Sub-calcaneal plantar fat pad assessment using dual-energy computed tomography: First experience in the diabetic foot.

BACKGROUND: This study assessed the use of dual-energy computed tomography (CT) to evaluate sub-calcaneal plantar fat pad changes in people with diabetic neuropathy. METHODS: Dual-energy CT scans of people with diabetic neuropathy and non-diabetic controls were retrospectively included. Average CT values (in Hounsfield Units) and thickness (in centimeters) of the sub-calcaneal plantar fat pad were measured in mono-energetic images at two energy levels (40 keV and 70 keV). The CT values measured in patients with diabetic neuropathy were correlated to barefoot plantar pressure measurements performed during walking in a clinical setting. FINDINGS: Forty-five dual-energy CT scans of people with diabetic neuropathy and eleven DECT scans of non-diabetic controls were included. Mean sub-calcaneal plantar fat pad thickness did not significantly differ between groups (diabetes group 1.20 ± 0.34 cm vs. control group 1.21 ± 0.28 cm, P = 0.585). CT values at both 40 keV (-34.7 ± 48.7 HU vs. -76.0 ± 42.8 HU, P = 0.013) and 70 keV (-11.2 ± 30.8 HU vs. -36.3 ± 27.2 HU, P = 0.017) were significantly higher in the diabetes group compared to controls, thus contained less fatty tissue. This elevation was most apparent in patients with Type 1 diabetes. CT values positively correlated with the mean peak plantar pressure. INTERPRETATION: Dual-energy CT was able to detect changes in the plantar fat pad of people with diabetic neuropathy.

[Functioning of the acute psychiatric emergency chain in Amsterdam-Amstelland during the COVID-19 pandemic]. / Functioneren van acute crisisketen psychiatrie in Amsterdam-Amstelland tijdens de coronapandemie.

BACKGROUND: At the start of the COVID-19 pandemic, there were fears that a higher proportion of patients with a psychiatric disorder would find themselves in crisis due to the threat of COVID-19 and the impact of the restrictions. If the emergency mental health department would become blocked this could work through to emergency rooms (ER). Acute psychiatry is also assessed at the ER due to lack of space in the emergency mental health department, this is called ‘overflow’. There already was the fear that the virus would flood the hospitals with SARS-CoV-2 infected patients. The emergency mental health department and hospitals agreed that the psychiatric assessments and admissions would take place at the mental health departments as much as possible. AIM: To describe and evaluate the use of measures taken and set up facilities in Amsterdam-Amstelland to minimize psychiatric assessments in the emergency room during the COVID-19 pandemic. Secondly, to present how psychiatric assessments and admissions were conducted safely if there was suspicion or infection with SARS-CoV-2. METHOD: Use of acute psychiatric crisis monitor, the minutes of regional acute care counsel and literature. RESULTS: People with a psychiatric crisis were rarely suspected to be infected with SARS-CoV-2. There was always
sufficient capacity in COVID-19 wards in the mental health department. During the lockdown, we managed to
minimize overflow from the mental health emergency department to emergency rooms. Conclusion During the COVID-19 pandemic effective collaboration between healthcare partners was achieved in Amsterdam-Amstelland, so that psychiatric assessments and admissions with (suspected) COVID-19 could be conducted safely. Interventions to relieve the emergency room from overflow during lockdown were effective.

[Radicalization and psychiatry: a plea for a broad perspective]. / Radicalisering en psychiatrie: pleidooi voor een brede blik.

BACKGROUND: The extent to which psychiatry can, and should, contribute to the prevention of terrorism and the countering of radicalization is under debate. The political dimension of the problem raises questions about the desirability of active psychiatric involvement.
AIM: To deepen the debate by discussing the role of psychiatric disorders in terrorist activities, as well as the role of societal determinants in radicalization processes.
METHOD: Review of relevant literature and theoretical analysis.
RESULTS: Radicalization processes are heterogeneous and have determinants at individual, social and societal level. In a small minority of 'radicalizing' individuals severe psychopathology plays a role.
CONCLUSION: Knowledge of the factors relevant to radicalization at individual, social and societal level is necessary for psychiatrists to act responsibly, both at case level, and in the public and scientific debate.

The association between ethnic background and characteristics of first mental health treatment for psychotic disorders in the Netherlands between 2001 and 2005.

PURPOSE: To test the hypothesis that ethnic minority status of patients is associated with specific psychotic disorder treatment characteristics. METHODS: Longitudinal data (2001-2005) were extracted from a nationwide psychiatric case register in the Netherlands. The sample consisted of 30,655 episodes of mental health treatment for 23,122 patients with psychotic disorders. Information was available about waiting time and treatment duration, source of referral, occurrence of crisis contacts, admittance to clinical care and compulsory admissions. In addition, information was available about ethnicity (based on country of birth), gender, age and marital status. Results were calculated for ethnic and gender groups separately. In addition, a number of multivariate regression analyses were conducted to correct for differences in age and marital status. RESULTS: There was substantial variation between ethnic minority and gender groups in relation to the treatment characteristics. Compared with a Dutch ethnic background, ethnic minority background was generally associated with less waiting time, and more police referrals, crisis contacts, admittance to clinical care and compulsory admission, but shorter treatment duration. Characteristics appeared to be least favorable in episodes that involved male patients with Antillean and Surinamese backgrounds, whereas episodes were quite similar for ethnic Dutch and Turkish patients. CONCLUSIONS: Characteristics of mental health treatment for psychosis in the Netherlands are different for ethnic minority patient groups than for patients with an ethnic Dutch background. However, there were substantial differences between ethnic minority groups.

Violent offenders as a target population for Public Mental Health Care.

The study sought to specify which part of a population of young adult violent offenders in Amsterdam (mean age 24.9 years, sd = 8.2) were eligible for Public Mental Health Care (PMHC). The results of a semi-structured clinical interview were used (N = 454), which included the Self-Sufficiency Matrix (SSM-D). Using the SSM-D and two distinct definitions of what constitutes a need for PMHC, the size of the PMHC target population was determined twice. Depending on which definition was used, 35.9% (mathematical algorithm which put weights to single SSM-D domains) and 34.8% (problematic levels of self-sufficiency on a selection of domains) appeared to be eligible for entering the PMHC system. The study confirms that a substantial proportion of vulnerable people are among the forensic population.

Psychometric properties of an interviewer-administered version of the Kessler Psychological Distress scale (K10) among Dutch, Moroccan and Turkish respondents.

The Kessler Psychological Distress scale (K10) is an instrument that is widely used to screen for mental disorders, but information is lacking on its psychometric qualities in non-Western samples. This study used a population-based sample (N = 725) to assess the reliability and validity of the K10 across ethnic groups in an urban area. The results were generally supportive of the K10 as a reliable and valid instrument to screen for anxiety and depression in all three groups. Cronbach's alpha was high (0.93) and the results indicated the existence of a solid single factor structure. Item bias in relation to ethnic background was minor. In each group, there was good criterion validity with respect to one-month DSM-IV diagnosis for depressive and/or anxiety disorder. The results nevertheless highlight the importance of cross-cultural validation, as we found different cut-off values for ethnic subgroups to obtain optimal sensitivity and specificity for detecting depressive and/or anxiety disorders.