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Exploiting powerful techniques from physics and mathematics, this book studies animal movement in ecology, with a focus on epidemic spread. Pulmonary syndrome is not only feared in epidemics of recent times, such as COVID-19, but is also characteristic of epidemics studied earlier such as Hantavirus. The Hantavirus is one of the book's central topics. Correlations between epidemic outbreaks and precipitation events like El Niño are analyzed and spatial reservoirs of infection in off-period of the epidemic, known as refugia, are studied. Predicted traveling waves of infection are successfully compared to field observations. Territoriality in scent-marking animals is presented, with parallels drawn with the theory of melting. The flocking and herding of birds and mammals are described in terms of collective excitations. For scientists interested in movement ecology and epidemic spread, this book provides effective solutions to long-standing problems.
The current study explored changes in trend of anaemia and BMI among currently pregnant nullipara adolescent women against socio-economic determinants in India from 2005 through 2015. The association between anaemia in currently pregnant nullipara adolescent women v. currently pregnant nullipara older women of reproductive age was also explored.
We used the 2005 and the 2015 nationally representative Indian Demographic and Health Surveys (DHS). The outcomes of interest, anaemia and BMI, were measured based on the DHS methodology following WHO standards and indicators. Place of residence, educational attainment and wealth quintiles were used as determinants in the analysis.
In total, 696 adolescent girls from the India 2005 DHS and 3041 adolescent girls from the India 2015 DHS.
The 10-year transition from 2005 to 2015 showed differences between the least and most wealthy sections of society, with heaviest gains in anaemia reduction over time among the latter (from 50·0 to < 40·0 %). The odds of anaemia were significantly higher among the adolescent population when compared with adult women both in 2005 and in 2015 (OR = 1·2).
Despite an overall improvement in the prevalence of both BMI < 18·5 and anaemia among adolescents nullipara in India, the adjusted risk of anaemia in the latter category was still significantly higher as compared with their adult counterparts. Since the inequalities evidenced during the first round of DHS remained unchanged in 2015, more investments in universal health care are needed in India.
Vitamin D deficiency (serum 25-hydroxyvitamin D (25(OH)D) concentration <50 nmol/l) is recognised as a public health problem globally. The present study details the prevalence and predictors of vitamin D deficiency in a nationally representative sample (n 3250) of Australian Aboriginal and Torres Strait Islander adults aged ≥18 years. We used data from the 2012–2013 Australian Aboriginal and Torres Strait Islander Health Survey (AATSIHS). Serum 25(OH)D concentrations were measured by liquid chromatography-tandem MS. Survey-weighted logistic regression models were used to determine the independent predictors of vitamin D deficiency. Approximately 27 % of adult AATSIHS participants were vitamin D deficient. Vitamin D deficiency was more prevalent in remote areas (39 %) than in non-remote areas (23 %). Independent predictors of vitamin D deficiency included assessment during winter (men, adjusted OR (aOR) 5·7; 95 % CI 2·2, 14·6; women, aOR 2·2; 95 % CI 1·3, 3·8) and spring (men, aOR 3·3; 95 % CI 1·4, 7·5; women, aOR 2·6; 95 % CI 1·5, 4·5) compared with summer, and obesity (men, aOR 2·6; 95 % CI 1·2, 5·4; women, aOR 4·3; 95 % CI 2·8, 6·8) compared with healthy weight. Statistically significant associations were evident for current smokers (men only, aOR 2·0; 95 % CI 1·2, 3·4), remote-dwelling women (aOR 2·0; 95 % CI 1·4, 2·9) and university-educated women (aOR 2·4; 95 % CI 1·2, 4·8). Given the high prevalence of vitamin D deficiency in this population, strategies to maintain adequate vitamin D status through safe sun exposure and dietary approaches are needed.
On coronavirus disease 2019 (COVID-19) wards, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleic acid was frequently detected on high-touch surfaces, floors, and socks inside patient rooms. Contamination of floors and shoes was common outside patient rooms on the COVID-19 wards but decreased after improvements in floor cleaning and disinfection were implemented.
In this study, we evaluated the efficacy, expressed as a mean weight decrease of the whole echinococcal cyst mass, of novel benzimidazole salt formulations in a murine Echinococcus granulosus infection model. BALB/c mice were intraperitoneally infected with protoscoleces of E. granulosus (genotype G1). At 9 months post-infection, treatment with albendazole (ABZ), ricobendazole (RBZ) salt formulations, and RBZ enantiomer salts (R)-(+)-RBZ-Na and (S)-(−)-RBZ-Na formulations were initiated. Drugs were orally applied by gavage at 10 mg kg−1 body weight per day during 30 days. Experimental treatments with benzimidazole sodium salts resulted in a significant reduction of the weight of cysts compared to conventional ABZ treatment, except for the (S)-(−)-RBZ-Na enantiomer formulation. Scanning electron microscopy and histological inspection revealed that treatments impacted not only the structural integrity of the parasite tissue in the germinal layer, but also induced alterations in the laminated layer. Overall, these results demonstrate the improved efficacy of benzimidazole salt formulations compared to conventional ABZ treatment in experimental murine cystic echinococcosis.
Mental health disorders and their treatments produce significant costs and benefits in both healthcare and non-healthcare sectors. The latter are often referred to as intersectoral costs and benefits (ICBs). Little is known about healthcare-related ICBs in the criminal justice sector and how to include these in health economics research.
The triple aim of this study is (i) to identify healthcare-related ICBs in the criminal justice sector, (ii) to validate the list of healthcare-related ICBs in the criminal justice sector on a European level by sector-specific experts, and (iii) to classify the identified ICBs.
A scientific literature search in PubMed and an additional grey literature search, carried out in six European countries, were used to retrieve ICBs. In order to validate the international applicability of the ICBs, a survey was conducted with an international group of experts from the criminal justice sector. The list of criminal justice ICBs was categorized according to the PECUNIA conceptual framework.
The full-text analysis of forty-five peer-reviewed journal articles and eleven grey literature sources resulted in a draft list of items. Input from the expert survey resulted in a final list of fourteen unique criminal justice ICBs, categorized according to the care atom.
This study laid further foundations for the inclusion of important societal costs of mental health-related interventions within the criminal justice sector. More research is needed to facilitate the further and increased inclusion of ICBs in health economics research.
The model of action phases makes a distinction between motivational (goal setting) and volitional (goal implementation) phases of goal pursuit. The model implies that changing the behavior of individuals who are in a pre-decisional action phase (i.e., have not crossed the “Rubicon” yet with respect to turning their many wishes into binding goals) needs a different approach than changing the behavior of people who are in a post-decisional phase (i.e., have crossed the Rubicon and need to implement their goals). The model is, therefore, also known as the “Rubicon” model. What exactly needs to be targeted to achieve behavior change in pre-decisional versus post-decisional individuals is addressed in the mindset theory of action phases, which explicates the Rubicon model in terms of the relevant psychological processes. It is argued that solving the tasks people face while still being pre-decisional requires different modes of thought (i.e., mindsets conceived of as a distinct assembly of activated cognitive procedures) than solving the tasks people face in post-decisional phases. These distinct features of pre-decisional (deliberative) versus post-decisional (implemental) mindsets as specified in the model need to be considered when trying to instigate behavior change. Furthermore, research on the implemental mindset has led to the discovery of a powerful self-regulation strategy promoting goal striving: the formation of implementation intentions. The chapter also outlines psychological mechanisms that underpin the facilitating effects of implementation intentions on behavior change and, when forming implementation intentions, are expected to help people to reach their goals.
Two types of mentalization-based treatment (MBT), day hospital MBT (MBT-DH) and intensive outpatient MBT (MBT-IOP), have been shown to be effective in treating patients with borderline personality disorder (BPD). This study evaluated trajectories of change in a multi-site trial of MBT-DH and MBT-IOP at 36 months after the start of treatment.
All 114 patients (MBT-DH n = 70, MBT-IOP n = 44) from the original multicentre trial were assessed at 24, 30 and 36 months after the start of treatment. The primary outcome was symptom severity measured with the Brief Symptom Inventory. Secondary outcome measures included borderline symptomatology, personality and interpersonal functioning, quality of life and self-harm. Data were analysed using multilevel modelling and the intention-to-treat principle.
Patients in both MBT-DH and MBT-IOP maintained the substantial improvements made during the intensive treatment phase and showed further gains during follow-up. Across both conditions, 83% of patients improved in terms of symptom severity, and 97% improved on borderline symptomatology. No significant differences were found between MBT-DH and MBT-IOP at 36 months after the start of treatment. However, trajectories of change were different. Whereas patients in MBT-DH showed greater improvement during the intensive treatment phase, patients in MBT-IOP showed greater continuing improvement during follow-up.
Patients in both conditions showed similar large improvements over the course of 36 months, despite large differences in treatment intensity. MBT-DH and MBT-IOP were associated with different trajectories of change. Cost-effectiveness considerations and predictors of differential treatment outcome may further inform optimal treatment selection.
To document the lived experience of Italian pediatric emergency physicians during the coronavirus disease 2019 (COVID-19) pandemic.
We developed a structured interview to collect the lived experience of the staff of the pediatric emergency department (PED) of a tertiary referral university hospital in Northern Italy. The open-ended questions were draft according to the suggestions of Canadian colleagues and administered by 1 interviewer, who was part of the PED staff, at the end of March 2020. All the PED staff was interviewed, on a voluntary basis, using purposive sampling.
Most respondents declared to be afraid of becoming infected and of infecting their families. The number of patients seen in the PED has decreased, and the cases tend to be more severe. A shift in the clinical approach to the ill child has occurred, the physical examination is problem-oriented, aiming to avoid un-necessary maneuvers and to minimize the number of practitioners involved. The most challenging aspects reported are: (1) performing a physical examination in personal protective equipment (PPE), (2) being updated with rapidly evolving guidelines, and (3) staying focused on the possible COVID-19 clinical presentation without failing in differential diagnosis.
During the COVID-19 pandemic, it seems that pediatric emergency physicians are radically changing their clinical practice, aiming at prioritizing essential interventions and maneuvers and self-protection.
Seismic-reflection surveys of the Isle Royale sub-basin, central Lake Superior, reveal two large end moraines and associated glacial sediments deposited during the last cycle of the Laurentide Ice Sheet in the basin. The Isle Royale moraines directly overlie bedrock and are cored with dense, acoustically massive till intercalated down-ice with acoustically stratified outwash. Till and outwash are overlain by glacial varves, a lower red unit and an upper gray unit.
The maximum extent of late Younger Dryas-age readvance into the western Lake Superior basin is uncertain, but it was probably controlled by both ice dynamics and climate. Our data indicate that during retreat from the maximum, the ice paused just long enough to construct the outer of the two moraines, >100 m high, and then retreated to the inner moraine, during which time most of the lower glacial-lacustrine sequence (red varves) was deposited. Retreat from the inner moraine coincided with a marked flux of icebergs at the calving margin and a change to gray varves. Rapid retreat may be related to both an influx of meltwater from Glacial Lake Agassiz about 10,500 cal yr BP and retreat of the calving margin down an adverse slope into the Isle Royale sub-basin.
For patients with methicillin-resistant Staphylococcus aureus (MRSA) colonization, a traditional fist-bump greeting did not significantly reduce MRSA transfer in comparison to a handshake. However, transfer was reduced with a modified fist bump that minimized the surface area of contact and when hand hygiene was performed before the handshake.
Classical stewardship efforts have targeted immunocompetent patients; however, appropriate use of antimicrobials in the immunocompromised host has become a target of interest. Cytomegalovirus (CMV) infection is one of the most common and significant complications after solid-organ transplant (SOT). The treatment of CMV requires a dual approach of antiviral drug therapy and reduction of immunosuppression for optimal outcomes. This dual approach to CMV management increases complexity and requires individualization of therapy to balance antiviral efficacy with the risk of allograft rejection. In this review, we focus on the development and implementation of CMV stewardship initiatives, as a component of antimicrobial stewardship in the immunocompromised host, to optimize the management of prevention and treatment of CMV in SOT recipients. These initiatives have the potential not only to improve judicious use of antivirals and prevent resistance but also to improve patient and graft survival given the interconnection between CMV infection and allograft function.
This article captures the webinar narrative on March 31, 2020 of four expert panelists addressing three questions on the current coronavirus disease 2019 (COVID-19) pandemic. Each panelist was selected for their unique personal expertise, ranging from front-line emergency physicians from multiple countries, an international media personality, former director of the US Strategic National Stockpile, and one of the foremost international experts in disaster medicine and public policy. The forum was moderated by one of the most widely recognized disaster medical experts in the world. The four panelists were asked three questions regarding the current pandemic as follows:
1. What do you see as a particular issue of concern during the current pandemic?
2. What do you see as a particular strength during the current pandemic?
3. If you could change one thing about the way that the pandemic response is occurring, what would you change?
Depressed patients show a disturbed hypothalamic-pituitary-adrenal (HPA) axis regulation, resulting in increased cortisol levels, inadequate cortisol suppression following a low dose of dexamethasone, increased concentrations of corticotropin releasing hormone (CRH) in the cerebrospinal fluid, and a blunted adrenocorticotropic hormone (ACTH) response following CRH administration. Treatment with antidepressants, but seemingly also cognitive behavioral therapy (CBT), is associated with an improvement of a disturbed HPA-axis regulation, which can be most sensitively evaluated with the combined dexamethasone (dex)/CRH test. Favorable response to antidepressant treatment can be predicted at an early stage by determining the degree of normalization of HPA-axis function under treatment in a second dex/CRH test.
We report about the predictive validity of HPA-axis normalization on the favorable response of CBT in medicated depressed patients.
Medicated depressed patients receiving CBT at the Max-Planck-Institute of Psychiatry in Munich are studied using the State-Trait-Angstinventar (STAI), Beck Depression Inventory (BDI), Volitional-Components-Questionnaire (VCQ-3), Emotion-Regulation Questionnaire (EPQ) and the Self-Control and Self-Management Scale (SCMS). Neuroendocrine parameters including measures of HPA-axis regulation are measured before and after therapy via dex/CRH test.
Up to the present moment data for N=38 depressed patients have been collected (N=21 male, 25-78 years; N=17 female, 21-80 years). The mean level of depression and anxiety showed a significant decrease between pre- and post-treatment measurement. Measures of perceived self-regulation and self-estimation increased and measures of perceived self-inhibition and inhibition of will decreased.
The expected changes in depression, anxiety and self-regulation after treatment with antidepressants and CBT were observed. Endocrine data are currently under analysis.
Depression has frequently been reported to be associated with other physical diseases and changes in the cytokine system. We aimed to investigate associations between a medical history of depression, its comorbidities and cytokine plasma levels in the Bavarian Nutrition Survey II (BVS II) study sample and in patients suffering from an acute depressive episode.
The BVS II is a representative study of the Bavarian population aged 13–80 years. The disease history of its 1050 participants was assessed through face-to-face interviews. A sub-sample of 568 subjects and 62 additional acutely depressed inpatients of the Max Planck Institute of Psychiatry participated in anthropometric measurements and blood sampling. Tumor necrosis factor-α (TNF-α) and soluble TNF receptor (sTNF-R) p55 and sTNF-R p75 plasma levels were measured using enzyme-linked immunosorbent assays.
A history of depression was associated with a higher incidence of high blood pressure, peptic ulcer, dyslipoproteinemia, osteoporosis, allergic skin rash, atopic eczema and thyroid disease.
Within the BVS II sample, participants with a history of depression differed from subjects who had never had depression with regard to sTNF-R p55 and sTNF-R p75 levels even when controlling for age, BMI and smoking status. Acutely depressed inpatients showed even higher levels of sTNF-R p55 and sTNF-R p75 than subjects in the normal population. TNF-α levels were also significantly elevated in acutely depressed patients.
These results confirm earlier studies regarding the comorbidities of depression and support the hypothesis that activation of the TNF-α system may contribute to the development of a depressive disorder.
Schizophrenics differ in their outcome mainly because different response and side effects to treatment, and clinicians do not have good instruments to choose the best antipsychotic (AP) for each individual. Weight gain is a frequently observed side effect with many AP treatments and seems to be underreported and under-recognized in many patients.
The potential effect of the Trp64Arg variant in beta3 adrenergic receptor gene on weight gain and obesity was investigated applying meta-analytic techniques, combining all published data while restricting our analysis to studies investigating the Trp64Arg in antipsychotic-induced weight gain and obesity. We also investigated whether ancestry (Caucasian versus African-American) and clinical factors moderated any association.
We found no evidence for association of the Arg64 allele with weight gain and obesity (z= 0.49 p = 0.626) but without significant between studies heterogeneity (chi-squared = 0.17 (d.f. = 1) p = 0.678).
Our meta-analysis does not provide support for the association of Trp64Arg in weight gain but indicates that firmly establishing the role of pharmacogenetics in clinical psychiatry requires much larger sample sizes that have been hitherto reported. On the other hand, the number of the studies employing psychotic patients is too small compared to the number of studies that have investigated this polymorphism in obesity.
Antipsychotic therapy is the cornerstone of the treatment of schizophrenia and other psychoses. Although clinical guidelines tend to recommend the use of antipsychotics in monotherapy, combination of two or more antipsychotics (that is, polytherapy) is a common habit in clinical practice.
To assess differences in antipsychotic combination profile between patients with schizophrenia and patients with other psychoses.
A total of 241 patients (40.2% females, mean age 39.7+/−13.0 years) consecutively admitted during 2009 to a psychiatric inpatient ward with diagnosis of schizophrenia and other psychoses were assessed.
145 (60.2%) patients were diagnosed with schizophrenia while 96 patients (39.8%) were diagnosed with other psychoses (schizoaffective disorder n = 35, delusional disorder n = 8, schizophreniform disorder n = 8, brief psychotic disorder n = 13, psychotic disorder not otherwise specified n = 27, and other psychoses n = 5). Out of the total sample, polytherapy was used in 150 (62.2%) patients. A total of 100 (69.0%) patients with schizophrenia were on polytherapy, compared to 52.1% of those with other psychoses (p = 0.008). After controlling for age and gender, the association between a diagnosis of schizophrenia and being in polytherapy remained significant (p = 0.046).
Patients diagnosed with schizophrenia are more prone to be in polytherapy than those with other psychoses.
Schizophrenia requires new antipsychotic that can relieve suffering and improve the prognosis of schizophrenic patients.
To study efficacy and safety of Ariprazole in patients with acute schizophrenia.
We studied 16 patients with acute episode of schizophrenia, 6 were first episodes and 10 acute reactivations. We used ARIPRAZOLE for 6 months to evaluate its effectiveness and tolerance. All patients were hospitalised and received Ariprazole in progressively larger doses, beginning with 10 mg/day and increasing to 30 mg at 10 days. Evaluation measures were PANSS, initial and 6 months, and CGI, initial (severity) and 6 months (evolution-improvement). Side effects were evaluated.
Mean PANSS in first episodes: 85 at onset and 36 at 6 months; in reactivations: 75 at onset and 32 at 6 months. ICG showed a mean severity of 4.6 in the first episodes and 4.2 in reactivations; at 6 months the mean improvement was 2.3 in the first episodes and 2.3 in reactivations. The transitory side effects were found, which did not require discontinuation of the drug: insomnia in 15% of first episodes and in 22% of reactivations; nausea in 16% vs. 22%; a certain disinhibition (not manic) in 83% of first episodes and in 77% of reactivations.
ARIPRAZOLE is an effective antipsychotic in the first and successive episodes of schizophrenia. It improved insight and the subjective feeling of well-being and made the psychotic condition easier to bear. This definitely made it a drug of first choice for acute or reactivated schizophrenia.