Owning the brand of psychiatry

In Australia and New Zealand, conversations around mental health are playing out in the public space with increasing frequency. Mental health promotion campaigns and organizations are embraced by mainstream and other forms of media, and supported by government. Whilst public knowledge of mental illness is increasing, the profile of psychiatrists as leaders and medical experts in mental illness is a more difficult brand to sell. With a somewhat tarnished history behind us, the modern evidence-based practice of psychiatry is not always at the forefront of public impression. Furthermore, in Australia, more than half of the population (56%) is unaware that psychiatrists have undertaken medical training as a doctor. This presentation will outline Royal Australian and New Zealand college of psychiatrists (RANZCP) action to improve community information about psychiatry, psychiatrists and treatment experiences.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.

Patient restrictions following total hip arthroplasty: A national survey

In this prospective nation-wide web based survey we describe the current practice regarding patient restrictions following total hip arthroplasty. A web-based survey involving 20 items was developed and tested prior to administration. The questionnaire included general information, type of restrictions, specification and duration of restrictions. The target population consisted of all orthopaedic surgeons registered with the Dutch Orthopaedic Association working at one of the 94 orthopaedic departments in the Netherlands. The response rate of the orthopaedic departments was 78% (n=74). The majority of orthopaedic departments use patient restrictions following THA. Restrictions were used with different rates per type of surgical approach: anterior (69%), anterolateral (100%), straight lateral (94%) and posterolateral (93%). The duration of these restrictions is generally six weeks. Patient restrictions following THA are current practice, regardless of the surgical approach.

Tertiary Lymphoid Organs in Central Nervous System Autoimmunity

Multiple sclerosis (MS) is an autoimmune disease characterized by chronic inflammation in the central nervous system (CNS), which results in permanent neuronal damage and substantial disability in patients. Autoreactive T cells are important drivers of the disease; however, the efficacy of B cell depleting therapies uncovered an essential role for B cells in disease pathogenesis. They can contribute to inflammatory processes via presentation of autoantigen, secretion of pro-inflammatory cytokines, and production of pathogenic antibodies. Recently, B cell aggregates reminiscent of tertiary lymphoid organs (TLOs) were discovered in the meninges of MS patients, leading to the hypothesis that differentiation and maturation of autopathogenic B and T cells may partly occur inside the CNS. Since these structures were associated with a more severe disease course, it is extremely important to gain insight into the mechanism of induction, their precise function, and clinical significance. Mechanistic studies in patients are limited. However, a few studies in the MS animal model experimental autoimmune encephalomyelitis (EAE) recapitulate TLO formation in the CNS and provide new insight into CNS TLO features, formation, and function. This review summarizes what we know so far about CNS TLOs in MS and what we have learned about them from EAE models. It also highlights the areas that are in need of further experimental work, as we are just beginning to understand and evaluate the phenomenon of CNS TLOs.

Review of psittacine beak and feather disease and its effect on Australian endangered species

BACKGROUND

Since it was first described in the early 1980s, psittacine beak and feather disease (PBFD) has become recognised as the dominant viral pathogen of psittacine birds in Australia. Our aim was to evaluate and review the effect of PBFD and its position as a key threatening process to Australian psittacine bird species. We review the origin/evolutionary pathways and potential threat of PBFD to endangered psittacine bird populations and captive-breeding flocks.

CONCLUSIONS

The most recent beak and feather disease virus (BFDV) phylogenetic analyses indicate that all endangered Australian psittacine bird species are susceptible to, and equally likely to be infected by, BFDV genotypes from a range of host psittacine species. Management of the disease in captive-breeding programs has relied on testing and culling, which has proven costly. The risk of PBFD should be considered very carefully by management teams contemplating the establishment of captive-breeding flocks for endangered species. Alternative disease prevention tools, including vaccination, which are increasingly being used in wildlife health, should be considered more seriously for managing and preventing PBFD in captive flocks of critically endangered species.

Interpretation of Post-operative Distal Humerus Radiographs After Internal Fixation: Prediction of Later Loss of Fixation

PURPOSE

Stable fixation of distal humerus fracture fragments is necessary for adequate healing and maintenance of reduction. The purpose of this study was to measure the reliability and accuracy of interpretation of postoperative radiographs to predict which implants will loosen or break after operative treatment of bicolumnar distal humerus fractures. We also addressed agreement among surgeons regarding which fracture fixation will loosen or break and the influence of years in independent practice, location of practice, and so forth.

METHODS

A total of 232 orthopedic residents and surgeons from around the world evaluated 24 anteroposterior and lateral radiographs of distal humerus fractures on a Web-based platform to predict which implants would loosen or break. Agreement among observers was measured using the multi-rater kappa measure.

RESULTS

The sensitivity of prediction of failure of fixation of distal humerus fracture on radiographs was 63%, specificity was 53%, positive predictive value was 36%, the negative predictive value was 78%, and accuracy was 56%. There was fair interobserver agreement (κ = 0.27) regarding predictions of failure of fixation of distal humerus fracture on radiographs. Interobserver variability did not change when assessed for the various subgroups.

CONCLUSIONS

When experienced and skilled surgeons perform fixation of type C distal humerus fracture, the immediate postoperative radiograph is not predictive of fixation failure. Reoperation based on the probability of failure might not be advisable.

TYPE OF STUDY/LEVEL OF EVIDENCE

Diagnostic III.

A New Pragmatic Classification System for Varicose Veins

Objective:

An anatomical classification system for varicose veins which has a direct and pragmatic bearing on treatment.

Methods:

A group of trial participants from the two vascular units involved met to design a system. A consensus on the form and content of the system was reached. This process included forming a set of ideal classification criteria, a literature review of existing classification systems and a pilot study of the proposed system.

Results:

The identified classification systems were felt to be unsatisfactory for a number of reasons including being difficult to understand and use, requiring special investigations and not linking through to clinical management options. The pilot study demonstrated consensus between clinicians when using our system.

Conclusion:

A system has been developed that is easy to learn, use and understand. It can be employed in a busy outpatient setting and produces an acceptable degree of agreement regarding the anatomical nature of varicose veins.

Handgrip strength is inversely and independently associated with multimorbidity among older women: Results from the KORA-Age study

BACKGROUND

Data on the association between handgrip strength and multimorbidity (MMB) are missing.

AIM

The purpose of this study was to examine if handgrip strength is related to MMB in a large population-based sample of older persons.

METHODS

The cross-sectional analysis was based on 1079 older people (aged 65-94years), who participated in the KORA-Age study in the Augsburg region, southern Germany. Participants underwent an interview and extensive examinations, including anthropometric measurements, registration of chronic diseases, determination of health-related behaviors (smoking, alcohol intake and physical activity), collection of blood samples, and muscle strength measurement using hand-grip dynamometry.

RESULTS

In men, handgrip strength correlated strongly with the number of co-existing diseases (r=-0.176, p<0.001), and the same pattern was observed for women (r=-0.287, p<0.001). Among women, handgrip strength in the lower tertile compared to the upper tertile was significantly associated with an increased odds of having MMB (OR: 2.57, 95% CI: 1.30-5.07, p=0.007) after controlling for age, BMI, education, alcohol intake, smoking habits, medications number, inflammatory markers, telomere length and levels of physical activity. Contrary, no significant association between handgrip strength and MMB was found among men (OR: 1.32, 95% CI: 0.73-2.40, p=0.362) after multivariable adjustment.

CONCLUSION

Lower levels of handgrip strength are associated with a higher odd of MMB among older women even after adjusting for traditional and novel confounders. Increasing the levels of muscular strength in older women seems to be important in order to reduce the risk for the co-occurrence of multiple chronic diseases.

Double Bragg Interferometry

We employ light-induced double Bragg diffraction of delta-kick collimated Bose-Einstein condensates to create three symmetric Mach-Zehnder interferometers. They rely on (i) first-order, (ii) two successive first-order, and (iii) second-order processes which demonstrate the scalability of the corresponding momentum transfer. With respect to devices based on conventional Bragg scattering, these symmetric interferometers double the scale factor and feature a better suppression of noise and systematic uncertainties intrinsic to the diffraction process. Moreover, we utilize these interferometers as tiltmeters for monitoring their inclination with respect to gravity.

What prevents old people living alone from feeling lonely? Findings from the KORA-Age-study

OBJECTIVES

Living alone in later life is an important risk factor of loneliness for elderly people unless they have resources to compensate for that. The aim of this investigation was to identify these resources.

METHOD

Data were drawn from the population-based KORA-Age-study (KOoperativen Gesundheitsforschung in der Region Augsburg) conducted in the Region of Augsburg, Germany in 2008/2009 with 1079 elderly men and women (64-94 years). Loneliness was measured by the short version of the UCLA-Loneliness-Scale in a face-to-face interview. Multiple logistic regression analyses were conducted to identify associations between loneliness and potential protecting resources.

RESULTS

A total of 346 (32%) subjects reported to be living alone, among them 70% (n = 241) expressed no feelings of loneliness. Participants with a stable social network had a fourfold higher chance (OR 4.08, 95% CI 1.20-13.88, p = 0.025) and with the absence of depression a threefold higher chance (OR 3.04, 95% CI 1.59-5.78, p-value < 0.001) of not feeling lonely. Physical or mental resources were not correlated with lower levels of loneliness.

CONCLUSION

Absence of depression and a functioning social network are the most important protecting resources against loneliness for elderly people living alone, while income, level of education and age-related limitations have no impact. These findings should be considered when supporting the elderly in successful aging.