Depression assessed over 1-year survival in patients with myocardial infarction.

OBJECTIVE: To estimate the prevalence of ICD-10 depression using a self-reported questionnaire and to examine if depression is associated with increased 1-year mortality in patients with myocardial infarction (MI). METHOD: In total, 763 MI-patients completed the Major Depression Inventory at discharge. Information from hospital notes was collected and patients were followed 1 year for re-admission and mortality through national registries. RESULTS: Seventy-three patients (9.6%) were depressed at discharge. Depression was not a significant independent predictor of mortality; however, there was a significant trend for increasing mortality with increasing severity of the depressive state (P = 0.028). All mortality among depressed patients was in patients with non-Q-wave infarction. CONCLUSION: Ten per cent of MI-patients fulfilled diagnostic criteria for depression at discharge. There was a significant trend for increasing mortality with increasing severity of the depressive episode. All mortality among depressed patients was seen in patients with non-Q-wave infarction. These findings indicate future studies in selected subgroups of MI-patients.

Psychosocial predictors of depression in patients with acute coronary syndrome.

OBJECTIVE: To describe the prevalence of depression according to ICD-10 criteria using a self-completed questionnaire and to identify psychosocial predictors of depression at discharge in patients with acute coronary syndrome. METHOD: A total of 899 patients with acute coronary syndrome completed the Major Depression Inventory at discharge and a questionnaire regarding previous depression and family history of depression. Information concerning civil status was obtained from the Civil Person Registry. RESULTS: Ninety patients (10%) were depressed according to ICD-10 criteria at discharge with 7.2% having a moderate to severe depression at discharge. Women were significantly more frequently and severely depressed than men. Patients with and without depression reported primarily somatic symptoms of depression. Cardiovascular risk factors or treatment did not differ between patients with and without depression. Previous depression (OR 2.9, 95% CI 1.4-6.0 adjusted) and female gender (OR 2.5, 95% CI 1.5-4.3 adjusted) predicted depression at discharge in a logistic regression model. CONCLUSION: Somatic symptoms of depression are prevalent in patients with acute coronary syndrome. The use of self-completed non-diagnostic questionnaires assessing symptoms of depression therefore is cautioned as patients may wrongly be identified as depressed. In patients with acute coronary syndrome depression is predicted by well-known psychosocial risk factors.

Psychosocial distress during pregnancy and the risk of infantile colic: a follow-up study.

AIM: To examine the association between psychosocial exposures during pregnancy and the risk of infantile colic. METHODS: The study included 378 infants and was conducted as a substudy of the Danish National Birth Cohort from 1997 to 1999, with prenatal data collected twice during pregnancy. A diary with a record for postpartum weeks 4-8 was used to quantify the amount of the infants' crying and fussing. RESULTS: The cumulative incidence proportion of infantile colic was 8.2%. A threefold increased risk of infantile colic (OR = 3.7; 95% CI: 1.1-13.2) was found for mothers who reported distress during pregnancy. Close to a twofold increased risk of IC was found for the women who scored higher than 8 on the psychological distress scale (adjusted OR = 1.9; 95% CI: 0.5-7.2). CONCLUSION: The results indicate that general distress during pregnancy influences the risk of infantile colic. Whether or not this relationship is causal requires further investigations.

[Infantile colic--an assessment of possible risk factors]. / Tremånederskolik--en vurdering af mulige risikofaktorer.

Infantile colic is defined as crying or fussing for more than three hours a day for more than three days a week. The aetiology is unknown, although many hypotheses have been examined: allergy, type of feeding, the development of the gastrointestinal tract, the development of the central nervous system, and the mother/infant relationship. The frequency varies between 8% and 40% in industrialised countries. We found that education, parity, age, obstetric factors, and gender were not important risk factors. There are no unambiguous results on psychosocial risk factors and infantile colic. Giving parents advice and education in parenting were more effective than changing diets. Elimination of cow's milk or the diet of the mother had some effect. This review comprises studies where infantile colic is defined quantitatively. Despite this, no unambiguous results, which are consistent with a multifactorial aetiology were found.

[Psychology in the curriculum of Royal Dental College, Copenhagen]. / Faget psykologi i undervisningen på Københavens Tandlaegehøjskole.

In the curriculum of the Royal Dental College, Copenhagen, psychology has been offered as a separate discipline since 1986. In total there are 38 lectures and 31 seminars each of 2 hours. The teaching is divided into 6 main subjects: theory og education (learning, remembering and thinking), motivation and emotion, personality and the individual, biological and developmental processes, social behavior and conflict, adjustment and mental health. A general theme is a psychological understanding of anxiety and pain, and how to create positive attitudes and behavior to dental care and to the dentist. The lectures and seminars are primarily placed in the two first semesters of the dental education. In the final part of the education there are follow-up teaching in the disciplines pedodontics, gerodontics, sociology and dental ethics.

[Psychology of phobias in relation to dental anxiety]. / Fobiens psykologi i relation til odontofobi.

In this article the most important etiologic factors related to dental anxiety are presented and form the basis for the exposition of a model for the psychologic development of dental anxiety. The model shows that personality factors related to emotion and cognition can influence the development of dental anxiety. In order for the anxiety to develop and become manifest it is also necessary that: 1: the individual experiences a given stimulus as presenting a physical threat, e.g. in the form of pain, 2: the individual has been exposed to an experience or a learning situation involving the stimulus, and finally, 3: the individual in connection with this stimulus, experiences somatic reactions such as sweating, abdominal discomfort or tachycardia. This triad interacts in such a way that the individual elements can reinforce each other and thus increase the anxiety, (full-drawn arrow) or also the opposite, (stipled arrow). In this way pain control (anesthesia/sedation), positive reinforcement/information or bodily control (relaxation/biofeedback) will contribute to attenuate or prevent the development and manifestation of anxiety. The model further demonstrates that odontophobia also develops and is contingent upon the opinions, attitudes, feelings and behavior with regard to dental health, hygiene and dentists which is present in the social relationships in the family, the group, social class and the culture. This complex social psychologic process is called socialization, and it expresses the individuals more or less conscious adaptation to society. An important part of this process is imitation or social learning, which forms an important aspect of human development.(ABSTRACT TRUNCATED AT 250 WORDS)

[Psychologic considerations in the recording of dental anxiety]. / Psykologiske overvejelser ved registrering af odontofobi.

The recording procedure is an especially important aspect of the psychologic treatment, since it contributes to the establishment of confidence between the dentist and his patient, and as such is an essential prerequisite to a successful treatment. The article argues that the registration should concern itself with situations and stimuli which have a traumatic character and with the associated learning processes. Furthermore recording of changes in behavior, somatic aspects of anxiety and of the emotional and cognitive aspects of anxiety should be involved. Based on these general requirements, recording of phobias has five main purposes: Firstly, a recording should contribute to a reliable diagnosis or a sufficiently differentiated description of the phobia that one can offer the best possible treatment and prognosis evaluation. Secondly, the recording should ensure that one can evaluate the effects of different types of treatment or the effects of correction of already initiated treatments. Thirdly, recording should contribute to testing the validity of various models of phobia, and by this means attempt to produce new and better hypotheses for the origin of phobias, their extent, treatment and prevention. Fourthly registration should ensure that different recorders and therapists work with as uniform a conception of phobias as possible, (continual calibration). Finally a registration should be of such a nature that it can be incorporated in an epidemiologic study. In addition to the interview method, the article considers the various objective psychologic and physiological instruments available for the registration of components of anxiety and especially dental anxiety. Weaknesses and sources of error in relation to the reliability and validity of these methods are discussed.

[Behavior therapy for patients with dental fear]. / Adfaerdsterapi over for odontofobier.

Many dentists, in the course of their daily work with their patients, engage in a more or less explicit psychologic treatment of their patients where these evidence symptoms of odontophobia. In the case of many patients, the personal characteristics and individual psychologic skills of the dentist can be sufficient to the occasion, but for patients who suffer from serious phobic reactions to the dental situation, both good psychologic insight and experience are required in order that a psychologic treatment may be embarked upon with the prospect of a successful outcome. This article describes the various treatment techniques relevant to odontophobia which have their theoretical basis in the modern forms of behavior therapy. Thus the procedures associated with systematic desensitisation, fading, flooding, stress inoculation training, modelling, assertiveness training, progressive relaxation and biofeedback are briefly described. An absolutely necessary requirement for the successful treatment of a phobia is the establishment of a satisfactory and trusting relationship between patient and therapist, a requirement which in the case of dental anxiety is all too often ignored. The article emphasises that these treatment procedures are generally time-consuming, and that economic considerations dictate that it is difficult to incorporate them into private practice.

Dental health behaviors and periodontal disease indicators in Danish youths. A 10-year epidemiological follow-up.

The purpose of the present study was to analyse the epidemiologic relationship between dental health behaviors and periodontal disease. Indicators of periodontal disease in terms of bleeding and calculus were measured dichotomously (absence/presence). Periodontal pockets were as follows: normal pockets (0-3 mm), shallow pockets (4-5 mm), and deep pockets (6+ mm). The indicators were measured on 4 surfaces on 6 index teeth (16, 11, 26, 36, 31, 46) in 1984-85. The highest value for each tooth of bleeding (0/1), calculus (0/1) and pockets (0/1/2) was used for calculation of the bleeding index, the calculus index and the pocket index. The participation rate in 1984-85 was 86%, and the study population involved 368 males and 388 females. Information concerning dental health behavior was obtained both in childhood (1974) when the individuals were 9-10 years of age, and in adulthood (1984-85) when the individuals were 20-21 years of age. Information concerning dental health behaviors in adulthood, i.e., regularity of dental visits, frequency of tooth brushing, and regular use of interdental aids, was obtained through a self-administered questionnaire (1984-85). Dental health behaviors in childhood (1974) was operationalized as level of plaque, gingivitis, and dmfs. The results showed that dental health behaviors in childhood and in adulthood were together responsible for 9.4-13.8% of the variance in level of periodontal disease indicators. Determinants of early dental health behaviors in terms of plaque and dmfs at age 9-10 years were significant predictors in pocket index at age 20-21.(ABSTRACT TRUNCATED AT 250 WORDS)

[Pediatric dentistry and dental fear]. / Bornetandpleje og tandlaegeskraek.

The development of dental anxiety is often related to dental experiences in the childhood. A. study (3) from Copenhagen shows that among 20-21-year-old Danes, 37% had a negative assessment of child dental care and 14% had phobic reactions to dental care. The article examines factors which could have influence on the psychologic atmosphere in the clinic and in this way the psychologic reactions of the child. Some factors are not specifically related to the dentist, such as the availability of parent/child's choice of dentist, the psychologic interaction in the treatment triangle, the specific interaction between the dentist and the clinic assistant and finally the physical aspects of the clinic (dental instruments, dental equipment, dental clothing, and colors and dimensions of the dental cabinet). Factors which are specifically related to the dentist are the dentist experience and psychologic skills and awareness of his own limitations, and requirement to take the time to communicate and create an atmosphere of confidence. Also sex and age could have some influence. Finally the dentist should have a thorough knowledge and experience in the administration of pharmacologic agents. The best way to evaluate the psychologic factors is continually to record the child's behavior in the treatment situation and the parents opinion about the dental care system. A very concrete way to evaluate, is to record some treatment situations on a video and discuss the communication and the behavior of the child with the clinic assistant.

Influence of age and immunization on development of gingivitis in rats.

To study the effect of age and antigenic priming on the development of gingivitis, 33 healthy rats were placed in contact with Streptococcus mutans, Actinomyces viscosus, Fusobacterium nucleatum, and Bacteroides gingivalis. On days 0, 3, 7, and 14 after inoculation, the gingival condition was judged clinically and histologically, and serum antibody titers against the bacteria were measured. The rats were divided into three groups: 1 month old, 3 months old, and 3 months old immunized. None of the young rats developed gingivitis during the experiment, whereas half of the adult and all of the adult immunized rats bled on probing on days 7 and 14. In general, antibody titers against the bacteria were low in young rats, moderate in adult rats, and high in adult immunized rats. These results indicate that adult rats react stronger to plaque antigens than young rats and that previous contact with the antigens increases the reaction.

Use of dental services among Danish youths: role of the social environment, the individual, and the delivery system.

The purpose of the present study was to analyze the separate effect and the total effect of the social environment, the individual and the delivery system on frequency of use of dental services among youths. The variables of use were divided into the three main groups according to Coleman (12). Information concerning use of dental services, individual and structural variables was obtained by a self-administered questionnaire to 756 Danes 20-21 yr old in 1984-85. Information concerning social environmental variables was obtained by a postal questionnaire to the mothers of the individuals in 1974 (16). Information from 552 mothers was available. Firstly, the variables concerning the social environment were inserted into a multiple dummy regression analysis as independent variables, and it was found that the following characteristics of the mothers were significant predictors: regularity of dental visits and perceived economic barriers. Secondly, the variables concerning the individual resources were set into a multiple dummy regression model as independent variables. The results showed that the following variables had a significant effect: sex, social conditions, pain tolerance, dental anxiety, and perceived economic barriers. Thirdly, multiple dummy regression analysis showed that among the structural variables general assessment of Child Dental Care compared to Youth Dental Care, and a personality assessment of the general dental practitioner were significant predictors. Finally the predictors from the three main groups all together were inserted as independent dummy variables into a regression model. The results showed that sex, social conditions, pain tolerance, dental anxiety, perceived economic barriers of the youth themselves, general assessment of Child Dental Care compared to Youth Dental Care were significant predictors.(ABSTRACT TRUNCATED AT 250 WORDS)

Dental health status and attitudes to dental care in families participating in a Danish fluoride tablet program.

The caries experience and dental fluorosis of 84 Danish children, who had used fluoride tablets for 1-4 yr in the period 1976-80, were compared with those of a group matching in sex, age, place of living, and socioeconomic status. The average age of the children at the time of examination was 5.8 yr. A recording of mothers' attitudes to dental care, knowledge about tooth brushing, attitudes to candy, and number of teeth in the maxilla showed no difference between the fluoride tablet group and the non-users' group. Moreover, there was no significant difference between the two groups with respect to dental caries. The findings are discussed in relation to recent reports on the decline of dental caries resulting from widespread use of local administration of fluorides.

Epidemiologic indices for pulp treatment and extraction of primary molars.

The purpose of the present study is to introduce and discuss four indices to be used in epidemiologic recording of pulp treatment and extraction of primary molars. The indices are constructed on the basis of the four combinations existing between pulp treatment/no pulp treatment and extraction/no extraction. The NPE-index (No Pulp treatment or Extraction) reflects the relative number of teeth which are neither extracted nor pulp treated. EPM-index (Extracted Primary Molars) reflects the relative number of teeth, which have been extracted. PPM-index (Pulp treated Primary Molars) reflects the relative number of teeth which have been pulp treated. PNE-index (Pulp treatment No Extraction) reflects the relative number of pulp treated and not extracted teeth.