Antibodies against SARS-CoV-2 after natural infection in healthcare workers and clinical characteristics as putative antibody production prediction.

Introduction: There is a need for detailed data on early antibody responses against SARS-CoV-2 as this may contribute to the prediction of the clinical course of COVID-19 and the optimization of convalescent plasma treatment. This study aims to gain insight into developing antibodies to SARS-CoV-2 in health care workers (HCWs) infected in the first wave of the SARS-CoV-2 pandemic in the Netherlands. Materials and methods: In this retrospective analysis, sera from PCR-confirmed COVID-19 positive HCWs are included at the time of the initial PCR (T = 0, n = 95) and at least 21 days after the initial serum (T ≥ 21, n = 133). This study assesses correlations between qualitative total Ig, IgM, IgA, IgG, and quantitative anti-S-RBD antibody responses and participant characteristics. Results: Higher Ct values were associated with higher antibody positivity rates for total Ig (OR 1.261 (95% CI 1.095-1.452)), IgM (OR 1.373 (95% CI 1.125-1.675)), and IgA (OR 1.222 (95% CI 1.013-1.475)). Gender was predictive of IgM and IgA antibody positivity rates at T = 0 (OR 0.018 (95% CI 0.001-0.268)) and (OR 0.070 (95% CI 0.008-0.646)). At T ≥ 21, a substantial proportion of HCWs developed IgM (103/133; 77.4%) and total Ig (128/133; 96.2%) antibodies. IgA and IgG seroconversions were observed in only 51.1% (67/131) and 55.7% (73/131) of HCWs. Anti-S-RBD responses were higher when the interval between onset of symptoms and sampling was longer. Conclusion: The findings of this study give insight into early antibody responses and may have implications for the selection of convalescent plasma donors and the further development of monoclonal antibody treatment.

How clinical teaching teams deal with educational change: 'we just do it'.

BACKGROUND: In postgraduate medical education, program directors are in the lead of educational change within clinical teaching teams. As change is part of a social process, it is important to not only focus on the program director but take their other team members into account. The purpose of this study is to provide an in-depth insight into how clinical teaching teams manage and organize curriculum change processes, and implement curriculum change in daily practice. METHODS: An explorative qualitative semi-structured interview study was conducted between October 2016 and March 2017. A total of six clinical teaching teams (n = 6) participated in this study, i.e. one program director, one clinical staff member, and one trainee from each clinical teaching team (n = 18). Data were analysed and structured by means of thematic analysis. RESULTS: The analysis yielded to five factors that positively impact change: shared commitment, reinvention, ownership, supportive structure and open culture. Factors that negatively impact change were: resistance, behaviour change, balance between different tasks, lack of involvement, lack of consensus, and unsafe culture and hierarchy. Overall, no clear change strategy could be recognized. CONCLUSIONS: Insight was gathered in factors facilitating and hindering the implementation of change. It seems particularly important for clinical teaching teams to be able to create a sense of ownership among all team members by making a proposed change valuable for their local context as well as to be capable of working together as a team. Cultural factors seem to be particularly relevant in a team's ability to accomplish this.

The veridicality of punitive childhood experiences reported by adolescents and young adults.

OBJECTIVE: The primary goal of the present research was to determine whether retrospective reports of childhood disciplinary experiences and perceptions of that discipline correspond to actual childhood events and whether the accuracy of that report was influenced by the affective state of the respondent. METHOD: Eighty-three adolescent and young adult males completed a retrospective measure of physical child maltreatment, Assessing Environments (AEIII), and the Brief Symptom Inventory (BSI). As children the participants had been observed naturalistically in their homes interacting with their parents an average of 10 years earlier. RESULTS: Analyses were consistent with the hypothesis that both current mood and actual observations of parent-child interactions during childhood predict self-reported recollections of childhood maltreatment by one's parents. Further the veridicality of such recollections appears to depend upon the objective specificity versus the perceptive nature of the questions used to elicit the recollections. CONCLUSIONS: The findings suggest that assessment instruments suitable for obtaining information regarding earlier childhood victimization must utilize behaviorally specific items. Thus, items that are either global or intimate a normative comparison should be avoided.

Computed tomography of the lacrimal drainage system: retrospective study of 107 cases of dacryostenosis.

PURPOSE: To evaluate the role of computed tomography in patients with dacryostenosis. METHODS: One hundred seven cases of dacryostenosis (94 patients) were assessed by thorough clinical and lacrimal history and examination, and lacrimal region computerized tomography (CT). The lacrimal drainage system examination included the state and position of the puncta; Jones testing; lacrimal syringing; and, in the latter half of the study, telescopic nasal endoscopy. The patients were drawn from the hospital outpatients and private office of the operating lacrimal surgeon in this series (I.C.F.). Of the 107 cases, 79 either underwent dacryocystorhinostomy surgery or had this planned. RESULTS: In 14 of the 107 cases (12 patients), preoperative CT led to an alteration of patient management, usually referral to an otolaryngologist for further evaluation or treatment. In addition to the detection of two tumors extrinsic to the sac, conditions such as ethmoiditis, lacrimal sac mucoceles, soft tissue opacity in the nasolacrimal duct, gross nasal polyposis, fungal sinusitis, and a dacryolith were observed by CT. CONCLUSION: Similar to the role of functional endoscopic sinus surgery in otolaryngology, CT imaging will become increasingly important in the assessment of many patients with symptoms of lacrimal drainage obstruction.

Functional bowel disorders. A multicenter comparison of health status and development of illness severity index.

In a multicenter study of patients with painful functional bowel disorders (FBD), we compared the demographic, health status, and diagnostic features of patients with FBD and developed a functional bowel disorder severity index (FBDSI) for research and clinical care. Two hundred seventy patients with FBD in the United States, England, and Canada were surveyed on symptoms and health status, and their physicians made a diagnosis and rated illness severity as mild, moderate, or severe. Comparisons of 22 demographic and clinical variables were made by study site in addition to physicians' severity ratings. To develop the FBDSI, multiple regression analysis used the demographic and clinical variables to predict the physician's rating of severity. We found that most health status measures of patients with FBD across study sites are comparable and the derived and validated FBDSI scoring system uses three easy to obtain variables: FBDSI = [current pain by visual analog scale (0-100)] + [diagnosis of chronic functional abdominal pain (0 if absent and 106 if present)] + [number of physicians visits over previous six months x 11]. The FBDSI can be used to select patients for research protocols and/or follow their clinical outcome or response to treatments over time.

Some problems and solutions in the study of change: significant patterns in client resistance.

Latent growth curve methodology was applied to the study of patterns of change in client resistance during parent training therapy. The clinical sample consisted of 68 mothers of children, 52 boys and 16 girls, ages 5 through 12 years, with confirmed conduct problems. Simple linear and linear spline growth models were fit to the three repeated observational measures of maternal resistance during therapy and found inadequate. Instead, a quadratic growth model was used. Pretherapy maternal characteristics of inept discipline and antisocial behavior predicted chronically high levels of resistance. Maternal depressed mood predicted less negative quadratic curvature. No significant predictors of overall change in resistance were detected. Lack of negative curvature of the resistance growth curves predicted child court offenses during a 2-year posttermination follow-up. Results are discussed with reference to the struggle-and-working-through hypothesis of client resistance.

Parent and teacher ratings in the assessment and prediction of antisocial and delinquent behaviors.

Subjects consisted of a sample of two cohorts of approximately 100 boys each whose behaviors were rated by their parents and teachers. Criterion variables included antisocial behavior, based on parent, child, teacher, and interviewer reports, and delinquency, based on parent and child reports in addition to cumulative arrest data taken from juvenile court records. The data suggest that mothers are focused on the daily, irritating behaviors of their sons. Teachers, on the other hand, appear to focus on a relatively small number of items (e.g., child physically attacks others, associates with deviant peers), and thereby provide ratings that are better predictors of delinquency and arrest. When the mothers' ratings were constrained to include only items that were salient for teachers, their predictive validity coefficients approached the magnitude of the teacher coefficients.

A comparative evaluation of parent-training interventions for families of chronic delinquents.

Fifty-five families of chronically offending delinquents were randomly assigned to parent-training treatment or to service traditionally provided by the juvenile court and community. The families in the parent-training group received an average of 44.8 hours of professional contact (23.3 hours of which were phone contacts), and each control group family received treatment estimated at more than 50 hours on the average. Comparisons of police contact data at baseline and subsequent years for the two groups showed that subjects in both groups demonstrated reduced rates of offending during the followup years. The finding most relevant was significant treatment-by-time effect for offense rates, with most of this effect accounted for by a greater reduction in serious crimes for the experimental group during the treatment year, and a similar reduction of the community control group occurring in the first of three followup years. These early decrements in offense rates persisted during followup for both groups. Throughout the study, boys in the experimental group spent significantly less time in institutional settings than did boys in the control group. Parent training had a significant impact, but the reduction in offending was produced at very high emotional cost to staff. Although it is clear that this population requires substantial treatment resources, this study underscores the need for more work on prevention.

The spectrum and natural history of common bile duct stenosis in chronic alcohol-induced pancreatitis.

Sixty patients with chronic alcohol-induced pancreatitis with endoscopic retrograde cholangiopancreatography evidence of common bile duct stenosis were studied to determine the clinical spectrum and natural history of this complication, as well as the indications for biliary bypass. In 17% of patients, common bile duct stenosis (CBDS) was an incidental finding at ERCP, while in the remaining cases pain and jaundice were the predominant symptoms in 35% and 48%, respectively. Biliary drainage was performed in 38% of patients for persistent or recurrent jaundice, cholangitis, and while undergoing pancreatic duct or cyst drainage procedures for pain. The benign nature of CBDS in chronic alcohol-induced pancreatitis (CAIP) in patients without persistent jaundice is emphasized. In particular, no histologically proved cases of secondary biliary cirrhosis were noted. The majority of patients with CBDS due to CAIP may be safely managed without biliary bypass but require close follow-up.

Delinquency prevention through training parents in family management.

Nearly two decades of clinical research at the Oregon Social Learning Center (OSLC) have helped to shape a theory of antisocial behavior in boys. Models depicting the theory are presented and discussed. In addition, family management variables such as "discipline," "monitoring," "positive parenting," and "problem solving" are described as used in clinical applications. Total aversive behavior (TAB), based on home observations, and parent daily report (PDR), based on telephone interviews, are examined as outcome indicators for a variety of studies investigating the efficacy of the OSLC social interactional therapy. Several recent reports of treatment for adjudicated adolescents and their families are included; law violations are the dependent measures in those studies. Examples of the interface between clinical work and theory at OSLC are presented. Questions of generalization of the clinical methodology to large urban populations, and access to parents who most need to learn the parenting techniques are noted.

Comparison of pirenzepine with cimetidine in duodenal ulcer disease. A short-term and maintenance study.

Sixty-seven patients with endoscopically proven duodenal ulceration were entered into a double-blind study and randomized to treatment with pirenzepine (PZ) (Gastrozepin; Boehringer Ingelheim) 50 mg twice daily or cimetidine (CM) (Tagamet; Smith Kline & French Laboratories) 400 mg twice daily, given 30 minutes before breakfast and supper. Patients underwent endoscopic examination before entry, at 4 weeks, and at 8 weeks if unhealed at 4 weeks. Once healing was achieved, 43 patients were entered into a single-blind maintenance study with either PZ 50 mg at night or CM 400 mg at night according to their original randomization. CM had a slight, but not significant, advantage over PZ after 4 weeks, but the 8-week data showed identical healing rates. The relapse rate appeared to be higher in the PZ-treated group, but this difference was also not significant. It is suggested that the evening dose of PZ be amended to 50 or perhaps 100 mg before bed in the short-term treatment of duodenal ulcer, and that a dose of 100 mg at night be considered for maintenance therapy in certain high-risk populations.

Peptic ulcer. A follow-up study.

One hundred and ten patients who had been entered into an ulcer healing study 2 to 4 years previously were recalled during an 8-week period for clinical assessment and endoscopy. Fifty-five gastric ulcer patients were followed-up after an average period of 21.2 months. Nine of these had undergone gastric surgery; of the remaining 46 patients, recurrent ulceration was found in 16 (35%). Fifty-five patients with duodenal ulcer disease were also followed-up after an average of 35.6 months. Five of these patients had undergone surgery and of the remaining 50, 25 (50%) had a recurrent duodenal ulcer. About one-third of both gastric and duodenal ulcer recurrences were asymptomatic. Smoking had no effect on recurrence rates.

Effect of mepyramine on the untoward side-effects of impromidine.

The value of impromidine, a potent histamine H2-receptor agonist, as an effective acid-secretory stimulant is limited by its tendency to cause cardiovascular side-effects. The possibility that the latter may be mediated not only by H2-receptors in the heart and peripheral blood vessels but also by overflow stimulation of H1-receptors was investigated in a double-blind study using impromidine with or without the H1-antagonist, mepyramine maleate. There was no significant difference between the two groups, suggesting that the side-effects are mediated by H2-receptors in the cardiovascular system alone.

6-Mercaptopurine-related pancreatitis in 2 patients with inflammatory bowel disease.

Two patients with inflammatory bowel disease who developed acute pancreatitis within 21 days of commencing treatment with 6-mercaptopurine are presented. Both were inadvertently reexposed to the drug and developed recurrent pancreatitis within 3 hr of a single dose.

Subacute cor pulmonale in hypersensitivity pneumonitis. A case report.

A 37-year-old non-smoking woman exposed to avian antigens developed progressive respiratory symptoms over several months, culminating in cor pulmonale. Transient nodular shadowing was noted on the chest radiograph, and pulmonary function tests showed a predominantly obstructive pattern. Elimination of antigenic exposure and treatment with diuretics and subsequently corticosteroids resulted in marked but incomplete improvement.

Depression, physical health and somatic complaints in the elderly: a study of the Zung Self-Rating Depression Scale.

The relationships between depression, measured by the Zung Self-Rating Depression Scale (SDS), somatic symptoms based on self-reports, and health based on medical evaluations, were investigated in 60 depressed older persons (median age 64.5 years) in relatively good physical health. No relationship was found between health ratings and depression scores, but a significant association emerged between a Somatic Symptom subscale, specifically the single item of fatiguability, physicians' ratings of health, and depression scores. Results of factor analyses of the Zung Self-Rating Depression Scale were similar to those reported in previous studies and indicated a factor structure apparently based on the positioning of the positively and negatively worded items. It is suggested, therefore, that further investigations be carried out to evaluate the possible response bias on this scale.

Health in old age: how do physicians' ratings and self-ratings compare?

The present study was designed to provide information on the relationship between self-reports of health and physicians' ratings in an aged sample, and to determine how both of these measures of health relate to longevity. Subjects were 69 survivors (median age = 84.25 years) of a sample of aged twins who had been followed longitudinally since 1947 to 1949. Self-reports of health were found to be significantly correlated with ratings assigned by a physician on the basis of medical records. Both types of measures were predictive of differences in survival time among the younger subjects in the sample, but neither was significantly related to longevity for older subjects. The results suggest that self-reports could provide a valid, cost-effective means of health assessment in studies in which other forms of health information are lacking.