bluuebunny/crossref_metadata_2025_split huggingface dataset:
The role of smoking and alcohol intake in the development of high‐grade squamous intraepithelial lesions among high‐risk HPV‐positive women
Authors: Tolstrup Janne , Munk Christian , Lykke Thomsen Birthe , Svare Edith , van den Brule Adriaan J.C. , Grønbæk Morten , Meijer Chris , Krüger Kjær Susanne 
Published: December 2009

AbstractBackground. Infection with human papillomavirus is considered a necessary factor in developing high‐grade squamous intraepithelial lesions of the cervix. However, most human papillomavirus positive women do not develop high‐grade squamous intraepithelial lesions and other factors may be important for this transition. The objective of the present study was to examine if smoking and alcohol intake are associated with the risk of developing high‐grade squamous intraepithelial lesions in women positive for high‐risk human papillomavirus types. Methods. We used baseline information on exposures on 548 high‐risk human papillomavirus positive women with normal cytology, comparing 94 women who developed high‐grade squamous intraepithelial lesions with 454 women who remained cytologically normal. Logistic regression was applied for statistical analysis. Results. Compared with never smokers, the odds ratio for high‐grade squamous intraepithelial lesions among current smokers was 1.99 (95% CI: 1.21–3.28). Among current smokers, number of cigarettes, years of smoking, and early age at smoking initiation were associated with increased risk. However, when modeled simultaneously, it seemed that smoking duration and age at smoking initiation were more associated with risk of high‐grade squamous intraepithelial lesions than amount of smoking. Alcohol intake was not associated with risk of high‐grade squamous intraepithelial lesions among these women. Conclusion. Smoking is associated with an increased risk of developing high‐grade squamous intraepithelial lesions in women who are infected with oncogenic human papillomavirus.
Short‐ and long‐term results of the tension‐free vaginal tape procedure in the treatment of female urinary incontinence
Authors: Ankardal Maud , Heiwall Bengt , Lausten‐Thomsen Niels , Carnelid Jill , Milsom Ian 
Published: December 2009

AbstractBackground. The aim was to describe the short‐ and long‐term results of treatment for urinary incontinence (UI) in women using the tension‐free vaginal tape (TVT) procedure at a single unit and to identify factors predictive of successful outcome. Material and methods. Consecutive female patients (n=707) treated for UI with the TVT procedure at Karlstad Hospital from November 1996 to June 2004 were included. After a standardized preoperative evaluation, the women were classified as having either stress urinary incontinence (SUI) or mixed urinary incontinence (MUI). The results of surgery were evaluated after 1, 2, and 5 years, by means of a postal questionnaire. An objective evaluation was performed after 5 years in a subsample of the first patients included (n=59). Factors influencing the cure rate were analyzed using multiple regression analysis. Results. The subjective cure rate was 83% after 1 year and 73% after 5 years. The objective cure rate was 83% in the subgroup after 5 years. Surgical time was 30±9 min (mean±SD). The rate of bladder perforations was 1.7%. In patients with MUI the cure rate was lower than in patients with SUI (after 5 years 54.9% versus 81.0%). Type of incontinence was the only independent variable found to influence surgical outcome. Conclusions. The TVT procedure, performed in over 700 women at a single gynecological unit, was found to be a safe and efficient surgical procedure. Type of incontinence was the only independent variable found to predict for outcome of surgery.
Outcomes of external cephalic version and breech presentation at term, an audit of deliveries at a Sydney tertiary obstetric hospital, 1997–2004
Authors: NASSAR NATASHA , ROBERTS CHRISTINE L. , CAMERON CAROLYN A. , PEAT BRIAN 
Published: December 2009

AbstractBackground. Probabilistic information on outcomes of breech presentation is important for clinical decision‐making. We aim to quantify adverse maternal and fetal outcomes of breech presentation at term. Methods. We conducted an audit of 1,070 women with a term, singleton breech presentation who were classified as eligible or ineligible for external cephalic version or diagnosed in labor at a tertiary obstetric hospital in Australia, 1997–2004. Maternal, delivery and perinatal outcomes were assessed and frequency of events quantified. Results. Five hundred and sixty (52%) women were eligible and 170 (16%) were ineligible for external cephalic version, 211 (20%) women were diagnosed in labor and 134 (12%) were unclassifiable. Seventy‐one percent of eligible women had an external cephalic version, with a 39% success rate. Adverse outcomes of breech presentation at term were rare: immediate delivery for prelabor rupture of membranes (1.3%), nuchal cord (9.3%), cord prolapse (0.4%), and fetal death (0.3%); and did not differ by clinical classification. Women who had an external cephalic version had a reduced risk of onset‐of‐labor within 24 h (RR 0.25; 95%CI 0.08, 0.82) compared with women eligible for but who did not have an external cephalic version. Women diagnosed with breech in labor had the highest rates of emergency cesarean section (64%), cord prolapse (1.4%) and poorest infant outcomes. Conclusions. Adverse maternal and fetal outcomes of breech presentation at term are rare and there was no increased risk of complications after external cephalic version. Findings provide important data to quantify the frequency of adverse outcomes that will help facilitate informed decision‐making and ensure optimal management of breech presentation.
Persistence of fetal memory into neonatal life
Authors: GONZALEZ‐GONZALEZ N.L. , SUAREZ M.N. , PEREZ‐PIÑERO B. , ARMAS H. , DOMENECH E. , BARTHA J.L. 
Published: December 2009

AbstractObjectives. To test the hypothesis that fetal memory persists into the neonatal period. Study design. Forty‐one newborns that had been repeatedly stimulated by using fetal vibroacoustic stimulation were compared with 31 controls. The same vibroacoustic stimulator was used for both fetal and neonatal stimulation tests. For the neonatal test the stimulus was applied against the mastoid of the newborn with the interposition of a specifically designed solid–liquid interface to simulate intrauterine conditions. Student's t‐test was used. Results. Neonatal habituation rate (the number of consecutive stimuli applied before a baby stopped responding) was significantly higher in those newborns who had not participate in the fetal habituation study (7.0±5.4 stimuli) than in those who had (4.1±4.1 stimuli), p = 0.01. Conclusions. Newborns who were stimulated in utero habituated earlier than those who had not previously experienced the stimulation. These results suggest that fetal memory persists into neonatal life.
Sexual experience of partners after hysterectomy, comparing subtotal with total abdominal hysterectomy
Authors: LONNÉE‐HOFFMANN RISA A. M. , SCHEI BERIT , ERIKSSON NILS H. 
Published: December 2009

AbstractBackground. There is a lack of knowledge about partners’ sexual experience after hysterectomy. The aim of this study was to explore potential differences in the experience of sexual intercourse by the partner, related to the operation method (subtotal versus total abdominal hysterectomy). Method. Of all patients having undergone abdominal hysterectomy for benign indications at St Olav Hospital, Trondheim between February 2001 and March 2003, Norway, 120 patients (60 total, 60 subtotal abdominal hysterectomy) were identified. Each patient and partner received a postal questionnaire addressing sexuality in connection with the operation. Results. Of the 240 questionnaires, 111 were returned, a response rate of 46%. Among partners of women having undergone total hysterectomy, proportionally more noticed during sexual intercourse that the uterus had been removed (12%) compared to partners of women having undergone subtotal hysterectomy (4%); this was not significant and all of these partners experienced this as positive. Sexual satisfaction was improved or unchanged in most women and their partners, regardless of operation type. Partners who reported poor satisfaction before the operation were significantly more likely to report poor satisfaction after the operation. A high proportion of partners in both hysterectomy groups had not discussed sexuality in relation to the surgery either before or after the operation (subtotal: 44%; total: 24%; not significant). Conclusion. The majority of women and their partners reported no negative impact on sexual satisfaction after abdominal hysterectomy, regardless if subtotal or total. The only predictor of negative sexual experience of partners after hysterectomy was negative sexual experience before hysterectomy.
Relation between severity of dysmenorrhea and endometrioma
Authors: CHOPIN NICOLAS , BALLESTER MARCOS , BORGHESE BRUNO , FAUCONNIER ARNAUD , FOULOT HERVÉ , MALARTIC CÉCILE , CHAPRON CHARLES 
Published: December 2009

AbstractBackground. To evaluate the relationship between the severity of dysmenorrhea and endometrioma. Methods. Descriptive study with prospective design. Two hundred and thirty‐nine women with histologically proved endometriomas. The severity of dysmenorrhea was assessed prospectively with a 10‐cm visual analog scale. Various indicators concerning the endometrioma and the extent of deep infiltrating endometriosis were recorded during surgery in 239 patients. Correlations were sought with a multiple regression logistic model. Results. According to univariate analysis, the following variables were related to more severe dysmenorrhea: subperitoneal infiltration (uterosacral ligament and rectal infiltration) and R‐AFS score of implants. None of the specific characteristics of endometriomas were associated with severe dysmenorrhea. After multiple regression analysis, rectal infiltration and R‐AFS score of implants were the only factors that remained related to dysmenorrhea severity. Conclusions. When there is an endometrioma, severe dysmenorrhea is not directly related with the characteristics specific to these ovarian cysts. The associated deep infiltrating endometriotic lesions and in particular rectal infiltration could explain these symptoms.
Ureaplasma urealyticum: no independent role in the pathogenesis of bronchopulmonary dysplasia
Authors: AALTONEN RIIKKA , VAHLBERG TERO , LEHTONEN LIISA , ALANEN ANNA 
Published: December 2009

AbstractBackground. Ureaplasma urealyticum has been linked to short and long‐term morbidity of preterm infants. We wanted to analyze if it has an independent role in the pathogenesis of bronchopulmonary dysplasia if prenatal history with possible exposure to intrauterine infection is taken into account. Methods. Lower respiratory tract colonization with U. urealyticum was analyzed from 49 infants born before the 30th week of gestation. The need for supplemental oxygen at the age of 28 days and 36 gestational weeks was studied. Results. Forty‐five percent of the 33 infants born after spontaneous onset of labor were colonized with U. urealyticum, while none of the electively born were. If analyzed based on the Ureaplasma colonization, bronchopulmonary dysplasia was more common in the colonized infants at the age of 28 days (OR 4.57, 95% CI 1.18–17.68), but not at the gestational age of 36 weeks (OR 1.00). Based on the prenatal history, the OR of bronchopulmonary dysplasia in infants born after spontaneous onset of labor was greater than in infants born electively both at the age of 28 days (OR 4.33, 95% CI 0.83–22.75) and at 36 weeks of gestation (OR 2.8, 95% CI 0.30–26.42). Conclusions. If possible exposure to intra‐amniotic inflammation is taken into account, U. urealyticum seems not to have an independent role in the pathogenesis of bronchopulmonary dysplasia. Its role has been overemphasized, as it is the most common cause of intra‐amniotic bacterial infection.
Maternal and perinatal outcome in idiopathic thrombocytopenic purpura (ITP) with pregnancy
Authors: SURI VANITA , AGGARWAL NEELAM , SAXENA SHILPI , MALHOTRA PANKAJ , VARMA SUBHASH 
Published: December 2009

AbstractBackground.Idiopathic thrombocytopenic purpura commonly affects women of childbearing age and is associated with maternal and fetal complications. Management of a pregnant patient is difficult and requires combined care of obstetrician and a neonatologist. We report our experience of idiopathic thrombocytopenic purpura during pregnancy during the last 7 years.Method.A retrospective study over the 7‐year period 1997–2003 was carried out in the Department of Obstetrics and Gynaecology in the Postgraduate Institute of Medical Education and Research, Chandigarh, India. The course of pregnancy, disease and perinatal outcome of 19 pregnancies in 16 patients with idiopathic thrombocytopenic purpura was studied.Results.Out of 16 patients with idiopathic thrombocytopenic purpura, eight were already diagnosed while the other eight were diagnosed during pregnancy. Five patients diagnosed during pregnancy had severe thrombocytopenia, and four of them showed hemorrhagic manifestation. Nine patients required steroids during pregnancy. Two patients received immunoglobulin therapy. During the antenatal period one patient developed pre‐eclampsia and one patient had gestational diabetes mellitus. Both of these patients were on steroids. There was no postpartum hemorrhage or maternal death. None of the neonates had bleeding complication, irrespective of mode of delivery.Conclusion.Pregnant patients with idiopathic thrombocytopenic purpura have generally good maternal and perinatal outcomes.
A cost‐effectiveness analysis of tension‐free vaginal tape versus laparoscopic mesh colposuspension for primary female stress incontinence
Authors: VALPAS ANTTI , RISSANEN PEKKA , KUJANSUU ERKKI , NILSSON CARL‐GUSTAF 
Published: December 2009

AbstractBackground. Evaluation of cost‐effectiveness of new surgical techniques is important. As the data on incontinence procedures are scarce, we evaluated the cost‐effectiveness of tension‐free vaginal tape procedure and laparoscopic mesh colposuspension as a primary surgical treatment for female stress urinary incontinence. Methods. In four university teaching hospitals and two central hospitals 128 stress incontinent women were randomized to tension‐free vaginal tape procedure (n = 70) or laparoscopic mesh colposuspension (n = 51) in order to investigate the clinical performance of these two procedures. Primary objective clinical outcome measures were: stress test and 48‐h pad test. Secondary subjective outcome measures were health‐related quality of life measured in terms of visual analogue scale and Urinary Incontinence Severity Score. Alongside the clinical trial, a cost‐effectiveness analysis for the main outcome measures was performed. Results. The changes in the 48‐h pad test result did not reach statistical significance (p = 0.105). When the visual analogue scale or Urinary Incontinence Severity Score are used as the outcome measure, the tension‐free vaginal tape is more cost‐effective than laparoscopic mesh colposuspension over a follow‐up period of one year (p<0.000). Conclusion. The clinical and economic data of the present study suggest that over a follow‐up period of one year the tension‐free vaginal tape procedure is more cost‐effective than laparoscopic mesh colposuspension as a primary treatment for female stress urinary incontinence.
‘Learning Organizations’: A Clinician's Primer
Authors: O'Connor Nick , Kotze Beth 
Published: December 2009

Objectives: Most clinicians are poorly informed in relation to the key concepts of organizational learning. Yet the paradigm may offer clinicians a powerful method for using their knowledge and skills to respond to the demands of a changing environment through experimentation and learning. The concept is critically examined. Organizational learning principles are presented, including a conceptual framework for assessing health services as Learning Organizations. Barriers to organizational learning and strategies to overcome these are discussed. Methods: The seminal works of Argyris and Senge are reviewed and a framework for assessing organizational learning in health services is proposed. Current area health service actions are evaluated against the ‘diagnostic’ framework for a Learning Organization. Results: Although critical examination reveals a poor empirical basis for the concept, the metaphor of the Learning Organization provides a useful conceptual framework and tools for individuals and organizations to apply in developing knowledge and effecting change. The Clinical Practice Improvement and Root Cause Analysis programs being conducted across NSW area health services meet the criteria for effective organizational learning. Conclusions: Key concepts from organizational learning theory provide a diagnostic framework for evaluating area health services as Learning Organizations and support two current strategies for overcoming barriers to organizational learning.
The Wellness Recovery Action Plan (WRAP): Workshop Evaluation
Authors: Doughty Carolyn , Tse Samson , Duncan Natasha , McIntyre Leo 
Published: December 2009

Objective: This study evaluated the delivery of a series of workshops on mental health recovery. The aims were to determine if the workshops changed participants’ attitudes and knowledge about recovery, if there were any differences in views between consumers and health professionals of mental health services, and how the delivery and content of the program could be improved. Methods: A total of 187 consumers and health professionals from mental health services attended a workshop based on the Wellness Recovery Action Plan (WRAP). Questionnaires were administered before and after the workshop. Results: There was a significant change in total attitudes and knowledge about recovery (p<0.001) in the expected direction, with no differences between consumers and health professionals. The majority of participants found the workshop useful, and the majority of comments were positive. Conclusions: This study provides preliminary support for the use of WRAP to change consumers’ and mental health professionals’ knowledge and attitudes about recovery.
Interventions to Address Violence Associated with Mental Illness
Authors: Scott Russ 
Published: December 2009

Objectives: The aim of this paper is to consider the association between mental illness and violence, and discuss broad intervention approaches. Conclusion: The necessary elements of intervention to reduce violence by the mentally ill are holistic care, access to services and, where necessary, legal leverage. In the custodial setting, this includes screening, early intervention and treatment in prison, and assertive post-release case management to divert mentally ill offenders away from substance use and to support their return to the community. In the community setting, active case management, including access to inpatient beds and co-ordination between mental health services and other agencies, is crucial to providing continuity of care for patients at risk of violence in the community.
Quality of Life and Cholinesterase Inhibitors: A Qualitative Study of Patients with Alzheimer's Disease and Their Carers
Authors: Smith Bethany , Chur-Hansen Anna , Neale Alice , Symon Jonathon 
Published: December 2009

Objectives: Cholinesterase inhibitors’ (ChEIs) impact on cognitive functioning in Alzheimer's disease has been extensively researched. The effect of ChEIs on improving day-to-day living and quality of life in conjunction with level of functioning for patients or their carers has not been investigated. Method: Five spouse dyads (patient and carer) and one additional carer were interviewed about their perceptions of ChEIs in relation to their influence on daily life for both parties. Interviews were transcribed and thematic analysis conducted. Results: Themes identified were forgetfulness, differences in long-term versus short-term memory, independence/dependence, negative emotion, no appreciable benefit, sense of hopelessness, carer as motivator, stabilization of the patient, and never regain what has been lost. Conclusions: This study suggests that ChEI medication does not enhance life for the patient or their primary caregiver. Further qualitative and quantitative research is required into the impact of ChEIs upon both the patient and their caregivers.
Predicament Suicide: Concept and Evidence
Authors: Pridmore Saxby 
Published: December 2009

Objective: The aim of this paper is to introduce the term ‘predicament suicide’ and add to the evidence that suicide may occur in the absence of Axis I diagnoses. Method: The term ‘predicament suicide’ was described as suicide which occurs when the individual without mental disorder is in unacceptable circumstances from which they cannot find an acceptable alternative means of escape. Accounts of suicide that satisfied these criteria, and could be illustrated by images, were sought. Results: Four accounts were identified: Ajax, Brutus, Mayor Freyberg and Commander Donnicke. Conclusions: Predicament suicide appears to be a useful designation. This work added evidence indicating that suicide may occur in the absence of an Axis I mental disorder.
Life Events, Gender and Suicidal Behaviours in the Acute Community Setting
Authors: Cupina Denise 
Published: December 2009

Objective: The aim of this paper is to examine gender differences in relation to negative life events and suicidal behaviours in patients presenting to an acute community mental health team in Auckland, New Zealand. Method: Clinical files of all patients referred to one of the Auckland community crisis teams in 2007 were surveyed (n = 442). Those presenting with suicidal behaviours were included in the study (‘suicidal behaviours’ refers to the presence of suicidal ideas or suicide attempts). Demographic information and reasons for presentation were collected from the file. Results: Seventy patients aged 18–65 years met the inclusion criteria. For 86% of women and 85% of men separation from their partners and relationship conflicts were the main stressors precipitating suicidal behaviours and referral to the local community crisis team. Suicidal behaviours did not differ between males and females. Conclusion: Irrespective of gender, relationship loss and conflicts were the most commonly identified negative life events precipitating suicidal behaviours in the acute community setting. These findings can have important implications in risk assessment, suicide prevention and provision of acute community services.
The Impact of a Changed Environment on Arousal Levels of Patients in a Secure Extended Rehabilitation Facility
Authors: Olver James , Love Mervyn , Daniel Jeffrey , Norman Trevor , Nicholls Daniel 
Published: December 2009

Objective: This study sought to investigate the effect of changes of the physical ward environment on levels of arousal and aggression in long-stay patients in a secure extended rehabilitation facility. Method: Seclusion episodes, extended seclusion episodes, staff report of aggressive incidents and Brief Psychiatric Rating Scale (BPRS) measures of psychopathology were compared in the same group of long-stay rehabilitation patients over a period of 3 months before and 3 months after a move from a temporary, refurbished medical ward to a large, light-filled, purpose-built facility. Results: Fifteen patients were present during both investigation periods. The majority were male (80%) and had a diagnosis of schizophrenia (53%) or schizoaffective disorder (13%). There were statistically significant reductions in the mean number of seclusion episodes, mean number of extended seclusion episodes (> 4 hours) and BPRS total score following the move. There were statistically significant increases in ambient light conditions in the new unit. Conclusions: The physical environment of long-stay rehabilitation wards may influence aggressive behaviour and arousal in chronically ill patients.