Little or no solar wind enters Venus' atmosphere at solar minimum.

Venus has no significant internal magnetic field, which allows the solar wind to interact directly with its atmosphere. A field is induced in this interaction, which partially shields the atmosphere, but we have no knowledge of how effective that shield is at solar minimum. (Our current knowledge of the solar wind interaction with Venus is derived from measurements at solar maximum.) The bow shock is close to the planet, meaning that it is possible that some solar wind could be absorbed by the atmosphere and contribute to the evolution of the atmosphere. Here we report magnetic field measurements from the Venus Express spacecraft in the plasma environment surrounding Venus. The bow shock under low solar activity conditions seems to be in the position that would be expected from a complete deflection by a magnetized ionosphere. Therefore little solar wind enters the Venus ionosphere even at solar minimum.

Predictors of treatment discontinuity in outpatient mental health care.

BACKGROUND: Discontinuity of service utilisation among newly referred community outpatients is a common concern. However, knowledge about factors associated with service utilisation is inconsistent. METHOD: This study examined service utilisation of 323 newly referred patients in three community mental health centres (CMHCs) in Vienna, Austria over a 4-month period. Of this original cohort, 111 patients were interviewed at treatment start to identify factors associated with treatment discontinuity. RESULTS: After 4 months, one-third of the 323 newly referred patients had dropped out of CMHC treatment; one-third discontinued treatment at the CMHCs because of referrals or mutual agreement on treatment termination, and one-third was still in CMHC treatment. Multivariate analyses yielded a negative association between treatment discontinuity and the diagnosis of schizophrenia, availability of home care, living alone, and a high quality of life in the domains living situation and family/significant others. A positive association was found with unemployment, previous psychiatric admissions, low patient satisfaction with staff competence, and high self-assessment in global functioning. CONCLUSION: In treatment, differing perceptions of a patient's health status by the patient and by the psychiatrist should be addressed. Professionals should be aware that patients' difficulties in private social relations might affect both treatment alliance and service utilisation.

Satisfaction of inpatients and outpatients with staff, environment, and other patients.

The study described here compared levels of satisfaction with staff, environment, and other patients among 420 first-time and long-term patients in psychiatric outpatient and inpatient settings. The demographic, clinical, and outcome variables associated with satisfaction were explored. Patient satisfaction was related to quality of life, social functioning, treatment expectations, and one-year psychological and physical prognoses. Perceptions of other patients were significantly more positive among long-term patients than among first-time patients. The concerns of first-time patients about other patients are of special importance, and they should be addressed during initial treatment.

[Expectations of psychiatric patients from their outpatient and inpatient treatment]. / Was erwarten sich psychisch Kranke von ambulanter und stationärer Behandlung?

OBJECTIVE: This study describes patient evaluations about treatment interventions and the subjective value of specific treatment expectations. METHOD: A random sample of 425 out-patients and in-patients was assessed to evaluate importance of treatment interventions and specific expectations of psychiatric treatment. RESULTS: Preferences regarding treatment interventions varied among diagnostic groups. Psychiatric patients ranked medication and supporting therapeutic conversations the highest. Sociodemographic characteristics, numbers of previous hospitalizations, quality of life and social abilities influenced treatment expectations. A patient's perception of dissatisfying quality of life and high social vulnerability increased the need for social assistance. CONCLUSION: Subjective treatment expectations of psychiatric patients should be the start-out for every treatment-regime. Socially vulnerable patients should be identified and specific treatment plans should be developed at treatment-start.

[Quality of life of the mentally ill]. / Die Lebensqualität psychisch Kranker.

Object of this research project was to study the subjective quality of life of psychiatric patients. The vulnerability of 424 out- and inpatients was assessed. The Vulnerability Index, composed of: marital status, income, health, life conditions, occupation, and risk factors in childhood was used. According to their vulnerability, two groups of patients were differentiated: patients with high and low vulnerability. We compared these objective criteria of vulnerability with the subjective quality of life (Q-LES-Q). Quality of life was also compared with diagnosis, severity of illness, and treatment (first contact/long-term contacts). Quality of life of 250 patients was analysed after one year follow up. Patients with a low vulnerability score are more satisfied with 'social relations' than patients with a high vulnerability score. In-patients are more satisfied with 'social relations' than out-patients. Out-patients are more satisfied with their 'physical health', 'subjective feelings', 'leisure time activities', and 'overall life satisfaction' than in-patients. Patients with a mild affective disorder have a better 'life satisfaction' than patients with severe affective disorder. Quality of life of schizophrenics and of patients with anxiety and adjustment disorders has improved significantly after one year.

[Assisted living for former long-term hospitalized psychiatric patients]. / Unterstütztes Wohnen für ehemals langzeithospitalisierte psychisch Kranke.

OBJECTIVES: The aim of the study is the evaluation of essential characteristics of patients who entered the sheltered group homes of the Psychosozialen Dienst (PSD) in the city of Vienna after the establishment of sectorized psychiatric out-patient care facilities. METHOD: Eighty patients who lived in these group homes on the first key day, June 30th 1993, were investigated. Any change in their living situation and rate of hospitalization was ascertained at follow-up, 3.5 years after the first key day. RESULTS: The patients had an average period of hospitalization of 240.5 days per year before entry to a group home, which decreased to 12.4 days per year after entry to a sheltered group home. At follow-up more than half of all patients (65%) were still able to live in the community successfully. The number and the length of hospitalizations between the first key day and the follow-up were lowest for patients who had moved to private homes. CONCLUSIONS: Sheltered group homes play an essential role in the process of rehabilitation towards independent living within the community. The results demonstrate that rehabilitation in private apartments can be possible even after 5.7 years of residence in sheltered group homes.

[Utilization of psychiatric treatment. Who drops out, who comes back and who stays?]. / Inanspruchnahme psychischer Behandlung. Wer bricht ab, wer kommt wieder und wer bleibt?

OBJECTIVE: The aim of this study is the prediction of specific factors associated with utilization patterns of mental health care. METHOD: Course of treatment of 272 out-patients and in-patients was observed for one year. Patients were asked five times (baseline, 1 month, 3, 6, and 12 months) about their utilization behavior. RESULTS: 71% of the patients continued treatment, 6% ended treatment in agreement with their therapists, and 23% dropped out of treatment. 24 patients of those who dropped out, i.e. 38% of this subgroup, returned to treatment during the one year period. Multivariate analyses indicate that continuity of treatment is associated with referrals from other institutions, male gender, the diagnosis of functional psychosis, high subjective well-being, and poor social functioning. First-time use of the corresponding institution, in-patient status, and living alone are predictors of treatment-dropout. Patients who ended treatment in agreement with their therapists are the best socially integrated group. Drop-outs who returned to treatment during the one year period have more unfavorable clinical premises, and are less well integrated socially than drop-outs who do not take up their treatment again. CONCLUSIONS: Therapeutic interventions, such as permanent efforts towards the maintenance of a supportive therapeutic relationship, motivate psychiatric patients to keep a continuing treatment-alliance. Well functioning communication between, or rather coordination of out-patient and in-patient treatment increases the chance of a continuous course of treatment.

[Social vulnerability, social isolation of chronic psychiatric patients]. / Soziale Vulnerabilität, soziale Isolation bei chronisch psychisch Kranken.

Social vulnerability and social isolation as to different, light and severe grades of chronically ill psychiatric patients were evaluated. A social vulnerability index, composed out of marital status, income, health, living conditions, occupation, and risk factors in childhood was used. The vulnerability of 64 severely chronically ill patients and of 84 chronically ill patients was assessed. According to their vulnerability, the patients were divided into a group of highly vulnerable and a group of less vulnerable patients. The social isolation of the two groups (severely chronically und chronically ill patients) was compared and assessed. We used objective criteria (such as living alone, no friends, no contact to family members) and subjective criteria (feeling isolated). Social Vulnerability and social isolation are higher in severely chronically ill patients compared to chronically ill patients. The severely sick group is significantly more affected by objective and/or by subjective isolation than the less sick group. In both groups patients have more difficulties in social relationships than non-isolated patients. There is no significant correlation between objective isolation and subjective isolation.

[Results and limits of fibrin-unspecific thrombolysis in acute myocardial infarct]. / Ergebnisse und Grenzen einer nicht fibrinspezifischen Thrombolyse beim akuten Herzinfarkt.

Acute myocardial infarction is caused by thrombotic occlusion of a coronary vessel. Mortality and quality of life are both determined by the extent of infarction. It is possible to interrupt the development of necrosis by early fibrinolytic therapy. If reperfusion is initiated within three to six hours, a significant reduction in mortality is likely. Currently available fibrin-unspecific plasminogen activators such as streptokinase and urokinase are effective thrombolytic agents but do not fulfill all the criteria of an ideal plasminogen activator. Recanalisation rates are relatively low after intravenous administration, since the agents are not fibrin-specific and because the effect is delayed. Serious hemorrhagic complications may occur, since therapeutically effective dosage results in a hemostatic defect. The possible advantages of reduction in blood viscosity for collateral circulation in the ischemic region and a possible antithrombotic effect have not been defined. A complex strategy is necessary for optimal treatment of acute myocardial infarction. Early intervention is decisive in regard to recanalisation rate, infarct size, left ventricular function and mortality, while delayed interventions serve to maintain the advantages of early recanalisation by limiting angina pectoris and preventing reinfarction. Therefore, a combination of early intravenous administration of a fibrinolytic agent with subsequent invasive intervention appears reasonable and advantageous. Progress in the treatment of acute myocardial infarction will depend on development of effective plasminogen activators capable of achieving rapid and complete recanalisation without major side effects after intravenous administration.

[Doppler echocardiographic findings in hypertrophic cardiomyopathy]. / Doppler-echokardiographische Befunde bei hypertropher Kardiomyopathie.

This study was performed to evaluate diastolic and systolic flow parameters in patients with hypertrophic cardiomyopathy as assessed by Doppler echocardiography. We examined 45 patients with hypertrophic cardiomyopathy (35 of which had an obstruction) and compared the results of diastolic and systolic measurements with those of two groups of normals (less than 25 years, n = 15; greater than 40 years, n = 10). For the diastolic parameters the isovolumetric relaxation time showed a significant prolongation with 107 +/- 23 ms as compared to normals (greater than 40 years) with 86 +/- 10 ms. No differences were found for the time-to-peak velocity in early diastole. The ratio of the time-velocity-integrals of early and late diastolic filling (E/A) with 2.4 +/- 1.3 was significantly lower as compared to young normals with 4.0 +/- 1.9 but not for the group of normals greater than 40 years with 2.5 +/- 1.0. The time-to-peak velocity in systole (TPVS) of the left ventricular outflow was prolonged in patients with an intracavitary obstruction, and the ratio of TPVS/LVET significant lower as compared to normals. Pressure gradients measured with Doppler showed good correlations to invasive measurements with an r = 0.88, SEE 28.5 mmHg. In color-coded Doppler echocardiography turbulent flow is portrayed as a color-mosaic. The location of turbulence in the outflow tract as well as an accompanying mitral insufficiency are immediately visible, but color-flow Doppler does not allow for quantifying the degree of an obstruction. Conventional and color-coded Doppler echocardiography is an enhancement of noninvasive diagnostics also in hypertrophic cardiomyopathy with respect to the assessment of pathologically changed systolic and diastolic flow parameters, the localization and quantification of an obstruction and the assessment and semiquantification of an concomitant mitral regurgitation.

[Detection of regional hypertrophy in hypertrophic cardiomyopathy with ECG triggered nuclear magnetic resonance tomography--comparison with hypertensive patients and persons with healthy hearts]. / Nachweis der regionalen Hypertrophie bei hypertrophischer Kardiomyopathie mit der EKG-getriggerten Kernspintomographie--Vergleich mit Hypertonikern und Herzgesunden.

Gated magnetic resonance tomography (MRT) was conducted in 40 patients (13 normal volunteers, 9 hypertensives and 18 patients with hypertrophic cardiomyopathy) using a 0.35 Tesla superconducting magnet. Multisectional spin echo imaging (35/400 msec) was obtained in coronal, transversal and sagittal planes. Myocardial wall thickness was measured in different segments and the three groups were compared to each other. 15/18 patients with hypertrophic cardiomyopathy (HCM) had asymmetrical regional thickening involving the septum and the anterior wall, in 8/15 the lateral wall was also hypertrophic. The distribution pattern in 3/15 patients with HCM was symmetric. Involvement of the right ventricle was found in 14/18 patients with HCM. There were significant differences (p less than 0.001) in wall thickness for the septal segment in all three groups and for the ratio septal to posterior wall between the HCM and the hypertensives and the normal volunteers. We conclude that MRT can differentiate HCM from hypertensives and normals, and is superior to echocardiographic imaging in the evaluation of the distribution of left ventricular hypertrophy in hypertrophic cardiomyopathy.