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The COVID-19 pandemic has created an unprecedented global crisis, necessitating drastic changes to living conditions, social life, personal freedom and economic activity. No study has yet examined the presence of psychiatric symptoms in the UK population under similar conditions.
We investigated the prevalence of COVID-19-related anxiety, generalised anxiety, depression and trauma symptoms in the UK population during an early phase of the pandemic, and estimated associations with variables likely to influence these symptoms.
Between 23 and 28 March 2020, a quota sample of 2025 UK adults aged 18 years and older, stratified by age, gender and household income, was recruited by online survey company Qualtrics. Participants completed standardised measures of depression, generalised anxiety and trauma symptoms relating to the pandemic. Bivariate and multivariate associations were calculated for demographic and health-related variables.
Higher levels of anxiety, depression and trauma symptoms were reported compared with previous population studies, but not dramatically so. Anxiety or depression and trauma symptoms were predicted by young age, presence of children in the home, and high estimates of personal risk. Anxiety and depression were also predicted by low income, loss of income and pre-existing health conditions in self and others. Specific anxiety about COVID-19 was greater in older participants.
This study showed a modest increase in the prevalence of mental health problems in the early stages of the pandemic, and these problems were predicted by several specific COVID-related variables. Further similar surveys, particularly of those with children at home, are required as the pandemic progresses.
A subcommittee of the Hawaii Governor's Joint Task Force on Rat Lungworm Disease developed preliminary guidelines for the diagnosis and treatment of neuroangiostrongyliasis (NAS) in 2018 (Guidelines, 2018). This paper reviews the main points of those guidelines and provides updates in areas where our understanding of the disease has increased. The diagnosis of NAS is described, including confirmation of infection by real-time polymerase chain reaction (RTi-PCR) to detect parasite DNA in the central nervous system (CNS). The treatment literature is reviewed with recommendations for the use of corticosteroids and the anthelminthic drug albendazole. Long-term sequelae of NAS are discussed and recommendations for future research are proposed.
This study explored family caregivers’ use of technology to care for people with dementia living at home. Three questions were pursued: (1) what are the important, unmet needs of family caregivers, (2) how do they use technologies to assist in care tasks, and (3) what do health care providers know about caregivers’ needs and technology use? Two comprehensive surveys were developed to answer these questions: one for family caregivers (n = 33), and one for health care providers (n = 60). Descriptive and quantitative analyses showed that caregivers’ important, unmet needs were in the domains of information, formal services, and emotional support. Caregivers make limited use of technology but believe in its potential usefulness. Health care providers agree that technology is useful in dementia care; however, they underestimate caregivers’ willingness to adopt technologies to communicate with providers. Findings prove caregiver willingness to use technology to support their care role and provide guidance regarding the caregiver needs that these technologies should address.
OBJECTIVES/GOALS: Although their 5-year survival >90%, young patients with HL face tradeoffs between near-term disease control and risk of treatment-related adverse effects decades later, so we seek to understand what patients and clinicians value in HL treatment decisions. METHODS/STUDY POPULATION: Leveraging our access to large cohorts of physicians, HL patients/survivors, and caregivers, we will use adaptive choice-based conjoint analysis (ACBC) to elicit treatment preferences when offered scenarios that incorporate tradeoffs, e.g., would a patient rather live 20 years with 10% risk of second malignancy or live 40 years with 30% of second malignancy. To reduce survey fatigue, prior choice responses limit subsequent scenarios. Through ACBC, we will identify variations in preferences and the importance of disease outcomes, treatment characteristics, and late effects for HL by respondent type. RESULTS/ANTICIPATED RESULTS: The goal is a final sample of 200 physicians and 200 patients/caregivers. We will collect demographics from physicians (age, type of physician, years practicing, type of practice, gender, and geography) and patients/caregivers (age at diagnosis, time since treatment, race, gender, smoker, education). We will ask questions about values of disease outcomes, late effects (second cancers, cardiac disease, chronic fatigue and neuropathy), and treatment characteristics (uncertainty of late effects, salvageability). Results will include utilities about participants views on disease-control and late effects. We anticipate participants to value disease control over late effects. DISCUSSION/SIGNIFICANCE OF IMPACT: Our study will elicit how physicians and patients/caregivers value treatment tradeoffs for HL. In an era of multiple treatment choices with varying short- and long-term benefits and harms, identifying values and preferences become critical for patient-centered treatment decisions.
Forgetting names is a common memory concern for people with amnestic mild cognitive impairment (aMCI) and is related to explicit memory deficits and pathological changes in the medial temporal lobes at the early stages of Alzheimer’s disease (AD). In the current experiment, we tested a unique method to improve memory for face–name associations in people with aMCI involving incidental rehearsal of face–name pairs.
Older adults with aMCI and age- and education-matched controls learned 24 face–name pairs and were tested via immediate cued recall with faces as cues for associated names. During a 25- to 30-min retention interval, 10 of the face–name pairs reappeared as a quarter of the items on a seemingly unrelated 1-back task on faces, with the superimposed names irrelevant to the task. After the delay, surprise delayed cued recall and forced-choice associative recognition tests were administered for the face–name pairs.
Both groups showed reduced forgetting of the names that repeated as distraction and enhanced recollection of these pairs.
The results demonstrate that passive methods to prompt automatic retrieval of associations may hold promise as interventions for people with early signs of AD.
In this paper, we characterize a high repetition-rate regenerating plasma mirror produced by the thin film of liquid formed when two laminar streams collide. The use of a flowing liquid film is inexpensive and the interaction surface refreshes automatically, avoiding buildup of on-target debris. The composition of the liquid material and the relative angle of the film-generating nozzles was optimized for this application. Spectra measured in reflection from a water-based plasma mirror showed a blue shift but an optical reflectivity of up to 30%. The thickness of the film was found to be of the order of 2
m, and the stability of the reflected spot was
mrad. The reflected beam profile was highly distorted but stable. Further optimization of the nozzles to affect the fluid flow should enable significant improvements in control of the fluid films and increase in the reflectivity of these mirrors.
Epidemiological and clinical evidence highlight the benefit of dietary fibre consumption on body weight. This benefit is partly attributed to the interaction of dietary fibre with the gut microbiota. Dietary fibre possesses a complex food structure which resists digestion in the upper gut and therefore reaches the distal gut where it becomes available for bacterial fermentation. This process yields SCFA which stimulate the release of appetite-suppressing hormones glucagon-like peptide-1 and peptide YY. Food structures can further enhance the delivery of fermentable substrates to the distal gut by protecting the intracellular nutrients during upper gastrointestinal digestion. Domestic and industrial processing can disturb these food structures that act like barriers towards digestive enzymes. This leads to more digestible products that are better absorbed in the upper gut. As a result, less resistant material (fibre) and intracellular nutrients may reach the distal gut, thus reducing substrates for bacterial fermentation and its subsequent benefits on the host metabolism including appetite suppression. Understanding this link is essential for the design of diets and food products that can promote appetite suppression and act as a successful strategy towards obesity management. This article reviews the current evidence in the interplay between food structure, bacterial fermentation and appetite control.
To compare Magnetic Resonance Imaging (MRI) and Magnetic Resonance Spectroscopy (1H-MRS) between people with Alzheimer's disease (AD) and mild cognitive impairment (MCI).
AD is characterised by cognitive impairment. 10-15% of people with MCI progress to dementia each year. The hippocampus is involved in memory functioning and is one of the brain regions first affected by AD. MRI based hippocampal volumetric measurement enables accurate quantification of atrophy. In addition, 1H-MRS can be used to measure concentrations of brain metabolites including myoinositol (mI) and N-acetylaspartate (NAA). NAA is a proxy measure of neuronal density.
Subjects with AD (n=46), MCI (n=28) and controls (n=39) were scanned using a 1.5 Tesla MR system. Manual tracing of hippocampal volumes was undertaken using Measure software. 1H-MRS voxels of interest were defined in the left and right hippocampi. A point-resolved spectroscopy pulse sequence produced spectra from each voxel and clearly resolved NAA and mI peaks. Statistical analysis was undertaken using SPSS15.
Hippocampal volumes were significantly reduced between AD and controls (p=0.003) and between AD and MCI (p=0.001). Compared to controls, individuals with AD and MCI had a significant reduction in [NAA]. MCI showed a non-significant increase in [mI]. A positive relationship was found between hippocampal volume and [NAA] and between hippocampal volume and [mI] for MCI.
AD is associated with decreased viable neuronal density/function (as measured by NAA) and a reduction in hippocampal volume associated with impaired cognitive functioning. The elevated [mI] in MCI may be a “tipping point” into dementia.
To compare Magnetic Resonance Imaging (MRI) findings in Alzheimer's dementia (AD) in the general population with Down's syndrome dementia.
Background review: AD is characterised by cognitive dysfunction interfering with activities of daily living. Mild cognitive impairment (MCI) is an intermediate state between normal aging and dementia. People with Down's syndrome have an increased risk of developing AD. AD pathology initially appears in the entorhinal cortex, followed by the hippocampus and later in the temporal lobes. These areas are critical for memory functioning.
Volumetric analysis was performed on MRI brain scans using Measure software. Manual tracing was undertaken for the hippocampus, temporal lobes and lateral ventricles as well as the total brain volume of the cerebral hemispheres and cerebellum. Brain volumes were normalised as a percentage of traced intracranial volumes. Freesurfer software was used to obtain entorhinal cortical thickness measures. Statistical analysis was undertaken using SPSS15.
Subjects with AD (n=46), MCI (n=28) and controls (n=39) were compared with Down's syndrome demented subjects (DS+, n=20), non-demented subjects with Down's syndrome (DS-, n=45) and age-matched controls (n=43). Hippocampi, entorhinal cortex and temporal lobes were significantly reduced in AD and DS+ compared to controls. Lateral ventricles were significantly increased in AD and DS+ compared to controls. MCI and DS- produced findings between those of dementia and controls.
Critical memory regions atrophy in dementia corresponding to decreased cognitive functioning. DS+ morphology is comparable to AD in the general population but the atrophy is less pronounced.
There are high rates of psychiatric morbidity associated with refractory epilepsy. It is unclear whether seizure frequency or comorbid psychiatric illness impacts more upon patients’ quality of life in epilepsy. The objective of this study was to establish which of these two factors impacted more upon patients.
Patients with medically refractory epilepsy who were admitted to the National Neurological Centre in Beaumont Hospital were recruited to the study. Structural Clinical Interview for DSM IV (Axis I) (SCID I) and SCID II (Axis II) were the objective measures and HADS, and QOLIE-89 were the subjective measures utilized.
A total of 138 patients had SCIDs conducted over the four year study. 75 patients (54.4%) had an Axis I disorder. Of these 30 patients (21.7%) had a mood disorder, 18 patients (13%) had an anxiety disorder and 49 patients (35.5%) were diagnosed with a psychotic disorder. There was no relationship between patient seizure frequency and HADS (p=0.94) or QOLIE-89 (p=0.93) scores. Patients having a high number of seizures were not more likely to have a SCID Axis I diagnosis than patients with a low number of seizures (p=0.246). Patients with a mood disorder were more likely to have a lower QOLIE-89 score than patients without a mood disorder (p=0.0001).
Patients with medically refractory epilepsy have high rates of psychopathology. Seizure frequency is not correlated with the presence, severity of psychiatric symptoms or quality of life. The presence of a psychiatric disorder and its severity is strongly correlated with quality of life.
Involuntary admission and treatment is often a traumatic experience for patients and there is a wide variation in attitudes towards care even when patients are recovered.
The purpose of this large prospective study was to identify clinical predictors of attitudes towards care during involuntary admission.
Three hundred and ninety-one consecutively admitted involuntarily patients to three psychiatric inpatient units over a 30-month period were invited to participate in the study. Comprehensive assessments at admission and 3 months after discharge were attained including measures of symptoms, insight, functioning, attitudes towards involuntary admission and coercive experiences. Multiple linear regression modelling was used to determine the optimal explanatory variables for attitudes towards care.
Two hundred and sixty-three individuals participated at baseline and 156 (59%) successfully completed follow-up assessments. Individuals improved significantly over time clinically and in their attitudes towards their care. At baseline greater insight (P < 0.001) and less symptoms (P = 0.02) were associated with more positive attitudes towards care as was older age (P = 0.001). At follow-up, greater insight (P < 0.001), less symptoms (P = 0.02) and being older (P = 0.04) were associated with more positive attitudes towards care. More positive attitudes towards care at follow-up were associated with greater improvements in insight over time (P < 0.001) and having a diagnosis of an affective psychosis (P = 0.0009).
The best predictors of positive attitudes towards care during and after involuntary admission are illness related factors, such as levels of insight and improvement in insight, rather than service or legislation related factors, such as the use of coercive measures, seclusion and restraint.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Cognitive deficits have been reported during the early stages of bipolar disorder; however, the role of medication on such deficits remains unclear. The aim of this study was to compare the effects of lithium and quetiapine monotherapy on cognitive performance in people following first episode mania.
The design was a single-blind, randomised controlled trial on a cohort of 61 participants following first episode mania. Participants received either lithium or quetiapine monotherapy as maintenance treatment over a 12-month follow-up period. The groups were compared on performance outcomes using an extensive cognitive assessment battery conducted at baseline, month 3 and month 12 follow-up time-points.
There was a significant interaction between group and time in phonemic fluency at the 3-month and 12-month endpoints, reflecting greater improvements in performance in lithium-treated participants relative to quetiapine-treated participants. After controlling for multiple comparisons, there were no other significant interactions between group and time for other measures of cognition.
Although the effects of lithium and quetiapine treatment were similar for most cognitive domains, the findings imply that early initiation of lithium treatment may benefit the trajectory of cognition, specifically verbal fluency in young people with bipolar disorder. Given that cognition is a major symptomatic domain of bipolar disorder and has substantive effects on general functioning, the ability to influence the trajectory of cognitive change is of considerable clinical importance.
The Mental Health Act 2001 provides a legal framework for the involuntary admission and treatment of individuals deemed to have a mental disorder to psychiatric units. The perspectives of people who have been detained are relatively poorly understood.
To develop a theoretical understanding of individual's experiences throughout the trajectory of their detention and to understand the psychological and social processes that individuals use to cope before, during and after detention.
Fifty individuals subject to detention across three psychiatric units consented to be interviewed three months after their detention. Using a semi-structured interview people recounted their experiences. Interviews were analysed using the principles underpinning Grounded Theory.
The theory ‘Preserving Control’ encapsulates individuals’ experiences and consists of three related themes: ‘Losing Control’, ‘Regaining Control’ and ‘Maintaining Control’. ‘Losing Control’ describes individuals’ experiences of losing their autonomy and liberty thought the process of detention and hospitalisation. ‘Regaining Control describes, the strategies individuals used in an attempted to restore their loss of autonomy and control. ‘Maintaining Control’ describes how individuals lived with the consequences of detention and contended with impact on discharge.
Whilst a large variation existed in relation to the subjective experience of being detained, the characteristic process that individuals tend to experience related to identifiable phases of preserving control in the face of this loss of autonomy. Findings from this study highlight the importance of more sensitive interactions support and information during and after the detention process.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
ADHD in childhood is associated with development of negative psychosocial and behavioural outcomes in adults. Yet, relatively little is known about which childhood and adulthood factors are predictive of these outcomes and could be targets for effective interventions. To date follow-up studies have largely used clinical samples from the United States with children ascertained at baseline using broad criteria for ADHD including all clinical subtypes or the use of DSM III criteria.
To identify child and adult predictors of comorbid and psychosocial comorbid outcomes in ADHD in a UK sample of children with DSM-IV combined type ADHD.
One hundred and eighteen adolescents and young adults diagnosed with DSM-IV combined type ADHD in childhood were followed for an average of 6 years. Comorbid mental health problems, drug and alcohol use and police contact were compared for those with persistent ADHD, sub-threshold ADHD and population norms taken from the Adult Psychiatric Morbidity Study 2007. Predictors included ADHD symptomology and gender.
Persistent ADHD was associated with greater levels of anger, fatigue, sleep problems and anxiety compared to sub-threshold ADHD. Comorbid mental health problems were predicted by current symptoms of hyperactivity-impulsivity, but not by childhood ADHD severity. Both persistent and sub-threshold ADHD was associated with higher levels of drug use and police contact compared to population norms.
Young adults with a childhood diagnosis of ADHD showed increased rates of comorbid mental health problems, which were predicted by current levels of ADHD symptoms. This suggests the importance of the continuing treatment of ADHD throughout the transitional years and into adulthood. Drug use and police contact were more common in ADHD but were not predicted by ADHD severity in this sample.
The history of religious migration and experience of exile in the early modern period has received a great deal of attention in recent years. Neglected within this scholarship, however, is sustained discussion of linguistic encounter within these often fraught transcultural and transnational interactions. This article breaks new ground by exploring the linguistic experiences of religious exiles in English convents founded in the Low Countries. Most women within English communities in exile were linguistically challenged; focusing on the creative ways these women subsequently negotiated language barriers sheds new light on female language acquisition and encounter during this period.
Research has shown that religious affiliation has a protective effect against deliberate self-harm. This is particularly pronounced in periods of increased religious significance, such as periods of worship, celebration, and fasting. However, no data exist as to whether this effect is present during the Christian period of Lent. Our hypothesis was that Lent would lead to decreased presentations of self-harm emergency department (ED) in a predominantly Catholic area of Ireland.
Following ethical approval, we retrospectively analysed data on presentations to the ED of University Hospital Limerick during the period of Lent and the 40 days immediately preceding it. Frequency data were compared using Pearson’s chi-squared tests in SPSS.
There was no significant difference in the overall number of people presenting to the ED with self-harm during Lent compared to the 40 days preceding it (χ2 = 0.75, df = 1, p > 0.05), and there was no difference in methods of self-harm used. However, there was a significant increase in attendances with self-harm during Lent in the over 50’s age group (χ2 = 7.76, df = 1, p = 0.005).
Based on our study, Lent is not a protective factor for deliberate self-harm and was associated with increased presentations in the over 50’s age group. Further large-scale studies are warranted to investigate this finding as it has implications for prevention and management of deliberate self-harm.
Dietary Zn has significant impacts on the growth and development of breeding rams. The objectives of this study were to evaluate the effects of dietary Zn source and concentration on serum Zn concentration, growth performance, wool traits and reproductive performance in rams. Forty-four Targhee rams (14 months; 68 ± 18 kg BW) were used in an 84-day completely randomized design and were fed one of three pelleted dietary treatments: (1) a control without fortified Zn (CON; n = 15; ~1 × NRC); (2) a diet fortified with a Zn amino acid complex (ZnAA; n = 14; ~2 × NRC) and (3) a diet fortified with ZnSO4 (ZnSO4; n = 15; ~2 × NRC). Growth and wool characteristics measured throughout the course of the study were BW, average daily gain (ADG), dry matter intake (DMI), feed efficiency (G : F), longissimus dorsi muscle depth (LMD), back fat (BF), wool staple length (SL) and average fibre diameter (AFD). Blood was collected from each ram at four time periods to quantify serum Zn and testosterone concentrations. Semen was collected 1 to 2 days after the trial was completed. There were no differences in BW (P = 0.45), DMI (P = 0.18), LMD (P = 0.48), BF (P = 0.47) and AFD (P = 0.9) among treatment groups. ZnSO4 had greater (P ≤ 0.03) serum Zn concentrations compared with ZnAA and CON treatments. Rams consuming ZnAA had greater (P ≤ 0.03) ADG than ZnSO4 and CON. There tended to be differences among groups for G : F (P = 0.06), with ZnAA being numerically greater than ZnSO4 and CON. Wool staple length regrowth was greater (P < 0.001) in ZnSO4 and tended to be longer (P = 0.06) in ZnAA treatment group compared with CON. No differences were observed among treatments in scrotal circumference, testosterone, spermatozoa concentration within ram semen, % motility, % live sperm and % sperm abnormalities (P ≥ 0.23). Results indicated beneficial effects of feeding increased Zn concentrations to developing Targhee rams, although Zn source elicited differential responses in performance characteristics measured.
There are a variety of causes of acute heart failure in children including myocarditis, genetic/metabolic conditions, and congenital heart defects. In cases with a structurally normal heart and a negative personal and family history, myocarditis is often presumed to be the cause, but we hypothesise that genetic disorders contribute to a significant portion of these cases. We reviewed our cases of children who presented with acute heart failure and underwent genetic testing from 2008 to 2017. Eighty-seven percent of these individuals were found to have either a genetic syndrome or pathogenic or likely pathogenic variant in a cardiac-related gene. None of these individuals had a personal or family history of cardiomyopathy that was suggestive of a genetic aetiology prior to presentation. All of these individuals either passed away or were listed for cardiac transplantation indicating genetic testing may provide important information regarding prognosis in addition to providing information critical to assessment of family members.
Background: There is a paucity of research regarding ALS epidemiology in Canada. Previously published data from Newfoundland and Labrador (NL) demonstrate an average incidence of 2.4/100,000 from 2000-2004 (peak 3.3 in 2001, the highest reported in Canada). Local neurologists believe that the incidence has continued to increase. Methods: Clinicians affiliated with the electromyography (EMG) lab at the Health Sciences Centre in St. John’s compiled a list of patients diagnosed with ALS from 2012-2016, based on recall. Their medical records were reviewed and demographic information collected. This was cross-referenced with new referrals to the ALS Society NL per year. Results: Based on new referrals to ALS Society NL the average incidence between 2012-2016 was 2.81/100,000 (peak 3.6 in 2015). Average age-adjusted incidence from the EMG lab was 1.33 (peak 1.73 in 2016). The EMG lab documented a crude incidence of 3.97 in 2018. Conclusions: The incidence of ALS in NL is increased compared to the usual incidence of 1-2/100,000 per year. After the preliminary study, the EMG lab maintained more thorough records and an incidence of 3.97/100,000 was found in 2018. This makes a compelling argument for future research which could explore potential genetic or environmental causes for the increased incidence in this population.
Introduction: Telephone Triage Services (TTS) manage phone calls from the public regarding general medical problems and provide telephone advice. This telephone based care can overlap with care provided by Poison Centres. Our objective was to examine the impact of a provincial 811 TTS on the IWK Regional Poison Centre (RPC). Methods: This is a retrospective descriptive study using interrupted time series methodology. We compared monthly IWK RPC call volume in the pre-811 era (January 2007-July 2009) and the post-811 era (September 2009-December 2017). We summarized the characteristics of callers who accessed the IWK RPC in terms of client age, sex, intentionality, time of day, call disposition and outcome. Caller characteristics were compared between the pre- and post-811 eras using chi-square test for categorical variables. We used segmented regression analysis to evaluate changes in slope of call volume in the pre- and post 811 eras. The Durbin-Watson statistic was performed to test for serial correlation and the Dickey-Fuller test to investigate seasonality. Results: The dataset included 82683 calls to the IWK RPC – 27028 pre-811 and 55655 post-811. Overall, 55% of calls were for female clients and the largest age group was children aged 0-5 years (37%). Most calls originated from home (47%), followed by a health care facility (23%). Most calls were managed at home (65%). Less than 3% of calls resulted in major effect or death. The Durbin Watson statistic was not statistically significant (p = 0.94). The Dickey-Fuller test indicated series stationarity (p = 0.001). There was no statistically significant change in call volume to the IWK RPC due to the introduction of 811 (p = 0.39). There was no significant variation by time of day, day of week or month, with most calls occurring in the evening. There were significantly more calls regarding intentional ingestions in the post-811 era (23% vs. 19% pre-811, p < .001). Outcomes in the pre and post 811 eras were as follows: minor/no effect/non-toxic/minimal 80% vs. 78%; moderate 7% vs. 10%; and, major/death 1.7% vs. 2.0%. Conclusion: The introduction of a TTS did not change call volumes at our RPC. The increase in the percentage of calls about intentional ingestions may reflect an increase in call acuity as the 811-TTS likely manages calls about minor/non-toxic ingestions without consulting with the RPC. Our future research will examine the nature of poison related calls to the 811-TTS.