No abstract available.
Adolescent* ; Female* ; Humans ; Psychology*

Postpartum mental illness arises from a culmination of factors at the time of the motherhood transition, and bears impact on maternal wellbeing, as well as the infant. Whilst traditional psychiatric approach focuses primarily on symptomatology, diagnostic assessment, and treatment aimed largely at symptoms relief, the infant’s wellbeing and development is of key concern. And thus follows the need to address the space between mother and infant – the dyadic experience. Understanding the world of the infant, the nature of mother-infant bonding, and possible disorders allows us to care better for mothers with perinatal mental illness. Methods: Literature review of the evidence and possible approaches to addressing the mother-infant relational disorder will be discussed based on case reports. In particular, the Watch Wait and Wonder technique, an infant/child-led psychotherapy will be demonstrated with case studies. Results: The case studies demonstrate important themes of mother-infant bonding difficulties common to mothers with postpartum mental illness. Therapy specifically addressing these issues can enable mothers to process feelings of ambivalence and conflicts that hamper the development of the dyadic relationship. Conclusion: The maternal-infant dyadic relationship is a key focus in postpartum mental illness, and mental healthcare for postpartum depression and other illness should consider interventions as needed.

No abstract available.
Histocompatibility Antigens* ; Histocompatibility*

In Japan, awareness has increased in recent years of the importance of evaluating clinical educators. In Europe and North America, the Objective Structured Teaching Evaluation (OSTE), which employs standardized students, multiple stations, video recording, and scoring by multiple observers, is used to evaluate clinical educators. We report on the implementation of an OSTE in Japan.1) Ten clinician-educator physicians participated in the OSTE, which comprised 5 stations and included standardized residents. The stations were video-recorded, and the educators were assessed by 7 different evaluators.2) The educators were evaluated with a checklist and a 5-point scale. We assessed the reliability and validity of the checklist and analyzed the background characteristics of the clinician educators.3) The factors most closely associated with high ratings on the checklist and the 5-point scale were: having a history of attendance at a seminar for clinician-educators, having greater than 5 years experience as an educator, and not being an internist. There was no interobserver variability among the evaluators.4) The generalizability of the checklist was 0.81, and its reliability index was 0.83. The correlation coefficient between the total scale score and the checklist score was 0.8. 5) Although biases by participants were identified, our project suggests that the OSTE could be used in Japan to objectively evaluate the teaching skills of clinician-educators. Further research on the OSTE in Japan is warranted.

The clinical analysis on the etiologies was done along with frequency of the patient's complaints of epiphora.The etiologies of the fifty-four patients screened by fluorescein dye disappearance test were classified by the causative location of the lacrimal pathway. The average of the patient's ages was 48.7 years old and average duration of symptom was 26.1 months.The causative locations were punctum[35.2%], nasolacrimal duct, lacrimal pump and nasal cavity in following order.The most common causes of each group were senile lid laxity[5.6%] for lacrimal pump, conjunctivochalasis and punctual atresia[11.1%]for lacrimal pump, idiopathic narrowing[9.3%]for canaliculus and idiopathic narrowing[16.6%]for nasolacrimal duct.Probing was the most common past history[18.5%]and the kinds of treatment were dacryocystorhinostomy, punctoplasty, lid tightening, probing, and conjunctivod acryocystorhinostomy. These data are expected to be a useful guide of rapid diagnosis and appropriate treatment for the epiphora patients without complicate processes and discomfort.
Dacryocystorhinostomy ; Diagnosis ; Fluorescein ; Humans ; Lacrimal Apparatus Diseases* ; Nasal Cavity ; Nasolacrimal Duct

Postnatal depression is a major public health problem with clearly established adverse effects in child outcomes. This study examines the 4-year outcomes of a screening and early intervention programme, in relation to improvement in symptoms, functioning and health quality of life. Women were prospectively recruited up to 6 months postdelivery, using the Edinburgh Postnatal Depression Scale (EPDS) as a screening tool. High-scorers (EPDS >13), were offered psychiatric consultation, and those with borderline scores (EPDS 10-12) were provided counselling, and offered follow-up phone counselling by the assigned case manager. Outcome measures were obtained at baseline, and at 6 months or discharge if earlier, for levels of symptoms, functioning, and health quality of life. From 2008 to 2012, 5245 women were screened, with 307 (5.9%) women with EPDS >13 receiving intervention. Of these, 70.0% had depression, 4.6% anxiety and 3.4% psychosis. In the depression subgroup, the net change was improvement of 93.4% EPDS symptom scores, 92.2% Global Assessment of Functioning (GAF) scores, and 88.3% visual analogue scale (EQ VAS) health quality of life scores. Outcome scores across diagnostic categories demonstrated median changes of 10 points on EPDS, 20 points on GAF, and 25 points on EQ VAS, reflecting 73.9%, 36.4% and 41.7% change from baseline scores. Women with psychosis showed the biggest (80.0%) relative change in GAF functioning scores from baseline to discharge but had the lowest median change in EPDS symptom scores. A screening and intervention programme rightly-sited within an obstetric setting can improve clinical outcomes because of early detection and intervention.
Adult ; Anxiety Disorders ; diagnosis ; therapy ; Case Management ; Counselors ; Delivery of Health Care ; Depression, Postpartum ; diagnosis ; therapy ; Early Medical Intervention ; Female ; Health Status ; Humans ; Mass Screening ; Obstetrics ; Outcome Assessment (Health Care) ; Prospective Studies ; Psychiatry ; Psychotic Disorders ; diagnosis ; therapy ; Puerperal Disorders ; diagnosis ; therapy ; Quality of Life ; Referral and Consultation ; Singapore

In this study we reviewed the results of 215 operations for intermittent and alternating exotropia of the total, 120 cases had a bilateral rectus muscle recessions and 95 cases had lateral rectus muscle recession and medial rectus muscle resection. The patient in the bilateral rectus muscle recessions group ranged from 2 to 31 years of age, averaging 9.8 years, and the follow up period after operation ranged from 2 months to 25 months averaging 5.4 months. The patient in the latral rectus muscle recession and medial rectus muscle resection group ranged from 4 to 53 years of age, averaging 18.6 yeras, and the post-operative follow up period ranged from 2 to 30 months, averaging 5.8 months. The success rate of operation in bilateral rectus muscle recessions group was 83.3%(100/120), and that in lateral rectus muscle recession and medial rectus muscle resection group was 88.8%(84/95). This difference in success rate between two groups was not statistically significant.
Exotropia* ; Follow-Up Studies ; Humans

We reviewed the clinical characteristics and surgical results of patients who had consecutive esotropia after exotropia surgery with at least 6 months of follow-up. The number of transient esotropic cases with more than 10 prism diopter postoperatively was 105[9%] in total 1128 cases and persistent esotropic cases at least for six months after surgery was 24[2%]. Significant correlations were found between the development of consecutive esotropia and the presence of amblyopia[p=0.04], poor stereopsis[p=0.02], suppression of the Worth 4-dot test[p<.01], and recession-resction surgery[p=0.02]. The corrective surgery for consecutive esotropia was performed on 12 cases[1.1%] with unilateral lateral rectus advancement[7 cases], bilateral lateral rectus advancement[3 cases], unilateral medial rectus recession[1 case] and bilateral medial rectus recession[1 case]. All of them showed good results.
Esotropia* ; Exotropia* ; Follow-Up Studies ; Humans

Persistent physical stimulation and foreign body contact in prosthesis wearers may develop secondary infection, frequent conjunctival injection and responses such as giant papillary conjunctivitis. In 77 patients wearing prostheses, the bilateral conjunctival flora was studied and compared with the expect of conjunctival floral change. The predominent organisms were essentially the same in both sides: Staphylococcus epidermidis, Staphylococcus aureus followed by streptococcus. The incidence of bacterial isolation on the anophthalmic side (67.5%) was significantly higher than on the healthy side (32.5%). Especially the incidence of potential pathogenic bacterial isolation(Staphylococcus aureus, Streptococcus, Gram negative bacilli)(27.9%) was significantly higher on the anophthalmic side than on the healthy side(6.5%). The conjunctival smear study showed the higher incidence of polymorpho nucleoleukocyte and bacteria on the anophthalmic side. The isolation rates of the moderate to marked responded conjunctiva(46.9%) was lower than on the mild responded conjunctiva(69.2%) . The wearing time of the prostheses, the frequency of cleaning of prostheses, type of cleaner and topical drops used did not effect the incidence of bacterial isolation of conjunctival sac. Therfore these results showed that persistent physical stimulation and foreign body contact with prosthesis wearing may alter the microbial flora of the conjunctival sac.
Bacteria ; Coinfection ; Conjunctivitis, Allergic ; Foreign Bodies ; Humans ; Incidence ; Physical Stimulation ; Prostheses and Implants* ; Staphylococcus aureus ; Staphylococcus epidermidis ; Streptococcus

The objective of this study was to ascertain the elationship between the various ocular traumas and the change of pulsatile ocular blood flow[POBF] measured with Ocular Blood Flow Tonograph[OBF Laboratories, UK Ltd.]. We tested POBF with Ocular Blood Flow Tonograph 3 times repeatedly within 48 hours after trauma in the 33 ocular trauma patients.In all the trauma eyes, heart rate[HR]and intraocular pressure[IOP]were higher and pulse amplitude [PA], pulse volume[PV], POBF were lower than in all the fellow eyes.In the hyphema group, HR, IOP, PA, PV, POBF were higher, especially IOP and OBF%S.D.were statically significant, than in non-hyphema group.In the orbital fracture group, only POBF and OBF%S.D.were higher than those of in non-fracture group. Therefore, these results show the change of POBF after various ocularinjuries in the ocular trauma patients.The further studies to follow up the serial change of POBF are necessary.
Heart ; Humans ; Hyphema ; Orbital Fractures