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One of the major challenges with antidepressant (AD) use is poor adherence and early treatment discontinuation. In addition to socio-demographic and clinical variables, treatment discontinuation may also be related to the capacity of the health system to assure and maintain continuity and intensity of care. Among health system factors that may interfere with adherence to pharmacological treatment, use of generic drugs may play a key role. It has been argued that, although the lower cost of generics may favour persistence on treatment, a widespread a priori scepticism about their effectiveness and safety by doctors and patients may have an opposite effect. This compelling research question has recently been addressed by an observational cohort study that involved 16 778 Medicare fee-for-service beneficiaries who received a new depression diagnosis and initiated generic v. brand AD therapy. The study found that generic initiation was associated with improved adherence. The benefits resulted from the lower out-of-pocket cost associated with generic ADs. In this commentary, we discuss the main findings of this study in view of its methodological strengths and limitations, and we suggest implications for policy.
To determine the prevalence of women of childbearing age with schizophrenia and bipolar disorder exposed to antipsychotic (AP) drugs and mood stabilizers (MS) in Lombardy, a European region of 10 million inhabitants and 1 752 285 women of childbearing age.
The data concerning psychiatric care, drug treatments and pregnancy outcomes were retrieved from local administrative databases during a 12-month census period.
During a 12-month census period, 2893 women of childbearing age with schizophrenia (74.8% of all women of childbearing age with schizophrenia) and 918 with bipolar disorder (80.1% of all women of childbearing age with bipolar disorder) were exposed to AP drugs or MS, yielding a prevalence of exposure for women with schizophrenia of 1.65 (95% confidence interval (CI) 1.59–1.71) per 1000 female inhabitants, and for women with bipolar disorder of 0.52 (95% CI 0.49–0.55) per 1000 female inhabitants. Persistent exposure to potentially teratogenic medications accounted for one in every 1000 women of childbearing age. Of the 57 pregnancies in women with schizophrenia, normal delivery was recorded in 23 (40%) cases; of the 26 pregnancies in women with bipolar disorder, normal delivery was recorded in 10 (38%) cases.
In women of childbearing age with severe mental disorders, exposure to psychotropic drugs is substantial, which suggests that the issue of reproductive health is epidemiologically relevant and a major public health concern.
The objective was evaluating the psychometric properties of the Sociocultural Attitudes Towards Appearance Questionnaire-3 (SATAQ–3) among Brazilian young adults of both genders. The sample was composed by 506 undergraduate students (295 females and 211 males), aged between 17 and 29 years old. Exploratory and confirmatory factor analyses were used for construct validity (N = 506). Correlations between the SATAQ–3 scores and those of the Tripartite Influence Scale (TIS) and Body Shape Questionnaire (BSQ) were used for convergent validity. Reliability was assessed through internal consistency (α) and reproducibility (test-retest) through comparison of the means obtained at two different time points and through intra-class correlation. The scale presented a factor structure composed of five factors, replicated in the confirmatory factor analysis with satisfactory values for the measurements of adjustment to the model. Correlations with the BSQ and TIS scores were rho = .52 and rho = –.35, respectively. Cronbach’s alpha coefficients were satisfactory, and their stability was demonstrated. Brazilian SATAQ–3 had good validity and reproducibility, being indicated for use in samples of Brazilian youths.
In this article the main contents of this special issue are introduced. In particular, some of the main problems related to multi-level electoral competition in Italy are presented and how this work intends to analyse them. It will be shown that both parties and voters have strategically adapted and responded to the challenges of multi-level electoral competition to an extent that was probably unexpected in a system undergoing transformation and whose inefficiencies are a conventional wisdom.
The prismatic variety of fluoro-edenite, a new amphibole found in lavas from Mt Etna in Biancavilla (Catania Province, Sicily, Italy), has been characterized by μ-Raman and μ-FTIR spectroscopy. The wavenumbers at which the bands are detected in the μ-Raman and μ-FTIR spectra are compared with tremolite, asbestos the chemical and crystallographic characteristics of which are very similar to those of fluoro-edenite.
In this work TF values for 90Sr and 137Cs were measured for reference plants grown in lysimeters containing soils representative of large agricultural areas in Brazil: Ferralsol, Nitisol and Acrisol. These results were discussed in the light of pedological analyses and results from the follow sequential chemical extraction protocol: 1) slightly acidic phase containing readily bioavailable elements;
2) easily reducible phase containing elements bound to Mn oxides; 3) oxidizable phase containing elements bound to labile organic matter; 4) alkaline phase containing mainly elements bound to Fe compounds; 5) resistant phase not potentially available to crops. These results showed that the main soil factors influencing the 137Cs transfer to these soils were: exchangeable K, organic matter and iron oxides content. These results showed that 90Sr plant uptake was influenced by exchangeable Ca. All these finds are in accord with previous studies and seems confirm the vulnerability of Ferralsol and Acrisol to 137Cs contamination
Background and objective: Differences in sensitivity to anaesthetic drugs may exist among human races. Allelic variants for drug metabolizing isoenzymes and other pharmacokinetic/pharmacodynamic differences may account for a variable response to anaesthetic drugs. This study was designed to investigate comparatively the anaesthetic requirements and the recovery trends of three different ethnic groups: Caucasians, African blacks and Brazilians.
Methods: The anaesthetic depth and recovery of groups of 45 patients undergoing total intravenous anaesthesia with propofol and fentanyl were compared. The bispectral index and clinical parameters were used to assess the depth of anaesthesia. The bispectral index, the response to verbal stimuli and the eye opening time were used to assess recovery.
Results: After stopping propofol, the bispectral index values of Caucasians returned to the baseline in about 10.8 ± 4 min, that of Kenyan African blacks in 18 ± 7 min and that of Brazilians in a highly variable time ranging from 5 to 25 min, (14.9 ± 9.9). The time from discontinuation of propofol and fentanyl infusion to eye opening was 18.8 ± 7.1 min in African blacks (P < 0.01) and 13.5 ± 8.8 min in Brazilians (P > 0.05) vs. 11.6 ± 4.5 min in Caucasians. Time to respond to verbal commands was 16.8 ± 8 min in African blacks (P < 0.01) and 12.8 ± 8.1 min in Brazilians (P > 0.05) vs. 9.9 ± 4.5 min in Caucasians.
Conclusions: The recovery of Kenyan African blacks from anaesthesia with propofol and fentanyl is much slower, in comparison with Caucasians. The recovery time of Brazilians is much more variable, in comparison with Caucasians.
Background. There is very little information on long-term follow-up of social phobia.
Methods. A consecutive series of 70 patients satisfying the DSM-IV criteria for social phobia was treated in an out-patient clinic with behavioural methods based on exposure homework. Forty-five patients were judged to be remitted after eight individual sessions of psychotherapy. A 2 to 12 year (median = 6 years) follow-up was performed. Survival analysis was selected to characterize the clinical course of patients. Assessments were performed before treatment, at the end of therapy, after 1 year, and subsequently on a yearly basis, and utilized selected items of Paykel's Clinical Interview for Depression.
Results. Six of the 45 patients (13%) had a relapse of social phobia at some time during follow-up. The estimated cumulative percentage of patients remaining in remission was 98 after 2 years, 85 after 5 years and 85 after 10 years. Such probabilities increased in the absence of a personality disorder, of residual social phobic avoidance after exposure, and of concurrent use of benzodiazepines.
Conclusions. The findings suggest that, even though one patient out of three is unable to complete treatment or does not benefit sufficiently from it, exposure treatment can provide lasting effects to the majority of patients with social phobia. Disappearance of residual, subclinical social phobic avoidance appears to be the target of treatment.
Background. There is a paucity of long-term outcome studies of panic disorder that exceed a 2-year follow-up. The aim of the study was to evaluate the long-term follow-up of patients with panic disorder with agoraphobia treated according to a standardized protocol.
Methods. A consecutive series of 200 patients satisfying the DSM-IV criteria for panic disorder with agoraphobia was treated in an out-patient clinic with behavioural methods based on exposure homework. One hundred and thirty-six patients became panic free after 12 sessions of psychotherapy and 132 were available for follow-up. A 2- to 14-year (median = 8 years) follow-up was performed. Survival analysis was employed to characterize the clinical course of patients.
Results. Thirty-one of the 132 patients (23%) had a relapse of panic disorder at some time during follow-up. The estimated cumulative percentage of patients remaining in remission was 93·1 after 2 years, 82·4 after 5 years, 78·8 after 7 years and 62·1 after 10 years. Such probabilities increased with younger age, and in the absence of a personality disorder, of high pre-treatment levels of depressed mood, of residual agoraphobic avoidance after exposure, and of concurrent use of benzodiazepines and antidepressant drugs.
Conclusions. The findings suggest that exposure treatment can provide lasting relief to the majority of patients with panic disorder and agoraphobia. Disappearance of residual and subclinical agoraphobic avoidance, and not simply of panic attacks, should be the aim of exposure therapy.
Ten BALB/c mice were infected with the cestode Echinococcus granulosus. After the infection, serum was collected at different periods of time and monocyte chemotactic protein-1 (MCP-1) and macrophage inflammatory protein-2 (MIP-2) were determined. The level of MCP-1 increased from 290±12 pg ml-1 (mean±SD) at day 20 post infection (p.i.), to a maximum of 820±23 pg ml-1 on day 60 p.i., then decreased to 460±12.6 pg ml-1 on day 130 p.i. A second peak was observed at day 150 p.i. In addition, MIP-2 was detectable in serum as late as day 100 p.i. The highest level (100±11 pg ml-1) was observed on day 130 p.i., and decreased thereafter. Serum from noninfected animals (controls) contained no detectable levels of either MCP-1 or MIP-2. However, MCP-1 and MIP-2 appear to be implicated in E. granulosus infections, but their exact role during the disease is under determination.
Wolf-Rayet galaxies are a subset of blue emission-line galaxies, whose spectra show the signature of large numbers of WR stars, with ages in the range 1-10 x 106 yr. Mid infra-red observations are well suited to the study of their hot, massive stars since this spectral region contains many fine-structure nebular lines which depend very sensitively on stellar content. The observations of ISO have opened-up this window, which we are exploiting through a Guest Observer program with the Short Wavelength Spectrometer (sws), that includes NGC 5253, a nearby (4 Mpc) WR galaxy. NGC 5253 contains several young super-star clusters, no older than a few million years and has been the focus of many recent studies which have shown that the extinction is very high and patchy in the UV and optical. ISO observations of NGC 5253 are particularly important since the interstellar extinction at mid-IR wavelengths is low and because of its remarkably hot and young stellar population.
Barley plants experimentally infected with Erysiphe
graminis f. sp. hordei were subjected to a curative treatment
(TC), to find out if the thickenings induced by the treatment in the fungal
and host cell walls might be related to an increased
production of chitosan. The presence of chitosan was assessed by colorimetric
method, histological staining and ultrastructural
localization with chitosanase bound to colloidal gold. The results showed
that after TC treatment the amount of chitosan increase in
the cell walls of hyphae and haustoria, and also in the haustorial encasements.
Background. There is increasing awareness of the prognostic
value of residual symptomatology in
affective disorders and of the need for specific therapeutic strategies
in this phase of illness. The aims
of the study were to apply a novel, short-term psychotherapeutic approach
for increasing well-being, based on Ryff's conceptual model, to
remitted patients with affective disorders and to
compare the results with those obtained with symptom-oriented cognitive
Methods. Twenty patients with affective disorders (major
depression, panic disorder with
agoraphobia, social phobia, generalized anxiety disorder, obsessive–compulsive
disorder) who had been successfully treated by behavioural or pharmacological
methods were randomly assigned to a
well-being enhancing therapeutic strategy (well-being therapy) or
cognitive–behavioural treatment of residual symptoms.
Results. Both well-being and cognitive–behavioural
therapies were associated with a significant
reduction of residual symptoms. However, a significant advantage of well-being
cognitive–behavioural strategies was observed with observer-rated
Discussion. These preliminary results suggest the feasibility
well-being therapy in the residual
stage of affective disorders. Further research should determine its
value as a relapse-preventive strategy in specific mood and anxiety disorders.
Heteroepitaxial GaN films grown on sapphire are usually in a compressive residual biaxial stress state that is typically 100 – 500 MPa but can be as high as 1 GPa. Spatially resolved measurements of GaN film stresses obtained via micro-Raman spectroscopy using shifts in the frequency of the E2 phonon are presented. The spatial resolution of this stress measurement technique is ca. 2 μm laterally and 10 μm in the axial (growth) direction. Two interesting stress gradients are found near cleaved edges. (1) On the surface of the cleaved edge the compressive film stress is a maximum at the GaN/sapphire interface and relaxes to a nearly stress-free state towards the free edge. (2) In the lateral direction, the stress increases away from the edge, reaching a steady-state value at approximately 10x the film thickness. It is shown that the effects are consistent with existing finite element models used to treat strained growth of surface structures in other semiconductor systems. An axial stress gradient that is not associated with edge effects is found in some thick (>20 μm) HVPEgrown films. The interface region is found to be up to 500 MPa in compression, but this stress declines toward the film surface, which is found to be nearly stress free.
Strain in GaN epitaxial layers at room temperature is measured with three complementary methods: Raman spectroscopy (via shifts of phonon frequencies), low temperature photoluminescence (via shifts of band-edge luminescence), and X-ray diffraction (via shifts in lattice spacings). GaN films grown on the c-plane of sapphire tend to be in compression. Increasing the Si-dopant concentration (up to 1019 cm−3) is observed to add compressive strain to the layer. Axially resolved measurements obtained by micro-Raman in 4 μm thick Si-doped films reveal strain relaxation toward the sample surface at Si concentrations above 1018 cm−3. Mg- and Si-doped GaN films on SiC substrates are found to be in tension. An experimental methodology is presented that separates two contributions to the room temperature residual stress in GaN epilayers: (1) the thermal stress due to differences in the thermal expansion coefficients of the epilayer and substrate and (2) the intrinsic stress, which is influenced by the growth conditions. We measure stress as a function of temperature up to 325 C, about one-third of the growth temperature, by monitoring the frequency of the E2 phonon mode by Raman spectroscopy. A high-quality bulk single crystal of GaN is used as a strain-free standard. Over this temperature range, most layers behave elastically; the observed stress trends are well-fit by a thermal expansion model using previous reported values of the thermal expansion coefficients of GaN and the substrates. The intrinsic stress states at the growth temperature for films grown on sapphire and SiC are predicted to be tensile and compressive, respectively, in agreement with the a-plane lattice coefficient mismatch.
In the present study 90 multiple pregnancies were examined. These were subdivided on the basis of the number of embryos involved (74 twins, 10 triplets, 6 quintuplets) and on whether they were followed at our clinic for the entire pregnancy or not. In each group we analysed certain variables, calculating the respective mean values and standard deviations. We used the ANOVA test to discriminate the eventual differences in the means of the variables analysed, operating a p<0.05 significance value. In addition, significant differences were analysed by the test of Contrasts (Scheffe F-test). The concept that emerged from the data investigated is that careful management of these pregnancies, carried out in high-level structures, can reduce the incidence of complications on both the maternal and fetal side and thus prevent “minimal brain damage” in the newborn.
The LMC star R84 (-HDE 269227 -BR 18) belongs to the group of Ofpe/WN stars believed to be closely related to the Luminous Blue Variables. Support for such a relation comes from the spectral resemblance of these stars to AG Car during visual minimum, and from the observed outburst of the Ofpe/WN star R127.
The spectral analysis of R84 presented here is based on model calculations with the NLTE comoving-frame code described by Wessolowski et al. (1988) and references therein. The helium model atom was represented by 28 levels and hydrogen by 9 levels. The free model parameters were varied until the observed line profiles and the absolutely calibrated and dereddened continuum flux were reproduced. The comparison of the theoretical continuum flux distribution with the observed one yields a reddening of EB-V =0.1.