Medical management should be routinely used as primary therapy for ectopic pregnancy

It does not appear that methotrexate can or should be used to totally replace laparoscopic salpingostomy. However, given its success rate in selected patients, its cost-effectiveness, and its low incidence of side effects, methotrexate therapy certainly can be used as an alternative therapy. The next step in developing this treatment option will be to conduct a randomized clinical trial comparing laparoscopic salpingostomy with intramuscular methotrexate. This type of study will answer questions regarding the patient's health related quality of life and economic impact of the two treatment modalities. For now, it seems prudent to offer methotrexate to those patients with an unruptured ectopic gestational mass 3.5 cm or less in greatest dimension.     

Inequality, discrimination, and the power of the status quo: Direct evidence for a motivation to see the way things are as the way they should be.

How powerful is the status quo in determining people’s social ideals? The authors propose (a) that people engage in injunctification, that is, a motivated tendency to construe the current status quo as the most desirable and reasonable state of affairs (i.e., as the most representative of how things should be); (b) that this tendency is driven, at least in part, by people’s desire to justify their sociopolitical systems; and (c) that injunctification has profound implications for the maintenance of inequality and societal change. Four studies, across a variety of domains, provided supportive evidence. When the motivation to justify the sociopolitical system was experimentally heightened, participants injunctified extant (a) political power (Study 1), (b) public funding policies (Study 2), and (c) unequal gender demographics in the political and business spheres (Studies 3 and 4, respectively). It was also demonstrated that this motivated phenomenon increased derogation of those who act counter to the status quo (Study 4). Theoretical implications for system justification theory, stereotype formation, affirmative action, and the maintenance of inequality are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Whorfian hypothesis and numerical cognition: is 'twenty-four' processed in the same way as 'four-and-twenty'?

Recent theoretical developments have redefined a Whorfian effect as a processing difference due to the language of the individual, and no longer as a marker for or against linguistic determinism. Within this framework. Whorfian effects can be used to investigate whether a particular part of the cognitive system is penetrable by language processes or forms an encapsulated module, provided the experimenter ensures that the target language difference is not caused by peripheral input or output processes. In this article, we examine the possibility of a Whorfian effect in numerical cognition by making use of the fact that in the Dutch number naming system the order of tens and units is reversed (i.e. 24 is read 'four-and-twenty'). In a first experiment, we asked native French- and Dutch-speaking students to name the solution of addition problems with a two-digit and a single-digit operand (e.g. 20 + 4 =?, 24 + 1 =?). The order of the operands was manipulated (20 + 4 vs. 4 + 20) as well as the presentation modality (Arabic vs. verbal). Three language differences emerged from this study. Experiment 2, however, showed that these differences were all due to input or output processes rather than differences in the addition operation (i.e. the differences between Dutch and French disappeared when subjects were asked to type the answer rather than pronounce it). On the basis of these findings, we question the idea that mathematical operations are based on verbal processes.     

The ABCs of deception: Do young children understand deception in the same way as adults?

Most research suggests that it is not until age 4 that children understand deception as a means of creating a false belief. Yet children could have failed on these tasks because of either (1) conceptual problems (an inability to understand that deception is a means of creating false belief), or (2) pragmatic problems (an inability to articulate an understanding of false beliefs) and task complexity (an inability to follow the narrative or make appropriate inferences). Three experiments were conducted to determine why children might fail deception tasks, and results indicated that (1) children were no better at understanding deception whether they were "active deceivers" or observers of a deceptive act, and (2) children's difficulty appeared to be associated with a conceptual deficiency (e.g., they could leave clues that would lead another to a possible belief but not a false belief). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Environmental-medical diagnosis and therapy. Hasty diagnosis of unspecified environmental syndromes should be avoided

In the past ten years environmental medicine has virtually exploded. Major instruments for the interdisciplinary environmental-medical diagnosis are history, on-site inspection, biomonitoring and ambient monitoring. Since the definitive diagnosis of an environment-related disease usually requires a joint evaluation of toxicological, somatic and psychosomatic findings, it is recommended that cooperation with an experienced center for environment medicine should be established early on. By doing so, an inappropriate diagnosis of unspecific environment-medical symptom complexes such as, e.g., multiple chemical sensitivity may be avoided. Such "diagnoses" may result in drastic, and for the patient and his family, often stressful, consequences.     

Time to remove our theoretical blinders: Integrity therapy may be the right way.

Suggests the use of O. H. Mowrer's (1950, 1960) integrity therapy as a possible theoretical model when the emotional experience of guilt plays an integral role in the subjective distress and behavioral problems of the patient. Three case studies are offered as examples of instances in which integrity therapy might have been used effectively as a practical and therapeutically sound technique to cope with, confront, and overcome problems in which the patient's emotional experience of guilt was of instrumental significance. (7 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

When and how should the long-term anti-epileptic treatment be stopped

Although for some decades it has been customary to stop long-term treatment of epilepsy in patients who have been free of crises for several years, there is still no general agreement as to when, how and in which cases such treatment should be stopped. Several factors have to be taken into account when making such a decision: the known toxicity of anti-epileptic drugs; the fact that 10-20% of the patients on such treatment have recurrences of their epileptic crises and that around 25% of the children and 40% of the adults relapse when long-term treatment is stopped. On the other hand, factors which reduce the risk of relapse have recently been identified. When the psychological benefit of no longer having to take anti-epileptic drugs together with their high cost are also considered, it would seem advisable to stop treatment when the patient has had no epileptic crises for several years. Since there is no significant difference in the frequency of relapses when anti-epileptic drugs are suspended 2-5 years after the last crises, and these crises are more frequent when paroxystic activity is seen on the EEG before stopping the drugs, we recommend that treatment be stopped after 2 years free of crises in idiopathic epilepsy, after 3 years with no sign of abnormality in the EEG in patients with partial cryptogenic epilepsy and after at least 4 years without crises and 2 years of normal EEG in patients with partial symptomatic or generalized cryptogenic or symptomatic epilepsy. The criteria for suspending drug treatment should take account of the pharmacokinetic features and permit EEG control. Therefore we recommend that 40% of the total dose be stopped during the first 6 months at a rate of 20% every three months and then a further 20% every two months until medication has been stopped completely.     

Should the same glucose values be targeted for type 1 as for type 2 diabetics in pregnancy?

OBJECTIVE: Our purpose was to determine whether the same maternal glycemic control is necessary to achieve similar perinatal outcomes for type 1 as for type 2 diabetics. STUDY DESIGN: The subjects were all women with pregestational diabetes mellitus delivered of live-born singletons. Glycemic control was achieved with diet and insulin. Self-monitoring of blood glucose was performed before meals and at bedtime. Target glucose values were 60 to 90 mg/dl fasting and 60 to 105 mg/dl at other times. RESULTS: Of 60,628 deliveries, 46 type 1 and 113 type 2 diabetic women met inclusion criteria. Respective differences were found between type 1 and type 2 diabetics in average daily glucose levels (112 mg/dl vs 97 mg/dl, p < 0.001), percent of values within target ranges (35% vs 57%, p < 0.001), and mean amplitude of glycemic excursion (48.1 mg/dl vs 24.9 mg/dl, p < 0.001). At least one daily glucose value was < 50 mg/dl during 19% of observation days for type 1 vs 2% of observation days for type 2 pregnancies (p < 0.001). There were no statistically significant differences between type 1 and type 2 diabetic pregnancies in neonatal macrosomia (30% vs 34%), proportion of cesarean deliveries during labor for arrest disorders (67% vs 69%), shoulder dystocia (2% vs 6%), and neonatal hypoglycemia (18% vs 26%). CONCLUSIONS: Less stringent maternal glycemic control may permit comparable maternal and neonatal outcomes for type 1 compared with type 2 diabetics. Higher target values for type 1 diabetics may decrease the frequency of maternal hypoglycemic episodes.     

Study of the injury epidemiology should be developed in China]

A 24-year-old woman presented with left-sided ptosis, diplopia, sensory impairment on the left side of her face and diminished hearing in her left ear. The neurological findings were hypo-anesthesia in all three divisions of the trigeminal nerve, left-sided facial paralysis of the oculomotor and abducens nerves. Initially the condition was misdiagnosed as maxillary sinusitis and was treated with antibiotics. It seems that this presentation has not been previously described in commonly read English-language journals. In our case, the tumour was removed totally and the neuropathological diagnosis was schwannoma. The case report describes the presentation, investigations, management and outcome in this patient.     

Alcoholics anonymous and behavior therapy: Can habits be treated as diseases? Can diseases be treated as habits?

Alcoholics Anonymous (AA) and behavior therapy have often been characterized as having opposing views of the nature and treatment of alcohol problems. This article describes the theoretical foundations, view of the change process, and treatment practices of AA and behavior therapy. Theoretical and practice perspectives on integration of the two models are examined, and advantages and disadvantages of integration are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)