Search

Background: Nosocomial infections are major causes of morbidity in hospitalized patients. Methods: Retrospective laboratory-based surveillance during 1999-2001 and 2005-2010 identified 2175 cases of nosocomial bloodstream infections (BSIs) in Tampere University Hospital (TAUH), Finland. Results: Analysis revealed that 57% of BSIs were caused by a gram-positive organism, 27% by a gram-negative organism, 5% by a fungal organism, and 11% were polymicrobial. The most common cause of nosocomial BSI was coagulase-negative staphylococci (23%). Candida species caused 5% of the infections. The 7-day and 30-day case fatalities were 8% (161/2158) and 15% (313/2175), respectively, and were highest in BSIs caused by Candida albicans (22% and 44%) and Pseudomonas aeruginosa (17% and 25%). The median age of patients was 54 years in 1999-2001, 57 years in 2005-2007, and 60 years in 2008-2010 (p < 0.001). The median time from hospital admission to the onset of BSI was 11 days (quartiles 5-18 days). This period was shortest for Streptococcus agalactiae BSI and longest for Candida non-albicans fungemia (1 vs 19 days). The case fatality rate in nosocomial BSI decreased during the years studied: 7-day and 30-day case fatalities were 9% and 16% during 1999-2001, 8.5% and 16% during 2005-2007, and 5% and 12% during 2008-2010, respectively (p < 0.003 and p = 0.022, respectively). Conclusions: Gram-positive infections predominate in nosocomial BSIs. The median age of patients with nosocomial BSI has risen during the study years. The case fatality associated with nosocomial BSI has decreased. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the occurrence of axis I and II psychiatric disorders among patients with traumatic brain injury (TBI). Design: Prospective observational study. Forty-five adult patients, who had attended an emergency unit because of TBI, were recruited. At 12 months, 38 patients were interviewed. Measures: Psychiatric disorders were evaluated using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II). Results: Before TBI, the 12-month rate of axis I psychiatric disorders was relatively high (39.5%%) and the rate of alcohol dependence was especially elevated (18.4%%). During the 12 months after TBI, axis I disorders were found in 47.4%% of subjects. Six patients (15.8%%) were found to have a disorder with an onset after TBI. Of these, five patients had depressive disorders (13.2%%). Almost one third of the subjects (29.0%%) had personality disorders. Antisocial and obsessive-compulsive personality disorders were the most frequent (10.5%%). Conclusions: Both axis I and II psychiatric disorders are common among patients with TBI. Alcohol dependence and personality disorders are prevalent in individuals prone to TBI, whereas depressive disorders typically develop after injury. Psychiatric disorders should be addressed in rehabilitation, as otherwise they will hinder the recovery after TBI. [ABSTRACT FROM AUTHOR]

Objective: This study explored 12-month outcome and its associations to social adjustment-related variables in patients with first-episode non-affective psychosis in Finland and Spain. Methods: Forty-nine Finnish and 37 Spanish patients were evaluated at admission on various characteristics of social adjustment. Outcome was measured for 68 (79%) patients by the Brief Psychiatric Rating Scale, Global Assessment Scale, and Grip on Life. Results: One-fourth of the patients experienced psychotic symptoms at follow-up. Sixty per cent of the patients showed good global functioning and Grip on Life. In both patient groups, poor earlier global functioning, weak social network, poor Grip on Life, and psychological dependence on family of origin were associated with poor outcome. In the Finnish group, few social contacts, lack of social recreational activities, and lack of stability in couple relations were related to poor outcome. In the Spanish group, low parental criticism was associated with poor outcome. Conclusion: Our findings support the notion that the level of earlier social adjustment is important in recovery from first-episode psychosis. However, different aspects of social adjustment, i.e., peer relations in the Finnish group and family relations in the Spanish group, appear to have prognostic importance in these two social environments. [ABSTRACT FROM AUTHOR]