The reliability and validity of DSM 5 diagnostic criteria for neurocognitive disorder and relationship with plasma neurofilament light in a down syndrome population.

The validity of dementia diagnostic criteria depends on their ability to distinguish dementia symptoms from pre-existing cognitive impairments. The study aimed to assess inter-rater reliability and concurrent validity of DSM-5 criteria for neurocognitive disorder in Down syndrome. The utility of mild neurocognitive disorder as a distinct diagnostic category, and the association between clinical symptoms and neurodegenerative changes represented by the plasma biomarker neurofilament light were also examined. 165 adults with Down syndrome were included. Two clinicians independently applied clinical judgement, DSM-IV, ICD-10 and DSM-5 criteria for dementia (or neurocognitive disorder) to each case. Inter-rater reliability and concurrent validity were analysed using the kappa statistic. Plasma neurofilament light concentrations were measured for 55 participants as a marker of neurodegeneration and between group comparisons calculated. All diagnostic criteria showed good inter-rater reliability apart from mild neurocognitive disorder which was moderate (k = 0.494). DSM- 5 criteria had substantial concurrence with clinical judgement (k = 0.855). When compared to the no neurocognitive disorder group, average neurofilament light concentrations were higher in both the mild and major neurocognitive disorder groups. DSM-5 neurocognitive disorder criteria can be used reliably in a Down syndrome population and has higher concurrence with clinical judgement than the older DSM-IV and ICD-10 criteria. Whilst the inter-rater reliability of the mild neurocognitive disorder criteria was modest, it does appear to identify people in an early stage of dementia with underlying neurodegenerative changes, represented by higher average NfL levels.

Psychometric Properties of a Brief Screening Measure for ADHD in Adults.

The use of screening tools is an effective and practical approach within the clinical diagnostic assessment of attention deficit hyperactivity disorder (ADHD) in adults. Existing screening measures for adult ADHD have focused on a younger population. Subsequently, the current study aimed to evaluate the utility and general usability of an adapted four-item screening tool for adult ADHD: a brief version of the Wender Utah Rating Scale (WURS-brief), within a middle-aged population. The sample consisted of 69 adults, aged between 30 and 63 (age M= 45, SD=6.95), who had been referred to a specialist adult ADHD outpatients clinic. Using factor analysis, the WURS-brief screening measure was compared to existing ADHD diagnostic tools that were used as reference measures within the analysis. The WURS-brief had respectable sensitivity when compared with existing diagnostic tools. This study highlights the importance of validating brief screening measures for middle-aged adults with ADHD within clinical settings and offers suggestions for future research.

El uso de herramientas de detección es un enfoque efectivo y práctico dentro de la evaluación de diagnóstico clínico del trastorno por déficit de atención con hiperactividad (TDAH) en adultos. Las medidas de detección existentes para el TDAH en adultos se han centrado en una población más joven. El presente estudio tuvo como objetivo evaluar la utilidad y la usabilidad general de una herramienta de detección de cuatro ítems adaptada para el TDAH en adultos: una versión breve de la Escala de Calificación Wender Utah (WURS-brief), dentro de una población de mediana edad. La muestra consistió en 69 adultos, con edades comprendidas entre 30 y 63 años (edad M = 45, DE = 6.95), que habían sido remitidos a una clínica especializada para pacientes externos con TDAH en adultos. Mediante el análisis factorial, la medida de detección breve de WURS se comparó con las herramientas de diagnóstico de TDAH existentes que se utilizaron como medidas de referencia dentro del análisis. El WURS-brief tenía una sensibilidad respetable en comparación con las herramientas de diagnóstico existentes. Este estudio destaca la importancia de validar breves medidas de detección para adultos de mediana edad con TDAH dentro de entornos clínicos y ofrece sugerencias para futuras investigaciones.

Self-measurement with Icare HOME tonometer, patients' feasibility and acceptability.

PURPOSE: To evaluate and compare the accuracy of self-measurement of intraocular pressure using Icare Home rebound tonometer with Goldmann applanation tonometer and assess acceptability of self-tonometry in patients with glaucoma and ocular hypertension. METHODS: In the study, 117 subjects were trained to use Icare Home for self-measurement. Icare Home tonometer readings were compared with Goldmann applanation tonometer, including one eye per patient. Agreement between the two methods of measurement was evaluated by Bland and Altmann analysis. Questionnaire was used to evaluate patients' perception of self-tonometry. RESULTS: One hundred and three out of 117 patients (88%) were able to measure their own intraocular pressure and 96 (82%) fulfilled the requirements for certification. The mean (SD) difference Goldmann applanation tonometer minus Icare Home was 1.2 (2.4) mmHg (95% limits of agreement, -3.4 to 5.9 mmHg). The magnitude of bias between the two methods depended on central corneal thickness, with greater bias at central corneal thickness <500 µm. In 65 out of 96 subjects (67.7%), Icare Home results were within 2 mmHg of the Goldmann applanation tonometer. Seventy-three out of 93 (78.5%) felt that self-tonometry was easy to use and 75 patients (80.6%) responded that they would use the device at home. CONCLUSION: Icare Home tonometry tends to slightly underestimate intraocular pressure compared to Goldmann applanation tonometer. Most patients were able to perform self-tonometry and found it acceptable for home use. Measurements using rebound self-tonometry could improve the quality of intraocular pressure data and optimize treatment regimen.

Improving Reading in Adolescents and Adults With High-Functioning Autism Through an Assistive Technology Tool: A Cross-Over Multinational Study.

People with autism spectrum disorder (ASD) experience reading comprehension difficulties, often misinterpreting complex texts, metaphors, and idioms. We have developed and tested a new assistive technology tool for adaptive, personalized text simplification, called Open Book. This tool is an open-sourced, online platform that uses Natural Language Processing with the specific aim of assisting reading and aiding understanding of written text for people with ASD. The accessibility and effectiveness of Open Book was tested by examining the differences in text comprehension scores between the original texts and texts that were simplified by Open Book tool, randomly allocated to study participants. Two hundred forty-three participants (153 adults and 90 adolescents) with high-functioning ASD were recruited in the UK, Spain, and Bulgaria. Regarding the primary outcome, results showed that both adults and adolescents with ASD gave more correct answers for the simplified (M = 11.2, SD = 4.1) than original texts (M = 10, SD = 4.1; p < 0.001). This finding was consistent across age groups and countries. Regarding the secondary outcome, when participants were asked to blindly rate how easy was to understand each text, simplified texts were rated as easier (M = 7.6, SD = 2.4) to understand than the original texts (M = 8.7, SD = 2.6; p < 0.001). The Open Book software seems to have the potential to be a useful tool in assisting reading among people with ASD. Our findings support our primary hypothesis that texts simplified through Open Book were easier to comprehend compared to original texts.

The outcome of low-frequency intravitreal bevacizumab therapy for macular edema in retinal vein occlusions.

AIM: We aimed to evaluate the 1-year efficacy and safety of low-frequency intravitreal bevacizumab in the treatment of macular edema due to retinal vein occlusions (RVOs). METHODS: The study comprised an interventional prospective study of patients with macular edema due to central retinal vein occlusion (CRVO) or branch retinal vein occlusion, followed for 12 months. Treatment-naïve patients with reduced best-corrected visual acuity (BCVA) and central macular thickness (CMT) of at least 250 µm received intravitreal injection of bevacizumab. After 1 month, BCVA and optical coherence tomography (OCT) images of the macula were recorded. In patients with <30% improvement in BCVA and CMT, two more injections were applied at 1.5-month intervals. In all other patients, further injections were applied as needed. In cases with ischemic areas of retina, laser photocoagulation of the retina was performed. RESULTS: In total, 33 patients with CRVO and 55 with BRVO were treated. After 1 year, 65 eyes (73.86%) had clinically significant improvement of BCVA (>0.3 log of the minimum angle of resolution [logMAR] units) with average number of injections of 1.98. Improvement of mean BCVA in CRVO was significant (P=0.001) from baseline (1.2±0.95 logMAR units) to 1 year (0.75±0.6 logMAR units). Significant improvement of mean BCVA (P<0.001) was also found in BRVO, from 0.71±0.75 logMAR units at baseline to 0.28±0.5 logMAR units at 1 year. Baseline CMT was 852.21±298.20 µm for CRVO and 597.95±185.63 µm for BRVO. In both groups, there was significant decrease (P<0.001) in CMT after 1 year of treatment. Panretinal laser photocoagulation was done in 75.8% of all eyes with CRVO and sectoral photocoagulation in 49.1% of eyes with BRVO. CONCLUSION: In macular edema due to RVO, intravitreal bevacizumab provides improvement in visual acuity and reduction of macular edema in a high percentage of treated eyes after 1 year, even with low number of injections.

A blind spot on the global mental health map: a scoping review of 25 years' development of mental health care for people with severe mental illnesses in central and eastern Europe.

Just over 25 years have passed since the major sociopolitical changes in central and eastern Europe; our aim was to map and analyse the development of mental health-care practice for people with severe mental illnesses in this region since then. A scoping review was complemented by an expert survey in 24 countries. Mental health-care practice in the region differs greatly across as well as within individual countries. National policies often exist but reforms remain mostly in the realm of aspiration. Services are predominantly based in psychiatric hospitals. Decision making on resource allocation is not transparent, and full economic evaluations of complex interventions and rigorous epidemiological studies are lacking. Stigma seems to be higher than in other European countries, but consideration of human rights and user involvement are increasing. The region has seen respectable development, which happened because of grassroots initiatives supported by international organisations, rather than by systematic implementation of government policies.

Religious discrimination and common mental disorders in England: a nationally representative population-based study.

PURPOSE: Although the impact of discrimination on mental health has been increasingly discussed, the effect of religious discrimination has not been examined systematically. We studied the prevalence of perceived religious discrimination and its association with common mental disorders in a nationally representative population-based sample in England. METHODS: We used data from the Adult Psychiatric Morbidity Survey 2007 that represents all adults age 16 years and over living in private households in England. Common mental disorders were ascertained using the Revised Clinical Interview Schedule. Experience of discrimination was assessed by a computer-assisted self-report questionnaire and potential paranoid traits by the Psychosis Screening Questionnaire. RESULTS: From the total of 7318 participants, 3873 (52.4%) reported adhering to religion. 108 subjects (1.5%) reported being unfairly treated in the past 12 months due to their religion. Non-Christian religious groups were more likely to report perceived religious discrimination compared to Christians (OR 11.44; 95% CI 7.36-17.79). People who experienced religious discrimination had increased prevalence of all common mental disorders. There was a two-fold increase in the risk of common mental disorders among people who reported experience of religious discrimination independent of their ethnicity, skin colour or suspected paranoid traits. CONCLUSIONS: The impact of perceived religious discrimination on mental health should be given more consideration in treatment and future preventative policies.

The pathways to mental healthcare worldwide: a systematic review.

PURPOSE OF REVIEW: Pathways-to-care studies represent a valid and cost-effective tool to provide information on patients' access to psychiatric care. However, no direct comparison of data concerning the pathways to mental healthcare, at the world level, is available yet. RECENT FINDINGS: Data obtained from different countries of the world may offer a global perspective on psychiatric pathways to mental healthcare, highlighting the strengths and weaknesses of different mental health systems and reflecting cultural, economic, social and political differences. We evaluated all studies that used a standardized methodology to describe pathways to mental healthcare of all adult patients, presenting for the first time to psychiatric services. SUMMARY: Our findings highlight that considerable variations of pathways to mental healthcare across different countries still exist. A consensus on the quality standards of psychiatric care should be reached and actions to ensure their implementation in low-middle income countries should be taken in the near future. The role of primary care doctors and social networks still represent an unsolved issue for psychiatric care worldwide. Stigma and discrimination towards patients with mental illnesses may still represent a relevant limiting factor for equal delivery of mental healthcare.

[FIRST: a tool for facilitating reading comprehension in high-functioning autism spectrum disorder]. / FIRST: una herramienta para facilitar la comprensión lectora en el trastorno del espectro autista de alto funcionamiento.

INTRODUCTION: Numerous studies have been documenting during the last decades the difficulties of reading comprehension shown by people with autism spectrum disorder (ASD), including those with preserved intelligence. These difficulties can condition their educational path and directly impact on social inclusion, autonomy and access to employment. DEVELOPMENT: This article presents the work developed by a multidisciplinary team under the framework of a project funded by the European Union. It is an explanatory document intended to justify the needs that the population with high-functioning ASD have to access written information. The project is developing a software (Open Book) designed not only 'for' people with ASD, but 'with' people with ASD. CONCLUSION: Both the child population as well as the adult population of persons with ASD show difficulties in all formal components of written language. The tool needs to be flexible and facilitate it's personalized use in order to respond to the great heterogeneity of this population.

TITLE: FIRST: una herramienta para facilitar la comprension lectora en el trastorno del espectro autista de alto funcionamiento.Introduccion. Durante las ultimas decadas han surgido numerosas investigaciones que documentan las dificultades de comprension lectora que muestran las personas con trastorno del espectro autista (TEA), incluidas aquellas que tienen la inteligencia preservada. Estas dificultades pueden condicionar su trayectoria educativa e incidir de forma directa sobre su inclusion social, autonomia y acceso al mundo laboral. Desarrollo. Este articulo presenta el trabajo elaborado por un equipo multidisciplinar en el marco de un proyecto financiado por la Union Europea. Es un documento explicativo que pretende justificar las necesidades que tiene la poblacion de personas con TEA de alto funcionamiento para acceder a la informacion escrita. Es un proyecto que esta desarrollando una herramienta informatica (Open Book) que no solo esta siendo diseñada 'para' personas con TEA, sino que esta siendo desarrollada 'con' personas con TEA. Conclusion. Tanto la poblacion infantil como la poblacion adulta de personas con TEA muestran dificultades en todos los componentes formales del lenguaje escrito. La herramienta tiene que ser flexible y favorecer su uso individualizado, para dar respuesta a la enorme heterogeneidad de esta poblacion.

FIRST: una herramienta para facilitar la comprensión lectora en el trastorno del espectro autista de alto funcionamiento / FIRST: a tool for facilitating reading comprehension in high-functioning autism spectrum disorder

Introducción. Durante las últimas décadas han surgido numerosas investigaciones que documentan las dificultades de comprensión lectora que muestran las personas con trastorno del espectro autista (TEA), incluidas aquéllas que tienen la inteligencia preservada. Estas dificultades pueden condicionar su trayectoria educativa e incidir de forma directa sobre su inclusión social, autonomía y acceso al mundo laboral. Desarrollo. Este artículo presenta el trabajo elaborado por un equipo multidisciplinar en el marco de un proyecto financiado por la Unión Europea. Es un documento explicativo que pretende justificar las necesidades que tiene la población de personas con TEA de alto funcionamiento para acceder a la información escrita. Es un proyecto que está desarrollando una herramienta informática (Open Book) que no sólo está siendo diseñada ‘para’ personas con TEA, sino que está siendo desarrollada ‘con’ personas con TEA. Conclusión. Tanto la población infantil como la población adulta de personas con TEA muestran dificultades en todos los componentes formales del lenguaje escrito. La herramienta tiene que ser flexible y favorecer su uso individualizado, para dar respuesta a la enorme heterogeneidad de esta población (AU)

Introduction. Numerous studies have been documenting during the last decades the difficulties of reading comprehension shown by people with autism spectrum disorder (ASD), including those with preserved intelligence. These difficulties can condition their educational path and directly impact on social inclusion, autonomy and access to employment. Development. This article presents the work developed by a multidisciplinary team under the framework of a project funded by the European Union. It is an explanatory document intended to justify the needs that the population with highfunctioning ASD have to access written information. The project is developing a software (Open Book) designed not only ‘for’ people with ASD, but ‘with’ people with ASD. Conclusion. Both the child population as well as the adult population of persons with ASD show difficulties in all formal components of written language. The tool needs to be flexible and facilitate it’s personalized use in order to respond to the great heterogeneity of this population (AU)

Treatment of idiopathic macular hole with silicone oil tamponade.

PURPOSE: We analyzed the anatomical and visual outcomes after surgical treatment of idiopathic macular holes with pars plana vitrectomy, internal limiting membrane (ILM) peeling using Brilliant Blue dye, and silicone oil tamponade without postoperative posturing. METHODS: This was a retrospective interventional study of 10 eyes in eight patients who underwent surgical treatment of idiopathic macular holes using pars plana vitrectomy, ILM peeling using Brilliant Blue dye, and silicone oil tamponade without postoperative posturing. The preoperative staging of macular holes and postoperative anatomic outcomes were assessed using spectral-domain optical coherence tomography. RESULTS: All patients were women with a mean age of 66.86 ± 4.8 years. In two patients, bilateral macular holes were present and both eyes were operated on. Stage 2 macular hole was diagnosed in three eyes, three eyes had stage 3, and four eyes had stage 4 macular holes. Anatomical success and closure of the macular hole was achieved in nine eyes (90%) after one operation. In one eye, the macular hole was closed after reoperation. The preoperative mean best-corrected visual acuity (BCVA) was 0.15 decimal units (0.8 logMAR units). Until the end of the follow-up period, BCVA was 0.25 decimal units (0.6 logMAR units). Visual acuity was improved in seven patients (70%). In two patients (20%), visual acuity remained at the same level, and in one eye (10%), visual acuity decreased. Postoperatively, all patients reported a significant reduction of metamorphopsia. CONCLUSION: Initial results after 20G pars plana vitrectomy with peeling of the ILM, use of dye (Brilliant Blue), and tamponade with silicone oil without postoperative posturing gave good anatomical and functional outcome in terms of visual acuity and reduction of metamorphopsia. Taking into account the age of the patients, this method, which does not require prolonged postoperative face-down posturing, was well tolerated by the patients. Because the anatomical and visual outcome as well as the rate of postoperative complications are comparable to those when gas is used as a tamponading agent, silicone oil tamponade can also be safely used as a first option in surgery of macular holes. However, a longer period of follow-up of the operated eyes, as well as a larger group of operated eyes, will be required to identify long-term outcomes of this surgical treatment.

Epilepsy and psychiatric comorbidity: a nationally representative population-based study.

PURPOSE: In a nationally representative population-based study in England, we estimated the burden of psychiatric and neurodevelopmental comorbidities in people with epilepsy. We investigated whether any overrepresentation of comorbidities could be explained by epilepsy being a chronic medical or neurologic condition, or by the confounding effect of demographic and socioeconomic factors or other health conditions. METHODS: The Adult Psychiatric Morbidity Survey 2007 comprised detailed interviews with 7,403 individuals living in private households in England. Doctor-diagnosed epilepsy (and asthma, diabetes, and migraine, chronic conditions for comparison) was ascertained by self-report, and extensive diagnostic and screening interviews were used to assess psychiatric and neurodevelopmental conditions. KEY FINDINGS: The estimated lifetime prevalence of epilepsy in the adult (≥ 16 years old) population of England was 1.2% (95% confidence interval [CI] 1.0-1.5). Almost one-third of the people with epilepsy had an International Classification of Diseases, Tenth Revision (ICD-10) anxiety or depressive disorder (compared with one in six people without epilepsy). Among these, social phobia and agoraphobia, generalized anxiety disorder, depression, and measures of suicidality had strong associations with epilepsy, which remained robust after accounting for potential confounders. These associations were consistently stronger than those in people with asthma or diabetes, and similar to those in people reporting migraine or chronic headaches. Epilepsy was also strongly associated with autism spectrum disorders (odds ratio [OR] 7.4, 95% CI 1.5-35.5) and possible eating disorders, and these associations were not evident in people with asthma, diabetes, or migraine. SIGNIFICANCE: Psychiatric and neurodevelopmental conditions were overrepresented in people with epilepsy. These associations were stronger than with other nonneurologic chronic conditions, and not explained by confounding. Some overlap in the psychopathology observed in epilepsy and migraine cannot rule out the presence of common pathways of psychiatric comorbidity in neurologic conditions. However, associations of epilepsy with conditions such as autism spectrum disorders point to comorbidities specific to epilepsy that may not be shared by other neurologic conditions.

Borderline personality disorder often goes undetected.

Borderline personality disorder (BPD) is a complex mental disorder characterised by mood instability, impulsivity, relationship difficulties and disturbed self-image. There is a pervasive pattern of emotional instability, impulsive aggression, repeated self-harm and chronic suicidal tendencies often associated with suicide attempts. Some patients are able to sustain a certain level of social and occupational functioning, while others experience a very high level of emotional distress. There is often rapid fluctuation from periods of confidence to despair. A large proportion of those affected are unrecognised and untreated. Women present to services three times more often than men. Most people show symptoms in late adolescence or early adult life. BPD is not entirely related to environmental factors. A study of more than 40 twin pairs showed high heritability. One common denominator of BPD appears to be dysfunctional regulation of emotions. People with BPD present at times of crisis, often following an episode of self-harm. Presentation is accompanied by a sense of urgency and anxiety. People with BPD have marked difficulty differentiating reality from fantasy, so that health problems may be perceived as life threatening. This may result in loss of perspective and miscommunication with the GP. The doctor should provide very clear information to counter any elaborate fantasies about their illness. Patients with suspected BPD should be referred to a psychiatrist for assessment and diagnosis.

Validity across translations of short survey psychiatric diagnostic instruments: CIDI-SF and CIS-R versus SCID-I/NP in four European countries.

OBJECTIVES: The aims of the study are: first, to compare two short diagnostic instruments, CIDI-SF and CIS-R, with respect to the structured clinical interview for non-patient (SCID-I/NP) for anxiety and depressive disorders; and second, to evaluate the influence of four languages, Italian, Romanian, Spanish and French, on the concordance tests. METHODS: A total of 120 participants from Italy and Romania, 119 from Spain and 141 from France (N = 500) were recruited randomly in a local primary care research centre (GPs or medical centres). The instruments were administered during a unique session: the lay instruments by students in psychology and the SCID by experienced psychiatrists. Kappa, sensitivity/specificity/negative (NPV) and positive predictive values (PPV), ROC curve (AUC) and the Youden Index (Y) were calculated. RESULTS: Results were better for the CIDI-SF than the CIS-R for anxious disorders, depressive disorders and any of them. The results were identical to that obtained by the CIDI 3.0 for the three categories and constant across the languages except for depressive disorders in Romania and France. CONCLUSIONS: CIDI-SF is a cost-effective instrument and could be easily integrated into health surveys; its performance values are better across languages than values proposed by the CIS-R and could be increased by inclusion of few additional information.

Age variation in life events and their relationship with common mental disorders in a national survey population.

BACKGROUND: Life events (LEs) are recognised to be important risk factors for common mental disorders (CMD). Their prominence may vary across age groups but this issue has received little systematic investigation. METHOD: Data were analysed from the 2000 UK National Survey of Psychiatric Morbidity comprising 8,580 participants aged 16-74 years. A history of recent life events pertaining to health threats, bereavement, interpersonal problems and redundancy was established for the preceding six months. Participants were also asked about earlier lifetime stressors including sexual abuse and expulsion from school. CMD, depression and generalised anxiety disorder were ascertained through the revised Clinical Interview Schedule. RESULTS: The strongest associations between LEs and CMD were for recent threats to health, recent interpersonal problems and lifetime stressors. Recent LEs were more strongly associated with depression than anxiety whereas the associations for lifetime stressors were similar in strength. The strength of association between recent LEs and CMD increased steadily up to the 45-54 years age group and then declined. In the 65-74 year age range, CMD was not significantly associated with any recent LE but instead was associated with the following lifetime stressors: bullying, sexual abuse, running away from home, and institutional care in childhood. CONCLUSIONS: Recent life events were most strongly associated with CMD in mid-rather than early or late adult life. In later life, stronger associations were found with lifetime stressors than recent events.

Markers of inflammation and cognitive decline in an African-Caribbean population.

BACKGROUND: Inflammatory processes may play an important role in cognitive decline and dementia. We investigated the prospective association between levels of three markers of inflammation, plasma interleukin-6 (IL-6), serum C-reactive protein (CRP), serum amyloid A (SAA), and cognitive decline in an African-Caribbean community population. METHODS: Of 290 participants aged 55-75 years at baseline sampled from Primary Care registration lists in south London, 216 (75%) were re-interviewed after 3 years. Baseline plasma concentrations of IL-6, CRP and SAA were ascertained through immunoassays. A battery of psychometric tests was administered on both occasions and decline in both individual tests and a composite outcome was analysed. RESULTS: After adjustment for potential confounding factors, raised levels of IL-6 (>3.1 pg/ml) were associated with cognitive decline in the total sample (odds ratio 2.9, 95% CI 1.1-7.5), but no associations were found for CRP or SAA. Raised IL-6 was most strongly associated with decline in orientation and immediate verbal recall tasks, with weaker associations for delayed recall and psychomotor speed. CONCLUSIONS: Raised IL-6 but not CRP predicted cognitive decline in this population Inflammatory changes associated with cognitive decline may be specific to particular causal pathways.

[Visual acuty after trabeculectomy].

BACKGROUND/AIM: In this study we compared the two groups of glaucoma patients who had underwent trabeculectomy, with or without intraoperative application of antimetabolite 5-Fluorouracile (5 FU). METHODS: We followed up 50 glaucoma patients (group I) in a four-years period after trabeculectomy alone (antimetabolites were not applied), and 50 patients in whom antimetabolite 5 FU was applied (group II). We followed up intraocular pressure (IOP), visual acuity (VA), lens transparency, optic disc changes, visual fields (VF perimetry). The IOP at the time of the surgery, and the period of the treatment before the surgery were the important data for the follow-up. RESULTS: The results that we got in the first group were: in 8 patients (16%) there was no change of VA, and of optic disc with a mild VF deterioration; in 18 patients (33%) the worsening of VA by 1 Snellen line (3 years after the surgery) with no change of the disc and a mild VF progressing; in 10 patients (20%) VA decreased by 2 Snellen lines with the progressive VF changes and cataract appearance, (cataract and VA worsening appeared mainly 3 years after the surgery); in 6 patients (12%) by 3 Snellen lines, and in 4 patients (8%) by 4 Snellen lines. In 4 patients (8%), the highest worsening of VA--(0.2) and the best (0.9) at the time of the surgery were observed. The VA ranging from 0.4-0.6 at the time of the surgery yielded the longest preservation of vision. In the group II (5 FU applied intra-operatively): in 5 patients (10%) there was no change of VA and of optic disc with a mild VF deterioration; in 20 patients (40%) the worsening of VA by 1 Snellen line, with no change of the disc and a mild VF progressing. In 14 patients (28%) VA decreased by 2 Snellen lines with the progressive VF changes and cataract appearance; in 7 patients (14%) by 3 Snellen lines, and in 4 patints (8%) by 4 Snellen lines. CONCLUSION: All of the checked parameters were better in the group II of the patients, (5 FU applied intraoperatively). Also, in the group of the patients with the longest treatment before the surgery and with the good VA, and in the patients with the shorter treatment and with the bad VA, the quickest progression of the vision losts was observed. The best preservation of VA was recordered in the patients with a mild IOP, and in those who had not been treated more than 1 or 2 years with the drops before the surgery. The VA ranging from 0.4-0.6 at the time of the surgery allowed the longest preservation of vision.

Pathways to psychiatric care in Eastern Europe.

BACKGROUND: There has been almost no research into mental health services in Eastern Europe. A pathways study is a quick and useful starting point, requiring few resources. AIMS: To improve understanding of prior care-seeking and treatment of new patients seen at mental health services. METHOD: Pathways diagrams were drawn showing the routes of care-seeking for 50 new patients in eight centres. Patterns of care-seeking, durations and previous treatments were compared for ICD-10 diagnostic groups. RESULTS: The diagnoses varied according to the organisation of services. Major pathways included general practitioners, direct access and hospital doctors. General practitioners have a limited role as 'gatekeeper' in centres in Albania, Croatia, Macedonia, Romania and Serbia-Montenegro, and rarely prescribed treatment, except sedatives, for mental disorders. CONCLUSIONS: Findings highlight areas that require attention if aspirations for community-oriented mental health care are to be realised, particularly integration of mental health into primary care.