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The production of specialty coffee has several factors and parameters that are added up in the course of production, so that the quality is expressed in the act of consumption. Based on this scenario, this study included the analysis of ten genotypes of arabica coffee, the materials being subjected to irrigated and rainfed water regimes, in a low altitude region, to identify responses for sensory and physical–chemical quality. The genotypes were evaluated in a split-plot scheme with a randomized block design, with three replications. Arabica coffee fruits were harvested with 80% cherry seeds and processed by the wet method. Subsequently, the characteristics related to physical–chemical and sensory analyses were evaluated. The genotypes of the Paraíso group showed great variability for the physical–chemical and sensory variables for rainfed and irrigated regimes. The genotypes of the Catuaí group, however, showed less variability for sensory characteristics in both cultivation environments and for physical–chemical characteristics in the irrigated regime. In the sensorial data set, the genotypes Catuaí 144 CCF and Catuaí 144 SFC (when irrigated) and Paraíso H 419-3-3-7-16-2, Paraíso H 419-3-3-7-16-11 and Catucaí 24-137 (rainfed cultivation), are more favourable to the production of specialty coffee at low altitude.
This study aimed to analyse the spatial–temporal distribution of COVID-19 mortality in Sergipe, Northeast, Brazil. It was an ecological study utilising spatiotemporal analysis techniques that included all deaths confirmed by COVID-19 in Sergipe, from 2 April to 14 June 2020. Mortality rates were calculated per 100 000 inhabitants and the temporal trends were analysed using a segmented log-linear model. For spatial analysis, the Kernel estimator was used and the crude mortality rates were smoothed by the empirical Bayesian method. The space–time prospective scan statistics applied the Poisson's probability distribution model. There were 391 COVID-19 registered deaths, with the majority among ⩾60 years old (62%) and males (53%). The most prevalent comorbidities were hypertension (40%), diabetes (31%) and cardiovascular disease (15%). An increasing mortality trend across the state was observed, with a higher increase in the countryside. An active spatiotemporal cluster of mortality comprising the metropolitan area and neighbouring cities was identified. The trend of COVID-19 mortality in Sergipe was increasing and the spatial distribution of deaths was heterogeneous with progression towards the countryside. Therefore, the use of spatial analysis techniques may contribute to surveillance and control of COVID-19 pandemic.
To assess the associations between nutrient intake and dietary patterns with different sarcopenia definitions in older men.
Sarcopenia was defined using the Foundation for the National Institutes of Health (FNIH), the European Working Group on Sarcopenia in Older People (EWGSOP) and the European Working Group on Sarcopenia in Older People 2 (EWGSOP2). Dietary adequacy of fourteen nutrients was assessed by comparing participants’ intakes with the Nutrient Reference Values (NRV). Attainment of NRV for nutrients was incorporated into a variable ‘poor’ (meeting ≤ 9) v. ‘good’ (meeting ≥ 10) using the cut-point method. Also, two different dietary patterns, monounsaturated:saturated fat and n-6:n-3 fatty acids ratio and individual nutrients were used as predictor variables.
A total of 794 men aged ≥75 years participated in this study.
The prevalence of sarcopenia by the FNIH, EWGSOP and EWGSOP2 definitions was 12·9 %, 12·9 % and 19·6 %, respectively. With the adjustment, poor nutrient intake was significantly associated with FNIH-defined sarcopenia (OR: 2·07 (95 % CI 1·16, 3·67)), but not with EWGSOP and EWGSPOP2 definitions. The lowest and second-lowest quartiles of protein, Mg and Ca and the lowest quartiles of n-6 PUFA and n-3 PUFA intakes were significantly associated with FNIH-defined sarcopenia. Each unit decrease in n-6:n-3 ratio was significantly associated with a 9 % increased risk of FNIH-defined sarcopenia (OR: 1·09 (95 % CI 1·04, 1·16)).
Inadequate intakes of nutrients are associated with FNIH-defined sarcopenia in older men, but not with the other two sarcopenia definitions. Further studies are required to understand these relationships.
Functional impairment is a defining feature of psychotic disorders. A range of factors has been shown to influence functioning, including negative symptoms, cognitive performance and cognitive reserve (CR). However, it is not clear how these variables may affect functioning in first-episode psychosis (FEP) patients. This 2-year follow-up study aimed to explore the possible mediating effects of CR on the relationship between cognitive performance or specific clinical symptoms and functional outcome.
A prospective study of non-affective FEP patients was performed (211 at baseline and 139 at follow-up). CR was entered in a path analysis model as potential mediators between cognitive domains or clinical symptoms and functioning.
At baseline, the relationship between clinical variables or cognitive performance and functioning was not mediated by CR. At follow-up, the effect of attention (p = 0.003) and negative symptoms (p = 0.012) assessed at baseline on functioning was partially mediated by CR (p = 0.032 and 0.016), whereas the relationship between verbal memory (p = 0.057) and functioning was mediated by CR (p = 0.014). Verbal memory and positive and total subscales of PANSS assessed at follow-up were partially mediated by CR and the effect of working memory on functioning was totally mediated by CR.
Our results showed the influence of CR in mediating the relationship between cognitive domains or clinical symptoms and functioning in FEP. In particular, CR partially mediated the relationship between some cognitive domains or clinical symptoms and functioning at follow-up. Therefore, CR could improve our understanding of the long-term functioning of patients with a non-affective FEP.
To examine changes in micronutrient intake over 3 years and identify any associations between socio-economic, health, lifestyle and meal-related factors and these changes in micronutrient intakes among older men.
Dietary adequacy of individual micronutrient was compared to the estimated average requirement of the nutrient reference values (NRV). Attainment of the NRV for twelve micronutrients was incorporated into a dichotomised variable ‘not meeting’ (meeting ≤ 6) or ‘meeting’ (meeting ≥ 7) and categorised into four categories to assess change in micronutrient intake over 3 years. The multinomial logistic regression analyses were conducted to model predictors of changes in micronutrient intake.
Seven hundred and ninety-four men participated in a detailed diet history interview at the third wave (baseline nutrition) and 718 men participated at the fourth wave (3-year follow-up).
The mean age was 81 years (range 75–99 years). Median intakes of the majority of micronutrients decreased significantly over a 3-year follow-up. Inadequacy of the NRV for thiamine, dietary folate, Zn, Mg, Ca and I were significantly increased at a 3-year follow-up than baseline nutrition. The incidence of inadequate micronutrient intake was 21 % and remained inadequate micronutrient intake was 16·4 % at 3-year follow-up. Changes in micronutrient intakes were significantly associated with participants born in the UK and Italy, low levels of physical activity, having ≥2 medical conditions and used meal services.
Micronutrient intake decreases with age in older men. Our results suggest that strategies to improve some of the suboptimal micronutrient intakes might need to be developed and implemented for older men.
This study aimed to analyse the trend and spatial–temporal clusters of risk of transmission of COVID-19 in northeastern Brazil. We conducted an ecological study using spatial and temporal trend analysis. All confirmed cases of COVID-19 in the Northeast region of Brazil were included, from 7 March to 22 May 2020. We used the segmented log-linear regression model to assess time trends, and the local empirical Bayesian estimator, the global and local Moran indexes for spatial analysis. The prospective space–time scan statistic was performed using the Poisson probability distribution model. There were 113 951 confirmed cases of COVID-19. The average incidence rate was 199.73 cases/100 000 inhabitants. We observed an increasing trend in the incidence rate in all states. Spatial autocorrelation was reported in metropolitan areas, and 178 municipalities were considered a priority, especially in the states of Ceará and Maranhão. We identified 11 spatiotemporal clusters of COVID-19 cases; the primary cluster included 70 municipalities from Ceará state. COVID-19 epidemic is increasing rapidly throughout the Northeast region of Brazil, with dispersion towards countryside. It was identified high risk clusters for COVID-19, especially in the coastal side.
Accurate estimates of methane (CH4) production by cattle in different contexts are essential to developing mitigation strategies in different regions. We aimed to: (i) compile a database of CH4 emissions from Brazilian cattle studies, (ii) evaluate prediction precision and accuracy of extant proposed equations for cattle and (iii) develop specialized equations for predicting CH4 emissions from cattle in tropical conditions. Data of nutrient intake, diet composition and CH4 emissions were compiled from in vivo studies using open-circuit respiratory chambers, SF6 technique or the GreenFeed® system. A final dataset containing intake, diet composition, digestibility and CH4 emissions (677 individual animal observations, 40 treatment means) obtained from 38 studies conducted in Brazil was used. The dataset was divided into three groups: all animals (GEN), lactating dairy cows (LAC) and growing cattle and non-lactating dairy cows (GCNL). A total of 54 prediction equations available in the literature were evaluated. A total of 96 multiple linear models were developed for predicting CH4 production (MJ/day). The predictor variables were DM intake (DMI), gross energy (GE) intake, BW, DMI as proportion of BW, NDF concentration, ether extract (EE) concentration, dietary proportion of concentrate and GE digestibility. Model selection criteria were significance (P < 0.05) and variance inflation factor lower than three for all predictors. Each model performance was evaluated by leave-one-out cross-validation. The Intergovernmental Panel on Climate Change (2006) Tier 2 method performed better for GEN and GCNL than LAC and overpredicted CH4 production for all datasets. Increasing complexity of the newly developed models resulted in greater performance. The GCNL had a greater number of equations with expanded possibilities to correct for diet characteristics such as EE and NDF concentrations and dietary proportion of concentrate. For the LAC dataset, equations based on intake and animal characteristics were developed. The equations developed in the present study can be useful for accurate and precise estimation of CH4 emissions from cattle in tropical conditions. These equations could improve accuracy of greenhouse gas inventories for tropical countries. The results provide a better understanding of the dietary and animal characteristics that influence the production of enteric CH4 in tropical production systems.
Prospective, randomized, two-arm, parallel assignment. 150 individuals diagnosed with major depression disorder (MDD) according to DSM-IV-TR criteria, taking combined therapy in doses considered appropriate for at least 9 months, without showing clinical remission, defined as having an HAMD17 total score ≤ 7, attending the out-patient psychiatry clinic, were initially screened through an interview with a psychiatrist. Those meeting study criteria were randomized to one of two groups: control and aerobic exercise. The study protocol was approved by the Institutional Review Board. All participants provided written informed consent. Study protocol Exercise group: individuals were assigned moderate intensity exercise, in addition to their usual pharmacological therapy. Control group: individuals who were not assigned any exercise and remained taking their usual pharmacological therapy. Both groups maintained the pharmacological therapy unchanged during the 12 week study period. All participants were evaluated at baseline (time 0: before starting the physical activity program), and at 4, 8 and 12 weeks for depressive symptoms, functional assessment and Quality of Life.
Results show that participants in the exercise group improved their quality of life parameters, suggesting that exercise could be an effective therapeutic adjuvant for non-remitted MDD patients.
Gender differences in mental health disorders may serve as a useful heuristic for integrating epidemiological and psychobiological data. The vast majority of mental disorders may express major gender-related variations in prevalence, natural history, symptoms, prognosis, and treatment outcome.
To compare demographic and clinical characteristics of women and men admitted to a psychiatric unit.
Retrospective data of all the patients admitted to a psychiatric inpatient unit, from January 2004 to December 2007, were reviewed. The demographic and clinical characteristics of the two genders were compared.
Of a total of 1114 patients admitted, 53.1% were women. They differed significantly from male inpatients in being older (46.7 vs. 40.7 years), less frequently black (14.6 vs. 25.4%), more frequently diagnosed with bipolar and delusional disorders, and in receiving fewer diagnosis of schizophrenia. Women had a longer average length of stay, a different seasonal pattern in admissions, with a much lower rate of admissions than men in December (38.6 vs. 61.4%), and a lower percentage of patients with three or more readmissions. Only 37.2% of the 180 compulsory admissions were of women.
There are significant differences in clinical and demographic characteristics of female and male psychiatric inpatients. While some results may be explained by gender specific biological factors (as in the type of diagnosis), others are probably associated with different gender roles (as in the seasonality of admissions).
In recent years, physical exercise has shown some promising results as an adjuvant therapy for several psychological disorders, helping to improve not only depression parameters but also quality of life. However, and due to the different populations, settings and exercise programs, not all studies have shown a positive association.
To assess the effect of a moderate intensity 12 week exercise program on the quality of life of a population sample of patients with non-remitted Major Depressive Disorder (MDD).
Study design Prospective, randomized, two-arm, parallel assignment. Population 150 individuals diagnosed with MDD according to DSM-IV criteria, taking combined therapy in doses considered appropriate for at least 9 months, without showing clinical remission, defined as having an HAMD17 total score ≤ 7, attending the out-patient psychiatry clinic, were initially screened through an interview with a psychiatrist. Those meeting study criteria were randomized to one of two groups: control (N = 11) and aerobic exercise (N = 22). Study protocol Exercise group: moderate intensity exercise program for 12 weeks, in addition to their usual pharmacological therapy. Control group: regular daily activities and their usual pharmacological therapy. Instruments WHOQOL-Bref and SF-36, two validated instruments to assess quality of life.
At the end of the exercise program, participants in the exercise group showed improvement on the physical domain of SF-36 and on the social domain of WHOQOL-Bref (p < 0.05).
Results suggest that exercise could help improve some aspects of the quality of life in non-remitted MDD patients.
Men and women who develop schizophrenia are at increased risk, compared with the general population, to engage in violence toward others and, in so doing, often lay waste to their own lives. The reasons for this finding remain obscure.
The present work aims to analyze the relationship between active symptoms of the disease, substance abuse and violence in schizophrenic patients admitted to a forensic ward in our country (Portugal).
A population of inpatients (male and female) from two forensic wards was studied as to personal and psychiatric history, substance abuse, social and cultural background, family history, symptoms at the time of the violent behavior and patient's insight.
The prevalence of offenses was the highest among male schizophrenic subjects with coexisting substance abuse, and more than half of the schizophrenic offenders also had problems with substance abuse. Most perpetrators were acutely ill at the time of the offence but only a small number was under mental healthcare.
Our results were consistent with those found in classic literature. We hope this will help us start a structured programme in our hospitals in which behavioral factors, substance misuse and social dislocation are managed together with the active symptoms of the disorder in order to prevent such violent behavior and to promote adequate treatment of schizophrenic patients.
In recent years, physical exercise has shown some promising results as an adjuvant therapy for several psychological disorders. However, and due to the different populations, settings and exercise programs, not all studies have shown a positive association.
To assess the effect of a moderate intensity 12 week exercise program on depression and functional parameters in a population sample of patients with non-remitted Major Depressive Disorder (MDD).
Study design Prospective, randomized, two-arm, parallel assignment. Population 150 individuals diagnosed with MDD according to DSM-IV criteria, taking combined therapy in doses considered appropriate for at least 9 months, without showing clinical remission, defined as having an HAMD17 total score ≤ 7, attending the out-patient psychiatry clinic, were initially screened through an interview with a psychiatrist. Those meeting study criteria were randomized to one of two groups: control (N = 11) and aerobic exercise (N = 22). Study protocol Exercise group: moderate intensity exercise program for 12 weeks, in addition to their usual pharmacological therapy. Control group: regular daily activities and their usual pharmacological therapy. Assessed parameters HAMD17, Beck Depression Inventory (BDI), Global Assessment of Functioning (GAF), Clinical Global Impression Scale - Severity (CGI-S).
Participants in the exercise group showed better depression and functional parameters at the end of the study, both compared to the beginning of the study and compared to the control group (lower HAMD17, BDI and CGI-S and higher GAF, p < 0.05).
Results suggest that exercise could be an effective adjuvant therapy for non-remitted MDD patients.
Although several electrophysiological studies have demonstrated the role of theta band during the execution of different visuospatial attention tasks, this study is the first to directly investigate the role of theta power during the planning, execution and cognitive control of SEM.
Saccadic eye movements (SEMs) represent the first stage of visual sensorimotor integration and are relevant for the visuospatial attention. The current study aims to address this issue by investigating absolute theta power over the frontal cortex during the execution of stimulus- and memory-driven SEMs.
12 healthy volunteers (3 male; mean age: 26.25), performed two tasks involving different conditions in the planning, execution and cognitive control of SEMs while their brain activity pattern is recorded using quantitative electroencephalography.
We found an interaction between SEM condition (memory- vs stimulus-driven) and electrode (F3, F4, Fz), and a main effect of time point and electrode. Our key finding revealed that the stimulus presentation induces different patterns over frontal theta power increase between the left and right hemisphere.
We conclude that right and left frontal regions are an important factor to discriminate between memory- versus stimulus-driven SEMs, and speculate on their role for different levels within the visuospatial attention.
The efficacy of electroconvulsive therapy (ECT) is widely recognized and indications are well defined for acute treatments. Surprisingly, the use of continuation and maintenance ECT (M-ECT) is uncommon after acute remission. This is partly because of the scarcity of scientific evidence. Indications are poorly defined and the practice is based on case reports and small open studies. Recent data suggest that M-ECT is a viable treatment option in severe affective and psychotic illnesses, especially in recurring, drug-resistant or medically compromised patients who suffer toxic effects with psychotropics.
Studies regarding the duration and frequency of treatment sessions are laking. The time interval between sessions and duration of treatment vary according to clinical requirements, and should be individualized. The length of treatment and deciding when to stop it are still uncertain. Controversial data about the relation between the frequency of sessions and diagnostic is found. An inverse relation between good prognostic factors for each patient and the frequency of M-ECT was described. During continuation and maintenance ECT, seizure threshold increases until a plateau not being clear when the plateau is reached and if it depends on other treatment variables.
The risk of cognitive dysfunction following M-ECT is one major concern. A transient memory and attention dysfunction are described after acute ECT. Recent studies seem to suggest that M-ECT is cognitively safe.
A small subset of patients with above average admissions to psychiatric inpatient units is recognized in clinical practice. These frequent users tend to be younger and to have a diagnosis of schizophrenia or affective disorder. Social conditions and the severity of the illness seem to be associated with this increased number of admissions.
To study demographic and clinical characteristics of frequent and non-frequent users of a psychiatric inpatient unit.
Retrospective data of all the patients admitted to a psychiatric inpatient unit from January 2004 to December 2008 were reviewed. Frequent-users were defined as patients with 3 or more admissions over that period of time, and non-frequent users as those with less than 3 admissions. The two groups were compared in terms of age, gender, ethnicity, psychiatric diagnosis and compulsory admissions
In a total of 2018 admissions and 1348 patients, the frequent-user group represented 10.2% (n = 137) of the patients and 28.9%(n = 584) of the admissions. Frequent-users were significantly younger (39.5 vs. 44.5 years, p = .001), more frequently black (22.6 vs. 19.4%, p < .001) and compulsorily admitted (27.7 vs. 14%, p < .001) than non-frequent users. Patients with bipolar disorder (p = .001), schizophrenia (p = .003) belonged significantly more to frequent-users group, while unipolar depressive patients (p = .016) and other diagnosis (p = .011) was more significantly represented in the non-frequent users group. Frequency of admission did not differ with gender.
The results concerning age and psychiatric diagnosis are consistent with previous studies. Compulsory admissions and black ethnicity were significantly higher among frequent- users.
Physical exercise has shown promising results as an adjuvant therapy for depression. However, most studies rely on self-reported measures, which are subject to bias.
To assess, using accelerometer data, compliance to a moderate intensity 12 week exercise program, exercise patterns and relationship between exercise dose and response to treatment, in a population sample of patients with treatment-resistant MDD.
Study design Prospective, randomized, two-arm, parallel assignment. Population 150 individuals diagnosed with treatment-resistant MDD were initially screened. Those meeting study criteria were randomized to one of two groups: control (N = 11) and aerobic exercise (N = 22). All participants maintained their usual pharmacotherapy. Study protocol Exercise group: moderate intensity exercise program for 12 weeks. Control group: regular daily activities. All participants wore an ActiGraph® GT1M LLC accelerometer during the 12 weeks. Assessed parameters Moderate plus vigorous physical activity (MVPA), HAMD17, BDI, GAF, CGI-S.
The exercise group showed better depression and functional parameters at the end of the study compared to the control group (lower HAMD17, BDI, CGI-S; higher GAF, p < 0.05). Compliance was 97% based on accelerometer data and 91% based on self-reports. Participants showed preference for exercising on weekdays and on specific periods of the day.
Although not statistically significant, there was a trend for increasing MVPA from no response to response and remission. MVPA showed significant favourable correlations with all depression and functioning parameters.
Future implementation of effective exercise augmentation therapy programs should consider exercise dose and objective measures that will allow the quantification of that dose.
Symptomatic neurosyphilis in immunocompetent patients is nowadays a rare diagnosis. Yet, if not properly diagnosed and treated, consequences for the patient's health are severe. Known as “the great imitator”, its detection involves both a high degree of suspicion and adequate diagnostic tests. Psychiatric symptoms are often the presenting symptoms of this illness.
The authors report four cases of neurosyphilis with psychiatric symptoms (general paresis) in immunocompetent patients. all four patients were initially referred for observation by a psychiatrist in the emergency room. Special diagnostic features of each case and potential diagnostic pitfalls are highlighted.
To raise awareness to the importance of this rare but highly disabling disease.
Review of clinical records and complementary exams.
All patients were male, two Caucasian and two African Black, with ages ranging from 41–56 years old. Clinical presentations were quite distinct, showing the symptomatic heterogeneity of paretic neurosyphilis. Blood VDRL test was negative in one case, CSF VDRL was negative in another case. TPHA was always positive in blood and CSF. White cell count and protein quantification in the CSF remains important to confirm diagnosis.
Current prevalence of symptomatic neurosyphilis in Western Europe is unknown. Atypical cases presenting with heterogeneous psychiatric and neurologic symptoms, with no previous history of mental illness, should undergo blood VDRL testing, and specific blood treponemal testing should be considered in specific situations. A high index of clinical suspicion is needed. Confirmation of diagnosis is only possible through further CSF analysis.
There is robust evidence recommending electroconvulsive therapy (ECT) in treating severe acute affective disorders. The clinical use of bitemporal electrode placement is still favoured to unilateral placement with just a relative disadvantage in cognitive side effects. Recently, bifrontal placement has gained popularity but there is still limited evidence on its relative benefits.
Compare bitemporal and bifrontal ECT efficacy in patients with pharmacologically resistant affective disorders, based on the number of acute phase treatments required to reach symptomatic remission.
Review of all patients' charts submitted to acute phase ECT, between June 2006 and June 2011. A total of 70 ECT treatment courses performed in a group of 67 patients met inclusion criteria. Thirty-eight of the total 70 courses received bitemporal ECT, and 32 received bifrontal ECT. A statistical analysis was performed. An attempt to use t-test was foiled due to breach of population variance homogeneity (p = 0,021). The non-parametric Mann-Whitney test was the alternative choice (M-W = 534;p = 0,377).
Bitemporal and bifrontal groups matched for age and sex. Bitemporal patients received on average five ECT treatments, while the average of bifrontal treatments to remission was six, but this difference was not statistically significant (p > 0.05).
Our results showed that bitemporal and bifrontal placements are equally effective. According to the largest randomised controlled trial conducted on ECT in depressive illness (Kellner et al,2010), bitemporal placement led to a faster rate of improvement. Additional studies and larger samples are required to understand if bifrontal placement's efficacy and cognitive advantages justify its popularity.