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To develop and test a tool to assess the price and availability of low-carbon footprint and nutritionally balanced dietary patterns in retail food environments in Ontario, Canada.
Availability and price of selected food from discount and regular grocery stores (n 23) in urban/rural areas of northern/southern Ontario were assessed with the Sustainable Nutrition Environment Measures Survey in 2017.
Inter-rater reliability was high for price (intra-class correlation coefficients = 0·819) and for availability (Cohen’s κ = 0·993). The tool showed 78 % of the selected food items were available in all stores. Overall, price differences were small between urban and rural locations, and northern and southern Ontario. The greatest price difference was between discount and regular stores.
The tool showed excellent inter-rater agreement. Researchers and public health dietitians can use this tool for research, practice and policy to link consumer-level health outcomes to the retail environment.
To evaluate the involvement of nod-like receptor pyrin domain-containing protein 3 (NLRP3) inflammasome in schizophrenia-like behaviour in young animals exposed to maternal immune activation (MIA).
To this aim, on the 15th gestational day, the females received an injection of lipopolysaccharides. When the animals completed 7, 14 and 45 postnatal days, they were killed and the whole brain was dissected for biochemical analysis. Animals with 45 postnatal days were submitted to behavioural tests of locomotor activity, social interaction and stereotyped movements.
It was observed that the animals presented schizophrenia-like behaviour at 45 postnatal days associated with the increase of NLRP3 inflammasome expression and IL-1β levels on 7, 14 and 45 postnatal days.
This study shows that MIA may be associated with a schizophrenia-like behaviour. This behaviour can be induced to a neuroinflammatory profile in the brain. These evidences may base future studies on the relationship between neuroinflammation and psychiatric disorders.
We aimed to assess the validity of maternal recall of exclusive breastfeeding (EBF) at 3 months obtained 12 months after childbirth.
A population-based birth cohort study. The gold standard is maternal report of EBF at the age of 3 months (yes or no) and age of introduction of other foods in the infant’s diet. EBF was considered when the mother reported that no liquid, semi-solid or solid food was introduced up to that moment. The variable to be validated was obtained at 12 months after childbirth when the mother was asked about the age of food introduction. The prevalence of EBF at 3 months, and sensitivity, specificity, positive (PPV) and negative predictive values (NPV), and accuracy of 12-month recall with 95 % CI were calculated.
3700 mothers of participants of the Pelotas 2004 Birth Cohort.
The prevalence of EBF at 3 months was 27·8 % (95 % CI 26·4, 29·3) and 49·0 % (95 % CI 47·4, 50·6) according to gold standard and maternal recall, respectively. The sensitivity of maternal recall at 12 months was 98·3 % (95 % CI 97·4, 99·0), specificity 70·0 % (95 % CI 68·2, 71·7), PPV 55·8 % (95 % CI 53·4, 58·1), NPV 99·1 % (95 % CI 98·6, 99·5) and accuracy 77·9 % (95 % CI 76·6, 79·2). When the analyses were stratified by maternal and infant characteristics, the sensitivity remained around 98 %, and the specificity ranged from 64·4 to 81·8 %.
EBF recalled at the end of the first year of infant’s life is a valid measure to be used in epidemiological investigations.
Detrital zircon populations from six samples of upper Triassic sandstone (Algarve Basin) were analysed, yielding mostly Precambrian ages. zircon age populations of the Triassic sandstone sampled from the western and central sectors of the basin are distinct, suggesting local recycling and/or lateral changes in their sources. Our findings and the available detrital zircon ages from the Palaeozoic terranes of SW Iberia, Nova Scotia and NW Morocco were jointly examined using the Kolmogorov–Smirnov test and multidimensional scaling diagrams. The obtained results enable direct discrimination of competing Laurussian-type and Gondwanan-type sediment sources, involving recycling and mixing relationships. The detrital zircon populations of the Algarve Triassic sandstone are very different from those of the lower–upper Carboniferous Mértola and Mira formations (South Portuguese Zone), upper Devonian – lower Carboniferous Horta da Torre, Represa and Santa Iria formations (Pulo do Lobo Zone), and the late Carboniferous Santa Susana and early Permian Viar basins, which are ruled out as potential sources. The detrital zircon populations of Triassic sandstone from the central sector and those from the Ossa–Morena Zone Ediacaran–Cambrian siliciclastic rocks, upper Devonian – Carboniferous Ronquillo, Tercenas, Phyllite-Quartzite and Brejeira formations (South Portuguese Zone), and Frasnian siliciclastic rocks of the Pulo do Lobo Zone are not statistically distinguishable. Thus, sedimentation in the central sector was influenced by Gondwanan- and Laurussian-type putative sources exposed in SW Iberia, in contrast to the western sector, where Meguma Terrane and Sehoul Block Cambrian siliciclastic rocks allegedly constituted the main (Laurussian-type) sources. These findings provide insights into the denudation of distinctive source terranes distributed along the late Palaeozoic suture zone that juxtaposed the Laurussian and Gondwanan margins.
This research communication describes the influence of diet, mammary quarter position and milking process on the temperature of teats and udder of cows fed diets containing different lipid sources. Five primiparous cows were fed diets containing cottonseed, sunflower seed, soybeans or soybean oil as a source of lipids and a reference diet without the inclusion of lipid sources in a 5 × 5 Latin Square design. Milk yield was determined in the last five days of each period. Milk samples were collected for SCC analysis on the last two days of each experimental period. The images of the mammary gland were obtained using an infrared camera and were analyzed with appropriate computer software. Milk yield was 14.8% higher for cows fed soybeans as a source of lipids. Diets and somatic cell counts did not influence the temperature of teats and udder. The milking process reduced the temperature of teats and udder by 0.79°C. Rear teats and rear quarters had higher surface temperatures than front teats and fore quarters. Changes in temperature of teats and mammary quarters occurred as a function of the milking process and quarter position. However, the diet and the SCC did not influence the temperature of teats and mammary quarters in this experiment.
Early growth pattern is increasingly recognized as a determinant of later obesity. This study aimed to identify the association between weight gain in early life and anthropometry, adiposity, leptin, and fasting insulin levels in adolescence. A cross-sectional study was conducted in 366 school children aged 11–13 years. Weight, height, and waist circumference (WC) were measured. Fat mass (FM) was assessed using bioelectrical impedance analysis. Blood was drawn after a 12-h fast for insulin and leptin assay. Birth weight and weight at 6 months and at 18 months were extracted from Child Health Development Records. An increase in weight SD score (SDS) by ≥0.67 was defined as accelerated weight gain. Linear mixed-effects modeling was used to predict anthropometry, adiposity, and metabolic outcomes using sex, pubertal status, accelerated weight gain as fixed factors; age, birth weight, and family income as fixed covariates, and school as a random factor. Children with accelerated weight gain between birth and 18 months had significantly higher body mass index (BMI) SDS, WC SDS, height SDS, %FM, fat mass index (FMI), fat free mass index (FFMI), and serum leptin levels in adolescence. Accelerated weight gain between 6 and 18 months was associated with higher BMI SDS, WC SDS, %FM, and FMI, but not with height SDS or FFMI. Accelerated weight gain at 0–6 months, in children with low birth weight, was associated with higher height SDS, BMI SDS, WC SDS, %FM, and FMI; in children with normal birth weight, it was associated with BMI SDS, WC SDS, height SDS, and FFMI, but not with %FM or FMI. Effects of accelerated weight gain in early life on anthropometry and adiposity in adolescence varied in different growth windows. Accelerated weight gain during 6–18 months was associated with higher FM rather than linear growth. Effects of accelerated weight gain between 0 and 6 months varied with birth weight.
Deficits in social functioning are a core feature of schizophrenia and are influenced by both symptomatic and neurocognitive variables.
In the present study we aimed to determine the reliability and validity of the Portuguese version of the Personal and Social Performance (PSP) scale, and possible correlations with measures of cognitive functioning.
One-hundred and four community and inpatients with schizophrenia were assessed using measures of social functioning and symptom severity alongside measures of executive function, processing speed and verbal memory.
The reliability of the PSP was found to be satisfactory, with a Cronbach's alpha coefficient of 0.789. Inter-rater reliability in the four domains of the PSP varied from 0.430 to 0.954. Low-functioning patients (PSP < 70) were older, had longer duration of illness, were more symptomatic and had worse cognitive performances, as compared to high-functioning patients (PSP ≥ 70). In a regression model, deficits in social functioning were strongly predicted both by symptomatic and neurocognitive variables; these together accounted for up to 62% of the variance.
The present study supports the reliability and validity of the Portuguese language version of the PSP and further supports the original measure. The co-administration of brief cognitive assessments with measures of functioning may lead to more focused interventions, possibly improving outcomes in this group.
The number of immigrants using health services has increased across Europe. For assessing and improving the quality of care provided for immigrants, information is required on how many immigrants use services, what interpreting services are provided and whether staff members are from immigrant groups.
Structured interviews were conducted with 15 health services (9 primary care, 3 emergency departments, 3 mental health) located in areas with high immigrant populations in each of 16 European countries (n = 240). Responses were collected on the availability of data on service use by immigrant patients, the provision of interpreting services and immigrant staff members.
Data on service use by immigrants were recorded by only 15% of services. More than 40% of services did not provide any form of interpreting service and 54% of the services reported having no immigrant staff. Mental health services were more likely to use direct interpreting services, and both mental health and emergency services were more likely to have immigrant staff members.
For assessing and improving the quality of care provided for immigrants, there is a need to improve the availability of data on service use by immigrants in health services throughout Europe and to provide more consistent access to interpreting services.
The HCV has been associated with significant impairment of quality of life, irrespective of the degree of liver injury. The association of this disease with psychiatric comorbidities, especially depression, has been well described in the scientific literature. However, despite also significantly affect the quality of life of individuals, the Posttraumatic Stress Disorder (PTSD) has not been well studied in this population.
Evaluate whether individuals perceive the liver disease as a potentially traumatic experience and investigate the impact of PTSD diagnosis on health-related quality of life in hepatitis C virus-infected subjects.
We conducted a cross-sectional survey of 127 consecutive hepatitis C-infected outpatients. We investigated Traumatic Experiences and the subject's perception about the disease using the Trauma History Questionnaire. PTSD and others psychiatry diagnoses were assessed trough M.I.N.I. PLUS. Quality of life was assessed by the Short-Form 36.
Approximately 38.6% of the patients perceived the hepatitis C as a traumatic experience, 60.7% had PTSD diagnosis. It were no associate with the disease severity (been eligible for transplant), however there was a significant association with diagnosis of PTSD (p = 0.003). Roughly 22% of the sample showed PTSD diagnosis. PTSD imposed a significant impairment in quality of life of individuals in seven of the eight domains in the bivariate and multivariate analysis. This difference remained significant after adjustment for covariates such as major depressive disorder comorbidity.
The results suggest high prevalence of PTSD diagnosis in VHC infected patients and it impose impairment in their quality of life.
The European Federation of Psychiatric Trainees (EFPT) brings together trainee organisations from across Europe. Founded in 1993, the Federation now has over thirty member nations. The EFPT conducts transnational research, orchestrates an exchange programme, promotes recruitment and helps establish new national trainee organisations.
To deliver a Europe-wide forum for psychiatric trainee organisations to collaborate effectively.
1) Evaluate 2014 Forum
2) Identify ways to improve
The fulcrum of the EFPT's activities is the annual Forum, which brings together representatives of member organisations for five days of work, fun and intercultural learning. In 2014 the Forum took place in London. A local organising committee was established to develop the programme. Funding was obtained from various sources, including the Royal College of Psychiatrists and Maudsley Charity. The programme included site visits, by country reports, working group sessions and finally the Annual General Meeting. A survey was sent to all delegates to evaluate the Forum.
85% of delegates who responded rated the Forum very good or excellent. 70% said that the inspiration to improve training in their own countries was very good or excellent. Free-form responses identified friendly interactions with colleagues from different countries, international networking and the scientific content as highlights. Suggested improvements included writing up country reports and providing a toolkit to prepare potential delegates.
Discussion and Conclusions
The EFPT provides a mechanism for communication between national trainee organisations. Trainees highly value the opportunity afforded by the annual Forum to network with colleagues in an inspiring atmosphere of mutual collaboration.
The EFPT (European Federation of Psychiatric Trainees) is the first and only Federation of medical trainee associations, to our knowledge.
It is composed of 38 member associations from 35 countries across Europe. With 22 years of experience it is well placed to comment on training issues and of those transversal to a large number of countries, such as mobility and its impact on healthcare.
One of EFPT's current main activities is the Exchange Programme which is trainee-led and was created in order to facilitate mobility during training. For over 10 year trainees from Europe have identified mobility as need in training, acknowledged in EFPT statements. But is was only in 2011 that the Programme was established with the objective to provide trainees with opportunities to:
- Promote awareness of intercultural aspects of Psychiatry
- Engage in clinical, and/or research, and/or teaching activities
- To become acquainted with different mental health systems
- To gain experience of different illness manifestations and treatment options
- To experience a different training programme
- To socialise with peer group, promote networking and discuss coping strategies regarding work life balance
There are 11 countries offering vacancies (Fig. 1). To date, 44 exchange placements were completed and by December it is expected there will be 61 (Fig. 2). Feedback has been overly positive.
Training is the core of excellence in healthcare. By equipping trainees with additional skills through mobility during training, we believe we are contributing to improving mental healthcare globally.
Fatigue is an important clinical finding in Hepatitis Virus Chronic Infection. However, the absence of scales to measure fatigue, translated and validated for Brazilian Portuguese, prevents access to information essential to clarify specific clinical conditions in this population.
To determine the psychometric properties of the Fatigue Impact Scale for Daily Use (D-FIS), in Brazilian Portuguese, in patients with hepatitis C virus (HCV) and hepatitis B virus (HBV) chronic infection.
In this cross-sectional study, the authors evaluated the D-FIS in 101 outpatients, followed at the reference hospital.
Relevant psychometric D-FIS results were: floor effect proved to be 1%; skewness was 0.46; item homogeneity was 0.59 and SEM (SD = 8.51) was 2.4. The Cronbach's alpha was 0.920 and item-total correlation yielded coefficients ranging from 0.65 (item 1) to 0.85 (item 3). In a linear regression model, fatigue and depression influenced the self-report quality of life.
This study concludes that the Fatigue Scale for Daily use in Brazilian Portuguese can be considered as a useful tool to verify the presence of fatigue in patients with hepatitis viruses B and C.
Morbid obesity is a serious public health problem due to its increasing prevalence, increased morbidity and mortality and medical and psychological consequence. Obesity has a multifactorial etiology that includes genetic, environmental, dietary, cultural and psychosocial factors.
The surgical treatment of obesity has been consistently shown to be effective in long-term marked weight loss and in bringing significant improvement to medical comorbidities. Surgery is indicated in patients with BMI greater than 35 kg/m2 with severe obesity-related comorbidity and for those with BMI greater than 40 kg/m2 with or without comorbidity. Surgery candidates should be selected and evaluated in order to achieve optimal outcomes.
Psychological factors are thought to play an important role for maintaining the surgical weight loss. The findings suggest that pre-surgical cognitive function, personality, state of mental health, psychological variables and binge eating may predict post-surgical weight loss to the extent that these factors influence post-operative eating behaviour.
The high prevalence of psychiatric disorders in surgery candidates is gaining more attention than before. Studies show that around 40% of all bariatric surgery patients have at least one psychiatric diagnosis. Depressive, anxiety, and binge eating disorders are the most common diagnoses and should be treated before surgery. The most common psychiatric conditions contraindicated to surgery are active psychosis, current substance abuse, heavy drinking, and multiple suicide attempts or a suicide attempt within the previous year.
We made a review of literature on psychological predictors of surgical weight loss in order to clarify the role of pre-surgical psychiatric evaluation.
E-learning may be a cost-efficient alternative or addition to traditional continuous medical education (CME) face-to-face courses. Even though some data are available regarding views on e-learning of general medicine physicians, preferences of psychiatrists have not been systematically assessed as yet.
To assess early career psychiatrists' (ECPs) preferences on e-learning.
To explore: 1) What do early career psychiatrists want to learn via e-learning? 2) How should e-learning be provided?
Online focus groups were conducted via skype. Participants were purposively sampled for professional qualification (trainees/newly-qualified psychiatrists) and recruited in 14 European countries. Qualitative analysis of the data is in progress. Preliminary findings are presented.
Four focus groups with in total 20 early career psychiatrists from different countries were conducted. The number of participants to focus groups varied from four to seven.
ECPs would use e-learning to learn about topics not normally thaught during standard psychiatric training, and to have contact with experts in the field. E-learning courses on general basic knowledge (psychotherapy theories, psycho-pharmacology) need to be related to clinical practice.
ECPs suggested that e-learning courses should be interactive, user-friendly and accredited by national authorities. Cost of e-learning courses and lack of awareness of e-learning opportunities are significant barriers to access, particularly for trainees.
Access of ECPs to e-learning may be increased by offering information on courses and affordable fees. Content-wise, e-learning should provide specialist knowledge or training in generic skills closely related to practice. E-learning courses should be delivered by renowned international experts.
This study investigates the factors associated with the impairment of awareness in mild dementia.
Using a longitudinal design, 69 people with mild Alzheimer's disease (AD), and their family caregivers were interviewed and reassessed after one year. The dyads completed the Assessment Scale of Psychosocial Impact of the Diagnosis of Dementia (ASPIDD), the Quality of Life in Alzheimer's Disease Scale (QoL-AD), the Mini-Mental State Examination (MMSE), the Clinical Dementia Rating (CDR) scale, the Cornell Scale for Depression in Dementia (CSDD), the Pfeffer Functional Activities Questionnaire (PFAQ), the Neuropsychiatric Inventory (NPI), and the Zarit Burden Interview (ZBI). Univariate and ordinal regression analyses were conducted to examine the contribution of the various factors.
The level of awareness of disease presented a significant difference (p<0.001) between baseline and after one year. After one year, there was no change in the level of awareness of disease in 61.8%, whereas 25.4% worsened. However, the level of awareness improved in 12.3%. At baseline, ordinal regression showed that impaired awareness was associated with cognitive function (p<0.05) and ADL (p<0.001). After one year, the predictors of impaired awareness were ADL (p<0.001), low levels of PwD QoL-AD reported by caregivers (p<0.05) and higher levels of caregivers’ formal education (p<0.05).
At least in the earlier stages of dementia, it should not be assumed that awareness will inevitably decrease as dementia progresses. The results confirmed that awareness and cognition are relatively independent, and showed that in mild PwD awareness is mainly manifested by poor recognition of changes in ADLs.
This study aimed to 1) determine changes over time in PwD and caregiver ratings of PwD QoL 2) to identify the factors associated with any changes in QoLratings and 3) to identify any discrepancies between PwD and caregiver ratings of PwD QoL.
Using a longitudinal design, we investigated QoL of 69 people with mild Alzheimer’s disease and their caregivers. We examined the influence of awareness of disease, cognitive status, mood, functionality, neuropsychiatric symptoms and burden. Univariate and multivariate regression analyses were conducted to examine the contribution of the various co-factors.
At baseline, we observed that caregivers’s QoL was associated to PwD QoL (t= 3.557, p< 0.001) and mood (t = −3.673, p < 0.001). PwD QoL was associated to caregivers’s QoL (t= 5.087, p<0.001). After one year, caregiver’s QoL was associated to awareness of disease (t=-2.196, p< 0.05) and PwD mood (t=-2.242, p< 0.05) and QoL (t=3.696, p<0.001). PwD QoL was associated to caregivers’ QoL (t=4.596, p<0.001).
In mild dementia, the cognitive impairment and functionality were not the primary factors that accounted in PwD and family caregivers’ ratings of QoL. Our findings suggested that there was an association between PwD and caregivers’ QoL over time. In addition, non-cognitive factors, such as awareness of disease and mood played an important role in PwD and caregivers’ QoL ratings.
This is the first European psychiatric exchange programme and it aims to promote an intercultural professional exchange and cooperation among psychiatric trainees across Europe, with a focus on individual experience.
To provide trainees with the opportunities to:
promote awareness of intercultural aspects of psychiatry
engage in clinical, and/or research, and/or teaching activities
become acquainted with different mental health systems
gain experience of different illness manifestations and treatment options
experience a different training programme
socialise with peer group, promote networking and discuss coping strategies regarding work life balance
The programme was developed by the exchange working group of the EFPT in 2011 and it offers 2-6 weeks in observational placements across Europe in diverse areas.
Feedback from pilot phase (January-July 2012) has shown excellent overall satisfaction of participants in the project. In the 2nd phase (August-December 2012) the programme has expanded offering more observational placements in 8 countries such as: Croatia, Denmark, France, Italy, Portugal, Slovenia, Spain and UK. In the 3rd phase (January-July 2013) it expanded further to include Ireland, Netherlands and Romania in a total of 11 hosting countries. Placements are offered in many subspecialties such as: psychotherapy, emergency psychiatry, child and adolescent psychiatry, eating disorders, family therapy, liaison psychiatry and psychosomatics, drug addictions, learning disabilities, forensic psychiatry and old age psychiatry.
We hope that the diversity of placements offered by this innovative programme will constitute a new approach to the improvement of psychiatric training and practice across Europe.
Insecure attachment and the inability to identify emotions are seen as possible explanations for dysfunction of the emotional system in borderline personality disorder. There is a strong association between Borderline personality disorder and insecure attachment, and the attachment types that are most characteristic of these subjects are unresolved, preoccupied, and fearful. Previous studies have demonstrated that insecure attachment patterns, a trait disposition toward negative affect and impulsivity are associated with borderline personality disorder features.
This review aims to identify the relationship between attachment pattern during childhood and the development of borderline personality disorder in adulthood.
The high prevalence and severity of insecure attachments found in these subjects support the central role of disturbed interpersonal relationships in clinical theories of Borderline Personality disorder.