Compulsory admissions of patients with mental disorders: State of the art on ethical and legislative aspects in 40 European countries.

BACKGROUND: Compulsory admission procedures of patients with mental disorders vary between countries in Europe. The Ethics Committee of the European Psychiatric Association (EPA) launched a survey on involuntary admission procedures of patients with mental disorders in 40 countries to gather information from all National Psychiatric Associations that are members of the EPA to develop recommendations for improving involuntary admission processes and promote voluntary care. METHODS: The survey focused on legislation of involuntary admissions and key actors involved in the admission procedure as well as most common reasons for involuntary admissions. RESULTS: We analyzed the survey categorical data in themes, which highlight that both medical and legal actors are involved in involuntary admission procedures. CONCLUSIONS: We conclude that legal reasons for compulsory admission should be reworded in order to remove stigmatization of the patient, that raising awareness about involuntary admission procedures and patient rights with both patients and family advocacy groups is paramount, that communication about procedures should be widely available in lay-language for the general population, and that training sessions and guidance should be available for legal and medical practitioners. Finally, people working in the field need to be constantly aware about the ethical challenges surrounding compulsory admissions.

VITAMIN D STATUS IN PATIENTS WITH MENTAL DISORDERS: A CROSS-SECTIONAL ANALYSIS OF SINGLE COHORT FROM ROUTINE PRACTICE.

CONTEXT: Clinical research suggests that vitamin D deficiency correlates with mental illnesses. OBJECTIVE: The aim was to prove that the patients from the psychiatric health care service in Serbia had higher vitamin D deficiency than patients from general practice. DESIGN: The study had a cross-sectional design. METHODS: The study included 47 patients aged 19 - 76 of both sexes with different mental disorders. We performed sample size calculation on available data for vitamin D deficiency in patients in health care facilities compared with the general population. The concentrations of vitamin D in serums were measured by HPLC (high performance/pressure liquid chromatography). RESULTS: The mean value of vitamin D (standard deviation) in the whole group of study subjects was 16.27(10.62) ng/mL; 68.1% of the patients had a deficiency of vitamin D (25(OH)D<20 ng/mL). The difference is statistically significant from expected proportion of people with vitamin D deficiency in general practice (p=0.040). Serum concentrations of 25(OH)D were significantly correlated with serum concentrations of phosphorus (ϱ=0.336, p=0.024) and sodium (ϱ=0.304, p=0.038). CONCLUSIONS: The patients of psychiatry health care had significantly higher frequency of vitamin D deficiency than expected. There is a significant association between serum levels of vitamin D, and phosphate and sodium.

Cross-talk between muscle and bone in postmenopausal women with hypovitaminosis D.

OBJECTIVES: Visceral fat is more harmful than subcutaneous fat. Women with high amounts of visceral fat have an increased risk of metabolic syndrome (MetS), insulin resistance and low level of serum vitamin D. METHODS: This was a prospective, randomized and controlled study. Postmenopausal women (n = 101) aged 45-70 years were included. The assessed parameters were: body mass index (BMI), waist circumference (WC), 25-hydroxyvitamin D (25-OHD) status, serum insulin and HOMA-IR, bone mineral density, total fat mass, fat mass index (FMI) measured by DXA, and muscle strength. RESULTS: Significantly lower values of 25-OHD (35.26 ± 1.61 nmol/l) were found in women with MetS compared to those without MetS (47.52 ± 3.47nmol/l) (t = 3.699; p < 0.000). A significant negative correlation was observed between 25-OHD levels and: WC (rhoWC = -0.94; p < 0.004), BMI (rhoBMI = -0.80; p < 0.002), FMI (rhoFMI = -0.31; p < 0.002) and impaired fasting glucose (IFG) (rhoIFG = -0.23; p < 0.001). The percentage of body fat was statistically significantly higher in the group with insufficient 25-OHD (39.6%) and in the group with a deficit of 25-OHD (48.2%), compared with the maximum permitted percentage body fat of 35% for a female (t = -22.63; p < 0.002). The average hand grip strength of these moderately obese participants was 27.4 ± 4.7 kg. It was significantly lower than the normative grip strength for referent range groups (t = -21.65; p < 0.001). CONCLUSION: A low 25-OHD level in postmenopausal women is associated with high body fat, metabolic syndrome, low muscular strength and osteopenia.

Surface spin flip probability of mesoscopic Ag wires.

Spin relaxation in mesoscopic Ag wires in the diffusive transport regime is studied via nonlocal spin valve and Hanle effect measurements performed on Permalloy/Ag lateral spin valves. The ratio between momentum and spin relaxation times is not constant at low temperatures. This can be explained with the Elliott-Yafet spin relaxation mechanism by considering the momentum surface relaxation time as being temperature dependent. We present a model to separately determine spin flip probabilities for phonon, impurity and surface scattering and find that the spin flip probability is highest for surface scattering.

Dynamic micro-Hall detection of superparamagnetic beads in a microfluidic channel.

We report integration of an InAs quantum well micro-Hall magnetic sensor with microfluidics and real-time detection of moving superparamagnetic beads. Beads moving within and around the Hall cross area result in positive and negative Hall voltage signals respectively. Relative magnitudes and polarities of the signals measured for a random distribution of immobilized beads over the sensor are in good agreement with calculated values and explain consistently the shape of the dynamic signal.

Negative nonlocal resistance in mesoscopic gold Hall bars: absence of the giant spin Hall effect.

We report the observation of negative nonlocal resistances in multiterminal mesoscopic gold Hall bar structures whose characteristic dimensions are larger than the electron mean-free path. Our results can only be partially explained by a classical diffusive model of the nonlocal transport, and are not consistent with a recently proposed model based on spin Hall effects. Instead, our analysis suggests that a quasiballistic transport mechanism is responsible for the observed negative nonlocal resistance. Based on the sensitivity of our measurements and the spin Hall effect model, we find an upper limit for the spin Hall angle in gold of 0.023 at 4.5 K.

A quantitative morphometric study of rectal mucosa in adult and aged healthy subjects.

Rectal mucosa is relatively susceptible to pathological processes and frequently it is affected by various diseases. However, there is a notable lack of quantitative data regarding normal rectal mucosa, which would provide a reference for histoquantitative studies of the pathologically changed tissue. Therefore, we obtained the tissue from 27 healthy patients subjected to diagnostic rectoscopy during active screening for asymptomatic cancer of the large intestine, in which no disease was found. Using computer-aided morphometric analysis, we studied all structural elements of the rectal mucosa. The patients were divided into four groups according to the age and sex: adult males, elderly males, adult females and elderly females. The patients under 60 years of age were grouped as adult and those older than 60 years as aged subjects. A decreased height of surface epithelium was registered in both elderly male and female groups. This finding, however, was significant only when adult and elderly male groups were compared. The tendency towards reduction of the mucosal height was also registered comparing male adult and elderly groups. The number of crypts per 0.1 mm2 of tissue increased with aging in both males and females, whereby the crypts were always more numerous in males than in females. The increase in number of crypts in male subjects was accompanied by a decrease in their diameter and perimeter. The changes associated with ageing were discrete and affected only the male subjects.

The principles of chemotherapy of colorectal cancer in elderly.

The prevalence of colorectal cancer (CRC) increases significantly with age, with 40% of patients in Europe being older than 74 years of age at the time of initial diagnosis. The individualized management of the older-aged patient with cancer is based on the answers to the following questions: 1) will the patient die of cancer or with cancer; 2) will the patient suffer cancer-related morbidity; and 3) is the patient able to handle the toxicity of treatment? More than chronological age, the following parameters are important when elderly patients are to be treated with antineoplastic agents: general condition, liver function, kidney function and bone marrow status. Frail elderly with malignant disease should not be treated with cytostatic therapy. In the case of fit elderly, the standard chemotherapy (i.e. FOLFOX) regimen could be administered. In elderly ineligible for combination chemotherapy, the capecitabine used orally, as a single-agent therapy, is an important therapeutic option for colorectal cancer.

Comparison of two approaches to amitriptyline dose individualisation.

Individualisation of an amitriptyline dose regimen offers substantial advantages over non-individualised treatment. In our study, we have compared both clinical effects, adverse effects and plasma steady-state concentrations of amitriptyline in 15 patients with major depressive disorder divided in three groups; (i) patients in group A were taking non-individualised doses of amitriptyline; (ii) patients in group B were taking doses of amitriptyline individualised by modified Bayesian method; and (3) patients in group C were taking doses of amitriptyline individualised by the multiple point method. The treatment course was 8 weeks long, in the setting of a psychiatric clinic. The patients in group A were taking significantly higher doses throughout the treatment course; the initial doses for the patients in group B were higher than doses for the patients in group C, but after corrections based on measured steady-state plasma concentrations they became similar. While Hamilton score descended uniformly in all three groups, both adverse effects and steady-state plasma concentrations of amitriptyline were higher in non-individualised group during the whole treatment course. The results of our study suggest that the multiple points method is the most precise, but tedious and not practical. The modified Bayesian method with correction based on first measured plasma steady-state concentration of amitriptyline offers similar therapeutic outcome and adverse effects score combined with low cost and being easy-to-use.

[Recall of metamizole from the market in countries with modern pharmacotherapy]. / O povlacenju leka metamizola is prometa u zemljama sa savremenom farmakoterapijom.

Metamizole sodium (noraminophenazon sodium) is a pyrazolone derivate with analgesic, antipyretic and antiinflammatory activity, introduced in therapy in 1921. Since then, it was widely used all over the world, even in the counter preparations. In seventies its use was connected with severe, sometimes fatal side effects (agranulocytosis), resulting in gradual withdrawal of the drug. Metamizol has been withdrawn from the market in many developed countries, its use severely restricted in some of them, or permitted only in parenteral preparations for strictly defined indications (exceptionally severe pain such as posttraumatic, postoperative, abdominal colics and high body temperature unresponsive to the other antipyretics. In contrast to that, preparations containing metamizole are still in use in many countries, in some even as over the counter drugs.

[Mortality in malignant brain tumors in Yugoslavia]. / Mortalitet od malignih tumora mozga u Jugoslaviji.

Malignant tumours of head and neck, as a common group of diseases, is mentioned in Yugoslavia for the first time in 1972, where as the american authors have been studying this group of diseases as a whole since 1954 (1969). The data about death persons of malignant brain tumours (codes 191), of all causes of death (codes 000-999), of defined death causes of all the neoplasms (codes 140-209) and neoplasms of head and necks (codes 140-149, 160-161, 190-193), according to the eighth and ninth Revision of the International Classification of Diseases, Lesions and Death Causes, are based on official data of the Institute of Statistics of Yugoslavia for the period 1969-1988 (1988). In the analysis of mortality were used the standardized death rates according to the method of direct standardization after the world population by Segi (1976), further specific death rates according to sex and age, proportions and linear trend (1983). The results of these researches have shown that in the period from 1969 to 1988 there were recorded in Yugoslavia 13687 dead of malignant brain tumours in all. The average standardized mortality rate was 2.94 per 100,000 inhabitants; it is higher in men (3.59), than in women (2.40). On the basis of the results of linear trend it is shown that the average standardized rates of total mortality are increasing (y = 2.94 + 0.16x); it is in the males y = 3.59 + 0.23x, in females y = 2.40 + 0.12x. Age specific mortality rates are the highest in the group 55-64 years (10.37%). In this group the risk of dying is much greater in the males (13.63%), than in the females (7.85%).

[Mortality in malignant hemopathies in Yugoslavia]. / Smrtnost od malignih hemopatija u Jugoslaviji.

The authors have analysed the mortality of malignant haemopathies in Yugoslavia from 1978 to 1987. The standardized rate of mortality among all malignant haemopathies was from 6.5 to 7.2%000. These rates were higher in males (7.8-8.8%000), than in the females (4.8-5.9%000). The mortality of this group of malignant tumors shows a decreasing tendency, which is more evident in females than in males. Since Hodgkin's disease and lymphoid leukemia participate with about 50% in the structure of mortality from all malignant hemopathies, and for that reason, mortality from these two diseases is especially analysed. The standardized rate of mortality from Hodgkin's disease was between 1.7-2.5%000 (males 2.1-3.2%000; females 1.3-2.0%000). Mortality from this malignant haemopathy has a tendency of decreasing, which is approximately of the same intensity in both sexes. Mortality from lymphoid leukemia in the period between 1978 and 1987 was from 0.7 to 1.2%000 (males 0.9-1.7%000; females 0.5-1.0%000). The mortality trend from lymphoid leukemia shows a similar slight decrease in males and females.

[Changes in sleep in Parkinson's disease]. / Promene u nocnom spavanju u Parkinsonovoj bolesti.

In a sample of 44 patients with Parkinson's disease, REM latency showed a unimodal rather than bimodal distribution, with peak frequency between 0-10 min. A total of 16 patients exhibited (36.4%) a sleep onset REM period (SOREMP-10); i.e. REM latency of 10 min during the night; an additional 4 patients (9%) showed REM latencies of 11-20 min, while 8 patients (18.2%) showed REM latencies of less than 50 min (63.6 of the total sample). Patients with REM latencies of less than 50 min were older, both at the time of study and at the age of onset of the disease. There were more patients with depressive syndrome in this group than in the other group. They also showed a higher sleep amount. No other clinical or polysomnographic differences were found between patients with short REM latencies and patients exhibiting REM latencies of more than 50 min. Very short REM latencies probably reflect depressive syndrome associated with Parkinson's disease.