To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Severe health anxiety is a chronic and costly disorder if untreated. Patient self-referral may lower barriers to treatment and decrease diagnostic delay.
This study evaluated the accuracy of self-referral for severe health anxiety and compared characteristics of patients self-referred to internet-delivered treatment with patients referred by a clinician to face-to-face treatment.
Two trials in the same clinic employed different referral methods for health anxiety, namely self-referral and clinician-referral (trial registration: clinicaltrials.gov: NCT01158430 and NCT02735434). The trials were conducted at different time points but with largely comparable eligibility criteria. The accuracy of the recruitment methods was compared by looking at the number of eligible patients in the two trials. Patients completed a baseline questionnaire and subsequently underwent a diagnostic interview by experienced clinicians. Mean differences in self-report and clinical data explored between-group demographic and clinical characteristics.
In total, 101/151 (67%) self-referred patients were eligible compared with 126/254 (50%) clinician-referred patients (P = 0.001). Self-referred patients were 3.4 years older (P = 0.008) and had a somewhat higher educational level (P = 0.030). Patients who self-referred reported significantly higher levels of health anxiety, emotional distress and somatic symptoms compared with clinician-referred patients. Yet, they had less clinician-assessed comorbid anxiety disorders (P<0.001) and better physical health-related quality of life (P<0.001) suggesting a more distinct symptom profile.
Self-referral was found to be an accurate method to recruit highly relevant patients with treatment-demanding health anxiety. Thus, both self-referral and clinician-referral seem feasible and valid referral methods, but they may recruit patients with slightly different characteristics.
Focused assessment with sonography for trauma (FAST) has been incorporated into the initial evaluation of trauma for decades. It is an important screening tool in the detection of intra-abdominal fluid. The objective of this study was to perform a systematic review of the use and accuracy of FAST as an imaging tool for blunt abdominal trauma in disaster/mass casualty settings. A systematic review of literature was conducted using key words and search terms. Two independent reviewers screened abstracts to determine inclusion using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS). For studies passing QUADAS, a meta-analysis was performed calculating sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). FAST results were compared with the gold standard, which was a combination of CT scan results, operative findings, and medical records of the clinical course. Initial database screening resulted in 133 articles, of which 21 were selected for QUADAS evaluation. Five studies passed QUADAS and were selected in the final meta-analysis, with a total of 4263 patients. The sensitivity of FAST was 92.1% (87.8–95.6), specificity 98.7% (96.0–99.9), PPV 90.7% (70.0–98.0), and NPV 98.8% (98.1–99.5) for the detection of intra-abdominal injury. In our meta-analysis, FAST was both sensitive and specific in the evaluation of trauma in the disaster setting.
This comment expands on Hooks et al.’s criticism of the problematic and overly general uses of “stress” within the microbiota-gut-brain field. The comment concludes that, for the microbiota-gut-brain field (as for other fields drawing on “stress”), much work is yet to be done in terms of how we explore and understand biology vis-à-vis psychology.
Identifying options for the sustainable intensification of cropping systems in southern Africa under prevailing high climate risk is needed. With this in mind, we tested an intercropping system that combined the staple crop maize with lablab, a local but underutilised legume. Grain and biomass productivity was determined for four variants (i) sole maize (sole-maize), (ii) sole lablab (sole-lablab), (iii) maize/lablab with both crops sown simultaneously (intercropped-SP) and (iv) maize/lablab with lablab sown 28 days after the maize crop (intercropped-DP). Soil water and weather data were monitored and evaluated. The trial was conducted for two seasons (2015/2016 and 2016/2017) at two sites in the Limpopo Province, South Africa: Univen (847 mm rainfall, 29.2 °C maximum and 18.9 °C minimum temperature average for the cropping season over the years 2008–2017) and Syferkuil (491 mm rainfall, with 27.0 °C maximum and 14.8 °C minimum temperature). Analysis revealed three key results: The treatment with intercropped-SP had significantly lower maize yields (2320 kg ha−1) compared with maize in intercropped-DP (2865 kg ha−1) or sole-maize (2623 kg ha−1). As expected, maize yields in the El Niño affected in season 2015/2016 were on average 1688 kg ha−1 lower than in 2016/2017. Maize yields were significantly lower (957 kg ha−1) at Univen, the warmer site with higher rainfall, than at Syferkuil. In 2015/2016, maximum temperature at Univen exceeded 40 °C around anthesis. Furthermore, soil water was close to the estimated permanent wilting point (PWP) for most of the cropping season, which indicates possible water limitations. In Syferkuil, the soil water was maintained well above PWP. Lablab yields were low, around 500 ha−1, but stable as they were not affected by treatment across season and site. Overall, the study demonstrated that intercropped-DP appears to use available soil water more efficiently than sole maize. Intercropped-DP could therefore be considered as an option for sustainable intensification under high climate risk and resource-limited conditions for smallholders in southern Africa.