Rok Tavcar

A Prospective, Randomized Comparison of Semitendinosus and Gracilis Tendon versus Patellar Tendon Autografts for Anterior Cruciate Ligament Reconstruction: Five-Year Follow-Up

Background There are still controversies about graft selection for primary anterior cruciate ligament reconstruction. Prospective randomized long-term studies are needed to determine the differences between the materials. Hypothesis Five years after anterior cruciate ligament reconstruction, there is a difference between hamstring and patellar tendon grafts in development of degenerative knee joint disease. Study Design Randomized controlled trial; Level of evidence, 1. Methods From June 1999 to March 2000, 64 patients were included in this prospective study. A single surgeon performed primary arthroscopically assisted anterior cruciate ligament reconstruction in an alternating sequence. In 32 patients, anterior cruciate ligament reconstruction was performed with hamstring tendon autograft, whereas in the other 32 patients, anterior cruciate ligament reconstruction was performed with patellar tendon autograft. Results At the 5-year follow-up, no statistically significant differences were seen with respect to the Lysholm score, clinical and KT-2000 arthrometer laxity testing, anterior knee pain, single-legged hop test, or International Knee Documentation Committee classification results; 23 patients (82%) in the hamstring tendon group and 23 patients (88%) in the patellar tendon group returned to their preinjury activity levels. Graft rupture occurred in 2 patients from the hamstring tendon group (7%) and in 2 patients from the patellar tendon group (8%). Grade B abnormal radiographic findings were seen in 50% (13/26) of patients in the patellar tendon group and in 17% (5/28) of patients in the hamstring tendon group (P =. 012). Conclusion Both hamstring and patellar tendon grafts provided good subjective outcomes and objective stability at 5 years. No significant differences in the rate of graft failure were identified. Patients with patellar tendon grafts had a greater prevalence of osteoarthritis at 5 years after surgery.

Community Rehabilitation Service for Patients with Severe Psychotic Disorders: The Slovene Experience

Background: Rehabilitation can be carried out at various sites. Method: Two groups of patients with severe mental disorders were compared: those included in community rehabilitation service and those only attending an outpatient clinic regarding their clinical status, social functioning, standard of living and quality of life. Results: We found no significant global differences in group characteristics, social functioning and clinical status, but we did prove the lower social status of the group included in the rehabilitation service and their satisfaction with the services they use. Conclusions: The community rehabilitation services in Slovenia are coping with existential social needs of their users but this study failed to demonstrate their success in improving health or social functioning.

Cost-Utility Analysis

Cost-utility analysis is a method which is most often used when benefits cannot be expressed in monetary (profit) or metric values (days of sick leave). The utilities in cost-utility analyses are in fact preferences of each person, a selected group, or the whole population. Since quality of life is one of the preferences, estimation of quality of life is frequently used in health economics. The results of cost-utility analyses are expressed in QALY – quality adjusted life years. QALY indicates the average number of years of quality life which a person with a defined health status will be able to live in a case that a certain intervention is carried out. This indicator therefore shows the cost of intervention with regard to a specific outcome, life in quality. In psychiatry the measurements of health outcome like survival, disability, sick leave, quality of life, satisfaction of clients, etc., were traditionally important but in the recent years the awareness of costs associated with any health intervention has grown. In studying mental disorders the situation seems somewhat specific since traditional outcome indicators do not always reflect the many (complex) faces of mental disorder. Although the methodology is appropriate to compare health economic issues of different mental disorders these studies are scarce, probably due to a complicated design. It is much easier to conduct an outcome study with a single diagnostic category. On the other hand there were many studies that were comparing costs and other outcomes of different preventive and therapeutic interventions in a single diagnostic category. The results of cost-utility analyses are useful in many situations: planning of service development, resource allocations, to find out the best available intervention for persons with a certain health status, etc.

The knowledge of inpatients with schizophrenia on their medication at hospital discharge.

Purpose—To examine the knowledge of schizophrenic in patients regarding their medication.

EPA-1049 – Painful physical symptoms: is there a difference between bipolar and unipolar depression

Introduction Depression and pain symptoms are often comorbid and share common neurobiological and psychological background. Objectives and aimes To find out the prevalence of painful physical symptoms (PPS) in otherwise healthy patients hospitalized due to recurrent unipolar (UD) and bipolar depression (BD) and to compare socio-demographic and illness related characteristics. Methods 180 somatically healthy patients were recruited in the study. Symptoms of depression were evaluated with standard clinical tools. The presence of somatic illness was excluded. Visual Analogue Scale was used to evaluate the intensity and location of painful symptoms. Sociodemographic, illness and therapy related data, substance use, and suicidality were recorded as well. Results 41 patients met criteria for BD and 139 for UD. The average age was 50 years (75% females). Higher prevalence of PPS in group of UD (72.6%) in comparison to BD (58.5%) was found. The average intensity of painful symptoms was high. Patients with UD+PPS had higher total number of PPS and scored higher on HAM-D 21 and Zung Self Rating Depression Scale than patients with BD+PPS. Use of analgesics and anxiolytics was high. Conclusions The study offers an insight in the high prevalence of PPS in patients with acute severe unipolar and bipolar depression and the results warn of possible over prescribing of analgesics and anxiolytics. Lower prevalence of PPS in BD might be explained with less severe depression symptoms. The results offer new information on PPS in acute bipolar depression since there is very little research data on this topic.

DEPRESSION AND DIABETES MELLITUS

BACKGROUND The prevalence of depression among diabetic patients is twice as high as in the generalpopulation. CONCLUSIONS The authors want to turn attention to this problem, considering also the previous findingsof epidemiological surveys, and try to explain the possible causes of comorbidity. Biological, psychological, and socio-economic factors concerning the interrelation between depression and diabetes are discussed in more detail. The authors emphasize the co-influence between the diseases, which can complicate the treatment or accelerate the progressionof both of them, especially when depression in diabetic patients is not recognized, and isconsequently not properly treated. Basic approaches to treatment of depressive symptomsin diabetic patients based on the use of antidepressants and cognitive behavioral therapyare described

Evidence-based prevention strategies of suicide behavior in the world: implications for Slovenia.

In this review we consider how Slovenia could consider tackling its high rate of suicide (overall 29 per 100,000, 46 in males, 13 in females). First, we consider the evidence for risk factors that may contribute to Slovenias high rate of suicide. Second, we describe the interventions to try to reduce the impact of these factors and the evidence for such interventions. We categorize interventions in terms of their operation at either the population level or that of high-risk groups. However, it should be borne in mind that settings often assumed to provide access to population groups, such as general practice and schools, do not reach some people who are likely to be at high risk; for example those who have dropped out of school or who have been excluded from a GPs list. We focus particularly on those for high-risk groups, as a number of East-European countries with high suicide rates such as Slovenia, Hungary, and the Baltic republics are currently considering a shift toward more community-based mental health services. The provision of community mental health services in Slovenia would provide an opportunity to study their impact on the suicide rate. However, we conclude that their development should be accompanied by other initiatives operating at population levels. This multilevel approach acknowledges the complexity of the etiology of suicide, the impossibility of reaching all those at risk through services and the lack of strong evidence for any one intervention.