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Major depressive disorder (MDD) is a leading cause of morbidity and mortality. Shortfalls in treatment quantity and quality are well-established, but the specific gaps in pharmacotherapy and psychotherapy are poorly understood. This paper analyzes the gap in treatment coverage for MDD and identifies critical bottlenecks.
Seventeen surveys were conducted across 15 countries by the World Health Organization-World Mental Health Surveys Initiative. Of 35 012 respondents, 3341 met DSM-IV criteria for 12-month MDD. The following components of effective treatment coverage were analyzed: (a) any mental health service utilization; (b) adequate pharmacotherapy; (c) adequate psychotherapy; and (d) adequate severity-specific combination of both.
MDD prevalence was 4.8% (s.e., 0.2). A total of 41.8% (s.e., 1.1) received any mental health services, 23.2% (s.e., 1.5) of which was deemed effective. This 90% gap in effective treatment is due to lack of utilization (58%) and inadequate quality or adherence (32%). Critical bottlenecks are underutilization of psychotherapy (26 percentage-points reduction in coverage), underutilization of psychopharmacology (13-point reduction), inadequate physician monitoring (13-point reduction), and inadequate drug-type (10-point reduction). High-income countries double low-income countries in any mental health service utilization, adequate pharmacotherapy, adequate psychotherapy, and adequate combination of both. Severe cases are more likely than mild-moderate cases to receive either adequate pharmacotherapy or psychotherapy, but less likely to receive an adequate combination.
Decision-makers need to increase the utilization and quality of pharmacotherapy and psychotherapy. Innovations such as telehealth for training and supervision plus non-specialist or community resources to deliver pharmacotherapy and psychotherapy could address these bottlenecks.
The Adult Attachment Interview (AAI) is a widely used measure in developmental science that assesses adults’ current states of mind regarding early attachment-related experiences with their primary caregivers. The standard system for coding the AAI recommends classifying individuals categorically as having an autonomous, dismissing, preoccupied, or unresolved attachment state of mind. However, previous factor and taxometric analyses suggest that: (a) adults’ attachment states of mind are captured by two weakly correlated factors reflecting adults’ dismissing and preoccupied states of mind and (b) individual differences on these factors are continuously rather than categorically distributed. The current study revisited these suggestions about the latent structure of AAI scales by leveraging individual participant data from 40 studies (N = 3,218), with a particular focus on the controversial observation from prior factor analytic work that indicators of preoccupied states of mind and indicators of unresolved states of mind about loss and trauma loaded on a common factor. Confirmatory factor analyses indicated that: (a) a 2-factor model with weakly correlated dismissing and preoccupied factors and (b) a 3-factor model that further distinguished unresolved from preoccupied states of mind were both compatible with the data. The preoccupied and unresolved factors in the 3-factor model were highly correlated. Taxometric analyses suggested that individual differences in dismissing, preoccupied, and unresolved states of mind were more consistent with a continuous than a categorical model. The importance of additional tests of predictive validity of the various models is emphasized.
Intermittent food restriction (IFR) is used mainly for weight loss, however, its effects on adipose tissue are not known when alternating with obesogenic diet. To demonstrate its effects on morphological dynamics of fat deposits, female Wistar were distributed into the groups: standard control (ST-C), with commercial diet; DIO control (DIO-C), with a diet that induces obesity (DIO) during the first and last 15 days, replaced by a standard diet for 30 intermediate days; standard restricted (ST-R), with standard diet during the first and last 15 days, with six cycles of IFR at 50% of ST-C; and DIO restricted (DIO-R), in DIO during the first and last 15 days, with six cycles of IFR at 50% of DIO-C. At 105 days of life, white adipose tissue (WAT) and brown adipose tissue (BAT) deposits were collected, weighed and histology performed. IFR groups showed higher food intake (DIO-R: 670.8±31.86kcal/g vs DIO-C: 606.5±26.23kcal/g, p<0.0001), energy efficiency (DIO-R: 3.80±0.15 g/kcal vs DIO-C: 3.26±0.17 g/kcal, p<0.0001), WAT (DIO-R: 5.65±0.30g/100g, ST-R: 3.64±0.23g/100g vs. DIO-C: 4.56±0.30g/100g, ST-C: 2.87±0.31g/100g, p<0.0001) and BAT (DIO-R: 0.13±0.004g/100g vs DIO-C: 0.13±0.005g/100g, p<0.0001) than its respective controls. Furthermore, IFR groups presented hypertrophy of WAT and BAT, as well as fibrosis in BAT. Thus, IFR can establish prospective resistance to weight loss by favoring changes in adipose tissue morphology, increased energy intake, and efficiency. Finally, the DIO diet before and after IFR aggravates the damages caused by the restriction.
Denture-related stomatitis caused by Candida spp. affects elderly individuals using partial/total prosthesis, provoking several discomforts including burning sensation and altered taste. Herein, we have studied 52 denture-wearing individuals (>60 years-old), attended at the dentistry clinic of UNIVALE, aiming to isolate Candida spp. directly from the stomatitis lesions and to evaluate their potential to produce virulence attributes. A low prevalence of denture-related stomatitis was reported in these patients (4/52; 7.7%). Candida albicans was isolated in the 4 selected patients, with the ability to form biofilm over a polystyrene surface and to produce aspartic protease, esterase and hemolysin. However, neither phospholipase nor caseinase activities were detected. Planktonic-growing yeasts were susceptible to amphotericin B and caspofungin, while the susceptibility to azoles (fluconazol, itraconazole and voriconazole) varied depending on either the isolate or antifungal. Relevantly, biofilm-forming C. albicans cells exhibited resistance to all studied antifungals. So, new effective drugs against resistant C. albicans isolates causing denture-related stomatitis are urgently required.
An adequate intake of branched-chain amino acids (BCAAs) is required for protein synthesis and metabolic functions, including insulin metabolism. Emerging studies found positive associations between BCAAs and the risk of various diseases sharing etiological aspects with colorectal cancer (CRC), including type 2 diabetes, obesity, and pancreatic cancer.
We investigated the relation between dietary BCAAs and CRC using data from a multicentric Italian case-control study, including 1953 cases of CRC (of these, 442 of sigmoid colon) and 4154 hospital controls with acute, non-neoplastic diseases. A validated food-frequency questionnaire was used to estimate the participants’ usual diet and to assess dietary intakes of various nutrients, including energy, BCAAs and calcium. Odds ratio (ORs) and corresponding confidence intervals (CI) were computed by multiple logistic regression models adjusted for age, sex and other confounding factors, including total energy intake.
BCAA intake was inversely related to CRC risk (OR for the highest versus the lowest quintile, 0.73; 95% CI, 0.55-0.97), but the association was attenuated after adjustment for calcium intake (OR, 0.90; 95% CI, 0.65-1.25). A linear inverse association with sigmoid colon cancer risk remained also after adjustment for other dietary factors, including calcium intake (OR, 0.49; 95% CI, 0.27-0.87).
This study provides supporting evidence that higher levels of dietary BCAA intake are not associated with an increase of CRC risk, but confirms that they may be related to a reduced risk of sigmoid colon cancer.
One of the main health-related worries for older adults is becoming dependent. Even healthy older adults may worry about becoming dependent, generating guilt feelings due to the anticipation of future needs that others must solve. The guilt associated with self-perception as a burden has not been studied in older adults, and there is no instrument available to measure these feelings.
To adapt the Self-Perceived Burden Scale (SPBS; Cousineau et al., 2003) for the assessment of feelings of guilt for perceiving oneself as a burden for the family in older adults without explicit functional or cognitive impairment.
Participants were 298 older adults living independently in the community. Participants completed the assessment protocol, which included measures of guilt associated with self-perception as a burden, depressive and anxious symptomatology, self-perceived burden, and sociodemographic information.
Results from exploratory, parallel and confirmatory factor analyses suggest that the scale, named Guilt associated with Self-Perception as a Burden Scale (G-SPBS), has a unidimensional structure, explaining 57.04% of the variance of guilt. Good reliability was found (Cronbach’s alpha = .94). The results revealed significant (p < .01) positive associations with depressive and anxious symptomatology.
These findings suggest that the G-SPBS shows good psychometric properties which endorse its use with healthy community older adults. Also, guilt associated with perceiving oneself as a burden seems to be a relevant variable that can contribute to improving our understanding of psychological distress in older adults.
Different countries have adopted strategies for the early detection of SARS-CoV-2 since the declaration of community transmission by the World Health Organization (WHO) and timely diagnosis has been considered one of the major obstacles for surveillance and healthcare. Here, we report the increase of the number of laboratories to COVID-19 diagnosis in Brazil. Our results demonstrate an increase and decentralisation of certified laboratories, which does not match the much higher increase in the number of COVID-19 cases. Also, it becomes clear that laboratories are irregularly distributed over the country, with a concentration in the most developed state, São Paulo.
The supplementation of nitrogen can be increased by the use of nitrogen-fixing, diazotrophic bacteria such as Azospirillum brasilense. These bacteria can act to promote plant growth in various plant species, including corn (Zea mays L.). However, there is a need to understand the behavior of these bacteria in different agricultural systems. The objective of this study was to evaluate the effect on the growth and yield of corn inoculated with A. brasilense, and to identify the type of farming system which benefited most from the use of A. brasilense-based inoculants. The experiment conducted over two corn crop seasons was arranged in a 6 × 2 factorial scheme, consisting of six farming systems and the presence or absence of inoculation with the bacteria A. brasilense. The farming systems were derived from a long-term experiment with different fertilization systems that has been conducted since 1984. Among these systems, there were three conventional systems (CNT1: conventional no-till without fertilizer; CNT2: conventional no-till with 150 kg ha−1 of mineral fertilizer + 50 kg ha−1 of urea; CNT3: conventional no-till with 300 kg ha−1 of mineral fertilizer + 100 kg ha−1 of urea), and three organic systems (ONT1: organic no-till with 40 m3 ha−1 of organic compost; ONT2: organic no-till with 20 m3 ha−1 of organic compost; ONT3: organic no-till with 40 m3 ha−1 of organic compost and intercropped with Canavalia ensiformis). Although the Azospirillum population in the soil before planting was the same for all six systems, the count in the rhizospheric soil was higher in the organic systems, and there was no increase in that count due to inoculation. In this study, the only difference observed was within the CNT1 system, between the inoculated (CNT1-I) and uninoculated (CNT1-NI) treatments. In this system, inoculation resulted in an increase in plant height, in addition to higher concentrations of foliar N and P, and a higher plant survival rate, which culminated in higher yield. Corn inoculated with A. brasilense in the CNT1-I treatment showed a significant increase in yield—2839 kg ha−1 higher than that recorded for CNT1-NI. This study shows that, in the conventional low input treatment CNT1-I, inoculation with A. brasilense resulted in an increase in corn growth and yield.
Housekeeping genes (HKG) are paramount for accurate gene expression analysis during preimplantation development. Markedly, quantitative reverse transcription polymerase chain reaction (RT-qPCR) in ovine embryos currently lacks HKGs. Therefore, we tested 11 HKGs for RT-qPCR normalization during ovine parthenogenetic preimplantation development. Seven HKGs reached the qPCR efficiency threshold (97.20–105.96%), with correlation coefficients ranging from −0.922 to −0.998 and slopes from −3.22 to −3.59. GeNorm ranked glyceraldehyde 3-phosphate dehydrogenase (GAPDH) and TATA-binding protein (TBP) as the best HKG pair, while H3 histone, family 3A (H3F3A) was the third HKG. Relative gene expression was measured for zinc finger protein X-linked (ZFX) and developmental pluripotency-associated 3 (DPPA3) transcripts during ovine parthenogenetic preimplantation development. ZFX did not show any transcript abundance fluctuation among oocytes, cleavage-stage embryos, and morulae. DPPA3 transcript abundance was also similar among all developmental stages, therefore suggesting that it may not display a maternal gene expression profile. In silico analysis of ovine DPPA3 mRNA and protein showed high conservation to bovine orthologues. However, DPPA3 orthologues differed in regulatory motifs. In conclusion, GAPDH, TBP and H3F3A are stable HKGs in ovine parthenogenetic embryos and allow accurate RT-qPCR-based gene expression analysis.
To identify sex-specific cut-off points for waist circumference (WC) in the definition of metabolic syndrome (MetS) for the Chilean adult population.
MetS was defined as the presence of at least two out of four of the following criteria: TAG ≥1·7 mmol/l; HDL-cholesterol: <1·3 mmol/l in women and <1·0 mmol/l in men; systolic blood pressure ≥130 mmHg and/or diastolic blood pressure ≥85 mmHg; and fasting glucose ≥ 5·6 mmol/l or current treatment for diabetes. The receiver operating characteristics curve and the AUC were computed to derive the specificity and sensitivity using bootstrapping (10 000 iterations restricted to have at least between 40 and 60 % of the original population). The optimal cut-off point for the Chilean population was computed by sex.
A representative sample of the Chilean population aged ≥15 years.
8182 participants (60 % women) from the three available Chilean National Health Surveys conducted in 2003, 2009–2010 and 2016–2017.
WC had a good predictive ability for MetS (AUC for men 0·74 (95 % CI 0·72, 0·76); AUC for women 0·71 (95 % CI 0·68, 0·73)). The optimal cut-off points for WC, in the definition of MetS, were 92·3 cm (95 % CI 90·5, 94·4) and 87·6 cm (95 % CI 85·8, 92·1) for men and women, respectively.
The mentioned cut-off points should be used for WC in the definition of MetS in Chile. As a result, the current recommendation (WHO/International Diabetes Federation) for WC, in the identification of MetS, is not supported by these findings in a representative sample of the Chilean adult population.
Four new actinospore types belonging to the sphaeractinomyxon collective group (Cnidaria, Myxosporea) are described from the coelomic cavity of a marine Baltidrilus sp. (Oligochaeta, Naididae) inhabiting a northern Portuguese estuary. Host identification supports the usage of marine oligochaetes, namely of the family Naididae Ehrenberg, 1828, as definitive hosts for myxosporeans inhabiting estuarine/marine environments. The absence of mixed infections in the host specimens analysed is suggested to reflect the influence of host-, parasite- and environmental-related factors regulating myxosporean–annelid interactions. Molecular analyses matched the SSU rDNA sequences of three of the four new types with those of mugiliform-infecting Myxobolus spp., namely Myxobolus mugiliensis and a Myxobolus sp. from flathead grey mullet Mugil cephalus, and Myxobolus labrosus from thicklip grey mullet Chelon labrosus. These results directly link, for the first time, the sphaeractinomyxon collective group to a myxospore counterpart, further confirming their previously hypothesized specific involvement in the life cycle of myxobolids that infect mullets. Acknowledging this life cycle relationship, the functionality of the sphaeractinomyxon morphotype is suggested to have been decisive for the evolutionary hyperdiversification of the genus Myxobolus in mullets. Unlike other actinospore morphotypes, sphaeractinomyxon lack valvular processes, which implies a limited capability for buoyancy. Considering the benthic-feeding nature of mullets, this feature is most likely crucial in promoting successful transmission to the vertebrate host.
Brazilians comprise a rapidly growing immigrant Latino group in the USA, yet little research has focused on health issues affecting Brazilian children in immigrant families. As increasing evidence is documenting fathers’ influential role in their children’s eating behaviours and ultimately weight status, the current study sought to explore the Brazilian immigrant fathers’ perspectives and practices related to child’s feeding practices and their preschool-aged children’s eating.
Qualitative study using in-depth, semi-structured interviews. Interviews were conducted in Portuguese by native Brazilian research staff using a semi-structured interview guide. Interviews were audio-recorded and transcribed verbatim. Transcripts were analysed thematically using a hybrid approach that incorporated deductive and inductive analytical approaches.
Twenty-one Brazilian immigrant fathers who had at least one child aged 2–5 years.
Results revealed fathers’ awareness of the importance of healthy eating for their children, their influence as role models and their involvement in feeding routines of their preschool-aged children. Moreover, fathers were receptive to participating in family interventions to promote their children’s healthy eating. Nearly all fathers reported wanting to learn more and to do ‘what’s right’ for their children.
The current study provides new information about Brazilian immigrant fathers’ views about factors influencing their children’s healthy eating behaviours and paternal feeding practices. Future research should quantify fathers’ feeding styles and practices and solicit fathers’ input in the design of culturally appropriate family interventions targeting the home environment of preschool-aged children of Brazilian immigrant families.
Glacial extent and mass balance are sensitive climate proxies providing solid information on past climatic conditions. However, series of annual mass-balance measurements of more than 60 years are scarce. To our knowledge, this is the first time the latewood density data (MXD) of the Swiss stone pine (Pinus cembra L.) have been used to reconstruct the summer mass balance (Bs) of an Alpine glacier. The MXD-based Bs well correlates with a Bs reconstruction based on the May to September temperature. Winter precipitation has been used as an independent proxy to infer the winter mass balance and to obtain an annual mass-balance (Bn) estimate dating back to the glaciological year 1811/12. The reconstructed MXD/precipitation-based Bn well correlates with the data both of the Careser and of other Alpine glaciers measured by the glaciological method. A number of critical issues should be considered in both proxies, including non-linear response of glacial mass balance to temperature, bedrock topography, ice thinning and fragmentation, MXD acquisition and standardization methods, and finally the ‘divergence problem’ responsible for the recently reduced sensitivity of the dendrochronological data. Nevertheless, our results highlight the possibility of performing MXD-based dendroglaciological reconstructions using this stable and reliable proxy.
The current coronavirus disease (COVID-19) has a great impact worldwide. Healthcare workers play an essential role and are one of the most exposed groups. Information about the psychosocial impact on healthcare workers is limited.
3109 healthcare workers completed a national, internet-based, cross-sectional 45-item survey between 9 and 19 April 2020. The objective is to assess the psychological impact of the COVID-19 pandemic in Spanish healthcare workers. A Psychological Stress and Adaptation at work Score (PSAS) was defined combining four modified versions of validated psychological assessment tests (A) Healthcare Stressful Test, (B) Coping Strategies Inventory, (C) Font-Roja Questionnaire and (D) Trait Meta-Mood Scale.
The highest psychosocial impact was perceived in Respiratory Medicine, the mean (S.D.) PSAS was 48.3 (13.6) and Geriatrics 47.6 (16.4). Higher distress levels were found in the geographical areas with the highest incidence of COVID-19 (>245.5 cases per 100 000 people), PSAS 46.8 (15.2); p < 0.001. The least stress respondents were asymptomatic workers PSAS, 41.3 (15.4); p < 0.001, as well as those above 60 years old, PSAS, 37.6 (16); p < 0.001. Workers who needed psychological therapy and did not receive it, were more stressed PSAS 52.5 (13.6) than those who did not need it PSAS 39.7 (13.9); p < 0.001.
The psychological impact in healthcare workers in Spain during COVID-19 emergency has been studied. The stress perceived is parallel to the number of cases per 100 000 people. Psychotherapy could have a major role to mitigate the experimented stress level.
Constitutive heterochromatin typically exhibits low gene density and is commonly found adjacent or close to the nuclear periphery, in contrast to transcriptionally active genes concentrated in the innermost nuclear region. In Triatoma infestans cells, conspicuous constitutive heterochromatin forms deeply stained structures named chromocenters. However, to the best of our knowledge, no information exists regarding whether these chromocenters acquire a precise topology in the cell nuclei or whether their 18S rDNA, which is important for ribosome function, faces the nuclear center preferentially. In this work, the spatial distribution of fluorescent Feulgen-stained chromocenters and the distribution of their 18S rDNA was analyzed in Malpighian tubule cells of T. infestans using confocal microscopy. The chromocenters were shown to be spatially positioned relatively close to the nuclear periphery, though not adjacent to it. The variable distance between the chromocenters and the nuclear periphery suggests mobility of these bodies within the cell nuclei. The distribution of 18S rDNA at the edge of the chromocenters was not found to face the nuclear interior exclusively. Because the genome regions containing 18S rDNA in the chromocenters also face the nuclear periphery, the proximity of the chromocenters to this nuclear region is not assumed to be associated with overall gene silencing.
Greater levels of insight may be linked with depressive symptoms among patients with schizophrenia, however, it would be useful to characterize this association at symptom-level, in order to inform research on interventions.
Data on depressive symptoms (Calgary Depression Scale for Schizophrenia) and insight (G12 item from the Positive and Negative Syndrome Scale) were obtained from 921 community-dwelling, clinically-stable individuals with a DSM-IV diagnosis of schizophrenia, recruited in a nationwide multicenter study. Network analysis was used to explore the most relevant connections between insight and depressive symptoms, including potential confounders in the model (neurocognitive and social-cognitive functioning, positive, negative and disorganization symptoms, extrapyramidal symptoms, hostility, internalized stigma, and perceived discrimination). Bayesian network analysis was used to estimate a directed acyclic graph (DAG) while investigating the most likely direction of the putative causal association between insight and depression.
After adjusting for confounders, better levels of insight were associated with greater self-depreciation, pathological guilt, morning depression and suicidal ideation. No difference in global network structure was detected for socioeconomic status, service engagement or illness severity. The DAG confirmed the presence of an association between greater insight and self-depreciation, suggesting the more probable causal direction was from insight to depressive symptoms.
In schizophrenia, better levels of insight may cause self-depreciation and, possibly, other depressive symptoms. Person-centered and narrative psychotherapeutic approaches may be particularly fit to improve patient insight without dampening self-esteem.
Evaluating the improvements of placing the treatment isocentre at the boost centre of mass (CoM) in a hybrid treatment for breast cancer radiotherapy.
Material and methods:
Twenty-two patients were planned in two isocentre locations with two forward intensity-modulated radiation therapy (fIMRT) tangentials to the breast and a volumetric-modulated arc therapy (VMAT) to the boost. A simultaneous integrated boost technique was used. Breast Boost (BB) Vector was investigated as a criterion for selecting an appropriate isocentre placement. Various metrics for boost, breast and hybrid plans were analysed using analysis of variance statistics.
Comparing hybrid plans at the boost CoM vs. hybrid plans at the breast CoM, no significant differences were found. Analysis of relative variations of planning target volume (PTV) boost coverage vs. BB Vector indicated an upgrade in boost CoM isocentre strategy. Dose to organs at risk was comparable: V5Gy (26·24 vs. 25·69%, p = 0·8), V20Gy (14·66 vs. 14·58%, p = 0·959) and the mean dose (7·37 Gy vs. 7·26 Gy, p = 0·879) to ipsilateral lung; V5Gy (15·60 vs. 15·22%, p = 0·903), and the mean dose (4·91 Gy vs. 4·86 Gy, p = 0·950) to heart and dose to free breast of boost (46·71 Gy vs. 46·62 Gy, p = 0·408).
The hybrid fIMRT–VMAT technique centred at the boost CoM resulted equivalent to plans centred at the breast CoM, while benefiting from an enhancement in PTV boost coverage for patients with BB Vector superior to 5.
A clinical and psychosocial follow-up study of a cohort of 85 patients affected by panic disorder (PD) with or without agoraphobia was performed an average of 40 months after initial observation and following a mean duration of illness of 8 years.
Eighty-five out of 130 patients affected by PDs with or without agoraphobia according to DSM-III R criteria, examined between 1990 and 1995 at an outpatient clinic were re-examined in 1997/1998 using the same standardized clinical evaluation performed on admission. Patients also underwent a structured diagnostic interview (Mini International Neuropsychiatric Interview, MINI) and psychosocial evaluation (Scale of Sheehan’s Disability Scale, DISS, Baker and Intagliata’s Satisfaction with Life Domains Scale, SLDS).
At follow-up, the percentage of patients who had either improved or were in remission was considerably higher among those initially diagnosed as PD with respect to those diagnosed as panic disorder with agoraphobia (PDA): Thirty-eight percent of PD and 20.6% of PDA patients were in clinical remission. Mild panic symptoms and phobic avoidance were found in the majority of patients who were still symptomatic (respectively 71% and 57%). Approximately 60% of patients reported a significant difficulty in performing daily activities and 40% expressed dissatisfaction in at least 50% of life domains considered. Seventy-two percent of subjects examined were still undergoing pharmacological treatment at the time of follow-up.
The findings of the study are suggestive of a chronic illness with a significant impact on everyday quality of life of patients.