Update of the S2k guideline on the management of IgE-mediated food allergies

Not available.

Binary pseudo-random patterned structures for modulation transfer function calibration and resolution characterization of a full-field transmission soft x-ray microscope

We present a modulation transfer function (MTF) calibration method based on binary pseudo-random (BPR) one-dimensional sequences and two-dimensional arrays as an effective method for spectral characterization in the spatial frequency domain of a broad variety of metrology instrumentation, including interferometric microscopes, scatterometers, phase shifting Fizeau interferometers, scanning and transmission electron microscopes, and at this time, x-ray microscopes. The inherent power spectral density of BPR gratings and arrays, which has a deterministic white-noise-like character, allows a direct determination of the MTF with a uniform sensitivity over the entire spatial frequency range and field of view of an instrument. We demonstrate the MTF calibration and resolution characterization over the full field of a transmission soft x-ray microscope using a BPR multilayer (ML) test sample with 2.8 nm fundamental layer thickness. We show that beyond providing a direct measurement of the microscope's MTF, tests with the BPRML sample can be used to fine tune the instrument's focal distance. Our results confirm the universality of the method that makes it applicable to a large variety of metrology instrumentation with spatial wavelength bandwidths from a few nanometers to hundreds of millimeters.

Open scapulothoracic dissociation

Scapulothoracic dissociation refers to the traumatic separation of the shoulder from the chest wall. This most commonly occurs as a closed injury. We present a case of open scapulothoracic dissociation and emphasize clinical features unique to this injury. In both closed and open scapulothoracic dissociation, the force necessary to shear the scapula from its thoracic attachments results in vascular disruption and neurologic injury to the upper extremity. As a consequence, patients have a pulseless, flail upper extremity with a significant chest wall hematoma (closed) or active bleeding (open). The first priority is to resuscitate and address life-threatening injuries. If the patient has active bleeding, immediate vascular control to prevent exsanguination is essential. Patients with ischemia and an incomplete injury or unreliable neurologic examination need revascularization. Outcome is based on the extent of brachial plexus or cervical nerve root avulsion. Patients with loss of neurologic function ultimately benefit from amputation at the appropriate level.

Combined blunt thoracic aortic and abdominal trauma: diagnostic and treatment priorities

Combined blunt trauma to the thoracic aorta and abdomen challenges the surgeon from a diagnostic and therapeutic standpoint. Appropriately prioritizing diagnostic workup and treatment is critical to assuring patient survival. A management approach that considers the patient's injuries and clinical condition as well as the availability of aortography and cardiac surgery are essential. Patients with blunt aortic injury who are hemodynamically unstable with signs of intra-abdominal injury should have immediate abdominal exploration. Further assessment of the aortic injury and surgical repair can be delayed until after the critical intra-abdominal bleeding has been addressed. The stable patient who has both blunt abdominal trauma and blunt thoracic aortic injury but has no signs of ongoing abdominal hemorrhage should initially have arch aortography. Additional abdominal diagnostic studies may be done but should not delay indicated surgical repair of the aortic injury.

The association of medical comorbidity in schizophrenia with poor physical and mental health

This study determined the prevalence of medical comorbidities in a cohort of persons receiving treatment for schizophrenia and the association of medical comorbidity with physical and mental health status. A total of 719 persons with schizophrenia sampled from a variety of community and treatment settings as part of the schizophrenia Patient Outcomes Research Team (PORT) participated in a survey interview. Multiple regression analyses were used to assess sociodemographic factors associated with the number of current medical comorbidities and the association of medical comorbidity count with patient ratings of physical health, mental health, symptoms, and quality of life. The majority of patients reported at least one medical problem. Problems with eyesight, teeth, and high blood pressure were most common. A greater number of current medical problems independently contributed to worse perceived physical health status, more severe psychosis and depression, and greater likelihood of a history of a suicide attempt. This study underscores the need to attend to somatic health care for persons with schizophrenia as well as the linkage of physical and mental health status.

Perceptuomotor function of homeless males in alcohol rehabilitation

In a sample of 76 alcohol rehabilitation program (ARP) residents, homeless men demonstrated significantly poorer perceptuomotor function than nonhomeless men. This difference persisted despite similarities in several factors associated with neurobehavioral test scores including demographic characteristics; frequency, quantity, and duration of alcohol and other substance use; psychosocial factors, including motivation and social support; health, including history of head trauma; and neurotoxic occupational exposure.

The epidemiology of alcohol, drug, and mental disorders among homeless persons

This article describes recent research on the prevalence of alcohol, drug, and mental (ADM) disorders and the characteristics of homeless substance abusers and persons with mental illness. Methodological problems in homelessness research are reviewed, particularly in relation to definitions of homelessness and sampling- and case-ascertainment methods. Prevalence rates of ADM disorders are much higher in homeless groups than in the general population. As is true of homeless people in general, homeless substance abusers and mentally ill persons are characterized by extreme poverty; underutilization of public entitlements; isolation from family, friends, and other support networks; frequent contact with correctional agencies; and poor general health. Knowledge of these disadvantages should be used to advocate for better services to prevent homelessness and support homeless people.

The epidemiology of alcohol, drug, and mental disorders among homeless persons

This article describes recent research on the prevalence of alcohol, drug, and mental (ADM) disorders and the characteristics of homeless substance abusers and persons with mental illness. Methodological problems in homelessness research are reviewed, particularly in relation to definitions of homelessness and sampling- and case-ascertainment methods. Prevalence rates of ADM disorders are much higher in homeless groups than in the general population. As is true of homeless people in general, homeless substance abusers and mentally ill persons are characterized by extreme poverty; underutilization of public entitlements; isolation from family, friends, and other support networks; frequent contact with correctional agencies; and poor general health. Knowledge of these disadvantages should be used to advocate for better services to prevent homelessness and support homeless people.

[Schönlein-Henoch purpura. A clinical study of 119 patients with special reference to unusual complications]

119 patients with Schönlein-Henoch purpura from 1 to 17 years were investigated. All patients had a rash, 76% joint affections, 76% gastrointestinal symptoms, 54% renal involvement, 17% of the boys orchitis, 2% intramuscular bleeding and 2% coagulation disorder. 1 boy showed perforation of the nasal septum, to our knowledge not described in Schönlein-Henoch purpura up to now. The mean age was 6.4 years. The seasonal peak was in October, 63% of our patients had a preceding infection, mostly of the upper respiratory tract, pointing to various infectious agents as a trigger of this disease. Patients with abdominal pain had a 4-fold, patients with bloody stools a 7.5-fold increased risk of renal involvement. 13/38 Patients had a serum albumin level below 3.5 g/dl that may have been caused either by renal or gastrointestinal losses.

[Recurrent acidosis with hypoglycemia in an infant: fructose-1,6-diphosphatase deficiency]

A seven months old infant presented with recurrent episodes of acidosis and hypoglycemia triggered by fasting and febrile infections. The diagnosis of fructose-1,6-diphosphatase deficiency was made by demonstrating the enzyme deficiency in a liver biopsy specimen. Fructose-1,6-diphosphatase is a key enzyme of gluconeogenesis. Fructose-1,6-diphosphatase deficiency results in hypoglycemia and lactic acidosis during episodes of fasting. Diagnosis is made preferably by liver biopsy. Treatment includes elimination of fructose and sucrose from the diet and avoidance of fasting. Acute attacks are treated by intravenous infusion of glucose and bicarbonate if necessary.

Health and mental health problems of homeless men and women in Baltimore

A study of homeless people in Baltimore, Md, focused on their health and other characteristics, with special emphasis on their needs for services. In the first stage, 298 men and 230 women were randomly selected from the missions, shelters, and jail in Baltimore to respond to a baseline interview that provided extensive sociodemographic and health-related data. In the second stage, a subsample of 203 subjects was randomly selected from the baseline survey respondents to have systematic psychiatric and physical examinations. Data are presented from both stages. Data from the first stage demonstrate, among other things, the high levels of disaffiliation of this population and their heavy involvement in substance abuse. Data from the clinical examinations demonstrate the high prevalence of mental illnesses and other psychiatric disorders and of a wide range of physical disorders and confirm the high prevalence of alcohol abuse disorders. The high rates of comorbidity of these conditions is demonstrated and data are provided on the subjects' needs for mental health and substance abuse services.

AML associated with previous cytotoxic therapy, MDS or myeloproliferative disorders: results from the MRC's 9th AML trial

The outcome of treatment with standard first line therapy of 66 patients with acute myeloid leukaemia (AML) secondary to preceding chemotherapy (Group 1), a myelodysplastic state (Group 2) or a myeloproliferative disorder (Group 3) was analysed in relation to the preceding disorder, the cytogenetic pattern where available, and the cytology and cytochemistry of blood and bone marrow. The complete remission (CR) rate for the secondary AMLs was 36% (24/66), with 24% (16/66) dying in the induction period and 39% (26/66) having resistant disease. The CR rate was 25% (5/20) for Group 1, 42% (15/36) for Group 2, and 40% (4/10) for Group 3. Even after allowance for the generally older age of the secondary AML patients, they still had a significantly poorer CR rate than the de novo AMLs (P = 0.0004). The lower CR rate was chiefly due to resistant disease. Despite this, overall survival was not significantly worse for the secondary AML patients (P = 0.15). For the 36% that achieved remission, remission duration appeared similar to that of de novo cases. Of 62 cases with adequate cytology, 38 (61%) had evidence of erythroid and/or megakaryocytic dysplasia with a CR rate of 32% (12/38). The CR rate of these multineage leukaemias was not significantly different from that of the 24 (39%) who showed granulocyte/monocyte precursor involvement only, 42% (10) of whom achieved CR. The presence of features of differentiation within blast cells such as Auer rods or sudanophilia (greater than 50% positive blasts) was associated with a higher remission rate 47% (18/38) than that of poorly differentiated cases 17% (3/18) (P = 0.04) and thus appeared to be a more important determinant of CR achievement than was lineage involvement. Cases with a normal karyotype had a 33% (7/21) CR rate, while those with chromosomal abnormalities had a 37% (9/24) CR rate. Only 12 of the 45 cases with adequate cytogenetic analysis showed deletions or monosomies involving chromosomes 5 or 7, and seven of these were in Group 1.

Criminal activity among the homeless: a study of arrests in Baltimore

To illuminate the role of criminal activity among the homeless, particularly the homeless mentally ill, the author compared 634 arrests of homeless persons with 50,524 arrests in the general population that were made in Baltimore in 1983. Significant differences were found in the demographic characteristics of the two groups of arrested persons and in the types of offenses prompting the arrests. Among the homeless, those arrested were more likely to be male, white, and over age 45 and to have committed trivial, victimless crimes. Evidence suggests that ostensibly serious offenses such as assault, larceny, and burglary charged to homeless persons tended to involve petty thievery, entry into vacant buildings, and other acts aimed at maintaining subsistence in the absence of housing.

Medical care of chronic psychiatric outpatients

Chronic psychiatric patients often fail to receive adequate general medical care. In a study of 42 outpatients in a psychosocial rehabilitation program, 93 percent were found to have at least one problem warranting assessment, treatment, or follow-up. Minor gynecologic disease was the most common problem among women and gross dental disease among men. Only 11 percent of the men's and 26 percent of the women's problems were receiving appropriate care. Seventy-seven percent of the previously unrecognized problems were found just by routine physical examination and hematocrit determination. Medical care for chronic psychiatric patients would improve if psychiatric clinics provided simple medical screening and if therapists were aware of their patients' general health needs.

Mental health and social characteristics of the homeless: a survey of mission users

Selected mental health and social characteristics of 51 homeless persons drawn as a probability sample from missions are compared to those of 1,338 men aged 18-64 years living in households from the NIMH Epidemiologic Catchment Area survey conducted in Eastern Baltimore. Differences between the two groups were small with respect to age, race, education, and military service but the differences in mental health status, utilization patterns, and social dysfunction were large. About one-third of the homeless scored high on the General Health Questionnaire which measures distress. A similar proportion had a current psychiatric disorder as ascertained by the Diagnostic Interview Schedule (DIS), with the homeless exhibiting higher prevalence rates in every DIS/DSM III diagnostic category compared to domiciled men. Homeless persons reported higher rates of hospitalization than household men for both mental (33 per cent vs 5 per cent) and physical (20 per cent vs 10 per cent) problems but a lower proportion received ambulatory care (41 per cent vs 50 per cent). Social dysfunction among the homeless was indicated by fewer social contacts and higher rates of arrests as adults than domiciled men (58 per cent vs 24 per cent), including multiple arrests (38 per cent vs 9 per cent) and felony convictions (16 per cent vs 5 per cent). Implications of these findings are discussed in terms of research and health policy.

Utilization of child health clinics following introduction of a copayment

The effect of introduction of a copayment on utilization of well child services was investigated in St. Mary's County, Maryland between 1975 and 1979. Utilization declined between the pre-copayment and post-copayment periods for White and non-White infants under six months of age. The deterrent impact of the copayment suggested by the results may be related to crossover to private care but may also represent a drop in use of preventive services.

Epidemiologic observations on the relationship between calcium intake and eclampsia

In Guatemala, the obstetric population has a very low incidence of eclampsia despite the presence of factors that would be expected to favor appearance of the disease. In this study, the eclampsia incidence and calcium intake for three countries, Guatemala (low eclampsia incidence, high calcium intake); Cali, Colombia (high eclampsia incidence, low calcium intake); and the USA (low eclampsia incidence, high calcium intake) have been compared. Crude rates for eclampsia incidence were adjusted to control the effects of well-documented predisposing factors: age, parity, and prenatal care. Results of the study support an association between calcium intake and development of eclampsia.