Avoidable mortality among psychiatric patients

Avoidable mortality is a selection of causes of death considered to be amenable to health care and thereby used as an indicator of the quality of health care. In this study avoidable mortality for more than 30,000 psychiatric patients discharged from any hospital of Stockholm County between 1981 and 1985 has been followed up in the Cause of Death Register for the period 1986–1990. Standardised rate ratios were calculated for different groups of psychiatric disorders compared to the general population of Stockholm County for indicators of avoidable mortality, suicide, other mortality (“unavoidable”) and causes possibly related to treatment with psychotrophic drugs. As expected, the psychiatric patients had the most pronounced elevated risk for suicide, i.e. 6- to 24-fold compared to the general population, and noticeably more elevated for women. It is also noteworthy that the relative mortality risks for diagnoses amenable to medical interventions and potential side-effects of psychotrophic drugs are higher than for other causes of death (“unavoidable”). The relative risks for avoidable mortality were 4.7 for men and 3.8 for women and for diagnoses possibly related to side-effects of psychotrophic drugs, 7.2. The relative risks for “unavoidable” mortality were 3.4 for men and 3.2 for women. The excess avoidable mortality rates for psychiatric patients and the elevated suicide risk, especially for female patients, are warning signals of shortcomings in psychiatric care that warrants further investigation. Accepted: 19 January 1998     

The Angelman or "happy puppet" syndrome. Clinical and electroencephalographic features and cerebral blood flow

Two cases of happy puppet or Angelman syndrome are presented. They have the typical clinical features and represent the first Swedish cases. One of the patients is a man of 75 years of age, which shows that this form of severe mental retardation is well compatible with long life. Extended EEG monitoring may identify the typical EEG abnormality when this is difficult to demonstrate in routine EEG records. The typical laughter has no specific correlate in the EEG and thus is probably not an epileptic manifestation. Regional cerebral blood flow studies were normal in the young patient (11 years of age) but in the older patient showed a reduced cerebral circulation, compatible with organic dementia.     

Demonstration of cavernomatous transformation of the portal vein by magnetic resonance imaging

A case of cavernomatous transformation of the portal vein demonstrated by magnetic resonance (MR) imaging is reported. Correlative images on scintigraphy and ultrasound are included. As in other vascular abnormalities, MR imaging is capable of depicting the findings noninvasively.     

The effect of aerosol size distribution and measurement method on respirator fit

The particle size-dependent leakage into a respirator was examined by measuring the leakage of particle sizes between 0.07 to 4.4 microns through three hole sizes in a negative-pressure half-mask respirator worn by a human subject. This investigation showed that the size distribution of an aerosol test agent and the measurement method have an effect on the leakage measured in a quantitative fit test. For instance, the ratio of percent leakage measured by light scattering between test aerosols with count median diameters of 2.2 and 0.28 microns can be as large at 5:1. Likewise, the ratio of the percent leakage measured by a particle count method vs. a mass method of detection of the same polydisperse aerosol with a count median diameter equal to 2.2 microns can be as high as 4:1. The mass leakage into a mask with a leak is also greater for an exposure aerosol with a count median diameter between 0.15 to 0.30 micron compared to exposure aerosols with larger count median diameters for aerosols with the same mass concentration.     

The vascular nurse in practice: results of prescribed exercise training in patients with intermittent claudication

Intermittent claudication (IC) is a mild stage of peripheral arterial disease that affects between 3% and 7% of the population and up to 1 in 5 patients over the age of 75 years. Risk factors such as hypertension, hyperlipidemia, diabetes, smoking, and genetics increase the incidence of peripheral arterial disease. Patients with IC have limitations in functional capacity and can benefit from regular exercise. Walking is the preferred mode of exercise and improves the symptoms of claudication in several ways. Vascular nurses can play an important role during exercise therapy. A personalized, home-based exercise program can be developed, and nurses can assist and motivate patients during follow-up periods. Helping patients to quit smoking and control other risk-factor modifications (ie, high blood pressure and lipid levels) also has high priority in daily practice of the vascular nurse. This prospective study will illustrate the results of prescribed home-based exercise training by a vascular nurse on the maximum painless walking distance for patients with IC and will be applied to subgroups of vascular pathology.     

Cardiac rhabdomyosarcoma: diagnosis by MR imaging

We report a case of cardiac rhabdomyosarcoma the initial clinical features of which were pericardial effusion, clinical symptoms of congestive heart failure and probable pulmonary thromboembolism, in which echocardiography constituted the first approach to the diagnosis of cardiac tumor and MRI confirmed it, precisely delimiting the tumoral extension and possible infiltration of pericardiac structures. A brief literature review of this entity is given, the MRI findings obtained in our case are described, and we discuss the advantages and limitations of this technique as compared with other alternatives of image diagnosis. Received: 5 November 1997; Revision received: 6 April 1998; Accepted: 7 July 1998     

Recurrent biliary cystadenoma: MR imaging appearance

The authors report the case of a 37-year-old woman with a biliary cystadenoma that mimicked a liver cyst. The magnetic resonance (MR) imaging features of this rare lesion were correlated with the pathologic findings, showing the potential of MR imaging for depicting and aiding in the diagnosis of biliary cystadenoma and its recurrence.     

Reduction of exposure to solvents and formaldehyde in surface-coating operations in the woodworking industry

A 1-year study has been performed at a company which manufacturers office furniture, and can be subdivided into three phases: measurement of exposure prior to remedial measures; remedial measures whose purpose was to reduce exposure; and new measurements after remedial measures. Remedial measures concentrated on changes which would reduce exposure to solvents. These measures fall into two categories: (i) the training of employees about the way airborne pollutants spread and ways of avoiding exposure; and (ii) locating and eliminating important sources of emission. Employees were trained mainly by the PIMEX (PIcture Mix EXposure) method for showing them how exposure depended on methods of work and conditions at the workplace. The most important sources of solvent emissions were pin-pointed by the GridMap method. The results show that exposure can be greatly reduced through training, adjustment of existing equipment and minor technical measures. This is the case even when exposure is initially at a concentration which is clearly below hygienic limit values. This approach should also reduce exposure to formaldehyde, though this could not be evaluated because the raw materials used changed during the study.