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The aim of this pilot study is to assess, in a sample of patients with chemical (alcohol) and behavioural (gambling) dependence, the specifical association between core symptoms and Separation Anxiety Disorder, both in Childhood and in Adulthood.
Materials and methods
After a stabilization period of three months, outpatients with alcohol dependence (n = 30), patological gambling (n = 30) and a control group of anxiety disorders (n = 30) will be assessed with the following psychometric battery:
• SCI-SAS (Structured Clinical Interview for Separation Anxiety) Child and Adult
• SASI (Separation Anxiety Symptom Inventory)
• ASA-27 (Adult Separation Anxiety Questionnaire)
• TCI-R (Temperament anc Character Inventory Revised)
• GAF (Global Assess of Functioning)
• SCL-90-R (Symptom Checklist Revised)
• SOGS (South Oaks Gambling Scale)
• ADS (Alcohol Dependence Scale)
• HAM-A (Hamilton Anxiety Rating Scale)
A preliminary analisys of collected datas (n = 33) shows a strong inter-reliability of the Separation Anxiety Scales (SCI-SAS, SASI and ASA-27) with a p = 0.001 and an association between levels of functioning (GAF) and ASA-27 and SASI scores (p = 0.010 and p = 0,001).
It shows a statistical correlation between ASA-27 and TCI-R: inverse proportion with Self Directness (SD) (p = 0.004) and direct relation with Self Trascendency (ST) (p = 0.003).
Even if the sample is still limited we found an interesting trend between Separation Anxiety symptoms, TCI-R dimensions and core symptoms of dependance. We should focus better, when the study will be over, on narrow and specific sub-analisys that should lead us to a better understanding of the disorders.
Adult Separation Anxiety Disorder (ASAD) is related to greater personal dysfunction and to a reduced sensitivity to conventional treatment, such as cognitive-behavioural therapy or anti-panic drugs, even considering severity of anxiety symptoms, number of co-morbid disorders, socioeconomical status, disease duration, and severity of agoraphobia.
To evaluate separation anxiety, psychiatric co-morbidity, levels of anxiety, character and temperament personality traits, and global functioning, in subjects with anxiety disorders attending a tertiary-level outpatient clinic.
To predict the outcome and customize treatment for anxiety disorders.
After symptom stabilization of one month (T0) 40 patients with anxiety disorders were assessed by means of SCI- SAS, SASI, ASA -27, MINI, HAM- A, TCI-R, GAF. Prospective evaluation is planned at T60 and T180.
According to preliminary cross-sectional data, higher scores of separation anxiety show statistically significant correlations with some domains of the TCI-R; in addition, patients with ASAD show greater psychiatric co-morbidity. No correlations were found between the presence of separation anxiety and levels of anxiety at HAM-A or GAF scores at baseline.
The prospective study of long-term response to treatment is ongoing and the sample will be expanded. The comprehension of anxiety symptoms appraisal in the framework of psychobiological personality characteristics is expected to influence the choice of both pharmacological and psychological therapeutic tools, particularly in patients showing higher levels of dysfunction.
The Lasting Power of Attorney (LPA), under the Mental Capacity Act 2008, came into effect in Singapore on March 2010. as more people become aware of the LPA and the demand for making one rises, it is imperative for healthcare professionals to be knowledgeable about it, in order to provide sound and timely advice to the public.
This study aims to assess the Knowledge, Attitudes and Practices of doctors and medical social workers (MSWs) in Tan Tock Seng Hospital, Singapore, with regards to the making of an LPA.
209 structured questionnaires were distributed and analyzed across seven medical and surgical disciplines between January-April 2011.
Only 8.89% of surgeons, 29.3% of physicians and 29.2% of MSWs have ever encountered an LPA before. 51% of respondents felt that they knew little or nothing at all about the LPA. Only 67% knew the difference between an LPA and an Advanced Medical Directive (AMD). Only 26% were aware of the information sources available for the making of an LPA.
The results of the study revealed limited knowledge and inconsistent attitudes. This resulted in misconceptions, leading to non-standard practices amongst doctors and medical social workers surveyed with regards to the LPA document, in Singapore. It is crucial to address and rectify this deficiency in knowledge. Hopefully in time, this will translate to better practices and the public would be more comfortable approaching their doctors for advice regarding creating a Lasting Power of Attorney for themselves and their loved ones.
Pathological Gambling (PG) includes extremely different types of game and many gamblers suffer from anxiety disorders. According to the self-medication hypothesis, Gambling Behaviour may be a strategy to tolerate suffering and compensate uneasiness; otherwise social problems related to gambling may lead to anxiety disorders, possibly unmasking an adult form of Separation Anxiety Disorder (SAD).
To investigate possible relationships between PG and SAD, considering the different games, the age of onset, the symptom severity, and the distinction between Adult and Child SAD.
32 gamblers attending an outpatient psychiatric clinic completed the following tests: SOGS and ASI to investigate the kind of gambling, the age of onset and the social conditions of gamblers; SCI-SAS, SASI, ASA-27 to evaluate the Separation Anxiety in childhood and adulthood; HAM-A; GAF.
There are statistically significant correlations between later age of onset of PG and development of SAD in adults. Higher scores in GAF are related to lower scores in Separation Anxiety scales and HAM-A. There is a strong inter-correlation among the Separation Anxiety scales. Higher scores in HAM-A correlate with higher scores in SASI and ASA-27. Male gamblers have an earlier onset and increasing with the age of onset increases the addiction to “dissociative” games instead of “active” ones.
Our preliminary data do not support self-medication hypothesis; possibly, a later-onset gambling is related to a more neurotic and less impulsive psychopathological pattern.
The use of benzodiazepines and z-drugs in clinical practice is a double-edged sword. There is a paucity of literature studying the prescribing trends of benzodiazepines and z-drugs in Singapore.
The objective of this study is evaluate the outpatient prescribing trends of oral benzodiazepines and z-drugs in a general hospital in Singapore over a 9 years period, from 2005 to 2013.
Data was obtained from the electronic records of all outpatient benzodiazepine and z-drug prescriptions over the study period. The parameters studied were daily dose (in mg/day), duration (in days) and total dose (in mg) of the drug of interest in each prescription. Stratification of these parameters by age groups and gender of patients was performed. A multivariate linear regression model was used to analyze the prescribing patterns across time while adjusted for confounders.
There was a significant drop in the number of benzodiazepine and z-drug prescriptions between 2011 and 2013. The specified parameters of Alprazolam, Diazepam and Lorazepam prescriptions showed steep drops between 2011 and 2013, while those of Midazolam increased considerably over the same period. Full Linear regression analysis for mean total dose showed negative coefficients for Alprazolam, Diazepam, Lorazepam, Zopiclone and Zolpidem prescriptions and a positive coefficient for Midazolam prescriptions.
There is preliminary evidence for an overall drop in the prescribing trend of benzodiazepines and z-drugs; this study is a stepping-stone for much needed future research in this area.
Stigma towards mental illness and psychiatry have a major impact on psychiatric patients’ quality of life; in particular, prejudicial beliefs make it more difficult for future doctors to send patients to mental health services, leading to a delay of necessary care.
Our aim is to evaluate the stigma towards mental illness and psychiatry, in a sample of Italian medical students. We studied the differences between the first-year students who have not attended the academic course in psychiatry, compared to the senior students who have attended the psychiatric lectures.
We tested 113 medical students, using the following questionnaires:
– Attitudes Towards Psychiatry (ATP 30);
– Community Attitudes Towards Mental Ill (CAMI);
– Perceived Discrimination Devaluation Scale (PDD), to assess the discrimination towards mental illness perceived in society;
– Baron-Cohen's Empathy Quotient (EQ), to measure empathy.
Among the 113 students, 46 have already attended the academic course of psychiatry and CAMI scores were less stigmatizing as total score (P = 0.014) and in authoritarianism subscale (P = 0.049), social restriction (P = 0.022) and ideology of mental health in the community (P = 0.017). However, there were no statistically significant differences in empathy, perceived discrimination in the society and stigmatization of psychiatry.
The 67 students who have not attended the academic course of psychiatry are more stigmatizing, considering psychiatric patients as inferior people that require coercive attitudes, socially dangerous and that should be treated faraway from the community. Studying psychiatry is therefore useful to reduce, in the future doctors, these prejudices toward mentally ill patients.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Stigma towards mental illness has a major impact on the quality of life and the health care of psychiatric patients. Several studies have reported that health professionals have more negative attitudes than general population.
To explore empathy and attitudes towards mental illness in nursing students (NS) and non-health university students. Our purpose is to see how NS have more empathic and less stigmatizing attitudes towards psychiatric patients, compared to other university students.
We tested 96 university students (50 NS and 46 non-health university students), with the following questionnaires anonymously filled out:
– Community attitudes towards mental ill (CAMI), to evaluate the different students’ attitudes towards mental illness;
– Empathy quotient (EQ), to assess empathy.
NS differs from the other group in 5 items of CAMI (P < 0.05 in 3 items and P < 0.01 in 2 items), and Authoritarianism subscale (P = 0.023). This shows that NS have a greater general awareness and less stigmatizing attitudes about the need to hospitalize the mentally ill, the difference between psychiatric patients and general population, the wrong need of segregation and the real causes of mental illness. There is also a significant difference in EQ (items 6, 21, 25, 44, 59): future nurses seem to have a slightly higher empathy, even though the EQ total score does not differ in the two groups.
These results suggest that there is a difference with respect to the attitudes towards psychiatric patients in NS and students who do not follow health-care courses: NS have more empathetic and less stigmatizing attitudes.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Stigma towards psychiatry and mental illness significantly worsens the quality of life of psychiatric patients. Negative prejudices in medical students make it difficult for future doctors to send patients to mental health services and promote an increased risk of premature death.
Our aim is to assess stigma towards mental illness and psychiatry in medical students, and to study the influence of real-world experiences, such as having visited a psychiatric ward, having personally met a psychiatric patient or having friends and/or family members who suffer from a mental illness.
One hundred and thirteen Italian medical students completed the following tests:
Having visited a psychiatric ward correlates with a better attitude towards psychiatry (P = 0.008), rather than towards the mentally ill. Having personally known someone with mental disorders correlates with less stigmatizing scores in CAMI: total score (P = 0.002), authoritarianism (P < 0.001), benevolence (P = 0.047) and social restriction (P = 0.001). Similar results emerged in those who have close relationships with a psychiatric patient. There is no statistical significance as to empathy.
The students who have visited a psychiatric ward have a less stigmatizing vision of psychiatry, while having personally known psychiatric patients favors a less stigmatizing attitude towards them. Those who have not had this experience, have a more hostile and intolerant vision of mental illness, and consider psychiatric patients as inferior subjects that require coercive attitudes and that would be better to avoid because socially dangerous.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Psychiatric patients often do not receive the same health treatment reserved for patients with no mental disorders. Stigma in mental-health nurses can worsen the patients’ healing time and quality of care.
To explore the different attitudes towards mental illness and psychiatry in nursing students (NS) of the first and the final year of university, and the importance of having visited a psychiatric ward and having known a psychiatric patient.
Fifty NS completed the following tests:
– Community attitudes towards mental ill (CAMI);
– Attitudes towards psychiatry (ATP-30);
– Empathy quotient (EQ).
NS of the final year differ significantly from those of the first year in 4 CAMI items, in Authoritarianism subscale (P = 0.041), Social Restrictiveness (P = 0.029) and Community Mental Health Ideology (P = 0.045), indicating a more mature and responsible approach to psychiatric patients, without considering them a threat to be secluded. EQ does not show a significant difference in empathy, not even considering the individual items. Final year NS also have more positive attitudes toward Psychiatry in 3 ATP-30 items and total score (P = 0.01). Those who visited a psychiatric ward have more positive attitudes towards mental illness and Psychiatry, in 6 CAMI items and 3 ATP-30 items. Having personally known a psychiatric patient leads to positive attitudes in only a few CAMI items.
Last-year NS, who have had more direct relationships with patients through practical training, have more empathetic and less stigmatizing attitudes. It is also very useful to attend a psychiatric ward during the nursing training.
Normal 0 14 false false false IT X-NONE X-NONE.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Gaia DR2 was released in April 2018 and contains a photometric catalogue of more than 1 billion sources. This release contains colour information in the form of integrated BP and RP photometry in addition to the latest G-band photometry. The level of uncertainty can be as good as 2 mmag with some residual systematics at the 10 mmag level. The addition of colour information greatly enhances the value of the photometric data for the scientific community. A high level overview of the photometric processing, with a focus on the improvements with respect to Gaia DR1, was given. The definition of the Gaia photometric system, a crucial part of the calibration of the photometry, was also explained. Finally, some of the photometric improvements expected for the next data release were described.
We report the utility of whole-genome sequencing (WGS) conducted in a clinically relevant time frame (ie, sufficient for guiding management decision), in managing a Streptococcus pyogenes outbreak, and present a comparison of its performance with emm typing.
A 2,000-bed tertiary-care psychiatric hospital.
Active surveillance was conducted to identify new cases of S. pyogenes. WGS guided targeted epidemiological investigations, and infection control measures were implemented. Single-nucleotide polymorphism (SNP)–based genome phylogeny, emm typing, and multilocus sequence typing (MLST) were performed. We compared the ability of WGS and emm typing to correctly identify person-to-person transmission and to guide the management of the outbreak.
The study included 204 patients and 152 staff. We identified 35 patients and 2 staff members with S. pyogenes. WGS revealed polyclonal S. pyogenes infections with 3 genetically distinct phylogenetic clusters (C1–C3). Cluster C1 isolates were all emm type 4, sequence type 915 and had pairwise SNP differences of 0–5, which suggested recent person-to-person transmissions. Epidemiological investigation revealed that cluster C1 was mediated by dermal colonization and transmission of S. pyogenes in a male residential ward. Clusters C2 and C3 were genomically diverse, with pairwise SNP differences of 21–45 and 26–58, and emm 11 and mostly emm120, respectively. Clusters C2 and C3, which may have been considered person-to-person transmissions by emm typing, were shown by WGS to be unlikely by integrating pairwise SNP differences with epidemiology.
WGS had higher resolution than emm typing in identifying clusters with recent and ongoing person-to-person transmissions, which allowed implementation of targeted intervention to control the outbreak.
The objectives of this study were to compare the quality-of-life scores of Malaysian children with CHD and their healthy siblings, to determine the level of agreement between proxy-reports and child self-reports, and to examine variables that have an impact on quality of life in those with CHD.
Parental-proxy scores of the Pediatric Quality of Life Inventory 4.0 core scales were obtained for 179 children with CHD and 172 siblings. Intra-class coefficients were derived to determine the levels of proxy–child agreement in 66 children aged 8–18 years. Multiple regression analysis was used to determine factors that impacted Pediatric Quality of Life Inventory scores.
Proxy scores were lower in children with CHD than siblings for all scales except physical health. Maximum differences were noted in children aged 5–7 years, whereas there were no significant differences in the 2–4 and 13–18 years age groups. Good levels of proxy–child agreement were found in children aged 8–12 years for total, psychosocial health, social, and school functioning scales (correlation coefficients 0.7–0.8). In children aged 13–18 years, the level of agreement was poor to fair for emotional and social functioning. The need for future surgery and severity of symptoms were associated with lower scores.
Differences in proxy perception of quality of life appear to be age related. The level of proxy–child agreement was higher compared with other reported studies, with lower levels of agreement in teenagers. Facilitating access to surgery and optimising control of symptoms may improve quality of life in this group of children.
In Singapore, influenza vaccination is recommended for persons at higher risk of complications of seasonal influenza, including those with chronic medical conditions and the elderly (individuals aged ⩾65 years). We investigated the factors associated with influenza vaccine uptake based on a nationally representative sample of community-dwelling adults aged >50 years. The data for this study were obtained from the National Health Surveillance Survey (NHSS) 2013. The association between influenza vaccine uptake and socio-demographic and health-related variables was analysed using univariable and multivariable logistic regression models. Of 3700 respondents aged ⩾50 years in the NHSS, 15·2% had received seasonal influenza vaccination in the past year. Older age, single marital status and economic inactivity were the socio-demographic variables independently associated with vaccine uptake. Health-related factors which were predictive of influenza vaccine uptake were sufficient total physical activity, better self-rated health, having at least one medical condition at risk of influenza complications and a regular family doctor/general practitioner. Influenza vaccine uptake in community-dwelling older adults was low. Our findings are of relevance in the formulation of public health policies and targeted health promotion strategies to increase vaccine uptake in this population group.
An outbreak of gastroenteritis affected 453 attendees (attack rate 28·5%) of six separate events held at a hotel in Singapore. Active case detection, case-control studies, hygiene inspections and microbial analysis of food, environmental and stool samples were conducted to determine the aetiology of the outbreak and the modes of transmission. The only commonality was the food, crockery and cutlery provided and/or handled by the hotel's Chinese banquet kitchen. Stool specimens from 34 cases and 15 food handlers were positive for norovirus genogroup II. The putative index case was one of eight norovirus-positive food handlers who had worked while they were symptomatic. Several food samples and remnants tested positive for Escherichia coli or high faecal coliforms, aerobic plate counts and/or total coliforms, indicating poor food hygiene. This large common-source outbreak of norovirus gastroenteritis was caused by the consumption of contaminated food and/or contact with contaminated crockery or cutlery provided or handled by the hotel's Chinese banquet kitchen.
The purpose of this study is to assess the effectiveness of diabetes self-management education (DSME) in a rural agricultural town.
In this prospective, education-intervention trial, 85 adults with type 2 diabetes mellitus from villages randomly assigned to DSME and 70 from villages assigned to standard care participated. The DSME group underwent a curriculum delivered by peer educators; those in the standard group received usual advice. Outcome measures were anthropometric, biochemical, health behaviors, and medication use data taken at baseline then after three and six months.
DSME group had a lower median A1C after three and six months. After six months, there was a 0.5% median A1C reduction in DSME group and a 0.25% increase in the standard group. There were more participants in DSME group with A1C ⩽7.0% after three and six months. By the third month, there were more participants in DSME group performing foot examination.
DSME in this rural agricultural town improved glycemic control and promoted foot examination.
Coxsackievirus A6 (CV-A6), coxsackievirus A16 (CV-A16) and enterovirus 71 (EV-A71) were the major enteroviruses causing nationwide hand, foot and mouth disease (HFMD) epidemics in Singapore in the last decade. We estimated the basic reproduction number (R0) of these enteroviruses to obtain a better understanding of their transmission dynamics. We merged records of cases from HFMD outbreaks reported between 2007 and 2012 with laboratory results from virological surveillance. R0 was estimated based on the cumulative number of reported cases in the initial growth phase of each outbreak associated with the particular enterovirus type. A total of 33 HFMD outbreaks were selected based on the inclusion criteria specified for our study, of which five were associated with CV-A6, 13 with CV-A16, and 15 with EV-A71. The median R0 was estimated to be 5·04 [interquartile range (IQR) 3·57–5·16] for CV-A6, 2·42 (IQR 1·85–3·36) for CV-A16, and 3·50 (IQR 2·36–4·53) for EV-A71. R0 was not significantly associated with number of infected children (P = 0·86), number of exposed children (P = 0·94), and duration of the outbreak (P = 0·05). These enterovirus-specific R0 estimates will be helpful in providing insights into the potential growth of future HFMD epidemics and outbreaks for timely implementation of disease control measures, together with disease dynamics such as severity of the cases.
Background: White matter changes are common finding during brain autopsies especially in elderly. Although there are many studies applying radiological-pathological correlation on these lesions, their pathogenesis is still unclear. However, a number of possible causes have been suggested including: hypoxic-ischemia, altered blood brain barrier permeability, vascular pathology and chronic hypoperfusion. As usually there is a multiplicity of causes in any individual case, it is very difficult to pinpoint the major causal factor contributing to observed pathological changes. In this study, we document the white matter pathology in global acute hypoxic/ischemic injury due to cardiac arrest as the major causal factor.
Method: We retrieve 16 cases of cardiac arrest encephalopathy in our archive with post arrest survival range from 6 hours to 14 days. Several special, and immunohistochemical stains were used to study the axonal and myelin pathology.
Result: The pathogenicity of the cardiac arrest was confirmed in all cases by demonstrating the expected gray matter pathology, albeit in varying degree of severity. The white matter changes range from unremarkable in the first 2 days, evidence of cerebral edema (visualized from 3rd day on), and early axonal degeneration, to diffuse myelin pallor secondary to marked axonal loss on day 14.
Conclusion: The white matter changes in post cardiac arrest are mainly due to early cerebral edema and axonal degeneration and the effect on myelin is secondary.
To assess the impact of past dengue epidemics in Singapore, we undertook a national seroepidemiological study to determine the prevalence of past dengue virus (DENV) infection in the adult population in 2010 and make comparisons with the seroprevalence in 2004. The study involved residual sera from 3293 adults aged 18–79 years who participated in a national health survey in 2010. The overall prevalence of anti-DENV IgG antibodies was 56·8% (95% confidence interval 55·1–58·5) in 2010. The seroprevalence increased significantly with age. Males had significantly higher seroprevalence than females (61·5% vs. 53·2%). Among the three major ethnic groups, Malays had the lowest seroprevalence (50·2%) compared to Chinese (57·0%) and Indians (62·0%). The age-standardized seroprevalence in adults was significantly lower in 2010 (54·4%) compared to 2004 (63·1%). Older age, male gender, Indian ethnicity, permanent residency and being home-bound were independent risk factors significantly associated with seropositivity. About 43% of the Singapore adult resident population remain susceptible to DENV infection as a result of the successful implementation of a comprehensive nationwide Aedes surveillance and control programme since the 1970s. Vector suppression and concerted efforts of all stakeholders in the community remain the key strategy in the prevention and control of dengue.
Current evidence suggests that regenerative v. degenerative endothelial responses can be integrated in a clinical endothelial phenotype, reflecting the net result between damage from risk factors and endogenous repair capacity. We have previously shown that a cocoa flavanol (CF) intervention can improve endothelial function and increase the regenerative capacity of the endothelium by mobilising circulating angiogenic cells in patients with coronary artery disease (CAD). The aim of the present study was to investigate whether CF can lower the levels of circulating endothelial microparticles (EMP), markers of endothelial integrity, along with improvements in endothelial function. The levels of EMP in the frozen plasma samples of CAD patients were measured along with endothelial function (flow-mediated vasodilation, FMD); n 16, FMD data published previously), and these data were compared with those of young (n 12) and age-matched (n 12) healthy control subjects. The CAD patients exhibited significantly increased levels of EMP along with impaired FMD when compared with the healthy control subjects. The levels of CD144+ and CD31+/41− EMP were inversely correlated with FMD (r − 0·67, P= 0·01 and r − 0·59, P= 0·01, respectively). In these CAD patients, the levels of EMP were measured after they had consumed a drink containing 375 mg of CF (high-CF intervention, HiFI) or 9 mg of CF (macro- and micronutrient-matched low-CF control, LoFl) twice daily over a 30-d period in a randomised, double-blind, cross-over study. After 1 month of HiFI, the levels of CD31+/41− and CD144+ EMP decreased ( − 25 and − 23 %, respectively), but not after LoFl. Our data show that flavanols lower the levels of EMP along with higher endothelial function, lending evidence to the novel concept that flavanols may improve endothelial integrity.
Chemical and structural data are reported for platinum–palladium intermediates from two nuggets found at Córrego Bom Sucesso, Minas Gerais, Brazil. Three grains with simple stoichiometries (i.e. PtxPd1−x with x ∼0.67, ∼0.5 and ∼0.33, which correspond to Pt2Pd, PtPd and PtPd2, respectively) were characterized by single-crystal X-ray diffraction and electron-probe microanalysis. In the absence of single-crystal data it might be tempting to hypothesize that such simple stoichiometries represent distinct mineral species, however structural analyses show that all of the phases are cubic and crystallize in space group Fmm. They are, therefore, natural intermediates in the palladium–platinum solid solution. Reflectance and micro-hardness values are reported for the samples and a comparison with the pure metallic elements made. On the basis of information gained from the chemical and structural characterization it can be concluded that there is a complete solid solution between Pt and Pd in nature. These findings corroborate results from experiments on synthetic compounds.