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Biomedical subjects

M Engberg

Publications and source records attributed to M Engberg.

16 recordsLinked to original sources
PubMed1997

Psychiatric morbidity in primary public health care: a multicentre investigation. Part II. Hidden morbidity and choice of treatment.

A total of 1,281 patients were examined during consultation with their GP in a Nordic multicentre study focusing on the prevalence of psychiatric illness, hidden psychiatric morbidity, treatment and pathways to specialized care. The methodology and prevalence were reported in an accompanying paper. The present paper presents results concerning the variables hidden psychiatric morbidity, treatment and pathways to specialized care. The GPs detected 44% of the psychiatric cases compared with the result of a diagnostic interview (PSE). The distinction between psychosis and non-psychosis did not influence the GPs' ability to detect a mental illness. According to the GPs' assessment the majority of patients suffering from a mental disorder consulted their GP about physical complaints. The GPs treated the patients themselves, and only a limited number of cases were referred to psychiatrists or psychologists.

Adolescent↗
PubMed1996

Mental disorder and crime. Evidence from a Danish birth cohort.

BACKGROUND: Evidence has accumulated since the mid 1960s from a number of different countries indicating an association between mental disorder and crime and particularly between the major mental disorders and violence. Registries in Denmark were used to identify a birth cohort and to document all psychiatric admissions and all criminal proceedings of the 324401 members of this cohort up to the age of 43 years. METHODS: Persons who had been admitted to a psychiatric ward were assigned to a diagnostic category according to a hierarchy of principal discharge diagnoses. They were compared with persons never admitted to a psychiatric ward as to the prevalence, type, and frequency of criminal convictions. RESULTS: Women and men who had been hospitalized in psychiatric wards were more likely to have been convicted of a criminal offense than persons with no history of psychiatric hospitalization. The offenders who were hospitalized committed all types and, on average, as many offenses as did the never-hospitalized group of the same sex. CONCLUSIONS: These findings confirm those from 2 other post-World War II Scandinavian birth cohorts that have found an association between psychiatric hospitalization and criminal convictions. They also concur with findings that patients discharged from psychiatric wards are more likely than other persons living in the same community to commit crimes and with results from North America showing elevated rates of major mental disorders among incarcerated offenders. Generalization of these findings is limited to nations with similar criminal justice, mental health, and social welfare systems.

Adult↗
PubMed1995

Psychiatric morbidity in primary public health care: a Nordic multicentre investigation. Part I: method and prevalence of psychiatric morbidity.

The prevalence of mental illness in five different Scandinavian primary care populations was investigated in this study. Patients consecutively consulting their general practitioner a particular week-day were included in the study. Initially the SCL-25 was applied and next the high scores and a sample of the low scores were interviewed by the PSE. In the analysis the screening procedure was first validated. The internal validity of the SCL was tested by means of Rasch latent structure analysis and the external validity tested by ROC/QROC analysis. Based on this, a short 8-item version of the SCL was developed. The prevalence of mental illness in all centres was 0.26 with a minimum of 0.14 in Nacka and a maximum of 0.34 in Turku.

Adolescent↗
PubMed1994

Mortality and suicide rates of involuntarily committed patients.

The mortality and suicide rates for involuntarily committed patients in Denmark are presented. Two cohorts of psychiatric patients committed to a mental hospital from January 1, 1971 to December 31, 1975 (8322 people) and January 1, 1981 to December 31, 1985 (5253 people) have been followed. The standard mortality rate (SMR) in relation to the total Danish population were 4.9 (4.5-5.4) and 5.2 (4.7-5.8), respectively, for the two cohorts, during the first year after involuntarily commitment to a mental hospital. During the same period, the SMR for suicide among the committed patients were 44.9 (37.1-53.9) and 30.9 (24.2-38.9), respectively. The crude suicide rates among the committed patients during the first year after the commitment were 14.3 and 14.0, respectively, per 1000 years, unchanged between the cohorts. Short length of stay in hospital (< 14 days), a nonpsychotic main diagnosis, male sex, and age 35 years or more were equally related to high risk of suicide in the 1971 cohort as evaluated to proportional hazard methods (Cox regression), and short length of stay and commitment on the danger indication provided the most information in relation to high suicidal risk in the 1981 cohort. Methodological problems and the reasons for the results are discussed.

Accidents↗
PubMed1992

[Use of compulsory measures in psychiatry after introduction of the new psychiatric law].

Investigation of compulsory treatment and mechanical restraint in the Psychiatric Hospital in Arhus reveals that no great changes in the employment of compulsory measures in psychiatry during the period around introduction of the new Danish legislation on October 1 1989 have occurred. The total duration of mechanical restraint constituted 0.3% of the entire duration of psychiatric hospitalisation in acute admission wards after the introduction of the legislation. The mean duration of mechanical restraint was 4.3 hours (5 minutes-5.3 days) and was similar in men and women. In 55.5% of the cases of mechanical restraint, a waist-belt alone was employed while, in the remaining cases, wrist or ankle cuffs were employed in addition. A doctor was present in 48.9% of the cases when mechanical restraint was applied. No differences were observed between the sexes in the extent of mechanical restraint but female patients were seen by a doctor prior to restraint more frequently than male patients. A tendency to employ a waist-belt alone was observed as the first form of restraint in women whereas men were frequently restrained by means of wrist or ankle cuffs also. The most frequent reason for restraint was that the patients constituted a danger to themselves and others.

Adolescent↗
PubMed1992

[Deprivation of liberty in psychiatry after introduction of the new psychiatric law].

This investigation shows that the rate of commitment to mental hospitals in Denmark increased from the year before the introduction of the new Danish psychiatric legislation when it was 24.4 (23.1-25.8) per 100,000 of the population till the year after when it was 28.4 (27.0-29.9) of the population. The increase in the commitment rate may, wholly or partially, be the result of the fact that the deprivation of liberty, which was previously more or less informal, was now registered. The results do not suggest that commitment of non-psychotic patients is employed more frequently than previously. The commitment rates for men and women were found to be identical after introduction of the new legislation. On the basis of data from the closed wards in the Psychiatric Hospital in Arhus, which receives approximately 11% of all committed patients in Denmark, it was found that the total number of admissions where patients were deprived of their liberty was nearly twice that of the number of involuntary admissions in the period immediately after introduction of the legislation. The average duration of involuntary detainment for committed patients was 20 days (1-101 days) and for patients admitted voluntarily but detained involuntarily 10 days (1-104 days). Involuntary detainment of patients admitted voluntarily occurred on an average two days (0-144 days) after admission. Following involuntary admission, significantly more women (51.5%) as compared with men (15.6%) were detained involuntarily whereas men had an excessive risk for deprivation of liberty for more than three days without formal involuntary detainment.

Adolescent↗
PubMed1991

Postoperative pulmonary complications and lung function in high-risk patients: a comparison of three physiotherapy regimens after upper abdominal surgery in general anesthesia.

The effect of three postoperative regimens of respiratory therapy on pulmonary complications and lung function was compared in high-risk patients. Fifty-one patients were randomized to: 1) conventional chest physiotherapy alone (PHYS), 2) chest physiotherapy and positive expiratory pressure (PEP), or 3) chest physiotherapy with both positive expiratory pressure and inspiratory resistance (RMT). Treatments were given twice daily by a physiotherapist and self-administered. The incidence of postoperative pulmonary complications (PPC) was respectively, 71%, 76% and 65% in the PHYS-, PEP- and RMT-groups. The incidence of PPC requiring treatment with antibiotic, bronchodilator or supplementary oxygen according to the existing clinical practice was 47%, 47% and 29%. The incidence of atelectasis was 65%, 64% and 60% and of pneumonia 29%, 35% and 6%. There was no difference between the groups, except for a tendency to a lower frequency of pneumonia in the RMT-group. Postoperatively forced vital capacity (FVC) decreased to mean 54%, forced expired volume in 1 s to 48% and functional residual capacity to 76% of preoperative values. Arterial oxygen tension (PaO2) declined to mean 8.1 kPa and arterial saturation (SaO2) to 89%. There was no difference between the groups except for FVC, PaO2 and SaO2 (P = 0.008, P = 0.008 and P = 0.002), which showed the least decrease in the RMT-group. None of the regimens could be considered as satisfactory concerning the prevention of PPC, but RMT seemed to be the most efficient. Insufficient self-administration of treatment was probably one of the causes of the overall high incidence of PPC in this study.

Abdomen↗
PubMed1991

Involuntary commitment in Greenland, the Faroe Islands and Denmark.

Greenland, the Faroe Islands and Denmark have common legislation and registration for involuntary commitment. Commitment rates were calculated based on information from the Danish psychiatric register for 1984-1988. Direct standardization with the Danish male and female population as a standard population (1984-1988) was carried out to evaluate differences in rates. An increased risk of commitment was found in Greenland, where the crude commitment rate was 43.5 commitments per 100,000 inhabitants. The commitment rate on the Faroe Islands was 19.2 per 100,000 and 24.2 per 100,000 in Denmark. The relative risk of commitment in Greenland vs Denmark was 2.0 (1.6-2.4) and increased to the same extent for both sexes. Young men constituted a high-risk group for commitment in Greenland. Males between 15 and 34 years accounted for 55% of the total number of commitments in Greenland. The high relative commitment risk in Greenland is related to higher homicide rates, lower psychiatric bed availability, reduced access to psychiatric treatment, small settlements and increased alcohol consumption and violence than in Denmark.

Adolescent↗
PubMed1990

[Commitment of the mentally ill].

This investigation consists of a cross-sectional study on 1 June 1989 of committed or compulsorily detained psychiatric patients in Denmark according to the legislation no. 118 of 13 April 1938. All of the departments which had received committed patients during the past five years participated. 87.2% replied. A total of 275 persons were found who were involuntarily admitted or compulsorily detained during their stay in hospital, or both. 59.9% of the patients were in closed departments and the remainder in open departments. The prevalence of committed or compulsorily detained patients was low compared with conditions in Norway and Sweden. Almost half of the patients were schizophrenic. The voluntarily admitted, but compulsorily detained patients comprised 28.8% of the reported patients. Notifications of compulsory detentions to the Ministry of Justice involved 34.4%. Half of the patients were admitted less than 2 1/2 months prior to the investigation but approximately 10% had been admitted for over ten years, which emphasizes the necessity of good physical and mental surroundings in psychiatric institutions.

Adolescent↗
PubMed1990

[Compulsory admissions].

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Commitment of Persons with Psychiatric Disorders↗
PubMed1990

Changes of blood pressure and cerebral arterio-venous oxygen content differences (AVDO2) with and without bupivacaine scalp infiltration during craniotomy.

In 20 patients subjected to craniotomy for supratentorial cerebral tumours, the effect of scalp infiltration with bupivacaine before incision was evaluated by measuring mean arterial blood pressure (MABP) and cerebral arterio-venous oxygen content differences (AVDO2) repeatedly during the operation. All patients were given halothane 0.5% anaesthesia. Ten patients were given bupivacaine 0.25% and ten patients were given normal saline for scalp infiltration prior to incision. The study was performed in a double-blind randomized fashion. Significantly higher values of MABP (P less than 0.0005) after incision were found in the saline group compared to the bupivacaine group. Significantly lower values of AVDO2 (P less than 0.0005) after incision were seen in the saline group compared to the bupivacaine group. The results indicate that the increase in MABP associated with a decrease in AVDO2, suggesting an increase in CBF and cerebral hyperperfusion, is reduced by using bupivacaine scalp infiltration prior to incision.

Adult↗
PubMed1989

Per- and postoperative changes in the arterio-venous oxygen content difference (AVDO2) in patients subjected to craniotomy for cerebral tumours.

Sixteen patients with supratentorial cerebral tumours were subjected to craniotomy under thiopentone, fentanyl, nitrous oxide, halothane anaesthesia during moderate hypocapnia (PaCO2 level 4.0 kPa). The arterio-venous oxygen content difference (AVDO2) was measured peroperatively, and repeatedly during the first three hours after extubation. Peroperatively the level of AVDO2 averaged 8.0 vol% during opening of the dura, and decreased to 7.0 vol% during closure of the dura (P less than 0.05). Immediately after extubation the AVDO2 decreased to 4.3 vol% (P less than 0.05), and during the next 3 hours a gradual increase to 5.8 vol% (P less than 0.05) was disclosed. In individual cases the postoperative changes in AVDO2 correlated fairly well with changes in mean arterial blood pressure (MABP), but other factors including duration of the operation, age of the patients, size of the tumour, level of PaCO2 and adaptation to prolonged hyperventilation during operation are supposed to be responsible for the low levels of AVDO2 observed in the postoperative period.

Adult↗
PubMed1989

The cerebral arterio-venous oxygen content differences (AVDO2) during halothane and neurolept anaesthesia in patients subjected to craniotomy.

In 20 patients subjected to craniotomy for supratentorial cerebral tumours, the haemodynamic changes during halothane and neurolept anaesthesia were evaluated by measuring mean arterial blood pressure (MABP) and cerebral arterio-venous oxygen content differences (AVDO2) repeatedly during the operation. Ten patients were given 0.5% halothane anaesthesia and ten patients neurolept anaesthesia. MABP, AVDO2 and PaCO2 were measured after induction of anaesthesia, before and after incision, after opening and closure of the dura, at the time of extubation and 1 h later. Concerning MABP and PaCO2, no significant difference between the two groups was found. In both groups an increase in MABP was observed after incision (P less than 0.01 in the neurolept group and P less than 0.05 in the halothane group) and in the neurolept group after extubation (P less than 0.01). In both groups a decrease in AVDO2 was observed after incision (P less than 0.01) and after extubation (P less than 0.01 in the neurolept group and P less than 0.05 in the halothane group). During the operation AVDO2 values were significantly higher in the neurolept group (P less than 0.05). The results indicate that even a moderate increase in MABP after incision during neuroanaesthesia affects AVDO2 values, suggesting an increase in cerebral blood flow. The study suggests that autoregulation of cerebral blood flow might be better preserved during neurolept anaesthesia. A state of hyperperfusion of the brain after extubation was unveiled in both groups.

Adult↗
PubMed1988

Cerebral blood flow, cerebral metabolic rate of oxygen and relative CO2 reactivity during neurolept anaesthesia in patients subjected to craniotomy for supratentorial cerebral tumours.

In 10 patients subjected to craniotomy for supratentorial cerebral tumours in neurolept anaesthesia, cerebral blood flow (CBF) and cerebral metabolic rate of oxygen (CMRO2) were measured twice peroperatively by a modification of the Kety & Schmidt technique, using 133Xe. The relative CO2 reactivity was assessed indirectly as the % change of the arteriovenous oxygen difference (AVDO2) per mm change in PaCO2. The patients were premedicated with diazepam 10-15 mg perorally. For induction, thiopentone 4-6 mg/kg, droperidol 0.2 mg/kg and fentanyl 5 micrograms/kg were used, and for maintenance N2O 67% and fentanyl 4 micrograms/kg/h. During the first flow measurement the median and range of CBF was 30 ml/100 g/min (range 17-45), of AVDO2 8.0 vol % (range 4.1-9.5), and of CMRO2 2.28 ml O2/100 g/min (range 1.57-2.84). During the second CBF study, AVDO2 increased to 9.3 vol % (range 3.4-11) (P less than 0.05), and CMRO2 increased to 2.51 ml O2/100 g/min (range 1.88-3.00) P less than 0.05, while CBF was unchanged. The CO2 reactivity was present in all studies, median 1.8%/mmHg (range 0.5-15.1). The correlation coefficients between jugular venous oxygen tension/saturation, respectively, and CBF were high at tensions/saturations exceeding 4.0 kPa and 55%, indicating that hyperperfusion is easily unveiled by venous samples from the jugular vein during this anaesthesia.

Adult↗