Suicide-Specific Training Experiences and Needs Among Military Mental Health Providers.

BACKGROUND: Military suicide rates have risen over the past two decades, with a notable spike in recent years. To address this issue, military mental health providers must be equipped with the skills required to provide timely and effective care; yet little is known about the suicide-specific training experiences or needs of these professionals. METHODS: Thirty-five mental health care providers who treat active duty personnel at military treatment facilities participated in this mixed-methods study. All participants completed a survey assessing training and clinical experiences, comfort and proficiency in working with patients at risk for suicide, and perceived barriers to obtaining suicide-specific training. A sub-set of participants (n = 8) completed a telephone interview to further describe previous experiences and perceived challenges to obtaining training. RESULTS: The majority of participants (79.4%) had 6+ years of clinical experience, had a patient who had attempted suicide (85.3%), and completed at least one suicide-related training since finishing their education (82.4%). Survey results showed the leading barrier to enrolling in suicide-specific trainings was perceived lack of training opportunities (40.7% reported it was a barrier "quite often" or more), followed by lack of time (25%). Interview results revealed lack of time, location and logistical issues, and low perceived need for additional training among providers could impede enrollment. CONCLUSIONS: Study results identified several modifiable barriers to receiving suicide-specific continuing education among military mental health providers. Future efforts should develop accessible training programs that can be easily integrated into routine clinical operations to mount the best defense against suicide. HIGHLIGHTSMilitary mental health providers report significant experience and relatively high degrees of comfort and proficiency working with patients at high risk for suicide.Most providers reported receiving training in suicide assessment and screening; few reported prior training in management of suicidality.Study results identified several modifiable barriers to receiving suicide-prevention continuing education among military mental health care providers; future efforts should seek to develop accessible training programs that can be easily integrated into routine clinical operations to mount the best defense against suicide.

Modelling informally collected quantities of bulky waste and reusable items in Austria.

Disparities in earnings between Western and Eastern European countries are the reason for a well-established informal sector actively involved in collection and transboundary shipment activities from Austria to Hungary. The preferred objects are reusable items and wastes within the categories bulky waste, WEEE and metals, intended to be sold on flea markets. Despite leading to a loss of recyclable resources for Austrian waste management, these informal activities may contribute to the extension of the lifetime of certain goods when they are reused in Hungary; nevertheless they are discussed rather controversially. The aim of this paper is to provide objective data on the quantities informally collected and transhipped. The unique activities of informal collectors required the development and implementation of a new set of methodologies. The concept of triangulation was used to verify results obtained by field visits, interviews and a traffic counting campaign. Both approaches lead to an estimation of approx. 100,000 t per year of reusable items informally collected in Austria. This means that in addition to the approx. 72 kg/cap/yr formally collected bulky waste, bulky waste wood, household scrap (excluding packaging) and WEEE, up to a further 12 kg/cap/yr might, in the case that informal collection is abandoned, end up as waste or in the second-hand sector.

Comparative analysis on antibiotic resistance characteristics of Listeria spp. and Enterococcus spp. isolated from laying hens and eggs in conventional and organic keeping systems in Bavaria, Germany.

By investigating the prevalence and antimicrobial resistance characteristics of Gram-positive bacteria from organic and conventional keeping systems of laying hens, it was to be determined to what extent these properties are influenced by the different systems. For this purpose, a total of 799 cloacal swabs and 800 egg samples were examined. Prevalences for all selected bacteria from cloacal swabs were much the same for both organic and caged birds: Listeria spp.1.3%[org] versus 1.6%[con]; Enterococcus spp. 95.5%[org] versus 97.5%[con]. Egg contents and eggshells were generally contaminated to a lesser extent, primarily with Enterococcus spp. Listeria isolates were susceptible to almost all tested antibiotics, only three Listeria innocua from conventional keepings were resistant to clindamycin; one isolate additionally to imipenem. High percentages of Enterococcus faecalis were resistant to doxycycline and macrolides. Enterococcus faecium proved to have high resistance rates to clindamycin, fosfomycin and erythromycin; 9.1% were even resistant to the reserve antibiotic synercid. Further, Enterococcus spp. showed higher resistance rates to doxycycline, erythromycin, fosfomycin and rifampicin. No glycopeptide resistant enterococci were detected. A correlation between keeping system and resistance/susceptibility rates could be demonstrated. In detail, E. faecalis from organic laying hen husbandries showed significant lower resistance prevalences to tylosin, streptomycin and doxycycline; susceptibility rates were higher for enrofloxacin and ciprofloxacin. Rifampicin and imipenem were more effective in isolates from conventional keepings (P < 0.05). The amounts of resistant isolates of the Enterococcus raffinosus from organic farms were significantly lower, the amounts of sensitive isolates were significantly higher than from conventional farms concerning eight antibiotics (P < 0.05). When comparing the susceptibility/resistance rates, as well as the mean minimum inhibitory concentrations values, the consistent tendency is that bacteria from organic layer flocks are more susceptible to antimicrobials. These results show that organic livestock farming plays a part in contributing to reduced antibiotic resistance.

Comparative analysis of antibiotic resistance characteristics of Gram-negative bacteria isolated from laying hens and eggs in conventional and organic keeping systems in Bavaria, Germany.

By investigating the prevalence and resistance characteristics of Gram-negative bacteria from organic and conventional kept laying hens against 31 (Campylobacter: 29) different antibiotics using the microdilution method, we determined to what extent different keeping systems influence bacterial resistance patterns. For this purpose, samples from 10 organic and 10 conventional flocks in Bavaria (Germany) were investigated four times between January 2004 and April 2005. Altogether, 799 cloacal swabs and 800 eggs (contents and shells) were examined. The bacterial investigation performed with standardized cultural methods showed prevalence for all bacteria groups in about the same order of magnitude in the two different keeping systems: Salmonella spp. 3.5% (organic ([org])) versus 1.8% (conventional ([con])); Campylobacter spp. 34.8%(org) versus 29.0%(con) and E. coli 64.4%(org) versus 69.0%(con). Coliforms (Citrobacter, Enterobacter, Pantoea) were only isolated in single cases. In eggs, generally less bacteria were detected, predominantly Escherichia; Salmonella and Campylobacter were only scarcely isolated. Salmonella enterica ssp. enterica serovar Typhimurium (n=10) were resistant to up to nine, S. of the serogroup B (n=4) up to six antibiotics. All tested Salmonella (n=23) proved to be resistant to spectinomycin. Escherichia coli (n=257(org) and 276(con)) from organic layers showed significant lower resistance rates and higher rates of susceptible isolates to nine agents, namely amoxicillin/clavulanic acid, ampicillin, cefaclor, cefoxitin, cefuroxime, doxycycline, mezlocillin, neomycin and piperacillin. In contrast, only two antibiotics turned out to be more effective in conventional isolates (gentamicin and tobramycin). In the case of Campylobacter jejuni (n=118(org) and 99(con)), statistically significantly better rates were observed for isolates from organic flocks concerning imipenem and amoxicillin/clavulanic acid, whereas fosfomycin was more potent in strains from conventional flocks. Results of this study indicate that both resistance rates and mean minimum inhibitory concentrations of bacteria isolated from organic keeping systems have lower values than those from conventional ones, particularly recognizable for E. coli. Thus, organic livestock farming with its restrictions and additional requirements contributes to further effectiveness of antibiotics.

[Alarm signs in drug-induced skin reactions]. / Alarmzeichen bei medikamentös bedingten Hautreaktionen.

Drug-induced skin reactions may represent warning signs in three different situations. First, the cutaneous rash may reveal an underlying systemic disease being perhaps still undiagnosed. The following examples illustrate this concept: the drug-induced eruption observed in patients suffering from infectious mononucleosis, from lymphoproliferative malignancy or from HIV infection. Second, the cutaneous rash may indicate a drug-induced multisystemic disease possibly more severe than the cutaneous symptoms. Third, the cutaneous rash may herald the most severe drug-induced skin reaction, Lyell syndrome, due to epidermal necrolysis probably of immunological origin.

Systemic corticosteroids do not prevent postherpetic neuralgia.

We review the use of corticosteroids in preventing postherpetic neuralgia (PHN) in a retrospective study over 5 years and 10 months. Out of 113 patients evaluable, 46 (40%) had PHN. 21 of these 46 patients (38%) had received prednisone (p = 0.49; n.s.). Duration and intensity of PHN were not different in the prednisone-treated group. This long-term study does not support the use of prednisone for preventing PHN.

L-tryptophan-induced eosinophilia-myalgia syndrome. I. Report of two cases with pseudoxanthoma-elasticum-like skin changes.

Two female patients who fulfilled the criteria for L-tryptophan-induced eosinophilia-myalgia syndrome (EMS) had, together with morphea-like and fasciitis-like sclerotic changes of the skin, lesions that clinically mimicked pseudoxanthoma elasticum (PXE). Histology was compatible with the diagnosis; electron microscopy did not reveal calcium deposits. PXE-like changes may represent an additional feature of the pleomorphic L-tryptophan-induced EMS.

[Cutaneous manifestations of infection due to hepatitis B virus]. / Les manifestations cutanées de l'infection par le virus de l'hépatite B.

Two entities can precede the clinical and biological signs of hepatitis B virus (HBV) infection: the various lesions of the serum sickness-like prodrome (urticaria, maculopapular exanthem, purpura, etc.) induced by the deposition of intravascular circulating immune complexes and papular acrodermatitis of childhood in which the physiopathological role of HBV has not yet been established. The persistence of HBs antigen (HBs Ag) may give rise to the purpuric lesions of essential mixed cryoglobulinemia and to the livedo, the nodules and ulcerations of poly-arteritis nodosa.

[Cutaneous manifestations of tuberculosis]. / Manifestations cutanées de la tuberculose.

Tuberculous lesions of the skin occur rarely nowadays. We therefore have mostly lost the knowledge to recognize this entity. Furthermore, the great variability of the clinical and particularly dermatologic manifestations of the disease can tax the most astute clinician. The challenge is even greater, when the patient has an intercurrent condition such as a malignancy or AIDS. In order to make understanding easier, we replace all descriptive terms, some carried over from the last century, by a useful pathogenetic and clinical, algorithmic classification. Finally the necessity of biopsy and specific cultures for proper diagnosis and treatment of any skin lesion consistent with skin tuberculosis is emphasized.

[Pasteurellosis in human pathology]. / Pasteurellose en pathologie humaine.

Pasteurella are common bacteria among healthy animals. Humans usually are infected by dog and cat bites or scratches. Besides, local skin infection, Pasteurella may spread, in some cases, to lungs, joints, bones or, less frequently, to other organs.

A patient with features of both Bardet-Biedl and Alström syndromes.

We describe a 30-year-old patient with acanthosis nigricans, diabetes mellitus with insulin resistance, hypogonadotropic hypogonadism, pigmentary degeneration of the retina and cerebellar, pyramidal and posterior columnar involvement. He had normal mental function, normal hearing and no hexadactyly. The patient had symptoms of both Bardet-Biedl and Alström syndromes, but did not manifest all the main features of either syndrome. This suggests either that the Bardet-Biedl, Alström, Laurence-Moon syndromes (including the variant described by Edwards) have a highly variable expression or that our case is a new variant within this group of syndromes.

[Hoigné's syndrome or pseudo-anaphylactic reaction to procaine penicillin G: a still current classic]. / Syndrome de Hoigné ou réaction pseudo-anaphylactique à la procaïne-pénicilline G: un classique d'actualité.

In this journal in 1959 R. Hoigné described the first cases of pseudo-anaphylactic reactions induced by intramuscular administration of procaine penicillin G. This complication, characterized by acute psychological and neurological manifestations, is still of current interest since recently three cases of Hoigné's syndrome were diagnosed at the University Hospital of Geneva. This entity deserves consideration because it must be differentiated from authentic anaphylactic shock due to penicillin. The distinction is important from a therapeutic viewpoint since Hoigné's syndrome allows continuation of treatment, whereas it is absolutely contraindicated in anaphylactic shock.

Age-related rather than ulcer-related impairment of venous function tests in patients with venous ulceration.

Various noninvasive tests of venous function and skin oxygenation were studied in 12 patients with unilateral venous ulcer and in 24 control subjects. In the ulcer patients, there was no difference between the leg with and the leg without ulcer regarding all the tests studied. Except for the maximal venous outflow, the patients and their age- and sex-matched controls did not differ with regard to all parameters studied. In contrast to these findings, ageing was associated with a reduction in maximum venous outflow, a shortening in venous filling time, an increase in venous pressure in the posterior tibial vein and a diminution of transcutaneous partial oxygen pressure.

[Leg ulcer complicated by secondary amyloidosis]. / Ulcère de jambe compliqué d'amyloïdose secondaire.

A 76-year-old woman with a chronic leg ulcer for the last thirty-seven years was hospitalized in our institution for chronic diarrhea and terminal kidney failure with proteinuria. The diagnosis of secondary amyloidosis due to persistent skin inflammation was confirmed by aspiration of subcutaneous abdominal fat and by kidney biopsy which showed AA type systemic amyloidosis. This appears to be a rare complication of chronic leg ulcers as there have been only eight publications covering eleven cases in the literature.

Bullous pemphigoid and multiple sclerosis: more than a coincidence? Report of three cases.

In three patients with long-standing multiple sclerosis, bullous pemphigoid developed. The diagnosis of bullous pemphigoid was based on histologic findings, direct and indirect immunofluorescence, and Western blots showing IgG reacting with the 220 to 240 kD bullous pemphigoid antigen in the serum of three patients. Contrary to previous observations, bullous pemphigoid associated with multiple sclerosis was not different from bullous pemphigoid alone. Three similar cases have been reported previously, so the occurrence of bullous pemphigoid in patients with multiple sclerosis may be more than a coincidence.