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Contextually appropriate interventions delivered by primary maternal care providers (PMCPs) might be effective in reducing the treatment gap for perinatal depression.
To compare high-intensity treatment (HIT) with low-intensity treatment (LIT) for perinatal depression.
Cluster randomised clinical trial, conducted in Ibadan, Nigeria between 18 June 2013 and 11 December 2015 in 29 maternal care clinics allocated by computed-generated random sequence (15 HIT; 14 LIT). Interventions were delivered individually to antenatal women with DSM-IV (1994) major depression by trained PMCPs. LIT consisted of the basic psychosocial treatment specifications in the World Health Organization Mental Health Gap Action Programme – Intervention Guide. HIT comprised LIT plus eight weekly problem-solving therapy sessions with possible additional sessions determined by scores on the Edinburgh Postnatal Depression Scale (EPDS). The primary outcome was remission of depression at 6 months postpartum (EPDS < 6).
There were 686 participants; 452 and 234 in HIT and LIT arms, respectively, with both groups similar at baseline. Follow-up assessments, completed on 85%, showed remission rates of 70% with HIT and 66% with LIT: risk difference 4% (95% CI −4.1%, 12.0%), adjusted odds ratio 1.12 (95% CI 0.73, 1.72). HIT was more effective for severe depression (odds ratio 2.29; 95% CI 1.01, 5.20; P = 0.047) and resulted in a higher rate of exclusive breastfeeding. Infant outcomes, cost-effectiveness and adverse events were similar.
Except among severely depressed perinatal women, we found no strong evidence to recommend high-intensity in preference to low-intensity psychological intervention in routine primary maternal care.
Cancer-related drowsiness (CRD) is a distressing symptom in advanced cancer patients (ACP). The aim of this study was to determine the frequency and factors associated with severity of CRD. We also evaluated the screening performance of Edmonton Symptom Assessment Scale-drowsiness (ESAS-D) item against the Epworth Sedation Scale (ESS).
We prospectively assessed 180 consecutive ACP at a tertiary cancer hospital. Patients were surveyed using ESAS, ESS, Pittsburgh Sleep Quality Index, Insomnia Severity Index, and Hospital Anxiety Depression Scale.
Ninety of 150 evaluable patients had clinically significant CRD (ESS); median (interquartile ratio): ESS. 11 (7–14); ESAS-D. 5 (2–6); Pittsburgh Sleep Quality Index. 8 (5–11); Insomnia Severity Index. 13 (5–19); Stop Bang Scoring 3 (2–4), and Hospital Anxiety Depression Scale-D 6 (3–10). ESAS-D was associated with ESAS (r, p) sleep (0.38, <0.0001); pain (0.3, <0.0001); fatigue (0.51, <0.0001); depression (0.39, <0.0001); anxiety (0.44, <0.0001); shortness of breath (0.32, <0.0001); anorexia (0.36, <0.0001), feeling of well-being [(0.41, <0.0001), ESS (0.24, 0.001), and opioid daily dose (0.19, 0.01). Multivariate-analysis showed ESAS-D was associated with fatigue (odds ratio [OR] = 9.08, p < 0.0001), anxiety (3.0, p = 0.009); feeling of well-being (OR = 2.27, p = 0.04), and insomnia (OR = 2.35; p = 0.036). Insomnia (OR = 2.35; p = 0.036) cutoff score ≥3 (of 10) resulted in a sensitivity of 81% and 32% and specificity of 70% and 44% in the training and validation samples, respectively.
Significance of results
Clinically significant CRD is frequent and seen in 50% of ACP. CRD was associated with severity of insomnia, fatigue, anxiety, and worse feeling of well-being. An ESAS-D score of ≥3 is likely to identify most of the ACP with significant CRD.
The aim of this study was to determine the factors associated with a feeling of well-being using the Edmonton Symptom Assessment Scale (ESAS)–Feeling of Well-Being item (ESAS–FWB; where 0 = best and 10 = worst) among advanced lung or non-colonic gastrointestinal cancer patients who were referred to an outpatient palliative care clinic (OPCC). We also examined the association of performance on the ESAS–FWB with overall survival (OS).
We reviewed the records of consecutive patients with incurable advanced lung cancer and non-colonic gastrointestinal cancer presenting to an OPCC from 1 January 2008 through to 31 December 2013. Descriptive statistics were employed to summarize patient characteristics. Multivariate regression analysis was used to determine the factors associated with ESAS–FWB severity. We also examined the association of ESAS–FWB scores and survival using Kaplan–Meier survival analysis.
A total of 826 evaluable patients were analyzed (median age = 62 years, 57% male). Median ESAS–FWB scores were five times the interquartile range (5 × IQR; 3–7). ESAS–FWB score was found to be significantly associated with ESAS fatigue (OR = 2.31, p < 0.001); anxiety (OR = 1.98, p < 0.001); anorexia (OR = 2.31, p < 0.001); cut down, annoyed, guilty, eye opener (CAGE) score (hazard ratio [HR] = 1.80, p = 0.008); and family caregiver distress (HR = 1.93, p = 0.002). A worse ESAS–FWB score was significantly associated with decreased OS (r = –0.18, p < 0.001). However, ESAS–FWB score was not independently associated with OS in the final multivariate model (p = 0.35), which included known major clinical prognostic factors.
Worse ESAS–FWB scores were significantly associated with high scores on ESAS fatigue, anorexia, anxiety, CAGE, and family caregiver distress. More research is necessary to understand how palliative care interventions are capable of improving the contributory factors related to ESAS–FWB score.
Introduction: In Canada, major trauma is a healthcare priority and in 2014 was responsible for over 15866 deaths, with a total economic burden of 26.8 billion dollars. Numerous factors influence the likelihood of occurrence and outcome from major trauma, including incident factors, host, EMS response, emergency, surgical and critical care. Traditionally trauma registers contained information that mainly concerning hospital treatment and host factors. This collaborative analysis uses matched data from a Provincial Trauma Research Register and records from a Provincial Ambulance Service. Methods: A retrospective observational (registry) study comparing rural and urban adult and pediatric major trauma patients (Injury Severity Score >15) who were injured in a motor vehicle crash (ICD V20-V99) and presented to a level 1 or level 2 trauma centre by EMS by primary or secondary transfer, between April 2011 and March 2013 in a selected province in Canada. Comparisons of the process care times, and patient disposition, were made in an inclusive trauma system. Results: 108 cases meet the inclusion criteria with 78 considered rural and 30 urban using published definitions. The median response times were 16.2 minutes for rural (95% CI: 13.2 -19.8) and 7.8 minutes for urban (95% CI: 7.2 - 10.5) with 60% and 61% meeting response targets respectively. A greater proportion of urban patients are taken initially to level 3-5 centers and require secondary transfer (45% urban vs 24% rural p=<0.01). Median times intervals to surgical care were double for the urban patients (14 rural vs 32 hrs urban p=<0.01). Conclusion: The majority of serious road traffic collisions occur in rural areas. Although rural patients wait longer for an initial EMS response, more rural patients are taken directly to a level 1 or 2 trauma center. Unexpectedly then rural patients have much shorter times to surgical care. The benefits of an inclusive trauma system should be weighed against the benefits of bypass processes in urban environments where the nearest Emergency Department is not a Level 1 or 2 Trauma Center.
Cannabis use has been reported to be associated with an earlier onset of symptoms in patients with first-episode psychosis, and a worse outcome in those who continue to take cannabis. In general, studies have concentrated on symptoms of psychosis rather than mania. In this study, using a longitudinal design in a large naturalistic cohort of patients with first-episode psychosis, we investigated the relationship between cannabis use, age of presentation to services, daily functioning, and positive, negative and manic symptoms.
Clinical data on 502 patients with first-episode psychosis were collected using the MiData audit database from seven London-based Early Intervention in psychosis teams. Individuals were assessed at two time points – at entry to the service and after 1 year. On each occasion, the Positive and Negative Syndrome Scale, Young Mania Rating Scale and Global Assessment of Functioning Scale disability subscale were rated. At both time points, the use of cannabis and other drugs of abuse in the 6 months preceding each assessment was recorded.
Level of cannabis use was associated with a younger age at presentation, and manic symptoms and conceptual disorganization, but not with delusions, hallucinations, negative symptoms or daily functioning. Cannabis users who reduced or stopped their use following contact with services had the greatest improvement in symptoms at 1 year compared with continued users and non-users. Continued users remained more symptomatic than non-users at follow-up.
Effective interventions for reducing cannabis use may yield significant health benefits for patients with first-episode psychosis.
While bipolar disorder (BD) is a leading cause of disability, and an important contributor to disability in BD is cognitive impairment, there is little systematic research on the longitudinal course of cognitive function and instrumental activities of daily living (IADLs) in late-life. In this report, we characterize the 2-year course of cognitive function and IADLs in older adults with BD.
We recruited non-demented individuals 50 years and older with BD I or BD II (n = 47) from out-patient clinics or treatment studies at the University of Pittsburgh. Comparator subjects (‘controls’) were 22 individuals of comparable age and education with no psychiatric or neurologic history, but similar levels of cardiovascular disease. We assessed cognitive function and IADLs at baseline, 1- and 2-year time-points. The neuropsychological evaluation comprised 21 well-established and validated tests assessing multiple cognitive domains. We assessed IADLs using a criterion-referenced, performance-based instrument. We employed repeated-measures mixed-effects linear models to examine trajectory of cognitive function. We employed non-parametric tests for analysis of IADLs.
The BD group displayed worse cognitive function in all domains and worse IADL performance than the comparator group at baseline and over follow-up. Global cognitive function and IADLs were correlated at all time-points. The BD group did not exhibit accelerated cognitive decline over 2 years.
Over 2 years, cognitive impairment and associated functional disability of older adults with BD appear to be due to long-standing neuroprogressive processes compounded by normal cognitive aging rather than accelerated cognitive loss in old age.
We investigate the formation of inAs-rich layers at the interface between InP and arsenicbased Ill-V alloys grown by chemical beam epitaxy (CBE). In-situ spectroscopic ellipsometry, low temperature photoluminescence, secondary ion mass spectrometry and transmission electron microscopy were used to characterize the formation of these layers. We present evidence for interfacial layer roughness that depends strongly on growth temperature and on the presence of surface steps, and show that modifications of the interface chemistry and of the gas-switching sequence can reduce interfacial layer thicknesses.
It has been recently shown that high quality ZnSe and ZnTc filns can be grown on GaAs using low temperature growth techniques such as Metal-Organic Chemical Vapor Deposition ( MOCVD). All samples: ZnSe, ZnTe, ZnSc(l−x)Tc(x) epilayers and ZnSe/ZnTc superlattices were grown using a novel zinc precursor, the Tri-Ethyl-Amine Di-Methyl-Zinc, while we used the classical precursors H2Se and Di-Isopropyl-Tellurium for selenium and tellurium. Investigation of the photoluminescence (PL) properties of ZnSc and ZnTe single layers enabled us to optimize the growth conditions of these compounds. The crystal growth conditions for mixed alloys and superlattices were determined by direct comparison to the aspect of low-temperature PL features. Strong PL spectra were obtained from these materials, suggesting us that tellurium has the ability to behave like an iso-clectronic center. At low concentration of tellurium in ZnSe, an interesting physical situation is observed, which we have interpreted in terms of extrinsic exciton “self-trapping” mechanism.
By Pulsed Gas CVD-growth, heteroepitaxial growth of pure Ge-layers from pure GeH4 has been accomplished at 650 °C on Si-substrates without intermediate Si1−xGex-bufferlayers. The material has been studied by means of RBS, SEM, ECP, XRD and cross-sectional, highresolution and plan-view TEM. The thickness of the Ge-layers varied between 2 and 24 monolayers. From 5 monolayers on, some part of the Ge appears to be fully relaxed. Uptill 12 monolayers, the growth is fully 2-dimensional and results in specular, flat surfaces; for thicker layers islanding starts (Stranski-Krastanow growth). The material is completely defect-free. According to XRD-measurements, the perpendicular strained Ge-cell dimension is 5.748 Å, which is very reproducible for all layer-thicknesses. Nevertheless, from linear elastic theory considerations, it should be 5.83 Å. The Ge-layers so formed appear to be suitable for use in short-period (SinGem)p-superlattices.
The misfit dislocation structure of vicinal InP-on-GaAs heterostructures is studied by transmission electron microscopy (TEM). An island type growth is identified. The misfit stress is not fully relaxed at the interface. X-ray measurements on strain relaxation and epilayer misorientation are also reported, and the latter results are explained with the asymmetric introduction of 6Ø° dislocations at island edges. Comparing the results, it is concluded that x-ray data supply additional, although indirect, information on initial growth which is hardly detectable by TEM.
Silicon lamellae grown laterally over silicon dioxide by liquid phase epitaxy are investigated using X-ray double crystal topography. The lamellae are grown from Indium solution. All of the lamellae show growth striations with indium concentration differences of about 1016...4x1017 cm−3 Overgrowth widths up to 320μm are obtained on sides of the seeding window by growth under conditions of low supersaturation. Facetting of the lamella edges then becomes less pronounced and, therefore,striations are detected farther away from the windows.
About 60% of the lamellae are free of crystallographic defects. In the defective lamellae single dislocations parallel to the sample surface are detected. They extend between seeding window edges and re—entrant corners at the lamella edges. Dislocations probably form during the cooling process due to strains near the edges of the seeding windows, and as a result of indium incorporation in high concentration.
We describe a detailed quantitative theoretical and experimental analysis of strain relief mechanisms in GexSi1−x/Si(110). For this interface, both partial and total glide dislocations may effect strain relief. Detailed comparison between experimental measurement and theoretical prediction of the regimes in which the two types of dislocations are observed allows a very accurate determination of the stacking fault energy in GexSi1−x alloys.
For the first time, Si1 xGex layers on amorphous SiO 2 were produced by modification of the Si surface layer of a SIMOX wafer. We used two alternative methods. An additional Si1.. Gey layer was deposited epitaxially on a SIMOX wafer followed by rapid thermal annealing. Diffusional intermixing of the layers produced a homogeneous Si1 xGex layer on SiO 2. In a second attempt, Ge was implanted into the Si surface layer and thermally treated. In both cases epitaxial Si1 xGex layers on SiO2 with minimum yield values around 9% were obtained. Rutherford backscattering and cross sectional transmission electron microscopy were used to characterize the new structures.