Patient characteristics in relation to perceptions of how individualized care is delivered--research into the sensitivity of the Individualized Care Scale.

The purposes of this study were to examine how hospital patients' backgrounds and clinical illness are related to their perceptions of the individualized care they receive and to test the sensitivity of the Individualized Care Scale (ICS). Cross-sectional explorative survey data were obtained using questionnaires completed by 861 (response rate = 88%) predischarge hospital patients from six hospitals in Southern Finland in 2004. Self-administered questionnaires included the ICS as well as the 15D, a measure of health-related quality of life, and gathered information about the patients' backgrounds. Based on association tests, younger age, poorer state of health, and higher level of education were associated with more critical perceptions of individualized care. Using simultaneous regression analysis and presenting the results from stronger to weaker, we found age to be the strongest predictor of patients' positive perceptions of the individualized care they received. This was followed by health-related quality of life (HRQoL) as measured by the 15D, vocational education, and type of admission. The ICS was found to be a valid tool for the measurement of individualized care in hospitals. The self-reported patient data from this survey suggest that some patient characteristics are associated with the patients' perceptions about the individualized care they receive. There is now a need to consider how these characteristics can be taken into account in nursing care delivery to increase individualized care for hospital patients. The results also support use of the ICS in the measurement of individualized care in hospitals.     

Effect of alcohol abuse on human brain histamine and tele-methylhistamine

Inflammation Research -     

Adolescent suicides with adjustment disorders or no psychiatric diagnosis

Detailed characteristics of adolescent suicides (aged 13–19 years) with adjustment disorders (AD) (N=11) or no psychiatric diagnosis (N=3) in a nationwide adolescent suicide population (N=53) from Finland are presented. The data were collected in a psychological autopsy study of all suicides in Finland (N=1397) during a 12-month period in 1987–1988. Data collection included thorough interviews with the victims' family members and professionals, and information from official records. All the suicides with AD or no diagnosis were males. Most of these victims used highly lethal suicide methods. Previous psychiatric treatment and previous suicide attempts were rare. They were seldom under the influence of alcohol when committing suicide. The process leading to suicide seemed to be of relatively short duration. According to informant reports, withdrawn or narcissistic individual characteristics predominated in many cases. Psychosocial stressors preceding suicide often involved interpersonal losses or conflicts. Talking of suicidal intentions prior to the act was common, indicating the need to take seriously all adolescents' expressions of intended suicide, even in the absence of explicit psychopathology.

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Zusammenfassung Es werden detaiilierte Beschreibungen von Selbst-morden im Jugendalter, verbunden mit Anpassungsstörungen (N=11) oder keiner psychiatrischen Diagnose (N=3) vorgestellt. Diese stammten aus der Gesamtheit aller jugendlichen Selbstmörder (N=53) aus Finnland. Die Daten wurden in einer psychologischen Obduktionsstudie aller Selbstmörder Finnlands (N=1397) während eines einjährigen Zeitraumes zwischen 1987 und 1988 gesammelt. Die Datenerhebung umfaßte ausgiebige Interviews mit den Familienmitgliedern, beteiligten Fachkräften und Informationen von offizieller Seite. Die Selbstmörder mit Anpassungstörungen oder keiner Diagnose waren alle männlich. Die meisten dieser Opfer benützten sehr letale Suizidmethoden. Vorangegangene psychiatrische Behandlungen und Selbstmordversuche waren selten. Sie standen nur selten unter dem Enfluß von Alkohol, als der Selbstmord vollzogen wurde. Der Prozeß, der zu dem Suizid führte, schien von relativ kurzer Dauer zu sein. Entsprechend den Angaben der Informanden prädominierten in vielen Fällen zurückgezogene oder narzißtische Persönlichkeitsmerkmale. Psychosoziale Stressoren, die dem Suizid vorangingen, umfaßten interpersonelle Verluste oder Konflikte. Häufig wurde über die Suizidabsichten vor der Tat gesprochen. Dies verdeutlicht die Notwendigkeit, alle Suizidäußerungen von Jugendlichen ernstzunehmen, selbst dann, wenn eine explizite Psychopathologie fehlt.

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Résumé Les caractéristiques détaillées de suicides d'adolescents (âgés de 13 à 19 ans) avec troubles avec l'adaptation (AD) (N=11) ou l'absence de diagnostic psychiatrique (N=3) sur une population de suicides d'adolescents s'étendant sur l'ensemble du pays (N=53), la Finlande sont présentées. Les faits ont été collectés dans le cadre d'une étude d'autopsie psychologique de tous les suicides en Finlande (N=1397) pendant une période de 12 mois 1987–1988. Le recueil des faits incluait des interviews avec les membres de la famille des victimes et les professionels ainsi que les informations provenant de documents officiels. Tous les suicides avec un trouble de l'adaptation ou sans diagnostic étaient masculins. La plupart de ces victimes utilisait des méthodes hautement mortelles. Les traitements psychiatriques précédents et les tentatives précédentes de suicides étaient rares. Ils étaient rarement sous l'influence de l'alcool quand ils ont commis les suicides. Le processus conduisant au suicide semblait être de durée relativement brève. Selon les rapports d'information, une attitude de retrait ou des caractéristiques individuelles de retrait prédominaient dans la majorité des cas. Les facteurs de stress psycho-sociaux précédent le suicide impliquaient souvent des pertes inter-personnelles ou des conflits. Parler du désir du suicide devant le passage à l'acte était habituel indiquant la nécessité de prendre au sérieux tous les adolescents exprimant le désir de suicide, même en l'absence d'une psychopathologie explicite.

     

Pharmacokinetics in Rat of 3-Chloro-4-(dichloromethyl)-5-hydroxy-2(5H)-furanone (MX), a Drinking Water Mutagen,after a Single Dose

Abstract: The pharmacokinetics of 3-chloro-4-(dichloromethyl)-5-hydroxy-2(5H)-furanone (MX) was evaluated after a single oral or intravenous administration in the rats using ¹⁴C-labelled compound. Twenty to 35% of the dose was absorbed into circulation from the gastrointestinal tract as assessed from the excretion in urine. The mean elimination half-life of the radioactivity in blood (T_1/2 k₁₀) was 3.8 hr. Traces of radioactivity remained in the blood for several days. The tissues lining the gastrointestinal and urinary tract, kidneys, stomach, small intestines and urinary bladder contained the highest radioactivity. The activity declined slowest in the kidneys. Urine was the main excretion route. Seventy-seven % of the total amount excreted appeared in urine in 12 hr and 90% in 24 hr. No radioactivity was exhaled in air suggesting that elimination through respiration did not occur. After an intravenous administration of ¹⁴C-MX, the T_1/2 k₁₀, was much longer, 22.9 hr, and the total elimination half-life (T_1/2 β), 42.1 hr. The results indicate that MX is absorbed from the gastrointestinal tract to a considerable degree and it is excreted in urine very rapidly. A fraction of MX or its metabolites is retained in blood for a longer period of time. The pharmacokinetics of MX does not suggest extensive cumulation of MX in tissues after continuous exposure.     

Recombinant allergen fragments as candidate preparations for allergen immunotherapy

Background: Lately, renewed interest has arisen in the new forms of allergen immunotherapy because they may offer alternatives for drug treatment. Objective: The purpose of this study was to develop a well-characterized preparation of the main respiratory cow dander allergen, Bos d 2, with attenuated allergenic activity. Methods: The immunologic characteristics of Bos d 2 preparations were studied by indirect IgE ELISA, ELISA inhibition, Western blotting, histamine release, skin prick tests, and the proliferation tests of allergen-specific T-cell clones. Results: The complete recombinant Bos d 2 was observed to bind effectively, IgE of cow-allergic patients in indirect ELISA. In other experiments, the IgE-binding capacity of recombinant Bos d 2 proved to be lower compared with native Bos d 2. When the two overlapping recombinant fragments of Bos d 2 (corresponding amino acids 1-131 and 81-172, respectively) covering the whole molecule were compared with the complete recombinant Bos d 2 with several methods, only a low level of residual reactivity was observed. For example, recombinant fragments could not bind antibody at all in ELISA inhibition tests retaining, however, some reactivity in skin prick tests. In contrast, the fragments were able to stimulate vigorously Bos d 2-specific T-cell clones. Conclusion: The approach we have taken may offer a simple and reproducible way to produce hypoallergenic preparations for immunotherapy, circumventing simultaneously some of the problems of other experimental methods such as individual T-cell epitope recognition in peptide-based immunotherapy. (J Allergy Clin Immunol 1997;100:721-7.)     

Evaluation of a new cellulose sponge-tipped swab for microbiological sampling: a laboratory and clinical investigation

A new type of swab (Cellswab; Cellomeda, Turku, Finland), utilizing a highly absorbent cellulose viscose sponge material, was compared to some traditional swabs. The survival of 14 aerobic and 10 anaerobic and microaerophilic bacterial species in the Cellswab, two commercial swab transport systems (Copan, Brescia, Italy, and Orion Diagnostica, Espoo, Finland), and one Dacron swab (Technical Service Consultants Ltd. [TSC], Heywood, United Kingdom) was evaluated. Bacteria were suspended in broth, into which the swabs were dipped. The Cellswab absorbed 1.3 times more fluid and released 3.5 times more fluid upon plating than the other swabs. Aerobic bacteria were stored in dry tubes, the others in transport medium, at 4 degrees C and room temperature (RT), for up to 14 days. Swab samples were transferred to plates at 0, 1, 2, 4, 7, and 14 days. For 10 strains the Cellswab yielded > or =10% of the original CFU for longer than all the other swabs. In the clinical study, the ability of the Cellswab to detect beta-hemolytic streptococci from throat samples (n = 995) was compared to that of the TSC Dacron swab. The swabs performed equally, both when their samples were transferred to plates immediately and after storage for 1 day at 4 degrees C or RT. The changes in normal microbiota after storage were also similar. The Cellswab was found to perform at least as well as ordinary swabs. It was better at storing fastidious strains, and at keeping bacteria viable for long storage times; it might well be a useful replacement or complement to ordinary swabs.     

The relationship between job-related burnout and depressive disorders--results from the Finnish Health 2000 Study

BACKGROUND: Depression and burnout are common health problems in working populations today. They appear to be interrelated, and the need for their differential diagnosis has been highlighted in many reviews. We analysed the overlap of job-related burnout and depressive disorders, i.e., major depressive disorder, dysthymia, and minor depressive disorder. METHODS: We used the population-based 'Health 2000 Study' in Finland. Our nationally representative sample comprised 3276 employees aged 30-64 years. Burnout was assessed with the Maslach Burnout Inventory-General Survey. Diagnoses of depressive disorders were based on the Composite International Diagnostic Interview. RESULTS: Burnout and depressive disorders were clearly related. The risk of depressive disorders, especially major depressive disorder (12-month prevalence), was greater when burnout was severe. Half of the participants with severe burnout had some depressive disorder. Those with a current major depressive episode suffered from serious burnout more often than those who had suffered a major depressive episode earlier. LIMITATIONS: This study was cross-sectional. CONCLUSIONS: The concepts of burnout and depression complement each other and cover partly overlapping phenomena. Depressive disorders are related to job-related burnout, particularly when it is severe. A current major depressive episode is likely to be associated with the experience of burnout. When encountering working patients, it is recommended to assess both the occurrence of burnout and of depressive disorders.     

RHD maternal-fetal genotype incompatibility and schizophrenia: extending the MFG test to include multiple siblings and birth order

Rh incompatibility disease (ie Rh hemolytic disease of the fetus and newborn) has been implicated as a risk factor for schizophrenia. Here, we extend the maternal-fetal genotype incompatibility (MFG) test used in an earlier case-parent trio study that found significant evidence for an increased risk of schizophrenia in RHD MFG-incompatible children. We modify the MFG test for case-parent trios to include any number of siblings. This modified test enables us to use more of the available data from the earlier study. The increased sample size not only gives us greater power to test for MFG incompatibility but it also enables us to model the impact of previous RHD MFG-incompatible pregnancies on the relative risk of RHD MFG incompatibility in later-born siblings. This modeling is important, because RHD MFG incompatibility is a proxy for Rh incompatibility disease, and the risk of Rh incompatibility disease increases with the number of previous RHD MFG-incompatible pregnancies. The best-fitting models are consistent with the hypothesized effect that previous incompatible pregnancies increase the risk of schizophrenia due to RHD MFG incompatibility. There was significant evidence that the relative risk of schizophrenia in the second- and later-born RHD MFG-incompatible children is 1.7, consistent with earlier estimates. Our extension of the MFG test has general application to family-based studies of maternal-genotype and MFG interaction effects.     

Feed intake after inhibition of histamine catabolism

It has been reported that histamine and its precursor histidine have a feeding-suppressing effect. The present study shows that metoprine (20 mg/kg i.p.), which increases brain histamine levels by inhibiting its catabolism, also significantly decreases daily feed intake in rats. The reduced feed consumption is evident in different states of water balance. These results agree with an involvement of histaminergic systems in the regulation of feeding behaviour.