Suicide risk-related knowledge and attitudes of general practitioners

BACKGROUND

Those attempting or committing suicide very often contact their general practitioner (GP) in the weeks before the suicidal act. Therefore, the ability of GPs to detect and treat suicidality is of major importance for suicide prevention.

OBJECTIVES

This study investigated the knowledge, attitudes, experiences, and potential problems GPs have in dealing with persons at risk of committing suicide in Vienna, a city well known for having a rather high suicide rate.

METHODS

A 41-item questionnaire was developed and mailed to a random sample of 200 Viennese GPs who practice under the health insurance system.

RESULTS

GPs' knowledge on suicidality and its management is sufficient, as is their awareness of risk groups, particularly regarding the suicide risk of depressed persons. However, there is a marked underestimation of the suicide risk of alcoholics and an overestimation of the risk of physicians. GPs also found it difficult to assess suicide risk, and they generally did not receive enough training in suicide prevention and were interested in further training.

CONCLUSIONS

The results indicate a high general knowledge on suicidality, and a rather liberal attitude towards the issue, but they also reveal deficits and a need for further training.

Patterns of gadopentetate-enhanced MR imaging of radiocarpal joints of healthy subjects

OBJECTIVE

The aim of our study was to evaluate prospectively the grades and patterns of gadopentetate-enhanced MR imaging in the radiocarpal joints of healthy subjects after IV contrast administration.

SUBJECTS AND METHODS

The study included 18 healthy subjects (nine men, nine women; age range, 24-34 years; mean age, 30.8 years). We obtained coronal T1-weighted spin-echo images with fat suppression before and after IV administration of gadopentetate dimeglumine and additional axial T1-weighted spin-echo images after contrast administration. Patterns of signal-intensity enhancement in and around the radiocarpal joints were evaluated qualitatively and quantitatively.

RESULTS

In eight (44.4%) of 18 healthy subjects, enhancement of the radiocarpal joints was seen and exclusively located in the region of the prestyloid recess. Enhancement patterns were bandlike in three (16.7%) of 18 healthy subjects, homogeneous in another three (16.7%) of 18, and nodular in two (11.1%) of 18.

CONCLUSION

After IV administration of gadopentetate, signal-intensity enhancement in the radiocarpal joint is frequently seen in healthy subjects and is not predictive of inflammatory joint disease. If contrast enhancement is present, three distinct patterns are usually revealed, all invariably located in the region of the prestyloid recess.

Three-dimensional histomorphometric analysis of distraction osteogenesis using an implanted device for mandibular lengthening in sheep

The aim of this study was to lengthen the sheep mandible with a fully buried device and to quantitatively analyze the tissue regenerate in the distraction gap by means of two-dimensional and three-dimensional histomorphometry. A custom-made device for continuous distraction was used in five adult sheep and fixed with three bicortical screws on either side of an osteotomy, anterior to the premolar region of the mandible. A cable-connected power and control unit was implanted in the neck region. After a 5-day latency period, distraction was activated every 2 hours and advanced at a rate of 1.01 mm per day. The distraction period was planned for 14 days, but because of stability problems and cable breakage, the actual distraction period ranged from 2 to 17 days, resulting in gap distances from 1.7 to 17.1 mm (mean, 0.95 mm/day). Osteogenesis was followed by radiographic imaging, and after a 6-week consolidation period, the harvested mandibles were serially sectioned for histologic and two-dimensional histomorphometric analysis, with three-dimensional reconstruction. Histologic examination of the specimens demonstrated predominantly membranous bone formation with remodeling bridging the distraction gap mainly in the periosteal region of the lingual side. In addition, cartilaginous areas and chondral bone formation were observed where the bridging appeared incomplete. Because of device fixation on the buccal side of the mandible, the preservation of the lingual periosteum seemed to play the major role for sufficient bone repair in the distraction gap. Cartilage within the distraction gap suggests fixation instability in this animal model.

2D- and 3D-based measurements of orbital floor fractures from CT scans

OBJECTIVE

Two methods for area and volume calculation of the orbit were evaluated following blow-out fractures of the orbital floor using computed tomography (CT) scans.

MATERIAL AND METHODS

Isolated blow-out fractures of the orbital floor in human cadavers were simulated by fracturing the orbital floor and placing a defined volume of silicone within each defect. The area of fracture and the volume of silicone simulating herniated periorbital tissue were evaluated in 16 orbits by the use of a three-dimensional (3D) CT-based software package (Analyze((R)); Mayo Clinic, Rochester, MN, USA) and software based on two-dimensional (2D) coronal CT scans. Both methods were compared with direct anatomical measurements and evaluated with Lin's concordance coefficient (rho(c)).

RESULTS

Between-method concordance of area and volume calculation were rho(c)=0.962, and 0.872 for the 3D-CT-based method, and 0.981 and 0.952 for the 2D-CT method, respectively. The time allocated for measurement was significantly longer for the 3D-CT than for the 2D-CT method (p<0.001).

CONCLUSION

Calculations of blow-out fractures of the orbital floor by 3D-CT and 2D-CT method are accurate for assessing the area of fracture and the volume of herniated tissue. Lesser processing time and simple usage favour the 2D-CT-based calculation method.

Evidence for lack of change in seasonality of suicide from Timiş County, Romania

Evidence from politically and socially stable countries in Northern Europe and the Southern Hemisphere indicates a marked decrease in the seasonality of suicide over the past two decades. Generalizabiity of this trend to societies in transition has not yet been investigated. Data for suicide by hanging in Timiş County of Romania show both a nondecrease in seasonality of suicide for the current transitional period (1990-98), relative to the last decade of the Communist regime (1980-89) and shifts in location for suicide peak and trough months. Recent decreases in the seasonality of suicide might not generalize to societies in transition, and research would improve from focusing on the "natural laboratories" these societies represent.

A computer-based method for calculation of orbital floor fractures from coronal computed tomography scans

PURPOSE

A computer program recently developed for the calculation of the orbital floor and fracture areas from coronal computed tomography (CT) scans was used in a study to evaluate the accuracy and ability of this new method.

MATERIAL AND METHODS

The size of orbital floors and fabricated fractures in 14 dried, anatomic specimens were measured in coronal CT scans by 3 independent observers. Based on this data set, the orbital floor and fracture regions were calculated with the newly developed computer program. These calculated regions were then compared with a direct measurement of the specimens that had been obtained by digital photography. The accuracy of the computer-based calculations was assessed using Lin's concordance correlation coefficient.

RESULTS

The size of the orbital floor (mean +/- SD) was found to be 5.21 +/- 0.39 cm(2) by direct measurement of the specimens and 5.30 +/- 0.52 cm(2) by calculation with the computer program. The region of the fracture (mean +/- SD) was 1.05 +/- 0.64 cm(2) by direct measurement and 1.01 +/- 0.62 cm(2) by computer calculation. The between-method mean difference (direct measurement minus computer based calculation) was -0.09 cm(2) (or 1.7% of mean orbital floor region) for orbital floor region and 0.04 cm(2) (or 3.8% of mean fracture region) for fracture region.

CONCLUSIONS

This accurate and time-saving method is practicable for determining the size and location of orbital floor fractures. This calculation program can be advantageously applied in the clinical management of blowout fractures of the orbit.

Incidence of registered male and females suicides in the Republic of Singapore

Parker et al. (31, 549–553) analysed the monthly incidence of registered male and female suicides in the Republic of Singapore for the 120 consecutive months 1989–98.

Reperfusion of autotransplanted teeth--comparison of clinical measurements by means of dental magnetic resonance imaging

OBJECTIVE

Dental magnetic resonance imaging (dMRI) with administration of contrast material is one method of assessing pulpal perfusion. The purpose of this study was to evaluate the level of contrast enhancement displayed by means of dMRI after transplantation of teeth and to compare these findings with the results of tooth mobility, pocket depth, cold, and electrical tests.

STUDY DESIGN

Twenty-three teeth with either complete root formation or incomplete root formation (IRF) were investigated by using dMRI and were clinically examined at intervals of 2, 4, 8, and 12 weeks, as well as 6 months and 12 months after transplantation.

RESULTS

An analysis of the enhancement in the dental images revealed a significant difference between teeth with IRF and teeth with complete root formation. In addition, the time to occurrence of a positive reaction to the cold test was significantly longer for teeth with IRF.

CONCLUSIONS

The findings of this study indicate that transplanted IRF teeth are associated with reperfusion seen by means of dMRI as well as with delayed occurrence of a positive cold test.

Medical students' attitudes towards psychotherapy: an intervention-based pre-post comparison

BACKGROUND

Despite a wealth of studies on medical students' attitudes towards psychiatry in general, little is known about their specific attitudes towards psychotherapy. There is no evidence on the flexibility of these attitudes in the context of a curriculum-implemented psychotherapy information session.

OBJECTIVES

To assess medical students' attitudes towards psychotherapy and short-term flexibility therein, with an introductory course on psychotherapy as the relevant intervention for this pre-post comparison.

METHODS

A random sample of 159 advanced medical students completed a short questionnaire before and after a short course on psychotherapy. The questionnaire consisted of indirect attitude measures towards psychotherapy (associations and connotations), a likelihood rating for future training in psychotherapy, a statement about one's most preferred medical specialty for one's future career, and basic demographics.

RESULTS

Participants' pre-interventional connotations of psychotherapy were predominantly positive. In the pre-post comparison, more than one third of the connotation measures shifted substantially and favorably. Post-interventionally, participants' distinctive static word association style regarding psychotherapy was attenuated in favor of a more differentiated style and an enlarged field of associations. The data are suggestive of significant pre-interventional sex differences, with females holding more positive views towards psychotherapy and reporting a greater likelihood of future psychotherapeutic training. The data also suggest that the intervention acted differently upon the sexes. Likelihood ratings for future training in psychotherapy did not decline after the course, despite the fact that the cost and duration of training were mentioned in the course.

CONCLUSIONS

Even minimal educational interventions can enhance medical students' predominantly positive attitudes towards psychotherapy. This finding calls for further implementation of psychotherapy-related material in medical curricula.

[Application of a context-oriented model for the planning of psychotherapy]

Since clinical experience has shown that creating a therapeutic setting with borderline or psychotic patients is extremely difficult the Department of Psychoanalysis and Psychotherapy at Vienna University Hospital has developed a method of treatment designed to increase the possibilities to work with this group of patients. This procedure is conceptualised as "context oriented model exploration in psychotherapy planning" COMEPP. Initially the context is explored in which the psychotherapeutic model should be implemented which has so far failed for different reasons. Following this a setting is created in which the therapeutic team and the patient(s) can constructively and creatively reflect on alternative therapeutic models. A clinical case illustrates the problems and the basic structure of COMEPP in a schematic and condensed form.

[Ambulatory psychosocial and rehabilitation services in cerebral cognitive deficits]

Because of the well known changes in social and demographic structure of our population the availability of an integrated and coordinated attainment for psychosocial care for people with impaired cerebral function is of increasing importance. Vienna as the capital of the Federal Republic of Austria has structured psychosocial welfare services for the entire city, which consists of 8 psychosocial service regions ("catchment-areas"). 1 for every 200.00 inhabitants. For elderly psychosocially handicapped persons special supplies are provided. In this survey the methods and activities of these facilities are described. The increasing demand of psychosocial care for outpatients in the age of above 80 years is discussed; the importance of home visits is stressed.