The influence of folic acid supplement on the outcome of pregnancies in the county of Funen in Denmark. Part I.

OBJECTIVE: To determine whether a supplement of folic acid given preconceptionally or early in pregnancy had any influence on, birth weight, incidence of preterm labour, low birth weight and small for gestational age. Furthermore, the aim was to elucidate, whether the outcome differed following the administration of two different dosages of folic acid, namely 2.5 and 1.0 mg. MATERIAL: All women in the childbearing age living on the island of Funen, Denmark (population 500,000) were offered a supplement of folic acid over a period of 3 years and 3 months. 14,021 women, who gave birth to 13,860 single-born and 325 multiborn children, were registered. A total of 8184 women took part in the double-blind randomized trial: 2310 had a supplement of folic acid without being randomized and 2721 women received no folic acid supplement. No information regarding the use of folic acid was available in 806 pregnancies. Abortions (512) were excluded. RESULTS AND CONCLUSIONS: A supplement 1.0 mg folic acid had the same effect as 2.5 mg. The effects of supplementing the diet with folic acid given preconceptionally or in the first half of pregnancy in an affluent Northern country were a slight increase of birth weight and a decrease in the incidence of preterm labour, infants with low birth weight and small for gestational age. The greatest effect was seen in the groups receiving folic acid preconceptionally.

The influence of folic acid supplement on the outcome of pregnancies in the county of Funen in Denmark. Part III. Congenital anomalies. An observational study.

OBJECTIVE: The effect of folic acid supplement on the prevalence of congenital anomalies was studied in a Danish population. MATERIAL AND METHODS: From 1983 to 1986 all Danish women resident in the county of Funen were offered free folic acid when pregnant or planning a pregnancy. Data concerning the starting time of folic acid supplement and congenital anomalies were recorded on close to all pregnancies. Children of folic acid supplemented mothers were subdivided as to start of supplement with dividing lines at week 7 and week 11 calculated from the last menstrual period. Structural malformations were subdivided into an early group with malformation development in the first 7 weeks from the last menstrual period and a late group where malformations develop in weeks 8 to 11. RESULTS: In a total of 14,021 pregnancies 10,494 pregnant women (74.8%) had folic acid supplement. No folic acid was taken by 2721 women (19.4%) and in 806 cases (5.8%) information was lacking. The prevalence of congenital anomalies was 380 in 14,185 children (26.7/1000). Children whose mothers started folic acid supplement before the 7th week of pregnancy showed a significantly lower prevalence of the malformations which develop in the first 7 weeks, when compared to pregnancies with a later start of supplement. The result was interpreted as a clearcut trend.

The influence of folic acid supplement on the outcome of pregnancies in the county of Funen in Denmark. Part II. Congenital anomalies. A randomised study.

OBJECTIVE: The effect of folic acid supplement on the prevalence of congenital anomalies was studied in a Danish population. MATERIAL AND METHODS: From 1983 to 1986 all Danish women resident in the county of Funen were offered free folic acid when pregnant or planning a pregnancy. Folic acid dose was randomised to 2.5 or 1.0 mg. A randomised control group was not feasible for ethical reasons. Hospitals, midwives and most general practitioners cooperated to procure information on close to all pregnancies and congenital anomalies were recorded. RESULTS AND CONCLUSIONS: In a total of 14,021 pregnancies resulting in child birth 8184 women (58.4%) had folic acid with randomisation. Supplement was started in the randomised group before the last menstrual period in 1359/8184 (16.6%) and in the first 19 weeks of pregnancy in 6825/8184 (83.4%). The prevalence of congenital anomalies was 224 in 8293 children (27.0/1000). No dose-dependent differences were found in either total anomalies or in those specific malformations which have been reported to occur with reduced prevalence with periconceptional folic acid. The result was probably influenced by a start of supplement too late to affect malformation development in many cases and by the high level of both folic acid doses given compared to usual recommendations. Pregnancies without folic acid supplement showed prevalences similar to the supplemented groups.

Combined treatment with imipramine and mianserin. A controlled pilot study.

The effect of imipramine plus mianserin and imipramine plus a placebo was compared in 40 depressed patients with a median age of 60 years. The imipramine dosage was flexible to give a plasma concentration around 200 nmol/l and mianserin was given at a fixed dosage of 30 mg daily. After six weeks of treatment the results showed that the scores on the Hamilton Depression Scale as well as on the Melancholia Scale were significantly more improved in the imipramine-plus-minaserin group than in the group of patients receiving imipramine alone (P less than 0.01). In terms of percentage of improvement (a reduction of baseline rating scores of 50% or more) 77% of the imipramine-plus-mianserin group had improved, compared with 27% of the imipramine group. The combination of imipramine and mianserin was well tolerated both as regards clinical side-effects and laboratory tests.

Bromazepam in generalized anxiety. Randomized, multi-practice comparisons with both chlorprothixene and placebo.

Bromazepam was compared with placebo and with chlorprothixene in a randomized, double-blind group-comparative multicenter trial in general practice. Two hundred and forty-five patients with generalized anxiety disorder (DSM-III 1980) were treated for 2 weeks with two daily doses of bromazepam, 3 mg or chlorprothixene, 15 mg or placebo. Median reductions in Hamilton Anxiety rating were 12 (bromazepam), 10.3 (chlorprothixene) and 7.3 (placebo). The study revealed significant superiority of bromazepam over placebo (median differences 3.3, 95% confidence limits: 0.3 and 6.1) but not over chlorprothixene (median difference 1.4, 95% confidence limits -0.8 and +3.5). Significantly higher rates of tiredness, sedation and hypersomnia were found on bromazepam and chlorprothixene compared to placebo. Tolerance was rated as "at least good" in 85.6% on bromazepam, in 86% on chlorprothixene and in 87.8% on placebo. Neither previous psychopharmacological treatment nor presence of psychosocial stress were of perceptible influence. Bromazepam and chlorprothixene are both superior to placebo in generalized anxiety states treated in general practice, but spontaneous improvements/placebo effects are substantial.

Psychiatric care of refugees exposed to organized violence. A comparative study of refugees and immigrants in Frederiksborg County, Denmark.

Psychiatry in Scandinavia has a tradition for research and clinical work with people from other countries, especially related to refugees and survivors after the Second World War. In recent years an increasing number of refugees have arrived, especially from the countries of the Middle East. The aim of this study was to evaluate the refugee situation in a Danish county, on the basis of data on 49 refugees treated in the county's psychiatric departments from January 1, 1986 to December 31, 1987 and 44 immigrants seen from January 1, 1983 to December 31, 1987. The clinical data illustrated marked differences between immigrants and refugees with respect to social situation and background, symptom pattern and exposure to organized violence. Both groups terminated treatment after very few contacts, and the psychiatric staff seems to need better training. The general need for psychiatric and psychological treatment of immigrants and refugees is still uncertain and further research is required.

Moclobemide and clomipramine in reactive depression. A placebo-controlled randomized clinical trial.

The purpose of this study was to compare moclobemide and clomipramine in reactive depression according to the Newcastle II classification. Sixty patients were allocated to either 300 mg moclobemide, 150 mg clomipramine or placebo, all divided in 3 daily doses. Improvements occurred over time, but differences between treatments and compared with placebo were never statistically significant. Dizziness, tremor and anticholinergic symptoms were significantly more frequent with clomipramine than with moclobemide and placebo.

Brachial artery injuries associated with posterior elbow dislocation.

Posterior elbow dislocation is rarely associated with brachial arterial injury, occurring in two of 23 patients. A cool pulseless hypesthetic arm associated with swelling at the elbow after a history of a fall on an outstretched arm indicates arterial injury associated with posterior elbow dislocation. Concomitant neurologic and bone injury may occur as well. Arterial repair and stabilization of the elbow is the treatment of choice and should result in a functional extremity.