bluuebunny/crossref_metadata_2025 huggingface dataset:
General practice intervention to increase opportunistic screening for chlamydia
Authors: Merritt Tony D. , Durrheim David N. , Hope Kirsty , Byron Paul
Published: December 2007

We describe an 18-month intervention that was designed to improve opportunistic screening for chlamydia in General Practice. Key strategies included engaging and informing general practitioners, adopting a simplified screening protocol, providing feedback on practice testing performance and developing resources for use with patients. This uncontrolled before and after study found that the overall impact on testing was modest and largely transient, and was insufficient to impact on the current chlamydia epidemic. Major additional measures would be required to further substantially increase testing levels. These could include financial incentives linked to screening performance and increased community awareness to increase patient demand for testing.
Introducing early medical abortion in Australia: there is a need to update abortion laws
Authors: de Costa Caroline M. , Russell Darren B. , de Costa Naomi R. , Carrette Michael , McNamee Heather M.
Published: December 2007

Recent changes to Federal Therapeutic Goods Administration legislation have seen the limited introduction of the drug mifepristone to Australia for the purpose of early medical abortion. At the same time it has become evident that both methotrexate and misoprostol, licenced and available for other indications, are being used safely and appropriately for early abortion by Australian medical practitioners. Early medical abortion is widely practiced overseas where its safety and effectiveness are well supported by current evidence. However, abortion law in many states is still contained within the Criminal Codes and does not reflect current evidence-based abortion practice. In other states and territories restrictions on where abortions may be performed pose potential barriers to the introduction of mifepristone for medical abortion. There is an urgent need for abortion law to be clarified and made uniform across the country so that the best possible services can be provided to Australian women.
11. SEX AND SPORT: A COMMUNITY BASED PROJECT OF CHLAMYDIA TESTING AND TREATMENT IN RURAL AND REGIONAL VICTORIA
Authors: Kong F. , Kyle-Link C. , Hocking J. , Hellard M.
Published: December 2007

Chlamydia is the most common notifiable infectious disease in Australia with the number of notifications increasing 92% over the past 5 years. The "Sex and Sport" Project is piloting a community based chlamydia testing and treatment program reaching young people in a specific community setting, sporting clubs. This multifaceted approach utilises health education, population screening and collection of data on risk taking behaviour as the first steps in enhancing health and shaping future service provisions. The project's primary aim is to assess the feasibility of an outreach testing and treatment program. Secondary aims are to measure the prevalence of chlamydia and assess sexual risk behaviour in this population.
Strong community collaborations and integration into local health services through the Primary Care Partnerships is important in the project's sustainability; in particular key community members respected by sporting clubs needed to be identified, capacity developed to deliver effective health promotion messages and improve young people's access to sexual health services. Additionally, local knowledge has guided overall program implementation and provides opportunities for capacity building to regionally based services. For example, poor access to sexual health services is being addressed by the participants being able to access services via telephone consultation with Melbourne Sexual Health Centre.
Approximately 1000 Victorians aged 16-25 years from the Loddon Mallee region of Victoria will be tested between June and September 2007.
This paper will report on the feasibility, challenges and possible solutions in establishing a community based outreach testing and treatment program.
16. A RANDOMIZED CONTROLLED TRIAL OF THE IMPACT OF EMAIL AND TEXT (SMS) MESSAGES ON THE SEXUAL HEALTH OF YOUNG PEOPLE
Authors: Lim M. S. C. , Hocking J. S. , Aitken C. K. , Jordan L. , Fairley C. K. , Lewis J. A. , Hellard M. E.
Published: December 2007

Objective: To trial a novel method of sexual health promotion - sending email and mobile phone text messages (SMS) about safe sex and STI to promote reductions in STI behaviours and increases in STI knowledge and testing.
Methods: Young people (aged 16-29) were recruited at a music festival in Melbourne. They completed a questionnaire about sexual risk behaviour and were randomised to either the intervention arm of the study (to receive messages) or a control group. Text messages were sent every 3-4 weeks for a twelve month period and included catchy STI prevention slogans. Emails were sent monthly and contained detailed information about STI topics and links to related websites. Participants completed follow-up questionnaires online after 3, 6 and 12 months. Clustered weighted estimating equations were used to compare outcomes of the two groups.
Results: 994 people completed at least one questionnaire (507 in the intervention group and 487 in the control group); at baseline 58% were female, the median age was 19 years and 82% had ever had sex. At 12 months, STI knowledge was higher among the intervention group for both males (OR 3.19, 95% CI 1.52, 6.69) and females (OR 2.36, 95% CI 1.27, 4.37). Females in the intervention group were also more likely to have discussed sexual health with a clinician (OR 2.92, 95% CI 1.66, 5.15) and to have had an STI test in the past 6 months (OR 2.51, 95% CI 1.11, 5.69). There were no significant differences in condom use between the groups. Respondents' opinions of the SMS and emails were positive.
Conclusions: Receiving regular sexual health-related SMS and email messages can improve knowledge in young people and health seeking behaviour in young women. SMS and email are low cost, widely available and convenient, which - when combined with their popularity among youth - means that these media have considerable potential for sexual health promotion.
25. ANAL SEXUALLY TRANSMISSIBLE INFECTIONS AS RISK FACTORS FOR HIV SEROCONVERSION
Authors: Jin F. , Prestage G. P. , Imrie J. C. G. , Kippax S. C. , Pell C. M. , Donovan B. , Templeton D. J. , Cunningham P. H. , Cunningham A. L. , Mindel A. , Kaldor J. M. , Grulich A. E.
Published: December 2007

Objectives: Sexually transmitted infections (STIs) are believed to increase the risk of HIV acquisition, but few studies have focused on homosexual men. We examined sexual behaviour and common STIs as independent risk factors for HIV seroconversion in a community-based cohort of homosexual men in Sydney.
Methods: Between 2001 and 2004, 1427 initially HIV-negative men were enrolled. They were tested annually for HIV, for gonorrhoea and chlamydia in the urethra and anus (strand displacement amplification, BDProbeTec), and for herpes simplex virus types 1 and 2 (HSV-1 and HSV-2) using type specific ELISA. Participants also reported diagnoses of STIs since their last interview. Detailed information on sexual risk behaviours was collected every 6 months.
Results: There were 49 HIV seroconversions through 2006, an incidence of 0.80 per 100PY. A higher number of episodes of insertive and receptive unprotected anal intercourse (UAI) with HIV positive or HIV status unknown partners was each significantly associated with HIV seroconversion. In multivariate analysis of behavioural risk factors, HIV seroconversion was significantly associated with a higher number of episodes of receptive UAI with a partner of unknown HIV status (p trend <0.001) or with a partner known to be HIV positive (p trend <0.001). After controlling for these sexual behaviours, a study diagnosis of anal gonorrhoea remained strongly related to HIV seroconversion (RR�=�7.41, 95% CI 1.75-31.75). Most cases of anal gonorrhoea diagnosed were asymptomatic. In addition, there was an independent association with anal warts (RR�=�3.43, 95% CI 1.43-8.19), and prevalent HSV-1 infection was of borderline significance (RR�=�2.78, 95% CI 0.99-7.80).
Conclusion: Certain anal STIs were associated with HIV seroconversion, even after adjustment for UAI. For some anal conditions, in particular gonorrhoea, infection was frequently asymptomatic. Screening for anal STIs should be investigated as a potential HIV prevention intervention.
30. TESTING FOR SEXUALLY TRANSMISSIBLE INFECTIONS AMONG GAY MEN IN SYDNEY, AUSTRALIA
Authors: Prestage G. , Zablotska I. , Frankland A. , Imrie J. , Grulich A.
Published: December 2007

Introduction: Recently, rates of sexually transmissible infections (STIs) have been increasing among gay men in Australia and elsewhere. We explored trends in STI testing among gay men in Sydney.
Methods: We used behavioural data from the six-monthly Sydney Gay Community Periodic Survey (SGCPS). Men are recruited through gay community venues, clinics and events in Sydney. Since 2003 men were asked whether they had received the following tests in the previous year: Anal swab, throat swab, penile swab, urine sample, and blood test for STIs other than HIV. Men recruited from clinics were excluded from the following analyses.
Results: In 2006, 3145 completed questionnaires were received from non-clinic sites, with 40.9% of respondents reporting having received an anal swab, 45.4% a throat swab, 34.6% a penile swab, 52.7% a urine sample, and 56.1% a blood test for STIs other than HIV. The majority (67.2%) reported at least one test for STIs, with 25.5% having received all five forms of STI test. Although there was no increase during 2003-2006 in having any STI tests, the proportion of men having received all five types of test increased. The largest increase was in the proportion reporting anal swabs: from 23.8% in 2003 to 40.9% in 2006. Among men reporting unprotected anal intercourse with casual partners (UAIC), as well as among men with more than ten casual partners in the previous six months, rates of STI testing were higher but the time trends were similar.
Conclusion: The majority of men report STI testing in the previous year, and this testing has become more comprehensive, with men receiving a broader range of STI tests over time. Men at higher risk for STIs tested at increased rates.
44. SEX AND SEXAGENARIANS
Authors: Dennerstein L. , Guthrie J.
Published: December 2007

This paper will describe the sexual function of postmenopausal women in their seventh decade and contrast this with their sexual function some 13 years earlier when the women were premenopausal.
The presentation uses data obtained in the Melbourne Women's Midlife Health project, a longitudinal population based study of women's health. Australian-born women aged 45!!55 and resident in Melbourne were eligible for the initial telephone interview. All those who were still menstruating and not taking the oral contraceptive pill were invited to take part in a longitudinal study.
At follow-up, a similar proportion of the women had a sexual partner at mean ages of 51 (81%) and 63 (83%). A marked decline in sexual function was evident. The percentage of partnered women who became sexually inactive increased from 17 to 23%, the percentage who had sex less than once a week increased from 15% to 42%, while the percentage having sex more than once a week declined from 20% to 4%.
The overall score on the SPEQ significantly declined but only 19% of these women were significantly distressed about this. When specific domains of sexual function were examined, women using hormone therapy at L13 have significantly higher libido and greater responsivity (Sexual Response) than postmenopausal women not using HT. There was no significant difference with respect to dyspareunia, frequency of intercourse, partner problems or partner feelings. Sexual Response was significantly affected by prior function, feelings for partner, change in partnership, estradiol level and mood as well as aging. The circulating level of estradiol is highly significantly linked to Sexual Response.
Thus both chronologic and reproductive aging have negative effects on sexual function and estradiol therapy may be needed.
48. TREPONEMA PALLIDUM PCR: APPLICATION AND DIAGNOSTIC VALUE IN 2 CASES OF PRIMARY SYPHILIS
Authors: Lowe P. C. , Couldwell D. L. , Jeoffreys N.
Published: December 2007

Epidemics of infectious syphilis have been ongoing in large cities in industrialised countries since the turn of the millennium. These epidemics have almost exclusively involved homosexually active men, with a disproportionately high rate among HIV infected individuals. Genital ulcerative disease, including syphilis, has a strong correlation with onward transmission of viral and bacterial sexually transmitted infections.
Due to the lack of a culture system for Treponema pallidum, the causative organism of syphilis, other direct test methods are needed in the evaluation of skin lesions possibly due to syphilis. Dark ground microscopy was once commonly used by sexual health clinicians, but skills in this method have waned in recent years. Polymerase chain reaction (PCR) assays are being increasingly used in the diagnosis of infectious syphilis.
We describe the use of a nucleic acid amplification assay for Treponema pallidum, which targets the 47 kilodalton gene, in the diagnosis of primary syphilis in 2 patients with genital lesions. The first patient was an HIV infected man who presented with an ulcer typical of a chancre but who denied any recent risk behaviour. The second was an HIV negative homosexually active man with an atypical genital lesion. In both cases, Treponema pallidum PCR was positive and serology was consistent with the diagnosis of primary syphilis.
Conclusion/Recommendation: Appropriately validated Treponema pallidum nucleic acid amplification assays could replace dark ground microscopy and direct fluorescent antigen tests as a direct test for early infectious syphilis. It could be particularly useful in individuals who have treponemal skin lesions of atypical appearance.
59. PATIENT DELIVERED PARTNER THERAPY FOR CHLAMYDIAL INFECTION: WHAT WOULD BE MISSED?
Authors: McNulty A. M. , Teh M. F. , Freedman E. F.
Published: December 2007

The number of contacts of STIs who are tested and treated is generally low. Patient delivered partner therapy ( PDPT) has been proposed in order to increase the number of sexual partners of the index case that are treated. PDPT does not require the contact to be clinically assessed and tested. We sought to determine whether PDPT for chlamydial infection would result in missed diagnoses of other STIs or of the complications of chlamydial infection.
The Sydney Sexual Health Centre database was accessed to identify patients who presented as contacts of chlamydia and chlamydia associated conditions and to determine whether other STIs were diagnosed at the time of presentation. Those who were contacts of more than one bacterial STI or HIV were excluded. In the 3 years from June 2003 to June 2006, 626 individuals presented as contacts of chlamydia, NGU or PID. Of these, 212 (34%) tested positive for Chlamydia trachomatis by PCR. Of the 442 heterosexual patients, 36% had chlamydial infection diagnosed. Of the 184 men who had sex with men (MSM), 29% had chlamydial infection diagnosed. Of the heterosexuals who presented as contacts, 13 were diagnosed with other bacterial STIs or complications of chlamydia. Of these, 2 women and 2 men had gonococcal infection (0.9%), 1 woman had syphilis of unknown duration, 6 women (3%) were diagnosed with PID and 2 men (0.8%) with epididymitis. Of the MSM, 9 (5%), were newly diagnosed with HIV infection, 15 (8%) with gonococcal infection and none with syphilis.
PDPT would result in a missed opportunity to diagnose other STIs in MSM. In heterosexuals a small number of cases of PID and epididymitis would be inadequately treated and a small number of gonococcal infections would be missed.
69. LABORATORY CONTRIBUTION FOR CONTROL OF CHLAMYDIA
Authors: Tabrizi S.
Published: December 2007

Infection with Chlamydia trachomatis may present a wide spectrum of clinical symptoms in patients. Diagnosis based on presenting symptoms however may be of limited value in asymptomatic patients. Therefore, laboratory tests are utilized; in particular nucleic acid amplification technology (NAAT) based assays. In the recent years, NAAT testing has improved diagnosis of chlamydia to a great degree. The increased sensitivity of NAAT assays has also allowed for better detection of chlamydia in extragenital samples, diagnosis of lymphogranuloma venereum and has made the use of non-invasive self-collected samples possible. Chlamydia genotyping and sequence based comparisons are also increasingly being used in investigation of types present in the population as well as providing possibility of differentiating a new infection from re-infection. Such methods continue to play a major role not only in patient diagnosis but also in epidemiology and public health.
8. 'STAMP OUT CHLAMYDIA' PROJECT - BRINGING CHLAMYDIA SCREENING TO TERTIARY STUDENTS IN THE AUSTRALIAN CAPITAL TERRITORY
Authors: Davis B. K. , Schmidt M. , O'Keefe E. , Currie M. J. , Baynes A. M. , Bavinton T. , McNiven M. , Bowden F. J.
Published: December 2007

Study's objective: Stamp Out Chlamydia (SOC) is a pilot research project funded by the Commonwealth Department of Health & Aging to devise and implement a cost effective program for education and chlamydia screening for ACT tertiary students aged 16-26 years at The Australian National University (ANU), University of Canberra and Canberra Institutes of Technology, that may be suitable for national implementation.
Methodology: A collaborative clinical outreach project between Canberra Sexual Health Centre, Sexual Health and Family Planning ACT and ANU Medical School, whereby the SOC team attends student-initiated events on ACT tertiary campuses to educate and test young people, using self-obtained urine specimens.
Summary of Results: The majority of these outreach events were attended by two Registered Nurses and the Health Promotion Officer. To date they have attended 19 events including Orientation Week activities, BBQ's, Easter Scavenger Hunt, Gay Pride Week events and sports events. Promoting the SOC project has been through word of mouth, SOC 'Champions', convenience and media advertising and a dedicated web site.
By May 2007 the SOC project had:

Interfaced with 1512 tertiary students and offered them the opportunity to participate in the research

Screened 445 for chlamydia

Found a chlamydia prevalence of 1.8%

Treated eight cases and their contacts

Of those screened:

Male 240

Female 205

Target group 412

Conclusion: ACT tertiary students accept this outreach approach. Of students approached, over a quarter agreed to have screening. The high profile of the SOC project is leading to an increased awareness of chlamydia. Many students are unaware of the high incidence and/or the consequences of chlamydia, if left untreated and report that they would not have attended mainstream services for screening.
Ongoing data analysis will determine if this project is cost effective and feasible.
A high-affinity molybdate transporter in eukaryotes
Authors: Tejada-Jiménez Manuel , Llamas Ángel , Sanz-Luque Emanuel , Galván Aurora , Fernández Emilio
Published: December 2007

Molybdenum is an essential element for almost all living beings, which, in the form of a molybdopterin-cofactor, participates in the active site of enzymes involved in key reactions of carbon, nitrogen, and sulfur metabolism. This metal is taken up by cells in form of the oxyanion molybdate. Bacteria acquire molybdate by an ATP-binding-cassette (ABC) transport system in a widely studied process, but how eukaryotic cells take up molybdenum is unknown because molybdate transporters have not been identified so far. Here, we report a eukaryotic high-affinity molybdate transporter, encoded by the green alga
Chlamydomonas reinhardtii
gene
MoT1
. An antisense RNA strategy over the
MoT1
gene showed that interference of the expression of this gene leads to the inhibition of molybdate transport activity and, in turn, of the Mo-containing enzyme nitrate reductase, indicating a function of
MoT1
in molybdate transport. MOT1 functionality was also shown by heterologous expression in
Saccharomyces cerevisiae
. Molybdate uptake mediated by MOT1 showed a
K
m
of ≈6 nM, which is the range of the lowest
K
m
values reported and was activated in the presence of nitrate. Analysis of deduced sequence from the putative protein coded by
MoT1
showed motifs specifically conserved in similar proteins present in the databases, and defines a family of membrane proteins in both eukaryotes and prokaryotes probably involved in molybdate transport and distantly related to plant sulfate transporters SULTR. These findings represent an important step in the understanding of molybdate transport, a crucial process in eukaryotic cells.
Deletion of the core-
H
region in mice abolishes the expression of three proximal odorant receptor genes in
cis
Authors: Nishizumi Hirofumi , Kumasaka Kouhei , Inoue Nobuko , Nakashima Ai , Sakano Hitoshi
Published: December 2007

We have previously reported that a 2.1-kb homology (
H
) sequence, conserved between mouse and human, regulates the odorant receptor (OR) gene
MOR28
in transgenic mice. Here, we narrowed down the essential sequences of the
H
to a core of 124 bp by using a transient expression system in zebrafish embryos. Transgenic experiments in mice demonstrated that the core-
H
sequence is sufficient to endow expression of the
MOR28
minigene. Deletion and mutation analyses of the core-
H
region revealed two homeodomain sequences to be essential for the
H
enhancer activity. Targeted deletion of the core-
H
abolished expression of three proximal OR genes,
MOR28
,
MOR10
, and
MOR83
, in
cis
, indicating the presence of another locus control region/enhancer in the downstream region, that regulates four distal OR genes in the same
MOR28
cluster. In the heterozygous mice, the
H
−
phenotype of the mutant allele was not rescued by the wild-type
H
+
allele in
trans
.
The heat kernel as the pagerank of a graph
Authors: Chung Fan
Published: December 2007

The concept of pagerank was first started as a way for determining the ranking of Web pages by Web search engines. Based on relations in interconnected networks, pagerank has become a major tool for addressing fundamental problems arising in general graphs, especially for large information networks with hundreds of thousands of nodes. A notable notion of pagerank, introduced by Brin and Page and denoted by PageRank, is based on random walks as a geometric sum. In this paper, we consider a notion of pagerank that is based on the (discrete) heat kernel and can be expressed as an exponential sum of random walks. The heat kernel satisfies the heat equation and can be used to analyze many useful properties of random walks in a graph. A local Cheeger inequality is established, which implies that, by focusing on cuts determined by linear orderings of vertices using the heat kernel pageranks, the resulting partition is within a quadratic factor of the optimum. This is true, even if we restrict the volume of the small part separated by the cut to be close to some specified target value. This leads to a graph partitioning algorithm for which the running time is proportional to the size of the targeted volume (instead of the size of the whole graph).
How processing of aspartylphosphate is coupled to lumenal gating of the ion pathway in the calcium pump
Authors: Toyoshima Chikashi , Norimatsu Yoshiyuki , Iwasawa Shiho , Tsuda Takeo , Ogawa Haruo
Published: December 2007

Ca
2+
-ATPase of skeletal muscle sarcoplasmic reticulum is the best-studied member of the P-type or E1/E2 type ion transporting ATPases. It has been crystallized in seven different states that cover nearly the entire reaction cycle. Here we describe the structure of this ATPase complexed with phosphate analogs BeF
3
−
and AlF
4
−
in the absence of Ca
2+
, which correspond to the E2P ground state and E2∼P transition state, respectively. The luminal gate is open with BeF
3
−
and closed with AlF
4
−
. These and the E1∼P·ADP analog crystal structures show that a two-step rotation of the cytoplasmic A-domain opens and closes the luminal gate through the movements of the M1–M4 transmembrane helices. There are several conformational switches coupled to the rotation, and the one in the cytoplasmic part of M2 has critical importance. In the second step of rotation, positioning of one water molecule couples the hydrolysis of aspartylphosphate to closing of the gate.
Other-regarding preferences in a non-human primate: Common marmosets provision food altruistically
Authors: Burkart Judith M. , Fehr Ernst , Efferson Charles , van Schaik Carel P.
Published: December 2007

Human cooperation is unparalleled in the animal world and rests on an altruistic concern for the welfare of genetically unrelated strangers. The evolutionary roots of human altruism, however, remain poorly understood. Recent evidence suggests a discontinuity between humans and other primates because individual chimpanzees do not spontaneously provide food to other group members, indicating a lack of concern for their welfare. Here, we demonstrate that common marmoset monkeys (Callithrix jacchus) do spontaneously provide food to nonreciprocating and genetically unrelated individuals, indicating that other-regarding preferences are not unique to humans and that their evolution did not require advanced cognitive abilities such as theory of mind. Because humans and marmosets are cooperative breeders and the only two primate taxa in which such unsolicited prosociality has been found, we conclude that these prosocial predispositions may emanate from cooperative breeding.
Abortion and the Struggle to be Good in the 1970s
Authors: Wainer Jo
Published: December 2007

Objective: This study used social science methodology to illuminate an important clinical question that had been inaccessible to researchers until the 1970s. The question was what effect did an abortion have on normally rule abiding women. Abortion had been presumed to be illegal until a judicial decision in 1969. In 1972 Australia's first abortion clinic was established, and the participants in this study were the women who attended it in 1974. This study was the first of its kind in Australia.

Method: Interviews were conducted with 32 women who had a lawful termination of pregnancy and who agreed to be interviewed one year later. 84% of women agreed to follow-up contact, and 34 were contacted. Social science theory about deviance, social stigma and norm violation was used to inform the study.

Results: Single, nulliparous women, were troubled by the potential exposure of their rule breaking sexual activity. The abortion was in part an action taken to preserve their persona as competent, moral beings capable of taking care of themselves. The abortion was the sensible next step in managing a missed menstrual period, the back up when contraception or plans for love and marriage failed. These women took mothering seriously and had an abortion to avoid becoming inadequate mothers. Abortion was a challenge to the married women's sense of themselves as good mothers, and their motives related to good mothering. The working class women had histories of managing tough and challenging life events, and they used the strengths, skills and networks they had established and applied those to the abortion decision.

Conclusion: The most important and frequent effect of abortion was to make women feel more competent in managing their lives. The skills required to locate and access an abortion clinic against a backdrop of general social disapproval, expanded their sense of themselves as actors in their own lives. Their stories, as well as networks of support, enabled them to integrate abortion into their sense of themselves as good women.
Antenatal Psychosocial Risk Factors and Depression Among Women Living in Socioeconomically Disadvantaged Suburbs in Adelaide, South Australia
Authors: Edwards Belinda , Galletly Cherrie , Semmler-Booth Tracy , Dekker Gus
Published: December 2007

Objective: This study reports the prevalence of psychosocial risk factors and the incidence of depression in women presenting for their first antenatal visit at a general hospital in a socioeconomically deprived area. We also investigated the association between specific psychosocial risk factors and antenatal depression.

Method: Four hundred and twenty one women completed the Antenatal Psychosocial Questionnaire (APQ) and the Edinburgh Postnatal Depression Scale (EPDS). Logistic regression analysis was used to identify psychosocial risk factors predictive of EPDS caseness.

Results: 88% of women endorsed at least one psychosocial risk factor. 35.6% had been abused as children, 34.9% had suffered recent major life stresses, 24.5% had thoughts of self harm, 8% admitted to recently hitting or hurting someone in anger and 5.6% had been victims of violence since becoming pregnant. The incidence of depression, measured using an EPDS cut-off score of 10 or more, was 29.7%. The questionnaires were generally acceptable, apart from questions about drug and alcohol abuse which were not completed by one in five subjects. Factors associated with an increased risk of antenatal depression were being hit by someone since becoming pregnant, having recently hit someone else in anger, obsessional traits, previous feelings of depression and anxiety, and requiring both past and current treatment for emotional problems. Protective factors were having someone to talk to and feeling confident.

Conclusion: Our findings suggest that women birthing at the LMHS are a very vulnerable group. Violence (either by or towards the pregnant women) was the strongest predictor of antenatal depression and may be under recognized. Antenatal screening for psychosocial risk factors and depression was useful and was well accepted by the women and the clinic staff. It is important that appropriate services are available once women at risk are identified.
Do Women Express and Experience Psychosis Differently from Men? Epidemiological Evidence from the Australian National Study of Low Prevalence (Psychotic) Disorders
Authors: Morgan Vera A. , Castle David J. , Jablensky Assen V.
Published: December 2007

Objective: To examine how women differ from men in their expression and experience of psychosis.

Method: Using an epidemiological sampling frame, 1090 cases of psychosis (schizophrenia, schizoaffective disorder, affective psychoses, and other psychoses) were randomly selected from a catchment of 1.1million people as part of the Australian Study of Low Prevalence (Psychotic) Disorders. Women and men were compared with respect to their premorbid functioning, onset and course of illness, symptomatology, levels of disability and service utilization.

Results: Results within diagnostic groupings confirm differences in how men and women experience and express their illness. Within each diagnostic group, women reported better premorbid functioning, a more benign illness course, lower levels of disability and better integration into the community than men. They were also less likely to have a chronic course of illness. There were no significant differences in age at onset. Differences between women across the diagnostic groups were more pronounced than differences between women and men within a diagnostic group. In particular, women with schizophrenia were severely disabled compared to other women.

Conclusions: These comparisons across diagnostic groupings are among the most systematic and comprehensive in the literature. It is likely that several mechanisms are needed to explain the differences. Greater social integration and functioning in women across diagnostic groups may well reflect culturally and socially determined gender differences. In contrast, variability and attenuated findings with respect to symptom profiles beg the question of biological mechanisms with some degree of specificity.
Women, Catastrophe and Mental Health
Authors: Raphael Beverley , Taylor Mel , McAndrew Virginia
Published: December 2007

This paper examines the concept of catastrophic experience, its relationship to the range of acute and prolonged stressors to which women may be exposed and the broad impacts on their mental health and well-being. It identifies catastrophe in terms of multiple accumulated stresses including death, loss, victimization, demoralization, shame, stigmatization, helplessness and identity. Catastrophic experiences include personal violence in domestic circumstances of intimate partner abuse, sexual assault and child physical and sexual abuse. Women's experiences of loss through the violent deaths of children and loved ones may also have such enduring impacts. Terrorism victimizes men and women in this way, with the enduring impacts for women in terms of threat of ongoing attacks as well as acute effects and their aftermath. The catastrophes of war, conflict, genocide, sexual exploitation and refugee status differentially affect large numbers of women, directly and through their concerns for the care of their children and loved ones. Ultimate catastrophes such as Hiroshima and the Holocaust are discussed but with recognition of the very large numbers of women currently experiencing catastrophe in ongoing ways that may be silent and unrecognized. This is significant for clinical care and population impacts, and in the losses for women across such contexts.
Does Antenatal Screening for Psychosocial Risk Factors Predict Postnatal Depression? A Follow-Up Study of 154 Women in Adelaide, South Australia
Authors: Edwards Belinda , Galletly Cherrie , Semmler-Booth Tracy , Dekker Gus
Published: December 2007

Objective: This study investigated the effectiveness of antenatal screening for psychosocial risk factors in predicting postnatal depression, in women living in a socioeconomically deprived area.

Method: 154 women completed the Antenatal Psychosocial Questionnaire (APQ) and the Edinburgh Postnatal Depression Scale (EPDS). Logistic regression analysis was used to identify antenatal psychosocial risk factors predictive of EPDS caseness, with an EPDS score of 10 or more being taken to indicate depression.

Results: Antenatal depression was more common than postnatal depression. 44 women (30%) met criteria for antenatal depression and 33 women (22.6%) met criteria for postnatal depression. 21 women (14.4%) were depressed both before and after delivery of their baby, and women who had antenatal depression were significantly more likely to be depressed postnatally. Whilst there were high rates of endorsement of antenatal psychosocial risk factors, the only item from the APQ that predicted postnatal depression was emotional abuse as a child.

Conclusion: Antenatal screening for psychosocial risk factors was useful in identifying problems during the antenatal period, but was not useful as a predictor of postnatal depression.
Assessing Negative Consequences in Patients with Substance Use and Bipolar Disorders: Psychometric Properties of the Short Inventory of Problems (SIP)
Authors: Bender Rachel E. , Griffin Margaret L. , Gallop Robert J. , Weiss Roger D.
Published: December 2007

The Short Inventory of Problems (SIP), a questionnaire that measures negative consequences of alcohol use, has not been validated among substance users with co‐occurring psychiatric illness. This study examined the psychometric properties of the SIP in 57 outpatients diagnosed with substance use disorder and bipolar disorder. We modified the items to assess drugs in addition to alcohol and, further, we added corresponding items to assess consequences of bipolar disorder. This modified version of the SIP was psychometrically sound, and may be useful in patients with both disorders. A greater understanding of perceived negative consequences may enhance outcome assessment in dually diagnosed populations.
Clinic Variation in the Cost‐Effectiveness of Contingency Management
Authors: Olmstead Todd A. , Sindelar Jody L. , Petry Nancy M.
Published: December 2007

This study determined whether, and by how much, the cost‐effectiveness of contingency management (CM) varied across the eight clinics in the National Institute on Drug Abuse Clinical Trials Network MIEDAR trial. Incremental costs, incremental outcomes, and incremental cost‐effectiveness ratios (ICERs) of CM compared to usual care were calculated, compared and contrasted for each of the clinics. Results showed that the incremental cost of using CM compared to usual care varied by a factor of 1.9 across the clinics, ranging from an additional $306 to an additional $582 per patient. The effect of CM on the longest duration of continuous stimulant abstinence (LDA) varied by a factor of 8.0 across the clinics, ranging from an additional 0.5 to an additional 4.0 weeks. The ICERs for the LDA varied by a factor of 4.6 across the clinics, ranging from $145 to $666. These results show that the cost‐effectiveness of CM varied widely among the clinics in the MIEDAR trial. Future research should focus on identifying the sources of this variation, perhaps by identifying clinic‐level best practices and/or identifying those subgroups of patients that respond the most cost‐effectively, with the ultimate goal of improving the cost‐effectiveness of CM overall.
Assessment of Club Drug Use in a Treatment‐Seeking Sample of Individuals with Marijuana Dependence
Authors: Verduin Marcia L. , Payne Rebecca A. , McRae Aimee L. , Back Sudie E. , Simpson Stacey A. , Sarang Rajesh Y. , Brady Kathleen T.
Published: December 2007

Club drug use is becoming increasingly popular in the United States and has been associated with chronic psychiatric symptoms and neuropsychological abnormalities. Patterns of club drug use and characteristics of club drug users are not homogeneous. Thus, treatment‐seeking marijuana‐dependent individuals may have a differential pattern of club drug use. Baseline assessments collected from 55 individuals participating in a pharmacological treatment study for marijuana dependence were examined. Individuals completed a 16‐item self‐report questionnaire assessing club drugs used, frequency and patterns of use, problems associated with use, and reasons for use. Subjects were primarily male (87.3%) and Caucasian (81.8%), with a mean age of 32.1 (±9.1 years). As expected, a large number of individuals had used ecstasy (75%). However, LSD and methamphetamine use was also reported by many users (82.5% and 47.5% respectively), with many individuals reporting the use of more than one club drug. Notably, 31.6% of individuals reported tolerance to club drugs. These results emphasize the significant co‐occurrence of club drug use in marijuana‐dependent individuals. This appears to be the first study to report on club drug use in treatment‐seeking marijuana‐dependent individuals. Clinical implications and directions for future research are discussed.
Differences in Early Onset Alcohol Use and Heavy Drinking among Persons with Childhood and Adulthood Trauma
Authors: Waldrop Angela E. , Santa Ana Elizabeth J. , Saladin Michael E. , McRae Aimee L. , Brady Kathleen T.
Published: December 2007

We examined predictors for age at onset of first alcohol use and onset of heaviest alcohol use among men (n = 43) and women (n = 46) with alcohol dependence and PTSD, PTSD only, alcohol dependence only, and controls, with a particular focus on individuals with child versus adult trauma. Using analysis of variance procedures, results showed differences in onset of first alcohol use and heaviest drinking between childhood and adulthood trauma victims. These preliminary results indicate that behavioral mechanisms associated with alcohol use patterns between individuals with childhood and adulthood trauma are dissimilar, suggesting greater psychopathological consequences for individuals with childhood trauma.
Dietary Supplement Polypharmacy: An Unrecognized Public Health Problem?
Authors: Nisly Nicole L. , Gryzlak Brian M. , Zimmerman M. Bridget , Wallace Robert B.
Published: December 2007

Excessive and inappropriate use of medications, or ‘polypharmacy’, has been recognized as a public health problem. In addition, there is growing use of dietary supplements in the United States; however, little is known about the patterns of supplement use. Recent reports in the literature of cases of excessive or inappropriate use of herbal dietary supplements leading to the term ‘polyherbacy’. The clinical vignettes described in this article highlight the need for further research on the nature and extent of multiple and inappropriate dietary supplement use or ‘dietary supplement polypharmacy’. Clinical interviewing and population surveys both address this issue in complementary ways, and provide a further understanding of dietary supplement use patterns.
The incidence of preterm deliveries decreases in Finland
Authors: Jakobsson M , Gissler M , Paavonen J , Tapper A‐M
Published: December 2007

Objective  We examined the trends and risk factors of preterm delivery.

Design  Register‐based retrospective cohort study from Finland.

Setting  National Medical Birth Register data during 1987–2005.

Population  The study population consisted of 1 137 515 deliveries, of which 59 025 were preterm (5.2%).

Methods  We calculated the population attributable risks for using the risk factor prevalence rates in the population. We further calculated odds ratios with 95% CI by multivariate logistic regression to adjust for confounders.

Main outcome measures  Preterm delivery rate subclassified into moderately preterm (32–36 weeks), very preterm (28–31 weeks) and extremely preterm (less than 28 weeks).

Results  Preterm delivery rates increased from 5.1% in the late 1980s to 5.4% in the late 1990s but then decreased to 5.2% for 2001–05. The proportion of extremely preterm deliveries decreased substantially by 12% (P < 0.01). The greatest risk factors were multiplicity (OR 13.72, 95% CI 13.26–14.19), followed by elective delivery (OR 1.86, 95% CI 1.82–1.89), primiparity (OR 1.47, 95% CI 1.45–1.50), in vitro fertilisation treatment (OR 1.39, 95% CI 1.31–1.47), maternal smoking (OR 1.31, 95% CI 1.29–1.34) and advanced maternal age (OR 1.02, 95% CI 1.02–1.03 for each additional year of age). Prematurity rates decreased by 1.8% after adjusting for risk variables.

Conclusions  The rate of preterm delivery has not increased from 1987 to 2005 in Finland, while the risk for extremely preterm delivery has decreased. This finding is in contrast with recent trends in other countries.
A survey of women’s views of Thermachoice endometrial ablation in the outpatient versus day case setting
Authors: Marsh F , Bekker H , Duffy S
Published: December 2007

Objective  To determine women’s preference towards Thermachoice being performed either awake in the outpatient setting or under general anaesthetic (GA) as a day case.

Design  Questionnaire.

Setting  Large teaching hospital.

Population  One hundred women.

Methods  The questionnaire was developed from prior research on factors associated with preference for procedures performed in the outpatient versus day case setting.

Main outcome measures  (1) Describe women’s preference towards outpatient versus day case Thermachoice and other menorrhagia treatments. (2) Identify variations in preference by demographic characteristics and prior experience of anaesthesia.

Results  There was an exact split in preference with 50% preferring Thermachoice as an outpatient and 50% as a day case. The mean age of women preferring outpatient Thermachoice was significantly higher (41.5 years) than those preferring day case (33.5 years) (P < 0.005). Women with children and a higher qualification were more likely to opt for outpatient Thermachoice. A previous bad experience of GA was associated with preference for outpatient Thermachoice. Spending less time in hospital, attending for one visit, feeling well straight after treatment and choosing the treatment setting were important factors to the majority of women. Most women (70%) who opted for Thermachoice as a menorrhagia treatment would prefer to have it performed in the outpatient setting.

Conclusions  If the Department of Heath is to target services towards women’s choice, there is a need to increase the provision of outpatient menorrhagia treatments, such as Thermachoice, to more women in the UK.
Image quality and localization accuracy in C‐arm tomosynthesis‐guided head and neck surgery
Authors: Bachar G. , Siewerdsen J. H. , Daly M. J. , Jaffray D. A. , Irish J. C.
Published: December 2007

The image quality and localization accuracy for C‐arm tomosynthesis and cone‐beam computed tomography (CBCT) guidance of head and neck surgery were investigated. A continuum in image acquisition was explored, ranging from a single exposure (radiograph) to multiple projections acquired over a limited arc (tomosynthesis) to a full semicircular trajectory (CBCT). Experiments were performed using a prototype mobile C‐arm modified to perform 3D image acquisition (a modified Siemens PowerMobil). The tradeoffs in image quality associated with the extent of the source‐detector arc , the number of projection views, and the total imaging dose were evaluated in phantom and cadaver studies. Surgical localization performance was evaluated using three cadaver heads imaged as a function of . Six localization tasks were considered, ranging from high‐contrast feature identification (e.g., tip of a K‐wire pointer) to more challenging soft‐tissue delineation (e.g., junction of the hard and soft palate). Five head and neck surgeons and one radiologist participated as observers. For each localization task, the 3D coordinates of landmarks pinpointed by each observer were analyzed as a function of . For all tomosynthesis angles, image quality was highest in the coronal plane, whereas sagittal and axial planes exhibited a substantial decrease in spatial resolution associated with out‐of‐plane blur and distortion. Tasks involving complex, lower‐contrast features demonstrated steeper degradation with smaller tomosynthetic arc. Localization accuracy in the coronal plane was correspondingly high, maintained to down to , whereas sagittal and axial localization degraded rapidly below . Similarly, localization precision was better than within the coronal plane, compared to out‐of‐plane for tomosynthesis angles below . An overall 3D localization accuracy of was achieved with for most tasks. The high in‐plane spatial resolution, short scanning time, and low radiation dose characteristic of tomosynthesis may enable the surgeon to collect near real‐time images throughout the procedure with minimal interference to surgical workflow. Therefore, tomosynthesis could provide a useful addition to the image‐guided surgery arsenal, providing on‐demand, high quality image updates, complemented by CBCT at critical milestones in the surgical procedure.
Implantable MOSFET detectors: Evaluation of a new design
Authors: Briere Tina Marie , Gillin Michael T. , Beddar A. Sam
Published: December 2007

The authors have studied the performance of a new version of the implantable MOSFET detector designed for clinical use. Detectors were irradiated under 6‐ and 18‐MV beams in water at body temperature to the calibration dose of 200 cGy/fraction for 20 daily fractions to determine their response and reproducibility. Additional measurements were performed in a solid phantom under 6‐MV irradiation at room temperature to daily doses of 100, 150, 200, 250, 400 and 600 cGy/fraction. Finally, the angular dependence with respect to rotation about the detector's longitudinal axis was studied. At body temperature, the detectors were found to have an average response within of the calibration dose with a standard deviation of or less. At room temperature, doses lower than the calibration dose led to a slight overresponse while doses higher than the calibration dose led to a slight underresponse. Angular dependence was not significant, on average within of the mean. When used as specified by the manufacturer, these detectors should provide data useful to verify the delivered dose for external beam radiation therapy within a certain tolerance.