Changes in analgesic prescriptions in Dutch general practice.

BACKGROUND: Increases in opioid prescriptions have been described; however, recent trends and prescribing patterns of analgesics in Dutch general practice are largely unknown. OBJECTIVE: To investigate recent changes in the number of analgesic prescriptions, and the indications for prescribing strong opioids. Furthermore, we aim to identify risk factors for chronic opioid use in Dutch general practice. DESIGN AND SETTING: A retrospective cohort study from 1 July 2013 to 31 June 2022, using a primary care practice based research network. SUBJECTS: Patients with ≥1 prescription for analgesics during the study period were included. MAIN OUTCOME MEASURE: Changes in the number of prescriptions for paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs) and opioids in Dutch general practice during the 9-year study period. Moreover, we analyzed indications for prescribing strong opioids by the general practitioner (GP). RESULTS: A total of 18,433 analgesic users were identified. Over time, prescriptions for paracetamol, NSAIDs and weak opioids decreased, while the number of strong opioid prescriptions increased. General practitioners prescribed more strong opioids for non-malignant pain, whereas prescriptions for malignant pain remained stable over time. Risk factors for chronic opioid use (≥90 days) included older age, lower educational level, smoking status and having a history of a musculoskeletal or psychological disorder, a malignancy or sexual, physical or psychological abuse. CONCLUSIONS: Considering the increase in strong opioid prescriptions for benign conditions, GPs need to be vigilant for patients who are at risk for chronic use. Regular monitoring and awareness for psychosocial factors in treatment of chronic pain may be key in preventing harms associated with persistent opioid use.

[Hardnekkige aanhoudende lichamelijke klachten in de huisartsenpraktijk]. / Hardnekkige aanhoudende lichamelijke klachten in de huisartsenpraktijk.

BACKGROUND: In the care of patients with persevering (‘treatment-resistant’) persistant physical symptoms (PPS), problems are common. With this study, we want to identify starting points for improvement of care, including suggestions for the role of mental health care. AIM: Using the profile for persevering PPS we will estimate the prevalence, describe characteristics of this patient group and map problems encountered in their care. METHOD: Online survey in general practitioners (GPs). RESULTS: The response rate to the survey was 12.8%. The mean estimated prevalence of persevering PPS in general practice was 0.7% (corresponding to an estimated 122,500 patients throughout the Netherlands). Many patients encountered iatrogenic harm, experience societal problems and limitations in mobility and ADL independence. Although there was a general increased use of health care in these patients, some also avoided care or were under-treated. In the persistence of symptoms, patient-related factors played a role (like insisting on further somatic diagnostic tests, lack of motivation for PPS-specific treatment), but health-care related factors, like rejection for care or a lack of regional treatment options for patients with PPS, also had a causal role. CONCLUSION: Almost every GP experiences problems in the care for patients with persevering PPS. Mental health care professionals can support the GP better, by optimizing options for consultation and referral.

[Consultative psychiatry in the general practice]. / Consultatieve psychiatrie in de huisarts­praktijk.

BACKGROUND: The high demand for mental health care is increasing the pressure on Dutch basic and specialized mental health care. Consultative psychiatry in primary care may help to support primary mental health care. These consultations are increasingly used nationwide. However, little is known about how this help takes shape in practice and what the experiences of both patients and caregivers are. METHOD: We carried out a database and file study into the characteristics of the patients who received psychiatric consultation, in which we also examined the consultation questions of the general practitioners (GP) and the given advice. In addition, 15 semi-structured in-depth interviews were conducted with patients, general practitioners, mental healthcare nurse practitioners and psychiatrists, after which the transcripts were coded and analyzed thematically. AIM: To explore for which patients the GP requests a psychiatric consultation, what the consultation questions are and the advice given, and to identify the experiences of patients and healthcare providers with consultative psychiatry in general practice. RESULTS: The database study showed that consultative psychiatry was mainly used for patients with a psychiatric history, multiple psychiatric diagnosis and current psychopharmaceutical use. The consultation question usually concerned medication or treatment advice. In addition to advice regarding the consultation question, the psychiatrist often gave additional advice. Consultative psychiatry was experienced positively by both health care providers and patients due to the low threshold of the general practice, the mutual trust that is involved, the short waiting times compared to the second and third line psychiatry and the expertise of the psychiatrist. CONCLUSION: Consultative psychiatry in general practice is widely applicable, but is mainly applied to patients with multiple psychiatric diagnoses and current psychopharmaceutical use. It is experienced as positive by both patients and healthcare providers.

Resistance to COVID-19 vaccination has increased in Ireland and the United Kingdom during the pandemic.

OBJECTIVES: Hesitance and resistance to COVID-19 vaccination poses a serious challenge to achieving adequate vaccine uptake in the general population. Cross-sectional data from the early months of the pandemic indicates that approximately one-third of adults in multiple nations are hesitant or resistant to a vaccine for COVID-19. Using longitudinal data, we tracked changes in attitudes to COVID-19 vaccination during the pandemic. STUDY DESIGN: This is a quantitative, longitudinal design. METHOD: Nationally representative samples of the adult general population of the Republic of Ireland (N = 1041) and the United Kingdom (N = 2025) were assessed for their attitudes towards COVID-19 vaccination at three points from March to August 2020. RESULTS: Statistically significant increases in resistance to COVID-19 vaccination were observed in Irish (from 9.5% to 18.1%) and British (from 6.2% to 10%) adults. CONCLUSION: Resistance to vaccination has significantly increased in two European nations as the pandemic has progressed. Growing resistance to COVID-19 vaccination will pose a challenge to public health officials responsible for ensuring sufficient vaccine coverage.

Alternative Hosts in the Families Poaceae and Cyperaceae for Xanthomonas vasicola pv. vasculorum, Causal Agent of Bacterial Leaf Streak of Corn.

The bacterial pathogen Xanthomonas vasicola pv. vasculorum was first reported in the United States causing bacterial leaf streak on Nebraska corn (Zea mays) in 2016. The bacterium is also known to cause disease in sugarcane, grain sorghum, broom bamboo, and various palm species. The objective of this study was to identify alternative hosts for X. vasicola pv. vasculorum among plants commonly found in corn growing areas of the United States. In repeated greenhouse experiments, 53 species of plants found in the United States that had not been tested previously for susceptibility to X. vasicola pv. vasculorum were inoculated with the pathogen and monitored for symptom development. Eleven species in the family Poaceae exhibited symptoms: oat (Avena sativa), rice (Oryza sativa), orchardgrass (Dactylis glomerata), indiangrass (Sorghastrum nutans), big bluestem (Andropogon gerardii), little bluestem (Schizachyrium scoparium), timothy (Phleum pratense), sand bluestem (Andropogon hallii), green foxtail (Setaria viridis), bristly foxtail (Setaria verticillata), and johnsongrass (Sorghum halepense). Yellow nutsedge (Cyperus esculentus) in the Cyperaceae also was a symptomatic host. In addition, endophytic colonization by X. vasicola pv. vasculorum was found in three asymptomatic alternative hosts: downy brome (Bromus tectorum), tall fescue (Festuca arundinacea), and western wheatgrass (Pascopyum smithii). Experiments were also conducted in the field to determine the potential for alternative hosts to become infected by natural inoculum. Symptoms developed only in big bluestem and bristly foxtail in field experiments. These results suggest that infection of alternative hosts by X. vasicola pv. vasculorum can occur, but infection rates might be limited by environmental conditions.

Agronomic Factors Associated with Bacterial Leaf Streak Development Caused by Xanthomonas vasicola pv. vasculorum in Corn.

In 2016, the bacterium Xanthomonas vasicola pv. vasculorum was reported causing bacterial leaf streak on Nebraska corn. Prior to this report, the pathogen was reported on corn only in South Africa. Hence, there was a lack of information about the effects of corn production practices on bacterial leaf streak development. A survey of growers, crop consultants, extension agents, and others in the field of agriculture was initiated during the 2016 and 2017 corn growing seasons to examine agronomic factors that may affect the disease. Survey respondents were asked to submit a symptomatic leaf sample for pathogen confirmation via polymerase chain reaction, along with a completed survey on corn production practices. Analyses of 325 survey responses via random forest analysis indicated that irrigation, planting date, and crop rotation were the three most important predictors of corn samples testing positive for X. vasicola pv. vasculorum. According to a classification and regression tree analysis, irrigation use, the V7-R2 range of crop stages, multiple years of corn in a crop rotation or a corn-sorghum rotation, and planting dates after 2 May, were most closely associated with corn samples testing positive for X. vasicola pv. vasculorum. χ2 tests of independence indicated that applications of nitrogen fertilizer and glyphosate herbicide use may also be related to bacterial leaf streak development.

Training residents in patient-centred communication and empathy: evaluation from patients, observers and residents.

BACKGROUND: Patient-centred communication and empathy are key enablers for patient-centred care. However, several studies suggest a downward trend regarding the empathic communication skills of physicians during medical residency. It is known that communication training can have a positive effect on patient-centred communication, empathy and relational skills. Training residents in patient-centred communication and empathy can be an opportunity to improve the patient-centred care. To evaluate the training a tri-focal perspective will be used. METHODS: A 3-day training was developed to improve residents' patient-centred communication and empathy skills at an academic medical health centre, in the Netherlands. The training included: (1) the basics of patient-centred communication and empathy (through presentations, scientific literature), (2) practicing with actors, and (3) reflecting on residents' video recorded consultations (by themselves and communication experts). A pilot study with a pre-post design was conducted to evaluate the training from patient and observer perspectives. Semi-structured interviews were used to get insight into residents' perspective. Nine residents from different specialities followed the training and enrolled in the pilot study. During two random days consultations between residents and patients were video recorded. Patients were asked to fill in two questionnaires, indicating their perspective on residents' empathy and communication skills before as well as after the consultation. All video recorded consultations were coded to rate residents' communication skills, empathy, computer use and agenda-setting. Statistical analysis were performed using multilevel analysis. RESULTS: A total of 137 eligible patients took part in the pilot study. Trained residents showed significant improvement in patient-rated empathy scores. According to observers, residents' computer use improved significantly after the training. The communication skills of trained residents did not improve significantly. Agenda setting by residents showed a downward trend. Almost all residents were satisfied with the training, especially with the video-feedback. CONCLUSIONS: A brief training significantly increased residents' empathy scores according to patients and significantly decreased residents' computer use according to observers. These findings indicate that the quality of patient-centred care can be improved by integrating patient-centred communication into residency programs, at an academic medical health centre. The ultimate goal is to structurally embed the training in residents' education program.

Association of prenatal folate status with early childhood wheeze and atopic dermatitis.

BACKGROUND: Prenatal folic acid supplementation is recommended to prevent birth defects. Some foods are fortified in the USA to ensure sufficient intake among reproductive-aged women. However, high prenatal folate exposure may be a risk factor for childhood atopic diseases. We investigated associations between prenatal folate and early childhood wheeze and atopic dermatitis in a US cohort. METHODS: We studied 858 mother-child dyads, enrolled prenatally. Folate was measured in 2nd and 3rd trimester maternal plasma. Parents reported current wheeze (previous 12 months) and healthcare provider diagnosis of atopic dermatitis at 3 years. We examined associations using logistic regression, modeling folate continuously and dichotomously (< or ≥20 ng/mL), a level often considered supraphysiologic. RESULTS: Over half of women were African American and on Medicaid. Median (interquartile range) folate levels were 22.6 (15.9-30.0) and 23.1 (16.1-30.0) ng/mL for 2nd and 3rd trimesters, respectively. Current wheeze and atopic dermatitis were reported for 20.4% and 26.8% of children, respectively. Second trimester folate as a continuous exposure was not significantly associated with outcomes. Decreased odds of current wheeze were observed in children born to mothers who had 2nd trimester folate ≥20 ng/mL (adjusted odds ratios = 0.67, 95% confidence interval = 0.46, 0.97) compared to children with maternal levels <20 ng/mL. Third trimester folate was not associated with outcomes. CONCLUSIONS: High plasma folate in mid-pregnancy was associated with decreased odds of current wheeze at age 3. Our findings do not support harmful effects of high prenatal folate levels on childhood atopic diseases in this setting.

Detection and Characterization of Xanthomonas vasicola pv. vasculorum (Cobb 1894) comb. nov. Causing Bacterial Leaf Streak of Corn in the United States.

Bacterial leaf streak of corn (Zea mays) recently reached epidemic levels in three corn-growing states, and has been detected in another six states in the central United States. Xanthomonas vasicola was identified as the causal agent of this disease. A multilocus sequence alignment of six housekeeping genes and comparison of average nucleotide identity from draft genome sequence were used to confirm phylogenetic relationships and classification of this bacteria relative to other X. vasicola strains. X. vasicola isolates from Nebraska and South Africa were highly virulent on corn and sugarcane and less virulent on sorghum but caused water-soaking symptoms that are typical of X. vasicola infection on the leaves of all three hosts. Based on host range and phylogenetic comparison, we propose the taxonomic designation of this organism to X. vasicola pv. vasculorum ( Cobb 1894 ) comb. nov. Polymerase chain reaction-based diagnostic assays were developed that distinguish X. vasicola pv. vasculorum and X. vasicola pv. holcicola from each other and from other Xanthomonas spp.

Substitution scenario in follow-up of chronic cancer patients in primary care: prevalence, disease duration and estimated extra consultation time.

BACKGROUND: The incidence of cancer as well as survival rates for it are increasing. It is debated whether care in the chronic phase of cancer can be positioned in primary care due to doubts about capacity and workload. OBJECTIVE: To estimate GPs' extra consultation time if they assume responsibility for the care in the chronic phase of cancer. METHOD: Retrospective cohort study. Estimation of extra consultation time by quantifying prevalence, incidence, survival, number of chronic cancer patients, current practice contacts and registration of risk factors in patients with all types of cancers. RESULTS: The most prevalent types of cancer (with 5-year survival rates) are as follows: breast cancer (91.5%), colorectal cancer (63.8%), prostate cancer (78.3%), melanoma (91.9%) and bladder and urinary tract cancer (77.3%). Primary care practices include ~32 chronic cancer patients, with a potential extra consultation time of ~19 hours per year per 1000 patients. One-third (35%) are already in a chronic disease management programme and 57% were diagnosed >5 years ago. Registration of risk factors for cancer is incomplete, but of better quality when comorbidity is present. CONCLUSION: Numbers of chronic cancer patients and possible time investment by primary care professionals in the case of a substitution scenario should not be a limiting factor for transition of follow-up from secondary to primary care, as most of the patients were diagnosed >5 years ago and a large proportion of these patients are already monitored in an existing chronic care programme.

Nutrient displacement associated with walnut supplementation in men.

BACKGROUND: Dietary guidance issued by various global government agencies recommends nut consumption within the context of a healthy-eating pattern. Nuts are nutrient dense and may promote nutrient adequacy. As an energy-dense food, nuts must replace other foods in the diet to prevent an excess of calories. METHODS: We evaluated how recommending the inclusion of walnuts (75 g day(-1) ) in the diet affected energy and nutrient intake in men (45-75 years; mean body mass index = 27.6 kg m(-2) ; n = 19) at risk for developing prostate cancer. Guidance was provided about incorporating walnuts isocalorically in a healthy diet. Three-day food records and body weight were collected at baseline and after two 8-week diet periods (usual versus walnut supplement diets). RESULTS: Energy intake on the walnut supplement diet exceeded the usual diet, although body weight was maintained. Energy intake was lower on the actual walnut supplement diet than the calculated walnut diet [10,865 kJ (2595 kcal) versus 11,325 kJ (2705 kcal) per day, respectively] and contributed 23% less energy than 75 g of walnuts. Approximately, 86% and 85% of the total fat and saturated fatty acids from walnuts were not displaced, whereas the increase in fibre from the usual diet to the actual walnut supplement diet represented less than one-half (39%) of the fibre provided by 75 g of walnuts. Walnuts were substituted, in part, for other foods, and the nutrient profile of the diet was improved, however, the beneficial effect of walnuts on the diet quality was not optimized. CONCLUSIONS: Individuals do not optimally implement food-based guidance. Consequently, nutrition professionals play a key role in teaching the implementation of food-based recommendations.

Large molecules reveal a linear length scaling for double photoionization.

We have measured the ratio of doubly to singly charged parent ions of benzene, naphthalene, anthracene, and pentacene using monochromatized synchrotron radiation up to 30 eV above the corresponding threshold. Our measurements show a striking similarity between the ratio of doubly charged to all parent ions and the ratio for helium. Moreover, the magnitudes of the ratios for these molecules scale linearly with their lengths with an amazing accuracy. A high ratio, i.e., a high relative double-photoionization probability, makes a molecule an important source of low-energy electrons that can promote radiation damage of biomolecules [B. Boudaïffa et al., Science 287, 1658 (2000)].

Photoemission of cooper pairs from aromatic hydrocarbons.

We report the discovery of the formation of an electron Cooper pair approximately 40 eV above the double-ionization threshold in benzene, naphthalene, anthracene, and coronene after absorption of a single photon. We have measured the ratios of doubly to singly charged parent ions of the above mentioned molecules as well as pyrrole and furan by using monochromatized synchrotron radiation up to 100 eV above the corresponding thresholds. We also recorded photoelectron spectra of benzene and naphthalene at selected energies. The electron-pair formation is based on the specific structure of the molecules and does not exist for pyrrole and furan.

Evaluation of the ability of neurobiological, neurodevelopmental and socio-economic variables to predict cognitive outcome in premature infants.

BACKGROUND: When developed in the 1990s, the Neurobiologic Risk Score (NBRS) and Neurodevelopmental Risk Exam (NRE) correlated well with developmental outcomes in premature infants. Given recent advances in neonatology, we assessed their present ability to predict cognitive outcome, alone and combined with socio-economic factors. METHODS: One hundred and twenty-nine neonates <32 weeks gestational age were assessed at 6, 12 and/or 24 months corrected age with the Cognitive Adaptive Test/Clinical Linguistic and Auditory Milestone Scale (CAT/CLAMS). Indices of socio-economic status included maternal education and marital status. RESULTS: At 24 months corrected age (n= 67), the NBRS (r=-0.5), maternal education (r= 0.46) and marital status (r= 0.37) correlated with the CAT/CLAMS. These correlations increased when NBRS and maternal education were combined (r= 0.63) and when specific NBRS components (intraventricular haemorrhage, periventricular leukomalacia, seizures) and maternal education were combined (r= 0.66). CONCLUSIONS: In the contemporary neonatal intensive care unit, measures used to predict cognitive outcome should incorporate both neurobiological risk factors and socio-economic variables.

Clinical empathy in GP-training: Experiences and needs among Dutch GP-trainees. "Empathy as an element of personal growth".

OBJECTIVE: Clinical empathy has been described as a key component of effective person-centeredness in patient-physician communication. Yet little is known about general practitioner (GP) trainees' experiences and opinions regarding clinical empathy, empathy-education and the development of empathic skills. This study aimed to explore trainees' experiences with clinical empathy during GP training. METHODS: This study used focus group interviews. GP trainees at two Dutch universities were approached by e-mail. Focus groups were conducted between April and November 2018. Six focus groups were conducted: two with starting trainees, two with trainees at the end of their first year and two with trainees at the end of their 3 years' training. Two experienced qualitative researchers analyzed the focus groups. During the thematic analysis the differences and similarities between the various stages of education were taken into account and a framework for the identified themes and subthemes was developed. RESULTS: Thirty-five GP trainees took part. Four main themes could be identified. Starting trainees experienced frictions regarding the influence of personal affective reactions on their medical competencies. Trainees at the end of their first year indicated that they reached a balance between empathic involvement and their responsibility to carry out relevant medical tasks, such as following GP guidelines. Trainees at the end of their three years' training recognized the mutual relationship between the development of the behavioral part of clinical empathy and personal growth. All trainees stated that their needs concerning education changed during their GP training and proposed changes to the curriculum. CONCLUSIONS: GP trainees face various obstacles in developing empathic skills and behavior. Particularly they mention handling personal affective reactions. Trainees express a clear wish for clinical empathy, in its theoretical as well as its skill and emotional aspects, to play a central role in the curriculum. PRACTICE IMPLICATIONS: More explicit attention to be paid to empathy by embedding theoretical education, explicit attention to skill training and assessment of empathic behavior by patients and supervisors.

A randomised controlled trial testing the efficacy of Fit after COVID, a cognitive behavioural therapy targeting severe post-infectious fatigue following COVID-19 (ReCOVer): study protocol.

BACKGROUND: Coronavirus disease 2019 (COVID-19) results in debilitating long-term symptoms, often referred to as Post-Acute Sequelae of SARS-CoV-2 Infection (PASC), in a substantial subgroup of patients. One of the most prevalent symptoms following COVID-19 is severe fatigue. Prompt delivery of cognitive behavioural therapy (CBT), an evidence-based treatment that has shown benefit in reducing severe fatigue in other conditions, may reduce post-COVID-19 fatigue. Based on an existing CBT protocol, a blended intervention of 17 weeks, Fit after COVID, was developed to treat severe fatigue after the acute phase of infection with SARS-CoV-2. METHOD: The ReCOVer study is a multicentre 2-arm randomised controlled trial (RCT) to test the efficacy of Fit after COVID on severe post-infectious fatigue. Participants are eligible if they report severe fatigue 3 up to and including 12 months following COVID-19. One hundred and fourteen participants will be randomised to either Fit after COVID or care as usual (ratio 1:1). The primary outcome, the fatigue severity subscale of the Checklist Individual Strength (CIS-fatigue), is assessed in both groups before randomisation (T0), directly post CBT or following care as usual (T1), and at follow-up 6 months after the second assessment (T2). In addition, a long-term follow-up (T3), 12 months after the second assessment, is performed in the CBT group only. The primary objective is to investigate whether CBT will lead to a significantly lower mean fatigue severity score measured with the CIS-fatigue across the first two follow-up assessments (T1 and T2) as compared to care as usual. Secondary objectives are to determine the proportion of participants no longer being severely fatigued (operationalised in different ways) at T1 and T2 and to investigate changes in physical and social functioning, in the number and severity of somatic symptoms and in problems concentrating across T1 and T2. DISCUSSION: This is the first trial testing a cognitive behavioural intervention targeting severe fatigue after COVID-19. If Fit after COVID is effective in reducing fatigue severity following COVID-19, this intervention could contribute to alleviating the long-term health consequences of COVID-19 by relieving one of its most prevalent and distressing long-term symptoms. TRIAL REGISTRATION: Netherlands Trial Register NL8947 . Registered on 14 October 2020.

Course and prognosis of myasthenia gravis: a systematic review.

The clinical course of myasthenia gravis (MG) is variable, and spontaneous remission is still uncommon. Knowledge of the prognostic factors may help understand the course of MG and thus optimize its management. A systematic review search was conducted in MEDLINE and EMBASE for English language studies from 1985 through 2009. We identified additional studies by reviewing bibliographies of retrieved articles and hand search main journal of neurology. Studies evaluating variables associated with or predictive of remission in adult patients with MG were included. Because of methodological heterogeneity, we refrained from statistical pooling, instead, a best evidence synthesis was used for summarizing the results. From 1810 potentially relevant studies, 13 cohort studies met the inclusion criteria. The included studies were heterogeneous considerably in sample size, disease duration, follow-up years, definition of remission, and analysis. Study quality was limited by retrospective design in most studies and lack of multivariate analysis. Time of diagnosis from onset (<1 year) showed strong evidence of predicting a better remission. In studies using completely stable remission outcomes, there was strong evidence that age at onset (<40 years) was of prognostic importance. Furthermore, gender showed no association with remission. Time of diagnosis from onset and age at onset were found to be predictors of remission. Gender does not seem to predict the course of MG. Our findings should be interpreted with caution because of the clinical and methodological heterogeneity of included studies.

The impact of maternal malaria on newborns.

BACKGROUND: Each year, malaria threatens 125 million pregnancies, and gestational malaria is responsible for up to 200,000 infant deaths in sub-Saharan Africa. With advancing knowledge of malaria in pregnancy and its impact on newborns, improved preventive and therapeutic interventions are possible. METHODS: We reviewed and, by consensus, evaluated published literature relevant to malaria and newborns. Important findings are summarised. RESULTS: Pregnant women are more likely than others to be inoculated with and infected by malaria parasites. Poor outcomes are particularly common in primigravid women and their offspring. The placenta is affected through cellular adhesion, cytokine production and mononuclear cell infiltrates. As a result, newborns may have low birthweight owing to intrauterine growth retardation or prematurity. Recent evidence suggests that a subset of these infants is also at higher risk of malaria infections later in life. Preventive strategies to improve maternal and fetal outcomes include intermittent preventive treatment and insecticide-treated bed nets. Asymptomatic malaria infection is not uncommon in newborns, and symptomatic disease occurs. Fever and death are possible during the early days of life, and presentation with a sepsis-like illness can occur during the 1st 2 months of life. Malaria-affected infants face higher than usual risks of infantile anaemia, subsequent malaria infection and death during the 1st year of life. CONCLUSIONS: Malaria is common during pregnancy and can have serious consequences for neonatal health. Neonatal morbidity and mortality can be significantly reduced by proper implementation of insecticide-treated nets and intermittent preventive treatment.

Psychiatric characteristics of older persons with medically unexplained symptoms: A comparison with older patients suffering from medically explained symptoms.

BACKGROUND: Empirical studies on the clinical characteristics of older persons with medically unexplained symptoms are limited to uncontrolled pilot studies. Therefore, we aim to examine the psychiatric characteristics of older patients with medically unexplained symptoms (MUS) compared to older patients with medically explained symptoms (MES), also across healthcare settings. METHODS: A case-control study including 118 older patients with MUS and 154 older patients with MES. To include patients with various developmental and severity stages, patients with MUS were recruited in the community (n = 12), primary care (n = 77), and specialized healthcare (n = 29). Psychopathology was assessed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria (Mini-International Neuropsychiatric Interview) and by dimensional measures (e.g., psychological distress, hypochondriasis, and depressive symptoms). RESULTS: A total of 69/118 (58.5%) patients with MUS met the criteria for a somatoform disorder according to DSM-IV-TR criteria, with the highest proportion among patients recruited in specialized healthcare settings (p = 0.008). Patients with MUS had a higher level of psychological distress and hypochondriasis compared to patients with MES. Although psychiatric disorders (beyond somatoform disorders) were more frequently found among patients with MUS compared to patients with MES (42.4 vs. 24.8%, p = 0.008), this difference disappeared when adjusted for age, sex, and level of education (odds ratio = 1.7 [95% confidence interval: 1.0-3.0], p = 0.070). CONCLUSIONS: Although psychological distress is significantly higher among older patients with MUS compared to those with MES, psychiatric comorbidity rates hardly differ between both patient groups. Therefore, treatment of MUS in later life should primarily focus on reducing psychological distress, irrespective of the healthcare setting patients are treated in.

Pds5p is an essential chromosomal protein required for both sister chromatid cohesion and condensation in Saccharomyces cerevisiae.

The PDS5 gene (precocious dissociation of sisters) was identified in a genetic screen designed to identify genes important for chromosome structure. PDS5 is an essential gene and homologues are found from yeast to humans. Pds5p function is important for viability from S phase through mitosis and localizes to chromosomes during this cell cycle window, which encompasses the times when sister chromatid cohesion exists. Pds5p is required to maintain cohesion at centromere proximal and distal sequences. These properties are identical to those of the four cohesion complex members Mcd1p/Scc1p, Smc1p, Smc3p, and Scc3p/Irr1p (Guacci, V., D. Koshland, and A. Strunnikov. 1997. Cell. 91:47-57; Michaelis, C., R. Ciosk, and K. Nasmyth. 1997. Cell. 91:35-45; Toth, A., R. Ciosk, F. Uhlmann, M. Galova, A. Schleiffer, and K. Nasmyth. 1999. Genes Dev. 13:307-319). Pds5p binds to centromeric and arm sequences bound by Mcd1p. Furthermore, Pds5p localization to chromosomes is dependent on Mcd1p. Thus, Pds5p, like the cohesin complex members, is a component of the molecular glue that mediates sister chromatid cohesion. However, Mcd1p localization to chromosomes is independent of Pds5p, which may reflect differences in their roles in cohesion. Finally, Pds5p is required for condensation as well as cohesion, which confirms the link between these processes revealed through analysis of Mcd1p (Guacci, V., D. Koshland, and A. Strunnikov. 1997. Cell. 91:47-57). Therefore, the link between cohesion and condensation is a general property of yeast chromosomes.