Radiology is valuable to general practitioners; but who pays?

This study evaluated an open access general practitioner radiological service. Questionnaires were completed in 216 out of 250 cases both before and after radiological examination. Chests and specials (bariums, intravenous urography, ultrasound) were most often of diagnostic value when confirming normality, while other radiographs were more likely to be of value in assessing the severity of known disease (P less than 0.001). Patient therapy was altered in 31% of cases following receipt of the radiological report, and management was changed in 40%. In 25% of cases the patient was discharged on receipt of the report. In 28% of cases the report avoided a hospital referral. Special examinations were most likely (P less than 0.05) to avoid a referral. It is concluded that open access radiology is a considerable help with diagnosis and management, and substantially reduces out-patient referrals. The possible consequences for the acute services of providing a full general practitioner diagnostic service are discussed.     

Essstörungen und Typ-1-Diabetes im Kindes- und Jugendalter

This paper gives an overview of concurrent type 1 diabetes mellitus and eating disorders during childhood and adolescence. In addition to the presentation of epidemiological data and study designs, theoretical assumptions on the concurrence of both diseases and on the causality of both are summarized and discussed. In addition, somatic complications are listed and long-term sequelae are considered. The authors identify a need for further research and interdisciplinary management efforts on behalf of this patient group, which is characterized by an elevated risk of mortality.     

Atypical retardation pattern: can performance of classification be improved?

PURPOSE: (1) To evaluate and compare the classification performance of Wavelet-Fourier analysis (WFA), Fast-Fourier analysis (FFA), and the standard GDx-variable corneal compensator (VCC) output in identifying glaucomatous eyes from a mixed group of healthy and glaucomatous eyes with atypical retardation pattern (ARP). (2) To investigate if classification performance improves when only the superior and inferior quadrants are used for WFA and FFA. (3) To evaluate the classification performance as a function of severity of ARP. METHODS: Retinal nerve fiber layer (RNFL) estimates were obtained from 445 eyes of 240 individuals. On the basis of typical scan score (TSS), 348 eyes had typical retardation pattern (TRP) and 97 had ARP (78% TRP and 22% ARP). The classification performance of WFA and FFA classifiers was tested using three different ways: (1) Classifiers were trained on the TRP data, and tested on ARP data. (2) Classifiers were trained on TRP and 90% ARP data using 10-fold cross validation technique and tested on ARP data (10%). (3) Classifiers were trained and tested using the ARP data using 10-fold cross validation technique. Sensitivity, specificity, and Receiver Operating Characteristic Curve (ROC) areas were calculated. The classification performance was also assessed for the standard parameters of GDx-VCC. RESULTS: Of the standard GDx-VCC parameters, the nerve fiber indicator (NFI) had the highest ROC area (0.80). Of the shape-based analyses, WFA and FFA of the complete temporal, superior, nasal, inferior, and temporal curve had the highest ROC area (0.85 and 0.82, respectively). The difference in the ROC areas did not reach the statistically significant level (p = 0.07). On eyes with severe ARP (TSS < 60) all metrics performed similarly, but in case of moderate ARP (TSS 60 to 79), the ROC area of WFA and FFA were both greater than that of NFI (the difference was 9% and 7%, respectively). CONCLUSION: Although the WFA and FFA classification performance was greater than NFI as assessed by ROC area the difference was not statistically significant.     

Structural determinants of the binding of gliadin fragments to human peripheral blood lymphocytes

A series of alpha-gliadin fragments, structurally related to alpha-gliadin-(43-49), were synthesized. The effect of these fragments and beta-casomorphin and naloxone on the steady-state binding of [125I]-alpha-gliadin-(43-49) to human peripheral blood lymphocytes was investigated. In an attempt to correlate the binding data with the conformation of the peptides, their circular dichroism spectra were measured in both trifluorethanol and aqueous solution. It was found that there is a striking correlation between the results of the binding studies and the chiroptical properties of the gliadin fragments. The presence of N-terminal tyrosine and the tendency of the peptides to adopt periodic, 310 helix-like secondary structure appear to be crucial for the binding to human peripheral blood lymphocytes.     

Termination of long term treatment in a residential home: quotas, conditions and additional comments

The method of discharge of 235 children from a pedagogic-psychotherapeutic children's home between 1968 and 1987 was examined. The centre of interest were the terminations by the parents (13% of all discharges) and those brought about by the home itself (8%). The latter were partly those falsely admitted, some of these developed complications during a later stage in the treatment. The results indicate that the terminations by the parents were independent of age on admission, sex of the child and the type of disturbance involved. It was, however, noticible that parents of children with autistic disturbances and multiple partial performance deficiencies did not require early termination. An increase in parental termination was shown where individual limitations of parent-child contact were implemented. Terminations by the home showed a systematic relationship to certain contraindications to institutionalized conditions of treatment. The introduction of parental participation in particular lead to a dramatic decrease in the total of all terminations.     

Altered lymphocyte acetylcholinesterase activity in patients with senile dementia

Reductions in the acetylcholinesterase (AChE) activity of certain brain areas in patients with senile dementia of Alzheimer type (SDAT) have been found to correlate with the severity of the disease, suggesting a central cholinergic lesion. Since AChE is expressed on the surface of various blood cells too, the AChE activity of lymphocytes and erythrocytes was determined to test the possibility whether the cholinergic lesion is also reflected on these readily available cells. The AChE activity of lymphocytes in SDAT and in alcoholic dementia (AD) were significantly lower as compared to those of the age-matched healthy volunteers. In contrast, there was no significant difference in the activity of lymphocyte AChE between age-matched healthy controls and patients with multi-infarct dementia of vascular origin (MID). No changes could be demonstrated in the erythrocyte AChE activities of the patients studied, and the age-matched healthy individuals, when comparing them to the healthy blood donors. The AChE activity of lymphocytes may thus be a useful marker to follow the alterations in the metabolism of acetylcholine (ACh) in the central nervous system (CNS) of different types of dementia.     

Urinary excretion of albumin in adolescents with type 1 diabetes: persistent versus intermittent microalbuminuria and relationship to duration of diabetes, sex, and metabolic control.

OBJECTIVE: Urinary excretion of albumin is a marker for incipient diabetic nephropathy in adults. The intra-individual variability, as well as the relationship to duration of diabetes, onset of the disease, and long-term metabolic control, have not been evaluated in a large sample of pediatric patients. RESEARCH DESIGN AND METHODS: A total of 5,722 nocturnal urinary albumin excretion rates were determined in 447 children, adolescents, and young adults with type 1 diabetes, comprising 1,821 years of observation. Excretion rates were related to duration of diabetes, age at onset of diabetes, sex, blood pressure, and metabolic control. RESULTS: Based on repeated measurements in individual patients, the positive predictive value of one sample was 76%, the negative 99.5%. After a duration of diabetes of 11 years, 5% of patients displayed persistent microalbuminuria (10% after 13 years). The duration of diabetes until persistent microalbuminuria was identical for patients with prepubertal or pubertal onset of diabetes. In addition to duration, female sex (P < 0.03) and insufficient long-term metabolic control (P < 0.03) contributed significantly and independently to urinary albumin excretion. CONCLUSIONS: Determination of urinary albumin excretion rate is useful in pediatric patients. Female subjects with a long duration of diabetes and insufficient metabolic control are especially at risk for microalbuminuria. Even if persistent microalbuminuria usually becomes evident in patients aged > 11 years, the prepubertal duration of diabetes contributes equally to this risk. Good metabolic control therefore should be aspired to from the onset of diabetes.     

Hospitalization among diabetic children and adolescents and the general population in Germany. German Working Group for Pediatric Diabetology

OBJECTIVE: To compare hospitalization in a multicenter-based cohort of diabetic children and adolescents (aged 1-19 years) in Germany with that of the general population. RESEARCH DESIGN AND METHODS: Based on standardized documentation, hospital stays after manifestation were ascertained in diabetic subjects 1-19 years of age in 1997. Hospitalization data in the general German population were derived from official statistics. Incidence rates and numbers of hospital days were estimated. Ratios of hospitalization incidences and numbers of hospital days between the diabetic and the general population were calculated. Costs for hospital care in the German diabetic population in 1997 were determined. RESULTS: A total of 5,874 patients came from 61 pediatric centers (52% male, age [mean +/- SD] 12.2 +/- 4.3 years, diabetes duration 4.6 +/- 4.4 years). Hospitalization incidence rates and hospital days per person-year (95% CI) were 0.27 (0.25-0.29) and 1.80 (1.75-1.84) in the diabetic population and 0.0948 (0.0946-0.0949) and 0.6416 (0.6412-0.6420) in the general population. The standardized ratio of hospital incidences was 3.1 (2.9-3.2), and the ratio of numbers of hospital days was 2.8 (2.7-2.9). Costs for hospital care after manifestation were estimated to be $506 (U.S. dollars) per person-year and $12.4 million in the whole German diabetic population aged 1-19 years in 1997; including hospital stays at diabetes onset, total annual costs were $24 million ($970 per person-year). CONCLUSIONS: Diabetic children and adolescents in Germany had an approximately three times higher hospitalization risk and three times more hospital days than the age-matched general population. Including hospitalization at diabetes onset, the annual costs of hospital care for the German diabetic population aged 1-19 years amounted to approximately 1% of all costs for hospital care in this age-group. Thus, costs were largely overproportional (diabetes prevalence 0.1%).     

Raising suspicion of maltreatment from burns: Derivation and validation of the BuRN-Tool

Background

10–25% of childhood burns arise from maltreatment.