[Feminisation: does it make a difference?] / Feminisering: maakt het verschil?

In a digital orientating survey of gender differences among 156 male and 98 female dentists in the Netherlands, many similarities were found between the two groups. Men and women generally report that they are in good health, experience comparable levels of burnout (about 10%) and are equally satisfied with their choice of profession. To a large extent, they perceive the same aspects of their work as attractive, with 'patient care' as by far the most attractive feature. According to the dentists as well as 122 assistants and dental hygienists (who were also questioned in this survey), they have comparable leadership styles, while the dentists, on average, rate their leadership behaviour more highly than the assistants and dental hygienists do. In addition, a limited number of significant gender differences were found in the sample. Women feel less competent in conducting complex interventions than men, and they find surgical interventions and complex restorative treatments less attractive aspects of their work. Women consult colleagues more often and their preference for working in a team is greater.

Tympanic plate fractures in temporal bone trauma: prevalence and associated injuries.

BACKGROUND AND PURPOSE: The prevalence of tympanic plate fractures, which are associated with an increased risk of external auditory canal stenosis following temporal bone trauma, is unknown. A review of posttraumatic high-resolution CT temporal bone examinations was performed to determine the prevalence of tympanic plate fractures and to identify any associated temporal bone injuries. MATERIALS AND METHODS: A retrospective review was performed to evaluate patients with head trauma who underwent emergent high-resolution CT examinations of the temporal bone from July 2006 to March 2012. Fractures were identified and assessed for orientation; involvement of the tympanic plate, scutum, bony labyrinth, facial nerve canal, and temporomandibular joint; and ossicular chain disruption. RESULTS: Thirty-nine patients (41.3 ± 17.2 years of age) had a total of 46 temporal bone fractures (7 bilateral). Tympanic plate fractures were identified in 27 (58.7%) of these 46 fractures. Ossicular disruption occurred in 17 (37.0%). Fractures involving the scutum occurred in 25 (54.4%). None of the 46 fractured temporal bones had a mandibular condyle dislocation or fracture. Of the 27 cases of tympanic plate fractures, 14 (51.8%) had ossicular disruption (P = .016) and 18 (66.6%) had a fracture of the scutum (P = .044). Temporomandibular joint gas was seen in 15 (33%) but was not statistically associated with tympanic plate fracture (P = .21). CONCLUSIONS: Tympanic plate fractures are commonly seen on high-resolution CT performed for evaluation of temporal bone trauma. It is important to recognize these fractures to avoid the preventable complication of external auditory canal stenosis and the potential for conductive hearing loss due to a fracture involving the scutum or ossicular chain.

Suicidal ideation in ethnic minority and majority adolescents in Utrecht, the Netherlands.

We investigated the prevalence and explored the vulnerability to suicidal ideation across several ethnic minority versus ethnic majority adolescents in the city of Utrecht in The Netherlands. Exploratory analyses were conducted on a dataset obtained from the Municipal Health Services in Utrecht. We examined whether ethnic minority adolescents are at risk for suicidal ideation because of a family background of migration, social-economic position and certain family factors, which influence psychological constellations. We found that levels of suicidal ideation among adolescents of Turkish background were significantly higher than in both majority and other minority adolescents, The Turkish adolescents at risk for suicidal ideation reported that they do not enjoy being at home with their families. Psychological factors, in particular lack of self-pride and the idea of not becoming successful in life, appeared to be important, as well as feelings of loneliness. Suicidal ideation was not found equally across all ethnic minority groups. A history of migration, ethnic minority status, or low socioeconomic status were not sufficient to explain the variation across ethnicities. Our results suggest that specific social-cultural factors, contextualized in the individual and located in the family environment, are relevant in explaining the disproportionate rates for Turkish adolescents in Utrecht.

Efficacy and tolerability of the new antiepileptic drugs I: treatment of new onset epilepsy: report of the Therapeutics and Technology Assessment Subcommittee and Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society.

OBJECTIVE: To assess the evidence demonstrating efficacy, tolerability, and safety of seven new antiepileptic drugs (AEDs) (gabapentin, lamotrigine, topiramate, tiagabine, oxcarbazepine, levetiracetam, and zonisamide-reviewed in the order in which these agents received approval by the US Food and Drug Administration) in the treatment of children and adults with newly diagnosed partial and generalized epilepsies. METHODS: A 23-member committee, including general neurologists, pediatric neurologists, epileptologists, and doctors in pharmacy, evaluated the available evidence based on a structured literature review including MEDLINE, Current Contents, and Cochrane library for relevant articles from 1987 until September 2002, with selected manual searches up until 2003. RESULTS: There is evidence either from comparative or dose-controlled trials that gabapentin, lamotrigine, topiramate, and oxcarbazepine have efficacy as monotherapy in newly diagnosed adolescents and adults with either partial or mixed seizure disorders. There is also evidence that lamotrigine is effective for newly diagnosed absence seizures in children. Evidence for effectiveness of the new AEDs in newly diagnosed patients with other generalized epilepsy syndromes is lacking. CONCLUSIONS: The results of this evidence-based assessment provide guidelines for the prescription of AEDs for patients with newly diagnosed epilepsy and identify those seizure types and syndromes where more evidence is necessary.

Efficacy and tolerability of the new antiepileptic drugs II: treatment of refractory epilepsy: report of the Therapeutics and Technology Assessment Subcommittee and Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society.

OBJECTIVE: To assess the evidence demonstrating efficacy, tolerability, and safety of seven new antiepileptic drugs (AEDs) (gabapentin, lamotrigine, topiramate, tiagabine, oxcarbazepine, levetiracetam, and zonisamide) in the treatment of children and adults with refractory partial and generalized epilepsies. METHODS: A 23-member committee including general neurologists, pediatric neurologists, epileptologists, and doctors in pharmacy evaluated the available evidence based on a structured literature review including MEDLINE, Current Contents, and Cochrane library for relevant articles from 1987 until March 2003. RESULTS: All of the new AEDs were found to be appropriate for adjunctive treatment of refractory partial seizures in adults. Gabapentin can be effective for the treatment of mixed seizure disorders, and gabapentin, lamotrigine, oxcarbazepine, and topiramate for the treatment of refractory partial seizures in children. Limited evidence suggests that lamotrigine and topiramate are also effective for adjunctive treatment of idiopathic generalized epilepsy in adults and children, as well as treatment of the Lennox Gastaut syndrome. CONCLUSIONS: The choice of AED depends upon seizure and/or syndrome type, patient age, concomitant medications, AED tolerability, safety, and efficacy. The results of this evidence-based assessment provide guidelines for the prescription of AEDs for patients with refractory epilepsy and identify those seizure types and syndromes where more evidence is necessary.

Vagus nerve stimulation therapy for epilepsy in older adults.

The authors assessed the efficacy, safety, and tolerability of vagus nerve stimulation (VNS) for refractory epilepsy in 45 adults 50 years of age and older. They determined seizure frequency, adverse effects, and quality of life. At 3 months, 12 patients had a >50% decrease in seizure frequency; at 1 year, 21 of 31 studied individuals had a >50% seizure decrease. Side effects were mild and transient. Quality of life scores improved significantly with time.

Assessing the Winning Teams program of interactive satellite-based training.

This research assessed an interactive satellite-based training program integrating interactive audiovisual experiences with face-to-face interactions. Key elements were content created by experts, high-quality video segments, satellite-based interaction, off-line interactions among teams of parents and caregivers, workshops, and team building exercises. For pragmatic reasons, it was necessary to develop brief assessment instruments concurrently with training. A large set of survey items were created from draft materials and reduced empirically through piloting to those with the best psychometric properties. To avoid the appearance of traditional testing, knowledge was assessed with Likert items. Surveys measured participant satisfaction, knowledge, attitudes, and the application and articulation of concepts. Participant satisfaction was high. Participants increased positive attitudes and learned appropriate vocabulary. Training was more effective than no training or watching videotapes. The program appears to represent a viable model of training that could successfully be applied to Internet technologies.

Neurology without borders: neurological disease in a shrinking world.

The last half of the twentieth century has seen social, political, economic, and environmental changes which have altered patterns of health care in all parts of the world. International influences are becoming stronger each year, and the practice of medicine in any single country is becoming more and more influenced by events and practices in others. Environmental degradation may involve widespread dissemination of neurological toxins. Newly emerging or drug-resistant infections include those involving the nervous system. Effective neurological practice is more dependent than ever on knowledge of international health. Neurologists can act as effective advocates for appropriate treatment, allocation of resources, and prevention of neurological diseases.

Wada difference a day makes: interpretive cautions regarding same-day injections.

OBJECTIVE: To determine whether memory scores after second intracarotid amobarbital procedure (IAP) injections are affected by the time between the first and second injections. METHODS: Sixty-two patients received their second IAP injection on the day after the first injection. Forty-three other patients received the second injection on the same day as the first injection. Both groups underwent similar IAP protocols and memory assessments, except for the timing of the second injection. RESULTS: The second IAP memory scores in the two-day group were significantly higher (p < 0.05) than those in the one-day group. Timing of second injection was a significant correlate of second memory scores, but amobarbital dosage, first IAP memory score, and pre-IAP measures of memory and intelligence were not significant correlates. CONCLUSION: One-day and two-day IAP protocols do not result in similar memory scores after the second injection. Nineteen percent of a subset of patients in the one-day protocol were misclassified, in terms of IAP memory ratings, because of the deleterious effect of having both injections on the same day. It is recommended that correction scores be considered, for some patients who receive two IAP injections on one day, to approximate what the second IAP memory score would have been had the second injection occurred on a second day.

A comparison of rectal diazepam gel and placebo for acute repetitive seizures.

BACKGROUND: Acute repetitive seizures are readily recognizable episodes involving increased seizure frequency. Urgent treatment is often required. Rectal diazepam gel is a promising therapy. METHODS: We conducted a randomized, double-blind, parallel-group, placebo-controlled study of home-based treatment for acute repetitive seizures. Patients were randomly assigned to receive either rectal diazepam gel, at a dosage varying from 0.2 to 0.5 mg per kilogram of body weight on the basis of age, or placebo. Children received one dose at the onset of acute repetitive seizures and a second dose four hours later. Adults received three doses -- one dose at onset, and two more doses 4 and 12 hours after onset. Treatment was administered by a care giver, such as a parent, who had received special training. The number of seizures after the first dose was counted for 12 hours in children and for 24 hours in adults. RESULTS: Of 125 study patients (64 assigned to diazepam and 61 to placebo) with a history of acute repetitive seizures, 91 (47 children and 44 adults) were treated for an exacerbation of seizures during the study period. Diazepam treatment was superior to placebo with regard to the outcome variables related to efficacy: reduced seizure frequency (P<0.001) and improved global assessment of treatment outcome by the care giver (frequency and severity of seizures and drug toxicity) (P<0.001). Post hoc analysis showed diazepam to be superior to placebo in reducing seizure frequency in both children (P<0.001) and adults (P=0.02), but only in children was it superior with regard to improvement in global outcome (P<0.001). The time to the first recurrence of seizures after initial treatment was longer for the patients receiving diazepam (P<0.001). Thirty-five patients reported at least one adverse effect of treatment; somnolence was the most frequent. Respiratory depression was not reported. CONCLUSIONS: Rectal diazepam gel, administered at home by trained care givers, is an effective and well-tolerated treatment for acute repetitive seizures.

De novo psychogenic nonepileptic seizures after epilepsy surgery.

PURPOSE: The occurrence of de novo nonepileptic seizures (NES) after epilepsy surgery have been reported only twice in the literature (one article and one abstract). METHODS: We report three patients whose de novo NES were documented by video-EEG telemetry after epilepsy surgery. These patients were drawn from a sample of 166 consecutive patients who underwent epilepsy surgery at our center between 1989 and 1996. RESULTS: Two patients became seizure free after surgery, and one had significant improvement of her seizures. The interval between the date of surgery and the development of the symptoms was variable (8, 10, and 47 months, respectively). The clinical phenomena of NES differed from those of the epileptic seizures preceding surgery. Their diagnosis had not been suspected in two patients before the diagnostic video-EEG monitoring study. After the diagnosis of NES, spells stopped in two patients and recurred rarely in one. CONCLUSIONS: We conclude that de novo NES appears to occur rarely after epilepsy surgery. Given that the possibility of NES was suspected in only one patient, its incidence after surgery may be higher than so far reported. Physicians should therefore consider NES in the differential diagnosis of recurrent seizures after a seizure-free period after epilepsy surgery.

Preventable neurological diseases worldwide.

Neuropsychiatric disorders make up a large proportion of medical conditions causing disability and death worldwide. This paper reviews the most significant neurological disorders, emphasizing the preventability of most of them. The worldwide impact of cerebrovascular disease, protein-energy malnutrition causing cognitive impairment, tetanus, dementia, meningitis, and epilepsy is summarized. The burden of neurological dysfunction as a complication of tuberculosis, measles, road accidents, congenital anomalies, malaria, falls, war, violence, alcohol, HIV, diabetes, syphilis, and rheumatic heart disease might also be lessened by preventive measures. As in other health problems, major risk factors are poverty, poor access to health care, and social instability.

Special report from the World Federation of Neurology. The worldwide impact of new drugs: development, distribution, and use.

Access to appropriate drug treatments and preventive agents for neurologic disorders is determined by medical, economic, political, social, and personal choices and policies. The development of new agents is dominated by large, often transnational companies located in economically advanced countries. Adequate breadth and stability of pharmaceutical supplies may be jeopardized by local economic, physical, and organizational constraints. Appropriate medical choices of drugs, their number, routes of administration, and sources, are made by physicians informed by their basic and continuing medical education but also influenced to varying degrees by patient expectation, financial incentives, and marketing information provided by the drug industry. Attempts to increase the availability of necessary drug treatment for all include initiatives by the World Health Organization, attention of national health planners to drug development, supply, and use, and industry-government cooperation. Although there are significant differences among countries, many national health planners have taken similar approaches: increasing attention to cost-effectiveness in prescribing and to competitive purchasing; the use of essential drug lists, formularies, and generic drugs; the devising of economic incentives for the development of needed but unprofitable drugs; careful planning of drug procurement and storage; and an emphasis on professional and patient education.