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Concerns have been raised about ecological momentary assessment (EMA) acceptability among patients with schizophrenia spectrum disorders (SSD), which is of major relevance during the e-Mental health-focused COVID-19 pandemic.
To investigate i) the levels of adherence to a passive smartphone-based EMA tool, the Evidence-Based Behavior (eB2), among SSD patients; and ii) putative predictors of this.
Sample: SSD (F20-29-ICD10) outpatients, age 18-64, without financial incentives, recruited over 17/06/2019-11/03/2020 at the Hospital Universitario Fundación Jiménez Díaz (Madrid, Spain). Those who accepted the eB2 installation -users- and those who did not -non-users- were compared in sociodemographic, clinical, premorbid adjustment, neurocognitive, psychopathological, insight and metacognitive variables by a multivariable binary logistic regression model.
Sample (N=77): n=41 males; age: 47.69±9.76 years, n=24 users (31.2%). n=14 users (70%) had the eB2 installed at follow-up (median=14.50 weeks).
Multivariable binary logistic regression model on ‘user’ as outcome
Acceptability of a smartphone-based EMA application among SSD patients was low. Age (young) and good premorbid adjustment predicted acceptability. e-Mental Health methods need to be tailored for patients with SSD. Otherwise, these highly vulnerable individuals may be neglected by e-health-based services in the post-COVID-19 years ahead.
Persistent negative symptoms are associated with worse outcome in both first-episode and chronic subjects with schizophrenia. The identification of these symptoms in recent-onset subjects is still controversial as retrospective data are often unavailable. The prospective assessment of persistence of negative symptoms might represent a valid alternative but the length of the persistence is still to be established. The present study investigated the prevalence of negative symptoms of moderate severity, unconfounded by depression and extrapyramidal symptoms at baseline in a large cohort of patients in the early stage of a schizophrenia-spectrum disorder, recruited to the OPTiMiSE trial. Persistent unconfounded negative symptoms were assessed at 4, 10 and 22 weeks of treatment. Symptomatic remission, attrition rate and psychosocial functioning was evaluated in subjects with short-term (4 weeks) persistent negative symptoms (PNS) and in those with negative symptoms that did not persist at follow-up and/or were confounded at baseline (N-PNS). Negative symptoms of moderate severity were observed in 59% of subjects at baseline and were associated to worse global functioning. PNS were observed in 7.9% of the cohort, unconfounded at both baseline and end of 4-week treatment. PNS subjects showed lower remission and higher attrition rates at the end of all treatment phases. Fifty-six percent of subjects completing phase 3 (clozapine treatment) had PNS, and 60% of them were non-remitters at the end of this phase. The presence of short-term PNS during the first phases of psychosis was associated with poor clinical outcome and resistance to antipsychotic treatment, including clozapine.
Prof Mucci has been a consultant and/or advisor to or has received honoraria from Gedeon Richter Bulgaria, Janssen Pharmaceuticals, Lundbeck, Otsuka, Pfizer and Pierre Fabre.
Given the high prevalence of multiple non-communicable chronic diseases in Mexico, the aim of the present study was to assess the association between dietary patterns and sleep disorders in a national representative sample of 5076 Mexican adults (20–59 years) from the 2016 National Health and Nutrition Survey. Through a cross-sectional study, we used the Berlin sleep symptoms questionnaire to estimate the proportion of adults with insomnia, obstructive sleep apnoea (OSA) and other related problems such as daytime symptoms and inadequate sleep duration. Dietary data were collected through a seven-day semi-quantitative food frequency questionnaire, and dietary patterns were determined through cluster analysis. Associations between dietary patterns and sleep disorders were assessed by multivariate logistic regression models adjusted for age, sex, well-being, rural/urban area type, geographical region, tobacco use, physical activity level and energy intake. Three dietary patterns were identified: traditional (high in legumes and tortilla), industrialised (high in sugar-sweetened beverages, fast foods, and alcohol, coffee or tea) and mixed (high in meat, poultry, fruits and vegetables). Multivariate logistic regression showed that the industrialised pattern yielded higher odds for daytime symptoms (OR 1⋅49; 95 % CI 1⋅12, 1⋅99) and OSA (OR 1⋅63; 95 % CI 1⋅21, 2⋅19) compared with the traditional pattern. In conclusion, dietary patterns are associated with sleep disorders in Mexican adults. Further research is required to break the vicious cycle of poor-quality diet, sleep symptoms and health.
Rabies is endemic in Bangladesh. To identify risk factors, a case-control study was conducted based on hospital-reported rabid animal bite (RAB) cases in domestic ruminants, 2009 − 2018. RAB cases (n = 449) and three controls per case were selected. Dogs (87.8%) and jackals (12.2%) were most often identified as biting animals. In the final multivariable model, the risk of being a RAB case was significantly higher in cattle aged >0.5–2 years (odds ratio (OR) 2.89; 95% confidence interval (CI): 1.56–5.37), >2–5 years (OR 3.63; 95% CI: 1.97–6.67) and >5 years (OR 6.42; 95% CI: 3.39–12.17) compared to those aged <0.5 years. Crossbred cattle were at higher risk of being a RAB case (OR 5.48; 95% CI: 3.56–8.42) than indigenous. Similarly, female cattle were more likely to be a RAB case (OR 1.26; 95% CI: 1.15–2.29) than males. Cattle in rural areas (OR 39.48; 95% CI: 6.14–254.00) were at a much higher risk of being RAB cases than those in urban areas. Female, crossbred and older cattle, especially in rural areas should either be managed indoors during the dog breeding season (September and October) or vaccinated. A national rabies elimination program should prioritise rural dogs for mass vaccination. Jackals should also be immunised using oral bait vaccines. Prevention of rabies in rural dogs and jackals would also reduce rabies incidence in humans.
Cyclospora cayetanensis is a parasite causing cyclosporiasis (an illness in humans). Produce (fruits, vegetables, herbs), water and soil contaminated with C. cayetanensis have been implicated in human infection. The objective was to conduct a scoping review of primary research in English on the detection, epidemiology and control of C. cayetanensis with an emphasis on produce, water and soil. MEDLINE® (Web of ScienceTM), Agricola (ProQuest), CABI Global Health, and Food Science and Technology Abstracts (EBSCOhost) were searched from 1979 to February 2020. Of the 349 relevant primary research studies identified, there were 75 detection-method studies, 40 molecular characterisation studies, 38 studies of Cyclospora in the environment (33 prevalence studies, 10 studies of factors associated with environmental contamination), 246 human infection studies (212 prevalence/incidence studies, 32 outbreak studies, 60 studies of environmental factors associated with non-outbreak human infection) and eight control studies. There appears to be sufficient literature for a systematic review of prevalence and factors associated with human infection with C. cayetanensis. There is a dearth of publicly available detection-method studies in soil (n = 0) and water (n = 2), prevalence studies on soil (n = 1) and studies of the control of Cyclospora (particularly on produce prior to retail (n = 0)).
With the legalization of marijuana (Cannabis sativa) and increasing use during pregnancy, it is important to understand its impact on exposed offspring. Specifically, the effects of Δ-9-tetrahydrocannabinol (Δ9-THC), the major psychoactive component of cannabis, on fetal ovarian development and long-term reproductive health are not fully understood. The aim of this study was to assess the effect of prenatal exposure to Δ9-THC on ovarian health in adult rat offspring. At 6 months of age, Δ9-THC-exposed offspring had accelerated folliculogenesis with apparent follicular development arrest, but no persistent effects on circulating steroid levels. Ovaries from Δ9-THC-exposed offspring had reduced blood vessel density in association with decreased expression of the pro-angiogenic factor VEGF and its receptor VEGFR-2, as well as an increase in the anti-angiogenic factor thrombospondin 1 (TSP-1). Collectively, these data suggest that exposure to Δ9-THC during pregnancy alters follicular dynamics during postnatal life, which may have long-lasting detrimental effects on female reproductive health.
Understanding place-based contributors to health requires geographically and culturally diverse study populations, but sharing location data is a significant challenge to multisite studies. Here, we describe a standardized and reproducible method to perform geospatial analyses for multisite studies. Using census tract-level information, we created software for geocoding and geospatial data linkage that was distributed to a consortium of birth cohorts located throughout the USA. Individual sites performed geospatial linkages and returned tract-level information for 8810 children to a central site for analyses. Our generalizable approach demonstrates the feasibility of geospatial analyses across study sites to promote collaborative translational research.
To investigate potential age, period and birth cohort effects in the prevalence of suicide ideation in European ageing population.
A total of 50 782 community-dwelling adults (aged + 50) from 20 different European countries were collected in the Survey Health Ageing and Retirement study. A multilevel logistic regression model of repeated measures was modelled to assess the effects of age and other variables, including the variability of observations over three levels: birth cohort groups, time period assessment and individual differences.
The larger effect of variability was attributed to individual-level factors (57.8%). Youngest-old people (65–79 years) showed lower suicide ideation than middle-aged people (50–64 years). No significative differences were found for suicide ideation between middle-aged people and oldest-old (80 + years). Only 0.85% and 0.13% of the total variability of suicide ideation accounted for birth cohort and period effects, respectively. Cohorts born between 1941 and 1944 possessed the lowest estimates of suicide ideation. Conversely, suicide ideation started to rise with post-War generations and reached a significant level for people born from 1953–1957 to 1961–1964. Regarding the time period, participants assessed in 2006–2007 showed a lower likelihood of suicide ideation. The rest of the cohorts and period groups did not show any significant effect on the prevalence of suicide ideation.
Our results suggest that age and suicide ideation relationship is not linear in middle and older age. The European Baby boomers born from 50s to mid-60s might report higher suicide ideation than their ancestors. This scenario would imply a greater need for mental healthcare services for older people in the future.
Both decreases in compositional similarity with increasing geographic distances between sites (i.e. distance–decay relationship) and vertical stratification of species composition are key issues in ecology. However, the intersection between these two trends has scarcely been investigated. Here we use identical sampling methods in the canopy and at ground level in a tropical rainforest remnant on the coast of the Gulf of Mexico to evaluate, for the first time, a distance–decay relationship within vertical strata in insect assemblages. We found that the ant assemblage was vertically stratified; ant species richness was higher at ground level than in the canopy, and the species composition differed between the two vertical strata. Moreover, we observed that β-diversity increased with geographic distance at ground level, but not in the canopy strata. However, contrary to our prediction, there was less species turnover (lower β-diversity) between vertical strata than between trees. These findings may reflect differences in the dispersal capacity and nest habit of ants from each vertical stratum, and also habitat heterogeneity on the horizontal scale, e.g. the species of sampled trees. Our results illustrate the importance of sampling more than one vertical stratum to understand the spatial distribution patterns of biological diversity in tropical rainforests.
To conduct a systematic review of studies for the validation of semiquantitative FFQ (SFFQ) that assess food intake in adults.
The authors conducted a systematic search in PubMed for articles published as late as January 2020 in Spanish, English, French and Portuguese. Individual searches (twelve in total) paired three hyphenated and non-hyphenated variations of ‘semiquantitative food frequency questionnaire’ with both ‘validity’ and ‘validation’ using the ‘all fields’ and the ‘title/abstract’ retrieval categories. Independent extraction of articles was performed by four authors using predefined data fields.
We searched for original SFFQ validation studies that analysed general diet composition (nutrients with or without food groups or energy analysis) in healthy adults, in any setting, and that also reported correlation coefficients.
Sixty articles were included. The preferred comparison standard for validation was food records (n 37). The main correlation coefficients used were Pearson’s (n 41), and validity coefficients varied from −0·45 to 1. Most correlation coefficients were adjusted by energy (twelve studies presented only crude values). The elements mentioned most frequently were energy, macronutrients, cholesterol, SFA, PUFA, fibre, vitamin C, Ca and Fe.
Although all these SFFQ are reported as validated, coefficients may vary across groups of foods and nutrients. Based on our findings, we suggest researchers to consult our revision before choosing a SFFQ and to review important issues about them, such as their validation, number of items, number of participants, etc. Systematic Review Registration: PROSPERO number CRD42017064716. Available at: http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42017064716.
Aggressive behaviour is a highly prevalent and devastating condition in autism spectrum disorder resulting in impoverished quality of life. Gold-standard therapies are ineffective in about 30% of patients leading to greater suffering. We investigated cortical thickness in individuals with autism spectrum disorder with pharmacological-treatment-refractory aggressive behaviour compared with those with non-refractory aggressive behaviour and observed a brain-wide pattern of local increased thickness in key areas related to emotional control and overall decreased cortical thickness in those with refractory aggressive behaviour, suggesting refractoriness could be related to specific morphological patterns. Elucidating the neurobiology of refractory aggressive behaviour is crucial to provide insights and potential avenues for new interventions.
Bipolar disorder (BD) is associated with social cognition (SC) impairments even during remission periods although a large heterogeneity has been described. Our aim was to explore the existence of different profiles on SC in euthymic patients with BD, and further explore the potential impact of distinct variables on SC.
Hierarchical cluster analysis was conducted using three SC domains [Theory of Mind (ToM), Emotional Intelligence (EI) and Attributional Bias (AB)]. The sample comprised of 131 individuals, 71 patients with BD and 60 healthy control subjects who were compared in terms of SC performance, demographic, clinical, and neurocognitive variables. A logistic regression model was used to estimate the effect of SC-associated risk factors.
A two-cluster solution was identified with an adjusted-performance group (N = 48, 67.6%) and a low-performance group (N = 23, 32.4%) with mild deficits in ToM and AB domains and with moderate difficulties in EI. Patients with low SC performance were mostly males, showed lower estimated IQ, higher subthreshold depressive symptoms, longer illness duration, and poorer visual memory and attention. Low estimated IQ (OR 0.920, 95% CI 0.863–0.981), male gender (OR 5.661, 95% CI 1.473–21.762), and longer illness duration (OR 1.085, 95% CI 1.006–1.171) contributed the most to the patients clustering. The model explained up to 35% of the variance in SC performance.
Our results confirmed the existence of two discrete profiles of SC among BD. Nearly two-thirds of patients exhibited adjusted social cognitive abilities. Longer illness duration, male gender, and lower estimated IQ were associated with low SC performance.
Improving functioning in patients with bipolar disorder (BD) is one of the main objectives in clinical practice. Of the few psychosocial interventions that have been specifically developed to enhance the psychosocial outcome in BD, functional remediation (FR) is one which has demonstrated efficacy. The aim of this study was to examine which variables could predict improved functional outcome following the FR intervention in a sample of euthymic or subsyndromal patients with BD.
A total of 92 euthymic outpatients were included in this longitudinal study, with 62 completers. Partial correlations controlling for the functional outcome at baseline were calculated between demographic, clinical and neurocognitive variables, and functional outcome at endpoint was assessed by means of the Functioning Assessment Short Test scale. Next, a multiple regression analysis was run in order to identify potential predictors of functional outcome at 2-year follow-up, using the variables found to be statistically significant in the correlation analysis and other variables related to functioning as identified in the previous scientific literature.
The regression model revealed that only two independent variables significantly contributed to the model (F(6,53): 4.003; p = 0.002), namely verbal memory and inhibitory control. The model accounted for 31.2% of the variance. No other demographic or clinical variable contributed to the model.
Results suggest that patients with better cognitive performance at baseline, especially in terms of verbal memory and executive functions, may present better functional outcomes at long term follow-up after receiving functional remediation.
A new design methodology for long life and large size (Ll-Ls) products called Design for Installation (DfI) is proposed. Ll-Ls products are usually made up of large parts that need to be assembled on field. The proposed methodology, based on adapted Design Structure Matrix (DSM) and Design for Manufacturing and Assembly (DfMA) methods, enables to optimize the design of a Ll-Ls product in order to reduce time and cost of the installation process. The new methodology works with a conceptual design of the product and the weight and size restrictions given by logistic factors as inputs.
There are 80.000 patients undergoing replacement opiate programs in Spain, mainly methadone. Gender differences and the ratio of dual diagnosis in this population are unknown.
To describe gender differences in the current therapeutic management of opiate-dependent patients undergoing a replacement therapy program in Spain.
624 patients from 74 centers in Spain were included between September 2008 and February 2009 in an observational, cross-sectional, multicenter study. Patients were ≥ 18 years, had a diagnosis of opiate dependence according to DSM-IV-TR criteria, were currently scheduled in a replacement therapy program in Spain and were given written informed consent.
Only 16% of patients were female. Methadone average doses were significantly higher in man (57,59mg ± (SD 46,77) vs 52,81mg ± (SD 50,81) (p< 0.05)). Most women were caretaken by their partner (56.8% vs 34,2%) and man by their parents (61,6% vs 37,8) p< 0,05.Women were found to have significantly more sexual disorders than men (6% versus 2%; p=0.0316); but less delirium, dementia, amnesic and other cognitive disorders (none versus 6%; p=0.0486); schizophrenia and other psychotic disorders (3% versus 13%; p=0.0226); and adaptive disorders (2% versus 9%; 0.0427). No significant differences were found between sexes for other psychiatric comorbidities.
The ratio between men and women was close to 5/1, being bigger than that in the general opiate dependent Spanish population. Dual diagnosis rates vary by gender, but not in the number of diagnosis in Axis I or II. Gender differences must be considered when planning dependence services as women.
To determine the association between functional impairment, as reported in a lay-administered structured interview (CIDI), and severity of depression, depressive symptoms and risk factors for depression.
We undertook a cross-sectional study of 5442 consecutive attendees at general practices in seven Spanish provinces participating in the PredictD-Spain study on predictors of depression. Participants were administered the depression section of the Composite International Diagnostic Interview (WHO-CIDI 2.1), allowing diagnoses by the ICD-10 and DSM-IV classifications for depressive episodes. Impairment was measured using the CIDI question about whether symptoms seriously interfered with important areas of functioning, such as work or looking after the house and family. We measured a set of 39 known risk factors for depression.
Firstly, the 6-month prevalence of a depressive episode according to ICD-10 was 28.7% (1563) and of major depression according to DSM-IV it was 13.6% (742). Secondly, out of the 1563 patients with a depressive episode according to ICD-10, nearly half (47.9%; n=749) had no impairment in important areas of functioning.
As the ICD-10 criteria for depressive diagnoses do not include the criteria that symptoms cause impairment in social, occupational or other important areas of functioning, a large number of false positive cases are included in reported prevalence rates; and secondly, the measurement of functional impairment, at least operationalized using a lay-administered structured interview such as CIDI, is not enough, in epidemiological research studies, to assess the clinical importance of depressive symptoms.
Describe the prevalence and characteristics of psychotic symptoms in the context of cocaine injection use in a harm reduction program.
To find associations between intravenous cocaine use and other drug use in cocaine dependent patients suffering from cocaine induced psychosis (CIP). Cannabis was found to be a risk factor for developing CIP in non-intravenous cocaine dependence.
During a period of 6 months professionals from our Outpatient Drug Clinic completed a confidential questionnaire to describe the adverse clinical effects following cocaine injection. It included age, gender, ethnic group, daily consumption rate and other drugs used in the last 30 days.
Survey was achieved with a sample of 75 Caucasians patients, 69 men and 6 women with an average age of 32 years old. Seventeen percent (13/75) had psychotic symptoms, of which 84% (11/13) had hallucinations (visuals 4/11, auditive 7/11 and kinaesthetic 2/11), 15% (2/13) illusions.
Eighteen percent (14/75) had stereotypy movements and 3% (2/75) had aggressive behaviour. Drugs used by CIP patients, the previous 30 days were: 61% (8/13) cannabis, 31% (4/13) opiates and 15% (2/13) alcohol.
Intravenous cocaine use produced acute psychotic symptoms in 17% of our patients, of which 61% used cannabis. Despite the ethical and practical implications of this type of study, it is necessary to do more observational studies with bigger surveys to conclude these results with statistically significance.
To evaluate risperidone long-acting injectable (RLAI) versus placebo in prevention of mood episodes in adults with bipolar I disorder.
A 12-week open-label period with RLAI (N=585) was followed by an 18-month randomized, double-blind period with RLAI (25, 37.5 or 50 mg/2 weeks; N=137) or placebo (N=140); a third group (N=138) was randomized to olanzapine for reference and exploratory comparisons. Primary efficacy endpoint: time to relapse of any mood episode for risperidone LAI vs. placebo in the double-blind period (Kaplan-Meier analysis). Relapse was defined by criteria including DSM diagnosis, further treatment, hospitalisation, or Clinical Global Impression score ≥4 combined with YMRS or MADRS >12.
Dosing was fixed during the double-blind period at patients’ final open-label dose (25 mg, 66%; 37.5 mg, 31%; 50 mg, 4%). Time to recurrence (any mood episode) was longer with RLAI versus placebo (log-rank test stratified by region and patient type, p=0.062; stratified by region only, p=0.032); the difference was significant for time to recurrence of elevated mood episodes (p=0.005) but not depressive episodes (p=0.587). Discontinuations due to adverse events (AEs) occurred in 2% of patients in the open-label period, and 4% and 1% in the RLAI and placebo groups, respectively, in the double-blind period. The most frequently reported AE in the open-label period was insomnia (15%). During double-blind treatment, the most frequently reported AEs with RLAI were weight increased (24%; placebo, 9%) and insomnia (16%; placebo, 17%).
Type of recurrence
Type of episode, n (%)
Risperidone LAI (N=135)
All mood episodes
Elevated mood episode
RLAI significantly delayed time to relapse of elevated mood episodes and was well tolerated.
Obsessive compulsive-disorder (OCD) is a group of highly debilitating condition characterized by intrusive troubling thoughts, repetitive, compulsive behaviors or mental rituals. A notable percentage of patients are refractory to pharmacological treatment and cognitive behaviour therapy. Increasing attention has been paid to the efficacy of Deep Brain Stimulation (DBS) therapies in alleviating pharmacoresistant psychiatric disorders including OCD.
The aim of this prospective study was to determine the efficacy of DBS using several targets in a pharmacoresistant OCD population with heterogeneous symptoms.
Five patients (3 males) have been included in the study. Patients were classified according to their prominent features as follows: contamination/cleaning, symmetry/checking, exactness/counting and forbidden thoughts.
The entire surgical procedure was performed under general anaesthesia. Direct targeting based on stereotactic MRI without microelectrode recordings was done. A combination of two of the following targets was simultaneously implanted for all patients: subthalamic nucleus, accumbens nucleus and bed nucleus of stria terminalis, limbic globus pallidus internus.
Patients were assessed pre-and postoperatively using the Yale-Brown Obsessive Compulsive Scale.
Mean age at surgery was of 42.6±12.68 years. Mean follow-up with DBS was of 21±14.88 months.
Mean preoperative Y-BOCS scores was 31.6±2.70 and of 11±7.97 (p=0,057, Wilcoxon signed Rank test).
Subthalamic nucleus and accumbens nucleus targets seem to be comparable in alleviating several subtypes of compulsions (checking, cleaning, counting) as well as obsessions. Further investigations are required to assess the role of limbic globus pallidus in improving pharmacoresitant OCD. Implanted system was well accepted without triggering new obsessions.