Recalling and anticipating positive events to improve the positive affect and mental health of adolescents: A cluster randomized controlled trial in secondary schools.

This cluster randomized controlled trial examined the effectiveness of Positive Events Training (PET), a combined group training aimed at simultaneously improving positive autobiographical memory (AM) and episodic future thinking (EFT) among adolescents (12-16 years). Delivered as a universal school-based program, PET was compared with an active (creative writing) control group (CREAT). Effects on resilience, wellbeing, positive emotions, emotional response styles towards positive emotions (savoring, dampening), anhedonia, depressive symptoms, and multiple AM and EFT indices were examined. Adolescents (NPET = 95, NCREAT = 93) completed self-report scales at baseline, post-training and two-month follow-up. Multilevel models revealed that PET led to significant improvements in certain AM and EFT skills. Moreover, a decrease in anhedonia was observed at post-training. However, this effect did not withstand correction for multiple testing. Absence of changes in the other outcomes should be interpreted within the context of the universal school-based approach and the potential limited scope for detectable changes. Exploratory analyses suggest the importance of further investigating PET's potential in addressing positive affect dysregulations in indicated samples, and exploring perceived likelihood of generated future events and dampening as potential underlying mechanisms. Study limitations and future directions to maximize the demonstrated potential of PET are discussed.

Molecular and immunohistochemical distinction of equine sarcoid from schwannoma.

Ten equine skin tumors that had been classified as schwannomas on routine histological examination were analyzed by polymerase chain reaction for bovine papillomavirus DNA. All 10 were positive for bovine papillomavirus 1 or 2, and all 10 were immunohistochemically negative for S-100 protein and strongly positive for vimentin. Nine tumors were moderately positive for laminin and 8, for smooth muscle actin. Five tumors were variably and weakly positive for type IV collagen. The lack of S-100 protein expression made Schwann cells an unlikely cell of origin, as opposed to peripheral nerve sheath tumors, which typically express S-100 protein, at least in some neoplastic cells. The immunohistochemical reactivity is consistent with myofibroblastic origin of the neoplastic cells, although smooth muscle cell or pericyte origin cannot be ruled out. These tumors represent an atypical form of equine sarcoid. Polymerase chain reaction for bovine papillomavirus and S-100 immunohistochemistry are strongly recommended for all equine skin tumors with histological characteristics typical of schwannoma or peripheral nerve sheath tumor.

Peritoneal closure or non-closure at caesarean section.

At caesarean section, the closure or non-closure of the parietal and/or the visceral peritoneum has short-term and long-term advantages and disadvantages. The majority of reports have compared double closure vs double non-closure, non-closure of the parietal, or non-closure of the visceral parietal, with special emphasis on operation time, febrile morbidity, and duration of hospital stay. The present study compares the three methods in 692 consecutive caesarean sections in a South African rural hospital, with special emphasis on wound sepsis, operation time and febrile morbidity. The prevalence of wound sepsis and febrile morbidity was 4.9% and 2.5%, respectively. The only significant difference between the three groups was that double closure resulted in the longest operation time.

Distal limb cast sores in horses: risk factors and early detection using thermography.

REASONS FOR PERFORMING STUDY: There is a lack of evidence-based data on the prevalence, outcome and risk factors of distal limb cast sores, and no objective tool has been described for the early detection of cast sores. OBJECTIVES: To investigate the prevalence, location, outcome and risk factors of cast sores after application of a distal limb cast and to determine whether static thermography of the cast is a valuable tool for the assessment of sores. METHODS: A prospective study was conducted on horses treated with a distal limb cast. At each cast removal, cast sores were graded as superficial sores (SS), deep dermal sores (DS) or full thickness skin ulcerations (FS). In several cases, a thermographic evaluation of the cast was performed immediately prior to removal and differences in temperature (AT) between the coolest point of the cast and 2 cast regions predisposed for sore development (dorsoproximal mc/mtIII and palmar/plantar fetlock) were calculated. RESULTS: Mean +/- s.d. total casting time of 70 horses was 31 +/- 18 days. Overall, 57 legs (81%) developed at least SS. Twenty-four legs (34%) ultimately developed DS and one horse had an FS. Multivariable analysis showed that the severity of sores was positively associated with increasing age (OR: 1.111, P = 0.028), a normal (vs. swollen) limb (OR: 3387, P = 0.023) and an increase in total casting time (OR per week: 1.363, P = 0.002). The thermographic evaluation (35 casts) revealed that the severity of sores was positively associated with increasing deltaT (OR: 2.100, P = 0.0005). The optimal cut-off values for the presence of SS and DS were set at, respectively, deltaT = 23 and 43 degrees C. CONCLUSION AND POTENTIAL RELEVANCE: Distal limb cast is a safe coaptation technique with increasing risk of developing sores with time. Thermography is a valuable and rapid clinical tool to monitor the development of cast sores.

Revising the primigravid partogram: does it make any difference?

OBJECTIVE: To investigate the distribution of the rate of cervical dilatation of primigravid labour and its deviation from the standard partogram. DESIGN: Retrospective observational study. SETTING: South African district hospital serving an indigent rural population. POPULATION: Expectant management of labour of healthy nulliparous women in active labour, at term, with a singleton pregnancy and cephalic presentation. METHODS: Audit of 1,595 partograms of spontaneous primigravid labour. The standard partogram's alert line was replaced by a customised alert line based on the lowest 10th centile of the rate of cervical dilatation of the study population and an alert line representing the 10% slowest labours. The action line was placed parallel and 4 h to the right of the alert lines. MAIN OUTCOME MEASURE: The distribution of labours left to and on the respective alert lines, and right to the action lines. RESULTS: The lowest 90th centile of the customised alert line yielded a rate of cervical dilatation of 0.860 cm/h. Three quarters of labours evolved left to the revised alert line as opposed to 56.1% left of the standard alert line [Odds ratio (OR) 0.49, 95% confidence interval (CI) 0.42-0.56]. The mean rate of cervical dilatation of the 10% slowest labours was 0.535 +/- 0.076 cm/h (P < 0.0001), and 95.7% of labours evolved left to the corresponding alert line (OR 8.40, 95% CI 6.44-11.0). CONCLUSION: The alert line representing the mean of the 10% slowest labours leads to an unrealistic distribution of labour on the partogram. A revised alert line based on the lowest 10th centile of the local population is more representative and should perhaps be used in the management of labour.

Factors affecting outcome of extensor tendon lacerations in the distal limb of horses. A retrospective study of 156 cases (1994-2003).

Distal limb lacerations are common injuries in horses, with a better prognosis reported for extensor tendons lacerations compared to flexor tendons lacerations. The objective of the present study was to determine the influence of type and location of injury, modalities of treatment and post surgical complications on the outcome of extensor tendon lacerations. The medical records of 156 horses surgically treated for extensor tendon lacerations over a 10-year period were analysed retrospectively. Information was obtained for 124 horses with a minimum of 18 months follow-up. Statistical analysis was performed on 129 horses (five horses were euthanatized during hospitalization) in order to determine factors affecting outcome. Seventy-four percent of the horses returned to soundness, 17% had moderate gait impairment and 9% remained lame. Approximately 60% of the sports horses returned to an equal or higher level of performance, and 17.5% returned to a lower level. In the multivariate statistical analysis, the only significant factor that favourably influenced outcome was complete suture of the wound. A significant association could not be detected between outcome and absence of a functional extensor tendon, The most important post-surgical complication was extensive scarring of the wound. The present results report outcome of extensor tendon lacerations in a large number of horses and outline the importance of primary wound healing in order to avoid major scarring with potential functional consequences.

Neonatal outcome after caesarean birth for fetal distress and/or meconium staining in a South African rural setting.

The aim was to evaluate the effect of caesarean delivery on the neonatal outcome after labour with fetal distress and/or meconium staining (MS). We audited 199 caesarean sections performed for non-reassuring fetal condition (NRFC) and/or MS in a rural regional hospital. The 1 and 5 min Apgar scores were compared with those of 33 vaginal births after labour with MS. There were five neonates out of 232 (2.2%) with an Apgar score <7 at 5 min; one died early, neonatally. In the caesarean section group for NRFC, there were two fresh stillbirths and one early neonatal death, a perinatal mortality of 15.1/1,000 births. The 5 min Apgar score was not statistically significantly affected by the mode of delivery. Caesarean delivery does not improve the neonatal outcome when the amniotic fluid is meconium stained.

High prevalence of bovine papillomaviral DNA in the normal skin of equine sarcoid-affected and healthy horses.

Bovine papillomavirus (BPV), the causative agent of papillomas in cattle, has been shown to play a major role in the pathogenesis of equine sarcoids in horses. BPV has also been detected occasionally in normal equine skin. In this study, presence and activity of BPV in normal skin and peripheral blood of 4 groups of horses were evaluated: sarcoid-affected horses, horses living in contact with sarcoid-affected horses, horses living in contact with papilloma-affected cattle and control horses. From each horse, 3 samples on 4 locations were collected: a swab of the intact skin surface and both a swab and a biopsy after decontamination. BPV DNA was found in the normal skin of 24 of 42 horses (57%). Mainly sarcoid-affected horses and horses living in contact with cattle were carriers (73%), but BPV DNA was also detected in 50% of the horses living in contact with sarcoid-affected horses and in 30% of the control population. BPV mRNA was detected in 58% of the samples positive for BPV DNA, although in a much lower quantity compared to sarcoids. In most of the BPV DNA positive samples mild acanthosis, slight basophilic cytoplasmic swelling of the epidermal layers and/or thickening of the basal membrane were noticed, but these observations were also present in several BPV DNA negative normal skin samples. BPV DNA could not be detected in peripheral blood. These findings suggest latent infection and a wide-spread occurrence of BPV in the horse population.

Efficacy of a single misoprostol regimen in the first and second trimester termination of pregnancy.

A total of 273 women underwent termination of pregnancy (TOP) with a single regimen of misoprostol (400 microg orally and 800 microg vaginally), without mifepristone. A total of 98 (35.9%) were first trimester and 175 (64.1%) second trimester gestations. Of these women, 189 (69.2%) responded to a single administration of misoprostol and 84 (30.8%) required between two and six administrations of misoprostol. The medical TOP was complete in 90.8% of all cases. A surgical intervention was needed in 23 (27.4%) of those requiring repeated administrations of misoprostol vs only two (1.1%) of those responding to a single administration. Age, parity and gestational age did not affect the response rate to the misoprostol regimen. The need for a D&C was related to the response to misoprostol: most D&Cs were needed in cases of repeat administrations of misoprostol. This study shows the feasibility of medical TOP in the developing world. It has the great advantage of significantly reducing the need for surgical termination where the required skills are scarce.

Bovine papillomavirus load and mRNA expression, cell proliferation and p53 expression in four clinical types of equine sarcoid.

Equine sarcoids, the most common skin tumours in horses, are induced by bovine papillomavirus (BPV). Their clinical appearance varies from small stable patches to aggressively growing masses. Differences in BPV load and mRNA expression and Ki67 and p53 immunostaining among four clinical types (fibroblastic, occult, nodular and verrucous sarcoids) were evaluated to test the hypothesis that the clinical behaviour of equine sarcoids correlates with BPV activity. Viral load and expression of the BPV E2, E5, E6 and E7 genes were determined using quantitative real-time PCR. The proliferative fraction (PF) of the tumours was determined by Ki67 immunostaining and expression of p53 was analysed by immunohistochemistry. Nodular sarcoids showed a significantly higher viral load than the other types. A significant overall difference among the four types was observed for E2, E5, E6 and E7 mRNA expression. Nodular sarcoids showed the highest expression level for each BPV gene examined, followed by verrucous, fibroblastic and occult tumours. Viral DNA and mRNA outcomes correlated with each other, indicating a similar transcription pattern in each type of sarcoid. The PF was significantly higher in the superficial layers of verrucous and fibroblastic sarcoids compared with occult and nodular types. No significant difference was observed for the PF in the deep layers and for p53 expression. These results clearly demonstrate the omnipresence and active transcription of BPV in equine sarcoids. However, the hypothesis that the clinical behaviour of an equine sarcoid can be explained on the basis of differences in BPV activity could not be demonstrated.

A comparison of women's, providers' and ultrasound assessments of pregnancy duration among termination of pregnancy clients in South Africa.

OBJECTIVE: To compare providers' and women's estimates of duration of pregnancy with ultrasound estimates for determining medical abortion eligibility. DESIGN: Cross-sectional study. SETTING: Public termination of pregnancy (TOP) services in three provinces. SAMPLE: A total of 673 women attending the above services for TOP. METHODS: Women participating in a medical abortion feasibility study in South Africa provided estimates of pregnancy duration and date of last menstrual period (LMP). Each woman also had clinical and ultrasound exams. We compared estimates using the four methods, calculating the proportion of women in the 'caution zone' (< or = 8 weeks gestation by woman or provider estimate and > 8 weeks by ultrasound). MAIN OUTCOME MEASURES: Mean gestational age by each method; difference between provider and LMP estimates and ultrasound estimates; and percentage of women in the 'caution zone'. RESULTS: Women's estimates of pregnancy duration were 19 days fewer than ultrasound estimates (95% CI = -27 to 63). Mean provider- and LMP-based estimates were two (95% CI = -30 to 35) and less than one day(s) (95% CI = -46 to 51) fewer than ultrasound estimates. Comparing provider and ultrasound estimates, 15% of women were in the 'caution zone'; this fell to 12% if estimates of 9 weeks or fewer were considered acceptable. CONCLUSIONS: Provider estimates of gestational age were sufficiently accurate for determining eligibility for medical abortion. LMP-based estimates were also accurate on average, but included more extreme differences from ultrasound estimates. Medical abortion could be provided in TOP facilities without ultrasound or with ultrasound on referral.

Anaemia and pregnancy outcomes in a South African rural population.

The purpose of this study was to evaluate whether the booking haemoglobin (Hb) did affect the mode of delivery or the birth weight. A total of 3,214 booking Hb was available from 1,628 primiparas and 1,586 multiparas. A total of 507 had a caesarean section and 2,707 a spontaneous vaginal delivery (SVD). Moderate and severe anaemia were defined, respectively as an Hb of <10 and <8 g/dl. There were only 112 women with recorded evidence of iron and folate supplementation. The overall prevalence of anaemia was 19.7%. Multigravidas with SVD had a 22.5% prevalence of booking Hb <10 vs 14.2% in primigravidas (p < 0.0001). The prevalence of severe anaemia was similar for all subgroups. Simple regression analysis showed no significant correlation between the booking Hb and pregnancy outcome in terms of birth weight or mode of delivery. However, booking visit anaemia could predispose to caesarean delivery. Documented iron and folate supplementation did not appear to result in different pregnancy outcomes.

The partogram's result and neonatal outcome.

The aim was to investigate to what extent low Apgar scores are linked to the partogram's result and, more specifically, if the action line should be set 3 rather than 4 h parallel and right to the alert line. Some 24.0% of all labours evolved left to the alert line and 26.3% of the labours right to the alert line crossed the 4-h action line. An Apgar score of

Detection of bovine papillomavirus DNA on the normal skin and in the habitual surroundings of horses with and without equine sarcoids.

The purpose of the present study was to examine whether bovine papillomavirus (BPV) DNA can be detected on the normal skin and in the habitual surroundings of horses with and without equine sarcoids by means of superficially taken swabs. In affected horses, no significant difference in presence of BPV-DNA could be observed between samples obtained from the equine sarcoid surface, from normal skin close to the tumour and from a normal skin site in direct contact with the tumour. From the group of healthy horses living in contact with affected horses, 44% were BPV-DNA positive. The surroundings of affected and non-affected horses are probably not a major source of BPV-DNA contamination. It can be concluded that BPV-DNA is present on the normal skin of horses affected by equine sarcoid and to a lesser degree, on the normal skin of horses living in contact with affected horses.

Mode of delivery after one cesarean section.

OBJECTIVES: To investigate labor patterns and mode of delivery of aginal births after cesarean (VBAC) versus unsuccessful trial of labor after cesarean (TOLAC) in a South African district hospital, and the influence of the indication for the primary cesarean section (C-section) on the subsequent mode of delivery. METHODS: Retrospective audit of the partogram of 202 VBAC and 382 repeat C-section. There were 108 elective repeat cesarean deliveries (ERCD) and 274 emergency repeat C-sections after unsuccessful TOLAC. The indication of the primary C-section was known in 127: 43 (33.9%) VBAC and 84 (66.1%) repeat C-sections. RESULTS: The indication for the primary C-section in terms of recurrent/non-recurrent did not affect the subsequent mode of delivery (chi(2)=3.5; P=0.06; OR 0.49, 95% CI 0.23-1.04). The indication of the primary C-section in terms of dysfunctional/non-dysfunctional labor did not reoccur in the same parturients (chi(2)=0.01; P=0.91; OR 0.94, 95% CI 0.35-2.55). CONCLUSION: Dysfunctional labor accounted for most primary and repeat emergency C-sections, but not as a recurrent condition in the same parturients.

The multigravid partogram--should it be customised?

Multigravid labour is conducted according to an alert line and an action line derived from primigravid spontaneous labour. Although it is widely recognised that multigravid labour is significantly faster than primigravid labour, the standard of care for both is the 'usual-care' partogram. A series of 1398 partograms of spontaneous multigravid labours resulting in vaginal delivery was audited. Retrospectively, the labours were graphed on a usual-care and on a customised partogram. The customised alert line was built to represent the rate of cervical dilataion of the lower 90 per cent. (after excluding the 10 per cent of very rapid labours.) The effect of putting the action line 2, 3 or 4 hours behind the alert line on the relative distribution of labours was tested. The results indicate that the norms of the usual-care partogram do not reflect the facts of multigravid labour.

Opportunistic testing of medically underserved women for cervical cancer in South Africa.

OBJECTIVE: To determine the yield of opportunistic Pap smears taken in an unscreened and medically underserved population in the Transkei Region of South Africa. STUDY DESIGN: Cross-sectional study of 22,160 cervical cytology specimens from an unscreened population attending gynecologic outpatient clinics between January 1990 and December 1996. RESULTS: The overall prevalence of atypical squamous cells of uncertain significance (ASCUS), low grade squamous intraepithelial lesions (LSIL) and high grade squamous intraepithelial lesions (HSIL) was, respectively, 34.7%, 8.3% and 2.4%. The ASCUS: SIL ratio was 3:1. The prevalence of invasive squamous cell carcinoma was 1.6%. The yield of opportunistic Pap smears was 10.7% including only LSIL and HSIL. CONCLUSION: The pathologic process of precursor lesions of cervical cancer appears to start at an early age since > 20% of cases are diagnosed before the age of 30 years. In the absence of a national screening program, opportunistic testing of medically underserved women needs to be maintained and encouraged.