Beginning Of Hospitalization Research Articles

Influence of individual psychological support on the severity of psychopathological symptoms in patients with paranoid schizophrenia

Aim of the studyThe aim of the study was to investigate the relationship between psychological therapeutic interactions and the severity of psychopathological symptoms in patients diagnosed with paranoid schizophrenia during their hospitalisation.Subject or material and methodsThe study involved 60 patients hospitalised for paranoid schizophrenia. They were divided into two groups of 30. The first group consisted of patients actively using psychological assistance and the second group of patients not benefiting from such aid. The PANSS and the author’s own questionnaire were used to conduct the assessment. In the survey, patients were asked to determine the frequency and quality of contact with a psychologist.ResultsThe results show that at the beginning of hospitalisation, patients in both groups did not differ significantly from one another in terms of the severity of psychopathological symptoms measured with PANSS. The group actively using psychological support during hospitalisation received significantly lower scores in general PANSS. Also, all subscales of PANSS indicate a significant decrease in scores. This means that in patients of the first group there was a significant weakening of positive, negative and general symptoms as compared with the second group.DiscussionThe results confirm the validity of the inclusion of psychotherapy in treatment of people with paranoid schizophrenia.ConclusionsPatients in the group actively using psychological support during hospitalisation achieved significantly greater reduction in the severity of psychopathological symptoms compared with patients in the group not participating in therapy. Persons in contact with therapists became significantly healthier (symptomatic improvement) than those in the second group.

DYNAMICS OF PSYCHOPATHOLOGICAL SYMPTOMS IN PATIENTS WITH DISTURBANCES OF SСHIZOPHRENIC SPECTRUM UNDERGOING COMPULSORY TREATMENT AT GENERAL TYPE MENTAL HOSPITAL

Aim. To assess the manifestation and dynamics of psychopathological symptoms by positive and negative symptoms scale (PANSS) in 82 patients with schizophrenia and disturbances of schizophrenic spectrum undergoing a course of compulsory treatment at the mental hospital of general type taking into account gender peculiarities. Materials and methods. The results of observation of 62 patients undergoing a course of treatment at the mental hospital of general type were studied. Paranoid form of schizophrenia prevailed irrespective of a gender composition. Manifestation and dynamics of psychopathological symptomatology was assessed using PANSS. To register the data, PANSS signs reflected in three subscales (positive, negative and general pathological) as well as total summary score were applied. The data were estimated at the beginning of hospitalization and at the moment of discharge from hospital. Results. Manifestation of psychopathological symptoms at admission to hospital was significantly higher ( p <0,001) in female patients (69,2±12,9 in women and 58,8±10,0 in men), predominantly at the expense of positive and general pathological symptoms. At the moment of discharge form hospital, women had a reduced manifestation of positive and general pathological symptoms with a reliable difference ( p <0,001) as compared to the admission symptoms. Among men, in spite of decreased PANSS values, this dynamics was less evident. By the moment of discharge from hospital, manifestation of general pathological symptoms in women (29,5±3,9) was higher than the analogous indices in men (25,6±5,3) with a reliable difference ( p <0,001). Conclusion. The reached relapse of mental disorders is one of the necessary conditions for assessment of the efficiency of compulsory treatment, however, it is not the only efficiency criterion. Individual-psychological peculiar features and social setting taken into account are not less important.

Étude comparative de l’insight et des facteurs l’influençant dans la schizophrénie et le trouble bipolaire chez une population de patients marocains hospitalisés

IntroductionInsight is a multidimensional concept first used in schizophrenia and in several psychiatric disorders including bipolar disorder. Its improvement is a major issue in patient's treatment. The aim of our study was to compare insight in schizophrenia and bipolar disorder during and after psychotic and manic episodes, and whether the factors influencing insight in these two disorders are the same, in order to deduce the therapeutic implications. Population and methodWe first evaluated and compared insight of 46 schizophrenics and 41 bipolar patients in the beginning and end of hospitalization, using Q8 scale and Birchwood IS scale (with its three sub-scales). Then, we analyzed various demographic factors (age, sex, occupation and marital status), and clinical factors (history of hospitalization, suicidal ideation, suicide attempts, aggression against others, drug use, psychiatric family history, duration and type of treatment). ResultsPatients in this study are mostly young adults, male, not living with a partner. Schizophrenic patients are less well integrated in terms of profession and family. At the beginning of hospitalization, insight is low for both populations, but it is relatively better in bipolar patients with a greater awareness of symptoms. We observed a marked improvement in all dimensions of insight in patients with bipolar disorder at the end of hospitalization. Schizophrenic patients improved their awareness of symptoms and need of treatment, while their awareness of the disease remains poor. Multivariate analysis shows that factors influencing the scores of insight for both populations are: the type of treatment (atypical antipsychotics for schizophrenics and mood stabilizers for bipolar patients) and the presence of a personal history of suicidal ideation. ConclusionsIn schizophrenic population, it seems more appropriate to work on the consciousness of the need for treatment. Psycho-educational measures and psychotherapeutic interventions targeting the improvement of insight are useful but must be accompanied with monitoring and management of depressive complication and suicidal tendencies in both populations.

Associação entre sintomatologia depressiva e óbito hospitalar em idosos

OBJETIVO: Avaliar se a presença de sintomas depressivos associa-se a uma evolução hospitalar desfavorável (aumento da permanência e mortalidade hospitalar), independente da capacidade funcional. MÉTODO: Coorte prospectivo em pacientes idosos internados nas enfermarias de Clínica Médica do Hospital Universitário Lauro Wanderley (HULW), avaliados em dois momentos (segundo dia de internação e na alta). Os instrumentos utilizados foram a Escala de Depressão Geriátrica, versão breve (EDG-15) e Índice de Barthel para Incapacidade em Atividades da Vida Diária (IBAIVD). RESULTADOS: A idade dos 100 pacientes variou entre 60 e 96 anos (69,47 ± 7,45). A mortalidade hospitalar relacionou-se com os escores da EDG-15 da internação (p = 0,001). Observou-se correlação entre os escores da EDG-15 e IBAIVD no início (p = 0,008) e final da internação (p = 0,01), verificando-se correlações lineares inversas (p = -0,30), porém de magnitudes fracas (p = -0,30 e p = -0,28, respectivamente). CONCLUSÃO: Sintomatologia depressiva associou-se à maior mortalidade, independente da capacidade funcional. Ressalta-se a importância da avaliação da sintomatologia depressiva nos idosos internados. Novos estudos e análises prospectivas poderão oferecer mais indicadores sobre esse problema de pesquisa.

66 Breastfeeding Preterm Infants - A Danish Survey

BackgroundBreastfeeding of preterm infants is not well researched in Denmark, although breast milk is of great importance for these infants because it protects against infections, decrease the risk for severe...

Patient's Origin and Lifestyle Associated with CTX-M-Producing Escherichia coli: A Case-Control-Control Study

BackgroundGlobal dissemination of Escherichia coli producing CTX-M extended-spectrum β-lactamases (ESBL) is a public health concern. The aim of the study was to determine factors associated with CTX-M- producing E. coli infections among patients hospitalised in the Assistance Publique-Hôpitaux de Paris, the largest hospital system in France (23 000 beds), through a prospective case-control-control study.Methods/Principal FindingsFrom November 2008 to June 2009, 152 inpatients with a clinical sample positive for CTX-M-producing E. coli (cases), 152 inpatients with a clinical sample positive for non ESBL-producing E. coli on the day or within the three days following case detection (controls C1), and 152 inpatients with culture-negative clinical samples since the beginning of hospitalisation and until three days after case detection (controls C2) were included in ten hospitals of the Paris area. Factors studied were related to patient's origin, lifestyle and medical history as well as care during hospitalisation. Those independently associated with CTX-M-producing E. coli were determined. Three independent factors were common to the two case-control comparisons: birth outside of Europe (cases vs C1: OR1 = 2.4; 95%CI = [1.3–4.5] and cases vs C2: OR2 = 3.1; 95%CI = [1.4–7.0]), chronic infections (OR1 = 2.9; 95%CI = [1.3–6.9] and OR2 = 8.7; 95%CI = [2.0–39.7]), and antibiotic treatment between hospital admission and inclusion (OR1 = 2.0; 95%CI = [1.0–3.8] and OR2 = 3.3; 95%CI = [1.5–7.2]). Cases were also more likely to be (i) functionally dependent before hospitalisation than C2 (OR2 = 7.0; 95%CI = [2.1–23.5]) and (ii) living in collective housing before hospitalisation than C2 (OR2 = 15.2; 95%CI = [1.8–130.7]) when CTX-M-producing E. coli was present at admission.ConclusionFor the first time, patient's origin and lifestyle were demonstrated to be independently associated with isolation of CTX-M-producing E. coli, in addition to health care-related factors.

P-1089 - With psychopharmacs titration to the therapeutic effectiveness and reduction of side effect

Aim Describe the possibility that medications without anticipated anticholinergic effects can have that type of side effect. Method We would like to present a 57-year-old patient, admitted to hospital because symptoms of major depressive episode with psychotic features. The main symptoms were auditory delusions with imperative character, base diminished mood and unregulated restless sleep. Psychological testing is obtained and showed the difficulty in sustaining attention, confused thinking, a strong depressive shift, a drop of vital energy, hypersensitivity, which turned into projections. Results At the beginning of hospitalization were corrected prescribed drugs before admission and transferred to fluvoxamine and at sixth day of hospitalization, quetiapine was added, with a gradual reduction until the termination of risperidon and promasinum. Within a week after taking fluvoxamine in dose of 200 mg per day patient allege the occurrence of dry mouth. Regard that the quetiapine and fluvoxamine usually have tha side effect of dry mouth, We have decided to reduce the dose of fluvoxamine on the usual daily-defined dose of 100 mg and the dose of quetiapine keep the same, because at lower doses at patient were still present auditory hallucinations. Conclusion Regard that the reduction of dose of fluvoxamine showed also reduction of side effect, we believe that in the presented case fluvoxamine was drug responsible for the appearance of aforementioned side effect, although we do not exclude a synergistic effect.

Early incontinence after radical prostatectomy: A community based retrospective analysis in 911 men and implications for preoperative counseling

IntroductionRadical prostatectomy (RP) is curative for localized prostatic cancer. Incontinence after RP (P-RP-I) varies widely (2% to <60%) according to the definition and quantification of incontinence, timing of evaluation, and who evaluates (physician or patient). Conservative treatments, including pelvic floor muscle training (PFMT), anal electrical stimulation (AES), lifestyle adjustment, or combination are usually recommended at first for P-RP-I. MethodsBetween January 2002 and December 2004, a total of 911 patients, median age 63years (46–78), with different grades of P-RP-I have been retrospectively examined for perioperative risk factors and effect of rehabilitation procedures. These consecutive patients were from 67 clinics with median postoperative interval of 26 days. Incontinence was graded by Stamey classification, number of used pads and pads' consistency (dry, lightly wet, and wet). Therapeutic measures were done by team of specialists in rehabilitation, psycho-oncology, physiotherapy, internal medicine, and urology. ResultsNinety-six percent of patients suffered different grades of incontinence at beginning of hospitalization. This was reported as Stamey first grade (49.4%), second grade (36.4%), and third grade (10.3%). Analysis included patients' age, body mass index (BMI), prostate volume, surgical approach, nerve sparing, pelvic lymphadenectomy, previous therapy, and catheterization time. Analysis showed age, nerve sparing, and BMI as significant risk factors for P-RP-I. Conservative therapy, including PFMT, AES, or combinations has been performed on all patients. Grade of P-RP-I showed significant improvement after 3weeks rehabilitation period. ConclusionPreoperative counseling of patients should provide them with realistic expectations for P-RP-I and motivate them to conservative therapy, as it reduces the duration and degree of urinary incontinence.

Comparison of three types of diabetic foot ulcer education plans to determine patient recall of education

Type 2 diabetes affects almost 4% of the world's population and the rates of amputation range from 43.9 per 100,000 per year among Americans. As healthcare providers, we can motivate our patients and improve compliance if we better understand the learning styles of our patients. The need to better prepare patients and caregivers to manage illnesses and participate as partners in their care has been recognized as a national priority. This study of educational preferences for diabetic patients with a risk for developing foot ulcers utilizes a written education plan provided by the hospital and a video developed by the staff of the vascular surgery inpatient unit. One hundred participants were initially requested; however, the final sample of 30 individuals completed the study from the beginning of hospitalization to day of discharge. The majority of patients were able to increase their post-education test scores using the video education tool. A significant difference between the pretest and posttest scores for the groups who received video education was found. In contrast, although there was an improvement in pretest and posttest scores for the written-material-only group and the written/video material group, this difference was not statistically significant. Diabetes in adults is increasing in our community; however, the sample size was not representative of the population. A follow-up study is needed to provide more evidence of patient preferences when education about their illness is presented in any format.

Do not attempt resuscitation: the importance of consensual decisions

To describe the involvement and input of physicians and nurses in cardiopulmonary resuscitation (CPR / do not attempt resuscitation (DNAR) decisions; to analyse decision patterns; and understand the practical implications. A Qualitative Grounded Theory study using one-time open-ended interviews with 40 volunteer physicians and 52 nurses drawn from acute care wards with mixes of heterogeneous cases in seven different hospitals in German-speaking Switzerland. Establishing DNAR orders in the best interests of patients was described as a challenging task requiring the leadership of senior physicians and nurses. Implicit decisions in favour of CPR predominated at the beginning of hospitalisation; depending on the context, they were relieved/superseded by explicit DNAR decisions. Explicit decisions were the result of hierarchical medical expertise, of multilateral interdisciplinary expertise, of patient autonomy and/or of negotiated patient autonomy. Each type of decision, implicit or explicit, potentially represented a team consensus. Non-consensual decisions were prone to precipitate personal or team conflicts, and, occasionally, led to non-compliance. Establishing DNAR orders is a demanding task. Reaching a consensus is of crucial importance in guaranteeing teamwork and good patient care. Communication and negotiation skills, professional and personal life experience and empathy for patients and colleagues are pivotal. Therefore, leadership by experienced senior physicians and nurses is needed and great efforts should be made with regard to multidisciplinary education.

Predictors of institution admission in the year following acute hospitalisation of elderly people.

The aim of the study was to identify factors related to institutionalisation within one-year follow up of subjects aged 75 or over, hospitalised via the emergency department (ED). Prospective multicentre cohort. Nine French university teaching hospitals. One thousand and forty seven (1 047) non institutionalised subjects aged 75 or over, hospitalised via ED. A sub-group analysis was performed on the 894 subjects with a caregiver. Patients were assessed using Comprehensive Geriatric Assessment (CGA) tools. Cox survival analysis was performed to identify predictors of institutionalisation at one year. Within one year after hospital admission, 210 (20.1%) subjects were institutionalised. For the overall study population, age >85 years (HR 1.6; 95%CI 1.1-2.1; p=0.005), inability to use the toilet (HR 1.6; 95%CI 1.1-2.4; p=0.007), balance disorders (HR 1.6; 95%CI 1.1-2.1; p=0.005) and presence of dementia syndrome (HR 1.9; 95%CI 1.4-2.6; p<0.001) proved to be independent predictors of institutionalisation; while a greater number of children was inversely linked to institutionalisation (HR 0.8; 95%CI 0.7-0.9; p<0.001). Bathing was of borderline significance (p=.09). For subjects with a caregiver, initial caregiver burden was significantly linked to institutionalisation within one year, in addition to the predictors observed in the overall study population. CGA performed at the beginning of hospitalisation in acute medical wards is useful to predict institutionalisation. Most of the predictors identified can lead to targeted therapeutic options with a view to preventing or delaying institution admission.

P03-27 Effects of topiramate in prevention of obesity in schizophrenic patients treated by olanzapine

Aims:Schizophrenic patients treated with atypical antipsychotics commonly suffer weight gain. Additive flow of using these drugs lead to more researches to solve this problem. Weight gain is associated not only with several medical conditions (such as hypertension, diabetes, cardiovascular disease, etc) but also may be related to treatment noncompliance. Topiramate is an anticonvulsant drug that has been used in psychiatric disorders and also leads to weight reduce. Many researches have been studied this effect of topiramate and positive outcomes of weight reduce without creation or development of psychotic signs have already been reported. as there is no approved therapeutic dose of topiramate for appropriate weight loss and also no study referred to its prophylactic effect of weight gain in these patients, in this study we proceed to check forenamed subjects.Method:Forty - eight schizophrenic patients treated with olanzapine in beginning of hospitalization in Ibn-e-Sina Hospital were selected and randomly placed in four groups: placebo, 50, 100, 200 mg topiramate daily was added to their treatment regimen. Patients were followed for 12 weeks for body weight changes, BMI, waist and wrist diameters. Data were analyzed by SPSS software.Results:Only BMI and waist diameter had significant difference in patients treated with 200 mg topiramate daily in compare with placebo group in 12th week. other data had no significant difference in handling.Conclusion:Prophylactic treatment of obesity in schizophrenic patients with topiramate is effective in 200 mg daily dosage and no significant adverse effects were found.

Evaluation of effect of therapy of somatic diseases and cognitive impairment in geriatric patients

Human aging is characterized by progressive decrease of the homeostatic reserves of every organ system with a possible impairment of cognitive functions. The study was aimed at examining and proving the correlations between cognitive failure and somatic diseases in patients belonging to geriatric population as well as at following the efficiency of treatment of somatic diseases by Mini mental examination test score. A group of 100 geriatric patients did Mini mental examination test at the beginning of hospitalisation and after three weeks of treatment of different.somatic diseases. The patients underwent many examination tests-biochemical analyses of blood and urin, ultrasound examination, X-ray examination of lungs and heart, hormones of thyroid gland, concentrations of B12 vitamin, folan acid. The statistical study showed that there was a significant correlation between the recovery of somatic diseases and the score of cognitive functions of patients. MMSE score was significantly increased after three weeks of successful treatment of somatic diseases in hospital. The highest statistical significance in the difference of M'ISE score at the beginning and after three weeks of hospital treatment was found in the group of patients with successful results of the treatment of their somatic diseases such as cardiomyopathies and disorders of respiratory system, such as pneumonia. MMSE score did not increase in patients chronic disease with malignant diseases of lungs or liver and chronic disease with frequent exacerbations. It was a group of patients without significant change in their somatic state.

The Evaluation Incidence and Risk Factors of Mortality among Patients with End Stage Renal Disease in Southeast Turkey

Aim. End stage renal disease (ESRD) presents with higher morbidity and mortality with respect to the general population. In recent study, the causes of mortality and associated risk factors in ESRD have been evaluated. Materials and Methods. In this study, 1538 patients diagnosed with ESRD in 10-year period were evaluated retrospectively. The patients were divided as dead (group 1) and alive (group 2). The patients' demographic features, causes of death, comorbidity at hospitalization, hematological and biochemical analyses, creatinine clearance at the beginning of hospitalization, daily urine volume, blood gas results, CRP value as inflammatory marker, ejection fraction, interventricular septum diameter, left ventricle posterior wall end-diastolic diameter, and left atrium diameter determined with echocardiography were recorded. Results. Mortality ratio of ESRD patients in a 10-year period was 14.1%. While the general mean age of all patients was 54.7 ± 16.6 and male/female ratio was 781/757, these ratios were 66.3 ± 21.8 and 114/103 in Group 1 and 52.8 ± 21.7 and 667/654 in Group 2. One or more comorbid pathologies were present in 82.9% of Group 1. The most common cause of mortality was cardiovascular diseases (CVD), and the most common cause of comorbidity was infections. Older age, anemia, absence of residual renal function, hypoalbuminemia, inflammation, impaired Ca and P metabolism, and left ventricular hypertrophy were significantly higher in Group 1 than in Group 2. Conclusion. CVD are the most important preventable causes of morbidity and mortality in all stages of chronic kidney disease. Taking precaution against CVD and the associated complications will provide a positive contribution in reducing morbidity and mortality among ESRD patients.

Associations between Chlamydophila infections, schizophrenia and risk of HLA-A10

Several microbes have been suspected as pathogenetic factors in schizophrenia. We have previously observed increased frequencies of chlamydial infections and of human lymphocyte antigen (HLA)-A10 in independent studies of schizophrenia. Our aim here was to analyze frequencies of three types of Chlamydiaceae in schizophrenic patients (n=72), random controls (n=225) and hospital-patient controls (n=36), together with HLA-A genotypes. Patients were diagnosed with schizophrenia according to Diagnostic and Statistical Manual of Mental Disorders-IV. Blood samples were collected at the beginning of hospitalization and analyzed with Chlamydiaceae species-specific polymerase chain reaction (PCR). Control panels consisted of randomly selected volunteers and hospitalized, non-schizophrenic patients. We found chlamydial infection in 40.3% of the schizophrenic patients compared to 6.7% in the controls. The association of schizophrenia with Chlamydiaceae infections was highly significant (P=1.39 x 10(-10), odds ratio (OR)=9.43), especially with Chlamydophila psittaci (P=2.81 x 10(-7), OR=24.39). Schizophrenic carriers of the HLA-A10 genotype were clearly most often infected with Chlamydophila, especially C. psittaci (P=8.03 x 10(-5), OR=50.00). Chlamydophila infections represent the highest risk factor yet found to be associated with schizophrenia. This risk is even further enhanced in carriers of the HLA-A10 genotype.

Factors relating to the use of physical restraints in psychogeriatric care: A paradigm for elder abuse

The purpose of this study was to address one component of the complex topic "elder abuse". A prospective observational study in the psychogeriatric unit of an acute psychiatric hospital demonstrated that 30% (n=37) of all included patients (n=122) were physically restrained. The highest incidence (48%) was found in elderly patients with severe cognitive impairments (diagnosis of dementia and/or delirium) (n=60). The most commonly used devices of physical restraints were bed rails (100%), belts (trunk 93%, limbs 40%) and chair-tables ("gerichair") (41%). Most restraints occurred at the beginning of hospitalization (83%). Physical restraints were continued for many days and on average of many hours a day. Patients with low cognitive status and serious mobility impairments showed a very high risk of being restrained (p=0.015; OR 32.0 [95% CI:2.0-515.1]). Inability to perform ADL activities increased the frequency of restraint use (p=0.035; OR27.7 [95%CI: 1.3-604.1]). As possible co-factors repetitive disruptive behaviors were found. There was no significant difference between the frequency of falls in restrained or unrestrained patients during the observational period, but fall-related fractures (n=2) only occurred in restrained patients. It is possible that restraints increase the use of benzodiazepines and classical neuroleptics. These results confirm that physical restraints remain a common practice in psychogeriatric care. No evidence-based data support the value of restraints in regard to fall prevention and control of behavioral disturbances in elderly people with serious mental illness. In contrast, these devices can have serious adverse effects and mean one of the most severe interventions in fundamental human rights.

Suicide and Auto-aggression, Depression, Hopelessness, Self-communication-- Results of a Prospective Study

A prospective study (N=503) conducted at the Department of Psychiatry, University Clinic Graz, investigated possible differences in intensity of auto-aggression tendencies, depression, hopelessness and self-communication between patients who committed or attempted suicide (failed suicide) in a 1-year follow-up (G1), patients who committed parasuicide in the period under observation (G2), and a non-suicidal control group (G3). In a final analysis (N=55), patients who committed or attempted suicide (n=16) differed from patients of the same age and sex in the non-suicidal control group (n=26) only in their greater self-aggression at the beginning of hospitalization. Patients who committed parasuicide (n=13) in the follow-up period were more auto-aggressive and more negative in their self-communication both at the beginning and end of hospitalization and were also more depressive and hopeless at the beginning of treatment than the non-suicidal control group (n=26).

Immunologic Alterations in Schizophrenia: Neopterin, L-Kynurenine, Tryptophan and T-Cell Subsets in the Acute Stage of Illness

Abstract It is well established now that in diseases with activated cell-mediated immunity increased formation of neopterin and degradation of tryptophan is an indication of endogenous production of interferon-γ in patients. Therefore increased neopterin levels are associated with increased kynuremne levels and decreased tryptophan in patients suffering from virus infections, malignant diseases or autoimmunity. To investigate cell-mediated immunity m schizophrenia, neopterin, L-kynurenine, L-tryptophan and T-cell-subsets were measured in 10 chronic schizophrenic patients, addmitted to hospital due to acute psychiatric relapse. Low neopterin concentrations were found at the beginning of hospitalisation and followed by a significant increase at the time of discharge (p = 0.02). Mean neopterin values were still within the 95th percentile of healthy controls. Kynuremne levels showed a similar development (p = 0.03) as neopterin whereas tryptophan values were low at admission without any significant changes thereafter. CD3 + and CD4+-cells presented with highest numbers at admission, followed by a continuous decrease and NK-cells were found lowest on day 0 with a gradual increase by day 7. These findings argue against acute virus infection in acutely ill schizophrenic patients because this would be associated with incerased neopterin fromation and tryptophan dagradation, rather the data would be in line with a shift from TH-1 to TH-2-type immune reaction which which is common in chronic infections.

Can patterns of coping explain more? a study of coping and emotions in surgical stress

Patterns of coping, defined as complex sets of coping strategies, were identified in a group of surgical patients awaiting surgery. The patterns were labelled as asthenic, problem-oriented, active and avoidant. The four patterns consisted of different combinations of eight forms of coping, measured by the Ways of Coping Questionnaire. The obtained results show that—compared to the coping strategies analysed separately—those coping patterns were poorer predictors of the emotional outcome. Patients assigned to groups representing particular coping patterns showed different levels of anxiety measured at the beginning of hospitalization; however, no differences or changes in emotions were observed after a one-week lapse. More relationships were found between the coping strategies and measures of negative emotions (anxiety and anger) and their changes.

Intense acute phase response in ischemic patients

The aim of this study was to estimate the qualitative and quantitative changes of acute phase proteins in patients suffering from coronary heart disease. The study was carried out on 74 patients and 12 healthy volunteers. The patients were divided into three groups as follows: patients with myocardial infarction ( n=37), Group I—without heart failure, Group II—with heart failure (II-III NYHA), Group III—patients with unstable angina pectoris ( n=35); controls—healthy volunteers ( n=12). The immunological measurements were performed at the beginning of hospitalisation (point 0), after 4, 8, 12 and 72 h, and after 6, 9 and 12 days of hospitalisation. The concentrations of C-reactive protein (CRP), α 1-acid glycoprotein (AGP) and α 1-antichymotrypsin (ACT) were measured using rocket immunoelectrophoresis according to Laurell. Glycosylation profiles of AGP and ACT were determined using crossed affinity immunoelectrophoresis with Con A as ligand according to Bøg-Hansen. Between Groups I and II statistically significant differences were observed for all investigated parameters. Highest concentration values were observed for Groups II and III; for Group II they appeared earlier than for Group III. The maximal values for reactivity coefficients (AGP-RC and ACT-RC) were observed earlier than the respective maximal values of concentrations. Continuous activation occurring in unstable angina leads to a more rapid increase in the concentrations of acute phase proteins and more marked alterations in their glycosylation profiles. In a way these patients seem to be `primed' with constant stimulation, so that they respond dramatically to the stimulus of ischemia.