Functional somatic symptoms in youths in general practice: A cross-sectional study on prevalence, clinical management and perceived burden.

OBJECTIVE: Functional somatic symptoms (FSS) may progress into a functional disorder if poorly managed, which may have serious implications. This cross-sectional study describes the management of youths compared to adults in general practice and estimates the prevalence of FSS in youths in this setting by comparing consultation-related aspects between youths with FSS and 1) youths with a specific diagnosis and 2) adults with FSS. METHODS: We used data from a Danish survey (2008-2009), including 3295 face-to-face consultations between GPs and patients aged 15-64 years. Patients were divided into youths (15-24 years) and adults (25-64 years) and then into subgroups according to the GPs' classifications: 1) specific diagnosis, 2) resolving symptom and 3) FSS. Logistic regression analysis was used for all comparisons, and estimates were adjusted for gender, concomitant chronic disorder and GP cluster. RESULTS: The GPs more frequently ensured continuity of care in adults (AOR:0.75, 95%CI:0.61-0.92, p < 0.01) and perceived youths as less time consuming (AOR:0.58, 95%CI: 0.43-0.77, p < 0.01) and less burdensome (AOR:0.60; 95%CI: 0.45-0.81, p < 0.01) compared to adults. FSS prevalence was 4.4% in youths and 9.0% in adults. However, GPs perceived youths with FSS as more burdensome (AOR:7.77, 95%CI:2.93-20.04, p < 0.01) and more time consuming (AOR:3.98, 95%CI:1.42-11.12, p < 0.01) than youths with a specific diagnosis. No significant differences were found between youths and adults with FSS, respectively, in regards to perceived burden and consultation time. CONCLUSION: The results indicate age-related variations in the prevalence and clinical management of FSS in general practice. The GPs perceived both youths and adults with FSS time consuming, which underlines a need for supportive management strategies.

Self-help interventions for young people with persistent physical symptoms: A systematic review.

OBJECTIVE: Persistent physical symptoms are frequent among young people causing considerable social, psychological, and economic consequences. Easily accessible interventions adapted to non-specialized settings are needed. We aimed to systematically review randomized controlled trials on self-help interventions for young people with persistent physical symptoms compared to active or passive control groups. Our purpose was to 1) describe applied therapeutic approaches and content and 2) examine potential effects on symptom burden and psychosocial outcomes. METHODS: We included randomized controlled trials on minimal contact self-help interventions for young people with persistent physical symptoms. Systematic literature searches in PubMed, Cochrane Central, Embase, and PsycINFO were conducted. Study selection, data extraction and quality assessment were performed independently by two reviewers. A narrative synthesis of the effects was performed. RESULTS: We identified 11 studies on self-help interventions for young people. The methodological quality of the studies was generally low. Participants suffered from impairing fatigue, headache, abdominal pain, and musculoskeletal or multi-site pain. Applied therapeutic approaches were cognitive behavioral therapy, relaxation training, hypnotherapy, and written self-disclosure. Outcomes were diverse and mainly related to symptom burden, whereas psychosocial outcomes were only sporadically examined. Overall, evidence of effectiveness of self-help interventions in alleviating symptom burden was weak, and potential effects could not be linked to one specific theoretical approach. CONCLUSION: Few self-help interventions of diverse content exist for young people with persistent physical symptoms. Rigorously designed studies that include recommended outcome domains assessed by aligned measures are needed to determine and compare the clinical value of such interventions.

Caring for patients with spinal metastasis during an MRI examination.

INTRODUCTION: Magnetic resonance imaging (MRI) is without question the best tool used for diagnosing and evaluating spinal metastasis. An MRI examination is known to be of great value for the treatment planning and survival of these patients. Radiographers have an important role in how the quality of care is experienced by the patients during an MRI examination. The purpose of the study was to describe the radiographers' perceptions of caring for patients with spinal metastasis during an examination with MRI. METHODS: Phenomenography was used to analyze the data in this study. Ten radiographers, one male and nine females were interviewed about their perception of caring for patients with spinal metastasis during an MRI examination. RESULTS: The findings showed that the radiographers' caring perspective influenced their approach towards what they consider to be essential in the care of patients with spinal metastasis. This can impact the extent of the adjustment to the care needs of the patients. Furthermore, the findings showed that there was a strong connection between the radiographers' care approach and preparedness to personalize the care. CONCLUSION: This study shows that it is important to be flexible when providing care for the patients. A person-centered care is achieved when the caring perspective is based on the patient's view and adjustments are made in agreement with the patient.

Is psychotherapy for functional somatic syndromes harmful? A mixed methods study on negative effects.

INTRODUCTION: Concern for negative effects of psychotherapy for functional somatic syndromes (FSS) has been expressed by clinicians and some patient associations, which may prevent patients from seeking treatment. Therefore, we sought to explore the occurrence and characteristics of negative effects from group-based psychotherapy as experienced by patients with severe or multiple FSS. METHODS: An adapted version of the explanatory sequential mixed methods design was applied. We used data from an on-going pilot study on Acceptance and Commitment Therapy and Mindfulness-Based Stress Reduction. Negative effects were measured by Inventory for the assessment of Negative Effects of Psychotherapy (INEP). In addition, telephone interviews were conducted with randomly chosen patients and patients who reported negative effects. The latter were asked to elaborate on their INEP response. Quantitative data were analysed descriptively while interview transcripts were explored by thematic analysis. RESULTS: Eighty patients responded to the questionnaire (89%). Negative effects to different extent (from 'slightly agree' to 'fully agree') were reported by 25 (31%). The most frequent negative effects were dependence on the therapist (12%), feeling down after therapy (6%) and insurance problems (7%). By exploring 27 participants' experiences of negative effects 3 main themes were identified: relations in therapy, outcome and transition from therapy to everyday life. CONCLUSION: Patients with FSS reported a few specific negative effects, all with low frequency. Generally, therapy was well-received. Some patients did however express negative effects both within and outside the therapeutic context. It is important to inform patients about potential negative effects prior to psychotherapy.

Women with abnormal Pap smear result: a qualitative study of Swedish healthcare professionals' experiences.

A Papanicolaou (Pap) smear can be used to detect pre-cancerous cellular changes, so that they can be treated before they develop into cervical cancer. When the results of a Pap smear test are abnormal, women need further investigation, treatment and follow-up. Healthcare professionals (HCPs) are in a position to care for these women with abnormalities. The aim of this study was to explore the experiences of HCPs in caring for women with abnormal Pap smear results. In total, 20 HCPs from two counties in south-eastern Sweden participated in individual interviews, based on two open-ended questions. Interviews were recorded, transcribed verbatim and analysed using content analysis. The results showed that HCPs experienced that abnormal Pap smear results created anxiety in women, who often sought information from the Internet as a way to cope. Furthermore, the HCPs thought that it was a problem that women chose not to attend investigation, treatment and follow-ups. However, information about the seriousness of abnormal Pap smear results causes women to participate. It is a challenge for HCPs to inform in a reassuring manner. Finally, HCPs should collaborate with women to meet their information needs and to also provide support regarding finding and filtering reliable information on the Internet.

Validation of the Verbal and Social Interaction questionnaire: carers' focus in the carer-resident relationship in supported housing facilities for persons with psychiatric disabilities (VSI-SH).

A questionnaire to measure the verbal and social interactions between carers and residents in supported housing facilities for persons with psychiatric disabilities has been developed. It is an adaptation of a questionnaire originally used in a forensic psychiatric setting. The aim of the present study was thus to investigate the construct validity and the reliability of this new version of the Verbal and Social Interactions questionnaire for use in supported housing facilities (VSI-SH). Two hundred and twenty-three carers from municipal and privately run housing facilities completed the questionnaire. A factor analysis was performed, which resulted in six factors. The number of items was reduced from the original 47 to 30 in order to minimize factorial complexity and multiple loadings. The reliability was tested with Cronbach's alpha and good internal consistency for the questionnaire and five of the six factors was found. The resulting six factors and the items were compared to the conceptual model and four of the six factors corresponded well with the categories in this original theoretical model. The questionnaire can be a useful contribution to the study of interactions between carers and residents in supported housing facilities for persons with psychiatric disabilities.

Diet shifts and food selection of perch Perca fluviatilis and roach Rutilus rutilus in humic lakes of varying water colour.

The field data from four humic lakes suggested that water colour may have both direct and indirect effects on inter- and intra-specific interactions of perch Perca fluviatilis and roach Rutilus rutilus. The results agree with suggestions that, compared with R. rutilus, P. fluviatilis may be an inferior forager on zooplankton in highly coloured water. As an indirect effect, water colour decreases the coverage of macrophytes and limits suitable littoral habitats, benefiting R. rutilus over P. fluviatilis. Perca fluviatilis benefiting from complex habitats does not have the advantage in macrophyte-poor highly coloured water.

Environmental factors regulate the effects of roach Rutilus rutilus and pike Esox lucius on perch Perca fluviatilis populations in small boreal forest lakes.

In this study of 18 small boreal forest lakes, the effects of abiotic and biotic factors (roach Rutilus rutilus and pike Esox lucius) on various population variables of perch Perca fluviatilis were examined. As a single variable, the gillnet catch per unit effort (CPUE) of R. rutilus was negatively related to the mean mass of small (< 200 mm) and the growth rate of young (1-2 years) P. fluviatilis. The mean mass of large (> or = 200 mm) P. fluviatilis was the highest at intermediate CPUE of R. rutilus. Redundancy analysis including environmental factors and P. fluviatilis population variables suggested that 'predation-productivity-humus' gradient affected P. fluviatilis populations by decreasing the CPUE and mean mass of small individuals but increasing these variables of large individuals. The CPUE of R. rutilus and lake area had a negative effect on small and a positive effect on large P. fluviatilis growth rate. In small boreal forest lakes, P. fluviatilis populations are affected by the partially opposite forces of competition by R. rutilus and predation by E. lucius, and the intensity of these interactions is regulated by several environmental factors.

Validation of the verbal and social interaction questionnaire: nurses' focus in the nurse-patient relationship in forensic nursing care.

There is a need to develop a questionnaire that measures nurses' verbal and social interactions (VSI) with their patients from the nurses' perspective as well as from the patients' perspective in the psychiatric and especially in the forensic psychiatric field. The major aim of the present study was to determine the construct validity and the internal consistency reliability of the VSI questionnaire. The study had a methodological and developmental design and was carried out in four steps: construction of the items, face validity, data collection and data analysis. The number of items was reduced from 50 to 21. The factor analysis of the final 21 items resulted in three quite distinct factors, namely, 'inviting the patient to establish a relationship', 'showing interest in the patients' feelings, experiences and behaviour' and 'helping the patients to establish structure and routines in their everyday life'. The results showed satisfactory psychometric properties in terms of content validity, construct validity and the internal consistency reliability of the questionnaire.

Temporal coherence in water temperature and chemistry under the ice of boreal lakes (Finland).

Temporal coherence was assessed for 11 limnological variables--water temperature, oxygen, conductivity, alkalinity, pH, colour, calcium (Ca), iron, aluminium, total phosphorus and total nitrogen--between 28 boreal lakes in southern Finland for the winter ice-covered period. The lakes were mainly small (<0.2 km2) and brown-coloured, and located within a circle of 10-km radius. A mean Pearson correlation coefficient for all lake pairs and variables averaged 0.37. Temporal coherence of variables across lake pairs was highest for conductivity, Ca, water temperature and alkalinity. The lake pairs with a direct surface water channel connection had a higher coherence than the lake pairs not connected by a stream. The size of the lake or catchment area had little effect on the coherence between the lakes. Temporal coherence was not strongly related to the difference in water colour (dystrophy) between the lakes. However, between polyhumic lakes (colour > 100 g Pt m(-3)) the coherence was generally higher than between less coloured lakes. Year-to-year variation in limnological characteristics could be partly explained by the variation in local weather. In March, water temperature and chemistry were infrequently related to winter weather, rather they correlated with the weather conditions of the previous autumn, while the ambient late winter weather seemed to have a stronger influence on lake conditions in April. Temporal variation in some variables was related to the atmospheric pressure changes over the North Atlantic (the North Atlantic Oscillation, NAO). Our results suggest that the potential effects of climatic change on lakes can be generalised regionally for brown-coloured dystrophic lakes.

Non-lethal infection parameters in mice separate sheep Type II Toxoplasma gondii isolates by virulence.

The zoonotic protozoan parasite Toxoplasma gondii can infect all warm-blooded animals, but virulence of isolates has previously been characterised mainly by the ability to kill mice after experimental infections. In the present study, 15 Type II strains of T. gondii, isolated from five adult sheep, six sheep abortions, two pigs, one cat and one fox were examined for their virulence to young mice by less dramatic parameters. Clinical disease of inoculated mice, directly evidenced by reduced weight gain, was correlated to increase in serum level of haptoglobin and level of specific antibodies. Although Type II T. gondii strains are non-virulent to mice by lethality studies, significant differences in mouse virulence were observed between the strains of T. gondii isolated either from adult sheep or from sheep abortions. It was not possible to characterise strains isolated from sheep abortions as being more or less virulent than strains isolated from adult slaughter sheep.

Interventions in the nurse-patient relationship in forensic psychiatric nursing care: a Swedish survey.

Nurses (Registered nurses, RN, and Licensed Mental Nurses, LMN) working in five Swedish forensic psychiatric units filled in a questionnaire designed for general psychiatric nursing, but modified for forensic use. In this report, data concerning the extent to which treatment interventions included verbal elements, and the focus of these nurse--patient verbal interactions, were analysed. The most commonly used interventions were 'social interaction', 'regular communication' and 'social skills training'. The most common focus in verbal nurse--patient interaction were 'explaining consequences, confronting and encouraging the patient to talk about his/her crime/behaviour', 'interpretative communications with the patient', and 'communication about functions in daily life'. The salient findings were: (1) seven of the fifteen interventions used by the nurses included verbal elements to a great extent; (2) nurses often used confronting interventions, despite the fact that the large EE (expressed emotion) literature suggest that hostility and critical remarks may provoke a worsening of symptoms among psychotic patients; (3) there was only little correspondence between actual practice and theoretical models; and (4) there were unexpectedly small differences between the two professional groups (RN and LMN), suggesting that the roles are not distinct.

Forensic psychiatric nursing care--nurses apprehension of their responsibility and work content: a Swedish survey.

This questionnaire study aimed to investigate nurses' views regarding the areas of responsibility, work content and the theoretical perspectives found to dominate nursing duties in Swedish forensic care. The sample (n = 350) was chosen randomly from the five forensic units which provide treatment for patients in Sweden and there was a response rate of 70% (n = 246). The role of the nurses consisted mainly of actions related to activities of daily living (ADL)-activities. It is worth noting that, within the area of ADL-activities, practical work on the ward was the nurses' most common responsibility as well as work content. Less dominating aspects, were educating patients' families, leading group discussions with family or patients, co-operating with social authorities as well as activities related to life outside the unit. There were no significant differences with regard to gender but several differences between registered nurses (RNs) and licensed mental nurses (LMNs) were noted. There were mostly weak correlations between areas of responsibility or work content and theoretical perspectives. The results thus suggest that nurses in forensic care view their work to be mainly directed at patients' capacity for ADL-activities, medical psychiatric actions, informing and educating patients and families and assessing patients. An even greater emphasis on these aspects may be warranted because of the patients' serious deficits in social and life skills. It may be useful to consider an increased focus on a psycho-educational approach and to develop and test methods focusing on the development of patients' capacity for activities related to daily living in a broad sense. Further research is needed to investigate whether the aspects that dominate nursing care also coincide with what the patients apprehend as beneficial for their recovery.

Neospora caninum infection and repeated abortions in humans.

To determine whether Neospora caninum, a parasite known to cause repeated abortions and stillbirths in cattle, also causes repeated abortions in humans, we retrospectively examined serum samples of 76 women with a history of abortions for evidence of N. caninum infection. No antibodies to the parasite were detected by enzyme-linked immunosorbent assay, immunofluorescence assay, or Western blot.

The influence of the design of two different bioresorbable barriers on the results of guided tissue regeneration therapy. An intra-individual comparative study in the monkey.

The aim of the present study was to compare two bioresorbable barriers to evaluate whether differences in design influence the result of guided tissue regeneration (GTR) therapy. Twenty-four (24) plaque exposed, recession type defects in 4 monkeys were treated. Contralateral defects were randomized for test or control treatment. During a healing period of 6 weeks, gingival recession resulting in device exposure occurred at 3 test and 10 control sites. One control barrier was exfoliated. Histologically, 9 of the 12 test barriers were completely integrated with the surrounding tissues. At 3 test sites, epithelium had migrated apically outside the barrier to a level not exceeding one-third of the height of the device. Seven of the 11 control barriers were enclosed by dentogingival epithelium. The adjacent connective tissue exhibited local inflammatory cell infiltrates (ICT). At the remaining 4 control sites, the epithelial downgrowth as well as the adjacent ICT areas were limited to the coronal 1/3 of the device. New attachment; i.e., new cementum with inserting collagen fibers, averaged 2.2 mm and 0.8 mm at the test and control sites respectively (P < 0.01). Based on the results of the present study, it was concluded that a bioresorbable GTR device, designed to prevent epithelial downgrowth along the barrier surface, has a higher potential to promote new attachment formation than a device which does not have this property.

A 20 bp cis-acting element is both necessary and sufficient to mediate elicitor response of a maize PRms gene.

Transient gene expression assays in barley aleurone protoplasts were used to identify a cis-regulatory element involved in the elicitor-responsive expression of the maize PRms gene. Analysis of transcriptional fusions between PRms 5' upstream sequences and a chloramphenicol acetyltransferase reporter gene, as well as chimeric promoters containing PRms promoter fragments or repeated oligonucleotides fused to a minimal promoter, delineated a 20 bp sequence which functioned as an elicitor-response element (ERE). This sequence contains a motif (-246 AATTGACC) similar to sequences found in promoters of other pathogen-responsive genes. The analysis also indicated that an enhancing sequence(s) between -397 and -296 is required for full PRms activation by elicitors. The protein kinase inhibitor staurosporine was found to completely block the transcriptional activation induced by elicitors. These data indicate that protein phosphorylation is involved in the signal transduction pathway leading to PRms expression.

Reproductive status, blood chemistry, gill histology and growth of perch (Perca fluviatilis) in three acidic lakes.

Perch (Perca fluviatilis L.) were sampled soon after spawning in three small acidic lakes (pH 4.3-6.1, Al(lab) 5-106 microg litre(-1), Ca2+ 0.01-0.08 mmol litre(-1)) and in one circumneutral lake (pH 5.9-6.4, Al(lab) 4-12 microg litre(-1), Ca2+ 0.06-0.07 mmol litre(-1)) in southern Finland. Due to the delayed spawning of perch in the acidic lakes, sampling in those lakes was performed later than in the reference lake. In spite of that, the gonadosomatic index (GSI) of males in all the acidic lakes was significantly greater than in the reference lake. Of the two lakes with similar low water pH, the effects on reproduction were more prominent in the lake with higher water Al content. The plasma Ca2+ concentrations of females in the acidic lakes were significantly smaller than in the females of the reference lake. The low female:male plasma Ca2+ ratio (1.0-1.32) depicted delay of spawning. Stress in perch in acidic water was also seen in elevated blood haematocrit values, especially in females. On the other hand, a low plasma Cl- level, a common response to acidic water in salmonids, was not detected in perch in the most acidic lakes. The amount of Al accumulated in the gill epithelium was highest in the most acidified lake with high Al concentration, but was also pronounced in a lake with low pH and low Al concentration.

Changes in the density, population structure, growth and reproduction of perch, Perca fluviatilis L. in two acidic forest lakes in southern Finland.

The density of the perch populations decreased rapidly during the 1980s in two acidified lakes in southern Finland. In an acid-humic lake the density of the perch population decreased from 240 to 60 ha(-1) and in an acid clearwater lake from 150 to 20 ha(-1). In both lakes the rapid decrease was mainly due to failures in reproduction, although post-spawning mortality of adult fish was also recorded. The perch spawned annually in both lakes but according to the field exposures of egg strands, most of the eggs died before hatching. Nevertheless, some new recruits appeared in both lakes. These perch, born in 1983-1986, grew faster than those of the more abundant year-classes of the late 1970s, indicating a clear density-dependent growth response. According to the mortality estimate and the age distribution of perch, the latest year-classes that produced more than 100 adult perch ha(-1) were born in 1978 or 1979 in both lakes. It was calculated that the density of both populations was >500 ha(-1) in the early 1980s.