Utility of the Brief Symptom Inventory in the Assessment of Psychological Distress

Introduction People with intellectual disabilities are now acknowledged to be susceptible to the full range of mental health disorders. This acknowledgement has resulted in the need to develop and evaluate instruments for the assessment and detection of mental health problems. This research evaluates the use of the Brief Symptom Inventory (BSI) with 200 people with mild intellectual disabilities representing community, clinical and forensic populations. Results and conclusions Results illustrate the reliability of the BSI for each of the groups and demonstrates how the Positive Symptom Total (PST) index effectively discriminates between study groups. Case rates for each group are provided. The study illustrates that the BSI could be employed as a brief multitrait assessment instrument and as a treatment outcome measure with people with an intellectual disability.     

Stability of human methanogenic flora over 35 years and a review of insights obtained from breath methane measurements.

BACKGROUND & AIMS: Breath methane measurements reflect the in situ activity of the methanogenic colonic flora. Thirty-five years ago we found that 34% of healthy adult subjects were methane producers (breath methane level >1 ppm above atmospheric methane levels). The current study presents a new survey of breath methane levels designed to determine if the activity of the methanogenic flora has changed over the past 35 years. In addition, we review insights into the methanogenic flora that have resulted from breath methane measurements. METHODS: The end-alveolar breath methane concentrations of 212 healthy adults living in the Minneapolis area were determined via gas chromatography. The influence of sex, age, and bowel movement frequency on methane production was assessed. RESULTS: The findings that 36.4% of participants were methane producers, with a mean methane concentration in these producers of 16.6 ppm, are strikingly similar to the values of 33.6% and 15.2 ppm observed 35 years ago. Neither sex nor age showed a statistically significant relationship to methane production. There was a negative correlation between frequency of bowel movements and breath methane concentration in methane producers. CONCLUSIONS: The activity of the methanogenic flora of healthy adults remained remarkably stable over the past 35 years despite widespread antibiotic use and dietary changes. A literature review revealed that many associations have been shown between methane production and clinical states, but it remains to be determined if methanogens actively influence human physiology or are simply a marker of colonic function.     

Are Continuity Clinic Patients Less Satisfied When the Resident Is Postcall?

Due to recent public debate and newly imposed resident work hour restrictions, we decided to investigate the relationship of resident call status to their ambulatory patients' satisfaction. Resident continuity clinic patients were asked to rate their level of satisfaction on a 10-point Likert-type scale. Using multiple regression approaches, these data were then assessed as a function of resident call status. We found that in 646 patient encounters, patient satisfaction scores were significantly less when the resident was postcall, 8.99 ± 1.8, than when not postcall, 9.31 ± 1.3. We herein discuss etiologies and implications of these findings for both patient care and medical education.     

Flexible endoscopes: structure and function: the endoscopic retrograde cholangiopancreatography elevator system.

Flexible endoscopes are complex medical instruments that are easily damaged. In order to maintain the flexible endoscope in optimum working condition, the user must have a thorough understanding of the structure and function of the instrument. This is the fourth in a series of articles presenting an in-depth look at the care and handling of the flexible endoscope. The first three articles discussed the air-water system, the suction channel system, and the mechanical system. This article will focus specifically on the endoscopic retrograde cholangiopancreatography elevator system.     

The Results of Water Fluoridation in Ireland

The visit of Dr. Trendley Dean to Dublin in the mid-1950s helped accelerate the decision to introduce water fluoridation as a public health measure in the prevention of caries in the Republic of Ireland. A challenge to the constitutional validity of the Health (Fluoridation of Water Supplies) Act 1960 failed and in 1964 the water supplies of Dublin city were fluoridated. Over the next seven to eight years all the major urban communities in the Republic of Ireland were fluoridated. Currently, 67 percent of the 3.5 million people in the country reside in fluoridated communities. Studies conducted over the last 20 years show that residents of fluoridated communities have better dental health than those in nonfluoridated communities—the mean dmft is lower in children and the number of natural teeth present in adults is higher.     

Beta irradiation of recurrent ptergia: results and complications.

Although postoperative beta irradiation for prevention of pterygium recurrence is widely used, its complication rate has not been widely appreciated. Thirty-six patients underwent pterygium excision followed by irradiation with 90Sr to between 1600 and 5300 cGy (median 2400) in two to four fractions over 7 to 27 days. A median of three fields were used in each treatment course (range two to 10). Most patients had undergone previous treatment for their pterygia, including surgery alone (25 patients), or both surgery and irradiation (5 patients). Overall, recurrences developed in 10 eyes (28%). Recurrence occurred in one eye after re-irradiation (20%), compared to 9 of 31 (29%) previously non-irradiated eyes (p greater than 0.1). There was no association with number of excisions and recurrences, although all but 6 patients had undergone more than one excision. Thirteen patients (36%) developed complications including: epithelial defect or corneal thinning (3), symblepharon (5), cataract (4) and corneal ulceration (1). Complications developed in 4 of the 5 (80%) re-irradiated eyes compared to 9 of 31 (29%) previously non-irradiated eyes (p less than 0.05). The power of the statistical analysis was limited by sample size, but no significant association was observed between the development of complications or recurrences and total dose, number of abutting fields, number of previous surgical excisions or patient age, even when re-irradiated patients were excluded. Recently described calibration uncertainties with the 90Sr applicator may explain in part these complications. Alternatively, technical factors such as the number of fields or volume treated may play a role. Excessive complications and recurrences with the use of postoperative beta irradiation in this series emphasize the danger of re-treatment and the need for alternative safe and effective therapies.