Arthroscopic-assisted hook plate fixation for acromioclavicular joint dislocation

Purpose

We present a new technique of arthroscopic-assisted AC-hook plate fixation for acromioclavicular joint dislocation with all the advantages of minimally invasive surgery and the possibility to treat concomitant pathologies.

Methods

Initially a glenohumeral arthroscopy is performed to address concomitant intra-articular injuries. Under subacromial visualisation the drill hole for the hook of the plate can be exactly positioned in the acromion. The hook plate is put in place under visual control.

Results

The initial results (n = 3) are promising with good to excellent results in the Constant score [90.5 (range 82–100)] in all cases studied. The cross-body test was slightly positive in one case. The median follow-up time after the index procedure was seven months (range five to ten).

Conclusions

In conclusion, arthroscopic-assisted reconstruction of acromioclavicular joint separation is feasible and may provide patients with all the benefits of AC-hook fixation with decreased risks related to open surgery. The described technique is recommended for all surgeons familiar with arthroscopic surgery.     

Facilitative effects of VNS on the motor threshold: implications for its antidepressive mode of action?

In the present study, the effects of vagus nerve stimulation (VNS) on the resting motor threshold (rMT) of patients treated with repetitive transcranial magnetic stimulation were evaluated. Patients showed a significant decrease in the rMT during VNS-on stimulation. VNS was the only significant factor affecting rMT changes and did not appear to be a static variable. Further studies should focus on the effect of VNS on neural neurogenesis in depressive disorders, and the effects of other treatment options for major depressive disorder on the rMT should also be determined.     

Psychometric properties of the Norwegian Impact of Event Scale-Revised in a non-clinical sample

Background: Despite the widespread use of the Impact of Event Scale to measure post-traumatic stress symptoms, psychometric evaluations of the scale have revealed mixed findings. Aim: The aim of the present study is to provide new empirical evidence and examine the factor structure, reliability, and predictive validity of the Norwegian version of the IES-R. Methods: Posttraumatic stress symptoms were recorded in a student sample (n=312) 3 weeks after the Southeast Asian tsunami disaster in December 2004. Confirmatory factor analyses of the IES-R behavior items using structural equation modeling (SEM) were performed on four models from existing research. Results: The original three-factor model of intrusion, avoidance and hyperarousal symptoms exhibited the best goodness-of-fit indices when defined as oblique. The IES-R also revealed satisfactory reliability. Symptom levels of intrusion and avoidance were moderate, while hyperarousal scores were low, with a significant gender difference. Conclusion: Taken together, the IES-R revealed good psychometric properties in this nonclinical student sample and could be a useful instrument to assess and follow-up on PTSD symptoms after a certain identified trauma.     

Social competence and emotional/behavioral problems in a birth cohort of Sami and Norwegian preadolescents in Arctic Norway as reported by mothers and teachers

In a 7-year follow-up birth cohort from the general population in the Sami core area in Finnmark, Arctic Norway, we examined mothers’ and teachers’ reports of social competence and emotional/behavioral problems among 71 indigenous Sami and 77 Norwegian 11–12-year-olds. The instruments used were the Child Behavior Checklist (CBCL) for parents and the Teacher Report Form (TRF). No ethnic differences were found on competence scales. Total Problems reported by Sami and Norwegian mothers were low in comparison with the overall mean found in multicultural meta-studies. Sami mothers reported lower Total Problems and Attention Problems than did Norwegian mothers. There were no ethnic differences on the TRF measures. Consistent with other international studies, mothers and teachers rated girls higher than boys on social competence and boys higher than girls on Externalizing and Attention Problems. Gender differences were larger on the TRF than on the CBCL. The very low problem ratings made by the Sami mothers indicate that there is a need for specific clinical cut-off points to distinguish between clinically referred and non-referred children in this indigenous Arctic population.     

Therapist predictors of early patient-rated working alliance: A multilevel approach

Abstract

The present study investigated whether and how various therapists' (N=68) self-reported characteristics relating to their therapeutic work predicted patients' (N = 335) early ratings of the working alliance in a naturalistic psychotherapy study. Results from multilevel modeling demonstrated that certain self-reports accounted well for the therapist effect in the early alliance. The effect of therapists' experiences of difficulties in practice was particularly strong: a negative influence of difficulties termed negative personal reaction (NPR) and a surprising positive influence of another factor, professional self-doubt (PSD), were found. The latter was interpreted as reflecting an attitude of therapist humbleness and sensitivity, which seems to facilitate alliance development. A negative impact of self-reported skills in using one's own and the patients' emotional reactions in the therapeutic relationship (advanced relational skills) was found when controlling for a warm interpersonal style. The negative effect of advanced relational skills depended on the level of NPR difficulties. The findings suggest that therapists should be cautious in using this kind of relational skill unless they experience relating to patients in a warm manner and report low levels of NPR in their practice.     

Prevalence of the metabolic syndrome in patients with borderline personality disorder: results from a cross-sectional study

Metabolic syndrome (MetS) is an important risk factor for the development of type-2 diabetes and coronary artery disease. We aimed to compare the MetS prevalence in patients with borderline personality disorder (BPD) with comparison subjects followed in primary care from a similar region. One hundred and thirty-five BPD patients according to DSM-IV diagnostic criteria were compared to 1009 subjects from primary care. We used the American Heart Association/National Heart, Lung and Blood Institute criteria to determine the rate of MetS. The age-standardized prevalence of MetS was more than double in patients with BPD compared to comparison subjects (23.3 vs. 10.6 %, p < 0.05). Regarding individual MetS criteria, hyperglycemia was significantly more prevalent in both genders (p < 0.05). Abdominal obesity (p < 0.05) and hypertriglyceridemia (p < 0.05) were significantly higher only in women with BPD. Within BPD patients, an increased rate of MetS was associated with higher BMI (p = 0.004), age (p = 0.03), treatment with second-generation antipsychotics (quetiapine, olanzapine and clozapine; p = 0.032), dysthymia (p = 0.031), panic disorder (p = 0.032), benzodiazepine dependency (p = 0.015) and binge eating disorder p = 0.02). Our results demonstrate an increased MetS rate, dysregulated glucose and lipid metabolism in patients with BPD. Cardiometabolic monitoring and careful screening for physical health conditions among people with BPD is warranted.     

Predictors of psychiatric comorbidity in cancer patients at the time of their discharge from the hospital

Purpose

A cancer diagnosis can have a substantial impact on one’s mental health. The present study investigated the prevalence and predictors of psychiatric comorbidities in cancer patients at the time of their discharge from the hospital.

Methods

Psychiatric comorbidities were assessed shortly before hospital discharge and half a year after hospitalization using a structured clinical interview (SCID), based on the diagnostic and statistical manual of mental disorders (DSM-IV). Frequencies at both time points were estimated using percentages and corresponding 95% confidence intervals. Predictors of mental disorders were identified using binary logistic regression models.

Results

At time of hospital discharge, 39 out of 334 patients (12%) were diagnosed with a psychiatric comorbidity, and 15 (7%) were diagnosed half a year later. Among the diagnoses, adjustment disorders (3%) were most frequent at the time of hospital release, while major depression (3%) was the most frequent 6 months later. Having a mental disorder was associated with unemployment (odds ratio (OR) 3.4, confidence interval (CI) 1.1–10.9, p = 0.04). There was no evidence that school education (OR 2.0, CI 0.4–9.0, p = 0.38), higher education (OR 0.7, CI 0.2–2.4, p = 0.60), income (OR 1.0, CI 1.0–1.0, p = 0.06), tumor stage (OR 1.1, CI 0.4–3.2, p = 0.85), type of disease (OR 0.6, CI 0.2–2.1, p = 0.47), pain (OR 1.0, CI 1.0–1.0, p = 0.15), fatigue (OR 1.0, CI 1.0–1.0, p = 0.77), or physical functioning (OR 1.0, CI 1.0–1.0, p = 0.54) were related to the presence of a psychiatric comorbidity.

Conclusions

Unemployment was associated with at least a threefold increased risk of mental disorder, which highlights the need for special attention to be given to this subgroup of cancer patients.