[Primary care psychology in Belgium: clinical characteristics and service use]. / Eerstelijns psychologische zorg in België: klinische kenmerken en zorggebruik.

BACKGROUND: Against the treatment gap and the long delays in seeking treatment for mental health problems, primary care psychology (PCP) was added to reimbursed outpatient mental health services in the Belgian healthcare system. AIM: To describe the characteristics of patients treated within the measure of reimbursement of PCP. METHOD: A total of 350 patients participated in an online survey at the start of their PCP treatment within one of the 31 mental healthcare networks in Belgium. Besides sociodemographic characteristics, they were questioned about their mental disorders, suicidality, service use, and delays in seeking treatment. RESULTS: Almost 90% of all patients screened positive for a lifetime and 12-month DSM-5 mental disorder, mostly anxiety and depressive disorders. Over 1/3 were experiencing suicidal thoughts and/or behaviors (STB) in the last 12 months. For 49.1% of patients, PCP was the first treatment ever. The median delay in seeking treatment was 6 years. CONCLUSION: PCP in Belgium serves mostly a clinical population with high proportions of lifetime and 12-month mental disorders and STB, and many of them have been in mental health treatment before. These findings raise the question whether PCP fits the needs for the patients that are treated.

High-energy versus low-energy extracorporeal shock wave therapy for calcifying tendinitis of the shoulder: which is superior? A meta-analysis.

BACKGROUND: There are several treatment options for calcifying tendinitis of the shoulder. The next step treatment after conservative treatment fails is still a matter of dispute. Extracorporeal shock wave therapy (ESWT) has been shown to be a good alternative to surgery, but the best treatment intensity remains unknown. High-energy ESWT is much more painful, more expensive, and usually is done in an inpatient setting, whereas low-energy ESWT can be performed in an outpatient setting by a physical therapist. QUESTIONS/PURPOSES: A systematic review and meta-analysis of randomized trials was performed to answer two clear research questions: (1) Is there a greater increase in the Constant-Murley score in patients treated with high-energy ESWT compared with those treated with low-energy ESWT by 3 months and by 6 months? (2) Is there a greater chance of complete resorption of the calcifications in patients treated with high-energy ESWT compared with those treated with low-energy ESWT by 3 months and by 6 months? METHODS: Five relevant electronic online databases, Medline (through PubMed), EMBASE (through OVID), Cinahl (through EBSCO), Web of Science, and the Cochrane Central Register of Controlled Trials, were systematically searched. We also crosschecked the reference lists of articles and reviews for possible relevant studies. Eligible for inclusion were all randomized controlled trials (RCTs) that compared high-energy ESWT (> 0.28 mJ/mm(2)) with low-energy ESWT (< 0.08 mJ/mm(2)). One author examined titles and abstracts of each identified study to assess study eligibility. Two reviewers independently extracted data and assessed the risk of bias and study quality. The primary outcome measure, the Constant-Murley score, was assessed by comparing mean functional outcome scores between the groups. Secondary outcomes were assessed using odds ratios, when appropriate data were pooled. Based on this process, five RCTs (359 participants) were included. RESULTS: All five RCTs showed greater improvement in functional outcome (Constant-Murley score) in patients treated with high-energy ESWT compared with patients treated with low-energy ESWT at 3 and 6 months. The 3-month mean difference was 9.88 (95% CI, 9.04-10.72, p < 0.001; 6-month data could not be pooled). Furthermore, high-energy ESWT more often resulted in complete resorption of the deposits at 3 months. The corresponding odds ratio was 3.40 (95% CI, 1.35-8.58) and p = 0.009 (6-month data could not be pooled). CONCLUSION: When shock wave therapy is chosen, high-energy shock wave therapy is more likely to result in improved Constant-Murley score and resorption of the deposits compared with low-energy therapy. LEVEL OF EVIDENCE: Level I, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

[A Dutchman from Mali with a perianal ulcer caused by cutaneous amoebiasis]. / Een nederlander uit mali met een perianaal ulcus veroorzaakt door cutane amoebiasis.

A 66-year-old Dutchman, living in Mali, presented with an extensive progressive perianal ulcer despite local and antibiotic treatment. Microscopic examination of the stool revealed Entamoeba histolytica/dispar cysts and phagocytosing trophozoites were seen in fresh scrapings of the ulcer, a diagnostic feature of infection with E. histolytica. The diagnosis was cutaneous amoebiasis and the patient was effectively treated with metronidazole and local debridements. Primary cutaneous amoebiasis is a rare disease. Diagnosis and treatment are relatively simple but lack of familiarity with the disease may lead to misdiagnosis or diagnosis at a late stage ofthe infection.