bluuebunny/crossref_metadata_2025_split huggingface dataset:
Are patients with bipolar affective disorder socially disadvantaged? A comparison with a control group
Authors: Abood Zainab , Sharkey Alison , Webb Marcus , Kelly Alan , Gill Michael 
Published: March 2003

Background:
Bipolar affective disorder (BPAD) has considerable implications for personal and social functioning. However a tendency to be over‐represented in high socio‐economic classes has been reported in earlier studies, suggesting that social disadvantage accompanying the illness is not severe. In addition, an association between affective disorders in general and increased residential mobility has been suggested, but it is unclear if such an association exists with BPAD.
Objectives:
(1) To investigate the suggestion made in previous studies that patients with bipolar disorder are advantaged socially. (2) To test the hypothesis that patients with bipolar disorder show greater residential mobility compared with other patients with psychiatric disorders.
Method:
Ninety patients with DSM IV diagnosis of bipolar disorder admitted to the acute in‐patient unit of a public‐financed district psychiatric service in Dublin were compared with a control group of 91 randomly selected patients with other psychiatric diagnoses, excluding schizophrenia. Socio‐economic, educational and employment ratings were compared, and also duration of illness, frequency of admission and residential mobility. The data were collected retrospectively from case notes and through semistructured interviews with patients or their relatives. The bipolar group was compared with the control group and to the unipolar depression subgroup.
Results:
The bipolar and control groups were found to have similar demographic and socio‐economic features, although the bipolar group had more years of education compared with the whole control group but not when compared with the unipolar depression group. The bipolar group showed longer duration of psychiatric disorder, more frequent hospital admissions and more frequent residential moves since the onset of the illness.
Conclusion:
Bipolar patients requiring in‐patient care in this service experience severe disruption to their lives over prolonged periods.
Antidepressants and neuroplasticity
Authors: D'Sa Carrol , Duman Ronald S 
Published: March 2003

Objective:
We review the literature on the cellular changes that underlie the structural impairments observed in brains of animals exposed to stress and in subjects with depressive disorders. We discuss the molecular, cellular and structural adaptations that underlie the therapeutic responses of different classes of antidepressants and contribute to the adaptive plasticity induced in the brain by these drugs.
Methods:
We review results from various clinical and basic research studies.
Results:
Studies demonstrate that chronic antidepressant treatment increases the rate of neurogenesis in the adult hippocampus. Studies also show that antidepressants up‐regulate the cyclic adenosine monophosphate (cAMP) and the neurotrophin signaling pathways involved in plasticity and survival. In vitro and in vivo data provide direct evidence that the transcription factor, cAMP response element‐binding protein (CREB) and the neurotrophin, brain derived‐neurotrophic factor (BDNF) are key mediators of the therapeutic response to antidepressants.
Conclusions:
These results suggest that depression maybe associated with a disruption of mechanisms that govern cell survival and neural plasticity in the brain. Antidepressants could mediate their effects by increasing neurogenesis and modulating the signaling pathways involved in plasticity and survival.
Pharmacotherapy patterns in the treatment of bipolar disorder
Authors: Russo Patricia , Smith Mark W , Dirani Riad , Namjoshi Madhav , Tohen Mauricio 
Published: March 2003

Objectives:  To assess medication use patterns of patients with bipolar disorder, and, through multivariate analysis, to elucidate the role of selected demographic and clinical factors on medication choice and use patterns.Methods:  Patients were privately insured individuals aged 18–64, continuously enrolled in a health plan for 15 months or longer during the years 1994–1998, and either diagnosed with bipolar disorder or prescribed lithium or valproate at least 90 days after the start of the study period. Medical and pharmacy claims data were used to analyze medication therapy over a 12‐month period.Results:  First‐generation antipsychotics were used by 16.4% of patients and second‐generation agents by 12.4%. Patients starting on antipsychotics tended to stay with them for 12 months or longer, while patients starting on anticonvulsants or antidepressants were more likely to stop therapy or to switch to another medication class. Patients treated with olanzapine appeared to have more psychiatric comorbidities and more psychiatric hospitalizations than users of first‐generation agents.Conclusions:  Although mood stabilizers and anticonvulsant agents are widely used to treat bipolar disorder, antipsychotic agents are also present in the treatment regimens of bipolar patients. Demographic and clinical factors were significant predictors of the choice of initial medication therapy and subsequent use patterns. In particular, patient gender and the number of psychiatric and physical comorbidities were significantly related to the course of medication therapy.
Clinical decision‐making using the General Behavior Inventory in juvenile bipolarity
Authors: Findling Robert L , Youngstrom Eric A , Danielson Carla K , DelPorto‐Bedoya Denise , Papish‐David Raïsa , Townsend Lisa , Calabrese Joseph R 
Published: March 2003

Objective:
The General Behavior Inventory (GBI) is a questionnaire that has utility in the assessment of mood disorders in adults. The purpose of this study was to examine how the GBI might optimally be used in the assessment of youths.

Method: Children and adolescents between the ages of 5 and 17 years participated in this study. All youths were evaluated with the Schedule for Affective Disorders and Schizophrenia for School‐Age Children (K‐SADS). Based on the K‐SADS results, subjects were then assigned to one of four groups: a bipolar spectrum group, a depressive disorders group, a disruptive behaviors disorders group, and a no diagnosis group. Guardians completed a version of the GBI modified for parent reporting. Patients 10 years old or greater also completed the GBI as a self‐report measure.

Results: There were 196 subjects who participated. Both parent report and youth self‐report assigned patients to the appropriate diagnostic group with better than 74% accuracy. Combining information from multiple informants did not significantly improve diagnostic group assignment.

Conclusions: These data suggest that the GBI may be a useful adjunct in the diagnosis of mood disorders in youths, particularly when diagnostic specificity is more important than sensitivity.
Regulation of ER stress proteins by valproate: therapeutic implications
Authors: Bown Christopher D , Wang Jun‐Feng , Chen Biao , Young L Trevor 
Published: March 2003

Objectives:
This paper reviews results of our studies examining the regulation of endoplasmic reticulum (ER) stress proteins by valproate (VPA), and discusses the possible implications in bipolar disorder.

Methods: Our previous studies in the field are reviewed along with relevant literature.

Results: Using differential display PCR, we identified GRP78 as a VPA‐regulated gene in rat cerebral cortex. We also showed that other members of the ER stress proteins family, GRP94 and calreticulin, are also upregulated by VPA. Immunohistochemistry identified that ER stress proteins are increased in frontal and parietal cortex, as well as regions of the hippocampus in rat brain following chronic treatment with VPA.

Conclusions: Regulation of ER stress proteins by VPA may prove to be important to the mechanism of action of the drug. The neuroprotective role of these proteins may also prove to be involved in the pathophysiology of bipolar disorder.
Social support in elderly patients with bipolar disorder
Authors: Beyer John L , Kuchibhatla Maragatha , Looney Chris , Engstrom Elena , Cassidy Frederick , Krishnan K Ranga R 
Published: March 2003

Objective:  The role of social support in bipolar disorder is poorly understood. It is known that young and middle‐aged patients with impaired social support are more likely to be treatment resistant and have increased hospitalization. However, the role of social support in elderly patients with bipolar disorder has not been studied. Our purpose was to evaluate social support in older adults with bipolar disorder compared with peer controls and younger bipolar patients. In addition, we looked at the role of social support in the age of illness onset.Methods:  We evaluated social support of 29 older subjects with bipolar disorder (age 50 or older) and 56 younger subjects with bipolar disorder using the Duke Social Support Index, comparing them to non‐psychiatric, peer controls. Using logistic regression we then examined the relationship of demographic, social support factors, and age of onset.Results:  Both older and younger bipolar subjects perceived their social support as inadequate (OR=14.98; OR=9.05) compared with similar aged controls. Younger bipolar subjects also had less social interactions than younger controls (OR=4.63). These findings remained significant when controlled for gender, marital status, race, and education. No significant differences were noted between early‐onset and late‐onset bipolar subjects.Conclusions:  Older and younger bipolar patients have decreased perceptions of social support than older controls. No effect was found based on the age of illness onset. In addition, younger subjects had less social interactions than peer controls.
Limits of the applicability and generalizability of drug trials in mania
Authors: Licht Rasmus W 
Published: March 2003

Licht RW. Limits of the applicability and generalizability of drug trials in mania.  Bipolar Disord 2002: 4(Suppl. 1): 66–68. ©Blackwell Munksgaard, 2002During recent years, the majority of drug trials in mania have been conducted for the purpose of drug approval. On this background, this paper addresses to what extent these trials may actually provide the practising clinician with useful information. One major point is that selection prior to the point of randomization in RCTs in mania may limit the applicability of study results to patients seen in ordinary clinical practice. Limitations in study credibility and study design are also discussed. The need for large scale pragmatic studies using broad inclusion criteria, comparing the various treatments, alone or in combination, is emphasized.
A prospective study of the discrete fascial defect rectocele repair
Authors: GLAVIND KARIN , MADSEN HANS 
Published: March 2003

Background. The aim of this study is to describe the results of the discrete fascial defect rectocele repair with special emphasis on dyspareunia after the operation.Methods. Sixty‐seven women underwent rectocele repair from October 1997 to January 1999. Repair was limited to reapproximation of discrete defects in the rectovaginal fascia when possible and a small perineorrhaphy. Each patient was evaluated as to whether or not a discrete defect was present and the location of the fascial defect. Outcome measures were complications, recurrent prolapse after 3 months, changes in defecation problems and dyspareunia after the operation.Results. In 96% (64/67) of the patients a discrete defect was present. Before the operation 40% (27/67) reported problems with evacuation of the rectum and 12% (8/67) dyspareunia or problems with intercourse because of the prolapse. The patients were evaluated 3 months after the operation. Only three patients still complained of evacuation problems and only two patients with prior dyspareunia still had problems, which were cured after a further 3 months. Two patients had de novo dyspareunia but in only one patient was an anatomical defect found.Conclusions. The discrete defect rectocele repair offers an anatomical correction of the rectocele, which alleviates the symptoms but, most important, does not give the woman dyspareunia. Long term results of the operation are awaited.
The prevalence and bothersomeness of lower urinary tract symptoms in women 40–60 years of age
Authors: ALLING MØLLER LARS , LOSE GUNNAR , JØRGENSEN TORBEN 
Published: March 2003

Aim. To assess the prevalence and bothersomeness of lower urinary tract symptoms in women aged 40–60 years.Study design. Ongoing longitudinal cohort study.Methods. Four thousand women recruited on a random basis from the Civil Registration System, in one rural and one urban county in Denmark, were asked to fill in a self‐administered, validated questionnaire on lower urinary tract symptoms. Logistic regression analysis was performed to assess the relationship between LUTS, bothersomeness, age, and county residency. Symptom scores and bother scores were compared in order to obtain a valid measure of lower urinary tract symptoms (LUTS).Results. The prevalence of LUTS occurring more than weekly was 27.8% (95% CI: 26.2%–29.4%) and 16.1% (95% CI: 14.8–17.4) had urinary incontinence. The prevalence of stress incontinence increased from at 40 years up to the age of 55 years (OR=1.9 (95% CI: 1.3–2.7)) and declined thereafter. Irritative symptoms such as urge incontinence and urgency steadily escalated in an almost linear fashion with increasing age ((OR=2.7 (95% CI: 1.6–4.5) and OR=2.1 (95% CI: 1.5–2.8), respectively). Incontinence symptoms were the most bothersome. Age was positively associated with most LUTS, but not with bothersomeness. County residency was not associated with LUTS.Conclusion. Women aged 40–60 years frequently have bothersome lower urinary tract symptoms. Age, but not county residency, is an important factor associated with the occurrence of lower urinary tract symptoms in perimenopausal women. LUTS occurring more often than weekly seem to be the most appropriate single measure of LUTS.
Effect of lactoferrin on lipopolysaccharide (LPS) induced preterm delivery in mice
Authors: MITSUHASHI YUICHI , OTSUKI KATSUFUMI , YODA AKI , SHIMIZU YUKIKO , SAITO HIROSHI , YANAIHARA TAKUMI 
Published: March 2003

Background. The present study attempted to confirm the preventive effect of lactoferrin on lipopolysaccharide (LPS) induced preterm delivery in mice.Methods. Female C3H/HeNCrj mice were pair‐mated with male Crj: B6D2F1 mice. On day 15 of gestation, a 50 μ/kg intraperitoneal injection of LPS (LPS group) was administered twice with a 3‐hour interval between injections (at 2:00 and 5:00 PM). The mice were also given an intraperitoneal injection of lactoferrin (0.2 or 1 mg/200 μl/body) 1 hour prior to each LPS injection) (at 1:00 and 4:00 PM). To determine the effect of LF on plasma IL‐6 level, mother mice were sacrificed and blood samples were obtained at 6 hours after the second treatment of LPS.Results. Preterm delivery was induced by LPS in all mice on day 16 of gestation. Lactoferrin administration to LPS‐treated mice significantly prolonged (p<0.001) gestation when compared with the LPS group. Plasma levels of IL‐6 in the LPS group (1.628±115 pg/ml) were significantly higher (p<0.001) than in the untreated group (497±39 pg/ml). On the other hand, administration of lactoferrin (1 mg/body) to LPS‐treated mice significantly suppressed (p<0.001) IL‐6 levels (1.060±154 pg/ml).Conclusions. Lactoferrin exerts a preventive effect on the incidence of preterm delivery in mice via a suppression of plasma IL‐6 augmentation by LPS.
Domestic violence during pregnancy
Authors: HEDIN LENA WIDDING , JANSON PER OLOF 
Published: March 2003

Background. The aim of this study was to estimate the prevalence of physical injuries, alcohol and tobacco use, abortions and miscarriages due to domestic violence during pregnancy and to compare socio‐economic background factors between abused and non abused women.Method. Personal interview combined with a standardized questionnaire involving 207 pregnant Swedish born women married to or cohabiting with Swedish born men. The women were consecutively chosen from three different antenatal clinics in Göteborg, Sweden.Results. Overall 30 women were abused during the current pregnancy as defined from the category ‘symbolic violence’ in the Severity of Violence Against Women Scale (SVAW). The most frequent targets for physical abuse were: the upper arm, the forearm, and the face and neck region. Ninety‐five percent of women abused during pregnancy had been abused prior to the pregnancy. Notable was the finding that 4.3% of the pregnant women had been exposed to serious violence. Abused women were significantly younger and single, had lower income and education compared to the non abused women. In the group of abused women a higher proportion of women had undergone one or more abortions than in the non‐abused group. Smoking and alcohol use among partners were strongly correlated with physical and sexual abuse.Conclusions. The results suggest that in antenatal and obstetric clinics, emphasis should be focused on previous history of abuse and a complete physical examination of the women. Since bruises often were located at hidden areas of the body, it is of importance to scrutinize those sites as part of a routine examination. It is also important to look for common defensive marks on the forearms. The partner's cigarette and alcohol use is also an important piece of information regarding risk factors connected to domestic violence.
Changing trends in genital herpes simplex virus infection in Bergen, Norway
Authors: NILSEN ARVID , MYRMEL HELGE 
Published: March 2003

Aim of study. To document the proportion of each herpes simplex virus (HSV) type in genital HSV infection and changes over time during a 10 year period.Design. Retrospective comparative study in sexually transmitted disease (STD) patients with genital HSV infection at the outpatient clinic for STD, Haukeland Hospital, Bergen, Norway.Results. HSV‐2 was the major cause during the 80's, whereas HSV‐1 constitutes a greater part of the cases during the 90's, especially in female patients and in the younger age groups with primary or initial disease, where HSV‐1 is the causative viral type in up to 70–90% of the cases.Conclusion. The documented change from HSV‐2 towards HSV‐1 in cases of genital HSV infection may have implications as to prognosis, future usefulness of vaccines, present and future usefulness of new type‐specific serological tests.
Course and outcome of obstetric patients in a general intensive care unit
Authors: COHEN JONATHAN , SINGER PIERRE , KOGAN ALEX , HOD MOSHE , BAR JACOB 
Published: March 2003

Background. To characterize the course, interventions required to achieve predetermined end‐points and outcome of obstetric patients admitted to a general intensive care unit.Methods. A retrospective case series study was performed including all pregnant patients admitted to an 8‐bed general intensive care unit at a tertiary care university‐affiliated hospital over a 4‐year period. All patients referred by the obstetricians were admitted. Patients were divided into two groups: group 1, (n=19) those requiring mechanical ventilatory support and group 2, (n=27) those requiring intensive monitoring. Data collected included demographics, reason for admission, admission diagnosis, Acute Physiology and Chronic Health Evaluation (APACHE II) and Therapeutic Intervention Scoring System (TISS) scores, intensive care unit course, types of interventions used and outcome. End‐points of therapy included systolic blood pressure 110–150 mmHg, urine output ≥1 cc/kg/h and oxygen saturation >95%.Results. Over the study period, 46 obstetric patients were admitted to the intensive care unit, representing 0.2% of all deliveries and an intensive care unit utilization rate of 2.3%. Commonest admission diagnoses were pregnancy‐induced hypertension and hemorrhage. Reason for admission was mechanical ventilation in 41% while 59% were admitted for monitoring. Median length of stay was 25±80.9 (mean 48.8) hours. The median APACHE II score was 6±3.9 (mean 7.24) and the TISS score was >20 in both groups. Only one patient died (mortality rate 2.3%).Conclusion. Despite a short length of stay and low APACHE score, the high TISS score in obstetric patients admitted for both ventilation and monitoring suggests that these patients require a level of intervention and care typically provided by a general intensive care unit.
Clinical outcome and tissue trauma after laparoscopic and abdominal hysterectomy:
Authors: HÄRKKI‐SIRÉN PÄIVI , SJÖBERG JARI , TOIVONEN JUHANI , TIITINEN AILA 
Published: March 2003

Background. To evaluate clinical outcome and tissue trauma after laparoscopic and abdominal hysterectomy.Methods. Fifty women scheduled for abdominal hysterectomy were randomized to undergo either laparoscopic (n=25) or abdominal (n=25) hysterectomy. Surgical characteristics, hospital stay, convalescence and complications were analyzed. Blood samples for assay of markers of tissue trauma (interleukin‐6, C‐reactive protein, tumor‐associated trypsin inhibitor and tumor‐associated antigen CA 125) were taken preoperatively, on the first, second and seventh postoperative day and at the follow‐up visit four weeks after surgery.Results. In uncomplicated hysterectomies (n=18) the operating time (85.3 min versus 57.5 min, p<0.00001) was longer for laparoscopic group but the hospital stay (2.1 days versus 3.4 days, p<0.00001) and sick leave (21.4 days versus 38.5 days, p<0.00001) were shorter in the laparoscopic group. Postoperative increases in all markers were significant in both groups. The interleukin‐6 concentration was highest on the first postoperative day in both groups, that of C‐reactive protein on the second postoperative day in both groups, tumor‐associated trypsin inhibitor on the seventh postoperative day in the laparoscopic group and on the second postoperative day in the abdominal group and tumor‐associated antigen CA 125 on the seventh postoperative day in both groups. Both interleukin‐6 and C‐reactive protein levels were lower in the laparoscopic group on the first (p=0.01 and p=0.03, respectively) and on the second postoperative day (p=0.02 and p<0.001, respectively) compared with the abdominal group. No differences were seen in tumor‐associated trypsin inhibitor and tumor‐associated antigen CA 125 levels between the groups.Conclusion. Laparoscopic hysterectomy should replace abdominal hysterectomy whenever possible because of a more favorable clinical outcome and less tissue trauma.