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PubMed1983

Home environment of children in a new Stockholm suburb. A prospective longitudinal study.

Children who were born in the early 1980s in the Stockholm suburb that was studied had a home environment that may be described as follows. The material standards in the area were good, the dwellings were spacious and modern, the outdoor environment was pleasant for children and the municipal service facilities were well developed. The transport services to the city are frequent, comfortable and convenient. In a typical case, the parents are about 30 years old, they are of old Swedish stock and are living together, married or unmarried. They received a good education and usually also occupational training. Generally, both parents have a job outside the home. In quite a few such cases the mother has shift- or nightwork. Although both parents have jobs, the family surprisingly often has financial problems. Thus more than one family in five needed financial assistance from the authorities. The financial difficulties may be due to illness and addiction in the parents. About one in ten of the mothers has been hospitalised for a chronic somatic disease and about one in ten of the fathers is in the records for alcoholism. Criminality is also common, every sixth or seventh father having a police record. About every fourth child born in this suburb will grow up in a home where either the father or the mother is known for an addiction and/or criminality, and/or has been treated for mental illness. To conjure up and describe the atmosphere in a home in this suburb is not easy but in the present study information was obtained supporting the suspicion that many homes are characterised by insecurity, isolation and hopelessness and a serious unsatisfied need for help. Many of the mothers have grown up in rather special social conditions--for instance, in "broken homes", or with an alcoholic father or a mentally ill mother. As a result, nearly every tenth mother had been placed outside the home at an early age (in a foster-home or suchlike). In later years also, many of the mothers have had the burden of sick, malformed or mentally retarded children in their home, or have experienced the serious illness or death of some person close to them. Particularly in the period before their child's birth many women have had reason to feel anxious. About one woman in three has already had a miscarriage and/or abortion, and during pregnancy she may have suffered from serious nausea or depression. Quite a few also needed to take medicines during that time. In many families, it is reported, the man and woman have had trouble in living together, with resultant divorce situations, quarrels and assaults.(ABSTRACT TRUNCATED AT 400 WORDS)

Child Development↗
PubMed2006

Drastic elevations in mortality among female injection drug users in a Canadian setting.

The health and social conditions of women living in Vancouver's Downtown Eastside has recently been the focus of substantial international attention. Since few studies have examined rates and correlates of death among addicted women in Canada, we have characterized patterns of mortality among female injection drug users (IDUs) in Vancouver. The Vancouver Injection Drug Users Study (VIDUS) is a prospective open cohort study of IDUs. The analyses presented here, were restricted to women enrolled between May 1996 and May 2002 and who were aged 14 years or older. We estimated cumulative mortality rates using Kaplan-Meier methods and Cox regression was used to calculate univariate and adjusted relative hazards. Between May 1996 and May 2002, 520 female IDUs have been recruited from the Vancouver area among whom 68 died during the study period. Elevated rates of mortality were observed among those who reported, baseline sex-trade involvement, those with HIV-infection at baseline, and those who lived in unstable housing at baseline (all log-rank: p<0.05). In adjusted analyses, HIV infection (RH = 3.09 [95% CI: 1.86-5.11]; p<0.001), unstable housing (RH = 1.74 [95% CI: 1.10-2.86]; p=0.029) and sex-trade involvement (RH = 1.82 [95% CI: 0.95-3.45]; p=0.071) were associated with the time to death. When the number of observed deaths was compared to the number of expected deaths based on the general female population of British Columbia using indirect standardization, the rate of death among female IDUs was elevated by a factor of 47.3 (95% CI: 36.1-58.5). In Vancouver, female IDUs have rates of mortality almost 50 times that of the province's female population. Our findings are consistent with a growing number of reports from other settings internationally, and demonstrate the need for an appropriate evidence-based strategy to address the health and social needs of addicted women.

Adult↗
PubMed1994

Psychotherapy and integrated treatment of social phobia and comorbid conditions.

Various treatment interventions for social phobia and its comorbid conditions have been developed in the past decade, including psychodynamic, cognitive-behavioral, and psychopharmacological approaches. Because social phobia has only fairly recently been recognized, no one form of treatment has been identified as superior to another. The difficulty in recognizing social phobia and identifying its frequent comorbidity with other psychiatric disorders poses particular treatment challenges. In this light, the author suggests eight operating principles that should be implemented to facilitate an effective, integrated approach to the treatment of patients with social phobia and comorbid conditions.

Clinical Protocols↗
PubMed1987

Self-assessment of hearing problems in an elderly population. A longitudinal study.

As part of a large population study, 386 randomly selected probands 70 years of age, representative of the population of an industrialized Swedish city, were questioned regarding hearing difficulties in different social conditions. The same questions were presented to the participants of that study, at the age of 75 and 79 years. The results showed that of the 70-year-old persons, more than 95% had quite a good estimate of their hearing capacity. The subjective hearing problems increased with increasing age. However, at the age of 79 years, 86% still had no hearing problems or had only slight or moderate difficulties. The males reported that they had more hearing problems than the females. The prevalence of irritating tinnitus was about the same for males as for the females (8%). The number of probands with severe tinnitus was constant throughout the investigated period. It is suggested that hearing difficulties experienced when talking to only one person can be used to estimate the need for hearing amplification. A comparison between two cohorts with an age difference of 5 years was made. In a difficult listening situation at the age of 70 years, the hearing of subjects born in 1906-07 was reportedly worse than that of these born in 1901-02.

Aged↗
PubMed1997

Effects of isolation housing and timing of drug administration on amikacin kinetics in mice.

AIM: To study the influences of social condition and drug administration time on amikacin metabolism in mice. METHODS: Forty Male ICR mice were randomly assigned into 4 groups according to 1) housing condition: individual housing (I, one mouse in a cage) or aggregated housing (A, 10 mice in a cage) and 2) drug administration time: at midday (D) or at midnight (N), i.e. I-D, I-N, A-D, and A-N groups. Amikacin was injected s.c. 15 mg.kg-1 after 4 wk of raising at D or N. Blood samples were taken at 5, 10, 15, 20, 30, and 60 min after medication in each mouse. Plasma amikacin was measured by enzyme immunoassay. The concentration-time data were fitted with one-compartment open model in each mouse and data were analyzed with group t test. RESULTS: The clearance (Cl) of amikacin was larger and the half-life (T1/2) was shorter in A-N group than in A-D or I-N groups respectively. AUC(0-1) in A-N group was less than in I-N group. No differences of kinetic parameters between 2 isolated housing (I-D and I-N) groups were found. CONCLUSION: Aggregated housing and midnight drug administration increased the disposition of amikacin.

Amikacin↗
PubMed1988

[The significance of the family as primary caregiver for the aged in need of assistance].

This study focuses on the experiences of the primary care-giver of somatically impaired older people and intends to get a better understanding of the social conditions, difficulties and limitations of family care. Data come from qualitative in depth interviews with 52 primary care-givers: 24 spouses, 21 children (mostly daughters) and seven other women. In this article special attention is given to the importance of other people (mostly members of the family) to the primary care-giver. Fifty % of the primary care-givers experienced their situation as not so burdensome, 25% as rather and also 25% as very burdensome. Support turns out to be very important for the primary care-giver but lots of support does not always prevent a situation from becoming very burdensome. Three kinds of stress have been distinguished: care-stress, relation-stress and network-stress. Particularly network-stress turns out to be indicative for very burdensome situations. Pre-eminently one is experiencing this kind of stress if one is also experiencing care- and relation-stress. In spite of much stress and feelings of burden however, people tend to continue with caring. A strong sense of duty plays a mayor part here. Finally, the current political trend to effect a shift to more informal care, is critically evaluated in the light of the results of the research.

Aged↗
PubMed1985

Psychiatric illness among the mentally retarded. A swedish population study.

Object--The aim of this investigation was in the first place to study the relation between mental retardation and other mental disturbances. The second aim was to study the frequency of severe and mild mental retardation in an adult Swedish population and to throw some light on the socio-medical situation of the adult mentally retarded. Methods--A primary sample, stratified with respect to population density, was extracted from the population in the age group 20-60 years, resident in Kopparberg County, Sweden, on 1 July 1977. The mildly and severely mentally retarded in this sample were identified. Enquiry was made into the presence of additional handicaps in the mentally retarded. Social conditions including alcohol consumption and the occurrence of abuse and criminality were studied in the two retarded groups and a control group representing the rest of the population. The three groups were compared by rating with the Comprehensive Psychopathological Rating Scale (CPRS), by classification of any mental illness present according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) and by determining their intake of psychotropic drugs and anti-epileptics. The mildly mentally retarded and the control group were also compared with respect to neuroticism and extraversion-introversion by rating with the Eysenck Personality Inventory (EPI). Results--The study revealed a prevalence of 0.27% for severe (IQ less than 53) and 0.32% for mild (IQ 53-73.7) mental retardation in the age group 20-60 years. All the severely retarded, but only just over half the mildly retarded, were known to the care authority. The majority of the former were living in some form of institution, whereas this applied to only 15% of the mildly retarded. Nineteen per cent of the severely retarded and 4% of the mildly retarded had manifest epilepsy. Defects of movement and of hearing were most prominent among the mildly retarded, while the frequency of specific speech disturbances was greater among the severely retarded, approximately 10% of whom had no power of verbal communication. Visual defects were recorded in about one-third of both groups. The study showed that alcohol intake was lower among both the severely and mildly mentally retarded than among the persons in the control group and that the frequency of abuse and criminality was as high among persons of higher intelligence as among the mentally retarded. The severely retarded, particularly the men, showed a raised psychiatric morbidity as compared with the mildly retarded and the control group.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1999

Outpatient management of fever in children with sickle cell disease (SCD) in an African setting.

Because hospitalization and intravenous antibiotics for treatment of a potentially fatal bacterial infection in febrile children with sickle cell disease (SCD) are difficult to apply, outpatient treatment has been considered in developed countries for selected patients. Eligibility criteria and procedures may differ in developing countries because of unique economic and social conditions. After clinical evaluation within 36 hr of the onset of a fever exceeding 38.5 degrees C, children with SCD who are being closely followed as a part of a SCD cohort in Cotonou (West Africa), were treated as outpatients. The antibiotic regimen consisted of intramuscular injection of ceftriaxone 50 mg/kg/day for 2 days followed by amoxicillin 25 mg/kg x 3/day x 4 days and oral hyper-hydration. Patients were observed for 6 hr and thereafter discharged with a medical control at day 2, day 8 + day 15. All 60 children included completed their treatment, and none were lost to follow-up. A definite or a presumed bacterial infection was the cause of the febrile episode in 76.7% of cases. An appreciable decrease in fever was observed from day 2 and only 2 patients were hospitalized at day 3, one for abdominal painful crisis and one other for persistent fever without documented infection. No severe bacterial infections, recurrence of febrile episode, nor death were encountered during the follow-up. The cost of this outpatient approach is US $30 per patient as compared to US $140 per patient if the patient had been hospitalized. Outpatient management of febrile episode in children with SCD is feasible and cost-effective in Sub-Saharan African. It requires, however, improved medical education on SCD and immediate medical attention after the onset of fever.

Abdominal Pain↗
PubMed1999

Quality of life and oral function following radiotherapy for head and neck cancer.

BACKGROUND: Multiple oral complaints occur following radiotherapy for oropharyngeal cancer, but the frequency and severity of symptoms of dysfunction and discomfort are not well understood. The purpose of this investigation was to assess the quality of life, oral function, and oral symptoms following radiotherapy. METHODS: A general quality of life survey (the European Organization for Research and Treatment of Cancer [EORTC] Quality of Life Questionnaire QLQ-C30), with an added oral symptom and function scale was mailed to 100 patients more than 6 months following radiotherapy. RESULTS: Sixty-five patients responded. Difficulty chewing or eating was reported by 43% of respondents. Dry mouth was reported by 91.8%, change in taste by 75.4%, dysphagia by 63.1%, altered speech by 50.8%, difficulty with dentures by 48.5%, and increased tooth decay by 38.5% of dentate patients. Pain was common (58.4%) and interfered with daily activities in 30.8%. Mood complaints were reported by approximately half the patients. Interference of the physical condition social activities was reported by 60%. The frequency of oral side effects correlated with radiation treatment fields and dose. CONCLUSION: Oral complications following radiotherapy for head and neck cancer are common and affect quality of life. Use of a general function scale such as the EORTC questionnaire with the addition of disease/site specific scales may provide useful data on outcome of therapy and upon the complications associated with therapy and impact upon the quality of life.

Adult↗
PubMed2000

The effect of lead on male fertility: a time to pregnancy (TTP) study.

BACKGROUND: Growing attention has been paid in recent decades to the effects on male reproduction of occupational exposures to toxic agents. There is strong evidence that high level exposure to lead, i. e. blood lead level (PbB) > 70 microg/dl, is associated with male infertility and some reports suggest an effect even at lower PbB (i. e. < 50 microg/dl). The aim of this study is to shed more light on the postulated association between occupational exposure to relatively low levels of inorganic lead and reduced fertility in men estimated by the length of time taken to conceive: time to pregnancy (TTP). METHODS: A survival analysis of TTP of the last pregnancy was performed adopting the Kaplan Meier methodology. The target population included 782 lead-exposed workers and 165 controls. 251 lead workers and 119 controls were finally eligible and interviewed. Lead-exposed subjects were distributed into four exposure levels according to their blood lead concentration (i.e. < 20; 20-29; 30-39, and >/= 40 microg/dl). The Cox model was adopted to estimate the Relative Risk of unsuccessful waiting time to pregnancy associated to the exposure to lead. RESULTS: A statistically significant difference in fecundability (shorter TTP) in favor of exposed subjects was detected. Nevertheless, longer TTP was associated within the exposed group to higher levels of PbB, even though the gradient is not statistically significant. The exposed workers revealed an average number of children larger than those not exposed, and a clear gradient of the same variable was evident from the lowest to the highest PbB level. Focusing on subjects with one child only, the Cox model confirmed no significant difference in fecundability between exposed and not exposed, whereas a statistically significant longer TTP was associated to the exposure level >/= 40 microg/dl. CONCLUSIONS: It is not easy to assert or to deny the effect of inorganic lead on male fecundity, quantitatively estimated by TTP, with the data available for this study. In fact, while the general data seem to exclude effects of Pb on male fecundability a more detailed analysis suggests an unfavorable effect at relatively high levels of exposure but some confounding attributable to personal and social conditions of the workers cannot be ruled out. Further investigations with a better control of confounding are needed.

Adult↗