Moving beyond transition outcomes: Meta-analysis of remission rates in individuals at high clinical risk for psychosis

Recent evidence suggests that transition risks from initial clinical high risk (CHR) status to psychosis are decreasing. The role played by remission in this context is mostly unknown. The present study addresses this issue by means of a meta-analysis including eight relevant studies published up to January 2012 that reported remission rates from an initial CHR status. The primary effect size measure was the longitudinal proportion of remissions compared to non-remission in subjects with a baseline CHR state. Random effect models were employed to address the high heterogeneity across studies included. To assess the robustness of the results, we performed sensitivity analyses by sequentially removing each study and rerunning the analysis. Of 773 subjects who met initial CHR criteria, 73% did not convert to psychosis along a 2-year follow. Of these, about 46% fully remitted from the baseline attenuated psychotic symptoms, as evaluated on the psychometric measures usually employed by prodromal services. The corresponding clinical remission was estimated as high as 35% of the baseline CHR sample. The CHR state is associated with a significant proportion of remitting subjects that can be accounted by the effective treatments received, a lead time bias, a dilution effect, a comorbid effect of other psychiatric diagnoses.     

Activity limitations in personal,domestic and vocational tasks: a study of adults with inborn and early acquired mobility disorders

Purpose: To compare activity limitations at the workplace with those in the home situation.

Subjects and methods: Sixty-nine subjects, 22?–?49 years of age, with inborn or early acquired mobility disorders and with experience of vocational employment were studied. They were interviewed to assess their level of dependence according to the Functional Independence Measure (FIM) and Instrumental Activity Measure (IAM) and in 22 vocation-related items. Rasch analysis was perfomed in order to assess the relative difficulty of the items. In the vocational items the subjects rated perceived difficulty on a 4-level scale. Satisfaction in one general and six domain-specific areas was rated on a 6-level scale.

Results: Forty-six per cent of the subjects were dependent in one or several FIM items, 90% in IAM items and 38% in the vocation-related items. In 15 of these items great difficulty was reported by few subjects. Collapsing the 7-category scale for dependence to four categories gave the best Rasch model. Most of the IAM items were the hardest to manage without assistance. FIM social-cognitive and cognitive vocation-related items were the easiest items. Most subjects were satisfied in the general and domain-specific areas.

Conclusions: Activities related to household tasks and transportation demonstrated the highest level of dependence, whereas it was easier to acquire independence in most vocation-related tasks.     

Derivation of occupational exposure limits: Differences in methods and protection levels

Frameworks for deriving occupational exposure limits (OELs) and OEL-analogue values (such as derived-no-effect levels [DNELs]) in various regulatory areas in the EU and at national level in Germany were analysed. Reasons for differences between frameworks and possible means of improving transparency and harmonisation were identified. Differences between assessment factors used for deriving exposure limits proved to be one important reason for diverging numerical values. Distributions for exposure time, interspecies and intraspecies extrapolation were combined by probabilistic methods and compared with default values of assessment factors used in the various OEL frameworks in order to investigate protection levels. In a subchronic inhalation study showing local effects in the respiratory tract, the probability that assessment factors were sufficiently high to protect 99% and 95% of the target population (workers) from adverse effects varied considerably from 9% to 71% and 17% to 87%, respectively, between the frameworks. All steps of the derivation process, including the uncertainty associated with the point of departure (POD), were further analysed with two examples of full probabilistic assessments. It is proposed that benchmark modelling should be the method of choice for deriving PODs and that all OEL frameworks should provide detailed guidance documents and clearly define their protection goals by stating the proportion of the exposed population the OEL aims to cover and the probability with which they intend to provide protection from adverse effects. Harmonisation can be achieved by agreeing on the way to perform the methodological steps for deriving OELs and on common protection goals.     

Arginine Supplementation Improves Rotorod Performance in Sickle Transgenic Mice

Patients with sickle cell disease (SCD) have been shown to have impaired visual-motor speed and coordination. Sensorimotor deficits in mice can be investigated by motor coordination tests that require whole body movements such as the rotorod. A sickle transgenic mouse model (S+S-Antilles) that expresses human α, human β S and human β S-Antilles , is homozygous for the mouse β major deletion, and has low plasma arginine was compared to control C57BL/6J mice and S+S-Antilles mice supplemented with 5% arginine on the rotorod. The rotorod consists of a 2.5 cm diameter, grooved rod turning at constant acceleration, requiring postural adjustments on the part of the mice to maintain equilibrium. C57BL mice on Purina ® mouse chow had an average latency to fall of 169±61 s, S+S-Antilles mice on Purina ® mouse chow had an average of 127±56 s ( P <0.005 ). S+S-Antilles mice after 5% arginine supplementation had a mean latency of 180±32 s ( P <0.003 ). Arginine may improve rotorod performance in sickle transgenic mice by increasing NO synthesis thereby improving vasodilatation and blood flow with reversal of ischemia in brain and/or muscle. In conclusion, impaired rotorod performance in sickle transgenic mice presents an opportunity to apply this simple task to provide an efficient method to screen some types of therapeutic regimens for efficacy in SCD.     

Retained surgical sponges: what the practicing clinician should know

Retained surgical sponges (RSS) are an avoidable complication following surgical operations. RSS can elicit either an early exudative-type reaction or a late aseptic fibrous tissue reaction. They may remain asymptomatic for long time; when present, symptomatology varies substantially and includes septic complications (abscess formation, peritonitis) or fibrous reaction resulting in adhesion formation or fistulation into adjacent hollow organs or externally. Plain radiograph may be useful for the diagnosis; however, computed tomography is the method of choice to establish correct diagnosis preoperatively. Removal of RSS is always indicated to prevent further complications. This is usually accomplished by open surgery; rarely, endoscopic or laparoscopic removal may be successful. Prevention is of key importance to avoid not only morbidity and even mortality but also medicolegal consequences. Preventive measures include careful counting, use of sponges marked with a radiopaque marker, avoidance of use of small sponges during abdominal procedures, careful examination of the abdomen by the operating surgeon before closure, radiograph in the operating theater (either routinely or selectively), and recently, usage of barcode and radiofrequency identification technology.     

Outcome and clinical changes in patients 3, 6, 12 months after a severe or major hand injury - can sense of coherence be an indicator for rehabilitation focus?

Background  

Our objective was to explore outcome and clinical changes in hand function, satisfaction in daily occupations, sleep disturbances, health and quality of life in consecutive patients after a severe or major hand injury. Our objective was also to investigate possible differences between groups according to severity of injury, presence of peripheral nerve injury and the patients' sense of coherence.