[Assessing deinstitutionalization of the nursing home area of a large state mental hospital from the point of view of patients and staff]. / Der Enthospitalisierungsprozess des psychiatrischen Heimbereichs eines ehemaligen Grosskrankenhauses aus Patienten- und Mitarbeitersicht.

OBJECTIVE: Within the deinstitutionalization process of a large psychiatric hospital, the development of two cohorts of patients with chronic schizophrenia is compared over a two-year period: patients living in the hospital's nursing-home area (n = 50) vs. patients already released to two social therapeutic hostels (n = 51). Results of the cohort study were compared with assessments of nurses working in the nursing home (n = 55), focusing on their subjective views of the deinstitutionalization process and its impact on their working conditions. METHODS: Patients are assessed through yearly home-visits in their place of residence. The instruments used measure several outcome parameters: psychopathology, social disabilities, subjective quality of life, and normative needs for care. Concurrent staff assessments were conducted using standardized survey instruments focusing on current working conditions and quality of teamwork. Nineteen nurses participated in qualitative interviews evaluating the deinstitutionalization process. RESULTS: For all measures, patients living in the nursing home show significantly worse outcomes. Furthermore, during the study period 34 % experienced a change in their living situation with which they were dissatisfied. Needs for care and the number of areas of "unmet" need increased significantly for this subgroup. Patients living in social therapeutic hostels demonstrate stable levels of psychopathological symptoms, social disabilities, and needs for care. Assessments indicating a deterioration in patients' subjective quality of life focus mainly on areas important for social contacts. Regarding "personal concerns" and "insecurity at work", ratings from nursing home staff were significantly worse than those of a reference group from several other health care institutions (n = 224). Staff showed a tendency to give higher ratings for their opportunities to participate in decisions, in contrast with the low ratings for chances to improve their knowledge in the workplace, a result which may indicate a lack of prospects. In general, staff faces the conundrum of being asked to adopt a new mental health care paradigm while organisational structures are being eliminated and insecurity about career opportunities is increasing. CONCLUSION: To adequately manage deinstitutionalization of care, all participating parties must be involved in the process as early as possible to clarify expectations and to demonstrate commitment to future opportunities in the new system.

Changes in brain metabolism associated with remission in unipolar major depression.

OBJECTIVE: Functional brain correlates of remission in patients with major depressive disorder (MDD) are measured with positron emission tomography (PET) and 18F-fluorodeoxyglucose. METHOD: Glucose metabolism was measured in patients (n = 41) with moderate to severe MDD during acute depression and in the remitted state defined as a period of asymptomatic condition over 12 weeks. Data analyses used a region-of-interest (ROI) approach and statistical parametric mapping (SPM). RESULTS: There were significant decreases in metabolism upon remission with respect to the baseline scan in left prefrontal, anterior temporal and anterior cingulate cortex and bilateral thalamus (SPM analysis) and bilateral putamen and cerebellum (SPM and ROI analyses). There was a significant asymmetry in prefrontal and anterior cingulate cortex metabolism with lower metabolism in the left hemisphere that persisted despite clinical remission. CONCLUSION: These findings support the hypothesis that selective monoamine reuptake inhibition leads to an attenuation of a brain circuit that mediates depressive symptomatology.

Influence of reboxetine on salivary MHPG concentration and cognitive symptoms among patients with alcohol-related Korsakoff's syndrome.

This study is based on the hypothesis of a paraventricular cerebral noradrenaline deficit in alcoholic Korsakoff's syndrome. In a randomized open study the effects of a 4-week treatment with the selective noradrenaline reuptake inhibitor reboxetine on (1) the salivary concentration of the noradrenaline metabolite MHPG and (2) changes in cognitive performance measured by the Mini Mental Status Test were examined. The study group consisted of 105 patients diagnosed with alcohol-related Korsakoff's syndrome (ICD-10: F10.6). Korsakoff's patients showed a reduced concentration of salivary MHPG compared to healthy controls; this reduction did not correlate with the results of the Mini Mental Status Test. An increase in salivary MHPG was found together with an improvement in the Mini Mental Status Test both in the verum group treated with reboxetine and in the control group upon completion of the 4-week study. However, a subgroup with a shorter duration of disease (<1 year) was found to profit significantly from reboxetine treatment, as shown by improvements in cognitive performance.

[Psychiatric consultation service at the Psychiatric Clinic of the Görlitz Municipal Clinic GmbH, ECLW]. / Der Psychiatrische Konsiliardienst der Klinik für Psychiatrie an der Städtisches Klinikum Görlitz GmbH, ECLW.

The Psychiatric Hospital at the Municipal (General) Hospital in Görlitz, Germany, was the only Department of Psychiatry in a non-University (general) hospital in the newly integrated German provinces who were originally part of the so-called "German Democratic Republic" before the re-unification of Germany, to participate in the German collective study on "Psychiatric and Psychosomatic Consultation and Liaison Service in German General Hospitals-A Multicentre Empirical Study to Assess and Evaluate Existing Structures and Services". This study is an independent part project that includes specific questions forming part of the European collective study on "Effectiveness of Mental Health Consultation and Liaison Service Delivery in the General Hospital".

[Undetected psychiatric disorders in primary health care. A need for psychotherapy]. / Skrytá psychiatrická nemocnost v linii prevého odborného kontaktu (Potreba psychoterapie).

In joint collaboration of both Institutes the Leipzig-south survey of need of psychotherapy was replicated in a representative sample (N = 1708) of patients waiting one year to be examined and/or treated in out-patient departments of general practitioners and other specialists (gynaecology, orthopaedic surgery and internal medicine) in one district of Prague City (N = 1461) and a rural district in Kromeríz (N = 247). In a preceding pilot study (N = 207) the zero hypothesis of unspecificity of the Leipzig methodology was rejected. Roughly corresponding proportions of three classes of the need of psychotherapy (defined by means of cluster analysis) were found in the geographic areas, compared in waiting rooms of all out-patient departments except the evidently lower need of psychotherapy found in the rural GP's waiting rooms. Highest rates were those in waiting rooms of gynaecologists and orthopedic surgeons. The GHQ-60 and the Leipzig classifications were compared in both CS samples: 35.1% of male and 30.6% of female respondents did not need psychotherapy and very probably were not psychiatric cases. In 32.5% of males and 36.9% of females the need of generally oriented psychotherapy was combined with suspected hidden psychopathology. 3.8% male and 6.9% female respondents were very probably hidden psychiatric cases and in need of specifically oriented psychotherapy. Predictors of both measures of hidden psychopathology used were obtained from descriptions of personality, demographic background and health care need and attitudes case history by means of multivariate statistical techniques. 12 of 23 descriptors explained 48.8% variance of the global GHQ-60 score. An agreement of 62.9% of the need of psychotherapy back classification was attained by discriminant function using 11 of 23 descriptors. In both procedures the factor analysis derived dimensions of personality were found to be the most potent class of predictors.

[The significance of various hematological parameters for the early diagnosis of bacterial infection in premature and full-term neonates. 1. Patients and study methods, normal values for the blood picture of newborn infants]. / Untersuchungen zur Bedeutung einiger hämatologischer Parameter für die Früherkennung bakterieller Infektionen bei Früh- und reifen Neugeborenen. 1. Patienten und Untersuchungsmethoden, Normwerte für das Blutbild bei Neugeborenen.

We examined the white blood count in 101 premature infants and full-term neonates on their first day of life (before or within the 12th hour), on 2nd, 3rd, 4th, 5th, 10th, 15th and 20th day of life. Infection was suspected in the course in 31 infants (without demonstration of pathogenic organisms). In 73 infants without infections we were therefore able to establish normal values. We could establish reference limits corresponding to the standard deviation for all kinds of white blood cells, except the whole leucocyte count. Because of considerable individual differences of the whole white blood cell count in newborns without infections we fixed for this reference limits from 5 to 20 Gpt/l. The means of leucocyte and neutrophil counts reached their maximum in the 12th hour after birth, decreased until the 5th day of life and leveled off then. The segmented neutrophils and the lymphocyte counts crossed over after the 5th day of life resulting in a relative lymphocytosis. The physiologic left shift decreased in the first days of life. These described changes after birth were significant.

[The significance of various hematological parameters for the early diagnosis of bacterial infections in premature and full-term neonates. 3. Discussion of the study results]. / Untersuchungen zur Bedeutung einiger hämatologischer Parameter für die Früherkennung bakterieller Infektionen bei Früh- und Neugeborenen. 3. Diskussion der Untersuchungsergebnisse.

Haematological examinations may contribute, especially by repeated investigations of parameters changing dynamically, to a greater safety of decisions concerning the beginning or termination of chemotherapy in neonates with suspected infections. We recommend to check the blood count every 6-12 h in such cases. A normal blood count does not exclude a sepsis but haematological changes may precede clinical symptoms for hours. We can confirm the good experiences of some authors with "screening-scores" to detect early infants with sepsis. Such a score should include I/T-Quotient, thrombocyte count, CRP and micro-ESR. This contributes to a greater predictive probability of an infection.

[The significance of various hematological parameters for the early diagnosis of bacterial infections in premature and full-term neonates. 2. The blood picture in premature and full-term neonates with suspicion of existing infection or with confirmed infection]. / Untersuchung zur Bedeutung einiger hämatologischer Parameter für die Früherkennung bakterieller Infektionen bei Früh- und Neugeborenen. 2. Das Blutbild bei Früh- und reifen Neugeborenen mit Verdacht auf Vorliegen einer Infektion bzw. mit gesicherten Infektionen.

We compared the normal values of white blood counts in premature infants and full-term neonates, as described in part one of this paper, with blood counts of 31 infants with suspected infections and 81 infants with sepsis and/or meningitis. The half of these infected infants had leucocyte and neutrophil counts beyond the reference limits. The values tended to leucopenia in diseases beginning within the first five days of life and to leucocytosis later on. More than 80% of the patients had a left shift. One is able to predict a sepsis with a probability of 16.3%, according to our experiences, with leucocyte counts below 5 or above 20 Gpt/l. In the case of left shift the probability is about 25%. Combining these parameters the predictive value is even mounting to 56.1%. We were able to make a prognosis too referring to the blood count of infants with sepsis.

Sperm motile efficiency (SME) of fresh spermatozoa in a hypotonic medium correlates with their cryosurvival in fertile men and infertility patients (predicting test).

The sperm motile efficiency (SME) of fresh spermatozoa in a hypotonic medium was investigated concerning the prediction of post thaw motility and the differentiation between fertile men and infertility patients. A total of 95 semen samples were collected for this study. Twenty of these samples were obtained from semen donors of proven fertility and 75 samples were collected from male partners of infertile couples. There were no significant differences between the SME after mixture of the fresh semen with a 140 mOsm saline in equivalent volumes and after cryopreservation (Wilcoxon-matched pairs signed ranks-test) but a significant positive correlation between the SME after both treatments of semen samples was notable. Significant differences between the fertile control group and group of infertility patients could be determined concerning the SME after mixing of fresh semen with 140 mOsm saline as well as after cryopreservation (Mann-Whitney-U-test). The discriminant analysis revealed a most discriminating effectiveness for SME immediately after the addition of hypoosmotic saline.

[Occupationally-induced skin tumors in East Germany. Increased risk of basalioma in furriers and hide processors?]. / Berufsbedingte Hauttumoren in der DDR. Erhöhtes Basaliomrisiko bei Kürschnern und Rohfellbearbeitern?

The percentage of occupational cancer is only 0.5% of all tumors in the German Democratic Republic. International estimations are higher (4 to 38%). From 1981 to 1985 49 skin tumors (32 squamous cell tumors and 17 basal cell cancers) were accepted as occupationally induced disease in 47 patients. No tumors were registered in 5 of the 15 counties of the GDR. The occupational histories were analysed in 300 basalioma patients and 600 citizens of the same sex and age. The risk of getting a basalioma was significantly higher in the group of furriers than in the control population. It is recommended to accept a basalioma as occupational cancer in case of contact with carcinogens in furriers.

Physiological and psychological response to a three-month mental strain period in students.

Biochemical and immunological parameters, physical and mental performance, subjective complaints and behavioural characteristics were compared before and after 14 final examinations undertaken by 64 students during a three-month examination period. A decrease in cholesterol, triglycerides, HDL-cholesterol, physical performance and an increase in LDL/HDL cholesterol quotient, lactate level, mental performance were accompanied by a lower frequency of mental complaints and higher frequency of physical complaints. From the multidimensional variance and discriminant analysis 17 of the 44 variables discriminated between the state prior to and after the examination period. The results are interpreted in terms of the psychophysiological adaptation to adequate mental stress.

A comparison of prednisolone with azathioprine and prednisolone with intramuscular gold in rheumatoid arthritis.

Pulse prednisolone hemisuccinate therapy (500 mg given intravenously on three occasions over two weeks) has been combined with either intramuscular sodium aurothiomalate or azathioprine in an assessment of 30 patients with rheumatoid arthritis. Significant improvement in a variety of clinical and biochemical assessments was seen in both groups. Both treatments were well tolerated by the patients and prednisolone appeared to accelerate the response to sodium aurothiomalate and azathioprine but there was no great evidence that it enhanced it.

[Thermologic studies in inflammatory rheumatic diseases--general presentation and personal results in rheumatoid arthritis]. / Thermologische Untersuchungen bei entzündlich-rheumatischen Erkrankungen--allgemeine Darstellung und eigene Ergebnisse bei Rheumatoid-Arthritis.

The registration of the temperature of the body surface gains an increasing significance among others for the diagnosis of inflammatory rheumatic diseases. A criterion of the inflammation of the joint, the hyperthermy as well as the disturbances of the microcirculation may be made evident by means of the thermological methods. Own results in healthy persons and patients with rheumatoid arthritis as well as evidence of the literature confirm the possibilities of the measurements of temperature for the rheumatology. On account of the great inter- and intra-individual variability of the skin temperature an orientation at the temperatures of normal values of certain measuring regions is not reasonable. When the results of the temperature measurement are estimated, therefore, a comparison with temperature patterns of healthy persons must be done. Using dynamic measuring methods the evidence of thermological investigations may essentially be enlarged. The evaluation of the results of the measurement is increasingly performed with the help of computers.

[Dynamics of the age structure of residents in homes for the aged and nursing homes]. / Zur Dynamik der Altersstruktur bei Bewohnern von Feierabend- und Pflegeheimen.

In state-run residential and nursing homes in the GDR the proportion of those residents of at least 80 years of age increased from 41.5 to 56.0 p.c. between 1980 and 1983, diversified on districts they moved between 70.0 and 46.5 p.c. Some selected features were correlated, only a low degree of dependence being found on the age-structure of the district-population (r = +0.26), highest degree on the ratio home-capacity/district-population (r = -0.65).

Detection of cystic fibrosis heterozygotes using a modified loading with bromide.

A three day loading with sodium bromide was performed in 19 healthy controls, 16 definite cystic fibrosis heterozygotes, and 14 homozygote patients with cystic fibrosis. After three days sodium, potassium, chloride, and bromide were determined in serum and sweat. Using a multivariate discriminant analysis two nonelementary functions with the features sodium index, bromide index, potassium index, and chloride in sweat allowed us to identify the three groups. The reclassification of the probands, however, was correct in only 69.3%. A second analysis with the groups of controls and heterozygotes only resulted in a unidimensional nonelementary function with the features potassium index, bromide/sodium in sweat, and sodium index. The reclassification of the probands was correct in 91.4%. The discriminant values were 8.28 +/- 0.96 in the controls and 11.67 +/- 1.03 in the heterozygotes with an overlap of twice the standard deviations between 9.61 and 10.20.

[Multivariate discriminant analysis--a current method for evaluating the enzyme spectrum in cancer patients]. / Mnogomernyi diskriminantnyi analiz--sovremennyi metod obrabotki i otsenki fermentnogo spektra u onkologicheskikh bol'nykh.

The study was concerned with the procedure and results of evaluation of the clinical course versus enzymatic activity in blood serum of patients with breast, uterine and bladder tumors. Mathematical and statistical methods used in multivariate discriminant analysis offer more advantage as compared with the standard procedures for evaluation of enzymatic activity in blood serum of cancer patients.

[Social integration of older citizens--a factor analysis approach]. / Zur sozialen Integration älterer Bürger--ein faktoranalytischer Ansatz.

The paper deals with social integration problems of residents in homes for the elderly under city conditions on the basis of a questionnaire. By means of factor analysis results were found concerning influencing factors on the integration process. Attention is paid to essential aspects such as realizing human contacts, avoiding social isolation, safe-guarding social activity and psychial well-being.