Knowledge on types of treatment pressure. A cross-sectional study among mental health professionals

Treatment pressure restricts patients' voluntary and autonomous decisions. Yet interventions involving treatment pressure are widely used in mental health and psychosocial services. This cross-sectional study explored whether mental health professionals' knowledge on five types of treatment pressure (no coercion, persuasion or conviction, leverage, threat, and formal coercion) was associated with sociodemographic, professional and contextual factors. A more positive attitude towards interventions involving treatment pressure was associated with underrating the level of those interventions compared with a predefined default value. The treatment setting and professional group played a minor role in ‘leverage’ and ‘formal coercion’ types of treatment pressure, respectively.     

Solid extraintestinal malignancies in patients with inflammatory bowel disease

Malignancies constitute the second cause of death in patients with inflammatory bowel diseases (IBD), after cardiovascular diseases. Although it has been postulated that IBD patients are at greater risk of colorectal cancer compared to the general population, lately there has been evidence supporting that this risk is diminishing over time as a result of better surveillance, while the incidence of extraintestinal cancers (EICs) is increasing. This could be attributed either to systemic inflammation caused by IBD or to long-lasting immunosuppression due to IBD treatments. It seems that the overall risk of EICs is higher for Crohn’s disease patients and it is mainly driven by skin cancers, and liver-biliary cancers in patients with IBD and primary sclerosing cholangitis. The aims of this review were first to evaluate the prevalence, characteristics, and risk factors of EICs in patients with IBD and second to raise awareness regarding a proper surveillance program resulting in early diagnosis, better prognosis and survival, especially in the era of new IBD treatments that are on the way.     

Simultaneous Procedures During Left Ventricular Assist Device Implantation: Is Less Always More?

In up to 50 % of patients undergoing continuous flow, axial pump, left-ventricular and assist device (LVAD) placement, concomitant procedures are performed. The underlying lesions have a broad spectrum of severity, complexity, and impact on clinical outcomes. This review describes the concomitant lesions often encountered with LVAD implantation and clinical relevance of their repair.     

Chronic liver disease rarely follows acute hepatitis B in non-immunocompromised adults

Summary The risk of developing a chronic carriage state after acute hepatitis B infection in adults was evaluated. Two hundred and eighty-nine HBV-susceptible heterosexual partners of acute hepatitis B patients were used to investigate the effectiveness of post-exposure immunoprophylaxis; 75 of them received hepatitis B vaccine, 72 hepatitis B hyperimmune globulin (HBIG), 71 vaccine plus HBIG and 71 placebo. Participants were interviewed, clinically examined and serum specimens were taken at 1, 3, 6 and 9 months after their first intervention. Serum samples were tested for ALT and HBV markers (HBsAg, anti-HBc and anti-HBs) using radio immunoassays. Forty-six (15.9%) of the heterosexual partners examined were infected; the incidence of HBV infections was higher among placebo (18.3%, 13/71) and HBIG (18.1%, 13/72) recipients compared to vaccine (16.0%, 12/75) and HBIG plus vaccine (11.3%, 8/71) recipients, but the differences were not statistically significant. Infections were significantly more often subclinical after immunoprophylaxis (p=0.03). HBsAg was detected in all eight clinical and in 13 of the 38 subclinical cases. In the remaining 25 subclinical cases HBV infections were diagnosed by the development of anti-HBc and anti-HBs during the follow-up period. Finally, all 46 cases studied cleared the HBsAg.

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Bei Erwachsenen ohne Abwehrstörung geht die B-Hepatitis nur selten in eine chronische Lebererkrankung über

Zusammenfassung Die Entwicklung eines chronischen Trägerstatus wurde bei 289 für eine HBV-Infektion empfänglichen heterosexuellen Partnern von Patienten mit akuter Hepatitis B verfolgt, bei denen die Wirksamkeit einer postexpositionellen Immunprophylaxe geprüft wurde. Bei 75 Personen wurde Hepatitis B-Vakzine eingesetzt, bei 72 Hyperimmunglobulin (HBIG), bei 71 Vakzine plus HBIG und bei 71 Placebo. Anamnestische Befragung und Nachuntersuchungen erfolgten jeweils 1, 3, 6 und 9 Monate nach der ersten Intervention. Serumspiegel von ALT und HBV-Markern (HBsAg, anti-HBc und anti-HBs) wurden mittels Radioimmunoassay bestimmt. Insgesamt hatten 46 der heterosexuellen Partner die HBV-Infektion erworben (15,9%). Nach Placebogabe waren 13/71 (18,3%) mit HBV infiziert, nach HBIG 13/72 (18,1%). Die Infektionraten waren nach Vakzine (12/75; 16%) sowie nach HBIG plus Vakzine (8/71; 11,3%) neidriger, jedoch war der Unterschied nicht statistisch signifikant. Nach Immunprophylaxe verliefen die Infektionen signifikant häufiger subklinisch als nach Placebogabe (p=0,03). HBsAg war in allen acht Fällen einer klinischen und in 13 von 38 Fällen einer subklinischen HBV-Infektion nachzuweisen. In den übrigen 25 subklinischen Fällen wurde die HBV- Infektion durch das Auftreten von anti-HBc und anti-HBs im Verlauf der Beobachtungszeit diagnostiziert. In allen 46 Fällen wurde HBsAg schließlich eliminiert.