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Decision support systems play an important role in medical fields as they can augment clinicians to deal more efficiently and effectively with complex decision-making processes. In the diagnosis of headache disorders, however, existing approaches and tools are still not optimal. On the one hand, to support the diagnosis of this complex and vast spectrum of disorders, the International Headache Society released in 1988 the International Classification of Headache Disorders (ICHD), now in its 3rd edition: a 200 pages document classifying more than 300 different kinds of headaches, where each is identified via a collection of specific nontrivial diagnostic criteria. On the other hand, the high number of headache disorders and their complex criteria make the medical history process inaccurate and not exhaustive both for clinicians and existing automatic tools. To fill this gap, we present head-asp, a novel decision support system for the diagnosis of headache disorders. Through a REST Web Service, head-asp implements a dynamic questionnaire that complies with ICHD-3 by exploiting two logical modules to reach a complete diagnosis while trying to minimize the total number of questions being posed to patients. Finally, head-asp is freely available on-line and it is receiving very positive feedback from the group of neurologists that is testing it.
The purpose of this study is to contribute to the knowledge of the clinical characteristics of the bipolar spectrum by examining factors associated to course of symptoms in BP patients. We evaluated differences between acutely depressed versus subthreshold mixed patients.
90 depressed patients (Group 1, HDRS: 18.2±4.6, YMRS: 1.4±2.9) and 41 patients presenting a mixed subthreshold symptomathology (Group 2, HDRS: 9.1±3.2, YMRS: 9.6±6.4) were included in the study. All patients underwent structured diagnostic interviews for axis I and axis II disorders (SCID-I, SCID-II) and have been submitted to psychometric assessment with Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS), Young Mania Rating Scale (YMRS), Global Assessment Scale (GAS), Social Adjustment Self-reported Scale (SASS), Quality of Life Scale (QoL), at baseline and repeated follow-up (1, 3, 6, 12 months). Personality dimensions were evaluated by Temperament and Character Inventory (TCI-R).
The most important result is the slight increase in depressive symptoms in subthreshold mixed patients after 3 months of treatment. These patients were more likely diagnosed as BP-I, were non-SUD patients and/or non-comorbid for axis II personality disorders and had a shorter duration of current episode prior intake. Measures of social and functional adjustment were not different in the two groups, though a slight trend for depressed patients to report a poorer quality of life. No difference in personality traits were observed among the two samples.
Our study confirms the importance of considering subthreshold symptoms in the evaluation and treatment of patients with Bipolar Disorder.
Behavioural addictions (BAs) can be understood as disorders characterized by repetitive occurrence of impulsive and uncontrolled behaviours. Very few studies have investigated their association with mood disorders. The present study was undertaken to determine the prevalence of the main behavioural addictions in a sample of bipolar outpatients in euthymic phase or stabilised by medications and to investigate the role of impulsivity and temperamental and character dimensions.
One-hundred-fifty-eight Bipolar Disorder (BD) (DSM-IV) outpatients were assessed with tests designed to screen the main behavioural addictions: pathological gambling (SOGS), compulsive shopping (CBS), sexual (SAST), internet (IAD), work (WART) and physical exercise (EAI) addictions. TCI-R and BIS-11 were administered to investigate impulsivity and personality dimensions mainly associated with BAs. The clinical sample has been compared with 200 matched healthy control subjects.
In bipolar patients, 33% presented at least one BA respect to the 13% of controls. Significantly higher scores at the scales for pathological gambling (p< .001), compulsive buying (p< .05), sexual (p< .001) and work addictions (p< .05) have been found. Self-Directness (p=.007) and Cooperativeness (p=.014) scores were significantly lower while impulsivity level was significantly higher (p=.007) in bipolar patients with BA than those without BA.
To our knowledge, this is the first study investigating the prevalence of behavioural addictions in BD showing a significant association of these disorders. BAs are more frequent in bipolar patients than in healthy controls and are related to higher impulsivity levels and character immaturity.
The aim of the present study was to thoroughly investigate the existing comorbidity between Axis II and Bipolar Disorder (BD) pointing out as well the meaningful existing comorbidity between Personality Disorders and Cyclothymia.
Materials and methods
A study group composed of 70 patients affected by Bipolar Disorder (Type I, Type II, and Cyclothymia) was enrolled at the Bipolar Disorders Unit of the Catholic University of the Sacred Heart of Rome. Axis I diagnosis was made by SCID-I; Axis II diagnosis was made by SCID-II.
In a sample of 70 patients in euthymic phase, 39 patients (55.7%) showed comorbidity with Axis II Disorders. Clusters were represented as follows: 2 patients (5.1%) fell within cluster A; 24 patients (61.5%) within cluster B; 9 patients (23%) within cluster C; and 4 patients (10.4%) turned out to be affected by NAS Personality Disorders. On the whole 39 patients - 24 patients (61.5%) affected by BD I, 6 patients (15.3%) affected by BD II, and 9 patients (23.0%) affected by Cyclothymia were found to have comorbidity with Axis II Disorders. Besides, in our sample there was a significant comorbidity between Cyclothymia and Personality Disorders.
More than half of patients (55.7%) showed comorbidity with Axis II Disorders. Moreover most of patients turned out to be affected by Personality Disorders falling within cluster B while 23% of Cyclothymic patients were found to have comorbidity with Axis II Disorders.
Dans les cas des troubles bipolaires, les taux de comorbidité avec un TDAH peut varier entre 9,5 % et 27 % . Ces patients présentent un début de trouble plus précoce, avec plus d’épisodes dépressifs et des épisodes mixtes. Il existe peu d’étude sur le lien entre ces deux pathologies et les différentes dimensions de personnalité selon le modèle de Big Five.
Notre étude comporte 106 patients souffrant de dépression, 102 patients bipolaires et 120 témoins, tous homogènes vis-à-vis de leurs caractéristiques démographiques. Le diagnostic de TDAH se basait sur les critères DSM-IV-TR. Les traits de TDAH étaient autoévalués avec la Wender Utah Rating Scale (WURS), la Adult ADHD Self-rating Scale (ASRS) et la Brown Attention Déficit Disorder Scale (ADD). L’Inventaire de Personnalité-Révisé, le NEO PI-R, servait également à évaluer les dimensions de la personnalité au sein des groupes cliniques.
15,7 % des adultes souffrant d’un trouble bipolaire et 7,5 % souffrant d’une dépression sévère manifestaient une comorbidité d’un TDAH en comparaison avec seulement 3,3 % des témoins. Il existe des corrélations significatives entre des traits de personnalité et la présence d’un TDAH. Une analyse de régression logistique de l’ensemble des 208 sujets cliniques a montré que ceux avec des faibles niveaux de névrosisme manifestaient un taux moins important de comorbidité avec un TDAH.
Notre étude souligne le lien entre des troubles de l’humeur, notamment les troubles bipolaires, et la présence d’un TDAH chez des adultes. Nos résultats soutiennent la nécessité d’évaluer les sujets souffrant des troubles d’humeur sur une éventuelle comorbidité de TDAH en milieu clinique. Il faudra étudier d’une façon plus approfondie ces traits de personnalité et les liens entre des troubles de l’humeur et un TDAH afin de pouvoir adapter la prise en charge.
Adolescence seems to be a critical period of addiction vulnerability, based on both neurobiological, social, and familiar factors. The earlier onset of behavioural/substance dependence seems to predict greater addiction severity, morbidity, and multiple addictive disorders. The aim of this study was to assess the presence of multiple addictions in an Italian adolescent high-school population.
Data were collected from a sample of 2907 high school students recruited in the area of Barletta (Puglia) and Latina (Lazio). The sample had an average age of 16.69+/-1.89 years. Through different multi-item scales we evaluated different behavioural addictions: Pathological Gambling, Internet Addiction, Compulsive Buying, Sexual Addiction, Relationship Addiction, Mobile Phone Addiction, Exercise Addiction, Work Addiction.
the presence of pathological gambling was found in 4.4%, compulsive buying in 8.3%, internet addiction in 1.1%, work addiction in 7.2%, exercise addiction in 6.7% of the subjects. Males showed higher scores (p<.001) for pathological gambling, internet and exercise addiction, whereas females showed an higher score (p<.001) for mobile phone addiction. A positive correlation (p<.001) was found between all the scale employed, apart from the Compulsive Buying Scale, which was negatively correlated (p<.001) with the other scales.
The high number of subjects reporting a behavioural dependence is an unexpected data, which creates concern, and need an adequate analysis. It should be valued if these typologies of “addiction without the substance” are a temporary phenomenon occurring in adolescents or if they are a stable trait, and a consequent risk factor for a substance misuse.
The aim of our study is the investigation of burn-out indexes in public mental health services employees (psychiatrists, psychologists, nursing staff, care providers) working with patients affected by Bipolar Disorder in order to correlate them with patients’ indexes of satisfaction about received treatment and care.
A sample of 20 employees of mental health services (psychiatrists, psychologists, nurses) and one consisting of 22 patients with a diagnosis of Bipolar Disorder have been recruited at the Bipolar Disorders Unit of the Day Hospital of Psychiatry of the A. Gemelli Hospital in Rome. Operators have been submitted the Maslach Burnout Inventory (Emotional distress, Depersonalization, Personal satisfaction/achievement/fulfilment) while patients have been submitted the Questionnaire on Satisfaction of patient (QS)
By calculating the Spearman Correlation Coefficient the Depersonalization dimension proves highly correlated with the three subscales of QS: Doctor-Patient relationship quality (-.51); Information Quality and Doctor's therapeutic competence (-.48); Efficiency of service organization (-.58)
In our sample high levels of Depersonalization are correlated to a low satisfaction of patients. We therefore expect low levels of Depersonalization to be correlated with a higher satisfaction of the patient. Although it is not possible to generalize these results we can hypothesize that burn out negatively influences patients’ satisfaction.
Our study represents a pilot evaluation about how the MOOD-SR recognizes subthreshold manifestations that may be associated with clinical symptomatology in a group of bipolar patients.
At Day Hospital of Psychiatry, Policlinico “A. Gemelli”, Bipolar Disorders Unit, it has been conducted an experimental study on a heterogeneous sample of 24 patients with a diagnosis of Bipolar Disorder type I. Patients have been assessed with the MOOD-SR, a clinical self-reported interview, that is specific for the spectrum of subthreshold pathology, and with the Quality of Life (QoL), that investigates the patient's quality of life.
We have found that 16 patients on 24 report a score higher than 60 (68,4%). Among these, 10 female patients on 15 have a total score higer than 61 (68.75%) while 6 male patients on 9 obtain a total score higher than 60 (62,5%). However, these results have only preliminary value, further studies are needed in order to obtain a deeper evaluation.
Spectrum manifestations are both indicator of course and response to treatment and predictive for relapse. This finding may represent an important preventive instrument for maniacal relapse in patients with Bipolar Disorder, that is often underdiagnosed or confused for Unipolar Depression. By adequately recognizing the problem we will be able to refine diagnosis and individualize therapy.
A significant comorbidity between attention-deficit/hyperactivity disorder (ADHD) and affective disorders has been consistently reported in adults. Less data regarding the role of personality traits, and the influence of ADHD co-occurrence on clinical characteristics and outcome of mood disorders are currently available.
The sample consisted of 296 subjects, divided into three homogeneous groups according to demographic characteristics: 106 subjects diagnosed with major depressive disorder, 92 with bipolar disorders and 98 healthy controls. ADHD diagnosis was based on DSM-IV-TR criteria. Childhood and adult ADHD features were measured with the Wender Utah Rating Scale (WURS), the Adult ADHD Self-rating Scale (ASRS) and the Brown Attention Deficit Disorder Scale (ADD). The Hospital Anxiety and Depression Scale (HAD) and the Revised NEO Personality Inventory (NEO-PI-R) were also administered to the clinical groups, in order to investigate depressive/anxious symptoms and personality dimensions.
The prevalence of adult ADHD in subjects with bipolar disorders or major depressive disorder was 22.0% and 8.5% respectively (p < .001), compared to 3.1% in healthy controls. Significant associations between personality traits, depressive/anxious symptoms and ADHD features were found.
The present study emphasises the close relationship between affective disorders, especially bipolar disorders, and ADHD in adults. Our findings support the need to assess subjects with mood disorders in the clinical setting for possible co-existing ADHD and to further investigate personality traits to better understand the etiology of affective disorders and ADHD co-occurrence.
Illicit drug use is well known as an important contributor to the global burden of diseases, but the physical and psychopathological risks of recreational drugs misuse are often underestimated and drug-related fatalities in specific settings are under-investigated.
Objectives and methods
In the framework of the EU-funded project “EU-Madness”, we collected and analysed all the reports of drug-related fatalities in Ibiza from January 2010 to September 2016, with the aim of characterising the sample, and identifying the involved substances and the nature of deaths associated with their consumption.
Overall, 58 drug-related fatalities were registered from 2010 to September 2016 (87.9% males, 12.1% females, mean age 33.16; females were significantly younger than males). Most of the deceased were Britons (36.2%), followed by Spanish (22.4%), Italians (6.9%) and Germans (5.2%). In half the cases, the substance identified in post-mortem analyses was a stimulant; in 24.1% of the sample it was a depressor a prescription drug or more than two substances in 22.4%. Most of the fatalities were due to cardiovascular accidents (62%); 22.4% were deaths by drowning, 12% by fall from heights and 3.4% were due to mechanical asphyxia.
According to the results from our sample, stimulants (mainly MDMA and cocaine) are the substances of abuse involved in most drug-caused fatalities. The number of fatalities per year has been steadily increasing, but the growing diffusion of novel psychoactive substances (NPS) does not seem to be a direct cause (although better methods of their analysis in post-mortem samples should be designed).
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Although the diagnosis of bipolar disorder is currently based on clinical criteria, preliminary studies showed that palmitic and arachidonic acid levels are able to discriminate adult patients with major depressive disorder (MDD) from those with bipolar disorder (BD).
To replicate and to expand previous findings by investigating the relation between mood disorders and platelet and plasmatic fatty levels.
To compare the lipidic profile of individuals with different mood disorder (MDD vs. BD) and to investigate the relation with specific clinical features (duration of illness, attempted suicide, psychotic symptoms).
Potential participants were recruited from the outpatient and inpatient psychiatric units of the university hospital of Palermo (Italy). Diagnosis of DSM IV mood disorders was made using the MINI. Symptom severity was assessed using the HAM-D rating scale and the YMRS. Fatty acid profile was analyzed using mass spectrometry.
Preliminary analyses were performed on 8 patients with MDD and 6 with BD. Groups were similar in terms of demographic variables. Patients with MDD showed highest levels of platelet palmitic acid, stearic acid, and arachidonic acid. Furthermore, plasmatic docosahexaenoic acid was negatively related with manic symptoms severity (Rho = –0.697; P = 0.025) and platelet alpha linolenic acid was positively related with illness duration (Rho = 0.845; P = 0.040).
These preliminary findings suggest that platelet fatty acids may be possible biological markers to improve the diagnosis of BD.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Scholarly literature claims that health declines in populations when optimism about investing in the future wanes. This claim leads us to describe collective optimism as a predictor of selection in utero. Based on the literature, we argue that the incidence of suicide gauges collective optimism in a population and therefore willingness to invest in the future. Using monthly data from Sweden for the years 1973–2016, we test the hypothesis that the incidence of suicide among women of child-bearing age correlates inversely with male twin births, an indicator of biological investment in high-risk gestations. We find that, as predicted by our theory, the incidence of suicide at month t varies inversely with the ratio of twin to singleton male births at month t + 3. Our results illustrate the likely sensitivity of selection in utero to change in the social environment and so the potential for viewing collective optimism as a component of public health infrastructure.
In this paper, we study some connections between the polynomial ring
and the differential polynomial ring
. In particular, we answer a question posed by Smoktunowicz, which asks whether
is nil when
is nil, provided that
is an algebra over a field of positive characteristic and
is a locally nilpotent derivation.
OBJECTIVES/SPECIFIC AIMS: To establish an effective team of researchers working towards developing and validating prognostic models employing use of image analyses and other numerical metadata to better understand pediatric undernutrition, and to learn how different approaches can be brought together collaboratively and efficiently. METHODS/STUDY POPULATION: Over the past 18 months we have established a transdisciplinary team spanning three countries and the Schools of Medicine, Engineering, Data Science and Global Health. We first identified two team leaders specifically a pediatric physician scientist (SS) and a data scientist/engineer (DB). The leaders worked together to recruit team members, with the understanding that different ideas are encouraged and will be used collaboratively to tackle the problem of pediatric undernutrition. The final data analytic and interpretative core team consisted of four data science students, two PhD students, an undergraduate biology major, a recent medical graduate, and a PhD research scientist. Additional collaborative members included faculty from Biomedical Engineering, the School of Medicine (Pediatrics and Pathology) along with international Global Health faculty from Pakistan and Zambia. We learned early on that it was important to understand what each of the member’s motivation for contributing to the project was along with aligning that motivation with the overall goals of the team. This made us help prioritize team member tasks and streamline ideas. We also incorporated a mechanism of weekly (monthly/bimonthly for global partners) meetings with informal oral presentations which consisted of each member’s current progress, thoughts and concerns, and next experimental goals. This method enabled team leaders to have a 3600 mechanism of feedback. Overall, we assessed the effectiveness of our team by two mechanisms: 1) ongoing team member feedback, including team leaders, and 2) progress of the research project. RESULTS/ANTICIPATED RESULTS: Our feedback has shown that on initial development of the team there was hesitance in communication due to the background diversity of our various member along with different cultural/social expectations. We used ice-breaking methods such as dedicated time for brief introductions, career directions, and life goals for each team member. We subsequently found that with the exception of one, all other team members noted our working environment professional and conducive to productivity. We also learnt from our method of ongoing constant feedback that at times, due to the complexity of different disciplines, some information was lost due to the difference in educational backgrounds. We have now employed new methods to relay information more effectively, with the use of not just sharing literature but also by explaining the content. The progress of our research project has varied over the past 4-6 months. There was a steep learning curve for almost every member, for example all the data science students had never studied anything related to medicine during their education, including minimal if none exposure to the ethics of medical research. Conversely, team members with medical/biology backgrounds had minimal prior exposure to computational modeling, computer engineering and the verbage of communicating mathematical algorithms. While this may have slowed our progress we learned that by asking questions and engaging every member it was easier to delegate tasks effectively. Once our team reached an overall understanding of each member’s goals there was a steady progress in the project, with new results and new methods of analysis being tested every week. DISCUSSION/SIGNIFICANCE OF IMPACT: We expect that our on-going collaboration will result in the development of new and novel modalities to understand and diagnose pediatric undernutrition, and can be used as a model to tackle several other problems. As with many team science projects, credit and authorship are challenges that we are outlining creative strategies for as suggested by International Committee of Medical Journal Editors (ICMJE) and other literature.
Newborn adiposity, a nutritional measure of the maternal–fetal intra-uterine environment, is representative of future metabolic health. An anthropometric model using weight, length and flank skinfold to estimate neonatal fat mass has been used in numerous epidemiological studies. Air displacement plethysmography (ADP), a non-invasive technology to measure body composition, is impractical for large epidemiological studies. The study objective was to determine the consistency of the original anthropometric fat mass estimation equation with ADP. Full-term neonates were studied at 12–72 h of life with weight, length, head circumference, flank skinfold thickness and ADP measurements. Statistical analyses evaluated three models to predict neonatal fat mass. Lin’s concordance correlation coefficient, mean prediction error and root mean squared error between the predicted and observed ADP fat mass values were used to evaluate the models, where ADP was considered the gold standard. A multi-ethnic cohort of 468 neonates were studied. Models (M) for predicting fat mass were developed using 349 neonates from site 1, then independently evaluated in 119 neonates from site 2. M0 was the original anthropometric model, M1 used the same variables as M0 but with updated parameters and M2 additionally included head circumference. In the independent validation cohort, Lin’s concordance correlation estimates demonstrated reasonable accuracy (model 0: 0·843, 1: 0·732, 2: 0·747). Mean prediction error and root mean squared error in the independent validation was much smaller for M0 compared with M1 and M2. The original anthropometric model to estimate neonatal fat mass is reasonable for predicting ADP, thus we advocate its continued use in epidemiological studies.
The ‘DOHaD’ literature argues that stressors encountered at age t ‘program’ individual health at age t+n, and that this programming appears strongest when t defines critical developmental periods including gestation. Accordingly, children of ill-nourished pregnant women suffer greater later life morbidity than do offspring of well-nourished mothers. The possibility that circumstances other than access to nutritious food drive both a mother’s diet and fetal development remains, however, a threat to the inference of programming in utero. Attempts to rule out this threat include tests of the hypothesis that birth cohorts in gestation during famines exhibit shorter life spans than other cohorts. The tests produce conflicting results attributed to confounding by autocorrelation, selective migration and introduction of modern medicine. We offer a test in which neither medicine nor migration nor autocorrelation could obscure the presumed effect. We apply time-series regression methods to the life span of Swedes born between 1751 and 1800 to test the hypothesis that cohorts exposed in utero to the Swedish Famine of 1773 lived shorter lives than expected from trends and other forms of autocorrelation. We use these 50 birth cohorts not only because they included those exposed to severe famine but also because they may well be the only human birth cohorts that completed life unaffected by selective migration and unaided by modern medicine and for which we know life span. We find that the cohort born in 1773 live 4.2 years longer than expected from trends over the last half of the 18th century.
Hydatigera (Cestoda: Taeniidae) is a recently resurrected genus including species seldom investigated in sub-Saharan Africa. We surveyed wild small mammal populations in the areas of Richard Toll and Lake Guiers, Senegal, with the objective to evaluate their potential role as intermediate hosts of larval taeniid stages (i.e. metacestodes). Based on genetic sequences of a segment of the mitochondrial DNA gene cytochrome c oxidase subunit 1 (COI), we identified Hydatigera parva metacestodes in 19 out of 172 (11.0%) Hubert's multimammate mice (Mastomys huberti) and one out of six (16.7%) gerbils (Taterillus sp.) and Hydatigera taeniaeformis sensu stricto metacestodes in one out of 215 (0.5%) Nile rats (Arvicanthis niloticus). This study reports epidemiological and molecular information on H. parva and H. taeniaeformis in West African rodents, further supporting the phylogeographic hypothesis on the African origin of H. parva. Our findings may indicate significant trophic interactions contributing to the local transmission of Hydatigera spp. and other parasites with similar life-cycle mechanisms. We therefore propose that further field investigations of rodent population dynamics and rodent-borne infectious organisms are necessary to improve our understanding of host–parasite associations driving the transmission risks of rodent parasites in West Africa.
We here propose a new kinematic picture of central Sicily based on the results of detailed field mapping of the region, combined with structural analyses and the interpretation of the available literature subsurface data. Our study focused on the tectonic boundary of a structural depression, the Caltanissetta Trough, which is now filled with allochthonous terrains resting on the deep-seated inverted African palaeomargin units. Our data refer to the tectonosedimentary evolution of the thrust-top basins, from Late Tortonian to Quaternary times. The study points out the occurrence of regional E–W-oriented dextral shear zones, cutting the NE-oriented trends of the thrust belt. This new evidence would confirm the major role of the E–W trend in the tectonic inversion of the external portions of the Africa palaeomargin in Sicily. Our results could contribute to a better understanding of the location in Sicily of the tectonic lineaments accommodating the hundreds of kilometres of lateral displacement, caused by the Late Miocene–Quaternary Tyrrhenian Basin opening to the north of the island.