bluuebunny/crossref_metadata_2025_split huggingface dataset:
Eclampsia in Scandinavia: incidence, substandard care, and potentially preventable cases
Authors: Beathe Andersgaard Alice , Herbst Andreas , Johansen Marianne , Ivarsson Anna , Ingemarsson Ingemar , Langhoff‐Roos Jens , Henriksen Tore , Straume Bjørn , Øian Pål 
Published: December 2009

AbstractBackground. Description of incidence, clinical signs, symptoms, and consequences of eclampsia in Scandinavia, and assessment of substandard care and potential preventability. Methods. A descriptive cohort study including all women giving birth in a 2‐year period (mid‐1998–mid‐2000) in Scandinavia. Notifications of eclampsia cases were obtained from all obstetric units at 3‐monthly intervals. All patient files were reviewed, and systematic audit was performed to identify potentially preventable cases by using predefined criteria. Main outcome measures. Signs and symptoms preceding the eclamptic seizure, the standard of medical care, maternal and perinatal morbidity, and mortality were all recorded. Potentially preventable cases through improved care and cases eligible for primary prophylactic magnesium sulfate (MgSO4) were estimated. Results. The incidence of eclampsia was 5.0/10 000 maternities (CI = 4.3–5.7/10 000). Eighty‐six percent had a diagnosis of pre‐eclampsia before the seizure. Nine of 10 had at least one physical complaint before the first seizure, severe headache being the most common symptom, occurring in two‐thirds. Most seizures (90%) occurred after admission to hospital. By audit, 89 cases (42%) were classified as having received substandard care. Prophylactic use of magnesium sulfate might have reduced the number of eclampsia cases by 35 (17%). Conclusions. Eclampsia occurred mainly in hospital and the majority of women had symptoms heralding the seizure. In retrospect, nearly half of the cases were found potentially preventable by timely intervention, improved medical care, and systematic use of prophylactic treatment with MgSO4.
Cumulative incidence of previous spontaneous abortion in Sweden in 1983–2003: a register study
Authors: Adolfsson Annsofie , Larsson Per‐Göran 
Published: December 2009

AbstractAim. The aim of this study is to find out how common miscarriages are among women who have delivered a child.Methods. The numbers of deliveries and miscarriages were extracted from the Swedish Medical Birth Register between 1983 and 2003. Linear regression was performed in order to investigate whether the increasing mean age of mothers or differences in pregnancy identification methods could explain the increased frequency of miscarriage.Results. The reported number of miscarriages increased each year during the 21‐year period, with a marked increase between 1991 and 1993 and only a slight increase during the final 10 years. For primiparous women, the frequency of reported miscarriages per delivery increased from 8.6% in 1983 to 13.9% in 2003. The corresponding figures for 2‐parous women showed an increase from 14.5% to 21.3% respectively. Women aged 30–34 years had an odds ratio of 1.43 (95% CI 1.40–1.45) to suffer spontaneous abortion compared to the age group 25–29 years. Linear regression showed that an increase in mean age at delivery could only partly explain the increase in the frequency of reported miscarriages. A possible explanation could be differences in methods of identifying early pregnancy.Conclusion. Of all women who deliver a child, nearly 20% have experienced previous miscarriage. The increased mean age of women could only explain a small portion of the seen increase in miscarriage. The marked increase from 1991 to 1993 is interesting. Possible reasons for the increase are discussed.
Effect of oral hormone replacement therapy on plasma homocysteine levels
Authors: GUIMARÃES DANIELA AMORIM MELGAÇO , CARDOSO JARBAS , DUSSE LUCI MARIA SANT'ANA , FRANCO ROMERSON MARTINS , DE A. FRANCO HILTON , ALVIM TÚLIO CÉSAR , DA SILVA TEIXEIRA GEORGE , DAS GRAÇAS CARVALHO MARIA , PAULA FERNANDES ANA 
Published: December 2009

AbstractBackground. Various inherited or acquired conditions can lead to mild or severe hyperhomocysteinemia, which has toxic effects on the vascular endothelium. It has been reported that hormone replacement therapy is associated with decreased homocysteine plasma levels, but this is still a controversial issue. Purpose. To compare homocysteine plasma levels in women before and after 3 months of oral hormone replacement therapy. Methods. Twenty‐four women were selected to take part in the study. Blood samples were collected immediately before hormone replacement therapy (cyclic association of 2 mg of estradiol valerate and 1 mg of cyproterone acetate) and three months after the beginning of hormone replacement therapy. Samples collected before hormone replacement therapy were used as controls. Plasma homocysteine levels and the presence of C677T mutation in the methylene tetrahydrofolate reductase gene were evaluated in all participants. Results. The methylene tetrahydrofolate reductase gene mutation was detected in 8 women (33.3%) in heterozygosis, in 3 (12.5%) in homozygosis, and 13 women (54.2%) did not present the mutation. No significant differences were observed in homocysteine levels before and after three months of oral hormone replacement therapy, regardless of the C677T genotype. Conclusions. The results obtained indicate that homocysteine plasma levels are not affected after three months of oral hormone replacement therapy.
Depression and anxiety during pregnancy and six months postpartum: a follow‐up study
Authors: Andersson Liselott , Sundström‐Poromaa Inger , Wulff Marianne , Åström Monica , Bixo Marie 
Published: December 2009

AbstractAims. To investigate the relationship between antenatal and postpartum depression and anxiety and to explore associated maternal characteristics. Methods. From a population‐based sample of 1,555 women attending two obstetric clinics in Sweden, all women with an antenatal psychiatric diagnosis (n=220) and a random selection of healthy women (n=500) were contacted for a second assessment three to six months postpartum. The Primary Care Evaluation of Mental Disorders was used for evaluation on both occasions. Results. Fewer cases of depressive and/or anxiety disorders were prevalent postpartum compared with the second trimester screening. Depression and/or anxiety were prevalent in 16.5% of postpartal women versus 29.2% of pregnant women. There was a significant shift from a majority of subthreshold diagnoses during pregnancy to full Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) diagnoses during the postpartum period. A history of previous psychiatric disorder, living single, and obesity were significantly associated with a new‐onset postpartum psychiatric disorder. The absence of a previous psychiatric disorder was significantly associated with a postpartum recovery of depression or anxiety. Conclusions. Depression and anxiety appear to be less common postpartum than during pregnancy.
Morbidity related to maternal group B streptococcal infections
Authors: Muller Anouk E. , Oostvogel Paul M. , Steegers Eric A.P. , Joep Dörr P. 
Published: December 2009

AbstractGroup B streptococcus is known to be a leading cause of neonatal infection, but less appreciated is the fact that it causes maternal infection also. Maternal group B streptococcal infections during pregnancy and delivery threaten not only the mother, but the child as well. Postpartum infection, such as mastitis, bacteremia, sepsis, meningitis, endometritis, and wound infections are hazards to the mother. We describe the various maternal group B streptococcal infections, their characteristics, associated neonatal morbidity, and prevention and treatment strategies during pregnancy, delivery, and in the postpartum period.
Combining HPV and MIB‐1 tests reduces the number of colposcopies in women with equivocal cytology
Authors: WENSVEEN C.W.M. , KAGIE M.J. , VELDHUIZEN R.W. , TRIMBOS J.B.M.Z. , BOON M.E. 
Published: December 2009

AbstractBackground. In this study the MIB‐1 immunostaining pattern as an index of cellular proliferation was analyzed in smears diagnosed as borderline dyskaryosis in order to establish whether the combination of human papillomavirus testing and MIB‐1 staining could resolve equivocal cytology. Methods. Conventional Pap smears of 108 women diagnosed as borderline dyskaryosis were stained with MIB‐1 and the proliferation index was assessed. These women were evaluated by colposcopy, histological sampling, and human papillomavirus, semi‐quantitative evaluated by hybrid Capture II test. Results. All 64 human papillomavirus‐ and MIB‐1‐negative women had no underlying high‐grade cervical intraepithelial neoplasia or cervical cancer. Forty of the 104 women with normal histology or cervical intraepithelial neoplasia I were positive for human papillomavirus, compared to only one positive MIB‐1 test (i.e. proliferation index of more than 35%). Conclusions. Adding a MIB‐1‐test in human papillomavirus‐positive women with equivocal cytology might reduce the number of colposcopies needed to predict ≥ cervical intraepithelial neoplasia II. With this approach only four instead of 43 human papillomavirus‐positive women would have been referred for colposcopy.
Extremely preterm cesarean delivery: a clinical study
Authors: HÖGBERG U. , Håkansson S. , SERENIUS F. , HOLMGREN P.Å. 
Published: December 2009

AbstractObjectives. To describe indications for cesarean section for extremely preterm delivery, peri‐ and postoperative complications and perinatal outcome. Design. A case‐referent study with clinical follow‐up. Setting. A tertiary perinatal center. Population. All deliveries at gestational age <28 weeks at Umeå University Hospital in 1997–2003. For preterm cesarean section referents were women with elective first‐time term cesarean section. Methods. Indications for cesarean section delivery were assessed. Peri‐ and postoperative complications, asphyxia, and infant survival at discharge were described. Results. The cesarean section rate was 75%, in one third the operation was considered as difficult. Indications for extremely preterm abdominal delivery were severe disease during pregnancy and delivery complications. Six out of ten cesarean sections were performed on fetal indication. Nonisthmic incision was performed in 20% of cases. No major postoperative complications and few minor postoperative complications were noted. Irrespective of mode of delivery, few of the infants had severe asphyxia. Conclusion. In balancing the risks of complications related to the surgical procedure against the purported benefits of the infant, this study adds support to the argument to deliver even extremely preterm infants by cesarean section.
Two regimens of vaginal misoprostol in second trimester termination of pregnancy – a prospective randomised trial
Authors: KUMAR BHATTACHARYYA SUBIR , MUKHERJI JOYDEB , SANKAR KAMILYA GOURI , RAY SAILESH , HAZRA AVIJIT 
Published: December 2009

AbstractBackground. The search continues for a safe, effective, and cheap method for mid‐trimester termination of pregnancy. Misoprostol is a strong contender in this respect. The dose schedule of misoprostol is still not fixed. The objective of our present study was to compare the efficacy and adverse events of 2 dose regimens of vaginal misoprostol for second trimester termination. Method. A prospective, randomised, controlled trial was undertaken in 138 women at 14–20 weeks gestation, in a teaching hospital. Subjects were randomised to receive either regime A: 400 µg of intravaginal misoprostol every 3 h, or regime B: loading dose of 600 µg, followed by 200 µg every 3 h. The main outcome measure was the success rate at 48 h, total dose required, induction‐abortion interval, and adverse events. Data was analysed by Student's t‐test, Mann–Whitney U‐test, the chi‐squared test or Fisher's exact test, using Statistica 6.0 software. Results. There was no significant difference in the success rates at 24 and 48 h (Regime A: 97.18 and 98.59%; Regime B: 95.45 and 95.45%), and in mean induction‐abortion interval (12.97 versus 12.13 h). However, mean misoprostol requirement was significantly higher for Regime A (1701.4 versus 1269.7 µg). The incidence of fever was significantly less in Regime B (32.4 versus 14.9%). Conclusion. Use of vaginal misoprostol for second trimester abortion had comparable efficacy with less drug requirement for the 600 µg loading dose followed by 200 µg 3‐hourly regime compared to the 400 µg 3‐hourly regime.
Dual–Dual Action? Combining Venlafaxine and Mirtazapine in the Treatment of Depression
Authors: Malhi Gin S. , Ng Felicity , Berk Michael 
Published: December 2009

Objective: Venlafaxine and mirtazapine in combination are increasingly used in clinical practice to treat treatment-refractory depression. Putative efficacy for this combination of antidepressants, beyond that of monotherapy, stems from their synergistic actions. This paper describes a prospective case series that examined the efficacy of the venlafaxine–mirtazapine combination in the treatment of depressed patients who had failed at least one antidepressant trial. Method: Twenty-two depressed patients with major depression were treated with venlafaxine and mirtazapine in combination for an average of just under 8weeks. Baseline ratings on the 17-item Hamilton Depression Rating Scale (HAM-D17), Montgomery–Åsberg Depression Rating Scale (MADRS) and the Clinical Global Impression–Severity Scale (CGI-S) were repeated at end-point, determined by the naturalistic termination of the depressive treatment episode or the discontinuation of the combination treatment due to adverse effects. The length of treatment until end-point was documented for each patient. Descriptive statistics were used on the collated data. Results: At baseline, mean scores were 28.8 (SD=3.8) for HAM-D17, 30.1 (SD=5.8) for MADRS, and 4.5 (SD=0.5) for CGI-S, reflecting a cohort at the moderate to severe end of the spectrum. At end-point, mean absolute scores were 10.2 (SD=4.7) for HAM-D17, 10.8 (SD=4.6) for MADRS, and 2.3 (SD=0.6) for CGI-S. Mean change from baseline was 18.6 (SD=6.4) for HAM-D17, 19.3 (SD=6.8) for MADRS, and 2.3 (SD=0.6) for CGI-S. Mean duration of treatment was approximately 8weeks, producing a response rate of 81.8% and a remission rate of 27.3%. Only one patient was unable to tolerate the combination although nearly half (10) had significant side-effects during treatment. Conclusion: This study demonstrates relatively high response and remission rates that are encouraging and contribute to the efficacy database for this antidepressant combination. Further studies using randomized controlled designs are needed.
Social Distance Towards People with Mental Illness in Southwestern Nigeria
Authors: Adewuya Abiodun O. , Makanjuola Roger O. A. 
Published: December 2009

Objective: Recent research findings have challenged earlier claims that stigmatizing attitudes towards the mentally ill are less evident in non-Western cultures. A knowledge base of the attitude of the community towards the mentally ill is needed before embarking on an active anti-stigma programme in sub-Saharan Africa. The aim of the present study was to assess the lay public's attitude (social distance) towards people with mental illness in southwestern Nigeria and examine the factors correlating with such an attitude. Method: A cross-sectional survey was carried out in which respondents (n=2078) selected from three different communities in southwestern Nigeria completed questionnaires detailing sociodemographic variables, familiarity with mental illness, perceived causation of mental illness, perceived personal attributes of mental illness and perceived prognosis of mental illness. Their preferred social distance towards people with mental illness was measured with a modified version of the Bogardus Social Distance Scale. Results: The level of desired social distance towards the mentally ill was seen to increase with the level of intimacy required in the relationship, with 14.5% of the participants categorized as having low social distance, 24.6% as having moderate social distance and 60.9% as having high social distance towards the mentally ill. The independent correlates of high social distance towards the mentally ill included having never cared for the mentally ill (odds ratio (OR)=3.31, 95% confidence interval (CI)=2.14–5.21), age over 50 years (OR=1.93, 95%CI=1.59–2.33), perceived supernatural causation of mental illness (OR=1.82, 95%CI=1.51–2.18) and perceived ‘dangerousness’ stereotype of the mentally ill (OR=1.54, 95%CI=1.28–1.85). Conclusions: There is emerging evidence of a high level of social distance and stigmatization of mental illness in sub-Saharan Africa. There is need to incorporate anti-stigma educational programmes into the mental health policies of countries in sub-Saharan Africa. Such policy should include community education regarding the causation, manifestation, treatment and prognosis of mental illness.
Factors Encouraging Medical Students to a Career in Psychiatry: Qualitative Analysis
Authors: Wigney Tessa , Parker Gordon 
Published: December 2009

Objective: Declining interest in psychiatry is an urgent public health issue and has been the subject of many studies. The purpose of the present paper was to survey the attitudes of senior medical students in order to explore reasons why psychiatry might be regarded as an attractive option as a career. Method: Thirty-three students from an Australian university were asked during a written examination to consider why a psychiatric career might be an attractive choice for medical recruits. Key themes were identified and qualitatively analysed from the open-ended responses to the question: ‘On the basis of your clinical experience, consider why a psychiatric career is an attractive choice these days.’ Results: Thematic analysis indicated that the factors influencing decisions to specialize as a psychiatrist weighted financial and lifestyle advantages. The main drawcard profile was of challenging work that affords a good lifestyle and stimulating research opportunities. Other themes such as rewarding patient interaction, holistic care and variety were also raised. Conclusion: Concern that the Australian psychiatric profession is failing to attract sufficient numbers of high-quality recruits is growing. While the majority of essays analysed in this account suggested that the students perceived psychiatry as an adequate career that affords the benefits of a balanced lifestyle, the constraining nature of the survey question compelled examinees to provide positive responses. Despite this bias, the responses are nonetheless revealing and contribute to understanding of the factors that may influence trainees to enter the field. On the whole, it would appear that the discipline is currently not exciting keen passions in medical students.
Comprehensive Description of Adolescents Admitted to a Public Psychiatric Inpatient Unit and their Families
Authors: John Tonge Bruce , Catherine Hughes Georgina , Marie Pullen Jill , Beaufoy Jeanette , Gold Stanley 
Published: December 2009

Objective: Adolescents accessing inpatient psychiatric services typically have severe and complex disturbance. The aim of the present study was to provide a comprehensive description of an adolescent inpatient sample by examining their psychiatric diagnosis, symptomatology and functioning and associated parental mental health, family functioning and cultural and socioeconomic factors. Few studies have described all these factors and existing studies have reported varying results. Methods: Participants were 88 adolescents (37 male) aged 12–18 years (mean=15.4 years) consecutively recruited through a small number of case clinicians from a regional metropolitan public inpatient unit over a 5 year period. Adolescents and parents participated in clinical interviews and completed psychometric measures. Case clinicians provided diagnostic information. Results: In contrast to previous studies, adolescents were from a cross-section of socioeconomic backgrounds. Results showed a high rate of comorbid Axis I diagnoses with depressive disorders the most common principal diagnosis. Two-thirds of adolescents experienced clinical levels of internalizing problems. Clinical levels of thought disturbance and externalizing problems were reported for most adolescents, although adolescents self-reported fewer of these symptoms. Educational and social difficulties were common. A salient result was the high level of family dysfunction reported by multiple informants. Most parents reported minimal personality or psychological disturbance but results contradicted other studies and may reflect response bias. In a preliminary finding, non-English-speaking background and low socioeconomic status were associated with a psychosis-related principal diagnosis. Conclusion: Findings indicate the multiplicity of issues facing adolescent inpatients including psychiatric symptoms, impaired personal and family functioning and family cultural and background factors. Treatment that focuses on only some of these factors may have limited effectiveness.
Comparison of Insulin Resistance, Metabolic Syndrome and Adiponectin in Overweight Bipolar Patients Taking Sodium Valproate and Controls
Authors: Elmslie Jane L. , Porter Richard J. , Joyce Peter R. , Hunt Penelope J. , Shand Brett I. , Scott Russell S. 
Published: December 2009

Objective: Metabolic abnormalities in patients with bipolar disorder may be secondary to obesity, aspects of the disorder or its treatment. To investigate this further, the purpose the present study was to compare insulin resistance, components of the metabolic syndrome and adiponectin levels in a group of overweight bipolar patients taking sodium valproate and a group of non-psychiatric control subjects. Methods: Data were collected from 60 overweight bipolar patients who had experienced clinically significant weight gain thought to be related to sodium valproate treatment and from 60 control subjects without psychiatric illness matched for age, gender, body mass index and ethnicity. Results: The frequency of the metabolic syndrome was high in both groups (50% and 32%, respectively), although not significantly different between groups (p = 0.06). Similar frequencies of insulin resistance (HOMA-IR), abdominal obesity, hypertriglyceridaemia, hypertension and fasting hyperglycaemia were found in both groups. High-density lipoprotein cholesterol levels were lower in patients (p = 0.006), while adiponectin was unexpectedly higher than in control subjects (9.6±5.9 µg mL−1 vs 7.4±4.3 µg mL−1, p = 0.03). The frequencies of insulin resistance (HOMA-IR), the metabolic syndrome and its individual components were not significantly different in patients taking atypical antipsychotic medication and patients not on these medications. Conclusions: Frequencies of insulin resistance and the metabolic syndrome were similar in bipolar patients taking sodium valproate and matched control subjects, but dyslipidaemia was more frequent. Adiponectin levels were higher in patients. Further research is required to clarify the reasons for these findings.