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Background The present study aims to characterize knowledge, attitudes and practices in a sample of general practitioners (GPs) on management of travelers’ diarrhea (TD). Methods A total of 158 GPs (44.3% males; mean age 40.2 ± 12.4 years) completed a web questionnaire on antibiotic prophylaxis (AP) and/or an antibiotic treatment (AT) in TD cases. Participants were inquired on knowledge status (KS), risk perception and effectively applied recommendations for AP/AT through a specifically designed questionnaire. Multivariate odds ratios (OR) for predictors of AP/AT were calculated through regression analysis. Results All in all, while 15 (9.5%) participants recommended AP for TD, 61 of them (39.4%) recommended AT. KS was largely unsatisfying as participants extensively ignored the most recent AP/AT recommendations. Acknowledgment of TD as a severe disorder was predictive for recommendation of AP (OR 37.843, 95% CI 4.752–301.4). As for AT, it was relatively elevated in GPs ≥ 10 years (OR 2.653, 95% CI 1.169–6.019), but more rarely reported in participants with higher KS (OR 0.056, 95% CI 0.021–0.153). Conclusions Adherence of GPs to official recommendations for TD management was unsatisfying, particularly in older participants. Continuous Education of GPs should be improved by sharing up-to-date official recommendations on AT/AP for TD.

Structural disorder within grains formed by carbon doping is widely known to enhance the in-field transport critical current performance of MgB2 wire. The structural formation usually requires high-temperature sintering above 600 °C due to low reactivity of the dopant. In this study, we selected a carbohydrate (malic acid) that has a low-decomposition temperature as the carbon dopant and performed low-temperature sintering (below 600 °C) to introduce greater disorder within the MgB2 grains. We revealed that the doping and low-temperature sintering process cause severe disorder, especially along the out-of-plane (c-axis) direction. The disordered formation, in addition to the in-plane disorder combined with well-connected grains, eventually raised the in-field transport performance.

Confusion and delirium are the most common behavioural disorders seen in emergency departments and acute medical or surgical units. Delirium can be regarded as the new ‘cognitive superbug’. Confusion can be seen as a mild form of delirium and can give warning of the development of the more severe disorder. It causes an acute change of mental status characterized by abnormal and fluctuating attention. It affects 10–30% of medically ill patients, especially elderly individuals and often shortly after hospital admission. It causes prolonged admission, increased morbidity and mortality, and delayed discharge, often culminating in long-term care. Its causation is reviewed and its prevention and management are described.

Alcohol use disorders are common in developed countries, where alcohol is cheap, readily available, and heavily promoted. Common, mild disorders often remit in young adulthood, but more severe disorders can become chronic and need long-term medical and psychological management. Doctors are uniquely placed to opportunistically assess and manage alcohol use disorders, but in practice diagnosis and treatment are often delayed. Brief behavioural intervention is effective in primary care for hazardous drinkers and individuals with mild disorders. Brief interventions could also encourage early entry to treatment for people with more-severe illness who are underdiagnosed and undertreated. Sustained abstinence is the optimum outcome for severe disorder. The stigma that discourages treatment seeking needs to be reduced, and pragmatic approaches adopted for patients who initially reject abstinence as a goal. To engage people in one or more psychological and pharmacological treatments of equivalent effectiveness is more important than to advocate a specific treatment. A key research priority is to improve the diagnosis and treatment of most affected people who have comorbid mental and other drug use disorders.

Using a quantitative content analysis, this study focused on how depression has been portrayed and communicated on Pinterest. Key findings include: Depression-focused pins elicited high response levels for repins, likes, and comments, and more than half of the pins expressed perception of depression as a severe disorder. Various coping mechanisms were present in the pins, with the dysfunctional coping strategy most prevalent. Implications for practitioners on how to utilize visual media platforms to effectively engage at-risk publics on health issues were discussed.

Background Major Depressive Disorder (MDD) is a severe disorder with a lifetime prevalence of 15%. Recurrent or chronic MDD, which typically requires long-term treatment, occurs in the majority of patients. As previous efforts to predict recurrence/chronicity have met with limited success, novel avenues are required. In this study, we aimed to predict the future disease status of MDD patients from DNA methylation patterns in blood. Methods We assayed 28 million methylation sites in 581 MDD patients from the Netherlands Study of Depression and Anxiety (NESDA). A Machine Learning algorithm condensed all information into a single predictor labeled methylation risk score (MRS). The outcome was MDD disease status six years later. To evaluate the predictive power of our MRS, we obtained an unbiased estimate of the area under the curve (AUC) using k-fold cross validation. Results The AUC of the MRS was 0.724. We compared our MRS with predictions based on a set of five putative MDD biomarkers (e.g., assaying neurotrophic factors or inflammation), genome-wide genetic variant data, and 27 clinical, demographic or lifestyle variables (e.g., MDD symptom severity, childhood trauma, alcohol use). The MRS not only outperformed all these predictors but also seemed to capture their predictive power as the inclusion of any of these sets did not significantly increase the AUC of the MRS. Discussion The current study suggests a novel avenue for predicting future MDD status using DNA methylation patterns in blood. The predictive power of the MRS is comparable to the AUC of the Framingham Risk Score, one of the most widely used clinical tools to predict coronary heart disease. This AUC level can potentially support clinical decisions about treatment strategies by providing empirical information about the likelihood MDD is chronic or will recur in the future.

We examined the prevalence of body dysmorphic disorder (BDD) in a Veterans Affairs (VA) primary care behavioral health clinic. Of 100 Veterans, 11% (95% CI = 6.3-18.6%) had current BDD and 12% (95% CI = 7.0-19.8%) had lifetime BDD. However, only 8.3% of these Veterans had been diagnosed with BDD. BDD was significantly associated with a substantially elevated rate of suicide attempts, major depression, and obsessive-compulsive disorder. This severe disorder appears to be underdiagnosed in VA settings.

Confusion and delirium are the most common behavioural disorders seen in an acute medical or surgical unit. Confusion can be regarded as a mild form of delirium and may give warning of the development of the more severe disorder. It causes an acute change of mental status, characterized by abnormal and fluctuating attention. It affects between 10 and 30% of medically ill patients, especially the elderly and often shortly after admission to hospital. It causes prolonged admission, increased morbidity and mortality, and delayed discharge, often culminating in long-term care. Its causation is reviewed and its prevention and management are described.

Maladaptive cognitive processes, including selective attention and memory, distorted beliefs and interpretations, and thinking processes such as rumination and thought suppression, are strongly associated with many emotional disorders. This paper reviews research that extends these findings to the emotional dysfunction characteristic of borderline personality disorder (BPD). Results suggest that people with BPD habitually attend to negative stimuli, have disproportionate access to negative memories, endorse a range of BPD-consistent negative beliefs about themselves, the world, and other people, and make negatively biased interpretations and evaluations of neutral or ambiguous stimuli. They also engage in thought suppression and rumination and these tendencies are significantly associated with the severity of their BPD symptoms. It remains unclear whether maladaptive cognitive processes play a causal role in the development and maintenance of BPD or are correlates or consequences of having the disorder. Continued study of emotion-related cognitive processing in BPD may improve understanding and treatment of this severe disorder.

Obsessive–compulsive disorder (OCD) is a mental syndrome characterized by intrusive thoughts that trigger some repetitive action the individual feels driven to perform in order to relieve the anxiety engendered by the disturbing thoughts. A natural measure for the severity of OCD is the duration of the repetitive ritual. This paper presents a dynamic model of rational OCD that determines the optimal number of compulsory repetitions over the individual's lifecycle through the choice of therapy intensity. The analysis reveals that in the case of mild disorder, compulsory repetitions rise steadily along the rationally optimal trajectory. In the case of severe disorder, the rationally optimal trajectory is U-shaped, with compulsory repetitions declining for some time before turning around and rising again. Recent studies suggest, however, that the majority of patients experience a waning and waxing course of illness. In particular, symptoms are often worse during times of psychological stress. Incorporating stress into the model, the paper shows that a waning and waxing course may be the outcome of rational coping with the emergence of stress.

Leber's congenital amaurosis (LCA) is a clinically and genetically heterogeneous disorder characterized by severe loss of vision at birth. It accounts for 10-18% of cases of congenital blindness. Some patients exhibit only blindness of retinal origin whereas others show evidence of a multi-systemic involvement. We review the literature relating to this severe disorder, highlighting unresolved questions, in particular the nature of the association of LCA with mental retardation and with systemic findings and syndromic pictures. In recent years, genetic advances in the diagnosis of LCA have opened up new horizons, also from a therapeutic point of view. A better understanding of this pathology would be valuable for paediatric neurologists.

The 1994 approach to the definition of Chronic Fatigue Syndrome (CFS) describes a severe disorder with unknown etiology and pathophysiology. It results in substantial reduction in previous levels of occupational, educational, social, or personal activities. Most patients cannot continue their usual lifestyle. No causal treatments or other therapies suitable for all patients exist so far. Therefore it was intended to identify approaches to an effective disease management by the long time escort and observation of a CFS support group. CFS should be diagnosed according to the actual CDC guidelines. Conditions with similar symptoms explaining chronic fatigue have to be ruled out first. Then an individually shaped disease management comprising of different components plays a central role in the coping process. Medical long time care performed by a general practitioner and the membership in a suitable support group are integrated within this approach.

Patients with so-called Borderline Personality Disorder are generally considered as extremely difficult to treat. Until recently, conceptualizations of this severe disorder on which cognitive-behavioural therapy could be based were underdeveloped. The present paper presents a cognitive formulation based on previous cognitive and behavioural conceptualizations, and on empirical evidence pertaining to the relationship between childhood traumas and Borderline Personality Disorder. It is assumed that chronic traumatic abuse or neglect in childhood has led to the development of almost unshakeable fundamental assumptions about others (dangerous and malignant), about one's own capabilities (powerless and vulnerable) and upon one's value as a person (bad and unacceptable). These are assumed to underlie the complex symptomatic presentation of borderline patients. A treatment protocol is described, which takes 1.5–4 years, and consists of 5 stages: (1) construction of a working relationship; (2) symptom-management (gaining more control over symptoms); (3) correction of thinking errors; (4) emotional processing and cognitive re-evaluation of the childhood trauma and schema changes; and (5) termination. A case example is presented, and a call for research into the efficacy of this approach is made.

Tourette's syndrome (TS) is a neuropsychiatric disorder characterized by a changing repertoire of motor and phonic tics that typically begin in childhood and exhibit a fluctuating course. Obsessive-compulsive symptoms and problems of inattention, overactivity, and impulsiveness are present in some cases. Historically, TS has been viewed as a severe disorder. However, data from epidemiologic and family-genetic studies indicate that it shows a wide range of severity. This article, the first of two parts, examines the current notions concerning the origin, pathophysiology, and diagnosis of TS. The second article will present three cases and describe contemporary approaches to treatment.

Thrombotic microangiopathy is a severe disorder, which is a cause of stroke in young patients. Etiologic investigations are mandatory to diagnose underlying disease. Systemic lupus erythematosus is one of the diseases, which can be associated with thrombotic microangiopathy. Although lupus diagnosis is usually easy, relying on characteristic clinical manifestations, rare symptoms can be misinterpreted. We report here a case of polychondritis, which was the first manifestation of a lupus-associated thrombotic microangiopathy.

The author summarizes some of Grunberger's ideas on narcissism and certain of her own views on the subject. She stresses the fact that narcissism is almost always considered as being a hindrance to psychoanalytic treatment and a severe disorder. Without underestimating the dark and lethal face of narcissism that may lead the individual to hatred, aggression, destruction, suicide, and toward groups that attempt to annihilate the universe, she, following Grunberger, emphasizes the positive aspects of narcissism, especially in treatment, but also in other realms.

Summary Presumptive homozygous achondroplasia (PHA) is a rare disorder. The clinical and detailed histological findings of the fifth case of this chondrodystrophy, studied in detail, are presented here. There is a severe disorder of the normal growth of the long bones, whose nature, however, is not well understood; it shows some resemblance to the pathological changes described in thanatophoric dysplasia which also presents many clinical similarities. The aspect of greatest interest, however, is the relation of PHA to the “classical” form of achondroplasia. Some investigators have maintained that in that disorder there are no significant qualitative, and at most some quantitative, alterations in the growth plate to be demonstrated by histologic examination, but have not explained the apparent abnormalities in the development of the bones and in the external phenotype, which appears to be a milder expression of that seen in PHA. In view of the genetic relationship and external phenotypic similarity one would also have expected in “classical” achondroplasia a milder form of the severe changes seen in PHA. Judging by some of the published reports this is not the case. Attention is drawn to this intriguing discrepancy.