Low-dose (2-mSv) computed tomography for suspected appendicitis: Applicability in an emergency department

Objectives

To document the level of interobserver agreement and compare the diagnostic performances of emergency physicians and radiologists at interpreting low radiation CT images of acute appendicitis in adolescents and young adults.

Early identification of non‐remission in first‐episode psychosis in a two‐year outcome study

Simonsen E, Friis S, Opjordsmoen S, Mortensen EL, Haahr U, Melle I, Joa I, Johannessen JO, Larsen TK, Røssberg JI, Rund BR, Vaglum P, McGlashan TH. Early identification of non‐remission in first‐episode psychosis in a two‐year outcome study. Objective: To identify predictors of non‐remission in first‐episode, non‐affective psychosis. Method: During 4 years, we recruited 301 patients consecutively. Information about first remission at 3 months was available for 299 and at 2 years for 293 cases. Symptomatic and social outcomes were assessed at 3 months, 1 and 2 years. Results: One hundred and twenty‐nine patients (43%) remained psychotic at 3 months and 48 patients (16.4%) remained psychotic over 2 years. When we compared premorbid and baseline data for the three groups, the non‐remitted (n = 48), remitted for <6 months (n = 38) and for more than 6 months (n = 207), duration of untreated psychosis (DUP) was the only variable that significantly differentiated the groups (median DUP: 25.5, 14.4 and 6.0 weeks, respectively). Three months univariate predictors of non‐remission were being single, longer DUP, core schizophrenia, and less excitative and more negative symptoms at baseline. Two‐year predictors were younger age, being single and male, deteriorating premorbid social functioning, longer DUP and core schizophrenia. In multivariate analyses DUP, negative and excitative symptoms predicted non‐remission at 3 months, but only DUP predicted at 2 years. Conclusion: Long DUP predicted both 3 month and 2‐year non‐remission rates in first‐episode psychosis.     

Early detection of the first episode of schizophrenia and suicidal behavior

OBJECTIVE: The suicide rate in schizophrenia is high, with the risk being highest early in the course. The rate of suicide attempts before treatment onset is also high and is often the event leading up to first treatment contact. A previous report showed that the duration of untreated psychosis can be reduced through an early detection program, and that the reduction was associated with lower symptom levels at treatment initiation. Treatment programs that bring first-episode patients into treatment at lower symptom levels can have the potential to reduce risk for suicide attempts. METHOD: The authors examined consecutive patients with nonorganic, nonaffective psychosis who sought initial treatment at psychiatric treatment units in four catchment areas: two that had an early detection program and two that did not. RESULTS: The rate of severe suicidality (plans or attempts) was significantly higher in subjects from communities without the early detection program relative to those from early detection communities, even after adjustments for known predictors of suicidality. CONCLUSION: Early detection programs that bring patients into treatment at lower symptom levels may reduce suicidality risk at first treatment contact.     

The development of subjective quality of life over the first 2 years in first-episode psychosis

The main aim of this study was to examine changes in subjective quality of life (general s-QoL) in patients with first-episode psychosis from baseline to 2 years follow-up. A total of 201 of 252 patients had full quality of life assessment at both baseline and at 2 years. Repeated measure analyses of variance were done to evaluate the development over time, and multiple linear regression analyses to evaluate predictors of change. These patients with a first-episode psychosis showed a significant improvement in general s-QoL during the first 2 years of treatment. Improvements in general s-QoL were associated with increase in excitative symptoms and with improvements in depressive symptoms, global functioning, level of daily activities, level of social activities, and perceived general health.     

The key to reducing duration of untreated first psychosis: information campaigns

The TIPS early intervention program reduced the duration of untreated psychosis (DUP) in first-episode schizophrenia from 16 to 5 weeks in a health care sector using a combination of easy access detection teams (DTs) and a massive information campaign (IC) about the signs and symptoms of psychosis. This study reports what happens to DUP and presenting schizophrenia in the same health care sector when the IC is stopped. METHODS: Using an historical control design, we compare 2 cohorts of patients with first-episode Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition, non-affective psychosis at admission to treatment. The first cohort (N = 108) was recruited from January 1997 to December 2000, using an IC to raise awareness about recognizing psychosis to the public, the schools, and to general practitioners. The second cohort (N = 75) was recruited from January 2002 to June 2004 with no-IC. Easy access DTs were available to both cohorts. RESULTS: In the no-IC period, DUP increased back up to 15 weeks (median) and fewer patients came to clinical attention through the DTs. No-IC patients were diagnosed less frequently with schizophreniform disorder, more Positive and Negative Syndrome Scale positive and total symptoms, and poorer Global Assessment of Functioning (symptom) Scale scores. CONCLUSIONS: Intensive education campaigns toward the general public, the schools, and the primary health care services appear to be an important and necessary part of an early detection program. When such a campaign was stopped, there was a clear regressive change in help-seeking behavior with an increase in DUP and baseline symptoms.     

Effects on referral patterns of reducing intensive informational campaigns about first-episode psychosis

Aim: The primary aim of this study was to assess referral patterns and duration of untreated psychosis (DUP) following the partial dismantling of intensive, information campaigns (IC) to help detect first‐episode, non‐affective psychosis via early detection teams in the TIPS study. Methods: We compared referral patterns of potential cases from the same geographical region (Rogaland County, Norway) referred to low‐threshold, rapid‐response detection teams at three timepoints: early‐IC period (1997–1998), late‐IC period (1999–2000) and the no‐IC period (2002–2003). Results: A significant increase occurred in the total number of phone calls, Positive and Negative Syndrome Scale (PANSS)‐interviews and referrals from families from the early‐to the late‐IC period. A comparison of the late‐IC period versus no‐IC period showed a significant decrease in the number of PANSS‐interviews administered, as well as fewer cases referred to the assessment teams. Additionally, a significant decline occurred in the number of referrals from general physicians, whereas the number of direct referrals to the hospital units increased. The DUP increased from a median of 5 to 14 weeks. Conclusion: External referrals to easy access detection teams occurred more frequently when IC were intensive, especially referrals from families and general practitioners. A shorter DUP was observed in the IC period, suggesting the importance of IC in augmenting the effectiveness of detection teams in identifying first‐episode psychosis early in the course of illness.     

Caragasinin C: a new oligostilbene from the roots of Caragana sinica

A new oligostilbene, caragasinin C (1), and seven known compounds, betulinic acid (2), 4-hydroxybenzaldehyde (3), (?)-medicarpin (4), wistin (5), (2E,4S)-4-hydroxy-2-nonenoic acid (6), pallidol (7), and (+)-α-viniferin (8), were isolated from the roots of Caragana sinica. The structure of caragasinin C was established on the basis of spectroscopic techniques, including HRESIMS, 1D and 2D-NMR.     

Legume Proteins of the Vicilin Family are More Immunogenic Than Those of the Legumin Family in Weaned Piglets

Two experiments were conducted to study the systemic and local immune responses to legume proteins in piglets weaned at 28 d of age. The pigs were fed a control diet (C) based on casein or diets in which 50% of crude protein (CP) was supplied by soya bean meal (SBM), pea (P), faba bean (FB), or lupin (L) seeds in experiment 1, and white chickpea (WCP) or black chickpea (BCP) seeds in experiment 2. Blood samples and intestinal secretions were collected at slaughter four weeks later and analysed for specific antibodies using ELISA and western blotting. Piglets fed the legume-containing diets had higher ( P < 0.10) plasma immunoglobulin (Ig) G ELISA titres to legume proteins than did piglets fed a casein-based diet. Many protein bands in the molecular weight range of 94.0-14.4 kDa were recognized by plasma IgG and IgA antibodies. The most immunogenic bands belonged to proteins of the vicilin family and to other unidentified minor proteins. No specific IgA antibodies were detected in intestinal secretions by ELISA and western blotting.     

Legal outcomes for children who have been sexually abused: the impact of child abuse assessment center evaluations

Fifty children who were seen at a Child Abuse Assessment Center (CAAC) were matched on age and relationship to perpetrator with 51 children not evaluated at a CAAC to determine whether the groups differed in legal outcomes in cases of sexual abuse. CAAC children were significantly more likely to have cases filed rather than no-actioned, to have more overall counts charged in filed cases, to have more counts charged against biological fathers and stepfathers who were alleged perpetrators, and to have a greater number of defendants pleading or being found guilty compared to cases involving children not seen at the CAAC. There were also significantly more cases filed for 4- to 6-year-olds and children at least 12 years old if they were seen at the CAAC. The implications of the results are discussed in light of the use of CAACs.