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Course and outcome in schizophrenia are heterogeneous. Numerous studies have shown an association between the presence of negative symptoms and psychosocial and occupational functioning of patients.
To analyse the prevalence of negative symptoms in the course of illness in first episode psychosis and chronic schizophrenia and to establish its relation with the functional outcome.
43 patients with a first-episode psychosis (FEP) from our area were compared with 43 chronic schizophrenic patients and 43 normal controls from a parallel area. They were matched one on one for age, gender and years of education. All subjects were compared regarding psychopathology and functional outcome terms. Patients were examined with Positive and Negative Syndrome Scale (PANSS) for clinical symptom. Longitudinal functionality was prospectively assessed with the Clinical Global Impression (CGI) and Global Assessment of Functioning (GAF) rating scales.
We found significant differences between FEP and chronic patients in negative symptom severity (t = -4.97, p< 0.001) and global assessment of functioning (t = 7.58, p< 0.001). There was no statistically significant difference between the two groups in PANSS positive and general components or Clinical Global Impression. Negative symptom severity was associated with poorer GAF ratings in first episode psychosis and chronic schizophrenia.
Negative symptoms appear to be persistent. In our study negative symptom severity was associated with social and functional impairment, defined as Global Assessment of Functioning Scale score of less than or equal to 60.
We aimed to identify best predictors of cognitive and functional disability in chronic schizophrenia over time.
We examined 95 hospitalised patients with schizophrenia (DSM-IV criteria) in a long stage unit and 53 healthy controls (matched for age, gender, and years of education). Neuropsychological assessment included tests for Verbal Memory, Working Memory, Executive Functioning and Processing Speed. Functional Disability was assessed with the Disability Assessment Schedule (DAS-WHO) both at baseline and 6 months after.
As expected, patients" performance was significantly lower than healthy comparison subjects on all neurocognitive variables at baseline. Most, but not all, neurocognitive measures were positively correlated with the Functional Disability domains at follow up, including Self Care Management, Vocational Outcome, Family Contact and Social Competence. Results of mediation analyses suggest that all significant relationships identified between cognitive measures and functional outcome were significantly mediated by the Index Processing Speed (PS) with various effects ((between p < 0.05 for PS (z = -2.06) and p < 0.01 for PS (z = -3.01)).
Our data show that Processing Speed plays a determinant role in the relationship among neurocognitive symptoms and Self Care, Vocational Outcome and Social Competence. the model emphasizes the role of PS as the best longitudinal predictor of the level of autonomy in chronic patients with schizophrenia. PS acts as a pathway through which VM, EF and WM predict the course of patients’ functional ability over time.
Although it is well know that the substance use during pregnancy has a negative impact on mother and child health, there are few data on pregnancy - related substance use as a risk factor for postpartum depression and child outcomes.
Aims: To determine maternal and child outcomes at 8 and 32 weeks postpartum of women who reported substance use during pregnancy.
This is a cohort study of 1804 Caucasian women in postpartum. Exclusion criteria: psychiatric disorders during pregnancy. Women were evaluated at 2-3 days, 8 and 32 weeks postpartum. Socio-demographic, obstetric, personal and family psychiatric history and substance use during pregnancy; the Edimburgh Postpartum Depression Scale (EPDS) were assessed. All women with EPDS>9 at 8 and 32 weeks were evaluated by a structured interview (DIGS) for DSM-III major depression.
The mean (SD) age was 31.7 (4.6). Forty-six percent of them were primiparous. Thirty-one percent has a family and 16% a psychiatry history. Fifty percent of women reported substance use during pregnancy: 42% caffeine, 21.6% nicotine, 8% alcohol and 0.6% cannabis. Incidence of major postpartum depression was: 12.7%. Incidence of: Apgar scores < 7 at 5 min after birth:0.4%, gestational age at delivery < 37 weeks:7.3%, birth weigt < 2.5 Kg:7.3%, and congenital malformations:1.4%.
In the presentation, the maternal and child perinatal outcomes of women exposed to licit and ilicit drugs will be summarize and will include a discussion of the future clinical and research implications. This work has been done in part with Grants: GO3/184;FIS:PI04178;PI041635,PI041783,PI041779,PI041758,PI041761,PI041791,PI041766,PI041782,RD06/0001/1009; CIBER-SAM.
To examine the relative contributions of psychiatric symptoms, functional disability, neuropsychological functioning and sociodemographic variables to quality of life (QOL) in patients with chronic schizophrenia.
We examined 165 hospitalised patients with long term schizophrenia (DSM-IV). Measures of psychiatric symptoms included depression (Calgary depression Scale), insight (David Insight Scale), symptom severity (BPRS) and PANSS (Positive and Negative Symptom Scale). Neuropsychological battery included tests for verbal memory, executive functioning, verbal fluency, working memory, motor speed and processing speed. Functional disability was assessed with the Disability Assessment Schedule (DAS-WHO) and Quality of life was assessed with the Quality of Life Scale.
Age, years of evolution, negative symptoms, insight and neuropsychological variables (except motor speed) all were significantly related to level of quality of life. in a multiple regression analysis, entering the neuropsychological functioning, functional disability and negative symptoms generated a model which accounted for a 74.9% of the variance in QOL. Functional disability, as expected, accounted for 56% of the variance, whereas Processing Speed explained an additional 6.2%. Symptom Severity and Verbal Fluency predicted 3.7% and 3.5% of the variance, respectively. Negative symptoms, Verbal Memory and Vocabulary, were also significant predictors in the model, but had less predictive value. However, Positive Symptoms and Sociodemographic Variables did not significantly contribute to predict quality of life.
Our findings support the predictive value of neuropsychological functioning, functional disability and severity of negative symptoms in long term quality of life in schizophrenia.
Chronic hepatitis C infection (CHC) represents a public health problem that affects around 3% of population worldwide. Pegylated Interferon-alpha (PegIFN-α) and Ribavirin (RBV) is the recommended treatment reaching about 40–80% of sustained virological response. However, a common treatment side-effect is induced-depression that impairs patient's quality of life and treatment adherence (1,2). This paper showed polymorphisms in HTR1A, NCR1, TPH2 genes as predictive variables of IFN-induced depression.
396 consecutive, euthymic, CHC outpatients treated with PegIFN-α/RBV were included. Patients were assessed at baseline, 4, 12, 24 and 48 weeks of treatment using PHQ and MINI-DSM-IV-R interview to diagnose depression. Survival analysis was performed. in the univariated analysis functions were compared using logrank test. Significative variables (0.1 level) were extracted for the multivariated model, using a Weibull regression model.
The incidence of induced-depression along the treatment was 39.4%. Polimorphisms on HTR1A (P = 0.0104), TPH2 (P = 0.0231) and NRC1 (P = 0.0702) genes predicted IFN-induced depression.
Genes related with serotonine and inflamation system may play an important role in the pathogenesis of IFN-induced depression. Knowledge of predictive variables for IFN-induced depression may help to better manage patients at risk.
The death rate due to suicide in elderly people is particularly high. As part of suicide selective prevention measures for at-risk populations, the WHO recommends training “gatekeepers”.
In order to assess the impact of gatekeeper training for members of staff, we carried out a controlled quasi-experimental study over the course of one year, comparing 12 nursing homes where at least 30% of the staff had undergone gatekeeper training with 12 nursing homes without trained staff. We collected data about the residents considered to be suicidal, their management further to being identified, as well as measures taken at nursing home level to prevent suicide.
The two nursing home groups did not present significantly different characteristics. In the nursing homes with trained staff, the staff were deemed to be better prepared to approach suicidal individuals. The detection of suicidal residents relied more on the whole staff and less on the psychologist alone when compared to nursing homes without trained staff. A significantly larger number of measures were taken to manage suicidal residents in the trained nursing homes. Suicidal residents were more frequently referred to the psychologist. Trained nursing homes put in place significantly more suicide prevention measures at an institutional level.
Having trained gatekeepers has an impact not only for the trained individuals but also for the whole institution where they work, both in terms of managing suicidal residents and routine suicide prevention measures.
Neuroleptic malignant syndrome (NMS) is an uncommon but potentially fatal adverse effect of neuroleptic, both classic and atypical drugs.
To review the incidence, clinical characteristics, diagnosis and treatment of NMS.
We have described the case of a man of 32 years of age diagnosed with bipolar disorder treated with lithium. He precised high-dose corticosteroids after having tonsillitis. Then, he presented manic decompensation requiring neuroleptic treatment (oral risperidone). After 72 hours, he presented an episode characterized by muscular rigidity, fever, altered mental status and autonomic dysfunction. Life support measures and suspension of neuroleptic treatment were required.
A literature review of the NMS was performed using the PubMed database.
The frequency of NMS ranges from 0.02 to 2.4%. The pathophysiology is not clearly understood but the blockade of dopamine receptors seems to be the central mechanism. Some of the main risk factors described are: being a young adult, the concomitant use of lithium and metabolic causes, among others. NMS occurs most often during the first week of treatment or after increasing the dosage of the neuroleptic medication. Some issues of NMS are those related with diagnosis, treatment and reintroduction of antipsychotic treatment or not.
NMS can be difficult to diagnose due to the variability in the clinical symptoms and presentation. Because of it diagnosis is of exclusion, clinicians should always take it into consideration when a patient is treating with neuroleptic, especially when the dosage has been recently increased. NMS is a clinical emergency.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Glucocorticoids are widely prescribed for a variety of diseases and are known to cause neuropsychiatric as well as somatic side effects.
To review the incidence, clinical characteristics, course and treatment of neuropsychiatric effects of glucocorticoids.
We have described the case of a 86-year-old woman. She had no personal and no psychiatric medical history in her family. She presented wrist arthritis requiring high doses of an oral corticoid treatment (prednisona 20 mg/d). After a week, she started with symptoms characterised by persecutory and surveillance delusions. Organicity was ruled out. The patient got a progressive recovery after starting anti-psychotic medication and progressive reduction of the steroid drugs.
We have performed a literature review of the neuropsychiatric complications of glucocorticoids using the PubMed database.
Neuropsychiatric effects of glucocorticoids involve affective, behavioural, and cognitive manifestations. The incidence is variable, between 2 and 60% of patients who receive steroids. Although the effects of glucocorticoids are unpredictable, the administered dose is the most significant risk factor for the development of neuropsychiatric symptoms. Dosage reduction typically results in clinical recovery. Although the limited data on this subject, it is a problem that clinicians face on their regular basis. The administration of anti-psychotics or mood stabilizers may be beneficial in the prevention and treatment of this syndrome.
The neuropsychiatric effects of glucocorticoids are unpredictable and non-specific. More controlled trials are needed in order to perform evidence-based clinical guidelines for the treatment with glucocorticoids and for the prevention of neuropsychiatric manifestations.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Intensive treatment in partial hospitalization unit may represent an efficient alternative to traditional inward hospitalization. However, there is evidence suggesting that this clinical resource may not be equally effective for every psychiatric disorder.
We aimed to study possible differences in the effectiveness of treatment in a partial hospitalization regime for different psychiatric disorders.
Three hundred and thirty-one patients were admitted to the Valdecilla acute psychiatric day hospital between January 2013 and January 2015. Clinical severity was assessed using BPRS-E and HoNOS scales at admission and discharge. Other relevant clinical and socio-demographic variables were recorded. For statistical comparisons, patients were clustered into 4 wide diagnostic groups (non-affective psychosis; bipolar disorder; depressive disorder; personality disorder).
We observed a significant difference in the status of discharge (χ2 = 12.227; P = 0.007). Thus, depressive patients were more frequently discharged because of clinical improvement, while patients with a main diagnose of personality disorder abandoned the treatment more frequently (23% vs. 4,0%)
When analysing the clinical outcome at discharge, we found that patients with a diagnosis of bipolar disorder showed greater improvement in BPRS (F = 5.305; P = 0.001) than those diagnosed of psychosis or depressive disorder. Interestingly, we found no significant differences between diagnoses in hospital re-admission in the following 6 months after being discharged.
Our results suggest that acute treatment in partial hospitalization regime may be more effective for bipolar and depressive disorder, and particularly less effective for those patients with a personality disorder.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
There is substantial evidence suggesting that individual variability in antipsychotic treatment response could be genetically determined. Disrupted-in-Schizophrenia 1 (DISC1) gene has been previously associated to the illness and to treatment response in a sample of patients suffering from psychosis. However, there is a lack of studies on the effect of DISC1 on treatment response in samples of first episode psychosis.
The aim of this study was to explore the relation between variations in DISC1 gene and treatment response to antipsychotics in a sample of drug-naïve patients with a first episode of psychosis.
Two hundred and twenty Caucasian drug-naive patients experiencing a first episode of non-affective psychosis were genotyped for rs821616 (Ser704Cys), rs6675281 (Leu607Phe) and rs1000731. Early (6 weeks) response to antipsychotic treatment was assessed with the Brief Psychiatric Rating Scale, the Scale for the Assessment of Positive Symptoms, and the Scale for the Assessment of Negative Symptoms. Other clinical and socio-demographic variables were recorded to eliminate potential confounding effects.
We found a significant association between rs1000731 and treatment response. Thus, those patients homozygous for the G allele of rs1000731 were more frequently non-responders, measured with SANS, after 6 weeks of treatment, than those carrying the A allele (X2 = 4.019; P = 0.032). Moreover, when analysing the clinical improvement longitudinally, we observed that those patients carrying the A allele for the rs1000731 presented a greater improvement in positive symptoms dimension (F = 8.905; P = 0.003).
Our results suggest a minor contribution to antipsychotic drug response of genetic alterations in the DISC1 gene.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Tuberous sclerosis complex is a rare genetic disorder leading to the growth of hamartomas in multiple organs, including cardiac rhabdomyomas. Children with symptomatic cardiac rhabdomyoma require frequent admissions to intensive care units, have major complications, namely, arrhythmias, cardiac outflow tract obstruction and heart failure, affecting the quality of life and taking on high healthcare cost. Currently, there is no standard pharmacological treatment for this condition, and the management includes a conservative approach and supportive care. Everolimus has shown positive effects on subependymal giant cell astrocytomas, renal angiomyolipoma and refractory seizures associated with tuberous sclerosis complex. However, evidence supporting efficacy in symptomatic cardiac rhabdomyoma is limited to case reports. The ORACLE trial is the first randomised clinical trial assessing the efficacy of everolimus as a specific therapy for symptomatic cardiac rhabdomyoma.
ORACLE is a phase II, prospective, randomised, placebo-controlled, double-blind, multicentre protocol trial. A total of 40 children with symptomatic cardiac rhabdomyoma secondary to tuberous sclerosis complex will be randomised to receive oral everolimus or placebo for 3 months. The primary outcome is 50% or more reduction in the tumour size related to baseline. As secondary outcomes we include the presence of arrhythmias, pericardial effusion, intracardiac obstruction, adverse events, progression of tumour reduction and effect on heart failure.
ORACLE protocol addresses a relevant unmet need in children with tuberous sclerosis complex and cardiac rhabdomyoma. The results of the trial will potentially support the first evidence-based therapy for this condition.
The alpaca fiber diameter (FD) varies from 18 to 36 μm, being the finer fiber categories highly appreciated. However, the alpaca fiber presents some limitations in the textile industry due to the high incidence of fiber medullation and diameter variability, both reduces the comfort feeling of the garments. Decreasing or even removing medullation could be a possible selection objective in alpaca breeding programs for increasing economic value of the alpaca fiber. Therefore, the present work aimed to estimate genetic parameters regarding medullation traits, as well as the genetic correlations with other economical important traits, to be able to select the appropriate criteria to reduce or remove medullation on alpaca fiber and help to reduce the prickle factor in the garments. The data was collected from 2000 to 2017 and belonged to the Pacomarca experimental farm. There were 3698 medullation records corresponding to 1869 Huacaya and 414 Suri genetic types. The fiber samples were taken from the mid side, and were analyzed in an OFDA 100® device. The traits analyzed were percentage of medullation (PM), medullated fiber diameter (MFD), FD, standard deviation of FD, greasy fleece weight as fiber traits; density, crimp in Huacaya and lock structure in Suri, head conformation, leg coverage as morphological traits; weaning weight and age at first calving as secondary and functional traits. Genetic parameters were estimated via a multitrait restricted maximum likelihood. The heritabilities for PM and MFD were 0.225 and 0.237 in Huacaya genetic type and 0.664 and 0.237 in Suri genetic type, respectively; heritabilities for other traits were moderate for productive and morphological traits, and low to moderate for secondary and functional traits. The genetic correlations PM–FD and MFD–FD were high and favorable in both genetic types, between 0.531 and 0.975; the genetic correlation PM–MFD was 0.121 in Huacaya and 0.427 in Suri. The rest of genetic correlations with other traits were in general moderate and favorable. The repeatabilities were 0.556 and 0.668 for PM, and 0.322 and 0.293 for MFD in Huacaya and Suri genetic types, respectively. As a conclusion, PM was identified to be a good selection criterion, probably combined in an index with FD to reduce prickling factor.
Ranking trait was used as a selection criterion for competition horses to estimate racing performance. In the literature the most common approaches to estimate breeding values are the linear or threshold statistical models. However, recent studies have shown that a Thurstonian approach was able to fix the race effect (competitive level of the horses that participate in the same race), thus suggesting a better prediction accuracy of breeding values for ranking trait. The aim of this study was to compare the predictability of linear, threshold and Thurstonian approaches for genetic evaluation of ranking in endurance horses. For this purpose, eight genetic models were used for each approach with different combinations of random effects: rider, rider–horse interaction and environmental permanent effect. All genetic models included gender, age and race as systematic effects. The database that was used contained 4065 ranking records from 966 horses and that for the pedigree contained 8733 animals (47% Arabian horses), with an estimated heritability around 0.10 for the ranking trait. The prediction ability of the models for racing performance was evaluated using a cross-validation approach. The average correlation between real and predicted performances across genetic models was around 0.25 for threshold, 0.58 for linear and 0.60 for Thurstonian approaches. Although no significant differences were found between models within approaches, the best genetic model included: the rider and rider–horse random effects for threshold, only rider and environmental permanent effects for linear approach and all random effects for Thurstonian approach. The absolute correlations of predicted breeding values among models were higher between threshold and Thurstonian: 0.90, 0.91 and 0.88 for all animals, top 20% and top 5% best animals. For rank correlations these figures were 0.85, 0.84 and 0.86. The lower values were those between linear and threshold approaches (0.65, 0.62 and 0.51). In conclusion, the Thurstonian approach is recommended for the routine genetic evaluations for ranking in endurance horses.
The goal of this work was the assessment of commercial vineyard water status using on-the-go thermal imaging. On-the-go thermal imaging acquisition was conducted with a thermal camera operating at 1.20 m distance from the canopy, mounted on a quad moving at 5 km/h. Canopy temperature, cross water stress index (CWSI) and stomatal conductance index (Ig) were strongly and significantly correlated to stem water potential (Ψstem) in east and west side of the canopy. For CWSI, the values of the coefficient of determination (R2) were 0.88*** and 0.73*** for east and west sides, respectively. As regards the index Ig, its relationships with Ψstem showed R2=0.89*** and R2=0.77*** for east and west sides, respectively. These results are promising and evidence the potential of on-the-go thermal imaging to become a new tool to evaluate the vineyard water status.
Making a morphological pre-selection of Pura Raza Español horses (PRE) for dressage is a challenging task within its current breeding program. The aim of our research was to design an early genetic selection morphological linear traits index to improve dressage performance, using 26 morphological linear traits and six dressage traits (walk, trot, canter, submission, general impression – partial scores – and total score) as selection criteria. The data set included morphological linear traits of 10 127 PRE (4159 males and 5968 females) collected between 2008 and 2013 (one record per horse) and 19 095 dressage traits of 1545 PRE (1476 males and 69 females; 12.4 records of average) collected between 2004 and 2014. A univariate animal model was applied to predict the breeding values (PBV). A partial least squares regression analysis was used to select the most predictive morphological linear traits PBV on the dressage traits PBV. According to the Wold Criterion, the 13 morphological linear traits (width of head, head–neck junction, upper neck line, neck–body junction, width of chest, angle of shoulder, lateral angle of knee, frontal angle of knee, cannon bone perimeter, length of croup, angle of croup, ischium–stifle distance and lateral hock angle) most closely related to total score PBV, partial scores PBV and gait scores PBV (walk, trot and canter) were selected. A multivariate genetic analysis was performed among the 13 morphological linear traits selected and the six dressage traits to estimate the genetic parameters. After it, the selection index theory was used to compute the expected genetic response using different strategies. The expected genetic response of total score PBV (0.76), partial scores PBV (0.04) and gait scores PBV (0.03) as selection objectives using morphological linear traits PBV as criteria selection were positive, but lower than that obtained using dressage traits PBV (1.80, 0.16 and 0.14 for total score PBV, partial scores PBV and gait scores PBV) or dressage traits PBV and morphological linear traits PBV (2.97, 0.16 and 0.15 for total score PBV, partial scores PBV and gait scores PBV), as selection criteria. This suggests that it is possible to preselect the PRE without dressage traits PBV using as selection criteria the morphological linear traits PBV, but the expected genetic response will be lower.
The objective of this work was to study the changes that, selecting for environmental variability of birth weight (BW), could bring to other interesting traits in livestock such as: survivability at weaning (SW), litter size (LS) and weaning weight (WW), their variability assessed from standard deviations of LS, standard deviation of WW (SDWW) and also the total litter weight at birth (TLBW) and total litter weight at weaning. Data were registered after eight generations of a divergent selection experiment for BW environmental variability in mice. Genetic parameters and phenotypic and genetic evolution were assessed using linear homoscedastic and heteroscedastic models in which the traits were attributed to the female, except BW and WW that were in some models also attributed to the pup. Genetic correlation between the trait and variability levels was −0.81 for LS and −0.33 for WW. Clear divergent phenotypic trends were observed between lines for LS, WW and SDWW. Although animals were heavier in the high line, TLBW and at weaning was greater in the low line. Despite the negative genetic correlation that was obtained, SDWW was also higher in the high line. Heritabilities were 0.21 and 0.06, respectively, for LS and SW. Both phenotypic and genetic trends showed clear superiority of the low line over the high line for these traits, but inferior for WW. Heteroscedastic model performed similar to the homoscedastic model when there was enough information. Considering LS and survival, the low line was preferred from a welfare point of view, but its superiority from the productivity perspective was not clear. Robustness seemed higher as shown by a low variation and having a benefit to the animal welfare, but this still remains unclear. It was concluded that low variation benefits the welfare of animals.
Energy reserve, estimated as body condition score (BCS), is the major determinant of the re-initiation of ovarian activity in postpartum cows. Leptin, IGF-I and insulin are positively related to BCS and are putative mediators between BCS and reproductive function. However, when BCS and body composition dissociates, concentrations of these metabolic hormones are altered. We hypothesized that increasing lean muscle tissue, but not fat tissue, would diminish the reproductive response to oestrus induction treatments. Thirty lactating beef cows with BCS of 3.10±1.21 and 75.94±12 days postpartum were divided in two groups. Control cows (n=15) were supplemented with 10.20 kg of concentrate daily for 60 days. Treated cows (n=15) were supplemented equally, and received a β-adrenergic receptor agonist (β-AA; 0.15 mg/kg BW) to achieve accretion of lean tissue mass and not fat tissue mass. Twelve days after ending concentrate supplementation/β-AA treatment, cows received a progestin implant to induce oestrus. Cows displaying oestrus were inseminated during the following 60 days, and maintained with a fertile bull for a further 21 days. Cows in both groups gained weight during the supplementation period (Daily weight gain: Control=0.75 kg v. β-AA=0.89 kg). Cows treated with β-AA had a larger increase in BCS (i.e. change in BCS: control=1 point (score 4.13) v. β-AA=2 points (score 5.06; P<0.05), as a result of muscle accretion (i.e. change in muscle depth: control 0.21 cm v. β-AA 0.97 cm; P<0.05) but not adipose tissue (i.e. change in back fat depth; control 0.13 cm v. β-AA −0.06 cm; P<0.05). The changes in body composition in β-AA cows were associated with a reduction in serum concentrations of IGF-I (25.4%) and leptin (27.9%), without observed changes in insulin. Ovulation and pregnancy to 1st service (P>0.05) did not differ between groups. However, the number of cows displaying oestrus (control 13/15 v. β-AA 8/15; P<0.05) and the percentage cycling (control 6/8 v. β-AA 3/10; P=0.07) after progestin treatment and the pregnancy percentage at the end of the breeding period (control 13/15 v. β-AA 8/15; P<0.05) were lower in β-AA than control cows. In summary, the increase BCS through muscle tissue accretion, but not through fat tissue accretion, resulted in a lower response to oestrus induction, lower percentage of cycling animals and lower pregnancy percentage after progestin treatment; which was associated with a decrease in serum concentrations of leptin and IGF-I.
I deficiency is still a worldwide public health problem, with children being especially vulnerable. No nationwide study had been conducted to assess the I status of Spanish children, and thus an observational, multicentre and cross-sectional study was conducted in Spain to assess the I status and thyroid function in schoolchildren aged 6–7 years. The median urinary I (UI) and thyroid-stimulating hormone (TSH) levels in whole blood were used to assess the I status and thyroid function, respectively. A FFQ was used to determine the consumption of I-rich foods. A total of 1981 schoolchildren (52 % male) were included. The median UI was 173 μg/l, and 17·9 % of children showed UI<100 μg/l. The median UI was higher in males (180·8 v. 153·6 μg/l; P<0·001). Iodised salt (IS) intake at home was 69·8 %. IS consumption and intakes of ≥2 glasses of milk or 1 cup of yogurt/d were associated with significantly higher median UI. Median TSH was 0·90 mU/l and was higher in females (0·98 v. 0·83; P<0·001). In total, 0·5 % of children had known hypothyroidism (derived from the questionnaire) and 7·6 % had TSH levels above reference values. Median TSH was higher in schoolchildren with family history of hypothyroidism. I intake was adequate in Spanish schoolchildren. However, no correlation was found between TSH and median UI in any geographical area. The prevalence of TSH above reference values was high and its association with thyroid autoimmunity should be determined. Further assessment of thyroid autoimmunity in Spanish schoolchildren is desirable.
Cortical thickness measurement offers an index of brain development processes. In healthy individuals, cortical thickness is reduced with increasing age and is related to cognitive decline. Cortical thinning has been reported in schizophrenia. Whether cortical thickness changes differently over time in patients and its impact on outcome remain unanswered.
Data were examined from 109 patients and 76 healthy controls drawn from the Santander Longitudinal Study of first-episode schizophrenia for whom adequate structural magnetic resonance imaging (MRI) data were available (n = 555 scans). Clinical and cognitive assessments and MRIs were acquired at three regular time points during a 3-year follow-up period. We investigated likely progressive cortical thickness changes in schizophrenia during the first 3 years after initiating antipsychotic treatment. The effects of cortical thickness changes on cognitive and clinical variables were also examined along with the impact of potential confounding factors.
There were significant diagnoses × scan time interaction main effects for total cortical thickness (F1,309.1 = 4.60, p = 0.033) and frontal cortical thickness (F1,310.6 = 5.30, p = 0.022), reflecting a lesser thinning over time in patients. Clinical and cognitive outcome was not associated with progressive cortical changes during the early years of the illness.
Cortical thickness abnormalities do not unswervingly progress, at least throughout the first years of the illness. Previous studies have suggested that modifiable factors may partly account for cortical thickness abnormalities. Therefore, the importance of implementing practical actions that may modify those factors and improve them over the course of the illness should be highlighted.