bluuebunny/crossref_metadata_2025 huggingface dataset:
Conservative ambulatory management of prelabor rupture of the membranes at term in nulliparous women
Authors: Hagskog Katrin , Nisell Henry , Sarman Ihsan , Westgren Magnus
Published: November 2007

Objective. To assess maternal and fetal outcome at conservative ambulatory care of nulliparous women at term with prelabor rupture of the membranes.

Methods. A prospective study of 176 women managed conservatively in an ambulatory setting (nonstress test and assessment of amniotic fluid index every second day). Results. The median rupture of the membrane to delivery interval was 30 hours. Ninety per cent were delivered within 85 hours. The patients were divided into three groups according to the time period between rupture of membranes and delivery (under the 25th, 25th‐75th and above the 75th centile). The maternal infectious morbidity (0, 6, 7% respectively), fetal distress (5, 18, 17% respectively) and instrumental delivery rate (5, 16, 16% respectively) tended to be increased in the upper three quartiles, without reaching a statistically significant level as analysed by χ2‐test. Nonstress test or evaluation of amniotic fluid index was not able to predict intrapartum fetal distress. In no case was there a delay in the management of any complication due to the ambulatory care.

Conclusion. Awaiting spontaneous labor in nulliparous women with prelabor rupture of the membranes at term does not seem to be associated with any obvious advantage. If, however, a conservative attitude is implemented, the patients can preferably be treated on an ambulatory basis.
A new technique to test tubal patency under transvaginal sonographic control
Authors: Volpi Eugenio , De Grandis Tiziana , Rustichelli Sergio , Zuccaro Giancarlo , Patriarca Ambra , Slsmondi Plero
Published: November 2007

Objective. Since 1990 we have undertaken a trial to evaluate if TVS, even without contrast media, could diagnose tubal patency.

Materials and methods. A detailed description of the technique is given. Two hundred and seventy‐three patients underwent sonosalpingography in our department in the period 1990–1993. The sonographic findings were matched in 43 cases to hysterosalpingography and in 55 cases to laparoscopy.

Results. Tubal patency was demonstrated in 218 patients (80.5%), monolateral patency in 41 (15.1%) patients and bilateral tubal occlusion in 12 (4.4%) patients. In the 43 patients undergoing hysterosalpingography, discordance between the two examinations was observed in five cases (11.6%). However, only six out of 86 salpinxes had different results (6.9%). In only one case was total discordance observed. In three out of four other cases the difference was due to patency diagnosed at SSG and occlusion at HSG. Of the 55 patients undergoing laparoscopy 12 cases (21.8%) had discordant results. Complete discordance was observed in two cases while in ten cases one salpinx had a different patency report. The discordance goes to 12.7% when we take into account all the salpinxes evaluated.

Conclusion. Sonosalpingography gives very similar results to hysterosalpingography and may be used on clinical basis for tubal patency evaluation.
Use of pap‐smears in a population without a mass screening program
Authors: Forsmo Siri , Buhaug Harald , Stalsberg Helge
Published: November 2007

Study objective. To analyze the use of Pap‐smears in a population where a screening program was not offered.

Design. Retrospective analysis of pathology registry data on women resident in two counties of Norway.

Setting. Evaluation of opportunistic screening by age and year of birth. Proportion of population tested during successive 3‐year periods.

Material. 353 665 smears from 88048 women examined since 1973. For this purpose we concentrated on 257951 smears from 77431 women examined during the period 1981–90.

Results. Between 62 and 67% of women examined during each 3‐year period were 20–39 years old, 14–16% were 50–69 years of age. Throughout the ten‐year period the frequency of Pap‐smear testing of women over 60 and under 20 increased slightly whereas it decreased for women 20–39 years old. Follow‐up of positive or atypical smears comprised about 25% of all smears. The highest proportion of follow‐ups was found among women 30–49 years old. About one third of women aged 20–59 years had more than one smear taken in a 3‐year period, follow‐up smears excluded.

Conclusion. More than half of the women aged 50 and above have no smears or smears less than one every third year. This proportion increases with age. The use and distribution of smears by age is still far from the situation expected in an organized screening program although a slight amelioration was observed through the study period.
Breech at termmode of delivery?
Authors: Krebs Lone , Langhoff‐Roos Jens , Weber Tom
Published: November 2007

Background. The present study was designed to determine neonatal mortality and morbidity in non‐malformed singleton term infants delivered in breech presentation and identify a possible correlation between outcome on the one hand and mode of delivery, parity and birth weight on the other.

Methods. Register‐based cohort study of all (n=15718) singleton term breech deliveries of non‐malformed infants in Denmark 1982–1990. Process and outcome measures: mode of delivery, gestational age, birth weight, congenital malformations, intrapartum death, Apgar scores and early neonatal death.

Results. A total of 3247 (20.7%) term infants were delivered vaginally, 7106 (45.3%) by elective and 5356 (34.1%) by emergency cesarean section. Infants delivered vaginally and by emergency cesarean section had significantly higher rates of mortality (intrapartum and early neonatal death) and morbidity (low Apgar scores) when compared to those delivered by elective cesarean section. In vaginal deliveries, parity was not correlated with outcome, but infants with a birth weight above 4000 grams had significantly higher rates of low Apgar scores.

Conclusions. Register data on singleton term breech deliveries imply that vaginal delivery is associated with increased mortality and morbidity. However, validation of data and additional information from the medical records are needed before a recommendation of whether selection of parturients, structure of perinatal care or professional skills need to be improved, or all singleton term infants in breech presentation should be delivered by cesarean section.
Sexually transmitted diseases in Swedish women with experience of casual sex with men of foreign nationalities within Sweden
Authors: Arvidson Maria , Hellberg Dan , Mårdh Per‐Anders
Published: November 2007

Background. This study was performed in women who had attended the clinic for contraceptive advice to determine whether a history of casual sex with a foreign male, previously unknown to them (SFM) in their home country (Sweden), constituted an increased risk for acquiring sexually transmitted diseases (STD) as compared to women without such an experience (COMP).

Methods. Of 996 women enrolled, and who were subjected to a structured deep‐interview performed by midwives, 595 (59.7%) stated that they had experienced casual sex within Sweden with for them a previously unknown Swedish male (SSM).

Results. A history of SFM was reported by 120 (12.0%) women. A history of chlamydial infection (26.0%) and gonorrhea (13.0%) were more common in the SFM women than in either the COMP (16.0% and 3.0%) or the SSM (19.0% and 4.0%) groups. Genital warts (8.0%) and bacterial vaginosis (23.0%) were found more often in the SFM group as compared to both the COMP (3.0% and 12.0%) and the SSM (4.0% and 13.0%) group. Women in the SFM group more often had a current genital chlamydial infection (13.0%) than those in the COMP group (8.0%.). When adjustment was made for markers of sexual risk taking, only genital warts remained significantly (p=0.05) associated with SFM as compared to both SSM and COMP.

Conclusions. To conclude, the study shows that women with experience of SFM had, more often, a history of one or more STDs and were more often carriers of STD agents than those lacking experience of SFM and/or SSM. However, there was no such difference when comparing the SFM and SSM women when making adjustments for sexual risk behavior. Thus a sexual risky lifestyle is more important than the origin of the sex partner for acquiring STDs with possible exception of HIV/AIDS in the society studied.
Ambivalence among women applying for abortion
Authors: Husfeldt Charlotte , Hansen Susanne Kierstein , Lyngberg Ann , Nøddebo Merete , Petersson Birgit
Published: November 2007

Background. Our purpose was to characterize women expressing ambivalence when applying for abortion.

Material and methods. Data were collected, by self‐administered questionnaires, from 339 women. Thirty percent were in doubt about the decision when the abortion was due. Socio‐economic factors more often influenced the choice among ambivalent women than among those not in any doubt.

Results. Ambivalent women more often felt exposed to social pressure and some felt that the abortion was not their own choice. Their decision‐making was marked by doubt during the entire process.

Conclusions. There is a need for professional support during this decision‐making process. Many of the ambivalent women stated that their decision might not have been the same under different personal circumstances.
Plasma cyclic GMP concentrations and their relationship with changes of blood pressure levels in pre‐eclampsia
Authors: Schneider Francis , Lutun Philippe , Baldauf Jean‐Jacques , Quirin Laurence , Dreyfus Michel , Ritter Jean , Tempé Jean‐Daniel
Published: November 2007

Background. One of the possible mechanisms responsible for pre‐eclampsia is a loss of efficiency of the L‐arginine‐nitric oxide pathway with subsequent inactivation of the guanylyl cyclases of the vascular smooth muscle cells. As a result there should be a decrease in plasma cyclic 3′‐5′ guanosine monophosphate (cGMP) concentrations in pre‐eclampsia. We assessed the behavior of this nucleotid in the plasma of pre‐eclamptic women.

Subjects and methods. Sixteen pre‐eclamptic women, 16 normotensive pregnant women matched for gestational age and six nonpregnant controls were investigated. Arterial blood pressure was recorded at inclusion time and then once a‐day until the fourth day after delivery concomitantly with the collection of blood samples for determining plasma cGMP, atrial natriuretic peptides (ANP). creatinine, uric acid and platelet counts. Also 24 h urines were simultaneously collected to calculate renal clearance of cGMP.

Results. Before the initiation of antihypertensive treatment, plasma cGMP levels were significantly higher (p<0.01) in pre‐eclampsia women as compared both to pregnant normotensive controls and nonpregnant women (7.02±0.9 versus 4.8±0.76 versus 1.93±0.15 pmol‐ml−1, p<0.01). Under antihypertensive treatment, cGMP levels decreased significantly (p<0.05) to 5.48±0.9 pmol‐ml−1. The increase of plasma cGMP was associated with high ANP levels; the likelihood that a renal impairment could account for an increase in plasma cGMP was ruled out because the clearance of creatinine was not impaired. Similarly the possibility of a significant linear correlation between cGMP levels and blood pressure values or biological data was excluded in these women.

Conclusion. Plasma cGMP concentrations are increased in pre‐eclampsia. They decrease to control values when blood pressure returns to normal values; they indicate enhanced guanylyl cyclase activation by ANP and additional factors, but cannot be considered as a direct index of the severity of pre‐eclampsia.
Towards regional equality in family planning: teenage pregnancies and abortions in Finland from 1976 to 1993
Authors: Kosunen Elise Anna‐Lisa , Rimpelä Matti Keijo
Published: November 2007

Background.A major goal of Finnish family planning policy since the 1970s has been to minimize unintended pregnancies by providing equal contraception and abortion services throughout the country. This report looks at how this policy has succeeded among teenagers.

Methods.The data on childbirths, induced abortions and mean populations were collected from the national abortion and population registers. Regional and age‐specific rates were calculated for fertility, abortions and pregnancies in girls aged 15‐19.

Results.In 1993, the teenage pregnancy rate was 20/1000 and the abortion rate 9.5/1000 in the whole country. Although the pregnancy rate had dropped by half since the 1970s, the regional differences were still there: the lowest rate was 18/1000 and the highest 29/1000 (in Lapland) in 1991‐93. The abortion rate ranged from 8/1000 to 14/1000. Childbirths decreased, particularly at the beginning of the study period, while abortions declined sharply towards the end of the period. In 1986‐88, the abortion ratio exceeded 100 in all provinces except two. In the 1990s, it dropped below 100 again except in the capital province. In 16‐17 year‐olds, the trends were quite equal in different provinces. In 18‐19 year‐olds, pregnancies remained more frequent in the north and were more often carried to term, while the choice of abortion was more likely in the south.

Conclusions.Equally declining trends in pregnancies in all provinces suggest that teenage family planning services have a comprehensive coverage. However, regional differences still remain and imply a detailed analysis of their reasons.
Increased use of condoms among female university students: A 5‐year follow‐up of sexual behavior
Authors: Tydén Tanja , Björkelund Cecilia , Odlind Viveca , Olsson Sven‐Eric
Published: November 2007

Objective. To ascertain any changes in sexual behavior and attitudes as an indication of the impact of intensified information activities aiming at decreasing the risk of spread of sexually transmitted diseases among university students.

Methods. In 1989 questionnaires were offered to 275 consecutive female students visiting the Student Health Center. Identical questionnaires were mailed to 200 randomly selected women registered at Uppsala University. The study was repeated in 1994. The study was carried out in Uppsala, a city in Sweden with 27,000 university students.

Results. At the Student Health Center 241 (88%) participated in the study in 1989 and 262 (95%) in 3994. Corresponding figures in the postal survey were 137 (69%) in 1989 and 151 (76%) in 1994. Compared with the findings in 1989, in 1994 the sexual behavior was unchanged in terms of mean age at first intercourse (17.6 years), median number of life partners (3‐4) and median number of sexual partners during the last 12 months (1), but the awareness of sexually transmitted diseases had increased. Their attitudes to using condoms had become more positive and the actual use of a condom had also increased both at the first intercourse and when changing partner, from 40 to 60%. Concerns about safety of oral contraceptives decreased significantly.

Conclusions. This follow‐up shows that awareness of sexually transmitted diseases and condom use had increased between 1989 and 1994, possibly as a result of intensified information efforts.
Inhibition of contractile responses of human myometrium and intramyometrial arteries by potassium channel openers
Authors: Kostrzewska Anna , Laudaski Tadeusz , Batra Satish
Published: November 2007

Objectives. The effects of cromakalim and pinacidil on the contractile activity of the isolated human myometrium and intramyometrial arteries were studied.

Material and method. Myometrial strips and pieces of uterine arteries were obtained from women undergoing hysterectomy. Contractions were recorded under isometric conditions.

Results. Both compounds (10−9 M‐5±10−6 M) inhibited the spontaneous activity of the myometrium and vasopressin induced contractions of myometrium and intramyometrial arteries. There was no statistically significant difference in the responses of both tissues to cromakalim or pinacidil. Both compounds reduced responses of myometrium and intramyometrial arteries to low concentrations of K+ (<40 mM) but did not decrease contractions induced by 40 mM and 80 mM.

Conclusion. The combined effect on the uterus and intrauterine vasculature would suggest a potential in the use of cromakalim or pinacidil for the treatment of dysmenorrhea.
Variation in lipid levels during pregnancy in women with different types of hypertension
Authors: Gratacós Eduard , Casals Elena , Sanllehy Carolina , Cararach VicenÇ , Alonso Pedro L. , Fortuny Albert
Published: November 2007

Objectives. To evaluate the levels of serum lipids (cholesterol and triglycerides) in pregnant women with different types of hypertension, at the first, second and third trimesters of pregnancy.

Methods. Cholesterol and triglyceride levels at the first, second and third trimesters of gestation were recorded for 115 women with hypertension during pregnancy, and 115 healthy pregnant women matched for age and body mass index. Cases were classified as having mild gestational hypertension (25), severe gestational hypertension (15), mild preeclampsia (20), severe preeclampsia (20), chronic hypertension (20), and superimposed preeclampsia (15).

Results. Cholesterol levels were not statistically different between cases and controls in any form of hypertension. At 20 and 34 weeks' gestation, triglyceride levels were significantly higher than controls in women with severe gestational hypertension, mild and severe preeclampsia, and superimposed preeclampsia, but not in mild gestational hypertension or chronic hypertension. The significant elevation in triglycerides was already present at 10 weeks in mild and severe preeclampsia.

Conclusions. The data suggest that the alterations in lipid metabolism observed in preeclampsia are already present at the first trimester of pregnancy. Women with severe gestational hypertension presented a pattern of triglycerides similar to that of preeclamptic women, but mild gestational hypertension resembled chronic hypertension in this respect. This supports the concept that, although in many cases gestational hypertension represents latent essential hypertension, some of these women, probably the most severe cases, present with true pregnancy‐induced hypertension, or nonproteinuric preeclampsia.
Infections after hysterectomy a prospective nation‐wide Swedish study
Authors: Persson Elisabeth , Bergström Mats , Larsson Per‐Gunnar , Moberg Peter , Platz‐christensen Jens Jörgen , Schedvins Kjell , Wølner‐hanssen Pal ,   The Study Group on Infectious Diseases in Obstetrics and Gynecology within the Swedish Society of Obstetrics and Gynecology
Published: November 2007

Background. An increased use of prophylactic antibiotics to avoid postoperative infections in women undergoing hysterectomy has been observed in Sweden. This investigation was performed a) to study the infection rate to enable future evaluation of the effect of prophylactic antibiotic regimens and b) to identify subgroups suitable for intervention.

Method. A prospective study comprising all women undergoing pelvic surgery with hysterectomy during a two month period at forty‐two Departments of Obstetrics and Gynecology in Sweden. Relevant information regarding the surgical procedure and the postoperative course was included in a standardized form at discharge from hospital and at a follow‐up visit 4 to 6 weeks after surgery.

Results. Of the 1060 women included in the study, 23% developed postoperative infections; 9.4% had wound‐, cuff‐, and/or deep infections, 13% urinary tract infections, and 4% other infections unrelated to the surgical site. Only half of the wound/cuff‐/deep infections were diagnosed before discharge from the hospital. Wertheim‐Meigs procedures, bleedings per‐operatively exceeding 1000 ml, and presence of bacterial vaginosis (BV) were associated with an increased risk of postoperative infections. Among women undergoing abdominal hysterectomy for benign reasons, (n=159), wound‐cuff/deep infection was significantly associated with preoperative BV, i.e. 7 of 28 (25%) vs. 11 of 131 (8%), respectively (relative risk=3.0, p= 0.01). Infection was associated with prolonged postoperative hospital stay. Antibiotics were given pre‐ or postoperatively to 236 (22%) of the 1060 women. Reduction in the postoperative infection rate was seen among women undergoing vaginal hysterectomy who were given pre‐or postoperative antibiotics.

Conclusion. The postoperative infection rate after hysterectomy was clinically significant in this population. Wertheim‐Meigs procedures, peroperative bleeding > 1000 ml and BV were identified as risk factors for postoperative infections after hysterectomy.
Understanding Family Variables in Outcome Research in Schizophrenia
Authors: Bland Robert
Published: November 2007

Outcome studies in schizophrenia research consistently show the importance of family variables in predicting patient relapse. The concept of expressed emotion (EE) is clinically relevant, though concerns remain about its precise meaning. The history of the EE studies is reviewed in the light of other family research, and an alternative model of family emotional environment is proposed. A number of clinical implications are considered.
The Prevalence of Emotional and Behaviour Disorders and Patterns of Service Utilisation in Children and Adolescents
Authors: Sawyer Michael G. , Sarris Aspasia , Baghurst Peter A. , Cornish Catherine A. , Kalucy Ross S.
Published: November 2007

This study compared the prevalence of emotional and behavioural disorders in children attending schools of different socio-economic class. In addition, the study compared the rate of service utilization by children with and without disorders. Using cutoff scores recommended for use with Australian children, the prevalence of disorders in schools of different socio-economic class ranged from 2.3±2.2 to 13.9±5.3 per 100 children, with the highest prevalence being found in the lower socio-economic class schools. Although few children with disorders had been seen in a mental health clinic, advice had been sought from other services with regard to 66% of these children. This high rate of service utilization by children with disorders highlights the key role that general practitioners, school guidance officers and hospital services could play in facilitating the early identification and management of children with emotional and behavioural disorders.
A Survey of Dementia Carers: Doctors' Communications, Problem Behaviours and Institutional Care
Authors: Brodaty Henry , Griffin Dianne , Hadzi-Pavlovic Dusan
Published: November 2007

A survey of carers belonging to the Alzheimer's Disease and Related Disorders Society (ADARDS) had three aims: (i) to investigate the process of health professionals providing information to patients and carers: (ii) to determine the nature of problems burdening carers; and (iii) to examine factors associated with institutional placement. Carers reported on deficiencies in the provision of information and indicated their preferences as to how the information should be given. ADARDS, general practitioners and other health professionals were reportedly helpful, with each appearing to have a role in providing information about dementia. Multiple problem behaviours were reported by most carers, especially difficulties with communication, the need for constant supervision and disruption to personal life. Institutional care was most highly correlated with dependency problems, severity of dementia and a non-spouse carer. Implications include the need for training of doctors in communication and education about dementia with particular attention to management of dependency problems.
Schizophrenia in Migrants Living in the Western Region of Melbourne
Authors: Wijesinghe C. P. , Clancy D. J.
Published: November 2007

Comparison is made between migrant (n = 332) and Australian-born (n = 242) schizophrenic outpatients attending a regional psychiatric hospital. Age-corrected rates show that migrants are over-represented. The migrant patient-group was older, developed the illness later, and had a higher proportion of females. More female migrant patients had developed the illness before arrival and in the first five years after migration compared to males whose peak incidence was between 11 and 15 years after arrival. Migrant patients showed greater family cohesion. On broad socio-economic indices, illness characteristics and treatment received, no significant differences emerged. In many respects patients born in U.K. and Ireland resembled the Australian-born.
Paradigm Failure in Functional Psychosis: Review and Implications
Authors: McGony Patrick D.
Published: November 2007

Increasing sophistication in the neurosciences has re-stimulated expectations that the underlying biological mechanisms involved in the psychoses might finally be clarified. These expectations however coexist with a sense of mounting frustration over the continuing failure of such progress to occur. One important factor in this failure is an enduring reliance upon obsolete nosological concepts and tools. The persistence of concepts such as schizophrenia and manic-depressive illness, which are substantially based upon unsustainable assumptions concerning the relationship between pathophysiology, symptoms and outcome, interferes with the appropriate deployment of new technologies and the interpretation of the resulting data. As many have suspected for some time, we are in a state of chronic paradigm failure, yet the lack of a superior alternative makes it difficult to dispense with traditional concepts. Following a review of the principal nosological paradigms, it is argued that the psychopathology of psychosis is more fluid than acknowledged by the dominant neo-Kraepelinian paradigm in particular. An alternative, which may be termed the loose linkage model, is proposed, which though it falls short of full paradigm status, does represent more accurately the true state of affairs in psychotic disorder, with fewer historical preconceptions. Its importance lies particularly in its significance for research strategy, and its capacity to minimise early iatrogenic sequelae of the diagnostic process and permit a more honest approach to clinical care.
Women in Australian and New Zealand Psychiatry: The Fat Lady Sings
Authors: Quadrio Carolyn
Published: November 2007

Gender disadvantage within the professions significantly affects the development of women doctors, resulting in morbidity and less than optimal development. Paradoxically, for a profession primarily concerned with the study of the vicissitudes of human development, psychiatry in Australia and New Zealand has yet to articulate those issues which bear directly upon the development of its own members. Systemic problems are identified within the institutions of medicine and psychiatry which compromise the development of both female and male trainees and which must concern medical educators. Recommendations are made concerning the structure and content of training programmes, most particularly post-graduate psychiatry.
Psychosocial Management of Chronic Fatigue Syndrome in Adolescence
Authors: Rikard-Bell Christopher J. , Waters Brent G.H.
Published: November 2007

The state of chronic fatigue syndrome (CFS) as abnormal illness behaviour or as biologically determined disease is undecided. The ensuing, often public, debate has confused the community and has led to sharp differences in the therapeutic approach to individual patients. These challenges are compounded when the patient is an adolescent and intergenerational issues enter the picture. Two adolescent cases with different outcomes are presented and the principles of a rehabilitation approach to treatment are outlined which attempt to avoid being drawn into unproductive debates about aetiology.
Post-Traumatic Stress Disorder in Australian Prisoners of the Japanese: A Clinical Study
Authors: Watson Ian P. Burges
Published: November 2007

The clinical findings of examination of 11 Australian prisoners of the Japanese (POWs (J)) are reported. They were examined for evidence, past or present, of Post-Traumatic Stress Disorder (PTSD). Three currently satisfied the DSM-III-R criteria for a diagnosis of PTSD and at least three more would probably have done so if a complete assessment had been possible. All but two described many of the symptoms of PTSD and would probably have satisfied the criteria for the diagnosis at some time following their release from captivity. The subjects were all seen between mid 1988 and mid 1990 and the difficulties of the study and its implications are discussed.
Some Fallacies of Statistical Inferences about Psychotherapy
Authors: Morstyn Ron
Published: November 2007

Statistical methodology does not provide an effective, impartial, or objective way to determine the validity of theories of psychotherapy. Furthermore, the correlations revealed by statistical studies of psychotherapy are clinically irrelevant. Nevertheless there is a growing trend to recognise only statistically “proven” techniques of psychotherapy as legitimate medical treatment. The replacement of established medical standards for psychotherapy with this bogus new scientism is likely to lead to iniquitous clinical and administrative restrictions upon psychotherapists which will cause unnecessary suffering to patients.
Somatisation as a Presentation in Depression and Post-Traumatic Stress Disorder among Cambodian Refugees
Authors: Cheung Peter
Published: November 2007

Three Cambodian patients with Depression and Post-traumatic Stress Disorder (PTSD) presenting with somatic complaints are described. Their case histories support previous observations that somatisation is the most common presentation of Cambodian patients with Depression and PTSD. The probable reasons why depressed, traumatised Cambodian patients somatise their psychiatric problems are discussed. These cases illustrate the difficulties involved in engaging such patients in Western style psychotherapy, but show the effectiveness of small doses of antidepressants in treating the depressive and post-traumatic stress symptoms.
Treatment Resistant Depression in an Australian Context I: The Utility of the Term and Approaches to Management
Authors: Wilhelm Kay , Mitchell Philip , Hickie Ian , Brodaty Henry , Austin Marie-Paule , Parker Gordon , Boyce Philip
Published: November 2007

The concept of “treatment resistant depression” (TRD) has generally been defined in terms of failure to respond to a standard course of somatic therapy with little reference to diagnostic sub-types or relevant psychosocial factors. In this paper we examine problems with the use of the term “treatment resistant depression” and then outline an approach to TRD employed in an Australian mood disorders unit. After discussing the need for a biopsychosocial assessment, multimodal management strategies for melancholic and non-melancholic TRD patients are described.
Postnatal Depression in a Community Cohort
Authors: Webster M. Louise , Thompson John M. D. , Mitchell Edwin A. , Werry John S.
Published: November 2007

A community cohort of 206 European and Maori women completed a questionnaire screening for postnatal depression at 4 weeks postpartum. The prevalence of major depressive disorder amongst the women was 7.8% with a further 13.6% of women experiencing more minor depressive symptoms. Postnatal depression was more likely to occur in women who were single, were less than 20 years old at the birth of their first child, were unhappy with their relationship with their partner, had a history of previous psychiatric hospitalisation, and were Maori. Women who were depressed were more likely to show a lack of enjoyment of and less positive attitude towards their infant. The study highlights the value of screening for postnatal depression with a simple questionnaire, as few depressed women would have been otherwise recognised.
Psychogeriatric Training in Australia and New Zealand: A Survey of Psychiatry Trainees and Training Program Co-Ordinators
Authors: Draper Brian
Published: November 2007

Psychiatry trainees and training program co-ordinators in Australia and New Zealand were surveyed about psychogeriatric training. Responses were received from the co-ordinators of all training programs and 68% of trainees. Over 94% of responding trainees believe they require at least 3 months' psychogeriatric training. Currently about 70% of trainees obtain a psychogeriatric term by Year 4 of training, with 17 out of 21 training programs having positions available. Most trainees positively rate their psychogeriatric training experiences, with 89% enjoying it and 78% believing it adequate for their needs. It is recommended that psychogeriatric training be available to all trainees before sitting the RANZCP Section 1 examinations.
What the Doctor Ordered? Referrer Satisfaction with a Mood Disorders Unit
Authors: Eyers Kerrie , Brodaty Henry , Roy Kay
Published: November 2007

Assessment of referrer's needs, patterns and satisfaction ratings with a psychiatric service provides both a clinical and service performance indicator. This study explored referrer satisfaction with a tertiary referral mood disorders unit (MDU). The 147 responders comprised 75 psychiatrists, 59 general practitioners and 13 others. Thirty-two percent of referrers were “very satisfied” and 42%“quite satisfied” with their contact with the unit. Components of satisfaction were defined by piincipal components analysis as“technical competence”; “adequate information and follow-up support” and “access” to the facility, dimensions confirmed by responses to open-ended questions. Differences were established between the referral needs of psychiatrists and general practitioners, suggesting different treatment emphases. Such surveys provide a framework which can facilitate review and restructuring of important service components of any psychiatric facility.
Consultation-Liaison Psychiatry in General Medical Units
Authors: Clarke David M. , Smith Graeme C.
Published: November 2007

The activities of a consultation-liaison psychiatry service to general medical units in a university affiliated suburban teaching hospital are described, with a report from the MICRO-CARES clinical database on 165 consecutive referrals over a 12 month period. The referral rate was 4.2% of admissions. The data confirm the association of psychiatric referral and prolonged length of hospital stay (mean of 18 days for referred patients, 9 days for non-referred patients). The most common reasons for referral were depression, suicide risk evaluation, organic brain syndrome and suspected psychological component to illness. The most common psychiatric diagnoses were Mood Disorders (55%), Organic Mental Disorders (35%), Adjustment Disorders (19%), Somatoform and other Somatic Disorders (16%) and Personality Disorders (15%). Although 67% of patients received at least one confirmed diagnosis, 39% of all diagnoses remained “differential”, or unconfirmed, at discharge. Concordance with drug recommendations was 97% and with non-drug recommendations 95%. Two groups of patients were prominent among the referrals: the young self-poisoning patient, and the older patient living alone. The issues involved in providing a liaison psychiatry service to general medical units with these characteristics are described.
A Social Skills Group for Boys with Asperger's Syndrome
Authors: Marriage Keith J. , Gordon Victoria , Brand Linda
Published: November 2007

A social skills group was conducted for 8 boys aged 8 to 12 years on a weekly basis for 14 sessions. In this descriptive paper we discuss the planning for the group, the teaching techniques used, the actual group process and a subjective assessment of outcomes. Possible directions for future interventions are also presented.
Self Reports of the Interaction between Substance abuse and Schizophrenia
Authors: Baigent Michael , Holme Gwili , Hafner R. Julian
Published: November 2007

Fifty-three psychiatric hospital inpatients with a dual diagnosis of substance abuse and schizophrenia were given the Brief Symptom Inventory and the Schizophrenia/Substance Abuse Interview Schedule. Mean age was 29; 49 were men. Only 11% were employed. Forty percent abused mainly alcohol, 40% cannabis and 8% amphetamines; 20% abused more than one substance. Mean onset age of drug abuse was 16 years; schizophrenia was diagnosed a mean of 5 years later, and subjects had been admitted to hospital an average of 7 times since then. Most believed that drug abuse initiated or exacerbated their schizophrenia; 80% took drugs primarily to relieve dysphoria and anxiety. Amphetamines improved subjective well-being significantly more than alcohol, but choice of drugs was determined mainly by price and availability. Only cannabis increased positive symptoms of schizophrenia and only amphetamines reduced negative ones. Effectively treating this population requires an integration of psychiatric and drug treatment services, ideally in a community context.
The Initial Prodrome in Psychosis: Descriptive and Qualitative Aspects
Authors: Yung Alison R. , McGorry Patrick D.
Published: November 2007

Objective: This study aimed to describe in detail, using a retrospective approach, the prodromal symptoms in first-episode psychosis patients. This initial prodrome, the period of disturbance preceding a first psychotic episode, is potentially important for early intervention, identification of biological markers, and understanding the process of becoming psychotic. Method: A consecutive series of 21 first-episode patients was recruited from the Early Psychosis Prevention and Intervention Centre, a specialised service for young people aged between 16 and 30 with first-episode psychosis. Subjects were interviewed in the recovery phase after the acute episode, about the period leading up to the psychosis, using a combination of unstructured and semi-structured techniques.

Results: A wide variability of phenomena and sequence patterns was found, with symptoms being a mixture of attenuated psychotic symptoms, neurotic and mood-related symptoms, and behavioural changes. Symptoms were often disabling and some, such as suicidal thoughts, potentially life-threatening. Conclusions: The findings highlight the loss of information that has resulted from disregarding early phenomenological studies of the psychotic prodrome and instead focussing on behavioural features. The ground work has been laid for the development of better methodologies for assessing and measuring first psychotic prodromes with increased emphasis on experiential phenomena. This has the potential to lead to the early recognition and more accurate prediction of subsequent psychosis, as well as a deeper understanding of the neurobiology of the onset of psychotic disorder.
Hanging and Poisoning Autopsies in Fiji
Authors: Pridmore Saxby , Lawler Anthony , Couper David
Published: November 2007

Objective: Fiji is a Pacific nation with roughly equal numbers of indigenous Fijians and Indians. Previous studies, using police and medical records, have suggested significant racial, regional, age and gender differences in suicidal behaviour. The objective of the present study is to use a unique data set (autopsy reports) in the evaluation of earlier reports and to identify groups at greater risk.

Method: Hanging and poisoning autopsy reports from two distinct regions were examined.

Results: The rate of autopsy (per 100 000 population per year) among Indians (19.5) is significantly greater (p<0.0001) than among Fijians (1.53). In the north, among the Indians, there are more autopsies in females (21.2) than males (16.8), and hanging constitutes 85% of total suicides, while in the Central and Eastern Divisions hanging constitutes only 58% of the total. These are regional influences. Among Fijians, the rates of hanging autopsy are significantly greater (p<0.001) in males (1.98) than females (0.40); however, among Indians there is no significant difference. This is a racial difference. Hanging remains the preferred option for all groups. The mean age at autopsy is 31.7. There is no significant difference between the mean ages of the races, the sexes or the regions. There is no significant difference between the mean age of poisoning (31.5) and hanging (31.8).

Conclusion: There is a significant racial difference in rates of suicide but the influences of region, age and method are relatively slight.
Carrot Addiction
Authors: Kaplan Robert
Published: November 2007

Objective: A case report of carrot addiction is presented with a review of the literature and comment on the role of beta carotene in addictive behaviour. Clinical Picture: The addiction occurred in a 49-year-old woman under conditions of stress due to marital problems, leading to a depressive illness and increased smoking. The patient maintained that the sensations of carrot craving and withdrawal were quite distinct from those associated with smoking.

Treatment: The patient was advised to record her daily carrot consumption. Outcome: The patient did not return for several months, but stopped eating carrots after an operation, at which time she also stopped smoking. Conclusion: Compusive carrot eating, regarded as a rare condition, has received scant documentation, unlike hypercarotenemia due to unusual diets or food fads. Nervousness, craving, insomnia, waterbrash and irritability are associated with withdrawal from excessive carrot eating. The basis for the addiction is believed to be beta carotene, found in carrots. Does carrot eating, an aggressively oral activity, merely act as a behavioural substitute for smoking? Or does beta carotene contain a chemical element that replicates the addictive component of nicotine? Further study of this unusual but intriguing addiction may reveal more about the basis of all addictions, with particular implications for the cessation of cigarette smoking.
Unemployment and Health
Authors: Goldney Robert D.
Published: November 2007

The effect of unemployment on health Is an emotive issue. Careful appraisal of published work is required. Furthermore, when considering potential psychiatric illness effects, the prevalence of such illness in all populations must be allowed for before assuming unemployment to be a significant causal stressor.
The ‘Anatomy’ of Female Child Sexual Abuse: Who does what to Young Girls?
Authors: Romans Sarah E. , Martin Judy L. , Anderson Jessie C. , O'shea Martine L. , Mullen Paul E.
Published: November 2007

Objective: This paper aims to describe the characteristics of sexually abusive acts experienced by female children in order to identify those perpetrators who inflict intrusive and repeated child sexual abuse (CSA). Method: Data were collected from a random New Zealand sample of women aged 18 to 65 years who reported CSA, and a similar number of non-abused comparison women. Information on the perpetrator, the type of CSA, and perpetrator strategies were cross-tabulated.

Results: The perpetrators were usually young men, well known to the victim or her family. Greater CSA intrusiveness was statistically associated with greater CSA frequency. Father/stepfather abusers were most likely to perpetrate intrusive and frequent CSA. However, family associates and non-paternal relatives were numerically more often reported as perpetrators than fathers/stepfathers. Stranger-perpetrators featured infrequently.

Conclusion: We conclude that the most frequent and invasive CSA comes from someone well known to the child, particularly a family member or trusted friend. A focus by the courts or health professionals on either incest only (i.e. CSA between biological relatives) or ‘stranger danger’ will overlook the large categories of CSA perpetrated by secondary relative and family friend abusers.
The Development of a Patient Satisfaction Measure for Psychiatric Outpatients
Authors: Parker Gordon , Gladstone Gemma , Wright Murray , Robertson Sadie
Published: November 2007

Objective: To describe the first stage of development of a patient satisfaction form designed for psychiatric outpatients.

Method: An initial 62-item questionnaire was completed by 172 patients, who were asked to assess the importance of a number of practice and practitioner features in contributing to their satisfaction.

Results: Mean scores prioritised the psychiatrist respecting the rights of the patient; appointment and billing arrangements were of intermediate importance, while amenity issues were rated as unimportant. When rankings across the several practices were examined, very high levels of agreement were demonstrated, supporting the likely validity of the overall rankings. Four underlying domains were identified by factor analysis, the principal one being defined by respect for confidentiality, by support and adequate communication. The three remaining factors were contributed to more by practice (e.g. billing arrangements, amenities) than by practitioner features. Conclusion: We consider how a refined and modified version of the measure might be developed for use by both individual practitioners and group practices, as well as being used as a formal QA component activity.
Jumping the Gun: Firearms and the Mental Health of Australians
Authors: Dudley Michael , Cantor Chris , de Moore Greg
Published: November 2007

Objectives: The aims of this study were to (i) survey mental health-related correlates of firearms ownership and availability in Australia, and (ii) assess possible causal relationships between civilian gun deaths, gun availability and mental disorders.

Method: Available data regarding firearms ownership, injuries and deaths were reviewed as well as studies of (i) gun ownership, suicide and homicide, and (ii) gun control laws and suicide.

Results: Findings indicated that 85% of firearm deaths are triggered by distress, as opposed to crime. Most firearm homicides are intrafamilial or involve familiar persons. Firearm suicide rates, athough tapering off in recent years, continue to rise among certain groups. It was also found that:

(1) Beyond reasonable doubt, a causal relationship exists between gun ownership and firearm suicides and homicides. The role of method substitution is controversial, but is probably less important among the young. (2) Outside the United States, legislation may be useful in reducing firearm and possibly overall suicide rates. (3) If firearm owners are representative of the community, then 15–20% suffer from a psychiatric disorder at any time. While a modest increase in risk of firearms misuse exists for this group, especially those with a history of substance abuse or violence, concern also arises regarding those with mental disorders who access firearms because owners have not secured them. No uniform definition or way of verifying self-reports exists for gun licence applicants regarding these issues.

Conclusions: Further regulation of firearm safety and availability is warranted. Public health measures include improved surveillance regarding firearm events, advocacy for appropriate firearm legislation, and better education and communication about firearms.
The Early History of the New Zealand Association of Psychotherapists and the Related Movement for Primary Prevention in Mental Health: Some Recollections
Authors: Cook Peter S.
Published: November 2007

Following his return to New Zealand from London in 1940, Dr C. M. Bevan-Brown gave lectures leading to the formation of the Mental Health Club. In 1946 this became the Christchurch Psychological Society. The New Zealand Association of Psychotherapists was formed at a conference in 1947 and held annual conferences for many years. In 1948 and 1949 training courses for doctors and medical students were conducted. To combat widespread ignorance, a series of pamphlets on various aspects of emotional health was published, and in 1950 a book on psychotherapy and primary prevention. These inspired the formation of Parents' Centres from 1951, which, as branches increased, led to the New Zealand Federation of Parents' Centres. They later gained official medical recognition and played an historic role in transforming some aspects of New Zealand culture and guiding institutions towards greater sensitivity to the emotional and mental health aspects of pregnancy, childbirth and early parent-child relationships. The influence of this movement continues.