Predictive validity and clinical utility of DSM-5 Somatic Symptom Disorder: prospective 1-year follow-up study

OBJECTIVE

To compare the predictive validity and clinical utility of DSM-IV somatoform disorders and DSM-5 Somatic Symptom Disorder (SSD) at 12-month follow-up.

METHODS

In a sample of psychosomatic inpatients (n=322, mean age=45.6 years (SD 10.0), 60.6% females) we prospectively investigated DSM-IV somatoform disorders and the DSM-5 diagnosis of SSD plus a variety of psychological characteristics, somatic symptom severity, and health-related quality of life at admission, discharge, and follow-up.

RESULTS

DSM-IV diagnoses and DSM-5 SSD similarly predicted physical functioning at follow-up; SSD also predicted mental functioning at follow-up. Bodily weakness, intolerance of bodily complaints, health habits, and somatic attribution at admission were significant predictors of physical functioning at follow-up. The change in physical functioning during inpatient therapy was a significant predictor for the course of physical functioning until follow-up.

CONCLUSIONS

Psychological symptoms appear to be predictively valid diagnostic criteria for the 12-month functional outcome in patients with SSD. Mental functioning can be better predicted by the DSM-5 diagnosis than by DSM-IV diagnoses. Not the change in single psychological features but in physical functioning during the treatment interval predicted the change in physical functioning until follow-up.

Successful correction of D-lactic acid neurotoxicity (drunken lamb syndrome) by bolus administration of oral sodium bicarbonate

Drunken lamb syndrome (DLS) has recently been described as lamb D-lactic acidosis syndrome (LDLAS). In 2012, 18 lambs aged between 7 days and 28 days with LDLAS were identified. Biochemically, each lamb had a metabolic acidosis characterised by D-lactic acidosis and exhibited clinical signs including: not hyperthermic, no evidence of dehydration, demonstrating an ataxic gait tending to recumbency (DLS) and possibly somnolence. These lambs received 50 mmol of sodium bicarbonate as an 8.4 per cent solution given orally, together with parenteral long-acting amoxicillin. All 18 cases made a full clinical recovery. This study demonstrates a novel effective treatment for a disease that is usually fatal, and also demonstrates a strong correlation between venous plasma bicarbonate concentrations and venous plasma D-lactate concentrations (R(2)=0.49).

[Sexual risk behaviour of nursing students. A cross-sectional study at nursing schools in Saxony-Anhalt]

AIM

This work describes the sexual risk behaviour of nursing students.

METHODS

22 of 23 state-approved nursing schools in Saxony-Anhalt, Germany, participated in this cross-sectional study (study period 7/2005-5/2006). Participation was voluntarily and anonymous.

RESULTS

More male than female students (59.6% vs. 44.8%) used condoms to prevent STIs. More female students (58.9% vs. 43.4%) reported constant partnership with just one partner as an STI prevention method (chi² test, p<0.005). 29.6% of the nursing students reported >1 sexual partner in the past 12 months. 3.9% of the students demanded an HIV test from the partner, 69.3% had never tested themselves for HIV. 10.2% used no prevention against STIs.

CONCLUSIONS

Nursing students should be sensitised for sexual risk behaviour and STIs. This should be included in the content of teaching throughout the education, not least since nursing students are multiplicators and have an influence on health behaviour of the patients.

Phylogenetic lineages in Entomophthoromycota

Entomophthoromycota is one of six major phylogenetic lineages among the former phylum Zygomycota. These early terrestrial fungi share evolutionarily ancestral characters such as coenocytic mycelium and gametangiogamy as a sexual process resulting in zygospore formation. Previous molecular studies have shown the monophyly of Entomophthoromycota, thus justifying raising the taxonomic status of these fungi to a phylum. Multi-gene phylogenies have identified five major lineages of Entomophthoromycota. In this review we provide a detailed discussion about the biology and taxonomy of these lineages: I) Basidiobolus (Basidiobolomycetes: Basidiobolaceae; primarily saprobic); II) Conidiobolus (Entomophthoromycetes, Ancylistaceae; several clades of saprobes and invertebrate pathogens), as well as three rapidly evolving entomopathogenic lineages in the family Entomophthoraceae centering around; III) Batkoa; IV) Entomophthora and allied genera; and V) the subfamily Erynioideae which includes Zoophthora and allied genera. Molecular phylogenic analysis has recently determined the relationships of several taxa that were previously unresolved based on morphology alone: Eryniopsis, Macrobiotophthora, Massospora, Strongwellsea and two as yet undescribed genera of Basidiobolaceae.

[Cleaning and disinfection in nursing homes. Data on quality of structure, process and outcome in nursing homes in Frankfurt am Main, Germany, 2011]

Due to the Infectious Disease Prevention Act, public health services in Germany are obliged to check the infection prevention in hospitals and other medical facilities as well as in nursing homes. In Frankfurt/Main, Germany, standardized control visits have been performed for many years. In 2011 focus was laid on cleaning and disinfection of surfaces. All 41 nursing homes were checked according to a standardized checklist covering quality of structure (i.e. staffing, hygiene concept), quality of process (observation of the cleaning processes in the homes) and quality of output, which was monitored by checking the cleaning of fluorescent marks which had been applied some days before and should have been removed via cleaning in the following days before the final check. In more than two thirds of the homes, cleaning personnel were salaried, in one third external personnel were hired. Of the homes 85% provided service clothing and all of them offered protective clothing. All homes had established hygiene and cleaning concepts, however, in 15% of the homes concepts for the handling of Norovirus and in 30% concepts for the handling of Clostridium difficile were missing. Regarding process quality only half of the processes observed, i.e. cleaning of hand contact surfaces, such as handrails, washing areas and bins, were correct. Only 44% of the cleaning controls were correct with enormous differences between the homes (0-100%). The correlation between quality of process and quality of output was significant. There was good quality of structure in the homes but regarding quality of process and outcome there was great need for improvement. This was especially due to faults in communication and coordination between cleaning personnel and nursing personnel. Quality outcome was neither associated with the number of the places for residents nor with staffing. Thus, not only quality of structure but also quality of process and outcome should be checked by the public health services.

Construct validity and descriptive validity of somatoform disorders in light of proposed changes for the DSM-5

OBJECTIVE

Current diagnostic criteria for somatoform disorders demand revisions due to their insufficient clinical as well as scientific usability. Various psychological and behavioral characteristics have been considered for the proposed new category Somatic Symptom Disorder (SSD). With this study, we were able to jointly assess the validity of these variables in an inpatient sample.

METHODS

Using a cross-sectional design, we investigated N=456 patients suffering from somatoform disorder, anxiety, or depression. Within one week after admission to the hospital, informed consent was obtained and afterwards, a diagnostic interview and a battery of self-report questionnaires were administered. Logistic regression analyses were performed to determine which variables significantly add to construct and descriptive validity.

RESULTS

Several features, such as somatic symptom severity, health worries, health habits, a self-concept of being weak, and symptom attribution, predicted physical health status in somatization. Overall, our model explained about 50% of the total variance. Furthermore, in comparison with anxious and depressed patients, health anxiety, body scanning, and a self-concept of bodily weakness were specific for DSM-IV somatoform disorders and the proposed SSD.

CONCLUSIONS

The present study supports the inclusion of psychological and behavioral characteristics in the DSM-5 diagnostic criteria for somatoform disorders. Based on our results, we make suggestions for a slight modification of criterion B to enhance construct validity of the Somatic Symptom Disorder.

Predictive validity and clinical utility of DSM-5 Somatic Symptom Disorder--comparison with DSM-IV somatoform disorders and additional criteria for consideration

OBJECTIVE

Major changes to the diagnostic category of somatoform disorders are being proposed for DSM-5. The effect of e.g. the inclusion of psychological criteria (criterion B) on prevalence, predictive validity, and clinical utility of "Somatic Symptom Disorder" (SSD) remains unclear. A prospective study was conducted to compare current and new diagnostic approaches.

METHODS

In a sample of N=456 psychosomatic inpatients (61% female, mean age=44.8±10.4 years) diagnosed with somatoform, depressive and anxiety disorders, we investigated the current DSM-5 proposal (SSD) plus potential psychological criteria, somatic symptom severity, and health-related quality of life at admission and discharge.

RESULTS

N=259 patients were diagnosed with DSM-IV somatoform disorder (56.8%). With a threshold of 6 on the Whiteley Index to assess psychological criteria, the diagnosis of SSD was similarly frequent (51.8%, N=230). However, SSD was a more frequent diagnosis when we employed the recommended threshold of one subcriterion of criterion B. Patients diagnosed with only SSD but not with DSM-IV somatoform disorder showed greater psychological impairment. Both diagnoses similarly predicted physical functioning at discharge. Bodily weakness and somatic and psychological attributions at admission were among significant predictors of physical functioning at discharge. Reduction of health anxiety, bodily weakness, and body scanning significantly predicted an improvement of physical functioning.

CONCLUSIONS

Psychological symptoms enhance predictive validity and clinical utility of DSM-5 Somatic Symptom Disorder compared to DSM-IV somatoform disorders. The SSD diagnosis identifies more psychologically impaired patients than its DSM-IV precursor. The currently suggested diagnostic threshold for criterion B might increase the disorder's prevalence.

[Recommendations for the husbandry and welfare of sheep and goats by the German Small Ruminant Veterinary Association. Part 1]

Recommendations for the different forms of sheep and goat husbandry based on the legal regulations are summarized. These are given in particular respect to transhumance, tending, alpine farming, and indoor housing. The requirements for pasture, housing, supply of water and food, lambing, rearing of lambs, and health management are intensively discussed. The general requirements of the extensive as well as of the intensive husbandry of sheep and goats are defined. Examples of species-specific capabilities for adaption, the limits of adaption, and signs of decompensation are provided. Compliance with these recommendations should accord the animals entrusted to our care the "five freedoms (13)": 1. Freedom from hunger and thirst, 2. freedom from discomfort, 3. freedom from pain, injury, or disease, 4. freedom to express normal behaviour, and 5. freedom from fear and distress.

[High perinatal mortality associated with triple anthelmintic resistance in a German sheep flock]

High perinatal mortality, low milk yields and occasional ewe deaths were investigated in a Dorper sheep flock in Southern Germany. Parasitic gastroenteritis due to Trichostrongylus spp. associated with severe weight loss despite regular anthelmintic treatments of the flock was identified as the underlying cause. A faecal egg count reduction (FECR) test revealed zero reduction after treatment with ivermectin or albendazole, respectively, and a FECR of 57.9% following treatment with levamisole. These results indicate a lack of, or considerably reduced efficacy of substances from all three classical groups of anthelmintics and demonstrate that triple anthelmintic resistance is also present in Germany. The introduction of resistant worm populations with imported livestock, excessive use of anthelmintic drugs and under-dosing of goats have possibly led to the problem in the flock described. Veterinary advice on anthelmintic treatments and responsible parasite control programmes are therefore crucial in small ruminant flocks.

Fabrication and experimental demonstration of the first 160 Gb/s hybrid silicon-on-insulator integrated all-optical wavelength converter

We present a hybrid integrated photonic circuit on a silicon-on-insulator substrate that performs ultra high-speed all-optical wavelength conversion. The chip incorporates a 1.25 mm non-linear SOA mounted on the SOI board using gold-tin bumps as small as 14 μm. Τhe device performs chirp filtering and signal polarity inversion with two multi-mode interference (MMI) - based cascaded delay interferometers (DIs) monolithically integrated on the same SOI substrate. Full free spectral range (FSR) tuning of the DIs is accomplished by two independently tuneable on-chip thermal heaters. We demonstrate 160Gb/s all-optical wavelength conversion with power penalties of less than 4.6dB.

Fluid biopsy in patients with metastatic prostate, pancreatic and breast cancers

Hematologic spread of carcinoma results in incurable metastasis; yet, the basic characteristics and travel mechanisms of cancer cells in the bloodstream are unknown. We have established a fluid phase biopsy approach that identifies circulating tumor cells (CTCs) without using surface protein-based enrichment and presents them in sufficiently high definition (HD) to satisfy diagnostic pathology image quality requirements. This 'HD-CTC' assay finds >5 HD-CTCs mL(-1) of blood in 80% of patients with metastatic prostate cancer (n = 20), in 70% of patients with metastatic breast cancer (n = 30), in 50% of patients with metastatic pancreatic cancer (n = 18), and in 0% of normal controls (n = 15). Additionally, it finds HD-CTC clusters ranging from 2 HD-CTCs to greater than 30 HD-CTCs in the majority of these cancer patients. This initial validation of an enrichment-free assay demonstrates our ability to identify significant numbers of HD-CTCs in a majority of patients with prostate, breast and pancreatic cancers.

Hohe perinatale Sterblichkeit in einer Schafherde im Zusammenhang mit Dreifach-Anthelminthikaresistenz

Eine hohe Neugeborenensterblichkeit, Milchmangel und vereinzelte Todesfälle bei Mutterschafen führten zur Untersuchung einer Dorper-Schafherde in Süddeutschland. Als zugrunde liegende Ursachen wurden Abmagerung und eine hohe Belastung mit Trichostrongylus spp. trotz regelmäßiger anthelminthischer Behandlung identifiziert. Die weitere parasitologische Untersuchung der Herde mittels Eizahlreduktionstest ergab keinerlei Eizahlreduktion nach Anwendung von Ivermectin oder Albendazol sowie eine deutlich verminderte Eizahlreduktion von 57,9% nach Behandlung mit Levamisol. Diese Ergebnisse sind Zeichen einer fehlenden bzw. deutlich verringerten Wirksamkeit von Stoffen aus allen drei klassischen Anthelminthikagruppen. Dieser Fall zeigt, dass auch in Deutschland mit Mehrfachresistenzen gegen die klassischen Anthelminthikagruppen gerechnet werden muss. Einschleppung resistenter Wurmpopulationen durch Zuchttierimporte, übermäßiger Einsatz von Anthelminthika und Unterdosierung von Wirkstoffen bei Ziegen stellen mögliche Ursachen im beschriebenen Fall dar und verdeutlichen, dass dem Parasitenmanagement und der Beratung von Schaf- und Ziegenhaltern von tierärztlicher Seite erhöhtes Augenmerk zu schenken ist.

Empfehlung für die Haltung von Schafen und Ziegen der Deutschen Gesellschaft für die Krankheiten der kleinen Wiederkäuer, Fachgruppe der DVG

Der zweite Teil der Haltungsempfehlungen beschäftigt sich mit der Gesundheitsvorsorge sowie den gesetzlichen Rahmenbedingungen für die Haltung von Schafen und Ziegen, den Transport und die Eingriffe an Schafen und Ziegen. Das vorgeschlagene Konzept der Gesundheitsvorsorge zielt auf die Entwicklung eines für jede Herde individuellen Gesundheitsplans ab, in dem neben der Abwehr von anzeige- und meldepflichtigen Krankheiten gerade auch die chronischen, sich langsam entwickelnden Erkrankungen und ein regelmäßiges Parasitenmonitoring Berücksichtigung finden. Dabei liegt der Schwerpunkt auf dem frühen Erkennen und der Prophylaxe von Erkrankungen. In diesem Zusammenhang wird auf den Umgang mit Lahmheiten, die Schur, Tierzukauf und Quarantäne sowie die Reinigung und Desinfektion in Schaf- und Ziegenherden intensiver eingegangen. Zum Transport von Tieren und zu Eingriffen bei Tieren liegen mit der Tierschutztransportverordnung und entsprechenden europäischen Regelungen detaillierte Vorschriften zu diesen Komplexen vor. Die gesetzlichen Bestimmungen und die praktische Durchführung werden übersichtlich dargestellt.

[Recommendations for the husbandry and welfare of sheep and goats by the German Small Ruminant Veterinary Association. Part 2]

The second part of the recommendations deals with the healthcare and the regulatory framework for the husbandry of sheep and goats. The suggested concept for healthcare aims to develop an individual health plan for every flock. This health plan focuses not only on the prevention of notifiable diseases, but also on chronic and slow infections as well as on parasite monitoring. The emphasis is on early detection of diseases and prophylaxis. In conjunction with this, the handling of lameness, shearing, animal trade and quarantine as well as cleaning and disinfection in sheep and goat flocks are intensively discussed. There are detailed federal and European legal regulations concerning the transport and the physical well-being of animals. These laws are clearly presented and advice for their practical implementation is provided.

[Infectious causes of lameness in sheep - treatment options in veterinary practice]

Lameness in sheep induced by infectious agents can cause problems regarding animal welfare, diagnosis and treatment. Individual lame animals and lameness caused by systemic disease, but especially flock problems due to infectious causes of lameness, such as foot rot, can for various reasons pose a problem for veterinary treatment. The causes of lameness in sheep are described with a special focus on infectious flock problems, and the different treatment options such as foot trimming, foot baths and local and systemic antibiotic therapy as well as vaccination are discussed based on a review of recent international research. The limited choice of drugs licensed for use in sheep in Germany is highlighted. Treatment, therefore, often requires off-label use or the import of footbathing agents licensed in other European countries. The legal consequences of this lack of nationally licensed veterinary products in dealing with a "minor species" are discussed, with a final call for political solutions that will help improve this unsatisfactory situation.