All 112 patients aged 80 and above treated at the intensive care unit at the University Hospital in Lund, Sweden 1994-1995 were followed-up retrospectively in terms of six-month survival (SMS) and for survivors in terms of quality of life. Overall SMS was the same for both men and women--47%. Patients with the poorest SMS were those aged 90 and above with only one patient out of eleven surviving six months. Patients admitted for severe heart failure also showed a very poor outcome with SMS 27%. Patients were grouped in terms of living conditions prior to admission to the ICU, and a significant difference in six-month survival was noted between those living in their own homes (53%) prior to admission compared to those coming from a nursing home (25%). Patients surviving six months were interviewed by telephone regarding their living situation in March 1997. More than 50% of survivors were living in their own homes with external help no more than once a day. The average APACHE II score was 14.9 +/- 8.2. The average score for patients surviving six months was 13.4 +/- 5.9 and for those not surviving six months 16.8 +/- 5.1. No significant statistical difference in APACHE II scores between these two groups was shown.
Most of the data on psychological outcome and the mental health treatment available following natural disasters originate from the indigenous population of the region destroyed. Examining tourists returning from the area affected by the 2004 tsunami presents an opportunity of studying the impact of natural disasters on psychological outcome and mental health treatment in their countries of origin. The aim of the present study was to extend the current knowledge on psychiatric morbidity and potential positive outcomes, as well as subsequent mental health treatment following a natural disaster, based on the results from a sample of home-coming Swiss tourists.
Tourists who had been potentially affected by the 2004 tsunami were assessed using the Post-traumatic Diagnostic Scale, the Hospital Anxiety and Depression Scale, and the Post-traumatic Growth Inventory. Outcome variables were related to the degree of tsunami exposure. In addition, mental health treatment before and after the tsunami was assessed.
Of the 342 respondents, 55 (16.8%) fulfilled the criteria of post-traumatic stress disorder (PTSD). Evidence of anxiety or depressive disorder was found in 17.8% and 8.0%, respectively. The tsunami victims who had been directly affected showed significantly more symptoms of anxiety, depression and PTSD, as well as post-traumatic personal growth, than tourists who were indirectly affected or unaffected. A total of 12.3% of untreated respondents fulfilled the criteria for PTSD and 38% of respondents who had received psychiatric treatment were still fulfilling PTSD criteria 2(1/2) years after the tsunami.
A marked percentage of respondents reported symptoms of PTSD but they remained untreated or were treated insufficiently. We recommend that tourists returning from regions affected by natural disasters be informed about PTSD and that careful screening be given to those found to be at risk of PTSD. An open-door policy of mental health services is particularly needed for tourists returning home who have been affected by large-scale disasters.
The objective was to investigate the relationship between possible disaster stressors and subsequent health problems among tourists experiencing the 2004 South-East Asia tsunami. A cross-sectional study was performed as a postal survey concerning the experiences of the disaster exposure in retrospect and the presence of psychological symptoms (GHQ-28) in Norwegian tsunami victims 6 months post disaster. The strongest predictors of health complaints were danger of death, witness impressions, and bereavements. Aggravated outcomes were also seen in those who helped others in the acute phase or had sole responsibility for children when the tsunami struck. Having a family member or close friend who was injured was reversely associated with health problems. Women reported more psychological distress than men, but the difference disappeared with increasing degree of danger exposure. Dose-response relationships to psychological distress were found for single exposure factors as well as for the cumulative effects of being exposed to several exposure variables.
The authors' objective was to examine the ability of acute stress disorder (ASD) and other trauma-related factors in a group of physical assault victims in predicting post-traumatic stress disorder (PTSD) 6 months later. Subjects included 214 victims of violence who completed a questionnaire 1 to 2 weeks after the assault, with 128 participating in the follow-up. Measures included the Harvard Trauma Questionnaire, the Trauma Symptom Checklist, and the Crisis Support Scale. Twenty-two percent met the full PTSD diagnosis and 22% a subclinical PTSD diagnosis. Previous lifetime shock due to a traumatic event happening to someone close, threats during the assault, and dissociation explained 56% of PTSD variance. Inability to express feelings, hypervigilance, impairment, and hopelessness explained another 15% of PTSD variance. The dissociative, the reexperiencing, the avoidant, and the arousal criteria of the ASD diagnosis correctly classified 79% of the subsequent PTSD cases.
A total of 41 questionnaires were returned from 64 respondents who consented to receive a questionnaire through the mail. Almost all valued the opportunity to receive consultation to address their fertility concerns and discuss fertility preservation options. Psychological stress, time pressure, and costs were identified as main factors affecting respondents' decision to proceed with in-vitro fertilization to cryopreserve oocytes or embryos. About one third indicated that the discussion of fertility matters was initiated by themselves, their friends, and families rather than their health care providers. The findings have identified several major barriers encountered by female cancer patients when seeking fertility preservation services.
The aim of this study was to understand patient-reported perception of participation in a population-based web-survey focusing on sensitive issues for adolescent and young adult cancer survivors.
A population-based web survey for adolescent and young adult cancer survivors including a matched control group. Adolescent and young adult cancer survivors from the population-based Swedish National Cancer Registry from four of the six register holders at Regional Cancer Centers in Sweden. Controls were randomly identified from the Swedish National Population registry, from the same register holders.
Of 729 eligible participants, 540 completed the survey i.e. 74% participation rate. The study population included 285 adolescent and young adult cancer survivors and 255 matched controls. None of the participants answered that the survey had a very negative impact on them and a minority of 43 (7.9%) of the 540 responded that they were mildly negatively affected by their participation in the study. There was a no significant difference between patients and controls regarding the negative effect of the participation (p?=?0.29). Positive experiences of participating in the study were widely expressed and most participants (95%) found the study valuable.
These findings suggest that the benefits clearly outweigh the risks when adolescent and young adult cancer survivors participate in surveys including sensitive and trauma-related aspects, given that the study design is ethically sound and participants are approached carefully. We also present a modified ethical protocol for epidemiological surveys on adolescents and young adult cancer survivors.
Child sexual abuse (CSA) is a well-established risk factor for adult victimization in women, but little is known about the importance of relationship to perpetrator and exposure to other violence types. This study interviewed 2,437 Norwegian women (response rate = 45.0%) about their experiences with violence. Logistic regression analyses were employed to estimate associations of multiple categories of childhood violence with adult victimization. Women exposed to CSA often experienced other childhood violence, and the total burden of violence was associated with adult rape and intimate partner violence (IPV). Researchers and clinicians need to take into account the full spectrum of violence exposure.
Post-stroke depression affects approximately one third of stroke survivors. In non-stroke affected populations, depressive symptomatology is associated with hypoalbuminemia. This is also common among stroke survivors and associated with poor outcome and increased mortality. The role of stroke-associated hypoalbuminemia in post-stroke depression is not clear. We aimed to explore the relationship between serum albumin and post-stroke depression, as measured 20 months post-stroke.
Observational cohort study of elderly Swedish patients drawn from the 'Gothenburg 70+ Stroke Study' (n=149) and assessed at 20 months after stroke onset. Serum albumin was drawn from venous blood and analysed with gas chromatography/mass spectrometry. Depressive symptomatology was assessed using the Montgomery-Åsberg Depression Rating Scale (MADRS) and functional impairment was assessed using the Barthel Index.
Analysis of covariance analysis showed that serum albumin levels were associated with depressive symptoms at 20 months after stroke. Multivariate analysis of covariance showed that disability scores at 3 days were associated with depressive symptoms at 20 months after stroke and after accounting for the age covariate. Stroke survivors were not clinically deficient in serum albumin.
Low serum albumin appears to be associated with depressive symptoms in elderly individuals long term post-stroke.
In this study, we examined changes in alcohol consumption in the aftermath of a natural disaster, as well as possible predictors of both increased and decreased drinking.
Observational longitudinal study.
Repatriated Norwegian adults who resided in areas affected by the 2004 Southeast Asia tsunami completed a questionnaire at 6 and 24 months postdisaster (N = 649).
Weekly alcohol consumption and frequency of intoxication did not change significantly from 6 to 24 months postdisaster at the population level: 18.3% (n = 116) increased their alcohol consumption while 21.1% (n = 125) showed a reduction. Increased drinking was not predicted by severity of disaster exposure, post-traumatic stress, or measures of psychological functioning. Reduced alcohol consumption was predicted by younger age and social withdrawal, but not by any of the other study variables.
Our findings indicate that the tsunami experience had only minor effects on alcohol consumption, in contrast to some studies suggesting a relationship between trauma exposure and increased alcohol consumption.