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The Jorvi Bipolar Study JoBS ; is a collaborative ongoing bipolar research project between the Department of Mental Health and Alcohol Research of the National Public Health Institute, Helsinki, and the Department of Psychiatry, Jorvi Hospital, Helsinki University Central Hospital HUCH ; , Espoo, Finland. The JoBS is a prospective, naturalistic cohort study of secondary level care psychiatric out-and inpatients with a new episode of Diagnostic and Statistical Manual of Mental Disorders, 4th edition DSM-IV ; bipolar disorder BD ; . Altogether, 1630 patients aged 18-59 ; years were screened using the Mood Disorder Questionnaire MDQ ; for a possible new episode of DSM-IV BD. 490 patients were interviewed with semi-structured interview [the Structured Clinical Interview for DSM-IV Disorders, research version with Psychotic Screen SCID-I P ; ]. 191 patients with new episode of DSM-IV BD were included in the bipolar cohort study. Psychiatric comorbidity was evaluated using semi-structured interviews. At 6- and 18-month follow-up, the interviews were repeated and life-chart methodology was used to integrate all available information about nature and duration of all different phases. Suicidal behaviour was examined both at intake and follow-up by psychometric scale [Scale for Suicidal Ideation SSI ; ], interviewer's questions and medical and psychiatric records. The aim of this thesis was to evaluate prevalence of suicidal behaviour and incidence of suicide attempts, and examine the wide range of risk factors for attempted suicide both, at intake and follow-up, in representative secondary-level sample of psychiatric in- and outpatients with BD. In this study suicidal behaviour was common among psychiatric patients with BD. During the episode when patients were included into cohort study index episode ; , 20% of the patients had attempted suicide and 61% had suicidal ideation. Severity of depressive episode and hopelessness were independent risk factors for suicidal ideation, whereas hopelessness, comorbid personality disorder and previous suicide attempt predicted suicide attempts during the index episode. There were no differences in prevalence of suicidal behaviour between bipolar I and II disorder; the risk factors were overlapping but not identical.
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Treatment of pain in newborns is associated with problematic drug side effects. Previous studies show that intraoral sucrose is effective in alleviating pain in human infants. However, the ability of intraoral sucrose to alleviate pain across the first three postnatal weeks is unknown. Here, we investigated effects of intraoral sucrose 7.5% ; on withdrawal responses to thermal and mechanical stimuli in P021 rats. In some rats, Complete Freund's Adjuvant CFA ; was injected in a forepaw or hindpaw to produce inflammation. For thermal stimuli, sucrose-induced analgesia SIA ; emerged at P3, peaked at P710, then progressively declined and was absent by P17 18. For mechanical forepaw stimuli, SIA emerged ~P10 and was absent at P17. By contrast, SIA for the hindpaw emerged at P13, although it was also absent at P17. In inflamed animals, sucrose reduced allodynia and hyperalgesia as assessed with mechanical stimuli. SIA in inflamed animals was present at P3 for the forepaw and P13 for the hindpaw, and was absent by P17 for both limbs. Taken together, these results indicate that intraoral sucrose alleviates acute pain in response to thermal and mechanical stimuli and also effectively reduces inflammatory allodynia and hyperalgesia. SIA is age-dependent, emerging at ~P310 for the forelimb ; and is absent by weaning. The differential maturation of SIA for the forepaw versus hindpaw may be due to developmental changes in descending pain modulatory circuits. Supported by PHS grants DC03895, DE07309 and DE11964.
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And challenges won't happen overnight. Part of that is because the threat constantly evolves; and part is because, no matter what people may say about accepting and adapting to change, it simply defies human nature. People get comfortable in their patterns and ew weapons systems and habits, and change interjects a state-of-the-art technology degree of disruption and uncerare important parts of the tainty that most try to avoid. Defense Department's transforThat problem is compounded mation, but the key to the process in institutions, both in the private is the people involved. and government sector, and parI really do believe it's the peo- ticularly in organizations as large ple. It's the attitude . the culture. as DoD. The Defense Department's transIn both examples, the trick is formation is working because its to get people to let go of their old military and civilian leaders rec- practices so they can adapt to the ognize the need and are giving current requirements. the effort the top-level emphasis For the Defense Department, it requires. I hope that that means abandoning emphasis will serve a force structure that's almost like tossing a organized, trained, pebble in a pond, with a equipped and condiripple effect that reaches tioned to fight big throughout the departarmies, navies and air ment. forces and adapting one The terrorist attacks suited to new threats against the United States and challenges. actually accelerated The number of DoD's transformation uncertainties increases plans rather than bringas to where those chalDonald ing them to an abrupt lenges can come from Rumsfeld halt, as some people and what their nature may have thought. might be. That is a hard The Sept. 11 attacks thing for people to provided a sense of urgency for adjust to. us and an impetus, and I think in Even so, I'm impressed by the an interesting way, it enabled us way DoD's leaders are putting to change more rapidly because that resistance aside and embracwe had the need and the need ing measures that are helping was clear. move the department forward. Despite positive leadership They're demonstrating an and a clearly recognized threat, understanding of 21st-century letting go of Cold War-era concircumstances and enough selfventions and transforming the confidence that they're willing to Defense Department so it's better take risks and to alter the way adapted to 21st-century threats things were being done. Editor's note: These comments were made by Defense Secretary Donald H. Rumsfeld during an interview conducted by a staffer of the Pentagon Channel and reported in a March 17 article written by Donna Miles of the American Forces Press Service and
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A SMOKING CESSATION PROGRAM DELIVERED BY STUDENT NURSES Peter R. Smith, MD * ; M. Rafferty, MA, MPH, RN; D. Grasso, MSN, RN; J. Mackin, EdD, RN; K. Downie; J. Edwards; K. Kusterbeck; S. Matthews; K. Garrett-Szymanski, RRT; M. Bergman, MD; P. Meade, RN; Long Island College Hospital, Brooklyn, NY PURPOSE: Inpatient smoking cessation programs ISCPs ; are frequently more effective in achieving sustained 12 months ; abstinence than ambulatory programs. Time constraints may impact the ability of hospital staff to provide the necessary counseling. In 1996 the US Department of Health and Human Services DHHS ; recommended that hospitals develop ISCPs and that clinicians MDs, RNs etc ; learn cessation techniques. We developed an adjunct to our ISCP utilizing student nurses SNs ; . To our knowledge, this has not been previously reported. METHODS: 61 senior SNs were trained in smoking cessation SC ; based on the 1996 DHHS guideline AHCPR No. 96-0692 ; . This 1 hour training was reinforced through written materials and exam questions. Beginning in 2 04, teams of two SNs each spent a half-day providing SC counseling to an average caseload of 4 patients Pts ; . Sessions lasted about 15 minutes. SNs suggested that Pts ask their physicians about pharmacotherapy to assist SC. The intervention was documented in the medical record, and reported to the Pt's RN. SNs completed a data sheet for tracking abstinence after discharge. Pts agreeing to continued contact were telephoned on a monthly basis. RESULTS: Over 10 weeks SNs visited 104 Pts. SNs reported a high degree of satisfaction with the program. Results of the program are shown in the Table. CONCLUSION: SNs can effectively deliver SC interventions to hospitalized patients. Although the data are preliminary, the cessation rates achieved may be consistent with reported ISCPs and spironolactone.
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Dennis W. Jahnigen Memorial Award David Reuben, MD The Dennis W. Jahnigen Award recognizes an AGS member who has demonstrated leadership in training students in geriatrics and has contributed significantly to the progress of geriatrics education in health professions schools. Clinician of the Year Award Steven C. Castle, MD This award recognizes the importance of the geriatrics clinician in our health care delivery system and is awarded to a practitioner whose contributions have improved the delivery of health care to older people. Nascher Manning Award Peter Boling, MD The Nascher Manning award honors Dr. Ignatz Leo Nascher's pioneering work in the field of geriatrics by recognizing an individual with distinguished, life-long achievement in clinical geriatrics, including medicine, psychiatry, and all other relevant disciplines.
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