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To assess the relationship between food insecurity, sleep quality, and days with mental and physical health issues among college students.
Design:
An online survey was administered. Food insecurity was assessed using the ten-item Adult Food Security Survey Module. Sleep was measured using the nineteen-item Pittsburgh Sleep Quality Index (PSQI). Mental health and physical health were measured using three items from the Healthy Days Core Module. Multivariate logistic regression was conducted to assess the relationship between food insecurity, sleep quality, and days with poor mental and physical health.
Setting:
Twenty-two higher education institutions.
Participants:
College students (n 17 686) enrolled at one of twenty-two participating universities.
Results:
Compared with food-secure students, those classified as food insecure (43·4 %) had higher PSQI scores indicating poorer sleep quality (P < 0·0001) and reported more days with poor mental (P < 0·0001) and physical (P < 0·0001) health as well as days when mental and physical health prevented them from completing daily activities (P < 0·0001). Food-insecure students had higher adjusted odds of having poor sleep quality (adjusted OR (AOR): 1·13; 95 % CI 1·12, 1·14), days with poor physical health (AOR: 1·01; 95 % CI 1·01, 1·02), days with poor mental health (AOR: 1·03; 95 % CI 1·02, 1·03) and days when poor mental or physical health prevented them from completing daily activities (AOR: 1·03; 95 % CI 1·02, 1·04).
Conclusions:
College students report high food insecurity which is associated with poor mental and physical health, and sleep quality. Multi-level policy changes and campus wellness programmes are needed to prevent food insecurity and improve student health-related outcomes.
Acute ischemic stroke may affect women and men differently. We aimed to evaluate sex differences in outcomes of endovascular treatment (EVT) for ischemic stroke due to large vessel occlusion in a population-based study in Alberta, Canada.
Methods and Results:
Over a 3-year period (April 2015–March 2018), 576 patients fit the inclusion criteria of our study and constituted the EVT group of our analysis. The medical treatment group of the ESCAPE trial had 150 patients. Thus, our total sample size was 726. We captured outcomes in clinical routine using administrative data and a linked database methodology. The primary outcome of our study was home-time. Home-time refers to the number of days that the patient was back at their premorbid living situation without an increase in the level of care within 90 days of the index stroke event. In adjusted analysis, EVT was associated with an increase of 90-day home-time by an average of 6.08 (95% CI −2.74–14.89, p-value 0.177) days in women compared to an average of 11.20 (95% CI 1.94–20.46, p-value 0.018) days in men. Further analysis revealed that the association between EVT and 90-day home-time in women was confounded by age and onset-to-treatment time.
Conclusions:
We found a nonsignificant nominal reduction of 90-day home-time gain for women compared to men in this province-wide population-based study of EVT for large vessel occlusion, which was only partially explained by confounding.
With human influences driving populations of apex predators into decline, more information is required on how factors affect species at national and global scales. However, camera-trap studies are seldom executed at a broad spatial scale. We demonstrate how uniting fine-scale studies and utilizing camera-trap data of non-target species is an effective approach for broadscale assessments through a case study of the brown hyaena Parahyaena brunnea. We collated camera-trap data from 25 protected and unprotected sites across South Africa into the largest detection/non-detection dataset collected on the brown hyaena, and investigated the influence of biological and anthropogenic factors on brown hyaena occupancy. Spatial autocorrelation had a significant effect on the data, and was corrected using a Bayesian Gibbs sampler. We show that brown hyaena occupancy is driven by specific co-occurring apex predator species and human disturbance. The relative abundance of spotted hyaenas Crocuta crocuta and people on foot had a negative effect on brown hyaena occupancy, whereas the relative abundance of leopards Panthera pardus and vehicles had a positive influence. We estimated that brown hyaenas occur across 66% of the surveyed camera-trap station sites. Occupancy varied geographically, with lower estimates in eastern and southern South Africa. Our findings suggest that brown hyaena conservation is dependent upon a multi-species approach focussed on implementing conservation policies that better facilitate coexistence between people and hyaenas. We also validate the conservation value of pooling fine-scale datasets and utilizing bycatch data to examine species trends at broad spatial scales.
Non-invasive prenatal testing (NIPT) is increasingly being adopted as a screening test in the UK and is currently accessed through certain National Health Service healthcare systems or by private provision. This audit aims to describe reasons for and results of cytogenomic investigations carried out within UK genetic laboratories following an NIPT result indicating increased chance of cytogenomic abnormality (‘high-chance NIPT result’).
Method
A questionnaire was sent out to 24 genetics laboratories in the UK and completed by 18/24 (75%).
Results
Data were returned representing 1831 singleton pregnancies. A total of 1329 (73%) invasive samples were taken following NIPT results showing a high chance of trisomy 21; this was confirmed in 1305 (98%) of these by invasive sampling. Trisomy 21 was confirmed in >99% of patients who also had high-screen risk results or abnormal scan findings. Amongst invasive samples taken due to NIPT results indicating a high chance of trisomy 18, 84% yielded a compatible result, and this number dropped to 49% for trisomy 13 and 51% for sex chromosomes.
Conclusion
In the UK, the majority of patients having invasive sampling for high-chance NIPT results are doing so following an NIPT result indicating an increased chance of common trisomies (92%). In this population, NIPT performs particularly well for trisomy 21, but less well for other indications.
Quetiapine is a novel antipsychotic drug, which is efficacious in the treatment of schizophrenia and also helps reduce craving and consumption of stimulants and alcohol. Due to Quetiapine's promising receptor profile, we set out to examine its efficacy in relapse prevention treatment of alcoholic dependent patients suffering from craving and affective symptoms.
Methods
The three center pilot-RCT evaluated 40 alcohol dependent patients after withdrawal (Quetiapine vs. placebo). They were followed up for six months. We used operationalized questionnaires including OCDS-G, Form 90-CR, Form 90 short form-CR, PSQI, MADRS, STAI, BDI and FTND.
Hypotheses
We tested the one sided hypothesis that it takes longer for the first severe relapse to occur using Quetiapine compared to a placebo. The primary outcome measure is time to first severe relapse. Further, we tested the two sided hypothesis that Quetiapine will prolong time until first consumption of ethanol, decrease the number of drinking days and increase the number of abstinence days, decrease the cumulative amount of ethanol, decrease craving, improve depression symptoms, improve anxiety symptoms, improve quality of sleep, avoid deterioration of safety variables and decrease nicotine addiction.
Conclusion
Our pilot study is designed to provide evidence for the efficacy of Quetiapine in alcohol relapse prevention. Alcohol dependent patients after withdrawal should display a decrease in persistant craving and should be less afflicted by sleep disorders, excitement or symptoms of depression or anxiety. The poster provides the rational for conducting this study and describes the study protocol including the subject's characteristics.
Treatment for alcohol dependent patients represents a largely unmet challenge in psychiatry and psychotherapy. Less than 10% of individuals in need are actually receiving treatment, fewer than in any other field of psychiatry (Kohn et al., 2004). Evidence-based psychotherapy and pharmacotherapy is available and will be reviewed (incl. the United Kingdom Alcohol Treatment Trial UKATT and the COMBINE Study). In general, effect sizes are low and lag behind success rates in fields such as smoking cessation. The main reason is the heterogeneity of patients being offered rather specific treatments in conventional RCTs. While some patients may clearly benefit others may not and some even get worse, making means of results rather meaningless.
Early attempts to introduce “personalised” treatment into the psychotherapy of alcoholism failed (Project MATCH). Current approaches use several domains for the sub-classification of patients such as psychopathology, genetics, neuroimaging, neuropsychology etc. (Mann et al., 2009). A new RCT (PREDICT Study) did not show a significant difference between naltrexone, acamprosate and placebo. However, by using f-MRI cue reactivity, genetics and psychopathology more homogeneous subgroups of patients could be defined. In these subgroups significant differences for naltrexone over placebo were found.
Personalized treatment seems to be a promising approach in alcoholism therapy. It may help to improve results considerable and thus create more motivation and hope in patients as well as in psychiatrists.
Research has shown that Quetiapine reduce the craving and consumption for stimulants and alcohol. Due to Quetiapine's particulars and the promising receptor profile concerning addiction medicine, we set out to examine the tolerability and efficacy concerning relapse prevention of withdrawn alcoholics suffering from additional symptoms.
Methods
Our case observations attempted to evaluate nine alcoholics after withdrawal suffering from persisting craving, sleep disorder, excitement, depressive symptoms or anxiety symptoms. The patients were treated with quetiapine as relapse prevention and we followed them up in our outpatient clinic.
Results
Eight out of nine patients were abstinent under quetiapine over a period of 2 to 7 months. One of these patients relapsed after he stopped taking the preparation at his own initiative after 10 weeks. The ninths patient stopped taking the preparation immediately because of swollen nasal mucosae. All target symptoms disappeared in the patients after an average of [mean ± SD] 24.5 ± 18.1 days. The overall tolerability was considered to be very good, however initial sleepiness appeared in four patients.
Conclusion
Patients reported to be very satisfied with the medication. Reports about clearly reduced craving seem particularly worthy of attention. Although uncontrolled case observations can only be interpreted with caution quetiapine seems to deserve further investigation. A double-blind placebo-controlled study is in preparation to confirm these preliminary findings. Quetiapine may hold the potential for preventing alcohol relapse in alcoholics suffering from additional above mentioned symptoms, or as an alternative in alcoholics who do neither tolerate acamprosate nor naltrexone.
We have compared oxcarbazepine (OXC) with acamprosate (ACP) in relapse prevention in recently withdrawn alcohol dependent patients. Oxcarbazepine blocks voltage-sensitive sodium channels. Its metabolite reduces high-voltage-activated calcium currents in striatal and cortical neurons, thus reducing glutamatergic transmission at corticostriatal synapses. This reduction is of interest in the treatment of alcohol dependence, since acamprosate modulates NMDA receptors, resulting in an inhibition of glutamatergic transmission. Furthermore, OXC has revealed a mood-stabilizing effect in bipolar affective disorders.
Methods
In a randomized open label pilot study 30 detoxified alcohol dependent patients were followed up for six months to assess treatment outcome in pharmacological relapse prevention. 15 alcoholics were treated with OXC and 15 with ACP. We asked for the time until first and heavy relapse and for drinks on drinking days. We assessed craving (OCDS), the severity of depression (ADS) and the degree of state anxiety (STAI).
Results
After withdrawal, time to severe relapse and time to first consumption of any ethanol by OXC patients was not longer than for ACP patients. Abstinent patients in both study groups showed significantly lower OCDS-G than relapsed patients. No undesired effects occurred when OXC patients consumed alcohol.
While the current sample size clearly limits further conclusions from this pilot study, it is noteworthy that OXC is well tolerated. Thus, in medication-based relapse prevention, OXC could have the potential of a promising alternative for alcoholic patients unable to benefit from ACP or naltrexone or who suffer from affective lability. OXC certainly merits a larger placebo controlled trial.
Quetiapine is a novel antipsychotic, which is efficacious in the treatment of positive and negative symptoms in schizophrenia. Research has shown that Quetiapine also reduce the craving and consumption for stimulants and alcohol. We set out to examine the tolerability and efficacy concerning relapse prevention of withdrawn alcoholics suffering from additional symptoms.
Methods:
Our case observations attempted to evaluate nine alcoholics after withdrawal suffering from persisting craving, sleep disorder, excitement, depressive symptoms or anxiety symptoms. We followed the patients up in our outpatient clinic.
Results:
Eight out of nine patients were abstinent under quetiapine over a period of 2 to 7 months. One of these patients relapsed after he stopped taking the preparation at his own initiative after 10 weeks. The ninths patient stopped taking the preparation immediately because of swollen nasal mucosae. All target symptoms disappeared in the patients after an average of [mean ± SD] 24.5 ± 18.1 days. The overall tolerability was considered to be very good, however initial sleepiness appeared in four patients.
Conclusion:
The tolerability has proven to be very good and patients reported to be very satisfied with the medication. Reports about clearly reduced craving seem particularly worthy of attention. A double-blind placebo-controlled study is in preparation to confirm these preliminary findings. Quetiapine may hold the potential for preventing alcohol relapse in alcoholics suffering from additional above mentioned symptoms, or as an alternative in alcoholics who do neither tolerate acamprosate nor naltrexone.
Suicide, particularly in the case of current major depression, is quite common among patients who contact their GPs some weeks or months before their death. However, prior studies have shown that GP’s education, regarding the diagnosis and treatment of depressive disorders, can reduce suicide mortality in the given area served by trained GPs. The aim of our present study was to evaluate the effectiveness of a depression-management educational program for GPs in a region with a very high suicide rate (over 50 per 100.000) in Hungary. Twenty-eight GPs and their lead nurses, servicing 73,000 inhabitants in the region of Kiskunhalas, participated the 5-year educational program together with estabilishment of a Depression Outpatient Clinic and psychiatrist telephone consultation service. The annual suicide rate in the Kiskunhalas region decreased from 59.7/100.000 (5-year preintervention average) to 49.9/100.000. This decrease was significantly greater than both the county and whole Hungary (p=0.001 and p=0.001, respectively). However, the increase of antidepressant prescription was greater in the intervention region compared with both the county and whole Hungary and in women compared with men (p=0.02). There was no change in alcohol-related deaths or rate of unemployment in the intervention region during the whole study period (1996-2000 vs 2001 and 2005). The findings support earlier studies showing that continuous GP education on diagnosis and treatment of depression is an effective method of suicide prevention. The high importance of alcoholism in local suicides was unanticipated and not addressed, suggesting that optimal suicide prevention plans must also consider major local risk factors.
The objective of this study was to develop new standardized alcohol-associated cues and assess their effects on brain activation with functional magnetic resonance imaging (fMRI). Pictures of alcoholic and neutral beverages and affectively neutral pictures were presented to 44 abstinent alcoholics and 37 age-matched healthy control subjects. We assessed the skin conductance response, and the elicited arousal and valence. Alcoholics and control subjects did not differ in arousal, valence or skin conductance response evoked by alcohol-associated and affectively neutral stimuli, while nonalcoholic beverages were rated as more unpleasant and arousing by alcoholics compared with control subjects. In the fMRI pilot study, alcohol and abstract pictures were presented to six abstinent alcoholics and induced a significant activation of brain areas associated with visual emotional processes such as the fusiform gyrus, parts of the brain reward system (basal ganglia and orbitofrontal gyrus) and further brain regions in the frontal and parietal cortices associated with the attention network. These observations suggest that standardized pictures of alcoholic beverages can be used to assess brain circuits involved in the processing and evaluation of alcohol cues.
Quetiapine is a novel antipsychotic, which is efficacious in the treatment of positive and negative symptoms in schizophrenia. Research has shown that atypical antipsychotic also reduce the craving and consumption for stimulants and alcohol. Due to Quetiapine's particulars and the promising receptor profile concerning addiction medicine, we set out to examine the tolerability and efficacy concerning relapse prevention of withdrawn alcoholics suffering from craving and affective symptoms.
Subjects and methods
Our case observations attempted to evaluate nine alcoholics after withdrawal suffering from persisting craving, sleep disorder, excitement, depressive symptoms or anxiety symptoms. The patients were treated with quetiapine as relapse prevention and we followed them up in our outpatient clinic.
Results
Eight out of nine patients were abstinent under quetiapine over a period of 2–7 months. One of these patients relapsed after he stopped taking the preparation at his own initiative after 10 weeks. The ninth patient stopped taking the preparation immediately because of swollen nasal mucosae. All target symptoms disappeared in the patients after an average of (mean ± S.D.) 24.5 ± 18.1 days. The overall tolerability was considered to be very good; however, initial sleepiness appeared in four patients.
Conclusion
Although uncontrolled case observations can only be interpreted with caution quetiapine seems to deserve further investigation and may hold the potential for preventing alcohol relapse in alcoholics suffering from additional above-mentioned symptoms.
Alcohol intake is known to modulate plasma concentrations of neuroendocrine peptides. However, recent results suggest that the endocrine system may not only respond passively to alcohol intake, but that -vice versa- it also actively modulates alcohol intake behaviour. The most coherent body of data concerns the hypothalamo-pituitary-adrenocortical (HPA) axis, with low corticotropin releasing hormone (CRH) being associated with more intense craving and increased probability of relapse after acute detoxification. It is important to bear in mind that dysregulation of the HPA system, as observed in alcohol dependence, is also a feature of anxiety and depression, two conditions which are frequently linked with alcohol dependence and have been reported to be associated with a poor prognosis. In depression, increased secretion of CRH seems to be one crucial mechanism. It has been found as a marker of depressive symptoms, which normalises when depression is successfully treated. Hypersecretion of CRH is associated with a general hyperactivity of the HPA system, notably elevated plasma levels of ACTH and cortisol, a blunted cortisol stress response and a blunted dexamethasone suppression test. In any case, HPA dysregulation, alcohol dependence, and depression are closely interrelated. Exactly which component of this triad is the driving force behind the various neuroendocrine correlates of drinking behaviour is currently unclear, and will need to be elucidated by future research. This will allow for an enlightened choice of potentially therapeutic agents for the treatment of co-morbid anxiety, depression, and alcohol dependence, acting primarily on the HPA system.
Tardive dyskinesia (TD) is a movement disorder observed after chronic neuroleptic treatment. Smoking is presumed to increase the prevalence of TD. The question of a cause-effect-relationship between smoking and TD, however, remains to be answered. Purpose of this study was to examine the correlation between the degree of smoking and the severity of TD with respect to differences caused by medication.
Method
We examined 60 patients suffering from schizophrenia and TD. We compared a clozapine-treated group with a group treated with typical neuroleptics. Movement disorders were assessed using the Abnormal-Involuntary-Movement-Scale and the technical device digital image processing, providing rater independent information on perioral movements.
Results
We found a strong correlation (.80 < r < .90, always p < .0001) between the degree of smoking and severity of TD. Repeated measurements revealed a positive correlation between changes in cigarette consumption and changes of the severity of TD (p < .0001). Analyses of covariance indicated a significant group-effect with a lower severity of TD in the clozapine-group compared to the typical-neuroleptics-group (p = .010). Interaction-analyses indicated a higher impact of smoking on the severity of TD in the typical-neuroleptics-group compared to the clozapine-group (p = .033).
Conclusion
Concerning a possible cause-effect-relationship between smoking and TD, smoking is more of a general health hazard than neuroleptic exposure in terms of TD.
A synopsis of current treatment options shows only moderate effect sizes. They could be improved considerably if individual predictors were available.
Previous attempts to identify predictors for the treatment response in alcoholism have mainly concentrated on social and personality variables. Project MATCH was such an attempt which finally failed. The same holds true for similar attempts in pharmacotherapy. Therefore, we set out for a large oligocentre trial “Project PREDICT”. 432 patients are randomly assigned to treatment with acamprosate, naltrexone or placebo. At baseline patients are assessed with a battery of interviews, questionnaires and biological examinations (e.g. genetics). Specific emphasis is put on patients’ individual pathways into relapse. It is determined whether relapse drinking respresented a positive reinforcer (“reward craving”) or a negative reinforcer (“relief craving”). This is assessed with questionnaires, the startle reflex and fMRI. We hypothesize, that patients who are a priori identified as “positive reinforcers” better respond to naltrexone. Negative reinforcers should benefit most from acamprosate.
All patients have been included by now. Preliminary analyses suggest that it is possible to distinguish between the two craving types. The equivalent of positive reinforcement in the startle reflex correlates with fMRI responses to cues with a positive valence of about 0.7. These methods might offer a platform for a targeted pharmacotherapy in alcoholism.