Postpartum Depression - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

POSTPARTUM DEPRESSION A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2004 by ICON Group International, Inc. Copyright 2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Postpartum Depression: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-597-84595-6 1. Postpartum Depression-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International, Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on postpartum depression. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON POSTPARTUM DEPRESSION ....................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Postpartum Depression................................................................. 4 E-Journals: PubMed Central ....................................................................................................... 23 The National Library of Medicine: PubMed ................................................................................ 23 CHAPTER 2. NUTRITION AND POSTPARTUM DEPRESSION ............................................................. 55 Overview...................................................................................................................................... 55 Finding Nutrition Studies on Postpartum Depression ............................................................... 55 Federal Resources on Nutrition ................................................................................................... 57 Additional Web Resources ........................................................................................................... 57 CHAPTER 3. ALTERNATIVE MEDICINE AND POSTPARTUM DEPRESSION ....................................... 59 Overview...................................................................................................................................... 59 National Center for Complementary and Alternative Medicine.................................................. 59 Additional Web Resources ........................................................................................................... 66 General References ....................................................................................................................... 68 CHAPTER 4. DISSERTATIONS ON POSTPARTUM DEPRESSION ......................................................... 69 Overview...................................................................................................................................... 69 Dissertations on Postpartum Depression .................................................................................... 69 Keeping Current .......................................................................................................................... 71 CHAPTER 5. PATENTS ON POSTPARTUM DEPRESSION ................................................................... 73 Overview...................................................................................................................................... 73 Patents on Postpartum Depression.............................................................................................. 73 Patent Applications on Postpartum Depression.......................................................................... 75 Keeping Current .......................................................................................................................... 78 CHAPTER 6. BOOKS ON POSTPARTUM DEPRESSION ....................................................................... 79 Overview...................................................................................................................................... 79 Book Summaries: Online Booksellers........................................................................................... 79 Chapters on Postpartum Depression ........................................................................................... 81 CHAPTER 7. PERIODICALS AND NEWS ON POSTPARTUM DEPRESSION ......................................... 83 Overview...................................................................................................................................... 83 News Services and Press Releases................................................................................................ 83 Academic Periodicals covering Postpartum Depression.............................................................. 85 APPENDIX A. PHYSICIAN RESOURCES ............................................................................................ 89 Overview...................................................................................................................................... 89 NIH Guidelines............................................................................................................................ 89 NIH Databases............................................................................................................................. 91 Other Commercial Databases....................................................................................................... 93 APPENDIX B. PATIENT RESOURCES ................................................................................................. 95 Overview...................................................................................................................................... 95 Patient Guideline Sources............................................................................................................ 95 Finding Associations.................................................................................................................... 99 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 101 Overview.................................................................................................................................... 101 Preparation................................................................................................................................. 101 Finding a Local Medical Library................................................................................................ 101 Medical Libraries in the U.S. and Canada ................................................................................. 101 ONLINE GLOSSARIES................................................................................................................ 107 Online Dictionary Directories ................................................................................................... 107

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POSTPARTUM DEPRESSION DICTIONARY ....................................................................... 109 INDEX .............................................................................................................................................. 139

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with postpartum depression is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about postpartum depression, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to postpartum depression, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on postpartum depression. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to postpartum depression, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on postpartum depression. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON POSTPARTUM DEPRESSION Overview In this chapter, we will show you how to locate peer-reviewed references and studies on postpartum depression.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and postpartum depression, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “postpartum depression” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Imagine This!: Infinite Uses of Guided Imagery in Women's Health Source: Journal of Holistic Nursing. 17(4): 317-330. December 1999. Summary: This journal article examines the range of applications for guided imagery in women's health. First, it presents background information about the history of imagery, definitions, theoretical foundations, and guided imagery techniques. Then, it reviews research supporting the effectiveness of imagery in various applications such as reducing labor pain, promoting successful lactation, decreasing postpartum depression, and decreasing stress during cancer treatment. Next, it describes an approach to introducing the techniques of guided imagery during routine office procedures such as the pelvic examination, so women will be prepared for crisis situations such as the birth of a child or the diagnosis and treatment of cancer. Finally, it suggests additional

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Postpartum Depression

applications for guided imagery in women's health care, including other stressful office procedures, endometriosis, premenstrual syndrome, chemotherapy, high risk pregnancy, labor, menopause, urinary incontinence, and chronic illness. The article has 2 tables and 34 references.

Federally Funded Research on Postpartum Depression The U.S. Government supports a variety of research studies relating to postpartum depression. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to postpartum depression. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore postpartum depression. The following is typical of the type of information found when searching the CRISP database for postpartum depression: •

Project Title: PREGNANCY

ACUPUNCTURE

TREATMENT

OF

DEPRESSION

DURING

Principal Investigator & Institution: Manber, Rachel; Associate Professor; Psychiatry and Behavioral Sci; Stanford University Stanford, Ca 94305 Timing: Fiscal Year 2002; Project Start 30-SEP-1998; Project End 31-AUG-2007 Summary: (TAKEN FROM APPLICANT): Objective: The aim of the proposed randomized controlled study is to assess the efficacy and effectiveness of acupuncture treatment of depression during pregnancy. Significance: Depression is, unfortunately common during pregnancy and it has significant deleterious effects on mother and infant, including low birth weight, preterm delivery, and continued depression into postpartum. Few medically acceptable treatments are available for the treatment of depression during pregnancy. Our preliminary work provides evidence that acupuncture may be a safe and acceptable treatment option for depression. Specific aims: 1) to evaluate the efficacy of brief 8-week treatment with SPEC acupuncture for major depression during pregnancy relative to the two control treatments; 2) to evaluate the efficacy and clinical significance (pregnancy outcome) of continued treatment with SPEC acupuncture relative to the two control treatments; and 3) to evaluate the differential impact of treatment with SPEC acupuncture for major depression on the incidence of postpartum depression. Participants. Design: To test the efficacy of acupuncture designed specifically to address depressive symptomatology during pregnancy (SPEC) it will be compared, using random assignment, to the following 2 control conditions: 1) valid acupuncture that does not directly address depressive 2

Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

Studies

5

symptoms (NSPEC), thus controlling for the belief in the efficacy of the treatment; and 2) prenatal massage (MSSG), thus controlling for attention, physical contact, relaxation and respite from daily stress. The study includes three phases, acute, continuation and follows up. Participants: 180 participants meeting western diagnostic criteria for Major Depression with a score >: 14 on the first 17 items of the 24-item Hamilton Depression Rating Scale (HRSD) will be randomized. The ethnic distribution of the sample will be representative of the ethnic distribution in the San Francisco Bay Area. Treatments: The acute phase of treatment consists of 16 half-hour treatment sessions delivered over 8 weeks. To consolidate treatment gains and to prevent post partum depression, participants who have full or partial response at the end of the acute phase will continue to receive the same, but less frequent, treatment until 10 weeks post partum, and will be followed up for 6 more months. Main Outcome Measure(s): The primary outcome measures are the HRSD and the depression portion of the SCID-IV, to be administered monthly during the treatment phases and at 3 and 6 months follow up. Other important measures include the Beck Depression Inventory (weekly), expectations (of the participants and the providers), and delivery and infant measures. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CALCIUM FOR PREVENTION OF POSTPARTUM DEPRESSION Principal Investigator & Institution: Hatton, Daniel C.; Behavioral Neuroscience; Oregon Health & Science University Portland, or 972393098 Timing: Fiscal Year 2002; Project Start 08-FEB-2002; Project End 31-JAN-2005 Summary: (provided by applicant): Post-partum depression causes maternal suffering and can have a lasting negative influence on the child's cognitive and emotional development. Interventions that prevent or reduce the incidence of post-partum depression would be of significant value to society. Preliminary studies indicate that dietary calcium supplementation during pregnancy may provide an inexpensive, safe, and effective protection against postpartum depression while at the same time providing a number of other health benefits for the mother and child. We will conduct a rigorous test of the hypothesis that supplemental calcium during pregnancy reduces the incidence of post-partum depression in a randomized, double-blind, placebo-controlled clinical trial of a 2 g/day oral calcium supplement in 238 women at risk for postpartum depression as a consequence of a positive history of depression. Supplementation will begin between weeks 16 and 20 of gestation and continue through 12-weeks post partum. Women will be recruited by newspaper advertisements and clinic referrals. Prior to randomization, a computerized version of the SCID followed by a psychiatric diagnostic interview will be used to determine baseline clinical status. Those currently suffering from major depression, active substance abuse, active psychosis, schizophrenia, bipolar disorder or are on antidepressant medication, will be referred for treatment and will not be included in the study. Prior history of postpartum depression and parity will be controlled for during randomization. The antenatal version of the Edinburgh Postnatal Depression Scale (EPDS) will be used to screen for depression at 26, 32 and 38 weeks of gestation and the postnatal version will be used at 6 and 12 weeks postpartum. Those with a positive change score of 30 percent or a score greater than 16 on the EPDS at any screening visit will be evaluated using a psychiatric interview. Those suffering from major depression will be referred for treatment. The proportion of women in the calcium supplemented group who experience a first episode of major depression since entry into the study in the postpartum period, either at 6 or 12 weeks, will be compared to the proportion in the placebo condition. A significantly smaller proportion in the calcium group will be taken as evidence in

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Postpartum Depression

support of the hypothesis. Positive results from this trial will provide a strong foundation for a multicenter intervention trial. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CARE INTERVENTION FOR DEPRESSED MOTHERS & THEIR INFANTS Principal Investigator & Institution: Horowitz, June A.; Associate Professor; None; Boston College 140 Commonwealth Ave Newton, Ma 02467 Timing: Fiscal Year 2004; Project Start 15-MAR-2004; Project End 29-FEB-2008 Summary: (provided by applicant): Postpartum depression, (PPD), a commonly experienced childbirth complication, jeopardizes mothers' ability to interact responsively with their infants. Onset during the critical period of the first months of infants' lives threatens the maternal-infant relationship and adversely affects infant development. Despite the clinical significance of the problem, limited information exists on the treatment of maternal-infant relational disturbances associated with PPD. The overall goal of this randomized clinical trial is to mitigate negative effects of PPD on infants' development by promoting responsive interaction between depressed mothers and their infants. The specific aim is to test the efficacy of the relationship-focused Communicating And Relating Effectively (CARE) intervention in increasing maternalinfant relational effectiveness, increasing infant clarity of cues and responsiveness to parent, and reducing parenting stress for the treatment group at 3-months, 6-months, and 9-months after delivery. This proposed study builds on preliminary studies that: (a) demonstrated the feasibility of screening women for postpartum depression, and (b) tested the efficacy of a coaching intervention delivered by nurses to promote responsiveness between depressed mothers and their infants. In this study, the CARE intervention is designed to teach depressed mothers to recognize and interpret Infants' engagement and disengagement cues, and to coach mothers to alter withdrawn and intrusive maternal-infant interactive behaviors that are associated specifically with PPD. Nurses will screen approximately 1,500 postpartum women for PPD, randomly assign a minimum of 116 eligible participants to either the treatment or control group, and confirm depression status with a diagnostic interview. Using a repeated measures design, data will be collected at 6-weeks, and 3, 6, and 9 months postpartum. Standardized instruments will evaluate depression symptoms and parenting stress; blind coding of videotaped maternal-infant interaction will measure maternal-infant relational effectiveness and infant behavioral responses. The CARE intervention will be conducted during home visits at 6-weeks, and 2, 3, 4, 6 months postpartum by teaching mothers to interpret their infants' behavioral cues and to respond effectively. R-ANOVA and R-MANOVA will be used to test the study hypotheses and to answer the research question. Outcomes are expected to contribute to knowledge of evidence-based nursing practice models for the treatment of maternal-infant relational problems associated with PPD. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: CHILDBEARING HEALTH OF ABUSED AND NONABUSED WOMEN Principal Investigator & Institution: Records, Kathryn A.; None; Washington State University 423 Neill Hall Pullman, Wa 99164 Timing: Fiscal Year 2002; Project Start 01-APR-2002; Project End 31-MAR-2005

Studies

7

Summary: (provided by applicant) The purposes of this longitudinal project are to: 1. Investigate the relationship between previous or current abuse, prenatal health and postpartum depression: 2. Describe the changes in abuse and depression during the postpartum period, and 3. Test for differences in childbearing outcomes for abused and non-abused women. Stress response theory guides the study. The proposed study builds on completed studies and addresses the Healthy People 2010 (USDHHS, 1997) objectives of improving maternal and infant health and improving mental health. The study also addresses CDC (1997) recommendations regarding state of the science needs for research on abuse, specifically focusing on violence that occurs around the time of childbearing. A comparative, descriptive longitudinal design will be used to collect data from two groups of women according to their abuse (n=88) or non-abuse (n=88) status. Data will be gathered from semi-structured interview, paper and pencil questionnaires, and chart audits from women at six time points (T1-T6): third trimester of pregnancy, delivery, and months two, four, six and eight postpartum. Instruments utilized will be the Edinburgh Postnatal Depression Scale, the Centers for Epidemiologic Studies Depressed Mood Scale, the Predictors of Postpartum Depression Inventory, the Severity of Violence Against Women Scales, and the revised Childbearing Health Questionnaire. Data will be analyzed using SPSSX and Lisrel. This study makes an original contribution to nursing because no other quantitative or longitudinal studies have explored the relationship between the specified concepts, resulting in a knowledge gap regarding the childbearing health of abused women. Further, the state of scientific knowledge in this area does not reveal an understanding of how abuse may change through the childbearing period (CDC, 1997). Until these biopsychosocial relationships are described, interventions specific to abused women during childbearing cannot be developed and effectively tested. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CHRONOBIOLOGY OF POSTPARTUM DEPRESSION Principal Investigator & Institution: Parry, Barbara L.; Professor; University of California San Diego La Jolla, Ca 920930934 Timing: Fiscal Year 2002 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CLINICIAN MANAGED INTERPERSONAL PSYCHOTHERAPY Principal Investigator & Institution: Stuart, Scott P.; Associate Professor; Psychiatry; University of Iowa Iowa City, Ia 52242 Timing: Fiscal Year 2002; Project Start 28-SEP-2001; Project End 31-AUG-2006 Summary: (Adapted from the Applicant's Abstract): Empirical studies evaluating the effects of acute psychotherapeutic treatment have provided invaluable data demonstrating the efficacy of such treatments for major depression. Under controlled conditions, time-limited manual-based psychotherapies are efficacious in bringing about remission of depressive symptoms. Such efficacy studies, however, have several limitations. First, though the treatments are efficacious in laboratory settings, the effectiveness of such treatments, efficacy studies are limited by their lack of external validity. Second, though the acute effects of time-limited treatments for depression are impressive, the improvement is often not maintained, and recurrence of symptoms is common. Our proposed research project is an empirical investigation of the effectiveness of Clinician-Managed Interpersonal Psychotherapy (CM-IPT) for

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Postpartum Depression

postpartum depression, a treatment based on the manual of Klerman et al (1) and refined for a community setting. Timing and frequency of sessions will be determined collaboratively by the therapist and patient rather than arbitrarily specified by manualized directives. We will evaluate the effectiveness of 12 sessions of CM-IPT delivered over the course of a year compared to "standard" IPT for postpartum depression, a treatment which we have previously demonstrated to be efficacious compared to a waiting list control condition. Standard IPT will require that 2 sessions of IPT be delivered in the first 12 weeks after treatment assignment. The first major aim of this research application is to evaluate the longitudinal effectiveness of CM-IPT for postpartum depression compared to standard IPT. We predict that CM-IPT will be associated with lower cumulative levels of depressive symptoms and lower rates of depression over the first year than standard IPT. The second major aim of this research application is to demonstrate the acute effectiveness of CM-IPT for postpartum depression. We will compare CM-IPT and standard IPT at 12 weeks after treatment assignment (the conclusion of standard IPT treatment), at which time we expect the two treatments to be clinically equivalent. Our study, which uniquely combines the best elements of both efficacy and effectiveness research, will lead to more effective treatment for depressed postpartum women in the community. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DEPRESSION

CULTURALLY

RELEVANT

PSYCHOTHERAPY--PERINATAL

Principal Investigator & Institution: Grote, Nancy K.; None; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2003; Project Start 01-APR-2003; Project End 31-JAN-2008 Summary: (provided by applicant): Depression during the perinatal period has adverse effects on the mother, on the development of her newborn infant, and on her family relationships. The purpose of this proposed mentored Patient-Oriented Research Career Development (K23) Award is to promote the Candidate's long-term goal of conducting clinical trials of culturally relevant, psychosocial interventions for perinatal depression in low-income, African American and White Ob/Gyn patients to ameliorate their depression during pregnancy and prevent postpartum depression. The training and research activities described in this application will take place in the cross-disciplinary environment of the School of Social Work and the Department of Psychiatry, University of Pittsburgh. Training will enable the Candidate to assess perinatal mood disorders, develop culturally relevant strategies to effectively engage and retain Ob/Gyn patients in multi-session psychosocial interventions, conduct randomized clinical trials of psychosocial treatments, and collaborate with health services researchers to enhance the public health value of the intervention. Interpersonal psychotherapy (IPT) addresses both depressive symptoms and problematic interpersonal relationships and is an efficacious treatment for depression in general (Weissman, Markowitz, & Klerman, 2000), as well as for depressed African American and White primary care patients (Brown et al, 1999). The first phase of this research plan consists of employing an 8session form of IPT 0PT-B; Swartz, Frank, & Shear, 2002) and modifying it to be more culturally relevant to poor, African American and White Ob/Gyn patients by incorporating a number of engagement strategies to minimize practical and psychological practical barriers to care. The second phase of the research plan consists of a small, randomized pilot trial comparing treatment as usual to culturally relevant IPT-B (followed by monthly maintenance IPT up to 6 months postpartum) in a sample of depressed, pregnant, low-income African American and White patients in a public care

Studies

9

Ob/Gyn clinic. Participants will be assessed at baseline, posttreatment, and 2 months and 6 months postpartum. The skills, training, and pilot data obtained from this award will support the development of an RO1 application in Years 03-05 of the award period. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DEPRESSION INTERVENTION FOR POOR PREGNANT WOMEN Principal Investigator & Institution: Zlotnick, Caron; Associate Professor; Women and Infants Hospital-Rhode Island 101 Dudley St Providence, Ri 02905 Timing: Fiscal Year 2002; Project Start 27-AUG-2001; Project End 31-JUL-2004 Summary: (provided by applicant): In the postpartum period, approximately 10 to 16 percent of women will become clinically depressed. The impact of major depression in the postpartum period is profound with considerable emotional pain for the new mother as well as disturbances in infant development. Unfortunately, few preventive interventions have been developed or systematically tested to reduce the risk of postpartum depression. An area of even greater neglect is the development of such an intervention for financially disadvantaged women who are at high risk for postpartum depression and for the disturbances associated with postpartum depression. This treatment development application proposes to develop a psychosocial intervention for financially disadvantaged, pregnant women at risk for postpartum depression. and to collect preliminary data on the efficacy of this intervention in reducing the likelihood of postpartum depression. The intervention, "Life at Home with a New Baby," is an interpersonal-oriented intervention that targets those factors that may play a significant role in the development of postpartum depression (i.e., poor social support, role transitions, and life stressors). More specifically, the aims of this project are to: (i) develop the manual for the intervention, "Life at Home with a New Baby" (ii) develop, implement, and evaluate a therapist training program, (iii) develop and test the reliability and validity of competence and adherence rating scales that evaluate the training therapists' ability to perform the intervention and assess the reliable delivery of the intervention, and (iv) conduct a randomized controlled pilot study to evaluate the initial efficacy of the proposed intervention compared to a care as usual condition in a sample of financially disadvantaged, pregnant women at risk for postpartum depression. and to provide an estimate of effect size in comparison to the care as usual condition. This pilot study will lay the groundwork for a larger clinical trial evaluating the efficacy of this new group intervention. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: DETECTION AND TREATMENT OF POSTPARTUM DEPRESSION Principal Investigator & Institution: Yonkers, Kimberly A.; Associate Professor; Psychiatry; Yale University 47 College Street, Suite 203 New Haven, Ct 065208047 Timing: Fiscal Year 2002; Project Start 01-SEP-1999; Project End 31-AUG-2004 Summary: This Mentored Clinical Scientist Development Award (MRSCA) application defines a training program which will facilitate the development of the Principal Investigator (PI) as an independent investigator in effectiveness research. The educational activities outlined will enable the PI to change her focus from pharmacotherapy-based clinical trials in controlled environments to an investigator who examines the effectiveness, applicability, and costs of clinical interventions in actual clinical care settings. The training entails mastering a new treatment technique (Interpersonal Psychotherapy) and applying methods to measure a variety of health outcomes (symptomatic, quality of life, economic) in a diverse patient population. In

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Postpartum Depression

order to achieve these training goals, the PI has developed a program that includes unique preceptorships, didactic courses, tutorials and several pilot projects. The proposed pilot projects will afford a hands-on experience, reinforcing the information and technqiues learned in the mentored and classroom settings. Specifically, the research will focus on the screening, recruitment, engagement and treatment of underserved women suffering from postpartum depression. Depression, which is a serious medical condition, has a lifetime prevalence in women of 21 percent. The postpartum period constitutes a time of increased risk for depressive disorders, and encompasses an especially critical time in the life cycle of both mother and infant. Despite the magnitude of this problem, postpartum depressive illnesses are frequently unrecognized. Under diagnosis and under detection are especially germane to socioeconomically disadvantaged women since they have a greater likelihood of suffering from depressive disorders, yet have more limited access to health care. The screening and treatment techniques investigated in this proposal will be piloted in this population through the UTSWMC Maternal Health and Family Planning Clinics (MHFPCs). It is anticipated that the programs instituted through this grant will ultimately be employed in an ongoing and cost-effective manner. This MRSCA is crucial in launching the PI into the arena of effectiveness research. Through this award, she will be able to extend her previous research commitment by adding new skills and knowledge which will enable her to contribute more meaningfully to our understanding of psychiatric interventions in real world settings. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DEVELOPMENT SYMPTOMATOLOGY

OF

AN

INVENTORY

OF

DEPRESSIVE

Principal Investigator & Institution: Rush, Augustus J.; Betty Jo Hay Professor & Chair in Mh; Psychiatry; University of Texas Sw Med Ctr/Dallas Dallas, Tx 753909105 Timing: Fiscal Year 2003; Project Start 07-AUG-2003; Project End 31-JUL-2006 Summary: (provided by applicant): This application is a collaborative R01 submitted by Duke University, the University of Texas Southwestern Medical Center, and the University of Texas at Arlington in response to RFA 03-002. We plan to further develop and evaluate the 30-item Inventory of Depressive Symptomatology, which is available in clinician-rated (IDS30) and self-reported (IDS-SR30) forms, and to further develop and evaluate a shortened version (the Quick IDS), which is available in a 16-item selfreport (QIDS-SR16) and a clinician-rated (QIDS-C16) format. The properties of each of these four instruments as both screens for depression in general medical and psychiatric populations, and as measures of symptomatic change will be evaluated. We will analyze data that have been or that are now being collected from "ongoing" studies. We will also acquire and analyze new data from "prospective" studies to be conducted at Duke and at UT Southwestern. These studies will evaluate the performance of each measure to screen for major and minor depression, defined by a structured interview to render DSM-IV diagnoses - DIS (elderly), by SCID (adults), or by the K-SADS- PL (children/adolescents). We will evaluate concurrent validity with the Montgomery Asberg Depression Rating Scale (MADRS), the 17-item Hamilton Depression Rating Scale (HRSD1T), or Children's Depression Rating Scale (CDRS) as outcome measures in adolescent, adult, and older/elderly populations. Classic psychometric properties (e.g., factor analyses, Cronbach's alpha, and concurrent validity) will be established for each of these four measures (IDS-SR30, IDS-C30, QIDS-SR16, QIDS-C16). We will determine whether an anxiety subscale of the IDS-C3o or IDS-SR30 can be identified and compare the potential items against the Spielberger State Anxiety Inventory. We will create

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equivalence tables using Item Response Theory analysis to translate total scores on the IDS or QIDS to total scores on the HRSD17, MADRS, and CDRS. We will provide benchmark scores for depressive symptom severity by IDS/QIDS ratings to identify minimal, mild, moderate, and severe levels of impaired daily function, as measured by the Sheehan Disability Scale (DIS), SF-12, SF-36, or Social Adjustment Scale-Self-Report (SAS-SR). The result will be a matched self-report and clinician rating scale to assess only the core criterion symptoms of major depression (i.e., the QIDS-C and SR), and more expanded scales capable of assessing both core and associated symptoms (e.g., anxiety, irritability) (IDS-C and SR) that are in the public domain for use with patients across the age spans seen in practice and in research. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DEVELOPMENT SYMPTOMATOLOGY

OF

INVENTORY

OF

DEPRESSIVE

Principal Investigator & Institution: Bernstein, Ira H.; Psychology; University of Texas Arlington 301 South Center Street Arlington, Tx 76019 Timing: Fiscal Year 2003; Project Start 03-JUL-2003; Project End 30-JUN-2006 Summary: (provided by applicant): This proposal is a collaborative R01 submitted by Duke University, the University of Texas Southwestern Medical Center, and the University of Texas at Arlington. We plan to further develop and evaluate the 30-item Inventory of Depressive Symptomatology, which is available in clinician-rated (IDS30) and self-reported (IDS-SR30) forms, and to further develop and evaluate a shortened version (the Quick IDS), which is available in a 16-item self-report (QIDS-SR16) and a clinician-rated (QIDS-C16) format. The properties of each of these four instruments as both screens for depression in general medical and psychiatric populations, and as measures of symptomatic change will be evaluated. We will analyze data that have been or that are now being collected from "ongoing" studies. We will also acquire and analyze new data from "prospective" studies to be conducted at Duke and at UT Southwestern. These studies will evaluate the performance of each measure to screen for major and minor depression, defined by a structured interview to render DSM-IV diagnoses - DIS (elderly), by SCID (adults), or by the K-SADS-PL (children/adolescents). We will evaluate concurrent validity with the Montgomery Asberg Depression Rating Scale (MADRS), the 17-item Hamilton Depression Rating Scale (HRSD17), or Children's Depression Rating Scale (CDRS) as outcome measures in adolescent, adult, and older/elderly populations. Classic psychometric properties (e.g., factor analyses, Cronbach's alpha, concurrent validity) will be established for each of these four measures (IDS-SR30, IDS-C30, QIDS-SR16, QIDS-C16). We will determine whether an anxiety subscale of the IDS-C or IDS-SR can be identified and compare the potential items against the Spielberger State Anxiety Inventory. We will create equivalence tables using Item Response Theory analysis to translate total scores on the IDS or QIDS to total scores on the HRSD17, MADRS, and CDRS. We will provide benchmark scores for depressive symptom severity by IDS/QIDS ratings to identify minimal, mild, moderate, and severe levels of impaired daily function, as measured by the Sheehan Disability Scale (DIS), SF-12, SF-36, or Social Adjustment Scale-Self-Report (SAS-SR). The result will be a matched self-report and clinician rating scale to assess only the core criterion symptoms of major depression (i.e., the QIDS-C and SR), and more expanded scales capable of assessing both core and associated symptoms (e.g., anxiety, irritability) (IDSC and SR) that are in the public domain for use with patients across the age spans seen in practice and in research. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Postpartum Depression

Project Title: DEPRESSION

ELUCIDATING

THE

NEUROBIOLOGY

OF

POSTPARTUM

Principal Investigator & Institution: Moses-Kolko, Eydie L.; Psychiatry; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2002; Project Start 05-AUG-2002; Project End 31-JUL-2007 Summary: (provided by applicant): This revised Mentored Patient-Oriented Research Career Development Award Application (K23 describes a program of training and research using positron emission tomography (PET) to identify neurobiological processes mediating women's depressive syndromes that occur at reproductive transitions. Career development activities will focus on PET advanced analysis and modeling techniques reproductive endocrinology, cellular and molecular neuroscience, Psychiatric assessment, and clinical research design and statistical methods. These skills will be applied to the study of serotonin-IA (5HT1A receptor binding potential (BP) and resting cerebral blood flow (CBF) in DSM-lV-defined major depressive disorder (MDD) with postpartum onset. The association of female gonadal steroids (FGS with MDD and its treatment suggests FGS are important mediators of depressive disorders in women Because postpartum major depression (PPD) occurs in the setting of massive endocrine shifts, this provides a unique opportunity to explore the neurobiology of depressive syndromes that occur a reproductive transitions. Based upon existing characterization in the literature and in our PET Facility of depressive populations using probes for 5HT1A receptor BP ([11C] WAY-100635) and CBF ([15O] water) methods for measuring these targets will be applied in women with PPD, non-postpartum MDD postpartum healthy controls, and non-postpartum healthy controls. Hypothalamic-pituitary-ovarian (HPO and hypothalamic-pituitary-adrenal (HPA) axis function will be assessed in relation to PET measures Multidisciplinary didactic training, research experience, and preliminary data garnered from the proposed application will enable the candidate to become an independent investigator of the neurobiology of depressive syndromes associated with reproductive transitions. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: FAMILY TREATMENT FOR POSTPARTUM DEPRESSION Principal Investigator & Institution: Battle, Cynthia L.; Butler Hospital (Providence, Ri) 345 Blackstone Blvd Providence, Ri 02906 Timing: Fiscal Year 2002; Project Start 23-SEP-2002; Project End 30-JUN-2007 Summary: (provided by applicant): This Mentored Patient-Oriented Research Career Development Award (K23) application is to support Dr. Battle's development as an independent research scientist with expertise in developing and evaluating psychosocial treatments for depressed childbearing women. Her emphasis will be on creating a comprehensive intervention that promotes positive outcomes not only for the depressed mother, but also for other family members, in particular the children who are at risk for developmental problems. This area of research is important in light of the limited psychosocial treatment options currently available for depressed childbearing women, and the long-term negative consequences for children of depressed mothers. Dr. Battle's initial goal is to develop a family treatment for postpartum depression based on an existing, well-established model of family assessments and treatment, the McMaster Model of Family Functioning. Dr. Battle's training goals are to: 1) gain experience with treatment development, particularly family approaches to treating depression, 2) develop expertise treating and conducting research with depressed postpartum women, 3) improve skills in research design, methodology and ethics relevant to intervention

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research, 4) learn assessment techniques needed for evaluating child and maternal-child outcomes, 5) develop advanced statistical techniques relevant to clinical trials research, and 6) improve manuscript preparation and grant-writing skills. This training plan will be accomplished through 1) the resources available at Brown University Medical School; 2) high quality mentorship provided by Dr. Ivan Miller, Dr. Michael O-Hara, Dr. Ronald Seifer, and Dr. Teri Pearlstein; 3) completion of formal coursework, seminars and supervised clinical experiences; and 4) implementation of the proposed research project. As part of the career development award, Dr. Battle will complete a 5-year research plan focused on developing and evaluating the efficacy of the McMaster Family treatment for Postpartum Depression (MFTP). After an initial period of treatment development (Year 1), a randomized controlled pilot trial will be conducted between years 2-4, the findings from which will be used to further refine the treatment during a revision phase in year 5. Results from this research will be sued to justify an R01 application for a full-scale clinical trial to evaluate the efficacy of MFTP, which will be submitted during the final year of the award. This larger investigation will include more substantive assessment of child and family outcomes, building on the specialized training that Dr. Battle receives during the course of the K23 award. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HEALTH CARE UTILIZATION IN INFANTS OF DEPRESSED MOTHERS Principal Investigator & Institution: Moran, Tracy E.; Psychology; University of Iowa Iowa City, Ia 52242 Timing: Fiscal Year 2004; Project Start 16-OCT-2004 Summary: (provided by applicant): The proposed study will examine hypothesized relationships between postpartum depression and health care utilization in infants. A proposed direct relationship between postpartum depression and infant utilization will be examined as well as an indirect relationship through maternal parenting self-efficacy as a mediator. Two additional hypotheses will be addressed concurrently within the larger study:1) mother's anxiety disorder will serve as a moderator in the direct relationship between postpartum depression and pediatric utilization and 2) partner's mental illness will serve as a moderator in the relationship between maternal postpartum depression and parenting self-efficacy. Mothers and their partners will be recruited through the NIH-funded Interpersonal Psychotherapy for Antenatal Depression study (PI: Scott Stuart, M.D.). Regression analyses will be conducted to test the hypothesized relationships. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: IMPACT OF GONADAL STEROID UPON SEROTONERGIC FUNCTION Principal Investigator & Institution: Berga, Sarah L.; Professor and Chair; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2002 Summary: Objective: Gonadal steroids are important modulators of neuronal function and associated behavioral states. Sex steroid excursions have been implicated in premenstrual dysphoric disorder, postpartum depression, perimenopausal and menopausal mood changes, Alzheimer's Disease (AD), and overall cognitive function. A critical neuronal system mediating mood and cognition is serotonin. Methods to directly assess the effects of sex steroids upon central serotonergic function in humans are

14

Postpartum Depression

expanding with the development of specific serotonin radioligands. Through PET imaging with the 5-HT 2a radioligand [18F]altanserin, we aim to demonstrate that estrogen will upregulate central serotonin function, while progesterone will further modify the effects of estrogen. We also aim to explore the relationships between central 5-HT 2a receptor density, platelet 5-HT 2a and 5-Ht 2a density, and tests of neuropsychological function to determine the sample size needed for future studies to test hypotheses about the interrelationship of these variables. Design: Seven physically and mentally healthy menopausal women will receive 10 weeks of estrogen followed by 2 weeks of combined estrogen progestersone replacement. At three time intervals (baseline, following 10 weeks of unopposed estrogen treatment, and following 2 weeks of combined hormone treatment), subjects will undergo studies of neuropsychological functioning, blood sampling for platelet, serotonin activity, and PET studies with the 5HT 2a ligand[18F]altanserin. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: INTERVENTION FOR IRRITABLE BABIES WITH DEPRESSED MOTHERS Principal Investigator & Institution: Mcdonough, Susan C.; Associate Research Scientist; None; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, Mi 481091274 Timing: Fiscal Year 2004; Project Start 01-APR-2004; Project End 28-FEB-2009 Summary: (provided by applicant): Early mental health problems frequently are associated with risk factors in the mother, the infant, and in their interactions. Among these are maternal depression, infant negative emotionality, and parenting stress. Although offspring of depressed women are at higher risk for later problems and have been targeted for selective interventions, we propose that a triple risk selection model would be more efficient in reducing later child mental health problems. Mothers who are depressed are less adaptive in their interactions. Infants with excessive crying have self-regulation problems and require greater adaptability from their caregivers. Parent's sense of stress is a pathway for many ecological risk factors to alter effective and sensitive interactive behavior with children. 60% of infants with these three risk factors have a mental health problem in their 3rd year of life. A brief 12-session Interaction Guidance program will be delivered as a Preventive intervention between 7 and 14 months to high risk families to increase the adaptive relation between mother and infants. 160 families with depressed mothers and 6-month-old infants will be recruited and randomly assigned into an Interaction Guidance intervention group or a Phone Contact contrast group. Prime features of the Interaction Guidance intervention include (1) coaching parents with feedback on videotaped play interactions with the child, (2) focus on identifying positive parenting behaviors, and (3) empowerment of family members through attending to problems and insights that they initiate. Assessments of the infant, parent and their interaction will occur at a 7-month Pretest, a 14-month Posttest, and a 30-month Follow-Up at home and in the laboratory using a multi-method approach of parent self-reports, clinician interviews and ratings, and observations of interactive behavior. Comparisons will be made at the Posttest and at Follow-Up to determine if more adaptive interactions and better mental health are occurring in the. Within the Interaction Guidance treatment group subsidiary analyses will determine the relative impact of the intervention on the effects of the three primary risk conditions. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: LATE DEPRESSION

PREGNANCY

THYROID

STATUS

&

15

POSTPARTUM

Principal Investigator & Institution: Pedersen, Cort; University of North Carolina Chapel Hill Aob 104 Airport Drive Cb#1350 Chapel Hill, Nc 27599 Timing: Fiscal Year 2002 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CORTISOL

MATERNAL

DEPRESSION,

CHILD

TEMPERAMENT

AND

Principal Investigator & Institution: Huot, Rebecca L.; Psychology; Emory University 1784 North Decatur Road Atlanta, Ga 30322 Timing: Fiscal Year 2003; Project Start 17-SEP-2003; Project End 16-SEP-2006 Summary: (provided by applicant): Offspring of depressed mothers are at increased risk for developing behavior and psychological disorders later in life. Although there is certainly a genetic component for this increased vulnerability, it is also likely that the early environment of the infant and child plays a role in determining which individuals will develop disorders versus those that will not. The experiments proposed here were designed to measure changes in infancy through early childhood in offspring of mothers depressed during the prepartum and/or postpartum periods. In addition to assessing changes in child behavior, potential mediators of maternal depression on child development will be examined. The studies proposed are unique in that they are part of a larger study and the subject base is already very well characterized for both prepartum and postpartum depression (prospectively) such that the impact of lifetime history, prepartum and postpartum depression can be disentangled. Measuring early effects of maternal depression on offspring may shed some light on individual differences that may predict later impairment. In addition, since some data has already been collected on this population, it will be possible to look at some longitudinal changes in infants and children of depressed mothers. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NEUROSTEROIDS--STRUCTURE/FUNCTION OF DIMORPHIC SEX AREA Principal Investigator & Institution: Jorge-Rivera, Joan C.; University of Puerto Rico Med Sciences Medical Sciences Campus San Juan, Pr 00936 Timing: Fiscal Year 2002 Summary: The central goal of this project is to determine the structural, physiological, and behavioral consequences of allosteric modulation of GABAA-receptors by neurosteroids in the mitral cell layer of the accessory olfactory bulb (AOB) in defined endocrine environments. Neurosteroids have been implicated in affective disorders that seem to be sensitive to hormonal environments, including depression, postpartum depression, and anxiety. In addition, neurosteroids can modulate the expression of sexual behaviors and may increase the vulnerability to develop psychiatric disease, This study will take advantage of a simple experimental assay to determine the effects of neurosteroids on GABAergic neurotransmission. In Specific Aim 1, GABAA-currents to three neurosteroids, juvenile, and adult, male and female rats. The sensitivity of GABAA-currents to three neurosteroids; 3alpha, 5alpha- THP, 3alpha-DIOL, and DHEA will be tested. Similarly, in Specific Aim 2 GABAA-currents will be recorded and

16

Postpartum Depression

assessed for neurosteroid sensitivity during different stages of pregnancy and early after parturition. These aims will determine whether neurosteroids produce sex-specific and hormone-dependent effects or systemic administration or neurosteroids will be provided during neonatal development to determine if these compounds contribute to the sexually dimorphic structure of the AOB mitral cell layer. These experiments will establish whether neurosteroids have an impact in setting up the structure of brain regions associated with sex specific behaviors. Finally, in Specific Aim 4, neurosteroids will be infused into the AOB directly to determine if these compounds can modulate the expression of maternal behaviors in parturient rats. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PARENTAL POSTPARTUM DEPRESSION & THE FAMILY SYSTEM Principal Investigator & Institution: Goodman, Janice H.; None; Boston College 140 Commonwealth Ave Newton, Ma 02467 Timing: Fiscal Year 2002; Project Start 13-SEP-2002 Summary: (provided by applicant) Postpartum depression affects between 8 and 28 percent or new mothers, with up to 68 percent of new mothers experiencing some degree of depressive symptoms. New fathers also experience depression, especially if their partner is depressed, and postpartum depression is correlated with decreased marital satisfaction. Parent-infant interaction and attachment are major indicators of the quality of the infant?s nurturing environment. Postpartum depression has significant negative effects on mother-infant interaction and on child development. Little is known about how the infant is affected when a new father is depressed or when both parents are experiencing depressive symptoms. Also unknown is whether or not a nondepressed father may buffer the negative effects of a mother?s postpartum depression on the infant. Using a family systems framework, this study aims to explore the influences of maternal depressive symptoms, paternal depressive symptoms, quality of the couple relationship and parental dyad functioning on the parent-infant interaction and each parent?s attachment to the infant. A mixed-method triangulated design involving quantitative measures at 2 to 3 months postpartum, followed by in-depth qualitative interviews and quantitative measurements at 6 to 12 months with a purposive subset of study families will be used. Findings will be interpreted to increase understanding of how postpartum depressive symptoms impact the family, and a family systems model of postpartum depression will be generated. Knowledge gained from this study may be useful in developing nursing interventions that will promote optimal parent-infant relationships in the early postpartum months. This may be especially crucial to child development in families where early parenting is compromised by depression. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: POSTPARTUM DEPRESSION IN A PEDIATRIC CLINIC Principal Investigator & Institution: Chaudron, Linda H.; Assistant Professor; Psychiatry; University of Rochester Orpa - Rc Box 270140 Rochester, Ny 14627 Timing: Fiscal Year 2002; Project Start 03-JUL-2002; Project End 30-JUN-2007 Summary: (provided by applicant): This K23 Award will allow the candidate to gain the skills and depth of knowledge required to become a leader in women's health with focused expertise in postpartum depression research and to address this critical problem through an approach that integrates clinical and public health perspectives. Postpartum depression (PPD) is a serious public health problem affecting 10-20% of

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American women. PPD has significant repercussions for the health and functioning of mothers and the welfare of their children. It remains a poorly detected disorder by both women and their clinicians, in part due to its inadequate clinical characterization. Consequently, effective detection strategies have yet to be developed. The proposed research addresses these issues by 1) characterizing the mood disorders, depressive symptomatology and co-morbid psychiatric disorders throughout the postpartum year, 2) identifying effective screening tools for its detection, 3) establishing the feasibility of conducting a prospective longitudinal study of women during the postpartum year, and 4) collecting pilot data to describe the natural course and clinical correlates of PPD. To facilitate the application of this research to clinical settings, it will be conducted in the context of pediatric outpatient services where mothers are seen regularly throughout the postpartum year. Because an even greater paucity of data exists about PPD in ethnic and minority populations, this project focuses on a primarily African-American population of young women. To achieve her research and career goals, the candidate will follow a career development plan that consists of: 1) academic coursework to further develop general and health services research skills and to enhance her knowledge of early life development, parent-child interactions, and health systems; 2) mentorship and consultation with nationally and internationally recognized experts in postpartum depression, maternal and child health, and pediatric health services research; 3) innovative research of postpartum depression in a pediatric clinic. PPD is a disorder that cuts across traditional discipline boundaries of epidemiology, psychiatry, women's health, pediatrics and public health. An integrated model can provide a greater contribution to the detection and prevention of PPD than any individual discipline can provide independently. The candidate and this research project will lead to the creation of such a model. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: POSTPARTUM DEPRESSION: OMEGA-3 FA VS PLACEBO Principal Investigator & Institution: Freeman, Marlene P.; Psychiatry; University of Arizona P O Box 3308 Tucson, Az 857223308 Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 30-JUN-2007 Summary: (provided by applicant): Dr. Freeman is an Assistant Professor of Psychiatry at the University of Arizona and Director of the Women's Mental Health Program of the Department of Psychiatry. After receiving her M.D. from Northwestern University Medical School, she completed a psychiatry residency at the Harvard Longwood Psychiatry Residency Training Program and a Fellowship in Biological Psychiatry at the University of Cincinnati. Her immediate goals are: I) to obtain proficiency in clinical research methodology, with specific emphasis on gender-specific psychopharmacologic research, statistics, and ethical issues, and 2) to gain expertise in the research on mood disorders during pregnancy and the postpartum period. Long term goals are: 1) to become an independent investigator of mood disorders during pregnancy and postpartum, 2) to obtain an ROI award to support further study as an independent investigator, and 3) to serve as a mentor for junior investigators. The career development plan includes a structured didactic program designed to facilitate development to an independent investigator. Mentorship includes work with a primary mentor, Alan Gelenberg, M.D., and strong mentorship in the areas of women's psychiatry and omega-3 fatty acids. A multidisciplinary Advisory Committee will oversee the career development activities at the University of Arizona. The proposed research study is a double-blind, placebo-controlled 3-arm trial of omega-3 fatty acids (FA) in postpartum depression. Data suggest omega-3 fatty acids are efficacious in the

18

Postpartum Depression

treatment and prophylaxis of major depressive disorders. Omega-3 fatty acids may be especially relevant in the treatment of postpartum depression, due to the depletion of maternal omega-3 fatty acids that occurs during pregnancy. The purpose of this study is to determine the efficacy, as well as most effective dose, of omega-3 fatty acids for postpartum depression. Two omega-3 fatty acids in fish oil are eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Two different active arms are included in this protocol, one in which patients receive 2.8 g of EPA plus DHA (1.7 g EPA and 1.1 g DHA) and another in which patients receive I g EPA. The active arms were carefully chosen on the basis of pilot treatment data and epidemiological data; they should produce optimal tissue levels. These doses should provide an adequate test of the efficacy of omega-3 fatty acids while being safe for the mother and breastfeeding baby. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PREDICTORS OF ANTENATAL AND POSTPARTUM DEPRESSION Principal Investigator & Institution: Rich-Edwards, Janet W.; Associate Professor; Harvard Pilgrim Health Care, Inc. 93 Worcester St Wellesley, Ma 02481 Timing: Fiscal Year 2003; Project Start 01-JUL-2003; Project End 30-JUN-2006 Summary: (provided by applicant): Antenatal and postpartum depression together affect roughly 15% of mothers, and may have serious consequences for the health and well-being of the entire family. Despite significant advances in understanding major depression, the specific causes of antenatal and postpartum depression remain less understood. Like major depression, antenatal and postpartum depression appear to arise from interacting environmental and biological factors. A large volume of work implicates poverty and lack of social support as environmental determinants of major depression and postpartum depression. However, there has been little investigation into the impact of experiences of personal threat, such as violent abuse or racial discrimination, on the incidence of antenatal or postpartum depression. Among biological factors, disorders of the hypothalamic-pituitary-adrenal stress response have been implicated in depression. During normal pregnancy, cortisol levels are elevated, and the placenta contributes large quantities of corticotropin-releasing hormone (CRH) to matemal circulation. The implications of these high levels of stress hormones for onset of depression during and immediately following pregnancy are poorly understood. We predict that antenatal and postpartum depression are influenced by these endocrine factors as well as by the psychosocial environment. We hypothesize that: 1) Physical and/or sexual abuse in childhood, in adulthood, and/or during pregnancy are associated with antenatal and postpartum depression. 2) Experience of racial discrimination is associated with antenatal and postpamam depression among women of color. 3) Levels of CRH during pregnancy are associated with a history of depression, are correlated with antenatal depression, and predict postpartum depression; 4) Elevated morning cortisol and/or depressed evening cortisol levels in the first three postpartum months are associated with postpartum depression. Few studies have had the size or the data needed to investigate both biologic and environmental predictors of depression before, during, and after pregnancy. Project Viva and Project Access are two ongoing cohort studies of pregnant women and their children in Boston, supported by the National Institutes of Health and the March of Dimes to assess psychosocial and hormonal predictors of pregnancy outcome and child health. To date, they have enrolled over 2800 women; by the end of the project, the proposed project will include 3,500 participants. These ongoing longitudinal cohort studies will provide a cost-effective and unique resource with which to determine factors predicting depression during pregnancy and the postpartum.

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Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PRENATAL RISK FOR POST PARTUM DEPRESSION Principal Investigator & Institution: Jolley, Sandra N.; Family and Child Nursing; University of Washington Grant & Contract Services Seattle, Wa 98105 Timing: Fiscal Year 2002; Project Start 01-JUN-2002 Summary: Evidence suggests that post partum depression is very prevalent affecting 1060 percent of women depending on the socioeconomic status. Since there is evidence that chemical imbalances that develop in the mother during her pregnancy affect the fetus, there is a need for our ability to screen for depression and risk factors during pregnancy. The relationship of the neurobiological markers and the psychological adjustment to the maternal role needs to be explored and further understood so that women at risk of postpartum depression can be identified during pregnancy and interventions can be done during pregnancy to prevent the adverse outcomes in the infant. The purposes of this individual research training program will be to conduct an exploratory study to 1) identify a low risk group and a high risk group of pregnant women who are at risk of postpartum depression, 2) compare the anxiety of the two groups, focusing on maternal role development in the prenatal and post partum periods and 3) compare the two groups on mother's prenatal and postpartum neurobiological markers of anxiety and depression and on the infant's neurological markers. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: DEPRESSION

PREVENTION

OF

RECURRENT

POSTPARTUM

MAJOR

Principal Investigator & Institution: Wisner, Katherine L.; Professor; Psychiatry; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2004; Project Start 01-JUN-1994; Project End 30-NOV-2008 Summary: (provided by applicant): This application is a competing continuation of MHR01 53735, "Prevention of Recurrent Postpartum Major Depression". The original study was a randomized clinical trial of immediate post-birth antidepressant administration to prevent the recurrence of postpartum-onset depression (PPMD) in women who had previous episodes of PPMD. The major findings were that the tricyclic antidepressant nortriptyline (NTP) was equivalent to placebo (PL) in preventive efficacy. However, the serotonin selective reuptake inhibitor sertraline (SERT) was significantly more efficacious than placebo in the same preventive treatment model. The primary aim of the proposed study is to test the efficacy of SERT for the prevention of PPMD in a broader population of women. SERT was determined to be efficacious for the prevention of PPMD in women who had previous episodes specifically of PPMD; therefore, all subjects had at least one child. We will replicate the successful SERT vs PL study with an expanded population of subjects. Women who have had at least one episode of MD prior to the index pregnancy will be included. We will also determine the optimal duration of preventive therapy. During the previous study, SERT was tapered and discontinued at from weeks 17-20. The protection against recurrence was quickly lost, and the risk approached that of the PL-treated group. Therefore, the period of preventive therapy will be extended to the 24 weeks. We will re-randomize the women who respond to SERT at 24 weeks to either continued SERT or PL in order to assess both the durability of and necessity for longer-term preventive therapy. We will evaluate the effects of SERT exposure to infants through breast milk on pediatric and developmental outcomes at one year. Monitoring procedures included mother and

20

Postpartum Depression

infant serum antidepressant levels. Developmental evaluations of infants through 12 months of age will be performed. Maternal MD, an exposure that clearly has a negative impact upon several aspects of child development, also will be considered as an exposure with effects on child outcomes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PSYCHIATRIC DISORDERS IN ADULTS WITH DIABETES MELLITUS Principal Investigator & Institution: Lustman, Patrick J.; Professor of Psychiatry; Psychiatry; Washington University Lindell and Skinker Blvd St. Louis, Mo 63130 Timing: Fiscal Year 2002; Project Start 01-JUL-1985; Project End 31-MAR-2004 Summary: Diabetes increases the risks of maternal, fetal, and neonatal complications from pregnancy. Tight glycemic control during pregnancy reduces these risks but is difficult to achieve. Major depression is present in approximately 25 percent of diabetic women and is associated with significant deterioration in glycemic control. There has been no study in diabetic or nondiabetic subjects of depression treatment during pregnancy, and the effects of depression treatment on obstetric outcomes remain unknown. Recently, we showed that cognitive behavior therapy (CBT) was an effective nonpharmacologic treatment for depression in diabetes that produced durable improvements in glycemic control. In this study we plan to treat major depression in pregnant diabetic women with CBT and determine its effects on depression, glycemic control, and maternal and neonatal outcomes. We also plan to assess the relationship of diabetes during pregnancy and postpartum depression to neuropsychological development of the infants. 150 pregnant diabetic women will be recruited for study: 100 with and 50 without major depression. The nondepressed subjects function only as a comparison group in some of the statistical analyses. All subjects will be assessed serially during the 2nd and 3rd trimesters and the 1 year postpartum period while receiving the usual degree of intensive medical care for the diabetic pregnancy. Depressed patients will be assigned randomly to treatment with individual CBT (n =50) or supportive counseling (n =50). The pregnancy care team is informed of the depression status of all subjects and advised to give usual care for depression. The design blinds the pregnancy care team to treatment assignment, controls for nonspecific effects of attention and the influence of enhanced diabetes control on mood, provides a comparison group likely to remain depression free during gestation and the postpartum period, and is sensitive to human subject issues. We hypothesize that CBT will be superior to supportive counseling in terms of improving depression and glycemic control, and that the treatment-related improvements in glycemic control will reduce the adverse effects of diabetes in pregnancy, including c-section, macrosomia, neonatal hypoglycemia, and fetal hyperinsulinemia. We also expect that by improving glycemic control during pregnancy and reducing the risk of postpartum depression CBT will improve neuropsychological development in the offspring. The findings should demonstrate the relevance of depression treatment to maternal and neonatal outcomes of diabetic pregnancies and translate directly to the management of patients living with diabetes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: RELATIONAL GROUP INTERVENTION FOR POSTPARTUM DEPRESSION Principal Investigator & Institution: Clark, Roseanne; Associate Professor; Psychiatry; University of Wisconsin Madison 750 University Ave Madison, Wi 53706

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Timing: Fiscal Year 2002; Project Start 18-SEP-2001; Project End 31-JUL-2006 Summary: (provided by applicant): Major and minor depression in the postpartum period occurs in 10-15 percent of all new mothers, representing a significant public health problem. One of the major mechanisms by which PPD may influence infant outcomes is through its impact on the quality of the mother's affective and behavioral interactions during infancy, a critical time when physiological and emotional regulation and the capacity for human attachments are developing. Risk for disturbances in the mother-infant relationship as well as developmental delays and psychopathology in their infants represent significant areas of morbidity associated with postpartum depression and have not been addressed adequately by current intervention approaches. Therefore, the investigation of the efficacy of mother-infant relational treatment approaches for major depression during the postpartum period is warranted. The proposed study, representing a revision of the first R01 application by the principal investigator has four major aims: (1) To compare the efficacy of a manualized, relationally focused group treatment approach (M-ITG) for women with major depression in the postpartum period and their infants with a standard individual treatment (IPT) to ameliorate depressive symptoms and reduce recurrent episodes; (2) To compare the efficacy of M-ITG and IPT in improving the quality of mother-infant interactions; (3) To determine whether improvements in the mother-infant interaction mediate the impact of maternal depression on infant emotional, behavioral, and attention regulation; and (4) To examine the unique effects of depression severity and chronicity, comorbid anxiety and personality pathology on mother-infant interaction quality, and infant outcomes. Two hundred and eight women meeting criteria for major depression will be randomly assigned to one of two treatments for depression (1) M-ITG for mothers and their infants or (2) IPT. Assessments of mother, infant and motherinfant dyadic functioning, as well as parenting stress and marital conflict will be conducted at pre and post-treatment and at two follow-up points(l2 months posttreatment and when the infant is 24 months of age). Measures include diagnostic interviews, self and other report instruments and observational coding methods. The long-range objectives addressed by this research are to identify an effective intervention for postpartum depression that also reduces recurrences of depressive episodes in mothers, prevents subsequent psychopathology in their young children, and identifies key relational mechanisms that may inform the development of specifically targeted preventive interventions for high-risk dyads. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: RISK AND PREDICTORS OF POSTPARTUM DEPRESSION Principal Investigator & Institution: Altshuler, Lori L.; None; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, Ca 90024 Timing: Fiscal Year 2003; Project Start 11-APR-2003; Project End 31-MAR-2008 Summary: (provided by applicant): The postpartum period is a time of heightened risk for the emergence of psychiatric illness, particularly in women who already have a history of mood disorder. Given the prevalence of depressive disorders during the childbearing years, it is crucial to identify women who are at highest risk for new onset or recurrence of depression during the postpartum period. Identification of those women at greatest risk for postpartum depression may allow for interventions that would limit maternal morbidity associated with untreated postpartum depression. This proposal outlines a multi-institutional collaborative research project (R01) in response to PA-00-074, in which risk for postpartum depression will be evaluated in women with histories of major depressive disorder. Subjects who have had at least one episode of

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Postpartum Depression

DSM-IV major depression will be followed prospectively from late pregnancy (32-36 weeks gestation) up to six months after delivery using a series of standardized instruments. The primary aims of this investigation are (1) to identify clinical and psychosocial predictors of postpartum depression and functional impairment and (2) to determine the extent to which treatment (pharmacologic, nonpharmacologic or a combination) proximate to delivery modulates risk for postpartum relapse. How clinical and psychosocial variables including history of postpartum depression, severity of past depression, number of previous episodes, age at illness onset, depression during pregnancy, and social support affect risk for postpartum depression, as well as psychosocial functioning, will be investigated. The current submission is a natural extension of an ongoing academically productive collaboration in which risk for depressive relapse is evaluated in pregnant women with histories of major depression who either discontinue or maintain antidepressant treatment. This proposal provides an opportunity to study a rigorously followed population into a period of risk -- the postpartum period -- and to investigate the factors that confer or modulate risk for depression at this time. The three participating sites for this investigation include the Perinatal and Reproductive Psychiatry Clinical Research Program at the Massachusetts General Hospital, Harvard Medical School (Drs. Cohen, Nonacs and Otto), the Women's Life Center and Mood Disorders Research Program at UCLA (Dr. AItshuler, Dr. Hendrick), and the Emory Women's Mental Health Program at Emory University School of Medicine (Dr. Stowe). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ROLE OF EXPECTATIONS IN PREVENTING POSTPARTUM DEPRESSION Principal Investigator & Institution: Khazan, Inna Z.; Psychology; Clark University (Worcester, Ma) 950 Main Street Worcester, Ma 01610 Timing: Fiscal Year 2002; Project Start 13-MAR-2004; Project End 12-MAR-2005 Summary: (provided by applicant): The goal of the proposed study is to design, implement, and evaluate the effectiveness of an intervention program aimed at preventing or reducing the likelihood of postpartum depression. This intervention will focus on providing new mothers with more realistic expectations regarding infant and childcare-related stressors. This focus is justified by the findings of previous studies which have shown that: a. infant and childcare related stressors are among the few factors consistently found to account for a significant amount of variance in the postpartum depression scores; b. parents-to-be are likely to hold unrealistic expectations regarding many areas of their lives and violations of these expectations are linked to more difficulty during the transition to parenthood; c. both direct and indirect evidence links violated expectations regarding infant and childcare-related stressors to increased levels of postpartum depressive symptomatology. The proposed intervention will take place during childbirth classes (a control group will consist of families participating in standard childbirth education classes). Mothers will be asked to report on their expectations regarding infant and childcare related stressors both before and after the intervention. When the babies reach 3 months of age, mothers' levels of postpartum depressive symptomatology will be assessed and they will be asked to report on the reality of their infants' behavior and difficulty of childcare. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, and type “postpartum depression” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for postpartum depression in the PubMed Central database: •

A cross-sectional study of early identification of postpartum depression: Implications for primary care providers from The Ontario Mother & Infant Survey. by Watt S, Sword W, Krueger P, Sheehan D.; 2002; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=107838

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A Review of Postpartum Depression. by Andrews-Fike C.; 1999 Feb; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=181045

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with postpartum depression, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “postpartum depression” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for postpartum depression (hyperlinks lead to article summaries): •

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A checklist to identify women at risk for developing postpartum depression. Author(s): Beck CT. Source: Journal of Obstetric, Gynecologic, and Neonatal Nursing : Jognn / Naacog. 1998 January-February; 27(1): 39-46. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9475126

Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html.

With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print. 6 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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A controlled study of postpartum depression among Nepalese women: validation of the Edinburgh Postpartum Depression Scale in Kathmandu. Author(s): Regmi S, Sligl W, Carter D, Grut W, Seear M. Source: Tropical Medicine & International Health : Tm & Ih. 2002 April; 7(4): 378-82. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11952955

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A controlled study of postpartum depression in adult women. Author(s): Chen CH, Wang SY, Hwu HG, Chou FH. Source: Kaohsiung J Med Sci. 2000 March; 16(3): 156-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10846352

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A cross-sectional study of early identification of postpartum depression: implications for primary care providers from The Ontario Mother & Infant Survey. Author(s): Watt S, Sword W, Krueger P, Sheehan D; Ontario Mother & Infant Survey. Source: Bmc Family Practice [electronic Resource]. 2002 April 11; 3(1): 5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11950393

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A descriptive study of postpartum depression. Author(s): Ugarriza DN. Source: Perspectives in Psychiatric Care. 1995 July-September; 31(3): 25-9; Quiz 31-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7659496

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A group psychotherapy approach to postpartum depression. Author(s): Gruen DS. Source: Int J Group Psychother. 1993 April; 43(2): 191-203. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8473061

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A light in the fog: caring for women with postpartum depression. Author(s): Kennedy HP, Beck CT, Driscoll JW. Source: Journal of Midwifery & Women's Health. 2002 September-October; 47(5): 318-30. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12361343

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A meta-analysis of predictors of postpartum depression. Author(s): Beck CT. Source: Nursing Research. 1996 September-October; 45(5): 297-303. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8831657

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A meta-analysis of the relationship between postpartum depression and infant temperament. Author(s): Beck CT. Source: Nursing Research. 1996 July-August; 45(4): 225-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8700656

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A review of postpartum depression for the primary care physician. Author(s): Clay EC, Seehusen DA. Source: Southern Medical Journal. 2004 February; 97(2): 157-61; Quiz 162. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14982265

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An exploration of postpartum depression model using LISREL. Author(s): Chen CH. Source: Gaoxiong Yi Xue Ke Xue Za Zhi. 1994 May; 10(5): 229-38. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8040925

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Antepartum and postpartum depression. Author(s): Spinelli MG. Source: J Gend Specif Med. 1998 October-November; 1(2): 33-6. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11281010

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Are commonly used self-report inventories suitable for screening postpartum depression and anxiety disorders? Author(s): Muzik M, Klier CM, Rosenblum KL, Holzinger A, Umek W, Katschnig H. Source: Acta Psychiatrica Scandinavica. 2000 July; 102(1): 71-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10892613

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Baby, I've got the blues. Postpartum depression. Author(s): Yawn BP. Source: Minn Med. 1996 February; 79(2): 27-30. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8838567

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Barriers to postpartum depression prevention and treatment: a policy analysis. Author(s): Sobey WS. Source: Journal of Midwifery & Women's Health. 2002 September-October; 47(5): 331-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12361344

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Bittersweet: a postpartum depression support group. Author(s): Olson MR, Cutler LA, Legault F. Source: Canadian Journal of Public Health. Revue Canadienne De Sante Publique. 1991 March-April; 82(2): 135-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2049706

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Breast-feeding and postpartum depression: is there a relationship? Author(s): Misri S, Sinclair DA, Kuan AJ. Source: Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie. 1997 December; 42(10): 1061-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9469238

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Bright light therapy's effect on postpartum depression. Author(s): Corral M, Kuan A, Kostaras D. Source: The American Journal of Psychiatry. 2000 February; 157(2): 303-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10671419

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Calculating clinically significant change in postnatal depression studies using the Edinburgh Postnatal Depression Scale. Author(s): Matthey S. Source: Journal of Affective Disorders. 2004 March; 78(3): 269-72. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15013253

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Care for women with postpartum depression: “N*U*R*S*E” approach. Author(s): Sichel D, Driscoll JW. Source: Journal of Midwifery & Women's Health. 2002 September-October; 47(5): 392. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12361354

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Caregiver support for postpartum depression. Author(s): Ray KL, Hodnett ED. Source: Cochrane Database Syst Rev. 2001; (3): Cd000946. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11686971

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Caregiver support for postpartum depression. Author(s): Ray KL, Hodnett ED. Source: Cochrane Database Syst Rev. 2000; (2): Cd000946. Review. Update In: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10796226

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Characteristics and treatment of women with antenatal and postpartum depression. Author(s): Steinberg SI, Bellavance F. Source: International Journal of Psychiatry in Medicine. 1999; 29(2): 209-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10587816

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Childhood abuse, parenting and postpartum depression. Author(s): Buist A. Source: The Australian and New Zealand Journal of Psychiatry. 1998 August; 32(4): 47987. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9711360

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Childhood abuse, postpartum depression and parenting difficulties: a literature review of associations. Author(s): Buist A. Source: The Australian and New Zealand Journal of Psychiatry. 1998 June; 32(3): 370-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9672726

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Childhood sexual abuse, parenting and postpartum depression--a 3-year follow-up study. Author(s): Buist A, Janson H. Source: Child Abuse & Neglect. 2001 July; 25(7): 909-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11523868

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Childhood sexual abuse: a risk factor for postpartum depression? Author(s): Buist A, Barnett B. Source: The Australian and New Zealand Journal of Psychiatry. 1995 December; 29(4): 604-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8825822

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Clinical practice. Postpartum depression. Author(s): Wisner KL, Parry BL, Piontek CM. Source: The New England Journal of Medicine. 2002 July 18; 347(3): 194-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12124409

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Cognitive function, thyroid status and postpartum depression. Author(s): Mallett P, Andrew M, Hunter C, Smith J, Richards C, Othman S, Lazarus J, Harris B. Source: Acta Psychiatrica Scandinavica. 1995 April; 91(4): 243-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7625205

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Comorbid postpartum depression and bereavement: a complicated case. Author(s): Stowe ZN, Levy ST, Nemeroff CB. Source: The American Journal of Psychiatry. 1997 March; 154(3): 418-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9054793

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Comparative analysis of the performance of the Postpartum Depression Screening Scale with two other depression instruments. Author(s): Beck CT, Gable RK. Source: Nursing Research. 2001 July-August; 50(4): 242-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11480533

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Complementary therapies as adjuncts in the treatment of postpartum depression. Author(s): Weier KM, Beal MW. Source: Journal of Midwifery & Women's Health. 2004 March-April; 49(2): 96-104. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15010661

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Correlations between mood scores, LH, adrenocortical steroids, and urine volumes in a patient with a history of postpartum depression and monthly psychotic episodes. Author(s): Birmingham MK, Barta A, Solyom L, Lehoux JG, Vecsei P. Source: Endocrine Research. 1998 August-November; 24(3-4): 595-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9888544

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Creating a postpartum depression support group. Out of the blue. Author(s): Maley B. Source: Awhonn Lifelines / Association of Women's Health, Obstetric and Neonatal Nurses. 2002 February-March; 6(1): 62-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11913204

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Cultural elements of postpartum depression. A study of 327 Jewish Jerusalem women. Author(s): Med Hypotheses. 2000 Sep;55(3):266-76 Source: J Reprod Med. 2000 February; 45(2): 97-104. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10985922

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Culturally induced postpartum depression: a theoretical position. Author(s): Tentoni SC, High KA. Source: Jogn Nurs. 1980 July-August; 9(4): 246-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6903637

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Culture care meanings and experiences of postpartum depression among Jordanian Australian women: a transcultural study. Author(s): Nahas V, Amasheh N. Source: Journal of Transcultural Nursing : Official Journal of the Transcultural Nursing Society / Transcultural Nursing Society. 1999 January; 10(1): 37-45. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10476151

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Dementia presenting as postpartum depression. Author(s): Dell DL, Halford JJ. Source: Obstetrics and Gynecology. 2002 May; 99(5 Pt 2): 925-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11975961

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Diagnosing postpartum depression in mothers and fathers: whatever happened to anxiety? Author(s): Matthey S, Barnett B, Howie P, Kavanagh DJ. Source: Journal of Affective Disorders. 2003 April; 74(2): 139-47. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12706515

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Diagnosing postpartum depression: can we do better? Author(s): Fergerson SS, Jamieson DJ, Lindsay M. Source: American Journal of Obstetrics and Gynecology. 2002 May; 186(5): 899-902. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12015507

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Effect of maternal docosahexaenoic acid supplementation on postpartum depression and information processing. Author(s): Llorente AM, Jensen CL, Voigt RG, Fraley JK, Berretta MC, Heird WC. Source: American Journal of Obstetrics and Gynecology. 2003 May; 188(5): 1348-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12748510

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Effect of oestradiol on postpartum depression. Author(s): Ahokas A, Kaukoranta J, Aito M. Source: Psychopharmacology. 1999 September 1; 146(1): 108-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10485972

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Effects of gonadal steroids in women with a history of postpartum depression. Author(s): Bloch M, Schmidt PJ, Danaceau M, Murphy J, Nieman L, Rubinow DR. Source: The American Journal of Psychiatry. 2000 June; 157(6): 924-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10831472

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Effects of pregnancy and delivery on serum prolyl endopeptidase (PEP) activity: alterations in serum PEP are related to increased anxiety in the early puerperium and to postpartum depression. Author(s): Maes M, Libbrecht I, Lin A, Goossens F, Ombelet W, Stevens K, Bosmans E, Altamura C, Cox J, de Jongh R, Scharpe S. Source: Journal of Affective Disorders. 2000 January-March; 57(1-3): 125-37. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10708824

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Efficacy of interpersonal psychotherapy for postpartum depression. Author(s): O'Hara MW, Stuart S, Gorman LL, Wenzel A. Source: Archives of General Psychiatry. 2000 November; 57(11): 1039-45. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11074869

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Endocrine factors and postpartum depression. A selected review. Author(s): McCoy SJ, Beal JM, Watson GH. Source: J Reprod Med. 2003 June; 48(6): 402-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12856509

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Endocrine factors in the etiology of postpartum depression. Author(s): Bloch M, Daly RC, Rubinow DR. Source: Comprehensive Psychiatry. 2003 May-June; 44(3): 234-46. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12764712

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Estrogen deficiency in severe postpartum depression: successful treatment with sublingual physiologic 17beta-estradiol: a preliminary study. Author(s): Ahokas A, Kaukoranta J, Wahlbeck K, Aito M. Source: The Journal of Clinical Psychiatry. 2001 May; 62(5): 332-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11411813

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Etiology and treatment of postpartum depression. Author(s): Flores DL, Hendrick VC. Source: Current Psychiatry Reports. 2002 December; 4(6): 461-6. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12441026

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Etiology of postpartum depression--a review. Author(s): Chen CH. Source: Gaoxiong Yi Xue Ke Xue Za Zhi. 1995 January; 11(1): 1-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7707445

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Evaluation of postpartum depression using the Edinburgh postnatal depression scale in evaluation of postpartum depression in a rural community in India. Author(s): Banerjee N, Banerjee A, Kriplani A, Saxena S. Source: The International Journal of Social Psychiatry. 2000 Spring; 46(1): 74-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14529081

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Fatigue as a predictor of postpartum depression. Author(s): Bozoky I, Corwin EJ. Source: Journal of Obstetric, Gynecologic, and Neonatal Nursing : Jognn / Naacog. 2002 July-August; 31(4): 436-43. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12146933

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Fluoxetine treatment of postpartum depression. Author(s): Roy A, Cole K, Goldman Z, Barris M. Source: The American Journal of Psychiatry. 1993 August; 150(8): 1273. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8328582

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Fluvoxamine for postpartum depression. Author(s): Suri R, Burt VK, Altshuler LL, Zuckerbrow-Miller J, Fairbanks L. Source: The American Journal of Psychiatry. 2001 October; 158(10): 1739-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11579021

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Further validation of the Postpartum Depression Screening Scale. Author(s): Beck CT, Gable RK. Source: Nursing Research. 2001 May-June; 50(3): 155-64. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11393637

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Group treatment for postpartum depression: a pilot study. Author(s): Meager I, Milgrom J. Source: The Australian and New Zealand Journal of Psychiatry. 1996 December; 30(6): 852-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9034477

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Helping women with postpartum depression: midwives' expanding role. Author(s): Feingold SB. Source: The Birth Gazette. 1995 Summer; 11(3): 16-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7795426

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Hmong women and postpartum depression. Author(s): Stewart S, Jambunathan J. Source: Health Care for Women International. 1996 July-August; 17(4): 319-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8850766

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Hormonal aspects of postpartum depression. Author(s): Abou-Saleh MT, Ghubash R, Karim L, Krymski M, Bhai I. Source: Psychoneuroendocrinology. 1998 July; 23(5): 465-75. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9802121

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Hormonal changes in the postpartum and implications for postpartum depression. Author(s): Hendrick V, Altshuler LL, Suri R. Source: Psychosomatics. 1998 March-April; 39(2): 93-101. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9584534

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How I overcame postpartum depression. Author(s): Furnari J. Source: Midwifery Today Int Midwife. 2002 Spring; (61): 20. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11951668

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Identification of symptoms of postpartum depression: linking research to practice. Author(s): Horowitz JA, Damato E, Solon L, von Metzsch G. Source: Journal of Perinatology : Official Journal of the California Perinatal Association. 1996 September-October; 16(5): 360-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8915934

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Incidence of postpartum depression in Olmsted County, Minnesota. A populationbased, retrospective study. Author(s): Bryan TL, Georgiopoulos AM, Harms RW, Huxsahl JE, Larson DR, Yawn BP. Source: J Reprod Med. 1999 April; 44(4): 351-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10319305

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Infant temperament and postpartum depression: a review. Author(s): Mayberry LJ, Affonso DD. Source: Health Care for Women International. 1993 March-April; 14(2): 201-11. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8509323

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Interpersonal psychotherapy adapted for the group setting in the treatment of postpartum depression. Author(s): Klier CM, Muzik M, Rosenblum KL, Lenz G. Source: The Journal of Psychotherapy Practice and Research. 2001 Spring; 10(2): 124-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11264336

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Knowledge about postpartum depression is family's responsibility. Author(s): Henderson BJ. Source: Pediatric Nursing. 2002 September-October; 28(5): 542. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12424995

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Living with postpartum depression: the father's experience. Author(s): Meighan M, Davis MW, Thomas SP, Droppleman PG. Source: Mcn. the American Journal of Maternal Child Nursing. 1999 July-August; 24(4): 202-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10405560

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Low hemoglobin level is a risk factor for postpartum depression. Author(s): Corwin EJ, Murray-Kolb LE, Beard JL. Source: The Journal of Nutrition. 2003 December; 133(12): 4139-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14652362

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Lowered serum n-3 polyunsaturated fatty acid (PUFA) levels predict the occurrence of postpartum depression: further evidence that lowered n-PUFAs are related to major depression. Author(s): De Vriese SR, Christophe AB, Maes M. Source: Life Sciences. 2003 November 7; 73(25): 3181-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14561523

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Maternity blues and postpartum depression. Author(s): Beck CT, Reynolds MA, Rutowski P. Source: Journal of Obstetric, Gynecologic, and Neonatal Nursing : Jognn / Naacog. 1992 July-August; 21(4): 287-93. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1494971

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Measurement issues in postpartum depression part 1: anxiety as a feature of postpartum depression. Author(s): Ross LE, Gilbert Evans SE, Sellers EM, Romach MK. Source: Archives of Women's Mental Health. 2003 February; 6(1): 51-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12715264

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Measurement issues in postpartum depression part 2: assessment of somatic symptoms using the Hamilton Rating Scale for Depression. Author(s): Ross LE, Gilbert Evans SE, Sellers EM, Romach MK. Source: Archives of Women's Mental Health. 2003 February; 6(1): 59-64. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12715265

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Mother-infant interactions in postpartum depression: an early intervention program. Author(s): Milgrom J. Source: The Australian Journal of Advanced Nursing : a Quarterly Publication of the Royal Australian Nursing Federation. 1994 June-August; 11(4): 29-38. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7980887

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Multiple personality disorder presenting as postpartum depression. Author(s): Satel SL, Howland FC. Source: Hosp Community Psychiatry. 1992 December; 43(12): 1241-3. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1459548

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Nonpsychotic postpartum depression among adolescent mothers. Author(s): Troutman BR, Cutrona CE. Source: Journal of Abnormal Psychology. 1990 February; 99(1): 69-78. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2307769

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Obsessions and compulsions in women with postpartum depression. Author(s): Wisner KL, Peindl KS, Gigliotti T, Hanusa BH. Source: The Journal of Clinical Psychiatry. 1999 March; 60(3): 176-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10192593

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Olfactory neuroblastoma as acute postpartum depression. Author(s): Dascalu S, Chayen B, Kaplan B, Harel L. Source: The Journal of the American Board of Family Practice / American Board of Family Practice. 1998 September-October; 11(5): 414-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9796773

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Omega-3 polyunsaturated fatty acids for postpartum depression. Author(s): Chiu CC, Huang SY, Su KP. Source: American Journal of Obstetrics and Gynecology. 2004 February; 190(2): 582-3; Author Reply 583. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15002412

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On postpartum depression from the land downunder. Author(s): Ligtermoet H. Source: The Birth Gazette. 1995 Winter; 12(1): 38-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8704520

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Onset and persistence of postpartum depression in an inner-city maternal health clinic system. Author(s): Yonkers KA, Ramin SM, Rush AJ, Navarrete CA, Carmody T, March D, Heartwell SF, Leveno KJ. Source: The American Journal of Psychiatry. 2001 November; 158(11): 1856-63. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11691692

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Parental acceptance, postpartum depression, and maternal sensitivity: mediating and moderating processes. Author(s): Crockenberg SC, Leerkes EM. Source: Journal of Family Psychology : Jfp : Journal of the Division of Family Psychology of the American Psychological Association (Division 43). 2003 March; 17(1): 80-93. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12666465

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Paternal postpartum depression, its relationship to maternal postpartum depression, and implications for family health. Author(s): Goodman JH. Source: Journal of Advanced Nursing. 2004 January; 45(1): 26-35. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14675298

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Perceptions of nurses' caring by mothers experiencing postpartum depression. Author(s): Beck CT. Source: Journal of Obstetric, Gynecologic, and Neonatal Nursing : Jognn / Naacog. 1995 November-December; 24(9): 819-25. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8583272

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Perceptual defense and vulnerability to postpartum depression. Author(s): Borgeat F, David H, Saucier JF, Dumont M. Source: Acta Psychiatrica Scandinavica. 1994 December; 90(6): 455-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7892780

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Pharmacotherapy of postpartum depression. Author(s): Sharma V. Source: Expert Opinion on Pharmacotherapy. 2002 October; 3(10): 1421-31. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12387688

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Population-based screening for postpartum depression. Author(s): Georgiopoulos AM, Bryan TL, Yawn BP, Houston MS, Rummans TA, Therneau TM. Source: Obstetrics and Gynecology. 1999 May; 93(5 Pt 1): 653-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10912961

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Possible involvement of endorphin withdrawal or imbalance in specific premenstrual syndromes and postpartum depression. Author(s): Halbreich U, Endicott J. Source: Medical Hypotheses. 1981 August; 7(8): 1045-58. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7026993

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Postdelivery screening for postpartum depression. Author(s): Lee DT, Yip AS, Chan SS, Tsui MH, Wong WS, Chung TK. Source: Psychosomatic Medicine. 2003 May-June; 65(3): 357-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12764207

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Postpartum depression among adolescent mothers and adult mothers. Author(s): Chen CH. Source: Kaohsiung J Med Sci. 1996 February; 12(2): 104-13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8709172

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Postpartum depression among African-American women. Author(s): Amankwaa LC. Source: Issues in Mental Health Nursing. 2003 April-May; 24(3): 297-316. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12623687

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Postpartum depression and child development. Author(s): Murray L, Cooper PJ. Source: Psychological Medicine. 1997 March; 27(2): 253-60. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9089818

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Postpartum depression and companionship in the clinical birth environment: a randomized, controlled study. Author(s): Wolman WL, Chalmers B, Hofmeyr GJ, Nikodem VC. Source: American Journal of Obstetrics and Gynecology. 1993 May; 168(5): 1388-93. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8498417

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Postpartum depression and factitious disorder: a new presentation. Author(s): Gojer J, Berman T. Source: International Journal of Psychiatry in Medicine. 2000; 30(3): 287-93. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11209995

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Postpartum depression and gender-specific justice. Author(s): Legato MJ. Source: J Gend Specif Med. 2002 March-April; 5(2): 7-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11974680

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Postpartum depression and mother-infant relationship at 3 months old. Author(s): Righetti-Veltema M, Conne-Perreard E, Bousquet A, Manzano J. Source: Journal of Affective Disorders. 2002 August; 70(3): 291-306. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12128241

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Postpartum depression and mothers of infant twins. Author(s): Leonard LG. Source: Matern Child Nurs J. 1981 Summer; 10(2): 99-109. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6909479

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Postpartum depression and postpartum adaptation: overlapping constructs? Author(s): Hopkins J, Campbell SB, Marcus M. Source: Journal of Affective Disorders. 1989 November-December; 17(3): 251-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2529293

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Postpartum depression and the experience of motherhood. Author(s): Romito P. Source: Acta Obstetricia Et Gynecologica Scandinavica. Supplement. 1991; 154: 1-37. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1858488

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Postpartum depression and thyroid antibody status. Author(s): Harris B. Source: Thyroid : Official Journal of the American Thyroid Association. 1999 July; 9(7): 699-703. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10447017

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Postpartum depression as a family problem. Author(s): Martell LK. Source: Mcn. the American Journal of Maternal Child Nursing. 1990 March-April; 15(2): 90-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2108302

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Postpartum depression in an Israeli cohort: demographic, psychosocial and medical risk factors. Author(s): Glasser S, Barell V, Boyko V, Ziv A, Lusky A, Shoham A, Hart S. Source: Journal of Psychosomatic Obstetrics and Gynaecology. 2000 June; 21(2): 99-108. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10994182

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Postpartum depression in primiparous parents. Author(s): Atkinson AK, Rickel AU. Source: Journal of Abnormal Psychology. 1984 February; 93(1): 115-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6699268

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Postpartum depression in the breastfeeding mother. Author(s): Auerbach KG, Jacobi AM. Source: Naacogs Clin Issu Perinat Womens Health Nurs. 1990; 1(3): 375-84. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2206759

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Postpartum depression in women receiving public assistance: pilot study of an interpersonal-therapy-oriented group intervention. Author(s): Zlotnick C, Johnson SL, Miller IW, Pearlstein T, Howard M. Source: The American Journal of Psychiatry. 2001 April; 158(4): 638-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11282702

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Postpartum depression predictors inventory--revised. Author(s): Beck CT. Source: Advances in Neonatal Care : Official Journal of the National Association of Neonatal Nurses. 2003 February; 3(1): 47-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12882181

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Postpartum Depression Screening Scale: development and psychometric testing. Author(s): Beck CT, Gable RK. Source: Nursing Research. 2000 September-October; 49(5): 272-82. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11009122

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Postpartum depression screening scale: Spanish version. Author(s): Beck CT, Gable RK. Source: Nursing Research. 2003 September-October; 52(5): 296-306. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14501544

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Postpartum depression support. Author(s): Harlan C. Source: Can Nurse. 2002 June; 98(6): 6. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12098856

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Postpartum depression support. Author(s): Strass P. Source: Can Nurse. 2002 March; 98(3): 25-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11928293

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Postpartum depression vs. post birth trauma. Author(s): Lindstrom K. Source: The Birth Gazette. 1996 Summer; 12(3): 12-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9015964

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Postpartum depression with bipolar disorder. Author(s): Freeman MP, Keck PE Jr, McElroy SL. Source: The American Journal of Psychiatry. 2001 April; 158(4): 652. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11282711

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Postpartum depression, culture and African-American women. Author(s): Amankwaa LC. Source: J Cult Divers. 2003 Spring; 10(1): 23-9. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12776544

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Postpartum depression. Author(s): Vandenbergh RL. Source: Clinical Obstetrics and Gynecology. 1980 December; 23(4): 1105-11. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7004697

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Postpartum depression. Author(s): Lesh A. Source: Curr Pract Obstet Gynecol Nurs. 1978; 2: 52-64. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=255397

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Postpartum depression. Author(s): Blum LD. Source: The New England Journal of Medicine. 2003 March 27; 348(13): 1294. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12660400

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Postpartum depression. Author(s): Kennedy HP, Beck CT, Driscoll JW. Source: Journal of Midwifery & Women's Health. 2002 September-October; 47(5): 391. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12361353

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Postpartum depression. Author(s): Miller LJ. Source: Jama : the Journal of the American Medical Association. 2002 February 13; 287(6): 762-5. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11851544

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Postpartum depression. Author(s): DeGreg C, McGee K, Kenner C, Flandermeyer A. Source: Journal of Obstetric, Gynecologic, and Neonatal Nursing : Jognn / Naacog. 1992 July-August; 21(4): 322-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1322983

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Postpartum depression. Author(s): Daw JL. Source: Southern Medical Journal. 1988 February; 81(2): 207-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3340874

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Postpartum depression. Author(s): Murray JB, Gallahue L. Source: Genetic, Social, and General Psychology Monographs. 1987 May; 113(2): 193-212. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3497074

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Postpartum depression. Author(s): Garvey MJ, Tollefson GD. Source: J Reprod Med. 1984 February; 29(2): 113-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6708027

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Postpartum depression. Author(s): True-Soderstrom BA, Buckwalter KC, Kerfoot KM. Source: Matern Child Nurs J. 1983 Summer; 12(2): 109-18. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6554425

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Postpartum depression. Author(s): Carbary LJ. Source: J Nurs Care. 1982 July; 15(7): 11-3. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6922186

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Postpartum depression. A review of recent literature. Author(s): Dennerstein L, Varnavides K, Burrows G. Source: Aust Fam Physician. 1986 November; 15(11): 1470-2. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3800769

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Postpartum depression. A role for social network and life stress variables. Author(s): O'Hara MW, Rehm LP, Campbell SB. Source: The Journal of Nervous and Mental Disease. 1983 June; 171(6): 336-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6854298

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Postpartum depression. Identification of high-risk mothers. Author(s): Petrick JM. Source: Jogn Nurs. 1984 January-February; 13(1): 37-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6560048

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Postpartum depression. One nurse's personal experience. Author(s): Sampson K. Source: Awhonn Lifelines / Association of Women's Health, Obstetric and Neonatal Nurses. 2004 February-March; 8(1): 88, 86-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15031892

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Postpartum depression. Stopping the thief that steals motherhood. Author(s): Beck CT. Source: Awhonn Lifelines / Association of Women's Health, Obstetric and Neonatal Nurses. 1999 August-September; 3(4): 41-4. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10690011

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Postpartum depression. The lived experiences of Middle Eastern migrant women in Australia. Author(s): Nahas VL, Hillege S, Amasheh N. Source: Journal of Nurse-Midwifery. 1999 January-February; 44(1): 65-74. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10063227

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Postpartum depression: a clinical view. Author(s): Landy S, Montgomery J, Walsh S. Source: Matern Child Nurs J. 1989 Spring; 18(1): 1-29. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2702298

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Postpartum depression: how much do obstetric nurses and obstetricians know? Author(s): Lepper HS, DiMatteo MR, Tinsley BJ. Source: Birth (Berkeley, Calif.). 1994 September; 21(3): 149-54. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7857457

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Postpartum depression: identification of women at risk. Author(s): Nielsen Forman D, Videbech P, Hedegaard M, Dalby Salvig J, Secher NJ. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2000 October; 107(10): 1210-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11028570

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Postpartum depression: issues in clinical assessment. Author(s): Horowitz JA, Damato E, Solon L, Von Metzsch G, Gill V. Source: Journal of Perinatology : Official Journal of the California Perinatal Association. 1995 July-August; 15(4): 268-78; Quiz 279-80. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8558333

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Postpartum depression: prevalence and determinants in Lebanon. Author(s): Chaaya M, Campbell OM, El Kak F, Shaar D, Harb H, Kaddour A. Source: Archives of Women's Mental Health. 2002 October; 5(2): 65-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12510201

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Postpartum depression: risk-factors and treatments--introduction. Author(s): Glangeaud-Freudenthal NM, Boyce P. Source: Archives of Women's Mental Health. 2003 August; 6 Suppl 2: S31-2. Epub 2003 August 09. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14615920

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Postpartum depression: voice from a historian. Author(s): Coodley L. Source: Pediatric Nursing. 2002 May-June; 28(3): 300. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12087655

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Postpartum depression: what is it, what helps? Author(s): Handford P. Source: Can Nurse. 1985 January; 81(1): 30-3. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3843812

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Postpartum depression: what pediatricians need to know. Author(s): Chaudron LH. Source: Pediatrics in Review / American Academy of Pediatrics. 2003 May; 24(5): 15461. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12728188

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Postpartum depression: women's help-seeking behaviour and perceptions of cause. Author(s): McIntosh J. Source: Journal of Advanced Nursing. 1993 February; 18(2): 178-84. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8436707

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Postpartum depression--a specific concept? Author(s): Bell AJ, Land NM, Milne S, Hassanyeh F. Source: The British Journal of Psychiatry; the Journal of Mental Science. 1995 June; 166(6): 826-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7663843

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Postpartum thyroid dysfunction and postpartum depression: are they two linked disorders? Author(s): Lucas A, Pizarro E, Granada ML, Salinas I, Sanmarti A. Source: Clinical Endocrinology. 2001 December; 55(6): 809-14. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11895224

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Predictors of postpartum depression: an update. Author(s): Beck CT. Source: Nursing Research. 2001 September-October; 50(5): 275-85. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11570712

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Predictors, prodromes and incidence of postpartum depression. Author(s): Chaudron LH, Klein MH, Remington P, Palta M, Allen C, Essex MJ. Source: Journal of Psychosomatic Obstetrics and Gynaecology. 2001 June; 22(2): 103-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11446151

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Prevention of recurrent postpartum depression: a randomized clinical trial. Author(s): Wisner KL, Perel JM, Peindl KS, Hanusa BH, Findling RL, Rapport D. Source: The Journal of Clinical Psychiatry. 2001 February; 62(2): 82-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11247106

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Proactive nursing: the evolution of a task force to help women with postpartum depression. Author(s): Straub H, Cross J, Curtis S, Iverson S, Jacobsmeyer M, Anderson C, Sorenson M. Source: Mcn. the American Journal of Maternal Child Nursing. 1998 September-October; 23(5): 262-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9747089

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Prospective investigation of postpartum depression: factors involved in onset and recovery. Author(s): Gotlib IH, Whiffen VE, Wallace PM, Mount JH. Source: Journal of Abnormal Psychology. 1991 May; 100(2): 122-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2040762

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Prospective study of postpartum depression in an Israeli cohort: prevalence, incidence and demographic risk factors. Author(s): Glasser S, Barell V, Shoham A, Ziv A, Boyko V, Lusky A, Hart S. Source: Journal of Psychosomatic Obstetrics and Gynaecology. 1998 September; 19(3): 155-64. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9844846

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Prospective study of postpartum depression: 4 1/2-year follow-up of women and children. Author(s): Philipps LH, O'Hara MW. Source: Journal of Abnormal Psychology. 1991 May; 100(2): 151-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2040765

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Prospective study of postpartum depression: prevalence, course, and predictive factors. Author(s): O'Hara MW, Neunaber DJ, Zekoski EM. Source: Journal of Abnormal Psychology. 1984 May; 93(2): 158-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6725749

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Psychosocial aspects of Taiwanese postpartum depression phenomenological approach: a preliminary report. Author(s): Chen CH, Wu HY, Tseng YF, Chou FH, Wang SY. Source: Kaohsiung J Med Sci. 1999 January; 15(1): 44-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10063795

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Psychosocial predictors of postpartum depression in diverse groups of women. Author(s): Logsdon MC, Usui W. Source: Western Journal of Nursing Research. 2001 October; 23(6): 563-74. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11569330

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Psychotherapy for postpartum depression: a preliminary report. Author(s): Clark R, Tluczek A, Wenzel A. Source: The American Journal of Orthopsychiatry. 2003 October; 73(4): 441-54. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14609406

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Rapid decrease of serum cholesterol concentration and postpartum depression. Author(s): Ploeckinger B, Dantendorfer K, Ulm M, Baischer W, Derfler K, Musalek M, Dadak C. Source: Bmj (Clinical Research Ed.). 1996 September 14; 313(7058): 664. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8845727

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Recognizing and screening for postpartum depression in mothers of NICU infants. Author(s): Beck CT. Source: Advances in Neonatal Care : Official Journal of the National Association of Neonatal Nurses. 2003 February; 3(1): 37-46. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12882180

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Reconstruction in a case of postpartum depression. Author(s): Blum HP. Source: Psychoanal Study Child. 1978; 33: 335-62. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=715110

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Research on psychosocial factors and postpartum depression: a critique. Author(s): Arizmendi TG, Affonso DD. Source: Birth (Berkeley, Calif.). 1984 Winter; 11(4): 237-45. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6568827

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Revision of the postpartum depression predictors inventory. Author(s): Beck CT. Source: Journal of Obstetric, Gynecologic, and Neonatal Nursing : Jognn / Naacog. 2002 July-August; 31(4): 394-402. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12146928

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Risk factors and predictive signs of postpartum depression. Author(s): Righetti-Veltema M, Conne-Perreard E, Bousquet A, Manzano J. Source: Journal of Affective Disorders. 1998 June; 49(3): 167-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9629946

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Risk factors for postpartum depression in Japan. Author(s): Tamaki R, Murata M, Okano T. Source: Psychiatry and Clinical Neurosciences. 1997 June; 51(3): 93-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9225370

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Role functioning and symptom remission in women with postpartum depression after antidepressant treatment. Author(s): Logsdon MC, Wisner K, Hanusa BH, Phillips A. Source: Archives of Psychiatric Nursing. 2003 December; 17(6): 276-83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14685952

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Role of infant-related stressors in postpartum depression. Author(s): Hopkins J, Campbell SB, Marcus M. Source: Journal of Abnormal Psychology. 1987 August; 96(3): 237-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3680763

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Routine screening for postpartum depression. Author(s): Georgiopoulos AM, Bryan TL, Wollan P, Yawn BP. Source: The Journal of Family Practice. 2001 February; 50(2): 117-22. Erratum In: J Fam Pract 2001 May; 50(5): 470. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11219558

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Screening for postpartum depression in an inner-city population. Author(s): Morris-Rush JK, Freda MC, Bernstein PS. Source: American Journal of Obstetrics and Gynecology. 2003 May; 188(5): 1217-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12748483

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Screening for postpartum depression. Author(s): Ugarriza DN. Source: Journal of Psychosocial Nursing and Mental Health Services. 2000 December; 38(12): 44-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11131406

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Screening for postpartum depression. An antepartum questionnaire. Author(s): Posner NA, Unterman RR, Williams KN, Williams GH. Source: J Reprod Med. 1997 April; 42(4): 207-15. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9131493

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Screening for postpartum depression: a methodological note. Author(s): Whiffen VE. Source: Journal of Clinical Psychology. 1988 May; 44(3): 367-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3384962

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Screening for the patient at risk for postpartum depression. Author(s): Braverman J, Roux JF. Source: Obstetrics and Gynecology. 1978 December; 52(6): 731-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=733141

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Screening methods for postpartum depression. Author(s): Beck CT. Source: Journal of Obstetric, Gynecologic, and Neonatal Nursing : Jognn / Naacog. 1995 May; 24(4): 308-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7643261

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Screening women for postpartum depression at well baby visits: resistance encountered and recommendations. Author(s): Tam LW, Newton RP, Dern M, Parry BL. Source: Archives of Women's Mental Health. 2002 October; 5(2): 79-82. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12510203

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Seafood consumption, the DHA content of mothers' milk and prevalence rates of postpartum depression: a cross-national, ecological analysis. Author(s): Hibbeln JR. Source: Journal of Affective Disorders. 2002 May; 69(1-3): 15-29. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12103448

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Self-esteem, optimism, and postpartum depression. Author(s): Fontaine KR, Jones LC. Source: Journal of Clinical Psychology. 1997 January; 53(1): 59-63. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9120033

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Self-exclusion from health care in women at high risk for postpartum depression. Author(s): Murray L, Woolgar M, Murray J, Cooper P. Source: Journal of Public Health Medicine. 2003 June; 25(2): 131-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12848402

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Serum cholesterol concentration and postpartum depression. Authors should read the literature that they cite. Author(s): Smith GD. Source: Bmj (Clinical Research Ed.). 1997 January 11; 314(7074): 144. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9006483

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Serum cholesterol concentration and postpartum depression. Oestrogen may have been a confounder. Author(s): Luckas M, Buckett W, Aird I, Kingsland C. Source: Bmj (Clinical Research Ed.). 1997 January 11; 314(7074): 143-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9006482

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Should postpartum depression be targeted to improve child mental health? Author(s): McLennan JD, Offord DR. Source: Journal of the American Academy of Child and Adolescent Psychiatry. 2002 January; 41(1): 28-35. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11800202

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Social support and postpartum depression. Author(s): Logsdon MC, McBride AB, Birkimer JC. Source: Research in Nursing & Health. 1994 December; 17(6): 449-57. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7972923

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Social support in pregnancy: psychosocial correlates of birth outcomes and postpartum depression. Author(s): Collins NL, Dunkel-Schetter C, Lobel M, Scrimshaw SC. Source: Journal of Personality and Social Psychology. 1993 December; 65(6): 1243-58. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8295121

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Social support, infant temperament, and parenting self-efficacy: a mediational model of postpartum depression. Author(s): Cutrona CE, Troutman BR. Source: Child Development. 1986 December; 57(6): 1507-18. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3802975

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Teetering on the edge: a substantive theory of postpartum depression. Author(s): Beck CT. Source: Nursing Research. 1993 January-February; 42(1): 42-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8424067

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The dark days of postpartum depression. Primary care screening is essential. Author(s): Albert C. Source: Adv Nurse Pract. 2002 June; 10(6): 67-70. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12400366

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The development and validation of a predictive index for postpartum depression. Author(s): Cooper PJ, Murray L, Hooper R, West A. Source: Psychological Medicine. 1996 May; 26(3): 627-34. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8733220

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The downward spiral of postpartum depression. Author(s): Wood AF, Thomas SP, Droppleman PG, Meighan M. Source: Mcn. the American Journal of Maternal Child Nursing. 1997 NovemberDecember; 22(6): 308-16; Quiz 317. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9631625

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The effect of peer support on postpartum depression: a pilot randomized controlled trial. Author(s): Dennis CL. Source: Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie. 2003 March; 48(2): 115-24. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12655910

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The effect of postpartum depression on child cognitive development and behavior: a review and critical analysis of the literature. Author(s): Grace SL, Evindar A, Stewart DE. Source: Archives of Women's Mental Health. 2003 November; 6(4): 263-74. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14628179

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The effect of social support and acculturation on postpartum depression in Mexican American women. Author(s): Martinez-Schallmoser L, Telleen S, MacMullen NJ. Source: Journal of Transcultural Nursing : Official Journal of the Transcultural Nursing Society / Transcultural Nursing Society. 2003 October; 14(4): 329-38. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14535154

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The effectiveness of various postpartum depression treatments and the impact of antidepressant drugs on nursing infants. Author(s): Gjerdingen D. Source: The Journal of the American Board of Family Practice / American Board of Family Practice. 2003 September-October; 16(5): 372-82. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14645327

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The effects of postpartum depression on child development: a meta-analysis. Author(s): Beck CT. Source: Archives of Psychiatric Nursing. 1998 February; 12(1): 12-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9489170

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The effects of postpartum depression on maternal-infant interaction: a meta-analysis. Author(s): Beck CT. Source: Nursing Research. 1995 September-October; 44(5): 298-304. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7567486

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The impact of partner support in the treatment of postpartum depression. Author(s): Misri S, Kostaras X, Fox D, Kostaras D. Source: Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie. 2000 August; 45(6): 554-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10986574

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The lived experience of postpartum depression: a phenomenological study. Author(s): Beck CT. Source: Nursing Research. 1992 May-June; 41(3): 166-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1584660

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The prevention and psychotherapeutic treatment of postpartum depression. Author(s): Stuart S, O'Hara MW, Gorman LL. Source: Archives of Women's Mental Health. 2003 August; 6 Suppl 2: S57-69. Epub 2003 August 09. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14615924

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The psychiatrist's guide to right and wrong: Part III: Postpartum depression and the “appreciation” of wrongfulness. Author(s): Goldstein RL. Source: Bull Am Acad Psychiatry Law. 1989; 17(2): 121-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2758116

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The relationship between maternal role attainment and postpartum depression. Author(s): Fowles ER. Source: Health Care for Women International. 1998 January-February; 19(1): 83-94. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9479097

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The relationship of demographic variables, antepartum depression, and stress to postpartum depression. Author(s): Pfost KS, Stevens MJ, Lum CU. Source: Journal of Clinical Psychology. 1990 September; 46(5): 588-92. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2246364

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The role of pterins and related factors in the biology of early postpartum depression. Author(s): Abou-Saleh MT, Ghubash R, Karim L, Krymski M, Anderson DN. Source: European Neuropsychopharmacology : the Journal of the European College of Neuropsychopharmacology. 1999 June; 9(4): 295-300. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10422889

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The timing of norplant insertion and postpartum depression in teenagers. Author(s): Stevens-Simon C, Kelly L, Wallis J. Source: The Journal of Adolescent Health : Official Publication of the Society for Adolescent Medicine. 2000 June; 26(6): 408-13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10822182

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The treatment of postpartum depression: minimizing infant exposures. Author(s): Newport DJ, Hostetter A, Arnold A, Stowe ZN. Source: The Journal of Clinical Psychiatry. 2002; 63 Suppl 7: 31-44. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11995777

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Theoretical perspectives of postpartum depression and their treatment implications. Author(s): Beck CT. Source: Mcn. the American Journal of Maternal Child Nursing. 2002 September-October; 27(5): 282-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12209059

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Thyroid dysfunction in postpartum depression. Author(s): Claman P. Source: The American Journal of Psychiatry. 1990 August; 147(8): 1101. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2248646

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Thyroid function and postpartum depression. Author(s): Stewart DE. Source: The American Journal of Psychiatry. 1991 June; 148(6): 816. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2035734

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Transactional conflict between psychobiology and culture in the etiology of postpartum depression. Author(s): Hayes MJ, Roberts S, Davare A. Source: Medical Hypotheses. 2000 September; 55(3): 266-76. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10985922

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Transactional conflict between psychobiology and culture in the etiology of postpartum depression. Author(s): Cochrane Database Syst Rev. 2001;(3):CD000946 Source: Medical Hypotheses. 2000 January; 54(1): 7-17. Review. Corrected and Republished In: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11686971

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Treatment of postpartum depression with interpersonal psychotherapy. Author(s): Stuart S, O'Hara MW. Source: Archives of General Psychiatry. 1995 January; 52(1): 75-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7811164

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Treatment of postpartum depression. Author(s): Jermain DM. Source: Am Pharm. 1995 January; Ns35(1): 33-8, 45. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7887372

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Use of the Edinburgh Postnatal Depression Scale to identify postpartum depression in a clinical setting. Author(s): Schaper AM, Rooney BL, Kay NR, Silva PD. Source: J Reprod Med. 1994 August; 39(8): 620-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7996526

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Using maternal representational patterns to evaluate postpartum depression. Author(s): Trad PV. Source: American Journal of Psychotherapy. 1995 Winter; 49(1): 128-48. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7762695

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Venlafaxine in the treatment of postpartum depression. Author(s): Cohen LS, Viguera AC, Bouffard SM, Nonacs RM, Morabito C, Collins MH, Ablon JS. Source: The Journal of Clinical Psychiatry. 2001 August; 62(8): 592-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11561929

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Vitamin B6 status in women with postpartum depression. Author(s): Livingston JE, MacLeod PM, Applegarth DA. Source: The American Journal of Clinical Nutrition. 1978 May; 31(5): 886-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=645633

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Vulnerability of postpartum depression: a prospective multivariate study. Author(s): Whiffen VE. Source: Journal of Abnormal Psychology. 1988 November; 97(4): 467-74. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3204233

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What interventions may reduce postpartum depression. Author(s): Lumley J, Austin MP. Source: Current Opinion in Obstetrics & Gynecology. 2001 December; 13(6): 605-11. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11707664

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What midwives need to know about postpartum depression. Author(s): Barnes DL. Source: Midwifery Today Int Midwife. 2002 Spring; (61): 18-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11951666

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When joy becomes grief. Screening tools for postpartum depression. Author(s): Vieira T. Source: Awhonn Lifelines / Association of Women's Health, Obstetric and Neonatal Nurses. 2002 December; 6(6): 506-13. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12593259

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CHAPTER 2. NUTRITION AND POSTPARTUM DEPRESSION Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and postpartum depression.

Finding Nutrition Studies on Postpartum Depression The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.7 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “postpartum depression” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

7

Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

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The following information is typical of that found when using the “Full IBIDS Database” to search for “postpartum depression” (or a synonym): •

Estrogen for postnatal depression. Author(s): University of Virginia Health Sciences Center, Charlottesville, Virginia, USA. [email protected] Source: Cattell, D L King, E A J-Fam-Pract. 1996 July; 43(1): 22-3 0094-3509

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Incidence of postnatal depression in Malaysian women. Author(s): Department of Obstetrics and Gynaecology, Hospital Seremban, Malaysia. Source: Kit, L K Janet, G Jegasothy, R J-Obstet-Gynaecol-Res. 1997 February; 23(1): 85-9 1341-8076

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Influence of psychiatric disorder on the controlling behaviour of mothers with 1-yearold infants. A study of women with maternal eating disorder, postnatal depression and a healthy comparison group. Author(s): Leopold Muller Centre for Child and Family Mental Health, Department of Paediatrics and Child Health, Royal Free and University College Medical School, London, UK. [email protected] Source: Stein, A Woolley, H Murray, L Cooper, P Cooper, S Noble, F Affonso, N Fairburn, C G Br-J-Psychiatry. 2001 August; 179: 157-62 0007-1250

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Oestrogen and postnatal depression. Author(s): St Ita's Hospital, Portrane, Co Dublin, Ireland. Source: Murray, D Lancet. 1996 April 6; 347(9006): 918-9 0140-6736

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Oestrogens and progestogens for preventing and treating postnatal depression. Author(s): Department of Obstetrics and Gynaecology, University of Stellenbosch, Tygerberg Hospital, PO Box 19164, Tygerberg, Western Cape, South Africa, 7505. [email protected] Source: Lawrie, T A Herxheimer, A Dalton, K Cochrane-Database-Syst-Revolume 2000; (2): CD001690 1469-493X

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Postnatal depression and zinc status--a preliminary study. Source: Nichols, J. Morgan, J. Taylor, A. J-Nutr-Med. Abingdon, UK : Carfax Pub. Co. 1992. volume 3 (1) page 35-42. 0955-6664

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Prediction, detection, and treatment of postnatal depression. Author(s): Department of Psychology, University of Reading, Whiteknights. Source: Cooper, P Murray, L Arch-Dis-Child. 1997 August; 77(2): 97-9 0003-9888

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Randomised trial of thyroxine to prevent postnatal depression in thyroid-antibodypositive women. Author(s): Department of Psychological Medicine, Bronllys Hospital, Brecon, UK. [email protected] Source: Harris, Brian Oretti, Rossana Lazarus, John Parkes, Arthur John, Rees Richards, Colin Newcombe, Robert Hall, Reginald Br-J-Psychiatry. 2002 April; 180: 327-30 00071250

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The role of alternative medicine in treating postnatal depression. Author(s): Department of Public and Community Health, Oxford Brookes University, Oxford. Source: Mantle, F Br-J-Community-Nurs. 2001 July; 6(7): 363-8 1462-4753

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Transdermal oestrogen for treatment of severe postnatal depression. Author(s): Mental Health Services, Salisbury Health Care, Salisbury, UK.

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Source: Gregoire, A J KuMarch, R Everitt, B Henderson, A F Studd, J W Lancet. 1996 April 6; 347(9006): 930-3 0140-6736

Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

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Google: http://directory.google.com/Top/Health/Nutrition/

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Healthnotes: http://www.healthnotes.com/

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Open Directory Project: http://dmoz.org/Health/Nutrition/

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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

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WebMDHealth: http://my.webmd.com/nutrition

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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CHAPTER 3. ALTERNATIVE MEDICINE AND POSTPARTUM DEPRESSION Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to postpartum depression. At the conclusion of this chapter, we will provide additional sources.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to postpartum depression and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “postpartum depression” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to postpartum depression: •

A two-centred pragmatic randomised controlled trial of two interventions of postnatal support. Author(s): Reid M, Glazener C, Murray GD, Taylor GS. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2002 October; 109(10): 1164-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12387471

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Becoming whole: a pastoral story. Author(s): Meadow ML, Beyerle-Rutherford E. Source: Health Care for Women International. 1999 July-August; 20(4): 427-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10745757

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Benefits of infant massage for mothers with postnatal depression. Author(s): Glover V, Onozawa K, Hodgkinson A. Source: Seminars in Neonatology : Sn. 2002 December; 7(6): 495-500. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12614602

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Care for women with postpartum depression: “N*U*R*S*E” approach. Author(s): Sichel D, Driscoll JW. Source: Journal of Midwifery & Women's Health. 2002 September-October; 47(5): 392. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12361354

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Complementary and alternative medicine in pregnancy: a survey of North Carolina certified nurse-midwives. Author(s): Allaire AD, Moos MK, Wells SR. Source: Obstetrics and Gynecology. 2000 January; 95(1): 19-23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10636495

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Complementary therapies as adjuncts in the treatment of postpartum depression. Author(s): Weier KM, Beal MW. Source: Journal of Midwifery & Women's Health. 2004 March-April; 49(2): 96-104. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15010661

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Creating a postpartum depression support group. Out of the blue. Author(s): Maley B. Source: Awhonn Lifelines / Association of Women's Health, Obstetric and Neonatal Nurses. 2002 February-March; 6(1): 62-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11913204

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Developing a culture-specific tool to assess postnatal depression in the Indian community. Author(s): Mantle F. Source: British Journal of Community Nursing. 2003 April; 8(4): 176-80. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12732834

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Does pain relief during delivery decrease the risk of postnatal depression? Author(s): Hiltunen P, Raudaskoski T, Ebeling H, Moilanen I. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2004 March; 83(3): 257-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14995921

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Effect of maternal docosahexaenoic acid supplementation on postpartum depression and information processing. Author(s): Llorente AM, Jensen CL, Voigt RG, Fraley JK, Berretta MC, Heird WC.

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Source: American Journal of Obstetrics and Gynecology. 2003 May; 188(5): 1348-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12748510 •

Effect of reproductive hormones and selective estrogen receptor modulators on mood during menopause. Author(s): Soares CN, Poitras JR, Prouty J. Source: Drugs & Aging. 2003; 20(2): 85-100. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12534310

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Effects of postnatal depression. Author(s): Botes S. Source: Prof Nurse. 1999 October; 15(1): 5. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10595171

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Effects of postpartum psychiatric illnesses on family planning. Author(s): Peindl KS, Zolnik EJ, Wisner KL, Hanusa BH. Source: International Journal of Psychiatry in Medicine. 1995; 25(3): 291-300. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8567195

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Effects of support group intervention in postnatally distressed women. A controlled study in Taiwan. Author(s): Chen CH, Tseng YF, Chou FH, Wang SY. Source: Journal of Psychosomatic Research. 2000 December; 49(6): 395-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11182431

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Family dynamics of postnatally depressed mothers - discrepancy between expectations and reality. Author(s): Tammentie T, Paavilainen E, Astedt-Kurki P, Tarkka MT. Source: Journal of Clinical Nursing. 2004 January; 13(1): 65-74. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14687295

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Having a healthy, happy postpartum. How midwifery today's newest “baby” can help you. Author(s): Rosenberg J. Source: Midwifery Today Int Midwife. 2002 Spring; (61): 25. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11951671

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Homeopathic medicine for the postpartum period. Author(s): Martin P. Source: Midwifery Today Int Midwife. 2001 Spring; (57): 42-3. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12596410

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How I overcame postpartum depression. Author(s): Furnari J. Source: Midwifery Today Int Midwife. 2002 Spring; (61): 20. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11951668

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Increased risk of postpartum depressive symptoms is associated with slower normalization after pregnancy of the functional docosahexaenoic acid status. Author(s): Otto SJ, de Groot RH, Hornstra G. Source: Prostaglandins, Leukotrienes, and Essential Fatty Acids. 2003 October; 69(4): 237-43. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12907133

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Infant massage improves mother-infant interaction for mothers with postnatal depression. Author(s): Onozawa K, Glover V, Adams D, Modi N, Kumar RC. Source: Journal of Affective Disorders. 2001 March; 63(1-3): 201-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11246096

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Ka hua o'o ka pu'ao (the fruit of the womb). Presidential address. Author(s): McCorriston CC. Source: American Journal of Obstetrics and Gynecology. 1982 May 1; 143(1): 1-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7081303

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Kangaroo care: not just for stable preemies anymore. Author(s): Anderson GC, Dombrowski MA, Swinth JY. Source: Reflect Nurs Leadersh. 2001; 27(2): 32-4, 45. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11987376

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Labor pain is reduced by massage therapy. Author(s): Field T, Hernandez-Reif M, Taylor S, Quintino O, Burman I. Source: Journal of Psychosomatic Obstetrics and Gynaecology. 1997 December; 18(4): 286-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9443139

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Massage and relaxation therapies' effects on depressed adolescent mothers. Author(s): Field T, Grizzle N, Scafidi F, Schanberg S. Source: Adolescence. 1996 Winter; 31(124): 903-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8970662

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Mother courage. Interview by Mary Hampshire. Author(s): Smith M.

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Source: Nursing Standard : Official Newspaper of the Royal College of Nursing. 2001 October 31-November 6; 16(7): 20-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11974823 •

Motherhood--a potential killer. Author(s): Green M. Source: Lancet. 2004 January 24; 363(9405): 311. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14751706

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Mother-infant interactions in postpartum depression: an early intervention program. Author(s): Milgrom J. Source: The Australian Journal of Advanced Nursing : a Quarterly Publication of the Royal Australian Nursing Federation. 1994 June-August; 11(4): 29-38. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7980887

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Omega-3 fatty acids for the prevention of postpartum depression: negative data from a preliminary, open-label pilot study. Author(s): Marangell LB, Martinez JM, Zboyan HA, Chong H, Puryear LJ. Source: Depression and Anxiety. 2004; 19(1): 20-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14978781

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Omega-3 polyunsaturated fatty acids for postpartum depression. Author(s): Chiu CC, Huang SY, Su KP. Source: American Journal of Obstetrics and Gynecology. 2004 February; 190(2): 582-3; Author Reply 583. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15002412

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Out of the darkness and into the light: women's experiences with depression after childbirth. Author(s): Berggren-Clive K. Source: Can J Commun Ment Health. 1998 Spring; 17(1): 103-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10351169

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Postnatal depression. Author(s): Bewley C. Source: Nursing Standard : Official Newspaper of the Royal College of Nursing. 1999 January 6-12; 13(16): 49-54; Quiz 55-6. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10076357

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Postnatal depression: making better use of health visitors and community psychiatric nurses. Author(s): Parke S, Hardy B.

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Source: Prof Care Mother Child. 1997; 7(6): 151-2. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9516767 •

Postpartum care from ancient India. Author(s): Freeman M. Source: Midwifery Today Int Midwife. 2002 Spring; (61): 23-4, 63. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11951670

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Postpartum depression support. Author(s): Harlan C. Source: Can Nurse. 2002 June; 98(6): 6. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12098856

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Postpartum depression, culture and African-American women. Author(s): Amankwaa LC. Source: J Cult Divers. 2003 Spring; 10(1): 23-9. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12776544

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Postpartum depression: assessing risk, restoring balance. Author(s): Busch P, Perrin K. Source: Rn. 1989 August; 52(8): 46-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2602829

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Postpartum depression: what is it, what helps? Author(s): Handford P. Source: Can Nurse. 1985 January; 81(1): 30-3. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3843812

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Predicting postnatal mental disorder with a screening questionnaire: a prospective cohort study from Zimbabwe. Author(s): Nhiwatiwa S, Patel V, Acuda W. Source: Journal of Epidemiology and Community Health. 1998 April; 52(4): 262-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9616415

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Predictors of childbirth pain and maternal satisfaction. Author(s): Dannenbring D, Stevens MJ, House AE. Source: Journal of Behavioral Medicine. 1997 April; 20(2): 127-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9144036

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Promoting mental health after childbirth: a controlled trial of primary prevention of postnatal depression.

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Author(s): Elliott SA, Leverton TJ, Sanjack M, Turner H, Cowmeadow P, Hopkins J, Bushnell D. Source: The British Journal of Clinical Psychology / the British Psychological Society. 2000 September; 39 ( Pt 3): 223-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11033746 •

Reaching out: depression after delivery support group network. Author(s): Berchtold N, Burrough M. Source: Naacogs Clin Issu Perinat Womens Health Nurs. 1990; 1(3): 385-94. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2206760

•

Seafood consumption, the DHA content of mothers' milk and prevalence rates of postpartum depression: a cross-national, ecological analysis. Author(s): Hibbeln JR. Source: Journal of Affective Disorders. 2002 May; 69(1-3): 15-29. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12103448

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St. John's wort (Hypericum perforatum)--is it safe during breastfeeding? Author(s): Klier CM, Schafer MR, Schmid-Siegel B, Lenz G, Mannel M. Source: Pharmacopsychiatry. 2002 January; 35(1): 29-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11819157

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Taking St John's wort during pregnancy. Author(s): Goldman RD, Koren G; Motherisk Team. Source: Can Fam Physician. 2003 January; 49: 29-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12602839

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Teetering on the edge: a substantive theory of postpartum depression. Author(s): Beck CT. Source: Nursing Research. 1993 January-February; 42(1): 42-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8424067

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The experience of seeking help for postnatal depression. Author(s): Holopainen D. Source: The Australian Journal of Advanced Nursing : a Quarterly Publication of the Royal Australian Nursing Federation. 2002 March-May; 19(3): 39-44. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12002628

•

The Expert Consensus Guideline Series. Treatment of depression in women. Author(s): Altshuler LL, Cohen LS, Moline ML, Kahn DA, Carpenter D, Docherty JP; Expert Consensus Panel for Depression in Women.

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Source: Postgraduate Medicine. 2001 March; (Spec No): 1-107. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11500997 •

The role of alternative medicine in treating postnatal depression. Author(s): Mantle F. Source: Complementary Therapies in Nursing & Midwifery. 2002 November; 8(4): 197203. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12463609

•

The role of alternative medicine in treating postnatal depression. Author(s): Mantle F. Source: British Journal of Community Nursing. 2001 July; 6(7): 363-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11865227

Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

•

AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats

•

Chinese Medicine: http://www.newcenturynutrition.com/

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drkoop.com: http://www.drkoop.com/InteractiveMedicine/IndexC.html

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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

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Google: http://directory.google.com/Top/Health/Alternative/

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Healthnotes: http://www.healthnotes.com/

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MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine

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Open Directory Project: http://dmoz.org/Health/Alternative/

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HealthGate: http://www.tnp.com/

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WebMDHealth: http://my.webmd.com/drugs_and_herbs

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

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The following is a specific Web list relating to postpartum depression; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

General Overview Depression Source: Integrative Medicine Communications; www.drkoop.com PMS Source: Integrative Medicine Communications; www.drkoop.com Premenstrual Syndrome Source: Integrative Medicine Communications; www.drkoop.com

•

Alternative Therapy Massage Source: Integrative Medicine Communications; www.drkoop.com

•

Homeopathy Actaea Racemosa Source: Healthnotes, Inc.; www.healthnotes.com Arsenicum Album Source: Healthnotes, Inc.; www.healthnotes.com Aurum Metallicum Source: Healthnotes, Inc.; www.healthnotes.com Calcarea Carbonica Source: Healthnotes, Inc.; www.healthnotes.com Cimicifuga Source: Healthnotes, Inc.; www.healthnotes.com Ignatia Source: Healthnotes, Inc.; www.healthnotes.com Natrum Muriaticum Source: Healthnotes, Inc.; www.healthnotes.com Phosphorus Source: Healthnotes, Inc.; www.healthnotes.com Pulsatilla Source: Healthnotes, Inc.; www.healthnotes.com Sepia Source: Healthnotes, Inc.; www.healthnotes.com

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General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.

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CHAPTER 4. DEPRESSION

DISSERTATIONS

ON

POSTPARTUM

Overview In this chapter, we will give you a bibliography on recent dissertations relating to postpartum depression. We will also provide you with information on how to use the Internet to stay current on dissertations. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical dissertations that use the generic term “postpartum depression” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on postpartum depression, we have not necessarily excluded non-medical dissertations in this bibliography.

Dissertations on Postpartum Depression ProQuest Digital Dissertations, the largest archive of academic dissertations available, is located at the following Web address: http://wwwlib.umi.com/dissertations. From this archive, we have compiled the following list covering dissertations devoted to postpartum depression. You will see that the information provided includes the dissertation’s title, its author, and the institution with which the author is associated. The following covers recent dissertations found when using this search procedure: •

A MULTIVARIATE REGRESSION EXAMINATION OF STRESSFUL LIFE EVENTS, SOCIAL SUPPORT, AND THE POSTPARTUM DEPRESSION SYNDROME by COHEN, DAVID A., PHD from University of Southern California, 1983 http://wwwlib.umi.com/dissertations/fullcit/f3032981

•

A PREVENTIVE INTERVENTION FOR POSTPARTUM DEPRESSION IN PRIMIPAROUS WOMEN by MEEKER, CYNTHIA ANN HOUTMAN, PHD from University of Kansas, 1984, 169 pages http://wwwlib.umi.com/dissertations/fullcit/8424337

•

A prospective study of postpartum depression a test of the cognitive vulnerability model by Acton, Robert Gordon; PhD from The University of Saskatchewan (Canada), 1988 http://wwwlib.umi.com/dissertations/fullcit/NL45027

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•

Does an increase in psychosocial risk factors predict delayed medication treatment response in women with postpartum depression? by Czarkowski, Kathryn A.; MA from Southern Connecticut State University, 2003, 50 pages http://wwwlib.umi.com/dissertations/fullcit/1417098

•

INTERPERSONAL, ENVIRONMENTAL AND INTRAPSYCHIC CORRELATES OF POSTPARTUM DEPRESSION by WILLIAMS, ELIZABETH KING, PHD from Seton Hall University, School of Education, 1995, 102 pages http://wwwlib.umi.com/dissertations/fullcit/9535464

•

POSTPARTUM DEPRESSION AMONG LOWER SES TEEN MOTHERS by LILLICH, MARY HELEN, PHD from Marquette University, 1990, 130 pages http://wwwlib.umi.com/dissertations/fullcit/9117353

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POSTPARTUM DEPRESSION AND THE MEDICALIZATION OF MOTHERHOOD: A COMPARISON OF LAY AND PROFESSIONAL VIEWS (DEPRESSION) by RANSDELL, LISA LYNN, PHD from The Ohio State University, 1990, 229 pages http://wwwlib.umi.com/dissertations/fullcit/9105195

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Postpartum depression screening and Latinas by Koch, Lucy Francesca; MSW from California State University, Long Beach, 2003, 37 pages http://wwwlib.umi.com/dissertations/fullcit/1415472

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Postpartum depression: The need for prevention, early diagnosis and treatment by Hoefliger, Catherine M.; PsyD from Massachusetts School of Professional Psychology, 2003, 136 pages http://wwwlib.umi.com/dissertations/fullcit/3088236

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Self-esteem, stressful life events, social support, and postpartum depression in adolescent mothers in Thailand by Srisaeng, Pakvilai; PhD from Case Western Reserve University (Health Sciences), 2003, 206 pages http://wwwlib.umi.com/dissertations/fullcit/3107708

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Separating mothering and motherhood: Women's changing maternity experiences and the normalization of postpartum depression in Cagliari, Italy, 1943-1994 by Ketler, Suzanne Kristine, PhD from University of Pittsburgh, 1997, 366 pages http://wwwlib.umi.com/dissertations/fullcit/9816813

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The experience of postpartum depression: A grounded theory study by Regev, Michal; PhD from The University of British Columbia (Canada), 2001, 214 pages http://wwwlib.umi.com/dissertations/fullcit/NQ71525

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THE LEARNED HELPLESSNESS MODEL OFDEPRESSION: LOCUS-OFCONTROL, EXPERIENCED CONTROL, AND TRANSIENT POSTPARTUM DEPRESSION IN FIRST-TIME PARENTS by SANDBERG, JERRY LYNN, PHD from Brigham Young University, 1986, 135 pages http://wwwlib.umi.com/dissertations/fullcit/8627280

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The relationship between postpartum depression and social support by Confer, Linda Louise; MSW from California State University, Long Beach, 2003, 54 pages http://wwwlib.umi.com/dissertations/fullcit/1415441

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Two studies of differential parental investment: Child nutrition and health in a Yanomamo village, and the evolutionary psychology of postpartum depression (Venezuela) by Hagen, Edward Harold; PhD from University of California, Santa Barbara, 1999, 219 pages http://wwwlib.umi.com/dissertations/fullcit/9986891

Dissertations 71

•

Vulnerability to postpartum depression psychological and psychosocial factors by Whiffen, Valerie Elisabeth; PhD from Simon Fraser University (Canada), 1987 http://wwwlib.umi.com/dissertations/fullcit/NL36356

Keeping Current Ask the medical librarian at your library if it has full and unlimited access to the ProQuest Digital Dissertations database. From the library, you should be able to do more complete searches via http://wwwlib.umi.com/dissertations.

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CHAPTER 5. PATENTS ON POSTPARTUM DEPRESSION Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.8 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “postpartum depression” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on postpartum depression, we have not necessarily excluded non-medical patents in this bibliography.

Patents on Postpartum Depression By performing a patent search focusing on postpartum depression, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. 8Adapted

from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.

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The following is an example of the type of information that you can expect to obtain from a patent search on postpartum depression: •

Method of treatment for depression Inventor(s): Amento; Edward P. (Portola Valley, CA), Bauer; Eugene A. (Los Altos, CA) Assignee(s): Connetics Corporation (palo Alto, Ca) Patent Number: 5,753,623 Date filed: June 7, 1995 Abstract: Depression, particularly disease- and medical treatment-related depression, and especially postpartum depression, is treated by the administration of a therapeutically effective amount of relaxin. A treatment regimen and dosage form for gradual withdrawal from relaxin therapy is also disclosed. Excerpt(s): The present invention relates to treatments for depression and/or anxiety, particularly for disease- and medical treatment-related depression, and for postpartum depression, and specifically to such a treatment employing the administration of relaxin. As described in Textbook of INTERNAL MEDICINE, Kelley, et al. (eds.), Part X: Neurology, Chapter 469: Major Psychiatric Disorders, (J. Lippincott Co., Philadelphia), pp. 2198-2199 (1992), unipolar affective disorder (i.e., depression without episodes of mania or "major depression") can occur throughout life and is at least twice as common in women as in men. Patients often present without the subjective sense of being depressed but complaining of somatic symptoms of depression, most commonly fatigue, sleep disturbances, or impotence. Patients may describe feeling sad, blue, low, irritable, or anxious, as well as being depressed. Diagnosis of major depression is based either on a distinct change of mood that is prominent, generally persists throughout the day, and occurs each day for at least 2 weeks or on markedly diminished interest or pleasure in most activities over a similar period. The diagnosis requires that at least four of the following symptoms be present nearly every day for a period of 2 weeks: significant weight loss (or weight gain in some younger patients), prominent sleep disturbance, agitation or retardation with slow speech, fatigue, feelings of worthlessness and guilt, slowed thinking, and hopelessness. Depression can likewise be associated with the symptoms of disease (e.g., systemic lupus erythematosus) or as a side effect of the treatment of disease (e.g., with antihypertensive therapy). One form of depression, postpartum depression, has been commonly found in women during the period following childbirth. Web site: http://www.delphion.com/details?pn=US05753623__

•

Use of isoflavonoids in the treatment or prevention of postpartum depression Inventor(s): Gorbach; Sherwood L. (31 Perry La., Weston, MA 02193) Assignee(s): None Reported Patent Number: 6,083,526 Date filed: May 22, 1997 Abstract: A method of treating or preventing postpartum depression by administration of a composition containing one or more purified, naturally-occurring isoflavonoids.

Patents 75

Excerpt(s): The present invention relates to therapies for the prevention and treatment of postpartum depression, as well as other psychological disturbances that develop after childbirth. It has long been recognized that psychological disturbances are very common in the postpartum period, usually beginning within 6 weeks after delivery. The psychological conditions can range from "maternity blues," which are usually mild, to a more severe depression, which is known to occur in fully 10% of postpartum women. Depression can have psychological effects that last for several months and occasionally even longer. A related concern is the impaired cognitive abilities and delayed social development that can be seen in the children of women who have experienced postpartum depression. At least a part of the explanation for postpartum depression is the changing hormone milieu in the woman's body following childbirth. Estrogen hormone achieves and maintains a high level during pregnancy and then drops precipitously within 48 hours after delivery to nearly the follicular level, which is the lowest level in a normally menstruating woman. This causes an acute estrogen withdrawal state, which could have effects on psychological and mental functioning. In this regard postpartum depression has been treated successfully with estrogen. In other reports estrogen has been administered immediately after childbirth to prevent recurrence of depression and other psychological disorders in women who are at risk of developing these problems in the postpartum period. Various antidepressant drugs, such as lithium, tricyclic compounds and serotonin-specific reuptake inhibitors (SSRI), have been used in postpartum depression with varying degrees of success. There is, however, concern about their side effects and their safety in breastfeeding women. Treatment with large doses of estrogen is also a concern in breastfeeding women. Safer, effective therapies for treating and preventing postpartum depression continue to be sought. The invention features a method of treating or preventing postpartum depression in a woman who has recently given birth to a baby; the method involves administering to the woman, within six weeks (and preferably, within 24, or even 12, hours) a composition containing one or more purified isoflavonoids selected from the group consisting of genistein, daidzein, biochanin A, formononetin, Odesmethylangolensin, glycitin, and equol. Preferably, the composition is administered orally, providing a dosage of at least 20 mg of total isoflavonoid per serving. The orallyadministerable composition can be a non-naturally occurring dietary product such as a convectionary bar, cereal, biscuit, or beverage. Alternatively, the composition can take the form of a medicament such as a pill, capsule, tablet, powder, or syrup, in which the total isoflavonoid is present in at least an amount of 20 mg per unit dose. Preferably, the dietary product or medicament is orally consumed by the patient once, twice, or three times per day, to provide a daily oral isoflavonoid dose of between 20 and 300 mg. Preferably, the oral ingestion of the composition is sufficient to produce a transient concentration in the bloodstream of the woman of at least 50 nm of total isoflavonoid per liter of blood. By "purified" isoflavonoid is meant an isoflavonoid in more concentrated form than occurs in plants. Web site: http://www.delphion.com/details?pn=US06083526__

Patent Applications on Postpartum Depression As of December 2000, U.S. patent applications are open to public viewing.9 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take 9

This has been a common practice outside the United States prior to December 2000.

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several years.) The following patent applications have been filed since December 2000 relating to postpartum depression: •

Cytokine antagonists for neurological and neuropsychiatric disorders Inventor(s): Tobinick, Edward Lewis; (Los Angeles, CA) Correspondence: Ezra Sutton, ESQ.; Ezra Sutton, P.A.; Plaza 9; 900 Route 9; Woodbridge; NJ; 07095; US Patent Application Number: 20030049256 Date filed: October 9, 2002 Abstract: Methods for treating neurological or neuropsychiatric diseases or disorders in humans by administering to the human a therapeutically effective dose of specific biologics are presented. The biologics of consideration include antagonists of tumor necrosis factor or of interleukin-1. The administration of these biologics is performed by specific methods, most, but not all of which fall into the category of anatomically localized administration designed for perispinal use. Anatomically localized administration involving perispinal use includes, but is not limited to the subcutaneous, intramuscular, interspinous, epidural, peridural, parenteral or intrathecal routes. Additonally, intranasal administration is discussed as a method to provide therapeutic benefit.The clinical conditions of consideration include, but are not limited to the following: diseases of the brain, including neurodegenerative diseases such as Alzheimer's Disease and Parkinson's Disease; migraine headache; spinal radiculopathy associated with intervertebral disc herniation, post-herpetic neuralgia, reflex sympathethic dystrophy, neuropathic pain, vertebral disc disease, low back pain, amyotrophic lateral sclerosis, chronic fatigue syndrome; and neuropsychiatric diseases, including bipolar affective disorder, anorexia nervosa, nicotine withdrawal, narcotic addiction, alcohol withdrawl, postpartum depression, and schizoaffective illness. Excerpt(s): This is a continuation-in-part of application Ser. No. 10/236,097, filed on Sep. 6, 2002, which is a continuation-in-part of application Ser. No. 09/841,844, filed on Apr. 25, 2001, which is a continuation-in-part of application Ser. No. 09/826,976, filed on Apr. 5, 2001, now U.S. Pat. No. 6,419,944, which is a continuation-in-part of application Ser. No. 09/563,651, filed on May 2, 2000, which is a continuation-in-part of application Ser. No. 09/476,643, filed on Dec. 31, 1999, now U.S. Pat. No. 6,177,077, which is a continuation-in-part of application Ser. No. 09/275,070, filed on Mar. 23, 1999, now U.S. Pat. No. 6,015,557, which is a continuation-in-part of application Ser. No. 09/256,388, filed on Feb. 24, 1999, now abandoned. The present invention relates to novel methods of use of specific cytokine antagonists for the treatment of neuropsychiatric and neurological disorders in humans. More particularly, these cytokine antagonists are used in a new treatment of neuropsychiatric and neurologic diseases and disorders, including, but not limited to affective disorders, including unipolar and bipolar affective disorders; schizoaffective illness, schizophrenia, autism, depression, anorexia nervosa, obsessive-compulsive disorders, narcotic addiction, and smoking cessation/nicotine withdrawal; diseases and disorders of the brain; neurodegenerative disorders, including but not limited to Parkinson's Disease and Alzheimer's Disease; spinal cord injury, amyotrophic lateral sclerosis; headache syndromes, including, but not limited to migraine headaches and cluster headaches; neurologic disorders associated with neuropathic pain, including, but not limited to lumbar and cervical radiculopathy, low back pain, vertebral disc disease, fibromyalgia, post-herpetic neuralgia, and reflex sympathetic dystrophy; and chronic fatigue syndrome; utilizing specific anatomic methods of administration of these specific biologics. The delivery of these cytokine

Patents 77

antagonists is performed by specific methods, most of which fall into the categories of perispinal administration or intranasal administration. Perispinal administration involves an anatomically localized injection performed so as to deliver the therapeutic molecule directly into the vicinity of the spine. Perispinal administration includes, but is not limited to the subcutaneous, intramuscular, interspinous, epidural, peridural, parenteral, or intrathecal routes, and may be perilesional or alternatively, particularly when treating diseases of the brain, remote from the ultimate site of pathology. Intranasal administration includes the delivery of these particular cytokine antagonists by instillation into the nasal passages, either by nasal spray or nasal inhaler. The cytokine antagonists of consideration are those designed to block the action of, inhibit, or antagonize the biologic effects of tumor necrosis factoralpha (TNF) or interleukin-1 (IL-1). These antagonists may take the form of a fusion protein (such as etanercept); a monoclonal antibody (such as infliximab); a binding protein (such as onercept; Serono); an antibody fragment (such as CDP 870, Pharmacia); or other types of molecules which are potent, selective, and specific inhibitors of the action of these proinflammatory cytokines and are capable of being used by parenteral injection. Localized administration for the treatment of localized clinical disorders has many clinical advantages over the use of conventional systemic treatment. Locally administered medication after delivery diffuses through local capillary, venous, arterial, and lymphatic action to reach the anatomic site of pathology, or, alternatively, to reach the cerebrospinal fluid (CSF). In addition local administration of a biologic in the vicinity of the spine (perispinal administration) has the key advantage of improved delivery of the agent to the central nervous system (CNS). Local intranasal administration of a biologic is another method to improve delivery of the biologic to the CNS, and is discussed here as a method to treat neuropsychiatric disorders, including disorders of mood (depression, bipolar disorder) utilizing TNF antagonists or IL-1 antagonists. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Therapeutic uses of milk mineral fortified food products Inventor(s): Bastian, Eric Douglas; (Twin Falls, ID), Ward, Loren Spencer; (Twin Falls, ID) Correspondence: Banner & Witcoff; 1001 G Street N W; Suite 1100; Washington; DC; 20001; US Patent Application Number: 20030118662 Date filed: December 5, 2001 Abstract: Food products fortified with a therapeutically effective amount of milk mineral are administered for the treatment of high blood pressure, stroke, obesity, kidney stones, colon cancer, breast cancer, head and neck tumors, premenstrual syndrome, postpartum depression, hypertensive disorders of pregnancy, Type-2 diabetes, depression, asthma, inflammatory bowel disease, attention deficit disorder, migraine headaches, kidney disease, hypercholesterolaemia, congestive heart failure, or immune deficiency. Excerpt(s): The present invention is directed to milk mineral fortified food products and, more particularly to the treatment of high blood pressure, stroke, obesity, and various other disorders by administering food products fortified with a therapeutically effective amount of milk mineral. The natural milk minerals, especially calcium, magnesium, phosphorus, potassium and zinc, are of great importance in nutrition. Their importance is widely recognized for proper teeth and bone formation, as well as for skeletal

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structure development. During the period of late teenage to young adulthood, however, significant reductions in dietary calcium intake often occur. This is particularly true of the female population, where reduced dietary calcium intake usually occurs much earlier in life compared to their male counterparts. It has been observed that females are especially susceptible to a prolonged calcium deficit over their life span. This calcium deficit is believed to contribute to the greater incidence of osteoporosis in postmenopausal women. Calcium supplements and calcium-fortified foods containing calcium in such forms as calcium carbonate, calcium lactate, calcium citrate, calcium chloride, and calcium hydroxide have been proposed. These forms of calcium, however, can yield undesirable flavors and/or can strip desirable aroma and flavor compounds from food products. More significantly, these types of supplements deliver only calcium (no other minerals) and lack the balanced and pure form of the milk minerals (including calcium, phosphorus, potassium, magnesium, and zinc) present in milk and dairy products. As a result, these forms of calcium are less easily absorbed by the body and are inferior to milk and dairy products from a nutritional standpoint. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Keeping Current In order to stay informed about patents and patent applications dealing with postpartum depression, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “postpartum depression” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on postpartum depression. You can also use this procedure to view pending patent applications concerning postpartum depression. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

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CHAPTER 6. BOOKS ON POSTPARTUM DEPRESSION Overview This chapter provides bibliographic book references relating to postpartum depression. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on postpartum depression include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “postpartum depression” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “postpartum depression” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “postpartum depression” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •

Behind the Smile: My Journey Out of Postpartum Depression by Marie Osmond (Author), et al; ISBN: 044667852X; http://www.amazon.com/exec/obidos/ASIN/044667852X/icongroupinterna

•

Beyond the Baby Blues: Postpartum Depression and Psychosis (The Infinite Mind, Vol. 210) by Lichtenstein Creative Media Inc.; ISBN: 1888064870; http://www.amazon.com/exec/obidos/ASIN/1888064870/icongroupinterna

•

Beyond the Blues: A Guide to Understanding and Treating Prenatal and Postpartum Depression by Shoshana S. Bennett, Pec Indman; ISBN: 0971712417; http://www.amazon.com/exec/obidos/ASIN/0971712417/icongroupinterna

•

Beyond The Blues: Prenatal and Postpartum Depression, A Treatment Manual by Shoshana Bennett, Pec Indman; ISBN: 0971712409; http://www.amazon.com/exec/obidos/ASIN/0971712409/icongroupinterna

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•

Composing Myself: A Journey Through Postpartum Depression by Fiona Shaw; ISBN: 1883642973; http://www.amazon.com/exec/obidos/ASIN/1883642973/icongroupinterna

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Conquering Postpartum Depression: A Proven Plan for Recovery by Ronald, Md Rosenberg, et al; ISBN: 0738208418; http://www.amazon.com/exec/obidos/ASIN/0738208418/icongroupinterna

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Depression After Childbirth: How to Recognize, Treat, and Prevent Postnatal Depression by Katharina Dalton, Wendy M. Holton; ISBN: 0192632779; http://www.amazon.com/exec/obidos/ASIN/0192632779/icongroupinterna

•

Depression Sourcebook: Basic Consumer Health Information About Unipolar Depression, Bipolar Disorder, Postpartum Depression, Seasonal Affective Disorder, and Other Types of (Health Reference Series) by Karen Bellenir (Editor), Rhonda Rhea; ISBN: 0780806115; http://www.amazon.com/exec/obidos/ASIN/0780806115/icongroupinterna

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Out of the Darkness: Postpartum Depression Is Not Something We Can Fight Alone by Sheila Macdonald; ISBN: 1591297931; http://www.amazon.com/exec/obidos/ASIN/1591297931/icongroupinterna

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Overcoming Postpartum Depression & Anxiety by Linda Sebastian; ISBN: 1886039348; http://www.amazon.com/exec/obidos/ASIN/1886039348/icongroupinterna

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Overcoming Postpartum Depression, A Doctor's Own Story by Lois V. Nightingale; ISBN: 1889755257; http://www.amazon.com/exec/obidos/ASIN/1889755257/icongroupinterna

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Perinatal psychiatry : use and misuse of the Edinburgh Postnatal Depression Scale; ISBN: 0880486317; http://www.amazon.com/exec/obidos/ASIN/0880486317/icongroupinterna

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Postnatal Depression: A Guide for Health Professionals by John L. Cox; ISBN: 0443031789; http://www.amazon.com/exec/obidos/ASIN/0443031789/icongroupinterna

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Postpartum Depression - Overcoming Unique Barriers to Treatment [DOWNLOAD: PDF] by Datamonitor (Author); ISBN: B00008R3XO; http://www.amazon.com/exec/obidos/ASIN/B00008R3XO/icongroupinterna

•

Postpartum depression : January 1984 through December 1991 : 729 citations (SuDoc HE 20.3615/2:91-14) by Jennie P. Hunt; ISBN: B0001097CG; http://www.amazon.com/exec/obidos/ASIN/B0001097CG/icongroupinterna

•

Postpartum Depression and Child Development by Lynne Murray (Editor), Peter J. Cooper (Editor); ISBN: 1572305177; http://www.amazon.com/exec/obidos/ASIN/1572305177/icongroupinterna

•

Postpartum Depression: A Comprehensive Approach for Nurses (Sage Series in Clinical Nursing Research) by Kathleen A. Kendall-Tackett, Glenda Kaufman Kantor; ISBN: 0803950357; http://www.amazon.com/exec/obidos/ASIN/0803950357/icongroupinterna

•

Postpartum Depression: A Research Guide and International Bibliography by Laurence Kruckman, Chris Asmann-Finch; ISBN: 0824091213; http://www.amazon.com/exec/obidos/ASIN/0824091213/icongroupinterna

Books

•

Postpartum Depression: Causes and Consequences (Series in Psychopathology) by Michael W. O'Hara, L. B. Alloy; ISBN: 0387942610; http://www.amazon.com/exec/obidos/ASIN/0387942610/icongroupinterna

•

Postpartum Depression: Every Woman's Guide to Diagnosis, Treatment, and Prevention by Sharon L. Roan; ISBN: 1558507655; http://www.amazon.com/exec/obidos/ASIN/1558507655/icongroupinterna

•

Rock-A-By Baby: Feminism, Self-Help and Postpartum Depression by Verta A. Taylor; ISBN: 041591292X; http://www.amazon.com/exec/obidos/ASIN/041591292X/icongroupinterna

•

Sleepless Days : One Woman's Journey Through Postpartum Depression by Susan Kushner Resnick (Author); ISBN: 0312272278; http://www.amazon.com/exec/obidos/ASIN/0312272278/icongroupinterna

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The Darkest Days of My Life: Stories of Postpartum Depression by Natasha S. Mauthner; ISBN: 0674007611; http://www.amazon.com/exec/obidos/ASIN/0674007611/icongroupinterna

•

This Isn't What I Expected : Overcoming Postpartum Depression by Valerie Raskin, Karen R. Kleiman; ISBN: 0553370758; http://www.amazon.com/exec/obidos/ASIN/0553370758/icongroupinterna

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Treating Postnatal Depression : A Psychological Approach for Health Care Practitioners by Jeannette Milgrom (Author), et al; ISBN: 0471986453; http://www.amazon.com/exec/obidos/ASIN/0471986453/icongroupinterna

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Chapters on Postpartum Depression In order to find chapters that specifically relate to postpartum depression, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and postpartum depression using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “postpartum depression” (or synonyms) into the “For these words:” box.

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CHAPTER 7. PERIODICALS AND NEWS ON POSTPARTUM DEPRESSION Overview In this chapter, we suggest a number of news sources and present various periodicals that cover postpartum depression.

News Services and Press Releases One of the simplest ways of tracking press releases on postpartum depression is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “postpartum depression” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to postpartum depression. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “postpartum depression” (or synonyms). The following was recently listed in this archive for postpartum depression: •

Screening test can detect postpartum depression Source: Reuters Health eLine Date: March 02, 2004

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Counselling some help for postpartum depression Source: Reuters Health eLine Date: May 01, 2003

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Sertraline suppresses recurrent postpartum depression Source: Reuters Industry Breifing Date: April 03, 2003

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Postpartum depression may affect newborn's growth Source: Reuters Health eLine Date: December 31, 2002

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Midwife care can help cut postpartum depression Source: Reuters Health eLine Date: February 01, 2002

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Interpersonal psychotherapy effective for postpartum depression Source: Reuters Medical News Date: November 15, 2000

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Frequent trips to doctor sign of postpartum depression Source: Reuters Health eLine Date: August 12, 1999

•

Population-based screening for postpartum depression feasible, worthwhile Source: Reuters Medical News Date: May 04, 1999 The NIH

Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “postpartum depression” (or synonyms) into the search box, and click on “Search News.” As this service

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is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “postpartum depression” (or synonyms). If you know the name of a company that is relevant to postpartum depression, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “postpartum depression” (or synonyms).

Academic Periodicals covering Postpartum Depression Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to postpartum depression. In addition to these sources, you can search for articles covering postpartum depression that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

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APPENDICES

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APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute10: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

•

National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

•

National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

•

National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

•

National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

•

National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

•

National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

•

National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

10

These publications are typically written by one or more of the various NIH Institutes.

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National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

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National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

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National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

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National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

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National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

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National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

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National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

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National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

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National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

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National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

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National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

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National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

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National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

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Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

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National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

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National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

•

Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

•

Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.11 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:12 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

•

HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

•

NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

•

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

•

Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

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Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

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Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

•

Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

•

Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

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Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

•

MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

11

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 12 See http://www.nlm.nih.gov/databases/databases.html.

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Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

•

Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html

The NLM Gateway13 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.14 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “postpartum depression” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 1105 50 642 5 5 1807

HSTAT15 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.16 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.17 Simply search by “postpartum depression” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

13

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

14

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 15 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 16 17

The HSTAT URL is http://hstat.nlm.nih.gov/.

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.

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Coffee Break: Tutorials for Biologists18 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.19 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.20 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

•

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

18 Adapted 19

from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 20 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on postpartum depression can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to postpartum depression. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to postpartum depression. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “postpartum depression”:

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•

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Guides on postpartum depression Postpartum Depression http://www.nlm.nih.gov/medlineplus/postpartumdepression.html

•

Other guides Bipolar Disorder http://www.nlm.nih.gov/medlineplus/bipolardisorder.html Diabetes http://www.nlm.nih.gov/medlineplus/diabetes.html High Risk Pregnancy http://www.nlm.nih.gov/medlineplus/highriskpregnancy.html Mental Health http://www.nlm.nih.gov/medlineplus/mentalhealth.html Suicide http://www.nlm.nih.gov/medlineplus/suicide.html

Within the health topic page dedicated to postpartum depression, the following was listed: •

General/Overviews Postpartum Depression Source: American College of Obstetricians and Gynecologists http://www.medem.com/medlb/article_detaillb.cfm?article_ID=ZZZSLRXO97C& sub_cat=4 Postpartum Depression Source: National Women's Health Information Center http://www.4woman.gov/faq/postpartum.htm

•

Diagnosis/Symptoms Recognizing Postpartum Depression Source: National Mental Health Association http://www.nmha.org/children/ppd.pdf

•

Treatment Interpersonal Psychotherapy Effective for Treatment of Postpartum Depression Source: American Medical Association http://www.medem.com/MedLB/article_detaillb.cfm?article_ID=ZZZ4LE2OEFC &sub_cat=638 Medications Source: National Institute of Mental Health http://www.nimh.nih.gov/publicat/medicate.cfm

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Coping Postpartum Coping: The Blues and Depression Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=HQ01243 Tips on Healthy Parenting for Mothers with Depression Source: National Mental Health Association http://www.nmha.org/infoctr/factsheets/HealthyParentingTips.pdf

•

Specific Conditions/Aspects Answers to Common Questions About Postpartum Depression Source: American College of Obstetricians and Gynecologists http://www.medem.com/medlb/article_detaillb.cfm?article_ID=ZZZ125JYAWC& sub_cat=2001

•

Organizations National Institute of Mental Health http://www.nimh.nih.gov/ National Mental Health Association http://www.nmha.org/

•

Statistics Depression in Women Source: National Mental Health Association http://www.nmha.org/infoctr/factsheets/23.cfm

You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on postpartum depression. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •

Postpartum depression: Incidence, risk factors, diagnosis, treatment, and resources Source: Baltimore, MD: Center for Maternal and Child Health, Maryland Department of Health and Mental Hygiene. 2001. 6 pp.

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Contact: Available from Maryland Department of Health and Mental Hygiene, 201 West Preston Street, Baltimore, MD 21201. Telephone: (410) 767-6500 or (877) 463-3464 / Web site: http://www.dhmh.state.md.us. Available at no charge; also available from the Web site at no charge. Summary: This booklet for pregnant women and new mothers discusses postpartum depression, reality versus myth, incidence, making the diagnosis, risk factors, screening for hyperthyroidism, and treatments for postpartum depression and psychosis. Two organizational resources are provided. The National Guideline Clearinghouse™ The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search this site located at http://www.guideline.gov/ by using the keyword “postpartum depression” (or synonyms). The following was recently posted: •

Postnatal depression and puerperal psychosis. A national clinical guideline Source: Scottish Intercollegiate Guidelines Network - National Government Agency [Non-U.S.]; 2002 June; 28 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3360&nbr=2586&a mp;string=postpartum+AND+depression The NIH Search Utility

The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to postpartum depression. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

•

Family Village: http://www.familyvillage.wisc.edu/specific.htm

•

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

•

Med Help International: http://www.medhelp.org/HealthTopics/A.html

•

Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

•

Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

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WebMDHealth: http://my.webmd.com/health_topics

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to postpartum depression. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with postpartum depression. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about postpartum depression. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “postpartum depression” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “postpartum depression”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “postpartum depression” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months.

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The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “postpartum depression” (or a synonym) into the search box, and click “Submit Query.”

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APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.21

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

21

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)22: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

•

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

•

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

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California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

•

California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

•

California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

•

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

•

California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

•

California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

•

California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

•

California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

•

California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

•

California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

•

Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

•

Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

•

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

22

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

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•

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

•

Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

•

Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

•

Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

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Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

•

Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

•

Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

•

Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

•

Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

•

Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

•

Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

•

Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

•

Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

•

Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

•

Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

•

Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

•

Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

•

Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

•

Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

•

Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

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•

Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

•

Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

•

Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

•

Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

•

Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

•

Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

•

Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

•

Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

•

Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

•

Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

•

Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

•

Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

•

Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

•

Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

•

Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

•

Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

•

National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

•

National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

•

National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

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Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

•

New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

•

New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

•

New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

•

New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

•

New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

•

New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

•

New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

•

New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

•

Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

•

Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

•

Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

•

Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

•

Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

•

Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

•

Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

•

Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

•

Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

•

Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

•

Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

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•

South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

•

Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

•

Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

•

Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

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ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

•

MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

•

Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

•

Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

•

On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

•

Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

•

Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a).

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

•

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

•

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

•

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

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POSTPARTUM DEPRESSION DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abortion: 1. The premature expulsion from the uterus of the products of conception - of the embryo, or of a nonviable fetus. The four classic symptoms, usually present in each type of abortion, are uterine contractions, uterine haemorrhage, softening and dilatation of the cervix, and presentation or expulsion of all or part of the products of conception. 2. Premature stoppage of a natural or a pathological process. [EU] Acculturation: Process of cultural change in which one group or members of a group assimilates various cultural patterns from another. [NIH] Adaptability: Ability to develop some form of tolerance to conditions extremely different from those under which a living organism evolved. [NIH] Adaptation: 1. The adjustment of an organism to its environment, or the process by which it enhances such fitness. 2. The normal ability of the eye to adjust itself to variations in the intensity of light; the adjustment to such variations. 3. The decline in the frequency of firing of a neuron, particularly of a receptor, under conditions of constant stimulation. 4. In dentistry, (a) the proper fitting of a denture, (b) the degree of proximity and interlocking of restorative material to a tooth preparation, (c) the exact adjustment of bands to teeth. 5. In microbiology, the adjustment of bacterial physiology to a new environment. [EU] Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH] Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [NIH] Adverse Effect: An unwanted side effect of treatment. [NIH] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Alkaline: Having the reactions of an alkali. [EU] Alkaloid: A member of a large group of chemicals that are made by plants and have nitrogen in them. Some alkaloids have been shown to work against cancer. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and

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herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Amenorrhea: Absence of menstruation. [NIH] Amino acid: Any organic compound containing an amino (-NH2 and a carboxyl (- COOH) group. The 20 a-amino acids listed in the accompanying table are the amino acids from which proteins are synthesized by formation of peptide bonds during ribosomal translation of messenger RNA; all except glycine, which is not optically active, have the L configuration. Other amino acids occurring in proteins, such as hydroxyproline in collagen, are formed by posttranslational enzymatic modification of amino acids residues in polypeptide chains. There are also several important amino acids, such as the neurotransmitter y-aminobutyric acid, that have no relation to proteins. Abbreviated AA. [EU] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Anorexia: Lack or loss of appetite for food. Appetite is psychologic, dependent on memory and associations. Anorexia can be brought about by unattractive food, surroundings, or company. [NIH] Anorexia Nervosa: The chief symptoms are inability to eat, weight loss, and amenorrhea. [NIH]

Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Antidepressant: A drug used to treat depression. [NIH] Antidote: A remedy for counteracting a poison. [EU] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antihypertensive: An agent that reduces high blood pressure. [EU] Antineoplastic: Inhibiting or preventing the development of neoplasms, checking the maturation and proliferation of malignant cells. [EU] Anus: The opening of the rectum to the outside of the body. [NIH] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Anxiety Disorders: Disorders in which anxiety (persistent feelings of apprehension, tension, or uneasiness) is the predominant disturbance. [NIH] Applicability: A list of the commodities to which the candidate method can be applied as presented or with minor modifications. [NIH] Aqueous: Having to do with water. [NIH]

Dictionary 111

Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] ATP: ATP an abbreviation for adenosine triphosphate, a compound which serves as a carrier of energy for cells. [NIH] Atrial: Pertaining to an atrium. [EU] Atrioventricular: Pertaining to an atrium of the heart and to a ventricle. [EU] Atrium: A chamber; used in anatomical nomenclature to designate a chamber affording entrance to another structure or organ. Usually used alone to designate an atrium of the heart. [EU] Atrophy: Decrease in the size of a cell, tissue, organ, or multiple organs, associated with a variety of pathological conditions such as abnormal cellular changes, ischemia, malnutrition, or hormonal changes. [NIH] Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type. [EU] Bacterial Physiology: Physiological processes and activities of bacteria. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Behavior Therapy: The application of modern theories of learning and conditioning in the treatment of behavior disorders. [NIH] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Bereavement: Refers to the whole process of grieving and mourning and is associated with a deep sense of loss and sadness. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Bipolar Disorder: A major affective disorder marked by severe mood swings (manic or major depressive episodes) and a tendency to remission and recurrence. [NIH] Bladder: The organ that stores urine. [NIH] Blastocyst: The mammalian embryo in the post-morula stage in which a fluid-filled cavity,

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enclosed primarily by trophoblast, contains an inner cell mass which becomes the embryonic disc. [NIH] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood Glucose: Glucose in blood. [NIH] Blood Platelets: Non-nucleated disk-shaped cells formed in the megakaryocyte and found in the blood of all mammals. They are mainly involved in blood coagulation. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Calcium Carbonate: Carbonic acid calcium salt (CaCO3). An odorless, tasteless powder or crystal that occurs in nature. It is used therapeutically as a phosphate buffer in hemodialysis patients and as a calcium supplement. [NIH] Calcium Chloride: A salt used to replenish calcium levels, as an acid-producing diuretic, and as an antidote for magnesium poisoning. [NIH] Calcium Hydroxide: Ca(OH)2. A white powder that has many therapeutic uses. Because of its ability to stimulate mineralization, it is found in many dental formulations. [NIH] Capillary: Any one of the minute vessels that connect the arterioles and venules, forming a network in nearly all parts of the body. Their walls act as semipermeable membranes for the interchange of various substances, including fluids, between the blood and tissue fluid; called also vas capillare. [EU] Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. [NIH] Carcinogenic: Producing carcinoma. [EU] Cardiac: Having to do with the heart. [NIH] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Catecholamine: A group of chemical substances manufactured by the adrenal medulla and

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secreted during physiological stress. [NIH] Causal: Pertaining to a cause; directed against a cause. [EU] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Division: The fission of a cell. [NIH] Cellulose: A polysaccharide with glucose units linked as in cellobiose. It is the chief constituent of plant fibers, cotton being the purest natural form of the substance. As a raw material, it forms the basis for many derivatives used in chromatography, ion exchange materials, explosives manufacturing, and pharmaceutical preparations. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Central Nervous System Infections: Pathogenic infections of the brain, spinal cord, and meninges. DNA virus infections; RNA virus infections; bacterial infections; mycoplasma infections; Spirochaetales infections; fungal infections; protozoan infections; helminthiasis; and prion diseases may involve the central nervous system as a primary or secondary process. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebrospinal: Pertaining to the brain and spinal cord. [EU] Cerebrospinal fluid: CSF. The fluid flowing around the brain and spinal cord. Cerebrospinal fluid is produced in the ventricles in the brain. [NIH] Cerebrum: The largest part of the brain. It is divided into two hemispheres, or halves, called the cerebral hemispheres. The cerebrum controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. [NIH] Cervical: Relating to the neck, or to the neck of any organ or structure. Cervical lymph nodes are located in the neck; cervical cancer refers to cancer of the uterine cervix, which is the lower, narrow end (the "neck") of the uterus. [NIH] Cervix: The lower, narrow end of the uterus that forms a canal between the uterus and vagina. [NIH] Chemotherapy: Treatment with anticancer drugs. [NIH] Child Behavior: Any observable response or action of a child from 24 months through 12 years of age. For neonates or children younger than 24 months, infant behavior is available. [NIH]

Child Development: The continuous sequential physiological and psychological maturing of the child from birth up to but not including adolescence. It includes healthy responses to situations, but does not include growth in stature or size (= growth). [NIH] Chin: The anatomical frontal portion of the mandible, also known as the mentum, that contains the line of fusion of the two separate halves of the mandible (symphysis menti). This line of fusion divides inferiorly to enclose a triangular area called the mental protuberance. On each side, inferior to the second premolar tooth, is the mental foramen for the passage of blood vessels and a nerve. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Cholinergic: Resembling acetylcholine in pharmacological action; stimulated by or releasing acetylcholine or a related compound. [EU] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH]

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Chronic Fatigue Syndrome: Fatigue caused by the combined effects of different types of prolonged fatigue. [NIH] Clinical study: A research study in which patients receive treatment in a clinic or other medical facility. Reports of clinical studies can contain results for single patients (case reports) or many patients (case series or clinical trials). [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Cognition: Intellectual or mental process whereby an organism becomes aware of or obtains knowledge. [NIH] Cognitive behavior therapy: A system of psychotherapy based on the premise that distorted or dysfunctional thinking, which influences a person's mood or behavior, is common to all psychosocial problems. The focus of therapy is to identify the distorted thinking and to replace it with more rational, adaptive thoughts and beliefs. [NIH] Cohort Studies: Studies in which subsets of a defined population are identified. These groups may or may not be exposed to factors hypothesized to influence the probability of the occurrence of a particular disease or other outcome. Cohorts are defined populations which, as a whole, are followed in an attempt to determine distinguishing subgroup characteristics. [NIH] Colitis: Inflammation of the colon. [NIH] Colon: The long, coiled, tubelike organ that removes water from digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU]

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Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complete remission: The disappearance of all signs of cancer. Also called a complete response. [NIH] Compulsions: In psychology, an irresistible urge, sometimes amounting to obsession to perform a particular act which usually is carried out against the performer's will or better judgment. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Conception: The onset of pregnancy, marked by implantation of the blastocyst; the formation of a viable zygote. [EU] Confounder: A factor of confusion which blurs a specific connection between a disease and a probable causal factor which is being studied. [NIH] Congestive heart failure: Weakness of the heart muscle that leads to a buildup of fluid in body tissues. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Consultation: A deliberation between two or more physicians concerning the diagnosis and the proper method of treatment in a case. [NIH] Consumption: Pulmonary tuberculosis. [NIH] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Control group: In a clinical trial, the group that does not receive the new treatment being studied. This group is compared to the group that receives the new treatment, to see if the new treatment works. [NIH] Controlled clinical trial: A clinical study that includes a comparison (control) group. The comparison group receives a placebo, another treatment, or no treatment at all. [NIH] Controlled study: An experiment or clinical trial that includes a comparison (control) group. [NIH]

Cor: The muscular organ that maintains the circulation of the blood. c. adiposum a heart that has undergone fatty degeneration or that has an accumulation of fat around it; called also fat or fatty, heart. c. arteriosum the left side of the heart, so called because it contains oxygenated (arterial) blood. c. biloculare a congenital anomaly characterized by failure of formation of the atrial and ventricular septums, the heart having only two chambers, a

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single atrium and a single ventricle, and a common atrioventricular valve. c. bovinum (L. 'ox heart') a greatly enlarged heart due to a hypertrophied left ventricle; called also c. taurinum and bucardia. c. dextrum (L. 'right heart') the right atrium and ventricle. c. hirsutum, c. villosum. c. mobile (obs.) an abnormally movable heart. c. pendulum a heart so movable that it seems to be hanging by the great blood vessels. c. pseudotriloculare biatriatum a congenital cardiac anomaly in which the heart functions as a three-chambered heart because of tricuspid atresia, the right ventricle being extremely small or rudimentary and the right atrium greatly dilated. Blood passes from the right to the left atrium and thence disease due to pulmonary hypertension secondary to disease of the lung, or its blood vessels, with hypertrophy of the right ventricle. [EU] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Corpus: The body of the uterus. [NIH] Corpus Luteum: The yellow glandular mass formed in the ovary by an ovarian follicle that has ruptured and discharged its ovum. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Corticotropin-Releasing Hormone: A neuropeptide released by the hypothalamus that stimulates the release of corticotropin by the anterior pituitary gland. [NIH] Cortisol: A steroid hormone secreted by the adrenal cortex as part of the body's response to stress. [NIH] Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU] Craniocerebral Trauma: Traumatic injuries involving the cranium and intracranial structures (i.e., brain; cranial nerves; meninges; and other structures). Injuries may be classified by whether or not the skull is penetrated (i.e., penetrating vs. nonpenetrating) or whether there is an associated hemorrhage. [NIH] Cribriform: Pierced with small holes as in a sieve. Refers to the appearance of a tumor when viewed under a microscope. The tumor appears to have open spaces or small holes inside. [NIH]

Criterion: A standard by which something may be judged. [EU] Cues: Signals for an action; that specific portion of a perceptual field or pattern of stimuli to which a subject has learned to respond. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Cytokine: Small but highly potent protein that modulates the activity of many cell types, including T and B cells. [NIH] Dairy Products: Raw and processed or manufactured milk and milk-derived products. These are usually from cows (bovine) but are also from goats, sheep, reindeer, and water buffalo. [NIH] Decidua: The epithelial lining of the endometrium that is formed before the fertilized ovum reaches the uterus. The fertilized ovum embeds in the decidua. If the ovum is not fertilized, the decidua is shed during menstruation. [NIH] Delusions: A false belief regarding the self or persons or objects outside the self that persists

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despite the facts, and is not considered tenable by one's associates. [NIH] Dendrites: Extensions of the nerve cell body. They are short and branched and receive stimuli from other neurons. [NIH] Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Depressive Disorder: An affective disorder manifested by either a dysphoric mood or loss of interest or pleasure in usual activities. The mood disturbance is prominent and relatively persistent. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diploid: Having two sets of chromosomes. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Discrimination: The act of qualitative and/or quantitative differentiation between two or more stimuli. [NIH] DNA Topoisomerase: An enzyme catalyzing ATP-independent breakage of single-stranded DNA, followed by passage and rejoining of another single-stranded DNA. This enzyme class brings about the conversion of one topological isomer of DNA into another, e.g., the relaxation of superhelical turns in DNA, the interconversion of simple and knotted rings of single-stranded DNA, and the intertwisting of single-stranded rings of complementary sequences. (From Enzyme Nomenclature, 1992) EC 5.99.1.2. [NIH] Double-blind: Pertaining to a clinical trial or other experiment in which neither the subject nor the person administering treatment knows which treatment any particular subject is receiving. [EU] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Dura mater: The outermost, toughest, and most fibrous of the three membranes (meninges) covering the brain and spinal cord; called also pachymeninx. [EU] Dysphoric: A feeling of unpleasantness and discomfort. [NIH] Dystrophy: Any disorder arising from defective or faulty nutrition, especially the muscular dystrophies. [EU] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Embryo Transfer: Removal of a mammalian embryo from one environment and replacement in the same or a new environment. The embryo is usually in the pre-nidation phase, i.e., a blastocyst. The process includes embryo or blastocyst transplantation or transfer after in vitro fertilization and transfer of the inner cell mass of the blastocyst. It is not used for transfer of differentiated embryonic tissue, e.g., germ layer cells. [NIH] Empirical: A treatment based on an assumed diagnosis, prior to receiving confirmatory laboratory test results. [NIH]

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Endocrine System: The system of glands that release their secretions (hormones) directly into the circulatory system. In addition to the endocrine glands, included are the chromaffin system and the neurosecretory systems. [NIH] Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH] Endometrial: Having to do with the endometrium (the layer of tissue that lines the uterus). [NIH]

Endometriosis: A condition in which tissue more or less perfectly resembling the uterine mucous membrane (the endometrium) and containing typical endometrial granular and stromal elements occurs aberrantly in various locations in the pelvic cavity. [NIH] Endometrium: The layer of tissue that lines the uterus. [NIH] Endorphin: Opioid peptides derived from beta-lipotropin. Endorphin is the most potent naturally occurring analgesic agent. It is present in pituitary, brain, and peripheral tissues. [NIH]

Endotoxin: Toxin from cell walls of bacteria. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Epidemiological: Relating to, or involving epidemiology. [EU] Epidural: The space between the wall of the spinal canal and the covering of the spinal cord. An epidural injection is given into this space. [NIH] Estradiol: The most potent mammalian estrogenic hormone. It is produced in the ovary, placenta, testis, and possibly the adrenal cortex. [NIH] Estrogen: One of the two female sex hormones. [NIH] Estrogen receptor: ER. Protein found on some cancer cells to which estrogen will attach. [NIH]

Ethmoid: An unpaired cranial bone which helps form the medial walls of the orbits and contains the themoidal air cells which drain into the nose. [NIH] Family Health: The health status of the family as a unit including the impact of the health of one member of the family on the family as a unit and on individual family members; also, the impact of family organization or disorganization on the health status of its members. [NIH]

Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Family Relations: Behavioral, psychological, and social relations among various members of the nuclear family and the extended family. [NIH] Fat: Total lipids including phospholipids. [NIH] Fathers: Male parents, human or animal. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]

Fatty acids: A major component of fats that are used by the body for energy and tissue development. [NIH] Fertilization in Vitro: Fertilization of an egg outside the body when the egg is normally fertilized in the body. [NIH]

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Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] Foetoplacental: Pertaining to the fetus and placenta. [EU] Forearm: The part between the elbow and the wrist. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]

Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Genistein: An isoflavonoid derived from soy products. It inhibits protein-tyrosine kinase and topoisomerase-ii (dna topoisomerase (atp-hydrolysing)) activity and is used as an antineoplastic and antitumor agent. Experimentally, it has been shown to induce G2 phase arrest in human and murine cell lines. [NIH] Gestation: The period of development of the young in viviparous animals, from the time of fertilization of the ovum until birth. [EU] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glomeruli: Plural of glomerulus. [NIH] Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glycoprotein: A protein that has sugar molecules attached to it. [NIH] Goats: Any of numerous agile, hollow-horned ruminants of the genus Capra, closely related to the sheep. [NIH] Gonad: A sex organ, such as an ovary or a testicle, which produces the gametes in most multicellular animals. [NIH] Gonadal: Pertaining to a gonad. [EU] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Gravidity: Pregnancy; the condition of being pregnant, without regard to the outcome. [EU] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Haploid: An organism with one basic chromosome set, symbolized by n; the normal condition of gametes in diploids. [NIH] Headache: Pain in the cranial region that may occur as an isolated and benign symptom or as a manifestation of a wide variety of conditions including subarachnoid hemorrhage; craniocerebral trauma; central nervous system infections; intracranial hypertension; and other disorders. In general, recurrent headaches that are not associated with a primary disease process are referred to as headache disorders (e.g., migraine). [NIH]

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Headache Disorders: Common conditions characterized by persistent or recurrent headaches. Headache syndrome classification systems may be based on etiology (e.g., vascular headache, post-traumatic headaches, etc.), temporal pattern (e.g., cluster headache, paroxysmal hemicrania, etc.), and precipitating factors (e.g., cough headache). [NIH] Health Services: Services for the diagnosis and treatment of disease and the maintenance of health. [NIH] Health Status: The level of health of the individual, group, or population as subjectively assessed by the individual or by more objective measures. [NIH] Heart failure: Loss of pumping ability by the heart, often accompanied by fatigue, breathlessness, and excess fluid accumulation in body tissues. [NIH] Hemodialysis: The use of a machine to clean wastes from the blood after the kidneys have failed. The blood travels through tubes to a dialyzer, which removes wastes and extra fluid. The cleaned blood then flows through another set of tubes back into the body. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemostasis: The process which spontaneously arrests the flow of blood from vessels carrying blood under pressure. It is accomplished by contraction of the vessels, adhesion and aggregation of formed blood elements, and the process of blood or plasma coagulation. [NIH]

Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hyperthyroidism: Excessive functional activity of the thyroid gland. [NIH] Hypertrophy: General increase in bulk of a part or organ, not due to tumor formation, nor to an increase in the number of cells. [NIH] Hypoglycemia: Abnormally low blood sugar [NIH] Hypothalamic: Of or involving the hypothalamus. [EU] Hypothalamus: Ventral part of the diencephalon extending from the region of the optic chiasm to the caudal border of the mammillary bodies and forming the inferior and lateral walls of the third ventricle. [NIH]

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Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Immunity: Nonsusceptibility to the invasive or pathogenic microorganisms or to the toxic effect of antigenic substances. [NIH]

effects

of

foreign

Immunization: Deliberate stimulation of the host's immune response. Active immunization involves administration of antigens or immunologic adjuvants. Passive immunization involves administration of immune sera or lymphocytes or their extracts (e.g., transfer factor, immune RNA) or transplantation of immunocompetent cell producing tissue (thymus or bone marrow). [NIH] Immunoglobulin: A protein that acts as an antibody. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Implantation: The insertion or grafting into the body of biological, living, inert, or radioactive material. [EU] Impotence: The inability to perform sexual intercourse. [NIH] Incontinence: Inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the rectum (fecal incontinence). [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Infancy: The period of complete dependency prior to the acquisition of competence in walking, talking, and self-feeding. [NIH] Infant Behavior: Any observable response or action of a neonate or infant up through the age of 23 months. [NIH] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Inflammatory bowel disease: A general term that refers to the inflammation of the colon and rectum. Inflammatory bowel disease includes ulcerative colitis and Crohn's disease. [NIH]

Ingestion: Taking into the body by mouth [NIH] Insomnia: Difficulty in going to sleep or getting enough sleep. [NIH] Instillation: . [EU] Interleukin-1: A soluble factor produced by monocytes, macrophages, and other cells which activates T-lymphocytes and potentiates their response to mitogens or antigens. IL-1 consists of two distinct forms, IL-1 alpha and IL-1 beta which perform the same functions but are distinct proteins. The biological effects of IL-1 include the ability to replace macrophage

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requirements for T-cell activation. The factor is distinct from interleukin-2. [NIH] Interleukin-2: Chemical mediator produced by activated T lymphocytes and which regulates the proliferation of T cells, as well as playing a role in the regulation of NK cell activity. [NIH] Internal Medicine: A medical specialty concerned with the diagnosis and treatment of diseases of the internal organ systems of adults. [NIH] Interpersonal Relations: The reciprocal interaction of two or more persons. [NIH] Intervertebral: Situated between two contiguous vertebrae. [EU] Intervertebral Disk Displacement: An intervertebral disk in which the nucleus pulposus has protruded through surrounding fibrocartilage. This occurs most frequently in the lower lumbar region. [NIH] Intoxication: Poisoning, the state of being poisoned. [EU] Intracellular: Inside a cell. [NIH] Intramuscular: IM. Within or into muscle. [NIH] Intravenous: IV. Into a vein. [NIH] Involuntary: Reaction occurring without intention or volition. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Joint: The point of contact between elements of an animal skeleton with the parts that surround and support it. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Kidney Disease: Any one of several chronic conditions that are caused by damage to the cells of the kidney. People who have had diabetes for a long time may have kidney damage. Also called nephropathy. [NIH] Kidney stone: A stone that develops from crystals that form in urine and build up on the inner surfaces of the kidney, in the renal pelvis, or in the ureters. [NIH] Lactation: The period of the secretion of milk. [EU] Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]

Life cycle: The successive stages through which an organism passes from fertilized ovum or spore to the fertilized ovum or spore of the next generation. [NIH] Ligaments: Shiny, flexible bands of fibrous tissue connecting together articular extremities of bones. They are pliant, tough, and inextensile. [NIH] Linkages: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Lithium: An element in the alkali metals family. It has the atomic symbol Li, atomic number 3, and atomic weight 6.94. Salts of lithium are used in treating manic-depressive disorders. [NIH]

Local Government: Smallest political subdivisions within a country at which general governmental functions are carried-out. [NIH]

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Localized: Cancer which has not metastasized yet. [NIH] Locomotion: Movement or the ability to move from one place or another. It can refer to humans, vertebrate or invertebrate animals, and microorganisms. [NIH] Longitudinal Studies: Studies in which variables relating to an individual or group of individuals are assessed over a period of time. [NIH] Longitudinal study: Also referred to as a "cohort study" or "prospective study"; the analytic method of epidemiologic study in which subsets of a defined population can be identified who are, have been, or in the future may be exposed or not exposed, or exposed in different degrees, to a factor or factors hypothesized to influence the probability of occurrence of a given disease or other outcome. The main feature of this type of study is to observe large numbers of subjects over an extended time, with comparisons of incidence rates in groups that differ in exposure levels. [NIH] Low Back Pain: Acute or chronic pain in the lumbar or sacral regions, which may be associated with musculo-ligamentous sprains and strains; intervertebral disk displacement; and other conditions. [NIH] Lumbar: Pertaining to the loins, the part of the back between the thorax and the pelvis. [EU] Lupus: A form of cutaneous tuberculosis. It is seen predominantly in women and typically involves the nasal, buccal, and conjunctival mucosa. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]

Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphocyte: A white blood cell. Lymphocytes have a number of roles in the immune system, including the production of antibodies and other substances that fight infection and diseases. [NIH] Macrophage: A type of white blood cell that surrounds and kills microorganisms, removes dead cells, and stimulates the action of other immune system cells. [NIH] Mania: Excitement of psychotic proportions manifested by mental and physical hyperactivity, disorganization of behaviour, and elevation of mood. [EU] Manic: Affected with mania. [EU] Manic-depressive psychosis: One of a group of psychotic reactions, fundamentally marked by severe mood swings and a tendency to remission and recurrence. [NIH] Maternal Behavior: The behavior patterns associated with or characteristic of a mother. [NIH]

Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Medical Records: Recording of pertinent information concerning patient's illness or illnesses. [NIH]

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Medicament: A medicinal substance or agent. [EU] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Menopause: Permanent cessation of menstruation. [NIH] Menstrual Cycle: The period of the regularly recurring physiologic changes in the endometrium occurring during the reproductive period in human females and some primates and culminating in partial sloughing of the endometrium (menstruation). [NIH] Menstruation: The normal physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus. [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Mental Health: The state wherein the person is well adjusted. [NIH] Mental Processes: Conceptual functions or thinking in all its forms. [NIH] Meta-Analysis: A quantitative method of combining the results of independent studies (usually drawn from the published literature) and synthesizing summaries and conclusions which may be used to evaluate therapeutic effectiveness, plan new studies, etc., with application chiefly in the areas of research and medicine. [NIH] Metabolite: Any substance produced by metabolism or by a metabolic process. [EU] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Midwifery: The practice of assisting women in childbirth. [NIH] Mineralization: The action of mineralizing; the state of being mineralized. [EU] Modeling: A treatment procedure whereby the therapist presents the target behavior which the learner is to imitate and make part of his repertoire. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Modulator: A specific inductor that brings out characteristics peculiar to a definite region. [EU]

Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecular Structure: The location of the atoms, groups or ions relative to one another in a molecule, as well as the number, type and location of covalent bonds. [NIH] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA,

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can be made up of many thousands of atoms. [NIH] Monoclonal: An antibody produced by culturing a single type of cell. It therefore consists of a single species of immunoglobulin molecules. [NIH] Monocytes: Large, phagocytic mononuclear leukocytes produced in the vertebrate bone marrow and released into the blood; contain a large, oval or somewhat indented nucleus surrounded by voluminous cytoplasm and numerous organelles. [NIH] Mononuclear: A cell with one nucleus. [NIH] Mood Disorders: Those disorders that have a disturbance in mood as their predominant feature. [NIH] Morphine: The principal alkaloid in opium and the prototype opiate analgesic and narcotic. Morphine has widespread effects in the central nervous system and on smooth muscle. [NIH] Motility: The ability to move spontaneously. [EU] Muscular Dystrophies: A general term for a group of inherited disorders which are characterized by progressive degeneration of skeletal muscles. [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Narcosis: A general and nonspecific reversible depression of neuronal excitability, produced by a number of physical and chemical aspects, usually resulting in stupor. [NIH] Narcotic: 1. Pertaining to or producing narcosis. 2. An agent that produces insensibility or stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has morphine-like actions. [EU] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU] Nephropathy: Disease of the kidneys. [EU] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Neuralgia: Intense or aching pain that occurs along the course or distribution of a peripheral or cranial nerve. [NIH] Neuroblastoma: Cancer that arises in immature nerve cells and affects mostly infants and children. [NIH] Neurodegenerative Diseases: Hereditary and sporadic conditions which are characterized by progressive nervous system dysfunction. These disorders are often associated with atrophy of the affected central or peripheral nervous system structures. [NIH] Neurologic: Having to do with nerves or the nervous system. [NIH] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH]

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Neuropeptide: A member of a class of protein-like molecules made in the brain. Neuropeptides consist of short chains of amino acids, with some functioning as neurotransmitters and some functioning as hormones. [NIH] Nicotine: Nicotine is highly toxic alkaloid. It is the prototypical agonist at nicotinic cholinergic receptors where it dramatically stimulates neurons and ultimately blocks synaptic transmission. Nicotine is also important medically because of its presence in tobacco smoke. [NIH] Nonverbal Communication: Transmission of emotions, ideas, and attitudes between individuals in ways other than the spoken language. [NIH] Nortriptyline: A metabolite of amitryptyline that is also used as an antidepressive agent. Nortriptyline is used in major depression, dysthymia, and atypical depressions. [NIH] Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH] Nuclear Family: A family composed of spouses and their children. [NIH] Nurse Practitioners: Nurses who are specially trained to assume an expanded role in providing medical care under the supervision of a physician. [NIH] Obsession: A recurrent, persistent thought, image, or impulse that is unwanted and distressing (ego-dystonic) and comes involuntarily to mind despite attempts to ignore or suppress it. Common obsessions involve thoughts of violence, contamination, and selfdoubt. [EU] Obsessive-Compulsive Disorder: An anxiety disorder characterized by recurrent, persistent obsessions or compulsions. Obsessions are the intrusive ideas, thoughts, or images that are experienced as senseless or repugnant. Compulsions are repetitive and seemingly purposeful behavior which the individual generally recognizes as senseless and from which the individual does not derive pleasure although it may provide a release from tension. [NIH] Oestradiol: Growth hormone. [NIH] Oestrogen: A generic term for oestrus-producing steroid compounds; the female sex hormones. In humans, oestrogen is formed in the ovary, possibly the adrenal cortex, the testis, and the foetoplacental unit; it has various functions in both sexes. It is responsible for the development of the female secondary sex characteristics, and during the menstrual cycle it acts on the female genitalia to produce an environment suitable for the fertilization, implantation, and nutrition of the early embryo. Oestrogen is used in oral contraceptives and as a palliative in cancer of the breast after menopause and cancer of the prostate; other uses include the relief of the discomforts of menopause, inhibition of lactation, and treatment of osteoporosis, threatened abortion, and various functional ovarian disorders. [EU]

Olfactory Bulb: Ovoid body resting on the cribriform plate of the ethmoid bone where the olfactory nerve terminates. The olfactory bulb contains several types of nerve cells including the mitral cells, on whose dendrites the olfactory nerve synapses, forming the olfactory glomeruli. The accessory olfactory bulb, which receives the projection from the vomeronasal organ via the vomeronasal nerve, is also included here. [NIH] Olfactory Nerve: The 1st cranial nerve. The olfactory nerve conveys the sense of smell. It is formed by the axons of olfactory receptor neurons which project from the olfactory epithelium (in the nasal epithelium) to the olfactory bulb. [NIH] Omega-3 fatty acid: A type of fat obtained in the diet and involved in immunity. [NIH] Opacity: Degree of density (area most dense taken for reading). [NIH]

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Osteoporosis: Reduction of bone mass without alteration in the composition of bone, leading to fractures. Primary osteoporosis can be of two major types: postmenopausal osteoporosis and age-related (or senile) osteoporosis. [NIH] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Ovaries: The pair of female reproductive glands in which the ova, or eggs, are formed. The ovaries are located in the pelvis, one on each side of the uterus. [NIH] Ovary: Either of the paired glands in the female that produce the female germ cells and secrete some of the female sex hormones. [NIH] Ovum: A female germ cell extruded from the ovary at ovulation. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Parity: The number of offspring a female has borne. It is contrasted with gravidity, which refers to the number of pregnancies, regardless of outcome. [NIH] Partial remission: The shrinking, but not complete disappearance, of a tumor in response to therapy. Also called partial response. [NIH] Partial response: A decrease in the size of a tumor, or in the extent of cancer in the body, in response to treatment. [NIH] Parturition: The act or process of given birth to a child. [EU] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Pediatrics: A medical specialty concerned with maintaining health and providing medical care to children from birth to adolescence. [NIH] Pelvic: Pertaining to the pelvis. [EU] Pelvis: The lower part of the abdomen, located between the hip bones. [NIH] Pericardium: The fibroserous sac surrounding the heart and the roots of the great vessels. [NIH]

Peridural: Around or external to the dura mater. [EU] Perimenopausal: The time of a woman's life when menstrual periods become irregular. Refers to the time near menopause. [NIH] Perinatal: Pertaining to or occurring in the period shortly before and after birth; variously defined as beginning with completion of the twentieth to twenty-eighth week of gestation and ending 7 to 28 days after birth. [EU] Peripheral Nervous System: The nervous system outside of the brain and spinal cord. The peripheral nervous system has autonomic and somatic divisions. The autonomic nervous system includes the enteric, parasympathetic, and sympathetic subdivisions. The somatic nervous system includes the cranial and spinal nerves and their ganglia and the peripheral sensory receptors. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Pharmacotherapy: A regimen of using appetite suppressant medications to manage obesity by decreasing appetite or increasing the feeling of satiety. These medications decrease appetite by increasing serotonin or catecholamine—two brain chemicals that affect mood and appetite. [NIH]

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Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Pilot Projects: Small-scale tests of methods and procedures to be used on a larger scale if the pilot study demonstrates that these methods and procedures can work. [NIH] Pilot study: The initial study examining a new method or treatment. [NIH] Pituitary Gland: A small, unpaired gland situated in the sella turcica tissue. It is connected to the hypothalamus by a short stalk. [NIH] Placenta: A highly vascular fetal organ through which the fetus absorbs oxygen and other nutrients and excretes carbon dioxide and other wastes. It begins to form about the eighth day of gestation when the blastocyst adheres to the decidua. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Pneumonia: Inflammation of the lungs. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Polyunsaturated fat: An unsaturated fat found in greatest amounts in foods derived from plants, including safflower, sunflower, corn, and soybean oils. [NIH] Port: An implanted device through which blood may be withdrawn and drugs may be infused without repeated needle sticks. Also called a port-a-cath. [NIH] Port-a-cath: An implanted device through which blood may be withdrawn and drugs may be infused without repeated needle sticks. Also called a port. [NIH] Post partum: After childbirth, or after delivery. [EU] Postmenopausal: Refers to the time after menopause. Menopause is the time in a woman's life when menstrual periods stop permanently; also called "change of life." [NIH] Postnatal: Occurring after birth, with reference to the newborn. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Potentiates: A degree of synergism which causes the exposure of the organism to a harmful substance to worsen a disease already contracted. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the

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convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Predictive factor: A situation or condition that may increase a person's risk of developing a certain disease or disorder. [NIH] Pregnancy Outcome: Results of conception and ensuing pregnancy, including live birth, stillbirth, spontaneous abortion, induced abortion. The outcome may follow natural or artificial insemination or any of the various reproduction techniques, such as embryo transfer or fertilization in vitro. [NIH] Premenstrual: Occurring before menstruation. [EU] Premenstrual Syndrome: A syndrome occurring most often during the last week of the menstrual cycle and ending soon after the onset of menses. Some of the symptoms are emotional instability, insomnia, headache, nausea, vomiting, abdominal distension, and painful breasts. [NIH] Prenatal: Existing or occurring before birth, with reference to the fetus. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Primary Prevention: Prevention of disease or mental disorders in susceptible individuals or populations through promotion of health, including mental health, and specific protection, as in immunization, as distinguished from the prevention of complications or after-effects of existing disease. [NIH] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Projection: A defense mechanism, operating unconsciously, whereby that which is emotionally unacceptable in the self is rejected and attributed (projected) to others. [NIH] Prophylaxis: An attempt to prevent disease. [NIH] Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Protein-Tyrosine Kinase: An enzyme that catalyzes the phosphorylation of tyrosine residues in proteins with ATP or other nucleotides as phosphate donors. EC 2.7.1.112. [NIH] Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or

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vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Psychiatric: Pertaining to or within the purview of psychiatry. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Psychoactive: Those drugs which alter sensation, mood, consciousness or other psychological or behavioral functions. [NIH] Psychology: The science dealing with the study of mental processes and behavior in man and animals. [NIH] Psychometric testing: Psychological and mental testing and quantitative analysis of an individual's psychological traits or attitudes or mental processes. [NIH] Psychopathology: The study of significant causes and processes in the development of mental illness. [NIH] Psychosis: A mental disorder characterized by gross impairment in reality testing as evidenced by delusions, hallucinations, markedly incoherent speech, or disorganized and agitated behaviour without apparent awareness on the part of the patient of the incomprehensibility of his behaviour; the term is also used in a more general sense to refer to mental disorders in which mental functioning is sufficiently impaired as to interfere grossly with the patient's capacity to meet the ordinary demands of life. Historically, the term has been applied to many conditions, e.g. manic-depressive psychosis, that were first described in psychotic patients, although many patients with the disorder are not judged psychotic. [EU] Psychotherapy: A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. [NIH] Public Assistance: Financial assistance to impoverished persons for the essentials of living through federal, state or local government programs. [NIH] Public Health: Branch of medicine concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Puerperium: Period from delivery of the placenta until return of the reproductive organs to their normal nonpregnant morphologic state. In humans, the puerperium generally lasts for six to eight weeks. [NIH] Pulmonary: Relating to the lungs. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] Pulmonary hypertension: Abnormally high blood pressure in the arteries of the lungs. [NIH] Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Raloxifene: A second generation selective estrogen receptor modulator (SERM) used to prevent osteoporosis in postmenopausal women. It has estrogen agonist effects on bone and cholesterol metabolism but behaves as a complete estrogen antagonist on mammary gland and uterine tissue. [NIH] Random Allocation: A process involving chance used in therapeutic trials or other research

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endeavor for allocating experimental subjects, human or animal, between treatment and control groups, or among treatment groups. It may also apply to experiments on inanimate objects. [NIH] Randomization: Also called random allocation. Is allocation of individuals to groups, e.g., for experimental and control regimens, by chance. Within the limits of chance variation, random allocation should make the control and experimental groups similar at the start of an investigation and ensure that personal judgment and prejudices of the investigator do not influence allocation. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Randomized clinical trial: A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the participants can choose which group. Using chance to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively. At the time of the trial, it is not known which treatment is best. It is the patient's choice to be in a randomized trial. [NIH] Reality Testing: The individual's objective evaluation of the external world and the ability to differentiate adequately between it and the internal world; considered to be a primary ego function. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Receptors, Serotonin: Cell-surface proteins that bind serotonin and trigger intracellular changes which influence the behavior of cells. Several types of serotonin receptors have been recognized which differ in their pharmacology, molecular biology, and mode of action. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Reflex: An involuntary movement or exercise of function in a part, excited in response to a stimulus applied to the periphery and transmitted to the brain or spinal cord. [NIH] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Relapse: The return of signs and symptoms of cancer after a period of improvement. [NIH] Relaxin: Hormone produced by the ovaries during pregnancy that loosens ligaments that hold the hip bones together. [NIH] Reliability: Used technically, in a statistical sense, of consistency of a test with itself, i. e. the extent to which we can assume that it will yield the same result if repeated a second time. [NIH]

Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Renal pelvis: The area at the center of the kidney. Urine collects here and is funneled into the ureter, the tube that connects the kidney to the bladder. [NIH] Reproduction Techniques: Methods pertaining to the generation of new individuals. [NIH] Research Design: A plan for collecting and utilizing data so that desired information can be obtained with sufficient precision or so that an hypothesis can be tested properly. [NIH]

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Research Support: Financial support of research activities. [NIH] Retrospective: Looking back at events that have already taken place. [NIH] Retrospective study: A study that looks backward in time, usually using medical records and interviews with patients who already have or had a disease. [NIH] Rigidity: Stiffness or inflexibility, chiefly that which is abnormal or morbid; rigor. [EU] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Saponins: Sapogenin glycosides. A type of glycoside widely distributed in plants. Each consists of a sapogenin as the aglycon moiety, and a sugar. The sapogenin may be a steroid or a triterpene and the sugar may be glucose, galactose, a pentose, or a methylpentose. Sapogenins are poisonous towards the lower forms of life and are powerful hemolytics when injected into the blood stream able to dissolve red blood cells at even extreme dilutions. [NIH] Schizoid: Having qualities resembling those found in greater degree in schizophrenics; a person of schizoid personality. [NIH] Schizophrenia: A mental disorder characterized by a special type of disintegration of the personality. [NIH] Schizotypal Personality Disorder: A personality disorder in which there are oddities of thought (magical thinking, paranoid ideation, suspiciousness), perception (illusions, depersonalization), speech (digressive, vague, overelaborate), and behavior (inappropriate affect in social interactions, frequently social isolation) that are not severe enough to characterize schizophrenia. [NIH] Sclerosis: A pathological process consisting of hardening or fibrosis of an anatomical structure, often a vessel or a nerve. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Selective estrogen receptor modulator: SERM. A drug that acts like estrogen on some tissues, but blocks the effect of estrogen on other tissues. Tamoxifen and raloxifene are SERMs. [NIH] Senile: Relating or belonging to old age; characteristic of old age; resulting from infirmity of old age. [NIH] Serotonin: A biochemical messenger and regulator, synthesized from the essential amino acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis, and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the broad physiological actions and distribution of this biochemical mediator. [NIH] Sertraline: A selective serotonin uptake inhibitor that is used in the treatment of depression. [NIH]

Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Sex Characteristics: Those characteristics that distinguish one sex from the other. The primary sex characteristics are the ovaries and testes and their related hormones. Secondary sex characteristics are those which are masculine or feminine but not directly related to

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reproduction. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]

Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Smoking Cessation: Discontinuation of the habit of smoking, the inhaling and exhaling of tobacco smoke. [NIH] Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Social Support: Support systems that provide assistance and encouragement to individuals with physical or emotional disabilities in order that they may better cope. Informal social support is usually provided by friends, relatives, or peers, while formal assistance is provided by churches, groups, etc. [NIH] Social Work: The use of community resources, individual case work, or group work to promote the adaptive capacities of individuals in relation to their social and economic environments. It includes social service agencies. [NIH] Soma: The body as distinct from the mind; all the body tissue except the germ cells; all the axial body. [NIH] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Soybean Oil: Oil from soybean or soybean plant. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spleen: An organ that is part of the lymphatic system. The spleen produces lymphocytes, filters the blood, stores blood cells, and destroys old blood cells. It is located on the left side of the abdomen near the stomach. [NIH] Spontaneous Abortion: The non-induced birth of an embryo or of fetus prior to the stage of viability at about 20 weeks of gestation. [NIH] Sporadic: Neither endemic nor epidemic; occurring occasionally in a random or isolated

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manner. [EU] Sprains and Strains: A collective term for muscle and ligament injuries without dislocation or fracture. A sprain is a joint injury in which some of the fibers of a supporting ligament are ruptured but the continuity of the ligament remains intact. A strain is an overstretching or overexertion of some part of the musculature. [NIH] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stillbirth: The birth of a dead fetus or baby. [NIH] Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Stromal: Large, veil-like cell in the bone marrow. [NIH] Stupor: Partial or nearly complete unconsciousness, manifested by the subject's responding only to vigorous stimulation. Also, in psychiatry, a disorder marked by reduced responsiveness. [EU] Subarachnoid: Situated or occurring between the arachnoid and the pia mater. [EU] Subcutaneous: Beneath the skin. [NIH] Sublingual: Located beneath the tongue. [EU] Supplementation: Adding nutrients to the diet. [NIH] Support group: A group of people with similar disease who meet to discuss how better to cope with their cancer and treatment. [NIH] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Symptomatology: 1. That branch of medicine with treats of symptoms; the systematic discussion of symptoms. 2. The combined symptoms of a disease. [EU] Synapses: Specialized junctions at which a neuron communicates with a target cell. At classical synapses, a neuron's presynaptic terminal releases a chemical transmitter stored in synaptic vesicles which diffuses across a narrow synaptic cleft and activates receptors on the postsynaptic membrane of the target cell. The target may be a dendrite, cell body, or axon of another neuron, or a specialized region of a muscle or secretory cell. Neurons may also communicate through direct electrical connections which are sometimes called electrical synapses; these are not included here but rather in gap junctions. [NIH] Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU]

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Synaptic Transmission: The communication from a neuron to a target (neuron, muscle, or secretory cell) across a synapse. In chemical synaptic transmission, the presynaptic neuron releases a neurotransmitter that diffuses across the synaptic cleft and binds to specific synaptic receptors. These activated receptors modulate ion channels and/or secondmessenger systems to influence the postsynaptic cell. Electrical transmission is less common in the nervous system, and, as in other tissues, is mediated by gap junctions. [NIH] Systemic: Affecting the entire body. [NIH] Systemic lupus erythematosus: SLE. A chronic inflammatory connective tissue disease marked by skin rashes, joint pain and swelling, inflammation of the kidneys, inflammation of the fibrous tissue surrounding the heart (i.e., the pericardium), as well as other problems. Not all affected individuals display all of these problems. May be referred to as lupus. [NIH] Temperament: Predisposition to react to one's environment in a certain way; usually refers to mood changes. [NIH] Testis: Either of the paired male reproductive glands that produce the male germ cells and the male hormones. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thorax: A part of the trunk between the neck and the abdomen; the chest. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thymus: An organ that is part of the lymphatic system, in which T lymphocytes grow and multiply. The thymus is in the chest behind the breastbone. [NIH] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH] Thyroid Gland: A highly vascular endocrine gland consisting of two lobes, one on either side of the trachea, joined by a narrow isthmus; it produces the thyroid hormones which are concerned in regulating the metabolic rate of the body. [NIH] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tolerance: 1. The ability to endure unusually large doses of a drug or toxin. 2. Acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU] Tomography: Imaging methods that result in sharp images of objects located on a chosen plane and blurred images located above or below the plane. [NIH] Tooth Preparation: Procedures carried out with regard to the teeth or tooth structures preparatory to specified dental therapeutic and surgical measures. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Trachea: The cartilaginous and membranous tube descending from the larynx and branching into the right and left main bronchi. [NIH]

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Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transmitter: A chemical substance which effects the passage of nerve impulses from one cell to the other at the synapse. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Tricuspid Atresia: Absence of the orifice between the right atrium and ventricle, with the presence of an atrial defect through which all the systemic venous return reaches the left heart. As a result, there is left ventricular hypertrophy because the right ventricle is absent or not functional. [NIH] Tricyclic: Containing three fused rings or closed chains in the molecular structure. [EU] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Tumor Necrosis Factor: Serum glycoprotein produced by activated macrophages and other mammalian mononuclear leukocytes which has necrotizing activity against tumor cell lines and increases ability to reject tumor transplants. It mimics the action of endotoxin but differs from it. It has a molecular weight of less than 70,000 kDa. [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Ureters: Tubes that carry urine from the kidneys to the bladder. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] VE: The total volume of gas either inspired or expired in one minute. [NIH] Veins: The vessels carrying blood toward the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] Ventricular: Pertaining to a ventricle. [EU] Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH] Vertebrae: A bony unit of the segmented spinal column. [NIH] Vertebral: Of or pertaining to a vertebra. [EU] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and

Dictionary 137

treatment of diseases in animals. [NIH] Vomeronasal Organ: A specialized part of the olfactory system located anteriorly in the nasal cavity within the nasal septum. Chemosensitive cells of the vomeronasal organ project via the vomeronasal nerve to the accessory olfactory bulb. The primary function of this organ appears to be in sensing pheromones which regulate reproductive and other social behaviors. While the structure has been thought absent in higher primate adults, data now suggests it may be present in adult humans. [NIH] Weight Gain: Increase in body weight over existing weight. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]

Windpipe: A rigid tube, 10 cm long, extending from the cricoid cartilage to the upper border of the fifth thoracic vertebra. [NIH] Withdrawal: 1. A pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) A substance-specific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU] Womb: A hollow, thick-walled, muscular organ in which the impregnated ovum is developed into a child. [NIH]

139

INDEX A Abortion, 109, 126, 129 Acculturation, 50, 109 Adaptability, 14, 109 Adaptation, 36, 109 Adenosine, 109, 111, 128 Adjustment, 11, 19, 109 Adolescence, 62, 109, 113, 127 Adrenal Cortex, 109, 116, 118, 126, 129 Adverse Effect, 8, 20, 109, 133 Agonist, 109, 126, 130 Algorithms, 109, 111 Alimentary, 109, 127 Alkaline, 109, 112 Alkaloid, 109, 125, 126 Alternative medicine, 56, 66, 84, 109 Amenorrhea, 110 Amino acid, 110, 126, 129, 132, 135, 136 Anal, 110, 123 Analgesic, 110, 118, 125 Anatomical, 110, 111, 113, 121, 132 Anorexia, 76, 110 Anorexia Nervosa, 76, 110 Antibodies, 110, 123 Antibody, 37, 56, 77, 110, 114, 121, 123, 125 Antidepressant, 5, 19, 22, 47, 50, 75, 110 Antidote, 110, 112 Antigen, 110, 114, 121, 123 Antihypertensive, 74, 110 Antineoplastic, 110, 119 Anus, 110, 114 Anxiety, 10, 11, 13, 15, 19, 21, 25, 29, 33, 63, 74, 80, 110, 126 Anxiety Disorders, 25, 110 Applicability, 9, 110 Aqueous, 110, 111 Arterial, 77, 111, 115, 120, 129 Arteries, 111, 112, 116, 124, 130 Arterioles, 111, 112 Artery, 111, 116 Assay, 15, 111 ATP, 111, 117, 119, 128, 129 Atrial, 111, 115, 136 Atrioventricular, 111, 116 Atrium, 111, 116, 136 Atrophy, 111, 125 Atypical, 111, 126

B Bacterial Physiology, 109, 111 Base, 15, 111, 117, 122 Behavior Therapy, 111 Benign, 111, 119 Bereavement, 27, 111 Bile, 111, 134 Biochemical, 111, 132 Biotechnology, 23, 84, 91, 111 Bipolar Disorder, 5, 38, 77, 80, 96, 111 Bladder, 111, 121, 129, 131, 136 Blastocyst, 111, 115, 117, 128 Blood Coagulation, 112 Blood Glucose, 112, 120 Blood Platelets, 112, 132 Blood pressure, 77, 110, 112, 120, 130 Blood vessel, 112, 113, 116, 134, 135, 136 Bone Marrow, 112, 121, 123, 125, 134 Bowel, 110, 112, 121, 134 Branch, 105, 112, 130, 133, 134, 135 C Calcium, 5, 77, 112, 114 Calcium Carbonate, 78, 112 Calcium Chloride, 78, 112 Calcium Hydroxide, 78, 112 Capillary, 77, 112, 136 Carbon Dioxide, 112, 128 Carcinogenic, 112, 134 Cardiac, 112, 116, 125, 134 Cardiovascular, 112, 132 Catecholamine, 112, 127 Causal, 113, 115 Cell Division, 113, 128 Cellulose, 113, 128 Central Nervous System, 77, 113, 119, 125, 132 Central Nervous System Infections, 113, 119 Cerebral, 12, 113 Cerebrospinal, 77, 113 Cerebrospinal fluid, 77, 113 Cerebrum, 113 Cervical, 76, 113 Cervix, 109, 113 Chemotherapy, 4, 113 Child Behavior, 15, 113 Child Development, 15, 16, 20, 36, 49, 50, 80, 113

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Chin, 113, 124 Cholesterol, 46, 48, 111, 113, 130, 134 Cholinergic, 113, 126 Chronic, 4, 76, 113, 114, 121, 122, 123, 135 Chronic Fatigue Syndrome, 76, 114 Clinical study, 114, 115 Clinical trial, 4, 8, 9, 13, 91, 114, 115, 117, 129, 131 Cloning, 111, 114 Cognition, 13, 114 Cognitive behavior therapy, 20, 114 Cohort Studies, 18, 114 Colitis, 114, 121 Colon, 77, 114, 121 Complement, 114, 115 Complementary and alternative medicine, 59, 60, 68, 115 Complementary medicine, 59, 115 Complete remission, 115, 131 Compulsions, 34, 115, 126 Computational Biology, 91, 115 Conception, 109, 115, 119, 129 Confounder, 48, 115 Congestive heart failure, 77, 115 Connective Tissue, 112, 115, 119, 123, 135 Consultation, 17, 115 Consumption, 48, 65, 115 Contraindications, ii, 115 Control group, 6, 22, 115, 131 Controlled clinical trial, 5, 115 Controlled study, 4, 24, 36, 61, 115 Cor, 18, 115, 116 Coronary, 116, 124 Coronary Thrombosis, 116, 124 Corpus, 116, 129 Corpus Luteum, 116, 129 Cortex, 116 Corticotropin-Releasing Hormone, 18, 116 Cortisol, 18, 116 Cranial, 116, 118, 119, 125, 126, 127 Craniocerebral Trauma, 116, 119 Cribriform, 116, 126 Criterion, 11, 116 Cues, 6, 116 Curative, 116, 135 Cytokine, 76, 116 D Dairy Products, 78, 116 Decidua, 116, 128 Delusions, 116, 130 Dendrites, 117, 125, 126 Density, 14, 117, 126

Depressive Disorder, 10, 12, 18, 21, 117, 122 Diabetes Mellitus, 117, 120 Diagnostic procedure, 73, 85, 117 Diploid, 117, 128 Direct, iii, 13, 22, 117, 131, 134 Discrimination, 18, 117 DNA Topoisomerase, 117, 119 Double-blind, 5, 17, 117 Drug Interactions, 117 Dura mater, 117, 127 Dysphoric, 13, 117 Dystrophy, 76, 117 E Efficacy, 4, 6, 7, 9, 13, 18, 19, 21, 29, 49, 117 Electrolyte, 117, 128 Embryo, 109, 111, 117, 126, 129, 133 Embryo Transfer, 117, 129 Empirical, 7, 117 Endocrine System, 118 Endocrinology, 12, 44, 118 Endometrial, 118 Endometriosis, 4, 118 Endometrium, 116, 118, 124 Endorphin, 35, 118 Endotoxin, 118, 136 Environmental Health, 90, 92, 118 Enzymatic, 110, 112, 114, 118 Epidemiological, 18, 118 Epidural, 76, 77, 118 Estradiol, 30, 118 Estrogen, 14, 30, 56, 75, 118, 130, 132 Estrogen receptor, 118 Ethmoid, 118, 126 F Family Health, 34, 118 Family Planning, 10, 61, 91, 118 Family Relations, 8, 118 Fat, 112, 115, 118, 126, 128 Fathers, 16, 29, 118 Fatigue, 30, 74, 114, 118, 120 Fatty acids, 17, 118 Fertilization in Vitro, 118, 129 Fetus, 19, 109, 119, 128, 129, 133, 134, 136 Fibrosis, 119, 132 Foetoplacental, 119, 126 Forearm, 112, 119 G Gas, 112, 119, 120, 136 Gastrin, 119, 120 Gastrointestinal, 119, 132 Gastrointestinal tract, 119, 132

141

Gene, 111, 119 Genistein, 75, 119 Gestation, 5, 20, 22, 119, 127, 128, 133 Gland, 109, 119, 123, 128, 129, 130, 132, 134, 135 Glomeruli, 119, 126 Glucose, 112, 113, 117, 119, 120, 132 Glycoprotein, 119, 136 Goats, 116, 119 Gonad, 119 Gonadal, 12, 13, 29, 119, 134 Governing Board, 119, 128 Gravidity, 119, 127 Growth, 84, 109, 113, 119, 126, 128, 135, 136 H Haploid, 119, 128 Headache, 76, 119, 120, 129 Headache Disorders, 119, 120 Health Services, iv, 4, 8, 17, 47, 56, 92, 120 Health Status, 118, 120 Heart failure, 120 Hemodialysis, 112, 120 Hemoglobin, 32, 120 Hemorrhage, 116, 119, 120, 134 Hemostasis, 120, 132 Hormonal, 15, 18, 31, 111, 120 Hormone, 14, 16, 75, 116, 118, 119, 120, 126, 129, 131, 135 Hydrogen, 111, 120, 124 Hypertension, 119, 120 Hyperthyroidism, 98, 120 Hypertrophy, 116, 120, 136 Hypoglycemia, 20, 120 Hypothalamic, 12, 18, 120 Hypothalamus, 116, 120, 128 I Id, 57, 66, 97, 98, 104, 106, 121 Immunity, 121, 126 Immunization, 121, 129 Immunoglobulin, 110, 121, 125 Impairment, 15, 22, 121, 124, 130 Implantation, 115, 121, 126 Impotence, 74, 121 Incontinence, 4, 121 Indicative, 79, 121, 136 Infancy, 15, 21, 121 Infant Behavior, 6, 113, 121 Infarction, 116, 121, 124 Infection, 121, 123, 137 Inflammation, 114, 119, 121, 128, 135 Inflammatory bowel disease, 77, 121

Ingestion, 75, 121, 128 Insomnia, 121, 129 Instillation, 77, 121 Interleukin-1, 76, 77, 121 Interleukin-2, 122 Internal Medicine, 118, 122 Interpersonal Relations, 8, 122 Intervertebral, 76, 122, 123 Intervertebral Disk Displacement, 122, 123 Intoxication, 122, 137 Intracellular, 121, 122, 128, 131 Intramuscular, 76, 77, 122, 127 Intravenous, 122, 127 Involuntary, 122, 125, 131 Ions, 111, 117, 120, 122, 124 J Joint, 122, 134, 135 K Kb, 90, 122 Kidney Disease, 77, 90, 122 Kidney stone, 77, 122 L Lactation, 3, 122, 126 Leukocytes, 112, 122, 125, 136 Library Services, 104, 122 Life cycle, 10, 122 Ligaments, 116, 122, 131 Linkages, 120, 122 Lithium, 75, 122 Local Government, 122, 130 Localized, 76, 77, 121, 123, 128 Locomotion, 123, 128 Longitudinal Studies, 7, 123 Longitudinal study, 17, 123 Low Back Pain, 76, 123 Lumbar, 76, 122, 123 Lupus, 123, 135 Lymph, 113, 123 Lymph node, 113, 123 Lymphatic, 77, 121, 123, 133, 135 Lymphocyte, 110, 123 M Macrophage, 121, 123 Mania, 74, 123 Manic, 111, 122, 123, 130 Manic-depressive psychosis, 123, 130 Maternal Behavior, 16, 123 Mediate, 21, 123 Mediator, 13, 122, 123, 132 Medical Records, 123, 132 Medicament, 75, 124

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MEDLINE, 91, 124 Membrane, 114, 118, 124, 134 Memory, 110, 124 Meninges, 113, 116, 117, 124 Menopause, 4, 61, 124, 126, 127, 128 Menstrual Cycle, 124, 126, 129 Menstruation, 110, 116, 124, 129 Mental, iv, 4, 7, 13, 14, 17, 22, 33, 35, 40, 43, 47, 48, 49, 50, 51, 56, 64, 75, 90, 92, 96, 97, 98, 113, 114, 118, 123, 124, 129, 130, 132 Mental Disorders, 124, 129, 130 Mental Processes, 124, 130 Meta-Analysis, 24, 25, 50, 124 Metabolite, 124, 126 MI, 107, 124 Microbiology, 109, 111, 124 Midwifery, 24, 25, 26, 28, 31, 39, 40, 54, 60, 61, 62, 64, 66, 124 Mineralization, 112, 124 Modeling, 12, 124 Modification, 110, 124, 130 Modulator, 124 Molecular, 12, 91, 93, 111, 115, 124, 131, 136 Molecular Structure, 124, 136 Molecule, 77, 110, 111, 114, 124, 131 Monoclonal, 77, 125 Monocytes, 121, 122, 125 Mononuclear, 125, 136 Mood Disorders, 8, 17, 22, 125 Morphine, 125 Motility, 125, 132 Muscular Dystrophies, 117, 125 Myocardium, 124, 125 N Narcosis, 125 Narcotic, 76, 125 Nausea, 125, 129 Need, 3, 19, 42, 43, 54, 70, 81, 99, 125, 135 Neonatal, 16, 20, 23, 28, 30, 33, 35, 37, 39, 40, 46, 48, 54, 60, 125 Nephropathy, 122, 125 Nerve, 113, 117, 123, 125, 126, 132, 134, 136, 137 Nervous System, 113, 123, 125, 127, 135 Neuralgia, 76, 125 Neuroblastoma, 34, 125 Neurodegenerative Diseases, 76, 125 Neurologic, 76, 125 Neuronal, 13, 125 Neurons, 117, 125, 126, 134

Neuropeptide, 116, 126 Nicotine, 76, 126 Nonverbal Communication, 126, 130 Nortriptyline, 19, 126 Nuclear, 118, 126 Nuclear Family, 118, 126 Nurse Practitioners, 43, 126 O Obsession, 115, 126 Obsessive-Compulsive Disorder, 76, 126 Oestradiol, 29, 126 Oestrogen, 48, 56, 126 Olfactory Bulb, 15, 126, 137 Olfactory Nerve, 126 Omega-3 fatty acid, 17, 63, 126 Opacity, 117, 126 Osteoporosis, 78, 126, 127, 130 Outpatient, 17, 127 Ovaries, 127, 131, 132 Ovary, 116, 118, 119, 126, 127 Ovum, 116, 119, 122, 127, 129, 137 P Palliative, 126, 127, 135 Parenteral, 76, 77, 127 Parity, 5, 127 Partial remission, 127, 131 Partial response, 5, 127 Parturition, 16, 127 Patient Education, 97, 102, 104, 107, 127 Pediatrics, 17, 43, 127 Pelvic, 3, 118, 127, 129 Pelvis, 123, 127, 136 Pericardium, 127, 135 Peridural, 76, 77, 127 Perimenopausal, 13, 127 Perinatal, 8, 22, 32, 41, 42, 80, 127 Peripheral Nervous System, 125, 127 Pharmacologic, 22, 127, 135 Pharmacotherapy, 9, 35, 127 Phosphorus, 67, 77, 112, 128 Physiologic, 30, 109, 124, 128, 131 Physiology, 118, 128 Pilot Projects, 10, 128 Pilot study, 9, 31, 37, 63, 128 Pituitary Gland, 116, 128 Placenta, 18, 118, 119, 128, 129, 130 Plants, 75, 109, 112, 119, 128, 132 Plasma, 110, 120, 128 Pneumonia, 115, 128 Poisoning, 112, 122, 125, 128 Polyunsaturated fat, 33, 34, 63, 128 Port, 56, 128

143

Port-a-cath, 128 Post partum, 5, 19, 128 Postmenopausal, 78, 127, 128, 130 Postnatal, 5, 7, 26, 30, 53, 56, 59, 60, 61, 62, 63, 64, 65, 66, 80, 81, 98, 128 Potassium, 77, 128 Potentiates, 121, 128 Practice Guidelines, 92, 98, 128 Predictive factor, 45, 129 Pregnancy Outcome, 4, 18, 129 Premenstrual, 4, 13, 35, 67, 77, 129 Premenstrual Syndrome, 4, 35, 67, 77, 129 Prenatal, 5, 7, 19, 79, 117, 129 Prevalence, 10, 21, 43, 44, 45, 48, 65, 129 Primary Prevention, 64, 129 Progesterone, 14, 129, 134 Progressive, 119, 125, 129 Projection, 126, 129 Prophylaxis, 18, 129 Prospective study, 45, 69, 123, 129 Prostate, 126, 129 Protein S, 111, 129 Proteins, 110, 114, 121, 124, 128, 129, 131, 132 Protein-Tyrosine Kinase, 119, 129 Protocol, 18, 129 Psychiatric, 5, 10, 11, 12, 15, 17, 21, 24, 47, 50, 56, 61, 63, 74, 124, 130 Psychic, 124, 130 Psychoactive, 130, 137 Psychology, 11, 13, 15, 22, 33, 34, 37, 39, 44, 45, 47, 48, 49, 51, 53, 56, 65, 70, 115, 130 Psychometric testing, 38, 130 Psychopathology, 21, 81, 130 Psychosis, 5, 79, 98, 130 Psychotherapy, 7, 8, 9, 13, 24, 29, 32, 46, 53, 84, 96, 114, 130 Public Assistance, 37, 130 Public Health, 8, 16, 21, 25, 48, 92, 130 Public Policy, 91, 130 Puerperium, 29, 130 Pulmonary, 112, 115, 116, 130, 136 Pulmonary Artery, 112, 130, 136 Pulmonary hypertension, 116, 130 Q Quality of Life, 9, 130 R Raloxifene, 130, 132 Random Allocation, 130, 131 Randomization, 5, 131

Randomized, 4, 5, 6, 8, 9, 13, 19, 36, 44, 50, 117, 131 Randomized clinical trial, 6, 8, 19, 44, 131 Reality Testing, 130, 131 Receptor, 12, 14, 109, 110, 126, 131, 132 Receptors, Serotonin, 131, 132 Rectum, 110, 114, 119, 121, 129, 131 Recurrence, 7, 19, 21, 75, 111, 123, 131 Refer, 1, 114, 123, 130, 131 Reflex, 76, 131 Regimen, 74, 117, 127, 131 Relapse, 22, 131 Relaxin, 74, 131 Reliability, 9, 131 Remission, 7, 47, 111, 123, 131 Renal pelvis, 122, 131 Reproduction Techniques, 129, 131 Research Design, 12, 131 Research Support, 3, 132 Retrospective, 32, 132 Retrospective study, 32, 132 Rigidity, 128, 132 Risk factor, 14, 19, 27, 32, 37, 45, 46, 70, 97, 98, 129, 132 S Saponins, 132, 134 Schizoid, 132, 137 Schizophrenia, 5, 76, 132, 137 Schizotypal Personality Disorder, 132, 137 Sclerosis, 76, 132 Screening, 5, 6, 10, 17, 25, 27, 31, 35, 38, 41, 46, 47, 48, 49, 54, 64, 70, 83, 84, 98, 114, 132 Secretion, 122, 132 Selective estrogen receptor modulator, 61, 130, 132 Senile, 127, 132 Serotonin, 12, 13, 19, 75, 127, 131, 132, 136 Sertraline, 19, 84, 132 Serum, 20, 29, 33, 46, 48, 114, 132, 136 Sex Characteristics, 109, 126, 132 Shock, 133, 136 Side effect, 74, 75, 109, 133, 135 Signs and Symptoms, 131, 133 Skeletal, 77, 125, 133 Skeleton, 122, 133 Small intestine, 120, 133 Smoking Cessation, 76, 133 Social Environment, 130, 133 Social Support, 9, 18, 22, 50, 70, 133 Social Work, 8, 41, 133 Soma, 133

144

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Somatic, 33, 74, 109, 127, 133 Soybean Oil, 128, 133 Specialist, 99, 133 Species, 125, 133 Spinal cord, 76, 113, 117, 118, 124, 125, 127, 131, 133 Spleen, 123, 133 Spontaneous Abortion, 129, 133 Sporadic, 125, 133 Sprains and Strains, 123, 134 Steroid, 13, 116, 126, 132, 134 Stillbirth, 129, 134 Stimulus, 131, 134 Stomach, 119, 120, 125, 133, 134 Stool, 114, 121, 134 Stress, 3, 5, 6, 7, 14, 18, 21, 40, 51, 113, 116, 125, 134 Stroke, 77, 90, 134 Stromal, 118, 134 Stupor, 125, 134 Subarachnoid, 119, 134 Subcutaneous, 76, 77, 127, 134 Sublingual, 30, 134 Supplementation, 5, 29, 60, 134 Support group, 25, 28, 60, 61, 65, 134 Symptomatic, 9, 10, 11, 134 Symptomatology, 4, 10, 11, 17, 22, 44, 134 Synapses, 126, 134 Synaptic, 126, 134, 135 Synaptic Transmission, 126, 135 Systemic, 16, 74, 77, 112, 121, 135, 136 Systemic lupus erythematosus, 74, 135 T Temperament, 25, 32, 49, 135 Testis, 118, 126, 135 Therapeutics, 135 Thorax, 123, 135 Thrombosis, 129, 134, 135 Thymus, 121, 123, 135 Thyroid, 27, 37, 44, 52, 56, 120, 135 Thyroid Gland, 120, 135 Thyroxine, 56, 135

Tissue, 18, 110, 111, 112, 115, 117, 118, 121, 122, 123, 124, 125, 128, 130, 133, 135 Tolerance, 109, 135 Tomography, 12, 135 Tooth Preparation, 109, 135 Toxic, iv, 121, 126, 135 Toxicity, 117, 135 Toxicology, 92, 135 Trachea, 135 Transfection, 111, 136 Transmitter, 123, 134, 136 Trauma, 38, 136 Tricuspid Atresia, 116, 136 Tricyclic, 19, 75, 136 Tryptophan, 132, 136 Tumor Necrosis Factor, 76, 77, 136 U Unconscious, 121, 136 Ureters, 122, 136 Urethra, 129, 136 Urinary, 4, 121, 136 Urine, 28, 111, 121, 122, 131, 136 Uterus, 109, 113, 116, 118, 124, 127, 129, 136 V Vaccine, 130, 136 Vascular, 120, 121, 128, 135, 136 VE, 25, 45, 47, 53, 136 Veins, 112, 136 Venous, 77, 129, 136 Ventricle, 111, 116, 120, 130, 136 Ventricular, 115, 136 Venules, 112, 136 Vertebrae, 122, 133, 136 Vertebral, 76, 136 Veterinary Medicine, 91, 136 Vomeronasal Organ, 126, 137 W Weight Gain, 74, 137 White blood cell, 110, 122, 123, 137 Windpipe, 135, 137 Withdrawal, 35, 74, 75, 76, 137 Womb, 62, 136, 137