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The diversity of experiences among bilingual children is reflected in the variability of abilities in each of their languages. This paper describes the CECER-DLL Child and Family, and Teacher Questionnaires and discusses the utility of these tools. These questionnaires were created to address the need for valid and reliable tools to document contextual characteristics and language experiences of young bilingual children in developmental and educational research. A multi-site validity study using the CECER-DLL Questionnaires demonstrates how children's language skills are influenced by language exposure at home and at school, mothers’ and teachers’ skills in each language, mother's generational status, and languages used during language and literacy activities at home.
Social and environmental factors such as poverty or violence modulate the risk and course of schizophrenia. However, how they affect the brain in patients with psychosis remains unclear.
We studied how environmental factors are related to brain structure in patients with schizophrenia and controls in Latin America, where these factors are large and unequally distributed.
This is a multicentre study of magnetic resonance imaging in patients with schizophrenia and controls from six Latin American cities. Total and voxel-level grey matter volumes, and their relationship with neighbourhood characteristics such as average income and homicide rates, were analysed with a general linear model.
A total of 334 patients with schizophrenia and 262 controls were included. Income was differentially related to total grey matter volume in both groups (P = 0.006). Controls showed a positive correlation between total grey matter volume and income (R = 0.14, P = 0.02). Surprisingly, this relationship was not present in patients with schizophrenia (R = −0.076, P = 0.17). Voxel-level analysis confirmed that this interaction was widespread across the cortex. After adjusting for global brain changes, income was positively related to prefrontal cortex volumes only in controls. Conversely, the hippocampus in patients with schizophrenia, but not in controls, was relatively larger in affluent environments. There was no significant correlation between environmental violence and brain structure.
Our results highlight the interplay between environment, particularly poverty, and individual characteristics in psychosis. This is particularly important for harsh environments such as low- and middle-income countries, where potentially less brain vulnerability (less grey matter loss) is sufficient to become unwell in adverse (poor) environments.
In São Paulo, Brazil, the first case of coronavirus disease 2019 (CoViD-19) was confirmed on 26 February, the first death due to CoViD-19 was registered on 16 March, and on 24 March, São Paulo implemented the isolation of persons in non-essential activities. A mathematical model was formulated based on non-linear ordinary differential equations considering young (60 years old or less) and elder (60 years old or more) subpopulations, aiming to describe the introduction and dissemination of the new coronavirus in São Paulo. This deterministic model used the data collected from São Paulo to estimate the model parameters, obtaining R0 = 6.8 for the basic reproduction number. The model also allowed to estimate that 50% of the population of São Paulo was in isolation, which permitted to describe the current epidemiological status. The goal of isolation implemented in São Paulo to control the rapid increase of the new coronavirus epidemic was partially succeeded, concluding that if isolation of at least 80% of the population had been implemented, the collapse in the health care system could be avoided. Nevertheless, the isolated persons must be released one day. Based on this model, we studied the potential epidemiological scenarios of release by varying the proportions of the release of young and elder persons. We also evaluated three different strategies of release: All isolated persons are released simultaneously, two and three releases divided in equal proportions. The better scenarios occurred when young persons are released, but maintaining elder persons isolated for a while. When compared with the epidemic without isolation, all strategies of release did not attain the goal of reducing substantially the number of hospitalisations due to severe CoViD-19. Hence, we concluded that the best decision must be postponing the beginning of the release.
Sarcopenic obesity is characterised by the double burden of diminished skeletal muscle mass and the presence of excess adiposity. From a mechanistic perspective, both obesity and sarcopenia are associated with sub-acute, chronic pro-inflammatory states that impede metabolic processes, disrupting adipose and skeletal functionality, which may potentiate disease. Recent evidence suggests that there is an important cross-talk between metabolism and inflammation, which has shifted focus upon metabolic-inflammation as a key emerging biological interaction. Dietary intake, physical activity and nutritional status are important environmental factors that may modulate metabolic-inflammation. This paradigm will be discussed within the context of sarcopenic obesity risk. There is a paucity of data in relation to the nature and the extent to which nutritional status affects metabolic-inflammation in sarcopenic obesity. Research suggests that there may be scope for the modulation of sarcopenic obesity with alterations in diet. The potential impact of increasing protein consumption and reconfiguration of dietary fat composition in human dietary interventions are evaluated. This review will explore emerging data with respect to if and how different dietary components may modulate metabolic-inflammation, particularly with respect to adiposity, within the context of sarcopenic obesity.
Brain imaging studies have shown altered amygdala activity during emotion processing in children and adolescents with oppositional defiant disorder (ODD) and conduct disorder (CD) compared to typically developing children and adolescents (TD). Here we aimed to assess whether aggression-related subtypes (reactive and proactive aggression) and callous-unemotional (CU) traits predicted variation in amygdala activity and skin conductance (SC) response during emotion processing.
We included 177 participants (n = 108 cases with disruptive behaviour and/or ODD/CD and n = 69 TD), aged 8–18 years, across nine sites in Europe, as part of the EU Aggressotype and MATRICS projects. All participants performed an emotional face-matching functional magnetic resonance imaging task.
Differences between cases and TD in affective processing, as well as specificity of activation patterns for aggression subtypes and CU traits, were assessed. Simultaneous SC recordings were acquired in a subsample (n = 63). Cases compared to TDs showed higher amygdala activity in response to negative faces (fearful and angry) v. shapes. Subtyping cases according to aggression-related subtypes did not significantly influence on amygdala activity; while stratification based on CU traits was more sensitive and revealed decreased amygdala activity in the high CU group. SC responses were significantly lower in cases and negatively correlated with CU traits, reactive and proactive aggression.
Our results showed differences in amygdala activity and SC responses to emotional faces between cases with ODD/CD and TD, while CU traits moderate both central (amygdala) and peripheral (SC) responses. Our insights regarding subtypes and trait-specific aggression could be used for improved diagnostics and personalized treatment.
Understanding trends in grain consumption is essential to tackle the low consumption of healthful grain foods. This study aimed to evaluate trends and determinants of grain foods meeting the ≤10:1 carbohydrate:fibre ratio (≤10:1 ratio) in Brazil and to estimate this intake for the next years.
Three editions of the cross-sectional, population-based study Health Survey of São Paulo (2003, 2008 and 2015).
Urban area of São Paulo, Brazil.
The sample included 5801 participants aged 12 years or more.
A growing trend in the intake of these foods (0·9 percentage of energy (%E) in 2003 to 1·5 %E in 2015) was observed. Also, the proportion of the population consuming at least one grain food meeting the ≤10:1 ratio increased from 8·7 % in 2003 to 15·8 % in 2015, and 20·3 % of the population would be consuming some kind of healthful grain food by 2030. Sociodemographic factors associated with the consumption of grain foods meeting the ≤10:1 ratio changed according to study edition, but overall, older individuals (+79 %), females (+28 %), those with higher education (+138 %) and higher family income (+135 %) were more likely to consume grain foods meeting the ratio, whereas participants who self-reported black, brown or indigenous ethnicity were less likely to consume these foods (–30 %).
There was a growing trend to consume grain foods meeting the ≤10:1 ratio from 2003 to 2015, but this consumption continues to be far from recommended levels. Intersectoral changes are urgently needed in order to increase the intake of healthful grain foods.
The farrowing process is one of the most energy-demanding activities for the modern hyperprolific sow. This study evaluated the effects of supply of energy on the expected date of farrowing on the farrowing kinetics and piglets’ performance during the first 24 h after birth. A total of 80 sows were used. The sows and their respective litters were considered as the experimental unit. On the expected day of farrowing, the sows were allocated to one of the following groups: sows that did not have access to feed from farrowing induction until the end of the farrowing process (CON, n = 40); sows fed 500 g of energetic supplement, which consisted of 250 g of the basal lactation diet plus 250 g of cane sugar, 18 h after farrowing induction (SUP, n = 40). The farrowing duration, farrowing assistance, birth interval, number of total born, stillborn and mummified piglets were recorded for each sow. Piglets were weighed individually at birth and 24 h later. The interval from birth to first suckle was evaluated individually for each piglet in 16 randomly selected litters (eight litters per treatment group). Blood glucose concentrations of six sows were measured shortly after expulsion of the first piglet. Farrowing duration, farrowing assistance and stillborn rate tended to be greater (P = 0.06, P = 0.09 and P = 0.07, respectively) in sows from the CON group compared to sows from the SUP group. However, there was no difference (P > 0.05) between the groups for birth interval. Colostrum intake was greater (P < 0.05) for piglets from the SUP group compared to piglets from the CON group. Additionally, BW gain of the piglets suckling the SUP group was greater (P < 0.05) than those suckling the CON group at 24 h after birth. The blood glucose concentrations during the expulsive stage of farrowing were greater (P < 0.05) in the SUP group than for sows from the CON group. In conclusion, supplying modern hyperprolific sows energy on the expected day of farrowing is a valuable nutritional intervention to improve the farrowing kinetics and piglets’ performance in early life.
The giant gypsum crystals of Naica cave have fascinated scientists since their discovery in 2000. Human activity has changed the microclimate inside the cave, making scientists wonder about the potential environmental impact on the crystals. Over the last 9 years, we have studied approximately 70 samples. This paper reports on the detailed chemical–structural characterization of the impurities present at the surface of these crystals and the experimental simulations of their potential deterioration patterns. Selected samples were studied by petrography, optical and electronic microscopy, and laboratory X-ray diffraction. 2D grazing incidence X-ray diffraction, X-ray μ-fluorescence, and X-ray μ-absorption near-edge structure were used to identify the impurities and their associated phases. These impurities were deposited during the latest stage of the gypsum crystal formation and have afterward evolved with the natural high humidity. The simulations of the behavior of the crystals in microclimatic chambers produced crystal dissolution by 1–4% weight fraction under high CO2 concentration and permanent fog, and gypsum phase dehydration under air and CO2 gaseous environment. Our work suggests that most surface impurities are of natural origin; the most significant anthropogenic damage on the crystals is the extraction of water from the caves.
This systematic review examines the effectiveness and cost-effectiveness of behavioural health integration into primary healthcare in the management of depression and unhealthy alcohol use in low- and middle-income countries. Following PRISMA guidelines, this review included research that studied patients aged ≥18 years with unhealthy alcohol use and/or depression of any clinical severity. An exploration of the models of integration was used to characterise a typology of behavioural health integration specific for low- and middle-income countries.
Fifty-eight articles met inclusion criteria. Studies evidenced increased effectiveness of integrated care over treatment as usual for both conditions. The economic evaluations found increased direct health costs but cost-effective estimates. The included studies used six distinct behavioural health integration models.
Behavioural health integration may yield improved health outcomes, although it may require additional resources. The proposed typology can assist decision-makers to advance the implementation of integrated models.
The objective of this study was to examine the association of different personality traits on severity of addiction indexes and patterns of drug use level, in a sample of adolescent psychiatric patients with Substance Use Disorders (SUD), based on the dimensional model of Personality Psychopathology Five (PSY-5) of the MMPI-A.
The Teen Addiction Severity Index (T-ASI), the MMPI-A, and an inventory of drug use pattern were administered to 73 psychiatric patients (M=16.0, SD=1.18 years old; 51% male).
Rho Spearman correlations showed significant associations between Disconstraint (DISC) and T-ASI indexes of drug and social problems (rho= .342, p= .003, and rho= .320, p= .006) and also between DISC in relation to level of cannabis use and other drugs than cocaine and amphetamines (rho= .334, p= .004, and rho= .274, p= .023). The dimension of Psychoticism (PSYC) and Aggressiveness (AGGR) showed slight association with cannabis use (rho= .236, p= .045, and rho= .247, p= .035). The Negative emotionality (NEGE) and Introversion (INTR) showed a moderate association with the T-ASI index of psychiatric problems (rho= .265, p=0.023, and rho=.256, p= .029) but not with drug problems.
The DISC trait could represent a good indicator of risk for drug related problems. High scores in PSYC and AGGR are slightly associated to increase level of cannabis use. While psychiatric complaints are associated with NEGE and INTR traits.
The use of psychiatric services has been associated with a wide range of clinical variables. However, information about the impact of adolescent personality pathology related to hospital admissions is limited.
To analyze the different combination of personality pathology associated to variables of psychiatric hospital admissions (number of admissions, total of days spent as psychiatric inpatient, average of days for admission, and number of admissions in a day care hospital).
The ICD-10 and DSM-IV modules of the semi-structured interview IPDE (International Personality Disorders Examination) were administered, in a sample of 107 adolescent psychiatric patients (M=15.8, SD=0.8 years old; age rank 15-17; 79% female).
Personality pathology group identified by the IPDE showed significantly higher number (p< .001) of psychiatric admissions (M=1.48) than no personality pathology group (M=0.57), but not significant higher number of admissions in a day care hospital. Psychotic patients showed the highest rate of admissions (M=2.88). In present sample, between 30% and 38% of all hospital admitted patients showed a Cluster B personality disorder (PD).The users of psychiatric inpatient services with a complex PD (two o more PD from different clusters) presents in average: 2-2.5 admissions, 34-53 total days spent as psychiatric inpatient, and 11-16 days on each admission.
Patients with psychotic disorders or complex PD were the highest users of inpatients services, but not of day care hospital admissions.
Although anxiety disorders prevalence and incidence decline in later life, anxiety is a major health problem for the elderly. Epidemiology, neurobiology, and treatment of anxiety disorders are poorly studied in the geriatric population. Nevertheless, anxiety has a high impact on functional status and health-related quality of life.
To underline the significant impact of anxiety in the elderly. to discuss the sub-diagnosis and sub-treatment of late-life anxiety and subclinical symptoms.
Literature Review. MEDLINE and PubMed databases searches for peer-reviewed studies, published between 1998 and 2008, using combinations of the Medline Subject Heading terms anxiety, anxiety disorders and old age.
There are few studies in the literature addressing this topic. Late-life anxiety has a high prevalence and is associated with increased morbidity, mortality, functional impairment, poorer quality of life and significant societal costs. Clinical studies show that most cases of anxiety disorders in late life are undetected and under-treated. Intervention research in late-life anxiety disorders is lacking.
It is extremely important and urgent a more efficacious assessment and management of anxiety disorders in the elderly. It is also fundamental an increased attention to subtreshold anxiety, which will allow an earlier intervention and prevention of new cases of anxiety disorders. Well designed interventions will be capable of reducing the burden, morbidity and incidence of late-life anxiety.
Patients with eating disorders are reported to show emotional processing deficits compared to healthy controls.
To study and discuss the role of emotional processing in eating disorders.
Review of the literature.
Several studies found a marked impairment in emotional processing in eating disorder patients. These emotion-processing deficits seem to be independent of affective symptoms. Different studies address different concepts as emotional awareness, alexithymia and facial or voice emotional recognition. The emotional processing and functioning of eating disorder patients highly impact their relational styles and behaviour.
The literature suggests global emotion-processing deficits in eating disorders. The emotion-processing deficits in eating disorder patients may contribute to the poor interpersonal communication, lack of social cognition and lack of empathy frequently seen in these patients. It is extremely important a better understanding of these complex relationships as they can act as maintenance factors of the eating disorder, contributing to social isolation and therapeutic failure. The prognostic implications of these findings, as well as potential therapeutical interventions are topics valuable for future research in this area.
Significant life expectancy increase in HIV-positive patients undergoing antiretroviral therapy (HAART) has motivated inquiries into their quality of life.
To describe quality of life and reliability of WHO's Quality of Life Instrument ((WHOQOL HIV BREF) in depressed or non-depressed HIV/AIDS outpatients in a specialized facility in Rio de Janeiro.
Sectional study in 33 depressed (D) and 70 non-depressed (ND) HIV patients classified using Composite International Diagnostic Interview (CIDI10), Hamilton's depression scale, viral load, CD4 and demographic data. Means of all six WHOQOL HIV BREF domains were compared by the Student t test. Inter-interviewer reliability was evaluated by intraclass correlation coefficient (CCI) with CI of 95%.
The sample comprised mostly of male (62.2%), single (42.9%) AIDS patients (51%), who considered themselves ill (66.3%) and were on HAART (78%). Reliability was excellent, varying from CCI 0.95 (0.93-0.97) for the environmental domain to CCI 0.99 (0.98-0.99) for psychological, level of independence and spiritual domains. Means for all domains in depressed patients (D) were lower than those seen in non-depressed patients (ND) (p<0.005): physical domain 11.0 (D) and 15.3(ND); psychological domain 10.1(D) and 14.7(ND); level of independence domain 10.8(D) and 14.1(ND); social relationship domain 11.9(D) and 15.2(ND); environmental domain 11.9(D) and 15.1(ND); spiritual domain 11.5(D) and 15.5(ND).
WHOQOL HIV BREF's showed excellent reliability and its six domains discriminated several quality of life aspects in depressed and non-depressed HIV/AIDS's patients. Depressed patients have a worst perception of their quality of life for all WHOQOL HIV BREF's domains.
Déterminer si l’emploi addictif des nouvelles technologies (Internet – Jeux vidéo – Téléphone portable – Télévision) par les adolescents pourrait partager la même cause que celle qu’on observe dans les troubles alimentaires et dans les troubles d’externalisation, avec des altérations dans l’impulsivité, et partager également la même dysfonction neuropsychologique.
Introduction et objet
Les nouvelles technologies fournissent une meilleure qualité de vie, le problème est leur potentiel de dépendance surtout chez les adolescents souffrant de troubles du contrôle des impulsions, en particulier des troubles alimentaires et des troubles d’externalisation.
Il s’agit d’une étude descriptive et comparative. Le diagnostic s’établit selon notre protocole (DSM-IV/CIE-10), et selon l’application de trois instruments différents : BIS.11 (Barratt-échelle-de-l’impulsivité), DENA (questionnaire-de-dépistage-des-nouvelles addictions), IAT (Test-d’Addiction-à-l’Internet). La population a été divisée en deux groupes : les troubles de l’alimentation (n = 10) et les troubles d’externalisation (n = 10), dans la fourchette d’âge 12 à 17 ans, dans nos centres-d’ITA.
Les résultats ont démontré que le modèle de l’impulsivité est plus élevé chez les adolescents atteints de troubles de l’externalisation que chez ceux souffrant de troubles alimentaires. Les deux groupes avaient une tendance similaire dans l’utilisation des nouvelles technologies.
L’usage et l’abus potentiel des nouvelles technologies est similaire chez les adolescents hospitalisés pour troubles de l’alimentation et ceux hospitalisés pour pathologies liées à des troubles d’externalisation, ouvrant une zone problématique : celle de la canalisation de l’impulsivité dans l’emploi des nouvelles technologies. Il est nécessaire de mener à terme des recherches avec plus de population d’appui, ce qui pourrait fournir des lignes directrices en faveur d’une approche clinique.
The increasing attention given to dual diagnosis does not correlate with well defined and consensual therapeutic interventions. This issue is particularly evident in the case of comorbid severe personality disorders with clear indication for psychotherapy.
To report a case of comorbid borderline personality disorder and alcohol abuse disorder, underlining the impact of dysfunctional personality traits in a specific dangerous pattern of alcohol abuse. To present and discuss a combined psychotherapeutic and pharmocotherapeutic approaches in a dual diagnosis case.
Case study and review of the literature.
A 37 year old woman with a history of alcohol abuse and self-destructive behaviour was referred to an alcohol treatment unit. She had a personal history of childhood parental sexual abuse, alcohol abuse since adolescence and a high risk self-destructive behaviour. A brief psychotherapeutic intervention (weekly 4 months sessions) was started, along with treatment as usual (psychiatric consultation and psychopharmacological treatment). The psychotherapeutic intervention (Person-Centered therapy) focused on her relational difficulties, corresponding to her request - “dealing with unresolved issues in my life”. After the psychotherapeutic intervention, she was able to stop the episodes of alcohol abuse and to reorganize her life at several levels.
Choosing a psychotherapeutic and pharmacological approach for comorbid addiction disorder and personality disorder cases, presents difficulties due to lack of empirical evidence on dual diagnosis treatment. This case of combined psychotherapeutic and pharmacotherapeutic interventions had acknowledged success, in contrast to several prior treatment attempts focused mainly on the alcohol use disorder.
Bipolar disorder is a chronic, recurrent and debilitating mood disorder with a major impact on several aspects of everyday life. Although pharmacotherapy plays a central role in bipolar disorder treatment, psychosocial interventions are essential to a more complete and successful treatment.
To present a psychoeducation program for bipolar patients runned in a Portuguese psychiatric hospital - Hospital de Magalhães Lemos, Oporto. To review the impact of psychoeducative measures on bipolar patients.
A psychoeducative program for bipolar patients was developed and adapted, based on the Barcelona Bipolar Disorders Program"s experience. The psychoeducative program was applied to bipolar patients as an adjuvant of maintenance treatment.
Fifteen sessions were runned during 15 weeks. Twelve patients were recruited to integrate the psychoeducative group. The sessions addressed several topics including information about the illness, early detection of prodromal symptoms and symptoms management, stress management and the importance of maintaining routines.
The best treatment available for patients with bipolar disorder includes, along with the pharmacological treatment, psychosocial interventions aimed to target issues as early identification of prodromal symptoms, coping skills, medication adherence and understanding of the disorder. This broader approach of bipolar disorder treatment has proved to be efficient in reducing relapse rates, and improving patients’ feelings of self-efficacy and quality of life.
Brain volume abnormalities and oxidative cell damage have been reported to be pathological characteristics of schizophrenia patients. This study aims to assess a potential relationship between these two characteristics in child and adolescent patients with first-episode psychosis.
26 child and adolescent patients with first-episode early-onset schizophrenia, and 78 age- and gender-matched healthy controls were assessed. Magnetic resonance imaging (MRI) scans were used for volumetric measurements of five cerebral regions: gray matter of the frontal, parietal, and temporal lobes, sulcal cerebrospinal fluid (CSF), and lateral ventricles. Oxidative cell damage was traced by means of a systemic increase in lipid hydroperoxides (LOOH).
Lateral ventricle volumes were significantly higher in schizophrenia patients than in controls. In schizophrenia patients, a significant positive relationship was found between oxidative cell damage (LOOH levels) and the abnormal enlargement of the lateral ventricles, after controlling for total intracranial volume, age, gender, daily smoking status, intelligence quotient (IQ), psychopathology, and time since onset of psychotic symptoms. No association was found between brain volumes and oxidative cell damage in control subjects.
Our results suggest that, in patients with first-episode early-onset schizophrenia, enlargement of the lateral ventricles is associated with chronic oxidative cell damage.