The meaning of depression: Swedish nurses' perceptions of depressed inpatients.

People suffering from depressive disorder are affected by one of the western world's largest medical groups of disorders in both psychiatric and general medicine. Drug treatment is usually the first-line intervention and has been shown to be an effective treatment. Other therapies, including nursing interventions that could be implemented in care, are infrequently used. It is therefore important to understand whether nurses' perceptions of depressed people could be explained from the medical model by defining the nurses' view of psychiatric inpatients. Therefore, the aim of this study was, with the clinical picture as the starting point, to investigate the nurses' view of hospitalized patients with a diagnosis of depression. In this prospective study, 155 nurses' opinion of depression among depressive inpatients was assessed using a questionnaire based on the Montgomery-Asberg Depression Rating Scale. To elucidate the relationship between the variables in the questionnaire, factor analysis rotated by the Varimax method with Kaiser's normalization was used. The factor analysis identified five factors. The number of variables was reduced from 61 to 34. Based on the factor interpretation, an initial factor structure for the depressive inpatient was defined. The identified factors were interpreted and labelled to create the nurses' fused "picture" or meaning of the depressed inpatient as an individual who experienced feelings of annihilation, alienation, fatigue, emptiness and affliction, an individual who is disconnected from the whole of temporality.

Pharyngeal carriage of Neisseria meningitidis before and after treatment of meningococcal disease.

The aim of the study was to determine whether patients with meningococcal disease carry meningococci in the throat both before and after treatment for the disease. During the 7 months of the study 106 patients with confirmed meningococcal disease were admitted to Danish hospitals, of whom 77 (73%) had a throat swab examined at least once and were included in the study. Sixty-two patients were examined on admission and 52 were examined on discharge; 37 were examined on both occasions. On admission, meningococci were isolated from 18 (49%) of 37 throat specimens examined selectively for pathogenic Neisseria spp. Meningococci were not isolated from any throat specimen taken on discharge from hospital; 47 (90%) of 52 of these specimens had been examined adequately. From an observed carriage rate of 0 out of 47 it can be judged that the carrier rate does not exceed 6.4% (95% confidence limit). From these results we conclude that it is unlikely that patients who have been treated for meningococcal disease according to the regimens used in Denmark can be the source of infection for secondary cases.

Manual acupuncture reduces hyperemesis gravidarum: a placebo-controlled, randomized, single-blind, crossover study.

Hyperemesis gravidarum, severe vomiting, develops in about 1-2% of all pregnancies. Acupuncture on the point PC6 above the wrist on the palmar side has been found to prevent some types of nausea and vomiting. The purpose of the present study was to see if acupuncture, in addition to standard treatment, could hasten the improvement of hyperemesis gravidarum. Thirty-three women with hyperemesis were evaluated in a randomized, single-blind, crossover comparison of two methods of acupuncture, active (deep) PC6 acupuncture or placebo (superficial) acupuncture. The women estimated their degree of nausea on a visual analogue scale (VAS). The daily number of emesis episodes were documented. Crossover analyses showed that there was a significantly faster reduction of nausea VAS and more women who stopped vomiting after active acupuncture than after placebo acupuncture. This study suggests that active PC6 acupuncture, in combination with standard treatment, could make women with hyperemesis gravidarum better faster than placebo acupuncture.

STDS in women attending family planning clinics: a case study in Addis Ababa.

For cultural reasons modern contraception has been slow to gain acceptance in Ethiopia. Knowledge about contraception and abortion is still limited in many family and community settings in which it is socially disapproved. By 1990 only 4% of Ethiopian females aged 15-49 used contraception. Little is known of sexually transmitted disease (STD) prevalence in family planning (FP) attenders in Africa in general and Ethiopia in particular, even though attenders of family planning clinics (FPCs) are appropriate target groups for epidemiological studies and control programmes. A study of 2111 women of whom 542 (25.7%) attended FPCs in Addis Ababa showed utilisation rates to be highest in women who were: Tigre (33%) or Amhara (31%), aged 20-34 years (30%), age 16 or older at first marriage/coitus (28%:38% in those first married after 25 years); who had a monthly family income of 10 Ethiopian Birr (EB) or more (33%:36% for those with income 100-500 EB), three or more children (37%), more than five lifetime husbands/sexual partners (39%); or were bargirls (73%) or prostitutes (43%). The seroprevalence rates for all STDs, higher in FPC attenders compared with other women, were syphilis (TPHA) 39%, Neisseria gonorrhoeae 66%, genital chlamydia 64%, HSV-2 41%, HBV 40% and Haemophilus ducreyi 20%. Only 4% of FPC attenders had no serological evidence of STD: 64% were seropositive for 3 or more different STD. Clinical evidence of pelvic inflammatory disease (PID) was also more common in the FPC attenders (54%), 37% having evidence of salpingitis. The FPC provides a favourable setting for screening women likely to have high seroprevalence of STD, who for lack of symptoms will not attend either an STD clinic nor a hospital for routine check up. We recommend that measures be taken to adequately screen, treat and educate FPC attenders, their partners, and as appropriate and when possible their clients, in an attempt to control STDs and ultimately HIV in the community. Social, economic and cultural factors in the occurrence of STDs, prostitution, family planning and modern contraception coverage in Ethiopia are identified and deficiencies of current programmes briefly discussed with the objective of targeting services more effectively.

Combined influence of quartz dust, ozone and NO2 on chemotactic mobility, release of chemotactic factors and other cytokines by macrophages in vitro.

In this study the single as well as combined effects of quartz, ozone and nitrogen dioxide (NO2) on some immunofunctions of bovine alveolar macrophages (BAM) were investigated. After incubation with 10 micrograms/ml of particles the chemotactic response of BAM is increased nonspecifically, whereas after incubation with 100 micrograms/ml of quartz chemotaxis is specifically decreased. In addition, quartz induces tumor necrosis factor alpha (TNF-alpha) and chemokines to be released dependent on the concentration. Ozone by itself is also a very potent inducer of the release of chemokines and TNF-alpha, but in combination with ozone, quartz has not more than an additive effect. NO2 alone suppresses drastically the release of TNF-alpha. The results show that quartz, ozone and NO2 alter some immunofunctions of BAM and that by combining toxic particles such as quartz with these gases, additive but not synergistic effects might be expected.

An 18-month follow-up study of growth-retarded neonates. Relation to biochemical tests of placental function in late pregnancy and neurobehavioural condition in the newborn period.

Serial estimations of maternal urinary oestriol, serum cystine aminopeptidase (S-CAP), and human chorionic somatomammotrophin (S-HCS) were studied prospectively in 29 pregnancies complicated by intrauterine growth retardation. The newborn growth-retarded infants were examined by neurological and behavioural techniques. Growth variables and neurological and developmental findings were compared with those in 18 healthy controls at 5, 10 and 18 months of age. The growth-retarded infants caught up with regard to body size from 5 months of age, although the severely retarded infants (birth weight less than or equal to -2 SD) differed from the controls with regard to weight and head circumference at 18 months of age. Abnormal maternal oestriol excretions were negatively correlated to weight and length during the follow-up period. Infants who had been severely growth-retarded at birth were neurologically below optimal level at 10 months of age, compared to the controls. There were no significant differences between the growth-retarded infants and the controls with regard to psychomotor development, as assessed by a screening test and by Griffiths' method. Significant correlations were found between abnormal biochemical placental tests (especially urinary oestriol and S-CAP) and psychomotor development. Significant correlations also appeared between neonatal orientation and motor behaviour and some Griffiths' scales at 18 months of age. No relationship was found between the neurological condition in the neonatal period and the neurological findings and development at follow-up.

Antimicrobial susceptibility of Neisseria gonorrhoeae strains isolated in Nuuk, Greenland during 1998-1999.

Sixty-one gonococcal strains isolated in Greenland during 1998-1999 were tested locally for susceptibility to penicillin and ciprofloxacin by a disc diffusion method (Rosco) and at the reference laboratory in Copenhagen by the agar dilution method and the E-test, showed that more than 60% of the strains were less susceptible or resistant to penicillin (minimum inhibitory concentration [MIC] > or = 0.25 mg/L), indicating that penicillin should not be used as a first line drug for the treatment of gonorrhoea in Greenland. The Rosco disc diffusion method only identified 8% of strains as less susceptible to penicillin. Ciprofloxacin can still be used as a first line drug for treatment of gonorrhoea in Greenland since decreased susceptibility was only seen in one imported strain. However, the decreased susceptibility in this strain was not identified by the Rosco disc diffusion test, therefore the future local surveillance of antibiotic resistance in Neisseria gonorrhoeae will be based on MIC determinations.

Syphilis, gonorrhoea and chlamydial infection among women undergoing legal or illegal abortion in Maputo.

Our objectives were to compare the prevalence of sexually transmitted infections (STIs) in 103 women undergoing induced legal abortion (LA) and in 101 women with confirmed, recent illegal abortion (IA), in Maputo, Mozambique. For the purpose of this study, LA was considered the abortion provided in the Maputo Central Hospital with the approval of the Ministry of Health, and IA the one not provided through the approved facility, mentioned above. Women with IA were recruited in the outpatient gynaecology ward and women with LA in the emergency gynaecology ward in the Maputo Central Hospital, during the same time period. Serological tests for syphilis (rapid plasma reagin, ELISA-IgG and fluorescent treponemal antibody absorption), gonorrhoea (indirect haemagglutination) and chlamydia (microimmunofluorescence) were carried out. Direct immunofluorescence for detection of Chlamydia trachomatis antigen was done on endocervical smears from all the women. The prevalence of syphilis seropositivity in IA women is twice that of LA women (odds ratio [OR] 2.13; 95% confidence interval [CI] 0.55-9.95), with 10.9% and 4.9%, respectively. Exposure to gonorrhoea in these 2 groups is similar (OR 1.18; 95% CI 0.63-2.20), with seroprevalence of 31.1% in the LA and 34.7% in the IA group. The high titres are also similar in both groups. Serology findings for C. trachomatis indicate prevalence of seropositivity of 40.6% in the LA and 44.4% in the IA group with no significant difference (OR 1.17; 95% CI 0.64-2.13). In conclusion, STIs are highly prevalent in both IA and LA groups in Maputo. Urgent interventions are needed to reduce their prevalence and consequently their adverse consequences.

The relationship between prior cervical conization, cervical microbial colonization and preterm premature rupture of the membranes.

The occurrence of prior cervical conization and the cervical microbial colonization was investigated in 38 women with idiopathic preterm labor, 35 women with preterm premature rupture of the membranes (PPROM) and 75 normal pregnant women at 26-34 weeks of gestation. Data were analyzed by Fisher's exact test (two-tailed). The frequency of prior cervical conization was significantly higher in PPROM patients compared to normal pregnant women (P < 0.001) and to patients in preterm labor (P < 0.01). Lactobacilli occurred with a lower frequency in patients with PPROM compared to patients in preterm labor (P < 0.05) and control patients (P = 0.0543)-and with a lower frequency in patients with prior cervical conization (P < 0.05). All other microorganisms occurred with the same frequencies in all groups. The absence of lactobacilli may indicate changes in the cervical flora, which could increase the risk of PPROM. Prior cervical conization may impair the antimicrobial defense-mechanisms in the cervix, which could facilitate ascending microbial colonization. This may lead to a release of prostaglandins and proteolytic enzymes and subsequently preterm labor and rupture of the membranes.

Active surveillance of meningococcal meningitis in Poland.

Starting from 1970, the notification of N. meningitidis cases in Poland was compulsory and separated from other cases of meningitis purulenta. Based on the experience of European Monitoring Group on Meningococci, the active surveillance of meningococcal meningitis in Poland was initiated in April 1995. It was the first time that such study was conducted to recognise the actual situation of meningococcal meningitis infections in our country. Ninety seven N. meningitidis strains were isolated (31 in 1995 and 66 in 1996) from cerebrospinal fluid (CSF) of meningitis patients hospitalized in 54 hospitals located in 33 out of 49 provinces of Poland. Most patients were below 2 years of age and 43% belonged to infant group. Meningococcal strains were phenotypically characterized as follow: identification of N. meningitidis was performed by Gram staining, oxidase and catalase tests as well as latex or diagnostic sera agglutination assays. Meningococcal serotypes and subtypes were determined by whole-cell ELISA with monoclonal antibodies. The predominant meningococcal serogroup during 1995 and 1996 was B (80% of all isolates tested), the serogroup C (12.6%) and W-135 (3.5%). Only two non-groupable and two serogroup A strains were isolated in Poland. Active surveillance allowed to determine B:22:P1.14 to be the most prevalent N. meningitidis phenotype in Poland. Two isolates of N. meningitidis phenotype C:2a:P1.2,5, which caused emergency situation in Czech Republic since 1993, were isolated from CSF of patients in October 1996 in southern Poland. All strains were susceptible to cefotaxime, chloramphenicol, ciprofloxacin, rifampin and tetracycline; some strains were resistant to sulphonamides (60.6% - MIC = 32 mg/l and 14.8% - MIC = 128 mg/l). Only one of the tested strains in two years surveillance study in Poland was resistant to penicillin (MIC = 2 mg/l).

[Meningococcal disease: are patients carriers of meningococci after treatment with antibiotics?]. / Meningokoksygdom: Er patienterne meningokokbaerere efter behandling med antibiotika?

The aim of the study was to determine whether patients treated for meningococcal disease carried meningococci in the throat on discharge from hospital. If this were the case, supplementary treatment with e.g. rifampicin would be appropriate. The study comprised 106 patients: 98 patients in whom meningococci had been isolated from cerebrospinal fluid, blood or petechiae and eight patients with clinical signs of meningococcal disease in whom meningococci had been isolated only from tracheal aspirate or throat specimens. In 35% (22/62), meningococci were isolated from throat specimens on admission to hospital. From 20 throat specimens inoculated on 5% horse blood agar only, one meningococcal isolate was recovered (5%). From further 37 specimens inoculated on chocolate agar medium selective for pathogenic Neisseria, 18 meningococcal isolates were recovered (49%). This difference is statistically significant (p = 0.001). Meningococci were not isolated from any throat specimens taken on discharge from hospital; 90% (47/52) of these specimens were examined using selective chocolate agar medium. From an observed carriage rate of zero out of 47 it can be judged that the carrier rate does not exceed 6.4% (95% confidence limit). From these results, we conclude that it is unlikely that patients, who have been treated for meningococcal disease, are the source of infection in secondary cases.

[Meningococcal disease 1987-1989. Outbreak of serogroup B:15:P1.16 in the county of Frederiksborg]. / Meningokoksygdom 1987-1989. Udbrud af serogruppe B:15:P1.16 i Frederiksborg Amt.

Epidemiological features of an outbreak of group B:15:P1.16 meningococcal disease in Frederiksborg County 1987-1989 were investigated. The study comprised 149 cases notified during the outbreak and the two preceding years. One hundred and fifteen were confirmed by the isolation of Neisseria meningitidis. In 1989 the incidence had increased to 14.1 per 100,000 population. Among group B strains, B:15:P1.16. accounted for 80%. The overall mortality rate was 10%. Regarding cases due to group B:15:P1.16 strains, a significant time-space clustering was demonstrated, occurring exclusively within the 10-19 year-old group. The prophylactic measures used included administration of rifampicin to household contacts. During the outbreak the proportion of secondary cases was high (six to fifteen percent). All secondary cases occurred outside the household, indicating that the household had been protected.

[Occurrence of complement defects in meningococcal disease: who should be examined?]. / Forekomsten af komplementdefekter ved meningokoksygdom: Hvem skal undersøges?

Congenital complement deficiency states occur very rarely. These deficiencies are associated with a high risk of meningococcal disease (MD). We suggest that the following groups of individuals with MD are examined for complement deficiencies: 1. Individuals belonging to families, in which more than one case of MD has occurred with an interval exceeding one month. 2. Individuals infected with the low-virulent meningococcal serogroups W-135, 29E, X, Y, Z. 3. Individuals with recurrent MD. Since properdin deficiency probably is the most common deficiency associated with MD it is important that the screening includes the alternative complement pathway.

[Outbreak of serogroup C meningococcal disease among teenagers in Randers--preventive measures and examination of the meningococcal carrier conditions]. / Udbrud af serogruppe C-meningokoksygdom blandt teenagere i Randers--profylaktiske foranstaltninger og undersøgelse af meningokokboerertilstanden.

An outbreak involving 20 cases of serogroup C meningococcal disease, predominantly among teenagers, occurred over a seven-month period in the Randers area of Denmark. The cases were caused by a serogroup C:2a:P1.2 sulphonamide-resistant strain. The available evidence was against the transmission being related to particular schools. The outbreak was experienced as three clusters. At two schools involved in the first and the third cluster of the outbreak, 351 students were examined regarding pharyngeal carriage of meningococci, 282 of whom were tested again 17 weeks later; 308 students attending two similar schools in a nearby area were examined once. The majority of strains isolated from group C carriers in the high-risk area were serologically indistinguishable from the outbreak strain (13/14 = 95%), but less often sulphonamide-resistant (5/13 = 38%). In both areas, the overall carrier rate (30%), the overall group C rate (3%) and, the carrier rate for the outbreak strain (1%) were the same. The attack rate for the outbreak strain differed significantly: 1/40 in the high-risk area versus 1/2.500 in the normal risk area. No conditions that might explain this difference were revealed. Immediately after recognition of the first and the third cluster, 780 and 13,300 students, respectively, were vaccinated with meningococcal polysaccharide vaccine A+C. It was concluded that the definition of target groups for vaccination should be liberal, because the "at risk" population may be difficult to recognize at the onset of an outbreak.

[Prevalence of Chlamydia among young men. A screening among men liable for military service and coming before the military board]. / Forekomsten af klamydia blandt unge maend. En screeningsundersøgelse blandt maend fremmødt på session.

INTRODUCTION: Chlamydia is the most common sexually transmitted bacterial infection in Denmark. Each year 13-14,000 cases are diagnosed; of these about 3000 occur in men. In order to describe the prevalence of chlamydia among young men, screening for chlamydia was conducted in those liable for military service and coming before the medical board. MATERIALS AND METHODS: Of 2500 men coming before the medical boards in North Jutland State County, Arhus State County, and Copenhagen County during the winter of 1996-97, 1345 men aged 17-32 (median 18 years) were entered in the study. The participants sent a urine sample and a filled-in questionnaire to Statens Serum Institut. The urine samples were analysed by an in-house PCR and the test results were sent to the participant; if permission had been granted, the positive test results were further sent to the general practitioner, along with a second questionnaire. RESULTS: Chlamydia was found in 4.8% (65/1345) of all participants and in 6.9% of those sexually active. In North Jutland State County 7.1 and 9.8%, respectively, had chlamydia, whereas the corresponding figures for Arhus State County and Copenhagen County were about 4% and 6%. Two-thirds of the patients had no symptoms of urethritis. DISCUSSION: The results of this study indicate that a considerable reservoir of unrecognised chlamydia must exist in young men. The prevalence of chlamydia was higher in North Jutland State County than in the other two districts. One explanation could be that there is more focus on sexually transmitted infections and contact tracing in the largest cities than in the rest of the country.

[Treatment of gonorrhea at the Venereal Disease Clinic in Copenhagen in 1985. A study of the efficacy of standardized treatment compared with the sensitivity of Gonococcus to penicillin in vitro]. / Behandling af gonoré på Københavns Venereaklinik i 1985. En undersøgelse af effekten af standardbehandling sammenholdt med gonokokkernes følsomhed for penicillin in vitro.

In 1985, a total of 1,140 patients (907 men and 503 women) were treated for gonorrhoea at the Copenhagen County Outpatients Clinic at Rudolph Berghs Hospital. Failure of the standard treatment regimen (pivampicillin plus probenecid; patients stating penicillin allergy received a Sulfotrim-regimen) occurred in 79 (5.6%). A significant association between the in vitro susceptibility to penicillin and the efficacy of the standard treatment regimen was found; among 1,139 patients with uncomplicated urogenital gonorrhoea caused by penicillin susceptible gonococci, the failure rate was low (0.4-1.9%); the failure rate was high in patients infected with penicillin resistant gonococci. Continued surveillance of the in vitro antimicrobial susceptibility of gonococci is recommended as a basis for the choice of standard treatment regimen.

[Neonatal conjunctivitis after the abolition of compulsory Credé prophylaxis]. / Conjunctivitis neonatalis efter ophør med obligatorisk Credé-profylakse.

The prescript requiring application of silver nitrate eye drops (0.66% AgNO3) to the conjunctivae of the newborn within two hours after delivery was revoked in March 1985. The present study comprises a prospective investigation of the occurrence of microorganisms in specimens of eye secretion from neonates received during the period February-April 1986, and a review of findings of Neisseria species and B. catarrhalis in 3,485 specimens of ocular secretions and of C. trachomatis in 1,240 conjunctival scrapes received at the Neisseria Department 1986-1988. The numbers of cases of conjunctivitis neonatalis caused by the following microorganisms were: N. gonorrhoeae 8, N. cinerea 6, other Neisseria species 8, B. catarrhalis 49 and C. trachomatis 92. During the period 1984-1988, the total number of neonates with gonococcal conjunctivitis neonatalis was 18. The gonococcal infection was diagnosed within the first week of life in 50% of the cases but could occur as late as in the fourth week of life. Similarly, infection with B. catarrhalis was most common in neonates less than one week old (49%), whereas chlamydial infection was most common in the second week of life (39%). It is concluded that the eyes of neonates should be carefully observed for at least four weeks and that microbiological examinations for gonococci and chlamydia are indicated if signs of infection appear.

[Relation between cervical conization, microbial colonization and threatening preterm labor]. / Relationen mellem cervikal konisation, mikrobiel kolonisation i cervix og truende for tidlig fødsel.

UNLABELLED: The relationship between prior cervical conization, the cervical microbial colonization and threatening preterm delivery was investigated in 35 women with preterm premature rupture of the membranes (PPROM), 38 women with idiopathic preterm labor and 75 normal pregnant women at 26-34 weeks of gestation. Prior cervical conization occurred with a significantly higher frequency in PPROM patients than in patients with preterm labor (p < 0.01) and normal pregnant women (p < 0.001). The prevalence of lactobacilli was lower in patients with PPROM than in patients with preterm labor (p < 0.05) and control patients (p = 0.05)--and lower in patients with prior cervical conization than in patients without prior conization (p < 0.05). All other microorganisms occurred with the same frequencies in all groups. CONCLUSIONS: Prior conization was associated with PPROM. Women with prior conization and women with PPROM had a reduced prevalence of lactobacilli in the cervix. The "absence" of lactobacilli may indicate changes in the cervical microflora, which could be of importance for PPROM.