Management of bladder dysfunction and satisfaction of life after spinal cord injury in Norway

Background

There is limited knowledge about bladder dysfunction and bladder management in persons with spinal cord injury (SCI) after discharge from the hospital in Norway. The impact of bladder dysfunction on satisfaction of life has been rarely explored.

Setting

Community-based survey from Norway.

Methods

An anonymous cross-sectional postal survey. A questionnaire was sent to the registered members of the Norwegian Spinal Cord Injuries Association. A total of 400 participants, with traumatic or non-traumatic SCI, received the questionnaire.

Results

A total of 248 subjects (62%), 180 men and 68 women, answered the questionnaire. Mean age was 54 years and mean time since injury 13.4 years. A total of 164 participants (66.1%) used intermittent catheterization for bladder emptying (48.5% women versus 72.8% men); more paraplegics than tetraplegics (77.2% versus 55.7%). Recommendations given at the Spinal Cord Units were thoroughly followed by persons who had used catheters more than 5 years. Use of incontinence pads were associated with reduced satisfaction of life.

Conclusions

The most common method of management of bladder dysfunction is clean intermittent catheterization in Norway. Recommendations were followed more thoroughly by persons who have used intermittent catheterization for more than 5 years. Spinal Cord Units are important source for information and guidance.     

Biomarkers of inflammation in patients with unclassified polyarthritis and early rheumatoid arthritis. Relationship to disease activity and radiographic outcome

OBJECTIVE: To determine plasma interleukin 6 (pIL-6), plasma vascular endothelial growth factor (pVEGF), and serum (s) YKL-40 in patients with early rheumatoid arthritis (RA) and unclassified polyarthritis (PA), and investigate their relationship with radiographic outcome. METHODS: pIL-6 and pVEGF were determined by ELISA and sYKL-40 by an in-house radioimmunoassay in 51 patients with early RA and 21 with PA. Patients were followed with clinical and biochemical measurement every month for 2 years. Conventional radiographs of hands, wrists, and forefeet were scored according to the Larsen method, and magnetic resonance imaging of 2nd to 5th metacarpophalangeal joints of the dominant hand were evaluated for presence or absence of bone erosions. RESULTS: Baseline pIL-6, pVEGF, sYKL-40, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) were elevated in RA patients compared to healthy persons (p < 0.001), but were not in patients with PA. Patients with early RA had higher pIL-6 (p = 0.007), pVEGF (p = 0.02), and sYKL-40 (p = 0.024) compared to PA patients. pIL-6, sYKL-40, CRP, and ESR but not pVEGF decreased in patients that responded to treatment after 2 years. The mean value of pIL-6 during the first and second year were higher in patients with early RA with progression in bone erosions (n = 14) compared to early RA patients without progression (n = 30; first year 8.4 vs 2.8 ng/l, p = 0.04; second year 6.1 vs 3.6 ng/l, p = 0.03). CONCLUSION:Plasma IL-6 was the only biomarker related to treatment response and progressive erosive disease in patients with early RA, but it may not give additional information compared to CRP in relation to disease activity and treatment response.     

Profiles of orofacial dysfunction in different diagnostic groups using the Nordic Orofacial Test (NOT-S)—A review

Objective. The Nordic Orofacial Test-Screening (NOT-S) was developed as a comprehensive method to assess orofacial function. Results from the screening protocol have been presented in 11 international publications to date. This study reviewed these publications in order to compile NOT-S screening data and create profiles of orofacial dysfunction that characterize various age groups and disorders. Materials and methods. NOT-S results of nine reports meeting the inclusion criteria were reviewed. Seven of these studies not only provided data on the mean and range of total NOT-S scores, but also on the most common domains of orofacial dysfunction (highest rate of individuals with dysfunction scores), allowing the construction of orofacial dysfunction profiles based on the prevalence of dysfunction in each domain of NOT-S. Results. The compiled data comprised 669 individuals, which included healthy control subjects (n = 333) and various patient groups (n = 336). All studies reported differences between individuals with diagnosed disorders and healthy control subjects. The NOT-S data could measure treatment effects and provided dysfunction profiles characterizing the patterns of orofacial dysfunction in various diagnoses. Conclusions. This review corroborates previous results that the NOT-S differentiates well between patients and healthy controls and can also show changes in individuals after treatment. NOT-S could be used as a standard instrument to assess orofacial dysfunction, evaluate the outcomes of oral habilitation and rehabilitation and improve comparability in clinical practice and research.     

The Feasibility of Cognitive Adaptation Training for Outpatients with Schizophrenia in Integrated Treatment

Cognitive adaptation training (CAT) has been tested as a psychosocial treatment, showing promising results. To date there are no reported tests of CAT treatment outside the United States. Thus, we decided to adjust CAT treatment and apply it to an Integrated Treatment setting in Denmark. In this article we describe and discuss the feasibility of using CAT treatment in a randomized clinical trial in Denmark. The treatment period was shorter and the patients were instructed in prompting for specific actions by using newer tools such as schedules in their mobile phones. Social functioning, symptoms and quality of life were assessed using instruments validated in a Danish context. It was judged that, after some adjustments to fit the Danish assertive community treatment, CAT treatment was feasible in a Danish setting.     

Drop-out and continuity of care for patients suffering from schizophrenia and schizophrenia-like psychosis evaluated by means of routine registration

For most patients suffering from schizophrenia or other chronic psychoses, uninterrupted contact with psychiatric services for a long period is necessary. By means of routine registrations in Copenhagen County, the use of services in 1995 for patients suffering from schizophrenia or other ICD-10 F2 diagnoses ( n = 1356) was analysed. Substantial interregional differences were found in admission to more than one psychiatric department, admission to more than one similar ward, interruption in treatment and loss of contact with the patient. More than 25% had contact with at least four treatment modalities during 1995, and the proportion of patients who experienced interruption in treatment at least once during the year varied between 19% and 37%. It is concluded that routine registration of psychiatric services is a suitable means for quality assurance and ought to be used regularly in analyses like the one presented here. In concert with the literature, it is concluded that the interregional differences indicate that compliance with treatment can be improved by better organization of the psychiatric treatment.     

Perceptions of Coercion in the Community: A Qualitative Study of Patients in a Danish Assertive Community Treatment Team

Assertive community treatment (ACT) has been claimed to be paternalistic and coercive, yet little is known about how patients experience the assertive aspects of ACT. To explore views on—and perceptions of—coercion of patients in Danish assertive community teams. In-depth interviews were conducted with six purposefully selected patients and analysed using thematic analysis. Patients reported lack of influence on treatment process and a poor alliance with case-mangers, not being recognised as an autonomous person, and experiences of staff crossing the line and intruding privacy, as most central to perceptions of coercion. A collaborative and mutually trusting relationship, commitment, persistence and availability of staff, and recognition of the need for social support and help with everyday activities, were most important for counteracting such experiences. Perceptions of coercion were not emphasised in patients’ account of their engagement with ACT, and generally only related to patients’ initial contact with ACT staff. The study suggests that developing mental health practices that enhance the formation of a therapeutic relationship with patients will minimize circumstances that induce perceptions of coercion. ACT, with its engaged and committed staff with sufficient time, focusing on social and practical issues, is successful in facilitating such a contact, as experienced by patients.     

Incidence of breast cancer in Norwegian female radio and telegraph operators

Exposure to electromagnetic fields may cause breast cancer in women if it increases susceptibility to sex-hormone-related cancer by diminishing the pineal gland's production of melatonin. We have studied breast cancer incidence in female radio and telegraph operators with potential exposure to light at night, radio frequency (405 kHz-25 MHz), and, to some extent, extremely low frequency fields (50 Hz). We linked the Norwegian Telecom cohort of female radio and telegraph operators working at sea to the Cancer Registry of Norway to study incident cases of breast cancer. The cohort consisted of 2,619 women who were certified to work as radio and telegraph operators between 1920 and 1980. Cancer incidence was analyzed on the basis of the standardized incidence ratio (SIR), with the Norwegian female population as the comparison group. The incidence of all cancers was close to unity (SIR=1.2). An excess risk was seen for breast cancer (SIR=1.5). Analysis of a nested case-control study within the cohort showed an association between breast cancer in women aged 50 + years and shift work. In a model with adjustment for age, calendar year, and year of first birth, the rate ratio for breast cancer associated with being a radio and telegraph operator-in comparison with all Norwegian women born 1935 or later-analyzed with Poisson regression, was 1.5 after adjustment for fertility factors. These results support a possible association between work as a radio and telegraph operator and breast cancer. Future epidemiologic studies on breast cancer in women aged 50 and over, should address possible disturbances of chronobiological parameters by environmental factors.Mssrs Tynes, Andersen, and Haldorsen are with the Cancer Registry of Norway, Oslo, Norway. Authors are also affiliated with the Radiation Protection Authority, Østerås (Ms Hannevik, Mr Tynes), and the University of Oslo, Physics Department, Oslo, Norway (Dr Vistnes). Address correspondence to Mr Tynes, Norwegian Radiation Protection Authority, Pilestredet 46, N-0167 Oslo, Norway.     

Smoking reduction,smoking cessation,and mortality: a 16-year follow-up of 19,732 men and women from The Copenhagen Centre for Prospective Population Studies

The authors investigated the association between changes in smoking habits and mortality by pooling data from three large cohort studies conducted in Copenhagen, Denmark. The study included a total of 19,732 persons who had been examined between 1967 and 1988, with reexaminations at 5- to 10-year intervals and a mean follow-up of 15.5 years. Date of death and cause of death were obtained by record linkage with nationwide registers. By means of Cox proportional hazards models, heavy smokers (>or=15 cigarettes/day) who reduced their daily tobacco intake by at least 50% without quitting between the first two examinations and participants who quit smoking were compared with persons who continued to smoke heavily. After exclusion of deaths occurring in the first 2 years of follow-up, the authors found the following adjusted hazard ratios for subjects who reduced their smoking: for cardiovascular diseases, hazard ratio (HR) = 1.01 (95% confidence interval (CI): 0.76, 1.35); for respiratory diseases, HR = 1.20 (95% CI: 0.70, 2.07); for tobacco-related cancers, HR = 0.91 (95% CI: 0.63, 1.31); and for all-cause mortality, HR = 1.02 (95% CI: 0.89, 1.17). In subjects who stopped smoking, most estimates were significantly lower than the heavy smokers'. These results suggest that smoking reduction is not associated with a decrease in mortality from tobacco-related diseases. The data confirm that smoking cessation reduces mortality risk.     

Drop-out and continuity of care for patients suffering from schizophrenia and schizophrenia-like psychosis evaluated by means of routine registration

For most patients suffering from schizophrenia or other chronic psychoses, uninterrupted contact with psychiatric services for a long period is necessary. By means of routine registrations in Copenhagen County, the use of services in 1995 for patients suffering from schizophrenia or other ICD-10 F2 diagnoses (n = 1356) was analysed. Substantial interregional differences were found in admission to more than one psychiatric department, admission to more than one similar ward, interruption in treatment and loss of contact with the patient. More than 25% had contact with at least four treatment modalities during 1995, and the proportion of patients who experienced interruption in treatment at least once during the year varied between 19% and 37%. It is concluded that routine registration of psychiatric services is a suitable means for quality assurance and ought to be used regularly in analyses like the one presented here. In concert with the literature, it is concluded that the interregional differences indicate that compliance with treatment can be improved by better organization of the psychiatric treatment.