Expressed-emotion development and course of schizophrenic illness: considerations based on results of a CFI replication

This study examines the correlation between development of expressed emotion (EE) in relatives and course of illness of 99 DSM-III schizophrenic patients. Patients whose relatives were high EE at baseline and at the 2nd CFI approximately 20 months later had a poor prognosis at the very outset of the study and an unfavourable course of illness. They had a higher rehospitalisation rate, more symptoms, lower psychosocial assessment, and a poorer 2-year and even 8-year outcome. Patients from families with a fluctuating EE or a consistently low EE had better courses. Expessed emotion is therefore a valid predictor not only of symptomatic relapses, but also of other important aspects of schizophrenia. The connection between EE index and course of illness seerns not to be simply reactive or causal, but complex and non-uniform.     

Le rôle des représentations de la maladie et de la douleur dans la relation patient-thérapeute

Résumé  La rencontre entre patient et thérapeute dans la relation de soins met en présence non seulement deux individus, mais aussi deux systèmes de pensée. Elle suppose donc l'articulation de deux types de savoirs, profane d'une part et scientifique d'autre part. La clarification et la prise en compte des représentations du patient à propos de l'atteinte dont il souffre constitue un enjeu important de la relation. Il en va de même des attentes du thérapeute par rapport à ce qu'il considère comme un comportement douloureux adéquat, par exemple. Faute de la prise en compte des modèles de référence explicites et implicites tant du patient que du thérapeute, la relation peut déboucher sur des malentendus, des réactions d'agressivité, d'anxiété, et conduire à une rupture de cette relation.

---

Summary  The patient-therapist relationship involves not only two individuals, but also two systems of thinking. It calls forth lay knowledge on the one hand and scientific knowledge on the other hand. The patient's representations about his pain and suffering may play an important role in the patient-health care provider relationship and thus need to be clarified and taken into account. This need also holds true where the therapist's expectations are concerned, for example with regard to what is considered as an adequate pain behavior. Failing to take into account the explicit and implicit models of both the patient and the therapist may lead to misunderstandings, aggressive behaviors, anxious reactions, and thus hamper or even disrupt the patient-therapist relationship.

     

Effect of low glycogen on glycogen synthase in human muscle during and after exercise

Subjects cycled at a work load calculated to elicit 75% of maximal oxygen uptake on two occasions: the first to fatigue (34.5 ± 5.3 min; mean ± SE), and the second at the same workload and for the same duration as the first. Biopsies were obtained from the quadriceps femoris muscle before and immediately after exercise, and 5 min post-exercise. Before the first experiment, muscle glycogen was lowered by a combination of exercise and diet, and before the second, experiment muscle glycogen was elevated. In the low glycogen condition (LG), muscle glycogen decreased from 169 ± 15 mmol glucosyl units kg^-1dry wt at to rest to 13 ± 6 after exercise. In the high glycogen condition (HG) glycogen decreased from 706 ± 52 at rest to 405 ± 68 after exercise. Glycogen synthase fractional activity (GSF) was always higher during the LG treatment. During exercise in the HG condition, those subjects who cycled for < 35 min (n= 3) had GSF values in muscle which were lower than at rest, whereas those subjects who cycled for > 35 min (n= 4) had values which were similar to or higher than at rest. Thus the change in GSF in muscle during HG was positively related to the exercise duration (r= 0.94; y = 254–17x + 0.3x²; P < 0.001) and negatively related to the glycogen content at the end of exercise (r=–0.82; y= 516–2x + 0.001x²; P < 0.05). During LG exercise GSF remained constant. GSF increased markedly after 5 min post-exercise in both HG and LG conditions. cAMP dependent protein kinase activity increased similarly during both LG and HG exercise and reverted to the preexercise values 5 min post-exercise. It is concluded that muscle contraction decreases GSF, but low glycogen levels can attenuate or abolish the decrease in GSF. The rapid increase of GSF during recovery from exercise does not require glycogen depletion during the exercise.     

Prediction of outcome from intensive care after gastroenterologic emergency

Prognostic factors determining the outcome from intensive care were studied in 952 patients admitted to 25 Finnish ICUs after gastroenterologic emergency. Logistic regression analysis was used to create predictive models based on the APACHE II–system. The models were constructed by using data from a random two–thirds of the study population and validated in the remaining independent one–third together with the original APACHE II–index. The Acute Physiology Score, age, and a pre–existing liver disease were the three most important determinants of outcome. The inclusion of the TISS score describing the intensity of treatment into a model did not enhance the accuracy of the prediction. Our models were better calibrated than the original APACHE II–equation when tested by the goodness–of–fit –statistics. These statistical models may help the clinicians to predict the outcome for an individual patient by providing them information about the relative impacts of predictive factors or about the probability of death. These probabilities should be interpreted cautiously, taking into acount the limitations of statistical methods. This is especially important when assessing the highrisk patients. Their number in our study was too low for accurate outcome prediction.     

Relations between upper limb soft tissue disorders and repetitive movements at work

To make a preliminary assessment of whether upper limb soft tissue disorders might be associated with activities at work, we have conducted a case-control study of subjects attending orthopedic clinics in three cities. All subjects between the ages of 16 and 65 years, in whom defined soft tissue conditions of the upper limb were diagnosed by the participating orthopedic surgeons, were invited to take part. Controls were subjects attending the same clinics within the same age range whose clinical diagnosis did not include disease of the upper limb, cervical or thoracic spine. Information concerning repetitive movements of the upper limbs at work was elicited by questionnaire. Five hundred eighty cases and 996 controls were studied, representing 96% and 93%, respectively, of those invited to participate. The diagnoses of the cases included soft tissue conditions affecting the shoulder, elbow, forearm, wrist, thumb, hand, and fingers. The diagnoses of the controls included traumatic, degenerative, and inflammatory conditions, mostly of the legs and lower back. Women predominated among the cases (70%) and men among the controls (56%). Of 221 female cases with injury to the wrist and forearm, 32 were cleaner/domestics (14.5%) compared to 35 of 439 controls (8%), a difference statistically significant at the 2 1/2% level. Other jobs significantly overrepresented (5% level) among female cases with injuries at various anatomical sites included hairdressers, secretary/temps, assembly line workers, and machine operators (type unspecified). Among male cases, electricians were significantly overrepresented (5% level). Jobs for which there was a suggestion (p < 0.1) of overrepresentation among cases included butchers and teacher/ lecturers (both males only) and the combined job groups (chosen a priori for analysis) of keyboard operators, machine operators, and music teachers (all three jobs, females only).     

The Impact of Family Relations on Caregivers' Positive and Negative Appraisal of Their Caretaking Activities

This study examined the impact of family support and relationship difficulties between the caregiver and the care recipient on caregivers' satisfaction received from caregiving activities and subjective burden. Ninety‐seven individuals caring for a spouse or an adult child with schizophrenia or bipolar disorder participated in the study. Using hierarchical multiple regression analyses, findings showed that relationship difficulties between the caregiver and the care recipient were associated with both satisfaction received from caregiving activities and subjective burden, after the effects of personal, contextual, and stressor variables were controlled. Family support was not associated with caregivers' appraisal of the situation.     

Metastatic thyroid carcinoma presenting as an expansile intraluminal esophageal mass

We report a patient with metastatic thyroid carcinoma invading the esophagus in whom barium and MR examinations revealed an expansile intraluminal mass indistinguishable from that of a primary esophageal malignancy. Metastatic thyroid carcinoma should therefore be included in the differential diagnosis of an expansile esophageal mass. As in our patient, MR imaging may be useful for showing that the mass originates in the thyroid gland.     

医院门诊药房与医院分离的理性探讨

介绍了医药分业的定义、国外医药分业的目的和少数医院无门诊药房的原因。指出门诊药房从医院分离出去弊大于利,认为门诊药房从医院分离,难以达到预期目的,反而有损于医疗卫生事业的公益性;医药分离削弱、甚至取消了医院对医师不当处方和合理药物治疗等医疗行为的行政和技术监管与干预;医药分离不适合我国的国情,不符合我国卫生体制改革的精神,不利于医疗质量的提高,不利于病人安全、有效、经济用药,不利于调动医院广大药学技术人员的积极性,不利于医院药物治疗管理自动化的实现与信息的传递。建议医药结合的模式必须加强;保留门诊药房,加大监督力度;建立药品配送中心,完善社会化物流机制;加速非处方药药品的发展;在条件成熟后实施处方调剂费;高薪养廉,较大幅度提高医师职业的收入;解决当前医疗体系中分配不合理问题,适当提高挂号、手术、诊疗等收费标准,降低药品收入在医院总收入中所占的比例。     

普通外科危重患者围手术期的营养支持

目的：研究普通外科危重患者围手术期营养支持的临床疗效。方法：对1995年以来147例普通外科危重患者围手术期营养支持应用情况进行了分析，腹部手术138例（93.9%)，颈部手术9例（6.1%)，采用以全胃肠外营养（TPN）为主的阶段性营养支持方法补充营养。深静脉置管方法：经颈内静脉置管132例（89.8%)、腋静脉11例（7.5%)、股静脉4例（2.7%)，使用单腔导管127例（86.4%)，双腔20例（13.6%)，41例（27.9%)，放置肠内营养（EN）管。106例（72.1%)为TPN→PN 口服饮食→口服饮食，41例（27.9%)为TPN→PN EN→EN→EN 口服饮食→口服饮食。结果：本组营养支持期间无置管和代谢并发症。142例（96.6%)康复，5例（3.4%)死于原发病。结论：普通外科危重患者围手术期营养支持是重要辅助治疗方法，可保证手术安全，促进术后康复。