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Prevalence Of Smoking In Patients With Bipolar Disorder, Major Depressive Disorder And Schizophrenia And Their Relationships With Quality Of Life, Xiao-Hong Li, Feng-Rong An, Gabor S. Ungvari, Chee H. Ng, Helen F.K. Chiu, Ping-Ping Wu, Xin Jin, Yu-Tao Xiang

Medical Papers and Journal Articles

Few studies have compared the prevalence of smoking between patients with bipolar disorder, major depressive disorder (MDD) and schizophrenia. This study examined the prevalence of smoking and its relationships with demographic and clinical characteristics, and quality of life (QOL) in patients with these psychiatric disorders. A total of 1,102 inpatients were consecutively screened. Psychopathology and QOL were measured with standardized instruments. The prevalence of current smoking in the whole sample was 16.7%; 17.5% in bipolar disorder, 10.6% in MDD and 18.5% in schizophrenia. The rates of smoking in bipolar disorder (p = 0.004, OR = 2.5, 95%CI: 1.3–4.7) and schizophrenia …

Non-Invasive Assessment Of Pulmonary Vascular Resistance In Pulmonary Hypertension: Current Knowledge And Future Direction, P Naing, H Kuppusamy, G Scalia, G Hills, D Playford

Medical Papers and Journal Articles

Pulmonary Hypertension (PHT) is relatively common, dangerous and under-recognised. Pulmonary hypertension is not a diagnosis in itself; it is caused by a number of differing diseases each with different treatments and prognoses. Therefore, timely and accurate recognition of the underlying cause for PHT is essential for appropriate management. This is especially true for patients with Pulmonary Arterial Hypertension (PAH) in the current era of disease-specific drug therapy.

Measurement of Pulmonary Vascular Resistance (PVR) helps separate pre-capillary from post-capillary PHT, and is measured with right heart catheterisation (RHC). Echocardiography has been used to derive a number of non-invasive surrogates for PVR, …

Plasmodial Hsp40s: New Avenues For Antimalarial Drug Discovery, M Daniyan, G Blatch

Medical Papers and Journal Articles

Malaria, an infectious disease caused by Plasmodium spp, is one of the world's most dangerous diseases, accounting for more than half a million deaths yearly. The long years of co-habitation between the parasite and its hosts (human and mosquito), is a testimony to the parasite’s ability to escape the immune system and develop drug resistance mechanisms. Currently, an important search area for improved pharmacotherapy are molecular chaperones of the heat shock protein family, abundant in Plasmodium falciparum and contributing to its continuous survival and development. Thus far, small molecule inhibitor studies on P. falciparum Hsp70s and Hsp90s have indicated that …

Association Of Cerebral Small Vessel Disease Burden And Health-Related Quality Of Life After Acute Ischemic Stroke, Yan Liang, Yang-Kun Chen, Min Deng, Vincent C.T. Mok, De-Feng Wang, Gabor S. Ungvari, Chiu-Wing W. Chu, Akane Kamiya, Wai-Kwong Tang

Medical Papers and Journal Articles

Objective: Cerebral small vessel disease (SVD) is associated with increased mortality, disability and cognitive decline, depression in stroke survivors. This study examined the association between SVD burden, defined by a combination of SVD markers, and health-related quality of life (HRQoL) in acute ischemic stroke.

Methods: Patients admitted with acute ischemic stroke of any etiology were prospectively screened between January 2010 to December 2014 and enrolled in the study if they met study entry criteria. HRQoL was evaluated with the 12-item Stroke Specific Quality of Life (SSQoL) at 3 months after the onset of acute ischemic stroke. SVD was ascertained by …

Beta-Blocker Under-Use In Copd Patients, Kuan Pin Lim, Sarah Loughrey, Michael Musk, Melanie Lavender, Jeremy P. Wrobel

Medical Papers and Journal Articles

Background: Cardiovascular (CVS) comorbidities are common in COPD and contribute significantly to morbidity and mortality, especially following acute exacerbations of COPD (AECOPD). Beta-blockers (BBs) are safe and effective in COPD patients, with demonstrated survival benefit following myocardial infarction. We sought to determine if BBs are under-prescribed in patients hospitalized with AECOPD. We also sought to determine inpatient rates of CVS and cerebrovascular complications, and their impact on patient outcomes.

Methods: Retrospective hospital data was collected over a 12-month period. The medical records of all patients 40 years of age coded with a diagnosis of AECOPD were analyzed. Prevalent use and …

The Psychometric Properties Of The Quick Inventory Of Depressive Symptomatology-Self-Report (Qids-Sr) In Patients With Hbv-Related Liver Disease, Mei Liu, Yuanyuan Wang, Jing Zhao, Sujun Zheng, Gabor S. Ungvari, Chee H. Ng, Zhong-Ping Duan, Yu-Tao Xiang

Medical Papers and Journal Articles

Background: Comorbid depression in Hepatitis B virus (HBV) is common. Developing accurate and time efficient tools to measure depressive symptoms in HBV is important for research and clinical practice in China.

Aims: This study tested the psychometric properties of the Chinese version of the 16-item Quick Inventory of Depressive Symptomatology (QIDS-SR) in HBV patients.

Methods: The study recruited 245 depressed patients with HBV and related liver disease. The severity of depressive symptoms was assessed with the Montgomery-Asberg Depression Rating Scale (MADRS) and the QIDS-SR.

Results: Internal consistency (Cronbach’s alpha) was 0.796 for QIDS-SR. The QIDS-SR total score was significantly correlated …

Do Images Of A Personalised Future Body Shape Help With Weight Loss? A Randomised Controlled Study, Gemma Ossolinski, Moyez Jiwa, Alexandra Mcmanus, Richard Parsons

Medical Papers and Journal Articles

Background: This randomised controlled study evaluated a computer-generated future self-image as a personalised, visual motivational tool for weight loss in adults.

Methods: One hundred and forty-five people (age 18–79 years) with a Body Mass Index (BMI) of at least 25 kg/m2 were randomised to receive a hard copy future self-image at recruitment (early image) or after 8 weeks (delayed image). Participants received general healthy lifestyle information at recruitment and were weighed at 4-weekly intervals for 24 weeks. The image was created using an iPad app called ‘Future Me’. A second randomisation at 16 weeks allocated either an additional future self-image …

Perceptions Of Cancer Of Unknown Primary Site: A National Survey Of Australian Medical Oncologists, C Karapetis, L Guccione, M Tattersall, H Gooden, C Vajdic, S Lambert, M Robotin, L Mileshkin, P Schofield

Medical Papers and Journal Articles

Introduction: Despite being the 6th cause of cancer death in Australia, cancer of unknown primary (CUP) site remains poorly understood.

Aims: To describe practices relating to the diagnosis, investigation, classification, communication and management of CUP amongst medical oncologists.

Methods: We invited all members of the Medical Oncology Group of Australia to participate in a national, anonymous online survey about CUP. The survey collected data regarding diagnosis acceptance, diagnostic tests, treatment protocols and communication practices around the diagnosis of CUP.

Results: 302 oncologists were invited and 86 (28%) completed the survey. Eighty respondents (93%) were directly involved in the assessment of …

An Update On The Perioperative Management Of Children With Upper Respiratory Tract Infections, Adrian Regli, Karin Becke, Britta Von Ungern-Sternberg

Medical Papers and Journal Articles

Purpose of review: This review summarises the current evidence for the management for children with recent upper respiratory tract infections. Furthermore, the review includes management guidelines for children with upper respiratory tract infections.

Recent findings: Good history and clinical examination is sufficient in most children presenting with URTI. Testing for immune markers or preoperative NO measurement does not add any additional value. Preoperative bronchodilator administration, iv induction with propofol and non-invasive airway management all reduce the occurrence of respiratory adverse events.

Summary: Most children can be safely anaesthetised even in the presence of an upper respiratory tract infection if the …

Association Between Schizophrenia And Violence Among Chinese Female Offenders, Jun Wang, Xiao-Min Zhu, Si-Mei Zhang, Jian-Song Zhou, Qiguang Li, Qun Wang, Shao-Ling Zhong, Chee H. Ng, Gabor S. Ungvari, Yu-Tao Xiang, Xiao-Ping Wang

Medical Papers and Journal Articles

Little is known about the association between schizophrenia and violence in women in China. This study aimed to examine the association between schizophrenia and violence in Chinese female offenders. Fifty-two schizophrenia patients were identified from the female offenders who received forensic psychiatric assessments in 2011 in Hunan province, China. Using a propensity score matching method, 104 matched controls without psychiatric disorders were selected from female criminals in Hunan province. Violent offences and homicides were verified and recorded. The percentages of violent offences and homicides were significantly higher in female offenders with schizophrenia than in controls (78.8% vs. 30.8%, P < 0.001; 44.2% vs. 18.3%, P = 0.001, respectively). Multivariate logistic regression analyses revealed that diagnosis of schizophrenia, younger age at first offence, living in rural area and a lower education level were independently and positively associated with violent offences, while having a diagnosis of schizophrenia and lower education level were associated with homicides. There appears to be an independent and positive association between schizophrenia and violent offence in Chinese female offenders. Effective preventive approaches on violence in female schizophrenia patients are warranted.

Duration Of Untreated Bipolar Disorder: A Multicenter Study, Ling Zhang, Xin Yu, Yi-Ru Fang, Gabor S. Ungvari, Chee H. Ng, Helen F.K. Chiu, Hui-Chun Li, Hai-Chen Yang, Qing-Rong Tan, Xiu-Feng Xu, Gang Wang, Yu-Tao Xiang

Medical Papers and Journal Articles

Little is known about the demographic and clinical differences between short and long duration of untreated bipolar disorder (DUB) in Chinese patients. This study examined the demographic and clinical features of short (≤2 years) and long DUB (>2 years) in China. A consecutively recruited sample of 555 patients with bipolar disorder (BD) was examined in 7 psychiatric hospitals and general hospital psychiatric units across China. Patients’ demographic and clinical characteristics were collected using a standardized protocol and data collection procedure. The mean DUB was 3.2 ± 6.0 years; long DUB accounted for 31.0% of the sample. Multivariate analyses revealed …

Longitudinal Changes In Prospective Memory And Their Clinical Correlates At 1-Year Follow-Up In First-Episode Schizophrenia, Fu-Chun Zhou, Chuan-Yue Wang, Gabor S. Ungvari, Chee H. Ng, Yan Zhou, Liang Zhang, Jingjing Zhou, David H.K. Shum, David Man, Deng-Tang Liu, Jun Li, Yu-Tao Ziang

Medical Papers and Journal Articles

This study aimed to investigate prospective memory (PM) and the association with clinical factors at 1-year follow-up in first-episode schizophrenia (FES). Thirty-two FES patients recruited from a university-affiliated psychiatric hospital in Beijing and 17 healthy community controls (HCs) were included. Time- and event-based PM (TBPM and EBPM) performances were measured with the Chinese version of the Cambridge Prospective Memory Test (CCAMPROMPT) at baseline and at one-year follow-up. A number of other neurocognitive tests were also administered. Remission was determined at the endpoint according to the PANSS score _ 3 for selected items. Repeated measures analysis of variance revealed a significant …

Molecular Antimicrobial Resistance Surveillance For Neisseria Gonorrhoeae, Northern Territory, Australia, David Whiley, Ella Trembizki, Cameron Buckley, Kevin Freeman, Rob Baird, Miles Beaman, Marcus Chen, Basil Donovan, Ratan Kundu, Christopher Fairley, Rebecca Guy

Medical Papers and Journal Articles

Neisseria gonorrhoeae antimicrobial resistance (AMR) is a globally recognized health threat; new strategies are needed to enhance AMR surveillance. The Northern Territory of Australia is unique in that 2 different first-line therapies, based primarily on geographic location, are used for gonorrhea treatment. We tested 1,629 N. gonorrhoeae nucleic acid amplification test–positive clinical samples, collected from regions where ceftriaxone plus azithromycin or amoxicillin plus azithromycin are recommended first-line treatments, by using 8 N. gonorrhoeae AMR PCR assays. We compared results with those from routine culture-based surveillance data. PCR data confirmed an absence of ceftriaxone resistance and a low level of azithromycin …

Mind The (Treatment) Gap: A Global Perspective On Current And Future Strategies For Prevention Of Fragility Fractures, H C.W. Harvey, E V. Mccloskey, Paul Mitchell, B Dawson-Hughes, D D. Pierroz, J Reginster, R Rizzoli, C Cooper, J A. Kanis

Medical Papers and Journal Articles

This narrative review considers the key challenges facing healthcare professionals and policymakers responsible for providing care to populations in relation to bone health. These challenges broadly fall into four distinct themes: (1) case finding and management of individuals at high risk of fracture, (2) public awareness of osteoporosis and fragility fractures, (3) reimbursement and health system policy and (4) epidemiology of fracture in the developing world. Findings from cohort studies, randomised controlled trials, systematic reviews and meta-analyses, in addition to current clinical guidelines, position papers and national and international audits, are summarised, with the intention of providing a prioritised approach …

Tracking Of Vitamin D Status From Childhood To Early Adulthood And Its Association With Peak Bone Mass, Kun Zhu, Wendy Oddy, Patrick Holt, Wendy Chan She Ping-Delfos, Jennifer Mountain, Stephen Lye, Craig Pennell, Prue Hart, John Walsh

Medical Papers and Journal Articles

Background: To our knowledge, there are few longitudinal studies of vitamin D status from childhood to early adulthood, and it is uncertain whether vitamin D predicts peak bone mass in young adults.

Objectives: The purpose of this longitudinal study was to evaluate the long-term stability of vitamin D status from ages 6 to 20 y in healthy individuals and to study associations between serum 25-hydroxyvitamin D [25(OH)D] at different developmental stages and bone mass measured at age 20 y.

Design: Participants were offspring of the Western Australian Pregnancy Cohort (Raine) study. Serum 25(OH)D was assessed at ages 6, 14, 17, …

“Life Within The Person Comes To The Fore”: Pastoral Workers’ Practice Wisdom On Using Arts In Palliative Care, Clare O'Callaghan, Libby Byrne, Eleni Cokalis, David Glenister, Margaret Santilli, Rose Clark, Therese Mccarthy, Natasha Michael

Medical Papers and Journal Articles

Background: Pastoral care (also chaplaincy, spiritual care) assists people to find meaning, personal resources, and connection with self, others, and/or a higher power. Although essential in palliative care, there remains limited examination of what pastoral workers do. This study examined how pastoral workers use and consider the usefulness of art-based modalities.

Methods: Qualitative research was used to examine the practice wisdom (tacit practice knowledge) of pastoral workers experienced in using visual arts and music in palliative care. Two focus groups were conducted. Thematic analysis was informed by grounded theory.

Results: Six pastoral workers shared information. Three themes emerged. First, pastoral …

Extending Awareness Of Healthcare Ethics At Cabrini Health: Junior Clinicians' Perspectives, Clare O'Callaghan, Julia Trimboli, Xavier Symons, Margaret Staples, Emma Patterson, Natasha Michael

Medical Papers and Journal Articles

As Catholic healthcare organizations form a substantive part of healthcare delivery in the USA and Australia, ethical standards for Catholic health care were developed to guide practice. This study examined junior staff’s understanding of Catholic ethics. Using a qualitative descriptive design, we recruited 22 medical and nursing staff to interviews/focus groups. Though Catholic ethics seldom informed ethical approaches, the principles were acknowledged as being useful to support development of confident and respectful care approaches. Findings provide early insights into challenges faced in considering implementation of ethical codes across both secular and religious healthcare organizations, suggesting that a more creative and …

The Unmet Needs Of Aboriginal Australians With Musculoskeletal Pain: A Mixed Method Systematic Review, Ivan B. Lin, Samantha Bunzli, Donna Mak, Charmaine Green, Roger Goucke, Juli Coffin, Peter B. O'Sullivan

Medical Papers and Journal Articles

Objective: Musculoskeletal pain (MSP) conditions are the biggest cause of disability and internationally, Indigenous peoples experience a higher burden. There are conflicting reports about Aboriginal Australians and MSP. We conducted a systematic review to describe the prevalence, associated factors, impacts, care access, health care experiences, and factors associated with MSP among Aboriginal Australians.

Methods: A systematic search of quantitative and qualitative scientific and grey literature (PROSPERO number: CRD42016038342). Articles were appraised using the Mixed Methods Appraisal Tool. Due to study heterogeneity a narrative synthesis was conducted.

Results: Of 536 articles identified, 18 were included (14 quantitative, 4 qualitative), of high …

Editorial Commentary: The Acrid Bioscrew In Anterior Cruciate Ligament Reconstruction Of The Knee, Leo Pinczewski, Lucy J. Salmon

Medical Papers and Journal Articles

Bioresorbable screws have been widely adopted for graft fixation in knee anterior cruciate ligament (ACL) reconstruction on the promise of screw resorbtion and replacement by bone. When considering the value of bioresorbable screws, it is imperative to understand that the “A” in PGA and PLA, the base ingredient of all bioscrews, is for Acid. All resorb by a process of hydrolysis; the speed and extent of resorbtion is determined by both the acidity of the screw and the environment in which it is placed. Regrettably, the promise of reliable, predictable screw resorbtion and replacement by bone remains elusive, despite the …

Oesophageal Adenocarcinoma: A Patient And Physician's Perspective, Derek Maule, Mark Boccola, Reginald V. Lord

Medical Papers and Journal Articles

This article is co-authored by a patient with oesophageal adenocarcinoma and his physician, who performed oesophagectomy. The patient relates his pre-operative preparation and post-operative experience. The physician comments on the alarming increase in the incidence of this cancer, risk factors, and treatment. As illustrated by the patient’s report, the physician also discusses the importance of maintaining adequate nutrition, cardiorespiratory fitness, and a positive psychological attitude.

The Respiratory Pressure-Abdominal Volume Curve In A Porcine Model, Adrian Regli, Bart L. De Keulenaer, Bhajan Singh, Lisen E. Hockings, Bill Noffsinger, Peter V. Van Heerden

Medical Papers and Journal Articles

Background: Increasing intra-abdominal volume (IAV) can lead to intra-abdominal hypertension (IAH) or abdominal compartment syndrome. Both are associated with raised morbidity and mortality. IAH can increase airway pressures and impair ventilation. The relationship between increasing IAV and airway pressures is not known. We therefore assessed the effect of increasing IAV on airway and intra-abdominal pressures (IAP).

Methods: Seven pigs (41.4 +/−8.5 kg) received standardized anesthesia and mechanical ventilation. A latex balloon inserted in the peritoneal cavity was inflated in 1-L increments until IAP exceeded 40 cmH₂O. Peak airway pressure (pP_AW), respiratory compliance, and IAP (bladder pressure) …

What Is The Scope To Test A Smoking Cessation Intervention Aimed At Young People Admitted To Hospital?, George Tambakis, Jonathan Darby, Moyez Jiwa

Medical Papers and Journal Articles

Background: Young adults are reluctant to use evidence-based smoking cessation interventions. Subsequently, they are less successful at giving up smoking compared to older adults. This highlights the need for innovative strategies to engage young people in smoking cessation. A novel intervention using photoageing technology has been shown to be an effective trigger for smoking cessation.

Aims: To conduct a pilot study deploying photoageing care technology to trigger smoking cessation attempts in young adults admitted to hospital.

Method: A randomised controlled trial was designed. Thirty participants were recruited from a regional hospital in Melbourne, Australia. Participants were allocated to the intervention …

The Normal Ranges Of Cardiovascular Parameters Measured Using The Ultrasonic Cardiac Output Monitor, Giles N. Cattermole, P.Y Mia Leung, Grace Y.L Ho, Peach W.S Lau, Cangel P.Y Chan, Stewart S.W Chan, Brendan E. Smith, Colin A. Graham, Timothy H. Rainer

Medical Papers and Journal Articles

The ultrasonic cardiac output monitor (USCOM) is a noninvasive transcutaneous continuous wave Doppler method for assessing hemodynamics. There are no published reference ranges for normal values in adults (aged 18– 60 years) for this device. This study aimed to (1) measure cardiovascular indices using USCOM in healthy adults aged 18–60 years; (2) combine these data with those for healthy children (aged 0–12), adolescents (aged 12–18), and the elderly (aged over 60) from our previously published studies in order to present normal ranges for all ages, and (3) establish normal ranges of USCOM-derived variables according to both weight and age. This …

The Contribution Of Eu Funds To Wellbeing And Sustainable Development In Central European Countries, Mirjana Kranjac, Uros Sikimic, Srdan Tomic, Jelena Vapa-Tankosic

Research Collection Lee Kong Chian School Of Business

The European strategic goals are good standard of living, social and economic wellbeing and sustainability of the Planet Earth. Some of these requirements are contradictory. Often times, a successful economy exhausts nature well beyond its limits. Europe is achieving its goals by giving funds to many programs, thus enabling the elaboration of projects. The programs' and projects' goals and results must justify the global vision of European Union (EU) future, precisely defined in the document Europa 2020: to achieve a sustainable future. This paper is dealing with effects of the use of EU funds in Central European (CEE) countries. The …

Is Saying “Sorry” Enough? Examining The Effects Of Apology Typologies By Organization On Consumer Responses, May O. Lwin, Augustine Pang, Jun-Qi Loh, Marilyn Hui-Ying Peh, Sarah Ann Rodriguez, Nur Hanisah Binte Zelani

Research Collection Lee Kong Chian School Of Business

Apology has been found to be the most effective strategy in times of crises. However, there is a dearth of research on the kinds of apology used and how primary stakeholders, in particular consumers, received them. This study aims to examine consumer responses to the types of apologies offered post crises against the levels of attribution of responsibility. We also assess the potential mediating role of ethical concerns by developing the Perception-Behavioral Model of Crisis Response. An experiment was conducted to ascertain consumers’ impression of the organization post-apology. The results showed that the attribution of crisis responsibility significantly influences complaining, …

How Crisis Managers Define Ethical Crisis Communication In Singapore: Identifying Organizational Factors That Influence Adoption Of Ethical Stances, Augustine Pang, Yan Jin, Benjamin Meng-Keng Ho

Research Collection Lee Kong Chian School Of Business

This study explores the veracity of the six ethical variables proposed in the contingency theory of strategic conflict management – the role of PR practitioner, the role of top management, nature of the crisis, the activism of stakeholders; government regulation/intervention; diversity to different cultures and exposure external business environments. In-depth interviews with 10 communication professionals in Singapore were conducted. In line with the patriarchal management structure, the top management plays a critical role in determining ethical stances, with practitioners playing important consultative positions. Also, the role of the relevant government almost predisposes the organization toward certain ethical stances. The study …

Status Reports Of The Fisheries And Aquatic Resources Of Western Australia 2015/16. State Of The Fisheries, W.J Fletcher, M.D. Mumme, F J. Webster

Status Reports of the Fisheries and Aquatic Resources

As part of the transition to ultimately using a web based, hierarchical interface, this years’ edition of the Status Reports of the Fisheries and Aquatic Resources of Western Australia 2015/16 is adopting a more streamlined format. These changes include updates to the summary table which, in addition to displaying the stock and fishery performance levels, now includes current performance and risk levels for each of the other EBFM outcomes (e.g. bycatch, listed species, economics etc.).

Be Well: A Systems-Based Wellness Intervention Using Mindfulness In The Workplace – A Case Study, Kate M. Levett, Sharyn Coughlan, Sharon Longridge, Violet Roumeliotis, Jon Adams

Medical Papers and Journal Articles

Introduction: Healthy work environments are essential in determining improved well-being of Australians. Job stress has been identified as a significant factor in psychological distress. This study evaluated the effect of introducing a systems-based workplace wellness programme using mindfulness in the workplace.

Methods: The programme ‘Be Well’ was introduced as part of a systems-based approach to workplace health promotion, and evaluated using sick leave as a proxy for workplace stress, and the stress satisfaction offset score to determine the degree of change in stress and satisfaction.

Results: There was significant reduction in sick leave (2014 vs. 2012) (p<.001), and significant improvement in stress satisfaction offset score (p<.05). Logistic regression analysis identified the programme components most predictive of reduced stress and higher job satisfaction.

Conclusion: The impacts …

Isolated Intractable Nausea And Vomiting With Hiccups Heralds A Neuromyelitis Optica Area Postrema Syndrome, Michal Lubomski, Jacqueline Lubomski, Irene Tan, Michael Hayes

Medical Papers and Journal Articles

No abstract is available for this article.

Beneficial Effects On Pregnancy Outcomes Of Thyroid Hormone Replacement For Subclinical Hypothyroidism, N. Blumenthal, C. Eastman

Medical Papers and Journal Articles

Hypothyroidismand raised thyroid antibody levels have been associated with adverse obstetrical outcomes. Several studies have investigated causal associations, but results have been inconsistent and fewstudies have reported the effects of thyroxine replacement therapy on pregnancy outcomes in hypothyroid patients. Objective.The primary study objective was to determine the outcome of pregnancies in women diagnosed with overt and subclinical hypothyroidism (SCH) (serum TSH > 2.5mIU/L) and those with elevated circulating thyroid autoantibody levels in the first trimester of pregnancy and after the institution of appropriate thyroxine replacement therapy to maintain the serum TSH ≤ 2.5mIU/L. Study Design. This prospective observational study was undertaken …