The multidisciplinary depression guideline for children and adolescents : an implementation study

It is important that depressed patients receive adequate and safe care as described in clinical guidelines. The aim of this study was to evaluate the implementation of the Dutch depression guideline for children and adolescents, and to identify factors that were associated with the uptake of the guideline recommendations. The study took place in specialised child and adolescent mental healthcare. An implementation project was initiated to enhance the implementation of the guideline. An evaluation study was performed alongside the implementation project, using structured registration forms and interviews with healthcare professionals. Six multidisciplinary teams participated in the implementation study. The records of 655 patients were analysed. After 1 year, 72 % of all eligible patients had been screened for depression and 38 % were diagnosed with the use of a diagnostic instrument. The severity of the depression was assessed in 77 % of the patients during the diagnostic process, and 41 % of the patients received the recommended intervention based on the depression severity. Of the patients that received antidepressants, 25 % received weekly checks for suicidal thoughts in the first 6 weeks. Monitoring of the patients' response was recorded in 32 % of the patients. A wide range of factors were perceived to influence the uptake of guideline recommendations, e.g. the availability of capable professionals, available time, electronic tools and reminders, and the professionals' skills and attitudes. With the involvement of the teams, recommendations were provided for nationwide implementation of the guideline. In conclusion, a systematic implementation programme using stepped care principles for the allocation of depression interventions seems successful, but there remains room for further improvement

Secretory type II phospholipase A(2) binds to ischemic myocardium during myocardial infarction in humans

OBJECTIVE: An increase of circulating secretory Phospholipase A(2) (sPLA(2)) is a risk factor for coronary artery disease. We hypothesized that this reflects participation of sPLA(2) in local inflammatory reactions ensuing in ischemic myocardium. Therefore, we studied the course of circulating sPLA(2), in patients with acute myocardial infarction (AMI) or unstable angina pectoris (UAP), and investigated the presence of sPLA(2) in infarcted myocardial tissue. METHODS: Plasma samples of 107 patients with AMI or UAP, collected on admission and at varying intervals thereafter, were tested for the presence of sPLA(2) and C-reactive protein (CRP). Cumulative release values of these parameters were calculated, which allowed for comparison of the results rearranged in time according to the onset of symptoms. By immunohistochemistry we studied the presence of sPLA(2) and CRP in myocardial tissue of 30 patients who died subsequent to AMI. RESULTS: Levels of sPLA(2) became elevated during the disease course in 66 of the 87 patients with AMI, and were higher than those of the patients with UAP of whom 8 of the 20 had elevated levels. By immunohistochemistry sPLA(2) was found to be localized in the infarcted myocardium, particularly in its borderzone, from 12 h after the onset of AMI. Positive staining for sPLA(2) was more extensive than that for CRP. CONCLUSIONS: The localization pattern of sPLA(2) in infarcted myocardium as well as its plasma course, in relation to those of CRP, are in line with a supposed pro-inflammatory role during AMI for sPLA(2) as a generator of lysophospholipids serving as ligands for CR

Secretory type II phospholipase A(2) binds to ischemic myocardium during myocardial infarction in humans

OBJECTIVE: An increase of circulating secretory Phospholipase A(2) (sPLA(2)) is a risk factor for coronary artery disease. We hypothesized that this reflects participation of sPLA(2) in local inflammatory reactions ensuing in ischemic myocardium. Therefore, we studied the course of circulating sPLA(2), in patients with acute myocardial infarction (AMI) or unstable angina pectoris (UAP), and investigated the presence of sPLA(2) in infarcted myocardial tissue. METHODS: Plasma samples of 107 patients with AMI or UAP, collected on admission and at varying intervals thereafter, were tested for the presence of sPLA(2) and C-reactive protein (CRP). Cumulative release values of these parameters were calculated, which allowed for comparison of the results rearranged in time according to the onset of symptoms. By immunohistochemistry we studied the presence of sPLA(2) and CRP in myocardial tissue of 30 patients who died subsequent to AMI. RESULTS: Levels of sPLA(2) became elevated during the disease course in 66 of the 87 patients with AMI, and were higher than those of the patients with UAP of whom 8 of the 20 had elevated levels. By immunohistochemistry sPLA(2) was found to be localized in the infarcted myocardium, particularly in its borderzone, from 12 h after the onset of AMI. Positive staining for sPLA(2) was more extensive than that for CRP. CONCLUSIONS: The localization pattern of sPLA(2) in infarcted myocardium as well as its plasma course, in relation to those of CRP, are in line with a supposed pro-inflammatory role during AMI for sPLA(2) as a generator of lysophospholipids serving as ligands for CRP

Is leg compression beneficial for alpine skiers?

Background:This study examined the effects of different levels of compression (0, 20 and 40 mmHg) produced byleg garments on selected psycho-physiological measures of performance while exposed to passive vibration (60 Hz,amplitude 4-6 mm) and performing 3-min of alpine skiing tuck position.Methods:Prior to, during and following the experiment the electromygraphic (EMG) activity of different muscles,cardio-respiratory data, changes in total hemoglobin, tissue oxygenation and oscillatory movement ofm. vastuslateralis, blood lactate and perceptual data of 12 highly trained alpine skiers were recorded. Maximal isometric kneeextension and flexion strength, balance, and jumping performance were assessed before and after the experiment.Results:Thekneeangle(−10°) and oscillatory movement (−20-25.5%) were lower with compression (P<0.05inall cases). The EMG activities of thetibialis anterior(20.2-28.9%),gastrocnemius medialis(4.9-15.1%),rectus femoris(9.6-23.5%), andvastus medialis(13.1-13.7%) muscles were all elevated by compression (P< 0.05 in all cases).Total hemoglobin was maintained during the 3-min period of simulated skiing with 20 or 40 mmHg compression,but the tissue saturation index was lower (P< 0.05) than with no compression. No differences in respiratory parameters,heart rate or blood lactate concentration were observed with or maximal isometric knee extension and flexionstrength, balance, and jumping performance following simulated skiing for 3 min in the downhill tuck positionwere the same as in the absence of compression.Conclusions:These findings demonstrate thatwith leg compression, alpine skiers could maintain a deeper tuckposition with less perceived exertion and greater deoxygenation of thevastus lateralismuscle, with nodifferences in whole-body oxygen consumption or blood lactate concentration. These changes occurred withoutcompromising maximal leg strength, jumping performance or balance. Accordingly, our results indicate that theuse of lower leg compression in the range of 20-40 mmHg may improve alpine skiing performance by allowing adeeper tuck position and lowering perceived exertion.Swedish Winter Sports Research Centr

Accelerometry based assessment of gait parameters in children

The objective of this study was to examine if spatio-temporal gait parameters in healthy children can be determined from accelerations measured at the lower trunk as has been demonstrated in adults, previously. Twenty children aged 3-16 years, participated in a protocol that involved repeated walks of different distances in an indoor environment. During walking, accelerations were measured by three orthogonally mounted acceleration sensors in a small wireless device (DynaPort MiniMod) that was attached to the lower back. Based on an inverted pendulum approach, spatio-temporal gait parameters and walking distances were computed from the acceleration signals. Results were compared to video observations and known walking distances and durations. Steps were successfully detected in 99.6+/-0.6% of all observed steps (n=5554). On average, walking distance was accurately estimated (100.6+/-3.3%, range 93-106.7%). No correlation was found between the number of miscounted steps and the total number of steps or the age of the subject. It can be concluded that the use of an inverted pendulum model provides the possibility to estimate spatio-temporal gait parameters in children as well as in adults. The method allows an inexpensive and comfortable assessment of gait parameters in children, is applicable in controlled, indoor environments and could be tested for applicability under free living conditions