[Recognizing borderline intellectual functioning or mild intellectual disability in newly registered patients in a general psychiatric outpatient clinic]. / Onderkennen van zwakbegaafdheid of een lichte verstandelijke beperking bij aangemelde patiënten op een algemene psychiatrische polikliniek.

BACKGROUND: It is unclear whether borderline intellectual functioning (bif) and/or a mild intellectual disability (mid) in patients receiving treatment in mental health care are being recognized by care providers.
AIM: Exploratory study to register under-diagnosis of bif/mid in an outpatient clinic.
METHOD: The number of patients diagnosed with bif/mid according to the electronic patient file (epd) was determined. From 11 August to 11 December 2015, all newly registered patients for outpatient treatment with an mbo-2 or lower educational level were screened for the possible presence of bif/mid applying the screener for intelligence and mild intellectual disability (scil). For all patients, their mental health care practitioner was asked if they suspected bif/mid. These percentages were compared. The sensitivity and specificity and the positive and negative predictive value (ppv and npv) of the opinion of the mental health care practitioners were determined.
RESULTS: In the epd 2,8% of patients were diagnosed with bif, and 0,8% with mid. The percentage of suspected bif/mid of newly registered patients was 17,5%. The sensitivity of the assessors' opinion was 41%, the npv was 57%.
CONCLUSION: In newly registered patients at an outpatient clinic bif and mid are important but frequently missed co-morbidities.

Effect of collagen turnover and matrix metalloproteinase activity on healing of venous leg ulcers.

BACKGROUND: The presence of fibrous tissue in poorly healing venous leg ulcers suggests abnormal collagen metabolism. The aim was to determine whether there were differences in collagen turnover and matrix metalloproteinase (MMP) activity between ulcers that healed, those that did not heal and normal skin. METHODS: Biopsies were taken from the ulcers of 12 patients whose venous ulcers went on to heal and 15 patients whose ulcers failed to heal despite 12 months of compression bandaging. Biopsies were taken from 15 normal controls. Collagen turnover (collagen III N-terminal propeptide (PIIINP) and degraded collagen), and total MMP, MMP-1 and MMP-3 activities were measured. RESULTS: PIIINP and degraded collagen levels were higher in ulcers that healed compared with lesions that failed to heal (P = 0.005 and P < 0.001 respectively) and normal skin (P = 0.003 and P < 0.001). MMP-1 activity was also higher in healing ulcers than resistant ulcers (P < 0.001) and normal skin (P < 0.001). Significantly more total MMP activity was present in all ulcers than in normal skin (P < 0.001), but there was no difference in total MMP (and MMP-3 activity) between ulcers that healed and those that did not. CONCLUSION: Rapidly healing venous leg ulcers had increased collagen turnover and MMP-1 activity, which appeared to differentiate them from those that failed to heal within 12 months.