Biomedical subjects
Publications and source records attributed to G Nielsen.
An integrative form of brief dynamic psychotherapy was applied in 2 cases of insomnia. One patient had a sleep-onset latency problem, while the other suffered from early morning awakening. The treatments are described, and data on the long- and short-term effects of therapy are presented.
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In her book "Vårdandets Ide" the Finnish nurse, Katie Eriksson puts forward the thesis, that all kind af caring activities do have a common core. To establish this thesis professor Eriksson introduces the Aristotelian notion of an essence: Different kinds of caring activities do have a common set of essential properties constituting the act of caring. In this article we submit a thesis to the contrary: There may exist no set of essential properties common to all kind of caring activities: The belief is induced in us, that there may exist some common core to all caring activities, because the same term, namely "caring", is being used as a general term to cover a wide field of very different kinds of activities. Instead of the traditional Aristotelian craving for generality issuing in the notion of an essence, we suggest the use of the more modern Wittgensteinian concept of a family resemblance: There may be no common core but a set of family resemblances among the different kinds of caring activities. Instead of an abstract philosophical search for the common core of caring activities, we propose nurses to look at the actual use of the term "to care", thereby circumscribing the subject matter of caring. It goes without saying, that this article contains a good deal of philosophical arguments including, of course, an introduction to some basic Aristotelian notions, fundamental distinctions in the theory of definition, and finally the Wittgensteinian concept of family resemblance.
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Managers constantly strive to improve; it's an inherent goal of the job. Each of the three articles in this section contains valuable information designed to help the manager think, act or even just imagine.
In order to assess the possible suppression of immune responses to non-specific antigens in patients with generalized onchocerciasis, a vaccination study was conducted among the population of eight Liberian villages. Hundred and eighty-four persons infected with Onchocerca volvulus and 142 non-infected individuals were tested for delayed cutaneous hypersensitivity to tetanus antigen using the Multitest Mérieux. Prevalence of malaria and infections with intestinal nematodes with larval migration to the lung were much the same in all the villages examined. Other parasitic diseases had no significant influence. Persons aged 2-29 years with onchocerciasis had a significantly lower prevalence of positive tetanus reactions (p less than 0.05). Hundred and eighty persons showing a negative skin test were vaccinated twice with 75 i.u. tetanus toxoid and cell-mediated as well as humoral immune responses were recorded three months later. Analysis of sera collected before vaccinations indicated that 56% of the vaccinees had tetanus antibody levels of 0.01 i.u./ml or more and had, therefore, received a booster vaccination. Rates of seroconversion or booster were the same in persons with or without onchocerciasis (81% and 82% respectively). The conversion rate in the delayed cutaneous hypersensitivity test, however, was significantly lower in those infected with O. volvulus (67%) as compared to the controls (92%, p less than 0.001). These results demonstrate a diminished cell-mediated immune response to tetanus toxoid vaccinations in patients with generalized onchocerciasis. Considering the unimpaired humoral immune response, no changes in vaccination schedules are recommended.
In seven Liberian villages of different endemicity for onchocerciasis 629 persons were tested for tuberculin reactions using 5 i.u. purified protein derivative or old tuberculin. No correlation between infection with Onchocerca volvulus and reactivity to tuberculin was detected on a community level, but a direct comparison of results of infected and non-infected individuals in two neighboring villages revealed a lower responsiveness in persons with onchocerciasis. The conversion rate three months after BCG vaccination was significantly lower in children with onchocerciasis (48%) than in controls (85%). The possible impact of this finding on the efficacy of BCG vaccinations is discussed. Girls aged 2-16 years were screened for rubella antibodies using a latex agglutination test. Sera from 74 girls, who showed no antibodies, were examined before and four months after rubella vaccination by haemagglutination-inhibition-test and haemolysis-in-gel-test. No difference in the humoral immune response of girls with or without onchocerciasis was found. Seroconversion rates were 98% and 100%. Delayed cutaneous hypersensitivity (DCH) to seven ubiquitous recall antigens was tested in 147 persons infected with O. volvulus and compared to the results of 142 non-infected controls. A reduced responsiveness was seen in persons with onchocerciasis, the difference being greatest in young children 2-7 years of age. In connection with the results of tetanus vaccinations reported earlier, these findings verify the existence of a reduced in vivo responsiveness of cell-mediated immunity to non-specific antigens in onchocerciasis in the rain forest of West Africa. Humoral immune responses however appeared to be unaffected.
The selection criteria of Sifneos' short-term anxiety-provoking psychotherapy has been assumed to consist of two separate dimensions, resources and motivation. A factor analysis revealed three factors: ego-resources, motivation for psychotherapy and motivation or desire to change. The resource items on the evaluation form constitute one factor as assumed, it is the items on the motivation section that are split into two independent factors. The evaluation form might become more useful if the motivation items are reorganized according to the two different dimensions of the concept.
Forty-four patients were assessed for three different short-term dynamic therapies, with an evaluation form based on Sifneos' criteria for Short-Term Anxiety-Provoking Psychotherapy (STAPP). Ten patients were ascribed to STAPP, 22 patients to Malan's Brief Psychotherapy (BP), and 12 patients to a more eclectic/integrative form of brief psychotherapy in this project called the FIAT model. 78% of the patients completed their treatment in agreement with the original ascription to therapy, with good results for all three therapies. The evaluation form seems to be a reliable and valid instrument offering a good and systematic basis for designing a tailor-made treatment format for different types of patients.
Ten outpatients who complained of physical symptoms, without organic pathology, were treated with brief dynamic psychotherapy. Outcome ratings were provided by independent assessors at the end of therapy and 2 years post treatment. Improvement criteria included symptoms, adaptive functioning, and specific internal predispositions. The results showed that most of the patients gained substantially from their therapy experiences. Change did not only occur with regard to psychological difficulties, but also in their particular physical symptoms. Therapy gains at termination were maintained, and had even increased, at follow-up. Clinical improvement was confirmed by psychological test findings. In several patients marked positive change was also observed in their general body response patterns.
Change was assessed in 34 patients at the end of short-term dynamic psychotherapy (STDP), and at 2 follow-ups (1 year and 2 years subsequent to treatment). The assessment was made from different perspectives and according to multiple criteria and methods of measurement. The results indicate that, when a particular form of STDP is selected according to each patient's ego resources, motivation for therapy, and motivation for change, approximately 90% of the patients will attain substantial symptom relief. The majority of the patients in this study also gave evidence of positive change in adaptive functioning, while one-third attained some dynamic/structural change as well. Clinically rated improvement was confirmed by changes in the patients' self-reported distress level (SCL-90), and from psychological test findings (MMPI). Improvement observed at the end of therapy was sustained throughout the 2-year follow-up period.
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The specific serotonin receptor blocker ketanserin was given orally to 12 patients with traumatic vasospastic disease in a double blind crossover study. The effect of treatment was assessed by measuring finger systolic pressure and rewarming time after cold provocation and by medical interview and diaries. Median (range) percentage change in finger systolic pressure after cooling was 50 (0-100)% after treatment with ketanserin compared with 0 (0-90)% after placebo. Median (range) rewarming time after cooling decreased from 320 (236-972)s with placebo to 160 (88-404)s after treatment with ketanserin. These changes were not significant. Ninety five percent confidence intervals for difference between the treatments, however, showed that finger systolic pressure may be 80% better and rewarming time 256 seconds faster after treatment with ketanserin than after placebo. The number of attacks did not differ significantly between the two treatments. Two patients had a feeling of warmth in their hands during treatment with ketanserin. The results suggest that orally administered ketanserin may improve digital circulation in patients with traumatic vasospastic disease, but larger numbers of patients are required to assess the true effect of treatment with ketanserin in this disease.
In the period from 1963 to 1973, 143 heart catheterizations were carried out in children under two years of age. In 33 patients, the femoral vein was exposed by cutdown and ligated afterward. Ten of these patients (the other 23 having died in the intervening years) were available for follow-up and the venous outflow of the lower extremities was studied. Nine of the ten patients showed no abnormality, but one patient had developed varicose veins. In this patient, plethysmography showed reduced venous outflow, and phlebography showed narrowing of the common femoral vein at the site of earlier ligation, indicating recanalization. It is concluded that, if the femoral vein must be used, careful dissection is necessary to secure the bifurcation of the femoral vein and avoid ligation of the common femoral vein.
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