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Contact with psychiatric care prior to suicide: are there differences between migrants and the majority population in Sweden? A cohort study of 12 474 persons who died by suicide between 2006 and 2016
- E. Jonsson, H. Sjöqvist, M. Sundvall, S. Bäärnhielm, C. Dalman, A.C. Hollander
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- Journal:
- Epidemiology and Psychiatric Sciences / Volume 31 / 2022
- Published online by Cambridge University Press:
- 27 July 2022, e56
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Aims
The aim of this study was to determine possible differences in psychiatric care contact and the type of contact in the year prior to suicide by migrant status and region of origin compared to Swedish persons.
MethodsA population-based open cohort design, using linked national registers, to study all individuals aged 20–64 years who died by suicide between 1 January 2006 and 31 December 2016 in Sweden (N = 12 474). The primary exposure was migrant status compared to the Swedish majority population in the following categories: non-refugee migrants, refugee migrants and children of migrants. The secondary exposure was region of origin in seven regions: Sweden, other Nordic countries, Europe, Sub-Saharan Africa, the Middle East and North Africa, Asia, the Americas and Oceania. The four outcomes were psychiatric in- and outpatient care, prescribed and purchased psychotropic medication and a variable composing the other variables, all measured the year before death. Logistic regression models adjusted for age, sex, income and marital status estimated the likelihood of psychiatric care utilisation by type of care within the year prior to death by migrant status and region of origin (individually and combined).
ResultsOut of all who had died by suicide, 81% had had psychiatric care of any type in the year before death by suicide. Among refugees the prevalence of psychiatric care before death by suicide was 88%. Compared with the Swedish reference group, non-refugees and persons from Asia and Sub-Saharan Africa had a lower likelihood of utilising psychiatric care prior to suicide driven by a lower use of prescribed psychotropic medication. Persons from the Middle East and North Africa had a higher likelihood, driven by higher use of psychiatric outpatient care and prescribed psychotropic medication. Non-refugees' likelihood of utilising care before death by suicide was lower within the first 5 years of living in Sweden.
ConclusionA large share of those who die by suicide use psychiatric care the year before they die. Non-refugee migrants and persons from Asia and Sub-Saharan Africa have a lower likelihood of utilising psychiatric care prior to suicide compared to Swedish, whereas persons from the Middle East and North Africa have a higher likelihood. Health care and policy makers should consider both migrant status, region of origin and time in the new country for further suicide prevention efforts.
Characterisation of age and polarity at onset in bipolar disorder
- Janos L. Kalman, Loes M. Olde Loohuis, Annabel Vreeker, Andrew McQuillin, Eli A. Stahl, Douglas Ruderfer, Maria Grigoroiu-Serbanescu, Georgia Panagiotaropoulou, Stephan Ripke, Tim B. Bigdeli, Frederike Stein, Tina Meller, Susanne Meinert, Helena Pelin, Fabian Streit, Sergi Papiol, Mark J. Adams, Rolf Adolfsson, Kristina Adorjan, Ingrid Agartz, Sofie R. Aminoff, Heike Anderson-Schmidt, Ole A. Andreassen, Raffaella Ardau, Jean-Michel Aubry, Ceylan Balaban, Nicholas Bass, Bernhard T. Baune, Frank Bellivier, Antoni Benabarre, Susanne Bengesser, Wade H Berrettini, Marco P. Boks, Evelyn J. Bromet, Katharina Brosch, Monika Budde, William Byerley, Pablo Cervantes, Catina Chillotti, Sven Cichon, Scott R. Clark, Ashley L. Comes, Aiden Corvin, William Coryell, Nick Craddock, David W. Craig, Paul E. Croarkin, Cristiana Cruceanu, Piotr M. Czerski, Nina Dalkner, Udo Dannlowski, Franziska Degenhardt, Maria Del Zompo, J. Raymond DePaulo, Srdjan Djurovic, Howard J. Edenberg, Mariam Al Eissa, Torbjørn Elvsåshagen, Bruno Etain, Ayman H. Fanous, Frederike Fellendorf, Alessia Fiorentino, Andreas J. Forstner, Mark A. Frye, Janice M. Fullerton, Katrin Gade, Julie Garnham, Elliot Gershon, Michael Gill, Fernando S. Goes, Katherine Gordon-Smith, Paul Grof, Jose Guzman-Parra, Tim Hahn, Roland Hasler, Maria Heilbronner, Urs Heilbronner, Stephane Jamain, Esther Jimenez, Ian Jones, Lisa Jones, Lina Jonsson, Rene S. Kahn, John R. Kelsoe, James L. Kennedy, Tilo Kircher, George Kirov, Sarah Kittel-Schneider, Farah Klöhn-Saghatolislam, James A. Knowles, Thorsten M. Kranz, Trine Vik Lagerberg, Mikael Landen, William B. Lawson, Marion Leboyer, Qingqin S. Li, Mario Maj, Dolores Malaspina, Mirko Manchia, Fermin Mayoral, Susan L. McElroy, Melvin G. McInnis, Andrew M. McIntosh, Helena Medeiros, Ingrid Melle, Vihra Milanova, Philip B. Mitchell, Palmiero Monteleone, Alessio Maria Monteleone, Markus M. Nöthen, Tomas Novak, John I. Nurnberger, Niamh O'Brien, Kevin S. O'Connell, Claire O'Donovan, Michael C. O'Donovan, Nils Opel, Abigail Ortiz, Michael J. Owen, Erik Pålsson, Carlos Pato, Michele T. Pato, Joanna Pawlak, Julia-Katharina Pfarr, Claudia Pisanu, James B. Potash, Mark H Rapaport, Daniela Reich-Erkelenz, Andreas Reif, Eva Reininghaus, Jonathan Repple, Hélène Richard-Lepouriel, Marcella Rietschel, Kai Ringwald, Gloria Roberts, Guy Rouleau, Sabrina Schaupp, William A Scheftner, Simon Schmitt, Peter R. Schofield, K. Oliver Schubert, Eva C. Schulte, Barbara Schweizer, Fanny Senner, Giovanni Severino, Sally Sharp, Claire Slaney, Olav B. Smeland, Janet L. Sobell, Alessio Squassina, Pavla Stopkova, John Strauss, Alfonso Tortorella, Gustavo Turecki, Joanna Twarowska-Hauser, Marin Veldic, Eduard Vieta, John B. Vincent, Wei Xu, Clement C. Zai, Peter P. Zandi, Psychiatric Genomics Consortium (PGC) Bipolar Disorder Working Group, International Consortium on Lithium Genetics (ConLiGen), Colombia-US Cross Disorder Collaboration in Psychiatric Genetics, Arianna Di Florio, Jordan W. Smoller, Joanna M. Biernacka, Francis J. McMahon, Martin Alda, Bertram Müller-Myhsok, Nikolaos Koutsouleris, Peter Falkai, Nelson B. Freimer, Till F.M. Andlauer, Thomas G. Schulze, Roel A. Ophoff
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- Journal:
- The British Journal of Psychiatry / Volume 219 / Issue 6 / December 2021
- Published online by Cambridge University Press:
- 25 August 2021, pp. 659-669
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- December 2021
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Background
Studying phenotypic and genetic characteristics of age at onset (AAO) and polarity at onset (PAO) in bipolar disorder can provide new insights into disease pathology and facilitate the development of screening tools.
AimsTo examine the genetic architecture of AAO and PAO and their association with bipolar disorder disease characteristics.
MethodGenome-wide association studies (GWASs) and polygenic score (PGS) analyses of AAO (n = 12 977) and PAO (n = 6773) were conducted in patients with bipolar disorder from 34 cohorts and a replication sample (n = 2237). The association of onset with disease characteristics was investigated in two of these cohorts.
ResultsEarlier AAO was associated with a higher probability of psychotic symptoms, suicidality, lower educational attainment, not living together and fewer episodes. Depressive onset correlated with suicidality and manic onset correlated with delusions and manic episodes. Systematic differences in AAO between cohorts and continents of origin were observed. This was also reflected in single-nucleotide variant-based heritability estimates, with higher heritabilities for stricter onset definitions. Increased PGS for autism spectrum disorder (β = −0.34 years, s.e. = 0.08), major depression (β = −0.34 years, s.e. = 0.08), schizophrenia (β = −0.39 years, s.e. = 0.08), and educational attainment (β = −0.31 years, s.e. = 0.08) were associated with an earlier AAO. The AAO GWAS identified one significant locus, but this finding did not replicate. Neither GWAS nor PGS analyses yielded significant associations with PAO.
ConclusionsAAO and PAO are associated with indicators of bipolar disorder severity. Individuals with an earlier onset show an increased polygenic liability for a broad spectrum of psychiatric traits. Systematic differences in AAO across cohorts, continents and phenotype definitions introduce significant heterogeneity, affecting analyses.
S39.03 - Candidate genes and brain cortical morphology in schizophrenia
- I. Agartz, K. Varnäs, G. Lawyer, E.G. Jönsson, B. Kulle, R. Nesvåg, H. Hall, L. Terenius, P. Saetre
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- Journal:
- European Psychiatry / Volume 23 / Issue S2 / April 2008
- Published online by Cambridge University Press:
- 16 April 2020, p. S58
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Aim:
To investigate associations between schizophrenia candidate gene polymorphisms and regional cortical thickness and volume in patients with schizophrenia and healthy control subjects.
Methods:Genotyping was performed using PCR and pyrosequencing techniques. Cortical morphology was analyzed by processing magnetic resonance brain images with the FreeSurfer software package. General linear model analysis was used to study associations between gene variants and cortical thickness in patients and controls, respectively. Regional cortical volumes were defined from automatic cortical parcellations. Our first studies from 96 patients with schizophrenia and 104 healthy control subjects demonstrate that polymorphisms in the brain derived neurotrophic factor (BDNF) gene may be associated with variation in frontal lobe morphology. Associations seem to be stronger in patients with schizophrenia than in healthy controls.
Subsequent Higher Education After Adolescent Depression: A 15-Year Follow-Up Register Study
- U. Jonsson, H. Bohman, A. Hjern, L. von Knorring, G. Olsson, A.-L. von Knorring
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- European Psychiatry / Volume 25 / Issue 7 / November 2010
- Published online by Cambridge University Press:
- 16 April 2020, pp. 396-401
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Background
Adolescent depression has been shown to have a range of adverse outcomes. We used longitudinal data to investigate subsequent higher education in former depressed adolescents.
MethodA Swedish population-based investigation of depression in 16–17-year-olds was followed up in national registers 15 years later. Adolescents with depression (n = 361, 78% females) were compared to a group of non-depressed peers of the same age (n = 248, 77% females). The main outcome was graduation from higher education by age 30.
ResultsThe adolescent with depression were less likely than their non-depressed peers to have graduated from higher education by age 30, both regarding females (27.7% vs. 36.4%, p < .05) and males (12.7% vs. 28.6%, p < .05). After adjustment for early school performance, socioeconomic status and maternal education, the decreased likelihood of subsequent graduation from higher education remained for depressed males (OR, 0.27; 95% CI, 0.08–0.93) but not for depressed females (OR, 0.93; 95% CI, 0.58–1.49).
ConclusionContrary to what previous research has suggested, adolescent depression and its consequences might be particularly destructive to subsequent higher education in males.
A Monozygotic Schizophrenic Triplet
- C. Härnryd, E. Jönsson, D. Greitz, T. Johannesson, H. Nyman, J. Wahlström, G. Sedvall
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- European Psychiatry / Volume 11 / Issue S4 / 1996
- Published online by Cambridge University Press:
- 16 April 2020, p. 259s
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Health-related quality of life in psychiatric and other patients before and after treatment
- Helgason T., J.K. Björnsson, Tómasson K., Einarsson G.V., Harðarson P., Jónsson H.
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- European Psychiatry / Volume 13 / Issue S4 / 1998
- Published online by Cambridge University Press:
- 16 April 2020, p. 319s
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The Swedish HUBIN Project on Schizophrenia
- G. Sedvall, R. Adolfsson, I. Agartz, S. Arnborg, B. Ekholm, H. Hall, E. Jonsson, T.F. McNeil, G. Okugawa, U. Osby, M.J. Owen, L. Terenius
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- European Psychiatry / Volume 17 / Issue S1 / May 2002
- Published online by Cambridge University Press:
- 16 April 2020, pp. 4s-5s
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P0346 - Computerized training of working memory in adults with attention deficit/hyperactivity disorder and drug addiction
- M. Talvik, C. Haaparanta, L. Hetta, C. Jonsson, H. Westerberg
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- European Psychiatry / Volume 23 / Issue S2 / April 2008
- Published online by Cambridge University Press:
- 16 April 2020, p. S294
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Background and Aims:
Attention Deficit/Hyperactivity Disorder (ADHD) is clearly over represented among patients with drug addiction. Deficits in working memory (WM) are thought to be of central importance for ADHD. Previous studies indicate that WM can be improved by training.
In this pilot study we have examined if training of WM in adult patients with ADHD and a history of severe drug abuse would be possible to apply in a clinical setting. In addition, we hypothesized that the training would improve WM in this group.
Patients and Methods:Subjects: Nine patients with ADHD and a history of drug abuse were recruited. The age range was 21-52. One patient was addicted to alcohol, one to cannabis and seven patients to amphetamine. All patients had been drug-free more than two months prior to inclusion. Outcome measures: WM was assessed using four different tasks. The Self Rating Scale (CFQ) was used to score symptoms of cognitive failures in daily life. Training procedure: The treatment consisted of performing WM tasks implemented in a computer program (RoboMemo®).
Results:Eight patients completed the treatment and remained drug-free during the training. There was a clear improvement in two WM test. Seven patients reported a subjective improvement as rated in CFQ.
Conclusion:This pilot study shows that computerized training of working memory can be performed in a clinical setting of adults with ADHD and drug addiction. The improvement support that patients with drug-addiction may have the same plasticity in the brain that non-addictive patients show.
P-973 - Gray Matter Volume Alterations Associated With Dissociative Traits in Ptsd and Traumatized Controls
- M. Pagani, D. Nardo, G. Hogberg, R. Lanius, T. Bravo, H. Jacobsson, C. Jonsson, T. Hallstrom
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- European Psychiatry / Volume 27 / Issue S1 / 2012
- Published online by Cambridge University Press:
- 15 April 2020, p. 1
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Aims
Dissociation is a common feature of PTSD and neurobiological evidence distinguish it from nondissociative PTSD. The aim of this study is to investigate brain functional and structural alterations associated with dissociative traits along a continuum in a group of traumatized subjects either developing or non-developing PTSD.
MethodsAmong 32 traumatized subjects with and without clinical diagnosis of PTSD we identified two subgroups based on the amount of dissociative traits as investigated by Dissociative Experience Scale (DES). Ten subjects had high dissociative traits (D) and 22 lower (ND). MRI and SPECT scans were performed to investigate structural and functional differences, respectively, between subgroups. Statistical Parametric Mapping was implemented for statistical analysis.
ResultsD vs ND comparison showed significant Gray Matter volume (GMV) increases in the right prefrontal cortex, inferior parietal lobule and temporal pole (comprising adjacent parahippocampal gyrus) and in bilateral medial prefrontal cortex. ND vs D comparison showed a significant GMV reduction in D subjects in the right striatum. By regressing GMV against DES scores, we found a significant positive correlation, largely superimposing to the regions identified by the D vs ND contrast, in bilateral prefrontal and anterior cingulate cortex and temporal poles and in the right inferior parietal lobule. No significant differences were found at SPECT.
ConclusionsSignificant structural differences were found between D and ND in prefrontal and anterior temporal cortex in which GM highly correlated with DES scores suggesting a strong neurobiological ground for dissociation and the involvement of such structures in its processing.
Postmortem observations on rumen wall histology and gene expression and ruminal and caecal content of beef cattle fattened on barley-based rations
- N. N. Jonsson, H. J. Ferguson, H. H. C. Koh-Tan, C. A. McCartney, R. C. Cernat, E. M. Strachan, W. Thomson, T. J. Snelling, C. D. Harvey, I. Andonovic, C. Michie, R. J. Wallace
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Sub-acute ruminal acidosis (SARA) can reduce the production efficiency and impair the welfare of cattle, potentially in all production systems. The aim of this study was to characterise measurable postmortem observations from divergently managed intensive beef finishing farms with high rates of concentrate feeding. At the time of slaughter, we obtained samples from 19 to 20 animals on each of 6 beef finishing units (119 animals in total) with diverse feeding practices, which had been subjectively classified as being high risk (three farms) or low risk (three farms) for SARA on the basis of the proportions of barley, silage and straw in the ration. We measured the concentrations of histamine, lipopolysaccharide (LPS), lactate and other short-chain fatty acids (SCFAs) in ruminal fluid, LPS and SCFA in caecal fluid. We also took samples of the ventral blind sac of the rumen for histopathology, immunohistopathology and gene expression. Subjective assessments were made of the presence of lesions on the ruminal wall, the colour of the lining of the ruminal wall and the shape of the ruminal papillae. Almost all variables differed significantly and substantially among farms. Very few pathological changes were detected in any of the rumens examined. The animals on the high-risk diets had lower concentrations of SCFA and higher concentrations of lactate and LPS in the ruminal fluid. Higher LPS concentrations were found in the caecum than the rumen but were not related to the risk status of the farm. The diameters of the stratum granulosum, stratum corneum and of the vasculature of the papillae, and the expression of the gene TLR4 in the ruminal epithelium were all increased on the high-risk farms. The expression of IFN-γ and IL-1β and the counts of cluster of differentiation 3 positive and major histocompatibility complex class two positive cells were lower on the high-risk farms. High among-farm variation and the unbalanced design inherent in this type of study in the field prevented confident assignment of variation in the dependent variables to individual dietary components; however, the CP percentage of the total mixed ration DM was the factor that was most consistently associated with the variables of interest. Despite the strong effect of farm on the measured variables, there was wide inter-animal variation.
Letter to the Editor: Are older studies lost in database searches for systematic reviews?
- B. H. Jonsson, R. Winzer, C. Gornitzki
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- Journal:
- Psychological Medicine / Volume 48 / Issue 7 / May 2018
- Published online by Cambridge University Press:
- 27 November 2017, pp. 1218-1219
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Prefrontal cortical thinning links to negative symptoms in schizophrenia via the ENIGMA consortium
- E. Walton, D. P. Hibar, T. G. M. van Erp, S. G. Potkin, R. Roiz-Santiañez, B. Crespo-Facorro, P. Suarez-Pinilla, N. E. M. van Haren, S. M. C. de Zwarte, R. S. Kahn, W. Cahn, N. T. Doan, K. N. Jørgensen, T. P. Gurholt, I. Agartz, O. A. Andreassen, L. T. Westlye, I. Melle, A. O. Berg, L. Morch-Johnsen, A. Færden, L. Flyckt, H. Fatouros-Bergman, Karolinska Schizophrenia Project Consortium (KaSP), E. G. Jönsson, R. Hashimoto, H. Yamamori, M. Fukunaga, N. Jahanshad, P. De Rossi, F. Piras, N. Banaj, G. Spalletta, R. E. Gur, R. C. Gur, D. H. Wolf, T. D. Satterthwaite, L. M. Beard, I. E. Sommer, S. Koops, O. Gruber, A. Richter, B. Krämer, S. Kelly, G. Donohoe, C. McDonald, D. M. Cannon, A. Corvin, M. Gill, A. Di Giorgio, A. Bertolino, S. Lawrie, T. Nickson, H. C. Whalley, E. Neilson, V. D. Calhoun, P. M. Thompson, J. A. Turner, S. Ehrlich
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- Journal:
- Psychological Medicine / Volume 48 / Issue 1 / January 2018
- Published online by Cambridge University Press:
- 26 May 2017, pp. 82-94
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Background
Our understanding of the complex relationship between schizophrenia symptomatology and etiological factors can be improved by studying brain-based correlates of schizophrenia. Research showed that impairments in value processing and executive functioning, which have been associated with prefrontal brain areas [particularly the medial orbitofrontal cortex (MOFC)], are linked to negative symptoms. Here we tested the hypothesis that MOFC thickness is associated with negative symptom severity.
MethodsThis study included 1985 individuals with schizophrenia from 17 research groups around the world contributing to the ENIGMA Schizophrenia Working Group. Cortical thickness values were obtained from T1-weighted structural brain scans using FreeSurfer. A meta-analysis across sites was conducted over effect sizes from a model predicting cortical thickness by negative symptom score (harmonized Scale for the Assessment of Negative Symptoms or Positive and Negative Syndrome Scale scores).
ResultsMeta-analytical results showed that left, but not right, MOFC thickness was significantly associated with negative symptom severity (βstd = −0.075; p = 0.019) after accounting for age, gender, and site. This effect remained significant (p = 0.036) in a model including overall illness severity. Covarying for duration of illness, age of onset, antipsychotic medication or handedness weakened the association of negative symptoms with left MOFC thickness. As part of a secondary analysis including 10 other prefrontal regions further associations in the left lateral orbitofrontal gyrus and pars opercularis emerged.
ConclusionsUsing an unusually large cohort and a meta-analytical approach, our findings point towards a link between prefrontal thinning and negative symptom severity in schizophrenia. This finding provides further insight into the relationship between structural brain abnormalities and negative symptoms in schizophrenia.
(P2-14) Support System for Medical Command and Control at Major Incidents
- H. Nilsson, R. Lundin, E. Bengtsson, L. Gustafsson, C. Jonsson, T. Vikström
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- Journal:
- Prehospital and Disaster Medicine / Volume 26 / Issue S1 / May 2011
- Published online by Cambridge University Press:
- 25 May 2011, p. s140
- Print publication:
- May 2011
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Introduction
Communication and information are cornerstones of management during major incidents and disasters. To support medical command and control, the Web-based support system called Paratus Major Incident can be used. The Paratus Major Incident system can provide management staff with online information from the incident area, and support management and patient handling at both single and mass-casualty incidents. The purpose of the Web-based information technology (IT) system is to ensure communication and information between the medical management at the scene, hospital management, and regional medical command and control (gold level).
ExperiencesIn the region of Östergötland, Sweden, Paratus Major Incident system is used in operating topics such as: (1) information dissemination from the incident area; (2) communication between prehospital, regional, and hospital management; (3) continuous updates between the dispatch centre and medical commanders at all levels; (4) digital log-files for medical management and patient records; (4) database used for follow-up studies and quality control.
ResultsDuring 2,161 incidents, 746 “first incident reports” from ambulance on scene were sent to regional medical command and control within 2 minutes. Four hundred and fifty-six “verification reports” were sent within 10 minutes. During 15 incidents, the designated duty officer on regional level confirmed “major incident” directly via the digital system, thereby notifying all arriving ambulance resources and involved medical managements.
ConclusionThis Web-based IT system successfully has been used daily within prehospital management since 2005. The system includes medical command and control at the regional level and all involved hospitals in a major incident.
Production and egg quality in layers fed organic diets with mussel meal
- L. Jönsson, H. Wall, R. Tauson
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The first limiting nutrients in typical laying hen diets are the sulphur-containing amino acids and, in particular, methionine. To fulfil the birds’ recommended requirement, conventional diets are supplemented with synthetic methionine. As this is not allowed in organic production it becomes very important to have access to alternative high-quality protein feed ingredients. An experiment was performed to evaluate the possibility to compose a diet with 100% organically approved feed ingredients using mussel meal as a major source of methionine. The experiment included 678 Lohman Selected Leghorn (LSL) and 678 Hyline White, W-98, layers during 20 to 72 weeks of age. There were 12 aviary pens with 113 birds in each. The birds were fed one of the two experimental diets containing either 3.5% or 7% dried mussel meat meal or a commercial organic diet from a Swedish feed manufacturer for comparison. Production and mortality were recorded daily per group, and egg weight was recorded once weekly. At 33, 55 and 70 weeks, 10 eggs from each treatment group were collected and analysed for internal egg quality. Diets had no significant effect on laying percentage, egg mass, feed intake, feed conversion ratio, mortality, bird live weight or proportion misplaced, cracked or dirty eggs. Egg quality, that is, shell deformation, shell breaking strength, albumen height, shell percentage and proportion of blood and meat spots were also unaffected. There was a significant difference in egg yolk pigmentation, that is, the egg yolk was more coloured when feeding 7% mussel meal compared with the other diets. Hyline hens had lower feed intake and laying percentage, and higher egg weight, but lower egg mass production than LSL birds. The age of the birds influenced all egg quality traits except for meat and blood spots. The dry matter of the excreta was significantly lower for both genotypes fed the 7% mussel meal diet. These results indicate that mussels may be a high-quality protein source and may replace fishmeal in organic diets for layers.
Cognitive Behaviour Therapy for Withdrawal from Antidepressant Medication: A Single Case Series
- Paul Cromarty, Jaime Jonsson, Steve Moorhead, Mark H. Freeston
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- Journal:
- Behavioural and Cognitive Psychotherapy / Volume 39 / Issue 1 / January 2011
- Published online by Cambridge University Press:
- 20 September 2010, pp. 77-97
- Print publication:
- January 2011
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Background: Research has clearly established the efficacy of pharmacotherapy and cognitive behaviour therapy (CBT) for depression. There is less literature addressing cessation of treatment, such as relapse during withdrawal from antidepressant medication. Aims: The current study examines the role of psychological constructs that may influence relapse or fear of relapse and lead to resumption of medication. This hypothesizes that during withdrawal individuals may misinterpret normal variations in mood and dysphoric or other symptoms as reduced levels of medication in their bodies in keeping with a simplistic rationale for antidepressants. Method: The study uses an intensive single case AB style design in three cases during the withdrawal process. All participants had been treated with CBT plus antidepressants and had previously attempted to withdraw from antidepressants. The first part of the study naturalistically tracks belief changes as medication decreases; the second examines changes in these if/when a CBT intervention is introduced due to relapse or potential near-relapse. Daily self-monitoring diaries were used to measure target variables, together with standardized questionnaires up to 6 months follow-up. Results: Changes in symptoms, appraisal of symptoms, and beliefs about medication changed throughout the study. All participants remained medication free at 6 months follow-up. Two cases received CBT intervention due to possible relapse; the third underwent an unproblematic withdrawal. Conclusions: Patterns of change are discussed in terms of current approaches to medication cessation and the role of CBT during withdrawal.
Contributors
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- By Rose Teteki Abbey, K. C. Abraham, David Tuesday Adamo, LeRoy H. Aden, Efrain Agosto, Victor Aguilan, Gillian T. W. Ahlgren, Charanjit Kaur AjitSingh, Dorothy B E A Akoto, Giuseppe Alberigo, Daniel E. Albrecht, Ruth Albrecht, Daniel O. Aleshire, Urs Altermatt, Anand Amaladass, Michael Amaladoss, James N. Amanze, Lesley G. Anderson, Thomas C. Anderson, Victor Anderson, Hope S. Antone, María Pilar Aquino, Paula Arai, Victorio Araya Guillén, S. Wesley Ariarajah, Ellen T. Armour, Brett Gregory Armstrong, Atsuhiro Asano, Naim Stifan Ateek, Mahmoud Ayoub, John Alembillah Azumah, Mercedes L. García Bachmann, Irena Backus, J. Wayne Baker, Mieke Bal, Lewis V. Baldwin, William Barbieri, António Barbosa da Silva, David Basinger, Bolaji Olukemi Bateye, Oswald Bayer, Daniel H. Bays, Rosalie Beck, Nancy Elizabeth Bedford, Guy-Thomas Bedouelle, Chorbishop Seely Beggiani, Wolfgang Behringer, Christopher M. Bellitto, Byard Bennett, Harold V. Bennett, Teresa Berger, Miguel A. Bernad, Henley Bernard, Alan E. Bernstein, Jon L. Berquist, Johannes Beutler, Ana María Bidegain, Matthew P. Binkewicz, Jennifer Bird, Joseph Blenkinsopp, Dmytro Bondarenko, Paulo Bonfatti, Riet en Pim Bons-Storm, Jessica A. Boon, Marcus J. Borg, Mark Bosco, Peter C. Bouteneff, François Bovon, William D. Bowman, Paul S. Boyer, David Brakke, Richard E. Brantley, Marcus Braybrooke, Ian Breward, Ênio José da Costa Brito, Jewel Spears Brooker, Johannes Brosseder, Nicholas Canfield Read Brown, Robert F. Brown, Pamela K. Brubaker, Walter Brueggemann, Bishop Colin O. Buchanan, Stanley M. Burgess, Amy Nelson Burnett, J. Patout Burns, David B. Burrell, David Buttrick, James P. Byrd, Lavinia Byrne, Gerado Caetano, Marcos Caldas, Alkiviadis Calivas, William J. Callahan, Salvatore Calomino, Euan K. Cameron, William S. Campbell, Marcelo Ayres Camurça, Daniel F. Caner, Paul E. Capetz, Carlos F. Cardoza-Orlandi, Patrick W. Carey, Barbara Carvill, Hal Cauthron, Subhadra Mitra Channa, Mark D. Chapman, James H. Charlesworth, Kenneth R. Chase, Chen Zemin, Luciano Chianeque, Philip Chia Phin Yin, Francisca H. Chimhanda, Daniel Chiquete, John T. Chirban, Soobin Choi, Robert Choquette, Mita Choudhury, Gerald Christianson, John Chryssavgis, Sejong Chun, Esther Chung-Kim, Charles M. A. Clark, Elizabeth A. Clark, Sathianathan Clarke, Fred Cloud, John B. Cobb, W. Owen Cole, John A Coleman, John J. Collins, Sylvia Collins-Mayo, Paul K. Conkin, Beth A. Conklin, Sean Connolly, Demetrios J. Constantelos, Michael A. Conway, Paula M. Cooey, Austin Cooper, Michael L. Cooper-White, Pamela Cooper-White, L. William Countryman, Sérgio Coutinho, Pamela Couture, Shannon Craigo-Snell, James L. Crenshaw, David Crowner, Humberto Horacio Cucchetti, Lawrence S. Cunningham, Elizabeth Mason Currier, Emmanuel Cutrone, Mary L. Daniel, David D. Daniels, Robert Darden, Rolf Darge, Isaiah Dau, Jeffry C. Davis, Jane Dawson, Valentin Dedji, John W. de Gruchy, Paul DeHart, Wendy J. 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Yee, Viktor Yelensky, Yeo Khiok-Khng, Gustav K. K. Yeung, Angela Yiu, Amos Yong, Yong Ting Jin, You Bin, Youhanna Nessim Youssef, Eliana Yunes, Robert Michael Zaller, Valarie H. Ziegler, Barbara Brown Zikmund, Joyce Ann Zimmerman, Aurora Zlotnik, Zhuo Xinping
- Edited by Daniel Patte, Vanderbilt University, Tennessee
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- The Cambridge Dictionary of Christianity
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- 05 August 2012
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- 20 September 2010, pp xi-xliv
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Enterotoxigenic enteric bacteria in foods and outbreaks of food-borne diseases in Sweden
- M.-L. Danielsson, R. Möllby, H. Brag, N. Hansson, P. Jonsson, E. Olsson, T. Wadström
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- Journal of Hygiene / Volume 83 / Issue 1 / August 1979
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- 15 May 2009, pp. 33-40
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All of 86 foods routinely examined for potentially pathogenic enteric bacteria were found to harbour one or more coliform species. None of the strains isolated produced heat-labile enterotoxin (LT) or showed invasive properties. The suckling mouse test indicated that one strain of Escherichia coli produced heat-stable enterotoxin (ST). Twelve incidents of suspected food poisoning were also investigated. In two of them the foods examined contained LT-producing strains of E. coli and in two there were LT-producing strains of Klebsiella pneumoniae. The counts of viable enterotoxigenic micro-organisms in these foods were 3000–30 000 E. coli/g and 50 000 to 1 million K. pneumoniae/g. The dominant symptom in all the incidents was watery diarrhoea. These seem to be the first reported cases of foodborne enterotoxigenic enteric bacteria in Europe. Though enterotoxigenic E. coli and related gram-negative enterotoxin-producing species are rare in correctly handled food in Sweden, these micro-organisms should be searched for when outbreaks of food poisoning are investigated.
EUR-ASSESS Project Subgroup Report on Dissemination and Impact
- Alicia Granados, Egon Jonsson, H. David Banta, Lisa Bero, Ann Bonair, Mme. Camille Cochet, Nick Freemantle, Roberto Grilli, Jeremy Grimshaw, Emma Harvey, Ragnar Levi, Deborah Marshall, Andrew Oxman, Lionel Pasart, Virpi Räisänen, Elisa Rius, Josep A. Espinas
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- International Journal of Technology Assessment in Health Care / Volume 13 / Issue 2 / Spring 1997
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- 10 March 2009, pp. 220-286
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The objective of health technology assessment (HTA) is to support decision making in health care. HTA does not claim to provide a definite solution to a health care problem, but to assist decision makers with evidence-based information about the clinical, ethical, social, and economic implications of the development, diffusion, and use of health care technology.
Philosophy of Medicine, An Introduction, Henrick R. Wulff, Stig Andur Pedersen, and Raben Rosenberg. Oxford: Blackwell Scientific Publications, 1986, 222 pp. $35.50 cloth, $15.95 paper.
- Pia M. Jonsson, H. David Banta
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- International Journal of Technology Assessment in Health Care / Volume 4 / Issue 3 / July 1988
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- 10 March 2009, p. 478
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10 - The carbon economy of lichens
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- By K. Palmqvist, Department of Ecology and Ecology and Environmental Science Umeå University SE-90187 Umeå Sweden, L. Dahlman, Department of Ecology and Environmental Science Umeå University SE-90187 Umeå Sweden, A. Jonsson, Department of Ecology and Environmental Science Umeå University SE-90187 Umeå Sweden, T. H. Nash, School of Life Sciences Arizona State University Box 874501 Tempe, AZ 85287-4501 USA
- Edited by Thomas H. Nash, III, Arizona State University
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- Lichen Biology
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- 24 June 2008, pp 182-215
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Summary
Growth and survival of photosynthetic carbon autotrophs, such as lichens, are primarily limited by their photosynthetic carbon assimilation minus carbon dioxide (CO2) losses related to growth and maintenance respiration. The absolute, as well as the relative, rates of these two processes will hence determine their capacity to grow. In lichens, both photosynthesis (P) and respiration (R) are strongly constrained by prevailing environmental conditions, particularly water and light. There is also a variation in inherent P and R capacities among species and individuals. Significant progress has been made during the last two decades in understanding how such variations in external conditions and internal capacities affect lichen growth (Boucher and Nash 1990a; Muir et al. 1997; Sundberg et al. 1997, 2001; Hyvärinen and Crittenden 1998b; Palmqvist and Sundberg 2000; Hilmo and Holien 2002; Dahlman and Palmqvist 2003; Hyvärinen et al. 2003; Gaio-Oliveira et al. 2004a, 2006; Gauslaa 2006; Gauslaa et al. 2006b; Palmqvist and Dahlman 2006), including re-establishment of vegetative propagules (Hilmo and Sastad 2001; Hilmo and Ott 2002). This progress has been driven by the development of transplantation techniques in combination with more mechanistically oriented studies, knowledge that has further been used to formulate both conceptual (Palmqvist 2000) and more mechanistically oriented models (Link et al. 1985; Palmqvist and Sundberg 2000; Dahlman and Palmqvist 2003). Such models are useful for the direction of future research towards more explicit hypothesis testing, and could also be adopted to predict how environmental changes may affect particular lichen species, or compare species' abilities to utilize and acclimate to varying environmental conditions.