We studied 100 patients undergoing laparoscopic surgery or laparotomy. After prepping and draping, the operating surgeon felt for the aortic bifurcation to determine its position in relation to the umbilicus. We then related our findings to the height, weight, and body mass index of the patient. Results. The aorta could not be palpated in 15% of cases, including almost 2/3 of women who were obese (body mass index >30). In the remaining 85% cases, where the aorta was palpable, the bifurcation was above the level of the umbilicus in 30 (35%) cases, at the umbilicus in 45 (53%) cases, and below in 10 (12%) cases. We did not find any significant effect of body mass index, height, or weight on the level of the aortic bifurcation by palpation. No vascular injury occurred in the laparoscopic cases during the study. Conclusions. The aortic bifurcation is palpable in the majority of women undergoing surgery, including 93% of those with a low or normal body mass index who are at higher risk of vascular injury. We recommend the routine palpation for the aortic bifurcation as a simple means to reduce the risk of injury to a major retroperitoneal vessel.
N‐Acetyl cysteine and clomiphene citrate for induction of ovulation in polycystic ovary syndrome: a cross‐over trial
Authors: BADAWY AHMED , STATE OMNIA , ABDELGAWAD SOMA
Published: March 2007

Objective. To compare clomiphene citrate plus N‐acetyl cysteine versus clomiphene citrate for inducing ovulation in patients with polycystic ovary syndrome. Design. Prospective cross‐over trial. Setting. University teaching hospital and a private practice setting. Patients. Five hundred and seventy‐three patients were treated with clomiphene citrate for one menstrual cycle among which 470 patients were treated with clomiphene citrate plus N‐acetyl cysteine for another cycle. All women suffered from polycystic ovary syndrome. Interventions. Patients had clomiphene citrate 50‐mg tablets twice daily alone or with N‐acetyl cysteine 1,200 mg/day orally for 5 days starting on day 3 of the menstrual cycle. Outcome measures. Primary outcomes were number of mature follicles, serum E2, serum progesterone, and endometrial thickness. Secondary outcome was the occurrence of pregnancy. Results. Ovulation rate improved significantly after the addition of N‐acetyl cysteine (17.9% versus 52.1%). Although the number of mature follicles was more in the N‐acetyl cysteine group (2.1±0.88 versus 3.2±0.93), the difference was not statistically significant. The mean E2 levels (pg/ml) at the time of human chorionic gonadotropine injection, serum progesterone levels (ng/ml) on days 21–23 of the cycle, and the endometrial thickness were significantly improved in the N‐acetyl cysteine group. The overall pregnancy rate was 11.5% in the N‐acetyl cysteine group. Insulin resistance occurred in 260 patients (55.4%). There was no significant difference between the insulin resistance group (n = 260) and non‐insulin resistance group (n = 210) as regards ovulation rate, number of follicles, serum E2 (pg/ml), serum progesterone (ng/ml), endometrial thickness (mm), or pregnancy rate. Conclusion. N‐Acetyl cysteine is proved effective in inducing or augmenting ovulation in polycystic ovary patients.
Treatment of vulvovaginal erosive and stenosing lichen planus by surgical dilatation and methotrexate
Authors: KORTEKANGAS‐SAVOLAINEN OUTI , KIILHOLMA PENTTI
Published: March 2007

We treated five patients with stenosing lichen planus [LP] of the vulvovaginal region with methotrexate supplemented with ultrapotent corticosteroid cream and tacrolimus, in combination with surgical dilatation. All patients experienced long‐term symptom relief, and there was only minimal or moderate re‐stenosing of the vagina on follow‐up for 2–41 months.
Childbearing or induced abortion: the impact of education and ethnic background. Population study of Norwegian and Pakistani women in Oslo, Norway
Authors: ESKILD ANNE , NESHEIM BRITT‐INGJERD , BUSUND BJØRN , VATTEN LARS , VANGEN SIRI
Published: March 2007

Objective. To study patterns of induced abortion versus childbirth related to education among Norwegian and Pakistani women. Design and setting. Population‐based study in Oslo, Norway. Population. All women 15–50 years of age of Norwegian (n = 94,428) or Pakistani (n = 5,390) descent living in Oslo. Main outcome measures. Induced abortion or child delivery. Results. In Norwegian women with a university education, 15.3% delivered a child and 2.9% had an induced abortion between 2000 and 2002. In women with less than high school education, the figures were 5.3% and 4.3%. Pregnant women with less than high school education were twice as likely to have an induced abortion as women with a university education (odds ratio, 2.0; 95% confidence interval, 1.7–2.5), after adjustment for age, parity, marital status, and residential area. Among Pakistani women with a university education, 23.0% gave birth and 2.9% had an induced abortion. In Pakistani women with less than high school education, the figures were 20.8% and 2.8%. Among pregnant Pakistani women, those with less than high school education were less likely to have an induced abortion compared to women with a university education (odds ratio, 0.5; 95% confidence interval, 0.2–1.1). Conclusions. Childbirth was substantially more common in Pakistani than in Norwegian women living in Oslo. In Norwegian women, low education was associated with lower frequency of child delivery but higher frequency of induced abortion. In Pakistani women, child delivery was not related to education, but induced abortion tended to be more frequent in those with a university education.
Peritoneal fluid as an unrecognised vector between female reproductive tissues
Authors: HUNTER R.H.F. , CICINELLI E. , EINER‐JENSEN N.
Published: March 2007

This essay discusses the potential contribution of peritoneal fluid to the regulation of reproductive processes in female mammals. After noting the relatively high concentrations of diverse hormones in peritoneal fluid, and accepting that it bathes the surface of all the internal reproductive organs, peritoneal fluid is then proposed as a means of communication between the two ovaries. It could act to influence both the hierarchy of Graafian follicles and the rate and extent of development of a newly‐formed corpus luteum. Cytokines in peritoneal fluid are considered in this context, as are the differing populations of leukocytes. Circumstantial evidence is offered for entry of peritoneal fluid into the Fallopian tubes, especially close to the time of ovulation, with the suggestion that such entry could modify the nature of endosalpingeal secretion and transudation. Thereafter, the spectrum of gonadal hormones in peritoneal fluid could be influencing uterine tissues in a local manner. Finally, reference is made to regional differences in the concentration of steroid hormones in the peritoneal fluid of women, likewise to regional differences in domestic animals.
HPV DNA testing as an adjunct in the management of patients with low grade cytological lesions in Finland
Authors: TARKKANEN JUSSI , AUVINEN EEVA , NIEMINEN PEKKA , MALMI RAIJA , VARTIAINEN JUHANI , TIMONEN TUOMO , LAURILA PEKKA , Räisänen Ilkka , UNNERUS HANS‐ANDERS , SAKKI ARJA , MATTILA PETRI , VAN DEN BRULE ADRIAAN , TAPPER ANNA‐MAIJA
Published: March 2007

Background. Patients with recurrent low grade cytological abnormalities are at increased risk for high grade lesions. We wanted to see whether these patients could be identified by HPV DNA and pap tests. Methods. A prospective study of 663 patients referred for a colposcopy on the basis of ASC‐US or LSIL cytology. High‐risk HPV DNA positivity and cytology were compared with histology. Results. In total 65.6% samples were positive for HC2, and the overall proportion of CIN2+ lesions was 14.6%. No CIN2+ lesions were found in patients testing HC2−, pap−. There were 5/97 (5.2%) high grade lesions, which were HC2‐negative but pap‐positive, including 1 cervical adenocarcinoma in situ. The corresponding histological sections were all positive for p16INK in immunostaining. In further analysis by PCR, 3 samples were positive for HPV DNA. High‐risk HPV type 67, which is not included in the HC2 probe cocktail, was found in 1 case, and 2 cases were HPV positive but could not be typed. One CIN3 and one AIS remained HPV negative. In these 5 cases, the concomitant pap smear showed ASC‐US×1, LSIL×1, HSIL×2 and AGC×1. During 6‐month follow‐up, a relatively high number of CIN2+ (28/557, 5.0%) emerged from the non‐CIN–CIN1 group. Conclusions. The HC2 test or pap test alone were not sensitive enough to detect all CIN2+ lesions. A relatively high number of CIN2+ cases emerged from the non‐CIN–CIN1 group after 6 months. Adequate follow‐up of patients with mild cytological abnormalities, including a repeat pap smear taken during colposcopy and control at 6 months is underscored. Combination of hrHPV DNA and pap test should be considered, since it had high negative predictive value.
Patients' experiences of abuse in health care: a Nordic study on prevalence and associated factors in gynecological patients
Authors: SWAHNBERG KATARINA , SCHEI BERIT , HILDEN MALENE , HALMESMÄKI ERJA , SIDENIUS KATRINE , STEINGRIMSDOTTIR THORA , WIJMA BARBRO
Published: March 2007

Background. In an earlier Swedish study conducted with The NorVold Abuse Questionnaire, we found that one‐third of female patients who had experienced adult abuse in health care (AAHC) had a background of childhood emotional, physical and/or sexual abuse (EPSA) (‘revictimised’). But since the majority of women with AAHC were ‘new victims’ without such a background, there might be other factors associated with AAHC. The present study aimed to map prevalence of abuse in health care (AHC), and associated variables among new victims and revictimised patients. Methods. We carried out a cross‐sectional questionnaire study at 5 Nordic gynecological clinics. Associations between AAHC and other variables were tested in a multivariate model in 4 groups of women with adult EPSA, childhood EPSA, childhood and adult EPSA, and no EPSA. Results. The response rate was 77% (n = 3,641). The overall prevalence of any lifetime experience of AHC was 13–28%. High educational level, physical complaints, post‐traumatic stress symptoms, and sleeping problems were associated with AAHC in women without EPSA (new victims). Poor self‐rated health was strongly associated with AAHC in the 3 groups of women with EPSA. Conclusion. AHC is commonly reported by gynecological patients in the Nordic countries, but not yet properly explored or understood. The most important factors associated with AAHC were high educational level and poor self‐rated health.
Have Education and Publicity about Depression Made a Difference? Comparison of Prevalence, Service use and Excess Costs in South Australia: 1998 and 2004
Authors: Goldney Robert D. , Goldney Robert D. , Fisher Laura J. , Dal Grande Eleonora , Taylor Anne W. , Hawthorne Graeme
Published: March 2007

Objective: To identify changes in depression, its management and associated excess costs, between 1998 and 2004 in South Australia.

Methods: A face-to-face Health Omnibus Survey was conducted in 2004 among 3015 randomly selected participants aged 15 years and over, who were a random and representative sample of the South Australian population, and this was compared with a survey conducted in 1998 that used the same methodology. The main outcome measures were prevalence of depression detected by the Mood Module of the Primary Care Evaluation of Mental Disorders (PRIME-MD); use of health services; health-related quality of life assessed by the Assessment of Quality of Life; estimates of excess costs and demographic data.

Results: There was no significant change in the overall prevalence of depression, although there was a significant decrease in respondents with other depressions, and a non-significant increase in those with major depression. No significant differences in the mean number of PRIME-MD depression symptoms were reported. Greater use of predominantly non-medical treatment services and antidepressants were reported by both those with depression and those without depression. There was a marked increase in the associated excess costs of depression.

Conclusions: There has been no significant improvement in the prevalence of depression and its associated morbidity and financial burden in the South Australian community between 1998 and 2004, despite a number of professional and community education programmes. It is possible that without these efforts and the increased treatment reported on in this survey, there may have been an increase in the prevalence of depression and an even greater financial burden. However, it is also possible that community services for the provision of treatment for depression have not been able to implement research strategies that have been demonstrated to be effective.
Effects of Childhood Experiences on Cortisol Levels in Depressed Adults
Authors: Joyce Peter R. , Williamson Samantha A.H. , McKenzie Janice M. , Frampton Christopher M.A. , Luty Suzanne E. , Porter Richard J. , Mulder Roger T.
Published: March 2007

Objective: To evaluate the impact of childhood abuse and parental bonding on cortisol levels in depressed adults.

Methods: Mean afternoon cortisol levels were measured in 192 depressed adult patients at the beginning of a treatment trial. Childhood experiences of physical and sexual abuse were ascertained by interview, and perceived parenting by self-report.

Results: Maternal affectionless control, childhood sexual and physical abuse were all associated with cortisol levels.

Conclusion: Childhood experiences, especially maternal affectionless control, appear to be related to hypothalamic pituitary adrenal axis function in depressed adults.
Levels of Serum Interleukin (IL)-6, IL-1β, Tumour Necrosis Factor-α and Leptin and Their Correlation in Depression
Authors: Yang Kun , Xie Guangrong , Zhang Zhongxing , Wang Changhong , Li Wenbo , Zhou Weiqiang , Tang Yanqing
Published: March 2007

Objective: To investigate the relationship between leptin and cytokines in depressed patients.

Methods: Thirty-three unmedicated patients (24 female, nine male) with depressive disorder and 23 healthy controls (16 female, seven male) were assessed for serum levels of interleukin (IL)-6, IL-1β, tumour necrosis factor-α (TNF-α) and leptin.

Results: Levels of IL-6 and TNF-α in depressed patients were higher than in normal controls. There were significantly lower leptin levels in depressed patients than in normal controls. There were also significant differences in the leptin levels, being higher in female than in male patients, and in female than in male controls.

Conclusions: IL-6 and TNF-α cytokines and leptin are important in the psychoimmunology of depressed patients. There were gender differences in leptin levels in depression.
Atomoxetine versus Methylphenidate in Paediatric Outpatients with Attention Deficit Hyperactivity Disorder: A Randomized, Double-Blind Comparison Trial
Authors: Wang Yufeng , Zheng Yi , Du Yasong , Song Dong H. , Shin Yee-Jin , Cho Soo C. , Kim Bung N. , Ahn Dong H. , Marquez-Caraveo Maria E. , Gao Haitao , Williams David W. , Levine Louise R.
Published: March 2007

Objective: To (i) test whether atomoxetine is non-inferior to methylphenidate in treating symptoms of attention deficit hyperactivity disorder (ADHD) in paediatric patients; and (ii) determine the tolerability of the two drugs.

Method: This double-blind study was conducted in 6- to 16-year-old outpatients with ADHD (DSM-IV) in China, Korea and Mexico (January–October 2004). Patients were randomly assigned to once-daily atomoxetine (0.8–1.8 mg kg−1 day−1; n = 164) or twice-daily methylphenidate (0.2–0.6 mg kg−1 day−1; n = 166) for ∼8 weeks. Primary efficacy assessment was the comparison of response rates (≥40% reduction from baseline to end point in total score) on the Attention Deficit Hyperactivity Disorder Rating Scale-IV-Parent Version: Investigator-Administered and -Scored. Tolerability measures included, but were not limited to, the assessment of treatment-emergent adverse events (TEAEs) and weight.

Results: Atomoxetine was non-inferior to methylphenidate in improving ADHD symptoms based on response rates (atomoxetine, 77.4%; methylphenidate, 81.5%; one-sided 95% lower confidence limit = −11.7%, p = 0.404). Treatment-emergent adverse effects experienced significantly more frequently in the atomoxetine group, compared with the methylphenidate group, included anorexia (37.2% vs. 25.3%; p = 0.024), nausea (20.1% vs. 10.2%; p = 0.014), somnolence (26.2% vs. 3.6%; p <0.001), dizziness (15.2% vs. 7.2%; p = 0.024) and vomiting (11.6% vs. 3.6%; p = 0.007), most of which were of mild or moderate severity. Atomoxetine-treated patients experienced a small but significantly greater mean weight loss from baseline to end point than methylphenidate-treated patients (−1.2 kg vs. −0.4 kg; p <0.001).

Conclusions: This study suggests that atomoxetine is non-inferior to methylphenidate in the improvement of ADHD symptoms in paediatric outpatients. Although both of the drugs were well tolerated, atomoxetine was associated with a higher incidence of TEAEs than methylphenidate.
Mother and Baby Unit Admissions: Feasibility Study Examining Child Outcomes 4–6 Years On
Authors: Wan Ming Wai , Warburton Alison L. , Appleby Louis , Abel Kathryn M.
Published: March 2007

Objective: To compare the cognitive, social cognitive, behavioural, emotional and attachment security outcomes of children whose mothers were admitted to a psychiatric mother and baby unit (MBU) with those of offspring of mothers not admitted and with standardized norms.

Method: Children aged 4–6 years of mothers admitted (following childbirth) to the dedicated psychiatric MBUs in Manchester, and still living with their mother, were traced for recruitment. Observational and multi-informant measures of developmental functioning were administered during a home visit.

Results: From 94 consecutive admissions, 16 children participated and showed no poorer developmental outcomes than comparison children or standardized child norms. Girls, securely attached children and children of mothers with no current mental illness tended to show the most positive outcomes.

Conclusion: Possible reasons for low participant recruitment are discussed. Our provisional findings suggest that interventions should focus on improving infant attachment security, targeted at women with psychotic and chronic illness, who have no partner and/or who have a male child.
New Zealand Psychiatrists Views on Global Features of ICD-10 and DSM-IV
Authors: Mellsop Graham , Dutu Gaelle , Robinson Gail
Published: March 2007

Objective: The present accepted classificatory systems (ICD-10 and DSM-IV) represent the culmination of 100 years of post-Kraepelinian evolution. The present paper reports on a study to ascertain the views of New Zealand psychiatrists on their requirements of a classificatory system, and their opinions on those currently in use.

Method: An anonymous postal survey of 542 psychiatrists and trainees was undertaken in New Zealand.

Results: A total of 235 questionnaires were returned, completed. New Zealand psychiatrists primarily use DSM-IV and do so because that is what they were taught on. They make relatively limited use of the multiaxiality. The purposes of classificatory systems that they value most highly are reliable interclinician communication, and to inform patient management planning. The two purposes they valued least were usefulness for a national statistical base, or to indicate prognosis.

Conclusions: New Zealand psychiatrists’ views are consistent with some of the stated objectives of ICD-10 and DSM-IV, but there is significant diversity in the former and over-ambition in the latter, with much to be resolved.
AKT1 and Neurocognition in Schizophrenia
Authors: Pinheiro Andrea Poyastro , Keefe Richard S.E. , Skelly Tara , Olarte Megan , Leviel Keren , Lange Leslie A. , Lange Ethan M. , Stroup T. Scott , Lieberman Jeffrey , Sullivan Patrick F.
Published: March 2007

Objective: Previous research has shown conflicting results for the significance of five v-akt murine thymoma viral oncogene homolog 1 ( AKT1) single-nucleotide polymorphisms (SNPs) to the aetiology of schizophrenia. Neurocognition is a plausible endophenotype for schizophrenia and it was reasoned that the lack of agreement might be due to variability in neurocognition across studies. Therefore, the association of genetic variation in AKT1 with neurocognition was investigated in patients with schizophrenia.

Methods: The same five SNPs used in previous studies of the etiology of schizophrenia (rs2494732, rs2498799, rs3730358, rs1130241, and rs3803300) were genotyped in 641 individuals with schizophrenia who had participated in the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) project. The primary dependent variable was a neurocognitive composite score and exploratory analyses investigated five domain scores (processing speed, reasoning, verbal memory, working memory, and vigilance).

Results: There were no significant asymptotic or empirical associations between any SNP and the neurocognitive composite score. The authors also investigated the association of five-SNP haplotypes with the neurocognitive composite score. A marginally significant association was observed for the neurocognitive composite score with one of the five-SNP haplotypes (global score statistic 19.51, df = 9, permutation p = 0.02). Exploratory analyses of five domain scores (processing speed, reasoning, verbal memory, working memory, and vigilance) were non-significant for all five SNPs.

Conclusion: Results published to date for an association between genetic variation in AKT1 with schizophrenia are inconsistent. The results suggest that the AKT1 markers studied are not associated with neurocognition in schizophrenia, and do not support unassessed variation in neurocognitive scores as a reason for this discrepancy.
Zero Tolerance Approach to Aggression and its Impact upon Mental Health Staff Attitudes
Authors: Middleby-Clements Jane L. , Grenyer Brin F.S.
Published: March 2007

Objective: A natural study design provided an opportunity to investigate the effect of zero tolerance to aggression policy on health staff attitudes.

Method: This study compared a training programme used to train health service staff in aggression minimization (group 1) with a highly similar training programme that differed in that it emphasized a zero tolerance approach to aggression minimization in the health workplace (group 2). Prior to training and at follow up 117 health staff (57 from group 1, and 60 from group 2) completed a series of evaluations examining rigid attitudes toward managing aggression, tolerance for aggression and confidence and skills in dealing with aggression.

Results: The groups were equivalent with respect to age, sex and occupation. Prior to training the two groups did not differ with regard to rigidity, tolerance, confidence and skills. Both training interventions were effective in increasing confidence and skills. However, group 1 significantly decreased rigid attitudes toward the management of aggression, whereas group 2 significantly evidenced increased rigid attitudes and decreased tolerance toward aggression.

Conclusion: Zero tolerance for aggression had a negative impact on health staff attitudes in relation to managing aggression in the health workplace.
Does the Triple P–Positive Parenting Program Provide Value for Money?
Authors: Mihalopoulos Cathrine , Sanders Matthew R. , Turner Karen M.T. , Murphy-Brennan Majella , Carter Rob
Published: March 2007

Objective: The aim of the present study was to investigate the economic case for the implementation of the Triple P–Positive Parenting Program on a population basis in Queensland, Australia, in order to reduce the prevalence of conduct disorder in children.

Method: Threshold analysis was undertaken together with a limited cost-effectiveness analysis.

Results: The Triple P–Positive Parenting Program is a dominant intervention; that is, it costs less than the amount it saves, until the reduction in prevalence falls below 7% where net costs become positive.

Conclusions: Triple P is likely to be a worthwhile use of limited health funds. The economic case is promising, but further research is required to confirm the study results.