A two-step real-time PCR assay for quantitation and genotyping of human parvovirus 4.

Human parvovirus 4 (PARV4) of the family Parvoviridae was discovered in a plasma sample of a patient with an undiagnosed acute infection in 2005. Currently, three PARV4 genotypes have been identified, however, with an unknown clinical significance. Interestingly, these genotypes seem to differ in epidemiology. In Northern Europe, USA and Asia, genotypes 1 and 2 have been found to occur mainly in persons with a history of injecting drug use or other parenteral exposure. In contrast, genotype 3 appears to be endemic in sub-Saharan Africa, where it infects children and adults without such risk behaviour. In this study, a novel straightforward and cost-efficient molecular assay for both quantitation and genotyping of PARV4 DNA was developed. The two-step method first applies a single-probe pan-PARV4 qPCR for screening and quantitation of this relatively rare virus, and subsequently, only the positive samples undergo a real-time PCR-based multi-probe genotyping. The new qPCR-GT method is highly sensitive and specific regardless of the genotype, and thus being suitable for studying the clinical impact and occurrence of the different PARV4 genotypes.

Human parvoviruses B19, PARV4 and bocavirus in pediatric patients with allogeneic hematopoietic SCT.

Among the immunocompetent, infections with parvovirus B19 (B19V) and human bocavirus (HBoV) 1 range clinically from asymptomatic to severe, while following allogeneic hematopoietic SCT (HSCT) B19V can cause a persistent severe illness. The epidemiology and clinical impact of HBoV1 and the other emerging parvovirus 4 (PARV4) among immunocompromised patients have not been established. To determine the occurrence and clinical spectrum of B19V, PARV4 and HBoV1 infections, we performed a longitudinal molecular surveillance among 53 allogeneic HSCT recipients for pre- and post-HSCT DNAemias of these parvoviruses. Quantitative real-time PCR showed B19V DNA in sera of 16 (30%) patients, at mean levels of 4.6 × 10(3), 9.9 × 10(7), 1.1 × 10(10) and 1.6 × 10(2) B19V DNA copies/mL pre-HSCT (9/53), and at 1 (6/53), 2 (4/53) and 3 months (1/25) post HSCT, respectively. However, no clinical manifestation correlated with the presence of B19V viremia. All B19V sequences were of genotype 1. None of the sera investigated contained PARV4 or HBoV1 DNAs. Our data demonstrate B19V viremia to be frequent among pediatric allogeneic HSCT recipients, yet without apparent clinical correlates. PARV4 or HBoV1 viremias were not seen in these immunocompromised patients.

Suicides in persons suffering from rheumatoid arthritis.

OBJECTIVE: To assess the demographic and psychosocial profiles of patients with rheumatoid arthritis (RA) who committed suicide. Two control groups were used: osteoarthritis (OA) and suicide victims with neither RA nor OA. METHOD: A study based on a prospective, 13-yr follow-up database with linkage to national hospital discharge registers of all suicides (1296 males, 289 females) committed during the years 1988-2000 in the province of Oulu situated in northern Finland. RESULTS: Females were significantly over-represented among RA patients who committed suicide (52.6% RA women vs 17.3% women with neither RA nor OA). Comorbid depressive disorders preceded suicides in 90% of the female RA patients. Before their suicide, 50% of the female RA patients (vs 11% of the male RA patients) had experienced at least one suicide attempt. The method of suicide was violent in 90% of the RA females. RA males were less often depressive, but committed suicide after experiencing shorter periods of RA and fewer admissions than females. CONCLUSION: Attempted suicides and especially depression in female RA patients should be taken more seriously into account than previously in clinical work so that the most appropriate psychiatric treatment can be provided for such patients.

Endoscopic sympathetic block--new treatment of choice for social phobia?

Social phobia is a neglected disorder, which can cause very debilitating consequences in patients' lives. The patients tend to isolate and suffer from comorbid disorders such as depression, other anxiety disorders, and drug and alcohol abuse. Traditional treatment methods such as medication and psychotherapy do not help everyone. A prospective, uncontrolled follow-up study with 169 social phobic patients was performed by uni- or bilateral endoscopic sympathetic block of the upper thoracic ganglia. The method is reversible by taking the compression block away, if needed. The selected patients had conservative treatment resistant social phobia according to DSM IV. Structured interview, Davidson's modified brief social phobia scale, and Liebowitz Quality of life questionnaire were used both pre- and postoperatively to assess the value of the treatment. All aspects of social phobia, both somatic and psychological, were highly significantly improved. Reflex sweating as the only remarkable side effect was less than in most series for other indications with sympathetic ablative surgery elsewhere. Endoscopic sympathetic block is recommended as the treatment of choice in severe, conservative therapy resistant social phobia.

ESB in the treatment of addiction. A case report.

Alcohol and drug addiction are common with people with psychiatric disorders and addiction problems can be primary, leading to psychiatric disorders, or secondary to psychiatric disorder. Treating the primary problem first often helps the patient to recover from the secondary problems also. We present a case of a lady with severe social phobia, who recovered from both from her social phobia and her addiction problems after ESB.

Sympathetic surgery for psychiatry. Case report.

One of the authors has, for many years, operated patients suffering from social phobias by using compression block on the sympathetic nerve (1). The Finnish health insurance system has not accepted this treatment as valid for reimbursement. We planned a research based on a design of pre- and post-surgery interviews conducted by a psychiatrist. Data collection was started in 1997. The sample now consists of 45 persons, of whom 20 have also been interviewed after the operation. The results are fascinatingly good. Only one person did not benefit from the operation. We present two illustrating examples. As a conclusion, we suggest that this treatment should be accepted as a valid treatment for patients who have found no relief to their symptoms of social phobic disorder from psychotherapies or pharmacotherapies.

Somatizing frequent attenders in primary health care.

OBJECTIVE: The aim of this case-control study was to investigate the association of somatization with frequent attendance in primary health care. METHODS: Frequent attenders in a health center (FAs) (N=112) and age- and sex-matched controls (COs) (N=105) constituted the study series. Data were collected from annual statistics, medical records, postal questionnaires and personal interviews. Psychological distress was assessed using Symptom Checklist-36 (SCL-36), alexithymia was measured with Toronto Alexithymia Scale-20 (TAS-20) and hypochondriasis was screened with Whiteley Index (WI). RESULTS: About one-third of FAs were somatizers when a cut-off point of eight symptoms on the SCL-36 somatization subscale was used as a criterion. The significant association of somatization with frequent attendance disappeared in multivariate analyses when adjusted for age, sex and chronic somatic illnesses. Hypochondriacal beliefs and psychiatric comorbidity were connected with FAs' somatization. Hypochondriacal beliefs explained somatizers' frequent attendance. A significant interaction effect between somatization and hypochondriacal beliefs was found when explaining frequent attendance. CONCLUSION: The results emphasize the need to use a comprehensive approach of somatization, including hypochondriacal beliefs, when treating somatizing FA patients in primary health care.

Does alcohol drinking have an influence on suicides in cancer sufferers? A population-based study of 1515 suicide victims.

BACKGROUND: [corrected] We investigated whether alcohol drinking contributes to suicides in cancer sufferers when compared with non-cancer suicides. We also explored the suicide method used in cancer suicides. METHODS: The population-based, prospectively collected data sample consisted of 1515 completed suicides committed in the province of Oulu, Finland, during the period 1988-99. Victims who suffered from cancer were compared with other suicides. RESULTS: Cancer patients who committed suicide were significantly less commonly under the influence of alcohol than non-cancer suicide victims (84.8% vs 54.7%). Mental disorders were less prevalent among cancer patients than non-cancer patients. The cancer patients were significantly older and more often retired and a trend that a greater proportion of cancer suicide victims were male was noted. Shooting and poisoning were the most common suicide methods among cancer patients. CONCLUSION: An early recognition and evaluation of the extent of the suicidal tendencies among cancer patients is of great importance in clinical oncology, since preventive interventions would be effective especially for those without comorbid alcoholism at the time of the suicide.

Alexithymia, hypochondriacal beliefs, and psychological distress among frequent attenders in primary health care.

Frequent use of health services has been associated with such concepts as alexithymia, hypochondriasis, and psychological distress. The aim of this case-control study was firstly to assess whether alexithymia, hypochondriasis, and psychological distress are associated with frequent attendance and secondly to assess the gender differences of these associations in a primary health care setting. A sample of 304 frequent attenders (eight or more visits during 1 year), including all of the frequent attenders during 1994, and 304 randomly selected age- and sex-matched controls were selected. Half of the sample (every second individual selected in date-of-birth order) was invited for an interview, 113 frequent attenders and 107 controls completed a questionnaire during the interview. Alexithymia was measured with the Toronto Alexithymia Scale-20 (TAS-20), hypochondriasis was screened with the Whiteley Index (WI), and Symptom Checklist-36 (SCL-36) was used to determine psychological distress. We found a distinct gender difference in the associations of these characteristics with frequent attending. Significant associations of alexithymia, hypochondriasis, and psychological distress with frequent attending were found among men, but not among women. Alexithymia, hypochondriasis, and psychological distress should be considered when treating frequent attenders, especially males.

Frequent attenders in a Finnish health centre: morbidity and reasons for encounter.

OBJECTIVE: To describe the proportion of frequent attenders among primary health care patients and their sociodemographic characteristics, morbidity and reasons for encounter. DESIGN: A cross-sectional case-control study. SETTING: A municipal health centre in Oulainen, a small rural town in northern Finland. PARTICIPANTS: Three hundred and four frequent attenders (eight or more visits to health centre physicians (GPs) during the year 1994) and 304 age- and sex-matched controls. MAIN OUTCOME MEASURES: Sociodemographic characteristics, numbers of encounters, chronic diseases classified by ICD-9 and reasons for encounter coded by the International Classification of Primary Care chapter codes (ICPC). RESULTS: 4.7% of the population aged 15 years or older and 6.8% of the annual patients were frequent attenders and they made 23.5% of all encounters with GPs. The frequent attenders had lower basic education and there were more people on disability pension among them. They had significantly more mental disorders and diseases of the musculoskeletal and digestive systems than the controls. The frequent attenders' most common reasons for encounter were musculoskeletal problems, and they had significantly more musculoskeletal, digestive system and psychiatric reasons for encounters than the controls. CONCLUSIONS: Frequent attenders express more somatic and less psychiatric reasons for encounter than can be assumed according to their morbidity. The role of somatization is discussed.

Sex differences in the association between childhood experiences and adult depression.

BACKGROUND: In the present paper, sex differences in the association between adult depression and childhood experiences were examined. METHODS: The study series of the Finnish UKKI Study consisted of a population sample of 501 men and 499 women. Information concerning childhood experiences was gathered retrospectively in a baseline survey carried out in 1969-72. After the initial phase, the mental health of the subjects was evaluated by interviews, questionnaires and register data at the 5-year follow-up (1974-6) and at the 16-year follow-up (1985-7). RESULTS: Twelve per cent of men and 21% of women had suffered from depression during the 16-year follow-up period. A disturbed mother-child relationship and neurotic symptoms in childhood were associated with depression in women but not in men in the logistic model that included gender interaction. In separate analyses by gender several childhood factors showed statistically significant associations with depression in women but only a few in men. CONCLUSIONS: The finding suggests that childhood experiences are more highly predisposing factors to depression in women than in men.

Utilization of psychiatric in-patient care among new patients in a comprehensive community-care system: a 3-year follow-up study.

Utilization of psychiatric in-patient care among 537 new patients was studied in the Department of Psychiatry in Oulu, Finland, during a 3-year follow-up period. Hospitalization during the second and third years of the follow-up was predicted by hospitalization and number of emergency out-patient contacts during the first year of the study, diagnosis of functional psychosis or personality disorder, and previous in-patient care. In total, 5% of the cohort fulfilled our criteria for 'revolving-door' patients. The 'revolving-door' phenomenon was associated with in-patient care at the first contact with the psychiatric services and diagnosis of psychosis or personality disorder. In total, 2% of the cohort became long-stay hospital patients, and this was predicted by psychosis diagnosis. The clinical implications of these findings are that increased attention should be paid to the first assessment of new patients and to the interaction between psychiatric services and patients during the first year of care.

Is continuous intranasal salmon calcitonin effective in treating axial bone loss in patients with active rheumatoid arthritis receiving low dose glucocorticoid therapy?

OBJECTIVE: To investigate the efficacy of intranasal salmon calcitonin (sCT) in treating axial bone loss in patients with rheumatoid arthritis (RA) taking low dose glucocorticoids. METHODS: In this open, multicenter study 32 women with RA were treated one year with sCT 100 IU/day and calcium (Ca) 500 mg/day; 31 women were treated with Ca alone. Bone mineral density (BMD) was measured at the lumbar spine and proximal femur (femoral neck, Ward's triangle, trochanter) before sCT therapy and again after 6 and 12 months. RESULTS: Among valid completers treated with sCT and Ca (n = 26), the mean BMD increased at the lumbar spine (L1-L4), femoral neck, and Ward's triangle. In contrast, valid completers treated with Ca (n = 23) showed bone loss at the spine (L1-L4), femoral neck, Ward's triangle, and trochanter area. The differences of the changes in BMD were statistically significant between these groups at the femoral neck, Ward's triangle, and trochanter. There were no significant differences between groups in bone loss over 12 months at the lumbar spine (L1-L4), although analysis of the upper segment (L1-L2) suggested some possible benefit of sCT. CONCLUSION: Intranasal sCT (100 IU/day) appears to have beneficial effects on bone loss at the proximal femur in patients with active RA treated with low dose glucocorticoids for 12 months; longer studies are needed to exclude transient bone remodelling effects.

Incidence of mental disorders in the Finnish UKKI Study.

BACKGROUND: The aim was to give estimates of the incidence of different mental disorders from a Finnish prospective epidemiological follow-up study, the UKKI Study. METHOD: The original probability sample consisted of 1000 persons, aged 15-64 years. The baseline survey took place in 1969-71, and follow-up surveys were conducted 5 and 16 years after the baseline survey. The research methods included a personal psychiatric interview and data collection from different registers. The diagnostic system was based on the ICD-8 classification. RESULTS: The estimated annual incidence of all mental disorders was close to 15 per 1000 both between baseline and the 5-year follow-up as well as between the 5-year and the 16-year follow-up. During the entire 16-year follow-up period the annual incidence of all disorders was 14 per 1000 in men and 17 per 1000 in women. The annual income of neurotic disorders was 10 per 1000 in men and 14 per 1000 in women, and that of psychotic disorders 2 per 1000. CONCLUSIONS: In the literature, there are huge differences in the results concerning incidence of mental disorders. The results of the present study were rather close to those of the Swedish Lundby Study, but nowhere near the results of the American ECA Study.

Fire-setting from the viewpoint of an arsonist.

1. Arsonists have more psychiatric symptoms, such as self-destructive behavior and alcohol dependency, than other criminal offenders. 2. Arsonists are found to have poor social competence with low social status and a high unemployment rate. 3. The act of arson could be like an attempted suicide, a cry for help.

Arson trend increasing--a real challenge to psychiatry.

This research evaluated the arson trend in Finland since the 1960s by analyzing the Official Crime Statistics of Finland registered by the police and examined more detailed about arsonists (n = 98), who had been in the forensic psychiatric pretrial examination by using homicide offenders (n = 55) as control subjects. From 1965 to 1991 the percentage of arson in relation to all crimes increased fivefold and in the same timeframe the amount of arson increased nearly tenfold. According to the police in Finland there are committed over 700 arsons every year, of which 90% are committed by men. The percentage of women has however increased 0.2% yearly. Women today commit about 10% and juveniles 10 to 15% of all arsons. The arsonists differed from the homicide offenders regarding rural residence (P = 0.009), poor education (P = 0.004), absence of regular work at the time of the crime (P = 0.004), suicidality (P = 0.001), alcohol problems (P = 0.002), psychiatric care (P = 0.000.02) and arsonists more commonly found to be not responsible for the crime committed (P = 0.01).

A portrait of the juvenile arsonist.

In this study we evaluated if juvenile arsonists (n = 34) differ from juvenile criminals of violence (n = 33) in regard to suicide and mental problems in forensic psychiatric examination. Both arsonists and violent offenders were mostly male, poorly educated, unskilled and unemployed at the times of committing their crimes; and 79% of the arsonists and 58% of the control group had used public health services for treatment of their mental symptoms before the crime. This difference was significant (p = 0.05). Suicide was more common among the arsonists than the control subjects (p = 0.02); 74% of the arsonists had suicidal thoughts and 44% had tried to commit suicide before setting a fire. In the forensic psychiatric examination the arsonists were more often relieved from responsibility than the comparison group (p = 0.02).