Showing papers by "Stockholm County Council published in 1997"

Cause‐Specific Mortality in Epilepsy: A Cohort Study of More Than 9,000 Patients Once Hospitalized for Epilepsy

Abstract: Summary: Purpose: We studied overall and cause-specific mortality rates in a large cohort of patients with epilepsy compared with mortality rates of the general population in the same geographic area. Methods: The cohort consisted of all patients (N = 9,061) aged >15 years admitted with a diagnosis of epilepsy for inpatient care in Stockholm during the years 1980–1989. All patients were followed in the National Cause-of-Death Register, from which the causes of death were obtained, until December 31, 1992. Thus, 53,520 person-years were observed. Mortality rates were compared with those of the general population of Stockholm. Results: We observed 4,001 deaths in the cohort, compared with an expected number of 1,109 deaths in the general population. This yielded a standardized mortality ratio (SMR) of 3.6 [95% confidence interval (CI) 3.5–3.71] Although highest in the younger patients, the SMR was significantly increased in all age groups. The excess mortality rate in the cohort was due to a wide range of causes of death, including malignant neoplasms [SMR 2.6 (2.4–2.8)], diseases of the circulatory system, [SMR 3.1 (3.0–3.3)], diseases of the respiratory system [SMR 4.0 (3.64.5)], diseases of the digestive system [SMR 5.1 (4.4–5.8)], and injuries and poisoning [SMR 5.6 (5.0–6.3)]. Conclusions: Our results demonstrate that this large subgroup of patients with a diagnosis of epilepsy, once hospitalized and discharged, is a population at risk, with an excess mortality rate due to several different causes.

Effect of different concentrations of EDTA on smear removal and collagen exposure in periodontitis-affected root surfaces.

Abstract: The purpose of the present study was to explore the possibility of obtaining an acceptable smear-removing and collagen-exposing effect following EDTA etching with concentrations lower than supersaturation (24%). A flat dentin surface was created on human teeth extracted due to severe periodontitis. The teeth were etched with the following concentrations of EDTA for 2 min: 1.5% (group I), 5% (group II), 15% (group III) and 24% (group IV), and evaluated with scanning electron microscopy with respect to smear layer removal and exposure of root-associated collagen fibers. It was found that neither 1.5% nor 5% EDTA etching was sufficient to dissolve the smear layer to any higher degree. Etching with 15% EDTA dissolved the smear more effectively than the lower concentrations and collagen fibers were sparsely found. Following etching with 24% EDTA (group IV), significantly less smear was seen on the dentin surfaces than in any of the other groups and collagen fibers were seen covering the entire intertubular dentin surfaces. Based on these findings, the concentration of EDTA should be somewhere between 15 to 24% in order to obtain an acceptable smear removing and collagen-exposing effect within a clinically acceptable time period.

A repetition-prediction study of European parasuicide populations: a summary of the first report from part II of the WHO/EURO Multicentre Study on Parasuicide in co-operation with the EC concerted action on attempted suicide.

Abstract: One of the aims of the European Study on Parasuicide, which was initiated by the Regional Office for the European Region of the World Health Organization in the mid-1980s, was to try to identify social and personal characteristics that are predictive of future suicidal behaviour. A follow-up interview study (the Repetition-Prediction Study) was designed, and to date 1145 first-wave interviews have been conducted at nine research centres, representing seven European countries. The present paper provides an abridged version of the first report from the study. The design and the instrument used (The European Parasuicide Study Interview Schedules, EPSIS I and II) are described. Some basic characteristics of the samples from the various centres, such as sex, age, method of suicide attempt, and history of previous attempts, are presented and compared. The male/female sex ratio ranged from 0.41 to 0.85; the mean age range for men was 33-45 years and that for women was 29-45 years. At all of the centres, self-poisoning was the most frequently employed method. On average, more than 50% of all respondents had attempted suicide at least once previously. The representativeness of the samples is discussed. There were differences between the centres in several respects, and also in some cases the representativeness of the different samples varied. Results obtained from analyses based on pooled data should therefore be treated with caution.

Relationship between apical and marginal healing in periradicular surgery

Abstract: Objective. The purpose of the present study was to evaluate the relationship between apical and marginal periodontal healing after periapical surgery. Study design. The investigation was conducted on 59 patients referred for periradicular surgery. A radiographic examination as well as assessments of periodontal attachment and pocket depth of teeth undergoing surgery and control teeth were performed at the time of surgery and 1 year after surgery. The radiographic periapical healing pattern was evaluated. Results. After an observation time of 1 year, 85% of the healing patterns were classified as successful or uncertain. Teeth within the surgical area showed a significant loss of clinical attachment during the observation period. The mean clinical attachment loss in teeth with an unsuccessful healing was 0.85 mm and differed significantly from successfully healed cases (mean, 0.15 mm). Conclusions. A persisting endodontic infection may be regarded as a contributing risk factor for a progressing marginal attachment loss.

Blood cadmium as an indicator of dose in a long-term follow-up of workers previously exposed to cadmium

Abstract: Objectives This investigation attempted to follow the tubular function of 46 workers initially examined in 1984 and heavily exposed to cadmium 1955 to 1978 and the occurrence of renal stones among these workers. The different markers of tubular dysfunction were also studied, and blood cadmium was evaluated as an estimate of dose after the cessation of cadmium exposure. Methods Cadmium in blood (B-Cd) and urine (U-Cd) and the urinary excretion of b2-microglobulin (U-b2-microglobulin), protein HC (a1-microglobulin) and N-Acetyl-b-D-glucosaminidase (NAG) were determined. Results Although cadmium exposure ceased in 1978, 40% of the workers showed signs of tubular dysfunction both in 1984 and in 1993. The current B-Cd was the best dose indicator. Dose-response relationships were found for B-Cd and various tubular markers (U-b2-microglobulin, protein HC and NAG). Protein HC appeared to be the most sensitive, as well as an early, indicator of cadmium-induced tubular dysfunction. The levels of U-Cd had an average decrease of 48% for persons with a normal tubular function, 56% for those with slight tubular dysfunction, and 62% for workers with severe tubular damage. A history of renal stones was significantly more common for workers with high B-Cd levels. Conclusions Cadmium-induced tubular dysfunction is irreversible and best assessed in an analysis of protein HC (a1-microglobulin) in urine. B-Cd is the best dose estimate several years after the cessation of exposure, whereas U-Cd is less suitable for dose assessment in follow-up studies of persons with persistent tubular damage.

Contacts of suicide attempters with GPs prior to the event: a comparison between Stockholm and Bern

Abstract: The aim of this study was to investigate patterns of contact made with GPs by subjects in two cities prior to attempting suicide, in order to determine whether differences in the health care systems could be a possible factor influencing the help-seeking behaviour of people experiencing suicidal crises. Structured interviews were conducted with suicide attempters from geographically defined catchment areas in two countries with private and national health care systems, respectively. The subjects were suicide attempters, admitted consecutively, aged > or = 15 years and living either in Stockholm (n=202) or in Bern (n=66). Patients living in Bern had seen their GPs more regularly and more frequently throughout the year. There was an increase in the number of visits to the GP prior to the suicide attempt in both cities, but it was greater in Stockholm than in Bern. However, in Stockholm fewer patients who saw their GP in the week before the attempt talked about their suicidal thoughts. The differences in help-seeking behaviour between the two patient samples may be related to the higher number of practising GPs and a more personal and consistent patient-doctor relationship in Bern. It is possible that the private medical care system in Switzerland lowers the threshold enabling patients to talk to their GP about their suicidal plans. The results suggest that in both cities there is scope for improving communication of the suicidal patient with his or her doctor. Language: en

Tyrosine hydroxylase allelic distribution in suicide attempters

Abstract: A tetranucleotide repeat polymorphism in the first intron of the tyrosine hydroxylase (TH) locus was examined in a group of 118 adult suicide attempters and 78 control subjects. The suicide attempters were diagnosed according to DSM-III-R criteria at the index attempt and represented the following diagnoses: major depression (18), dysthymia (13), anxiety disorders (16), adjustment disorders (29), psychoactive substance abuse disorders (27) and psychotic disorders (15). A significant variation in the prevalence of carriers of the TH-K3 allele (high for suicide attempters with adjustment disorders, P =0.0023) and a tendency toward a variation of the TH-K1 allele (low among all suicide attempters, P =0.046) was observed. In light of other data the variation of TH-K1 and TH-K3 suggests that these alleles may reflect predisposition for a common phenotype with altered vulnerability for psychiatric disorders. © 1997 Elsevier Science Ireland Ltd.

When reality doesn't fit the blueprint: Doing research on psychoanalysis and long-term psychotherapy in a public health service program

Abstract: A public health service program in Sweden, involving the funding of psychoanalysis and long-term psychotherapy, seemed to offer an opportunity to conduct a large-scale natural experiment on long-term psychotherapy and psychoanalysis. This paper describes our experiences with this project, focusing on the methodological and practical difficulties we encountered in implementing our plans, primarily because of the complexities of patients' treatment histories and the consequent lack of control over the treatment variable. Thus, when confronted with the conditions of reality, our experimental design had to be transformed into a quasi-experimental one. Despite the various problems, valuable data has been secured on such issues as psychometrics, health outcomes, and comparative outcome processes. We conclude that health service projects may provide rare opportunities for conducting long-term psychotherapy outcome research, at the same time creating conflicts between external and internal validity.Empirische Dat...

Hepatitis A immunity in the Swedish population. A study of the prevalence of markers in the Swedish population.

Abstract: After a 20-year interval, the prevalence of seroimmunity to Hepatitis A (HA) was again investigated in a statistical sample of the adult Swedish population. Sera from 3382 of the 4800 originally selected persons were tested. The prevalence of antibodies to HA had not changed since the 1960s when only the Scandinavian population was considered. In the oldest population born at the beginning of this century, the presence of antibodies amounted to 69%. It gradually declined to 6% in those born in the 1940s. In the population born after 1950, the percentage of seropositive individuals was only 2%. A slightly higher prevalence was seen in the big cities, compared with the rural areas (13% vs 9%). Persons of non-Scandinavian origin showed a different pattern. Those from other European countries showed a prevalence of about 70% in all the age-groups investigated. Among the young adults of Arabic or Asiatic origin, the figure was > 90%. The conclusion is that the native Swedish population has a low natural exposure to HA, which has not changed during the last 20 years. Prophylaxis before going to countries where the disease is endemic is strongly recommended.

Strategies and Methods for Implementing a Community-Based Diabetes Primary Prevention Program in Sweden

Abstract: SUMMARY Non-insulin-dependent diabetes mellitus (NIDDM) is the most common type of diabetes with a prevalence of at least 4% in Sweden. There is convincing evidence that, besides a genetic predisposition, exogenous factors such as poor dietary habits (high fat, low fibre content), low physical activity and obesity are serious risk factors for NIDDM. Steps have been taken to develop a primary prevention program for NIDDM in Stockholm, Sweden. The program aims to reduce the incidence of NIDDM by 25% over a 10-year period, by influencing the risk factors in the populations of three intervention municipalities. The intervention will be developed through two approaches: ‘community intervention’, and ‘intervention within community’. Evaluation of the program will be performed by monitoring the prevalence and incidence of diabetes in the target population and by assessing the effects of strategies designed to increase physical exercise and improve diet. Furthermore, changes in awareness, knowledge, attitudes and practices related to prevention of diabetes, will be investigated. For this purpose, a baseline study is carried out in the three intervention municipalities and two selected control municipalities. The baseline study includes a sample of about 3200 men and the same number of women, aged 35‐54 years, from intervention and control populations. A follow-up study after 5 and 10 years will be made.

The prevalence of hepatitis B in Sweden; a statistical serosurvey of 3381 Swedish inhabitants.

Abstract: The prevalence of hepatitis B virus markers in the adult Swedish population was investigated according to age, sex, origin and demographic stratum. Sera were collected from 3382 persons in 1990-1. The sera were selected on a statistical basis considered to be representative of the Swedish population from adults aged > or = 18 years. Two of the sera (0.06%) were found to be hepatitis B surface antigen positive. The two hepatitis B carriers were of non-Scandinavian origin as were (8.9%) of those tested. A total of 90 persons had a marker of previous, hepatitis B virus infection, i.e. antibodies against hepatitis B core antigen. Of these, 66 (2.0%) were of Scandinavian origin and 24 (18.1%) from highly endemic areas. The overall hepatitis B virus marker prevalence was 2.7%. The highest age-specific prevalence of hepatitis B markers in those of Scandinavian origin was in those born in 1939 and earlier. In this age-group, women had a significantly higher prevalence (3.6%) than males (1.9%). The lowest prevalence was found in those born in 1970 and later. No significant, age-related differences between younger or older persons, or between men and women, could be found in persons of non-Scandinavian origin. The results showed significant differences in exposure to hepatitis B virus among the indigenous population, compared with those of non-Scandinavian extraction. The results do not support the proposal to include hepatitis B vaccination in the Swedish immunization schedule.

Nursing process documentation--effects on workload and quality when using a computer program and a key word model for nursing documentation.

Abstract: In 1993 the federation of County Councils commissioned Spri to carry out a broadly based study aimed at investigating individualised patient care as described in the notes kept at various care units using computers to support documentation of the nursing process. The wards involved in the study represented various disciplines such as surgery, obstetrics, internal medicine, geriatrics and psychiatry. During the study period certain measures designed to improve the documentation were implemented i.e. a special computer program and structured nursing documentation following the VIPS-model. Interviews with staff at the units confirm that the introduction of computers, in combination with the structure of the VIPS-model and training in nursing documentation, has made changes possible to working procedures and brought greater goal orientation to the activity of care. The overall examination of the nursing entries in the patients' notes showed that the language has improved. The entries were to a greater extent expressed clearly and distinctly.

Relationships between traumatic life events, symptoms and Sense of Coherence subscale meaningfulness in a group of refugee and immigrant patients referred to a psychiatric outpatient clinic in Stockholm

Abstract: This pilot study had the aim to test the long version of the Sense of Coherence (SOC) questionnaire and its relationship to mental symptoms using the Structured Clinical Interview for DSM-III-R (SCID) and a battery of traumatic life event questionnaires, in a multicultural immigrant and refugee sample of 33 volunteer patients at a psychiatric outpatient clinic. The total mean value of SOC was very low: 104.6 (SD=13.7), which is over 30 points lower than most published normative data. Since the Cronbach alpha coefficient was very low in this sample for SOC, totally 0.17, we analyzed the subscale with the highest alpha, i.e., meaningfulness 0.62. The SOC subscale meaningfulness scores were significantly correlated with three of the four dimensions of the Structured Clinical Interview for DSM-III-R used as well as with traumatic life events and mental symptoms. No gender differences were found. The results of this study are consistent with previously reported cross-sectional data, i.e., that low SOC subscale meaningfulness is associated with mental distress and impaired functioning. However, these findings must be considered in light of methodological issues and the limitations of research in this area. Implications of these findings are presented, as are methodological issues that concern Antonovsky's measure.

Psychoeducation for patients with bipolar disorder: An exploratory study

Abstract: We explored the effects of an education package on outpatients with bipolar disorder. The primary goals were to determine whether the patients' knowledge of the illness would be improved after an educational intervention and whether education would lead to changes in such areas as attitudes to lithium and psychiatric well-being. We also examined whether changes would be maintained at follow-up. This study included 10 patients with a DSM-III-R diagnosis of bipolar disorder. The patients were given a six-session education package that covered the following areas: 1) demographics; 2) aetiology; 3) illness (course and symp toms); 4) treatment; 5) hospital procedures; and 6) coping (including problem-solving) with the illness and stress. Patients were assessed immediately before and after the intervention, and at a 6-month follow-up. The measures used were The Bipolar Knowledge Questionnaire, The Lithium Attitudes Questionnaire, The Rosenberg Self-Esteem Scale. The Hopelessness Scale, The General Health Questi...

Reduction of the mite-allergen reservoir within mattresses by vacuum-cleaning. A comparison of three vacuum-cleaning systems

Abstract: Mattresses are considered to be the main source of house-dust-mite (HDM) allergen. This study aimed to investigate different types of vacuum cleaners for their ability to reduce this allergen reservoir. Three types of vacuum cleaners were examined: a conventional vacuum cleaner, a water-trap cleaner, and a central vacuum cleaner. Cut out pieces of mattresses were analyzed for content of mite allergen after vacuum-cleaning. Three polyester mattresses from the homes of three children were selected for the study. These three mattresses had earlier been found to be contaminated by group 1 HDM allergen (8-15 micrograms/g of dust). Each mattress was divided into three main sections, separated by a safety zone, and each main section was subdivided into four parts. The three main sections were cleaned by each vacuum-cleaning system. Pieces 2-cm-thick of the surface of the mattresses were cut out, and extracts were made to assess the amount of mite allergen still present after different intensities of vacuum-cleaning. A considerable reduction in the level of mite allergen was found after using all three of the vacuum-cleaning systems. Only 22% of the original mite-allergen reservoir remained after intense vacuum-cleaning. Since the number of mattresses in the investigation was low, and niche formations of group 1 HDM allergen within the mattresses were observed, the results must be interpreted with caution. Furthermore, allergen-producing living dust mites were not affected by this method. However, intense vacuum-cleaning seems to reduce considerably the level of the mattress-bound mite-allergen reservoir, a fact which may be important in mite-allergic and mite-exposed families.

Separation, termination process and long-term outcome in psychotherapy with severely disturbed patients.

Abstract: Long-term consequences of working through of intratherapeutic separations were studied in combined psychotherapy and milieu therapy with severely disturbed adult patients. Seven of the 10 cases were consistent with the hypothesis about the significance of therapeutic work with separation for the longitudinal outcome. Inability to mourn was connected with less emotional and functional improvement. Besides the therapist's contribution in the middle phase, the patients' different ways of dealing with the trauma of termination were decisive.

Periodontal healing in horizontal and vertical defects following surgical or non-surgical therapy.

Abstract: The aim of the present study was to investigate any relationship between the level of oral hygiene and probing pocket depth reduction over time after periodontal treatment in sites with either vertical or horizontal destructions. The investigation was conducted as a retrospective study on a 3-year consecutive referral population of periodontitis-prone patients based on full-mouth oral radiographic examinations, probing pocket depth registrations and plaque scores. The analyses were performed on a final sample of 3064 sites in 107 patients with regression analysis after adjusting for dependence within the patient. Probing pocket depth was significantly less reduced over time in sites with vertical destructions compared to sites with horizontal destructions following non-surgical treatment. Furthermore, the difference in probing pocket depth reduction between vertical and horizontal defects following non-surgical treatment increased over time in sites with plaque compared to sites without plaque, thus reflecting the importance of the patient's plaque control, especially in sites with vertical destructions. However, the difference in probing pocket depth reduction between vertical and horizontal defects did not increase over time for surgically treated teeth, a finding which probably can be attributed to a more thorough debridement of vertical defects during surgery and/or osteoplasty/osteoectomy limiting the surface area upon which a long junctional epithelium can form, which may facilitate recurrence of a periodontal pocket.

Psychotherapeutic change is predictable, spontaneous change is not.

Abstract: As a test of the possibility clinically to predict psychotherapy outcome for individual patients, eight psychotherapist judges rated 30 patients for suitability for psychotherapy and predicted individual outcomes of psychotherapy. Unknown to the judges, 15 of the patients had been in psychotherapy (T group), whereas the remaining 15 had not (NT group), but all patients had been rated with respect to change. The hypothesis was confirmed that judges would be able to predict change in the T group better than in the NT group, but that their suitability ratings would be equally predictive of change in the two groups. It was concluded that psychotherapeutic change was a systematic effect over and above initial status, large with some patients, small with others, but reliably so.

Evaluation of surveillance programmes for colorectal cancer in ulcerative colitis patients by case-control studies: methodological considerations

Abstract: Objectives-The evaluation of the efficacy of colonoscopy screening in patients with ulcerative colitis for colorectal cancer is associated with methodological difficul­ ties. Case-control studies can, however, be used to determine the efficacy of such a programme and the outline of the meth­ odology in such a programme is pre­ sented. Methods-The randomised controlled trial provides perspective for case-control studies of screening efficacy. Cases are selected from persons who have ulcerative colitis with manifestations of colorectal cancer: for example, those who have died of colorectal cancer or have symptomatic metastases. Controls are selected from persons who have ulcerative colitis, who had been alive when the case died of colorectal cancer, and who had been subject to the risk of dying from, but had not had, colorectal cancer diagnosed when the case was diagnosed with colorectal cancer. The relevant screening history for cases begins with the case's diagnosis of ulcerative colitis and ends with the case's diagnosis of colorectal cancer; that for controls should be comparable to that for cases to avoid bias. Cases and controls are compared with respect to their "expo­ sure" to colonoscopy during their screen­ ing histories: the occurrence of any screening, which took place during the period of time that an occult tumour (or an identifiable lesion) may plausibly have been present. Conclusion-The proposed methodology can evaluate the efficacy of a screening programme rapidly, practically, and ethi­ cally. (Journal ofMedical Screening 1997;4: 137-141)

Natural killer cell activity and CSF monoamine metabolites in suicide attempters

Abstract: The aim of this study was to investigate markers of serotonin and immune function in suicidal patients. Cytotoxic activity of natural killer cells (NK) and CD16 lymphocytes were studied in 28 suicide attempters and 26 healthy controls, and related in patients to 5-hydroxyindoleacetic acid (5-HIAA) in cerebrospinal fluid (CSF). Patients with CSF 5-HIAA below the median had significantly lower NK cell activity than other patients. CD16 cell frequency was significantly lower in patients than in controls, and patients also tended to have lower NK cell cytotoxicity than healthy controls. There were no statistically significant correlations between 4-hydroxy-3methoxyphenyl glycol (HMPG), homovanillic acid (HVA), CSF cortisol and NK cell activity. The results support the hypothesis of compromised immune function in suicidal patients with evidence of disordered serotonin function.