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A substantial proportion of persons with mental disorders seek treatment from complementary and alternative medicine (CAM) professionals. However, data on how CAM contacts vary across countries, mental disorders and their severity, and health care settings is largely lacking. The aim was therefore to investigate the prevalence of contacts with CAM providers in a large cross-national sample of persons with 12-month mental disorders.
In the World Mental Health Surveys, the Composite International Diagnostic Interview was administered to determine the presence of past 12 month mental disorders in 138 801 participants aged 18–100 derived from representative general population samples. Participants were recruited between 2001 and 2012. Rates of self-reported CAM contacts for each of the 28 surveys across 25 countries and 12 mental disorder groups were calculated for all persons with past 12-month mental disorders. Mental disorders were grouped into mood disorders, anxiety disorders or behavioural disorders, and further divided by severity levels. Satisfaction with conventional care was also compared with CAM contact satisfaction.
An estimated 3.6% (standard error 0.2%) of persons with a past 12-month mental disorder reported a CAM contact, which was two times higher in high-income countries (4.6%; standard error 0.3%) than in low- and middle-income countries (2.3%; standard error 0.2%). CAM contacts were largely comparable for different disorder types, but particularly high in persons receiving conventional care (8.6–17.8%). CAM contacts increased with increasing mental disorder severity. Among persons receiving specialist mental health care, CAM contacts were reported by 14.0% for severe mood disorders, 16.2% for severe anxiety disorders and 22.5% for severe behavioural disorders. Satisfaction with care was comparable with respect to CAM contacts (78.3%) and conventional care (75.6%) in persons that received both.
CAM contacts are common in persons with severe mental disorders, in high-income countries, and in persons receiving conventional care. Our findings support the notion of CAM as largely complementary but are in contrast to suggestions that this concerns person with only mild, transient complaints. There was no indication that persons were less satisfied by CAM visits than by receiving conventional care. We encourage health care professionals in conventional settings to openly discuss the care patients are receiving, whether conventional or not, and their reasons for doing so.
Research on post-traumatic stress disorder (PTSD) course finds a substantial proportion of cases remit within 6 months, a majority within 2 years, and a substantial minority persists for many years. Results are inconsistent about pre-trauma predictors.
The WHO World Mental Health surveys assessed lifetime DSM-IV PTSD presence-course after one randomly-selected trauma, allowing retrospective estimates of PTSD duration. Prior traumas, childhood adversities (CAs), and other lifetime DSM-IV mental disorders were examined as predictors using discrete-time person-month survival analysis among the 1575 respondents with lifetime PTSD.
20%, 27%, and 50% of cases recovered within 3, 6, and 24 months and 77% within 10 years (the longest duration allowing stable estimates). Time-related recall bias was found largely for recoveries after 24 months. Recovery was weakly related to most trauma types other than very low [odds-ratio (OR) 0.2–0.3] early-recovery (within 24 months) associated with purposefully injuring/torturing/killing and witnessing atrocities and very low later-recovery (25+ months) associated with being kidnapped. The significant ORs for prior traumas, CAs, and mental disorders were generally inconsistent between early- and later-recovery models. Cross-validated versions of final models nonetheless discriminated significantly between the 50% of respondents with highest and lowest predicted probabilities of both early-recovery (66–55% v. 43%) and later-recovery (75–68% v. 39%).
We found PTSD recovery trajectories similar to those in previous studies. The weak associations of pre-trauma factors with recovery, also consistent with previous studies, presumably are due to stronger influences of post-trauma factors.
Although specific phobia is highly prevalent, associated with impairment, and an important risk factor for the development of other mental disorders, cross-national epidemiological data are scarce, especially from low- and middle-income countries. This paper presents epidemiological data from 22 low-, lower-middle-, upper-middle- and high-income countries.
Data came from 25 representative population-based surveys conducted in 22 countries (2001–2011) as part of the World Health Organization World Mental Health Surveys initiative (n = 124 902). The presence of specific phobia as defined by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition was evaluated using the World Health Organization Composite International Diagnostic Interview.
The cross-national lifetime and 12-month prevalence rates of specific phobia were, respectively, 7.4% and 5.5%, being higher in females (9.8 and 7.7%) than in males (4.9% and 3.3%) and higher in high- and higher-middle-income countries than in low-/lower-middle-income countries. The median age of onset was young (8 years). Of the 12-month patients, 18.7% reported severe role impairment (13.3–21.9% across income groups) and 23.1% reported any treatment (9.6–30.1% across income groups). Lifetime co-morbidity was observed in 60.5% of those with lifetime specific phobia, with the onset of specific phobia preceding the other disorder in most cases (72.6%). Interestingly, rates of impairment, treatment use and co-morbidity increased with the number of fear subtypes.
Specific phobia is common and associated with impairment in a considerable percentage of cases. Importantly, specific phobia often precedes the onset of other mental disorders, making it a possible early-life indicator of psychopathology vulnerability.
Although there is robust evidence linking childhood adversities (CAs) and an increased risk for psychotic experiences (PEs), little is known about whether these associations vary across the life-course and whether mental disorders that emerge prior to PEs explain these associations.
We assessed CAs, PEs and DSM-IV mental disorders in 23 998 adults in the WHO World Mental Health Surveys. Discrete-time survival analysis was used to investigate the associations between CAs and PEs, and the influence of mental disorders on these associations using multivariate logistic models.
Exposure to CAs was common, and those who experienced any CAs had increased odds of later PEs [odds ratio (OR) 2.3, 95% confidence interval (CI) 1.9–2.6]. CAs reflecting maladaptive family functioning (MFF), including abuse, neglect, and parent maladjustment, exhibited the strongest associations with PE onset in all life-course stages. Sexual abuse exhibited a strong association with PE onset during childhood (OR 8.5, 95% CI 3.6–20.2), whereas Other CA types were associated with PE onset in adolescence. Associations of other CAs with PEs disappeared in adolescence after adjustment for prior-onset mental disorders. The population attributable risk proportion (PARP) for PEs associated with all CAs was 31% (24% for MFF).
Exposure to CAs is associated with PE onset throughout the life-course, although sexual abuse is most strongly associated with childhood-onset PEs. The presence of mental disorders prior to the onset of PEs does not fully explain these associations. The large PARPs suggest that preventing CAs could lead to a meaningful reduction in PEs in the population.
The SUPERBLINK survey catalogs all stars brighter than R = 19 mag and with proper motions larger than 40 mas yr−1, down to a declination of −33○. The catalog inevitably includes a significant fraction of the presumed low-mass members of several nearby young moving groups (Beta Pic, AB Dor, Tuc-Hor, Argus), or low-mass escapees from the Hyades and Pleiades clusters. We discuss opportunities and challenges in identifying the missing M dwarf members of these moving groups. While rounding up the majority of the potential M dwarf members of these groups, such samples are significantly affected by co-moving field stars, both young and old, due to the heavy clumping of the local field population in velocity space.
Considerable research has documented that exposure to traumatic events has negative effects on physical and mental health. Much less research has examined the predictors of traumatic event exposure. Increased understanding of risk factors for exposure to traumatic events could be of considerable value in targeting preventive interventions and anticipating service needs.
General population surveys in 24 countries with a combined sample of 68 894 adult respondents across six continents assessed exposure to 29 traumatic event types. Differences in prevalence were examined with cross-tabulations. Exploratory factor analysis was conducted to determine whether traumatic event types clustered into interpretable factors. Survival analysis was carried out to examine associations of sociodemographic characteristics and prior traumatic events with subsequent exposure.
Over 70% of respondents reported a traumatic event; 30.5% were exposed to four or more. Five types – witnessing death or serious injury, the unexpected death of a loved one, being mugged, being in a life-threatening automobile accident, and experiencing a life-threatening illness or injury – accounted for over half of all exposures. Exposure varied by country, sociodemographics and history of prior traumatic events. Being married was the most consistent protective factor. Exposure to interpersonal violence had the strongest associations with subsequent traumatic events.
Given the near ubiquity of exposure, limited resources may best be dedicated to those that are more likely to be further exposed such as victims of interpersonal violence. Identifying mechanisms that account for the associations of prior interpersonal violence with subsequent trauma is critical to develop interventions to prevent revictimization.
In this global study we sought to estimate the degree to which a family member might feel embarrassed when a close relative is suffering from an alcohol, drug, or mental health condition (ADMC) versus a general medical condition (GMC). To date, most studies have considered embarrassment and stigma in society and internalized by the afflicted individual but have not assessed family embarrassment in a large-scale study.
In 16 sites of the World Mental Health Surveys (WMHS), standardized assessments were completed including items on family embarrassment. Site matching was used to constrain local socially shared determinants of stigma-related feelings, enabling a conditional logistic regression model that estimates the embarrassment close relatives may hold in relation to family members affected by an ADMC, a GMC, or both conditions.
There was a statistically robust association such that subgroups with an ADMC-affected relative were more likely to feel embarrassed compared to subgroups with a relative affected by a GMC (p < 0.001), even with covariate adjustments for age and sex.
The pattern of evidence from this research is consistent with conceptual models for interventions that target individual- and family-level stigma-related feelings of embarrassment as possible obstacles to effective early intervention and treatment for an ADMC. Macro-level interventions are under way but micro-level interventions may also be required among family members, along with care for each person with an ADMC.
Current trends in population aging affect both recipients and providers of informal family caregiving, as the pool of family caregivers is shrinking while demand is increasing. Epidemiological research has not yet examined the implications of these trends for burdens experienced by aging family caregivers.
Cross-sectional community surveys in 20 countries asked 13 892 respondents aged 50+ years about the objective (time, financial) and subjective (distress, embarrassment) burdens they experience in providing care to first-degree relatives with 12 broadly defined serious physical and mental conditions. Differential burden was examined by country income category, kinship status and type of condition.
Among the 26.9–42.5% respondents in high-, upper-middle-, and low-/lower-middle-income countries reporting serious relative health conditions, 35.7–42.5% reported burden. Of those, 25.2–29.0% spent time and 13.5–19.4% money, while 24.4–30.6% felt distress and 6.4–21.7% embarrassment. Mean caregiving hours per week in those giving any time were 16.6–23.6 (169.9–205.8 h/week per 100 people aged 50+ years). Burden in low-/lower-middle-income countries was 2- to 3-fold higher than in higher-income countries, with any financial burden averaging 14.3% of median family income in high-, 17.7% in upper-middle-, and 39.8% in low-/lower-middle-income countries. Higher burden was reported by women than men and for conditions of spouses and children than parents or siblings.
Uncompensated family caregiving is an important societal asset that offsets rising formal healthcare costs. However, the substantial burdens experienced by aging caregivers across multiple family health conditions and geographic regions threaten the continued integrity of their caregiving capacity. Initiatives supporting older family caregivers are consequently needed, especially in low-/lower-middle-income countries.
The growing interest in the behavior of magnetic thin films on semiconductor substrates is due in part to their potential application in spin-sensitive heterostructure devices. High-quality epitaxial Fe(001) thin films can be grown on GaAs(001) substrates because of the small lattice parameter mismatch (−1.4%). Magnetic measurements performed on Fe films thinner than 3 nm have shown that such films exhibit an in-plane uniaxial magnetic anisotropy although an ideal bcc Fe(001) film should have fourfold symmetry. The source of this uniaxial component remains an open question and one of the mechanisms which may contribute to this is the epitaxial strain, through magnetoelastic coupling. Very small strains anisotropies are able to modify the magnetic anisotropy of iron thin films. Moreover the sign and magnitude of the magnetoelastic coupling seem to depend on the film thickness or film strain . In this study, the strain tensor components in two Fe thin films (1.7 and 3.0 nm thick) has been measured by XRD. The magnetic free energy has been derived, using the strain tensor components.
The substituted oxides Bi2Sr2−xLaxCuO6+y and Bi2Sr2Ca1−xYxCu2O8+y isostructural to the n = 1 and n = 2 members of the high Tc superconductors have been prepared. The solid solution Bi2Sr2−xLaxCuO6+y shows a superconducting transition for 0.2–0.25<x<0.5 with an onset Tc near 30K and zero resistance temperatures which depend on x and the heat treatment. For x = 1 the isostructural phases Bi2ALaCuO6.5+y with A = Ca or Ba have also been synthesized and are not superconducting. A modelfor the localization of the oxygen atoms is proposed based on neutron diffraction of Bi2Sr1.6La0.4CuO6+y and Bi2CaLaCuO6+y.
The Bi2Sr2Ca1−xYxCu2O8+y solid solution exhibits a superconducting transition for 0<x <0.7. The critical temperature remains almost constant (85–90K) for 0<x <0.3 and then decreases rapidly. The oxygen content value 8.65 for Bi2Sr2YCu2O8+y agrees well with the increase of the positive charge when calcium is replaced by yttrium.
We show that anomalous extinction (deviations from the traditionally adopted RV = AV/E(B − V) = 3.1 introduces large uncertainties in the distances of stars, for distances larger than 1-2 kpc. We argue that for such distances and for directions close to the galactic plane, the use of extinction models based on the gas distribution in the Galaxy is safer, for the moment, than the use of extinction maps.
A new all-sky catalog of stars with proper motions μ > 0.15″ yr−1 is presented. The catalog is largely a product of the SUPERBLINK survey, a data-mining initiative in which the entire Digitized Sky Surveys are searched for moving stellar sources. Findings from earlier proper motions surveys are also incorporated. The new all-sky catalog supersedes the great historic proper motion catalogs assembled by W. J. Luyten (LHS, NLTT), and provides a virtually complete > 98% census of high proper motion stars down to magnitude R = 19.
We have compiled a new catalogue of open clusters in the Galaxy
which updates the previous catalogues of Lyngå (1987) and of
Mermilliod (1995) (included in the WEBDA database). New objects
and new data, in particular, data on kinematics (proper motions,
radial velocities) that were not present in the old catalogues, have
been included. Virtually all the clusters (1622) presently known
were included, which represents an increment of about 450 objects
relative to the Lyngå (1987) catalogue. The catalogue is
presented in a single table containing all the important data
distances, ages, kinematics) which makes it easy to use. The catalogue includes mean absolute proper motions for hundreds of
open clusters (Dias et al. 2001, 2002a) obtained using the Tycho2
proper motions. Unpublished mean radial velocities of several
dozens of clusters are
also presented in this work. The catalogue is being constantly updated and the latest version can
be accessed on-line at
http://www.astro.iag.usp.br/~wilton/ were more data such
as membership probabilities for individual stars can also be
In 1994, a hospital reported an increase in nosocomial legionnaires' disease after implementing use of a rapid urinary antigen test for Legionella pneumophila serogroup 1 (Lp-1). This hospital was the site of a previous nosocomial legionnaires' disease outbreak during 1980 to 1982.
Infection control records were reviewed to compare rates of nosocomial pneumonia and the proportion of cases attributable to legionnaires' disease during the 1994 outbreak period with those during the same period in 1993. Water samples were collected for Legionella culture from the hospital's potable water system and cooling towers, and isolates were subtyped by monoclonal antibody (MAb) testing and arbitrarily primed polymerase chain reaction (AP-PCR).
Nosocomial pneumonia rates were similar from April through October 1993 and April through October 1994: 5.9 and 6.6 per 1,000 admissions, respectively (rate ratio [RR], 1.1; P=.56); however, 3.2% of nosocomial pneumonias were diagnosed as legionnaires' disease in 1993, compared with 23.9% in 1994 (RR, 9.4; P<.001). In 1994, most legionnaires' disease cases were detected by the urinary antigen testing alone. MAb testing and AP-PCR demonstrated identical patterns among Lp-1 isolates recovered from a patient's respiratory secretions, the hospital potable water system, and stored potable water isolates from the 1980 to 1982 outbreak.
There may have been persistent transmission of nosocomial legionnaires' disease at this hospital that went undiscovered for many years because there was no active surveillance for legionnaires' disease. Introduction of a rapid urinary antigen test improved case ascertainment. Legionella species can be established in colonized plumbing systems and may pose a risk for infection over prolonged periods.
This paper deals with the growth by molecular beam epitaxy of semimetallic (rare-earth group V element) compounds on III-V semiconductors. Results are presented, first on the Er-Ga-As and Er-Ga-Sb ternary phase diagrams, second on the lattice-mismatched ErAs/GaAs (δa ≈ +1.6%), YbAs/GaAs (δa/a = +0.8%), and ErSb/GaSb (δa/a ≈ +0.2%) heterostructures, and third on the lattice-matched Sc0.3Er0.7As/GaAs and Sc0.2Yb0.8As/GaAs systems (δa/a < 0.05%). Finally the growth of YbSb2 on GaSb(001) is reported. The studies made in situ by reflection high-energy electron diffraction (RHEED) and x-ray photoelectron diffraction and ex situ by x-ray diffraction, transmission electron microscopy, He+ Rutherford backscattering, and photoelectron spectroscopy are presented. We discuss the atomic registry of the epitaxial layers with respect to the substrates, the appearance of a mosaic effect in lattice-mismatched structures, and the optical and electrical properties of the semimetallic films. The problems encountered for III-V overgrowth on these compounds (lack of wetting and symmetry-related defects) are commented on, and we underline the interest of compounds as YbSb2 which avoid the appearance of inversion defects in the GaSb overlayers.
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