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To examine whether drug use (DU) is higher in people with eating disorders (EDs) than in matched comparison groups and to collate, summarize and perform a meta analysis where possible on the literature related to DU in people with EDs.
We searched electronic databases including Medline, PsycINFO, Web of Science and CINAHL and reviewed studies published from 1994 to August, 2007, in English, German or Spanish against a priori inclusion/exclusion criteria. A total of 248 papers were eligible for inclusion. Only a total of 16 papers fulfilled all the inclusion criteria and were finally included in the systematic review.
The meta-analysis including all the different drugs for every sort of ED revealed a negligible albeit significant (z=2.34, p<.05), pooled standardized effect size of 0.119. The data showed a high degree of heterogeneity across the studies (X2(74)= 1267.61, p<.001). When ED subdiagnoses were assessed individually, DU was found to be higher in people with bulimia nervosa (BN) as a moderate sized increase in DU was found in this ED subtype (δ =0.462, z=6.69, p=<.001). People with binge eating disorder (BED) had a small increased risk of DU (δ =0.14, z=2.28, p<.05). In contrast, people with anorexia nervosa (AN) had a lower risk of DU (δ=-.167, z=1.81, p=.070, p=NS).
The differential risk observed in BN patients might be related to differences in temperament or might be the result of reward sensitisation as a result of the ED behaviours specifically associated with BN.
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.
Schizophrenia is a psychiatric disorder which involves chronic or recurrent psychosis and it is commonly associated with impairment in social and occupational functioning. Antipsychotic medications are a first-line treatment, however, most patients experience disabling impairment even after benefiting from antipsychotics, including positive and negative symptoms, cognitive deficits, poor social functioning and episodes of acute symptomatic relapse.
Systematic literature review in UpToDate and Pubmed.
To identify the most relevant intervention areas of systematic rehabilitation in schizophrenia.
45 years old schizophrenic male who admitted in a Medium Stay Psychiatry Unit with severe behavioural impairment and psychotic symptoms. At least 10 hospitalizations and pronounced disability in basic life skills despite optimal treatment. Poor insight and compliance, frequent relapses, co-morbid substance abuse and difficult family support. Clozapine was added to his treatment with improvement in psychotic symptoms. A multidisciplinary intervention was also done and he was discharged home with important improvement in social skills, better insight and familiar functioning
Despite following an adequate antipsychotic treatment, including Clozapine as the main medication in resistant schizophrenia, it is often partially effective with severe impairments in social and occupational functioning. Family-based interventions, cognitive behavioural therapy and social skills training, added to this medication seem to be essential in the systematic treatment of schizoprenia. It includes a multidisciplinary team and a specific length of time but it is based on the patient's status. Despite evidence of their efectiveness, the availability of these interventions varies widely, as does the availability of clinicians to provide them.
Bipolar disorder in elderly patients may present as an evolution of the disease initiated in younger stages or as an entity newly emerging. In addition, mania in the elderly, has characteristics that make it different from the adult. These disorders can be correlated with underlying vascular or degenerative disorders .
Review of the relevant literature by searching PUBMED, limited to studies of greater scientific hierarchy.
The existence of changes in the manic phase motivated by the influence of vascular disease, as well as the importance of the changes experienced in therapy at the rate of underlying organic disease described. The useful pharmacotherapeutic approach in this case is discussed.
The most recent research points in the direction of a more organic for mania late age-related substrate. The diverse etiology requires differential diagnosis for addressing the underlying causes . The clinic does not dim with age, but increases the tendency to develop rapid cycling as age progresses. It is also more frequent occurrence of paranoid and aggressive traits, especially in situations of confrontation, along with increased dysphoria . The therapeutic management by neuroleptics require very careful attention, because of the vulnerability of this group to develop adverse effects. Mood stabilizers use has been demonstrated as effective as in young .
Disclosure of interest
The authors have not supplied their declaration of competing interest.
In the older adult hypochondria is one of the most common somatoform disorders, and represents a particular challenge for approach, diagnosis and treatment, since in this age group, non-psychiatric medical comorbidity and concomitant presence of other psychiatric disorders very high. It is therefore very complex differentiate hypochondria disease with a real organic cause .
Review of the relevant literature on the subject by searching PUBMED, limited to studies of greater scientific hierarchy.
Analysis of symptoms present in a hypochondriac patient with comorbid psychiatric disorders and organic pathology, valuing the importance it has in its clinical manifestations and the difficulty of differential diagnosis.
In the elderly, the high frequency of somatic disease conditions the need for a deeper physical and mental examination to avoid subjecting patients to unnecessary scrutiny and risky complementary tests .
The evolution of hypochondriacs, dragging hypochondria from youth is not good, persisting in his complaint and his need to see a doctor for diagnostic examinations . The therapeutic approach depends on the type of complaint, in which the treatment of the underlying disease as a psychotherapeutic and pharmacological mixed approach may be the right things .
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Social cognition has been associated with functional outcome in patients with first episode psychosis (FEP). Social cognition has also been associated with neurocognition and cognitive reserve. Although cognitive reserve, neurocognitive functioning, social cognition, and functional outcome are related, the direction of their associations is not clear. Therefore, the main aim of this study was to analyze the influence of social cognition as a mediator between cognitive reserve and cognitive domains on functioning in FEP both at baseline and at 2 years.
The sample of the study was composed of 282 FEP patients followed up for 2 years. To analyze whether social cognition mediates the influence of cognitive reserve and cognitive domains on functioning, a path analysis was performed. The statistical significance of any mediation effects was evaluated by bootstrap analysis.
At baseline, as neither cognitive reserve nor the cognitive domains studied were related to functioning, the conditions for mediation were not satisfied. Nevertheless, at 2 years of follow-up, social cognition acted as a mediator between cognitive reserve and functioning. Likewise, social cognition was a mediator between verbal memory and functional outcome. The results of the bootstrap analysis confirmed these significant mediations (95% bootstrapped CI (−10.215 to −0.337) and (−4.731 to −0.605) respectively).
Cognitive reserve and neurocognition are related to functioning, and social cognition mediates in this relationship.
The aim of the present study is to use the syndemic framework to investigate the risk of contracting HIV in the US population. Cross-sectional analyses are from The National Health and Nutrition Examination Survey. We extracted and aggregated data on HIV antibody test, socio-demographic characteristics, alcohol use, drug use, depression, sexual behaviours and sexually transmitted diseases from cycle 2009–2010 to 2015–2016. We carried out weighted regression among young adults (20–39 years) and adults (40–59 years) separately. In total, 5230 men and 5794 women aged 20–59 years were included in the present analyses. In total, 0.8% men and 0.2% women were tested HIV-positive. Each increasing HIV risk behaviour was associated with elevated odds of being tested HIV-positive (1.15, 95% CI 1.15–1.15) among young adults and adults (1.61, 95% CI 1.61–1.61). Multi-faceted, community-based interventions are urgently required to reduce the incidence of HIV in the USA.
Section 1 of the FM14 focus on bridging the astronomy research and outreach communities - recent highlights, emerging collaborations, best practices and support structures. This paper also contains supplementary materials that point to contributed talks and poster presentations that can be found online.
This review aimed to critically analyse data pertaining to the clinical presentation and treatment of neuroendocrine carcinomas of the larynx.
A PubMed search was performed using the term ‘neuroendocrine carcinoma’. English-language articles on neuroendocrine carcinoma of the larynx were reviewed in detail.
Results and conclusion
While many historical classifications have been proposed, in contemporary practice these tumours are sub-classified into four subtypes: carcinoid, atypical carcinoid, small cell neuroendocrine carcinoma and large cell neuroendocrine carcinoma. These tumours exhibit a wide range of biological behaviour, ranging from the extremely aggressive nature of small and large cell neuroendocrine carcinomas, which usually have a fatal prognosis, to the less aggressive course of carcinoid tumours. In small and large cell neuroendocrine carcinomas, a combination of irradiation and chemotherapy is indicated, while carcinoid and atypical carcinoid tumour management entails conservation surgery.
OBJECTIVES/SPECIFIC AIMS: High on-treatment platelet reactivity (HTPR) with clopidogrel imparts an increased risk for ischemic events in adults with coronary artery disease. Although more potent antiplatelet agents are available, clopidogrel remains the most commonly used P2Y12 inhibitor in Puerto Rico. Platelet reactivity varies with ethnicity and is influenced by both clinical and genetic variables; however, no clopidogrel pharmacogenetic studies with Puerto Rican patients have been reported. Therefore, we sought to identify clinical and genetic determinants of on-treatment platelet reactivity in a cohort of Puerto Rican patients with cardiovascular disease. METHODS/STUDY POPULATION: We performed a retrospective study of 111 Puerto Rican patients on 75 mg/day maintenance dose of clopidogrel. Patients were allocated into 2 groups: Group I, without HTPR; and Group II, with HTPR. Clinical data was obtained from the medical record. Platelet function was measured ex vivo using the VerifyNow® P2Y12 assay and HTPR was defined as P2Y12 reaction units (PRU)≥230. Genotyping of CYP2C19, ABCB1, PON1, PY2R12, B4GALT2, CES1, and PEAR1 was performed using Taqman® Genotyping Assays. RESULTS/ANTICIPATED RESULTS: The mean PRU across the cohort was 203±61 PRU (range, 8–324), and 42 (38%) patients had HTPR. One in four individuals carried at least 1 copy of the CYP2C19*2 variant allele. Hematocrit and PON1 p.Q192R variant were inversely correlated with platelet reactivity (p<0.05). Multiple logistic regression showed that 27% of the total variation in PRU was explained by a history of diabetes mellitus, hematocrit, CYP2C19*2, and PON1 p.Q192R. Body mass index (OR=1.15; CI: 1.03–1.27), diabetes mellitus (OR=3.46; CI: 1.05–11.43), hematocrit (OR=0.75; CI: 0.65–0.87), and CYP2C19*2 (OR=4.44; CI: 1.21–16.20) were the only independent predictors of HTPR. DISCUSSION/SIGNIFICANCE OF IMPACT: In a representative sample of Puerto Rican patients with cardiovascular disease, diabetes mellitus, hematocrit, CYP2C19*2, and PON1 p.Q192R were associated with on-treatment platelet reactivity. These factors may identify a subset of patients at higher risk for adverse events on clopidogrel in the Hispanic population.
The objective of the present study was to determine the pasture intake of European wild boar and domestic pigs throughout their growth period (from 60 to 207 days of age). The proportion of time that each animal type spent grazing was also determined. Twelve 60-day-old pure-bred European wild boar (six castrated males and six females, average live-weight (±s.e.m.) 6·8 ± 0·37 kg) and 12 70-day-old domestic pigs (Large White × Landrace, six castrated males and six females, average live-weight [ ± s.e.m.] 24·1 ± 0·66 kg) were used in the study. Each day during the study, the animals grazed from 08·00 until 16·00 h, after which they had ad-libitum access to a supplemental diet for 1 h. Every 14 days throughout the study (a total of ten determinations), the pasture consumption was determined as the difference between the pasture dry matter (DM) availability pre- and post-grazing. The supplemental diet consumption was also determined. Three times during the study (age of animals 85, 140 and 198 days), the behaviour of each animal was observed over four consecutive days while grazing. When considered on a metabolic bodyweight basis, the pasture consumption of the European wild boar was greater than that in the domestic pigs. Approximately 0·20 of the total DM intake by the wild boar was pasture, whereas only 0·10 of the total DM intake by the domestic pigs was pasture. However, domestic pigs consumed a greater quantity of supplemental diet than the wild boar. The wild boar obtained 0·20 of their total daily dietary apparent energy intake from pasture, compared with 0·07 in the domestic pigs. Wild boar were more active during 8-h grazing periods spending 0·54 of their time grazing or moving around, compared with 0·32 of the time in domestic pigs.
The present study aimed to evaluate trace mineral status of organic dairy herds in northern Spain and the sources of minerals in different types of feed. Blood samples from organic and conventional dairy cattle and feed samples from the respective farms were analysed by inductively coupled plasma mass spectrometry to determine the concentrations of the essential trace elements (cobalt (Co), chromium (Cr), copper (Cu), iron (Fe), iodine (I), manganese (Mn), molybdenum (Mo), nickel (Ni), selenium (Se) and zinc (Zn)) and toxic trace elements (arsenic (As), cadmium (Cd), mercury (Hg) and lead (Pb)). Overall, no differences between organic and conventional farms were detected in serum concentrations of essential and toxic trace elements (except for higher concentrations of Cd on the organic farms), although a high level of inter-farm variation was detected in the organic systems, indicating that organic production greatly depends on the specific local conditions. The dietary concentrations of the essential trace elements I, Cu, Se and Zn were significantly higher in the conventional than in the organic systems, which can be attributed to the high concentration of these minerals in the concentrate feed. No differences in the concentrations of trace minerals were found in the other types of feed. Multivariate chemometric analysis was conducted to determine the contribution of different feed sources to the trace element status of the cattle. Concentrate samples were mainly associated with Co, Cu, I, Se and Zn (i.e. with the elements supplemented in this type of feed). However, pasture and grass silage were associated with soil-derived elements (As, Cr, Fe and Pb) which cattle may thus ingest during grazing.
In Spain, the use of annual cover crops is a crop management practice for irrigated vineyards that allows controlling vineyard vigor and yield, which also leads to improve the crop quality. Recently, Cynodon dactylon (bermudagrass) has been reported to infest those cover crops and colonize the grapevine rows, resulting in significant yield and economic losses due to the competition for water and nutrients. From timely unmanned aerial vehicle (UAV) imagery, the objective of this research was to map C. dactylon patches in order to provide an optimized site-specific weed management. A quadrocopter UAV equipped with a point-and-shoot camera was used to collect a set of aerial red-green-blue (RGB) images over a commercial vineyard plot, coinciding with the dormant period of C. dactylon (February 2016). Object-based image analysis (OBIA) techniques were used to develop an innovative algorithm for early discrimination and mapping of C. dactylon, which had the ability to solve the limitation of spectral similarity of this weed with cover crops or bare soil. As a general result, the classified maps of the studied vineyard showed four main classes, i.e. vine, cover crop, C. dactylon and bare soil, with 85% overall accuracy. These weed maps allow developing new strategies for site-specific control of C. dactylon populations in the context of precision viticulture.
A Q fever outbreak was declared in February 2016 in a company that manufactures hoists and chains and therefore with no apparent occupational-associated risk. Coxiella burnetii infection was diagnosed by serology in eight of the 29 workers of the company; seven of them had fever or flu-like signs and five had pneumonia, one requiring hospitalisation. A further case of C. burnetii pneumonia was diagnosed in a local resident. Real-time PCR (RTi–PCR) showed a widespread distribution of C. burnetii DNA in dust samples collected from the plant facilities, thus confirming the exposure of workers to the infection inside the factory. Epidemiological investigations identified a goat flock with high C. burnetii seroprevalence and active shedding which was owned and managed by one of the workers of the company as possible source of infection. Genotyping by multispacer sequence typing (MST) and a 10-loci single-nucleotide polymorphism (SNP) discrimination using RTi–PCR identified the same genotype (MST18 and SNP type 8, respectively) in the farm and the factory. These results confirmed the link between the goat farm and the outbreak and allowed the identification of the source of infection. The circumstances and possible vehicles for the bacteria entering the factory are discussed.
Aims were to assess the efficacy of metacognitive training (MCT) in people with a recent onset of psychosis in terms of symptoms as a primary outcome and metacognitive variables as a secondary outcome.
A multicenter, randomized, controlled clinical trial was performed. A total of 126 patients were randomized to an MCT or a psycho-educational intervention with cognitive-behavioral elements. The sample was composed of people with a recent onset of psychosis, recruited from nine public centers in Spain. The treatment consisted of eight weekly sessions for both groups. Patients were assessed at three time-points: baseline, post-treatment, and at 6 months follow-up. The evaluator was blinded to the condition of the patient. Symptoms were assessed with the PANSS and metacognition was assessed with a battery of questionnaires of cognitive biases and social cognition.
Both MCT and psycho-educational groups had improved symptoms post-treatment and at follow-up, with greater improvements in the MCT group. The MCT group was superior to the psycho-educational group on the Beck Cognitive Insight Scale (BCIS) total (p = 0.026) and self-certainty (p = 0.035) and dependence self-subscale of irrational beliefs, comparing baseline and post-treatment. Moreover, comparing baseline and follow-up, the MCT group was better than the psycho-educational group in self-reflectiveness on the BCIS (p = 0.047), total BCIS (p = 0.045), and intolerance to frustration (p = 0.014). Jumping to Conclusions (JTC) improved more in the MCT group than the psycho-educational group (p = 0.021). Regarding the comparison within each group, Theory of Mind (ToM), Personalizing Bias, and other subscales of irrational beliefs improved in the MCT group but not the psycho-educational group (p < 0.001–0.032).
MCT could be an effective psychological intervention for people with recent onset of psychosis in order to improve cognitive insight, JTC, and tolerance to frustration. It seems that MCT could be useful to improve symptoms, ToM, and personalizing bias.
In the framework of archaeological surveys conducted in 2002-3 for the Soprintendenza per i Beni Archeologici dell'Umbria around the Via Flaminia, the Società Cooperativa Kronos discovered the site known as the “Villa of Rufio” (the name comes from an inscription dedicated to Caius Iulius Rufio). After 4 excavation campaigns (2003-6) the monumental character of a large villa was established, and in 2007 a team from the University of Alicante led by the first-named author began fieldwork, focusing on the analysis of agricultural and commercial production patterns through an examination of the type of manpower in use during the Augustan era. The site lies in the village of Giano dell'Umbria (Perugia), in the foothills of Gualdo Cataneo-Montefalco of southern Umbria (fig. 1). To the north is the Roman town of Mevania (Bevagna), to the south the Martani mountains, at the foot of which lies Mansio Ad Martis (Massa Martana).
Genomic and genetic variation among six Italian chicken native breeds (Livornese, Mericanel della Brianza, Milanino, Bionda Piemontese, Bianca di Saluzzo and Siciliana) were studied using single nucleotide polymorphism (SNP) and copy number variants (CNV) as markers. A total of 94 DNA samples genotyped with Axiom® Genome-Wide Chicken Genotyping Array (Affymetrix) were used in the analyses. The results showed the genetic and genomic variability occurring among the six Italian chicken breeds. The genetic relationship among animals was established with a principal component analysis. The genetic diversity within breeds was calculated using heterozygosity values (expected and observed) and with Wright’s F-statistics. The individual-based CNV calling, based on log R ratio and B-allele frequency values, was done by the Hidden–Markov Model (HMM) of PennCNV software on autosomes. A hierarchical agglomerative clustering was applied in each population according to the absence or presence of definite CNV regions (CNV were grouped by overlapping of at least 1 bp). The CNV map was built on a total of 1003 CNV found in individual samples, after grouping by overlaps, resulting in 564 unique CNV regions (344 gains, 213 losses and 7 complex), for a total of 9.43 Mb of sequence and 1.03% of the chicken assembly autosome. All the approaches using SNP data showed that the Siciliana breed clearly differentiate from other populations, the Livornese breed separates into two distinct groups according to the feather colour (i.e. white and black) and the Bionda Piemontese and Bianca di Saluzzo breeds are closely related. The genetic variability found using SNP is comparable with that found by other authors in the same breeds using microsatellite markers. The CNV markers analysis clearly confirmed the SNP results.
Unknown aspects of the initiation, evolution, and associated phenomena of coronal mass ejections (CMEs), together with their capability of perturbing the fragile technological equilibrium on which nowadays society depends, turn them a compelling subject of study. While space weather forecasts are thus far not able to predict when and where in the Sun will the next CME take place, various CME triggering mechanisms have been proposed, without reaching consensus on which is the predominant one. To improve our knowledge in these respects, we investigate a long-duration active region throughout its life, from birth until decay along five solar rotations, in connection with its production of ejective events. We benefit from the wealth of solar remote-sensing data with improved temporal, spatial, and spectral resolution provided by the ground-breaking space missions STEREO, SDO, and SOHO. During the investigated time interval, which covers the months July – November 2010, the STEREO spacecraft were nearly 180 degrees apart, allowing for the uninterrupted tracking of the active region and its ensuing CMEs. The ejective aspect is examined from multi-viewpoint coronagraphic images, while the dynamics of the active region photospheric magnetic field are inspected by means of SDO/HMI data for specific subintervals of interest. The ultimate goal of this work in progress is to identify common patterns in the ejective aspect that can be connected with the active region characteristics.
Control of fire was a hallmark of developing human cognition and an essential technology for the colonisation of cooler latitudes. In Europe, the earliest evidence comes from recent work at the site of Cueva Negra del Estrecho del Río Quípar in south-eastern Spain. Charred and calcined bone and thermally altered chert were recovered from a deep, 0.8-million-year-old sedimentary deposit. A combination of analyses indicated that these had been heated to 400–600°C, compatible with burning. Inspection of the sediment and hydroxyapatite also suggests combustion and degradation of the bone. The results provide new insight into Early Palaeolithic use of fire and its significance for human evolution.