Predicting frequency of suicide attempts of adolescent outpatients at Weskoppies Hospital using clinical and demographic characteristics

<p>The prevention of suicide, particularly adolescent suicide, remains one of the biggest challenges in psychiatry.</p><p><strong>Objectives. </strong>To ascertain: (i) clinical and demographic characteristics; and (ii) possible associations between these characteristics and suicide attempt frequency in a selected patient group at Weskoppies Hospital over 4 months.</p><p><strong>Methods.</strong> Fifty adolescent outpatients aged between 13 and 17 years with a history of one or more suicide attempts were interviewed to obtain demographic and clinical features. Chi square and Fisher’s exact tests assessed associations between these features and suicide attempt frequency. <strong></strong></p><p><strong>Results.</strong> Of the subjects, 79% were aged between 15 and 17 years; they were predominantly female (62%) and Caucasian (83%). Mainstream and special education schools were equally represented. Three-quarters had reached grades 8 - 10, and 14% lived with both biological parents, 33% in places of safety and 37% with one divorced parent. The minority of caregivers had a history of alcohol abuse and other substance use. Twenty-nine per cent of the subjects had attempted suicide on more than 10 occasions and 23% had made a single attempt. The most common methods were wounding (74%), tablet overdose (34%) and hanging (20%). Psychiatric diagnoses included major depressive disorder (64%), bipolar disorder (38%), alcohol abuse (18%) and other substance abuse (24%). Familial features included depression, substance abuse, antisocial behaviour and suicide. Familial suicidal behaviour included suicide attempts by parents (85%), siblings (36%), aunts and uncles (31%) and cousins (44%). Physical and sexual abuse was reported in 52% of families. Conclusion. Many findings and profiles of other studies were confirmed and point to school and home environments, family psychopathology and psychiatric diagnoses as factors associated with adolescent suicide attempts. Associations between the frequency of suicide attempts and the demographic and clinical characteristics were statistically inconclusive.</p>

[Health services research project "action alliance pain-free city Münster" : Objectives and methods]

Inadequate pain care in health care facilities is still a major concern. Due to structural and organizational shortcomings the potential of modern analgesia is far from being exhausted. The project "Action Alliance Pain-free City Münster" is designed to analyze the multiprofessional pain management in health care facilities in the model City of Münster in an epidemiologic study and aims to optimize pain management in accordance with nursing standards and medical guidelines. Hospitals, nursing homes, outpatient nursing services, hospices and pain care centers will be examined. After an analysis of the current state on the basis of a pre-test, the necessary optimization measures will be developed and implemented. Subsequently, the pain management will be reevaluated in a post-test. In partly still unexplored health care areas of Germany, epidemiologic data will be generated, barriers to the implementation of standards and guidelines revealed and measures of improvements developed and tested. In addition, interface problems between the evaluated sectors will be identified. In this article the objective and the methods of the project are described.

Significant immediate and long-term improvement in quality of life and disease coping in patients with vitiligo after group climatotherapy at the Dead Sea

Quality of life in patients with vitiligo is impaired. This study explored the immediate effect of 20 days of climatotherapy at the Dead Sea on quality of life, coping with the disease, general well-being and individual stress levels in a group of 71 patients with vitiligo and 42 matched controls. The long-term effect was assessed after 12 months in 33/71 patients and 12/42 controls. Study instruments were Dermatology Life Quality Index, Beck Depression Inventory and the Adjustment to Chronic Skin Disorders Questionnaire. Stress measurements were based on cortisol and β-endorphin concentrations in saliva samples. Quality of life was significantly improved at day 20 at the Dead Sea compared with day 1, and this was still significant after 12 months. Moreover, social anxiety/avoidance, anxious-depressive mood and helplessness as measured by the Adjustment to Chronic Skin Disorders Questionnaire were significantly reduced. There was no difference in levels of cortisol and β-endorphin between patients and controls, indicating that stress per se is not a significant contributor in vitiligo. In conclusion, therapy in patient groups offers an effective tool for long-lasting improvement in quality of life and patients' well-being.

[Ectoparasites. Part 1: lice and fleas]

Ectoparasites and epidermal parasitic skin diseases are a heterogeneous group of infections of the external layer of the skin. The most common forms world-wide are scabies, lice (Pediculosis capitis, corporis, vestimentorum and pubis), tungiasis and the hookworm-associated Larva migrans cutanea. The head louse is the most widespread parasite in children in Germany. The symptoms, apart from pruritus, eczematous skin eruptions and ictus reactions of the skin, are often unspecific and many differential diagnoses must be considered. Treatment of ectoparasites includes manual procedures, such as repeated cleansing and combing out of lice-infected hair and also local antiparasitic treatment with permethrin, pyrethrum extract, allethrin and dimeticon. Lindan which has been used for decades can no longer be used in medications after 2008 after a decision of the EU Commission. Failure of treatment of head lice can be a result of errors in the treatment which favor survival of the eggs, larvae or adults. This can be a result of too short reaction times and too economical use or unequal distribution of medications, excessive dilution due to wet hair or omitting repeated treatment stages. Additionally resistance of head lice to pyrethrum is a known phenomenon and has been reported in several countries.

Aflatoxigenic fungi and aflatoxin B1 in commercial pet food in Brazil

The aims of this study were to determine the aflatoxigenic mycoflora and the incidence of aflatoxin B1 in commercial samples of ready dog food. This in turn demonstrated the ability of the Aspergillus flavus and Aspergillus parasiticus strains to produce aflatoxin B1. 180 samples (standard, premium and super premium) were collected. Aspergillus was the prevalent genera followed by Penicillium and Fusarium. A. flavus and A. parasiticus were the prevalent species. All A. flavus and A. parasiticus strains from super premium samples were able to produce aflatoxin B1, whereas toxigenic strains isolated from standard and premium samples varied from 80 to 100%. A high percentage of ready pet food contaminated by toxigenic species from section Flavi was found and aflatoxin B1 levels were detected. The fungal counts from the three kinds of feed did not exceed the proposed value (1×104 cfu/g) and none of the samples exceeded the aflatoxin B1 recommended level (20 ng/g). The presence of A. flavus and A. parasiticus with aflatoxigenic ability could be a potential risk for production of AFB1 in feedstuffs when environmental storage conditions are not adequate.

Medical students' perceptions of accessibility and barriers to the utilisation of the University of Pretoria's support systems

OBJECTIVE

A campus-based website was set up by medical students following their study that showed a low awareness and utilsation of support systems at the University of Pretoria. The aim of the website was to improve the utilisation of the existing support systems. This study evaluated the students' perception of the support systems and whether the website would resolve barriers hindering utilisation of support.

METHOD

Focus groups were selected by theoretical sampling in the first and final quarter of the academic year. The sample group consisted of 120 medical students from all years of study. The transcribed tape recordings, field notes, e-mail responses and observations of the focus groups were analysed for themes by open, axial and selective coding.

RESULTS

The medical students varied in their awareness of the available support systems. The majority were unaware of procedures to access the support systems and what services were offered by each. There were numerous barriers to utilising the support systems effectively. The barriers included the students' perception of failure in admitting that they require assistance and the remainder were mostly of an administrative nature. Most students were aware of the website but utilisation was minimal.

CONCLUSIONS

The majority of students were aware of but underutilised the support systems for various reasons. The website failed to improve utilisation of the extensive existing support systems. The barriers suggest other ways of improving support that include addressing social support, socialisation and life skills training as well as streamlining the marketing of existing support systems.

Development and implementation of communication skills in dentistry: an example from South Africa

Dental students should realise early in their careers -- in dental school -- the importance of developing and mastering sound communication skills with patients. As a result, the aim of this study was to develop and implement a course in communication skills for third year dental students. The methodology employed in the study comprised the following three phases: Phase I: identification of specific outcomes essential for the dentist to be competitive in the emerging South African dental environment. Phase II: development of an outcome-based course according to the South African Qualifications Authority format (Purpose, Embedded knowledge, Assessment criteria). Phase III: implementation of the course. Implementation of the course involved a pre- and post-training cycle. The subjects were 67 third year dental students. The following instruments were employed: a study guide; a case study; an assessment rubric; two questionnaires, namely "Patient's" feedback and "Dentist's" feedback; a standardised patient. The results were as follows: the class as a whole scored significantly higher during training cycle 2 compared with training cycle 1 (P < 0.0001). The important roles of trust, empathy and active listening in establishing a meaningful relationship with a patient, which was conveyed by means of the course, were emphasised by the majority of students.

Immune based therapies in cancer

Immunotherapy of cancer has become a more promising approach in the past decade. Developments in both basic immunology and tumor biology have increased our knowledge of the interactions between the tumor cells and the immune system. The molecular identification of tumor-associated antigens and understanding of immunological pathways have cleared the way for development of different strategies for anti-tumor vaccines. The success of any cancer vaccine relies on the induction of an effective tumor-specific immune response to break tolerance and to elicit a long lasting anti-tumor immunity. It is also increasingly clear that the interactions of host-tumor are quite complicated leading to tumor escape mechanisms, which add another level of difficulty to this interaction. This review will summarize the recent developments in tumor immunotherapy as well as the clinical trials addressing novel immunotherapeutic approaches to cancer.

Basic research confirms coexistence of acquired Blaschkolinear Vitiligo and acrofacial Vitiligo

We report about a female patient with bilateral and unilateral blaschkolinear depigmentation on the extremities and coexistence of acrofacial vitiligo, who initially presented her first signs of depigmentation at the age of 32 years. The patient was otherwise healthy. The correct diagnosis was based on the latest up to date technology utilizing in vivo FT-Raman and Fluorescence spectroscopy, Wood's light examination of the depigmented skin and immunoreactivity of epidermal catalase expression in 3 mm punch biopsies from the linear depigmented area. The results yielded decreased catalase protein expression compared to healthy controls as well as complete absence of melanocytes. FT-Raman spectroscopy identified the presence of hydrogen peroxide (H(2)O(2)) in the mM range and Fluorescence spectroscopy demonstrated H(2)O(2)-mediated oxidation of tryptophan residues in the depigmented area. The results were in agreement with vitiligo. Repigmentation of the linear lesion was initiated after reduction/removal of epidermal H(2)O(2) with pseudocatalase PC-KUS further supporting the correct diagnosis. To the best of our knowledge this is the first case documented with vitiligo following Blaschko lines in coexistence with classical acrofacial vitiligo. This observation raises the question whether besides H(2)O(2)-mediated stress in association with genomic mosaicism could play a role in some cases with vitiligo.

Dissociation - a preliminary contextual model

<p><strong>Background.</strong> The Diagnostic and Statistical Manual of Mental Disorders (DSM) system has certain limitations when applied to two South African examples of dissociation, because it is descriptive (non-explanatory) and focuses on intrapsychic (non-communal) processes. Even the existing Western explanatory models of dissociation fail to accommodate fully the communal aspects of dissociation in our South African context.</p><p><strong>Objectives and methods.</strong> The aim was to explore an expanded perspective on dissociation that does not limit it to an intrapsychic phenomenon, but that accounts for the interrelatedness of individuals within their social context. Auto-ethnography was used. In this article a collective, socially orientated, contextual hermeneutic was applied to two local examples of dissociation. Three existing Western models were expanded along multicontextual, collective lines, for them to be more useful in the pluralistic South African context.</p><p><strong>Results.</strong> This preliminary contextual model of dissociation includes a person’s interpersonal, socio-cultural, and spiritual contexts, in addition to the intrapsychic context. Dissociation is considered to be a normal information-processing tool that maintains balanced, coherent selves-in-society, i.e. individuals connected to each other. In the South African context dissociation appears mostly as a normal phenomenon and seldom as a sign of mental illness. Dissociation is pivotal for the normal construction of individual and communal identities in the face of conflicting sets of information from various contexts. Dissociation may help individuals or communities to survive in a world of conflicting messages, where conflict is often interpersonal/cultural/societal in nature, rather than primarily intrapsychic.<strong></strong></p><p><strong>Conclusions.</strong> This model should be developed and evaluated further. Such evaluation would require suitable new local terminology.</p>

[Expression und function of the ORL-1 receptor on human leukocytes]

BACKGROUND

The ORL-1 receptor is expressed by human leukocytes. Limited knowledge exists about the function and interaction between the nervous and immune systems. The aim of our study was to investigate the expression of the nociceptin-ORL-1 receptor system on different leukocyte subsets and the influence of the ORL-1 receptor on the intracellular production of cytokines.

METHODS

Blood from healthy volunteers of different age and sex was analysed for the expression of the ORL-1 receptor by PCR and flow cytometry and the influence of nociceptin on the LPS-induced production of intracellular cytokines by flow cytometry.

RESULTS

The ORL-1 receptor mRNA is expressed by granulocytes, lymphocytes and monocytes. We could also show the expression of the ORL-1 receptor protein on the cell surface of all types of white blood cells. Nociceptin has no influence on LPS-induced cytokine production in human monocytes. There was neither a difference between young and old nor between male or female volunteers.

CONCLUSION

The ORL-1 receptor is expressed by all subtypes of leukocytes. The function of this receptor is not the modulation of cytokine production and requires further studies.

Optimization and validation of a fully automated silica-coated magnetic beads purification technology in forensics

Automated procedures for forensic DNA analyses are essential not only for large-throughput sample preparation, but are also needed to avoid errors during routine sample preparation. The most critical stage in PCR-based forensic analysis is DNA isolation, which should yield as much highly purified DNA as possible. The extraction method used consists of pre-treatment of stains and samples, cell lysis using chaotropic reagents, binding of the DNA to silica-coated magnetic particles, followed by elution of the DNA. Our work focuses mainly on sample preparation, obtaining the maximum possible amount of biological material from forensic samples, and the following cell lysis, to create a simple standardized lysis protocol suitable for nearly all forensic material. After optimization and validation, the M-48 BioRobot((R)) workstation has been used for more than 20,000 routine lab samples. There has been no evidence of cross contamination. Resulting DNA from as small as three nuclear cells yield reliable complete STR amplification profiles. The DNA remains stable after 2 years of storage.