bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outpatient cervical ripening before first‐trimester surgical abortion: a comparison between misoprostol and isosorbide mononitrate
Authors: RADULOVIC NINA , NORSTRÖM ANDERS , EKERHOVD ERLING 
Published: March 2007

AbstractBackground. Vaginal administration of prostaglandin analogues as well as nitric oxide donors before first‐trimester surgical abortion has been shown to induce effective cervical ripening. In addition, nitric oxide donors, such as isosorbide mononitrate and nitroglycerin, have been associated with a patient‐friendly side‐effect profile when administered 3 h before the surgical procedure. We wanted to compare the cervical ripening effect and possible side effects of isosorbide mononitrate and the prostaglandin analogue misoprostol when self‐administered at bedtime the evening before surgical abortion. Methods. One hundred and twenty nulliparous women scheduled for suction termination of pregnancy in the first trimester were randomly assigned to receive per vaginam either 40 mg of isosorbide mononitrate or 200 µg of misoprostol. Sixty of the women were included for assessment of cervical ripening as well as evaluation of side effects. The other 60 women were recruited for assessment of side effects only. Cervical ripening was evaluated by measuring baseline cervical dilation and the cumulative force to dilate the cervix to 9 mm by means of a cervical tonometer. For assessment of side effects, the women were asked to complete a symptom questionnaire. Results. Cervical resistance was significantly higher in women treated with isosorbide mononitrate compared to misoprostol (median cumulative force 73 versus 15 N). Common side effects of misoprostol were abdominal pain (69%), nausea (44%), and vaginal bleeding (66%), while in the isosorbide mononitrate group headache was frequently experienced (79%). In both treatment groups, the frequency and intensity of side effects gradually increased during the treatment interval. Conclusions. Misoprostol induced a more pronounced cervical ripening than isosorbide mononitrate, but both regimens were associated with a high frequency of side effects.
Analysis of malpractice claims with a focus on oxytocin use in labour
Authors: JONSSON MARIA , LINDEBERG NORDÉN SOLVEIG , HANSON ULF 
Published: March 2007

AbstractBackground. The objective of this study was to analyse the motives behind disciplinary action in obstetric malpractice cases concerning delivery, and to evaluate the frequency of inappropriate oxytocin use in these cases. Methods. An analysis of all malpractice claims resulting in disciplinary action against physicians and midwives during the period 1996–2003. Investigations and decisions made by the Board of Medical Responsibility were reviewed with special focus on the use of oxytocin. Results. Of 77 cases, 60 regarded patients in labour. In the majority, there had been a normal pregnancy and spontaneous start of labour (78%). At the beginning of labour, 87% showed a normal fetal heart rate (FHR) pattern, indicating fetal well‐being. In 70%, there was adverse fetal outcome with brain damage or death. The most common reason for disciplinary action was improper interpretation of fetal monitor tracings and corresponding failure to recognise fetal distress (76%). Injudicious use of oxytocin was common (68.5%), and was the primary reason for disciplinary action in 33% of the cases. Conclusion. In a Swedish setting, a few common clinical problems pervade; interpretation of FHR patterns and the use of oxytocin account for the majority of rulings of negligence in malpractice cases regarding delivery. Analysis of the cases suggests that the adverse fetal outcomes could possibly have been prevented.
Empirical Investigation of Two Assumptions in the Diagnosis of DSM-IV Major Depressive Episode
Authors: Sakashita Chika , Slade Tim , Andrews Gavin 
Published: March 2007

Objective: The aim of the current study was to examine two major assumptions behind the DSM-IV diagnosis of major depressive episode (MDE): that depression represents a distinct category defined by a valid symptom threshold, and that each depressive symptom contributes equally to the diagnosis. Methods: Data were from the Australian National Survey of Mental Health and Wellbeing. Participants consisted of a random population-based sample of 10 641 community volunteers, representing a response rate of 78%. DSM-IV diagnoses of MDE and other mental disorders were obtained using the Composite International Diagnostic Interview, version 2.0. Analyses were carried out on the subsample of respondents who endorsed either depressed mood or loss of interest (n =2137). Multivariate linear regression analyses examined the relationship between the number and type of symptoms and four independent measures of impairment. Results: The relationship between the number of depressive symptoms and the four measures of impairment was purely linear. Three individual symptoms (sleep problems, energy loss, and psychomotor disturbance) were all independent predictors of three of the four measures of impairment. Conclusions: Counting symptoms alone is limited in guiding a clear diagnostic threshold. The differential impact of individual symptoms on impairment suggests that impairment levels may be more accurately estimated by weighting the particular symptoms endorsed.
Self-reported Suicide Attempts and Associated Risk and Protective Factors Among Secondary School Students in New Zealand
Authors: Fleming Theresa M. , Merry Sally N. , Robinson Elizabeth M. , Denny Simon J. , Watson Peter D. 
Published: March 2007

Objective: To examine associations between individual, family, school and community characteristics and rates of suicide attempts in a national population sample of New Zealand secondary school students. Method: A total of 9570 randomly selected 9- to 13-year-old students from 114 schools were surveyed, using the New Zealand Adolescent Health Survey. This is a 523-item anonymous self-report comprehensive questionnaire delivered by Multi-Media Computer-Assisted Self-Interviewing. Multivariate analyses were used to examine correlates of self-reported suicide attempts within the last 12 months. Results: In total, 739 participants (4.7% of males and 10.5% of females) reported having made a suicide attempt within the last 12 months. Depressive symptoms, alcohol abuse, -having a friend or family member attempt suicide, family violence and non-heterosexual attractions were independently associated with increased rates of suicide attempts while parents caring, other family members caring, teachers being fair and feeling safe at school were independently associated with decreased rates of suicide attempts. Caring friendships, attending worship frequently, possible sexual abuse and anxiety symptoms were not independently associated with suicide attempts. Risk and protective factors operated in the same way for male and female students and for those with and without other suicide predictors. Conclusions: New Zealand secondary school students, particularly female students, report high rates of suicide attempts. Risk of suicide attempts is lower in students reporting caring home and fair, safe school environments and this effect remains once depression is taken into account. This study confirms the importance of depression, substance use, problem behaviour, negative life events, exposure to suicide behaviour by others and the significance of sexual orientation in suicidal behaviour among school students and provides evidence of the importance of the family and school environments in reducing risk among this group.
Better Outcomes in Mental Health Care: Impact of Different Models of Psychological Service Provision on Patient Outcomes
Authors: Morley Belinda , Pirkis Jane , Sanderson Kristy , Burgess Philip , Kohn Fay , Naccarella Lucio , Blashki Grant 
Published: March 2007

Objective: One hundred and eight Access to Allied Psychological Services projects have been funded under Australia's Better Outcomes in Mental Health Care programme since July 2001. All projects are run by Divisions of General Practice and enable general practitioners (GPs) to refer patients to allied health professionals for evidence-based care. They differ in the models they use to retain, locate and direct referrals to their allied health professionals. This paper examines the extent to which the projects are achieving positive patient outcomes, and explores the association between different models of service delivery and varying levels of patient outcomes. Method: The paper draws on two data sources (a purpose-designed minimum dataset and a survey of models of service delivery) to examine the level of patient outcomes within and across projects, and variations in the level of patient outcomes by models of service delivery. Results: The projects are achieving positive effects and these are mostly of large or medium magnitude. The projects do not differ markedly in terms of the patient outcomes they are achieving, despite differences in the models of service delivery they are using. However, those projects implementing a direct referral model, where the GP refers the patient directly to the allied health professional, have significantly greater effect sizes, indicating that they are achieving greater improvements in patient outcomes. In addition, there are non-significant trends toward direct employment of allied health professionals by Divisions being predictive of greater improvements in patient outcomes, and delivery of services from allied health professionals’ own rooms being predictive of weaker patient outcomes. Conclusions: Overwhelmingly, the Access to Allied Psychological Services projects are having a positive impact for patients in terms of their level of functioning, severity of symptoms and/or quality of life. Preliminary indications suggest that a service delivery model incorporating the use of a direct referral system may be associated with superior outcomes. The findings are discussed in the light of the imminent listing of psychologists’ services on the Medicare Benefits Schedule.
Reliability and Validity of the Kessler 10 and Patient Health Questionnaire among Injecting Drug Users
Authors: Hides Leanne , Lubman Dan I. , Devlin Harriet , Cotton Sue , Aitken Campbell , Gibbie Tania , Hellard Margaret 
Published: March 2007

Objective: To examine the reliability and validity of the Kessler 10 (K10) and the Patient Health Questionnaire (PHQ) in a sample of injecting drug users (IDUs). Method: Participants were 103 IDUs with a current substance use disorder accessing a needle and syringe programme. Presence of mental health disorders was assessed using the Mini International Neuropsychiatric Interview (MINI). Results: Both the K10 and PHQ had high levels of internal consistency and concurrent validity. Individuals with a positive screen on the K10 were ten lines more likely to have a current affective disorder, while those with a positive PHQ screen had nearly 14 times the risk. Conclusions: The K10 and PHQ are recommended as brief screening and diagnostic tools for current affective disorders among IDUs.
Changes in Brain-Derived Neurotrophic Factor Following Treatment with Mifepristone in Bipolar Disorder and Schizophrenia
Authors: Mackin Paul , Gallagher Peter , Watson Stuart , Young Allan H. , Nicol Ferrier I. 
Published: March 2007

Objective: Brain-derived neurotrophic factor (BDNF) is stress-responsive and has been implicated in a number of disparate neuropsychiatric disorders. Glucocorticoid antagonists have been shown to have beneficial effects on mood and cognitive function in bipolar disorder but not in schizophrenia. The aim of the present study was to investigate BDNF levels in patients with bipolar disorder and schizophrenia before and after treatment with the glucocorticoid receptor antagonist mifepristone. Methods: Peripheral BDNF levels were measured in patients with bipolar disorder (n=20), schizophrenia (n=20) and 14 matched healthy controls following 7 days of adjunctive mifepristone (600 mg day−1) treatment in a double-blind, placebo-controlled crossover design study. Results: Baseline BDNF values were similar in both patient groups and in healthy controls. Following treatment with mifepristone, cortisol levels were significantly increased and BDNF levels decreased in both schizophrenia and bipolar disorder. A significant correlation existed between change in cortisol level and change in BDNF levels following mifepristone treatment in schizophrenia, but not in bipolar disorder. Conclusion: Differing BDNF responses to increasing cortisol levels between patients with schizophrenia and with bipolar disorder may reflect underlying pathophysiological mechanisms.
Gene Expression Profiling in Brodmann's Area 46 from Subjects with Schizophrenia
Authors: Dean Brian , Keriakous Dahlia , Scarr Elizabeth , Thomas Elizabeth A. 
Published: March 2007

Objective: To identify altered gene expression in the dorsolateral prefrontal cortex obtained after death from subjects with schizophrenia. Method: Restriction fragment differential display (RFDD) was used to measure levels of mRNA in Brodmann area (BA) 46 from schizophrenia and control subjects. Findings on specific mRNA identified with RFDD were further investigated using real-time polymerase chain reaction (real-time PCR), PCR and western blotting. Results: Levels of mRNA for 63 of approximately 12 500 genes differed in BA 46 in schizophrenia. Subsequent real-time PCR has shown that mRNA for muscleblind protein 1 ( MBNL1) and protocadherin 17 ( PCDH17) are increased in BA 46 from subjects with schizophrenia of short, but not long, duration. Altered levels of mRNA for neither gene were present in BA 9 from subjects with schizophrenia or in either cortical area from subjects with bipolar 1 disorder. By contrast, both RFDD and real-time PCR failed to show altered expression of the schizophrenia candidate gene disrupted in schizophrenia 1 ( DISC1) BA46 from any diagnostic cohort. Conclusion: The present study has identified genes that are differentially expressed in BA 46 in schizophrenia. Initial studies have shown that there is a need for a careful validation of genes shown to be affected in schizophrenia using high-throughput technologies. In addition the present study has shown that gene expression may vary considerably depending on the duration of schizophrenia. This raises the hypothesis that changing gene expression may be underlying the change in symptom profile that occurs with disease progression in some subjects with schizophrenia.
Did Geographical Inequalities in Suicide Among Men Aged 15–44 in New Zealand Increase During the Period 1980–2001?
Authors: Pearce Jamie , Barnett Ross , Collings Sunny , Jones Irfon 
Published: March 2007

Objective: It has previously been reported that rates of suicide among men aged 15–44 increased rapidly during the 1980s and 1990s. The present study examines whether geographical inequalities in suicide rates among men in this age group rose during the period 1980–2001 in New Zealand. Methods: Age-standardized rates of suicide for men aged 15–44 were calculated for District Health Boards (DHBs) and in deprivation quintiles (using the 2001 New Zealand deprivation score) for the periods 1980–1982, 1985–1987, 1990–1992, 1995–1997 and 1999–2001. Geographical inequality was measured by calculating the ratio of the suicide rate deprivation quintile 5 to quintile 1. Results: Age-standardized rates of suicide among men aged 15–44 increased in all but two DHBs between 1980 and 2001. The ratio of inequality in suicide between the least deprived and most deprived areas of New Zealand rose from 1.68 in 1980–1982 to a high of 1.94 in 1990–1992, followed by a small reduction to 1.86 by the end of the study period. Conclusions: Geographical inequalities in suicide among men aged 15–44 grew during the period 1980–2001 and remain at high levels. The greatest increase in inequality was during the late 1980s and early 1990s, a period of rapid social and economic change to New Zealand society.
Antidepressants: Prevalence of Duplicate Therapy and Avoidable Drug Interactions in Australian Veterans
Authors: Roughead Elizabeth E. , McDermott Brian , Gilbert Andrew L. 
Published: March 2007

Objective: This study assessed the prevalence of duplicate antidepressant prescribing and avoidable potential antidepressant drug interactions in the Australian war veteran population. Method: The Department of Veterans’ Affairs Pharmacy Claims database was interrogated, using specific criteria, to identify antidepressant duplication. In addition, potential drug interactions where safer alternative therapies were available were assessed. These included anticholinergic agents with tricyclic antidepressants and tramadol with antidepressants. Episodic tramadol dispensings with antidepressants were also assessed. Results: A total of 46 859 veterans had antidepressants regularly dispensed to them in the period 1 April–31 July 2005. Overall, 4037 potential interactions were identified in 3818 veterans (8.1%) to whom were dispensed antidepressants regularly. Antidepressant and tramadol co-prescribing was the most common potential interaction identified among 3.6% of veterans. Two or more interactions were identified in 212 veterans (0.5%). Analysis of episodic tramadol dispensings with antidepressants suggested a much higher prevalence of 7.7%. Conclusion: The increasing use of antidepressants and the high level of potentially avoidable interactions detected in the present study, highlight the necessity of ongoing vigilance concerning the use of potentially inappropriate drug combinations, particularly in the elderly.
Characteristics of timed barium esophagogram in newly diagnosed idiopathic achalasia: clinical and manometric correlates
Authors: Andersson M. , Kostic S. , Ruth M. , Lönroth H. , Kjellin A. , Hellström M. , Lundell L. 
Published: March 2007

Purpose: To describe timed barium esophagogram (TBE) characteristics in patients with newly diagnosed idiopathic achalasia, and to correlate these with clinical and manometric variables. Material and Methods: Forty-six consecutive patients with newly diagnosed achalasia were examined with TBE. Esophageal emptying was assessed using the height, area, and volume of the barium column. Subjective evaluation was performed according to a standardized protocol in all patients. Objective diagnostic evaluation included manometry. Results: At the 1-min time point after contrast ingestion, the static parameters median height, maximum, and mean width of the barium column were 16.0, 4.4, and 3.3 cm, respectively. Emptying, expressed as volume of barium, showed significant inverse correlation with the resting and the maximal relaxing pressure of the lower esophageal sphincter (LES) ( R = −0.34 and R = −0.54, respectively). There was also an inverse correlation between emptied volume at TBE and the duration of symptoms ( R = −0.36), and between barium column width and postprandial chest pain ( R = −0.44). Conclusion: All patients with newly diagnosed achalasia presented with delayed emptying of barium the esophagus at TBE. The estimated emptied volume of barium (related to the ingested volume) correlated inversely with the basal tone and the relaxation pressure of the LES. Including estimation of the volume of emptied barium at TBE resulted in closer correlation with manometric values of LES tone than using the parameters traditionally recorded.
Imaging of four-corner fusion (SLAC arthrodesis) of the wrist with 64-slice computed tomography
Authors: Ekelund L. , Hagberg L. , Hörberg L. , Jörgsholm P. , Gunnarsson M. 
Published: March 2007

Purpose: To find out whether it is possible to evaluate the healing of wrist arthrodesis, carried out with a metallic spider plate, by means of 64-slice computed tomography (CT). Material and Methods: 18 CT examinations were performed in 12 patients 2 weeks to 37 months following scapholunate advanced collapse (SLAC) arthrodesis fixed with a metallic plate. Ten patients also had plain films of the wrist. Radiation doses were estimated. Results: Plain films were difficult to evaluate due to overprojection of the spider plate. With 64-slice CT, however, it was possible to evaluate the healing process in all patients in spite of metallic artifacts. Radiation doses were low. Conclusion: The healing of SLAC arthrodesis of the wrist is difficult to evaluate with conventional radiography due to the metallic plate. By means of 64-slice CT, however, it was possible to “see under” the plate in all 12 patients.
Forty-slice spiral computed tomography of the coronary arteries: assessment of image quality and diagnostic accuracy in a non-selected patient population
Authors: Grosse C. , Globits S. , Hergan K. 
Published: March 2007

Purpose: To investigate prospectively the image quality and diagnostic accuracy of 40-slice computed tomography (CT) for the detection of hemodynamically significant coronary artery disease (CAD) in a non-selected, consecutive patient cohort. Material and Methods: Forty consecutive patients (28 men, 12 women) underwent both 40-slice CT and conventional invasive coronary angiography (ICA) within 10±7 days. The results of both methods were compared on a per-segment and per-patient basis, using ICA as the standard of reference. Results: According to ICA, significant CAD was present in 30/40 patients (75%). Of a total of 545 segments, 43 segments (7.9%) could not be sufficiently evaluated by CT due to motion artifacts in 15 segments (34.9%), small vessel size and suboptimal contrast enhancement in 14 segments (32.6%), severe calcification in 10 segments (23.3%), and opacified adjacent structures such as cardiac veins in four segments (9.3%). Segment-based analysis for detection of significant stenosis >50% yielded an overall sensitivity, specificity, positive predictive value, and negative predictive value of 87%, 99%, 98%, and 95%, respectively. Restricting the assessment to clinically relevant proximal coronary segments led to an increase in sensitivity to 96%, specificity to 99%, and negative predictive value to 99%. Patient-based analysis demonstrated a high negative predictive value (91%) of CT for excluding significant CAD, even when all segments were included in the analysis. Conclusion: In a non-selected patient population with a high prevalence of CAD, 40-slice CT demonstrates high diagnostic accuracy in the assessment of significant CAD per patient and per segment.