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A growing body of studies in wall-bounded turbulence has shown that the generation of wall-shear stress fluctuations is directly connected with outer-layer large-scale motions. In the present study, we investigate the scale-based structures of the streamwise wall-shear stress fluctuations (
) in turbulent channel flows at different Reynolds numbers. The wall-shear stress structures are identified using a two-dimensional clustering methodology, and two indispensable factors, scale and sign, are considered for the analysis. The structures are classified into positive and negative families according to the sign of
. The statistical properties of the structures, including geometrical characteristics, spatial distribution, population density, fluctuating intensity, and correlations with outer motions are comprehensively investigated. Particular attention is paid to the asymmetries between positive and negative structures and their connection with wall-attached energy-containing eddies. In virtue of our results, only the large-scale structures of negative
contain the footprints of the inactive part of wall-attached eddies populating the logarithmic region.
To compare the degree of strictness and agreement of different nutrient profiling models (NPM) used to identify which foods would be required to show front-of-package (FOP) warning labels.
Using data of 11 434 packaged foods found in the five largest food retailers in Brazil, we used two published NPM: the Pan American Health Organization (PAHO) model and the NPM used in the Chilean nutritional FOP labelling policy, and compared them with a NPM proposed by the Brazilian National Health Surveillance Agency (Anvisa). The proportion of foods that would be required to show FOP warning labels was calculated overall and by food category. We also tested whether a modified version of the PAHO NPM would behave similarly to the original version.
Two-thirds of the packaged products (62 %) would receive FOP warning labels under the PAHO NPM, as compared with 45 % of products using the proposed Anvisa NPM and 41 % if the Chilean NPM was applied. The PAHO NPM identified more foods high in critical nutrients such as sweetened dairy and non-dairy beverages, canned vegetables and convenience foods. Overall agreement between models was considered good with kappa coefficient ranging from 0·57 to 0·92 but was lower for some food categories.
We found variations in the degree of strictness and agreement between assessed NPM. The PAHO NPM identified more foods and beverages high in sugar which are among the top contributors to sugar and energy intake in Brazil.
Post-traumatic stress disorder (PTSD) is a prevalent mental health condition that is often associated with psychiatric comorbidities and changes in quality of life. Prolonged exposure therapy (PE) is considered the gold standard psychological treatment for PTSD, but treatment resistance and relapse rates are high. Trial-based cognitive therapy (TBCT) is an effective treatment for depression and social anxiety disorder, and its structure seems particularly promising for PTSD. Therefore, we evaluated the efficacy of TBCT compared to PE in patients with PTSD.
Ninety-five patients (77.6% females) who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, criteria for PTSD were randomly assigned to receive either TBCT (n = 44) or PE (n = 51). Patients were evaluated before and after treatment, and at follow-up 3 months after treatment. The primary outcome was improvement in PTSD symptoms as assessed by the Davidson Trauma Scale (DTS). Secondary outcomes were depression, anxiety, and dysfunctional attitudes assessed by the Beck Depression/Anxiety Inventories and Dysfunctional Attitudes Scale, as well as the dropout rate.
A significant reduction in DTS scores was observed in both arms, but no significant difference between treatments. Regarding the secondary outcomes, we found significant differences in depressive symptoms in favor of TBCT, and the dropout rate was lower in the TBCT group than the PE group.
Our preliminary results suggest that TBCT may be an effective alternative for treating PTSD. Further research is needed to better understand its role and the mechanisms of change in the treatment of this disorder.
One of the most important prognostic factors in patients diagnosed with schizophrenia is the number of hospitalizations they need during their life. In this work we describe risk factors which determinate psychotic relapse.
Retrospective review of the clinical histories of patients diagnosed with schizophrenia who needed hospitalization during the year 2008 using Hospital Ramon Cajal's history software. Data were analyzed using the SPSS software 15.0 version.
- Socio-demographic: We collected a total of 57 patients, 60% were men and 77,2% were single who lived with their families. 52,8% only had Primary education and 14% had been to University. 38,6% were pensioner and 12,3% workers.
- Risk factors: 54,4% had abandoned their medication, 7% had had recent modifications in their medication, and 35,1% received long acting antipsychotic. 42,1% were identified as substance users.
- 40,4% had been diagnosed with schizophrenia more than three years ago; 57,9% had had less than 3 previous hospitalizations, and 54,4% need hospitalization the previous year.
Male under 30 years old have more risk of needing more hospitalizations. The main risk factor for suffering new psychotic episodes is the medication nonadherence, modifying medication only causes new episodes in few patients. Patients receiving long-acting antipsychotic agents suffer less psychotic relapse. Substance abuse among schizophrenia patients is a major complicating factor since almost half of the hospitalizations are related to it.
To describe the relation of psychosocial factors of care (phase illness, years of care, free time, extra help and symptoms of depression) influence the care burden of dementia family caregivers. To measure the relation of the level of depressive symptoms on an intense level of burden of the dementia family caregivers.
Is selected a sample of 102 primary caregivers by criteria of inclusion to which a surveys do to those that the following information gathered: sociodemographic dates of the caregivers and of the dementia patients, care burden (Zarit Interview) and depressive symptoms (Beck Depression Inventory) of the family caregivers.
Most of the sample experiences an intense burden level (74%) opposite to a light level (26%). Psychosocial characteristics are as per statistics significant in increasing the care burden there were free time, extra help and presence of symptoms of depression. Presence of serious symptoms of depression on the intense burden level are differently front or those who had a minor burden, 22% and 5% respectively.
There are most of the daughter-father/mother and spouse-spouse caregiver couples with a high percentage of caregivers of feminine sex (as in most of the studies realized on caregiver of dependent persons at European and international level). The need for free time and psychic self-care are cost-effective strategies to prevent the depressive disorders, as well as, to improve their caregiver's work. The psychoeducation programs that have being realized at European level directed to family caregiver are necessary in our country.
Despite the use of antipsychotics as monotherapy is considered to be the standard treatment for schizophrenia and other psychotic disorders, many studies prove that antipsychotic polypharmacy (AP) is more frequent than expected in accordance to the experts' guidelines.
To analyze the prescription of long-acting risperidone (LAR) for schizophrenic patients discharged after being admitted in our BHU and its relationship with the AP.
Material and methods:
This retrospective study reviews the antipsychotics prescribed to those discharged patients diagnosed as schizophrenic who were admitted in our BHU during 2005. A total of 209 patients are included. The data are analyzed in relation to the prescription of antipsychotics for discharged patients on LAR and the antipsychotic combinations for those patients discharged on another antipsychotic regime, both as a complementary treatment and to cover the LAR therapeutic window.
57 patients (27%) were discharged on LAR. 42% were treated with benzodiazepines, 56% with anticholinergics and 16% with mood stabilizers. 79% of patients treated with LAR were discharged with another antipsychotic in combination: oral risperidone (58%), followed by amisulpiride (18%). Similar dosages were used in patients discharged only on LAR and those used in patients prescribed with more than one antipsychotic (p>0.05).
LAR could be an efficient strategy both to enable the treatment compliance and to achieve a monotherapy treatment. Despite LAR is frequently combined with another antipsychotic, in most cases oral risperidone is used, consequently avoiding the use of two antipsychotics of different kind in the same patient.
The diagnostic frontiers of social anxiety disorder (SAD) are still controversial, since it could be described as part of a continuum of severity rather than as a disorder based on an arbitrary threshold with qualitative distinctions. The present study aims to investigate possible differences among subjects along the social anxiety spectrum using the Simulated Public Speaking Test (SPST), an experimental model of human anxiety. Afterwards, the anticipatory measures of SPST among groups were correlated with different volume of gray matter areas by MRI using the voxel-based morphometry method.
We evaluated patients with generalized SAD (n=25), subjects with subclinical SAD (with fear of a social situation without avoidance or impairment; n=14) and healthy controls (n=22).
The subjective SPST findings showed that avoidance and functioning impairment were due to a negative self-evaluation in SPST and not to the level of anxiety experienced. When all groups were pooled together, there was a positive correlation between levels of anxiety experienced and the volume of the right amygdala. The negative self-evaluation of performance in the SPST was associated with a reduction in the volume of the anterior cingulated complex (ACC) only in the SAD group.
These results suggest that the association between anxiety and amygdala volume may be a part of a continuum of social anxiety. However, the correlation between self-evaluation of performance with reduced ACC volume only in the SAD group does not support the idea that this association may be also part of a continuum.
Natural polyamines (putrescine, spermidine and spermine) are low molecular weight highly protonated aliphatic molecules that physiologically modulate NMDA, AMPA/kainate glutamatergic receptors and limbic dopaminergic neurotransmission. Previous studies had demonstrated that polyamine metabolism might be disrupted in schizophrenia, what could potentially be linked to glutamatergic dysfunction. In particular, polyamine levels in blood and fibroblast cultures from patients with schizophrenia had previously been found to be higher than in healthy controls. Indeed, a significant positive correlation between blood polyamine levels and severity of illness may exist.
In order to test potential differences in blood polyamine levels between drug-free schizophrenia in-patients (n = 12), and healthy controls (n = 26, blood donors), spermidine (spd), spermine (spm), and spermidine/spermine index (spd/spm) were determined using HPLC after dansylation.
No significant differences were found between groups (t = 0,974; df = 36; P = 0,337 for spd, t = l0, 52; df = 36; P = 0,959 for Spm, and, t = 0, 662; df = 36; P = 0,512 for spd/spm).
Though we couldn’t replicate previous findings suggesting disturbances in blood polyamine levels in schizophrenia, this issue may be a promising target. Future research should take into account possible factors such as sex, nutritional state, and stress.
Until a patient is diagnosed of schizophrenia often receives another diagnoses. Reasons can be multiple: difficulty for the differential diagnosis in prodromical phases, comorbidity with other psychiatric disorders, abuse of substances, behaviour disorders, etc.
The aim of this study is to analyze the diagnosis that received in the first admission a sample of schizophrenia diagnosed patients.
Patients and Methods
Health histories of schizophrenia diagnosed patients who entered the Brief Hospitalization Unit of Dr R. Lafora Hospital in 2005 are analyzed. A total number of 162 patients is obtained. The diagnosis that received in the first entrance to our hospital is extracted from the health history.
A 64,4% of the patients with diagnosis of schizophrenia in 2005 were diagnosed of schizophrenia in their first entrance. Another 8,6% were diagnosed of psychotic nonspecified disorder. A 7,4% did not receive psychiatric diagnosis. 6,4% brief psychotic episode. A 3,1% psychotic disorder induced by substances. A 2,5% schizoaffective disorder. A 0,6% bipolar disorder. And a 6,2% received other diagnoses.
The data of our study indicated that a 28,2% of the schizophrenia diagnosed patients received another diagnosis previously (a 7,4% did not receive diagnosis to the discharge). Of the previously data, a 21,4% received diagnoses of psychotic disorders different from schizophrenia. This must probably response to temporary criteria for the diagnosis of schizophrenia (brief psychotic episode) prodromical forms (psychotic nonspecified disorder) and to substances use (psychotic disorder induced by substances) that make difficult the diagnosis in the early phases of the disease.
The request of diagnostic imagining techniques, such as CT, is sometimes necessary when working in the emergency service as a psychiatrist. Common circumstances that need CT are altered level of consciousness, absence of psychiatric history, sudden beginning of the symptoms or visual hallucinations.
To study the profitability of the cranial CT for patients with psychiatric symptoms in the Emergency Service.
Retrospective review of the cranial CT was made to patients who presented psychiatric symptoms in the Emergency Service of our hospital from November 2009 to July 2010 using Hospital Ramon Cajal’s history software.
We collected a total of 94 patients.-Sex: there were no important differences, 45,7% were women and 53,3% were men. -Age: < 18 years (3,2%), 18–30 years (12,8%), 31–40 (7,4%), 41–50 (26,6%), 51–60 (17%), 61–70 (14,9%), >71 (18,1%) Cause of consulting: The most frequent cause of consulting was “behavior disorder” (35,1%) and psychotic symptoms (14,9%). Other causes were altered level of consciousness and neurological symptoms.
Image findings: It stands out that up to a 63,8% of the patients had no significant radiological findings. The most frequent diagnosis (26,6%) was cortical-subcortical atrophy, followed by vascular cerebral illness in 9,6%.
Diagnosis: 20,2% were diagnosticated of psychotic disorder, 11,7% neurological disorder and 10,6% dementia.
- Only in 6,4% of the cases the image results were indispensable to reach a correct diagnosis.
- Cranial CT requests should not be made routinely and guides should be followed more strictly.
Use of antipsychotic drugs in monotherapy is considered the standard treatment for schizophrenia and other psychotic disorders. Nevertheless, exist numerous studies that show as the polypharmacy with antipsyhotics (PA) is much more frequent than it would be expected attending to experts recommendations.
The objective is to compare the prescription habits, in reference to the PA as well as to other psychotropic drugs, of 8 psychiatrists of a Psychiatric Hospitalization Unit.
Material and methods:
Review of the psychotropic drugs prescribed as maintenance treatment in schizophrenia patients (n=200) at outcome in 2005.
55,5% of 200 studied patients were registered with PA. This frequency oscillates between 78% and the 33,3% based on the psychiatrist. The patients received an average of 3,06 (DS 1,26) of psychotropic drugs; rank between 2,69 (DS 1,10) and 3,38 (DS 0,52) in relation to the psychiatrist. As maintenance treatment at outcome, it was prescribed an average of 1.61 (DS 0.65) of antipsychotics, rank 1.33 (DS 0,49) – 2,00 (DS 0.7). 33,2% patients received anticholinergics (17,1%-100% according to psychiatrist). Benzodiazepines were prescribed to 62,2% of patients (17,1%-100%). Mood stabilizer in the 16,7% of the cases (8%-41%). It is observed that those psychiatrists who use more PA use less benzodiazepines and anticholinergics.
PA extended practice in spite of therapeutic guides recommendations. Although differences between the psychiatrists from the study are observed, most of the patients have 3 psychotropic drugs as maintenance treatment at outcome: 1 or 2 antipsychotics, benzodiazepines and anticholinergic drugs.
There is a subpopulation of schizophrenic patients sometimes referred to as “revolving door” patients due to the frequency of readmissions in psychiatric units. Substance abuse and noncompliance with medication are the most important factors related to frequency of hospitalization. It has been related also with the number of previous admissions.
To describe the profile of the “revolving door” schizophrenic patient.
This retrospective study examines demographic and diagnostic features of the patients who met criteria for schizophrenia and have been admitted in our brief hospitalization unit during 2005. 209 adult patients were included. We compared the data of patients with only one admission (n=132) with those who have been admitted two or more times (n=77) in the period of study.
We detected a significative difference between the two groups in the number of previous hospitalizations. The group with one admission during 2005 had 3.75 previous hospitalizations (SD 5.34) vs. 6.37 previous hospitalizations (SD 5.75) for the group with two or more admissions during 2005 (p<0.01). No differences were found between the two groups about gender, age, the subtype of schizophrenia, substance abuse, the presence of another psychiatric illness, or the length of the stay.
Our study shows that the number of previous readmissions could be used as a main predictor of the risk of rehospitalization. This fact supports the results of other studies. However, we have not found the substance abuse as a predictor of earlier readmission, as other studies do.
Recent structural magnetic resonance imaging (MRI) studies have employed voxel-based morphometry (VBM) to investigate whether there are brain volumetric abnormalities of gray and/or white matter regions in schizophrenia. This VBM study investigated volumetric reductions in corpus callosum (CC) subregions in association with first-episode psychosis (FEP). Also, we investigated whether such changes were related to deficits in interhemispheric transfer of somatosensory information, using the Crossed Finger Localisation Test (CFLT).
122 FEP subjects and 94 controls were examined. MRI processing was performed using Statistical Parametric Mapping. In a subsample of 31 FEP subjects, we investigated correlations between CC volumes and performance on the CFLT. In this task, a fingertip on one hand is touched by the experimenter and the subject's task is to respond by touching with their thumb the corresponding finger on the other hand.
Relative to controls, FEP subjects showed volume reduction in a cluster located in the anterior CC genu (Z=3.77, p<0.001 uncorrected), which retained significance when analyses were restricted to the schizophrenia/schizophreniform subgroup (n=62) compared to controls (Z=3.16, p<0.001 uncorrected). In the subsample of FEP subjects who performed the finger localization task, there were two clusters of significant positive correlation between performance on the CFLT and CC volumes, respectively in the anterior genu (Z=3.77, p<0.001 uncorrected) and the posterior genu (Z=3.30, p<0.001 uncorrected).
These findings indicate the presence of circumscribed foci of reduced CC volumes in association with FEP, and suggest that such abnormalities are related to deficits in interhemispheric transfer of information.
Déterminer comment la résilience peut être comprise comme un facteur de protection qui empêche le développement des symptômes de l’anxiété et de la dépression chez les adolescents subissant les facteurs de stress majeurs.
Signification et importance
La résilience est la capacité à affronter, dépasser et être renforcée ou transformée par l’expérience de l’adversité. Vous pouvez identifier les facteurs de résilience dans quatre catégories : J’ai ; Je suis ; Je me sens ; Je peux.
Conception de la recherche
Il s’agit d’une étude descriptive écologique, qui cherche à passer à travers 62 entretiens semi-structurés avec les différents applicatifs de type STAIC 4 instruments (anxiété), BDI (dépression), FAMILLE APGAR (interdépendance), résilience face à l’adversité (résilience) ; avec faire de la population de référence choisie pour l’étude, de vérifier l’existence des épisodes mixtes anxieux et/ou dépressifs symptômes avant que la situation stressante en ce qui concerne la violence ou de l’immigration décrit, à partir des résultats obtenus lors des entrevues et l’application de ces instruments dans le même groupe d’âge des 12–17 ans dans deux zones géographiques et les différents facteurs de stress sociaux, mais très complexe (zone de conflit vs l’immigration).
Résilience définit comme tel devient présent capacités humaines dans les différentes communautés et permet aux adolescents de faire face aux adversités de la vie-la violence-conflit armé-l’immigration. Le réseau social existant, est l’un des pivots essentiels pour promouvoir le développement harmonieux des déterminants de la résilience. L’immigration déclenche des états d’anxiété chez les adolescents, y compris les idées de rejet, de la vulnérabilité et des changements dans leur identité.
Violence against health professionals impacts both on the individual and on healthcare systems. Almost 25% of workplace violence belongs to the health sector. In 2001-2002, UK registered 14 incidents per month per 1,000 healthcare workers. In Spain, one third of physicians reported in 2004 having experienced a violent episode during his career. In a study in 2006, 11% of healthcare professionals suffered physical assaults and 64% psychological violence (26.9% and 51.6% respectively at Psychiatric Services), but only a 3.7% of physical assaults and no cases of threats or insults were officially reported.
Rates of complaints are alarmingly low, which requires a comprehensive approach. The UK launched in 1999 the “Zero Tolerance Zone Campaign” and reported incidents increased substantially, with a reverse trend in their severity.
Many prevention plans, records, training courses and awareness campaigns have been developed in Spain and the Supreme Court started considering the assault on a public health professional as a “crime of assault of a public official” in 2007, which increased the penalty. The Unit for Violence Against Physicians (UVAP) was created in Catalonia by Barcelona’s College of Physicians in 2010, and gives comprehensive advice to doctors. The UVAP handles 3-4 incidents per month, mainly of low-level violence and UVAP actions ranges from legal or security advice to legal action against the aggressor. Cases handled by the UVAP represent only the tip of the iceberg, but a short survey among physicians suggest that the mere existence of the unit decreases increases the feeling of safety.