Responses to the publication of the American Psychiatric Association’s DSM 5

The idea and practice of ‘diagnosis’ in psychiatry has always been controversial. Controversy came to a head in the period preceding and immediately after publication of the latest version of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, DSM-5. There was widespread international discussion and debate not only in scholarly journals but in mainstream and social media, and to the formation of International DSM Response Committee and an International Summit on Psychiatric Diagnosis. This article documents that process and outlines the issues that provoked, and continue to provoke most controversy, from the (admittedly personal) perspective of those involved. It ends with suggestions of alternatives to diagnosis, which avoid some of these problems and outlines how these are being taken forward. The next ten years are likely to see significant change

Key priorities for Australian infection control: summary of findings from the launch of the Centre for Research Excellence in Reducing Healthcare Associated Infections

The launch of the Centre of Research Excellence in Reducing Healthcare Associated Infection (CRE-RHAI) took place in Sydney on Friday 12 October 2012. The mission of the CRE-RHAI is to generate new knowledge about strategies to reduce healthcare associated infections and to provide data on the cost-effectiveness of infection control programs. As well as launching the CRE-RHAI, an important part of this event was a stakeholder Consultation Workshop, which brought together several experts in the Australian infection control community. The aims of this workshop were to establish the research and clinical priorities in Australian infection control, assess the importance of various multi-resistant organisms, and to gather information about decision making in infection control. We present here a summary and discussion of the responses we received

Guidelines for the prevention of endocarditis: report of the Working Party of the British Society for Antimicrobial Chemotherapy

These guidelines have been produced following a literature review of the requirement for prophylaxis to prevent bacterial endocarditis following dental and surgical interventions. Recommendations are made based on the quality of available evidence and the consequent risk of morbidity and mortality for ‘at risk’ patients

Medications and cognitive risk in Aboriginal primary care: a cross‐sectional study

Background: Aboriginal and Torres Strait Islander people are ageing with high rates of comorbidity, yet little is known about suboptimal prescribing in this population. Aim: The prevalence of potentially suboptimal prescribing and associated risk factors were investigated among older patients attending primary care through Aboriginal Community Controlled Health Services (ACCHSs). Methods: Medical records of 420 systematically selected patients aged ≥50 years attending urban, rural and remote health services were audited. Polypharmacy (≥ 5 prescribed medications), potentially inappropriate medications (PIMs) as per Beers Criteria and anticholinergic burden (ACB) were estimated and associated risk factors were explored with logistic regression. Results: The prevalence of polypharmacy, PIMs and ACB score ≥3 was 43%, 18% and 12% respectively. In multivariable logistic regression analyses, polypharmacy was less likely in rural (odds ratio (OR) = 0.43, 95% confidence interval (CI) = 0.24–0.77) compared to urban patients, and more likely in those with heart disease (OR = 2.62, 95% CI = 1.62–4.25), atrial fibrillation (OR = 4.25, 95% CI = 1.08–16.81), hypertension (OR = 2.14, 95% CI = 1.34–3.44), diabetes (OR = 2.72, 95% CI = 1.69–4.39) or depression (OR = 1.91, 95% CI = 1.19–3.06). PIMs were more frequent in females (OR = 1.88, 95% CI = 1.03–3.42) and less frequent in rural (OR = 0.41, 95% CI = 0.19–0.85) and remote (OR = 0.58, 95% CI = 0.29–1.18) patients. Factors associated with PIMs were kidney disease (OR = 2.60, 95% CI = 1.37–4.92), urinary incontinence (OR = 3.00, 95% CI = 1.02–8.83), depression (OR = 2.67, 95% CI = 1.50–4.77), heavy alcohol use (OR = 2.83, 95% CI = 1.39–5.75) and subjective cognitive concerns (OR = 2.69, 95% CI = 1.31–5.52). High ACB was less common in rural (OR = 0.10, 95% CI = 0.03–0.34) and remote (OR = 0.51, 95% CI = 0.25–1.04) patients and more common in those with kidney disease (OR = 3.07, 95% CI = 1.50–6.30) or depression (OR = 3.32, 95% CI = 1.70–6.47). Conclusion: Associations between potentially suboptimal prescribing and depression or cognitive concerns highlight the importance of considering medication review and deprescribing for these patients

Critical windows for nutritional interventions against stunting.

An analysis of early growth patterns in children from 54 resource-poor countries in Africa and Southeast Asia shows a rapid falloff in the height-for-age z score during the first 2 y of life and no recovery until ≥5 y of age. This finding has focused attention on the period -9 to 24 mo as a window of opportunity for interventions against stunting and has garnered considerable political backing for investment targeted at the first 1000 d. These important initiatives should not be undermined, but the objective of this study was to counteract the growing impression that interventions outside of this period cannot be effective. We illustrate our arguments using longitudinal data from the Consortium of Health Oriented Research in Transitioning collaboration (Brazil, Guatemala, India, Philippines, and South Africa) and our own cross-sectional and longitudinal growth data from rural Gambia. We show that substantial height catch-up occurs between 24 mo and midchildhood and again between midchildhood and adulthood, even in the absence of any interventions. Longitudinal growth data from rural Gambia also illustrate that an extended pubertal growth phase allows very considerable height recovery, especially in girls during adolescence. In light of the critical importance of maternal stature to her children's health, our arguments are a reminder of the importance of the more comprehensive UNICEF/Sub-Committee on Nutrition Through the Life-Cycle approach. In particular, we argue that adolescence represents an additional window of opportunity during which substantial life cycle and intergenerational effects can be accrued. The regulation of such growth is complex and may be affected by nutritional interventions imposed many years previously

g(HbF):a genetic model of fetal hemoglobin in sickle cell disease

Key Points The 3 established HbF genetic loci can be summarized into 1 quantitative variable, g(HbF), in SCD and influence markers of SCD severity. g(HbF) provides a quantitative marker for the genetic component of HbF% variability, potentially useful in genetic and clinical studies in SCD.</jats:p