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    The value of food fortification as a public health intervention

    Kenneth J Harvey and Basia O Diug
    Med J Aust 2018; 208 (3): . || doi: 10.5694/mja17.01095
    Published online: 19 February 2018

    Making iodine fortification of bread mandatory in Tasmania successfully improved population iodine levels

    Iodine is a micronutrient essential for thyroid hormone synthesis. Inadequate dietary intake is associated with preventable iodine deficiency disorders, including neurological impairment, goitre, and hypothyroidism. The effectiveness of iodised salt for improving population iodine levels and of urine iodine assessment for detecting deficits have led to iodine deficiency being eliminated in many countries where it was once a problem.1


    • 1 Monash University, Melbourne, VIC
    • 2 Medreach Pty Ltd, Melbourne, VIC


    Correspondence: kenneth.harvey@monash.edu
    Competing interests:

    No relevant disclosures.

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      Encephalopathy after chocolate consumption

      Amy Kunchok, Penelope J Spring and Michael W Hayes
      Med J Aust 2018; 208 (3): . || doi: 10.5694/mja16.01444
      Published online: 19 February 2018

      Clinical record


      • Concord Repatriation General Hospital, Sydney, NSW


      Correspondence: amykunchok@gmail.com
      Competing interests:

      No relevant disclosures.

      • 1. Lavi E, Rekhtman D, Berkun Y, Wexler I. Sudden onset unexplained encephalopathy in infants: think of cannabis intoxication. Eur J Pediatr 2016; 175: 417-420.
      • 2. Cao D, Srisuma S, Bronstein AC, Hoyte CO. Characterization of edible marijuana product exposures reported to United States poison centers. Clin Toxicol (Phila) 2016; 54: 840-846.
      • 3. Benjamin DM, Fossler MJ. Edible cannabis products: it is time for FDA oversight? J Clin Pharmacol 2016; 56: 1045-1057.

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        Identifying and treating codeine dependence: a systematic review

        Suzanne Nielsen, Tim MacDonald and Jacinta L Johnson
        Med J Aust 2018; 208 (10): . || doi: 10.5694/mja17.00749
        Published online: 12 February 2018

        Abstract

        Objectives: Codeine dependence is a significant public health problem, motivating the recent rescheduling of codeine in Australia (1 February 2018). To provide information for informing clinical responses, we undertook a systematic review of what is known about identifying and treating codeine dependence.

        Study design: Articles published in English that described people who were codeine-dependent or a clinical approach to treating people who were codeine-dependent, without restriction on year of publication, were reviewed. Articles not including empirical data were excluded. One researcher screened each abstract; two researchers independently reviewed full text articles. Study quality was assessed, and data were extracted with standardised tools.

        Data sources: MEDLINE and EMBASE were searched for relevant publications on 22 November 2016. The reference lists of eligible studies were searched to identify further relevant publications. 2150 articles were initially identified, of which 41 were eligible for inclusion in our analysis.

        Data synthesis: Studies consistently reported specific characteristics associated with codeine dependence, including mental health comorbidity and escalation of codeine use attributed to psychiatric problems. Case reports and series described codeine dependence masked by complications associated with overusing simple analgesics and delayed detection. Ten studies described the treatment of codeine dependence. Three reports identified a role for behavioural therapy; the efficacy of CYP inhibitors in a small open label trial was not confirmed in a randomised controlled trial; four case series/chart reviews described opioid agonist therapy and medicated inpatient withdrawal; two qualitative studies identified barriers related to perceptions of codeine-dependent people and treatment providers, and confirmed positive perceptions and treatment outcomes achieved with opioid agonist treatments.

        Conclusion: Strategies for identifying problematic codeine use are needed. Identifying codeine dependence in clinical settings is often delayed, contributing to serious morbidity. Commonly described approaches for managing codeine dependence include opioid taper, opioid agonist treatment, and psychological therapies. These approaches are consistent with published evidence for pharmaceutical opioid dependence treatment and with broader frameworks for treating opioid dependence.

        PROSPERO registration: CRD42016052129.


        • 1 National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW
        • 2 Currumbin Clinic, Gold Coast, QLD
        • 3 Griffith University, Gold Coast, QLD
        • 4 University of South Australia, Adelaide, SA
        • 5 Southern Adelaide Local Health Network, Adelaide, SA


        Correspondence: suzanne.nielsen@unsw.edu.au
        Acknowledgements: 

        Suzanne Nielsen holds a National Health and Medical Research Council Research Fellowship (1132433).

        Competing interests:

        Suzanne Nielsen is a named investigator on untied educational grants from Reckitt–Benckiser and Indivior. Tim MacDonald has received honoraria, fees and professional development resources from Servier, the Australian and New Zealand Mental Health Association, and Healthe Care; he works in the private sector and receives income for clinical services.

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          Population attributable fractions of perinatal outcomes for nulliparous women associated with overweight and obesity, 1990–2014

          Kate Cheney, Rachel Farber, Alexandra L Barratt, Kevin McGeechan, Bradley de Vries, Robert Ogle and Kirsten I Black
          Med J Aust 2018; 208 (3): . || doi: 10.5694/mja17.00344
          Published online: 12 February 2018

          Abstract

          Objective: To examine the prevalence across 25 years of overweight and obesity among nulliparous Australian women during early pregnancy; to estimate the proportions of adverse perinatal outcomes attributable to overweight and obesity in this population.

          Design: Cohort study; retrospective analysis of electronic maternity data.

          Setting, participants: 42 582 nulliparous women with singleton pregnancies giving birth at the Royal Prince Alfred Hospital, an urban teaching hospital in Sydney, January 1990 – December 2014.

          Main outcome measures: Maternal body mass index (BMI), socio-demographic characteristics, and selected maternal, birth and neonatal outcomes; the proportion of adverse perinatal outcomes that could be averted by reducing the prevalence of overweight and obesity in women prior to first pregnancies (population attributable fraction, PAF).

          Results: The prevalence of overweight among nulliparous pregnant women increased from 12.7% (1990–1994) to 16.4% (2010–2014); the prevalence of obesity rose from 4.8% to 7.3% in the same period, while the proportion with normal range BMIs fell from 73.5% to 68.2%. The PAFs for key adverse maternal and neonatal outcomes increased across the study period; during 2010–2014, 23.8% of pre-eclampsia, 23.4% of fetal macrosomia, and 17.0% of gestational diabetes were attributable to overweight and obesity. Were overweight and obese women to have moved down one BMI category during 2010–2014, 19% of pre-eclampsia, 15.9% of macrosomia, 14.2% of gestational diabetes, 8.5% of caesarean deliveries, 7.1% of low for gestational age birthweight, 6.8% of post partum haemorrhage, 6.5% of admissions to special care nursery, 5.8% of prematurity, and 3.8% of fetal abnormality could have been averted.

          Conclusions: Over the past 25 years, the proportions of adverse perinatal outcomes attributable to overweight and obesity have risen with the increasing prevalence of maternal overweight and obesity. A substantial proportion of these outcomes might be averted with obesity prevention strategies that reduce pre-pregnancy maternal weight.

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          • 1 Royal Prince Alfred Hospital, Sydney, NSW
          • 2 Sydney School of Public Health, University of Sydney, Sydney, NSW
          • 3 University of Sydney, Sydney, NSW


          Competing interests:

          No relevant disclosures.

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          • 29. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Management of obesity in pregnancy: College statement C-Obs 49. Updated Mar 2017. https://www.ranzcog.edu.au/Statements-Guidelines/Obstetrics/Obesity-in-Pregnancy,-Management-of-(C-Obs-49) (viewed July 2017).
          • 30. Talley N. National Health Summit on Obesity calls for Australia to take action to stem the pandemic. Med J Aust 2017; 206: 106-107. <MJA full text>

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            Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders: major depression summary

            Gin S Malhi, Tim Outhred, Amber Hamilton, Philip M Boyce, Richard Bryant, Paul B Fitzgerald, Bill Lyndon, Roger Mulder, Greg Murray, Richard J Porter, Ajeet B Singh and Kristina Fritz
            Med J Aust 2018; 208 (4): . || doi: 10.5694/mja17.00659
            Published online: 5 February 2018

            Abstract

            Introduction: In December 2015, the Royal Australian and New Zealand College of Psychiatrists published a comprehensive set of mood disorder clinical practice guidelines for psychiatrists, psychologists and mental health professionals. This guideline summary, directed broadly at primary care physicians, is an abridged version that focuses on major depression. It emphasises the importance of shared decision making, tailoring personalised care to the individual, and delivering care in the context of a therapeutic relationship. In practice, the management of depression is determined by a multitude of factors, including illness severity and putative aetiology, with the principal objectives of regaining premorbid functioning and improving resilience against recurrence of future episodes.

            Main recommendations: The guidelines emphasise a biopsychosocial lifestyle approach and provide the following specific clinical recommendations:

            • Alongside or before prescribing any form of treatment, consideration should be given to the implementation of strategies to manage stress, ensure appropriate sleep hygiene and enable uptake of healthy lifestyle changes.
            • For mild to moderate depression, psychological management alone is an appropriate first line treatment, especially early in the course of illness.
            • For moderate to severe depression, pharmacological management is usually necessary and is recommended first line, ideally in conjunction with psychosocial interventions.

             

            Changes in management as a result of the guidelines: The management of depression is anchored within a therapeutic relationship that attends to biopsychosocial lifestyle aspects and psychiatric diagnosis. The guidelines promote a broader approach to the formulation and management of depression, with treatments tailored to depressive subtypes and administered with clear steps in mind. Lifestyle and psychological therapies are favoured for less severe presentations, and concurrent antidepressant prescription is reserved for more severe and otherwise treatment-refractory cases.


            • 1 CADE Clinic, Royal North Shore Hospital, Sydney, NSW
            • 2 Northern Clinical School, University of Sydney, Sydney, NSW
            • 3 Westmead Clinical School, University of Sydney, Sydney, NSW
            • 4 UNSW Sydney, Sydney, NSW
            • 5 Epworth Clinic, Epworth Healthcare, Melbourne, VIC
            • 6 Monash Alfred Psychiatry Research Centre, Central Clinical School, Monash University, Melbourne, VIC
            • 7 Mood Disorders Unit, Northside Clinic, Sydney, NSW
            • 8 University of Otago, Christchurch, NZ
            • 9 Swinburne University of Technology, Melbourne, VIC
            • 10 Deakin University, Geelong, VIC


            Correspondence: gin.malhi@sydney.edu.au
            Acknowledgements: 

            The development of the clinical practice guidelines for mood disorders was supported and funded by the RANZCP.

            Competing interests:

            Gin Malhi has received grant or research support from Australian Rotary Health, the NHMRC, the American Foundation for Suicide Prevention, NSW Health, Ramsay Health, the University of Sydney, AstraZeneca, Eli Lilly, Organon, Pfizer, Servier and Wyeth; has been a speaker for AstraZeneca, Eli Lilly, Janssen-Cilag, Lundbeck, Pfizer, Ranbaxy, Servier and Wyeth; and has been a consultant for AstraZeneca, Eli Lilly, Janssen-Cilag, Lundbeck and Servier. Phillip Boyce has received consultation fees, sponsorship and speaker fees from Servier; is a member of the advisory board for Lundbeck, Eli Lilly, AstraZeneca and Janssen; has received speaker fees from Lundbeck, AstraZeneca and Janssen; and has received funding for a clinical trial from Brain Resource Company. Richard Bryant has received an NHMRC Program Grant and Project Grant. Paul Fitzgerald is supported by an NHMRC Practitioner Fellowship Grant; and has received equipment for research from MagVenture A/S, Medtronic Ltd, Neuronetics and Brainsway Ltd, and funding for research from Neuronetics. He is on scientific advisory boards for Bionomics Ltd and LivaNova and is a founder of TMS Clinics Australia. Bill Lyndon has received personal fees from Lundbeck Australia, AstraZeneca and Eli Lilly Australia. Greg Murray has received an NHMRC Project Grant and personal fees from Servier and CSL Biotherapies. Ajeet Singh has received personal fees from Servier Australia and Lundbeck Australia; has received a grant from Pfizer Australia; has equity in ; is the founder and owner of website; and has a patent on the Antidepressant Pharmacogenetics Report.

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              Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders: bipolar disorder summary

              Gin S Malhi, Tim Outhred, Grace Morris, Philip M Boyce, Richard Bryant, Paul B Fitzgerald, Malcolm J Hopwood, Bill Lyndon, Roger Mulder, Greg Murray, Richard J Porter, Ajeet B Singh and Kristina Fritz
              Med J Aust 2018; 208 (5): . || doi: 10.5694/mja17.00658
              Published online: 5 February 2018

              Abstract

              Introduction: In December 2015, the Royal Australian and New Zealand College of Psychiatrists published a comprehensive set of mood disorder clinical practice guidelines for psychiatrists, psychologists and mental health professionals. This guideline summary, directed broadly at primary care physicians, is an abridged version that focuses on bipolar disorder. It is intended as an aid to the management of this complex disorder for primary care physicians working in collaboration with psychiatrists to implement successful long term management.

              Main recommendations: The guidelines address the main phases of bipolar disorder with a particular emphasis on long term management, and provide specific clinical recommendations.

              Mania:

              • All physicians should be able to detect its early signs so that treatment can be initiated promptly.
              • At the outset, taper and cease medications with mood-elevating properties and institute measures to reduce stimulation, and transfer the patient to specialist care.

              Bipolar depression:

              • Treatment is complicated and may require trialling treatment combinations.
              • Monotherapy with mood-stabilising agents or second generation antipsychotics has demonstrated efficacy but using combinations of these agents along with antidepressants is sometimes necessary to achieve remission. Commencing adjunctive structured psychosocial treatments in this phase is benign and likely effective.

              Long term management:

              • Physicians should adjust treatment to prevent the recurrence of manic and/or depressive symptoms and optimise functional recovery.
              • Closely monitor the efficacy of pharmacological and psychological treatments, adverse effects and compliance.

              Changes in management as a result of the guidelines: The guidelines position bipolar disorder as part of a spectrum of mood disorders and provide a longitudinal perspective for assessment and treatment. They provide new management algorithms for the maintenance phase of treatment that underscore the importance of ongoing monitoring to achieve prophylaxis. As a first line treatment, lithium remains the most effective medication for the prevention of relapse and potential suicide, but requires nuanced management from both general practitioners and specialists. The guidelines provide clarity and simplicity for the long term management of bipolar disorder, incorporating the use of new medications and therapies alongside established treatments.


              • 1 CADE Clinic, Royal North Shore Hospital, Sydney, NSW
              • 2 Northern Clinical School, University of Sydney, Sydney, NSW
              • 3 Westmead Clinical School, University of Sydney, Sydney, NSW
              • 4 UNSW Sydney, Sydney, NSW
              • 5 Epworth Clinic, Epworth Healthcare, Melbourne, VIC
              • 6 Monash Alfred Psychiatry Research Centre, Central Clinical School, Monash University, Melbourne, VIC
              • 7 University of Melbourne, Melbourne, VIC
              • 8 Mood Disorders Unit, Northside Clinic, Sydney, NSW
              • 9 University of Otago, Christchurch, NZ
              • 10 Swinburne University of Technology, Melbourne, VIC
              • 11 Deakin University, Geelong, VIC


              Correspondence: gin.malhi@sydney.edu.au
              Acknowledgements: 

              The development of the clinical practice guidelines for mood disorders was supported and funded by the RANZCP.

              Competing interests:

              Gin Malhi has received grant or research support from Australian Rotary Health, the NHMRC, NSW Health, Ramsay Health, the University of Sydney, AstraZeneca, Eli Lilly, Organon, Pfizer, Servier and Wyeth; has been a speaker for AstraZeneca, Eli Lilly, Janssen-Cilag, Lundbeck, Pfizer, Ranbaxy, Servier and Wyeth; and has been a consultant for AstraZeneca, Eli Lilly, Janssen-Cilag, Lundbeck and Servier. Philip Boyce has received consultation fees, sponsorship and speaker fees from Servier; is a member of the advisory board for Lundbeck, Eli Lilly, AstraZeneca and Janssen; has received speaker fees from Lundbeck, AstraZeneca and Janssen; and has received funding for a clinical trial from Brain Resource Company. Richard Bryant has received an NHMRC Program Grant and Project Grant. Paul Fitzgerald is supported by an NHMRC Practitioner Fellowship Grant; and has received equipment for research from MagVenture A/S, Medtronic Ltd, Neuronetics and Brainsway Ltd, and funding for research from Neuronetics; he is on scientific advisory boards for Bionomics Ltd and LivaNova and is a founder of TMS Clinics Australia. Malcolm Hopwood has received a grant and personal fees from Servier, and personal fees from Lundbeck, Eli Lilly and AstraZeneca. Bill Lyndon has received personal fees from Lundbeck Australia, AstraZeneca and Eli Lilly Australia. Greg Murray has received an NHMRC Project Grant and personal fees from Servier and CSL Biotherapies. Ajeet Singh has received personal fees from Servier Australia and Lundbeck Australia; has received a grant from Pfizer Australia; has equity in ; is the founder and owner of website; and has a patent on the Antidepressant Pharmacogenetics Report.

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              • 52. Bassett D, Mulder R, Outhred T, et al. Defining disorders with permeable borders: you say bipolar, I say borderline! Bipolar Disord 2017; 19: 320-323.

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                Abnormal uterine bleeding: managing endometrial dysfunction and leiomyomas

                Annabelle Brennan and Martha Hickey
                Med J Aust 2018; 208 (2): . || doi: 10.5694/mja17.00726
                Published online: 5 February 2018

                Summary

                 

                • Abnormal uterine bleeding refers to any change in the regularity, frequency, heaviness or length of menstruation. There are several potential causes for bleeding disturbance, the two most common being primary endometrial dysfunction and fibroids. Management of abnormal uterine bleeding involves both medical and surgical options and will largely depend on a patient’s fertility plans.
                • The use of levonorgestrel-releasing intrauterine devices for heavy menstrual bleeding is increasing in Australia, and they are considered first-line medical management for women accepting of hormonal therapies. Tranexamic acid, non-steroidal anti-inflammatory drugs, the combined oral contraceptive pill and oral progestins offer alternatives.
                • Hysterectomy offers a definitive surgical approach to abnormal uterine bleeding and is associated with high levels of patient satisfaction.
                • Women wishing to preserve their fertility, or avoid hysterectomy, may be offered myomectomy. Submucosal fibroids should be removed via hysteroscopy in symptomatic or infertile patients. Intramural and subserosal fibroids may be removed via an open or laparoscopic approach.
                • There are several minimally invasive options, including uterine artery embolisation, magnetic resonance-guided focused ultrasound and endometrial ablation, but patients should be aware that there is insufficient evidence to ensure fertility preservation with these procedures and further research is needed.
                • Areas for additional research include cost-effectiveness of treatments and quality of life comparisons between management options using patient reported outcome measures to evaluate patient satisfaction.

                 


                • 1 Royal Women's Hospital, Melbourne, VIC
                • 2 Gynaecology Research Centre, Royal Women's Hospital, Melbourne, VIC


                Competing interests:

                No relevant disclosures.

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                  Frenotomy for tongue-tie in Australian children, 2006–2016: an increasing problem

                  Vishal Kapoor, Pamela S Douglas, Peter S Hill, Laurence J Walsh and Marc Tennant
                  Med J Aust 2018; 208 (2): . || doi: 10.5694/mja17.00438
                  Published online: 5 February 2018

                  There is no universally accepted definition of tongue-tie or ankyloglossia, but it may be described as a congenital abnormality of the lingual frenulum that limits the range of movement of the tongue, interfering with feeding or speech.1,2 There is little consensus among health professionals about how tongue-ties should be managed,1 and little reliable evidence for the benefits of frenotomy.2 A range of techniques are employed to treat clinically significant ties surgically (frenotomy or frenectomy), including scissors and laser surgery. Increases in the number of tongue-tie diagnoses and in lingual frenotomy rates have recently been reported in Canada and the United States.3,4

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                  • 1 University of Queensland, Brisbane, QLD
                  • 2 Lady Cilento Children's Hospital, Brisbane, QLD
                  • 3 The Possums Clinic, Brisbane, QLD
                  • 4 International Research Collaborative — Oral Health and Equity, University of Western Australia, Perth, WA


                  Competing interests:

                  No relevant disclosures.

                  • 1. Power R, Murphy J. Tongue-tie and frenotomy in infants with breastfeeding difficulties: achieving a balance. Arch Dis Child 2015; 100: 489-494.
                  • 2. O’Shea JE, Foster JP, O’Donnell CPF, et al. Frenotomy for tongue-tie in newborn infants. Cochrane Database Syst Rev 2017; (3): CD011065.
                  • 3. Walsh J, Links A, Boss E, Tunkel D. Ankyloglossia and lingual frenotomy: national trends in inpatient diagnosis and management in the United States, 1997–2012. Otolaryngol Head Neck Surg 2017; 156: 735-740.
                  • 4. Joseph KS, Kinniburg B, Metcalfe A, et al. Temporal trends in ankyloglossia and frenotomy in British Columbia, Canada, 2004–2013: a population-based study. CMAJ Open 2016; 4: e33-e40.
                  • 5. Douglas PS. Rethinking “posterior” tongue-tie. Breastfeed Med 2013; 8: 503-506.
                  • 6. Australian Bureau of Statistics [website]. 3101.0-Australian Demographic Statistics, Sept 2016. http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/3101.0Sep%202016?OpenDocument (viewed June 2017).

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                    Standard deviation and standard error: interpretation, usage and reporting

                    Petra Macaskill
                    Med J Aust 2018; 208 (2): . || doi: 10.5694/mja17.00633
                    Published online: 5 February 2018

                    Standard deviations (SDs) and standard errors are reported routinely in statistical analyses, but the distinction between them is not always well understood.1,2 Incorrect and also unclear reporting of results adds to the potential for confusion and misinterpretation of these measures.3,4


                    • University of Sydney, Sydney, NSW


                    Series Editors

                    John Attia

                    Michael Jones

                    Competing interests:

                    No relevant disclosures.

                    • 1. Altman DG, Bland JM. Standard deviations and standard errors. BMJ 2005; 331: 903.
                    • 2. Biau DJ. In brief: standard deviation and standard error. Clin Orthop Relat Res 2011; 469: 2661-2664.
                    • 3. Nagele P. Misuse of standard error of the mean (SEM) when reporting variability of a sample. A critical evaluation of four anaesthesia journals. Br J Anaesth 2003; 90: 514-516.
                    • 4. Wullschleger M, Aghlmandi S, Egger M, Zwahlen M. High incorrect use of the standard error of the mean (SEM) in original articles in three cardiovascular journals evaluated for 2012. PLoS One 2014; 9: 1-4.
                    • 5. Chapman AB, Schwartz GL, Boerwinkle E, Turner ST. Predictors of antihypertensive response to a standard dose of hydrochlorothiazide for essential hypertension. Kidney Int 2002; 61: 1047-1055.
                    • 6. Carlin JB, Doyle LW. Basic concepts of statistical reasoning: standard errors and confidence intervals. J Paediatr Child Health 2000; 36: 502-505.
                    • 7. Carlin JB, Doyle LW. Basic concepts of statistical reasoning: hypothesis tests and the t-test. J Paediatr Child Health 2001; 37: 72-77.

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                      Disease prestige and the hierarchy of suffering

                      Louise Stone
                      Med J Aust 2018; 208 (2): . || doi: 10.5694/mja17.00503
                      Published online: 5 February 2018

                      Suffering should not be hierarchical, and care should not be predicated on the prestige that a disease attracts

                      Symptoms may herald illness, but it is the diagnosis that announces the presence of disease. While the experience of illness is subjective, disease is authorised by a health professional through diagnosis (Box 1).1 A good diagnosis explains pathology, suggests prognosis, enables access to services, grounds evidence-based therapies and provides an explanation that makes sense of a patient’s suffering. Beyond this, a diagnosis justifies sickness, providing the patient with a rationale for their disabilities — for friends, family, employees, but most importantly for patients themselves.2 To be left without a diagnosis is to be left without a story, with no way of making sense of suffering or communicating distress to others. Diagnosis, then, is often a relief, even when the diagnosis suggests a bleak future (“thank goodness, I knew there was something wrong”).3

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                      • Australian National University, Canberra, ACT


                      Correspondence: louise.stone@anu.edu.au
                      Competing interests:

                      No relevant disclosures.

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                      • 12. McGowan L, Luker K, Creed F, Chew-Graham CA. ‘How do you explain a pain that can't be seen?’: the narratives of women with chronic pelvic pain and their disengagement with the diagnostic cycle. Br J Health Psychol 2007; 12: 261-274.
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                      • 14. Ryder AG, Chentsova-Dutton YE. Depression in cultural context: “Chinese somatization,” revisited. Psychiatr Clin North Am 2012; 35: 15-36.
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                      • 16. Sadler JZ. Values and psychiatric diagnosis. Oxford: Oxford University Press, 2005.

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