Baby Friendly Hospital Initiative: the Kerala experience

OBJECTIVE: Our purpose was to determine whether color flow pulsed Doppler could predict a luteal phase defect (LDP). METHOD: Twenty-one women with regular menstrual cycles and at risk for luteal phase defect were examined by transvaginal color Doppler during the follicular and luteal phase of the menstrual cycle. Progesterone was measured on the day of the Doppler exam. Ovulation was determined from the lutenizing hormone (LH) surge. Endometrial biopsy during the late luteal phase was performed on each patient. RESULT: Six patients (28.5%) were diagnosed with luteal phase defect. Mean resistance index in patients with luteal phase defect was significantly higher only throughout the luteal phases (p = 0.02). Mean progesterone levels were significantly lower for patients with LPD than for normal women (p < 0.001). Mean pulsatility index in luteal phase deficient cycles was significantly higher throughout the follicular and luteal phases (p = 0.03). CONCLUSION: Color Doppler may aid in assessing luteal phase adequacy. Doppler indices of corpus luteum blood flow in combination to plasma progesterone may be a useful index of luteal function.     

Interspecies hybrids: some thoughts

Air guns are commonly used for sporting entertainment. The inappropriate use of these weapons often leads to injury. In general, trauma inflicted by air weapons is trivial. However, the potential for more serious and fatal injuries is significant. We report two cases of serious air gun injury in children and a review of the relevant legislation covering the use of air weapons in the UK. Enhanced public education and awareness as well as coordinated policies by organizations involved in the care of children is desirable to prevent future calamities involving air weapons.     

When self-destructive thoughts flash through the mind: Failure to meet standards affects the accessibility of suicide-related thoughts.

When individuals realize that they fail to attain important standards or expectations, they may be motivated to escape the self, which could lead thoughts of suicide to become more accessible. Six studies examined this hypothesis, mainly derived from escape theory (Baumeister, 1990). The results indicated that whenever individuals realize that they fail to attain an important standard, they experience increased accessibility of suicide-related thoughts (Studies 1–6). In line with the idea that such effects reflect motivations to escape from negative self-awareness, they were especially pronounced when associated with high levels of self-consciousness and escapist motivations (Study 1) and with a large discrepancy between self and standards (Studies 2–4). Moreover, failure to attain standards increased suicide-thought accessibility along with the desire for an altered state of consciousness (Study 5). Finally, increases in suicide-thought accessibility after failure were associated with simultaneous increases in accessibility of general concepts related to escape (Study 6). Implications of these findings for escape and terror management theories are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Clinical training: Unthinkable thoughts.

Reflects on an assignment in which members of the clinical training committee of the University of Missouri were asked to imagine an approach to clinical training in which clinical staff take more responsibility for selection, education, and placement of students. (0 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mechanisms behind hepatitis B virus persistence: the search continues

An experience with examination and surgical treatment of 156 patients with angiodysplasia of lower extremities shows that the ultrasonic location and dopplerography are highly informative methods of diagnosis of this disease. The orthostatic probe (the Valsalva test effect) allows the spread of angiodysplasia (suprafascial or subfascial) to be determined. The adequate strategy and volume of surgery can be chosen correctly. These methods of examination being noninvasive and easy makes them helpful for the objective assessment of the effectiveness of the surgical procedures and control of further treatment.     

The Wise Baby and the Wild Analyst.

Sandor Ferenczi was Freud's most brilliant disciple, reevaluated after his historical eclipse and later idealization. As a "wise baby," he demonstrated extraordinary clinical acuity as well as a propensity for wild analysis. Despite his confusion regarding conscious confabulation versus unconscious fantasy, he illuminated critical issues of reality-fantasy and objectivity-subjectivity in the theory and practice of psychoanalysis. Ferenczi significantly contributed to present concepts of psychic trauma, countertransference, empathy, and the analyst as participant-observer. Ferenczi illuminated the relationship between perpetrator and victim of child sexual abuse but regarded the child as blissfully innocent. The Freud-Ferenczi relationship is important to the history of psychoanalysis and the evolution of psychoanalytic thought. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mechanism behind the Size Effect Phenomenon

Size effect (SE) on quasi-brittle fracture of concrete and concretelike heterogeneous materials has been commonly demonstrated by the influence of specimen size D on the transition from strength-dominant fracture to toughness-dominant fracture for geometrically similar specimens with a common initial-crack/specimen-size ratio, i.e., a0/D = constant. Under such a condition, size D appears to be the single controlling parameter for SE. In this study, we clarify that the primary source of quasi-brittle fracture, the presence of a large fracture process zone (FPZ) in front of a crack-tip, does not follow the condition of geometry similarity even for geometrically similar specimens. This suggests that the role of FPZ is not clearly explained for SE. Therefore, this study emphasizes the interaction between FPZ and the nearest specimen/structure boundary, and the consequent SE phenomenon. The deficiencies associated with the common SE models developed by Bazant and his coworkers are discussed through comparisons with the analysis on the boundary and FPZ interaction, or the boundary effect. It is shown that quasi-brittle fracture and the transition from strength-dominant fracture to toughness-dominant fracture can occur even if specimen/structure size D is constant, i.e., size D is not the dominant factor for SE.     

Letter: Random thoughts on abortion attitudes

Comments on a paper of physicians' attitudes toward abortion are presented. The reasons for approval of abortion which show about 80% citing medical or psychiatric and only 60% citing social reasons or a woman's right to do with her body what she wants support the belief in the sexist attitudes of physicians. Disbelief is voiced toward the 1 physician who feels a woman cannot become pregnant from incest or rape, and towards the physician who believes a woman's mental health is unthreatened by an unwanted pregnancy. The author wonders if there were differences between male and female physicians sampled.     

Women in prison: Sexism behind bars.

Identifies some problems experienced by women incarcerated in US prisons. Comparisons are made of the availability of occupational and educational programs in prisons for men and women. Problems of separation from families and the impact of inadequate health and mental health services on the lives of women prisoners are also examined. (29 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Baby K case: a search for the elusive standard of medical care

The present study compared the acute subject-rated and performance-impairing effects of trazodone and triazolam in seven healthy humans. Trazodone (50, 100 and 200 mg), triazolam (0.125, 0.25, 0.50 mg) and placebo were administered orally in a double-blind, crossover design. Drug effects were measured approximately 30 min before drug administration and repeatedly afterwards for 6 h. Trazodone and triazolam produced dose-related increases in subject-ratings of drug effect and sedation. The absolute magnitude of trazodone's and triazolam's effects was comparable across these measures, which suggests the doses tested were equivalent on some behavioral dimension. By contrast, triazolam, but not trazodone, increased subject ratings of "dizzy", "excited", "nervous", "restless", "stomach turning" and "itchy skin". Triazolam, but not trazodone, significantly impaired learning, recall and performance. The present findings suggest trazodone may be a viable alternative to benzodiazepine hypnotics like triazolam, especially when needing to minimize drug-induced impairment. Future research could extend the present findings by replicating them in a clinically relevant population such as individuals with histories of drug abuse.     

Going for the gold: the redistributive agenda behind market-based health care reform

Political conflict over the respective roles of the state and the market in health care has a long history. Current interest in market approaches represents the resurgence of ideas and arguments that have been promoted with varying intensity throughout this century. (In practice, advocates have never wanted a truly competitive market, but rather one managed by and for particular private interests). Yet international experience over the last forty years has demonstrated that greater reliance on the market is associated with inferior system performance--inequity, inefficiency, high cost, and public dissatisfaction. The United States is the leading example. So why is this issue back again? Because market mechanisms yield distributional advantages for particular influential groups. (1) A more costly health care system yields higher prices and incomes for suppliers--physicians, drug companies, and private insurers. (2) Private payment distributes overall system costs according to use (or expected use) of services, costing wealthier and healthier people less than finance from (income-related) taxation. (3) Wealthy and unhealthy people can purchase (real or perceived) better access or quality for themselves, without having to support a similar standard for others. Thus there is, and always has been, a natural alliance of economic interest between service providers and upper-income citizens to support shifting health financing from public to private sources. Analytic arguments for the potential superiority of hypothetical competitive markets are simply one of the rhetorical forms through which this permanent conflict of economic interest is expressed in political debate.