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To characterize associations between exposures within and outside the medical workplace with healthcare personnel (HCP) SARS-CoV-2 infection, including the effect of various forms of respiratory protection.
Data collected via online survey from international participants.
1130 HCP (244 cases with laboratory-confirmed COVID-19, 886 controls healthy throughout the pandemic) from 67 countries not meeting pre-specified exclusion (healthy but not working, missing workplace exposure data, COVID symptoms without lab confirmation).
Respondents were queried regarding workplace exposures, respiratory protection, and extra-occupational activities. Odds ratios for HCP infection were calculated with multivariable logistic regression and sensitivity analyses controlling for confounders and known biases.
HCP infection was associated with non-aerosol-generating contact with COVID-19 patients (adjusted OR 1.4, 95% CI 1.04–1.9, p=0.03) and extra-occupational exposures including gatherings of ten or more, patronizing restaurants or bars, and public transportation (adjusted ORs ranging 3.1-16.2). Respirator use during aerosol-generating procedures (AGPs) was associated with lower odds of HCP infection (adjusted OR 0.4, 0.2 to 0.8, p=0.005), as was exposure to intensive care and dedicated COVID units, negative pressure rooms, and personal protective equipment (PPE) observers (adjusted ORs ranging 0.4-0.7).
COVID-19 transmission to HCP was associated with medical exposures currently considered lower-risk and multiple extra-occupational exposures, while exposures associated with proper use of appropriate PPE were protective. Closer scrutiny of infection control measures surrounding healthcare activities and medical settings considered lower risk, and continued awareness of the risks of public congregation, may reduce the incidence of HCP infection.
Emergency Medical Services (EMS) systems have developed protocols for prehospital activation of the cardiac catheterization laboratory for patients with suspected ST-elevation myocardial infarction (STEMI) to decrease first-medical-contact-to-balloon time (FMC2B). The rate of “false positive” prehospital activations is high. In order to decrease this rate and expedite care for patients with true STEMI, the American Heart Association (AHA; Dallas, Texas USA) developed the Mission Lifeline PreAct STEMI algorithm, which was implemented in Los Angeles County (LAC; California USA) in 2015. The hypothesis of this study was that implementation of the PreAct algorithm would increase the positive predictive value (PPV) of prehospital activation.
This is an observational pre-/post-study of the effect of the implementation of the PreAct algorithm for patients with suspected STEMI transported to one of five STEMI Receiving Centers (SRCs) within the LAC Regional System. The primary outcome was the PPV of cardiac catheterization laboratory activation for percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). The secondary outcome was FMC2B.
A total of 1,877 patients were analyzed for the primary outcome in the pre-intervention period and 405 patients in the post-intervention period. There was an overall decrease in cardiac catheterization laboratory activations, from 67% in the pre-intervention period to 49% in the post-intervention period (95% CI for the difference, -14% to -22%). The overall rate of cardiac catheterization declined in post-intervention period as compared the pre-intervention period, from 34% to 30% (95% CI, for the difference -7.6% to 0.4%), but actually increased for subjects who had activation (48% versus 58%; 95% CI, 4.6%-15.0%). Implementation of the PreAct algorithm was associated with an increase in the PPV of activation for PCI or CABG from 37.9% to 48.6%. The overall odds ratio (OR) associated with the intervention was 1.4 (95% CI, 1.1-1.8). The effect of the intervention was to decrease variability between medical centers. There was no associated change in average FMC2B.
The implementation of the PreAct algorithm in the LAC EMS system was associated with an overall increase in the PPV of cardiac catheterization laboratory activation.
A large literature now shows that Alzheimer’s disease (AD) disrupts a number of social cognitive abilities, including social perceptual function and theory of mind (ToM). However, less well understood is how the specific subcomponents of ToM as well as both the broader and specific subcomponents of empathic processing are affected.
The current study provides the first meta-analytic review of AD that focuses on both empathy and ToM as broad constructs, as well as their overlapping (cognitive empathy and affective ToM) and distinct (affective empathy and cognitive ToM) subcomponents.
Aggregated across 31 studies, the results revealed that, relative to controls, AD is associated with large-sized deficits in both cognitive ToM (g = 1.09) and affective ToM/cognitive empathy (g = 0.76). However, no statistical differences were found between the AD participants and controls on affective empathic abilities (g = 0.36).
These data point to a potentially important disconnect between core aspects of social cognitive processing in people with AD. The practical and theoretical implications of these findings are discussed.
The search for mechanisms in personality disorders (PDs) is of growing importance, because PDs are prevalent, costly, and challenging to treat. Unfortunately, there is a dearth of compelling mechanistic research on PDs and psychopathology more broadly, due to equivocal definitions of a “mechanism” and study designs that are atheoretical and/or ill-suited for causal inferences.This chapter defines mechanisms as elements of possible causal sequence, which not only increase the probability of observed outcomes but also reveal how the outcomes occur. In addition, the authors argue that it is not always necessary to break down a mechanism to its most elemental physical parts; rather, it is important to consider how mechanisms act as complex, interacting components of a causal chain, with a focus on those that could serve as viable targets for prevention and intervention. Considering this broader definition of a “mechanism,” it is crucial that PD researchers ground their work in testable theories, such as those considering dimensional, transdiagnostic precursors to PDs. In this chapter, the authors also address various design and statistical considerations in PD mechanistic research and highlight promising developments in identifying mechanisms of PDs across multiple levels of measurement (e.g., biological, contextual, environmental) and across the lifespan.
This rejoinder addresses commentaries by Markon and Bornovalova and colleagues. Markon highlighted challenges associated with determining cause and effect in mechanistic research. He theorized that “weak emergence” may account, in part, for the complex development of personality pathology. Bornovalova and colleagues addressed transactional relations between various phenomena that may influence development of personality pathology over time. In this rejoinder, the authors build upon these commentaries to further highlight challenges associated with identifying true mechanisms in psychopathology. They hypothesize that dynamical systems models, which conceptualize people as systems open to incalculable environmental influences, may provide an alternative approach through which researchers can examine complex mechanisms more accurately. Although such models are nascent in clinical research, particularly in the context of personality disorders, these approaches may provide more nuanced interpretations of mechanisms and may ultimately enrich our understanding of processes underlying the emergence of personality disorders.
Background: Trauma care represents a complex patient journey, requiring multi-disciplinary coordinated care. Team members are human, and as such, how they feel about their colleagues and their work affects performance. The challenge for health service leaders is enabling culture that supports high levels of collaboration, cooperation and coordination across diverse groups. Aim Statement: We aimed to define and set the agenda for improvement of the relational aspects of trauma care at a large tertiary care hospital. Measures & Design: We conducted a mixed-methods collaborative ethnography using the Relational Coordination survey – an established tool to analyze the relational dimensions of multidisciplinary teamwork – participant observation, interviews, and narrative surveys. Findings were presented to clinicians in working groups for further interpretation and to facilitate co-creation of targeted interventions designed to improve team relationships and performance. Evaluation/Results: We engaged a complex multidisciplinary network of ~500 care providers dispersed across seven core interdependent clinical disciplines. Initial findings highlighted the importance of relationships in trauma care and opportunities to improve. Narrative survey and ethnographic findings further highlighted the centrality of a translational simulation program in contributing positively to team culture and relational ties. A range of 16 interventions – focusing on structural, process and relational dimensions – were co-created with participants and are now being implemented and evaluated by various trauma care providers. Discussion/Impact: Through engagement of clinicians spanning organizational boundaries, relational aspects of care can be measured and directly targeted in a collaborative quality improvement process. We encourage health care leaders to consider relationship-based quality improvement strategies, including translational simulation and relational coordination processes, in their efforts to improve care for patients with complex, interdependent journeys.
The introduction of the first atypical antipsychotic with a long acting formulation has open new therapeutic options for the treatment of schizophrenic patients. Our objective consists of comparing psychopathology levels and global functioning in patients with paranoid schizophrenia treated in monotherapy either with long-acting injectable risperidone (LAIR) or conventional depot antipsychotics (DA).
Patients attending at the community mental health center during the six-month recruitment period were eligible to enter the study. Scores achieved in positive and negative subscales of PANNS and EEAG scale of (Global Activity Evaluating Scale) were evaluated at baseline and 6 months later. Six patients treated with RLAI and six patients treated with DA were recruited. Data were analyzed both with the real sample (N=6 per group) and extrapoling the same results to a bigger sample size (N=24 per group).
Mean increase in scores for both PANNS positive and negative subscales were lower in patients treated with RLAI that in those treated with DA (positive subscale: 0.018±0.06 vs. 0.048±0.03, RLAI and DA, respectively, p=0.387; negative subscale: 0.232±0.076 vs. 0.3095±0.123, RLAI and DA, respectively, p=0.579). EEAG scores were higher for patients treated with RLAI than those treated with DA (1.250±0.56 vs. 0.333±0.225, p=0.144). When these results are extrapolated to a sample of 24 patients per group, differences in EEAG reach statistical significance (p=0.034).
After 6 months of treatment, patients treated with RLAI tend to show a greater improvement in their global activity than those treated with DA.
Two common approaches to identify subgroups of patients with bipolar disorder are clustering methodology (mixture analysis) based on the age of onset, and a birth cohort analysis. This study investigates if a birth cohort effect will influence the results of clustering on the age of onset, using a large, international database.
The database includes 4037 patients with a diagnosis of bipolar I disorder, previously collected at 36 collection sites in 23 countries. Generalized estimating equations (GEE) were used to adjust the data for country median age, and in some models, birth cohort. Model-based clustering (mixture analysis) was then performed on the age of onset data using the residuals. Clinical variables in subgroups were compared.
There was a strong birth cohort effect. Without adjusting for the birth cohort, three subgroups were found by clustering. After adjusting for the birth cohort or when considering only those born after 1959, two subgroups were found. With results of either two or three subgroups, the youngest subgroup was more likely to have a family history of mood disorders and a first episode with depressed polarity. However, without adjusting for birth cohort (three subgroups), family history and polarity of the first episode could not be distinguished between the middle and oldest subgroups.
These results using international data confirm prior findings using single country data, that there are subgroups of bipolar I disorder based on the age of onset, and that there is a birth cohort effect. Including the birth cohort adjustment altered the number and characteristics of subgroups detected when clustering by age of onset. Further investigation is needed to determine if combining both approaches will identify subgroups that are more useful for research.
S100B is a calcium-binding protein produced by the astrocytes that has been used as a biomarker of brain inflammation. S100B has been involved in the schizophrenia pathophysiology, being considered a marker of state and prognosis.
Studying the relationship between serum S100B levels and psychopathology in first-episode psychosis (FEP).
At admission and discharge, serum S100B levels were measured in 20 never-medicated FEP in-patients and 20 healthy controls. Psychopathology was assessed with the PANSS (Positive and Negative Syndrome Scale). The total, positive, negative and general psychopathology scores were assessed. Results are presented as mean±sd. and S100B levels in pg./ml.
At admission, patients had significantly higher serum S100B concentrations than healthy subjects (39.2±6.4 vs. 33.3±0.98, p<0.02). S100B levels increased from admission to discharge (39.2±6.4 vs. 40.0±6.8, p=0.285) but they do not reach statistical significance. There were no correlations between PANSS (total, positive, negative and general) scores and S100B at admission and discharge. Individual item by item PANSS correlations with S100B elicited a positive correlation with P5 (grandiosity) (r=0.486, p=0.030) and G5 (mannerisms/posturing) (r=0.514; p=0.02) at discharge. There also was a positive trend with G7 (motor retardation) (r=0.409; p=0.073) at discharge.
FEP in-patients have significantly increased serum levels of S100B proteins, suggesting an activation of glial cells that may be associated with a neurodegenerative/inflammatory process. Apart from the study of total scale scores, the analysis of individual item is also recommended. The long-term treatment effect (one year or more) may be relevant to see their relationship to S100B levels.
Although asthma has been one of the most investigated topics in psychosomatics, studies and papers on psychopathology in asthma are fairly scarce and of diverse meaning. Furthermore, psychopathology acoording to sex in asthma is not a common research topic.
Aim This study aims at analyzing psychopathology sex differences in asthmatics.
The psychopathology profile in a sample of 84 adult asthmatics in a hospital outpatient facility, mean age 34.62 (s.d.12.78), 36 male / 48 female, is studied. The Symptom Checklist-90-R (SCL-90-R) Self-Report Questionnaire was administered.
The symptomatic profile is characterized by higher scores in women, with a main elevation in the dimensions of Somatization (1.92), Depression (1.66), Obsession-Compulsion (1.62) and Anxiety (1.44) whereas lower scores are recorded in men, with a profile dominated by Hostility (1.70), Anxiety (1.68), Interpersonal Sensitivity (1.58) and Depression (1.44). These scores mainly contribute to the psychopathology pattern according to sex.
The possible clinical implications of the observed psychopathology sex differences should be taken into account in the management of these patients.
Tuberous Sclerosis Complex (TSC) is a genetic inherited disease characterized by hamartomatous growths in several organs as brain, skin, kidneys, hearth and eyes. The estimated incidence is approximately 1:6000 live births. The diagnosis is made clinically. Seizures are present in 87% of patients. Psychiatric comorbidity has been reported.
We report the clinical course of two patients with previous diagnosis of TSC. Psychiatric symptoms start in the adulthood without seizures history and absence of Subependimal Giant Cells Tumor (SGCT). The evolution and clinical features are described.
Married 33-years-old woman with two children affected with TSC. She was diagnosed after headache presentation in 2011. Initial MRI showed periventricular glioneuronal hamartomas. In January 2013 start with self-injurious (swallowing of objects) and autistic behaviours as well as several hospital urgency room visits. In addition, the patient presented with dull mood, emotional indifference and intellectual impairment, with no response to medication.
Married 43-years-old woman with a daughter affected with TSC. Diagnosis was made in 1999 and psychotic symptoms (delusional beliefs and auditory hallucinations) started in 2011 without previous psychiatric history. The MRI in 2013 shown subependymal nodules. Treatment with risperidone was effective.
Psychiatric symptoms are very often associated to the physical findings on TSC, even in adulthood diagnoses.
Psychiatric comorbidities are well described in literature. about 10-20% adult patients with TSC present clinically significant behavioral problems as self-injuries, frequently associated with SGCT. The European Expert Panel recommended regular assessment of cognitive development and behaviour and symptomatic treatment.
Immune dysfunction is thought to play a critical role in the pathophysiology of bipolar disorder (BD). Better insight into the genetic control of innate immune responses is of importance due to possible interactions with environmental risk factors such as infectious agents, particularly early in life.
Given the importance of Toll-like receptors (TLRs) in innate immunity, we analysed the association of selected genetic variants of TLR-2 and TLR-4, both major sensors of pathogenic infectious and non-infectious structures, with BD.
Explore possible implications of the innate arm of the immune response in BD.
Genomic DNAs from 572 BD patients and 202 controls were analyzed for the distribution of polymorphisms on the TLR-2 and TLR-4 loci using TaqMan®. Associations were examined using Chi-square test.
We found that TLR-4 rs1927914 AA and rs11536891 TT genotypes were more frequent in BD patients than in controls (corrected p; pc = .02 and .02 respectively) particularly in early-onset BD (EOBD) patients (pc = .004 and .006) born during the summer season (pc = 02 and .002 respectively). We also found that TLR-2 rs3804099 TT and rs4696480 TT genotypes were significantly more prevalent in EOBD group as compared to the late-onset BD (LOBD) subset, the latter only after excluding patients with positive family history of psychiatric disorders (pc=0.024 and 0.002 respectively).
We report an association between BD and TLR-2 and TLR-4 genetic variants suggesting an important role for pathogens in disease development.
We describe an ultra-wide-bandwidth, low-frequency receiver recently installed on the Parkes radio telescope. The receiver system provides continuous frequency coverage from 704 to 4032 MHz. For much of the band (
), the system temperature is approximately 22 K and the receiver system remains in a linear regime even in the presence of strong mobile phone transmissions. We discuss the scientific and technical aspects of the new receiver, including its astronomical objectives, as well as the feed, receiver, digitiser, and signal processor design. We describe the pipeline routines that form the archive-ready data products and how those data files can be accessed from the archives. The system performance is quantified, including the system noise and linearity, beam shape, antenna efficiency, polarisation calibration, and timing stability.
Humans are a social species, wired for relationships. The presence or absence of another has salient effects on human responding. This chapter discusses important considerations for dyadic research, including key concepts and theories, common designs and measures, recent innovations, and unique challenges. Attachment theory is foundational for understanding a range of dyadic relationships, including child-caregiver, peer, and romantic couples. Social baseline theory provides further context regarding how humans utilize relationships to enhance survival potential. Numerous dyadic methods and measures exist, though fewer are designed for peer relationships. Recent innovations have focused on automated coding methods, vocal pitch analysis, and cutting-edge statistics. Common obstacles for dyadic research include participant scheduling, ethical concerns, complex research paradigms, and data set configuration.
Specific changes in personality profiles may represent early symptoms of Alzheimer's disease (AD). Knowledge about relationship between personality changes and biomarkers of cerebral pathology can contribute to early diagnosis of AD.
To investigate to what extent the personality changes predict the cerebral AD pathology.
To describe the relationship between the personality changes and pathological cerebro-spinal fluid (CSF) biomarkers.
One hundred and ten subjects, of whom 57 patients with mild cognitive impairment (MCI), 9 subjects with mild dementia, and 44 healthy controls had an extensive medical and neuropsychological examination as well as lumbar puncture to evaluate concentrations of CSF biomarkers of AD pathology [amyloid-β1-42 (Aβ1-42), phosphorylated tau (ptau-181), and total-tau (tau)]. The proxies of the participants completed the Revised NEO Personality Inventory (NEO-PI-R) to assess subjects’ personality at the time being and 5 years retrospectively.
In a hierarchical multivariate regression analysis, including age, gender, education, Mini Mental State Examination (MMSE), and APOEe4 status, lower Aβ1-42 concentrations in CSF were associated with increasing neuroticism, and decreasing extraversion and conscientiousness. Decreasing extraversion, openness to experience and conscientiousness were associated with higher tau/Aβ1-42 ratio, and higher ptau-181/Aβ1-42 ratio was related to decreasing extraversion. Personality changes in the domain of agreeableness did not yield any significant effect as a predictor on any of CSF biomarkers.
Our findings suggest that early and specific changes in personality traits are associated with cerebral AD pathology, in particular with amyloid pathology, and may serve as clinical signs to consider when evaluating MCI and mild dementia.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Addiction to psychoactive substances (PAS) can lead to cardiovascular complications. Cardiotoxicity of drugs is known but it is rarely documented by toxicology.
We conducted a prevalence study on PAS use among patients with cardiac symptoms, with an analysis of diagnosis and a description of PAS user's characteristics.
To improve the therapeutic management in addictology for cardiac patients.
Prospective observational study performed during 3 months. Patients admitted in cardiology had to complete a hetero-questionnaire about his PAS consumption and a qualitative toxicological research in urine and/or blood (immunochemical/GC–MS detection).
One hundred and sixty-one patients were included: 86% men, aged 24–68 years (Table 1). Results show a high level of PAS use in our population: 8.7%. A significant PAS use is observed among patients aged 40–70 years, with a prevalence of 22% for the 40–49, 15% for the 50–59 and 7% for the 60–69. PAS detected were mainly cannabis and cocaine. Clinical diagnoses of patients positive to PAS were acute coronary syndromes and severe cardiac arrhythmias.
In patients admitted in cardiology, toxicological screening is rarely done. Our study shows a significant PAS use among patients aged 40–70 years. According to data of the French Health Barometer, there is regular use of cannabis and cocaine at respectively 3% and 1.1% among people aged 18–64. These results invite us to achieve a more systematic identification of PAS use among patients with cardiovascular disorders and to optimize the therapeutic management by a systematic orientation in addictology.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Psychotropic prescription rates continue to increase in the United States (USA). Few studies have investigated whether social-structural factors may play a role in psychotropic medication use independent of mental illness. Food insecurity is prevalent among people living with HIV in the USA and has been associated with poor mental health. We investigated whether food insecurity was associated with psychotropic medication use independent of the symptoms of depression and anxiety among women living with HIV in the USA.
We used cross-sectional data from the Women's Interagency HIV Study (WIHS), a nationwide cohort study. Food security (FS) was the primary explanatory variable, measured using the Household Food Security Survey Module. First, we used multivariable linear regressions to test whether FS was associated with symptoms of depression (Center for Epidemiologic Studies Depression [CESD] score), generalised anxiety disorder (GAD-7 score) and mental health-related quality of life (MOS-HIV Mental Health Summary score; MHS). Next, we examined associations of FS with the use of any psychotropic medications, including antidepressants, sedatives and antipsychotics, using multivariable logistic regressions adjusting for age, race/ethnicity, income, education and alcohol and substance use. In separate models, we additionally adjusted for symptoms of depression (CESD score) and anxiety (GAD-7 score).
Of the 905 women in the sample, two-thirds were African-American. Lower FS (i.e. worse food insecurity) was associated with greater symptoms of depression and anxiety in a dose–response relationship. For the psychotropic medication outcomes, marginal and low FS were associated with 2.06 (p < 0.001; 95% confidence interval [CI] = 1.36–3.13) and 1.99 (p < 0.01; 95% CI = 1.26–3.15) times higher odds of any psychotropic medication use, respectively, before adjusting for depression and anxiety. The association of very low FS with any psychotropic medication use was not statistically significant. A similar pattern was found for antidepressant and sedative use. After additionally adjusting for CESD and GAD-7 scores, marginal FS remained associated with 1.93 (p < 0.05; 95% CI = 1.16–3.19) times higher odds of any psychotropic medication use. Very low FS, conversely, was significantly associated with lower odds of antidepressant use (adjusted odds ratio = 0.42; p < 0.05; 95% CI = 0.19–0.96).
Marginal FS was associated with higher odds of using psychotropic medications independent of depression and anxiety, while very low FS was associated with lower odds. These complex findings may indicate that people experiencing very low FS face barriers to accessing mental health services, while those experiencing marginal FS who do access services are more likely to be prescribed psychotropic medications for distress arising from social and structural factors.
Although the Cascajal Block (CB), an incised greenstone slab from southeastern Veracruz, Mexico, arguably contains the earliest written text in the New World, debate remains regarding the object's authenticity, dating, and cultural affiliation. To address these issues, this article details recent analyses of the CB via polynomial texture mapping (PTM), X-ray fluorescence (XRF), and scanning electron microscopy (SEM). PTM revealed new details that have resulted in a new epigraphic drawing of the block's incised text and allowed for improved identification of several constituent signs. Spectrometric analysis confirmed that the chemical composition of the CB matrix is consistent with serpentine and identified a uniform patina on its surface, which provided additional contextual data. SEM micrographs of polymer replica molds taken from the incised text evidence manufacturing traces that correspond to lapidary techniques observed on other Formative-period Olmec objects of secure provenience. Results assist in clarifying the archaeological contexts of the object and confirm that in terms of symbols, material, and manufacture the CB conforms to other Formative-period Olmec objects, supporting the object's authenticity, dating, and cultural affiliation.
Early-life stress (ELS) has previously been identified as a risk factor for cognitive decline, but this work has predominantly focused on clinical groups and indexed traditional cognitive domains. It, therefore, remains unclear whether ELS is related to cognitive function in healthy community-dwelling older adults, as well as whether any effects of ELS also extend to social cognition. To test each of these questions, the Childhood Trauma Questionnaire (CTQ) was administered to 484 older adults along with a comprehensive neuropsychological test battery and a well-validated test of social cognitive function. The results revealed no differences in global cognition according to overall experiences of ELS. However, a closer examination into the different ELS subscales showed that global cognition was poorer in those who had experienced physical neglect (relative to those who had not). Social cognitive function did not differ according to experiences to ELS. These results indicate that the relationship between ELS and cognition in older age may be dependent on the nature of the trauma experienced.