Understanding weekly cycles in suicide: an analysis of Austrian and Swiss data over 40 years.

BACKGROUND: Seasonal as well as weekly cycles in suicide have been described, replicated and poorly understood for a long time. In Western countries, suicides are typically least frequent on weekends and most frequent on Mondays and Tuesdays. To improve understanding of this phenomenon a strategy is required which focuses on anomalous findings beyond the regular patterns. Here, we focused on instances where the weekly suicide patterns disappear or are interrupted. METHODS: We used data from Swiss and Austrian mortality statistics for the periods 1969-2010 and 1970-2010, respectively. First, the data were cross-tabulated by days of the week and the available socio-demographic information (sex, age, religious affiliation and region). Second, time series of cumulated daily frequencies of suicide were analysed by seasonal Autoregressive Integrated Moving Average (ARIMA) models which included intervention effects accounting for Easter and Pentecost (Whit) holidays. RESULTS: First, the cross tabulations showed that weekly cycles may be smoothed above all in young persons and smoothed in drowning, jumping and car gas exhaustion suicides. Second, the ARIMA analyses displayed occasional preventive effects for holidays Saturdays and Sundays, and more systematic effects for holiday Mondays. There were no after effects on Tuesdays following holiday Mondays. CONCLUSIONS: In general, the weekend dip and the Monday backlog effect in suicide show striking similarities to the Advent season effect and are interpretable within the same template. The turning points between low and high frequencies possibly provide promising frames for the timing of prevention activities.

Characteristics of police officer suicides in the Federal Austrian Police Corps.

BACKGROUND: Suicide rates among police officers may be high because of strong occupational stressors. AIMS: This study examined the suicide rate and suicide characteristics among police officers in the Federal Austrian Police Force. METHODS: All suicides among policemen during the period 1996-2006 were analyzed retrospectively on the basis of personalized police record files from all Austrian police departments. Information on sex, age, marital status, children, region, method and place of suicide, suicide notes, position, and length of service was extracted from these files. The general Austrian population, adjusted for sex and age composition, served as the comparison group. RESULTS: The suicide rate among male police officers was 30.2/100,000 (SD 11.0), which was comparable to the suicide rate in the adjusted general population (30.5/100,000; SD 2.9). The female police officer suicide rate was 1.8/100,000, while the corresponding suicide rate of the adjusted female general population was 12.5/100,000 (SD 1.7). Firearms were the most frequent suicide method (77.8%), and the incidence of suicide notes was 30.8%. CONCLUSIONS: Suicide rates among police officers seem comparable to those of the age-adjusted general population. Given the healthy-worker effect, these results still suggest an increased risk of suicide among police officers. These findings should stimulate further research on stressors and risk factors for suicide among officers and should also encourage departments to increase awareness regarding suicidal signs among officers.

Digit ratio (2D:4D) predicts sporting success among female fencers independent from physical, experience, and personality factors.

Research particularly focusing on male athletes and popular sports (running and soccer) suggests associations of lower (masculinized) second-to-fourth digit ratio (2D:4D), a putative marker of prenatal androgen action, with better sports performance. Studies focusing on women, non-mainstream sports, or controlling for covariates relevant for sporting success are still sparse. This study examined associations between 2D:4D and performance of both male and female athletes active in fencing (a non-mainstream sport dominated by male participants), while controlling for covariates. National fencing rankings and 2D:4D of 58 male and 41 female Austrian tournament fencers (mean age 24 years) were correlated. Among female, but not male, fencers, lower 2D:4D was related to better national fencing rankings. 2D:4D still accounted for incremental variance (12%) in fencing success, when the effects of salient performance factors (age, body mass index, years of fencing, training intensity, and the personality variables achievement, control, harm avoidance, and social potency) were controlled for (totaling 35% attributable variance). Athletes active in the most aggressive form (the sabre) had lower 2D:4D than those active in the other forms (épée and foil fencing). Sporting success in adult life might be partly prenatally programmed via long-lasting extragenital effects of testosterone.

Influence of psychotherapist density and antidepressant sales on suicide rates.

OBJECTIVE: Antidepressant sales and suicide rates have been shown to be correlated in industrialized countries. The aim was to study the possible effects of psychotherapy utilization on suicide rates. METHOD: We assessed the impact of antidepressant sales and psychotherapist density on suicide rates between 1991 and 2005. To adjust for serial correlation in time series, three first-order autoregressive models adjusted for per capita alcohol consumption and unemployment rates were employed. RESULTS: Antidepressant sales and the density of psychotherapists in the population were negatively associated with suicide rates. CONCLUSION: This study provides evidence that decreasing suicide rates were associated with both increasing antidepressant sales and an increasing density of psychotherapists. The decrease of suicide rates could reflect a general improvement in mental health care rather than being caused by antidepressant sales or psychotherapist density alone.

Consistency of immigrant and country-of-birth suicide rates: a meta-analysis.

OBJECTIVE: Multifaceted evidence (family, twin, adoption, molecular genetic, geographic and surname studies of suicide) suggests genetic risk factors for suicide. Migrant studies are also informative in this context, but underused. In particular, a meta-analysis of the associations of immigrant (IMM) and country-of-birth (COB) suicide rates is unavailable. METHOD: Thirty-three studies, reporting IMM suicide rates for nearly 50 nationalities in seven host countries (Australia, Austria, Canada, England, the Netherlands, Sweden and the USA), were retrieved. RESULTS: Total-population IMM and COB suicide rates were strongly positively associated (combined rank-order correlation across 20 eligible studies: 0.65, 95% CI: 0.56-0.73, P < 10(-9)). The effect generalized across both sexes, host countries and study periods. CONCLUSION: Following the logic of the migrant study design of genetic epidemiology, the correspondence of IMM and COB suicide rates is consistent with the assumption of population differences in the prevalence of genetic risk factors for suicide.

Relationships between finger-length ratios, ghrelin, leptin, IGF axis, and sex steroids in young male and female swimmers.

The aim of this study was to investigate possible relationships between different right-hand finger-length ratios and different fasting hormone concentrations in young swimmers. Fifty-five young swimmers participated in this study (26 boys and 29 girls, aged 10-17 years). The original method of Visnapuu and Jürimäe (J Strength Cond Res 21:923-929, 2007) was used for the measurement of length parameters of the hand. The following finger-length ratios were calculated: 1D:2D, 1D:3D, 1D:4D, 1D:5D, 2D:3D, 2D:4D, 2D:5D, 3D:4D, 3D:5D, and 4D:5D. All finger-length ratios were significantly higher in girls compared with boys. Ghrelin, leptin, testosterone in boys, estradiol in girls, insulin-like growth-factor I (IGF-I), IGFBP-3, and insulin were analyzed. Leptin and insulin concentrations were lower in boys compared with girls. In both groups, the relationships between finger-length ratios and basic anthropometric parameters were not significant. In girls, estradiol correlated negatively with 2D:3D (r = -0.51) and 2D:4D (r = -0.49) finger ratios. In boys, ghrelin concentration correlated with most of the finger-length ratios (r = 0.37-0.40). In girls, the relationship of ghrelin with the 2D:3D (r = 0.45) and 2D:4D (r = 0.48) finger ratios was significant. In boys, but not in girls, IGF-I (r = 0.42) and IGFBP-3 (r = 0.44) correlated only with the 2D:4D finger ratio. Leptin and insulin did not correlate with the finger-length ratios. In boys, the most important hormone to characterize several finger-length ratios was ghrelin (13.7-15.6% variance accounted for). Ghrelin and testosterone together accounted for 20.3% (R (2) x 100) of the variance in the 2D:4D ratio. In girls, estradiol was correlated with the 2D:3D ratio (25.7%) and estradiol in combination with ghrelin with the 2D:4D ratio (30.0%). In conclusion, ghrelin appears to be a further biochemical parameter in addition to the sex steroids which correlated with different digit-length ratios at least in boys.

Preoperative radiochemotherapy and radical resection for stages II to IV oral and oropharyngeal cancer: grade of regression as crucial prognostic factor.

The purpose of this study was to assess the prognostic value of histological response to preoperative radiochemotherapy in an established multimodal therapy concept for advanced oral and oropharyngeal cancer. Two hundred and twenty-two patients who underwent preoperative radiochemotherapy (RCT: 50 Gy, mitomycin C and fluorouracil) and radical surgery were retrospectively evaluated. Resected tumours of all patients were histologically analysed and response to RCT was classified in histopathological grades of regression (RG). In a multivariate statistical analysis, RG was compared with established factors regarding their predictive value for overall and disease-specific survival. The 5-year overall survival probability in the different groups of histopathological regression grades were: RG1 (no vital tumour): 73.4%, RG2 (minimal tumour remnants encompassing less than 5%): 72.1%, RG3 (5-50% vital tumour cells): 41.9%, RG4 (more than 50% vital tumour): 37.9%. For disease-specific survival probability no significant differences were found between both groups of "responders" (RG1 and RG2) nor between "non-responders" (RG3 and RG4), whereas responders and non-responders differed significantly from each other (log-rank test; p < 0.001). T-classification, N-classification and disease stage, histological grading, tumour site, age, and sex had less prognostic value than RG in a Cox regression model. In the neoadjuvant multimodal therapy concept, histological response to preoperative RCT is a crucial prognostic factor even when surgical R0-resection is accomplished. Thus, non-responders have to be regarded as high-risk patients for recurrence and may benefit from further therapy.

Preoperative radiochemotherapy and radical resection for stages II-IV oral and oropharyngeal cancer: outcome of 222 patients.

To analyse survival and locoregional control in patients with advanced oral and oropharyngeal squamous cell carcinoma (SCC) after multimodal therapy with preoperative radiochemotherapy (RCT) and radical surgery. We included in this analysis 222 patients who underwent multimodal therapy between 1990 and 2000. Eligible were patients with UICC disease stages II-IV (T2: 33.3%; T3: 12.6%; T4: 54.1%; N0: 45.9%; N1: 17.6%; N2: 33.3%; N3: 3.2%; stage II: 21.1%; stage III: 14.9%; stage IV: 64%). Patients received preoperative radiochemotherapy consisting of Mitomycin C (15-20 mg/m2, day 1) plus 5-Fluorouracil (750 mg/m2/24 h-infusion, days 1-5) and concomitant radiotherapy for a total dose of 50 Gy. Radical locoregional en bloc-resection according to the pretherapeutic tumour extension was carried out in all patients. After a median surveillance period of 72.3 months (24-152 months), 131 patients (59%) were alive, and 91 (41%) patients died; 12 (5%) of them died postoperatively, 46 (21%) due to tumour recurrence, and 33 (15%) deaths were not directly related to the primary tumour. Overall survival probability was 76% after 2 years, and 62% after 5 years. Two- and 5-year local control probability were 88 and 81%, respectively. Regarding the high percentage of stage IV disease in the reported patients, the multimodal concept is an effective therapy offering excellent survival and local control probability.

[Isolated fractures of the orbital floor]. / Isolierte Orbitabodenfrakturen. Korrelation von CT-Vermessungsdaten und ophthalmologischen Daten.

BACKGROUND: The goal of this retrospective study was quantitative calculation of area and volume of isolated orbital floor fractures from computed tomography (CT) and correlation of these data with post-traumatic ophthalmologic findings. PATIENTS AND METHODS: A total of 76 patients with isolated orbital floor fractures were evaluated radiologically and clinically. CT scanning was performed in coronal sections (1.5-mm to 3.0-mm slice thickness) with contiguous table feed. Orbital floor and fracture area as well as volume of displaced tissue were measured and calculated from the CT dataset. The relation of quantitative CT data to ophthalmologic findings (motility, diplopia, and globe position) was assessed statistically. RESULTS: Calculation of the CT dataset revealed a mean orbital floor area of 6.33+/-1.05 cm(2), a mean fracture area of 2.60+/-1.14 cm(2), and a mean volume of displaced tissue of 1.16+/-0.80 cm(3). Volume of displaced tissue correlated significantly with ophthalmologic findings (p< or =0.01). Fracture area correlated significantly with globe position (p< or =0.01) and was less associated with diplopia and motility disturbances (p<0.10). CONCLUSION: Efficient evaluation of two-dimensional CT data enables quantitative assessment of orbital floor fractures. Position and function of the globe are mainly affected by the volume of displaced periorbital tissue.

Self-report versus interview data of women's subjective theories of illness: concordance and predictive validity in a psychosomatic-gynecological liaison service.

Between-method comparisons of patient data from standardized self-report instruments and corresponding patient interview data frequently have poor agreement. We investigated the concordance and predictive validity of self-report measures and expert-rated interview data of women's subjective theories of illness in a psychosomatic-gynecological consultation liaison service. 31 patients completed two questionnaires (KKG, PATEF) on subjective theories of illness and were interviewed with a semistructured instrument on the same topic at the time of the initial appointment and after 1.5 years. External criteria for assessing the predictive validity of questionnaire versus interview data were: follow-up participation and psychotherapy utilization during the follow-up interval. Questionnaire and interview rating data were only modestly associated. Rater concordance on the interview data was low. Neither the initial-assessment interview nor the questionnaire data had predictive validity for patients' participation in the follow-up. None of the interview rating data but a portion of the questionnaire data, had predictive validity for patients' utilization of psychotherapy during the follow-up interval. The cognitive conceptualization of subjective theories of illness may fail in patients with psychosomatic disorders, due to their very mode of experience. A wider approach that includes assessment of nonverbal communication and countertransference might be useful.

Follow-up study of treatment of orbital floor fractures: relation of clinical data and software-based CT-analysis.

This retrospective study quantifies isolated orbital floor fractures using software-based CT-analysis and compares the clinical outcome across surgical and non-surgical treatment groups. Depending on the surgeon's interpretation of the clinical and radiological appearance, 10 fractures were treated non-surgically and 20 fractures surgically, either with antral balloon catheter alone or in combination with an orbital implant. Ophthalmologic findings were evaluated until 12 weeks after injury. Fracture area, and volume of displaced tissue (VDT) were assessed by software-based CT-analysis. VDT was marginally significantly smaller in non-surgically than in surgically-treated patients (P=0.08). Ophthalmologic findings improved in all groups during follow-up and no statistical difference was found between the groups. Diplopia remained moderate in three patients with balloon catheter alone, and minimal in four patients in both surgical groups. In one patient with non-surgical treatment, diplopia remained minimal after 12 weeks. Although CT-analysis revealed no significant difference between both surgical groups, patients treated with balloon catheter alone presented more diplopia after 12 weeks. Using balloon catheters for fracture repair a combined approach should be performed when large fractures involve the orbital floor to achieve sufficient reduction of orbital content and placement of an orbital implant. Software-based CT-analysis is helpful for objective interpretation in managing of orbital fractures.

Patterns of gadopentetate-enhanced MR imaging of radiocarpal joints of healthy subjects.

OBJECTIVE: The aim of our study was to evaluate prospectively the grades and patterns of gadopentetate-enhanced MR imaging in the radiocarpal joints of healthy subjects after IV contrast administration. SUBJECTS AND METHODS: The study included 18 healthy subjects (nine men, nine women; age range, 24-34 years; mean age, 30.8 years). We obtained coronal T1-weighted spin-echo images with fat suppression before and after IV administration of gadopentetate dimeglumine and additional axial T1-weighted spin-echo images after contrast administration. Patterns of signal-intensity enhancement in and around the radiocarpal joints were evaluated qualitatively and quantitatively. RESULTS: In eight (44.4%) of 18 healthy subjects, enhancement of the radiocarpal joints was seen and exclusively located in the region of the prestyloid recess. Enhancement patterns were bandlike in three (16.7%) of 18 healthy subjects, homogeneous in another three (16.7%) of 18, and nodular in two (11.1%) of 18. CONCLUSION: After IV administration of gadopentetate, signal-intensity enhancement in the radiocarpal joint is frequently seen in healthy subjects and is not predictive of inflammatory joint disease. If contrast enhancement is present, three distinct patterns are usually revealed, all invariably located in the region of the prestyloid recess.

A computer-based method for calculation of orbital floor fractures from coronal computed tomography scans.

PURPOSE: A computer program recently developed for the calculation of the orbital floor and fracture areas from coronal computed tomography (CT) scans was used in a study to evaluate the accuracy and ability of this new method. MATERIAL AND METHODS: The size of orbital floors and fabricated fractures in 14 dried, anatomic specimens were measured in coronal CT scans by 3 independent observers. Based on this data set, the orbital floor and fracture regions were calculated with the newly developed computer program. These calculated regions were then compared with a direct measurement of the specimens that had been obtained by digital photography. The accuracy of the computer-based calculations was assessed using Lin's concordance correlation coefficient. RESULTS: The size of the orbital floor (mean +/- SD) was found to be 5.21 +/- 0.39 cm(2) by direct measurement of the specimens and 5.30 +/- 0.52 cm(2) by calculation with the computer program. The region of the fracture (mean +/- SD) was 1.05 +/- 0.64 cm(2) by direct measurement and 1.01 +/- 0.62 cm(2) by computer calculation. The between-method mean difference (direct measurement minus computer based calculation) was -0.09 cm(2) (or 1.7% of mean orbital floor region) for orbital floor region and 0.04 cm(2) (or 3.8% of mean fracture region) for fracture region. CONCLUSIONS: This accurate and time-saving method is practicable for determining the size and location of orbital floor fractures. This calculation program can be advantageously applied in the clinical management of blowout fractures of the orbit.

Reperfusion of autotransplanted teeth--comparison of clinical measurements by means of dental magnetic resonance imaging.

OBJECTIVE: Dental magnetic resonance imaging (dMRI) with administration of contrast material is one method of assessing pulpal perfusion. The purpose of this study was to evaluate the level of contrast enhancement displayed by means of dMRI after transplantation of teeth and to compare these findings with the results of tooth mobility, pocket depth, cold, and electrical tests. STUDY DESIGN: Twenty-three teeth with either complete root formation or incomplete root formation (IRF) were investigated by using dMRI and were clinically examined at intervals of 2, 4, 8, and 12 weeks, as well as 6 months and 12 months after transplantation. RESULTS: An analysis of the enhancement in the dental images revealed a significant difference between teeth with IRF and teeth with complete root formation. In addition, the time to occurrence of a positive reaction to the cold test was significantly longer for teeth with IRF. CONCLUSIONS: The findings of this study indicate that transplanted IRF teeth are associated with reperfusion seen by means of dMRI as well as with delayed occurrence of a positive cold test.

Medical students' attitudes towards psychotherapy: an intervention-based pre-post comparison.

BACKGROUND: Despite a wealth of studies on medical students' attitudes towards psychiatry in general, little is known about their specific attitudes towards psychotherapy. There is no evidence on the flexibility of these attitudes in the context of a curriculum-implemented psychotherapy information session. OBJECTIVES: To assess medical students' attitudes towards psychotherapy and short-term flexibility therein, with an introductory course on psychotherapy as the relevant intervention for this pre-post comparison. METHODS: A random sample of 159 advanced medical students completed a short questionnaire before and after a short course on psychotherapy. The questionnaire consisted of indirect attitude measures towards psychotherapy (associations and connotations), a likelihood rating for future training in psychotherapy, a statement about one's most preferred medical specialty for one's future career, and basic demographics. RESULTS: Participants' pre-interventional connotations of psychotherapy were predominantly positive. In the pre-post comparison, more than one third of the connotation measures shifted substantially and favorably. Post-interventionally, participants' distinctive static word association style regarding psychotherapy was attenuated in favor of a more differentiated style and an enlarged field of associations. The data are suggestive of significant pre-interventional sex differences, with females holding more positive views towards psychotherapy and reporting a greater likelihood of future psychotherapeutic training. The data also suggest that the intervention acted differently upon the sexes. Likelihood ratings for future training in psychotherapy did not decline after the course, despite the fact that the cost and duration of training were mentioned in the course. CONCLUSIONS: Even minimal educational interventions can enhance medical students' predominantly positive attitudes towards psychotherapy. This finding calls for further implementation of psychotherapy-related material in medical curricula.

Marital status as a candidate moderator variable of male-female differences in sexual jealousy: the need for representative population samples.

Evolutionary psychological theories predict pronounced and universal male-female differences in sexual jealousy. Recent cross-cultural research, using the forced-choice jealousy items pioneered by Buss, et al., 1992, repeatedly found a large sex differential on these self-report measures: men significantly more often than women choose their mate's imagined sexual infidelity to be more distressing or upsetting to them than an imagined emotional infidelity. However, this body of evidence is solely based on undergraduate samples and does not take into account demographic factors. This study examined male-female differences in sexual jealousy in a community sample (N = 335, Eastern Austria). Within a logistic regression model, with other variables controlled for, marital status was a stronger predictor for sexual jealousy than respondents' sex. Contrary to previous research, the sex differential's effect size was only modest. These findings stress the pitfalls of prematurely generalizing evidence from undergraduate samples to the general population and the need for representative population samples in this research area.

[Application of a context-oriented model for the planning of psychotherapy]. / Kontextorientierte Modellentwicklung in der Psychotherapieplanung.

Since clinical experience has shown that creating a therapeutic setting with borderline or psychotic patients is extremely difficult the Department of Psychoanalysis and Psychotherapy at Vienna University Hospital has developed a method of treatment designed to increase the possibilities to work with this group of patients. This procedure is conceptualised as "context oriented model exploration in psychotherapy planning" COMEPP. Initially the context is explored in which the psychotherapeutic model should be implemented which has so far failed for different reasons. Following this a setting is created in which the therapeutic team and the patient(s) can constructively and creatively reflect on alternative therapeutic models. A clinical case illustrates the problems and the basic structure of COMEPP in a schematic and condensed form.

[Vienna version for clinical application of the Multiple Choice Vocabulary Intelligence Test]. / Wiener Versionen zur klinischen Applikation des Mehrfachwahl-Wortschatz-Intelligenztests (MWT-A, MWT-B).

A deterministic reliability analysis of the Mehrfachwahl-Wortschatz-Intelligenztest, Lehrl (MWT-A, MWT-B), a very economical device for the assessment of crystallized intelligence and the most frequently administered intelligence test by physicians in Germany, was performed on the test data of n = 300 in- and outpatients (University Clinic for Psychiatry, Vienna). Numerical outcomes showed a substantial lack of satisfying test properties, which are further also discussed under non-numerical aspects. For the clinical application of the MWT in Eastern Austria three alternative versions of the MWT (each consisting of 37 items and having better scale characteristics in the analysed sample than the original scales) were developed from the original item pool and presented as MWT-PIRIT, MWT-RIT, and MWT-PI. All five MWT scales were standardized for the present with the patient sample for clinical application. Correlational analyses with a measure for fluid intelligence (Standard Progressive Matrices) suggested only moderate associations between crystallized and fluid intelligence, as well as a differential validity for the MWT in our sample.