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Introduction: Workplace violence suffered by psychiatric trainees from the patients they treat jeopardizes their safety and the quality of their care. This phenomenon has been often described in many countries but had not been so far systematically surveyed in Europe. Objectives: The European Federation of Psychiatric Trainees (EFPT) -Research Working Group-Violence Against Psychiatric Trainees (VAPT) study aimed primarily at describing the extent and circumstances of the VAPT phenomenon in the European region (WHO). Methods: An online questionnaire of 15 items was designed following pilot surveys in Spain, France, and Turkey, and distributed to psychiatric trainees in European countries via national coordinators between June-December 2018. The questions asked for anonymous demographic data as well as information about violent episodes experienced, consequences, and surrounding circumstances. Statistical descriptive analyses were conducted in SPSS. This study was approved by an Ethics Committee in Spain. Results: 790 trainees from 38 European countries completed the survey (68.1% women and 80.1% trainees in adult psychiatry). 84.4% reported having ever been assaulted, most of them recently (77.5% verbally, 8.1% sexually and 47.7% physically). Most victims did not report the assault and experienced psychological consequences. Only a minority of respondents reported having proper preventive and management policies in their institutions. Conclusions: VAPT phenomenon is commonly reported by trainees across Europe and frequently incur psychological damage. However, a majority of trainees reported poor institutional policies to prevent and manage these events. These results encourage local and international policymakers to effectively tackle this problem. [ABSTRACT FROM AUTHOR]

Introduction Over the past years, catatonia received increasing attention. The concept of catatonia has been decoupled from schizophrenia and broadened. Aim The aim of our prospective study was to determine the prevalence of catatonia in patients admitted to an acute psychiatric ward. Material and methods We examined all patients acutely admitted to the Centre for Psychiatry and Addiction Medicine (CPAM) of Szent István and Szent László Hospitals, from 01/04/2015 to 31/07/2015. We used Bush Francis Catatonia Screening Instrument (BFCSI) for the assessment of catatonic signs. In case of presence of 2 or more symptoms on BFCSI, the severity of catatonia was rated with Bush Francis Catatonia Rating Scale (BFCRS). After detailed clinical examination, we used Structured Clinical Interview for DSM-IV, Mini Mental State Examination and Clock Drawing Test in setting up a diagnose. Results In the study period, altogether 338 patients were admitted to CPAM. Catatonia could be diagnosed in 8.55% of them, according to BFCRS and in case of 5.02% the diagnosis of catatonia could be set up according to DSM-5 diagnostic criteria. Female patients were present in 58.62%. The mean age was 57.62 years. Schizophrenia spectrum disorder was diagnose in 41.3%, dementia in 27.5%, affective disorder in 6.89%, alcohol, drug withdrawal syndrome, Down syndrome and mental retardation in 3.44% each, other organic disease in 10.34% of all catatonia cases. Conclusion Catatonia can be present in a variety of psychiatric conditions. Its specific therapy gives a special importance to the recognition of this syndrome. [ABSTRACT FROM AUTHOR]

We examined the mitochondrial identity of Aegean Natrixnatrixmoreotica representing different morphotypes, with a focus on new material from Milos and Skyros. We found no correlation between distinct morphotypes and mitochondrial identity. Our results support that grass snake populations are polyphenetic and that southern subspecies, including island populations, show a higher variability than northern ones., Competing Interests: The authors have declared that no competing interests exist., (Daniel Jablonski, Elias Tzoras, Alexios Panagiotopoulos, Marika Asztalos, Uwe Fritz.)

Competing Interests: The authors have no conflicts of interest or financial disclosures to report.

Objectives: Violence by patients against health care professionals has been widely described. Although psychiatric trainees are particularly exposed, little is known about the extent, context, and impact of violence toward them in Europe., Methods: A cross-sectional online survey was distributed between June 2018 and December 2019 among European psychiatric trainees through professional networks, using a snowball approach. The questionnaire asked about experiences of verbal abuse and physical and sexual assaults, as well as their context and impact. Descriptive analyses of the obtained data were conducted., Results: The survey was completed by 827 trainees from 39 countries (68.4% females). Most (83.6%) reported having been abused/assaulted at least once (of these, 92% verbally, 44.1% physically, and 9.3% sexually). Emergency rooms and inpatient units were the most frequent settings. Psychological impact of these events was commonly reported. Most respondents did not report abuses and assaults to their supervisors. They also described a lack of training for staff and aggression management plans at their institutions or of being unaware of their existence., Conclusions: Violence from patients is reported by many psychiatric trainees across countries in Europe, with very frequent verbal abuse and worrisome figures of physical and sexual assaults. Particularly concerning are the low proportion of trainees reporting to authorities, the lack of staff training and management protocols, and trainees' lack of awareness about those resources. Despite the study limitation of a small response rate, these results support a call for urgent efforts to address this problem in Europe, and possibly beyond., (© 2021. Academic Psychiatry.)

Objectives: A nationwide survey in Hungary found that 22 out of 58 psychiatric units performed ECT in 2014. Shortly after identifying the first COVID cases, strict control measures were introduced, and the hospital system was fundamentally transformed in the country that affected ECT provision as well. The aim of the current study was to survey the changes in ECT use in Hungary during the four waves of the COVID-19 pandemic., Methods: All the psychiatric units that indicated they had performed ECT in 2014 were sent a semi-structured question naire requesting information about changes in ECT practice and the treatment profile of the unit. If there was no reply, a follow-up telephone call was made., Results: There were only 3 centers where ECT was performed throughout all four waves of COVID. In nine centers (47%) ECT was suspended in all four waves. The main reason why ECT was halted during COVID was the restructuring of psychiatric inpatient care: six centers were fully transformed into general COVID units, and in the remaining 13 the number of psychiatric beds was reduced in favor of general COVID care. Staff shortage constituted another barrier to the provision of ECT. The number of infected patients in a wave of COVID-19 showed a significant negative correlation with the number of active ECT centers (p=0.05). No COVID-infected patient received ECT in Hungary., Conclusions: During the COVID pandemic in Hungary, nearly half of the ECT services were suspended and thus a number of patients missed out on receiving an effective treatment.

Clinical psychiatric practice should be intricately linked with research work. Although psychiatric trainees and early career psychiatrists (ECPs) are in the frontline of clinical services, little is known about how much access they have to research opportunities. A semi-structured questionnaire of 35 questions-exploring research goals achieved, facilitators and barriers as well as personal context-was sent to psychiatric trainees and ECPs across Europe. The survey was disseminated through the local committees of the main professional psychiatric societies in Europe. A total of 258 individuals working in 34 European countries participated. The majority (69.8%) were psychiatric trainees within training in adult psychiatry. Most participants (69.0%) were highly interested in research, but faced major obstacles toward their research activities, such as lack of time and funding. They were highly satisfied with mentoring and publishing papers. Only half of the participants, however, had already published a scientific article, and only a few have been able to contribute to randomized clinical trials (20.9%). A large proportion of participants (87.2%) reported to conduct research after or during a mixture of working hours and after working hours. Only one tenth ever received a grant for their work. These findings highlight that the key barriers for the performance of research are lack of time and funding. Psychiatric trainees and ECPs are motivated to perform research but need support and regular opportunities., Competing Interests: FR reports personal fees from Merz Pharma and Vifor Pharma, not related to the submitted work. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Koelkebeck, Andlauer, Asztalos, Jovanovic, Kazakova, Naughton, Pantovic-Stefanovic, Riese and Pinto da Costa.)

Background: Consultation-Liaison Psychiatry (CLP) provides services for patients with medical-psychiatric comorbidity at the general hospital. Referral satisfaction is considered as one of the most important outcome measures of CLP interventions. Our aim was to assess the levels of satisfaction with the CLP service amongst medical staff at a university hospital in Denmark., Methods: Medical staff answered an online survey regarding their experience with different aspects of inpatient and outpatient CLP services., Results: There were 152 responses from 16 medical units, with a survey return rate above 85%. Measured on a 5-point Likert scale, there was a median rating of 4 in response to questions regarding communication and organizational aspects, a median rating of 5 in response to questions regarding overall evaluation of the CLP service on both inpatient and outpatient questionnaire. The questions regarding treatment quality were rated with a median of 4 on the inpatient questionnaire and 2 of the outpatient questionnaire items, and with a median of 5 on 2 outpatient items. Physicians´ evaluations were statistically more positive than nurses´. As a group, respondents already employed before the CLP unit was established and those who used the CLP services more were statistically significantly more satisfied then respondents employed after the establishment of the CLP unit and those who used the CLP service less., Conclusion: The CLP services were positively appreciated and considered to be valuable among medical hospital staff. We believe that Consultation-Liaison Psychiatry deserves further help to implement and expand its services in general hospital settings. In addition, our results underline the feasibility of surveys as quality measures of clinical care.

Background and Purpose: This research focused on the knowledge and attitude toward to electroconvulsive therapy (ECT) in the general population of Hungary. There are only a few studies in the international literature focusing on the public's attitude towards ECT, and no such study has been published from Hungary., Methods: Participants were reached through social media and asked to fill out a semi-structured questionnaire on internet that comprised seventeen questions. Participation in the survey was entirely voluntary and anonymous. Participants of the survey were not working in health care; their answers to the questionnaire were compared to those of health-care workers., Results: The result showed a significant difference between healthcare workers' and lay people's knowledge and attitude towards ECT. Two third of lay participants have never heard about ECT. Those familiar with ECT were relatively well-informed about its certain aspects yet rejection of ECT was significantly higher in the group of lay participants than in health-care workers., Conclusion: Lay people's incomplete knowledge and negative attitude towards ECT was confirmed by this survey. The dissemination of reliable information - which should be the shared responsibility of mental health professionals and the media - would be vitally important to disperse the prejudices and doubts about ECT.

Objectives: The aim of this prospective study was to determine the prevalence of the catatonic syndrome in a cohort of patients admitted to acute psychiatric units in Hungary., Methods: Patients admitted to the acute inpatient unit of the Center of Psychiatry and Addiction Medicine, SzentIstván and SzentLászló Hospitals in a 4-month period were screened for catatonic signs and symptoms. Catatonic signs/symptoms were scored according to both the DSM-5 diagnostic criteria and the Bush-Francis Catatonia Rating Scale (BFCRS). Clinical diagnoses were established using the Structured Clinical Interview for DSM-IV Disorders (SCID), while cognitive performance was estimated with the Clock Drawing Test and the Mini-Mental State Examination (MMSE)., Results: During the study period, 342 patients were admitted to the above-mentioned acute inpatient units. The prevalence figures for the catatonic syndrome were 8.55% and 5.02% according to the BFCRS and the DSM-5, respectively., Conclusions: The prevalence of catatonic syndrome in an acute inpatient setting is within the broad range of figures reported in the literature. The difference between the standardized assessment (BFCRS) and routine clinical judgment (DSM-5) is noteworthy and suggests that a significant minority of catatonic patients might not be identified in clinical practice. As acute catatonia can be effectively treated, and early treatment could prevent potentially lifethreatening complications, recognition of catatonic symptoms is vitally important.

Objectives: A cleansing body wash containing diluted sodium hypochlorite (0.006% NaOCl) was evaluated for management of moderate-to-severe Staphylococcus aureus-colonized, atopic dermatitis in children., Methods: A 6-week, prospective, open-label study was conducted with 50 evaluable participants (ages 6 months to 17 years) who had moderate-to-severe atopic dermatitis with S aureus skin colonization documented by culture. Participants were instructed to continue using their current medications while using the study product, 0.006% NaOCl body wash, once daily to affected areas for 6 weeks. Primary outcome measures were Investigator's Global Assessment, Eczema Area and Severity Index, and Body Surface Area scores. Secondary outcome measures were the Visual Analog Scale for pruritus, Family Dermatology Life Quality Index, and Patient Satisfaction Questionnaire for Problem Areas. A subject daily diary and a six-item subject questionnaire that provided information on preferences for bleach bath vs body wash were secondary outcome measures., Results: Daily use of the 0.006% NaOCl body wash led to improvement for all outcome measures comparing baseline to 2-week and to 6-week evaluations. Of the 50 skin S aureus-positive subjects, 32/50 (64%) were still positive at 2 weeks. A 36.5% decrease in subject's daily record of topical corticosteroid application at end of study compared to baseline was found. Participant surveys indicated preferences for the body wash over bleach baths., Conclusions: Sodium hypochlorite (NaOCl) body wash improved all outcome measures for moderate-to-severe S aureus-colonized AD in infants, children, and adolescents. The limited reduction in S aureus further suggests that sodium hypochlorite has ameliorative effects other than antimicrobial actions., (© 2019 The Authors. Pediatric Dermatology Published by Wiley Periodicals, Inc.)

Objectives: To investigate the effect of delaying initiation of electroconvulsive therapy (ECT) after administration of anaesthetic agent and muscle relaxant., Methods: A retrospective cohort study utilizing a case-based analysis comparing number of re-stimulations, length of seizures, number of ECTs per series and stimulation dosage before and after introducing a new treatment regimen. In 2013, ECT was initiated approximately 60-90 seconds after administration of thiopental and succinylcholine. This interval was increased to 120 seconds in 2014. Ninety-three patients were included (40 in 2013 and 53 in 2014). Outcome measures were length of seizure, number of re-stimulations, number of ECTs per series and stimulation dosage. Regression model analyses were conducted with entering year of treatment (2013 vs. 2014), sex and age as covariates., Results: We showed that a lowered frequency of re-stimulation was independently associated with the 2014 treatment regimen. No effect of treatment regimen on duration of seizures as measured clinically or by EEG, on number of treatments per series or on stimulation dosage was observed., Conclusions: We found an association between an increased time interval from administration of thiopental and succinylcholine to ECT and a lowered risk of re-stimulations. The current study substantially strengthens the evidence on the benefits of delaying ECT after administration of anaesthetic agent and muscle relaxant.

Objective: Negative symptoms and cognitive deficits are main features of schizophrenia but with limited treatment options. Earlier studies have suggested that central nervous system (CNS) stimulants have a small effect on these domains, but with inconclusive results. As the first study to date, we aimed to investigate whether CNS stimulants improve naturalistic outcomes (psychiatric admissions and antipsychotic use) in patients with schizophrenia., Methods: By using extensive health registers all patients with schizophrenia and their use of CNS stimulants in Denmark were identified. Two models were used to investigate the effectiveness of CNS stimulants in patients with schizophrenia between 1995 and 2014; a mirror-image model with 605 individuals, using paired t tests and Wilcoxon signed rank tests, and a follow-up study with 789 individuals, using a conditional risk-set model., Results: CNS stimulants use was associated with a reduction in number of psychiatric admissions from 3.43 (95% CI = 2.86 to 4.01) to 2.62 (95% CI = 1.99 to 3.25) (P = .009), with a more pronounced reduction for women (mean difference: -1.37, 95% CI = -2.34 to -0.40, P = .006). Psychiatric bed-days were reduced by 40 (95% CI = 24.5 to 55.6, P < .001) for individuals with at least 1 admission before CNS stimulant use. In addition, the total amount of antipsychotic use (Defined Daily Dose [DDD]) was reduced (P = .001). The Hazard rate ratio in psychiatric admissions between women taking CNS stimulants compared to women not taking CNS stimulants was 0.77 (95% CI = 0.67 to 0.88)., Conclusion: CNS stimulants may have clinical potentials for improving functional outcomes in patients with schizophrenia and randomized clinical studies evaluating this topic are warranted., (© The Author(s) 2017. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Introduction: In spite of its efficacy, use of electroconvulsive therapy (ECT) has been declined in Hungary over the past decade. This survey explores the circumstances that have obstructed the accessibility to ECT in Hungary., Methods: This study was part of a comprehensive survey on the use of ECT in which two semi-structured questionnaires with 25 and 6 questions were sent out to all psychiatric departments in Hungary. The second questionnaire was targeted those departments that did not perform ECT in 2014. Questions were asked about the reasons for not using ECT and the available treatment strategies for patients who needed ECT., Results: Thirty-one of the 58 Hungarian psychiatric departments did not offer ECT in 2014. Twelve chiefs of service asserted that no patient needed ECT in that year. Due to unavailability of ECT, patients were transferred to other departments for ECT in further 12 departments. Finally, in 7 departments, patients who would have needed ECT were treated with pharmacotherapy instead of transferring them to ECT centers. As for the reasons for the lack of access to ECT, 17 departments had no ECT machine, 12 departments did not have access to anesthesiologists, 6 departments had no budget for ECT, and in 5 departments staff with expertise to deliver ECT was not available., Conclusion: The rate of ECT use in Hungarian psychiatric departments decreased by 20 percent between 2002 and 2014. The most important reasons for this decline were lack of the modern ECT devices or financial sources to buy a modern ECT machine. Further reasons for not using ECT were the availability of anesthesiologists or the lack of finances to employ them. The lack of experience in administering ECT was another reason for not utilizing ECT. These difficulties could be solved with the centralization of ECT provision to a few centres in the country together with defining the pathways for patients to reach these centres.

Background: Electroconvulsive therapy (ECT) was rarely used in Hungary in 2002, and the majority of patients receiving ECT were diagnosed with schizophrenia. This study aimed to explore the use of ECT in Hungary in 2014., Methods: Two semi-structured questionnaires were sent to all acute adult psychiatric units in Hungary. The first questionnaire contained items concerning ECT use, and the second explored the reasons for not using ECT., Results: Fifty-eight acute psychiatric inpatient units were identified, and 54 replied. Although 27 indicated that they used ECT, only 22 actually performed ECT in 2014. Thirty-one units did not offer ECT at all. In 2014, 174 patients received ECT in Hungary, constituting 0.59% of all inpatients treated in the departments where it was offered, equating to 0.176 patients/10,000 population. The indication for ECT shifted from schizophrenia in 2002 (55.6%) to mood disorders in 2014 (58.5%), but the absolute number of ECT-treated patients with mood disorders (110 vs 102) did not change. Reasons for not using ECT included the lack of an ECT machine, unavailability of an anesthesiologist, lack of finances, and lack of experienced staff., Conclusions: In view of the high frequency of depression and suicide in Hungary, it is very likely that a significant minority of patients who would benefit from ECT cannot access it, which constitutes a violation of their right to the best possible treatment. The main reasons for the inadequate ECT service are the underfinanced hospital system and a lack of necessary knowledge.

Hermansky-Pudlak syndrome (HPS) is a rare autosomal recessive disorder caused by mutations in one of nine genes involved in the packaging and formation of specialized lysosomes, including melanosomes and platelet-dense granules. The cardinal features are pigmentary dilution, bleeding diathesis, and accumulation of ceroid-like material in reticuloendothelial cells. Pulmonary fibrosis induced by tissue damage is seen in the most severe forms, and one subtype is characterized by immunodeficiency. We describe two patients with HPS type 1 and review the updated gene-based classification, clinical features, and recommendations for evaluation and follow-up., (© 2017 Wiley Periodicals, Inc.)

Background: Sedentary behavior (including sitting) is negatively associated with physical health, independent from physical activity (PA). Knowledge on the associations with mental health is less elaborated. Therefore this study aims to investigate the relationship between sitting and 5 indices of mental health in adults (psychological distress, depression, anxiety, somatization, and sleeping problems), and between sitting interactions (sitting×gender, sitting×age, sitting×education, and sitting×PA) and these mental health indices., Methods: A cohort of Belgian adults (25-64 years; n = 4344) provided self-reported data on sitting and PA and on 5 mental health indices. Cross-sectional associations were examined using multiple linear regression analyses., Results: Analyses adjusted for gender, age, education, and PA showed significant positive associations between sitting and the 5 mental health indices (P < .05). All associations were true for both men and women, and for low and high educated individuals, while some were only found in older individuals (somatization, P < .001) and those being insufficiently active (psychological distress, P = .007; depression, P = .002; and anxiety, P = .014)., Conclusions: More sitting seems to be associated with poorer mental health, independently of gender, age, education, and PA. Moderation analyses showed that these associations may differ according to age and PA levels.

Background: The present study aimed to explore associations of physical activity (PA), waist circumference (WC) and body mass index (BMI) with subjective health in a nationally representative sample of Belgian adults., Methods: Data from the 2004 Belgian Food Consumption Survey were used. A face-to-face questionnaire about sociodemographic and socioeconomic characteristics, general health, subjective health, lifestyle and PA was completed. Weight and height were self-reported, and WC was measured in orthostatic position. PA was assessed by the short International PA Questionnaire., Results: In total, 3208 individuals (49.9% women) were included in the study. About 41.3% of the Belgian population did not meet the minimum recommendations for PA, whereas 24.8% of the population engaged in health-enhancing PA. In total, 29.5% of the population was overweight, 10.1% was obese and 33.2% of the population had an excessive WC. About 23.6% of the population rated their health as poor. Obese individuals were significantly less likely to report good subjective health than those with normal BMI [odds ratio (OR) = 0.538; 95% confidence interval (CI): 0.390-0.742]. This association was also identified for men and women separately. Further, both individuals who participated in health-enhancing PA and those who participated in recommended PA reported significantly better subjective health than insufficiently active individuals (OR = 2.533; 95% CI: 1.952-3.287 and OR = 1.543; 95% CI: 1.256-1.894, respectively)., Conclusions: A strong association was found between PA and subjective health, and in addition, a significant negative association was found between BMI and subjective health. There was no relationship between WC and subjective health among Belgian adolescents and adults.

Jellyfish envenomation often causes an immediate painful vesiculopapular eruption. Less commonly it can cause a type IV allergic hypersensitivity that manifests with delayed or recurrent cutaneous lesions at the primary site or distant from the primary site. These secondary reactivations may be related to high antijellyfish immunoglobulin levels, intracutaneously sequestered antigen, or cross-reacting venom. Immunomodulators such as pimecrolimus and tacrolimus and topical and intralesional corticosteroid therapy decrease this recurrent dermatitis. We report a case of a 9-year-old girl with a recurrent jellyfish dermatitis lasting more than 1 year after the initial envenomation. The dermatitis finally resolved after treatment with tacrolimus and intralesional triamcinolone acetonide therapy., (© 2014 Wiley Periodicals, Inc.)

Objective: To explore gender-specific variations related to activity intensity in the relationship between physical activity (PA) and mental health (MH). Evaluating whether psychological well-being enhances with increases in PA at recommended levels and above, in the general population., Design: Cross-sectional., Setting: Population-based, representative for Belgium., Subjects: A total of 6803 adults aged 25-64 years from the Belgian National Health Interview Survey., Results: Multiple logistic regression analyses showed that clearly different intensity levels characterised the PA that associated with MH in women and men. In men, inverse associations existed between participation in vigorous-intensity PA and feelings of depression (OR = 0.580; 95 % CI 0.405, 0.830), anxiety (OR = 0.547; 95 % CI 0.364, 0.821) and symptoms of somatisation (OR = 0.590; 95 % CI 0.398, 0.874). In women, positive associations existed between walking and emotional well-being (OR = 1.202; 95 % CI 1.038, 1.394) and inverse associations between participation in moderate-intensity PA and symptoms of somatisation (OR = 0.737; 95 % CI 0.556, 0.977). Secondary analyses confirmed that differences in psychological complaints were significant for vigorous PA in men, and for moderate PA in women, whereas differences in emotional well-being were significant for walking exclusively in women., Conclusions: In the general population, the PA-MH relationship is always positive, regardless of activity intensity. In men, it addresses complaints (symptoms, palpable discomfort) and the optimal PA intensity is high. In women, it addresses complaints, but also distress (lowered mood, disturbing anxiety, altered well-being) and the PA intensity is mild.

Findings of previous studies suggest that the relationship between physical activity and mental health may change across different domains of physical activity, different dimensions of mental health, and different population subgroups. The present study examined associations between five types of physical activity with different contents: housework, leisure active transportation, biking to/from work, walking to/from work, and sports participation, and two dimensions of mental health: perceived stress and psychological distress, in 1919 participants aged 20-65 years, using the data from the Flemish Policy Research Centre Sport, Physical Activity and Health. Multiple logistic regression analyses were performed with the total sample, and with the sample stratified by gender, age, and occupational category. Further, separate models were used in the gender and age subgroups of each occupational category. Sports participation was the only type of physical activity inversely associated with both stress (OR=0.375; CI: 0.200-0.704) and distress (OR=0.480; CI: 0.253-0.910). Sports participation related to less distress in unemployed mid-aged adults, and to less stress in unemployed women, unemployed young adults, and young adults with blue-collar jobs. Housework was associated with more stress and more distress in women with blue-collar jobs. In young adults with white-collar jobs, however, an inverse association between housework and distress was found. Biking to and from work was associated with more stress in men with blue-collar jobs. Results invite consideration for the utility, and perhaps the necessity, of differentiated health recommendations for physical health and for mental health in different population subgroups.

The hepatotoxin cylindrospermopsin (CYN) is a potent inhibitor of protein synthesis in mammalian cells. It is produced by freshwater cyanobacterial blooms in countries such as Australia, the United States, Israel, Thailand, and Brazil. An interlaboratory comparison was organized as a first step to evaluate the measurement of CYN in lyophilized cyanobacterial cells. Six laboratories from Europe, Israel, and Australia participated in the trial. All of the methods used for extraction of the toxin and the high-performance liquid chromatography (HPLC) analysis were satisfactory on the basis of statistical evaluation, according to ISO standards 5725-1 and -2. Further comparison of all the extraction methods by the organizer indicated that the most effective extraction procedure used 5% formic acid to prevent interference in chromatograms by contaminant compounds when analyzed using HPLC employing isocratic conditions of 5% (v/v) aqueous methanol plus 0.1% (v/v) trifluoroacetic acid as the mobile phase.

The authors report the rare case of a simultaneous (intra- and extrauterine) pregnancy that ended with a mature delivery. (This case is the sixth in the Hungarian medical literature.) They discuss the reasons of occurrences, draw the attentions to the dangers of the disease.

In the period between 1973 and 1976, in order to prevent neonatal RDS, 24 insulin-dependent diabetic mothers were given Dexamethason before delivery. The treated group was compared with a control group comprising 26 women of the same gesational age, severity of diabetes and mode of delivery. Neonatal care was similar in both groups. In the group where steroid prophylaxis was applied, decrease of RDS morbidity and mortality was observed. The authors accentuate that Dexamethason given to the mother may have an unfavourable effect on carbohydrate metabolism. Therefore, it is recommended to perform 4-hour determinations of blood sugar, urinary sugar and acetone and accordingly, modification of therapy.

The lecithin-sphingomyelin ratio was determined by the authors, applying Gluck's technique to 98 amniotic fluid samples of 55 pregnant patients with diabetes, depending on gestational age. Amniocentesis was preceded by ultrasonic placentography. Carbohydrate metabolism of this group was kept under optimum management and regulation. Its L/S ratio (3.1) was twice as much as that recorded from another group of patients (1.5) without adequate management of the carbohydrate metabolism. The rate of complications in the first group was below that in the second. -- It has been emphasised by the authors that variation in the L/S ratio along with gestational age depended not only on the severity of the given course of diabetes but, as well, on the management of the carbohydrate metabolism during pregnancy. They found that in any pregnancy under the conditions of diabetes the L/S ratio was an important criterion for diagnostic assessment of foetal lung maturity.

The usefulness and side-effects of intrauterine contraceptive devices (IUDs) are evaluated on the basis of various aspects (e. g. effect of postabortal and post-partal insertion, expulsion of device, frequency of pregnancies, bleeding and inflammation, etc.) [1, 2, 3, 4]. However, the incrustation of the device has been ignored although the coating on the major part of the surface is easy to study. The rough surface coating is very likely to be associated with some side-effects [5]. In our report we have tried to find some links between the degree of incrustation and the duration of using the device.