Women and injuries--factors influencing recovery

This study focuses on female patients of working age, hospitalized due to moderate, mostly orthopaedic injuries. The aim was to highlight the medical and non-medical factors affecting outcome. Two groups of women, those who 12 months after the injury reported disability within at least three out of five possible areas (work, family, household, social life and leisure-time; n = 34), were compared with women reporting disability within two areas or less (n = 59). Four factors were predictive of outcome according to the multivariate analysis: injury severity as measured by the Abbreviated Injury Scale (AIS), self-perceived injury-related mental and physical health measured by the Visual Analogue Scale (VAS) during hospitalization and a history of three or more previous injuries requiring medical care. Sociodemographic background factors did not affect the outcome. By integrating information from AIS and VAS with the number of previous injuries, three quarters of the women were correctly classified; i.e., it was possible to detect a majority of those reporting a poorer outcome one year after the injury already during hospitalization. Simple screening instruments like these seem to be useful in the early detection of vulnerable patients. This study further suggests that more attention should be paid to non-medical factors, the importance of which may have been underestimated regarding a poorer outcome among female patients hospitalized due to injuries. Thus, psychosocial support should not only be offered to patients with major trauma or an obvious psychiatric disorder, but to all injured patients and should be considered as an integral part of medical care.

Suicide among foreign-born minorities and Native Swedes: an epidemiological follow-up study of a defined population

The increasing number of immigrants in Sweden during the past four decades has brought the health of ethnic groups into focus. The purpose of this study was to analyse the influence of ethnicity, age, sex, marital status and date of immigration on suicide rates. The study population consisted of all individuals over 15 years of age, N = 6,725,274, from the Swedish census of 1985 and is based on individual data. Suicides and undetermined deaths, during the follow-up period 1986-1989, were taken from the central Cause of Death Register. Ethnicity, defined as being foreign-born, was a risk factor for suicide for both men and women with risk ratios of 1.21 (1.11-1.31) and 1.36 (1.21-1.53), respectively, with control for age and marital status. Being unmarried was also a risk factor for both males and females with risk ratios from 1.26 to 5.55 in different age groups. The highest risk ratios for suicide in Sweden, adjusted for age, were found among males born in Russia and Finland. They also showed higher suicide risks than in their countries of birth. Females born in Hungary, Russia, Finland and Poland all had high risks of committing suicide in Sweden and they also had higher risks than in their countries of birth. Further, being of male sex, aged 45-54 or 75 and older, and born in Eastern Europe or Finland were significant risk factors for suicide. The same was true for those who had immigrated to Sweden in 1967 or earlier and were born in Finland, Eastern Europe or in non-European countries. These findings are of great importance for primary health care and psychiatric care planning.

Autoreactive T-cell clones from the nonobese diabetic mouse

The availability of cloned lines of T cells reactive with islet antigens has provided investigators with new tools to study how T cells contribute to autoimmune disease. T-cell clones isolated from the diabetes-prone nonobese diabetic (NOD) mouse are proving to be particularly valuable for analyzing pathogenesis and hold great promise for determining which T-cell subsets are involved in beta-cell destruction versus immunoregulation of the inflammatory process. Diabetogenic T-cell clones have been mostly of the CD4+, Th1 phenotype, but CD8+ T cell clones are also capable of transferring disease. In some cases, T-cell lines and clones (CD4+ and CD8+) have been found to have protective properties. In general T-cell antigen specificities have not been defined, as islet cells or lysates were used as the selecting antigen. However, there is an increasing number of reports of T cells specific for defined islet proteins, such as insulin and GAD, and some of these lines can induce disease. The variety of T-cell clones that have been produced indicate that there may a variety of conditions that lead to or protect against beta-cell destruction and provide further evidence that autoantigens are generated during development of disease.

Long-term clinical results after treatment with conical crown-retained dentures

The clinical outcome of treatment using conical crown-retained dentures was evaluated. Of the initial 25 patients provided with 26 conical crown-retained dentures, 18 patients with 18 restorations could be examined after a time ranging between 73 and 92 months. Of the eight restorations lost, four had been changed as a result of factors that might have been related to the prosthodontic care. Most of the patients were very satisfied with the restorations both functionally and esthetically and found their chewing comfort to be better after treatment with conical crown-retained dentures. However, 50% of the patients reported speech problems related to treatment. Technical failures were not insignificant but were treatable. The survival rate after 73 to 92 months was 78.3%.

Personality traits and psychiatric and somatic morbidity among kleptomaniacs

Although the behaviour of kleptomania has been identified for decades, very little is known about the reasons, prevalence, course and treatment of this disorder. Current knowledge about kleptomania is generally derived from case reports or from material collected from highly selected groups. There are no published systematic studies of personality traits among kleptomaniacs, and knowledge of somatic and psychiatric co-morbidity is limited. The purpose of the present study was to describe personality characteristics, psychiatric disorders and somatic illness among kleptomaniacs. A total of 37 patients (two-thirds of whom were female) who fulfilled the DSM-IV criteria for kleptomania were recruited by advertising in a daily newspaper. Monotony avoidance was a prominent personality trait, as was a low degree of socialization. Depression and anxiety were also very common, as was a history of attempted suicide. Somatic illness was commonly reported, and a high proportion of the kleptomaniacs were regularly receiving pharmacological treatment for either psychiatric or somatic illness. The representativeness of this group of kleptomaniacs is as yet unknown. However, the present study is based on the largest sample of patients fulfilling DSM-III-R/DSM-IV criteria for kleptomania to date who were not primarily recruited through the medical or legislative systems.

A study of patient-related characteristics and outcome after moderate injury

The purpose of all injury care is to restore patients' pre-injury functioning and to facilitate the return to normal activities. The aim of this prospective study was to describe and analyse psychiatric factors and other patient-related characteristics which influence long-term results after moderate injuries. One hundred and sixty-nine injured patients were randomized to go through a comprehensive psychosocial research protocol and to participate in the 12 month follow up. The 49 patients lost to follow-up differed significantly from all other patients. They were more often single, blue-collar workers with a lower educational level and had a less favourable psychosocial background, including alcohol abuse. The 120 patients who completed the follow-up were divided in two groups: the non-recovered group (NR, N = 58), patients reporting limitations in performing their work and/or limitations in carrying out housework and/or in social life, and the recovered group (R, N = 62), patients reporting full recovery or only minor limitations in exercise or sports 12 months after the injury. The NR patients were older (P < 0.05), had a slightly higher injury Severity Score (P < 0.01) and showed signs of depression both during the acute post-injury period and at 1 year follow up (P < 0.001). The multivariate analysis showed that measurements of pain and depression during the acute post-injury period were associated with the functional outcome after 12 months. Co-operation between injury and psychiatric units should be developed to identify patients needing psychosocial or psychiatric support during the early phase of rehabilitation.

Family violence among psychiatric in-patients as measured by the Conflict Tactics Scale (CTS)

The aim of this study was to analyse the frequency and pattern of family (domestic) violence in a group of psychiatric in-patients by using the Conflict Tactics Scale. The study is based on a consecutive series of 55 married or cohabiting psychiatric in-patients treated at Huddinge Hospital, Stockholm, Sweden in 1994. The study shows that males and females use similar types of both violent and non-violent strategies when trying to solve marital conflicts. Depressed patients use both non-violent and violent methods less often than non-depressed patients, while the opposite is true for patients with a personality disorder, and for schizophrenics. Psychosocial stressors appear to be of limited importance in this context, while poor general functioning is associated with destructive ways of trying to solve conflicts between husband and wife. However, there have been no Scandinavian population-based studies to establish the frequency and type of violence used when trying to solve marital conflicts. Thus there is a need for such studies, and the present investigation supports the American experience that the Conflict Tactics Scale is a usable and easily administered instrument for population-based studies.

Accuracy of machine milling and spark erosion with a CAD/CAM system

A method for manufacturing crowns and fixed partial dentures based on CAD/CAM has been developed as an alternative to the lost wax technique and the casting of an alloy. In this process two steps are included: milling and spark erosion. The computer-assisted design (CAD) relies heavily on the accuracy of the milling and spark erosion processes to achieve a clinically acceptable restoration. These two processes must be able to produce the crown data generated in the CAD files. This study evaluated the accuracy of the Procera CAD/CAM system in creating specific geometric bodies that were compared with the known dimensions in the CAD files for these bodies. The manufacturing errors of milling (ellipse +/- 6.5 microm, square +/- 3.4 microm, and cylinder +/- 5.8 microm) and spark erosion (ellipse +/- 8.6 microm and square +/- 10.4 microm) were determined. The accuracy of this manufacturing process demonstrated that this system was capable of producing a crown with a clinically accepted range for marginal opening gap dimension of less than 100 microm.

Women's work experiences and health in a male-dominated industry. A longitudinal study

This study aims to evaluate within-individual changes over time in work-role quality and quality of life and the relationship of these qualities to self-reported health as experienced by women in a male-dominated industry. Forty-seven women completed a questionnaire at two different points in time. The results showed evidence of a relationship between work-role quality and quality of life and self-reported health. There was a connection between changes in environmental demands and changes in musculoskeletal symptoms and between changes in quality of life and changes in gastrointestinal symptoms, except for psychological distress. The difference in medical symptoms is hypothesized to be an effect of hormonal signals. Four strategically selected women, who indicated improved or impaired health, were interviewed about their working situations. A tentative theoretical model was set up for perceptions of health.

Multilingual translation of the Functional Assessment of Cancer Therapy (FACT) quality of life measurement system

There is need for multilingual cross-culturally valid quality of life (QOL) instrumentation to assess the QOL endpoint in international oncology clinical trials. We therefore initiated a multilingual translation of the Functional Assessment of Cancer Therapy (FACT) Quality of Life Measurement System (Version 3) into the following languages: Dutch, French, German, Italian, Norwegian and Swedish. Prior to this project, the FACT Measurement System was available in English, Spanish and Canadian French. The FACT is a self-report instrument which measures multidimensional QOL. The FACT (Version 3) evaluation system uses a 29-49 item compilation of a generic core (29 Likert-type items) and numerous subscales (9-20 items each) which reflect symptoms associated with different diseases, symptom complexes and treatments. The FACT-G (general version) and eight of 18 available cancer-related subscales were translated using an iterative forward-backward translation sequence. After subsequent review by 21 bilingual health professionals, all near final language versions underwent pretesting with a total of 95 patients in the native countries. Available results indicate good overall comprehensibility among native language-speakers. Equivalent foreign language versions of the FACT will permit QOL evaluation of people from diverse cultural backgrounds.

Superiority of cisplatin or carboplatin in combination with teniposide and vincristine in the induction chemotherapy of small-cell lung cancer. A randomized trial with 5 years follow up

PURPOSE

The introduction of platinum compounds and epipodophyllotoxins in combination with vincristine as induction chemotherapy in small-cell lung cancer (SCLC) was investigated in order to: (1) compare the efficacy of cisplatin with that of carboplatin in combination with teniposide and vincristine as inducers of remission over three cycles; (2) compare the toxicity pattern of carboplatin and of cisplatin when given in combination regimens; and (3) compare a chemotherapeutic regimen consisting of three alternating combinations with that of regimens consisting of four alternating combinations.

PATIENTS AND METHODS

From November 1985 to September 1991, 484 consecutive, previously untreated patients with SCLC, performance status 0-4, entered a three armed randomized trial with three cycles of cisplatin (arm I) or carboplatin (arm II) in combination with teniposide and vincristine alternating with three treatment blocks of cyclophosphamide, etoposide, lomustine and vincristine (block A), doxorubicin and vincristine (block B) and cisplatin, hexamethylmelamine and vindesine (block C) versus alternating treatment with block A, B and C (arm III).

RESULTS

No difference in efficacy or toxicity was found between cisplatin and carboplatin at the present dosages. Induction chemotherapy with teniposide plus cisplatin or carboplatin did not result in higher complete response rates (objective response rates 63%, 72% and 65%, respectively) or in significantly greater toxicity, but overall survival was superior compared with the arm III (log-rank test, P = 0.02). The median survival difference was 7 weeks, and two year survival 15% versus 9%. The Cox regression analysis identified the arm III, poor performance status and elevated LDH as factors with statistically significant negative impact on survival.

CONCLUSION

Cisplatin and carboplatin produced similar response and survival rates and similar toxicity. Induction with platinum and epipodophyllotoxins did not improve objective response rates, but significantly improved survival without increasing the toxicity.

Sex hormones and alcohol withdrawal: does a good supply of testosterone prevent serious symptoms during detoxification?

Owing to the clinical similarity between the male climacteric syndrome and the results of previous studies on the alcohol withdrawal syndrome in relation to sex hormones, we hypothesized that alcoholics with a poor supply of testosterone will develop more pronounced symptoms during alcohol withdrawal than alcoholics with high levels of testosterone. Fifty-two male alcoholics were studied. To test our hypothesis we entered the mean values of the hormones, the mean age, and the mean consumption of liquor (CL) the week before admittance as regressors in a multiple forward stepwise regression analysis with four subclass constructed from the CPRS as dependent variables. Our results indicate that patients with low levels of testosterone develop more neurotic-asthenic symptoms, such as indecision, worrying about trifles, fatigability, and lassitude during alcohol withdrawal. Further, high levels of SHBG were related to a history of seizures and younger alcoholics received higher ratings on the paranoid-aggressive subscale. It is concluded that there is a relation between levels of testosterone and symptoms during alcohol withdrawal. The question of a causal relationship remains to be answered, however. One way to illuminate this would be to add testosterone during detoxification, which may reduce the symptoms mentioned above analogous to the male climacteric syndrome, which could be prosperously treated by a supplement of testosterone. This treatment strategy would have obvious advantages compared to benzodiazepine detoxification as such drugs are potentially addictive.

Lung cancer, smoking and diet among Swedish men

In a prospective case-control lung cancer study in the west of Sweden, the relationship between lung cancer, smoking and dietary factors was investigated. Suspected cases were collected from pulmonary units at two central hospitals in the area investigated and population controls of the same age and sex were selected from registers. The majority of cases and controls were interviewed by specially trained nurses, using a food frequency questionnaire. The lung cancer diagnosis (ICD 7, 162.1) was made using data from the local cancer register. In an analysis based on 308 cases and 504 controls, a dose-related increase in lung cancer risk for smokers was found, although no significant risk was found for males smoking 1-10 cigarettes/day for less than 20 years. A lower consumption of vegetables was related to a higher risk, both for smokers and nonsmokers. A higher consumption of milk was related to an increased risk.

Cohabiting relationships and sexual interest of male alcoholics

This study comprises data from a consecutive series of 52 heterosexual male alcoholics. The purpose of the study was to describe sexual interest and cohabiting relationships and to analyse the influence of personality and biological factors on these phenomena. An increased sexual interest or activity and frequent changes of cohabiting partners are two common characteristics of male alcoholics but these two phenomena are not interrelated. A decreased sexual interest is reported by only a minority of male alcoholics. The alcoholics with several previous cohabiting relationships stand out as being aggressive and hard drinking. The alcoholic with an increased sexual interest makes an opposite impression. He is non-aggressive, socially adjustable and unafraid of close interpersonal relations. When decreased sexual interest or activity occurs in male alcoholics, it is mainly a result of hormonal changes. Low levels of male and high levels of female sex hormones are common in these men.

Isolation of nifH and part of nifD by modified capture polymerase chain reaction from a natural population of the marine cyanobacterium Trichodesmium sp

A modified capture polymerase chain reaction (CPCR) technique was used to isolate the entire sequence of the nifH gene and its flanking regions from a natural population of Trichodesmium sp. A set of specific CPCR primers derived from a known 72-bp DNA segment of the nifH sequence permitted isolation of both the upstream and the downstream region of Trichodesmium sp. nifH. The 882-bp nifH gene presented here is the first full-length gene isolated from Trichodesmium sp. A sequence similar to a nif-like promoter was found in front of nifH. The nifH open reading frame of Trichodesmium sp. encoded 294 amino acids. Comparative analysis of the Trichodesmium sp. NifH sequence revealed strong similarity with 23 known NifH proteins. Amino acids postulated to be involved in binding of the 4Fe:4S cluster and those subjected to ADP-ribosylation were present. An open reading frame for the nifD gene was identified 189 bp downstream of nifH. A sequence similar to the consensus of the nif-like promoter was also found in front of nifD.

Dietary factors and lung cancer among men in west Sweden

BACKGROUND

Previous studies have reported an association between tea drinking and lung cancer. In view of these data, the relationship between tea drinking as well as other dietary factors and lung cancer was investigated in a case-control study in the west of Sweden.

METHODS

Patients with suspected lung cancer were collected from pulmonary units at central hospitals in the area investigated, and population controls were matched for age. The material reported here comprises 308 male cases with a confirmed diagnosis of lung cancer and 504 controls. The participants were interviewed by specially trained nurses, using a questionnaire to assess smoking, dietary habits, occupational exposures and conditions in the residential area (local air pollution). This paper reports the results from dietary factors studied with a food frequency technique.

RESULTS

The results demonstrated a strong protective effect of vegetables (odds ratio [OR] = 0.69, 95% confidence interval [CI]: 0.46-1.05, and OR = 0.37, 95% CI: 0.23-0.61 for intermediate and high consumption classes respectively). A low OR was consistent for all histological types of lung cancer. High consumption of fruits did not show any similar protective effect. Drinking milk was associated with a dose-response related risk increase after adjustment for smoking and vegetable consumption (P for trend = 0.07). Odds ratio was 1.73, 95% CI: 1.00-3.01 for high consumption of milk.

CONCLUSIONS

High intake of vegetables had a strong protective effect among males. Diet is thus a potential confounding factor in studies on lung cancer and environmental factors and should thus be taken into consideration in the planning of such studies.

Morbidity and injury recurrence in victims of firearm injuries

Civilian violence has become an increasing problem in the industrial world. Gunshot wounds, fatal or non-fatal, are often considered as acute trauma episodes. However, our previous study, based on 820 firearm injuries, showed that this group of patients was characterized by a high mortality rate and a pronounced involvement in criminality when compared to a control group. The aim of this study was to determine the general morbidity in the same group of firearm victims. Our hypotheses were that these patients consume a considerable amount of hospital care due to recurring trauma episodes and that their general morbidity is raised. Information was collected concerning all episodes of in-patient care for victims of firearm injuries from 1972-1992 in Stockholm, Sweden. The victims were compared with a sex- and age-matched control group. During the study period, 69.9% of the 820 firearm victims were treated for other reasons than gunshot injuries, compared to 45.5% of the 820 controls. The former group was hospitalized 3,703 times and the latter on 1,512 occasions. The firearm injury group showed an higher morbidity in almost all diagnostic subgroups according to ICD-9. The trauma recurrence rate was high and suicide, homicide and assault were relatively more common in this group. We suggest that the gunshot episode may be regarded as one expression of a "chronic trauma syndrome'. Patients exhibiting this "syndrome' are characterized by recurrent episodes of trauma, a risk-taking and destructive behavior, high morbidity and mortality as well as anti-social traits. Medical, social and legal complications are common making these patients extremely costly for society and their identification a matter of concern. It is probable that this "syndrome' also exists in other groups of trauma patients. Since hospitalization affords a unique opportunity of reaching patients who have a "chronic trauma syndrome' risk profile, we believe, that these patients should not only be treated for their acute injuries, but that they should be offered help in order to change their destructive life-style. Research should be undertaken to evaluate whether an intervention program, such as counseling, could have an effect on morbidity and injury recurrence for these patients.

Lung cancer in West Sweden 1976-1985. A study of trends and survival with special reference to surgical treatment

We reviewed 3 285 consecutive cases of lung cancer diagnosed in West Sweden during the period 1976-1985. Data were collected from the regional cancer registry, the Swedish National Population Registry, and medical records. During the study period, the annual female/male ratio increased from 0.29 to 0.42. In females, there was an increase primarily in the incidence of tobacco-related morphologic tumour types (i.e. squamous and small cell lung cancers). In males, a moderate increase of adenocarcinomas was seen, although squamous cell cancer remained the most common tumour type. The overall 5-year survival rate was 8.3%. In 641 patients (20%) a surgical tumour resection was carried out. The 5-year survival rate following resection was 38%, and the probability of 10-year survival was estimated at 25%. In a multifactorial model including gender, age, histology, pTNM stage and extent of resection, pTNM stage and, to a lesser degree, age were statistically significant independent predictors of postoperative survival. The five-year survival was 57% in stage 1, 21-27% in stage II and IIIa, and 10% in stage IIIb. Of all resected patients, 4.2% died within two months after resection. In males, early postoperative mortality was predicted by preoperative bicycle ergometry. The prognosis in non-resected patients was poor, with only 2% surviving 5 years or longer. In conclusion, the results indicate that some progress has been made with regard to surgical management of lung cancer, but they also point to the fact that the vast majority of patients are not amenable to curative treatments, and that the overall survival in lung cancer has improved only marginally during the last decades.

Cloning, sequencing, and regulation of the glutathione reductase gene from the cyanobacterium Anabaena PCC 7120

Glutathione reductase (GR) was purified from the cyanobacterium Anabaena PCC 7120. A 3-kilobase genomic DNA fragment containing the coding sequence for the GR gene (gor) was identified and cloned by polymerase chain reaction based on sequences of selected peptides isolated from proteolyzed GR. The coding sequence encompassing 458 amino acid residues, as well as 360 base pairs of the 5'-flanking region and 430 base pairs of the 3'-flanking region, were determined. Genomic Southern analysis indicates that gor is a single-copy gene. A gor antisense RNA probe hybridized with a 1.4-kilobase transcript, suggesting that the gene is not part of an operon including additional genes. The deduced GR amino acid sequence shows 41 to 48% identity with those of human, Escherichia coli, Pseudomonas aeruginosa, pea, and Arabidopsis thaliana GR. The coding sequence of GR was overexpressed in a GR-deficient E. coli strain, SG5, and the recombinant protein was purified. Anabaena GR is NADPH-linked, but a Lys residue replaces an Arg residue involved in NADPH binding in GR from other species. In addition, Anabaena GR carries the GXGXXG "fingerprint" motif which otherwise characterizes NAD(H)-dependent enzymes. These differences may contribute to the lack of affinity for 2',5'-ADP-Sepharose 4B of Anabaena GR. Three E. coli-type promoter sequences and a BifA/NtcA binding motif were found upstream of the open reading frame. The middle and the proximal promoters were shown to be active. However, the use of the middle promoter was dependent on the nitrogen source in the culture medium. Both GR activity and GR protein concentration increased in ammonium grown cultures in which both the middle and proximal promoters were used for transcriptional initiation. The BifA/NtcA-binding site overlaps the middle promoter sequence and may thus be involved in regulation of differential transcription.