bluuebunny/crossref_metadata_2025_split huggingface dataset:
Regional variations in neural tube defects and alfa‐fetoprotein screening in Denmark 1983‐88
Authors: Jacobsen Peter 
Published: November 2007

Background. An effect of maternal serum alpha‐fetoprotein screening on prevalence rates for neural tube defects (NTD's) has been demonstrated in some populations. The present study tests the hypothesis that regional rates in the Danish low risk population reflects screening activities.Methods. Cross‐sectional survey for neural tube defects through the Danish Malformation Register.Results. The prevalence rate for all neural tube defects was 5.8 pr 104 births which is lower than in most other populations. Standardized risk ratios for NTD in two regions with a program for alfa‐fetoprotein screening were 0.1 (95% c.i. 0.0‐0.7) and 0.4 (95% c.i. 0.2‐0.9). Relative risk at 0.6 (95% c.i: 0.4‐1.1) was found in one county with screening of approximately one third of pregnancies. In most other counties <5% of pregnant women had been examined and point estimates of relative risks varied from 0.9‐1.7.Conclusion. There was a good agreement between prevalence of neural tube defects at birth and regional alfa‐fetoprotein screening activity. This can be taken as a strong indication of a secondary preventive effect from screening in a population with a priori low risk for NTD's. However, other aspects of screening should also be taken into consideration before general programs are forwarded.
The prospects for vaginal delivery in gestations beyond 43 weeks
Authors: Olofsson Per , Saldeen Pia 
Published: November 2007

Objective. To reveal factors influencing the prospect for vaginal delivery in very prolonged pregnancy.Material and methods. Thirty‐six nulliparae and 14 multiparae delivered beyond 43 weeks followed a routine surveillance protocol. Labor was induced on strict indications (n=11; oligohydramnios, large fetus, hypertension) and on ‘soft’ indications (n=24; favorable cervix, emotional stress).Statistics. Receiver operating characteristic curves were obtained for maternal stature and birthweight with regard to mode of delivery. Student's unpaired r‐test, Mann‐Whitney U test, and Fisher's exact test were used with a two‐tailed p<0.05 considered statistically significant.Results. Labor started spontaneously within three days in >50% of cases managed expectantly. All multiparae had nonoperative vaginal deliveries. Of nulliparae, 89% delivered vaginally if spontaneous labor and 56% if induced. Failure to progress was the most common reason for operative delivery. A maternal height of 160 cm, a very unripe cervix, and a birthweight >4250 g were unfavorable factors in induced nulliparae. No case of perinatal mortality, severe birth asphyxia, meconium aspiration, or shoulder dystocia occurred. Fetal meconium release, fetal distress in labor, and birth asphyxia did not significantly differ with regard to parity or mode of labor.Conclusions. The prospect for vaginal delivery was strongly associated with parity. All multiparae had nonoperative vaginal deliveries, irrespective of spontaneous or induced labor. In nulliparae, a spontaneous onset was favorable but a maternal height of 160 cm, a very unripe cervix, and a birthweight >4250 g were unfavorable factors. In uncomplicated pregnancy with favorable factors spontaneous labor can be awaited for a few days.
The utilization rate and pregnancy outcome of multifetal pregnancy reduction in the nordic countries
Authors: Rådestad A. , Bui T‐H. , Nygren K. G. , Koskimies A. , Petersen K. 
Published: November 2007

Objective. To review the utilization rate and pregnancy outcome of multifetal pregnancy reductions (MFR) in the Nordic countries during the period January 1986‐June 1992. Study design. All centers offering assisted conception in Denmark, Finland, Norway and Sweden were retrospectively surveyed by means of a questionnaire with regard to the number and methods used for MFR, pregnancy loss and the outcomes of the pregnancies. The response rate was 100%.Results. During the period studied, 185 births of triplets or higher multiples occurred in Sweden, 120 in Finland and 102 in Denmark. MFR was performed in 42 women (Sweden 26, Finland 10, Denmark 6) but not in Norway at all. This gives an estimated average utilization rate of 1/7 multiple births of three or more in Sweden, 1/17 in Denmark and 1/12 in Finland. The most frequently used method was intracardiac or intrathoracic injection of a potassium chloride solution in gestational weeks 9‐12. One pregnancy was reduced from seven to four fetuses, two from five to three, 10 from five to two, one from four to three, 17 from four to two, one from four to one, five from three to two, four from three to one and one from two to one. Nine (21%) pregnancies terminated in a spontaneous abortion within one week (n=2) to several weeks (n=7) after the procedure. Of the remaining 33 (79%) pregnancies which continued to delivery, two fetuses died in utero in the second trimester, three infants died perinatally and one child had transverse limb reduction defects. A successful pregnancy defined by the discharge home of at least one infant occurred in 79% of the cases.Conclusion. This study gives national estimates on the utilization rate of MFR. Although MFR is performed more frequently in Sweden than in Denmark and Finland, the overall figures remain low in the Nordic countries. The incidence of pregnancy loss in this study is somewhat higher than in several larger reported series, probably reflecting the learning curve of the procedure. It seems reasonable that MFR should be performed in only a few centers in the Nordic countries.
Hysteroscopy is superior to hysterosalpingography in infertility investigation
Authors: Golan Abraham , Eilat Eran , Ron‐el Rafael , Herman Arieh , Soffer Yigal , Bukovsky Ian 
Published: November 2007

Background. The development of advanced endoscopic instrumentation in recent years has demonstrated the superiority of direct visual examination over radiographic demonstration of various body cavities. Just as laparoscopy has gradually taken a primary role in the surgical investigation of the ovulatory infertile patient, the role of intrauterine endoscopy in comparison to hysterosalpingography (HSG) needs to be reevaluated.Methods. Four hundred and sixty‐four infertile women had undergone both hysterosalpingography and a diagnostic hysteroscopy and the findings were analysed.Results. Compared to hysteroscopy the sensitivity of HSG was 98%, but its specificity only 15%, the positive predictive value 45%, and negative predictive value 95%. On hysteroscopy a normal uterine cavity was found in 53% of the cases with a filling defect and in 56% of those with uterine wall irregularity on HSG.Conclusions. Hysteroscopy, a safe and rapid direct visualisation of the uterine cavity, is superior to HSG in the identification of intrauterine pathology. In view of the low positive predictive value and the low specificity of the HSG, we believe it should be replaced by the diagnostic hysteroscopy as a first line infertility investigation.
Induced abortions and childbirths: trends in Estonia, Latvia, Lithuania, Russia, Belarussia and the Ukraine during 1970 to 1994
Authors: Mogilevkina Irina , Markote Solvita , Avakyan Yuri , Mrochek Ludmila , Liljestrand Jerker , Hellberg Dan 
Published: November 2007

Background, To analyse trends in childbirth, induced abortions and maternal morbidity from 1970 to 1994 in Estonia, Latvia, Lithuania, Russia, Belarussia and the Ukraine.Methods. Official health statistics from the six countries were compiled and analysed.Results. High abortion rates (up to 142 per 1000 women of fertile ages and years) were seen in all countries analysed, but since 1980 a continuing decrease is noted for Estonia, Latvia and Kaliningrad with a lowest rate of 50 abortions/1000 women/year in Latvia in 1994. Teenage abortions and childbirths are increasing. Maternal mortality, including complications of abortions, is still a reality in all the countries studied.Conclusion. The high abortion frequencies in all countries studied here indicate that national abortion prevention programs are needed. Such programs should focus on education, both of medical professionals, teenagers, fertile women and males. Concomitantly, the availability of cheap and modern contraceptives must increase, especially to defined risk groups.
Serum endometrial IgG antibodies and soluble CD23 concentrations in patients with endometriosis
Authors: Odukoya Olusegun , Bansal Amolak , Cooke Ian 
Published: November 2007

Objective. Serum endometrial antibodies have been found inconsistently in patients with endometriosis. Soluble CD23 is elevated in diseases associated with B cell activation. We evaluated serum levels of soluble CD23 and endometrial IgG antibodies in patients with endometriosis to determine whether there is B cell activation in this condition.Design. Fifty‐seven patients with pelvic pain diagnosed as endometriosis and 40 patients without pelvic pain or endometriosis who had laparoscopic sterilisation were sequentially recruited into the study. Blood was collected and the sera assayed by ELISA for endometrial IgG antibodies and soluble CD23.Results. There was a significant difference between endometriosis and control group in both the serum IgG endometrial antibodies (p<0.05) and soluble CD23 (p<0.05). There was significant but weak correlation between endometrial antibodies and soluble CD23 (r=0.3, p= 0.039), particularly in mild but not severe endometriosis.Conclusions. These data suggest the existence of B cell activation in patients with endometriosis with a significant correlation between endometrial antibodies and soluble CD23. Mild endometriosis appears to be immunologically more active than the severe form. The value of soluble CD23 in the management of endometriosis needs further evaluation.
Validity of a scored urological history in detecting detrusor instability in female urinary incontinence
Authors: Klovning Atle , Hunskaar Steinar , Eriksen Bjarne Chr. Sollie 
Published: November 2007

Background. Kauppila and co‐workers published in 1982 a detrusor instability score (DIS) for women with urinary incontinence. The aim of this study was to determine the validity of the DIS in an outpatient clinic for urogynecology.Methods. The DIS questionnaire was incorporated as part of an independent history at the first consultation. The DIS was compared with clinical diagnosis in 250 patients consecutively referred for evaluation. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and overall accuracy of the DIS in diagnosing genuine stress incontinence (GSI) were calculated using the gynecologist's clinical diagnosis based on urodynamic findings as the gold standard. An ROC‐curve was constructed for determining the optimum cut‐off point for the DIS for women with GSI.Results. A cut‐off point at 7 for the DIS, yielded sensitivity=0.77, specificity=0.52, PPV=0.74, NPV=0.52 and an overall accuracy=0.68. Optimum cut‐off point for GSI according to the ROC‐curve was at a DIS‐value of 5, yielding sensitivity=0.60, specificity=0.77, PPV=0.82, NPV=0.52 and overall accuracy=0.66.Conclusions. A cut‐off point at 7 diagnosed 159 women (64%) as having GSI, 41 of them (16% of 250) having a false positive DIS. Similarly, a cut‐off point at 5 diagnosed 112 women (45%) as having GSI, 20 of them (8% of 250) having a false positive DIS. These women, if otherwise feasible and indicated, might perhaps undergo continence surgery without preoperative urodynamics. A lower cut‐off point than originally proposed ought therefore to be used if the DIS is to become a useful preoperative tool for this kind of surgery.
The effect of intravascular transfusion for severely anemic fetuses on umbilical artery doppler flow velocity waveforms
Authors: Gungor Mete , Ekici Eyup , Kuscu Esra , Arslan Selcuk , Danisman Nuri , Gokmen Oya 
Published: November 2007

Background. To evaluate whether the doppler flow velocity waveforms reflect the fetal hematocrit and to assess the changes of the umbilical artery doppler indices before and after the puncture of the umbilical cord.Material and methods. In this prospective‐study, Pulsed‐Doppler examinations of blood flow velocities in the umbilical artery were carried out before and after 22 diagnostic cordocentesis and 14 fetal blood transfusions into the umbilical vein.Results. There were decreases in the systolic/diastolic ratio (p<0.001), the pulsatility index (PI) (p<0.001), and the resistance index (RI) (p<0.003) after cordocentesis but not after fetal blood transfusion. There were no correlations between the initial hematocrit and the umbilical artery doppler indices in both fetal blood transfusion group and fetal blood sampling group. There was no correlation between the increase in hematocrit and changes in umbilical artery blood‐velocity waveform indices following fetal blood transfusion. The umbilical artery doppler flow‐velocity indices did not predict the fetal hematocrit.Conclusion. These findings suggest that acute changes in blood viscosity following intravascular transfusion are not associated with an increase in resistance to flow as assessed by doppler velocimetry. Umbilical blood sampling per se may be associated with a humorally mediated reduction in placental vascular resistance to flow.
A randomized, double blind, controlled trial of tocolysis to assist external cephalic version in late pregnancy
Authors: Chung Tony , Neale Edmund , Lau Tze Kin , Rogers Michael 
Published: November 2007

Background. External cephalic version at term is not always successful. This trial was done to ascertain whether tocolysis has any effect on the success rate.Methods. A randomized, double blind, controlled trial, with continuous paired sequential analysis. Fifty‐one consecutive patients with a singleton fetus in a breech presentation between 36 and 38 weeks gestation, external version being attempted on each. Ritodrine infusion or placebo was infused before attempt at external cephalic version.Setting. A university teaching hospital with 8000 confinements annually.Results. Version was successful in 17 of the 25 patients given tocolysis, but in only eight of the 25 given placebo (p<0.01). A positive benefit for tocolysis was shown after version had been completed in 10 pairs of patients. However the trial was continued until 25 pairs had been analyzed. The benefit deteriorated during analysis of the last 15 pairs suggesting that the initial benefit may reflect a learning curve for the procedure.Conclusion. Tocolysis is likely to improve the success rate of external cephalic version in late pregnancy, especially in nulliparous mothers or where doctors are learning the technique.
Borderline Personality Disorder: A Challenge for Mental Health Services
Authors: Clarke Michael , Hafner R. Julian , Holme Gwili 
Published: November 2007

Objective: This study had two main aims: to determine the stability over time of the diagnosis borderline personality disorder (BPD) in a psychiatric hospital population; and to assess the quality and effectiveness of treatment offerred within a state mental health service. Method: The case notes of 47 psychiatric hospital patients followed up for 3 years after the index admission were analysed. Results: The mean number of previous psychiatric hospital admissions was 9.0, and at least 74% of the sample had further admissions (mean 3.7) during the 3 year follow-up. Comorbidity with schizophrenia and schizoaffective disorder was rare, and was only 13% with major depression. Longitudinal stability of diagnosis was very high. Conclusions: The study firmly supported BPD as a valid diagnosis. Its treatment within the state mental health system was generally haphazard and ineffective. Post-discharge plans were implemented for only 3 subjects. Current moves toward community psychiatric treatment represent a unique opportunity for improving treatment of BPD by using existing resources more effectively.
Fluoxetine Treatment of Depressed Patients with HIV Infection
Authors: Judd Fiona K. , Mijch Anne M. , Cockram Alex 
Published: November 2007

Objective: The aim of this paper is to describe the outcome of fluoxetine treatment of depressed patients with HIV infection. Method: An open study was made of 20 patients with varying stages of HIV infection treated for depression with fluoxetine. Results: 15 of 20 patients improved with fluoxetine treatment; the drug was generally well tolerated, with no significant drug-drug interactions. Conclusions: Fluoxetine appears to be effective for the treatment of depression in patients with HIV infection.
Long-Term Psychotherapy in Borderline and Narcissistic Disorders: When is it Necessary?
Authors: Beatson Josephine A. 
Published: November 2007

Objectives: This paper explores the barriers and impediments to psychological change in those patients with borderline and narcissistic character pathology requiring long-term psychotherapeutic treatment. Method: Examination of the relevant literature was made and the author's clinical experience included. Results: Those patients with borderline and narcissistic character pathology requiring long-term psychotherapeutic treatment to achieve lasting psychological change are characterised by their experience of severe early developmental trauma. This has resulted in the formation of entrenched adverse relational patterns which are unconscious, difficult to bring into consciousness and slow to change. These patients have failed to establish security of attachment patterns in the course of a depriving and/or traumatic childhood, often in the care of parents with similar character pathology. Such patients will often require a therapeutic relationship with an emotionally responsive therapist sustained over time within a secure therapy frame to achieve lasting psychological change. Conclusions: Patients with borderline and narcissistic pathology who have sustained severe early developmental trauma will often require long-term psychotherapeutic treatment to achieve lasting psychological change. Such treatment is necessary for the relief of suffering in the patients, and may contribute to the alleviation or prevention of the intergenerational transmission of these disorders.
The Psychiatric Care of People with Intellectual Disabilities: The Perceptions of Trainee Psychiatrists and Psychiatric Medical Officers
Authors: Lennox Nicholas , Chaplin Robert 
Published: November 2007

Objective: The main aim of this study was to document the perceptions of trainee psychiatrists and psychiatric medical officers regarding the psychiatric care of people with intellectual disabilities. Method: A 28-item self-administered questionnaire was developed by the investigators and pretested on eight psychiatrists and psychiatric trainees. A revised version of the questionnaire was then sent to 128 psychiatric trainees and 27 medical officers working in the public psychiatric services in Victoria. 116 questionnaires were returned, and the responses analysed. Results: The results indicate a high degree of interest in the psychiatry of intellectual disability, however this was tempered by a feeling that the respondents and their senior colleagues are inadequately trained. The respondents expressed major concerns regarding the care of people with dual disabilities in the hospital and community setting, and significant support for the development of specialised units and subspecialisation within psychiatry. The major concerns which were identified would in part explain why 30% of the respondents felt that they would prefer not to treat people with an intellectual disability and a psychiatric disorder. Conclusion: We can only support the assertion made by the Burdekin Report [12] that “there is an urgent need for academic research, increased clinical expertise and substantial increased resources in the much neglected area of dual disability.”
Continuing Medical Education in Marital and Family Therapy: A Survey of South Australian Psychiatrists
Authors: Allison Stephen , Powrie Ros , Pearce Colby , Martin Graham 
Published: November 2007

Objective: South Australian psychiatrists were surveyed to determine their impressions of the usefulness of marital and family therapy (MFT) in the management of serious psychiatric conditions and to ascertain their previous experience with Continuing Medical Education (CME) about family therapy. It was expected that psychiatrists' preferences regarding CME would be related to their clinical experience of the usefulness of MFT. Method: One hundred and twenty psychiatrists returned a questionnaire about their training, clinical and research interests, with ratings of the usefulness of MFT and CME preferences. This represented 65% of those eligible for the CME programme. Results: Thirteen percent of the respondents found MFT to be extremely useful and a further 47% found it moderately useful in their current practice. There was evidence of a possible training effect: respondents who had previous CME rated MFT as more useful, especially for mood disorders. Furthermore, the treatment of mood disorders seemed to have a particular relevance in family psychiatry, making a statistically unique contribution to ratings of MFT usefulness in the respondents' total practice. Sixty-nine percent of the respondents requested further CME in family therapy. This represented 45% of all South Australian psychiatrists. Respondents who rated MFT as more useful in practice were significantly more likely to be interested in CME. Conclusions: There seems to be sufficient interest and clinical experience among psychiatrists for MFT to be included in CME courses. It is recommended that further training focus on major mental disorders, especially mood disorders and schizophrenia.
Substance Abuse Disorders: Psychiatric Trainees' Knowledge, Diagnostic Skills and Attitudes
Authors: Roche Ann M. , Parle Michael D. , Campbell Jane , Saunders John B. 
Published: November 2007

Objective: The drug and alcohol related knowledge and attitudes of trainee psychiatrists were examined to obtain a baseline measure of these factors in order to determine whether current training is appropriate and adequate. Method: A questionnaire was distributed to trainees enrolled in the training program of the Royal Australian and New Zealand College of Psychiatrists in New South Wales, Victoria, Queensland and South Australia (N=425). Questions were asked relating to theoretical knowledge, diagnostic and problem solving skills for a number of drug groups; further questions concerned the respondents' attitudes and opinions on aspects of management. Results: Sixty per cent of recipients returned the questionnaire. Theoretical and applied knowledge levels were of an adequate standard overall, but highly variable. Notable areas of weakness included knowledge of opiates, barbiturates and stimulants. Trainees' views regarding treatment options were also variable. Alcoholics Anonymous was considered the best supported form of treatment from evidence from controlled trials. Low levels of self efficacy and little support were recognised for early intervention strategies. Conclusions: While positive views were generally expressed towards involvement with patients with alcohol and drug problems, specific strategies to enhance training and performance are needed. Findings are discussed in terms of continuing education. It is recommended that if sufficient training in this area is not provided then psychiatrists will have little confidence in appropriate therapeutic approaches in treating substance misusers.