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PubMed2001

Extension of generator longevity by use of high impedance ventricular leads.

The resistance of a pacing lead negatively correlates to current consumption. A prospective, randomized trial was conducted to evaluate the effect of a high impedance ventricular lead (CapSure Z) on generator longevity compared to a conventional lead (CapSure SP) eighty-nine patients were included in the study (51 male, 37 female, age 70.0+/-10.3 years). Forty-six patients received a CapSure SP lead (5024 bipolar), and 43 patients received a CapSure Z lead (5034 bipolar) in a randomized fashion. Follow-up data collected at 5 days, 3, 6, and 12 months postimplant included: lead impedance, pacing and sensing thresholds, impulse energy, and estimated time to replacement. All parameters were collected via pacemaker telemetry; the time to replacement was calculated automatically by a programmed algorithm of the pacemaker. There was no difference in the performance of the atrial lead when a dual chamber device was indicated. The CapSure Z leads displayed statistically significant higher impedance values than the CapSure SP lead in all follow-up periods. There was no significant difference in lead related complications. No significant differences were observed between pacing and sensing thresholds in both groups. The CapSure Z leads provided a significant reduction in current drain, resulting in a reduction of mean energy consumption at the 12-month follow-up from 10.4+/-5.0 microJ in the CapSure SP group to 6.6+/-1.4 microJ in the CapSure Z group (median from 9.9 microJ to 6.9 microJ, respectively), providing an estimated increase in mean longevity of more than 1 year from 81.1+/-23.5 months in the CapSure SP group to 94.5+/-13.4 months in the CapSure Z group (median: 76.5 months to 95.0 months, respectively). The use of a high resistance lead for ventricular pacing appears to result in a clinically relevant extension of generator longevity.

Aged↗
PubMedDate not supplied

Integrating medical informatics and health services research: the need for dual training at the clinical health systems and policy levels.

Reams of data pertaining directly to the core health services research mission are accumulating in large-scale organizational and clinical information systems. Health services researchers who grasp the structure of information systems and databases and the function of software applications can use existing data more effectively, assist in establishing new databases, and develop new tools to survey populations and collect data. At the same time, informaticians are needed who can structure databases that serve the needs of health service research and who can design and evaluate applications that effectively improve health care delivery. As long as health services researchers and informaticians work in separate spheres, however, opportunities to use data from health care encounters to improve care, expand knowledge, and develop more effective policies will be missed. This paper provides a brief exploration of 1) existing successful collaborations between health services researchers and informaticians and 2) needs and opportunities for additional joint work in several core research areas.

Curriculum↗
PubMed2002

Quantitative dual-probe microdialysis: evaluation of [3H]mannitol diffusion in agar and rat striatum.

Dual-probe microdialysis was used to study interstitial diffusion in the rat brain. A radiolabelled tracer, (3H]mannitol, was continuously infused at different concentrations via a probe acutely implanted into the striatum of an anaesthetized male rat or into a dilute agar gel. Samples were collected by a second probe placed 1 mm away from the first, and the recovered [3H]mannitol was measured by liquid scintillation counting. In the striatum, the delivery of [3H]mannitol was counteracted by its removal from the extracellular space by passive uptake into cells and clearance into the microcirculation, causing the diffusion profile to approach quasi steady-state levels within 2 h. Diffusion data from brain and agar were analysed using a mathematical model. The apparent (effective) diffusion coefficient for [3H]mannitol was D* = 2.9 x 10(-6) cm2/s, the effective volume fraction alpha* = 0.30 and the clearance rate constant kappa= 2.3 x 10(-5)/s. A tortuosity, lambda = 1.81, and penetration distance r = 4.2 mm, were calculated. We conclude that, using dual-probe microdialysis, parameters reflecting geometric and dynamic tissue properties may be obtained using appropriate mathematical analysis. Quantitative dual-probe microdialysis will be valuable in characterizing interstitial diffusion and the clearance processes underpinning volume transmission in the brain.

Agar↗
PubMedDate not supplied

[The biodiversity dynamics of the causative agents of diseases transmitted by ticks in the genus Ixodes: an analysis of multiyear data].

Fauna of pathogen's met in the organism of the primary tick-borne disease vectors--Ixodes persulcatus Schulze and Ixodes ricinus (L.) was observed. Prevalence of Borrelia mono- and poly-infection in the I. persulcatus ticks within a season of the vector activity was analyzed and increase of the number of the dual infected specimens during the season was demonstrated. The first determination of Ehrlichia infected I. ricinus and I. persulcatus collected in the Baltic region of Russia was stated. The triple infection of Ixodes ticks in was proved: infection by the two species of Borrelia and Ehrlichia; infection by the three species of Borrelia and infection by the tick-borne encephalitis virus and two species of Borrelia. The first determination of the tick-borne encephalitis virus in I. ricinus in the recreational zone of Kaliningrad Province (Courland [correction of Curonian] Spit) was described. Dipetalonema sp. was detected in the St. Petersburg population of I. persulcatus. The prevalence of poly-infection among I. persulcatus ticks was stated.

Animals↗
PubMed2003

[Longitudinal study on osteoarthritis and bone metabolism].

OBJECTIVE: The relationship between Osteoarthritis (OA) and Osteoporosis (OP) is not well defined due to lacking in longitudinal data, mainly regarding correlations between biochemical factors and OA incidence. Aim of this paper was to investigate the predictive value for OA incidence of bone mass variations and of selected biochemical markers in healthy women participating in a population-based longitudinal study carried out in Naples (Italy). SUBJECTS AND METHODS: High completion rate (85.2%) and statistically adequate sample size were obtained: 139 women (45 to 79 years of age) were examined and follow up visit was performed after two years (24+/-2 months), following the same protocol. Patients underwent medical examination, questionnaire, anthropometric measurements, blood sampling and urine collection. Bone mineral density (BMD) measurement was performed by dual energy X-ray absorptiometry (DEXA) at the lumbar spine (L1-L4) and femoral neck. Radiographs of dorsal and lumbar spine in lateral view were performed at basal and at 24 months visits; a team of three experts scored radiographs using Kellgren and Lawrence grading. RESULTS: The score was calculated for two individual radiographic features (narrowing of the joint space, presence of osteophytes) and as a global score. Results show a relevant percentage, 23% up, of subjects presenting both OA and OP. In the cross-sectional study the presence of osteophytosis correlates with anthropometric variables and PTH levels. In the longitudinal study results show a correlation between serum vitamin D and delta score for osteophytosis (beta=0.02 p<0.05). CONCLUSIONS: Data obtained outline the importance of further studies on the pathogenetic link between OA and bone metabolism.

Absorptiometry, Photon↗
PubMedDate not supplied

Evaluation of a virtual reality simulator for arthroscopy skills development.

We evaluated a virtual reality shoulder arthroscopy simulator using a standardized skills-assessment algorithm in 3 specific groups with various degrees of surgical expertise. The simulator (Mentice Corp, Gothenberg, Sweden) consists of a computer-based, dual-force feedback system with video monitor. Modeled structures include cartilage, labrum, ligaments, biceps tendon, and rotator cuff. The study included 3 groups of volunteers: group 1, medical students interviewing for orthopaedic residency (n = 35); group 2, orthopaedic residents interviewing for sports medicine fellowship (n = 22); and group 3, experienced faculty at a shoulder surgery course (n = 21). Data were collected anonymously and subjects completed a standardized test protocol designed to assess accuracy and efficiency. Subjects used the probe to "touch" a sphere that appeared at various locations within the joint (11 positions total). The sphere changed location immediately on contact with the tip of the probe. The following parameters were calculated by the computer: time (from touching the first ball until touching the eleventh ball), path ratio (percent of measured path length relative to the ideal path), collisions (number of times the probe / arthroscope contacted any tissue), and injuries (collisions beyond a threshold force). Test time and path ratio differed significantly as a function of surgical experience. There was no significant difference in probe collisions between the groups. Arthroscope collisions and injuries averaged 2 or less in all of the groups. There was significant correlation between path ratio and time to complete the test in groups 1 and 2 (r =.527 and r =.827, respectively, P <.001), but not in group 3 (r =.376, P =.10). There was essentially normal distribution of time performance in groups 1 and 2. Time was shorter and more consistent in group 3, suggesting greater consistency in the experienced surgeons. These data suggest that this arthroscopy simulator facilitates discrimination of arthroscopic skills. Computer-based simulation technology provides a major opportunity for surgical skills development without morbidity and operating room inefficiency.

Arthroscopy↗
PubMed2003

Low vitamin D and high parathyroid hormone levels as determinants of loss of muscle strength and muscle mass (sarcopenia): the Longitudinal Aging Study Amsterdam.

The age-related change in hormone concentrations has been hypothesized to play a role in the loss of muscle mass and muscle strength with aging, also called sarcopenia. The aim of this prospective study was to investigate whether low serum 25-hydroxyvitamin D (25-OHD) and high serum PTH concentration were associated with sarcopenia. In men and women aged 65 yr and older, participants of the Longitudinal Aging Study Amsterdam, grip strength (n = 1008) and appendicular skeletal muscle mass (n = 331, using dual-energy x-ray absorptiometry) were measured in 1995-1996 and after a 3-yr follow-up. Sarcopenia was defined as the lowest sex-specific 15th percentile of the cohort, translating into a loss of grip strength greater than 40% or a loss of muscle mass greater than 3%. After adjustment for physical activity level, season of data collection, serum creatinine concentration, chronic disease, smoking, and body mass index, persons with low (<25 nmol/liter) baseline 25-OHD levels were 2.57 (95% confidence interval 1.40-4.70, based on grip strength) and 2.14 (0.73-6.33, based on muscle mass) times more likely to experience sarcopenia, compared with those with high (>50 nmol/liter) levels. High PTH levels (>or=4.0 pmol/liter) were associated with an increased risk of sarcopenia, compared with low PTH (<3.0 pmol/liter): odds ratio = 1.71 (1.07-2.73) based on grip strength, odds ratio = 2.35 (1.05-5.28) based on muscle mass. The associations were similar in men and women. The results of this prospective, population-based study show that lower 25-OHD and higher PTH levels increase the risk of sarcopenia in older men and women.

Absorptiometry, Photon↗
PubMed2003

The small-world dynamics of tree networks and data mining in phyloinformatics.

MOTIVATION: A noble and ultimate objective of phyloinformatic research is to assemble, synthesize, and explore the evolutionary history of life on earth. Data mining methods for performing these tasks are not yet well developed, but one avenue of research suggests that network connectivity dynamics will play an important role in future methods. Analysis of disordered networks, such as small-world networks, has applications as diverse as disease propagation, collaborative networks, and power grids. Here we apply similar analyses to networks of phylogenetic trees in order to understand how synthetic information can emerge from a database of phylogenies. RESULTS: Analyses of tree network connectivity in TreeBASE show that a collection of phylogenetic trees behaves as a small-world network-while on the one hand the trees are clustered, like a non-random lattice, on the other hand they have short characteristic path lengths, like a random graph. Tree connectivities follow a dual-scale power-law distribution (first power-law exponent approximately 1.87; second approximately 4.82). This unusual pattern is due, in part, to the presence of alternative tree topologies that enter the database with each published study. As expected, small collections of trees decrease connectivity as new trees are added, while large collections of trees increase connectivity. However, the inflection point is surprisingly low: after about 600 trees the network suddenly jumps to a higher level of coherence. More stringent definitions of 'neighbour' greatly delay the threshold whence a database achieves sufficient maturity for a coherent network to emerge. However, more stringent definitions of 'neighbour' would also likely show improved focus in data mining. AVAILABILITY: http://treebase.org

Algorithms↗
PubMed2000

Assessment and prevalence of obesity: application of new methods to a major problem.

Overweight and obesity are major health problems worldwide. A body mass index of > or =25 has been classified as overweight and of > or =30 as obesity. However, national and epidemiologic data on overweight and obesity are not based on actual measures of body fat because of the difficulty of collecting such data from large groups and especially from the obese. There are now numerous direct and indirect methods to assess body fat. Anthropometric techniques are the most common indirect methods used in epidemiologic and clinical assessments, but these are restricted in the obese to circumferences. The other methods of assessing body fat are bioelectrical impedance, body density, total body water, and dual X-ray absorptiometry, all of which have advantages and limitations when applied to the obese. All these methods make use of statistical models in calculating body composition. There are several sources of available reference data for anthropometric measures for the US population, but no direct measures of body fat are currently available. There is a clear need for the continued development and validation of new and existing techniques to determine levels of fat.

Absorptiometry, Photon↗
PubMed1981

[Cerebrospinal fluid eosinophils in inflammatory processes of the central nervous system and its coverings].

Eosinophil cells play an important role in the signalization of cerebrospinal fluid (CSF) by inflammatory diseases of central nervous system and its leptomeningeal coverings (CNS), according to present data on neuroimmunology. The extent of their participation in local immunological phenomena is evaluated, and data on other changes in the CSF cytoprotein dual were considered for comparative purposes. CSF of two types of inflammatory diseases of the CNS were studied for this purpose: samples of 35 patients in early stages of acute eosinophilic leptomeningites possibly of viral origin (first group) and 20 samples of 10 patients with neurocysticercosis (second group). Samples of the second group were collected in the early stages of each one of two episodes of exhacerbation in the inflammatory reaction observed at each one of the two series of administration of Praziquantel, a pirazino-isochinoleinic derivate which action upon cysticerci has been reported. Statistical analysis shows that participation of eosinophil cells in the inflammatory response does not differ in the two groups. Their participation is related to changes observed in the CSF cytoprotein dual rather than to the type of the inflammatory model: acute and monophasic in the first group, and chronic an repetitive in the second. Gamma globulins participe in the exhacerbation of CSF inflammatory reaction in neurocysticercosis but their behaviour not always is similar. In some instances it is similar to that found in other chronic and repetitive inflammatory models, as multiple sclerosis for instance.

Adolescent↗
PubMed2000

Use of one-bottle adhesive as an intermediate bonding layer to reduce sealant microleakage on saliva-contaminated enamel.

PURPOSE: To evaluate the influence of three different adhesives, each used as an intermediary layer, on microleakage of sealants applied under condition of salivary contamination. MATERIALS AND METHODS: Six different experimental conditions were compared, 3 with adhesives and 3 without. After prophylaxis and acid etching of enamel, salivary contamination was placed for 10 s. In Group SC the sealant was applied after saliva without bonding agent and then light-cured. In Group SCA, after saliva, the surface was air dried, and then the sealant was applied and cured. In Groups ScB, SB and PB, a bonding agent (Scotchbond Dual Cure/3M, Single Bond/3M and Prime & Bond 2.1/Dentsply, respectively) was applied after the saliva and prior to the sealant application and curing. After storage in distilled water at 37 degrees C for 24 hrs, the teeth were submitted to 500 thermal cycles (5 degrees C and 55 degrees C), and silver nitrate was used as a leakage tracer. Leakage data were collected on cross sections as percentage of total enamel-sealant interface length. Representative samples were evaluated under SEM. RESULTS: Sealants placed on contaminated enamel with no bonding agent showed extensive microleakage (94.27% in SC; 42.65% in SCA). The SEM revealed gaps as wide as 20 microm in areas where silver nitrate leakage could be visualized. In contrast, all bonding agent groups showed leakage less than 6.9%. Placement of sealant with a dentin-bonding agent on contaminated enamel significantly reduced microleakage (P < 0.0001). The use of a bonding agent as an intermediary layer between enamel and sealant significantly reduced saliva's effect on sealant microleakage.

Acid Etching, Dental↗
PubMedDate not supplied

Clinical behavior of translucent-fiber posts: a 2-year prospective study.

PURPOSE: This study prospectively evaluated the clinical performance of three types of translucent posts over a follow-up period of between 2 and 3 years. MATERIALS AND METHODS: Selected were 225 patients with one premolar in need of endodontic treatment, followed by restoration with a fiber post and porcelain crown. The sample was randomly divided into three groups of 75 patients each. The same type of post was used in all patients within a group: group 1 = Aesthetic Plus; group 2 = DT; and group 3 = FRC Postec. For bonding the post, a light-curing adhesive (One-Step) and a dual-curing resin cement (Duo-Link) were applied in group 1 and 2 roots, whereas self-curing materials (Excite DSC as adhesive and MultiLink as resin cement) were used in group 3. After 6, 12, and 24 months, patients were recalled, and a clinical and radiographic examination was performed. For some patients, 30-month follow-up data were also collected. RESULTS: Debonding of the post occurrred in eight cases (3.5%); in another six cases, a recurrence of the periapical lesion was reported. CONCLUSION: The statistical analysis did not reveal any significant difference in the survival rate of the tested posts, suggesting that all are equally and sufficiently reliable for clinical use.

Adolescent↗
PubMed1995

Nonerotic dual relationships between therapists and clients: the effects of sex, theoretical orientation, and interpersonal boundaries.

We surveyed 223 APA members to investigate the roles of therapists' sex, theoretical orientation, interpersonal boundaries, and clients' sex in predicting therapists' assessments of the ethicality of nonerotic dual relationships with their clients. Results indicated that therapists' sex, interpersonal boundaries, and theoretical orientation influenced ethical judgments of these relationships. Theoretical and practical implications of our findings are discussed.

Attitude↗
PubMed2006

Dual system approach to computer-aided detection of breast masses on mammograms.

In this study, our purpose was to improve the performance of our mass detection system by using a new dual system approach which combines a computer-added detection (CAD) system optimized with "average" masses with another CAD system optimized with "subtle" masses. The two single CAD systems have similar image processing steps, which include prescreening, object segmentation, morphological and texture feature extraction, and false positive (FP) reduction by rule-based and linear discriminant analysis (LDA) classifiers. A feed-forward backpropagation artificial neural network was trained to merge the scores from the LDA classifiers in the two single CAD systems and differentiate true masses from normal tissue. For an unknown test mammogram, the two single CAD systems are applied to the image in parallel to detect suspicious objects. A total of three data sets were used for training and testing the systems. The first data set of 230 current mammograms, referred to as the average mass set, was collected from 115 patients. We also collected 264 mammograms, referred to as the subtle mass set, which were one to two years prior to the current exam from these patients. Both the average and the subtle mass sets were partitioned into two independent data sets in a cross validation training and testing scheme. A third data set containing 65 cases with 260 normal mammograms was used to estimate the FP marker rates during testing. When the single CAD system trained on the average mass set was applied to the test set with average masses, the FP marker rates were 2.2, 1.8, and 1.5 per image at the case-based sensitivities of 90%, 85%, and 80%, respectively. With the dual CAD system, the FP marker rates were reduced to 1.2, 0.9, and 0.7 per image, respectively, at the same case-based sensitivities. Statistically significant (p < 0.05) improvements on the free response receiver operating characteristic curves were observed when the dual system and the single system were compared using the test sets with either average masses or subtle masses.

Algorithms↗
PubMed2005

Laparoscopic repair of ventral and incisional hernias: our experience in 150 patients.

BACKGROUND: Incisional hernias develop in 2 to 20% of laparotomy incisions. Approximately 100,000 ventral hernias are operated on each year in the United States. The reported recurrence rates for open repair are 25-52% for primary and 12.5-19% for mesh repair. Compared to the open technique, laparoscopic repair has low rates of complications and recurrence, greater patient acceptance, and shorter hospital stay. MATERIALS AND METHODS: Between April 1999 and April 2004, we treated 150 patients (111 female, 39 male) with ventral and incisional hernias laparoscopically. Data concerning the age and sex of patients, the location, number, and size of fascial defects, the type of hernias and their contents, the size and type of meshes used in repair, operative time, length of hospital stay, and postoperative complications were collected. RESULTS: Of the 150 patients, 92 had incisional hernias and 58 had umbilical hernias. Polypropylene was used in 85 cases, dual mesh in 40 cases, and composite mesh in 25 cases. The mean age of the patients was 56.0 years (range, 33-81 years). Mean operative time was 63 minutes (range, 30-125 minutes). Mean postoperative hospital stay was 2.5 days (range, 1-15 days). The postoperative complication rate was 8.6% (seroma, paralytic ileus, small bowel injury, and suture-site neuralgia). The mean follow-up period was 32 months (range, 4-60 months). There was a 3% recurrence rate. Three subileus cases were detected during follow-up. CONCLUSION: The laparoscopic approach to ventral and incisional hernias is safe, feasible, and a good alternative to the open approach. Our results are comparable with those of other reports in the literature.

Adult↗
PubMed2003

Dual forms of malnutrition in the same households in Malaysia--a case study among Malay rural households.

This report is a part of a multi-centre study in Asia on the problem of dual forms of malnutrition in the same households. In Malaysia, the prevalence of underweight and stunting persist among young children from poor rural areas. Overweight in adults, especially women from poor rural areas has been reported in recent years. Thus, this study was undertaken in order to assess the presence of the dual burden of underweight child-overweight mother pairs in a poor rural community. Out of 140 Malay households identified to have at least one child aged 1-6 years and mother aged above 20 years, 52.1% of the mothers were overweight, 15.7% of the children were underweight, 27.1% stunted and 5% wasted. Socio-economic background and food intake frequency data were collected from 54 underweight child/overweight mother pairs (UW/OW) and 41 normal weight child/normal weight mother pairs (NW/NW). Compared with the overweight mothers, a higher percentage of the normal weight mothers had received secondary education, were employed and with a higher household monthly income, although these differences were not significant. Patterns of food intake of the mothers and children appeared to have more similarities than differences between the UW/OW and NW/NW groups. Quantitative dietary intakes for 2 days using 24-hr recall and physical activity energy expenditure over the same period were assessed in a sub-group of UW/OW and NW/NW mothers and children. The NW/NW children showed significantly higher intake of total calories, fat and riboflavin than the UW/OW counterparts. Mean energy and nutrient intake of mothers from both groups were not significantly different, although the NW/NW mothers showed higher intake adequacy for total calories and most nutrients. While most of the mothers from both groups reported having no chronic illnesses, about half of the children in both groups had infections, especially gastrointestinal infections, over a 2-week period. Energy expenditure from physical activity for both UW/OW and NW/NW mothers and children did not differ significantly. This study confirmed inadequate intake of total energy and nutrients as the major factor for underweight in Malay children from rural areas. However, assessing intake and physical activity by interview methods were not sensitive enough to overcome perceived problems of under-reporting of energy intake and over-estimation of energy expenditure, especially by overweight subjects. Further investigations on a larger sample are necessary to understand the family dynamics leading to the double burden of malnutrition within the same household.

Adult↗
PubMed1992

PGE2 regulates cAMP production in cultured rabbit CCD cells: evidence for dual inhibitory mechanisms.

In cultured cortical collecting duct (CCD) cells, exogenous prostaglandin E2 (PGE2) inhibited arginine vasopressin (AVP)-stimulated adenosine 3',5'-cyclic monophosphate (cAMP) production in a concentration-dependent manner. Although pertussis toxin (PT, 500 ng/ml) alone did not reverse the PGE2-dependent inhibition, PT and staurosporine, a protein kinase C inhibitor, together partially reversed the effect of exogenous PGE2. In contrast, PT completely reversed the inhibition of AVP-dependent cAMP production by sulprostone. These data suggest that exogenous PGE2 can inhibit AVP-stimulated cAMP production and that the inhibitory effects of PGE2 are mediated by staurosporine- and PT-sensitive component(s). Short-term (15-240 min) incubation with phorbol 12-myristate 13-acetate (PMA, 10(-7) M) inhibited PGE2-stimulated cAMP production. Long-term (20 h) incubation with PMA augmented PGE2-stimulated cAMP production. These data provide evidence for the maintenance of a PT-sensitive PGE2-dependent inhibitory pathway of cAMP production in cultured CCD cells. In addition, data are presented that support an inhibitory role for protein kinase C in the effects of PGE2 on the metabolism of cAMP in these cells.

Alkaloids↗
PubMed2001

Schizophrenia and substance misuse problems: a comparison between patients with and without significant carer contact.

AIM: Many researchers and clinicians in the mental health field have given much attention over the last few years to patients with co-morbid problems of schizophrenia and substance use. This population is becoming a focus of attention for all service providers owing to the suggested increase in numbers of patients with these dual diagnoses and the observed negative effects on patients and costs to services. The advantages for providing family interventions in schizophrenia are now well established and increasingly these interventions are being evaluated for families of dual diagnosis patients. Many dually diagnosed patients do not, however, have a great deal of contact with a carer/relative. This paper looks at whether differences exist between patients with a dual diagnosis that have carer contact and those who do not have carer contact in terms of their illness history and type of substance use. For the purpose of this article 'carer' refers to an individual who is an informal carer or relative with whom the client has weekly contact of 10 h. Many of these carers provide the client with emotional, physical and material support. METHOD: The identification process for both'carer contact' and 'no carer contact' patients was conducted through the screening of the hospital's care programme approach (CPA) lists and through contact with care coordinators and consultants. Case notes of all patients identified were screened and information on demographic data, duration of illness, admissions and substance use was collected. RESULTS: Results indicated that the 'no carer contact' group was older and had significantly more days in hospital at last admission. CONCLUSIONS: It is possible that as patients get older their contact with significant others decreases, i. e. loss of contact with key relatives is due to age rather than severity of substance use. Furthermore, patients' reduced contact results in them having longer stays in hospital possibly because they will not receive additional support when discharged.

Adult↗