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[Separation anxiety and reunion in the transference in 4 children].

In four ongoing cases treated with psychoanalytic psychotherapy, the reactions presented before and after a Christmas break and the place of such reactions in the transference are examined. Separation-anxiety was evident and expressed clearly in typical reactions. However, during the reunion, the reactions took diverse forms: failure to recognise the therapist; use of maniac defenses, use of body language and self injury; verbal and motor inhibition, use of symbolic angry material and concern for a fantasied baby.

Anxiety, Separation↗

Postponed suicide death? Suicides around birthdays and major public holidays.

The relationship between suicide and birthdays, and suicide and public holidays has been studied from data on 32,291 Danish suicides by persons ages 15 years and older in the 25-year period 1970-1994. Evidence was found to support the theory of the "broken-promise effect" for major public holidays in that there appears to be a postponement of a significant number of suicides from before a holiday until after. The division of holidays into nonworking and (half-time) working days showed that a "holiday effect" could only be found around major public holidays, particularly Christmas, Easter, and Whitsun. The postponing or transpositioning effect is relevant to prevention, especially because of the availability and accessibility of help at the end of and after major public (nonworking) holidays.

Adolescent↗

Influenza activity in England and Wales: October 1998 to June 1999.

Influenza activity in England and Wales in the winter of 1998/1999 reached the highest weekly levels seen since the epidemic of 1989/1990. Activity peaked at Christmas and the New Year, adding to the winter pressures on general practitioner and hospital services. Adults aged 65 years and over consulted with general practitioners at the highest rates. Outbreaks of influenza or flu-like illness occurred in several schools and nursing homes and, in June 1999, on a British cruise ship in the Mediterranean. Deaths from all causes reached a higher peak in week 1 of 1999 than occurred in the peak week of the influenza epidemic of 1989/90.

Adolescent↗

Measuring and modelling surgical bed usage.

Surgical departments treat two groups of inpatients--the simple and the complex--consequently a single average fails to describe the use being made of the occupied beds. Using decision support techniques, we show why indicators such as the average length, the average occupancy and the average admissions mislead. Furthermore, by analysing the fluctuating pattern of weekly admissions we show how weekends and the Christmas holiday periods impact on bed usage. Next, we demonstrate that flow process models can be used to describe how the in-patient workload concerns two groups of patients. On an average day, 71.4% of the beds contained patients who will have an average (exponential) stay of 4.8 days, and the other beds, 28.6%, contain patients who will have an average (exponential) stay of 22.8 days. The article concludes by demonstrating the short and long-term impact on daily admissions of a 10% change in four different parameters of the model. The data used come from a surgical department in Adelaide, as UK data sets report finished consultant episodes rather than completed in-patient spells.

Bed Occupancy↗

[Incidence of extra-arachnoid discharge following lumbar puncture].

Dimer-X is considered a good contrast medium for lumbar myelography. Its physical properties guarantee a homogeneous mixture with cerebrospinal fluid, with the result that postpunctural fluid leakage is easy to detect. One hundred Dimer-X lumbar myelographies were performed with two different spinal needles, a short beveled needle of 1.2 mm outer diameter and a special beveled "Quincke" needle of 0.7 mm outer diameter. Postpunctural fluid leakage is observed in 32% of the cases with the former and in only 12% with the latter. False-route injections occurred in 5% of the cases. Epidural leakage is the most frequent and can be detected by its "Christmas tree" appearance on antero-posterior X-ray. Subdural leakage is represented by a "railroad track" appearance on a lateral view. The leakage is observed more frequently in patients with normal myelogram (28%) than in patients with a herniated lumbar disc (18%).

Cerebrospinal Fluid↗

Influenza surveillance in England and Wales: October 1999 to May 2000.

The period of increased influenza activity in England and Wales in the winter of 1999/2000 was associated with considerable morbidity and mortality and well-publicized pressure on hospital services. The influenza activity coincided with the regular annual increase in respiratory syncytial virus infections and the Christmas and New Year holiday period. Consultation rates with general practitioners for influenza-like illness did not reach 'epidemic' levels but were higher than seen in many winters and comparable with those seen in two out of the previous three winters. In common with those winters, attack rates for influenza-like illness and acute bronchitis were especially high in elderly people among whom complications of acute infection and hospital admissions increased. Excess mortality due to influenza during this period appeared to be substantial but was not as high as seen in the last epidemic (1989/90).

Adolescent↗

[The sleeping girl from Oknö].

The peninsula of Oknö is located on the Baltic in Southern Sweden. It was here a 14 year-old girl "fell asleep" around Christmas time in the year 1875 - she woke up on April 3rd, 1908. She was then 46 years of age and had slept for 32 years. Except for numerous newspaper articles this unusual case has been described by the Swedish psychiatrist Harald Fröderström in 1912. The present article is based on his review and the investigation of the medical records at the hospital of the city of Oskarshamn where the woman in question was hospitalized for one month in 1892. At the city hospital she was given the diagnosis dementia paralytica - a diagnosis which was obviously wrong. When the woman woke up in 1908 she assumed a normal life and remained healthy until she died in 1950 through a brain hemorrhage. Fröderström, who except for an article written in French, wrote several extensive articles for Swedish newspapers about the sleeping girl. These articles are here reviewed from a modern psychiatric point of view.

Adolescent↗

[The eye department at Copenhagen municipal hospital. Part 3: the epoch of Braendstrup, 1957-1980].

Poul Braendstrup (PB 1912-80) was the best qualified to become head of the eye department at Kommunehospitalet (KH) in 1957, with an eminent great scientific production. He continued this work all his life. Three assistant doctors with different specialities were appointed 1966-72: M. Norn (external eye), K. Norskov (strabism) and Sv. E. Lorentzen (retina). Reasons for the ideal cooperation in the department are described (staff-meetings, christmas-staff-arrangements, meetings, courses etc). The number of operations increased steadily in the period, especially cataract-extractions. The newest techniques and instruments were used (cornea-grafting, vitreous surgery, xenoncoagulation (PB study tour in 1962) before laser-treatment etc). The scientific production increases, surpassing Rigshospitalet after 1967. The education was effective at all levels: In the eye-department, doctors evenings, A-and B-courses for eye specialists to become, referring eye specialists, students (from 1972 as an independent part (sect IV) of the University of Copenhagen with an ordinary professor from 1975). It was disturbing with the many removals at KH and at last the final total removal to KKHH (Hvidovre), causing loss of some of the best staff members, instrument breaks, increasing waiting lists up to one year, inconvenience for the patients and many other difficulties. This could be a warning against the continued great movings of departments in Copenhagen (H:S). The administration is criticised. PB's rationalisation of the duty-plan for all Copenhagen eye departments already from 1966 independent of the administration is mentioned.

Denmark↗

Pregnancy and delivery in a woman with hemophilia B.

Hemophilia B (Factor IX deficiency, Christmas disease) may cause excessive bleeding in women. The obstetric and hematologic management of the pregnancy and delivery of a woman with a Factor IX level of 4% is presented and discussed.

Adult↗

An outbreak of Norwalk-like viral gastroenteritis in a frequently penalized food service operation: a case for mandatory training of food handlers in safety and hygiene.

In 1999, in Toledo, Ohio, an outbreak of gastroenteritis occurred among people who had attended a Christmas dinner banquet and had eaten food prepared by a local caterer. Overall, 93 of the 137 attendees (67.9 percent) reported illness. Eight sought medical care, and one was hospitalized. Case-control studies revealed that the illness was associated with eating tossed salad (odds ratio [OR] = 2.5, 95 percent confidence interval [CI] = 1.02-6.26). Eleven of 12 stool specimens that were taken from ill people tested positive for a Norwalk-like virus (NLV) but were negative for E. coli O157:H7, Salmonella, and Shigella. The primary source of the outbreak was not determined, but an infected food handler may have played a role in the transmission of the virus. The catering facility had been cited frequently for food safety and hygiene violations. None of the personnel or food handlers at this facility had been appropriately trained in safe food-handling practices, nor had the personnel at another local caterer that had prepared food items suspected of causing a multistate outbreak of NLVs. In Toledo, food service operations with trained personnel/food handlers received better inspection reports than food service operations without trained personnel and were less likely to contribute to foodborne outbreaks. Training of personnel and food handlers may be important for preventing outbreaks.

Adolescent↗

Taking political responsibility for nursing's future.

House and Senate bills, H.R. 4387 and S. 1864, to develop and fund new initiatives for solving the nursing and nurse educator shortage, were passed shortly before the 107th Congress recessed for Christmas. These bills are now slated for compromise through a Congressional conference committee. The window of opportunity to influence the outcome of this process is short. To gain favorable political action that will improve our ability to care for patients and educate future nurses during this process, ACT NOW.

Forecasting↗

Serial changes in the coagulation system following clotting factor concentrate infusion.

Various parameters of the coagulation system have been monitored in patients with Christmas disease following the infusion of clotting factor concentrates. Significant reduction of clotting factor VIII and serum antithrombin III were observed in each of the five studies, whilst the plasma fibrinogen level fell in four subjects. The induced abnormalities were shortlived and there were no clinical sequelae. Further studies are required to assess the effects of similar concentrates in patients with liver disease.

Antithrombins↗

[Holiday effect in myocardial infarct].

Aimed measures of the organisation of the combat against infarction demand also the observation of temporary frequencies. On the basis of the evaluation of certificates of death of the month December of the years 1969 to 1973 of the GDR with differentiation according to so-called prehospital dead (persons who died at home and on the way to the hospital) and patients who died in the hospital with high significance an unwarrantedly high prehospital mortality during the period from Christmas to the end of the year (25th to 31st December) was established compared with the preceding week (18th to 24th December). Since in contrast to this the hospital cases and the cases "on the way" do not show any significant differences main tasks for the beginning of improvements concerning health policy may be deduced, all the more since the so-called holiday effect, expressed by a high home/clinic-relation of patients who died of myocardial infarction, could be restricted to 6 counties of the GDR on account of the analysis of further localities. From the results the tendency of a retrogression of the holiday effect is to be read off in the course of years. In the discussion an explantation of this peculiarity is attempted, and practicable conclusions for the removal and thus for the improvement the infarct situation are formulated.

Holidays↗

Hemophilia A and hemophilia B in a family of French bulldogs.

A congenital coagulation defect was suspected in 10 male French bulldogs, independently referred to the Small Animal Clinic of the Utrecht State University by private pet owners from all over the country. The cases are described in this report. Coagulation studies, performed in 8 of these dogs, revealed a factor VIII (anti-hemophilic globulin) deficiency in 5, and a factor IX (Christmas factor) deficiency in 3 propositi. A pedigree analysis revealed that all of the 10 propositi were lineal descendants, in the female line, of one and the same female ancestor. An inquiry by letter among the owners of 210 male descendants, in the female line, of this common ancestor revealed hemorrhagic episodes in at least another 10 male offspirng. The presence of a large number of carriers can be expected among the French bulldog population in the Netherlands, since the officially registered female offspring in the female line of the ancestor bitch, comprised over 170 dogs as of January, 1971. The possible mechanisms responsible for the simultaneous occurrence of hemophilia A and B in one canine family are discussed.

Animals↗

AIDS education reaches Pacific atolls.

The Republic of Kiribati consists of 33 islands and 69,000 inhabitants dispersed over a large area of the Central Pacific. It includes the former Gilbert Islands, which were linked as British colonies with the Ellice Islands until the latter declared themselves independent as Tuvalu. Kiribati became independent from Britain in 1979 and joined WHO [the World Health Organization] in 1984. Launched in 1988, the national AIDS program is now implementing its second medium-term plan. As part of this plan, the program recently held its first AIDS awareness workshop for hotel workers, health care workers and youth. The workshop was held on Kiritimati, the world's largest atoll. Also known as Christmas Island, the atoll of 2650 inhabitants has excellent bird-watching and fishing opportunities, which have drawn growing numbers of tourists in recent years. Although neither of the two HIV infections identified in Kiribati by March 1994 were on Kiritimati, the prevalence of other sexually transmitted diseases there has been on the rise. Meeting in a traditional thatched building, the workshop participants proved eager to learn about HIV and STDs [sexually transmitted diseases]. They received instruction in prevention skills, including a demonstration of proper condom use led by the national AIDS coordinator. At the close of the workshop, condoms were provided to hotel staff for distribution.

Acquired Immunodeficiency Syndrome↗

Bereavement: helping a patient with a learning disability to cope.

Our case study is of a 55-year-old man who has a moderate learning disability. He has been diagnosed as having bipolar disorder and is currently in remission. At Christmas six years ago while Dave Croft was on home leave from an NHS unit, his father died suddenly. His mother, acting in what she felt were Mr Croft's best interests, arranged the funeral and did not inform her son until after the ceremony had taken place. Mr Croft appeared to have adjusted to his loss, until November 2001 when he became increasingly upset and agitated at the mention of death. A multidisciplinary team approach and the use of a 'life event book' helped Mr Croft come to terms with his bereavement and allowed staff at the unit to put a strategy in place to help him prepare for future family bereavements.

Adaptation, Psychological↗

[Colchicine poisoning by accidental ingestion of the bulbs of Sandersonia aurantiaca: report of a case].

We report a case of colchicine poisoning in an 82-year-old woman. She had suffered from senile dementia and in her confused state ingested two bulbs of Sandersonia aurantiaca (Christmas-bells, Chinese lantern lily). She was admitted complaining of gastrointestinal symptoms, mainly severe watery diarrhea. The duration of her diarrhea was approximately 40 hours. On the 3rd day after ingestion, leukopenia and thrombocytopenia occurred. Although 50 micrograms of granulocyte-colony stimulating factor was administered from the 5th day to the 8th day, her white blood cell count did not increase and revealed nadir (100/microliter) on the 7th day. Her platelet count also revealed nadir on the 7th day. She died of respiratory failure in the early morning of the 9th day. The bulb of Sandersonia was found to contain colchicine at a concentration of 4.7 mg/g, and her serum level of colchicine was 6.3 ng/ml on the 6th day. Colchicine is an alkaroid extractable from the plants like Colchicum autumnale (meadow saffron, autumn crocus), and Gloriosa supra tuber. These plants belong to the lily family. Sandersonia aurantiaca also belongs to the lily family and we found that its bulb contained colchicine. To our knowledge, this is the first report of colchicine poisoning by Sandersonia aurantiaca.

Aged↗