bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk of preterm delivery in relation to maternal low birth weight
Authors: DE BARNA , LIN STEPHANIE , LOHSOONTHORN VITOOL , WILLIAMS MICHELLE A.
Published: May 2007

Objective. We examined the relationship between maternal low birth weight and preterm delivery risk. Methods. Information concerning maternal birth weight was collected during in‐person interviews. Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (95% CI). Preterm delivery cases were studied in aggregate, in subgroups (spontaneous preterm labor, preterm premature rupture of membranes, medically induced preterm delivery, moderate preterm delivery [gestational age at delivery 34–36 weeks], and early preterm delivery [gestational age at delivery <34 weeks]). Results. After adjusting for confounders, women weighing <2,500 g at birth had a 1.54‐fold increased risk of preterm delivery versus women weighing = 2,500 g (95% CI 0.97–2.44). Maternal low birth weight was associated with a 2‐fold increased risk of spontaneous preterm delivery (95% CI 1.03–3.89), but weakly associated with preterm premature rupture of membranes (OR = 1.44; 95% CI 0.67–3.09) and medically induced preterm delivery (OR = 1.10; 95% CI 0.43–2.82). Maternal low birth weight was more strongly associated with early preterm delivery (OR = 1.94) than with moderate preterm delivery (OR = 1.46). Women weighing <2,500 g at birth and who became obese (pre‐pregnancy body mass index, = 30 kg/m2) before pregnancy had a 3.65‐fold increased risk of preterm delivery (95% CI 1.33–10.02) versus women weighing =2,500 g at birth and who were not obese prior to pregnancy (<30 kg/m2). Conclusions. Results confirm earlier findings linking maternal low birth weight with future risk of preterm delivery.
Rupture of the scarred uterus
Authors: GROSSETTI E. , VARDON D. , CREVEUIL C. , HERLICOVIEZ M. , DREYFUS M.
Published: May 2007

Objective. To assess the risk of uterine rupture of the scarred uterus according to mode of delivery in subsequent births recorded as spontaneous labour, labour induced by oxytocin, labour after ripening with prostaglandin E2, and planned cesarean section. Methods. Retrospective study of 2,128 births with a low transversal scar after a previous cesarean section. The study population was realised in a level III university hospital from 1995 to 2003. The association between mode of delivery and uterine rupture was studied in a multivariate logistic regression model, and adjusted for specific antenatal confounding factors. Results. Over 9 years, we collected 22 cases (1%), including 11 asymptomatic ruptures in a population of 2,128 scarred uteri out of 28,248 deliveries. Uterine rupture occurred at a rate of 0.3 per 100 among women with repeated cesarean delivery without labour, 1 per 100 among women with spontaneous onset of labour, 1.4 per 100 among women with oxytocin‐induced labour, and 2.2 per 100 among women with prostaglandin cervical ripening. Compared to women with a planned cesarean section, women with spontaneous onset of labour were more likely to have uterine rupture (OR: 4.0; 95% CI: 0.8–42.0). A greater relative risk was observed among women with oxytocin‐induced labour (OR: 4.3; 95% CI: 0.3–60.0), and particularly those with prostaglandin‐induced labour (OR: 8.7; 95% CI: 1.5–97.3, p = 0.01). Conclusion. In women with a scarred uterus, prostaglandin E2 induction of labour is a risk factor for uterine rupture. The practice of a systematic cesarean section in cases with Bishop score <3, appropriate induction procedure, and rigorous monitoring of the labour, could make for a safer delivery.
Intraperitoneal octenidindihydro‐chloride – phenoxyethanol solution to prevent peritoneal adhesion formation in a rat peritonitis model
Authors: GÜZELSAĞALTICI NIHAT , GIRGIN SADULLAH , GEDIK ERCAN , BÜYÜKBAYRAM HÜSEYIN , BAÇ BILSEL
Published: May 2007

Background. Peritoneal adhesion is a common complication following abdominal surgery. Despite recent advances in diagnosis and treatment, it still presents a problem for the patients and surgeons. In the present study, we investigated the effects of octenidindihydro‐chloride – phenoxyethanol (OCP) on peritoneal adhesions. Method. Rats were divided into four groups: Group 1 (saline), Group 2 (peritonitis plus saline), Group 3 (OCP), and Group 4 (peritonitis plus OCP). Peritonitis was induced in the rats of Groups 2 and 4. The abdominal cavities of the rats in Groups 1 and 2 were washed with saline, while those of the rats in Groups 3 and 4 were irrigated with 1:10 OCP solution. Adhesion and fibrotic scores were determined by re‐laparotomy after 21 days. Results. The adhesion scores in Groups 1 (saline), 2 (peritonitis plus saline), 3 (OCP) and 4 (peritonitis plus OCP) were 3.30±0.94, 5.25±1.03, 1.12±0.83 and 0.28±0.48, respectively. Statistical analysis of adhesion scores revealed significant differences between groups, except between Groups 3 and 4 (p = 0.265). Statistical analyses of grades of histopathological signs showed that Group 1 differed from Groups 2 and 4 (p = 0.004, p = 0.003, respectively); Group 2 differed from Groups 3 and 4 (p = 0.001, p = 0.001, respectively). On the other hand, differences between Group 3 and Groups 1 and 4 were not significant (p = 0.06, p = 0.08, respectively). Conclusion. OCP decreased the peritoneal adhesion formation macroscopically and microscopically in the presence or absence of peritonitis. Peritoneal defects due to trauma are to be left open and OCP diluted 1:1 should not be used intraperitoneally.
Surgical staging, treatment, and follow‐up of borderline tumors in different hospital categories: a prospective nationwide survey in Finland
Authors: KUMPULAINEN SALLA , KUOPPALA TAPIO , LEMINEN ARTO , KOMULAINEN MARJA , PUISTOLA ULLA , SANKILA RISTO , MÄKINEN JUHA , GRÉNMAN SEIJA
Published: May 2007

Background. Surgical treatment and staging of ovarian borderline tumors have been reported to be often suboptimal and differ considerably. We evaluated the extent of surgical treatment of these tumors in different hospital categories. Material and methods. A prospective survey performed in 1999 included 65 patients operated on for borderline ovarian tumors and covered 78% of such patients reported to the Finnish Cancer Registry. Detailed information of demographic data and surgical treatment was reported by the responsible physicians using a special questionnaire after confirmation of histopathology. Results. Fifty‐eight patients (89%) had stage I tumor, only two patients (3%) had stage II disease and five patients (8%) had stage III disease with peritoneal implants. The majority of the patients underwent bilateral salpingo‐oophorectomy (66%) and hysterectomy (58%). Unilateral salpingo‐oophorectomy was performed for 21 (32%) and omentectomy for 22 (34%) patients. Ten out of the 16 women under 40 years of age had fertility‐sparing surgery. Peritoneal biopsies were taken in 16 (25%) women and lymphadenectomy was performed for 9 (14%) patients with clinical suspicion of invasive ovarian carcinoma. Frozen section was taken in half of the patients and the histology remained the same in 72% of the final pathology reports. No clear differences of the extent of surgical treatment were detected between different hospital categories. Overall cumulative 5‐year relative survival rate was 96%. Conclusions. Bilateral salpingo‐oophorectomy and hysterectomy was performed for the majority of patients with borderline ovarian tumor. More attention should be paid to adequate staging of borderline tumors in all hospital categories.
Medical management of first trimester miscarriage according to ultrasonographic findings
Authors: VEJBORG T.S. , NILAS L. , RØRBYE C.
Published: May 2007

Background. The efficacy of medical treatment of first trimester miscarriages may depend on the regimen used, the definition of success, clinical symptoms, and, possibly, on the ultrasonographic findings. Our primary aim was to assess if a single dose of misoprostol could reduce the number of surgical interventions in early pregnancy failure, and to compare efficacy in different ultrasonographically‐defined subgroups. Methods. A retrospective review of 355 consecutive patients treated for a first trimester miscarriage with a single dose of vaginal misoprostol (400 μg), followed by vaginal ultrasonography after either 1, 2 or 3 days. Treatment was successful if a complete abortion was diagnosed at follow‐up. The women were divided into 4 ultrasonographically‐defined groups: missed abortion with a crown rump length (CRL) ≥6 mm (Group A1) or CRL <6 mm (Group A2), anembryonic gestation with gestational sac ≥18 mm (Group B1) or <18 mm (Group B2). Results. The overall success rate was 39.2% (139/355). The regimen was more efficacious in Group A2 (50%) and less efficacious in Group B1 (26.6%) than in the other groups. The success rates were lower 1 day after treatment (30.2%) compared to days 2 and 3 (43.6%; p<0.05), and the difference was largest in Group B1 (12.9 versus 35.4%; p<0.05). Conclusions. Single dose misoprostol reduced the number of surgical interventions. The success rates of medically‐treated first trimester miscarriages varied according to the ultrasonographic definitions of pregnancy failure, time of assessment, and the criteria for success.
Testosterone versus clobetasol for maintenance of vulvar lichen sclerosus associated with variable degrees of squamous cell hyperplasia
Authors: AYHAN ALI , GUVEN EMINE SEDA GUVENDAG , GUVEN SULEYMAN , SAKINCI MEHMET , DOGAN N. UTKU , KUCUKALI TURKAN
Published: May 2007

Objective. To evaluate the therapeutic regimens and symptomatic response rates in patients with vulvar lichen sclerosus associated with variable degrees of squamous cell hyperplasia (mixed disease). Material and methods. Eighty‐three women with biopsy‐proven vulvar mixed disease were evaluated for this retrospective study. All patients were initially treated with topical fluorinated corticosteroids, and then 2% testosterone propionate in petrolatum or 0.05% clobetasol 17‐propionate (44 (53%) versus 39 (47%)). Results. The remission rates were 82 and 93% in the testosterone and clobetasol subgroups at the end of 6 months (p = 0.112), respectively. The disease recurred in 8% of the patients. The recurrence rates in the testosterone and clobetasol arms were 13 and 5%, respectively (p = 0.163). The histopathological review of the repeat vulvar biopsies of the patients without symptomatic relief revealed 6 (60%) patients with persistent disease, 2 (20%) with lichen sclerosus, 1 (10%) with atypical squamous hyperplasia, and 1 (10%) with VIN1. Two patients with recurrent disease and 2 patients with vulvar intraepithelial neoplasia I–II or atypical squamous hyperplasia were treated with skinning vulvectomy. Conclusions. Clobetasol resulted in higher remission and lower recurrence rates than those in testosterone therapy, although statistically significant differences were not obtained. In the evaluation of patients without symptomatic relief, the first step should be a vulvar biopsy to exclude the presence of atypical components.
Epidural ondansetron is more effective to prevent postoperative pruritus and nausea than intravenous ondansetron in elective cesarean delivery
Authors: HAN DONG WOO , HONG SOON WON , KWON JA‐YOUNG , LEE JAE WOO , KIM KI JUN
Published: May 2007

Background. Postoperative pruritus, nausea, and vomiting are common side effects of intrathecal or epidural opioids. Intravenous ondansetron has been used for postoperative emesis. However, there are no reports regarding epidural ondansetron. Two studies were conducted to evaluate the prophylactic effects of epidural ondansetron for opioid‐induced pruritus, nausea, and vomiting. Methods. Neurotoxic signs were checked after epidural injection of ondansetron in rats. A clinical study was conducted to compare the prophylactic effects of epidural ondansetron with intravenous ondansetron for opioid‐induced pruritus, nausea, and vomiting in cesarean delivery. Results. No neurotoxic evidence was found in rats. The incidence of pruritus and nausea was significantly lower in the epidural ondansetron group than in the intravenous ondansetron group at 24 and 48 h postoperatively. Conclusions. Epidural ondansetron is more effective in preventing postoperative pruritus and nausea than intravenous ondansetron.
Attitudes to self‐sampling of vaginal smear for human papilloma virus analysis among women not attending organized cytological screening
Authors: WIKSTRÖM INGRID , STENVALL HARRIET , WILANDER ERIK
Published: May 2007

Background. The major problem with the cytological screening is the non‐optimal participation rate among women invited for cervical smear collection. The aim of the present investigation was to examine the attitudes of the non‐responding women to perform self‐sampling of vaginal smear at home as a method to increase the coverage of the screening and to examine the prevalence of high‐risk human papilloma virus (HPV) among the responding women. Methods. From the database of the Department of Cytology, University Hospital of Uppsala 198 women, aged 35‐55 years, who had not attended the organized gynaecological screening for over 6 years were identified. They were sent a letter of information about the study and one week later a self‐sampling device aimed to collect vaginal smear. The vaginal smear of the women responding to the offer of self‐sampling was analysed for high‐risk HPV using Hybrid Capture 2 method or polymerase chain reaction amplification of HPV DNA. All women in the study also received a questionnaire in order to investigate their attitudes towards self‐sampling as an alternative in the organized screening. Results. Of the 198 women 15 women had to be excluded. Fifty‐eight per cent of the women responded and collected vaginal smear at home and among them 7% were positive for high‐risk HPV. The questionnaire revealed no significant difference of age, country of birth and occupation or marital status, on using self‐sampling of vaginal smear at home. The attitudes among responding and non‐responding women differed. The responding women who contributed by sampling vaginal smear were more positive to self‐sampling of vaginal smear (p<0.01). Conclusions. Offering self‐sampling of vaginal smear in women not attending the organized cytological screening increases the coverage and identifies an additional group of women with an increased risk to develop cervical cancer. The attitude towards self‐sampling was mainly positive.
Regulation of amphiregulin, EGFR‐like factor expression by hCG in cultured human granulosa cells
Authors: NEGISHI H.
Published: May 2007

Background. It has long been suspected that the epidermal growth factor (EGF) receptor and some of its putative ligands may play an important role in ovarian function. Amphiregulin (AR) is the growth factor with an EGF‐like motif, but its potential role in signalling in the ovary is still obscure. AR gene expression and its functional effect were evaluated in human granulosa cells from immature follicles. Method. Granulosa cells from immature follicles with early menstrual phase were cultured with or without 200 mIU/ml of FSH stimulation, following with or without 1 IU/ml of hCG. mRNA levels of AR and luteinising hormone replacement (LHR) were semi‐quantified using RT‐PCR. Progesterone (P) concentration in the medium was assayed. Results. LHR mRNA was expressed 48 h after FSH stimulation without AR mRNA expression. AR mRNA was expressed 1 h after hCG stimulation, and increased the intensity in 6 h. P biosynthesis was increased by AR in a dose‐dependent manner. AR mRNA was elevated by forskolin stimulation without FSH and hCG stimulation before LHR mRNA expression. When cultured with FSH for 15 h, followed by increasing doses of hCG stimulation for 6 h, the AR mRNA levels increased according to hCG concentration up to 1,000 mIU/ml. Conclusion. Occurrence of LHR gene expression following FSH stimulation was necessary for the AR gene expression in vivo, and the AR gene was induced by forskolin without LHR gene expression in vitro. P biosynthesis was stimulated, to some extent, by AR. This result suggests the differentiation effect of AR on granulosa cells. AR might be a mediator of LH signals before ovulation.
Infant mortality of very preterm infants by mode of delivery, institutional policies and maternal diagnosis
Authors: HÖGBERG U. , HOLMGREN P.A.
Published: May 2007

Objective. The aim of this study was to analyse infant mortality among infants born extremely preterm in relation to mode of delivery, maternal diagnosis, and different institutional policies. Methods. We conducted a national tertiary health care center study using Swedish Medical Birth Register (MBR) data from 1990 to 2002, to examine the 2,094 live births of infants at 23+0 to 27+6 weeks gestation. We assessed the association between mode of delivery, gestational age (GA), calendar year, maternal condition, and institutional policies on infant mortality outcome. Results. At 23–25 weeks, 38% of infants (range: 34–69%) were delivered by cesarean section (CS), while at 26–27 weeks, 66% (59–80%) were delivered by CS. The CS rate for fetal or maternal indications was 98% in cases of pre‐eclampsia/eclampsia, 42% for premature rupture of membranes (PROM), 68% for hemorrhage, 76% for PROM+hemorrhage, 56% for breech presentation, and 30% for preterm vertex with no other complications. After cases of pre‐eclampsia/eclampsia were excluded, vaginal delivery was associated with a small increase of risk for infant death. Vaginal delivery was associated with a significantly increased risk for infant death in breech presentations and multiple births, while vaginal delivery posed a non‐significant risk increase for PROM and hemorrhage. For preterm vertex without any other complications, 4 out of 5 infants were delivered vaginally without any risk increase. Conclusion. This study reports high CS rates for very preterm births at Swedish hospitals. In performing CS for very preterm infants, this study suggests a survival advantage for certain maternal conditions, but not for preterm labor with a vertex presentation without other obstetrical complications.
An important Finnish contribution to the advancement of women's reproductive health
Authors: MILSOM IAN
Published: May 2007

This issue of Acta Obstetricia Gynecologica Scandinavica contains new guidelines for the management of menorrhagia recommended by the Finnish Society of Obstetrics and Gynecology. The treatment of menorrhagia has undergone radical changes over the last 2 decades, and several new treatment techniques for the management of this common and troublesome condition have been introduced. It is perhaps particularly appropriate that these guidelines come from Finland, where one of the most important advances regarding the modern management of menorrhagia has its origin.
Comparison of Two Anticonvulsants in a Randomized, Single-Blind Treatment of Hypomanic Symptoms in Patients with Bipolar Disorder
Authors: Suppes Trisha , Kelly Dorothy I. , Hynan Linda S. , Snow Diane E. , Sureddi Suresh , Foster Barbara , Curley Eric
Published: May 2007

Objective: Oxcarbazepine was compared to divalproex to assess clinical effectiveness of a proven agent, divalproex, against a newer, less studied agent, oxcarbazepine, in the treatment of hypomania.

Method: Thirty patients with bipolar disorder, currently hypomanic, were randomized to receive oxcarbazepine or divalproex as add-on or monotherapy for 8 weeks. A rater blind to treatment assignment performed all symptom ratings. Hypomania and depression were rated using the Young Mania Rating Scale (YMRS) and the Inventory of Depressive Symptoms–Clinician Version (IDS-C). Random regression models were used to assess clinical symptom scores.

Results: There were no significant differences of YMRS or IDS-C scores between groups. Mean YMRS scores at baseline were 22.07±5.86 and 20.53±6.02 for the oxcarbazepine and the divalproex groups, respectively. Mean percent reduction from baseline to week 8 for the YMRS was 63.8% and 79.0% for oxcarbazepine and divalproex groups, respectively. Mean percent reduction from baseline to week 8 for the IDS-C was 48.7% versus 19.7% for oxcarbazepine and divalproex groups, respectively. Significant antimanic efficacy was noted for each medication. Both medications were generally well tolerated.

Conclusion: In this pilot study, oxcarbazepine was as effective as divalproex in the treatment of hypomania. Further controlled trials are warranted.
Taxometric Investigation of Depression: Evidence of Consistent Latent Structure Across Clinical and Community Samples
Authors: Slade Tim
Published: May 2007

Objective: Past taxometric studies of depression have yielded equivocal results. Diversity of sample type may provide one explanation for this. The aim of the present study was to examine the latent structure of depression across clinical and community samples using exactly the same taxometric procedures involving exactly the same indicators of depression.

Method: Two taxometric procedures, MAXEIG (maximum eigenvalue) and MAMBAC (mean above minus mean below a cut), were carried out on a clinical sample of 960 outpatients with mood and anxiety disorders. Simulated categorical and dimensional data sets as well as other consistency tests aided in the interpretation of the research data. Results were compared to a prior taxometric analysis in a community sample.

Results: The results of the current taxometric analyses were consistent with a dimensional latent structure and were compatible with the findings from identical analyses in a community sample.

Conclusions: The findings of the current study highlight the importance of identifying factors that may contribute to, and explain, differences in the identified latent structure of depression.
Venlafaxine Hyponatraemia: Incidence, Mechanism and Management
Authors: Roxanas Milton , Hibbert Emily , Field Michael
Published: May 2007

Objective: This prospective study was performed on patients aged >65 years commencing therapy with venlafaxine, in order to determine the incidence of hyponatraemia induced by the drug, to investigate the underlying pathophysiological mechanisms, and to evaluate a simple approach to management of this condition.

Method: All patients aged >65 years seen by one author (MR) from all referral sources were entered into the study. Baseline biochemical tests were ordered, and if hyponatraemia developed (plasma Na <130 mmol L−1) additional tests were performed to ascertain the mechanism, while the patient continued on venlafaxine and fluid restriction was instituted.

Results: A total of 58 patients were seen, of whom 10 developed hyponatraemia, giving an incidence of 17.2%. Of these 10 patients, five were excluded from prolonged observation because of either severe medical illness, side-effects from the antidepressant or being lost to follow up. When hyponatraemia developed, it invariably did so within a few days of starting venlafaxine, and was associated with non-suppression of antidiuretic hormone in the face of a low serum osmolality. Fluid restriction (800 mL day−1) was effective in raising the plasma sodium to the normal range within 2 weeks, after which the fluid restriction could be relaxed without relapse occurring. These patients remained well for the follow-up period of up to 6 months.

Conclusions: Patients >65 years of age should have their electrolytes measured 3–5 days after starting venlafaxine therapy. If hyponatraemia develops, it can be managed with modest fluid restriction without discontinuing drug treatment, subject to close continued clinical observation and biochemical monitoring.
Problem Alcohol Use in Young Australian Adults
Authors: Reid Sophie C. , Ukoumunne Obioha C. , Coffey Carolyn , Teesson Maree , Carlin John B. , Patton George C.
Published: May 2007

Objective: To examine the extent to which excessive drinking in young adults is associated with alcohol abuse and dependence.

Method: Cross-sectional analyses were conducted using data from the eighth wave of the Victorian Adolescent Health Cohort Study, which comprised 1943 Victorians currently aged 24–25 years drawn from 44 secondary schools across the state in 1992. The main outcome measures of interest were short-term risk drinking status (based on daily alcohol consumption) and long-term risk drinking status (based on total weekly alcohol consumption).

Results: Two out of 5 participants drank at moderate to high risk levels for short-term harm. Yet, because young people tend to drink on only 1–2 days a week, fewer (22%) were at moderate to high risk for long-term harm. Although 20% of the participants met criteria for a diagnosis of alcohol abuse or dependence, most of those in the moderate- to high-risk drinking categories were not diagnosed with either alcohol disorder.

Conclusion: Excessive alcohol use in one or two sessions a week appears to be common in young Australian adults. While short- and long-term risky drinking is more common in those with an alcohol use disorder, the majority of moderate- and high-risk drinking is done by those who do not meet criteria for an alcohol use disorder.
Testing the Validity of the Recovery Assessment Scale Using an Australian Sample
Authors: McNaught Mandy , Caputi Peter , Oades Lindsay G. , Deane Frank P.
Published: May 2007

Objective: Mental health services in Australia are increasingly becoming recovery orientated. However, there are varying meanings for recovery and few measures that specifically target recovery outcomes. The current study aimed to assess the construct and concurrent validity of a patient self-report measure, the Recovery Assessment Scale (RAS).

Method: Participants were 168 individuals with severe and persistent psychiatric disability who were participants in the Australian Integrated Mental Health Initiative (AIMhi) project. They completed self-report recovery and other mental health measures and their case workers completed the Health of the Nation Outcome Scales. Exploratory and confirmatory factor analyses were carried out to examine the factor structure of the RAS.

Results: Exploratory factor analysis of the RAS produced five factors that were replicated using confirmatory techniques. Each factor has satisfactory internal reliability (Cronbach α range = 0.73–0.91). The factors displayed convergent validity with positive and significant correlations with other recovery measures. Concurrent validity was demonstrated with significant but lower correlations with symptoms and clinician-rated measures of psychiatric functioning.

Conclusion: The factors of the RAS are consistent with the consumer literature on recovery. Correlations with other variable suggest that the RAS is measuring something different from traditional symptom or functional mental health measures. Further research is needed to clarify the extent to which the RAS is able to capture the range of recovery experiences that have been described by patients.
Early Psychosis in Rural Areas
Authors: Welch Mark , Welch Twilla
Published: May 2007

Early psychosis (EP), in which the terms first-episode psychosis or first-break psychosis are also considered, is an area of developing research intensity. Although it is apparent that considerable progress has been made in establishing best practice criteria and protocols for EP in general, the particular issues pertaining to rural areas have not received the same attention. The purpose of the present study was to conduct a systematic review of the literature of early psychosis programmes, initiatives and research in rural areas in order to help establish the best available evidence. The authors conducted a systematic search of major electronic databases, based on the NHMRC hierarchy of evidence, an established scale, for identified early psychosis cross-referenced with multiple rural terms, between the years 1995 and 2005. A total of 637 articles met the initial search criteria; 206 were identified as having primary significance; three dealt specifically with rural areas. There is a paucity of research findings or published literature concerning the specific needs or characteristics of early psychosis practice or service delivery in rural areas. A number of inferences and suggestions for further research, investigations and policy directions are put forward for consideration.
Group Intervention for Coexisting Psychosis and Substance use Disorders in Rural Australia: Outcomes over 3 Years
Authors: Bradley Adrian C. , Baker Amanda , Lewin Terry J.
Published: May 2007

Objective: Outpatient group interventions have been shown to be efficacious in reducing substance use among people with psychosis. This is the first Australian study to report on the effectiveness of such interventions provided in a rural area by mental health and drug and alcohol clinicians, with follow up over 3 years. The primary aim was to investigate whether an open-ended weekly outpatient group intervention, consisting of motivational interviewing (MI) and cognitive behaviour therapy (CBT), was effective in reducing substance use and improving symptomatology and general functioning among people with psychosis.

Method: This was a service evaluation project, with clinician-administered ratings made for four retrospective 3 monthly baseline observations and up to 12 3 monthly post-recruitment observations.

Results: Thirty-nine participants entered the group intervention, with an average attendance of 28.51 sessions (SD=24.61). Compared to a baseline period of 1 year, the group intervention was associated with significant improvements in substance use, symptomatology, treatment non-compliance, overall functioning and unscheduled service use. A median split according to treatment group attendance indicated that there was no difference in improvement profiles on a factor reflecting overall severity among those who attended fewer (mean=10.63) versus more sessions (mean=45.50), but there was a sharper reduction in the use of acute mental health services among those who attended more sessions.

Conclusions: Significant change in functioning (including substance use and symptomatology) can occur within the context of a regular but relatively short outpatient group intervention, delivered in addition to usual treatment. However, extended group attendance over a 1 year period may be further associated with prevention of relapse and less unscheduled service use.
Restraint and Eating Concern in North European and East Asian Women with and without Eating Disorders in Australia and Singapore
Authors: Li-Wey Soh Nerissa , Touyz Stephen , Dobbins Timothy A. , Surgenor Lois J. , Clarke Simon , Kohn Michael R. , Lee Ee Lian , Leow Vincent , Rieger Elizabeth , Khean Ung Ken Eng , Walter Garry
Published: May 2007

Objective: To investigate eating disorder psychopathology, restraint and eating concern in young women with and without an eating disorder from two different ethnic groups in Australia and Singapore.

Method: The relationship of Eating Disorder Examination Questionnaire Global, Restraint and Eating Concern scores to cultural orientation and sociocultural factors was analysed in 154 women with and without an eating disorder. Participants were from the following backgrounds: North European Australian, East Asian Australian, Singaporean Chinese and North European expatriates in Singapore.

Results: Women with eating disorders had similar psychopathology across the cultural groups. Among controls, Singaporean Chinese reported significantly greater overall eating disorder psychopathology than other cultural groups and greater restraint than North European Australians/expatriates. Eating concern was not associated with cultural group overall or acculturation to Western culture. Dissatisfaction with family functioning, socioeconomic status and education level were not significantly associated with any of the eating disorder measures.

Conclusion: In eating disorder psychopathology, the specific symptom of eating concern may transcend cultural influences.
Afghan Refugees in Iran, Pakistan, the U.K., and the U.S. and Life after Return: A Comparative Gender Analysis
Authors: Rostami-Povey Elaheh
Published: May 2007

This paper compares the divergent positioning of Afghan women in diaspora in Iran, Pakistan, the U.K., and the U.S. and in their return to Afghanistan since the fall of Taliban. Afghans comprise a diverse group in terms of ethnicity, age, class, and religion, and their experiences in diaspora vary accordingly. Afghan women in Iran and Pakistan may have relatively less access to resources, including citizenship rights, in comparison with Afghan women in the U.K. and the U.S. who may be transnational and of a higher social class. However, Afghan women in Iran and Pakistan are able to break down masculine domains more effectively than Afghan women in the U.K. and the U.S. This is because Afghan women in the West are constantly engaged in mediating between ‘Western’ values and their Afghan/Muslim cultural identities. Finally, women in Afghanistan face imported Western notions of market liberalization, governance, and gender mainstreaming, which have failed to bring about desired state building, peace, and security. For the majority of Afghan women, advancing women's rights is not just about challenging male domination; it is also about challenging imperialist domination, militaristically and economically as well as culturally. Although the main focus is on the transitions in women's lives, due to displacement and—in some cases—reintegration, I will also address how these changes have affected Afghan men. One critical theme runs through the paper: the issue of gender, agency, and identity and the ways in which women, through their positioning in diaspora and under invading forces, are also social actors.
Civic Commitment, Political Culture and the Estonian Inter-War Generation
Authors: Bennich-Björkman Li
Published: May 2007

The purpose of this article is to investigate to what extent civic commitment and the political culture from the Estonian first republic survived communism at an individual level. Have representatives of the Estonian inter-war generation who endured Soviet occupation been able to remain civically committed even though they were disconnected from democratic institutions for a major part of their lives? Sometimes labelled “republican,” this generation matured into early adulthood during an unusually formative period in Estonian history, when the new democratic state was taking shape in between the two world wars. Hence, it fulfils the criteria of a political generation as “a group of human beings who have undergone the same basic historical experiences during their formative years.” The analysis contributes to two different, although in this context interrelated, discussions. The first addresses the roots of Estonia's successful post-communist experiences, the second the extent to which early socialization endures dramatic institutional shifts.
Continuity and Change in the Regimes of Ethnicity in Austria, Germany, the USSR/Russia, and Turkey: Varieties of Ethnic Regimes and Hypotheses for Change
Authors: Akturk Sener
Published: May 2007

After World War I, Austria, Germany, Russia, and Turkey moved from dynastic-imperial political regimes to quasi-republican regimes justified on the basis of popular legitimacy. Prior to this transition, in the management and political (in)significance of ethnic categories these empires broadly resembled each other. After World War I, the core successor states to these four empires pursued radically different policies in dealing with ethnicity as a social category. One can therefore speak of distinct Austrian, German, Soviet/Russian, and Turkish models in managing multi-ethnic populations, models which persisted since the 1920s. Both the emergence of different regimes of ethnicity in the 1920s and the persistence of these policies throughout the twentieth century present very intriguing puzzles for political science. It is not possible to “explain” either the emergence or the persistence of these distinct policies within the confines of this paper. Instead, the major differences between state policies in these four countries will be described in detail in order to highlight the important differences and the most significant features of each case. Since the major contours of these policies did not change throughout the twentieth century, I will limit myself to a brief description of period-specific nuances in the distinct national trajectories between the 1920s and the 1990s. Finally, I will focus on a period of significant change in the late 1990s in Germany, Russia, and Turkey, and inquire as to the causes of these changes.
Boys Must be Boys: Gender and the Serbian Radical Party, 1991–2000
Authors: Irvine Jill A. , Lilly Carol S.
Published: May 2007

On 27 June 2004, Serbian voters went to the polls for the third time in a year to choose a president. The winner of the first two rounds of voting, Tomislav Nikolić, Deputy to the President of the extreme right Serbian Radical Party (SRS), lost the third round of voting to the more liberal Borisav Tadić by just under 8 percentage points (53.2 to 45.4), and the Radicals failed to form a ruling coalition in government. Nevertheless, more than five years after the last war in the disintegration of the Yugoslav state, the largest political party in the largest of the successor states has been characterized as the most extreme right party in the Balkans today. Indeed, the Radicals have been an enduring force in Serbian politics for the past decade and a half, sometimes ruling in coalition with Slobodan Milošević's Socialist Party of Serbia (SPS). SRS founder Vojislav Šešelj, a flamboyant, obstreperous, highly influential figure, and his fellow Radicals have sought and in many ways succeeded in shaping the post-communist transformation of Yugoslav politics and society, calling for a return to the true spirit of Serbia, when the nation was strong because its men defended its honor as well as its borders.
Ukraine within the USSR: An Economic Perspective, 1928/29–1932 and 1959–1980
Authors: Lew Melnyk Z.
Published: May 2007

The economic status of a country may be analyzed and measured in terms of a number of different attributes and components. The present study focuses on capital formation (i.e. generation of new wealth in the form of capital) because capital formation is a major and comprehensive determinant of the economy's growth. The ability of an economy to generate sufficient new capital is the foundation of its strength and vitality; only to a limited extent may domestic capital formation be supplemented by foreign funds.
Cost-effectiveness of computed tomographic colonography: a prospective comparison with colonoscopy
Authors: Arnesen R. B. , Ginnerup-Pedersen B. , Poulsen P. B. , von Benzon E. , Adamsen S. , Laurberg S. , Hart-Hansen O.
Published: May 2007

Purpose: To estimate the cost-effectiveness of detecting colorectal polyps with computed tomographic colonography (CTC) and subsequent polypectomy with primary colonoscopy (CC), using CC as the alternative strategy.

Material and Methods: A marginal analysis was performed regarding 103 patients who had had CTC prior to same-day CC at two hospitals, H-I (n = 53) and H-II (n = 50). The patients were randomly chosen from surveillance and symptomatic study populations (148 at H-I and 231 at H-II). Populations, organizations, and procedures were compared. Cost data on time consumption, medication, and minor equipment were collected prospectively, while data on salaries and major equipment were collected retrospectively. The effect was the (previously published) sensitivities of CTC and CC for detection of colorectal polyps⩾6 mm (H-I, n = 148) or ⩾5 mm (H-II, n = 231).

Results: Thirteen patients at each center had at least one colorectal polyp⩾6 mm or ⩾5 mm. CTC was the cost-effective alternative at H-I (€187 vs. €211), while CC was the cost-effective alternative at H-II (€239 vs. €192). The cost-effectiveness (costs per finding) mainly depended on the sensitivity of CTC and CC, but the depreciation of equipment and the staff's use of time were highly influential as well.

Conclusion: Detection of colorectal polyps⩾6 mm or ⩾5 mm with CTC, followed by polypectomy by CC, can be performed cost-effectively at some institutions with the appropriate hardware and organization.
Superselective arterial embolization for patients with high-flow priapism: results of follow-up for five or more years
Authors: Baba Y. , Hayashi S. , Ueno K. , Nakajo M.
Published: May 2007

Purpose: To retrospectively evaluate the long-term results of transcatheter arterial embolization for high-flow priapism.

Material and Methods: The study comprised six patients with high-flow priapism treated by superselective embolization of the internal pudendal arteries at our institution. The cause of priapism was traumatic in five patients and idiopathic in one. Follow-up was⩾5 years in all cases.

Results: A total of nine embolizations were performed in the six patients. Embolization was performed once in three patients, while repeated embolizations were performed in the remaining three. Eleven arteries were altogether treated. Embolic materials used were gelatin sponge in nine arteries, gelatin sponge and microcoils in one, and microcoils alone in one. Embolization of the internal pudendal arteries on both sides in one single session was performed in one patient. In one patient, complete occlusion of the pseudoaneurysm was not achieved. However, restoration of erectile function and detumescence were noted during follow-up. Complications during the procedure were not registered. At follow-up⩾5 years after successful embolization, all six patients experienced detumescence as well as normal erectile function.

Conclusion: Superselective embolization of the internal pudendal artery is the procedure of choice for treatment of high-flow priapism.
Noninvasive coronary angiography using 64-detector-row computed tomography in patients with a low to moderate pretest probability of significant coronary artery disease
Authors: Schlosser T. , Mohrs O. K. , Magedanz A. , Nowak B. , Voigtländer T. , Barkhausen J. , Schmermund A.
Published: May 2007

Purpose: To evaluate the value of 64-detector-row computed tomography for ruling out high-grade coronary stenoses in patients with a low to moderate pretest probability of significant coronary artery disease.

Material and Methods: The study included 61 patients with a suspicion of coronary artery disease on the basis of atypical angina or ambiguous findings in noninvasive stress testing and a class II indication for invasive coronary angiography (ICA). All patients were examined by 64-detector-row computed tomography angiography (CTA) and ICA. On a coronary segmental level, the presence of significant (⩾50% diameter) stenoses was examined.

Results: In a total of 915 segments, CTA detected 62 significant stenoses. Thirty-four significant stenoses were confirmed by ICA, whereas 28 stenoses could not be confirmed by ICA. Twenty-two of them showed wall irregularities on ICA, and six were angiographically normal. Accordingly, on a coronary segmental basis, 28 false-positive and 0 false-negative findings resulted in a sensitivity of 100%, a specificity of 96.8%, a positive predictive value of 54.8%, and a negative predictive value of 100%. The diagnostic accuracy was 96.9%.

Conclusion: Sixty-four-detector-row computed tomography reliably detects significant coronary stenoses in patients with suspected coronary artery disease and appears to be helpful in the selection of patients who need to undergo ICA. Calcified and non-calcified plaques are detected. Grading of stenoses in areas with calcification is difficult. Frequently, stenosis severity is overestimated by 64-detector-row computed tomography.
Influence of radiographic contrast media on myocardial oxygen tension: a randomized, NaCL-controlled comparative study of iodixanol versus iomeprol in pigs
Authors: Matschke K. , Gerk U. , Mrowietz C. , Park J. -W. , Jung F.
Published: May 2007

Purpose: To examine how a one-time bolus injection of radiographic contrast media (RCM; iodixanol 320 and iomeprol 350) into the left coronary artery of six pigs affects tissue oxygen tension in the artery's supply area (pO2 LAD) compared to a 0.9% sodium-chloride (NaCl) bolus.

Material and Methods: Each animal received a total of three boluses: one iodixanol, one iomeprol, and one NaCl (10 ml each). The radiographic contrast media and NaCl boluses were randomly assigned, and pO2 profiles were recorded.

Results: 26.7±16.4 s after iodixanol injection, pO2 LAD had declined by 3.5% from 42.2±5.6 mmHg to 40.7±5.9 mmHg ( P = 0.0357). After 53±16.7 s, the initial value was restored. The pO2 LAD was 41.9±7.4 mmHg before iomeprol injection, and, 303.3±58.9 s after injection, pO2 LAD had declined by 13.1% to 36.4±7.5 mmHg ( P = 0.0001). After 577±22 s, the initial value was restored. The bolus application of an isotonic NaCl solution resulted in no effect on pO2 LAD. Immediately after injection, it increased by 3%. In the supply area of the right coronary artery and the peripheral skeletal muscle, no effect of the RCM or NaCl on tissue oxygen tension was observed. Furthermore, no effect on tissue temperature, heart rate, systolic and diastolic blood pressure, or cardiac output per minute occurred.

Conclusion: The injection of RCM in a coronary artery can result in a significant local contrast-medium-induced microcirculation disorder. The high viscosity of iodixanol led to a very short-term insignificant effect on the microcirculation, while iomeprol induced a slight time-delayed pO2 decrease, which might be caused by the rigidification of erythrocytes. In comparison to a previous study with iopromide, the influence of iodixanol and iomeprol on myocardial oxygen tension was markedly less pronounced.
Lung cancer detection with low-dose spiral computed tomography in chronic obstructive pulmonary disease patients
Authors: Cilli A. , Ozkaynak C. , Onur R. , Erogullari I. , Ogus C. , Cubuk M. , Arslan G. , Ozdemir T.
Published: May 2007

Purpose: To determine whether low-dose spiral computed tomography (LDCT) can improve the lung cancer detection rate in chronic obstructive pulmonary disease (COPD) subjects.

Material and Methods: From October 1999 to December 2003, 374 COPD patients underwent LDCT for lung carcinoma screening. All subjects with an abnormal baseline CT scan were followed with serial CT scans as part of our protocol. Follow-up was continued until the demonstration of no change over a minimum of 24 months, or resolution. Sputum samples were also obtained for cytological analysis.

Results: On the baseline spiral CT scan, 132 of 374 patients (35.2%) had at least one non-calcified nodule that required periodic follow-up with CT scans. The median follow-up time was 21 months (range 2–48 months). Of the 374 COPD subjects, nine patients with primary lung cancer (2.4%) were detected: six were squamous cell carcinomas, two were small-cell lung carcinomas (SCLC), and one was adenosquamous carcinoma. Three of the nine tumors were in stage IA, two in stage IIB, two in stage IIIA, and two were limited SCLC. Potentially curative pulmonary resection was performed in four patients, pulmonary lobectomy in three, and wedge excision in one. One subject with stage IA squamous cell carcinoma received radiotherapy, as pulmonary function was severely impaired. In addition, four patients underwent removal of benign lesions. Sputum was collected in 205 (54.8%) of 374 patients. There were 154 (75 %) metaplasia, 14 (6%) moderate dysplasia, and one (0.4%) malignant case.

Conclusion: LDCT increases early lung carcinoma detection rate in COPD patients, but pulmonary function impairment may reduce its benefit.