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We aimed to study the association between self-reported voice disorders among teachers and indoor air quality in school buildings. We performed a questionnaire study of 538 Finnish teachers working in 67 school buildings utilizing both perceived and technical evaluations; the agreement between these two assessments was also studied. The technical assessment was provided by technical experts. Teachers with voice disorders reported significantly more complaints from indoor air than those without voice disorders. The results also indicated a possible connection between the technical assessment and voice disorders. After adjustment for sex, stress and asthma, the prevalence of voice disorders was 47% higher in teachers working in renovated buildings compared to those working in the non-problem buildings (aRR1.47; CI 95% 1.11–1.95). The prevalence of voice disorders was 28% higher among teachers working in buildings with problems compared to those working in non-problem buildings (aRR 1.28; 95% CI 0.99–1.64). In our study, poor perceived indoor air was significantly associated with self-reported voice disorders in teachers and there was an agreement between the perceived and technical assessments. Our results also indicated a possible connection between the technical assessment and voice disorders. Our results imply the need for longitudinal research with technical assessment to study the effect of renovation on voice disorders. [ABSTRACT FROM AUTHOR]

Our aim in this comparison study was to describe the continuation of domestic violence and to assess changes in the association among family functioning, health, and social support for participants who have or have not experienced violence for the years 2012 and 2015. We collected the data using a family functioning, health, and social support (FAFHES) questionnaire. We collected the baseline questionnaires (N = 188) from patients who visited a Finnish central hospital and mailed the follow-up survey (N = 71). The prevalence of violence remained constant. However, the violence varied and changed. Our findings should encourage health care professionals to better identify and intervene in violence. [ABSTRACT FROM AUTHOR]

Objective: Chronic tinnitus has been associated with several psychiatric disorders. Only few studies have investigated these disorders using validated diagnostic interviews. The aims were to diagnose psychiatric and personality disorders with structured interviews, to assess self-rated psychiatric symptoms and elucidate temporal relations between psychiatric disorders and tinnitus. Design: Current and lifetime DSM-IV diagnoses of axis-I (psychiatric disorders) and axis-II (personality disorders) were assessed using structured clinical interviews (SCID-I and -II). Current subjective psychiatric symptoms were evaluated via self-rating instruments: the Symptom Check List-90 (SCL-90), the Beck Depression Inventory, and the Dissociative Experiences Scale (DES). Study sample: 83 patients (mean age 51.7, 59% men) with chronic, disturbing tinnitus and a median Tinnitus Handicap Inventory score of 32. Results: The rates of lifetime and current major depression were 26.5% and 2.4%. The lifetime rate of obsessive-compulsive personality disorder (type C) was 8.4%. None of the patients had cluster B personality disorder or psychotic symptoms. The SCL-90 subscales did not differ from the general population, and median DES score was low, 2.4. Conclusions: Tinnitus patients are prone to episodes of major depression and often also have obsessive-compulsive personality features. Psychiatric disorders seem to be comorbid or predisposing conditions rather than consequences of tinnitus. Clinical trial reference: ClinicalTrials.gov (ID NCT 01929837). [ABSTRACT FROM AUTHOR]

Background: Infections greatly influence the outcome of acute myeloid leukemia (AML) patients receiving intensive treatment. The aim of this study was to establish the incidence, microbial etiology, risk factors and prognosis of bloodstream infections (BSIs) in patients with AML and compare the results with the previous treatment protocol (AML-92). Methods: Registery data were gathered prospectively from 357 patients aged 16–65 years recruited on the AML-2003 treatment protocol between November 2003 and November 2011 during different treatment cycles. Results: Blood culture data were available on 977 treatment episodes, in which there were 503 BSIs (51%). The overall incidence rate (IR) for BSIs (per 1000 hospital days) was 16.7. Twenty patients (5.6%) died due to an infection and 16 of them (80%) had a BSI. The most commonly detected microbes (polymicrobial episodes included) in blood cultures were coagulase-negative staphylococci (CoNS, 24.7%), viridans group streptococci (VGS, 19.1%), enterococci (13.9%) and Enterobacteriacae group (25.9%). The etiology of BSIs varied greatly from treatment cycle to cycle. Conclusions: Enterococcal BSIs have increased compared to our previous treatment protocol, and they represent significant pathogens in blood cultures. Infection-related mortality has decreased despite the increase in the IR of BSIs. Enterococci seem to be an increasingly prominent pathogen underlying BSIs in the AML patients, especially during induction therapy (20%). [ABSTRACT FROM AUTHOR]

Background:Both primary and non-primary maternal cytomegalovirus (CMV) infection during pregnancy can lead to vertical transmission. We evaluated the proportion of maternal primary/non-primary infections among 26 babies with symptomatic congenital CMV infection born in Finland from 2000 to 2012. Methods:We executed a database search on hospital records from all five university hospitals in Finland to identify infants with congenital CMV infection. The preserved maternal serum samples drawn at the end of the first trimester were analysed for CMV antibodies. Maternal infection was classified to be non-primary, if there was high avidity CMV immunoglobulin G (IgG) in the early pregnancy samples. Infection was considered primary in the case of either low avidity IgG (primary infection in the first trimester or near conception) or absent CMV IgG at the end of the first trimester (primary infection in the second or third trimester). Results:The majority of the symptomatic congenital CMV infections (54%) were due to maternal non-primary infection, 27% due to maternal primary infection in the first trimester or near conception, and 19% during the second or third trimester. Long-term sequelae occurred in 59% of patients: in 6/7 after primary infection in the first trimester, in 0/5 after primary infection in the second or third trimester, and in 9/14 after non-primary infection. Conclusions:In this register-based cohort, non-primary infections caused the majority of symptomatic congenital CMV infections, and resulted in significant morbidity. [ABSTRACT FROM PUBLISHER]

Objective: Young people regularly expose themselves to leisure noise and are at risk of acquiring tinnitus. This study examined the prevalence of leisure noise-induced tinnitus among Flemish young adults as well as the relation with sociodemographic factors, healthrelated variables and attitudes and beliefs towards noise. Design: A self-administered questionnaire was used to evaluate the presence of noise-induced tinnitus, the amount of leisure noise and attitudes towards noise and hearing protection. Study sample: 517 subjects between 18 and 30 years were included. Results: Temporary and chronic tinnitus occurred in 68.5% and 6.4% of the sample, respectively. Chronic tinnitus was more prevalent in male subjects and associated with more hearing-related symptoms. Furthermore, subjects with chronic tinnitus were more aware of the risks of noise and the importance of hearing protection. Finally, higher levels of leisure noise were independently associated with chronic tinnitus. Conclusions: Tinnitus is observed frequently in young adults. Results also indicate that persons with chronic tinnitus were exposed to a higher noise dose during their lives. Longitudinal studies may be useful to evaluate whether the experience of chronic tinnitus has led to behavioural changes. These findings further underpin the importance of educating youth about the risks of leisure noise exposure. [ABSTRACT FROM AUTHOR]

Background:Hantaviruses cause hemorrhagic fever with renal syndrome (HFRS) and hantavirus cardiopulmonary syndrome (HCPS) in humans. Hantavirus infections are characterized by thrombocytopenia. Our objective was to assess the association of thrombocytopenia with disease severity in HFRS induced by Puumala hantavirus (PUUV). Methods:Altogether 546 patients treated for acute serologically confirmed PUUV infection during 1982–2013 at Tampere University Hospital, Finland, were examined. Blood platelet count was determined daily and analysed in relation to different variables reflecting disease severity. The patients were divided into two groups according to the minimum platelet count: severe thrombocytopenia (<69 × 109/L, i.e. below median) and no severe thrombocytopenia (≥69 × 109/L). Results:Thrombocytopenia (platelet count <150 × 109/L) was detected in 90% of patients, and in 28% of patients platelet count was <50 × 109/L. Patients with severe thrombocytopenia had longer stay (8 versus 7 days,p = 0.002) and greater weight gain (2.8 versus 2.0 kg,p < 0.001) at the hospital, higher blood leukocyte count (11.2 × 109/L versus 9.6 × 109/L,p < 0.001), plasma C-reactive protein (81 versus 59 mg/L,p < 0.001), maximum hematocrit (0.44 versus 0.42,p < 0.001), urinary protein excretion (1.7 versus 1.1 g/24 h,p = 0.002), and lower plasma albumin concentration (27 versus 32 g/L,p < 0.001) than patients without severe thrombocytopenia (comparisons between medians). Maximum creatinine concentration did not differ between patients with or without severe thrombocytopenia (median 235 versus 214 μmol/L,p = 0.217). Conclusions:The severity of thrombocytopenia associates with the degree of inflammation and variables reflecting capillary leakage, but not with the severity of acute kidney injury in PUUV infected Finnish patients. [ABSTRACT FROM PUBLISHER]

ConclusionIDO might be useful for predicting progression of primary tumor stage T2 and T3 in tongue squamous cell carcinoma (TSCC), but does not seem like a specific biomarker for diagnosing TSCC and predicting patient survival.ObjectivesIndoleamine 2,3-dioxygenase (IDO) is expressed in many cells and it catabolises the essential amino acid tryptophan to kynurenine. IDO acts as an immune modulator through suppression of T-cell immunity and other pathways. In cancer cells, IDO has been proposed to promote tumor progression by enabling malignant cells to escape from the immune system. The aim of this study was to evaluate the association and prognostic relevance of IDO expression in TSCC.MethodOne hundred and eight retrospective tongue and lymph node specimens were stained immunohistochemically with monoclonal antibody anti-indoleamine 2,3-dioxygenase. The relative abundance of IDO positive epithelial cells, IDO staining intensity, and inflammation were assessed semi-quantitatively with light microscopy.ResultsIDO was expressed stronger in tongue hyperplasia than in TSCC. However, IDO expression associated with poor survival in the sub-groups with primary tumor stage T2–T4 and in the sub-group with strong inflammation in tumors’ invasive front. [ABSTRACT FROM PUBLISHER]

ConclusionThis is the first controlled study of balloon sinuplasty’s long-term efficacy with the follow-up time over 5 years. The results are in accordance with a previous 2-year-follow-up study. Both techniques retained the efficacy and patient satisfaction on average 6 years after the surgery. BackgroundEndoscopic sinus surgery (ESS) and balloon sinuplasty are considered as a treatment for chronic rhinosinusitis (CRS) after a failure of conservative therapy. High cost and lack of long-term follow-up studies restrain the use of balloon sinuplasty. ObjectiveThe aim of this study was to compare long-term efficacy and satisfaction in CRS patients who had undergone maxillary sinus operation with either balloon sinuplasty or ESS technique. Previous or additional sinonasal operations were exclusion criteria. Materials and methodsStudy patients were recruited from 208 CRS-patients who underwent either ESS or balloon sinuplasty. Patients with nasal polyposis (gradus ≥ 2), previous sinonasal surgery, unilateral disease, or immune deficiency were excluded. Altogether 45 patients in the ESS group and 40 patients in the balloon group were included. Of these, 30 and 28, respectively, answered to a phone interview held on average 6 years after primary surgery. Symptom reduction and long-term satisfaction were evaluated by using symptom scores of 19 parameters altogether. ResultsBoth groups experienced improvement in symptoms and were equally satisfied with the operation. The number of patient-reported acute exacerbations was higher among the balloon dilated patients. Also, the reduction of thick nasal discharge was less evident in the balloon sinuplasty group. Four patients in the balloon sinuplasty group underwent revision surgery. There were no revisions in the ESS group. [ABSTRACT FROM PUBLISHER]

Conclusions BMI-1 is an upstream repressor of tumor suppressor p16 and their inverse expression patterns have been linked with patient survival in OPSCC. In this material only p16 remained a relevant prognostic marker in OPSCC. Objectives HNSCC tumors carry variable phenotypes and clinical outcomes depending on their anatomical location. In OPSCC, expression of tumor suppressor p16 is used as a surrogate marker of HPV infection and has prognostic value. There are no good prognostic biomarkers for HNSCC tumors of other anatomical locations. Aim To study the expression patterns of p16 and BMI-1 in not only oropharyngeal but also oral, hypopharyngeal, and laryngeal squamous cell carcinomas and to clarify their putative connections with clinical parameters, survival, and each other. Method Hospital records on 130 patients (59 OPSCC, 18 OSCC, 20 HPSCC, and 33 LSCC) diagnosed between 1997–2008 at the Helsinki University Hospital, Finland, were reviewed. BMI-1 and p16 expressions were studied by immunohistochemistry. Results Sixty-eight per cent of OPSCC expressed p16 and expression correlated with lower age, lower T- and higher N-category, and with improved OS and DFS. BMI-1 expression was most prevalent in OPSCC and LSCC, but had no clinical correlations. No correlation between p16 and BMI-1 expression was found. [ABSTRACT FROM AUTHOR]

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 study the effects of a health check by a nurse alone or combined with an exercise intervention in middle-aged men at increased cardiovascular risk. Design. A randomized controlled trial. Setting and intervention. Primary care in Kirkkonummi municipality with 36 000 inhabitants. A health check by a nurse alone or combined with an exercise intervention to controls with no intervention was compared. Subjects. A total of 168 men aged 35 to 45 years with at least two cardiovascular risk factors and physical activity (PA) frequency < 3 times a week. Main outcome measures. Metabolic syndrome (MetS) as defined by International Diabetes Federation/American Heart Association and self-reported PA frequency. Results. Overall, focusing on health increased physical activity frequency in middle-aged men. After one year, 19% had increased PA to ≥ 3 times a week (95% CI 12-26). All study groups increased PA to ≥ 3 times: 26% of men in the exercise intervention group, 15% of men in the health check group, and 16% of controls. The differences between the groups were not statistically significant. The intervention did not have any meaningful impact on MetS or other cardiovascular outcomes at one-year follow up. Conclusions. Physical activity increased in all study groups of middle-aged men in this health-promotion trial. The interventions had no effect on metabolic syndrome or other cardiovascular outcomes in the participants. The trial increased awareness and collaboration in physical activity promotion among municipal health care and exercise services. [ABSTRACT FROM AUTHOR]

Conclusion: In four Nordic countries, peritonsillar abscess (PTA) patients are treated rather differently. Objectives: To study how such patients are treated in those countries. Methods: The 81 chief physicians of otorhinolaryngology departments of all central hospitals in Denmark ( n = 15), Norway ( n = 19), Sweden ( n = 27), and Finland ( n = 20) received a multiple-choice questionnaire. Results: A total of 73 physicians (90%) replied. The largest differences arose in treating patients with intravenous versus per oral antibiotics, and treating as inpatients versus outpatients. In Finland, 50% of PTA patients aged >16 years were treated as inpatients and 50% as outpatients, whereas the respective quotas in Sweden were 9 and 91%, Norway 19 and 81%, and Denmark 33 and 67%. Of Finnish physicians, 30% treated their patients primarily with oral antibiotics, 70% with intravenous antibiotics; in Sweden 91 vs 9%, Norway 53 vs 47%, and Denmark 18 vs 82%. In Denmark, almost all patients were operated on immediately, whereas in the other three countries, especially Sweden, operations more often were performed after a recovery period. Combining metronidazole with penicillin or cephalosporins was most common in Denmark: 58% reported usage, compared with 30% in Finland, 16% in Norway, and 4% in Sweden. [ABSTRACT FROM AUTHOR]

Objective: There is evidence that the cholinergic system is involved in cognitive sequels of traumatic brain injury (TBI). Nicotinic acetylcholine receptors (nAChRs) are known to have a major role in cognitive functions. Smokers have up-regulation of these receptors. This study investigated whether smoking is associated with the outcome from TBI. Methods: A specific questionnaire was sent, after checking inclusion and exclusion criteria, to 1022 subjects with TBI who had visited the neurological outpatient clinic of a university hospital during a 14-year period. Of these, 689 (67.4%) responded, forming the final study population. Associations between demographic variables, injury severity and outcome and smoking history were analysed using multivariate methods. Results: Smokers were more often men ( p < 0.001), younger at the time of the injury ( p = 0.008) and had less education ( p < 0.0001). In univariate analysis, non-smokers did not differ for outcome of TBI by GOS-E ( p = 0.08). Furthermore, in multivariate analysis, no association was found between smoking history and TBI outcome. Conclusions: This study does not suggest that smoking affects the outcome of TBI. [ABSTRACT FROM AUTHOR]

Patients with neurological diseases often suffer from sleep disturbances. Insomnia among adult brain tumor patients has usually been studied as part of quality-of-life studies, or some case reports on insomnia in these patients have been described. The authors aimed to study insomnia in a prospective study setting among patients with primary brain tumors and evaluate whether insomnia is related to tumor laterality. Entire study population consisted of 70 patients with a solitary primary supratentorial brain tumor treated surgically at the Clinic for Neurosurgery, Oulu University Hospital. The overall functional state of the patients was assessed by the Karnofsky Performance Scale, depression was measured by Beck Depression Inventory, and insomnia by Nottingham Health Profile. Repeated measurements were assessed before tumor operation as well as 3 months and one year after surgery. Prevalence of insomnia among patients with a primary brain tumor waiting for surgery was higher compared to general population, but level of insomnia significantly decreased as soon as 3 months after tumor operation. Patients with a bilateral primary brain tumor had significantly more often insomnia without comorbid depression compared to patients with a left or right tumor for up to one year after operation. The authors suggest that insomnia among patients with a bilateral brain tumor may not be associated with depression but have other biological background. [ABSTRACT FROM PUBLISHER]

Objectives: First, to compare multilevel emotion processing (EP) of pregnancy between substance-abusing and non-using women, and, second, to analyse whether different types of interventions can increase positive and functional EP and decrease negative and dysfunctional EP among substance-abusing mothers. EP was conceptualised according to the multifocal theory of emotions proposed by Frijda in 1986, comprising feeling states, behavioural urges to act, cognitive appraisals, and meta-emotions. Method: Participants were 101 women, 51 with substance abuse disorder and 50 comparisons. The substance-abusing women were provided with either intensive psychodynamic mother–infant group therapy (PGT; n = 25) or individually tailored psychosocial support (PSS; n = 26). All women reported their EP once during pregnancy (T1; N = 94), and twice postpartum, when the child was four (T2; N = 84) and twelve (T3; N = 76) months. Results: As hypothesised, the results indicated that the pregnancy-related EP of substance-abusing women was characterised by more negative and fewer positive feeling states, by more intense behavioural urges to act and by lower levels of cognitive appraisals of agency and predictability than the EP of the comparison women. As far as the interventions' effects on EP, intense behavioural urges to act decreased only in the PGT group, while negative feeling states decreased and agency and predictability appraisals increased from pregnancy to postpartum in the PSS group alone. Conclusions: The importance of helping substance-abusing mothers enhance optimal emotional quality as they prepare for and enter motherhood should be emphasised. [ABSTRACT FROM AUTHOR]

Objectives:The aim of this population-based study was to investigate the usefulness of the Geriatric Depression Scale 15-item version (GDS-15) to assess depressive symptoms among very old people with differing levels of cognitive function. Methods:The 834 participants were aged 85 and over. Feasibility of GDS-15 was evaluated as the proportion of people who completed the scale. Concurrent criterion validity was evaluated by calculating correlations between GDS-15 and Philadelphia Geriatric Center Morale Scale (PGCMS). PGCMS measures psychological wellbeing which is closely related with depressive symptoms. Correlations were calculated within groups according to cognitive function assessed with Mini-Mental State Examination (MMSE); 0–4, 5–9, 10–14, 15–19, 20–24, 25–27, and 28–30, using Pearson's two-sided correlation and compared using Fisher r-to-z transformation. Internal consistency of the GDS-15 was evaluated by calculating Cronbach's α in each group. Results:In total, 651 (78%) of the 834 participants completed the GDS-15. For the two MMSE-groups with scores of <10, the proportion who completed GDS-15 were 1% and 42%, respectively, compared to 65–95% in the MMSE-groups with scores of ≥10. Cronbach's α in each MMSE-group ranged from 0.636 (MMSE 28–30) to 0.821 (MMSE 5–9). The level of correlation between GDS-15 and PGCMS did not significantly differ between MMSE-groups with scores of 5–27 compared to the MMSE-group with scores of 28–30. Conclusions:The GDS-15 seems to have an overall usefulness to assess depressive symptoms among very old people with an MMSE score of 10 or more. More studies are needed to strengthen the validity of GDS-15 among older people with MMSE scores of 10–14. For older people with MMSE scores lower than 10, there is a need to develop and validate other measurements. [ABSTRACT FROM PUBLISHER]

Objective. Previous studies on smoking cessation have generally been conducted with adolescents or adults. Very little is known about the cessation attempts, their success, and/or use of pharmacological aids in young adult smokers who want to quit. The present study aimed to investigate quitting attempts in a group of both young male daily and occasional smokers. Design and subjects. 614 male smokers aged 18-26 years completed a standardized questionnaire about their smoking habits, quit attempts, and aids used in smoking cessation. Results. Nearly all daily smokers (95.3%, 95% CI 93.1-96.8) were nicotine addicted to some extend according to the standardized questionnaire, and the more addicted they were, the more often they had tried to quit (p = 0.025). Of the daily smokers, 55.6% (95% CI 51.3-59.9) had made quit attempts and 36.2% (95% CI 32.1-40.4) had used nicotine replacement therapy (NRT). In all, 34.1% (95% CI 25.2-44.3) of all occasional smokers reported having intended to quit but they had seldom made more than one attempt whereas 20.2% of daily smokers had made at least three attempts. The stronger the nicotine dependence in daily smokers was, the more likely the subject was to have attempted to use NRT (quite dependent 23.8% vs. totally dependent 48.9%) (p < 0.001). Conclusions. A high proportion of young male daily smokers were nicotine addicted. Young smokers make many unsuccessful attempts to stop smoking using nicotine replacement therapy (NRT) on their own. A better availability of professional cessation services directed to young adult smokers is needed. [ABSTRACT FROM AUTHOR]

Background: Cofactors of high-risk (HR) human papillomavirus (HPV) in the progression of cervical intraepithelial neoplasia (CIN) are incompletely characterized. In this study these cofactors were investigated in a longitudinal setting. Methods: A cohort of 329 women (mean age 25.5 y) were enrolled in the Finnish Family HPV Study, and followed-up for 6 y with serial cervical samples for HPV genotyping, virus integration status, and HPV serology. Hospital records were reviewed until March 2010 and linked with HPV detection data. All incident CIN lesions were subjected to HPV genotyping. HPV covariates were studied in an age- and HPV-matched nested case-control (1:4) setting. Results: Twelve of the 329 women developed an incident CIN: 2 CIN1, 3 CIN2, and 7 CIN3. HPV16 was detected most frequently (7/12), followed by HPV58 (2/12), HPV18, HPV31, and HPV42. HPV integration was present in 4/12 cases. Long-lasting persistence of HPV31 and HPV16 preceded incident CIN2 and CIN3. In multivariate conditional logistic regression, the risk for incident CIN increased up to 4-fold with increasing number of deliveries ( p == 0.024) and decreased with history of genital warts ( p == 0.036). Conclusion: Baseline HR-HPV infections and their persistence precede incident CIN by several years. The 2 independent covariates of HR-HPV were (1) number of deliveries (increasing the risk), and (2) history of genital warts (protective effect). [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]