Paramedics' Perceptions of Their Role in End of Life Care.

Aims Critical decisions made in the field by paramedics influence where patients die if their end of life (EOL) wishes are upheld and how appropriately health-care resources are used. The aim was to gauge perceptions as to the current and future role of paramedics in EOL care. Methods A qualitative approach collated data from two focus group interviews (group 1 n=7, group 2 n=8). Focus groups were audio recorded, transcribed, and analysed using Attride-Stirling's framework for thematic network analysis. Results The global theme 'Paramedics' Perceptions of Their Role in End of Life Care' emerged from five organising themes: 1. education and training; 2. current clinical practice guidelines; 3. communication; 4. environment and 5. staff support. Poor communication between those involved in patient care, lack of support from current clinical practice guidelines, limited training in managing EOL scenarios and inadequate staff supports were highlighted by participants. The clinical environment also effected how challenging practitioners found the call. Conclusion The pathway to improving EOL care must include an emphasis on improvements in practitioner education and training, enhanced communication between all those involved in a patient's care and offering non didactic practice guidelines that are practitioner driven and patient-focused. It must also include increased psychological supports for paramedics dealing with EOL patients.

The association of clinical and structural knee osteoarthritis with physical activity in the middle-aged population: the NEO study.

OBJECTIVE: To investigate if knee osteoarthritis (OA) is associated with lower physical activity in the general middle-aged Dutch population, and if physical activity is associated with patient-reported outcomes in knee OA. DESIGN: Clinical knee OA was defined in the Netherlands Epidemiology of Obesity population using the ACR criteria, and structural knee OA on MRI. We assessed knee pain and function with the Knee Injury and Osteoarthritis Score (KOOS), health-related quality of life (HRQoL) with the Short Form-36, and physical activity (in Metabolic Equivalent of Task (MET) hours) with the Short Questionnaire to Assess Health-enhancing physical activity. We analysed the associations of knee OA with physical activity, and of physical activity with knee pain, function, and HRQoL in knee OA with linear regression adjusted for potential confounders. RESULTS: Clinical knee OA was present in 14% of 6,212 participants, (mean age 56 years, mean BMI 27 kg/m2, 55% women, 24% having any comorbidity) and structural knee OA in 12%. Clinical knee OA was associated with 9.60 (95% CI 3.70; 15.50) MET hours per week more physical activity, vs no clinical knee OA. Structural knee OA was associated with 3.97 (-7.82; 15.76) MET hours per week more physical activity, vs no structural knee OA. In clinical knee OA, physical activity was not associated with knee pain, function or HRQoL. CONCLUSIONS: Knee OA was not associated with lower physical activity, and in knee OA physical activity was not associated with patient-reported outcomes. Future research should indicate the optimal treatment advice regarding physical activity for individual knee OA patients.

[Differences in non-native resident psychiatrists and native residents psychiatrists in completion of the psychiatry residency training programmes]. / Verschil in uitval tussen allochtone en autochtone artsen in opleiding tot psychiater; enquête onder opleiders.

BACKGROUND: A relatively small number of psychiatrists in the Netherlands have a non-Dutch origin. We suspect that resident psychiatrists who do not have Dutch as their first language are less likely than native Dutch speakers to complete the psychiatry residency training programmes.
AIM: To find out how often and for what reasons resident psychiatrists do not complete the psychiatry residency training programmes.
METHOD: All course coordinators in the Netherlands were asked to participate in a survey to provide information about the residents who had started but had abandoned the psychiatry residency training programmes between the years 2008 and 2015. They were also asked about factors that had influenced residents to abandon the course.
RESULTS: We were able to obtain data on 37% of the trainees. The data revealed that the number of non-native resident psychiatrists who failed to complete the training course was almost four times higher than the number of native trainee psychiatrists who dropped out before the end of the course. According to the coordinators, possible reasons for this discrepancy are lack of proficiency in Dutch, communication problems and cultural differences.
CONCLUSION: The results of our survey could possibly be used to adjust the training programmes.

A systematic review of the psychological impact of false-positive colorectal cancer screening: What is the role of the general practitioner?

Screening for colorectal cancer (CRC) has both advantages (e.g. reduction in morbidity and mortality) and disadvantages (e.g. false positives and distress). A systematic review was therefore performed to improve our understanding of how false-positive CRC screening results affect patients psychologically (and to make recommendations for primary care). The PubMed, Embase, PsychINFO, CINAHL and Cochrane databases were searched in October 2014 and supplemented in December 2016 to identify studies on the psychological impact of false-positive CRC screening. Original studies were eligible when they assessed psychological impact in a screening setting, provided they also included false-positive CRC screening results. Two authors independently assessed 2,367 available manuscripts and included seven. Heterogeneity in their outcome measures meant that data could not be pooled. Two studies showed that a false-positive CRC screening result caused some moderate psychological distress shortly before and after colonoscopy. The remaining five studies illustrated that the psychological distress of patients with true-positive and false-positive CRC screening results was comparable. We conclude that a false-positive CRC screening result may cause some moderate psychological distress, especially just before or after colonoscopy. We recommend that general practitioners mention this when discussing CRC screening with patients and monitor those with a false-positive outcome for psychological distress.

No difference in health-related quality of life, after a food challenge with cashew nut in children participating in a clinical trial.

BACKGROUND: Previous studies showed that health-related quality of life (HRQL) significantly improved after the food challenge, with greater improvements in HRQL after a negative outcome than after a positive outcome. It is currently unknown whether this also occurs in patients undergoing DBPCFCs with cashew nut in the context of a clinical trial. METHODS: Quality of life was studied in children enrolled in a cashew nut study using Food Allergy Quality of Life Questionnaires (FAQLQs). Children, teenagers and parents of the children completed the questionnaires before the challenge test and 6 months after the DBPCFC with cashew nut. The difference in the change in HRQL between the children with a positive and negative DBPCFC outcome was studied by Mann-Whitney U-test. RESULTS: In total, 112 children (67 boys, median age of 9 years) were included. The children, teenagers and parents of the children completed 143 sets of questionnaires in total. There were no significant differences in baseline total and domain scores compared to the follow-up scores in the FAQLQ-CF, FAQLQ-TF and FAQLQ-PF. In children, the delta FAIM score in the negative DBPCFC tested group was significantly better than the delta FAIM score in the positive challenged group (p = 0.026). There were no significant differences in the changes in the scores of the FAQLQ-CF and FAQLQ-PF in the children with a positive challenge outcome, compared to the children with a negative challenge result. However, there was a significant difference in the change in score between the latter groups in the domain 'accidental exposure' of the FAQLQ-TF (p = 0.049). CONCLUSION: This study showed no difference in the change in HRQL scores after a DBPCFC with cashew nut in children participating in a clinical trial. The utility of HRQL as an outcome for clinical trials in food allergy may be limited if participant baseline HRQL is relatively unimpaired.

The compliance and burden of treatment with the epinephrine auto-injector in food-allergic adolescents.

BACKGROUND: Food-allergic patients at high risk of potential fatal anaphylaxis should carry an epinephrine auto-injector (EAI) at all times. This treatment may be perceived as burdensome and this may affect compliance and health-related quality of life (HRQL). The aims of the study were (1) to determine the burden of treatment (BoT) of an EAI, (2) to examine the relationship between this burden and compliance, and (3) to analyze which factors contribute to the BoT of the EAI as perceived by food-allergic adolescents and their parents. METHODS: Dutch food-allergic adolescents prescribed an EAI, and their parents completed a questionnaire package (n = 55). Relationships between BoT and HRQL, illness severity and perception, and anxiety measures were investigated. RESULTS: Food-allergic adolescents and their parents were (extremely) positive about the EAI (54.5%; 72.7%, respectively) (=low BoT). The BoT measure showed a significantly greater burden in food-allergic adolescents prescribed an EAI who reported not carrying the EAI at all times than adolescents who reported they did. The BoT scores of both adolescents and their parents were not associated with HRQL, illness severity and perception, or trait anxiety. CONCLUSIONS: The majority of food-allergic adolescents and their parents were positive about the EAI (=low BoT). However, the BoT was significantly associated with self-reported compliance with carrying the EAI. The BoT was higher in food-allergic adolescents prescribed an EAI who reported not carrying the EAI at all times. The BoT measure seems to be a useful tool to study compliance with carrying an EAI. The BoT of an EAI is not associated with HRQL. The BoT measures a distinct concept related to compliance behavior.

Odd and even Kondo effects from emergent localization in quantum point contacts.

A quantum point contact (QPC) is a basic nanometre-scale electronic device: a short and narrow transport channel between two electron reservoirs. In clean channels, electron transport is ballistic and the conductance is then quantized as a function of channel width with plateaux at integer multiples of 2e(2)/h (where e is the electron charge and h is Planck's constant). This can be understood in a picture where the electron states are propagating waves, without the need to account for electron-electron interactions. Quantized conductance could thus be the signature of ultimate control over nanoscale electron transport. However, even studies with the cleanest QPCs generically show significant anomalies in the quantized conductance traces, and there is consensus that these result from electron many-body effects. Despite extensive experimental and theoretical studies, understanding these anomalies is an open problem. Here we report that the many-body effects have their origin in one or more spontaneously localized states that emerge from Friedel oscillations in the electron charge density within the QPC channel. These localized states will have electron spins associated with them, and the Kondo effect--related to electron transport through such localized electron spins--contributes to the formation of the many-body state. We present evidence for such localization, with Kondo effects of odd or even character, directly reflecting the parity of the number of localized states; the evidence is obtained from experiments with length-tunable QPCs that show a periodic modulation of the many-body properties with Kondo signatures that alternate between odd and even Kondo effects. Our results are of importance for assessing the role of QPCs in more complex hybrid devices and for proposals for spintronic and quantum information applications. In addition, our results show that tunable QPCs offer a versatile platform for investigating many-body effects in nanoscale systems, with the ability to probe such physics at the level of a single site.

Helicopter winchmens' experiences with pain management in challenging environments.

We conducted a survey of Irish Coast Guard Search and Rescue Helicopter winchmen to establish if their pain management scope of practice was adequate for their working environment. We surveyed 17 SAR personnel. 88% of winchmen have experienced scenarios where they were unable to reduce pain scores below 6/10. In seeking solutions within current Irish Prehospital Clinical Practice Guidelines, repeated descriptions of operations in extreme weather and sea conditions were given which were entirely incompatible with the dexterity required to break a glass ampoule and draw up solution, let alone site an intravenous (IV) line or administer a drug via intramuscular (IM) injection. Irish Coast Guard Search and Rescue Helicopter winchmen encounter polytrauma patients in extreme pain in uniquely challenging environments. Novel solutions to pain management within this tightly governed system are urgently required.

Adolescent-parent disagreement on health-related quality of life of food-allergic adolescents: who makes the difference?

BACKGROUND: Food-allergic adolescents are at highest risk for food allergy fatalities, which may be partly due to compromised self-management behavior. Such behavior may be negatively influenced by conflictual situations caused by adolescent-parent disagreement on the adolescent's health-related quality of life (HRQL). Comparisons of adolescent-self-reported and parent-proxy-reported HRQL of food-allergic adolescents have never extensively been studied. The aims of this study were to investigate disagreement in adolescent-self-reports and parent-proxy-reports on the HRQL of food-allergic adolescents and to investigate the factors influencing adolescent-parent disagreement. METHODS: Teenager Form (TF) and Parent Form (PFA) of the Food Allergy Quality of Life Questionnaire (FAQLQ), Food Allergy Independent Measure (FAIM), and Brief-Illness Perception Questionnaire (Brief-IPQ) were sent to food-allergic Dutch adolescents (13-17 years) and their parents. ICCs, t-tests, and Bland-Altman plots were used to investigate adolescent-parent disagreement. Participant characteristics, illness expectations, and illness perceptions influencing adolescent-parent disagreement were studied using regression analysis. RESULTS: Seventy adolescent-parent pairs were included. There were a moderate correlation (ICC = 0.61, P < 0.001) and no significant difference (3.78 vs 3.56, P = 0.103) between adolescent-self-reported and parent-proxy-reported HRQL at group level. However, Bland-Altman plots showed relevant differences (exceeding the minimal important difference) for 63% of all adolescent-parent pairs. Adolescent's age (> 15 years), poorer adolescent-reported illness comprehension (Brief-IPQ-TF, coherence), and higher adolescent-reported perceived disease severity (Food Allergy Independent Measure-Teenager Form & -Parent Form) were associated with adolescent-parent disagreement. CONCLUSIONS: Adolescent-parent disagreement on the adolescent's HRQL was mainly associated with adolescents' rather than parents' perceptions and characteristics. Illness comprehension of the adolescent may be an important target for intervention aimed at reducing adolescent-parent disagreement.

Parents report better health-related quality of life for their food-allergic children than children themselves.

BACKGROUND: Food allergy affects 5-6% of children and impairs health-related quality of life (HRQL). Children and parents may differ in their views concerning the child's HRQL. In food allergy, child- and parent-proxy-reported HRQL have never been compared using valid disease-specific instruments. OBJECTIVE: The aim of this study was to compare child- and parent-proxy reports on HRQL in food-allergic children (8-12 years). METHODS: The Food Allergy Quality of Life Questionnaire-Child Form (FAQLQ-CF), and -Parent Form (FAQLQ-PF) and the Food Allergy Independent Measure-Child Form and -Parent Form (FAIM-CF and -PF) were completed by Dutch food-allergic child-parent pairs. Child- and parent-proxy reports were correlated and tested for significant differences. Construct validity (Spearman's correlation coefficient between the FAQLQs and FAIMs) and internal consistency (Cronbach's α) were assessed and compared. RESULTS: Seventy-four child-parent pairs were included. The FAQLQ-CF score was significantly higher than the FAQLQ-PF score (3.74 vs. 2.68, P<0.001, where 1 indicates no impairment and 7 indicates extreme impairment). FAIM-CF and -PF scores were almost identical (3.29 vs. 3.33, P=0.594). There was moderate agreement between the FAQLQ-CF and -PF scores (ICC=0.57 [P<0.001]) and good agreement between the FAIM-CF and -PF scores (ICC=0.80 [P<0.001]). Construct validity was confirmed for the FAQLQ-CF (ρ=0.60, P<0.001) and -PF (ρ=0.58, P<0.001). Internal consistency was excellent for the FAQLQ-CF (α=0.95) and -PF (α=0.95). CONCLUSIONS AND CLINICAL RELEVANCE: Parents reported significantly less impact of food allergy on the child's HRQL than children themselves, while reported perceptions of disease severity were nearly identical. This may reflect real differences in perspectives between children and parents and may indicate that parents tend to underestimate their child's HRQL impairment. It is important for clinicians to include both the child's and their parent's perceptions in order to perform a complete assessment of the impact of food allergy on the child's HRQL and to identify areas of disagreement that need special attention in clinical practice.

Health-related quality of life of food allergic patients measured with generic and disease-specific questionnaires.

BACKGROUND: Health-related quality of life (HRQL) has never been measured with both generic and disease-specific questionnaires in the same group of food allergic patients. The aim of this study was to compare HRQL of food allergic patients as measured with generic and disease-specific questionnaires. METHODS: Generic questionnaires (CHQ-CF87 and RAND-36) and disease-specific HRQL questionnaires (FAQLQ-CF, -TF and -AF) were completed by 79 children, 74 adolescents and 72 adults with food allergy. Floor and ceiling effects, percentage of agreement and multivariate stepwise regression analysis were used to compare the generic and disease-specific measurements. RESULTS: The Food Allergy Quality of Life Questionnaires (FAQLQs) showed minimal floor or ceiling effects. The CHQ-CF87 and RAND-36 showed minimal floor effects, but remarkable ceiling effects (> 73%) were found for the scales role functioning-emotional (RE), role functioning-behaviour (RB), role functioning-physical (RP) in children and adolescents and the scale RE (> 79%) in adults. Additionally, we found low percentages of agreement between the generic and disease-specific questionnaires to identify the same food allergic patients with the best or worst HRQL. Only patients with the best disease-specific HRQL also tended to have the best generic HRQL. Finally, the explained variance in HRQL by patient characteristics was higher in the disease-specific questionnaires (30.7-62.8%) than in the generic scales (6.7-31.7%). CONCLUSION: Disease-specific HRQL questionnaires may be more suitable to measure clinically important impairments in HRQL or HRQL differences over time in food allergic patients. However, generic HRQL questionnaires are indispensable for the comparison between different diseases and are thus complementary.

Development, validity and reliability of the food allergy independent measure (FAIM).

BACKGROUND: The Food Allergy Quality of Life Questionnaire-Child Form, -Teenager Form and -Adult Form (FAQLQ-CF, -TF and -AF) have recently been developed. To measure construct validity in the FAQLQs, a suitable independent measure was needed with which FAQLQ scores could be correlated. However, in food allergy, no appropriate independent measure existed, which could be used for this purpose. AIMS OF THE STUDY: The aim of this study was to describe the development of a Food Allergy Independent Measure Child-Form, -Teenager Form and -Adult Form (FAIM-CF, -TF and -AF) and to assess their validity and reliability. METHODS: The FAIMs were developed using previously established methodology to capture the patients' expectation of outcome (EO). Face validity was determined by expert opinion. FAIM questions showing no correlation to any potential items in the FAQLQs were considered irrelevant and eliminated. To measure test-retest reliability, one-hundred and one patients were included and completed the FAIM twice with a 10-14 day interval. The intraclass correlation coefficient (ICC), Lin's concordance correlation coefficient (CCC) and Bland-Altman plots were used to assess test-retest reliability. RESULTS: Six FAIM questions were developed and considered relevant for the FAIM-CF and -AF, and five questions were relevant for the FAIM-TF. The FAIMs showed good reliability with ICCs and CCCs above 0.70 and with mean differences all close to zero. CONCLUSIONS: Food allergy independent measures were developed for children, adolescents and adults and were shown to be valid, relevant and reliable. This supports the suitability of the FAIMs for evaluating construct validity.

Resolución espontánea del higroma quístico en un feto con síndrome de turner y evolución postnatal / Spontaneous resolution of cystichygroma in a fetus with turner syndrome and postnatal evolution

Introducción. Con frecuencia el síndrome de Turner se presenta durante el embarazo con hidrops e higroma quístico, signos de mal pronóstico y alta mortalidad. En algunos pocos casos, los signos ecográficos remiten y el feto llega a nacer vivo e incluso sobrevive la etapa perinatal. Material y métodos. Estudio descriptivo a propósito de un caso. Resultados. Presentamos un embarazo con diagnóstico ecográfico a las 25 semanas de edad gestacional de hidrops e higroma quístico severo, con cariotipo 45,X en líquido amniótico y ecocardiograma fetal normal. En los controles ecográficos ulteriores, tanto el hidrops como el higroma, remitieron casi totalmente. El embarazo llegó hasta las 36 semanas de gestación y nació una niña con signos clínicos de síndrome de Turner: edema generalizado, predominante en miembros, dorso de manos y pies, y genitales externos; piel sobrante en nuca y cuello alado. Posnatalmente se diagnosticó una coartación de aorta, patología de difícil diagnóstico por ecocardiograma fetal, por lo que frecuentemente es subdiagnosticada, y la niña fue derivada para cirugía y falleció a la edad de un mes y cinco días por una complicación posquirúrgica. Conclusiones. La evolución observada en el presente caso, así como algunos otros pocos casos descriptos en la bibliografía, nos muestran que, aún en presencia de signos ecográficos prenatales severos, no puede predecirse el pronóstico de sobrevida en fetos con síndrome de Turner, por lo que conviene ser cautos en la comunicación con los padres.

Effects and feasibility of a standardised orientation and mobility training in using an identification cane for older adults with low vision: design of a randomised controlled trial.

BACKGROUND: Orientation and mobility training (O&M-training) in using an identification cane, also called symbol cane, is provided to people with low vision to facilitate independent participation in the community. In The Netherlands this training is mainly practice-based because a standardised and validly evaluated O&M-training in using the identification cane is lacking. Recently a standardised O&M-training in using the identification cane was developed. This training consists of two face-to-face sessions and one telephone session during which, in addition to usual care, the client's needs regarding mobility are prioritised, and cognitive restructuring techniques, action planning and contracting are applied to facilitate the use of the cane. This paper presents the design of a randomised controlled trial aimed to evaluate this standardised O&M-training in using the identification cane in older adults with low vision. METHODS/DESIGN: A parallel group randomised controlled trial was designed to compare the standardised O&M-training with usual care, i.e. the O&M-training commonly provided by the mobility trainer. Community-dwelling older people who ask for support at a rehabilitation centre for people with visual impairment and who are likely to receive an O&M-training in using the identification cane are included in the trial (N = 190). The primary outcomes of the effect evaluation are ADL self care and visual functioning with respect to distance activities and mobility. Secondary outcomes include quality of life, feelings of anxiety, symptoms of depression, fear of falling, and falls history. Data for the effect evaluation are collected by means of telephone interviews at baseline, and at 5 and 17 weeks after the start of the O&M-training. In addition to an effect evaluation, a process evaluation to study the feasibility of the O&M-training is carried out. DISCUSSION: The screening procedure for eligible participants started in November 2007 and will continue until October 2009. Preliminary findings regarding the evaluation are expected in the course of 2010. If the standardised O&M-training is more effective than the current O&M-training or, in case of equal effectiveness, is considered more feasible, the training will be embedded in the Dutch national instruction for mobility trainers. TRIAL REGISTRATION: ClinicalTrials.gov NCT00946062.

Banco público de sangre de cordón umbilical / A public cord blood bank. Programs for related and unrelated transplantation

La sangre de cordón umbilical (SCU) ofrece una fuente rica de células progenitoras hematopoyéticas para trasplante de médula ósea (TMO). En el año 1996 comenzó en nuestro Hospital un programa relacionado de Banco De SCU. Este programa permite que familias con un niño que padece una enfermedad tratable con TMO almacene la SCU de un hermano por nacer para su futuro uso. En este tabajo presentamos nuestra experiencia de más de 8 años. Uno de nuestros objetivos ha sido comparar retrospectivamente carecterísticas de los donantes y unidades de SCU según el tipo de parto (vaginal Vs. cesárea). Desde marzo de 1996 hasta noviembre de 2004 se inscribieron 106 familias. Características de las unidades: volumen colectado 113 más o menos 36 ml; volumen preservado 76 más menos 28 ml; células nucleadas totales 10 más menos 5 por 108 cél.; células CD34 más 2,41 más menos 2,31 por 106 cél. La dosis de células nucleadas fue mayor a 2 por 107 por Kg. de receptor para el 93 por ciento de las unidades almacenadas. Las colectas provenientes de partos por cesárea no difieren significativamente de los partos vaginales. Recientemente, el programa no relacionado ha sido aprobado y recibió apoyo financiero del Ministerio de Salud de la Nación para adquirir nuevo equipamiento. Este programa tiene como objetivo colectar y preservar unidades de SCU donadas de manera altruista, que quedan disponibles para su uso en TMO alogeneicos en pacientes que no poseen otro donante compatible. El funcionamiento de este Banco nos permitirá aumentar la oferta internacional de unidades con perfil HLA latinoamericano hispano, escaso en los registros existentes en la actualidad.

Vaginismus, a component of a general defensive reaction. an investigation of pelvic floor muscle activity during exposure to emotion-inducing film excerpts in women with and without vaginismus.

This study investigates the mechanism underlying vaginismus, which may be part of a general defense mechanism. Exposure to a threatening situation will evoke an increase in muscle activity. This muscle reaction will not be restricted to the pelvic floor but will also occur in postural muscles, such as in the trapezius region. Women with and without vaginismus were exposed to four stimuli: excerpts from threatening, erotic, neutral and sexual-threatening films. Subjects were 45 physician- or self-referred patients with vaginismus and 32 controls with no sexual or pelvic floor complaints. The activity of the pelvic floor muscles and of the muscles in the trapezius region was recorded with surface electrodes. There were no differences between women with and without vaginistic reactions. EMG measurement of both the pelvic floor muscles and the trapezius muscle showed an increase in muscle activity during the threatening and sexual-threatening excerpts in women with and without vaginismus. This increase of involuntary pelvic floor muscle activity is part of a general defense mechanism that occurs during exposure to threatening situations. This reaction is not restricted to a situation with a sexual content. The results of this study shed new light on the concept of vaginismus as a primarily sexual dysfunction.

The relationship between involuntary pelvic floor muscle activity, muscle awareness and experienced threat in women with and without vaginismus.

This study assessed the relationship between involuntary pelvic floor muscle activity, muscle awareness and experienced threat in women with and without vaginismus. Information about this relationship may help understand the mechanism of vaginismus. Twenty-two women with vaginismus and seven control women participated in the study. Women were exposed to four emotion-inducing film excerpts. Vaginal electromyography was recorded. Experienced threat was continuously monitored with the use of a lever. Women responded with increased pelvic floor muscle activity to the threatening and sexually-threatening film excerpt. No changes occurred during the neutral and erotic excerpt. The subjective experienced threat as indicated with the lever showed the same response pattern. However, awareness of changes in muscle activity showed a slightly different pattern. Individual data were inspected. In general, agreement was found between recorded changes in muscle activity and experienced threat. The results of the erotic excerpt showed that awareness of changes in muscle activity is not only determined by information from the pelvic floor muscles, but also by other factors like situational information and the expectations of the women. The data support the idea of a general defense reaction as a mechanism of involuntary pelvic floor muscle activity.

The cps genes of Streptococcus suis serotypes 1, 2, and 9: development of rapid serotype-specific PCR assays.

We developed three type-specific PCR assays for the rapid and sensitive detection of Streptococcus suis serotype 1 (plus 14), serotype 2 (plus 1/2), and serotype 9 strains in tonsillar specimens from pigs. The PCR primers were based on the sequences of type-specific capsular genes of S. suis serotype 1, 2, and 9 strains. We recently characterized a major part of the capsular biosynthesis (cps) locus of S. suis serotype 2. Here we extended these studies and characterized major parts of the cps loci of S. suis serotypes 1 and 9. Type-specific genes were identified by cross-hybridization experiments between the individual cps genes and chromosomal DNAs from the 35 different serotypes. Four genes of S. suis serotype 1 specifically hybridized with serotype 1 and 14 strains only. Five genes of S. suis serotype 2 specifically hybridized with serotype 2 and 1/2 strains only, and two genes of S. suis serotype 9 specifically hybridized with serotype 9 strains. Until now rapid and sensitive diagnostic tests were available only for pathogenic strains of serotype 2 and highly pathogenic strains of serotype 1. The serotype-specific PCR assays can therefore be useful tools for the identification of serotype 1, 14, 2, 1/2, and 9 strains both for diagnostic purposes and in epidemiological and transmission studies. Therefore, these tests may facilitate control and eradication programs.