Predictors of violent victimization amongst those with psychosis

OBJECTIVE: The aim of this study was to establish the prevalence and predictors of violent victimization amongst a community-dwelling sample of individuals with psychosis. METHOD: The 2-year prevalence of self-reported violent victimization was estimated for a sample of 708 individuals with chronic psychosis living in the community in four urban UK centres. Baseline socio-demographic and clinical factors were examined as possible risk factors for victimization over the 2-year follow-up period. RESULTS: The 2-year prevalence of violent victimization in the sample was 23%. Four factors were found to be independently predictive of victimization - history of victimization, less than daily family contact, young age at illness onset and the presence of co-morbid Cluster B personality disorder. CONCLUSION: Those with psychotic illnesses are at elevated risk of being assaulted. Given the likely adverse health implications, clinicians should routinely enquire about victimization in their assessments of those with psychotic disorders particularly amongst those who are socially isolated, with a younger age of illness onset and in those with co-morbid personality disorder.     

Clearance of amyloid-beta peptide by neuronal and non-neuronal cells: proteolytic degradation by secreted and membrane associated proteases

Deposition of amyloid-beta peptide (Abeta) in the brain is an early and invariant feature of all forms of Alzheimer's disease (AD). As for all proteins or peptides, the steady-state level of Abeta peptide is determined not only by its production, but also by its degradation. So, overactive proteases involved in generating Abeta from amyloid precursor protein or underactive Abeta-degrading enzymes could lead to abnormal Abeta deposition in the brain. Since in the sporadic forms of AD (90% of all AD cases) an impaired clearance of Abeta appears to be at the origin of its aggregation and tissue deposition, we have investigated its proteolytic degradation by several neuronal and non-neuronal cells. In this report, we show that these cell types exhibit a similar profile of Abeta-degradation by cell-surface and secreted proteases which were respectively characterized as metallo- and serine proteases. By using a combination of the liquid chromatography/on-line mass spectrometry, we demonstrate that: (i)-the membrane associated protease(s) hydrolizes Abeta40 essentially at Lys(28) Gly(29), Phe(19) Phe(20) and Val(18) Phe(19) bonds; and (ii)-the secreted protease(s) cleaves the generating fragments Abeta (1-28), Abeta (1-19), Abeta (1-18) at His(14) Gln(15) bond and also Abeta (1-28) at Phe(20) Ala(21) and Asp(23) Val(24) sites. This is the first time our results define a proteolytic degradation process of Abeta40 that appears to be independent of the cell type and may represent a general pattern of its enzymatic clearance.     

Embedding routine alcohol screening and brief interventions in a rural general hospital

Issues. Alcohol screening and brief intervention approaches (SBI) are strongly supported by evidence, but few health‐care facilities have successfully introduced and sustained routine SBI. Approach. This paper describes the first 2 years of implementing SBI in an Australian rural general hospital. The SBI project aims were to universally screen presentations to Northeast Health Wangaratta (NHW), to provide brief interventions to people screening at medium risk of harm from drinking and enhanced referral for persons screening at high risk. Key Findings. In 2007 and 2008, the NHW SBI project conducted 11 079 screens for alcohol use disorders using the Alcohol Use Disorders Identification Screening Test screening tool. Eighty‐five per cent of persons screened at low risk of alcohol‐related problems, 11% at medium risk and 4% at high risk. Implications. Policy and planning bodies and hospital management's support and the appointment of a dedicated project worker are critical to successful SBI implementation. Conclusion. It is possible to establish a SBI service in a rural general hospital setting. The NHW SBI project broadened the focus from treatment of persons with severe dependency to detection, early intervention and prevention for the larger, more easily treated, cohort of persons drinking at hazardous/harmful but non‐dependent levels. The challenge for any organisation is to maintain routine SBI deployment over the long term. [Fahy P, Croton G, Voogt S. Embedding routine alcohol screening and brief interventions in a rural general hospital. Drug Alcohol Rev 2011;30;47–54]     

生活方式改善对预防糖尿病的重要作用

营养过剩、肥胖．缺少运动是糖尿病发病的重要原因。本文针对这些原因阐述了防止肥胖、控制饮食和增加运动等生活方式的改善对预防糖尿病的重要作用。     

Nonsurgical airway management training for surgeons

PURPOSE: Airway management occupies a crucial component of surgical education. As such, it can be difficult to provide adequate training within the hospital setting alone. To be facile in all aspects of nonsurgical airway management, the surgical resident must have thorough cognitive understanding of the process as well as technical mastery. The Department of Surgery at the Methodist Hospital in Houston has developed a curriculum for nonsurgical airway management that uses multiple modalities for education, reinforcement, and testing. Didactic lectures based on established national guidelines are provided as a foundation. This method is supplemented by hands-on group scenarios that use inanimate models. Throughout the course, faculty leaders provide guidance and skills assessment. Residents are tested for competency using core value checklists based on knowledge and technical proficiency. During its pilot year, the curriculum has proven its need and success in residency education. Future improvements include development of specific clinical scenarios as well as integration of more advanced educational equipment and models for use in nonsurgical airway management. DEVELOPMENT OF THE ACTIVITY AND MATERIALS: Materials used for this program include an article by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway, the New England Journal of Medicine article entitled "Videos in clinical medicine. Orotracheal intubation" by Kabrhel et al,(2) "Management of the difficult and failed airway" by Hung and Murphy,(3) the American Heart Association Airway Management course 2007,(4) and the Manual of Emergency Airway Management by Walls et al.(5) EVALUATION COMPONENT: Before participating in the module, residents completed a written pretest and performed an initial simulation to establish a baseline. Residents then worked through a series of skills that provided experience in both the cognitive and the procedural aspects of airway management. To complete the module successfully, residents were required to attend three 3-hour sessions. After supervised practice, residents were tested on the procedural techniques via a procedural checklist and cognitive aspects with respect to emergency, crash, difficult, and failed airway algorithms.(1,5) The simulations are based on the 2003 American Society of Anesthesiologists Task Force on Management of the Difficult Airway Algorithms(1) and emergency, crash, difficult, and failed airway algorithms.(2,5) PROPOSED OUTCOME MEASURES: Proposed long-term outcome measures will include evaluations from faculty on a resident's noninvasive airway management skills and the resident's self-evaluation in actual noninvasive airway management situations. Resident performance will be evaluated by faculty using standardized checklists, review of simulation parameters, and review of audio-video recording of the simulation. EXPERIENCE TO DATE: This article describes our first implementation in the evolution of this module. The module was introduced to residents at all postgraduate levels in September 2007. Scores on pretests and performance on initial simulations were similar in all postgraduate years, with minimally superior pretest and initial simulation performance from the senior residents. Correct procedural adoption occurred rapidly after prebriefing and initial hands-on demonstration and supervised practice in simulated patient scenarios on airway mannequins. CONCLUSIONS AND NEXT STEPS: Our preliminary experience with a nonsurgical airway management training module for surgical residents has shown that a need for training exists in this critical area. Correct procedural adoption occurred rapidly after a didactic and procedural hands-on experience. Time intervals needed for review to maintain competence will also be studied. Improvements to the proficiency criteria and simulations are underway.     

Management of resistant halo nevi

Background: Halo nevus (HN) is a rare dermatologic disorder characterized by typical whitish rim surrounding an existing melanocytic nevus resembling halo. It is a cosmetic problem that may be linked to vitiligo, and it is advised to remove these nevi in order to avoid development of vitiligo.

Objectives: The aim of the present study is to evaluate the cosmetic outcome after nevus removal and leukoderma dermabrasion with epithelial graft followed by narrow-band ultraviolet B (NB-UVB) phototherapy as management of resistant halo nevi and avoidance of development of vitiligo.

Patients and Methods: Ten patients with persisting halo nevi were selected as candidates in this study. Superficial dermabrasion was carried out using proper diamond fraises on depigmented rim and then punch biopsy probes with suitable size were used to harvest the nevus. Thiersch graft was prepared and applied on the dermabraded depigmented area. After 1 week of the procedure, patients were exposed to NB-UVB twice weekly and were followed up for 3 months.

Results: Repigmentation was noticed in 2 weeks and was nearly fully accomplished in all 10 patients within the 3-month period. No other vitiligo lesions developed during this period in all patients except for one case.

Conclusion: Excision of Sutton’s nevus with combined dermabrasion and Thiersch grafting followed by phototherapy is a good aesthetic maneuver in treating halo nevi and helps in avoiding further vitiligo depigmentation.     

Sensitive skin evaluation in the Japanese population

Sensitive skin syndrome was first described in 1977; however, no robust study has been carried out to evaluate its prevalence in Japan. A national representative sample of the Japanese population over the age of 18 years was taken. Individuals were questioned by telephone and selected according to the quota method. When asked “Do you have a sensitive skin?”, 52.84% of men and 55.98% of women answered “rather sensitive” or “very sensitive”. There was no significant difference (P = 0.22) between the two sexes. The non‐response rate among respondents was zero, suggesting that the term “sensitive skin” held a meaning for the majority of the population. Concerning questions about the onset of a rash, tingling or irritation in the presence of various factors, such as emotional issues, cold, heat, sun, dry air, air‐conditioning, water, air pollution and temperature variations, respondents with rather sensitive or very sensitive skin responded “yes” more often than others: approximately three‐times more often for water (18.97%/6.15%), air pollution (39.29%/12.45%) and warm climatic conditions (29.74%/9.8%). To our knowledge, this epidemiological study is the first to focus on sensitive skin among Japanese people of this century. It is of particular interest for two reasons: (i) it was conducted on a representative sample of the Japanese population; and (ii) the methodology used was identical to that used for sensitive skin assessment studies conducted in Europe and the USA, making it possible to draw certain comparisons.     

克罗米芬联合促卵泡素治疗30例多囊卵巢综合征的疗效分析

目的探讨分析克罗米芬联合促卵泡素在多囊卵巢综合征（PCOS）治疗中的疗效。方法回顾性分析该院就诊并确诊为PCOS的患者共60例,随机数法分为两组,对照组治疗方案：克罗米芬＋人绒毛膜促性腺激素（HCG）,观察组治疗方案：克罗米芬＋促卵泡素＋人绝经期促性腺激素（HMG）＋HCG,排卵后黄体酮支持治疗两周,比较两组患者促排卵疗效。结果观察组患者排卵率和妊娠率均明显高于对照组（P〈0.05）;观察组患者治疗总有效率明显高于对照组（P〈0.05）。结论克罗米芬联合促卵泡素治疗PCOS促排卵疗效确切,能够有效提高排卵率和妊娠率,推荐临床推广应用。     

呼和浩特市区餐饮单位的餐具消毒效果

目的了解呼和浩特市餐饮单位餐具消毒状况,分析不同规模餐饮单位餐具消毒效果。方法采用大肠菌群快速检测纸片法,抽取2005-2007年本市餐饮单位消毒后备用餐具进行检测。结果3年共检测餐具7957份,合格率为64.28％;大、中、小型餐饮单位合格率分别为74.59％、65.32％和36.33％;大中专院校食堂合格率为68.21％。结论呼和浩特市餐具消毒总体合格率较低,应加大执法力度,加强监测频率,尤其要督促搞好学校食堂餐具消毒工作。     

Diagnosis and management of asthma in preschoolers: A Canadian Thoracic Society and Canadian Paediatric Society position paper

Asthma often starts before six years of age. However, there remains uncertainty as to when and how a preschool-age child with symptoms suggestive of asthma can be diagnosed with this condition. This delays treatment and contributes to both short- and long-term morbidity. Members of the Canadian Thoracic Society Asthma Clinical Assembly partnered with the Canadian Paediatric Society to develop a joint working group with the mandate to develop a position paper on the diagnosis and management of asthma in preschoolers.In the absence of lung function tests, the diagnosis of asthma should be considered in children one to five years of age with frequent (≥8 days/month) asthma-like symptoms or recurrent (≥2) exacerbations (episodes with asthma-like signs). The diagnosis requires the objective document of signs or convincing parent-reported symptoms of airflow obstruction (improvement in these signs or symptoms with asthma therapy), and no clinical suspicion of an alternative diagnosis. The characteristic feature of airflow obstruction is wheezing, commonly accompanied by difficulty breathing and cough. Reversibility with asthma medications is defined as direct observation of improvement with short-acting ß₂-agonists (SABA) (with or without oral corticosteroids) by a trained health care practitioner during an acute exacerbation (preferred method). However, in children with no wheezing (or other signs of airflow obstruction) on presentation, reversibility may be determined by convincing parental report of a symptomatic response to a three-month therapeutic trial of a medium dose of inhaled corticosteroids with as-needed SABA (alternative method), or as-needed SABA alone (weaker alternative method). The authors provide key messages regarding in whom to consider the diagnosis, terms to be abandoned, when to refer to an asthma specialist and the initial management strategy. Finally, dissemination plans and priority areas for research are identified.