Improving GPs' skills and competencies in child psychiatry

Concerned at the poor availability of psychiatric services for children and adolescents, the Finnish Parliament allocated extra funds for their development during 2000 and 2001. With this subsidy, a project was set underway to update general practitioners' (GPs') skills and knowledge in child psychiatry. The problem-based learning (PBL) method was used, combined with multidisciplinary teamwork. The present paper reports on changes Finnish GPs' perceptions of their knowledge and skills in child psychiatry over a 1-year period. The study sample comprised 761 physicians working in health centres in the area of Tampere University Hospital, with a catchment population of one million. GPs' self-assessments of their skills in child psychiatry in 16 areas were collected by postal questionnaire in 2000 and 2001. The response rates were 66.1% and 57.1%, respectively. Those who answered in both years were included in the analysis (n=371). Some GPs felt that their skills and competencies had improved and some that they had declined, while the majority reported no changes. According to logistic regression analysis, the only factor explaining a marked positive change was participation in child psychiatric training. In two areas of competence, GPs who had attended child psychiatric training rated their skills as significantly better than those who had not attended such training. We conclude that the effect of this undertaking was modest when implemented as a one-off training event.     

Women's sleep in health and disease

A huge amount of knowledge about sleep has accumulated during the last 5 decades following the discovery of rapid eye movement (REM) sleep. Nevertheless, there are numerous areas of considerable ignorance. One of these concerns the particularities of sleep in women. Most basic and clinical studies have been performed in male subjects, and only very recently research groups around the world have addressed women's sleep in health and disease. In this review, we summarize the present knowledge on the influence of oestrogens on the brain and on the distinctive changes of sleep across the menstrual cycle, during pregnancy and menopause. In addition, studies in female rodents are reviewed as well as the knowledge on female peculiarities regarding the interactions between sleep regulation and age-related changes in circadian rhythms. We also address specific aspects of sleep loss and sleep disorders in women. Finally, very recent studies on the sociology of sleep are summarized and future directions in the field are discussed.     

Quantitative electroencephalographic measures in homicidal men with antisocial personality disorder

Many symptoms of antisocial personality disorder have been proposed to be related to decreased daytime vigilance. To explore this hypothesis, quantitative analyses were conducted of the electroencephalographic (EEG) activity of drug-free and detoxified homicidal male offenders with antisocial personality disorder as the primary diagnosis. Subjects comprised 16 men recruited from a forensic psychiatric examination in a special ward of a university psychiatric hospital. Fifteen healthy age- and gender-matched controls with no criminal record or history of physical violence consisted of hospital staff and students. An overall reduction of alpha power was observed in the waking EEG of offenders. A bilateral increase in occipital delta and theta power was also found in these individuals. This study provides further support to the growing evidence of brain dysfunction in severe aggressive behavior. Homicidal offenders with antisocial personality disorder seem to have difficulties in maintaining normal daytime arousal. Decreased vigilance, together with social and psychological variables, may explain their aberrant behavior in everyday life. New studies are, however, needed to specify the vigilance problems of this patient group.     

Periprosthetic tibial bone mineral density changes after total knee arthroplasty: one-year follow-up study of 69 patients

BACKGROUND: The critical structure supporting the prosthetic components in total knee arthroplasty (TKA) is tibial trabecular bone. The quality of tibial bone can be evaluated by bone mineral density (BMD) measurements. PATIENTS AND METHODS: We prospectively measured changes in BMD in the proximal tibia after cemented TKA in osteoarthrotic knees. 69 patients were scanned by dual-energy X-ray absorptiometry (DXA) within a week after surgery, and after 3, 6 and 12 months. RESULTS: At baseline, the medial region of interest (ROI) BMD was higher in the varus knees than in the valgus aligned knees (p=0.02). The medial metaphyseal ROI showed a decrease in BMD during the follow-up in preoperatively varus knee joints (p<0.001). In preoperatively valgus knees, there was a slight increase in medial compartment BMD which was not significant (p=0.2). Alignment correction in both groups showed bone remodeling giving similar medial and lateral BMD values, suggesting that the bone became equally strong in both compartments of the metaphysis. There was no association between increasing American Knee Society (AKS) scores and bone remodeling. INTERPRETATION: We suggest that this remodeling is caused by postoperative changes in tibial loading. Our results support the clinical importance of recreating proper valgus alignment of the knee joint in the TKA operation, thus possibly providing better conditions for longevity of the tibial component.     

Germline mutation analysis of the androgen receptor gene in Finnish patients with prostate cancer

PURPOSE: Steroid hormones, particularly androgens, are suspected to have a major role in prostate carcinogenesis. Since androgen receptor mediates androgenic effects on cells and recent studies suggest that the androgen receptor gene is a putative prostate cancer susceptibility locus, we screened the coding region of the androgen receptor gene for germline mutations using the genomic DNA of patients with prostate cancer. MATERIALS AND METHODS: DNA samples from 38 patients with early onset prostate cancer and 36 from Finnish prostate cancer families showing no male-to-male transmission of prostate cancer were analyzed for mutations in the androgen receptor gene using single strand conformation polymorphism analysis and subsequent sequencing. RESULTS: R726L substitution in the hormone binding region of androgen receptor was found in 1 prostate cancer family but no previously uncharacterized germline mutations were detected. CONCLUSIONS: Our results indicate that constitutional androgen receptor mutations explain only a small fraction of familial and early onset prostate cancer cases in Finland.     

Skin contamination by oestradiol gel--a remarkable source of error in plasma oestradiol measurements during percutaneous hormone replacement therapy

Objectives: To study the consequence of skin contamination by oestradiol gel on circulating plasma oestradiol levels. Methods: We studied ten healthy, hysterectomized postmenopausal women who had used percutaneous oestradiol gel for at least 2 years. After wash-out period percutaneous dose of 1.5 mg 17β-oestradiol was administered once a day in the evening. The gel was applied with a bare or gloved hand to an arm or thigh according to the schedule. Blood samples for assay of plasma oestradiol concentrations were collected from both cubital veins 12 h after gel administration, at baseline and every time after using the gel, for 2 weeks. Results: Plasma oestradiol concentrations were significantly higher in the gel-contaminated samples: in the cubital vein of the gel-applying arm and in the cubital vein of the forearm on which the gel had been spread. Conclusions: Skin contamination by topical 17β-oestradiol can distort plasma oestradiol measurements by giving much higher oestradiol concentrations than in reality there are in the systemic circulation. This has an important meaning when tailoring individual oestrogen therapy.     

Isolation of free DNA from archived serum samples suitable for molecular genetic studies

INTRODUCTION: Collected and archived serum samples could be important sources for genetic studies, once DNA suitable for molecular genetic studies could be obtained from them. METHODS: DNA was isolated from 54 archived sera samples, collected previously from the participants of a Hungarian allergy study, with commercially available isolation kit. The authors have determined the concentration of the isolated DNA (81.88 +/- 52.36 ng/ml) and the size of the isolated fragments was estimated using semiquantitative real-time PCR. Two primers were used producing two different fragment size, for the phospholipase 2A and the actin beta genes, and melting curve analyses was performed as quality control. RESULTS: The concentration of the phospholipase 2A product was 2.9798 +/- 5.4454 microg/microl and the actin beta gene was 0.0015 +/- 0.0011 microg/microl. The melting curve analysis served as a quality control for the determination of the size of PCR products. In the case of the phospholipase 2A all samples produced the 133 bp PCR fragments, except one, while in the case of actin beta gene only six sample showed the expected 178 bp product, all the others samples had smaller fragments. CONCLUSIONS: These results confirm the suitability of the DNA isolated from archived sera samples for further molecular biological studies (SNP analysis, mutation detection) and give an estimate for the product size of the isolated DNA. Sera samples have been collected years ago can be a good source of genetic information on different diseases.     

Long-term progestin therapy for female chronic respiratory insufficiency?

End-stage chronic obstructive pulmonary disease often leads to hypercapnic respiratory failure. Oxygen supplementation therapy may further aggravate hypercapnia and not all patients are compliant with non-invasive ventilation. This case documents successful control of chronic respiratory failure with medroxyprogesterone in a postmenopausal woman during 1-year follow-up.     

Lower limb motor restlessness in Asperger's disorder, measured using actometry

The movement disturbances and brain imaging findings in Asperger's disorder (AD) suggest a dopaminergic deficit in movement regulation. Movement disorders of different etiologies have been quantified and specified with actometry. We compared 10 AD patients with 10 healthy controls, measuring their rest-activities by actometry. The lower limb motor activity was significantly higher in the AD group. They also displayed a rhythmic, periodic movement pattern similar to akathisia. These findings suggest a hypothesis of idiopathic akathisia and a special sensitivity to adverse effects of neuroleptic drugs.