Identification, assessment, and control of hazards in water supply: experiences from Water Safety Plan implementations in Germany.

According to the recommendations of the World Health Organization (WHO) for Water Safety Plans (WSP), a Technical Risk Management was developed, which considers standard demands in drinking water treatment in Germany. It was already implemented at several drinking water treatment plants of different size and treatment processes in Germany. Hazards affecting water quality, continuity, and the reliability of supply from catchment to treatment and distribution could be identified by a systematic approach, and suitable control measures were defined. Experiences are presented by detailed examples covering methods, practical consequences, and further outcomes. The method and the benefits for the water suppliers are discussed and an outlook on the future role of WSPs in German water supply is given.

Antibacterial and sebosuppressive efficacy of a combination of chloramphenicol and pale sulfonated shale oil. Multicentre, randomized, vehicle-controlled, double-blind study on 91 acne patients with acne papulopustulosa (Plewig and Kligman's grade II-III).

In a 3-armed, multicentre, randomized, double-blind, vehicle-controlled study involving 91 patients with acne papulopustulosa, Plewig's grade II-III, evidence could be provided of a significant reduction of the propionibacteria as well as a subosuppressive effect (squalene reduction) under a combination of 1% chloramphenicol (CAS 56-75-7) and 0.5% pale sulfonated shale oil versus the alcoholic vehicle (1-2 ml twice daily). Likewise, monotherapy with chloramphenicol resulted in a significant reduction in bacteria compared to the vehicle. The combination therapy was superior to the monotherapy with regard to the sebosuppressive effects. Based on a kinetics test carried out for a total of 2 h, a clinically relevant percutaneous absorption of chloramphenicol was ruled out. The chloramphenicol serum level was between < 5.0 microgram/l to 180 microgram/l (average 25 micogram/l). This is important because with systemic application (peroral, i.v.), the therapeutic chloramphenicol level is > 25 mg/l (25,000 microgram 1). None of the blood count and serum parameters were pathologically changed in a clinically relevant way before and after the therapy. An induction of resistance against chloramphenicol in the propionibacteria could be excluded. No adverse events and side effects occurred. The topical therapy of acne papulopustulosa with chloramphenicol as a monosubstance or in combination with pale sulfonated shale oil represents an effective and safe local antibiotic treatment possibility.

Characterization and sequence of the Escherichia coli panBCD gene cluster.

A 4589 bp DNA segment containing the Escherichia coli panBCD gene cluster was sequenced, and found to contain 6 complete open reading frames. panB, panC, and panD were identified by subcloning and insertional mutagenesis. The orientation of panD was also confirmed by orientation-specific expression of asparate-1-decarboxylase. panB and panC lie adjacent to one another, but are separated from panD by orf3, which is oriented in the opposite direction. Interruptions in the remaining open reading frames did not affect growth on glucose-minimal medium. No significant similarity to sequences in databases was found for orf1 and orf2. Orf3 contained extensive similarity to reading frames defined by E. coli yjiP, yjiQ, yhgA, and yafD. The function of these amino acid sequences is as yet undefined.

Personal and family stress in individuals with diabetes and vision loss.

The intrapersonal distress and the impact of diabetes and vision impairment on marital functioning were assessed. Significant degrees of intrapersonal distress were demonstrated by the Beck Depression Inventory, Rosenberg Self-Esteem Scale, and Rand Mental Health Index. Family functioning as assessed by the Family Assessment Device was significantly compromised. Vision impairment was a major stressor in the spousal relationship. Of 18 subjects who had been involved in a committed relationship at the onset of vision impairment, 9 had separated. Separation occurred at a mean of 1.6 years after the vision impairment. Totally blind individuals were at greater risk for separation than those who were legally, but not totally, blind. Psychological intervention was a limited benefit. Studies are necessary to identify the appropriate timing for further interventions.

Perceived parental characteristics of patients with obsessive compulsive disorder, depression, and panic disorder.

It has been hypothesized that parents of patients with obsessive compulsive disorder exhibit specific traits. 320 consecutive inpatient admissions who met criteria for OCD, depression, and panic disorder checked a list of adjectives to describe their parents. Patients with OCD were 1) less likely to perceive their mothers as disorganized than depressives, 2) more likely to perceive their mothers as overprotective than depressives and 3) less likely to perceive their fathers as demanding than patients with panic.

Sexual history and quality of current relationships in patients with obsessive compulsive disorder: a comparison with two other psychiatric samples.

It has been hypothesized that sexual conflict is a causal factor in the development of obsessive compulsive disorder. This study investigated the relationship between obsessive compulsive disorder and variables related to the individual's sexual history, present life, sexual satisfaction, and marital adjustment. Of inpatient admissions, 363 who met criteria for obsessive compulsive disorder, panic disorder, and depressive disorder completed a standard history questionnaire and the Marital Adjustment Test. Findings showed that obsessive compulsive individuals cannot be distinguished from either depressive or panic disordered groups by a particular sexual history. Future studies should use measures that do not rely on patient self-report.

Help-seeking patterns of community residents with depressive symptoms.

From a community sample, fifty-five individuals identified as having three or more symptoms of depression were asked if and where they had sought help and how they found or would find treatment. Only 20 subjects (33.9%) reported having sought professional help. No demographic differences were found between help-seekers and non-help-seekers. Eighty percent of the help-seekers had seen a mental health professional while 20% had seen a non-psychiatric physician. However, non-psychiatric physicians and friends or personal acquaintances were most frequently cited as the first point of contact for locating treatment. Results suggest that most individuals with a moderate number of depressive symptoms do not seek professional assistance but that, among those who do, a majority is eventually seen by a mental health professional. Virtually all utilize intermediaries other than mental health professionals, however, to locate assistance. The non-psychiatric physician plays a prominent role in locating help for depressed individuals, which suggests the need to educate physicians about appropriate treatment referral.

Characterization and sequence of Escherichia coli pabC, the gene encoding aminodeoxychorismate lyase, a pyridoxal phosphate-containing enzyme.

In Escherichia coli, p-aminobenzoate (PABA) is synthesized from chorismate and glutamine in two steps. Aminodeoxychorismate synthase components I and II, encoded by pabB and pabA, respectively, convert chorismate and glutamine to 4-amino-4-deoxychorismate (ADC) and glutamate, respectively. ADC lyase, encoded by pabC, converts ADC to PABA and pyruvate. We reported that pabC had been cloned and mapped to 25 min on the E. coli chromosome (J. M. Green and B. P. Nichols, J. Biol. Chem. 266:12971-12975, 1991). Here we report the nucleotide sequence of pabC, including a portion of a sequence of a downstream open reading frame that may be cotranscribed with pabC. A disruption of pabC was constructed and transferred to the chromosome, and the pabC mutant strain required PABA for growth. The deduced amino acid sequence of ADC lyase is similar to those of Bacillus subtilis PabC and a number of amino acid transaminases. Aminodeoxychorismate lyase purified from a strain harboring an overproducing plasmid was shown to contain pyridoxal phosphate as a cofactor. This finding explains the similarity to the transaminases, which also contain pyridoxal phosphate. Expression studies revealed the size of the pabC gene product to be approximately 30 kDa, in agreement with that predicted by the nucleotide sequence data and approximately half the native molecular mass, suggesting that the native enzyme is dimeric.

Evaluating Patients with Chronic Pain and their Families: How you can recognize maladaptive patterns.

Inclusion of family members in the assessment of patients with chronic pain can improve outcomes. Family functioning can be assessed in four basic areas: boundaries, power, communication, and intimacy. Early recognition of maladaptive patterns in the family allows the family physician to consider a variety of interventions ranging from educating the spouse to referring the family for therapy or multidisciplinary pain management.

The use of covert sensitization and social skills training in the treatment of an obscene telephone caller.

This case study examines the use of covert sensitization and social skills training to treat an obscene telephone caller on a behaviorally-oriented inpatient psychiatric unit. Rapid decreases in penile tumescence associated with obscene telephone calling were obtained after covert sensitization treatment and were maintained at one year follow-up. Social skills training led to a decrease in social anxiety and increase in social behavior. Results support the combined clinical effectiveness of covert sensitization and social skills training for the treatment of obscene telephone calling.

Reexamination of the relationship between birth order and obsessive-compulsive disorder.

In order to examine the hypothesis that being a firstborn or only child is specifically associated with obsessive-compulsive disorder, the birth order positions and sibship sizes of 62 patients with obsessive-compulsive disorder were compared with those of 60 agoraphobic and 92 depressed patients. No significant group differences were found for men, women, or both sexes combined. Results conflict with earlier findings which supported the hypothesized relationship between birth order status and development of obsessive-compulsive patterns in men. In addition to possible differences in methodology, discrepancies between the present findings and those of earlier studies may reflect a decline over the past 20 years in the percentage of male obsessive compulsives that were either firstborn or only children.

Teaching humanistic and psychosocial aspects of care: current practices and attitudes.

OBJECTIVE: To assess current practices and attitudes toward teaching humanistic and psychosocial aspects of care in internal medicine residency programs. DESIGN AND PARTICIPANTS: Survey questionnaires were sent to residency directors at all 434 internal medicine residency programs accredited in 1985-1986. Response rate for two mailings was 71%. MEASUREMENTS AND MAIN RESULTS: 78% OF RESIDENCY DIRECTORS and 70% of department chairpersons had high or moderately high levels of commitment to teaching humanistic/psychosocial aspects of care, but only 44% of responding programs offered mandatory training, and only 18% offered elective training in these areas. Obstacles to expanded teaching of the humanistic/psychosocial aspects rated high or moderately high by residency directors included insufficient curriculum time (51%), lack of trained faculty (44%), and pressures to reduce both training costs (40%) and patient-care costs (37%). CONCLUSIONS: Most of the training that does occur in the humanistic/psychosocial aspects of care probably happens informally via mentoring and role modeling. Appeals to expand teaching in these areas raise questions regarding what to include in medical training and the proper scope of internal medicine. Sustainable change will depend on the politics of resource distribution and the influence of general internal medicine and primary care on traditional training.

A qualitative review of psychosocial treatments for bulimia.

This review covers 32 individual and group therapy studies of the psychosocial treatment of bulimia published between 1976 and 1986. Using 14 criteria to assess the quality of experimental methodology, three studies were rated as high, 17 as medium, and 12 as low. Common methodological problems included the failure to use a control group or to specify the experience level of the therapist, overreliance on self-report outcome measures, and small sample sizes. Great variability was found among studies in inclusion criteria, treatment length, and length of follow-up. Thirty-eight percent of patients in group therapy and 41.5% of those in individual therapy were totally abstinent from bingeing and purging at follow-up. Although most studies used behavioral or cognitive-behavioral strategies, no modality of treatment has shown clear superiority. The results are discussed in terms of their implications for treatment, training, and future research.

A reconsideration of the Willoughby Personality Schedule with psychiatric inpatients.

Although the Willoughby Personality Schedule appears to be widely used to assess interpersonal anxiety, there are few studies of its clinical validity or psychometric properties. The purpose of this study was to investigate the factor analytic structure of the Willoughby Schedule in an inpatient psychiatric population. It also explored the relationship of the Willoughby Personality Schedule to the Beck Depression Inventory (BDI), the Gambrill-Richey Assertion Inventory and patient perception of treatment outcome. In contrast to three Willoughby Schedule factors previously reported in research with outpatients, six factors were found in this study. These were moderately correlated with scores on the BDI and the Assertion Inventory discomfort scale. Two Willoughby factors were related to the Assertion Inventory probability of assertive response scale and only one Willoughby factor was related to patient perception of treatment outcome. The overall results raise questions as to the usefulness of the Willoughby Schedule with inpatient populations.

Applying modern management principles to clinical administration of a behaviorally oriented inpatient unit.

Very few clinical administrators are trained managers, and the combined role of clinician-manager is laden with conflicting expectations. This paper describes the planning, inception, and administration of a new, behaviorally oriented inpatient psychiatric unit in a university medical center that was designed by the unit's clinical director and assistant clinical director. Contemporary management practices were adapted and applied to the development and administration of the unit. The unit's clear boundaries have allowed it to maintain its integrity within the hospital system, and its decentralized horizontal organizational structure has fostered a sense of ownership and responsibility on the part of staff at the operating level. A participative, personnel-oriented approach to unit operations has led to minimal staff turnover and high morale.

Status of behavioral medicine in American and Canadian medical training.

This article reports a survey of attitudes and current practices regarding behavioral medicine in American and Canadian medical school departments of psychiatry. Participants were eighty-two chairpersons of departments of psychiatry. Five major areas were addressed concerning the existence, location, and composition of behavioral medicine faculty and their contribution to training and research programs. Results indicate that behavioral medicine is represented in the majority of medical schools and teaching hospitals. Faculty tended to be located in psychiatry. A majority of the respondents did not think that behavioral medicine should be considered a separate clinical specialty area, but in actual practice behavioral medicine was distinct from consultation/liaison psychiatry as often as integrated with it. The analysis of subjects and methods taught in residency training programs suggested a meaningful trend in the data. The implications of these results for models underpinning traditional medical education and psychosomatic medicine are discussed.

Inpatient behavior therapy: the St. Louis University model.

Many of the problems that impede the practice of behavior therapy on traditional psychiatric and medical inpatient services can be avoided by a separate behaviorally-oriented inpatient unit, but few guidelines exist for establishing such a unit. The present paper describes the inpatient Behavioral Treatment Unit developed at St. Louis University Medical Center. Critical administrative and clinical features of the Unit are discussed, including the administrative philosophy which emphasizes unit autonomy and participative management, the central role of nursing staff, the importance of the clinical team system, the development of referral sources, admission procedures and criteria, and basic approaches to assessment and treatment.

Teaching Medical Students How to Talk with Patients about Cardiovascular Risk Factor Modification.

Although medical students are increasingly taught about the nature and importance of cardiovascular risk factors, they are less often taught how to talk about them with patients and how to encourage patients to modify certain behaviors (e.g., smoking), which are associated with high risk for cardiovascular disease. The authors describe a short educational module designed to help third year psychiatry clerks learn some practical, patient-oriented aspects of preventive cardiology. From a small group discussion that encourages active participation, students learn to assess and explore environmental factors, skill deficits, cognitive distortions and emotions that may prevent patients from changing high-risk behavior. Strategies for change are then suggested, discussed and assessed for effectiveness in sample situations. This type of module is readily adoptable into most medical school psychiatry curricula and, if widely used, could promote the necessary skills to effectively change high-risk behaviors and lead to a further reduction in cardiovascular disease.