Natural history of hepatitis B in perinatally infected carriers

Objectives: To establish natural seroconversion rates and incidence of hepatic pathology in perinatally infected hepatitis B carriers.

Methods: Seventy three perinatally infected hepatitis B carriers identified through maternal screening were evaluated. Fifty three were born to parents from the Indian subcontinent, nine were Oriental, six were Afro-Caribbean, and five were white. Median follow up was 10.24 (range 2.02–20.16) years.

Results: Only three of the children followed up had cleared hepatitis B surface antigen during this period, and 30% of the children had seroconverted to anti-HBe. Seroconversions to anti-HBe were observed in Asian (18/50) and white (4/5) children, but not in Oriental or Afro-Caribbean children. More girls (40%) than boys (23%) had seroconverted, but the difference was not significant. All children were asymptomatic with normal physical examination, growth, and development. Almost half (48%) of the hepatitis B e antigen (HBeAg) positive children had normal hepatic transaminases and liver function. Thirty five liver biopsies were performed in children with active virus replication (HBeAg or hepatitis B virus DNA positive) who were being considered for antiviral treatment as part of a clinical trial and were scored using the Ishak method. Two thirds (62%) of the children had mild hepatitis, 60% had mild fibrosis, and 18% had moderate to severe fibrosis. There was a weak correlation between histological evidence of hepatitis and hepatic transaminase activity, implying that biochemical monitoring of hepatic disease activity may be ineffective.

Conclusions: These asymptomatic hepatitis B virus carrier children remain infectious in the medium to long term with notable liver pathology. They should receive antiviral treatment to reduce infectivity and to prevent further progression of liver disease. Hepatic transaminases alone are not a reliable marker of liver pathology, and liver histology is essential before consideration for antiviral treatment.

An empirical investigation of women's affective responses to filmed violence

This thesis examined the subjective emotional responses of women to depictions of violent and sexually violent film. Findings highlighted the significance of contextual factors, such as the gender of the perpetrator and victim upon viewers, and found that exposure to sexual violence in the media has important implications for women. The portfolio's four case studies demonstrate the complexities involved in making risk judgements and treatment planning given the diversity of offences and needs, as well as the implications these decisions can have when determining the amenability of offenders to specific sex offender treatment.

Caring and nurturing in the lives of women married to alcoholics

Caring and nurturing are constants in all women's lives, and spouses of alcoholic men are no exceptions. In this article caring is treated as both an emotion and as labour and, therefore, builds on the growing body of work in this area. This article demonstrates that caring work in the lives of women in alcoholic relationships is at the extreme end of a contiuum in which all women are involved, not an abberation as has often been suggested. The women who are interviewed here live lives which are an extension from the good wife in all marriages to the good wife in an alcoholic marriage. It is only by hearing the stories that the link between the women in extreme relationships and women in conventional ones can be made.

Descriptive model of the offence process of women violent offenders : distal background variables

The literature indicates two areas of growing concern in regard to the perpetration of violence by women. One is that the incidence of violence perpetrated by women is increasing across jurisdictions. The other is that despite their growing numbers the knowledge and understanding of violent women has been greatly hindered by the general lack of empirical investigation of this population. The present study uses a grounded theory approach to develop a preliminary descriptive model of the offence process of women violent offenders. The women's violent offence model (WVOM) has four distinct levels or phases. The current article addresses the first of these in detail, consisting of the distal background variables. This phase of the model includes experiences of childhood and adolescence, providing preliminary insight into the more stable distal predispositional factors underlying women's violent offending.

Prevalence of mood and anxiety disorder in self reported irritable bowel syndrome (IBS). An epidemiological population based study of women

Background Irritable bowel syndrome (IBS) is commonly regarded as a functional disorder, and is hypothesized to be associated with anxiety and depression. This evidence mainly rests on population-based studies utilising self-report screening instruments for psychopathology. Other studies applying structured clinical interviews are generally based on small clinical samples, which are vulnerable to biases. The extant evidence base for an association between IBS and psychopathology is hence not conclusive. The aim of this study was therefore to re-examine the hypothesis using population-based data and psychiatric morbidity established with a structured clinical interview.

Methods Data were derived from a population-based epidemiological study (n = 1077). Anxiety and mood disorders were established using the Structured Clinical Interview for DSM-IV-TR (SCID-I/NP) and the General Health Questionnaire (GHQ-12). Current and lifetime IBS was self-reported. Hypertension and diabetes were employed as comparison groups as they are expected to be unrelated to mental health.

Results Current IBS (n = 69, 6.4%) was associated with an increased likelihood of current mood and/or anxiety disorders (OR = 2.62, 95%CI 1.49 - 4.60). Half the population reporting a lifetime IBS diagnosis also had a lifetime mood or anxiety disorder. Exploratory analyses demonstrated an increased prevalence of IBS across most common anxiety and mood disorders, the exception being bipolar disorder. The association with IBS and symptoms load (GHQ-12) followed a curved dose response pattern. In contrast, hypertension and diabetes were consistently unrelated to psychiatric morbidity.

Conclusions IBS is significantly associated with anxiety and mood disorders. This study provides indicative evidence for IBS as a disorder with a psychosomatic aspect.