Quality of life of people with severe mental health problems:Testing an interactive model

Improvement of subjective quality of life (QoL) is seen as an important treatment outcome in clinical practice. The aim of this study is to test the theoretical model of Cummins, which includes a homeostatic management system. According to this model, objective variables are almost irrelevant to general well-being, while the feeling of having an influence on one’s circumstances (perceived deficit) is related to subjective QoL. The variables of the Cummins model were operationalised based on the Lancashire Quality of Life Profile, a structured interview to assess the subjective QoL of people with severe mental health problems. The Cummins model was tested using structural equation modelling and a mediator model between Objective QoL, Subjective QoL and Perceived Deficit. Subjective QoL and General Well-Being were significantly related and having a meaningful perspective in life was related to General Well-Being. Contrary to the Cummins model, both Objective QoL and Perceived Deficit had a significant relation to Subjective QoL and Perceived Deficit was a partial mediator between Objective QoL and Subjective QoL. Cummins’ theoretical model was partially confirmed. The current study suggests that meaningful (treatment) evaluation of subjective QoL can only be performed if objective QoL, General Well-Being and subjective evaluation (Perceived Deficit and Framework) are taken into account

Microleakage after Thermocycling of Three Self-Etch Adhesives under Resin-Modified Glass-Ionomer Cement Restorations

This study was designed to evaluate microleakage that appeared on Resin-Modified Glass-Ionomer Cement (RMGIC) restorations. Sixty class V cavities (h × w × l = 2 mm × 2 mm × 3 mm) were cut on thirty extracted third molars, which were randomly allocated to three experimental groups. All the buccal cavities were pretreated with polyacrylic acid, whereas the lingual cavities were treated with three one-step Self-Etch adhesives, respectively, Xeno III (Dentsply Detrey GmbH, Konstanz, Germany), iBond exp (Heraeus Kulzer gmbH & Co. KG, Hanau, Germany), and Adper Prompt-L-Pop (3M ESPE AG, Dental products Seefeld, Germany). All cavities were completely filled with RMGIC, teeth were thermocycled for 800 cycles, and leakage was evaluated. Results were expressed as means ± standard deviations (SDs). Microleakage scores were analysed by means of generalized linear mixed models (GLMMs) assuming an ordinal logistic link function. All results were considered to be significant at the 5% critical level (P < .05). The results showed that bonding RMGIC to dentin with a Self-Etch adhesive rather than using polyacrylic acid did not influence microleakage scores (P = .091), except for one tested Self-Etch adhesive, namely, Xeno III (P < .0001). Nevertheless, our results did not show any significant difference between the three tested Self-Etch adhesive systems. In conclusion, the pretreatment of dentin with Self-Etch adhesive system, before RMGIC filling, seems to be an alternative to the conventional Dentin Conditioner for the clinicians as suggested by our results (thermocycling) and others (microtensile tests)

Neural tube defect diagnosis and outcomes at a tertiary South African hospital with intensive case ascertainment

Background. Neural tube defects (NTDs) are an important category of birth defect, but surveillance remains inadequate in South Africa.Objectives. To assess the identification of NTDs at a tertiary hospital using a range of prenatal, perinatal and postnatal data sources, and to estimate the impact of prenatal diagnosis and birth prevalence for the referral area.Methods. Cases of anencephaly, encephalocele and spina bifida (SB) in a 6-year period were retrospectively identified from 5 data sources covering prenatal, perinatal and postnatal care. These were cross-correlated to avoid duplicate entries and to determine the contribution of different data sources. Details of prenatal diagnosis and termination of pregnancy (TOP) were obtained for 10 years, and birth prevalence over 2 years.Results. During a 6-year period 195 NTDs were identified at a Western Cape Province tertiary hospital. These included 59 (30%) cases of anencephaly, 28 (14%) of encephalocele and 108 (55%) of SB. The majority of NTDs (71%) were detected prenatally, although SB was less commonly diagnosed prenatally than cranial defects (56% v. 88%; p&lt;0.001). Of SB cases ascertained pre- or postnatally, 57% of patients were born alive and 50% discharged alive, but 72% of survivors had not been diagnosed prenatally. Women receiving prenatal diagnosis of any type of NTD before 24 weeks’ gestation were nearly always offered TOP, and the majority accepted termination after non-directive counselling. For SB, later prenatal diagnosis was associated with much lower termination rates because the option was less often offered (51% v. 100%; p&lt;0.001), and perhaps less often accepted (57% v. 78%; p=0.06). The estimated NTD birth prevalence for the referral area was 0.76 - 0.80 per 1 000 live births, but perhaps up to 1.18 per 1 000 when considering under-referral of lethal cranial lesions from rural areas.Conclusions. A substantial number of NTDs can be ascertained from a tertiary hospital environment if multiple data sources are used, even though adding data from the Perinatal Problem Identification Program for outlying health facilities increases detection of lethal defects. Hospital-based surveillance can be considered, especially for SB. Prenatal diagnosis was fairly common and pregnancy termination was often offered and accepted if detected before 24 weeks’ gestation. A regional prenatal ultrasound programme, predominantly based in primary care but with ready access to a tertiary centre, can be quite effective, although limited or delayed access to prenatal diagnosis must be addressed

De consultatie-liaisonpsychiatrie in de Belgische ziekenhuizen van de eenentwintigste eeuw : quo vadis?

In een tijd waarin de geneeskunde zich uitsplitst in een groeiend aantal specialismen, subspecialismen en superspecialismen is er in de algemene en de universitaire ziekenhuizen een toenemende nood aan multidisciplinaire samenwerking. Deze vorm van samenwerking is nodig om hoogstaande holistische zorg te blijven verlenen aan de patiënt als centrale figuur in het zorgproces. De technologische mogelijkheden in de geneeskundige zorg nemen toe, maar er is een belangrijke comorbiditeit tussen de medische aandoeningen. De consultatie-liaisonpsychiatrie (CLP) is een van de disciplines die hierop inspeelt. Deze discipline focust vanuit een multidisciplinaire en integrale zorgvisie op de psychiatrische diagnostiek en behandeling van patiënten met psychiatrische en somatische comorbiditeit die hiervoor behandeld en opgevolgd worden in een algemeen ziekenhuis. Dit artikel wil een overzicht geven van de functies van de CLP zowel binnen als buiten het ziekenhuis en licht het historische en huidige Belgische beleid en de wetgeving ter zake toe. Er worden ook aanbevelingen geformuleerd voor de toekomst en men pleit voor de implementatie van de CLP als een volwaardige en structurele klinische activiteit en opdracht in de algemene ziekenhuizen

Neural tube defect diagnosis and outcomes at a tertiary South African hospital with intensive case ascertainment

CITATION: Krzesinski, E. I., Geerts, L. & Urban, M. F. 2019. Neural tube defect diagnosis and outcomes at a tertiary South African hospital with intensive case ascertainment. South African Medical Journal, 109(9):698-703, doi:10.7196/SAMJ.2019.v109i9.13863.The original publication is available at http://www.samj.org.zaBackground. Neural tube defects (NTDs) are an important category of birth defect, but surveillance remains inadequate in South Africa. Objectives. To assess the identification of NTDs at a tertiary hospital using a range of prenatal, perinatal and postnatal data sources, and to estimate the impact of prenatal diagnosis and birth prevalence for the referral area. Methods. Cases of anencephaly, encephalocele and spina bifida (SB) in a 6-year period were retrospectively identified from 5 data sources covering prenatal, perinatal and postnatal care. These were cross-correlated to avoid duplicate entries and to determine the contribution of different data sources. Details of prenatal diagnosis and termination of pregnancy (TOP) were obtained for 10 years, and birth prevalence over 2 years. Results. During a 6-year period 195 NTDs were identified at a Western Cape Province tertiary hospital. These included 59 (30%) cases of anencephaly, 28 (14%) of encephalocele and 108 (55%) of SB. The majority of NTDs (71%) were detected prenatally, although SB was less commonly diagnosed prenatally than cranial defects (56% v. 88%; p<0.001). Of SB cases ascertained pre- or postnatally, 57% of patients were born alive and 50% discharged alive, but 72% of survivors had not been diagnosed prenatally. Women receiving prenatal diagnosis of any type of NTD before 24 weeks’ gestation were nearly always offered TOP, and the majority accepted termination after non-directive counselling. For SB, later prenatal diagnosis was associated with much lower termination rates because the option was less often offered (51% v. 100%; p<0.001), and perhaps less often accepted (57% v. 78%; p=0.06). The estimated NTD birth prevalence for the referral area was 0.76 - 0.80 per 1 000 live births, but perhaps up to 1.18 per 1 000 when considering under-referral of lethal cranial lesions from rural areas. Conclusions. A substantial number of NTDs can be ascertained from a tertiary hospital environment if multiple data sources are used, even though adding data from the Perinatal Problem Identification Program for outlying health facilities increases detection of lethal defects. Hospital-based surveillance can be considered, especially for SB. Prenatal diagnosis was fairly common and pregnancy termination was often offered and accepted if detected before 24 weeks’ gestation. A regional prenatal ultrasound programme, predominantly based in primary care but with ready access to a tertiary centre, can be quite effective, although limited or delayed access to prenatal diagnosis must be addressed.http://www.samj.org.za/index.php/samj/article/view/12693Publisher's versio

Children's opinions about organ donation:a first step to assent?

Background: Parents have to decide about organ donation after the death of their child. Although most parents probably would like to respect their child's intentions, parents often are not aware of their child's wishes. This requires insight into children's opinions about donation. Methods: An internet survey that investigated whether Dutch children in the age range of 12 through 15 years had heard about organ donation, what their opinions were on donation and whether the topic had been discussed at home. Questionnaire response rate 38%. Results: Around 99% of 2016 responders had heard about organ donation and about the possibility of becoming a donor, 75% preferred to decide for themselves about donation, 43% had discussed organ donation more than once at home, 66% were willing to donate. The willingness to donate was positively associated with age and socio-economic status. Conclusion: This survey indicates that these children at 12 through 15 years of age are capable and willing to think about organ donation. Thought should be given about how to raise awareness and how to enable parents and children to develop some sort of health literacy concerning the concept of organ donation. Children and their parents should be given adequate opportunities to receive appropriate information, suited to their psychological and moral developmental status

Fatty fish and supplements are the greatest modifiable contributors to the serum 25-hydroxyvitamin D concentration in a multiethnic population

Objective: Because vitamin D synthesis is lower in a heavily pigmented skin than in a lighter skin, the relative contribution of determinants to the vitamin D concentration might differ between ethnic groups. The aim of this study was to assess the prevalence of vitamin D deficiency and the relative contribution of vitamin D consumption and exposure to sunlight to the vitamin D concentration in a multiethnic population. Design: Cross-sectional study. Patients A total of 613 adults aged 18-65 years from a random sample from general practices in the Netherlands (52 degrees N, 2003-05), stratified according to gender and ethnic group. Measurements Serum 25-hydroxyvitamin D [25(OH)D], PTH, ethnic group, sunlight exposure, consumption of foods and supplements rich in vitamin D. Results The prevalence (95% confidence interval) of vitamin D deficiency [serum 25(OH)D < 25 nmol/l] was higher in Turkish (41.3%; 32.5-50.1), Moroccan (36.5%; 26.9-46.1), Surinam South Asian (51.4%; 41.9-60.9), Surinam Creole (45.3%; 34.0-56.6), sub-Saharan African (19.3%; 9.1-29.5) and other adults (29.1%; 17.1-41.1) compared to the indigenous Dutch (5.9%; 1.3-10.5). Modifiable, significant determinants (standardized regression coefficients) for serum 25(OH)D concentration were: consumption of fatty fish (0.160), use of vitamin D supplements (0.142), area of uncovered skin (highest category 0.136; middle category 0.028), use of tanning bed (0.103), consumption of margarine (0.093) and preference for sun (0.089). We found no significant modification of ethnic group on the effect of sunlight determinants. Conclusion: Of the modifiable determinants, fatty fish and supplements are the greatest contributors to the serum 25(OH)D concentration in a multiethnic population.(aut. ref.

Tumor sialylation impedes T cell mediated anti-tumor responses while promoting tumor associated-regulatory T cells

The increased presence of sialylated glycans on the tumor surface has been linked to poor prognosis, yet the effects on tumor-specific T cell immunity are hardly studied. We here show that hypersialylation of B16 melanoma substantially influences tumor growth by preventing the formation of effector T cells and facilitating the presence of high regulatory T cell (Treg) frequencies. Knock-down of the sialic acid transporter created "sialic acid low" tumors, that grew slower in-vivo than hypersialylated tumors, altered the Treg/Teffector balance, favoring immunological tumor control. The enhanced effector T cell response in developing "sialic acid low" tumors was preceded by and dependent on an increased influx and activity of Natural Killer (NK) cells. Thus, tumor hypersialylation orchestrates immune escape at the level of NK and Teff/Treg balance within the tumor microenvironment, herewith dampening tumorspecific T cell control. Reducing sialylation provides a therapeutic option to render tumors permissive to immune attack

The vertical cloud structure of the West African monsoon: a 4 year climatology using CloudSat and CALIPSO

The West African summer monsoon (WAM) is an important driver of the global climate and locally provides most of the annual rainfall. A solid climatological knowledge of the complex vertical cloud structure is invaluable to forecasters and modelers to improve the understanding of the WAM. In this paper, 4 years of data from the CloudSat profiling radar and CALIPSO are used to create a composite zonal mean vertical cloud and precipitation structure for the WAM. For the first time, the near-coincident vertical radar and lidar profiles allow for the identification of individual cloud types from optically thin cirrus and shallow cumulus to congestus and deep convection. A clear diurnal signal in zonal mean cloud structure is observed for the WAM, with deep convective activity enhanced at night producing extensive anvil and cirrus, while daytime observations show more shallow cloud and congestus. A layer of altocumulus is frequently observed over the Sahara at night and day, extending southward to the coastline, and the majority of this cloud is shown to contain supercooled liquid in the top. The occurrence of deep convective systems and congestus in relation to the position of the African easterly jet is studied, but only the daytime cumulonimbus distribution indicates some influence of the jet position