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Individuals with a mental health disorder appear to be at increased risk of medical illness.
To examine rates of medical illnesses in patients with bipolar disorder (n = 1720) and to examine the clinical course of the bipolar illness according to lifetime medical illness burden.
Participants recruited within the UK were asked about the lifetime occurrence of 20 medical illnesses, interviewed using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and diagnosed according to DSM-IV criteria.
We found significantly increased rates of several medical illnesses in our bipolar sample. A high medical illness burden was associated with a history of anxiety disorder, rapid cycling mood episodes, suicide attempts and mood episodes with a typically acute onset.
Bipolar disorder is associated with high rates of medical illness. This comorbidity needs to be taken into account by services in order to improve outcomes for patients with bipolar disorder and also in research investigating the aetiology of affective disorder where shared biological pathways may play a role.
The objective of the present study was to gain an understanding of the organizational characteristics and processes in two child-care centres that may influence adoption of the Alberta Nutrition Guidelines for Children and Youth (ANGCY).
In-depth qualitative case studies. Data were collected through direct observations, key informant interviews and field notes. Diffusion of Innovations theory guided the evaluation and intrinsic case analysis.
Two urban child-care centres in Edmonton, Alberta, Canada identified as exemplary early adopter cases.
Ten key informants comprised of directors, junior and senior staff members participated in interviews.
Organizational processes such as leadership, networking and knowledge brokering, health champions and organizational culture positively influenced adoption behaviour in child-care centres. A key determinant influencing organizational behaviour within both centres was the directors’ strong leadership. Acceptance of and adherence to the guidelines were facilitated by organizational factors, such as degree of centralization, formalization and complexity, level of staff training and education. Knowledge brokering by directors was important for transferring and exchanging information across the centre. All child-care staff embraced their informal role as health champions as essential to supporting guideline adherence and encouraging healthy food and eating environments.
Organizational processes and characteristics such as leadership, knowledge brokering and networking, organizational culture and health champions played an important role in the adoption of nutrition guidelines in child-care centres. The complex interplay of decision making, organization of work and specialization of roles influenced the extent to which nutrition guidelines were adopted.
To examine the association between frequency of assisting with home meal preparation and fruit and vegetable preference and self-efficacy for making healthier food choices among grade 5 children in Alberta, Canada.
A cross-sectional survey design was used. Children were asked how often they helped prepare food at home and rated their preference for twelve fruits and vegetables on a 3-point Likert-type scale. Self-efficacy was measured with six items on a 4-point Likert-type scale asking children their level of confidence in selecting and eating healthy foods at home and at school.
Schools (n 151) located in Alberta, Canada.
Grade 5 students (n 3398).
A large majority (83–93 %) of the study children reported helping in home meal preparation at least once monthly. Higher frequency of helping prepare and cook food at home was associated with higher fruit and vegetable preference and with higher self-efficacy for selecting and eating healthy foods.
Encouraging children to be more involved in home meal preparation could be an effective health promotion strategy. These findings suggest that the incorporation of activities teaching children how to prepare simple and healthy meals in health promotion programmes could potentially lead to improvement in dietary habits.
To examine: (i) children's food intake and adherence to both Canada's Food Guide for Healthy Eating and Dietary Reference Intakes; and (ii) the social and demographic factors related to children's food intake.
A cross-sectional study.
Data were obtained through the Quebec Longitudinal Study of Child Development 1998–2010, a representative sample (n 2103) of children born in 1998 in the province of Quebec, Canada. Information on energy, macronutrient and food consumption was derived from responses to a 24 h dietary recall interview addressed to children's mothers and day-care staff when the children were 4 years old.
A total of 1549 children aged 4 years who participated in a nutritional sub-study.
The mean daily total energy intake was 6360 kJ (1520 kcal) for girls and 6916 kJ (1653 kcal) for boys. For boys and girls alike, energy intake was comprised of approximately 54 % carbohydrates, 31 % fats and 15 % proteins. The mean number of servings consumed from each of the four essential food groups closely approached the dietary recommendations made by Canada's Food Guide for Healthy Eating; however, <2 % of the children in the present study actually met the full dietary guidelines. The dietary intake of pre-school children was associated with socio-economic and demographic factors, most notably mother's level of education, mother's immigrant status and sex of the child.
Diet-related disparities associated with socio-economic and demographic factors exist from as early as 4 years of age.
Adverse drug reactions are important determinants of non-adherence to
antidepressant treatment but their assessment is complicated by overlap
with depressive symptoms and lack of reliable self-report measures.
To evaluate a simple self-report measure and describe adverse reactions
to antidepressants in a large sample.
The newly developed self-report Antidepressant Side-Effect Checklist and
the psychiatrist-rated UKU Side Effect Rating Scale were repeatedly
administered to 811 adult participants with depression in a
part-randomised multicentre open-label study comparing escitalopram and
There was good agreement between self-report and psychiatrists' ratings.
Most complaints listed as adverse reactions in people with depression
were more common when they were medication-free rather than during their
treatment with antidepressants. Dry mouth (74%), constipation (33%) and
weight gain (15%) were associated with nortriptyline treatment. Diarrhoea
(9%), insomnia (36%) and yawning (16%) were more common during treatment
with escitalopram. Problems with urination and drowsiness predicted
discontinuation of nortriptyline. Diarrhoea and decreased appetite
predicted discontinuation of escitalopram.
Adverse reactions to antidepressants can be reliably assessed by
self-report. Attention to specific adverse reactions may improve
adherence to antidepressant treatment.
There have been conflicting reports on whether the length polymorphism in
the promoter of the serotonin transporter gene (5-HTTLPR) moderates the
antidepressant effects of selective serotonin reuptake inhibitors
(SSRIs). We hypothesised that the pharmacogenetic effect of 5-HTTLPR is
modulated by gender, age and other variants in the serotonin transporter
To test the hypothesis that the 5-HTTLPR differently influences response
to escitalopram (an SSRI) compared with nortriptyline (a noradrenaline
The 5-HTTLPR and 13 additional markers across the serotonin transporter
gene were genotyped in 795 adults with moderate-to-severe depression
treated with escitalopram or nortriptyline in the Genome Based
Therapeutic Drugs for Depression (GENDEP) project.
The 5-HTTLPR moderated the response to escitalopram, with long-allele
carriers improving more than short-allele homozygotes. A significant
three-way interaction between 5-HTTLPR, drug and gender indicated that
the effect was concentrated in males treated with escitalopram. The
single-nucleotide polymorphism rs2020933 also influenced outcome.
The effect of 5-HTTLPR on antidepressant response is SSRI specific
conditional on gender and modulated by another polymorphism at the 5' end
of the serotonin transporter gene.
Tricyclic antidepressants and serotonin reuptake inhibitors are
considered to be equally effective, but differences may have been
obscured by internally inconsistent measurement scales and inefficient
To test the hypothesis that escitalopram and nortriptyline differ in
their effects on observed mood, cognitive and neurovegetative symptoms of
In a multicentre part-randomised open-label design (the Genome Based
Therapeutic Drugs for Depression (GENDEP) study) 811 adults with moderate
to severe unipolar depression were allocated to flexible dosage
escitalopram or nortriptyline for 12 weeks. The weekly Montgomery–Åsberg
Depression Rating Scale, Hamilton Rating Scale for Depression, and Beck
Depression Inventory were scored both conventionally and in a more novel
way according to dimensions of observed mood, cognitive symptoms and
Mixed-effect linear regression showed no difference between escitalopram
and nortriptyline on the three original scales, but symptom dimensions
revealed drug-specific advantages. Observed mood and cognitive symptoms
improved more with escitalopram than with nortriptyline. Neurovegetative
symptoms improved more with nortriptyline than with escitalopram.
The three symptom dimensions provided sensitive descriptors of
differential antidepressant response and enabled identification of
To examine the association between skipping breakfast, daily energy, macronutrients and food intakes, and BMI in pre-school children.
A cross-sectional study using information on children’s food consumption and measured height and weight. Energy and macronutrient intakes of the children were derived from parent/day-care attendant’s responses to 24 h recall interviews and eating behaviour questionnaires.
Data obtained from a representative sample (n 2103) of children born in Quebec (Canada) in 1998.
One thousand five hundred and forty-nine children, with a mean age of 49 (sd 3·12) months.
Ten per cent of children ate breakfast on fewer than 7 days per week. This behaviour was associated with a lower diet quality and concentrated energy intakes through higher protein intakes at lunch and the consumption of snacks higher in energy and carbohydrate in the afternoon and evening; yet total daily energy intakes were not significantly different from those of pre-school children who ate breakfast every day. Breakfast skippers’ mean BMI increased as intake of energy, carbohydrates or servings of grain products increased; however, this was not the case for breakfast eaters. When Cole’s cut-off for overweight/obesity was used, overweight/obesity in breakfast skippers was related to the dinner-time consumption of approximately 3000 kJ (700 kcal) or more for energy intake, approximately 100 g or more of carbohydrates, or approximately 3 servings or more of grain products.
Eating breakfast every day is associated with having a healthy body weight, likely due to a more even distribution of energy intake across meals throughout the day.
The present paper examines the relationship between social factors, food consumption during television viewing, and overall television viewing and how these are associated with BMI when the role of familial and social factors are considered in a population-based birth cohort of pre-school children from Québec (Canada).
The analyses were performed using data from the Longitudinal Study of Child Development in Québec (1998–2002) (LSCDQ). The study follows a representative sample (n 2103) of children born in 1998 in the Canadian province of Québec. A nutrition assessment was conducted on 1549 children aged 4·5 years and included a 24 h dietary recall, an eating behaviour and television viewing questionnaire, and a measurement of children’s heights and weights. Statistical analyses were performed.
Nearly one-quarter of children ate at least twice daily in front of the television. Children who consumed snacks while watching television on a daily basis had higher BMI than children who did so less frequently. Children who ate snacks in front of the television every day, or some times during the week, ate more carbohydrates (total), more fat and less protein, fewer fruits and vegetables, and drank soft drinks more often than children who never ate snacks in front of the television.
Health professionals should target parents of children at risk of overweight/obesity with focused strategies to help children change the types of foods consumed during television viewing and to reduce the time spent watching television, particularly during meal times, which may change children’s dietary intake and eating patterns.
The methods described below are those commonly used in the study of living microbial mats. Coverage here is not exhaustive; for some methods not here discussed only literature references are indicated. The material here presented (including appended tabulations of data: Tables 20.5–20.7) is relevant to the studies discussed in Chapter 6.
Preserved and Sectioned Material of Whole Mat (J. D. Farmer)
Syringe cores (30 cc) of mat are subsampled by slicing with a razor blade, and are fixed in a mixture of 3% glutaraldehyde and 1% formalin in pond water immediately following collection. Dehydrated samples are infiltrated with Spurr's Low Viscosity Embedding Medium (Spurr 1969; Polysciences, Inc.) under vacuum for several hours. A two-step graded series, beginning with a 50:50 mixture of resin and 100% ethanol for 2 hours, was found to enhance penetration. The hard cure schedule recommended by Polysciences is followed in order to obtain the hardest embedment for thin sections. Embedments are prepared in plastic “peel-a-way” molds (Polysciences, Inc.) and cured at 70°C for 8 hours.
Sections (20 to 30 µm thick, in order to facilitate comparisons with thin sections of fossil stromatolites) are prepared by hand grinding, following a modification of standard petrographic methods (Nye et al. 1972). Organisms in sections prepared from Spurr's resin can be stained using a 1% solution of toluidine blue in distilled water. A 1% solution of alizarine red in dilute HC1 is an effective counterstain for detecting carbonate.
Modern microbial mats are structurally coherent macroscopic accumulations of microorganisms. Mats are widely distributed on earth. They are found in a surprisingly large number of diverse environments from the equatorial zones to both polar regions. They vary in size from extensive terrestrial and hypersaline mats that cover areas several square kilometers in extent to minute mats only a few square centimeters in area found in small thermal springs. They vary in thickness from massive accumulations measured in meters, such as those in the Persian Gulf and the Red Sea region, to thin films less than a few millimeters in thickness. In addition to being highly varied in size, modern microbial mats are also very diverse in morphology, community structure, and physiological characteristics. What do such mats have in common? Under what conditions do they form? What is the basis of their diversity? What insight do they provide, if any, to the interpretation of the widespread stromatolites of the Proterozoic?
Microbial mats are accretionary cohesive microbial communities which are often laminated and found growing at the sediment-water (occasionally sediment-air) interface. Most mats stabilize unconsolidated sediment. The mats are comprised of the various microorganisms that accumulate along with their metabolic products. The most conspicuous of these products is usually a copious amount of extracellular polysaccharide which helps hold the cells together to form a cohesive structure.
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