Diagnosis and treatment of depression following acquired brain injury: a comparison of practice in the UK and the Netherlands.

OBJECTIVE: To describe and compare current practice in diagnosis and treatment of depression following acquired brain injury in two countries (UK and the Netherlands) which have different sets of guidelines. SETTING AND DESIGN: A cross-sectional survey of reported practice among rehabilitation physician members of the British and Dutch specialist societies. METHODS: A 12-item postal questionnaire was sent to 496 rehabilitation physicians with two reminders: N=353 (71%) responded, 146 of whom did not manage people with acquired brain injury, leaving 207 questionnaires for analysis (Netherlands N=121, UK N=86). Descriptive summary statistics were compiled. Categorical and dichotomous data were compared between the groups using chi-squared tests. RESULTS: Sixty-seven (78%) of British respondents served a predominantly younger adult (65 years) population, compared with only 27 (22%) of the Dutch, who mainly treated patients of all ages. In line with their respective guidelines, more British respondents reported that they screened all acquired brain injury patients for depression (68/86 (79%) British versus 71/121 (59%) Dutch, P<0.01), and used formal measures (37/68 (54%) versus 14/69 (20%), P<0.001). They also took a more active role in treatment of depression: only 1 (1%) never used antidepressants, compared with 22 (18%) of Dutch respondents (P<0.001). On the other hand, where antidepressants were prescribed, the Dutch respondents were more likely than the British to follow-up their patients (93/98 (95%) versus 67/84 (80%), P<0.01). CONCLUSIONS: The survey demonstrates a broadly similar approach, but highlights some significant variance in practice between the two countries which may stem from differences in population and service provision as well as their respective guidelines.

Surgically obtained sperm, and risk of gestational hypertension and pre-eclampsia.

The cause of pre-eclampsia is unknown, although a partner-specific immune maladaptation might be involved. We compared rates of pre-eclampsia and gestational hypertension in women whose genital tracts had and had not been exposed to their partner's sperm cells. Our aim was to ascertain whether or not protective partner-specific immune-tolerance is conveyed by sperm cells, rather than seminal fluid. Our findings indicate that, compared with women exposed to their partner's sperm cells and seminal fluid--ie, those treated with in-vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI) with ejaculated sperm--the risk of hypertension was doubled and the risk of pre-eclampsia tripled in those never exposed to their partner's sperm--ie, those treated with ICSI done with surgically obtained sperm.