[Regional healthcare labels: differences in care needs and psychosocial functioning]. / Regionale zorgvignetten: verschillen in zorgbehoeften en psychosociaal functioneren.

BACKGROUND: Severe mental illnesses (SMI) are associated with high mental healthcare and other healthcare costs. In 2012, mental healthcare labels were developed to create more transparency between insurance companies, municipalities, and mental healthcare. The labels are based on care intensity, and should provide a regional overview of the present groups of patients with SMI.
AIM: Explore the functionality and validity of the used labels in relation to needs for care and psychosocial functioning.
METHOD: The ROM data (needs for care, functioning) from 706 patients were tested per label by Chi-square tests and ANOVAs. For two high complex labels (alarming care avoiders and persons with safety risks), repeated measures ANOVAs and McNemar tests were used to analyse changes in functioning and needs over time.
RESULTS: To a limited extent, the labels were distinctive in care needs and functioning. The most restrictions in functioning and (unfulfilled) needs were present in the labels 'alarming care avoiders' and 'avoiding danger'. These findings were stable over time.
CONCLUSION: The labels are not sufficiently distinctive. To enhance regional care planning, it is desirable to combine existing information on healthcare labels with information on care needs and functioning. KEY WORDS functioning, mental healthcare labels, needs for care, routine outcome monitoring, severe mental illness.

[ROM for the elderly: a prospective cohort study of the outcomes on the HoNOS 65+ in various diagnostic groups]. / ROM bij ouderen: een prospectief cohortonderzoek naar de uitkomsten op de HoNOS 65+ bij verschillende diagnosegroepen.

BACKGROUND: Routine outcome monitoring (rom) provides us with opportunities to study treatment outcome in daily clinical practice and to learn from the results.
AIM: To assess the changes that occur in the psychological and social functioning of patients in geriatric psychiatry who are suffering from substance dependence, mood disorder, anxiety disorder, psychotic disorder, or personality disorder.
METHOD: We analysed data relating to 1,810 patients (aged 60-101) from nine mental health care organisations that together form SynQuest cv. The total scores and item scores on the Health of the Nation Outcome Scales for older people (Honos 65+) at the beginning and end of treatment were also analysed and were linked to the diagnosis.
RESULTS: Patients improved significantly (es=0.8). The degree of improvement depended on the patient's principal diagnosis; patients with a mood or anxiety disorder improved the most (es=1.0 and 0.8). The degree of improvement varied per Honos 65+ item. In particular, patients with 'depressive problems' and 'other mental and behavioral problems' showed considerable improvement.
CONCLUSION: Many older patients benefited from the treatment they received in gerontopsychiatry departments. This helps to give elderly patients with psychiatric disorders hope for the future. The scores on the individual items of the Honos 65+ can help clinicians to tailor treatment to the patient's specific problems and to monitor and evaluate treatment outcome in conjunction with the patient.

A novel antibody-drug conjugate targeting SAIL for the treatment of hematologic malignancies.

Although several new therapeutic approaches have improved outcomes in the treatment of hematologic malignancies, unmet need persists in acute myeloid leukemia (AML), multiple myeloma (MM) and non-Hodgkin's lymphoma. Here we describe the proteomic identification of a novel cancer target, SAIL (Surface Antigen In Leukemia), whose expression is observed in AML, MM, chronic lymphocytic leukemia (CLL), diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL). While SAIL is widely expressed in CLL, AML, MM, DLBCL and FL patient samples, expression in cancer cell lines is mostly limited to cells of AML origin. We evaluated the antitumor activity of anti-SAIL monoclonal antibodies, 7-1C and 67-7A, conjugated to monomethyl auristatin F. Following internalization, anti-SAIL antibody-drug conjugates (ADCs) exhibited subnanomolar IC50 values against AML cell lines in vitro. In pharmacology studies employing AML cell line xenografts, anti-SAIL ADCs resulted in significant tumor growth inhibition. The restricted expression profile of this target in normal tissues, the high prevalence in different types of hematologic cancers and the observed preclinical activity support the clinical development of SAIL-targeted ADCs.

[The aftermath of the reduction in inpatient care and treatment II: cross-sectional study relating to the health, the need for care, the quality of life, social functioning and the integration in society of chronic mental patients in Amsterdam]. / Na de extramuralisering. II. Een crosssectionele studie naar psychisch en sociaal functioneren en kwaliteit van leven van een steekproef van chronische psychiatrische patiënten in de Amsterdamse ggz.

BACKGROUND: The move from less hospital care to more community-based care was expected to have positive results for long-term mental patients. It was believed that independent living would improve the quality of life and promote better social functioning and better integration into society. The basic idea was that the needs of patients would be better served by outpatient care. AIM: To map particulars relating to illness symptoms, functioning, care needs, quality of life, extent and features of the social network and social integration of a group of long-term psychiatric patients in Amsterdam 15 years after the closure of the Santpoort psychiatric hospital. METHOD: Interviews and questionnaires were used to obtain information from a stratified sample of long-term mental patients in the care of the mental health organisations in Amsterdam. RESULTS: 323 patients and those who were treating them were interviewed. Most group members were fairly elderly and one-third suffered from schizophrenia. More than half of the group had long-term psychiatric problems. Most of the patients were in poor health, half of the group had somatic symptoms and a quarter abused alcohol or drugs. Patients and doctors had varying views on whether patients’ needs had been met. Patients had few social contacts. About one-third of these social contacts were with fellow-patients. Patients living independently caused few or no problems in the city. However, these patients were more often victim of discrimination, social exclusion and criminality. CONCLUSION: Many patients with long-term mental illness considered their current quality of life to be reasonably good and were satisfied with the health care they received. However, the limited number of social contacts, inadequate integration into society and the poor health of many patients are matters that still give cause for concern.

Are long-term psychiatric patients causing more crisis consultations outside office hours in mental health care?

BACKGROUND: As well as an improvement in community services, the de-institutionalization of patients receiving long-term psychiatric care can lead to marginally staffed mental health services, more homelessness, rising admission rates and more people in prison cells. It is assumed that an imbalance between community and hospital care for chronic patients puts pressure on crisis services. AIMS: In this study, the central question is whether patients receiving long-term psychiatric care in Amsterdam do indeed put pressure on the city's emergency mental health services. We compare the pressure exerted by this group with the pressure resulting from the use of these services by all registered patients. METHODS: Data were taken from the client registration systems of three mental health organizations in Amsterdam in the period from 2000 to 2004. Inclusion criteria for long-term psychiatric patients were age above 19 years and uninterrupted receipt of mental health care for a minimum of two successive years. RESULTS: Annually, 6%-8% of all non-long-term patients experienced a crisis outside office hours in the period under investigation; this was 4%-6% for long-term patients. The non-long-term patients accounted for 83% of crisis contacts outside office hours over the entire study period, with long-term patients accounting for 17%. CONCLUSIONS: The assumption that crises are more prevalent in long-term patients in the community seems to be an example of stigmatization rather than an observation based on fact.

[Routine outcome monitoring and benchmarking: how can treatment results be compared in a responsible manner?]. / Routine outcome monitoring en benchmarking: hoe kunnen we behandelresultaten op een zorgvuldige manier vergelijken?

BACKGROUND: The structural measurement of the results of treatment under the Dutch mental health services and a comparison of these results between mental health centres help to provide insight into the effectiveness of treatment in general practice. AIM: To provide an overview of the issues that require attention when the results of mental health centres are being compared. METHOD: Documentation, policy information and practical experience with routine outcome monitoring were analysed. RESULTS: We describe the problems that can arise when results obtained by mental health centres are compared and we suggest some solutions for these problems. Important factors that have emerged from our study are as follows: working with routine outcome monitoring is a process of natural growth and involves experiences with several solutions and the making of definitive choices on the basis of experience. CONCLUSION: It is instructive to compare mental health centres with each other and with regards to so-called 'best practices' (benchmarking). However, mental health centres draw on a differing wide mix of patients and use different measurement procedures and instruments. In this article we express the view that in the near future it should be possible to draw meaningful comparisons.

[The aftermath of the reduction in inpatient care and treatment; a retrospective study that considers the extent to which a group of chronic psychiatric patients made use of the Amsterdam mental health services]. / Na de extramuralisering; een retrospectief onderzoek naar omvang en zorggebruik van de groep chronische patiënten in de Amsterdamse ggz.

BACKGROUND: The move towards less hospital care and more community care for psychiatric patients began in the eighties. Chronic patients possibly have not really benefited from the new procedures. AIM: To find out whether chronic psychiatric patients in Amsterdam were receiving adequate care and made good use of the available psychiatric services. METHOD: We amalgamated the registration details of three mental health care institutions in Amsterdam over the period 1-1-2000 to 1-1-2005. RESULTS: In 2005 4576 patients met the criteria for chronic mental illness. In five years, the number of patients in mental health care had risen by 50%. Most of these patients had received care via specialised programmes. 38% of chronic patients had no access to specialised programmes, many of which had waiting lists. Only 6.5% of chronic patients received long-term inpatient care. Not many long-term psychiatric patients used the acute psychiatric services. Each year only 10% of long-term psychiatric patients were admitted to a psychiatric hospital. If admitted, they spent a much longer time in hospital. The average number of days spent in hospital rose from 86 in 2000 to 131 in 2004. Crisis contacts increased in line with the increase in the numbers of chronic patients in care, but these crisis contacts were registered mainly with the patient treatment team and not with the municipal acute psychiatric service. CONCLUSION: Only a small proportion of long-term psychiatric patients make use of the acute psychiatric services.

Symptoms in the palliative phase of children with cancer.

BACKGROUND: The aim of the study was to make a comprehensive inventory of the physical, psychological, and social symptoms of children with cancer and their parents during the palliative phase and the extent to which health professionals address those symptoms. PROCEDURE: Forty parents of children who died 1-3 years prior to data collection (structured questionnaire) were invited to participate in the study. RESULTS: The response rate was 32 out of 40 parents (80%). Most frequently mentioned physical symptoms were pain, poor appetite, and fatigue. The children's most mentioned psychological symptoms were sadness, difficulty in talking to their parents about their feelings regarding illness and death and fear of being alone. The symptoms of fear of death of the child and fear of physical symptoms were most frequently mentioned parents' psychological symptoms. Health professionals addressed 82% of the children's physical symptoms, 43% of the children's psychological symptoms, and 56% of the parents' psychological symptoms. Parents indicated that after professional attention the proportion of children's physical symptoms that were completely or partially resolved was 18 and 26%, respectively. For children's psychological symptoms the figures were 9 and 25%, respectively, and for parents' psychological symptoms 2 and 23%, respectively. CONCLUSIONS: The burden of symptoms of the child with cancer during the palliative phase and their parents is high. Health professionals focus mainly on the physical symptoms of the child. Relief of symptoms could not be achieved for a large proportion of symptoms. Further prospective research is necessary to investigate the kind, frequency and intensity of symptoms in order to tailor optimal palliative care to the needs of both child and parent.

Identification of probiotic microorganisms in South African products using PCR-based DGGE analysis.

Probiotic microorganisms in commercial yoghurts and other food products are currently identified by traditional methods such as growth on selective media, morphological and biochemical characteristics. In this study, PCR-based DGGE analysis was used for the rapid and accurate identification of probiotic microorganisms from South African yoghurts and lyophilized preparations in capsule and tablet form. To identify the microorganisms present in these products, the DGGE profiles obtained were compared to two reference markers (A and B) composed of five lactobacilli and seven Bifidobacterium species, respectively. The results obtained were confirmed by species-specific PCR, as well as sequence analyses of unknown bands not present in the reference markers. It was found that only 54.5% of the probiotic yoghurts contained the microorganisms stated on the label compared to only a third (33.3%) of the lyophilized probiotic products. Some Bifidobacterium species were incorrectly identified and various microorganisms were detected that were not listed on the label. Sequence analyses confirmed the presence of Streptococcus spp. other than the yoghurt starter, Streptococcus thermophilus, in some of these products and in some instances label information was vague and non-scientific. PCR-based DGGE analyses proved to be a valuable culture-independent approach for the rapid and specific identification of the microbial species present in South African probiotic products.

Prevalence of Chlamydia trachomatis in women attending a family planning clinic in Papua New Guinea.

OBJECTIVE: To determine the prevalence of Chlamydia trachomatis infection in women attending a family planning clinic in Papua New Guinea, in the period between April and June 1991. SETTING: The outpatient department of Obstetrics and Gynaecology of Port Moresby General Hospital, Port Moresby, Papua New Guinea, the departments of Dermato-Venereology and Clinical Microbiology of the Erasmus University, Rotterdam, The Netherlands and the National Institute of Public Health and Environmental Protection, Bilthoven, The Netherlands. PATIENTS: A total of 254 consecutive women who attended the family planning clinic at Port Moresby General Hospital, Papua New Guinea were enrolled into this study. METHODS: Cervical infections with C trachomatis were diagnosed using the direct immunofluorescent assay (DFA) and the polymerase chain reaction (PCR). Serum IgM and IgG antibodies directed against C trachomatis were detected using the enzyme-linked fluorescent assay (ELFA). RESULTS: The prevalence of C trachomatis was 14.6% using the PCR, 9.1% using the DFA and 17.3% when the results of the PCR and the DFA were combined. An elevated IgM titre was observed in 14.2% of the women, whereas 44.1% had an elevated IgG titre. The titres of IgM or IgG were significantly higher in women who were positive using the PCR or the DFA than in those who were negative in both the PCR and the DFA (p = 0.032 and p = 0.0046, respectively). CONCLUSION: Cervical infection by C trachomatis can be considered a major health problem in at least the studied population in Papua New Guinea. The prevalence of C trachomatis infection is at least comparable with that in groups with a high prevalence in industrialized countries. Effective screening and treatment programmes are imperative to combat this problem.

Chlamydia trachomatis-specific antibodies in patients with pelvic inflammatory disease: comparison with isolation in tissue culture or detection with polymerase chain reaction.

OBJECTIVE: The detection of acute phase antibodies against C trachomatis and its comparison with tissue culture or polymerase chain reaction (PCR) on samples of cervix and urethra obtained from patients with pelvic inflammatory disease (PID). METHODS: In the academic hospital Dijkzigt, Rotterdam, The Netherlands, prospective investigations were performed on 49 consecutive patients who were admitted with the diagnosis of PID. Infections with C trachomatis were traced using tissue culture, PCR or by determining acute phase IgG and IgM antibodies. Differences between the sensitivities of serology and tissue culture or PCR were calculated using the Fisher exact test. RESULTS: C trachomatis infection was detected more often in PID patients using serology in comparison with PCR (p < 0.05) or tissue culture (p < 0.05). All patients who were positive in tissue culture also had acute phase antibodies. CONCLUSION: The establishing of acute C trachomatis infections in PID patients on the basis of serology was superior to either tissue culture or PCR on samples obtained from cervix and urethra.

[Successful culture of Chlamydia pneumoniae in 2 asymptomatic patients]. / Succesvolle kweek van Chlamydia pneumoniae bij twee asymptomatische patiënten.

In two women, partners of 41 and 36 years old, positive cultures of Chlamydia pneumoniae were repeatedly obtained from the throat. Both individuals were asymptomatic during the period described. Eradication was not achieved despite treatment with doxycycline. C. pneumoniae on the basis of serological data is considered a common cause of respiratory tract infections. However, this micro-organism has only been isolated in the Netherlands once. Carrier status has been described in the literature, although its frequency is unknown.

A method for isolating and preparing silica bodies in grasses for scanning electron microscopy.

Silica bodies are discrete deposits of dehydrated silica within epidermal cells. To describe these bodies completely, surrounding organic and unsilicified material must be removed. Methods generally used for isolating and preparing silica bodies were unsuitable for most grass species. An effective method for studying grasses is described here. After ashing the plant tissue, the ash was repeatedly rinsed with HCl in a specialized multiple funnel manifold and collected on Nuclepore filters. In addition, the silica bodies were sonicated for a few minutes to remove any remaining mineral impurities. Compared to conventional procedures, this method has a number of advantages: unsilicified material and mineral impurities were removed effectively, smaller quantities of plant tissue could be used, and the loss of silica bodies was minimized.

The effects of medium and rate of freezing on the survival of chlamydias after lyophilization.

The effects of suspension media and rate of freezing on the survival of Chlamydia trachomatis LGV2 and Chlamydia pneumoniae after lyophilization were assessed. The highest loss in infectious elementary bodies (EBs) occurred during lyophilization. The survival was higher after freezing at a rate of 1 degree C min-1 and lyophilization than that after rapid freezing at -70 degrees C or -196 degrees C. The recovery (+/- 5%) was higher when fetal calf serum (FCS) containing glucose, saccharose or lactose were used as lyophilization media than that (0.5-3%) when yolk-sac, skimmed milk or phosphate buffer containing sucrose, glutamine and 10% FCS (SPG) were used. After lyophilization, the survival was not affected in the tested range from 10(4) to 5 x 10(6) inclusion-forming units (ifu) ml-1 prior to freezing. After storage for 4 months at 4 degrees C, the numbers of ifu of both Chlamydia serovars that were recovered were identical to the numbers of ifu immediately after lyophilization. It was concluded that chlamydias can be stored and transported in lyophilized form. However, a loss of 95% in infectious EBs should be taken into account.

Detection of IgG, IgM and IgA antibodies in patients with uncomplicated Chlamydia trachomatis infection: a comparison between enzyme linked immunofluorescent assay and isolation in cell culture.

The diagnostic value of serum IgG, IgM and IgA in patients with uncomplicated urogenital Chlamydia trachomatis infection was compared with isolation in cell culture. C. trachomatis specific antibodies were determined with an enzyme linked immunofluorescent assay using elementary bodies from C. trachomatis serotypes E,F,H,I,J and LGV2 as antigens. At least two sera from each patient were tested and cultures were also established on the same day. Excluding the IgM titres in men, significantly more IgG, IgA and IgM and combinations of these antibodies were observed in culture positive patients. The sensitivity with which IgG titres in men or IgG and/or IgM titres in men and women could be determined, was significantly lower using C. trachomatis LGV2 as the only antigen than when all 6 antigens were used. The presence of 10 or more leucocytes in the urine sediment of men correlated positively with an IgG or an IgG and/or IgM titre.

Factors influencing the infectivity of Chlamydia pneumoniae elementary bodies on HL cells.

The influence of variations in the pH, NaCl concentration, temperature, and concentrations of calcium and magnesium ions on the survival of Chlamydia pneumoniae elementary bodies (EBs) outside the host cells was investigated. The survival was determined after various incubation periods by counting the inclusion-forming units after C. pneumoniae was cultured for 72 h on monolayers of HL cells. The normal physiological conditions were restored prior to infecting the HL cells with C. pneumoniae. Declines in the infectivities of C. pneumoniae EBs were observed at pH values of lower than 5 and higher than 8 or at NaCl concentrations of less than 80 mM. The viability of C. pneumoniae EBs in SPG medium decreased as the temperature and/or incubation period increased. Incubation temperatures of up to 20 degrees C and incubation periods of up to 48 h did not affect the viability of C. pneumoniae. One hundred percent of the C. pneumoniae EBs were infective after 1 h of incubation at 35 degrees C, whereas 90, 50, and 40% survived after incubations of 8, 24, and 48 h, respectively. The viability of C. pneumoniae was unaffected within the investigated range of Ca2+ and Mg2+ ion concentrations in the medium. The presence of 10% fetal calf serum in the incubation medium had a stabilizing effect on the viability of C. pneumoniae. This effect became more pronounced as the incubation period increased.

Isotype switch and idiotype variation in hairy cell leukemia.

Hairy cell leukemia (HCL) cells are B lymphocytes expressing monoclonal surface bound immunoglobulins, B cell specific antigens, and activation markers. Based on immunophenotyping analysis, HCL cells have been reported to express simultaneously multiple Ig heavy chain isotypes. This is in contrast with the majority of other B cell malignancies. To analyse the tumor cell Ig in more detail, we have prepared somatic cell hybridomas from two patients with HCL. In both cases we found that the tumor cell derived hybridomas secreted IgM, IgG, or IgA indicating that a class-switch event does occur within the monoclonal tumor cell population. However these hybridomas expressed only single isotypes. The clonal relatedness of the tumor-derived Ig was shown by Ig gene analysis and by reactivity with a panel of idiotype specific antibodies. The tumor Ig of one patient analysed showed a striking variability in idiotope expression, indicative of somatic mutations of the expressed Ig genes. To our knowledge this is the first example of HCL and of a B cell malignancy other than follicular lymphoma for which somatic mutations have been demonstrated. This finding might be important for the therapeutic approach based on monoclonal anti-idiotype antibodies.

An improved method for studying grass leaf epidermis.

Leaf epidermis of grasses is elaborate and important in the systematics of the Poaceae at subfamily and genus level. Most available techniques used in preparing leaf epidermis for microscopic studies are time-consuming and often produce preparations inadequate for studying histological detail. A combination of the hand scraping and maceration methods with modifications is proposed in this paper to prepare epidermal peels comparatively rapidly. One epidermal layer was scraped off and the mesophyll tissue removed from the epidermis to be studied by maceration in HNO3. The recovered epidermal peel was neutralized in NaOH and stained with malachite green or safranin O. Preparations made by this technique are suitable for studies of epidermal features, measurements of special structures and determinations of trichome indices. This method has been used in a study investigating intraspecific variation in southern African pasture grasses.

Membrane properties of oxysterols. Interfacial orientation, influence on membrane permeability and redistribution between membranes.

The membrane properties of cholesterol auto-oxidation products, 7-ketocholesterol, 7 beta-hydroxycholesterol, 7 alpha-hydroxycholesterol and 25-hydroxycholesterol were examined. Monolayer studies show that these oxysterols are perpendicularly orientated at the interphase. Only 7 beta-hydroxycholesterol and 7 alpha-hydroxycholesterol are tilted at low surface pressures. In mixed monolayers with dioleoylphosphatidylcholine, 7-ketocholesterol, 7 beta-hydroxycholesterol and 7 alpha-hydroxycholesterol show a condensing effect in this order, although to a lesser extent that that observed for cholesterol. In liposomes these oxysterols also reduce glucose permeability and in the same order as their condensing effect. On the other hand 25-hydroxycholesterol shows no condensing effect in monomolecular layers whereas glucose permeability in liposomes is enormously increased. The permeability increase is already maximal at 2.5 mol% 25-hydroxycholesterol. Differential scanning calorimetry experiments reveal that all four oxysterols tested reduce the heat content of the gel----liquid-crystalline phase transition. It is concluded that 7-ketocholesterol, 7 beta-hydroxycholesterol and 7 alpha-hydroxycholesterol have a cholesterol like effect, although less efficient than cholesterol, whereas 25-hydroxycholesterol showing no condensing effect acts as a spacer molecule. Packing defects in the hydrophobic core of the bilayer due to the presence of the C-25 hydroxyl group are believed to cause the permeability increase. The transfer of radiolabelled (oxy)sterols from the monolayer to lipoproteins or vesicles in the subphase was studied. The transfer rate increases in the following order 7-ketocholesterol, 7 beta-hydroxycholesterol, 7 alpha-hydroxycholesterol, 25-hydroxycholesterol. The difference in rate between 7-ketocholesterol and 25-hydroxycholesterol is 20-fold. A higher rate of transfer is observed in the presence of high density lipoproteins and small unilamellar vesicles. A transfer rate for cholesterol is hardly measurable under these conditions. The transfer measured is consistent with the involvement of a water-soluble intermediate.

In vitro assessment of cytotoxic agents in murine cancers: comparison between antiproliferative and antimetabolic assays.

Different methods were compared for the in vitro evaluation of the therapeutic effects of the antineoplastic agents doxorubicin, cisplatin, fluorouracil, and vinblastine sulfate in a model system of murine tumor cell lines consisting of L1210 leukemia, P815 mast cell leukemia, and B16 melanoma. Excellent correlations were found with the in vivo effects with the use of a soft agar clonogenic assay, irrespective of the method of growth assessment (i.e., visual colony counting or incorporation of tritiated thymidine in proliferating colonies). Drug effects on the proliferation of tumor cell lines in liquid medium frequently led to an overestimation or underestimation of the actual in vivo effects. Direct incorporation of the radiolabeled precursors thymidine, uridine, and leucine after pretreatment with drugs always led to the prediction of resistance and was therefore considered unreliable.