Normative Performance on the Brief Smell Identification Test (BSIT) in a Multi-Ethnic Bilingual Cohort: A Project FRONTIER Study 1

The Brief Smell Identification Test (BSIT) is a commonly used measure of olfactory functioning in elderly populations. Few studies have provided normative data for this measure, and minimal data are available regarding the impact of sociodemographic factors on test scores. This study presents normative data for the BSIT in a sample of English- and Spanish-speaking Hispanic and non-Hispanic Whites. A Rasch analysis was also conducted to identify the items that best discriminated between varying levels of olfactory functioning, as measured by the BSIT. The total sample included 302 older adults seen as part of an ongoing study of rural cognitive aging, Project FRONTIER. Hierarchical regression analyses revealed that BSIT scores require adjustment by age and gender, but years of education, ethnicity, and language did not significantly influence BSIT performance. Four items best discriminated between varying levels of smell identification, accounting for 59.44% of total information provided by the measure. However, items did not represent a continuum of difficulty on the BSIT. The results of this study indicate that the BSIT appears to be well-suited for assessing odor identification deficits in older adults of diverse backgrounds, but that fine-tuning of this instrument may be recommended in light of its items’ difficulty and discrimination parameters. Clinical and empirical implications are discussed.     

Temporomandibular Joint: MR Fast Scanning

Eleven hundred ninety temporomandibular joints (TMJ) in 662 patients were studied with high field strength surface coil magnetic resonance using high resolution T1-weighted closed-mouth and short partial flip angle closed- and open-mouth images to evaluate internal derangement. Partial flip angle (gradient recalled acquisition in the steady state, or GRASS) images using image acquisition times as short as three seconds in most cases provided reliable information on disk position, morphology, and intrinsic signal. Abnormalities of disk function may be studied using sequential GRASS scans during incremental degrees of mouth opening. Joint effusions may be delineated by T2* effects, and avascular necrosis (AVN) of the mandibular condyle is demonstrated. Fast GRASS scans provide accurate information and may be employed alone or in conjunction with standard T1-weighted images in studies of the TMJ. Combined studies using both T1-weighted closed- and short GRASS open-mouth scans provide greater information than is obtained from either T1-weighted or GRASS scans alone, and examination times are short compared to T2-weighted pulse sequence techniques.     

Mental health treatment seeking among patients with OCD: impact of age of onset

Background

Several studies have described the deficits in the health care provided to persons with obsessive–compulsive disorder (OCD), however, without making any distinction between psychiatric–psychotherapeutic professionals and general practitioners or other professionals. Also, the relation between subjectively defined early signs of the disorder, diagnosis and utilization of professional help has not yet been investigated systematically. The present study addresses these questions, using a self-rating questionnaire for patients with OCD (questionnaire on the utilization of professional help by patients with OCD).

Methods

Eighty-eight patients with OCD, who came to our University Hospital Outpatient Clinic for obsessive–compulsive disorders in Leipzig, participated in the study. The questionnaire, which had been developed specially for this survey, asked study participants to remember when they had first perceived signs of their disorder and their first-time utilization of professional help.

Results

Patients with OCD and early onset of disorder sought professional help later than did patients with later onset of disorder. When professional help was utilized, it took 2 years on average before the diagnosis was made. Patients with OCD first consulted a psychiatrist or psychotherapist and not the general practitioner as their first professional contact person.

Conclusion

First signs in the early stages of OCD, particularly with an onset in childhood and adolescence have to be diagnosed at an earlier stage for appropriate treatment. Psychiatrists and psychotherapists, not primarily general practitioners, have a particularly high demand for further education about early diagnosis and treatment of OCD.     

Entwicklungen und Perspektiven der Notfallpflege in Deutschland

Background

During the last few years, emergency care has moved into the center of educational and political interest. Reinforced by the Krankenhausstrukturgesetz (KHSG), which focuses on strengthening the nursing profession and on improving emergency care, there are many efforts to recognize emergency care as an independent specialty.

Results

The DGINA recommendation for specialist training in emergency care is based on the number of hours recommended by the DKG for nursing training. The number of hours required in the Charité curriculum is similar. Two German states have continuing education programs in the area of emergency care that are legally recognized, but with greatly reduced hours. Moreover, emergency medical technicians (Notfallsanitäter) and academically qualified graduates represent new professional groups in the emergency room.

Conclusions

Many of the latest developments reinforce the professionalization of emergency care. The federal structures in the field of education and policy and the lack of superordinate care structures are a disincentive with regard to professionalization. A consensus catalog of learning objectives must be developed. Care-relevant quality indicators must be defined to reflect the quality of emergency care.

     

Implementation of the redesigned Community Health Fund in the Dodoma region of Tanzania: A qualitative study of views from rural communities

The need to understand how an intervention is received by the beneficiary community is well recognised and particularly neglected in the micro–health insurance (MHI) domain. This study explored the views and reactions of the beneficiary community of the redesigned Community Health Fund (CHF) implemented in the Dodoma region of Tanzania. We collected data from focus group discussions with 24 groups of villagers (CHF members and nonmembers) and in‐depth interviews with 12 key informants (enrolment officers and health care workers). The transcribed material was analysed thematically. We found that participants highly appreciate the scheme, but to be resolved are the challenges posed by the implementation strategies adopted. The responses of the community were nested within a complex pathway relating to their interaction with the implementation strategies and their ongoing reflections regarding the benefits of the scheme. Community reactions ranged from accepting to rejecting the scheme, demanding the right to receive benefit packages once enrolled, and dropping out of the scheme when it failed to meet their expectations. Reported drivers of the responses included intensity of CHF communication activities, management of enrolment procedures, delivery of benefit packages, critical features of the scheme, and contextual factors (health system and socio‐political context). This study highlights that scheme design and implementation strategies that address people's needs, voices, and values can improve uptake of MHI interventions. The study adds to the knowledge base on implementing MHI initiatives and could promote interests in assessing the response to interventions within the MHI domain and beyond.     

Pathology, natural history and treatment of abdominal aortic aneurysms

With increasing age of the population and improvement of diagnostic tools, the incidence of abdominal aortic aneurysms (AAA) has been rising steadily. Despite an improvement in operative and interventional treatment options, AAA is the cause of death in 1-3% of men over 65 years of age in industrial countries, mostly due to rupture [1]. Therefore, routine screening for AAA by ultrasonography has been postulated in the past: a 60 year old man with an abdominal aortic diameter of less than 3 cm has a life-time risk of developing AAA close to zero. However, routine screening has not been found to be cost effective. Despite of the results of two well-designed studies, the limits of AAA qualifying the patient for surgery or intervention in contrast to conservative treatment is still a matter of debate. The present review article summarizes the current knowledge of the pathology, incidence, risks, natural course as well as symptoms and current treatment strategies of AAA on the basis of the recent literature.