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Depressive and anxiety disorders are highly comorbid, which has been theorized to be due to an underlying internalizing vulnerability. We aimed to identify groups of participants with differing vulnerabilities by examining the course of internalizing psychopathology up to age 45.
We used data from 24158 participants (aged 45+) in 23 population-based cross-sectional World Mental Health Surveys. Internalizing disorders were assessed with the Composite International Diagnostic Interview (CIDI). We applied latent class growth analysis (LCGA) and investigated the characteristics of identified classes using logistic or linear regression.
The best-fitting LCGA solution identified eight classes: a healthy class (81.9%), three childhood-onset classes with mild (3.7%), moderate (2.0%), or severe (1.1%) internalizing comorbidity, two puberty-onset classes with mild (4.0%) or moderate (1.4%) comorbidity, and two adult-onset classes with mild comorbidity (2.7% and 3.2%). The childhood-onset severe class had particularly unfavorable sociodemographic outcomes compared to the healthy class, with increased risks of being never or previously married (OR = 2.2 and 2.0, p < 0.001), not being employed (OR = 3.5, p < 0.001), and having a low/low-average income (OR = 2.2, p < 0.001). Moderate or severe (v. mild) comorbidity was associated with 12-month internalizing disorders (OR = 1.9 and 4.8, p < 0.001), disability (B = 1.1–2.3, p < 0.001), and suicidal ideation (OR = 4.2, p < 0.001 for severe comorbidity only). Adult (v. childhood) onset was associated with lower rates of 12-month internalizing disorders (OR = 0.2, p < 0.001).
We identified eight transdiagnostic trajectories of internalizing psychopathology. Unfavorable outcomes were concentrated in the 1% of participants with childhood onset and severe comorbidity. Early identification of this group may offer opportunities for preventive interventions.
Telemedicine uses information and communication technologies to provide services in the field where the distance is a critical factor. The aim of the present study is to describe the experience of a synchronous telemedicine between two hospitals in Spain and Angola.
This is a retrospective observational study of all synchronous telemedicine sessions conducted between the Hospital Nossa Senhora da Paz in Angola and the Vall d'Hebron University Hospital in Spain from January 2011 to December 2014.
Seventy-two cases were discussed in the telemedicine sessions. The average age of patients was 18.02 (SD 13.75) years and mostly women (54.38 percent). Reasons to discuss the cases were 46.47 percent doubts in the diagnosis and therapeutic management, 15.47 percent were purely formative cases, and only 8.45 percent treatment doubt. At the time of presentation, 29 percent of the patients were already diagnosed, 95 percent of whom with infectious disease diagnostic, and from the undiagnosed patients 36 percent presented a febrile syndrome.
This study shows the viability of synchronous telemedicine between European and African countries without an excessively sophisticated technology.
Major depressive disorder (MDD) is a leading cause of morbidity and mortality. Shortfalls in treatment quantity and quality are well-established, but the specific gaps in pharmacotherapy and psychotherapy are poorly understood. This paper analyzes the gap in treatment coverage for MDD and identifies critical bottlenecks.
Seventeen surveys were conducted across 15 countries by the World Health Organization-World Mental Health Surveys Initiative. Of 35 012 respondents, 3341 met DSM-IV criteria for 12-month MDD. The following components of effective treatment coverage were analyzed: (a) any mental health service utilization; (b) adequate pharmacotherapy; (c) adequate psychotherapy; and (d) adequate severity-specific combination of both.
MDD prevalence was 4.8% (s.e., 0.2). A total of 41.8% (s.e., 1.1) received any mental health services, 23.2% (s.e., 1.5) of which was deemed effective. This 90% gap in effective treatment is due to lack of utilization (58%) and inadequate quality or adherence (32%). Critical bottlenecks are underutilization of psychotherapy (26 percentage-points reduction in coverage), underutilization of psychopharmacology (13-point reduction), inadequate physician monitoring (13-point reduction), and inadequate drug-type (10-point reduction). High-income countries double low-income countries in any mental health service utilization, adequate pharmacotherapy, adequate psychotherapy, and adequate combination of both. Severe cases are more likely than mild-moderate cases to receive either adequate pharmacotherapy or psychotherapy, but less likely to receive an adequate combination.
Decision-makers need to increase the utilization and quality of pharmacotherapy and psychotherapy. Innovations such as telehealth for training and supervision plus non-specialist or community resources to deliver pharmacotherapy and psychotherapy could address these bottlenecks.
Our objectives were to identify genes of the multi-drug efflux system and to evaluate the antimicrobial activities of polypyrrole nanoparticles (PPy-NPs) and aqueous extract of Moringa oleifera against Staphylococcus spp. isolated from dairy farms in Northeast Brazil. Initially, 162 Staphylococcus spp. isolates were subjected to in vitro antimicrobial sensitivity tests. Of these, 35 presented antimicrobial multi-drug resistance phenotypes. These 35 isolates were then referred for the detection of norA, norB, norC, msrA, mgrA, tet-38, and lmrS genes, all of which feature in multi-drug efflux systems. In the isolates carrying the genes, the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of PPy-NPs and Moringa oleifera aqueous extract were determined. In the molecular analysis of the 35 isolates norA, norC, tet-38, and msrA genes were detected and for the other genes norB, lmrS and mgrA there was no amplification. Antimicrobial activity was verified of PPy-NPs and aqueous extract of Moringa oleifera in Staphylococcus spp. carrying multi-drug efflux system genes. We concluded that there are multi-drug efflux system genes present in the Staphylococcus spp. from the agricultural environment in Northeast Brazil, and that aqueous extract of Moringa oleifera and PPy-NPs show bactericidal activity against these isolates.
The study described in this Research Communication investigated the genotypic and phenotypic profiles of resistance to beta-lactams and other antimicrobials in non-aureus Staphylococci (NAS) isolated from buffalo, goat and sheep mastitis in the Northeast region of Brazil. A total of 190 isolates were analyzed and 42.3, 43.9 and 23.6% of them were positive for blaZ gene in buffalo, goat and sheep, respectively. Regarding the animal groups, in goats, amoxicillin was the antimicrobial with highest resistance index (72.7%), followed by penicillin G in buffaloes (51.9%) and ampicillin in sheep (43.1%). With regard to multiple antimicrobial resistance, 30.8% of NAS isolates from buffalo milk samples, 25.8% from goats and 25.0% from sheep presented multidrug-resistance. In the minimum inhibitory concentration (MIC) technique, amoxicillin MIC50 and MIC90 were 64 and 128 μg/ml, respectively, among isolates of the three animal species. In conclusion, high rates of resistance to beta-lactams are presented among NAS isolated from mastitis cases in buffaloes, goats and sheep in Northeast region of Brazil. These results provide an alert to animal and human health researchers, suggesting that the frequency of NAS needs to be reduced because they carry resistance genes which might increase the existing levels of antimicrobial resistance.
Direct numerical simulations (DNS) of spatially evolving turbulent planar jets of viscoelastic fluids described by the FENE-P model, such as those consisting of a Newtonian fluid solvent carrying long chain polymer molecules, are carried out in order to develop a theory for the far field of turbulent jets of viscoelastic fluids. New evolution relations for the jet shear-layer thickness
, centreline velocity
and maximum polymer stresses
are derived and validated by the new DNS data, yielding
, respectively, where
is the coordinate in the streamwise direction. It is shown that, compared with a classical (Newtonian) turbulent jet, the effect of the polymers is to reduce the spreading rate, centreline velocity decay, Reynolds stresses and viscous dissipation rate. The self-preserving character of the flow is analysed and it is shown that profiles of mean velocity, Reynolds stresses and polymer stresses are self-similar provided the proper scales are used in the normalisation of these quantities. A fundamental difference from the Newtonian jet in this regard is the necessity for two, instead of only one, different velocity and length scales to properly characterise the evolution of the turbulent flow. These extra velocity and length scales are directly related to a time scale associated with the characteristic fading memory property of viscoelastic fluids.
The Developmental Origins of Health and Disease (DOHaD) states that intrauterine maternal environment influences postnatal life by programming offspring’s metabolism. Intrauterine milieu induced by exercise during pregnancy promotes long-lasting benefits to the offspring’s health and seems to offer some resistance against chronic diseases in adult life. Alzheimer’s disease is a public health concern with limited treatment options. In the present study, we assessed the potential of maternal exercise during pregnancy in long-term programming of young adult male rat offspring’s cerebellar metabolism in conferring neuroprotection against amyloid-β (Aβ) neurotoxicity. Female Wistar rats were submitted to a swimming protocol 1 week prior mating and throughout pregnancy (five sessions/a week lasting 30 min). Aβ oligomers were infused bilaterally in the brain ventricles of 60-day-old male offspring. Fourteen days after surgery, we measured parameters related to redox state, mitochondrial function, and the immunocontent of proteins related to synaptic function. We found that maternal exercise during pregnancy attenuated several parameters in the offspring’s male rat cerebellum, such as the reactive species rise, the increase of inducible nitric oxide synthase immunocontent and tau phosphorylation induced by Aβ oligomers, increased mitochondrial fission indicated by dynamin-related protein 1 (DRP1), and protein oxidation identified by carbonylation. Strikingly, we find that maternal exercise promotes changes in the rat offspring’s cerebellum that are still evident in young adult life. These favorable neurochemical changes in offspring’s cerebellum induced by maternal exercise may contribute to a protective phenotype against Aβ-induced neurotoxicity in young adult male rat offspring.
Agricultural production in Brazil has increased in recent decades. Despite this, the rural population continues to face income inequality. Policies targeting this issue, such as rural credit, have been implemented during this period. This study estimates the influence of credit on income inequality in Brazilian rural areas. Results suggest that the family farming credit program (PRONAF) is not associated with increase in inequality. However, access to rural credit from sources other than PRONAF has led to greater household income inequality. Results also indicate that greater levels of education and access to rural extension have boosted the effect of credit on income.
This research communication describes the influence of diet, mammary quarter position and milking process on the temperature of teats and udder of cows fed diets containing different lipid sources. Five primiparous cows were fed diets containing cottonseed, sunflower seed, soybeans or soybean oil as a source of lipids and a reference diet without the inclusion of lipid sources in a 5 × 5 Latin Square design. Milk yield was determined in the last five days of each period. Milk samples were collected for SCC analysis on the last two days of each experimental period. The images of the mammary gland were obtained using an infrared camera and were analyzed with appropriate computer software. Milk yield was 14.8% higher for cows fed soybeans as a source of lipids. Diets and somatic cell counts did not influence the temperature of teats and udder. The milking process reduced the temperature of teats and udder by 0.79°C. Rear teats and rear quarters had higher surface temperatures than front teats and fore quarters. Changes in temperature of teats and mammary quarters occurred as a function of the milking process and quarter position. However, the diet and the SCC did not influence the temperature of teats and mammary quarters in this experiment.
Background: Telemedicine has been defined as the use of technology to provide healthcare when the provider and patient are geographically separated. Use of telemedicine to meet the needs of specific populations has become increasingly common across Canada. The current study employs the Ontario Telemedicine Network (OTN) to connect the emergency departments of a community hospital system and a pediatric tertiary care hospital. OTN functions through a two-way video conferencing system, allowing physicians at the tertiary site to see and hear the patient being treated in the community hospitals. Aim Statement: The aim of this project is to ensure essential care is provided to CTAS 1 and 2 pediatric patients who present to Niagara Health emergency departments, to increase the number of appropriate patient transfers. Measures & Design: Data for this project include a) description of common diagnoses, b) time of call, c) occurrence of transfers, and d) professional perceptions of the technology. A descriptive design was used together with the implementation of quality improvement cycles as the intervention occurred. Quality improvement methodologies including plan-do-study-act (PDSA) cycles ensured continuous improvement to the process of OTN use and therefore patient safety throughout the study. Evaluation/Results: Since the intervention was employed on December 17, 2018 there have been a total of 19 cases for which 4 transfers were requested. Changes to the process were made including the addition of weekly technology tests and feedback to health professionals involved to garner further support for the use. Results have indicated that seizure was the most common diagnosis, accounting for 37% of cases. The majority of calls were placed after 19:00 hours with no calls being placed between 24:00 and 10:00. Discussion/Impact: Healthcare providers had positive perceptions of the technology agreeing that decision making between on-site and remote teams was timely and collaborative, as well as that patient care and outcomes were improved with its use. The results of this study will be used to determine the benefits of employing telemedicine in the emergency departments of other hospital systems.
There is a substantial proportion of patients who drop out of treatment before they receive minimally adequate care. They tend to have worse health outcomes than those who complete treatment. Our main goal is to describe the frequency and determinants of dropout from treatment for mental disorders in low-, middle-, and high-income countries.
Respondents from 13 low- or middle-income countries (N = 60 224) and 15 in high-income countries (N = 77 303) were screened for mental and substance use disorders. Cross-tabulations were used to examine the distribution of treatment and dropout rates for those who screened positive. The timing of dropout was examined using Kaplan–Meier curves. Predictors of dropout were examined with survival analysis using a logistic link function.
Dropout rates are high, both in high-income (30%) and low/middle-income (45%) countries. Dropout mostly occurs during the first two visits. It is higher in general medical rather than in specialist settings (nearly 60% v. 20% in lower income settings). It is also higher for mild and moderate than for severe presentations. The lack of financial protection for mental health services is associated with overall increased dropout from care.
Extending financial protection and coverage for mental disorders may reduce dropout. Efficiency can be improved by managing the milder clinical presentations at the entry point to the mental health system, providing adequate training, support and specialist supervision for non-specialists, and streamlining referral to psychiatrists for more severe cases.
Tuberculosis (TB) transmission in healthcare facilities is still a concern in low-income countries, where airborne isolation rooms are scarce due to high costs. We evaluated the use of single GeneXpert MTB/RIF, the molecular Mycobacterium tuberculosis (MTB) DNA and resistance to rifampicin (RIF) test, as an accurate and faster alternative to the current criteria of 3 negative acid-fast bacilli (AFB) smears to remove patients from airborne isolation.
In this real-world investigation, we evaluated the impact of a single GeneXpert MTB/RIF on the decision making for discharging patients from respiratory isolation. We enrolled patients with suspected pulmonary TB in a public hospital that provides care for high-complexity patients in Brazil. We studied the performance, costs, and time saved comparing the GeneXpert MTB/RIF with AFB smears.
We enrolled 644 patients in 3 groups based on the number of AFB smears performed (1, 2, and 3, respectively) on respiratory specimens. GeneXpert MTB/RIF demonstrated good performance compared to AFB smear to rule out TB in all groups. The negative predictive value for AFB smear was 94% (95% confidence interval [CI], 0.90–0.97) and 98% (95% CIs, 0.94–0.99) for GeneXpert MTB/RIF in G3. The isolation discharge based on 3 AFB smears took 84 hours compared to 24 hours with GeneXpert MTB/RIF, which represents 560 patient-days saved in the isolation rooms.
A single GeneXpert MTB/RIF is a fast and strong predictor for TB absence in a high-complexity hospital, which is quite similar to results obtained in recent studies in low-burden settings. This molecular test may also increase patient rotation through isolation rooms, with a positive impact in the emergency room and infectious diseases wards.
• To describe personality characteristics in personality disorders (PDs) patients with substance use disorders (SUDs) comorbidity.
• Data on demographic, family, and clinical factors were gathered among subjects admitted to our dual diagnosis unit who met DSM-IV criteria for PDs and had comorbidity with SUDs.
• To explore the psychometric characteristics we used the Temperament and Character Inventory-Revised (TCI-R).
• Overall, 32 subjects were assessed (72% males; mean age 38,4±7,3). Mean length of admission was 17,6 ± 7,5 days. Suicide attempt/ideation (50%) and behaviour disruption (19%) were main symptoms at admittance. Main drugs were alcohol (59,4%) and cocaine (15,6%); 24% had polydrug dependence (3 or more SUDs).
• TCI results showed a profile characterized by low self-directness (78,1%), low cooperativeness (46,9%) and high novelty seeking (31,3%).
• Sedative SUDs group (including alcohol, cannabis, and benzodiacepines SUDs) showed higher scores in asthenia (70,6 ± 2 vs. 57,52 ± 3,2; p=0,002), and locus of control (44,8 ± 4,1 vs. 31,4 ± 32,6; p=0,039) than stimulant SUDs group (including cocaine and amphetamine-like SUDs).
• Polydrug dependence group had higher scores in spiritual acceptance (63,6 ± 4,2 vs. 49,9 ± 2; p=0,003).
• The older group (38 thru highest) had higher scores in cooperativeness (44,8 ±3,2 vs. 35,7 ± 3,1; p=0,05) and compassion (47,9 ± 3,7 vs. 36,2 ± 3,8; p=0,03).
• We found a profile characterized by low scores in self-directness and cooperativeness as seen in previous surveys.
• The older patients seems attenuate some maladaptative personality characteristics.
Sociologists and anthropologists have long been engaged to study the changes in society, over time. This is particularly true since the end of the nineteenth century and beginning of the twentieth century, heights of history, that caused profound changes in the forms of relationships between men, in family scale and in the society itself. The industrial revolution, the exodus to the city, the emancipation of women, the world wars, the creation of the European economic community, the mass media and consumerism, have profoundly altered the social networks and engagement in which man lived since ancient times. The authors aim to address this issue, by trying to understand the behavioral changes that were needed to adapt to this new structure of society and in what way they were responsible for the loss of mechanisms of cooping, with the anti - social behaviour, with stress and depression.
The Portuguese example is finally exploited, given the most significant changes in the last century, as the fall of the monarchy, the instability of the early republic, the dictatorship, the colonial war, the April 25, the entry into the EEC.
Cardiovascular diseases represent the most important cause of morbimortality in Portugal. Individuals with severe mental disease have a higher risk of morbidity and mortality related with coronary disease. This is the principal cause of death of psychiatric patients and not suicide. The cardiovascular risk is potenciated by the adverse effects of psychodrugs like excessive weight and interference in glucose homeostasis.
To evaluate socio-demographic, clinical, analytical and pharmacologic variables in psychiatric patients and to determine the prevalence of metabolic syndrome.
Descriptive transversal study of hospitalized patients at Sobral Cid Hospital, random chosen from hospitalized acute and chronic patients.
In a total of 51 individuals, 88.2% were male, 21.6% have between 40 and 50 years old (mean- 50.5 years), without known cardiac disease (92.2%), without tobacco (58.8%), alcohol (74.5%) or other substances consumer (92.2%), having 13.7% diabetes mellitus and 31.4% hypertension. The diagnostic group most prevalent was Schizophrenia, schizotypal and delusional disorders. The following parameters were determined: abdominal obesity (15.75), hypertrygliceridemia (25.5%), low HDL (70.6%), arterial hypertension (41.2%), high level of glycaemia (13.7%), elevated PCR (35.3%), BMI superior or equal to 25 (56.9%) and metabolic syndrome (19.6%). In relation to therapeutics 45.1% were medicated with antidepressives and 76.5% with antipsychotics (47.1% with atypicals).
It is fundamental that the assistant psychiatry identifies and orients patients with cardiovascular risk systematically, and also take into account those parameters when prescribing psychodrugs.
Recent studies involved the pathways of kinases regulated by extracellular signal (ERK - extracellular signal regulated kinases), a broad range of key cellular processes, in the mechanisms of depression and consequently in the action of antidepressants. It is also known that the use of specific inhibitors of phosphorylation of ERKs1 / 2 showed to have antidepressant effect in animal models. Fluoxetina (SSRI) was recently discovered to be a potente inhibitor of phosphorylation of ERKs. The ERKs1 / 2 and recently the 3, are present in neurons and glia, these also engaged in biological mechanisms of depression.
The authors propose to do, based on the current literature, the characterization of the type (s) of cell (s) where changes in activation of ERKs1 / 2, occur during depression, and during the administration of antidepressants, in order to understand, to what extent these kinases may be considered as biological markers of depression. Possibly also to examine the feasibility of using these markers in clinical use.
The use of cultural approaches addressing stigma and discrimination promotes acceptance by raising consciousness. People with schizophrenia are often stigmatized by others.
Discrimination associated with common myths contributes to social exclusion and treatment delay, creating a barrier to recovery.This paper aims to present the development, implementation and evaluation of an anti-stigma campaign in the context of primary health care and local community using theatrical techniques.
In the Health Centre waiting rooms the invisible theatre technique was implemented, consisting in the performance of a previously rehearsed script without informing the public that it was a play, aiming to provoke debate and clarify problems related to social inequality and discrimination. The play script addressed common myths related to schizophrenia: People with schizophrenia are usually dangerous and violent; People with schizophrenia are unlikely to recover; Schizophrenia, as other mental conditions is a sign of weakness and not a true medical illness and others. In the local community, street performances were implemented based on image theatre techniques consisting in the use of living body imagery to address the myths described above.
Behavioural responses to the intervention were assessed using Likert type scale. Most of the people in both the settings were paying attention to the performances and dialogues. People watching street performances, however, were more active in expressing opinions or making specific questions related to the subject.
Further research on the impact of anti-stigma campaigns using theatre techniques is needed. These strategies may provide an effective approach to fight stigma in communitarian settings.
Several studies have been conducted to establish a profile of the suicidal/parasuicidal patient. Also several factors have been identified as possibly influencing the suicidal rates, including the religious practices.
Characterize the profile of suicidal behavior in a sample of patients followed in a general psychiatric consultation.
It was done an analytical observational study of a random sample of 100 patients followed in a general psychiatric consultation. A survey was conducted with the collection of socio-economic, religious aspects and clinical data, and it was consulted the patient"s clinical process. Data analysis was done in Excel 2003.
The sample was consisted mostly by women (74%), being the most representative age group between 40 and 50 years (27%), mostly married (61%), 24% had 2 children and 65% lived in the rural area. The clinical diagnosis (ICD-9) was in 46% of cases, neurotic depression. 52% consider themselves religious not practitioners, being 90% catholics. History of suicide attempts/parasuicide occurred in 32% of patients, in the form of drug intoxication (31%) or with another method (11%). Most of the individuals said to have already thought about suicide at least once in their lifetime (74%). Only 8% had current suicidal ideation. Family history of suicide occurred in 27%, particularly in first degree family members, mainly by drowning (7%) and hanging (7%).
Our results suggest that exists a high prevalence of suicidal behavior in this patients. For that reason, it should be done a systematic screening for suicidal ideation in this risk population.
The feeders are usually people who encourage others (the "gainer") to increase their weight by the pleasure of seeing eat or see "fat" or, more often, because of the relationship of domination, control and dependency that this holds. Although still little studied, there are references to “feeding” as a fetishism, disturbance of eating, or even as a form of physical and psychological violence with special features.
Target, Material and Methods:
Presentation of a clinical case (emerged in the consultation of general psychiatry) of a patient for 43 years, married, overweighted (because of imposed feeding of her husband) that presents depressive episodes. Hold a literature review based on the search Pubmed / Medline on the concepts of feeders and gainers and pharmacological approaches and psicotherapy.
There are numerous cases described in both sexes, weighing above normal and that fail to reach the ideal weight for food imposition of other persons, most often, someone close to the patient (spouse, parents, etc.). There is a need to distinguish this from the "fat lovers”, that as a sexual link. The imposition food can lead to an addiction control and the patient and the feeder often requires the psychiatry assistance in a systemic perspective.
Analysis of the mental health system in Portugal reveals some positive aspects in its development through recent decades, namely in what concerns the creation of decentralised services and rehabilitation programs. Despite this, Portuguese mental health services (MHS) still suffer from significant deficiencies, in terms of accessibility, equity and quality of care. There is a large gap between the number of people affected with mental disorders and those receiving treatment: for an estimated prevalence of 16.07%, the number of people receiving treatment in MHS was estimated to be 1.7%.
The major objectives of the new National Mental Health Plan are:
1) Assure equal access to care,
2) Promote and protect human rights
3) Reduce the impact of mental health disorders
4) Promote community delivery of care,
5) Promote the integration of MHS in the general health services.
A National Coordination Body for Mental Health has been empowered to assure the implementation of the National Mental Health Plan, with external monitoring by WHO.
Since the last three years, there has been significant changes and improvements at the following levels: new legislation, creation of new MHS, forensic services, financing model, residential facilities (long term care), deinstitutionalization, training, programs for homeless people, domestic violence, advocacy and stigma.
The implementation of the mental health plan can help to overcome some of the problems present in MHS in Portugal. Special attention should be given to the financing model, has it represents a crucial restraint to the development of the MHS.