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The objective of this study is to develop and validate a screening instrument for the recognition of child maltreatment in the emergency department (ED). Existing data on screening questions and outcomes (diagnosis of child maltreatment) from three large observational screening studies at eight different EDs in the Netherlands were harmonized. A multivariate logistic regression was performed to develop the Screening instrument for Child Abuse and Neglect (SCAN). The SCAN was validated by performing a cross-validation and calculating the discriminative ability. A total of 24,963 patients were included. Out of the potential screening questions the following questions were included in the final instrument: is the injury compatible with the history, and does it correspond to the child’s developmental level? (aOR 10.40, 95% CI 5.69–19.02), was there an unnecessary delay in seeking medical help? (aOR 3.45, 95% CI 1.73–6.88) and is the behaviour/interaction of the child and parents (carers) appropriate? (aOR 14.67, 95% CI 7.93–27.13). The SCAN had a pooled AUC of 0.75 (95% CI 0.63–0.87) in the cross-validation. The question “Are there other signals that make you doubt the safety of the child and/or family?” (available in only one of the original datasets, OR 182.9; 95% CI 102.3–327.4) was by consensus added to the final SCAN. Conclusion: This validated and brief Screening instrument for Child Abuse and Neglect (SCAN) is designed to improve early recognition of child maltreatment in the ED. A positive screening result of the SCAN warrants a thorough work-up for child maltreatment, including a top-toe examination, if necessary additional diagnostics and adequate safety measures.What is Known:• Screening instruments increase the detection of possible cases of child maltreatment in the emergency department and support health care professionals to identify these cases.• The application of different screening instruments led to the need for one brief validated instrument.What

Background Antidepressants are established first-line treatments for anxiety disorders, but it is not clear whether they are equally effective across the severity range. Aims To examine the influence of baseline severity of anxiety on antidepressant efficacy for generalised anxiety disorder (GAD), social anxiety disorder (SAD), obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD) and panic disorder. Method Fifty-six trials of second-generation antidepressants for the short-term treatment of an anxiety disorder were included. Baseline and change scores were extracted for placebo and treatment groups in each trial. Mixed effects meta-regression was used to investigate the effects of treatment group, baseline severity and their interaction. Results Increased baseline severity did not predict greater improvement in drug groups compared with placebo groups. Standardised regression coefficients of the interaction term between baseline severity and treatment group were 0.04 (95% CI 70.13 to 0.20, P = 0.65) for GAD, 70.06 (95% CI 70.20 to 0.09, P = 0.43) for SAD, 0.04 (95% CI 70.07 to 0.16, P = 0.46) for OCD, 0.16 (95% CI 70.22 to 0.53, P = 0.37) for PTSD and 0.002 (95% CI 70.10 to 0.10, P = 0.96) for panic disorder. For OCD, baseline severity did predict improvement in both placebo and drug groups equally (b = 0.11, 95% CI 0.05 to 0.17, P = 0.001). Conclusions No relationship between baseline severity and drug-placebo difference was found for anxiety disorders. These results suggest that if the efficacy of antidepressants is considered clinically relevant, they may be prescribed to patients with anxiety regardless of symptom severity.

Zn absorption is hampered by phytate (PA), which is present in large amounts in plant-based foods. We aimed to assess in vitro Zn accessibility at various PA/Zn molar ratios, as well as fractional absorption of Zn from partially polished intrinsically labelled rice with and without the addition of milk in humans. Triplicate samples of steamed white rice were blended with water, raw milk or UHT milk, and incubated for 4 hrs in the absence or presence of PA, and Zn content in the supernatant was assessed. Female subjects (n=18) were given 90 g of steamed rice that was intrinsically labelled with 67Zn (75%), either with water or milk in a cross-over design with a 1-month washout period. Both meals contained the same amount of Zn. An intravenous infusion dose of 0.02 mg 70Zn in saline was given half-way each meal. FAZ was determined from isotope ratios measured in spot urine samples collected 4 days after consumption of the rice meal. UHT milk and raw milk showed a significantly higher extraction of Zn from white rice in comparison to water at PA/Zn molar ratios of 15 and 30. In human subjects, FAZ from rice was 13.4% (SD 3.8) from rice consumed with water (n=18) and 21.7% (SD 4.0) from rice consumed with milk (n=17; paired t-test, P