Abdominal distension is one of the principal features of irritable bowel syndrome.'~' Characteristically, patients report that distension is absent in the morning and progressively appears during the day with eating being the most frequent exacerbating factor.4 The cause is entirely unclear and many question whether it is even a real phenomenon. Explanations to account for this symptom include excessive intraabdominal gas, depression of the diaphragm, increased lumbar lordosis, and voluntary protrusion of the abdomen.' There has been little or no investigation of the subject, however, not even to the extent of documenting whether girth does actually alter during the day.It was the purpose of this study to confirm or refute the existence of abdominal distension by objective measurements and then examine possible mechanisms with the aid of computed tomography.

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The purpose of this paper is to present an “Integrated Clinical Behavioral Assessment Approach” for use with persons with severe and persistent mental illness. This approach has been viewed as effective in facilitating successful competitive vocational outcomes within a model community support program.

BackgroundCervical cancer is the most common form of cancer in black women in South Africa and has almost a 60% mortality rate. However, adherence to cervical screening programmes of black women living in rural South Africa is not universal.AimThe aim of this study was to gain a better understanding of rural Zulu women’s knowledge of and attitudes towards Pap smear tests, and their reasons for participation or non-compliance with cervical screening.SettingThis study was conducted at the gynaecology and antenatal clinics in a secondary referral hospital in rural KwaZulu-Natal.MethodsA hospital-based cross-sectional study was undertaken in the form of a semi-structured patient questionnaire survey with open and closed questions. The responses to the open-ended questions were manually analysed by the authors using a thematic approach. Outcome measures included whether the woman had a previous Pap smear, her understanding of the cervical screening programme and causes of cervical cancer.ResultsThis study included a total analysis of 234 responses. The mean age was 29 years (s.d. = 8.3 years). Overall, 32.5% of women had previously had a Pap smear. Among the responders, 33.3% were human immunodeficiency virus (HIV)-positive and 53.0% were HIV-negative. Only 19.2% of women understood that a Pap smear was related to screening for cervical cancer.ConclusionsThis study illustrated a poor understanding of cervical screening, which may result in the low level of uptake of Pap smear reported; this is particularly concerning in HIV-positive women, who are at higher risk of developing cervical cancer. Urgent and extensive public health campaigning is required within rural South Africa to improve cervical screening uptake and decrease cervical cancer mortality.