Factors influencing general practitioners’ decisions in migrant patients with mental health disorder

Background

Patients with a migration background (MB) have more mental health disorders than those without migration background. Yet, those patients are still underrepresented in mental healthcare services and have more unmet medical needs. Although providers’ bias has been well studied, up to date, little is still known about the factors explaining those biases. We assessed the effect of general practitioners’ (GPs') individual and organizational factors on their decision-making regarding diagnosis, treatment and referral recommendations for patient with MB with symptoms of major depression.

Methods

An experimental study staged a video-vignette of a depressed patient with or without MB. GPs had to make decision about diagnosis, treatment and referral. We then assessed the influence of several factors on their decisions such as age, ethnicity, workload and patient confidence. ANOVA and MANOVA were used for analyses.

Results

Overall, we found more unfavourable decisions in GPs diagnosis and treatment recommendations regarding the patient with a MB (F = 3.56, p < 0.001). In addition, they considered the symptoms of the patient with a MB as less severe (F = 7.68, p < 0.01) and would prescribe less often a medical treatment to these patients (F = 4.09, p < 0.05). Nevertheless, few factors explained these differences, except the age, the workload and the patient trustworthiness.

Conclusions

This paper highlighted GPs biases based on apparent migration background of a patient with major depression that perpetuates ethnic inequalities in mental health care. Further research into the origins of discrimination in primary mental health care are needed to explain how and when those discriminations arise.

Key messages

• This paper shed light on pervasive unintentional discrimination still persist in mental health care among migrants in Europe.

• These findings may help us to further understand the role of general practitioner behaviour in primary mental health care discrimination.

The stratified medicalisation of mental health symptoms: educational inequalities in the use of psychotropic medication in Belgium

PURPOSE

Several studies have shown socioeconomic inequalities in psychotropic medication use, but most of these studies are inspired by Andersen's behavioural model of health care use, which strongly focusses on individuals' needs. Andersen's model pays little attention to health care use that is not based on need and insubstantially recognises the context dependentness of individuals. Medicalisation, however, is a context-dependent interactive process that not only interacts with need determinants, but also with non-need determinants that affect health care use. Therefore, this study will examine if psychotropic medication use is stratified, and whether this is not simply the result of differences in need for care, but also influenced by factors not based on need, initiating the stratified medicalisation of mental health symptoms.

METHODS

Data from the Belgian Health Interview Survey (BHIS) are used. This study covers information from five successive waves: 2001, 2004, 2013, 2018. The weighted data represent a sample of the adult Belgian population. The research aims are analysed using stepwise Poisson regression models, where the models are also plotted to detect evolutions over time, using marginal means postestimation.

RESULTS

The results reveal that educational inequalities in psychotropic medication use are significant and persistently visible over time. Even after entering need for care, educational inequalities remain significant.

CONCLUSION

This study shows that psychotropic medication use is stratified and that this is not simply the result of differences in need for care, but also influenced by factors linked to the stratified medicalisation of mental health symptoms.

Depressive symptoms in higher education students during the first wave of the COVID-19 pandemic. An examination of the association with various social risk factors across multiple high- and middle-income countries

Higher-education students face substantial risks for developing depressive symptoms during the COVID-19 pandemic or experiencing exacerbated pre-existing depressive symptoms. This study uses data from the COVID-19 International Student Well-Being Study, which collected data through a non-representative convenience sample in 125 higher-education institutions (HEI) across 26 high- and middle-income countries (N: 20,103) during the first wave of the COVID-19 pandemic. It describes the prevalence of depressive symptoms in higher-education students. We find substantial cross-national variation in depressive symptoms, with lowest mean levels established in the Nordic countries and France, while highest mean levels of depressive symptoms were found in Turkey, South Africa, Spain and the USA. Elevated risk for depressive symptoms was found in female students, students with fewer social support resources and in a more disadvantaged socioeconomic position, and students with a migrant background. COVID-19 related stressors, such as reduced social contact, increased financial insecurity, and academic stress explained a relatively larger proportion of the variance in depressive symptoms compared to non-COVID-19 related stressors. This finding shows that not the pandemic itself, but rather the secondary effects of the pandemic relate to students' mental health. Our results enable HEIs to be better equipped to target groups that are particularly at risk during a pandemic.

Discrimination between migrants and non-migrants in depression’s management by General Practitioners

Background

In Europe, migrants have a higher prevalence of depression compared to the native population and, more often, they face unmet medical needs, including less frequent referral to mental health services. According to social psychology, general practitioners (GPs) may undertreat migrants due to unconscious stereotypical bias that could lead to and sustain discrimination in primary health care. The central question in this research is whether patients' migration background influences GPs' attitudes and decisions regarding treatment and referral in mental health.

Methods

In 2021, an experimental design was delivered to GPs with two video vignettes staging a depressed native and a Belgo-Moroccan patient, respectively. The randomly assigned vignette was followed by an online questionnaire regarding treatment and referral decisions. We recruited a national sample of Belgian GPs' (n = 700). T-tests and chi-square were used for analyses.

Results

The preliminary results are based on the first 224 respondents. Overall, there was no significant difference in the management of depression between a Belgian patient and a Belgo-Moroccan patient. Nevertheless, severity of symptoms was rated lower in the Belgo-Moroccan as compared to the Belgo-Moroccan (t = 2.37, p = .019).

Conclusions

In summary, these results indicate that general practitioners seem to treat migrants fairly in comparison with non-migrants. However, underestimation of the severity of the symptoms could lead to a different medical decision. This hypothesis will be investigated in the coming months.

Key messages

These findings may help us to further understand the role of general practitioner behaviour in mental health care discrimination. This research shed light on current management of migrants’ mental health by the primary health care providers in Belgium.

The COVID-19 International Student Well-being Study

Background

We will present the COVID-19 International Student Well-being Study (C19 ISWS). The C19 ISWS is a cross-sectional multi-country study that collected data on higher education students during the first wave of the COVID-19 outbreak (spring 2020).

Methods

The dataset allows to describe (1) the living conditions, financial conditions and academic workload before and during the COVID-19 outbreak, (2) the current level of mental well-being and changes in healthy lifestyles, (3) perceived stressors, (4) resources (e.g., social support and economic capital), (5) COVID-19 related knowledge, and (6) attitudes towards COVID-19 measures implemented by the government and higher education institution (HEI). The dataset additionally includes information about COVID-19 measures taken by the government and HEI that were in place during the period of data collection.

Results

As a large international consortium of 26 countries and 110 higher education institutions (HEIs), we successfully developed and executed an online student survey during or directly after the initial peak of the Covid-19 pandemic.

Conclusions

The collected data provide a comprehensive and comparative dataset on student well-being. In this article, we present the rationale for this study, the development and content of the survey, the methodology of data collection and sampling, and the limitations of the study. In addition, we highlight the opportunities that the dataset provides for advancing social science research on student well-being during the COVID-19 pandemic in varying policy contexts. Thus far, this is the first cross-country student well-being survey during the COVID-19 pandemic, resulting in a unique dataset that enables high priority and socially relevant research.

Human Centric Lighting: The impact of light on sleep and attention of factory shift workers

Introduction

Increased blue-enriched morning light is often said to support circadian rhythm synchronization. Through a better sleep quality, one's cognitive and emotional functioning can also be enhanced. However, it is unclear which light characteristics (especially illuminance at eye level) are necessary to obtain a wellbeing effect in employees. This field study investigated different lighting conditions in a truck factory.

Methods

71 shift workers participated in the study during their morning shift (6 am - 2 pm). Measurements of sleep (MotionWatch8), attention (D2 attention task, go no-go computer task) and visual comfort (questionnaire) were administered before and after changing the lighting conditions. A Human Centric Lighting-condition (HCL; vertical melanopic equivalent daylight illuminance (MEDI) = 250 lux, CCT=5000 K; N = 33) was compared with a control LED-condition (MEDI = 44 lux, CCT=4000K; N = 38).

Results

Results show that workers in the HCL-condition showed a larger improvement in sleep efficiency (p=.057) and concentration (p=.01) than the control LED-group. No differences were found in visual comfort between groups.

Discussion

Preliminary results are promising and show that 250 MEDI might be a sufficient cut-off to stimulate workers' sleep and cognition. The high illuminance level was not detrimental in the HCL condition for the perceived visual comfort.

Key messages

Blue-enriched morning light supports sleep and concentration in shift workers. High illuminance levels are not detrimental for the perceived visual comfort.

Social inequality in morbidity, framed within the current economic crisis in Spain

INTRODUCTION

Inspired by the 'Fundamental Cause Theory (FCT)' we explore social inequalities in preventable versus relatively less-preventable illnesses in Spain. The focus is on the education-health gradient, as education is one of the most important components of an individual's socioeconomic status (SES). Framed in the context of the recent economic crisis, we investigate the education gradient in depression, diabetes, and myocardial infarction (relatively highly preventable illnesses) and malignant tumors (less preventable), and whether this educational gradient varies across the regional-economic context and changes therein.

METHODS

We use data from three waves of the Spanish National Health Survey (2003-2004, 2006-2007, and 2011-2012), and from the 2009-2010 wave of the European Health Survey in Spain, which results in a repeated cross-sectional design. Logistic multilevel regressions are performed with depression, diabetes, myocardial infarction, and malignant tumors as dependent variables. The multilevel design has three levels (the individual, period-regional, and regional level), which allows us to estimate both longitudinal and cross-sectional macro effects. The regional-economic context and changes therein are assessed using the real GDP growth rate and the low work intensity indicator.

RESULTS

Education gradients in more-preventable illness are observed, while this is far less the case in our less-preventable disease group. Regional economic conditions seem to have a direct impact on depression among Spanish men (y-stand. OR = 1.04 [95 % CI: 1.01-1.07]). Diabetes is associated with cross-regional differences in low work intensity among men (y-stand. OR = 1.02 [95 % CI: 1.00-1.05]) and women (y-stand. OR = 1.04 [95 % CI: 1.01-1.06]). Economic contraction increases the likelihood of having diabetes among men (y-stand. OR = 1.04 [95 % CI: 1.01-1.06]), and smaller decreases in the real GDP growth rate are associated with lower likelihood of myocardial infarction among women (y-stand. OR = 0.83 [95 % CI: 0.69-1.00]). Finally, there are interesting associations between the macroeconomic changes across the crisis period and the likelihood of suffering from myocardial infarction among lower educated groups, and the likelihood of having depression and diabetes among less-educated women.

CONCLUSION

Our findings partially support the predictions of the FCT for Spain. The crisis effects on health emerge especially in the case of our more-preventable illnesses and among lower educated groups. Health inequalities in Spain could increase rapidly in the coming years due to the differential effects of recession on socioeconomic groups.

The gender gap in mental health service use

PURPOSE

This study examines why men engage less in mental health service use, by studying how gender is performed in interactions, following the doing gender perspective. We hypothesize that seeking help for mental illness may constitute a gendered role conflict among men since help seeking is associated with femininity. Therefore, we expect that men will recommend reliance on self-care options to other men, and in cases in which professional treatment is recommended, they will prefer medication to psychotherapy. We also expect that men will report greater stigmatizing attitudes.

METHODS

The survey Stigma in a Global Context-Belgian Mental Health Study (2009) conducted interviews of a representative sample of the Belgian general population (N = 743). The vignette technique, depicting depressive and schizophrenic symptoms, was used. Multiple linear and logistic models were estimated in SPSS.

RESULTS

In male vignettes, self-care is more likely to be recommended, both by male and female respondents. Men are less likely to acknowledge the helpfulness of psychotherapy and women rate psychotherapy as less helpful when judging a man compared to a woman. Men rate tranquilizers as more helpful for other males than that women do for other females. Furthermore, male respondents seem to ascribe more shame and blame to the situation.

CONCLUSIONS

The gender gap in mental health service use is due not only to men and their negative attitudes toward help seeking, but also to structured social norms that are reconstructed in interactions. Women also contribute to the maintenance of masculinity norms.

Professional care seeking for mental health problems among women and men in Europe: the role of socioeconomic, family-related and mental health status factors in explaining gender differences

PURPOSE

This comparative study examines cross-national variation in gender differences in primary and specialized mental health care use in Europe. We investigate to what extent socioeconomic, family-related, and mental health factors explain the gender difference, and how the impact of these groups of determinants on gender differences in mental health care use varies between countries.

METHODS

Data from the Eurobarometer 248 (2005-2006) for 29 European countries is used and country-specific logistic regression analyses are performed.

RESULTS

Gender differences in professional care seeking are largely need based. In almost one-third of the countries examined, the gender difference is mainly attributable to women's poorer mental health status. However, in some countries, family and socioeconomic characteristics also have an independent contribution to the gender difference in mental health care use. Women's higher likelihood of a lower socioeconomic position, might partly explain their higher primary care use, while in some countries, it restricts their specialized care use. In addition, some social conditions, as having children and being widowed, seem to function in a few countries as suppressors of women's care use.

CONCLUSIONS

Our study has shown that the gender difference in mental health care use, with women having a higher care use, is not a consistent European phenomenon and is dependent on the type of care provider, with greater gender inequity in the use of primary health care. The social roles adopted by men and women have in some countries on top of the mental health status a relevant influence on the greater tendency among women to contact a care provider. How the socioeconomic and family characteristics moderate the relation between gender and mental health care use is not straightforward and country dependent.

Medicalizing versus psychologizing mental illness: what are the implications for help seeking and stigma? A general population study

PURPOSE

This study contrasts the medicalized conceptualization of mental illness with psychologizing mental illness and examines what the consequences are of adhering to one model versus the other for help seeking and stigma.

METHODS

The survey "Stigma in a Global Context-Belgian Mental Health Study" (2009) conducted face-to-face interviews among a representative sample of the general Belgian population using the vignette technique to depict schizophrenia (N = 381). Causal attributions, labeling processes, and the disease view are addressed. Help seeking refers to open-ended help-seeking suggestions (general practitioner, psychiatrist, psychologist, family, friends, and self-care options). Stigma refers to social exclusion after treatment. The data are analyzed by means of logistic and linear regression models in SPSS Statistics 19.

RESULTS

People who adhere to the biopsychosocial (versus psychosocial) model are more likely to recommend general medical care and people who apply the disease view are more likely to recommend specialized medical care. Regarding informal help, those who prefer the biopsychosocial model are less likely to recommend consulting friends than those who adhere to the psychosocial model. Respondents who apply a medical compared to a non-medical label are less inclined to recommend self-care. As concerns treatment stigma, respondents who apply a medical instead of a non-medical label are more likely to socially exclude someone who has been in psychiatric treatment.

CONCLUSIONS

Medicalizing mental illness involves a package deal: biopsychosocial causal attributions and applying the disease view facilitate medical treatment recommendations, while labeling seems to trigger stigmatizing attitudes.

Attitudes toward community mental health care: the contact paradox revisited

Contact with people with mental illness is considered to be a promising strategy to change stigmatizing attitudes. This study examines the underlying mechanisms of the association between contact and attitudes toward community mental health care. Data are derived from the 2009 survey "Stigma in a Global Context-Belgian Mental Health Study", using the Community Mental Health Ideology-scale. Results show that people who received mental health treatment themselves or have a family member who has been treated for mental health problems report more tolerant attitudes toward community mental health care than people with public contact with people with mental illness. Besides, the perception of the effectiveness of the treatment seems to matter too. Furthermore, emotions arising from public contact are associated with attitudes toward community mental health care. The degree of intimacy and the characteristics of the contact relationship clarify the association between contact and attitudes toward community mental health care.

[Flanders versus The Netherlands: focus on differences between depressive symptoms in men and women measured on the basis of CES-D8]

BACKGROUND

A consistent finding in international research is the higher prevalence of depression in women than in men, but it is not known to what extent this gender difference is robust in population research.

AIM

In this study we focus on gender differences in depressive symptoms of the population of Flanders and the Netherlands. method We made use of the European Social Survey organised in 2006 and 2007 (n = 3014); depression being measured by means of an 8-item version of the Center of Epidemiological Studies Depression Scale, CES-D. First we studied the psychometric properties of the depression inventory, looking closely at both the reliability and factional validity of the scale. Next we compared the gender and regional differences in the prevalence of depressive symptoms as measured by the CES-D8 scale. Finally, using regression analysis, we examined to what extent the gender differences between Flanders and the Netherlands were family-related and linked to socio-economic factors.

RESULTS

Our study pointed to the reliability and factional validity of the CES-D8. Our results confirmed a higher prevalence of depressive symptoms among women than among men. On average, Flemish respondents reported fewer depressive symptoms than Dutch respondents, but their scores showed greater dispersion.

CONCLUSIONS

These differences can be explained partly by different family and socioeconomic circumstances.

Measurement equivalence of the CES-D 8 in the general population in Belgium: a gender perspective

International research consistently finds gender differences in depression, but do women genuinely experience more complaints or are the findings contaminated by group-specific elements unrelated to depression but affecting its measurement? The study of gender differences in depression depends on the measurement quality of the instrument used to evaluate depression. In the present study we test the measurement equivalence of a shorter version of a commonly used instrument in mental health research, the Center for Epidemiologic Studies - Depression Scale (CES-D), using data from the Belgian sample of the third round of the European Social Survey (N = 1794). Evidence for measurement invariance can be established within the multigroup confirmatory factor analysis framework. This method allows us to evaluate a nested hierarchy of hypotheses to test different levels of cross-group measurement invariance: configural, metric, scalar and residual invariance, and clarifies under what conditions meaningful comparisons between the male and female respondents can be made. The best fitting factor model is then used to estimate the 'true' prevalence of depressive symptoms for both groups. In our study measurement equivalence is established at all levels, indicating that the current depression scale allows defensible quantitative gender comparisons. Our data also confirm the epidemiological finding that women report more complaints of depression than men.

Nonoperative treatment of active spondylolysis in elite athletes with normal X-ray findings: literature review and results of conservative treatment

The purpose of this study was to evaluate the healing capacity of fatigue fractures of the pars interarticularis in young elite athletes. Between 1991 and 2000, a fatigue fracture of the pars interarticularis was diagnosed in 34 highly competitive athletes. The study group included 28 athletes with a mean age of 17.2 years at diagnosis (range 12-27 years). The average time per week dedicated to sports was 10.9 h. Diagnosis was made with both planar and single-photon-emission computed tomographic (SPECT) bone scintigraphy and computed tomographic (CT) scan. Lesions were classified into three groups according to their distribution on the scintigram: unilateral, bilateral, or "pseudo-bilateral" (asymmetrical tracer uptake). The study was limited to athletes with subtle fractures, which means that they had normal radiographs and positive bone scans. All subjects were braced for a mean time of 15.9 weeks (range 12-32 weeks). We looked at healing of the fracture, subjective outcome, and sports resumption in the three groups. The athletes were reviewed after an average of 13.2 months (range 3-51 months), and a second CT scan was performed to evaluate osseous healing. Healing of the fracture was noted in all 11 athletes with a unilateral lesion, in five out of nine athletes with a bilateral lesion and in none of the eight athletes with a pseudo-bilateral lesion. Twenty-three athletes (82.2%) rated the outcome as excellent, three athletes (10.7%) as good, and two (7.1%) as fair. Twenty-five athletes (89.3%) managed to return to their same level of competitive activity within an average of 5.5 months after the onset of treatment. There was no difference in outcome or in sports resumption between the three groups. Our data suggest that osseous healing is most likely to occur in unilateral active spondylolysis. Chances of bony healing diminish when the fracture is bilateral, and diminish even further when it is pseudo-bilateral. Non-union does not seem to compromise the overall outcome or sports resumption in the short term.

Imaging of musculoskeletal soft tissue infection

The role of different imaging techniques in the assessment of musculoskeletal soft tissue infection will be reviewed in this article. As classification according to the causative agent is impossible with imaging, soft tissue infections will be classified in view of their location. Consecutively, musculoskeletal soft tissue infections of the joints, tendons and bursae, muscles, the skin and its related structures as well as infectious lymphadenitis and lymphangitis will be discussed.

MR imaging anatomy of the knee

MRI of the knee joint is one of the most common and important clinical applications in most MRI units today. Thorough knowledge of the detailed anatomy is a prerequisite for the understanding of knee pathology. This article reviews the MR anatomy of menisci, the cruciate ligaments, the medial and lateral supporting structures, the extensor mechanism, synovial plicae around the joint and some pitfalls in the interpretation.

Measuring the subjective well-being of people in a psychosocial rehabilitation center and a residential psychiatric setting: the outline of the study and the measurement properties of a multidimensional indicator of well-being

The outline of an ongoing outcome research project in a day rehabilitation center and in a residential psychiatric setting (with respectively 156 and 86 participants at baseline) in Bruges (Belgium) is presented. The study is first characterized by its emphasis on subjective well-being. Subjective well-being is considered to refer to more than satisfaction with specific domains of life, or the absence of psychiatric complaints. Attention is paid to feelings of empowerment, sense of control, feelings of joy and enthusiasm, and global self-esteem. Various aspects of the social relations of the participants and their satisfaction with services are also assessed. Second, the investigation is based on a longitudinal design with intake interviews, retest interviews during and at the end of the rehabilitation programs, and a follow-up interview. Finally, specific efforts are made to ground the outcome measures in sociological theories of mental health to make a theory-driven evaluation possible. After presenting the rationale of the research project, some preliminary results are given, mainly confined to the determination of the reliability, the construct validity, and the sensitivity to change of the various indicators of well-being.

MR imaging of the shoulder: imaging techniques and anatomy

Since the development of dedicated surface coils and the more widespread use of state-of-the-art arthrographic techniques, MR imaging of the shoulder has come to maturity. In this article the imaging techniques of conventional MR imaging and MR arthrography of the shoulder are reviewed. The complex anatomy, the many anatomic variations and diagnostic variants and pitfalls and discrimination of pathologic entities from normal findings are discussed. Familiarity with the normal anatomy is a prerequisite to achieve a high diagnostic accuracy in the detection of a variety of pathologic conditions of the shoulder joint.

The three-year persistence of depressive symptoms in men and women

Little is known about sex differences in the course of depression. The results of the few surveys of the general population are inconsistent. Furthermore, the generalizability of most of these findings is limited. First, only a handful of studies of the general population use a prospective design to estimate the persistence of depression in women and men. Second, in some studies only particular subgroups of the general population are sampled, and finally, depression persistence is often measured using unconventional short time-intervals. Using data from five waves of the Flemish subsample of the Panel Study of Belgian Households (PSBH)--a probability sample of 1168 (52.5%) women and 1055 (47.5%) men--we tried to go beyond these shortcomings. Depression persistence is estimated using a self-report inventory on four occasions separated by intervals of one year (1993, 1994, 1995, 1996). Results show a significant influence of sex, other sociodemographic characteristics, and depression severity at baseline on three-year depression persistence. Women experience more chronicity, a difference that can be partially ascribed to sex differences in employment status, education and marital status. Persistence in linked to marital status in women. In men persistence is associated with level of education and with employment status. Depression severity at baseline, however, largely explains the influence of these social conditions on depression persistence.

Dysphagia in a patient with giant osteophytes: case presentation and review of the literature

A patient with increasing dysphagia due to external bone compression of the oesophagus is presented. Radiographic evaluation revealed the underlying condition to be a diffuse idiopathic skeletal hyperostosis with exuberant and bumpy change within the anterior longitudinal ligament.

The concurrence of ring constrictions in Adams-Oliver syndrome: additional evidence for vascular disruption as common pathogenetic mechanism

We report on a girl with congenital scalp and acral reduction limb defects, consistent with the diagnosis of Adams-Oliver syndrome. The presence of constriction rings makes the limb anomalies in this case similar to those seen in the amniotic band disruption sequence. Vascular disruption--with or without secondary amniotic rupture--may be responsible for the observed anomalies. Therefore we believe that the present observation adds further evidence for the hypothesis that the Adams-Oliver syndrome is a vascular disruption sequence.

Sex differences in the course of depression: evidence from a longitudinal study of a representative sample of the Belgian population

Outcome studies of major depression indicate high rates of relapse and chronicity, and social role theories imply that chronicity should be greater for women, together suggesting that the well-known sex difference in depression is, at least partially, the result of differences in chronicity. Due to a lack of prospective longitudinal research answers to this empirical question are missing. Furthermore, the results of the few available surveys of the general population are inconsistent, showing either higher chronicity for older women or a lack of sex differences in the overall course of depression. Using data from three waves of the Panel Study of Belgian Households (complete data for 3204 women and 2907 men, aged 16 years and older) sex differences in the persistence of depressive behavior are estimated. Depression is measured using a self-report inventory on three occasions separated by intervals of 1 year (1992, 1993, 1994). Results show a significant influence of sex, other sociodemographic characteristics, and depression severity at baseline on depression persistence. Women experience more symptoms for a longer period of time, a difference that can be partially ascribed to sex differences in employment status, education and marital status. The findings are discussed.

Laparoscopic splenectomy after arterial embolisation

Laparoscopic splenectomy remains a challenging procedure, as haemorrhage causes the most complications. In order to reduce this risk, preoperative selective embolisation of the splicing artery has been performed in a series of six successful laparoscopic splenectomies in one male and five female patients with a mean age of 34.6 years (range 17-53 yrs). Indications for surgery were immune thrombocytopenic purpura (ITP)(n = 3), non-Hodgkin lymphoma with secondary haemolytic anaemia (n = 1), autoimmune haemolytic anaemia (n = 1) and congenital spherocytosis (n = 1). The mean splenic length was 12.3 cm (range 9-16 cm) and no accessory spleens were identified. Mean operative time was 96.7 min (range 90-150 min). There were no deaths nor haemorrhagic or septic complications. Recovery after surgery was excellent with a mean hospital stay of 5.2 days (range 2-10 days). We conclude that selective embolisation of the splenic artery, just prior to laparoscopic splenectomy adds to the safety, and operating time may be shortened.

Imaging of primary tumors and tumor-like conditions of the lumbosacral osseous spine

Primary tumors of the osseous spine are rare. This article illustrates some aspects of imaging of tumoral pathology of the osseous spine. Plain film and CT scan still remain the initial imaging modalities in the work-up of tumoral pathology of the osseous spine. MR imaging however has proven its potentials in the detection of lesions in areas with superimposing structures which hamper reliable reading of the plain films or in areas with a complex bony anatomy such as the sacrum. MR imaging is exquisite in determining the local extent of tumoral lesions and in defining the relationship to adjacent central nervous system structures. In some tumors or tumor-like lesions, MR imaging allows to make a correct tissue-related diagnosis or to strengthen the diagnosis made on plain film/CT observations. In other case MR imaging only has a role in staging or may have definitely no role at all.

Developing measures of type A behavior in children and adolescents

Development of measures of Type A behavior in children and adolescents is described and the results of two studies to validate these measures are given. Children in the fifth, seventh, and ninth grades (n = 120 in Study I; n = 652 in Study II) were given five measures of the Type A Behavior Pattern (TABP): the Student Type A Behavior Scale (STABS); Student Structured Interviews (SSI), scored separately for content and behavior; Matthews Youth Test for Health (MYTH); and Parent Observation Checklist, as well as measures of state anxiety, trait anxiety, and depression. Descriptive statistics from the two samples were very similar and indicated that boys scored significantly higher than girls on the MYTH, while seventh and ninth grade girls scored significantly higher than fifth grade girls or boys of any grade on Structured Interview Behavior (SSI-Behavior). Correlations suggested separate self-reported perceptual and behavioral components of Type A behavior in children. In both studies, STABS and SSI-Content correlated moderately well (.48 to .49) but had little relationship with SI-Behavior and the MYTH. Measures of anxiety and depression included to assess discriminant validity were correlated with the self-report measures of TABP (.22 to .56), but showed little relationship with the behavioral measures, especially in the larger cross-validation study. Parallels between these results and those of adult studies are discussed, and the use of multiple measures in classifying subjects is suggested.

Physical health correlates of type A behavior in children and adolescents

A physical examination including resting blood pressure, heart rate, Tanner scales, height, and weight was administered to 184 students in the fifth, seventh, and ninth grades. They completed the Physical Symptoms of Stress Inventory, Health Habits Inventory, and two self-monitoring logs of physical symptoms. School absenteeism, medical records, physician ratings, and family health history data were collected. No significant differences between high- and low-Type A behavior pattern (TABP) subjects were found on any of the physical measurements. However, retrospective and prospective reports of physical symptoms revealed a consistent pattern: high TABP subjects reported significantly more physical symptoms than low-TABP subjects. Self-ratings of stress and tension were significantly higher for high-TABP subjects. High-TABP subjects, however, neither missed more school because of illness nor used physician services more often than low subjects. Further, expected relationships between physical symptoms and illness behavior, including school absence, were evident only for low subjects.

Clinical and biochemical findings before and after portacaval shunt in a girl with type Ib glycogen storage disease

A girl presented with an important growth retardation, hepatomegaly, fasting hypoglycemia, lactic acidosis, increased serum cholesterol, triglycerides and uric acid, and increased liver glycogen (7.5%). There was no rise in blood glucose after IV galactose or fructose, but glucagon gave a delayed response. Type Ib glycogen storage disease was suggested by the low normal activity of glucose-6-phosphatase (G-6-Pase) which reached 1.8 units/g (normal, 2 to 10 units/g) and the normal activity of other glycogenolytic enzymes, measured in homogenates prepared in H2O (mean +/- S.E. in control subjects: 59% +/- 7; in type Ia GSD: 92% +/- 3). The activity of G-6-Pase measured as described above increased to 3.8 units/g of liver 1 year after PCS and 7.85 units/g of liver after 3 years. At that time, a simultaneous assay of the enzyme in a fresh, previously not frozen liver biopsy, homogenized in 0.25 M sucrose, revealed only about 29% of the activity of the same sample prepared in H2O (mean +/- S.E. in three controls: 95.8% +/- 8.9.