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In most trials and systematic reviews that evaluate exercise-based interventions in reducing depressive symptoms, it is difficult to separate treatment from prevention.
Aims
To evaluate the effectiveness of exercise-based interventions in reducing depressive symptoms in people without clinical depression.
Method
We searched PubMed, PsycINFO, Embase, WOS, SPORTDiscus, CENTRAL, OpenGrey and other sources up to 25 May 2020. We selected randomised controlled trials (RCTs) that compared exclusively exercise-based interventions with control groups, enrolling participants without clinical depression, as measured using validated instruments, and whose outcome was reduction of depressive symptoms and/or incidence of new cases of people with depression. Pooled standardised mean differences (SMDs) were calculated using random-effect models (registration at PROSPERO: CRD42017055726).
Results
A total of 14 RCTs (18 comparisons) evaluated 1737 adults without clinical depression from eight countries and four continents. The pooled SMD was −0.34 (95% CI −0.51 to −0.17; P < 0.001) and sensitivity analyses confirmed the robustness of this result. We found no statistical evidence of publication bias and heterogeneity was moderate (I2 = 54%; 95% CI 22–73%). Only two RCTs had an overall low risk of bias and three had long-term follow-up. Multivariate meta-regression found that a larger sample size, country (Asia) and selective prevention (i.e. people exposed to risk factors for depression) were associated with lower effectiveness, although only sample size remained significant when adjustment for multiple tests was considered. According to the Grading of Recommendations Assessment, Development and Evaluation tool, the quality of evidence was low.
Conclusions
Exercise-based interventions have a small effect on the reduction of depressive symptoms in people without clinical depression. It could be an alternative to or complement psychological programmes, although further higher-quality trials with larger samples and long-term follow-up are needed.
To investigate if depression risk modifies the association between frailty and mortality in older adults.
Design:
Ongoing cohort study.
Setting:
Albacete city, Spain
Participants:
Eight hundred subjects, 58.8% women, over 70 years of age from the Frailty and Dependence in Albacete (FRADEA) study.
Measurements:
Frailty phenotype, Geriatric Depression Scale (GDS), comorbidity, disability, and drug use were collected at baseline. Six groups were categorized: (G1: non-frail/no depression risk; G2: non-frail/depression risk; G3: prefrail/no depression risk; G4: prefrail/depression risk; G5: frail/no depression risk; and G6: frail/depression risk). Mean follow-up was 2542 days (SD 1006). GDS was also analyzed as a continuous variable. The association between frailty and depression risk with 10-year mortality was analyzed.
Results:
Mean age was 78.5 years. Non-frail was 24.5%, prefrail 56.3%, frail 19.3%, and 33.5% at depression risk. Mean GDS score was 3.7 (SD 3.2), increasing with the number of frailty criteria (p < 0.001). Ten-year mortality rate was 44.9%. Mortality was 21.4% for the non-frail, 45.6% for the prefrail, and 72.7% for the frail participants, 56% for those with depression risk, and 39.3% for those without depression risk. Mean survival times for groups G1 to G6 were, respectively, 3390, 3437, 2897, 2554, 1887, and 1931 days. Adjusted mortality risk was higher for groups G3 (HR 2.1; 95% confidence interval (CI) 1.4–3.1), G4 (HR 2.5; 95% CI 1.7–3.8), G5 (HR 3.8; 95% CI 2.4–6.1), and G6 (HR 4.0; 95% CI 2.6–6.2), compared with G1 (p < 0.001). Interaction was found between frailty and depression risk, although they were independently associated with mortality.
Conclusions:
Depression risk increases mortality risk in prefrail older adults but not in non-frail and frail ones. Depression should be monitored in these older adults to optimize health outcomes. Factors modulating the relationship between frailty and depression should be explored in future studies.
The coronavirus disease 2019 (COVID-19) pandemic has induced a reinforcement of infection control measures in the hospital setting. Here, we assess the impact of the COVID-19 pandemic on the incidence of nosocomial Clostridioides difficile infection (CDI).
Methods:
We retrospectively compared the incidence density (cases per 10,000 patient days) of healthcare-facility–associated (HCFA) CDI in a tertiary-care hospital in Madrid, Spain, during the maximum incidence of COVID-19 (March 11 to May 11, 2020) with the same period of the previous year (control period). We also assessed the aggregate in-hospital antibiotic use (ie, defined daily doses [DDD] per 100 occupied bed days [BD]) and incidence density (ie, movements per 1,000 patient days) of patient mobility during both periods.
Results:
In total, 2,337 patients with reverse transcription-polymerase chain reaction–confirmed COVID-19 were admitted to the hospital during the COVID-19 period. Also, 12 HCFA CDI cases were reported at this time (incidence density, 2.68 per 10,000 patient days), whereas 34 HCFA CDI cases were identified during the control period (incidence density, 8.54 per 10,000 patient days) (P = .000257). Antibiotic consumption was slightly higher during the COVID-19 period (89.73 DDD per 100 BD) than during the control period (79.16 DDD per 100 BD). The incidence density of patient movements was 587.61 per 1,000 patient days during the control period and was significantly lower during the COVID-19 period (300.86 per 1,000 patient days) (P < .0001).
Conclusions:
The observed reduction of ~70% in the incidence density of HCFA CDI in a context of no reduction in antibiotic use supports the importance of reducing nosocomial transmission by healthcare workers and asymptomatic colonized patients, reinforcing cleaning procedures and reducing patient mobility in the epidemiological control of CDI.
During menopause, women undergo a series of physiological changes that include a redistribution of fat tissue. This study was designed to investigate the effect of adding 10 g of cocoa-rich chocolate to the habitual diet of postmenopausal women daily on body composition. We conducted a 6-month, two-arm randomised, controlled trial. Postmenopausal women (57·2 (sd 3·6) years, n 132) were recruited in primary care clinics. Participants in the control group (CG) did not receive any intervention. Those of the intervention group (IG) received 10 g daily of 99 % cocoa chocolate in addition to their habitual diet for 6 months. This quantity comprises 247 kJ (59 kcal) and 65·4 mg of polyphenols. The primary outcomes were the between-group differences in body composition variables, measured by impendancemetry at the end of the study. The main effect of the intervention showed a favourable reduction in the IG with respect to the CG in body fat mass (–0·63 kg (95 % CI –1·15, –0·11), P = 0·019; Cohen’s d = –0·450) and body fat percentage (–0·79 % (95 % CI –1·31, –0·26), P = 0·004; Cohen’s d = –0·539). A non-significant decrease was also observed in BMI (–0·20 kg/m2 (95 % CI –0·44, 0·03), P = 0·092; Cohen’s d = –0·345). Both the body fat mass and the body fat percentage showed a decrease in the IG for the three body segments analysed (trunk, arms and legs). Daily addition of 10 g of cocoa-rich chocolate to the habitual diet of postmenopausal women reduces their body fat mass and body fat percentage without modifying their weight.
A large body of research states that cognitive impairment in schizophrenia is static. Nevertheless, most previous studies lack a control group or have small study samples or short follow-up periods.
Method
We aimed to address these limitations by studying a large epidemiological cohort of patients with first-episode schizophrenia spectrum disorders and a comparable control sample for a 10-year period.
Results
Our results support the generalized stability of cognitive functions in schizophrenia spectrum disorders considering the entire group. However, the existence of a subgroup of patients characterized by deteriorating cognition and worse long-term clinical outcomes must be noted. Nevertheless, it was not possible to identify concomitant factors or predictors of deterioration (all Ps > 0.05).
Conclusions
Cognitive functions in schizophrenia spectrum disorder are stable; however, a subgroup of subjects that deteriorate can be characterized.
Darwin's frogs Rhinoderma darwinii and Rhinoderma rufum are the only known species of amphibians in which males brood their offspring in their vocal sacs. We propose these frogs as flagship species for the conservation of the Austral temperate forests of Chile and Argentina. This recommendation forms part of the vision of the Binational Conservation Strategy for Darwin's Frogs, which was launched in 2018. The strategy is a conservation initiative led by the IUCN SSC Amphibian Specialist Group, which in 2017 convened 30 governmental, non-profit and private organizations from Chile, Argentina and elsewhere. Darwin's frogs are iconic examples of the global amphibian conservation crisis: R. rufum is categorized as Critically Endangered (Possibly Extinct) on the IUCN Red List, and R. darwinii as Endangered. Here we articulate the conservation planning process that led to the development of the conservation strategy for these species and present its main findings and recommendations. Using an evidence-based approach, the Binational Conservation Strategy for Darwin's Frogs contains a comprehensive status review of Rhinoderma spp., including critical threat analyses, and proposes 39 prioritized conservation actions. Its goal is that by 2028, key information gaps on Rhinoderma spp. will be filled, the main threats to these species will be reduced, and financial, legal and societal support will have been achieved. The strategy is a multi-disciplinary, transnational endeavour aimed at ensuring the long-term viability of these unique frogs and their particular habitat.
Previous literature supports antipsychotics’ (AP) efficacy in acute first-episode psychosis (FEP) in terms of symptomatology and functioning but also a cognitive detrimental effect. However, regarding functional recovery in stabilised patients, these effects are not clear. Therefore, the main aim of this study is to investigate dopaminergic/anticholinergic burden of (AP) on psychosocial functioning in FEP. We also examined whether cognitive impairment may mediate these effects on functioning.
Methods
A total of 157 FEP participants were assessed at study entry, and at 2 months and 2 years after remission of the acute episode. The primary outcomes were social functioning as measured by the functioning assessment short test (FAST). Cognitive domains were assessed as potential mediators. Dopaminergic and anticholinergic AP burden on 2-year psychosocial functioning [measured with chlorpromazine (CPZ) and drug burden index] were independent variables. Secondary outcomes were clinical and socio-demographic variables.
Results
Mediation analysis found a statistical but not meaningful contribution of dopaminergic receptor blockade burden to worse functioning mediated by cognition (for every 600 CPZ equivalent points, 2-year FAST score increased 1.38 points). Regarding verbal memory and attention, there was an indirect effect of CPZ burden on FAST (b = 0.0045, 95% CI 0.0011–0.0091) and (b = 0.0026, 95% CI 0.0001–0.0006) respectively. However, only verbal memory post hoc analyses showed a significant indirect effect (b = 0.009, 95% CI 0.033–0.0151) adding premorbid IQ as covariate. We did not find significant results for anticholinergic burden.
Conclusion
CPZ dose effect over functioning is mediated by verbal memory but this association appears barely relevant.
To review the current knowledge about Diogenes symptoms and organic personality disorder through systematic review of the literature and the analysis of a case.
Methods
Case report. Review. Literature sources were obtained through electronic search in PubMed.gov database of 10 last years.
Results
Background: Diogenes syndrome is a behavioral disorder characterized by severe self-neglect, hoarding, domestic dirt, and lack of shame regarding one's living state. Patients may present due to a range of reasons, few studies has been described hoarding symptoms secondary to brain injury. Early management could reduce their high-mortality condition.
Case presentation
We present a case of a 67-year-old Caucasian female known with a organic personality disorder secondary to a head trauma with obsessive hoarding symptoms. After being hospitalizated, we were authorized to explore her personal items trough photographs. Her handbag and her house were filled with rubbish and rotting food. Our patient had no insight into any self-hygiene or public health problems.
Conclusions
Information of the characteristics of Diogenes syndrome can help in earlier recognition of such persons, in order to decrease their morbidity and mortality.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Motor abnormalities (MAs) are the primary manifestations of schizophrenia. However, the extent to which MAs are related to alterations of subcortical structures remains understudied.
Methods
We aimed to investigate the associations of MAs and basal ganglia abnormalities in first-episode psychosis (FEP) and healthy controls. Magnetic resonance imaging was performed on 48 right-handed FEP and 23 age-, gender-, handedness-, and educational attainment-matched controls, to obtain basal ganglia shape analysis, diffusion tensor imaging techniques (fractional anisotropy and mean diffusivity), and relaxometry (R2*) to estimate iron load. A comprehensive motor battery was applied including the assessment of parkinsonism, catatonic signs, and neurological soft signs (NSS). A fully automated model-based segmentation algorithm on 1.5T MRI anatomical images and accurate corregistration of diffusion and T2* volumes and R2* was used.
Results
FEP patients showed significant local atrophic changes in left globus pallidus nucleus regarding controls. Hypertrophic changes in left-side caudate were associated with higher scores in sensory integration, and in right accumbens with tremor subscale. FEP patients showed lower fractional anisotropy measures than controls but no significant differences regarding mean diffusivity and iron load of basal ganglia. However, iron load in left basal ganglia and right accumbens correlated significantly with higher extrapyramidal and motor coordination signs in FEP patients.
Conclusions
Taken together, iron load in left basal ganglia may have a role in the emergence of extrapyramidal signs and NSS of FEP patients and in consequence in the pathophysiology of psychosis.
This study aims to explore whether the implicit processing of emotional symbols related to patriotic feeling may exert some effects on attention. Here, we have conducted an experiment using two interrelated tasks. First, we use flags with different meanings to participants for measuring the strength of the emotional attentional blink (EAB) within a rapid serial visual presentation (RSVP) paradigm. Then, we use a “congruency judgments” subjective test, where we confront participants to judge the affinity between pairs of politician leaders and flags of different sign for community participants, while recording two physiological measures (Heart Rate Variance and Galvanic Skin Response) to evaluate the variations elicited by that confrontation. Results on the EAB task show a significant emotion induced blindness for emotional stimuli representing Catalan and Spanish patriotism (α = .05), while the effect does not appear for the stimulus representing neutral patriotism. The interaction “Flags x Patriotism” was significant, F(1, 51) = 4.62; p = .036; ηp2 = .083. Results on the second task show that measures derived from electrophysiological records are sensitive to patriotic feeling, both being complementary. In addition, by using measures of congruence, the “Leaders x Flags” interaction was significant, F(3.682, 125.204) = 53.55; p < .001; ηp2 = .612. Finally, a multiple linear regression model for each emotional inductor was verified for the Catalan case, using the EAB effect as criteria, R2Adjusted = .79; p < .001. Some theoretical and methodological aspects derived of this exploratory study are discussed.
Breast-feeding is the ideal nutrition for a newborn’s integral necessities. It seems crucial therefore to know its composition in order to provide suitable infant formula when required. Of these, polyamines (with lactation and the microbiota being its intestinal source) are involved in the development of gut epithelium and immunity. Safety concerns limit human intervention studies. Therefore, we studied the amounts of polyamines supplied by breast milk (varying among mothers) or infant formula feeding, up to day 30 postpartum, in the faeces of newborns. Independent samples (68) of breast milk from fifty-nine healthy Caucasian woman (day 0, 1, 3, 5, 7, 15 and 30 postpartum) who had natural deliveries after week 38, same-day faeces of newborns when available (eighty-one from breast milk and fifty-five from infant formula fed) and six infant formulas were collected and the polyamine content was determined by HPLC. In breast milk, polyamines and isoamylamine (a primary amine), with inter-individual variations, increased over time (with a higher content of spermidine; no other amines were present). Overall, they were much higher than in infant formula. By the 2nd week after birth, polyamines, cadaverine and tyramine, but not isoamylamine, were higher in the faeces of those fed infant formula compared with those fed breast milk. Cadaverine and tyramine could be used to predict the feeding type used for newborns. The differences in the content may be related to distinct colonisation of amine-producing bacteria, which can be established by polyamines. Further studies are required to determine the clinical utility of these findings.
The uses of natural selection argument in politics have been constant since Charles Darwin’s times. They have also been varied. The readings of Darwin’s theory range from the most radically individualist views, as in orthodox socio-Darwinism, to the most communitarian, as in Peter Kropotkin’s and other socialist perspectives. This essay argues that such diverse, contradictory, and sometimes even outrageous political derivations from Darwin’s theory may be partially explained by some incompleteness and ambivalences underlying Darwin’s concepts. “Natural selection,” “struggle for existence,” and “survival of the fittest” are open concepts and may suggest some hierarchical and segregationist interpretations. Circumstantially, Darwin accepted social “checks,” such as discouraging marriage of “lower” individuals to prevent them from reproducing, in a vein of Malthusian politics. This makes Darwin’s theory of selection by struggle collide with his theory of social instincts, by which he explains the origins of morality. It also favors reading Darwin’s On the Origin of Species or The Descent of Man from opposite, mostly ideological perspectives. Darwin’s position is ambivalent, although hardly unreasonable. The recognition he makes of social instincts, as well as the use of the concept of artificial selection, entails accepting the role of human consciousness, by which social evolution cannot be reduced to natural evolution, as socio-Darwinians did next and as some neo-Darwinists seem to repeat. On these grounds, this essay argues the inadequacy of the conventional model of natural selection for understanding politics. If we want to describe politics in Darwin’s language, artificial rather than natural selection would be the concept that performs better for explaining the courses of politics in real society.
Polyphenols are a wide family of phytochemicals present in diverse foods. They might play a role in cancer development and progression. In vivo and in vitro studies have suggested beneficial properties and potential mechanisms. We aimed to evaluate the association between total and main classes of polyphenol intake and breast cancer (BC) risk in the Seguimiento Universidad de Navarra project – a prospective Mediterranean cohort study. We included 10 713 middle-aged, Spanish female university graduates. Polyphenol intake was derived from a semi-quantitative FFQ and matching food consumption data from the Phenol-Explorer database. Women with self-reported BC were asked to return a copy of their medical report for confirmation purposes; death certificates were used for fatal cases. Cox models were fitted to estimate multivariable-adjusted hazard ratios (HR) and 95 % CI for the association between tertiles (T) of polyphenol intake and BC. After 10·3 years of median follow-up, 168 probable incident BC cases were identified, out of which 100 were confirmed. We found no association between polyphenol intake and the overall BC risk. Nevertheless, we observed a significant inverse association between total polyphenol intake and BC risk for postmenopausal women, either for probable or only for confirmed cases (HRT3 v. T1 0·31 (95 % CI 0·13, 0·77; Ptrend=0·010)). Also, phenolic acid intake was inversely associated with postmenopausal BC. In summary, we observed no significant association between total polyphenol intake and BC risk. Despite a low number of incident BC cases in our cohort, higher total polyphenol intake was associated with a lower risk of postmenopausal BC.
The aim of this piece of research was to study the existence of clusters based on anger, empathy and cortisol and testosterone measures associated with aggressive behavior in school-aged children. The sample group comprised 139 eight-year-old children (80 boys and 59 girls). Aggressive behavior was measured using the Direct and Indirect Aggression Scale. Both psychological and biological variables were used to determine psychobiological profiles. The psychological variables considered were trait anger, measured using the State-Trait Anger Expression Inventory for Children and Adolescents, and empathy, measured using the Empathy Quotient-Child Version. Testosterone and cortisol concentrations were measured through saliva samples and analyzed using an ELISA (Enzyme-linked immunosorbent assay). A Cluster Analysis revealed three clusters which were clearly different as regards their psychological and biological characteristics. The analysis of variance (ANOVA) revealed that the cluster characterized by having higher anger levels, lower empathy levels and higher testosterone and cortisol levels was more aggressive than the other two (p < .0001, η2 = .19). The results indicate that studying psychological and biological variables together may help establish differentiated aggression patterns among children.
Between the years of 30 b.c. to a.d. 80, during the Late Formative period, the site of Izapa was flooded by lahars associated with an explosive eruption of the San Antonio volcano (part of the Tacaná Volcanic Complex). Computer simulations suggest that hot pyroclastic flows did not impact Izapa directly, but did impact the region considerably, filling and clogging the Cahuacan and Mixcun rivers with hot debris. The material was quickly saturated by heavy rains and, as the water from the rivers overtopped the obstruction, remobilized in the form of a hot mixture of mud and water known as a lahar (or flood of volcanic origin), which flowed down through the piedmont zone along the Cahuacan, Mixcun-Suchiate, and Izapa rivers. At Izapa, the flood took the form of a 6-m catastrophic wave of mud and water that likely destroyed crops and caused many causalities, surrounding the architectural mounds at Izapa with a muddy landscape. The floods also dramatically affected the rivers downstream, undoubtedly wreaking serious damage to the transport and trade of goods along the coast.
We consider three point positive masses moving on ${{S}^{2}}$ and ${{H}^{2}}$. An Eulerian-relative equilibrium is a relative equilibrium where the three masses are on the same geodesic. In this paper we analyze the spectral stability of these kind of orbits where the mass at the middle is arbitrary and the masses at the ends are equal and located at the same distance from the central mass. For the case of ${{S}^{2}}$, we found a positive measure set in the set of parameters where the relative equilibria are spectrally stable, and we give a complete classification of the spectral stability of these solutions, in the sense that, except on an algebraic curve in the space of parameters, we can determine if the corresponding relative equilibrium is spectrally stable or unstable. On ${{H}^{2}}$, in the elliptic case, we prove that generically all Eulerian-relative equilibria are unstable; in the particular degenerate case when the two equal masses are negligible, we get that the corresponding solutions are spectrally stable. For the hyperbolic case we consider the system where the mass in the middle is negligible; in this case the Eulerian-relative equilibria are unstable.
Cognitive deficits are a core feature of early stages in schizophrenia. However, the extent to which antipsychotic (AP) have a deleterious effect on cognitive performance remains under debate. We aim to investigate whether anticholinergic loadings and dose of AP drugs in first episode of psychosis (FEP) in advanced phase of remission are associated with cognitive impairment and the differences between premorbid intellectual quotient (IQ) subgroups.
Methods
Two hundred and sixty-six patients participated. The primary outcomes were cognitive dimensions, dopaminergic/anticholinergic load of AP [in chlorpromazine equivalents (Eq-CPZ) and the Anticholinergic Risk Scale (ARS), respectively].
Results
Impairments in processing speed, verbal memory and global cognition were significantly associated with high Eq-CPZ and verbal impairment with high ARS score. Moreover, this effect was higher in the low IQ subgroup.
Conclusions
Clinicians should be aware of the potential cognitive impairment associated with AP in advanced remission FEP, particularly in lower premorbid IQ patients.
This paper is focused on explaining the radiation test in temperature performed on the Engineering and Qualification Model of the Medium Gain Antenna Radiofrequency (MGA-RFA) Assembly of ESA's BepiColombo mission. The goal of this program is to observe and study Mercury and its surroundings in a very demanding environment in terms of temperature and radiation. The MGA is an X-band two-axis steerable horn, which provides bidirectional communications between spacecraft and Earth as backup of the High Gain Antenna and also operates as primary communication link at several mission stages or conditions. The paper presents the measurement set-up for the qualification campaign of the antenna, where it was necessary to characterize the antenna in a representative thermal environment, and the results obtained from this test. Results of test up to 150°C show how gain and radiation pattern shapes are slightly affected by thermal stress, but without jeopardizing mission requirements. In addition, by analyzing correlation of this test with RF analysis in the same thermal conditions, it becomes possible to accurately extrapolate the MGA-RFA behavior up to temperatures of more than 500°C. This fact allowed the successful space qualification of this model.