[Nursing home residents in Northern Jutland]

The purpose of the study was to describe a Danish nursing home population. The study consists of 288 nursing home residents (median age 84.6 years, 68% females). The psychiatric morbidity of the residents was diagnosed with the GMS-AGECAT. The staff was interviewed about the residents' ADL, disturbing behaviour and therapeutic measures. Seventy-one percent had a psychiatric disorder, with organic disorder as the most frequent (61%). Demented residents received significantly less hypnotics, were more often physically restrained and had lower ADL levels compared to other residents. The situation in Denmark can be seen as a paradox. While substantial effort has been made to increase the possibility of choice and to "deinstitutionalize" nursing homes, the majority of the residents are demented and thus not capable of making valid choices.

Somatization in primary care. Prevalence, health care utilization, and general practitioner recognition

To study the prevalence of somatoform disorders (SDs) in primary care, a questionnaire including the modified 25-item version of the Symptom Checklist-90 was administered to 191 patients consecutively consulting their family physician. A stratified sample of the patients was interviewed with the Schedules for Clinical Assessment in Neuropsychiatry. The study showed that 22.3% (confidence interval [CI]: 95%: 16.4-28.1) of the patients fulfilled the diagnostic criteria for an International Classification of Diseases--10th Revision (ICD-10) SD, excluding SD, unspecified, and 57.5% (CI: 95%: 50.5-64.5) for DSM-IV SD. But 30.3% met the criteria (CI: 95%: 23.8-36.9) when the DSM-IV Not Otherwise Specified (NOS) diagnostic group is excluded. The most frequent ICD-10 diagnosis was autonomous dysfunction, for which 14.1% of the patients fulfilled the criteria, whereas the prevalence of the other somatoform diagnosis was between 3.0% and 8.1%. The most frequent DSM-IV diagnoses were SD NOS and undifferentiated SD, which 29.93% and 27.3% of the interviewed patients, respectively, received, whereas the prevalence of the other diagnoses was between 1.0% and 8.1%. A high comorbidity between SDs and other mental disorders was found. The general practitioners identified between 50% and 71% of the patients with an ICD-10 SD and between 36% and 48%, according to DSM-IV criteria. Patients with SDs used more nonpsychiatric health care facilities than other patients (P = 0.01).

NC100150-enhanced 3D-SPGR MR angiography of the common carotid artery in a pig vascular stenosis model. Quantification of stenosis and dose optimization

PURPOSE

NC100150 is a new type of ultra-small iron oxide (USPIO) blood pool agent. The aim of this study was to compare NC100150-enhanced MR angiography (MRA) to time-of-flight (TOF) MRA, phase-contrast (PC) MRA, and digital subtraction angiography (DSA) in experimental stenoses in pigs, and furthermore to determine the optimal dose of the contrast agent.

MATERIAL AND METHODS

An experimental stenosis of the right and left common carotid artery (CCA) was applied surgically in 6 Yorkshire pigs. DSA was performed as the gold standard, followed by 3D-TOF, 3D-PC, and NC100150-enhanced MRA.

RESULTS

Eleven stenoses of the CCA were successfully applied. The degree of the stenosis, determined by NC100150-enhanced MRA, did not differ significantly from DSA, whereas TOF and PC MRA underestimated it. The image quality of the NC100150-enhanced MRA was superior to both TOF and PC MRA. The optimal dose of NC100150 was 5-6 mg Fe/kg, since higher doses did not further increase signal-to-noise ratio or contrast-to-noise ratio. There was a linear relationship between blood relaxation rate and contrast dose.

CONCLUSION

NC100150-enhanced MRA has the potential for quantification of carotid stenoses and provides an alternative to DSA. The optimal dose of NC100150 was 5-6 mg Fe/kg.

Screening for somatization and hypochondriasis in primary care and neurological in-patients: a seven-item scale for hypochondriasis and somatization

The aim of this study was to investigate the internal and external validity of the Whiteley Index as a screening instrument for somatization illness. A 14-item version of the Whiteley Index for hypochondriacal traits was given to 99 of 191 consecutive primary care patients, aged 18-65 years, and to 100 consecutive patients, aged 18-60 years, admitted for the first time to a neurological ward. The primary care sample was, in addition, interviewed by means of the SCAN (Schedules for Clinical Assessment in Neuropsychiatry) psychiatric interview. The GPs and the neurologists were asked to rate various characteristics of the patients that might indicate somatization. The internal validity of the Whiteley Index was tested by means of latent structure analysis. On this basis, a reduced seven-item scale (Whiteley-7 scale) and two subscales (i.e., an Illness Conviction and Illness Worrying scale, each with three items) were constructed. All three had a high internal validity fitting into the very restricted Rasch statistical model (p>0.05) and an acceptable transferability between most of the subpopulations investigated. In the primary care population, the Whiteley-7 and the Illness Conviction scales at cut-point 0/1 showed 1.00 and 0.87 sensitivity and 0.65 and 0.87 specificity, respectively, using as "gold standard" the fulfillment of criteria for at least one ICD-10 somatoform disorder, and 0.71 and 0.63 sensitivity and 0.62 and 0.87 specificity, respectively, as gold standard for the fulfillment of criteria for at least one DSM-IV somatoform disorder, excluding the NOS diagnostic group. The Illness Worrying subscale showed less impressive performance in this respect. The agreement between the Whiteley-7 scale including the two subscales and neurologists' rating and the GPs' rating and the somatization subscale on the SCL-90 was modest or worse. It may be concluded that the Whiteley-7 scale and the Illness Conviction subscale had acceptable psychometric profiles, and both seem to be promising screening tools for not only hypochondriasis but also for somatoform disorders in general.

[The use of psychopharmaceuticals, psychostimulants and antidepressants in children and adolescents]

The aim of this study is to estimate the use of psycholeptics, psychostimulants and antidepressants among children and adolescents younger than 19 years in Denmark. Children and adolescents were registered as being under treatment with psycholeptics, psychostimulants or antidepressants if they at least once during the test period July 1996 to June 1997, filled a prescription for such drugs at a Danish pharmacy. 3,890 children and adolescents, corresponding to 0.3% of the section of the population, are under treatment. The most prevalent drugs are of the ATC-group N05B (anxiolytics). The age group of 16-18 year olds has the largest consumption, and 87% received only one drug. The use of above mentioned medicine among children and adolescents is lower than the level of use in the general population.

Concurrent validity of the GMS-AGECAT (A3) package in a Danish nursing home population

AIM

To validate the Danish version of the GMS-AGECAT (A3), the Standardized Mini Mental State Examination (SMMSE) and the Geriatric Depression Scale-15 (GDS-15) by comparing them to clinical ICD-10 criteria in a Danish nursing home population.

METHODS

With a participation of 91%, the study included 100 residents. All residents were interviewed with the GMS-AGECAT (A3), SMMSE and GDS-15 by an MD and then blindly diagnosed by a consultant geriatric psychiatrist. All residents approached for an interview were included, also those who were not able to communicate (the non-accessibles).

RESULTS

The prevalence of clinical psychiatric ICD-10 main diagnoses was 56%. The non-accessibles had significantly higher psychiatric morbidity and lower ADL scores (modified Barthel ADL index) compared to those who were able to communicate. With the non-accessibles (N = 100) included, the optimal screening and diagnostic cutpoint for the GMS-AGECAT organic diagnoses was 2/3, with 96% sensitivity, 73% specificity, 77% predictive value of a positive test and 95% predictive value of a negative test. The SMMSE and GDS-15 had better screening properties compared to the GMS-AGECAT but only 60% of the residents were able to complete the SMMSE and 78% were able to complete the GDS-15.

CONCLUSION

The Danish version of the GMS-AGECAT has relevant diagnostic and screening properties for organic disorders in Danish nursing home populations.

Psychopathologic and functional outcome in the treatment of elderly inpatients with depressive disorders, dementia, delirium and psychoses

The objectives of this report were to investigate the functional implications and the possible rehabilitation potentials of dementia, delirium, and psychosis in elderly inpatients, compared with that in depression. During 1 year, all patients in a psychogeriatric university clinic were assessed on admission and at discharge with a selection of rating scales and diagnosed according to ICD-10 by consultants with no knowledge of the results of the ratings. All patients who had a principal diagnosis of major depression, dementia, delirium, or a psychosis are discussed. Ratings were made for psychopathology, behavioral disorders, depressive statements, intellectual functioning, activities of daily living, and gait. Depressive and delirious patients improved their status significantly (p < or = .03) in all six assessments, and patients with dementia improved their psychopathology status (p = .002), but the other assessments were unchanged. Results from the small sample (n = 8) of psychotic patients were mainly inconclusive, but there was a tendency for improvement with respect to psychopathology and gait.

Sports injuries in school-aged children. A study of traumatologic and socioeconomic outcome

In this Danish study we attempted to identify the socioeconomic consequences of sports injuries in children. A total of 1320 children, 650 boys and 670 girls, aged 6-17, completed questionnaires covering the period from the injury to recovery. The incidence rate was 74 per 1000 per year. The hospitalization rate was 4.1%. Due to the injury 37.2% of the children were absent from school for an average of 1.2 days (range 0-60 days), resulting in 1598 days' absence from school. Most of the children were injured during training (34.7%) or competition (22.6%). The other injuries occurred during recreational sporting activities (32.0%) or at school (10.7%). Fifty-four percent were absent from training or games, on average 6.0 times (range 0-99), with a total loss of 7897 training sessions. Fifteen percent of the parents were absent from work, on average for 2.2 days. Two hundred and nineteen children were absent from an after-school job, for an average of 8.6 days. The total loss was 1896 working days. The study shows that the socioeconomic consequences of sports injuries in children are a complex consisting of different parts and that the injuries had a substantial impact on the functional and social status of the children and their families.

[Puerperal fever. A survey of an epidemic using a case-controlled study]

Puerperal fever caused by group A streptococci (GAS) is a most serious infection deriving from the birth canal after childbirth or caesarian section and is manifest by fever and/or local signs of infections. Secundary infections in the umbilicus or skin can occur in the newborn child. As approximately 5% of the Danish population are carriers of GAS in nose, throat, rectum and/or vagina the risk of infection is present especially in childbirth. GAS epidemics in the community result in increased risk of hospital-acquired GAS infections. In the literature it is recommended to take action and implement preventive strategies when two simultaneous cases occur in one department. We describe the course of seven GAS infections in six patients (two children) in the same obstetric ward over a seven-week period, the elucidation by case-control analysis and the implementation of preventive measures. The importance of good hygienic practices is highlighted.

Psychiatric morbidity in primary public health care: a multicentre investigation. Part II. Hidden morbidity and choice of treatment

A total of 1,281 patients were examined during consultation with their GP in a Nordic multicentre study focusing on the prevalence of psychiatric illness, hidden psychiatric morbidity, treatment and pathways to specialized care. The methodology and prevalence were reported in an accompanying paper. The present paper presents results concerning the variables hidden psychiatric morbidity, treatment and pathways to specialized care. The GPs detected 44% of the psychiatric cases compared with the result of a diagnostic interview (PSE). The distinction between psychosis and non-psychosis did not influence the GPs' ability to detect a mental illness. According to the GPs' assessment the majority of patients suffering from a mental disorder consulted their GP about physical complaints. The GPs treated the patients themselves, and only a limited number of cases were referred to psychiatrists or psychologists.

[Improvement of functional abilities after treatment of depression in the elderly]

During one year all patients with a diagnosis of depression in accordance with ICD-10, referred to a psychogeriatric department, were assessed at admission and discharge with a number of rating scales: The Brief Geriatric Depression Scale, Katz' ADL-index, the Multidimensional Dementia Assessment Scale, the Mini-Mental State Examination and the Functional Ambulation Classification. The department has an active stepwise treatment strategy: SSRI (selective serotonin reuptake inhibitor), potentiation with mianserin, lithium potentiation, ECT. The 87 depressive patients had a median age of 79 and most had one or more severe somatic conditions. Fifty-nine were severely depressed at admission, 19 at discharge; the number of functionally disabled dropped from 22 to seven and the number of cognitively impaired from 35 to 19. In conclusion, a nihilistic approach to treatment in the very old is unfounded.

The epidemiology of sports injuries in school-aged children

In the 5-year-period 1988-1992, 6096 children aged 6-17 (54.5% boys and 45.5% girls) were treated at the Emergency Department at Esbjerg Central Hospital after having sustained a sports injury. The data were registered according to the European Home- and Leisure-Accident Surveillance System (EHLASS) protocol. We found a total incidence rate in the municipality of Esbjerg of 73.3 per 1000 per year. Boys were most often injured in soccer, skateboard, handball, gymnastics and basketball, and girls in handball, horse-riding, gymnastics, basketball and roller-skating. The types of injuries were contusions 37.1%, fractures 22.0%, sprains 24.8%, wounds 9.5%, strains 5.0% and luxations 1.4%. The hospitalization rate was 3.8%. Compared to other studies the total incidence rate was high.

[It is not always necessary to establish a "first aid station" at mass gatherings. Cutty Sark Tallships Race 1993]

Previous studies from outdoor music festivals have recommended medical service facilities at first-aid stations. The Cutty Sark Tallships Race was a large outdoor event that took place over four days in Esbjerg harbour with about 500,000 participants and spectators. A total of 68 patients were treated, 28 in the first-aid station at the harbour and 40 at the nearby located hospital. The disease and injuries presented were not severe. The orthopaedic casualties dominated (82%), wounds, contusions and fractures being the most common ones. Only seven casualties were related to alcohol abuse. No casualties were related to drug abuse. The economic expense was estimated to DKK 14,676. Thus, at outdoor mass gatherings of a nature like the Cutty Sark Tallships Race, located near a hospital, first-aid stations are not necessary.

Boneloc cemented total hip prostheses. Loosening in 28/43 cases after 3-38 months

We report our early results with 43 total hip prostheses (25 Charnley and 18 LMT) inserted during 1991 with Boneloc cement. The indication was primary arthrosis (38) and rheumatoid arthritis (5). After 18 (3-38) months, 28 stems were loose and 18 hips have been revised 1-4 years after primary surgery.

[Admission patterns of patients with dementia to psychiatric hospitals. A registry study over the period 1972-1988]

This paper describes the admission and discharge pattern in Danish psychiatric hospitals for first-ever admitted demented patients (290, 293.09, 293.19 ICD-8) aged 65 years and over admitted in the period 1972 to 1988. The results are based on data from the Danish Psychiatric Register. The admission rate, the commitment rate and the length of stay decreased significantly from 1972 to 1988. The readmission frequency did not change during the period. A significantly increasing proportion of the patients were admitted from somatic hospitals, and there was a tendency to a higher discharge rate to somatic hospitals. Two factors may have caused the decline in admission rate, the improvement of the psychogeriatric services in the eighties and the decline in the number of psychiatric beds. The psychiatric hospitals no longer serve as nursing homes for demented patients. The results also seem to indicate that for institutional care for demented patients may have been transferred from the psychiatric hospitals to other services e.g. the somatic departments and nursing homes.

Systemic and pulmonary haemodynamic effects of intravenous infusion of non-ionic isoosmolar dimeric contrast media. An investigation in the pig of two ratio 6 contrast media

The systemic and pulmonary haemodynamic effects of i.v. infusion (1 ml/s) of high doses (4 ml/kg) of 2 non-ionic, isoosmolar dimeric contrast media (CM) were investigated in 17 female pigs. The 2 CM were iodixanol and iotrolan. Both CM induced a significant increase of the following parameters: mean arterial, mean right atrial, mean pulmonary arterial, mean pulmonary arterial occlusion pressure, cardiac output, stroke volume, and diuresis. The plasma concentration of atrial natriuretic peptide was significantly increased following infusion of the 2 CM. A significant decrease was seen in the systemic and pulmonary vascular resistance.

[Diagnosis of dementia--an objective examination or a subjective evaluation?]

Case records of 404 elderly patients (aged 65 years or more) who were admitted for the first time to the Psychiatric Hospital in Aarhus, with a diagnosis of dementia were investigated retrospectively. In 315 patients the diagnoses were confirmed as senile dementia (290.09) or arteriosclerotic dementia (293.09) according to ICD-8. Eighty-seven patients had their diagnosis changed in the course of the case review. When case records of these 87 patients were investigated for the second time, four patients were diagnosed as demented: 66 patients were admitted because of confusion, 26 patients were diagnosed depressive, 10 of these manic-depressive. This investigation shows uncertainty and a tendency to overdiagnose of dementia, especially in the early stages. A wrong diagnosis may lead to therapeutic nihilism, especially when the patient suffers from confusion and/or depression.

[Violence-related cases in the emergency ward. A 5-year follow-up of registrations made in 1981 and 1986 at the Esbjerg emergency department]

During six-month periods in 1981, 1986 and 1991 a prospective registration was made of all injuries caused by violence treated in the casualty ward of Esbjerg Hospital. The numbers of such contacts during these periods were 236 in 1981, 379 in 1986 and 509 in 1991. There were no differences between the three periods with respect to the following parameters: age, sex, civil status, place, types of lesions, need for further treatment and influence of alcohol. The total incidence rate rose between 1986 and 1991 from eight to nine per 1000 (not significant). The only significant increase was among females aged 15-19, where the incidence rose from 2.0 per 1000 in 1986 to 11.3 in 1991. Fourteen percent of the injured required hospitalization, occupying 1216 hospital bed days during the 1991 period.