bluuebunny/crossref_metadata_2025 huggingface dataset:
Suboptimal care in stillbirths – a retrospective audit study
Authors: SAASTAD ELI , VANGEN SIRI , FRØEN J FREDERIK
Published: May 2007

Background. Stillbirth rates have decreased radically over the last decades. One reason for this is improved perinatal care. The aim of this study was to explore whether sub‐optimal factors in stillbirths were more frequent among non‐western than western women. Methods. Population‐based perinatal audit of 356 stillbirths after gestational week 23, in 2 Norwegian counties during 1998–2003 (4.2 per 1,000 deliveries); of these 31% were born to non‐western women. By audit, the stillbirths were attributed to optimal or sub‐optimal care factors. Multivariate methods were used to analyse the data. Results. Sub‐optimal factors were identified in 37% of the deaths. When compared to western women, non‐western women had an increased risk of stillbirth (OR: 2.2; 95% CI: 1.3–3.8), and an increased risk of sub‐optimal care (OR: 2.4; 95% CI: 1.5–3.9). More often, non‐western women received sub‐optimal obstetric care (p<0.001), as e.g. failure to act on non‐reassuring fetal status or incorrect assessment of labour progression. A common failure in antenatal care for both groups was unidentified or inadequate management of intrauterine growth restriction or decreased fetal movements. Non‐western women were less prone to attend the program for antenatal care or to take the consequences of recommendations from health professionals. Inadequate communication was documented in 47% of non‐western mothers; an interpreter was used in 29% of these cases. Conclusions. Non‐western women constituted a risk group for sub‐optimal care factors in stillbirths. Possibilities for improvements include a reduction of language barriers, better identification and management of growth restriction for both origin groups, and adequate intervention in complicated vaginal births; with increased vigilance towards non‐western women.
Cesarean section on maternal request: reasons for the request, self‐estimated health, expectations, experience of birth and signs of depression among first‐time mothers
Authors: WIKLUND INGELA , EDMAN GUNNAR , ANDOLF ELLIKA
Published: May 2007

Objective. The purpose of this study was to investigate first‐time mothers undergoing cesarean section in the absence of medical indication, their reason for the request, self‐estimated health, experience of delivery, and duration of breastfeeding. We also aimed to study if signs of depression postpartum are more common in this group. Method. In a prospective cohort study 357 healthy primiparas from two different groups, “cesarean section on maternal request” (n = 91) and “controls planning a vaginal delivery” (n = 266) completed three self‐assessment questionnaires in late pregnancy, two days after delivery and 3 months after birth. Symptom scores from the Edinburgh postnatal depression scale at three months after birth were also investigated. Results. Women requesting cesarean section experienced their health ass less good (p<0.001) and were more often planning for one child only (p<0.001). They more often reported anxiety for lack of support during labor (p<0.001), for loss of control (p<0.001), and concern for fetal injury/death (p<0.001). After planned cesarean section women in this group reported a better birth experience compared to women planning a vaginal birth (p<0.001). They were breastfeeding to a lesser extent three months after birth (p<0.001). There were no differences in signs of postpartum depression between the groups three months after birth (p = 0.878). Conclusion. The knowledge gained from this study may help in understanding why some women prefer to give birth with elective cesarean section. It also elucidates the need for awareness of professional support during vaginal birth.
Effects of maternal central hemodynamics on fetal heart rate patterns
Authors: TAMÁS PETER , SZILÁGYI ANDRÁS , JEGES SÁRA , VIZER MIKLÓS , CSERMELY TAMÁS , IFI ZSOLT , BÁLINT ANDRÁS , SZABÓ ISTVÁN
Published: May 2007

Background. This study was undertaken to evaluate the effects of maternal central hemodynamics on fetal heart rate patterns near term, with special regard to the maternal body position. Methods. Brief non‐stress test and bioimpedance cardiography were carried out in the supine position, then repeated in a full left lateral decubitus position of mothers with singular, 36–39 week‐old normal pregnancies in 106 cases. Computer‐aided data were processed by SPSS statistic program. Results. Due to the appearance of inferior vena cava syndrome, examinations had to be interrupted in 6 cases. Analysis of 100 complete registrations revealed a significantly increased number of accelerations, overall and short‐term variations, and longer high episodes with lower basal fetal heart rates were found in the lateral decubitus than in the supine maternal position. Turning to the left resulted in a significant increase of the stroke volume; however, due to decreasing pulse rate, the cardiac output remained unchanged. Parameters of non‐stress test showed correlations to hemodynamic indices. In the supine position, the short‐term variation correlated with cardiac output (r = 0.232, p = 0.020); in the left lateral position, the number of accelerations correlated with stroke volume (r = 0.221, p = 0.027) and cardiac output (r = 0.220, p = 0.028). Changes of stroke volume due to altered body position correlated to similar changes of overall variation (r = 0.264, p = 0.018), and marginally to those of short‐term variation (r = 0.221, p = 0.051). Conclusion. Maternal central hemodynamics influences fetal heart rate patterns in connection with different maternal body position.
Self‐administered measurement of symphysis‐fundus heights
Authors: BERGMAN EVA , KIELER HELLE , PETZOLD MAX , SONESSON CHRISTIAN , AXELSSON OVE
Published: May 2007

Background. Antenatal identification of infants small for gestational age (SGA) improves their perinatal outcome. Repeated measurement of symphysis‐fundus (SF) heights performed by midwives is the most widespread screening method for detection of SGA. However, the inefficiency of this method necessitates improved practices. Earlier start and more frequent SF measurements, which could be accomplished by self‐administered measurements, might improve the ability to detect deviant growth. The present study was set up to evaluate whether pregnant women can reliably perform SF measurements by themselves.Method. Forty healthy women with singleton and ultrasound‐dated pregnancies from 2 antenatal clinics in Uppsala, Sweden, were asked to perform 4 consecutive SF measurements once every week, from 20 to 25 weeks of gestation until delivery. The self‐administered SF measurements were recorded and systematically compared with midwives’ SF measurements.Results. Thirty‐three pregnant women performed self‐administered SF measurements over a 14‐week period (range: 1–21). The SF curves constructed from self‐administered SF measurements had the same shape as previously constructed population‐based reference curves. The variance for self‐administered SF measurements was higher than that of the midwives.Conclusions. Pregnant women are capable of measuring SF heights by themselves, but with higher individual variance than midwives. Repeated measurements at each occasion can compensate for the higher variance. The main advantage of self‐administered SF measurements is the opportunity to follow fetal growth earlier and more frequently.
Sequence variants in exons of the BMP‐15 gene in Chinese patients with premature ovarian failure
Authors: ZHANG PENG , SHI YU‐HUA , WANG LAI‐CHENG , CHEN ZI‐JIANG
Published: May 2007

Background. The bone morphogenetic protein‐15 (BMP‐15) gene is thought to be one of the important candidate genes involved in premature ovarian failure (POF). However, to date, there has been no consensus on the relationship between mutations in BMP‐15 and ovarian dysfunction. Objective. To analyse mutations in the BMP‐15 gene in Chinese women with POF. Materials and methods. We sequenced the BMP‐15 gene protein coding region of 92 patients and 76 healthy controls that cycle regularly. Results. No mutations were found in the BMP‐15 gene protein coding region. There was no difference in the incidence of single nucleotide polymorphism (SNP) rs 17003221 (C→T) in exon 2 (p>0.05), or SNP rs (3810682C→G: ss16336587) in the putative promoter region of exon 1, between the two groups. However, the allele gene frequency in SNP rs (3810682C→G: ss16336587) was C (97.92%) and G (2.08%), respectively, in Chinese women, which is different from other races. Conclusions. Our findings indicate that mutations in BMP‐15 exons, or changes in BMP‐15 pro‐peptide, are rare in Chinese women with POF. In addition, our data suggest that the 2 SNPs are not related to POF in Chinese women, while providing evidence for SNP variation between different races.
Extraperitoneal laparoscopic para‐aortic lymphadenectomy as a diagnostic procedure for lymph node recurrence of gynaecological cancers
Authors: SANJUÁN A. , ILLA M. , TORNÉ A. , MARTÍNEZ ROMÁN S. , JURADO M. , LEJARCEGUI J.A. , PAHISA J.
Published: May 2007

Objective. The aim of this study was to evaluate the feasibility of extraperitoneal laparoscopic para‐aortic lymphadenectomy for lymph node recurrence of gynecological cancers. Methods. Seven patients underwent extraperitoneal laparoscopic para‐aortic lymphadenectomies for suspected lymph node recurrence, detected by magnetic resonance image or CT scan. The suspicious nodes were removed through an extraperitoneal laparoscopic approach. Results. The median age of patients was 51 years (range: 39–67). The median operating time was 207 min (range 120–300). There were no intraoperative or postoperative complications. The median nodal yield was 7.3 (range: 1–15). The median hospital stay was 2.5 days (range: 2–3). Histological examination revealed metastasis in 6 of the 7 patients. Conclusion. The extraperitoneal laparoscopic para‐aortic lymphadenectomy for lymph node recurrence of gynecological cancers is a safe and feasible procedure which should be considered in the case of possible recurrence.
New insights into fatigue and health‐related quality of life after delivery
Authors: JANSEN A.J. GERARD , DUVEKOT JOHANNES J. , HOP WIM C.J. , ESSINK‐BOT MARIE‐LOUISE , BECKERS ERIK A.M. , KARSDORP VERONIQUE H.M. , SCHERJON SICCO A. , STEEGERS ERIC A.P. , VAN RHENEN DICK J.
Published: May 2007

Background. A delivery has a major impact on the health‐related quality of life (HRQoL) of the new mother, especially on fatigue. A common complication during delivery that might have a relationship with maternal morbidity is blood loss. The objectives were to investigate fatigue and HRQoL in women after vaginal delivery (VD), elective caesarean section (CS) and emergency CS, and its relationship with postpartum hemoglobin (Hb) levels during the first 6 weeks postpartum. Methods. Some 141 patients (71 after VD, 36 after elective CS and 34 after emergency CS) completed the HRQoL questionnaires MFI and EQ‐5D between 12 and 24 h after VD and 24–48 h after CS (t = 0). At 1, 3 and 6 weeks postpartum these questionnaires were repeated, together with the SF36. Results. Patients after VD had higher mean physical HRQoL scores than after CS. The average period to reach full physical recovery was 3 weeks after VD, 6 weeks after elective CS, and >6 weeks after emergency CS. Mean mental HRQoL scores of the study groups were similar or even better compared to reference values. The significant correlation between Hb level and mean physical HRQoL scores found at t = 0 had disappeared at 1 week postpartum. Conclusions. Results of this study provided insights into the natural course of fatigue and HRQoL postpartum. Important differences in fatigue and HRQoL scores were observed between the 3 modes of delivery. These HRQoL measures can be used in future clinical trials to assess the effects of interventions postpartum.
Sentinel node and vulvar cancer: a series of 47 patients
Authors: NYBERG REITA H. , IIVONEN MARJO , PARKKINEN JYRKI , KUOPPALA TAPIO , MÄENPÄÄ JOHANNA U.
Published: May 2007

Background. There is growing interest to apply the sentinel node technique in the treatment of vulvar cancer. Methods. All charts of the patients operated on for vulvar cancer at Tampere University Hospital from January 1, 2001 through June 30, 2005 were retrospectively reviewed. Demographic, clinical, and histopathological information was collected from each patient. The sentinel lymph node mapping was done intraoperatively either with a combination of the radioisotope and dye techniques (40 patients) or with the dye technique alone (7 patients). The sentinel lymph node was dissected separately for histopathological evaluation, and then a routine inguinal lymphadenectomy was performed. Results. The final FIGO surgical Stage distribution was: Stage I, 11 (23%); Stage II, 14 (30%); Stage III, 21 (45%); and Stage IV, 1 (2%). Sentinel lymph node was identified in 46 (98%) women with either one or both of the methods. In Stage I–II, the sentinel lymph node identification rate was 25/25 (100%) with the combined method. The only patient with unidentified sentinel lymph node had lymphatic spread beyond inguinal area or Stage IV disease. Eighteen of the sentinel lymph nodes (39%) were positive for tumor cells, and in 5 cases additional metastatic nodes were found. One patient with macroscopically enlarged metastatic inguinal nodes and Stage III disease had a negative sentinel lymph node. In the 25 patients with Stage I–II disease, the false‐negative rate of the sentinel lymph node method was 0/4, giving a negative predictive value of 1.00. Conclusions. A sentinel node identification rate of 98% with a false‐negative rate of 0% in the patients with Stage I–II disease is an encouraging finding.
Surgery of borderline tumors of the ovary: retrospective comparison of short‐term outcome after laparoscopy or laparotomy
Authors: ØDEGAARD ELIN , STAFF ANNE CATHRINE , LANGEBREKKE ANTON , ENGH VIBEKE , ONSRUD MATHIAS
Published: May 2007

Background. Laparoscopic management of borderline ovarian tumors is controversial. Objective. To retrospectively compare outcome after surgery by laparoscopy or laparotomy for borderline tumors. Methods. Ovarian tumors from all women operated at Ullevål University Hospital during a five‐year period were re‐evaluated histologically. Patients with borderline FIGO (International Federation of Gynaecology and Obstetrics) stage I tumors were retrospectively compared regarding surgery outcome following laparoscopy or laparotomy. Results. Histological re‐evaluation revealed only 3 misclassifications in 608 patients. Borderline tumors represented 36% of epithelial ovarian malignancies. The 107 borderline stage I included 52 serous, 53 mucinous, and 2 endometrioid tumors. Thirty‐eight patients were operated on primarily by laparoscopy and 69 by laparotomy (including 14 women starting with laparoscopy). In the laparoscopy group, more women were premenopausal (63% versus 35%, p = 0.01) and median tumor diameter was smaller (8.6 versus 16.4 cm, p<0.001) as compared to the laparotomy group. When tumor diameter exceeded 10 cm, intraoperative tumor rupture was significantly more frequent during laparoscopy than during laparotomy (p = 0.01). Less postoperative complications were seen after laparoscopic operations (p = 0.034), but laparoscopic surgeries were less extensive, without hysterectomy, as compared to laparotomy. During the 14–78 months follow‐up time, no relapse occurred in either group. After fertility‐sparing surgery, there was no statistical significant difference regarding successful pregnancies between the two groups. Conclusions. Laparoscopic treatment of borderline ovarian tumors is feasible if tumor is of moderate size (diameter below 10 cm), gives fewer complications, and shorter hospital stay. Long‐term follow‐up of larger materials is needed to determine the ultimate recurrence risk as well as fertility rates.
Accuracy of preoperative tumor grade and intraoperative gross examination of myometrial invasion in patients with endometrial cancer
Authors: TRAEN KOEN , HØLUND BERIT , MOGENSEN OLE
Published: May 2007

Background and aims. Preoperative prediction of metastases to the regional lymph nodes in women with endometrioid endometrial cancer is a challenge. According to the Danish Gynaecological Cancer Society guidelines, a pelvic lymphadenectomy is warranted in all poorly differentiated tumors and all stage Ic disease. We have evaluated the accuracy of preoperative tumor grade and intraoperative gross examination of myometrial invasion, in predicting the need for a pelvic lymphadenectomy. Methods. Preoperative tumor grade and intraoperative gross examination of myometrial invasion were prospectively registered in 72 women with stage I endometrioid endometrial cancer, operated between 1 September 2004 and 18 April 2006. The pre‐ and intraoperative findings were compared with the final pathology report. Results. The preoperative prediction of grade (well, moderate or poorly differentiated) was correct in 96% (69/72) of the patients. Gross examination of myometrial invasion correctly differentiated between stage Ia, Ib, and Ic disease in 89% (64/72) of the patients. The combination of preoperative tumor grade and intraoperative gross examination of myometrial invasion, led to wrong clinical decisions in 11% (8/72) of the patients. Three ‘unnecessary’ lymphadenectomies were performed, and 5 patients were primary operated upon without ‘warranted’ lymphadenectomy. Conclusions. Our data suggest that preoperative tumor grade and intraoperative gross examination of the uterus provide useful information for pre‐and intraoperative planning of pelvic lymphadenectomy. However, wrong decisions were made in 11% of the patients, and more reliable evaluation methods are needed.
Misoprostol‐only versus mifepristone plus misoprostol in induction of labor following intrauterine fetal death
Authors: VÄYRYNEN WILMA , HEIKINHEIMO OSKARI , NUUTILA MIKA
Published: May 2007

Background. Both misoprostol‐alone and a combination of mifepristone plus misoprostol have been used in induction of labor in cases of intrauterine fetal death (IUFD). Methods. Data from 130 women with IUFD at 21–42 weeks of gestation were analysed retrospectively. A total of 82 women received 100 μg (median) of misoprostol at 4‐h intervals. Some 48 women received 200 mg of mifepristone, followed 19 h (median) later by single doses of 25 μg of misoprostol at 4‐h intervals. Results. The induction‐to‐delivery time did not differ between the groups (13.3 versus 12.8 h). However, between 21 and 25 weeks of gestation, the induction‐to‐delivery time was shorter with the combination regimen (p = 0.04). The total dose of misoprostol needed was lower in the group pre‐treated with mifepristone (p = 0.0028). The 2 groups did not differ as regards complications experienced during labor and delivery. Conclusions. Both regimens, misoprostol‐only and the combination of mifepristone and misoprostol, are effective and safe in induction of labor after IUFD. Pre‐treatment with mifepristone is more effective at earlier gestational weeks.
Synergistic effect of renin‐angiotensin system and nitric oxide synthase genes polymorphisms in pre‐eclampsia
Authors: BENEDETTO CHIARA , MAROZIO LUCA , CICCONE GIOVANNINO , CHIEPPA GIUSEPPINA , QUAGLIA MARCO , MATULLO GIUSEPPE , BERTOLA LAURA , GUARRERA SIMONETTA , CARTURAN SONIA , STRATTA PIERO
Published: May 2007

Background. Components of the renin‐angiotensin system and endothelial nitric oxide synthase may co‐operate in spiral artery remodelling during placentation, and thus reduce the uteroplacental resistance typical of normal pregnancy. Since lack of such remodelling and abnormal placentation are specific features of pre‐eclampsia, it has been suggested that abnormal function of both components of the renin‐angiotensin system and endothelial nitric oxide synthase may be involved in its pathogenesis. However, previous studies of the association between pre‐eclampsia and polymorphisms of single genes encoding renin‐angiotensin system components and endothelial nitric oxide synthase have yielded conflicting results. The aim of this study was to assess if interactions among different polymorphisms of the renin‐angiotensin system and nitric oxide synthase are involved in the pathogenesis of pre‐eclampsia. Methods. Some 359 pregnant women were enrolled: 103 normotensive, 50 with chronic hypertension, 86 with gestational hypertension, and 120 with pre‐eclampsia. DNA analysis was performed to evaluate angiotensin‐converting enzyme I/D, angiotensin‐II receptor 1 1166A/C, angiotensinogen M235T and endothelial constitutive nitric oxide synthase 4b/a polymorphisms. Odds ratios (OR) with 95% confidence interval (CI) and χ2 tests were calculated. Results. The frequency of single gene polymorphisms was similar in each group. The frequency of pairs including the DD genotype of the angiotensin‐converting enzyme I/D polymorphism plus other homozygous genotypes was significantly higher in pre‐eclamptic patients than in controls (OR = 3.04, 95% CI = 1.16–7.93). Conclusions. Synergism of angiotensin‐converting enzyme I/D and other polymorphisms of renin‐angiotensin system components and nitric oxide synthase may be a risk factor for pre‐eclampsia.
Diagnosis and treatment of menorrhagia
Authors: HURSKAINEN R. , GRENMAN S. , KOMI I. , KUJANSUU E. , LUOTO R. , ORRAINEN M. , PATJA K. , PENTTINEN J. , SILVENTOINEN S. , TAPANAINEN J. , TOIVONEN J.
Published: May 2007

One‐third of all women experience heavy menstrual bleeding at some point in their life. In western countries, about 5% of women of reproductive age will seek help for menorrhagia annually. Half of all women who consult for hypermenorrhea have some uterine abnormality, most often fibroids (among patients under 40 years of age) and endometrial polyps (above 40 years of age). Appropriate treatment considerably improves the quality of life of these patients, and it is important to make a rigorous assessment of the patient to provide the best treatment options. This guideline provides instructions on how to examine and treat women of fertile age who have menorrhagia. The subject's own assessment of the amount of menstrual blood loss does not generally reflect the true amount. All patients should undergo a pelvic examination and, if the menstrual pattern has changed substantially or if anaemia is present, a vaginal sonography should be carried out as the most important supplemental examination. Vaginal sonography combined with an endometrial biopsy is a reliable method for diagnosing endometrial hyperplasia or carcinoma, but it is insufficient for diagnosing endometrial polyps and fibroids; these can be diagnosed more reliably by sonohysterography or hysteroscopy. Non‐steroidal anti‐inflammatory drugs and tranexamic acid reduce menstrual blood loss by 20–60%, and the effectiveness of a hormonal intrauterine system (IUS) is comparable with that of endometrial ablation or hysterectomy. Cyclic progestogens do not significantly reduce menstrual bleeding of women who ovulate. Treatment should be started with one of the drug therapies, i.e. the IUS, tranexamic acid, anti‐inflammatory drugs, or oral contraceptive. Drug treatment should be used and evaluated before surgical interventions are considered. With an effective training and feedback system, it is possible to organise the diagnostics, medical treatment and follow‐up of heavy menstrual bleeding in the primary health care setting or in outpatient clinics, which reduces the burden on specialist health care.
Mental Health Status of Aboriginal and Non-Aboriginal Australian Prisoners
Authors: Butler Tony , Allnutt Stephen , Kariminia Azar , Cain David
Published: May 2007

Objective: To compare the mental health of Aboriginal and non-Aboriginal prisoners in New South Wales.

Methods: The sample consisted of a cross-sectional random sample of sentenced prisoners, and a consecutive sample of reception prisoners. The sample was drawn from 29 correctional centres (27 male, two female) across New South Wales. Overall, 1208 men (226 Aboriginal), and 262 women (51 Aboriginal) participated in the study. Mental illness was detected using the Composite International Diagnostic Interview (CIDI-A) and a number of other screening measures incorporated into the programme.

Results: No differences were detected in mental illness between Aboriginal and non-Aboriginal men, apart from depression, which was lower in the latter group. Aboriginal woman were more likely than non-Aboriginal women to screen positive for symptoms of psychosis in the prior 12 months and have a higher 1 month and 12 month prevalence of affective disorder; they also had higher psychological distress scores. Suicidal thoughts and attempts were the same in both groups.

Conclusions: These findings confirm that the demand for mental health services in prisons is considerable, and that Aboriginal women are one of the most vulnerable groups. Services and programmes providing an alternative to incarceration are needed, as are culturally sensitive approaches to treatment.
Rural/Urban Differences in the Distribution of Eating Disorder Symptoms among Adolescents from Community Samples
Authors: Preti Antonio , Pinna Claudia , Nocco Silvia , Pilia Simona , Mulliri Emanuela , Micheli Valeria , Consuleo Casta Maria , Rita Petretto Donatella , Masala Carmelo
Published: May 2007

Objective: Rural/urban differences in the prevalence of mental disorders have often been reported in the last 30 years, among others in the distribution of eating disorder symptoms and suicide rates. The role of sex, age and socioeconomic status in the differences by place of residence has often been neglected in past studies.

Method: Two independent community samples of students (mean age=17.4 years, SD=1.4), taken from among those attending high school in an urban district (Cagliari; n=817) and in a rural one (Carbonia; n=507) of south Sardinia, Italy, were invited to fill in the Eating Attitudes Test (EAT), the Bulimic Investigatory Test of Edinburgh (BITE), the Body Attitudes Test (BAT) and the revised Hopkins Symptom checklist (SCL-90-R).

Results: Female students scored higher than male students on all inventories. In male participants, the scores on the EAT were higher in the urban than in the rural sample. Conversely, in both male and female students the rural sample reported higher scores on the BITE symptoms subscale. When the comparison was confined to the fraction of those who scored higher than the suggested cut-off on the EAT and the BITE, students in the urban sample outnumbered those in the rural sample. No other differences were found. Socioeconomic status and age did not influence the differences in the reporting of eating disorder symptoms by place of residence.

Conclusions: Although caution is required when reading the findings drawn from self-report instruments, it is evident that the factors influencing the distribution of eating disorder symptoms and their psychological correlates by place of residence are far more complex than currently thought.
Indigenous Australians’ Understandings Regarding Mental Health and Disorders
Authors: Ypinazar Valmae A. , Margolis Stephen A. , Haswell-Elkins Melissa , Tsey Komla
Published: May 2007

The purpose of the present paper was to determine what is currently documented about Indigenous Australians’ understandings of mental health and mental disorders through a meta-synthesis of peer-reviewed qualitative empirical research. The following databases were electronically searched (1995–April 2006): AOA-FT and AIATSIS, Blackwell Synergy, CINAHL and Pre CINHAL, Health source: nursing/academic edition, Medline, Proquest health and medical complete, PsycInfo, Science Direct, Synergy and Health InfoNet. Eligible studies were those written in English and published in peer-reviewed journals, empirical studies that considered Indigenous people's understandings of mental health and provided details on methodology. Five articles from four qualitative studies met these criteria. Meta-ethnography was used to identify common themes emerging from the original studies. Reciprocal translation was used to synthesize the findings to provide new interpretations extending beyond those presented in the original studies. An overarching theme emerged from the synthesis: the dynamic interconnectedness between the multi-factorial components of life circumstances. Reciprocal translations and synthesis regarding Indigenous understandings of mental health and illness resulted in five themes: (i) culture and spirituality; (ii) family and community kinships; (iii) historical, social and economic factors; (iv) fear and education; and (v) loss. The application of a meta-synthesis to these qualitative studies provided a deeper insight into Indigenous people's understandings of mental health and illness. The importance of understanding Indigenous descriptions and perceptions of mental health issues is crucial to enable two-way understandings between Indigenous people's constructs of wellness and Western biomedical diagnostic labels and treatment pathways for mental disorders and mental health problems.
Comparison of Diagnostic Guidelines for Juvenile Bipolar Disorder
Authors: Cahill Catherine , Hanstock Tanya , Jairam Rajeev , Hazell Philip , Walter Garry , Malhi Gin S.
Published: May 2007

The purpose of the present paper was to compare currently available diagnostic guidelines for juvenile bipolar disorder with respect to utility in research and clinical practice. A systematic search of psychiatric, medical and psychological databases was conducted using the terms ‘juvenile bipolar disorder’, ‘paediatric bipolar disorder’ and ‘guidelines’. Three main sets of guidelines issued by the National Institute of Health and Clinical Excellence (UK), The National Institute of Mental Health (USA) and Child Psychiatric Workshop (USA) were found. There were key differences in the recommendations made by each regarding the diagnosis and symptomatic presentation of juvenile bipolar disorder. Although the diagnosis of juvenile bipolar disorder is gaining increased recognition, its definition remains controversial. It is recommended that clinicians and researchers need to develop diagnostic guidelines that have clinical salience and can be used for future research by incorporating key features of those that are currently available.
Depressive symptom manifestation and help‐seeking among Chinese college students in Taiwan
Authors: Chang Hsaiowen
Published: May 2007

One longstanding hypothesis in the research of depression among Chinese populations is that they tend to express depressive symptoms in somatic terms, which, in turn, prevent them from seeking assistance from mental health services. This study aimed to examine the manifestation of depressive symptoms and its relationship to help‐seeking attitudes among Chinese college students. The Chinese Beck Depression Inventory‐II (BDI‐II; Beck, Steer, & Brown, 1996) and the Attitudes Toward Seeking Professional Psychological Help: Shortened Form (ATSPPH‐SF; Fischer & Farina, 1995) were administered to 1039 Chinese college students in a private university in Taiwan. Factor ratio scores analyses revealed that Chinese college students generally emphasized somatic complaints compared to cognitive‐affective complaints in expressing depressive symptoms. Probably‐depressed Chinese students (BDI‐II scores⩾16), however, placed significantly less emphasis on somatic symptoms than did nondepressed students. Additionally, multiple regression analyses showed that while Chinese students with elevated BDI‐II scores were less likely to seek professional psychological help, neither somatic nor cognitive‐affective symptoms were correlated with their attitudes toward seeking and avoiding professional psychological help. These findings seem to run counter to the common assumption that Chinese people tend to express depression in somatic terms and that somatic complaints help to explain their reluctance to seek professional psychological assistance. The current results suggest that Chinese students with elevated depressive symptoms readily acknowledged and expressed cognitive‐affective symptoms of depression and they were likely to distance themselves from professional psychological help. However, somatic symptoms did not explain their reluctance to utilize mental health services.
Emotion judgments do not differ as a function of perceived nationality
Authors: Matsumoto David
Published: May 2007

This article reports three studies concerning the relationship between emotion judgments and perceived nationality of the expressors being judged. Study 1 demonstrated that observers do not reliably make implicit assumptions about the nationalities of the expressors in judgment tasks. Study 2 examined judgments of Americans and Japanese observers who were told that Caucasian and Asian expressors were Americans and Japanese, respectively, and who made fixed‐choice judgments and intensity ratings. Study 3 examined judgments of Americans given similar instructions and who used a multiscalar rating task. Neither Studies 2 nor 3 provided evidence that nationality information affected judgments. These findings have implications not only for basic emotion theory, but also for international and intercultural communication training.
The IAT as a predictor of food choice: The case of fruits versus snacks
Authors: Richetin Juliette , Perugini Marco , Prestwich Andrew , O'Gorman Rick
Published: May 2007

One of the issues concerning the application of implicit measures like the IAT is whether they can be successfully applied to consumer choices. The empirical evidence of the predictive validity of the IAT so far has been mixed, both at the level of eating habits and of specific behavioural food choices. Moreover, whereas the predictive validity of the IAT has been tested in a number of studies, its incremental validity has not been studied as thoroughly. In this contribution, four studies, run at different points in time and analysed as a single sample (N = 399), tested the predictive and incremental validity of an IAT of attitudes towards fruits versus snacks on the choice of a fruit or a snack at the end of the experimental session. Specifically, an additive pattern in which both implicit and explicit measures predict independently, and an interactive one in which implicit and explicit measures predict interactively, were tested for the prediction of the behavioural preference towards snacks or fruits. The results showed that the IAT has both predictive and incremental validity, over and above the significant prediction provided by explicit measures for behavioural food choice. Furthermore, no interaction effect between implicit and explicit measures in the behavioural prediction was obtained, supporting the additive rather than the interactive pattern. Finally, only the explicit attitude towards snacks predicted behavioural choice whereas the explicit attitude towards fruits did not. This result indirectly suggests that a single target IAT might be fruitfully adopted in future research.
Self‐esteem discrepancies and defensive reactions to social feedback
Authors: Schröder‐Abé Michela , Rudolph Almut , Wiesner Anja , Schütz Astrid
Published: May 2007

Recent research has provided increasing evidence that discrepancies between implicit and explicit self‐esteem (SE) are related to defensiveness. However, only one pattern, called fragile SE (a combination of high explicit and low implicit SE), has been the focus of research so far. Relatively little attention has been paid to the second possible SE discrepancy (low explicit/high implicit). We propose that both types of discrepancies are maladaptive, because they indicate a lack of integration in self‐representation. We conducted two studies on the correlates of discrepant SE in the sphere of defensiveness. We hypothesized that persons with discrepant SE exhibit more defensive behaviour than individuals with congruent SE. In two student samples, explicit SE was measured by means of the Multidimensional Self‐Esteem Scale. Implicit SE was measured with the Name Letter Technique (Study 1) and an Implicit Association Test (Study 2). In Study 1 (N = 102) we examined effects of implicit and explicit SE on defensive reactions to ambiguous statements. For this purpose, we adapted the Ambiguous Statements Task (AST, Tafarodi, 1998), a procedure that measures participants' tendency to interpret ambiguous expressions in a positive vs negative manner. We found that the combination of low explicit SE and high implicit SE was associated with a more positive interpretation of the ambiguous statements. Study 2 (N = 87) investigated the effects of discrepant SE on reactions to SE threat in an experimental setting. The time participants spent reading positive or negative social feedback was used as an unobtrusive measure of defensiveness. We found that people with discrepant SE went through the negative feedback faster than people with congruent SE. In sum, the studies provide converging evidence that both kinds of discrepancies between implicit and explicit SE are related to defensive behaviour.
Understanding the individual implicitly and explicitly
Authors: Nosek Brian A.
Published: May 2007

The possibility that behaviour is shaped by cognitions outside of conscious awareness or control is a long‐standing feature of psychological theory. Empirical support for this theoretical stance is accelerating with the advent of methodological innovations for assessing implicit cognition. The articles in this Special Section provide evidence for the construct and predictive validity of implicit measures, especially the Implicit Association Test, and illustrate the value of implicit constructs for personality theory. This commentary briefly discusses each article, and notes that discrepancies between implicit and explicit responses can take multiple forms, each with distinct implications for understanding the individual.
The Iranian Afghans
Authors: Adelkhah Fariba , Olszewska Zuzanna
Published: May 2007

Emigration from Afghanistan is the product of socio-political circumstances—drought, regime changes, wars—and economic structures—pastoralism and agricultural seasonal cycles—but it is also situated in a historical continuum of recurrent population movements on a regional scale. As a phenomenon, it has been well-researched in Pakistan, but has been less well understood from the Iranian side. However, many Afghans, notably but not exclusively Hazaras, have settled there since the end of the nineteenth century. Immigration from Afghanistan intensified from the 1970s onwards following the Iranian oil boom and drought in Afghanistan and the political turbulence in that country after 1978. The policies of the Islamic Republic towards this population have been both variable and inconsistent. Recently, their main priority has been the repatriation of Afghans in an atmosphere of both official and popular xenophobia. The experience of exile has resulted in important social changes, in particular with respect to education and the position of women. Moreover, the Afghan presence on Iranian soil appears to be irreversible: it satisfies economic needs, reflects the intensity of commercial exchanges between the two countries, and in itself constitutes a complex trans-border reality. Finally, it sustains a public and juridical debate on the definition of citizenship and appears to be inherent in the idea of the Iranian nation itself.
Being Neighbors to Imam Reza: Pilgrimage Practices and Return Intentions of Hazara Afghans Living in Mashhad, Iran
Authors: Glazebrook Diana , Abbasi-Shavazi Mohammad Jalal
Published: May 2007

Many Shi'a Afghan refugees and migrants—most of whom are Hazara—have intentionally settled in Mashhad, Iran, the home of the Shrine of Imam Reza. Hazara also make pilgrimage to the Shrine of Imam Hossein located in Kerbala, Iraq. Hazara comprise nearly half of all documented Afghans in Iran, yet until mid-2005, their returns comprised only one quarter of the total UNHCR-assisted return figures to Afghanistan. Drawing on literature from anthropology and refugee studies on the affect of religious practice in a context of displacement, this article considers whether pilgrimage aspirations and practices of Hazara Afghans in Iran might constitute a factor in their decision making about repatriation to Afghanistan. The study proposes that the decision to return to Afghanistan for certain categories of Hazara is influenced by their pilgrimage practices and attachment to Shrine locations in Iran.
“A Desolate Voice”: Poetry and Identity among Young Afghan Refugees in Iran
Authors: Olszewska Zuzanna
Published: May 2007

At the time of the Soviet invasion of Afghanistan in 1979, it may be said that Afghans began to form exilic communities in Iran rather than simply intermittent groups of seasonal migrant workers. The binding institutions of these communities, in particular the community of Shi‘a Afghans in Mashhad, were political parties and groups ofmojahedin, religious centers and leaders, and cultural figures—notably poets. Poetry (both oral and written) in court Persian and local vernacular, has a long tradition in Afghanistan—much of which is shared with Iran—and continues to be the most respected and most widely practiced of the arts. It has also always had a direct, but not always approving, relationship with power and politics. Among refugees, it has been a vehicle for political commentary and incitement to jihad; for dialogue between Afghans and Iranians; and (in lyrical forms such as the classical ghazal or contemporary blank verse) for expressing subjective experience, thought, and emotion, particularly love or the pain of exile, with some license to criticize or subvert social convention. In this ethnographic analysis, I examine the role of poets and poetry in the cultural life of Afghans in Iran since 1979, focusing on the latest generation of young poets and tracing the influence of modernist Iranian literary developments on their work in the context of the gradual depoliticization of Afghan communities in exile, in particular after September 2001. I also argue that literary activities have been important in sustaining a separate ‘Afghan’ identity that has helped many young people transform their sense of marginalization to one of pride both in their non-Iranian origins and in their common heritage with Iranians.
Children's roles and use of evidence in science: an analysis of decision‐making in small groups
Authors: Maloney Jane
Published: May 2007

This article reports the findings of a research project concerned with children engaging in scientific argumentation. Discussion activities were designed to enable groups of children to use evidence when making decisions. The findings show a variation in the success with which children construct scientific arguments; some groups debate most of the evidence and consider a range of options, whilst others explore a limited range of options and discuss only the evidence that supports their choice. Analysis of the data indicates that the roles children adopt have an important influence on how evidence is used. Drawing of the work of Belbin, a management theorist who explored the roles adopted by members of successful teams, key roles emerged and a taxonomy of children's roles was devised. This article explains the characteristics of these roles and their effect on the way the groups use evidence when making decisions in science.
Vertebroplasty: magnetic resonance findings related to cement leakage risk
Authors: Koh Y. H. , Han D. , Cha J. H. , Seong C. K. , Kim J. , Choi Y. H.
Published: May 2007

Purpose: To find magnetic resonance (MR) findings predicting cement leakage in patients receiving percutaneous vertebroplasty (PVP) due to osteoporotic compression fractures.

Material and Methods: MR was done in 43 patients (age 52–89 years) before PVP (56 vertebrae), which was done via a bipedicular approach with fluoroscopic monitoring. Shortly after the procedure, a non-contrast-enhanced computed tomography (CT) scan was done at the vertebroplasty sites for evaluation of bone cement leakage. The following MR findings of fractured vertebral bodies were retrospectively reviewed for correlation with leakage risk: severity of bone-marrow edema, presence of a T2-weighted low-signal-intensity line, percentage residual vertebral body height, presence of either a vacuum or cystic change within the vertebral body, and presence of a cortical disruption.

Results: After PVP, cement leakage was detected in 35 vertebrae (62.5%). Leakage was most frequently observed in the anterior external vertebral venous plexus (46%). Cement leakage rate increased when there was a cortical disruption ( P = 0.037), especially at the endplates, while it decreased when there was a vacuum or a cystic change within the fractured vertebra ( P = 0.019). Other MR findings were not related to the risk of cement leakage.

Conclusion: The risk of cement leakage in PVP increases when MR shows cortical disruption in a fractured vertebral body, especially at the endplates. It decreases when MR shows a vacuum or cystic change within the body.
Ultrasound, computed tomography, and laboratory findings in the diagnosis of appendicitis
Authors: Johansson E. P. , Rydh A. , Riklund Åhlström K.
Published: May 2007

Purpose: To determine the diagnostic accuracy and the clinical impact of ultrasound (US) and computed tomography (CT) in diagnosing appendicitis, and to evaluate the impact of laboratory tests on the treatment of acute appendicitis.

Material and Methods: All patients who, during 2005, underwent an acute ultrasound or CT investigation due to suspected appendicitis, or were diagnosed and/or surgically treated for appendicitis at Umeå University Hospital, Umeå, were included. The type of radiological investigation, its findings, the choice of treatment, final diagnosis, C-reactive protein (CRP), leukocyte particle count (LPC), body temperature, age, and sex were recorded for each patient. The histological result from surgery was considered the gold standard.

Results: The material included 305 cases with an overall appendicitis prevalence of 58%. Fifty-two percent of the patients were female. The mean age was 29 years, with a total range of 2–94 years. Twenty percent (60/305) underwent a CT investigation, 40% (123/305) underwent an US investigation, 5% (14/305) underwent both a CT and an US investigation, and 35% (108/305) of patients did not undergo any radiological investigation at all. The sensitivities and specificities were 91% and 94% for CT, and 83% and 98% for US, respectively. The positive likelihood ratio was 15.1 and 45.5 for CT and US, and the negative likelihood ratio was 0.09 and 0.18 for CT and US, respectively. It was not possible to visualize the appendix in 31% of patients examined with US. The prevalence of appendicitis in this group was the same as the prevalence among patients where it was possible to see the appendix, i.e., 35%. The mean CRP for all patients with appendicitis was 59 (95% CI 10–491) mg/l, and the mean LPC was 11.1 (95% CI 2.6–28.1) ×10−9/l. The mean LPC level was significantly higher for the appendicitis patients. Body temperature could not significantly verify or exclude appendicitis. The overall negative appendectomy rate was 9% (16/176), and it was higher in women, i.e., 11% (9/79). The negative appendectomy rate was slightly higher in the group that was examined by CT and/or US, i.e., 12% (8/69) compared to 7% (8/107) in the group not examined radiologically.

Conclusion: Diagnostic accuracy was high for US as well as for CT. US was better for diagnosing positive findings, while CT was better for excluding diagnosis of appendicitis. The diagnostic accuracy of LPC, CRP, and body temperature was low. By combining findings from the radiological examination with the results from the clinical examination and laboratory values, a low negative appendectomy rate can be achieved.