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Previous studies reported an association between advanced paternal age at birth and increased risk for schizophrenia and bipolar disorder. While some hypothesize that this association is caused by de-novo mutations in paternal spermatozoa, others cite factors associated with psycho-social characteristics of fathers who have children at a late age. This study aims to test these hypotheses.
A historical-prospective, population-based cohort study, performed by linking the Israeli Draft Board Registry and the Israeli National Psychiatric Hospitalization Registry (N = 916 439; 4488 with schizophrenia, 883 with bipolar disorder). Odds ratios (OR) and two-sided 95% confidence intervals (CI) were calculated by logistic regression models, using paternal age as predictor and risk for later hospitalizations for schizophrenia or bipolar disorder as outcome measure. Models were first fitted unadjusted, then adjusted for paternal age at birth of the first child.
In the unadjusted model, offspring of fathers aged 45 and above at birth had increased risk of schizophrenia (OR = 1.71, 95% CI 1.49–1.99) and bipolar disorder (OR = 1.63, 95% CI 1.16–2.24). However, taking into account paternal age at birth of first child, advanced paternal age was no longer associated with increased risk of schizophrenia (OR = 0.60, 95% CI 0.48–0.79) or bipolar disorder (OR = 1.03, 95% CI 0.56–1.90).
Controlling for paternal age at birth of the first offspring, advanced paternal age does not predict increased risk for schizophrenia or bipolar disorder. These data indicate that the association between advanced paternal age and having an offspring with schizophrenia and bipolar disorder is likely due to psychos-social factors, or common genetic variation associated with delayed initial fatherhood.
This article revisits a locus classicus of British Catholic History, the interpretation of the coin-hoard found in 1611 by the Lancashire squire William Blundell of Little Crosby.1 This article offers new information, approaching the Harkirk silver from several perspectives: Mark Blundell offers a memoir of his ancestor William Blundell, as well as lending his voice to the account of the subsequent fate of the Harkirk silver; Professor Jane Stevenson and Professor Peter Davidson reconsider the sources for William Blundell’s historiography as well as considering wider questions of memory and the recusant community; Dr Dora Thornton analyses the silver pyx made from the Harkirk coins in detail, and surveys analogous silverwork in depth.
Being a current psychiatric in-patient is one of the strongest statistical risk factors for suicide. It is usually assumed that this strong association is not causal but is a result of the combination of the selection of high-risk patients for admission and the imperfect protection from suicide afforded by psychiatric wards. Logically, a third factor, which is causal, might play a role in the association. It has recently been suggested that adverse experiences in psychiatric units such as trauma, stigma and loss of social role might precipitate some in-patient suicides.
To consider whether there is a causal association between psychiatric hospitalisation and suicide.
We used the framework of Austin Bradford Hill's criteria for assessing causality in epidemiology to consider the possibility that psychiatric hospitalisation might causally contribute to the extent and variation in in-patient suicide rates.
The association between psychiatric hospitalisation and suicide clearly meets five of the nine Hill's criteria (strength of association, consistency, plausibility, coherence and analogy) and partially meets three of the remaining four criteria (gradient of exposure, temporality and experimental evidence).
Admission to hospital itself might play a causal role in a proportion of in-patient suicides. The safety of being in hospital with respect to suicide could be examined with a large-scale randomised controlled trial (RCT). In the absence of an RCT, the possibility of a causal role provides further impetus to calls to make care in the community more available and psychiatric hospitals more acceptable to patients.
Children with cancer are potentially at a high risk of plasma 25-hydroxyvitamin D (25(OH)D) inadequacy, and despite UK vitamin D supplementation guidelines their implementation remains inconsistent. Thus, we aimed to investigate 25(OH)D concentration and factors contributing to 25(OH)D inadequacy in paediatric cancer patients. A prospective cohort study of Scottish children aged <18 years diagnosed with, and treated for, cancer (patients) between August 2010 and January 2014 was performed, with control data from Scottish healthy children (controls). Clinical and nutritional data were collected at defined periods up to 24 months. 25(OH)D status was defined by the Royal College of Paediatrics and Child Health as inadequacy (<50 nmol/l: deficiency (<25 nmol/l), insufficiency (25–50 nmol/l)), sufficiency (51–75 nmol/l) and optimal (>75 nmol/l). In all, eighty-two patients (median age 3·9, interquartile ranges (IQR) 1·9–8·8; 56 % males) and thirty-five controls (median age 6·2, IQR 4·8–9·1; 49 % males) were recruited. 25(OH)D inadequacy was highly prevalent in the controls (63 %; 22/35) and in the patients (64 %; 42/65) at both baseline and during treatment (33–50 %). Non-supplemented children had the highest prevalence of 25(OH)D inadequacy at every stage with 25(OH)D median ranging from 32·0 (IQR 21·0–46·5) to 45·0 (28·0–64·5) nmol/l. Older age at baseline (R −0·46; P<0·001), overnutrition (BMI≥85th centile) at 3 months (P=0·005; relative risk=3·1) and not being supplemented at 6 months (P=0·04; relative risk=4·3) may have contributed to lower plasma 25(OH)D. Paediatric cancer patients are not at a higher risk of 25(OH)D inadequacy than healthy children at diagnosis; however, prevalence of 25(OH)D inadequacy is still high and non-supplemented children have a higher risk. Appropriate monitoring and therapeutic supplementation should be implemented.
Objectives: To summarize the clinical characteristics and outcomes of pediatric sports-related concussion (SRC) patients who were evaluated and managed at a multidisciplinary pediatric concussion program and examine the healthcare resources and personnel required to meet the needs of this patient population. Methods: We conducted a retrospective review of all pediatric SRC patients referred to the Pan Am Concussion Program from September 1st, 2013 to May 25th, 2015. Initial assessments and diagnoses were carried out by a single neurosurgeon. Return-to-Play decision-making was carried out by the multidisciplinary team. Results: 604 patients, including 423 pediatric SRC patients were evaluated at the Pan Am Concussion Program during the study period. The mean age of study patients was 14.30 years (SD: 2.32, range 7-19 years); 252 (59.57%) were males. Hockey (182; 43.03%) and soccer (60; 14.18%) were the most commonly played sports at the time of injury. Overall, 294 (69.50%) of SRC patients met the clinical criteria for concussion recovery, while 75 (17.73%) were lost to follow-up, and 53 (12.53%) remained in active treatment at the end of the study period. The median duration of symptoms among the 261 acute SRC patients with complete follow-up was 23 days (IQR: 15, 36). Overall, 25.30% of pediatric SRC patients underwent at least one diagnostic imaging test and 32.62% received referral to another member of our multidisciplinary clinical team. Conclusion: Comprehensive care of pediatric SRC patients requires access to appropriate diagnostic resources and the multidisciplinary collaboration of experts with national and provincially-recognized training in TBI.
Applications that produce a large amount of heat, such as combustion engines, can benefit from high temperature thermoelectrics to reduce the amount of energy lost. Superlattice (SL) structures have shown reduced thermal conductivity at room temperature and below, suggesting applicability at high temperatures may be possible. This reduction could greatly increase the thermoelectric figure of merit. The Si/SiGe material system is studied here for high temperature application. Two growth temperatures of 300 C and 500 C are examined. Two superlattice periods were studied (8 nm and 20 nm) to determine the effects of lattice spacing on thermal conductivity. Laser Flash Analysis is applied to determine the thermal diffusivity, hence thermal conductivity, from 100 C to 500 C. Thermal diffusivity was found to be an order of magnitude lower than the constituent alloy at 100 C. Superlattice spacing and growth temperature showed little effect on the diffusivity within the error of this measurement.
Hope has long been considered a relevant variable in medical disciplines, but little attention has been paid to the concept, and its clinical and research implications, in psychiatry. This article illuminates the topic of hope from four different perspectives relevant to psychiatric research and practice. The four authors discuss hope from the viewpoint of their specific area of expertise, providing an overview of philosophical, conceptual, research and recovery-related reflections concerning hope in psychiatry.
A novel three dimensional (3D) self-assembled hierarchical bismuth oxide was prepared via a sol-gel synthesis with the aid of capping agent of polyethylene glycol-8000 (PEG-8000) at 85 ℃ in 45 min. The morphology evolution was studied versus reaction time and interpreted in terms of growth mechanisms. The as-grown 3D hierarchical flower-like bismuth oxide was crystalline cubic gamma-phase. The morphology and crystal phase of these 3D cubic gamma-phase bismuth oxide flowers were not changed with heating up to 600 ℃. The flower-like morphology was attributed to modification of the growth kinetics by the capping agent from the PEG-OH bond bridging with bismuth ions. Europium doped gadolinium oxide shell were further deposited on the bismuth oxide cores through sol-gel synthesis showing good photoluminescence characteristics at 610 and 622 nm under the excitation at 280 nm.
Previous work suggests that the association between urbanicity and schizophrenia may be greatest in those with pre-existing vulnerability.
To test for synergism in risk of schizophrenia between population density and a combined exposure of poor premorbid social and cognitive functioning.
For 371 603 adolescent males examined by the Israeli Draft Board on social and cognitive functioning, data on population density of place of residence and later hospitalisation for schizophrenia were obtained from population-based registries.
There was an interaction between population density (five levels) and poor premorbid social and cognitive functioning (interaction χ2=4.6, P=0.032). The adjusted increase in cumulative incidence associated with one unit change in population density was 0.10% in the vulnerable group (95% CI 0.019–0.18, P=0.015), nine times larger than that in the non-vulnerable group (0.011%, 95% CI 0.0017–0.020, P=0.021).
Risk of schizophrenia may increase when people with a genetic liability to the disorder, expressed as poor social and cognitive functioning, need to cope with city life.
Many manifestations of mental illness, risk factors, course and even response to treatment are shared by several diagnostic groups. For example, cognitive and social impairments are present to some degree in most DSM and ICD diagnostic groups. The idea that diagnostic boundaries of mental illness, including schizophrenia, have to be redefined is reinforced by recent findings indicating that on the one hand multiple genetic factors, each exerting a small effect, come together to manifest as schizophrenia, and on the other hand, depending on interaction with the environment, the same genetic variations can present as diverse clinical phenotypes. Rather than attempting to find a unitary biological explanation for a DSM construct of schizophrenia, it would be reasonable to deconstruct it into the most basic manifestations, some of which are common with other DSM constructs, such as cognitive or social impairment, and then investigate the biological substrate of these manifestations.
The notion that subtle cognitive, emotional, behavioral, and functional deviations from norms are present in many individuals several years before a formal diagnosis of schizophrenia has been around for almost a century. This notion has been at the base of the developmental hypothesis of schizophrenia and has been the impetus for the use of cognition as an endophenotype for studying the illness. The recent enthusiasm for prodromal research derives from two unrelated and controversial claims: that short duration of untreated psychosis is associated with better prognosis and that novel antipsychotic drugs have a better safety profile, supposedly enabling early intervention at a relatively lower risk of side effects to the patient.
At the current level of knowledge, the risk-benefit assessment of prodromal interventions turns out to be an almost unsolvable conundrum. On one hand, the age of onset of psychosis and schizophrenia, early and mid-ado-lescence, coincides with the age at which life-long social and vocational characteristics are shaped. Any intervention that could produce even minimal delay in onset of active psychosis or ameliorate its early course might have a life-long impact. Therefore, the idea of prodromal intervention cannot be easily dismissed. On the other hand, in absence of accurate markers for imminent psychosis and strong data indicating that treatment during the prodromal phase is effective, exposing adolescents to the stigma associated with the illness and the adverse effects of antipsychotics has raised serious hesitations among many researchers and clinicians.
Anxiety disorders are highly prevalent, are increasing in incidence, affect individuals early in life, and significantly impact health care and quality of life. As such, they are serious public health problems that deserve attention now and in the future. Over the last 10–20 years, there has been marked improvement in pharmacologic and psychosocial interventions for anxiety. Due to their broad spectrum of efficacy against common comorbidities and lack of association with abuse and dependence, serotonergic and mixed serotonergic noradrenergic antidepressants are first-line therapies for anxiety disorders. Benzodiazepines are still widely used in clinical practice because they are well tolerated and work quickly and effectively. Other medications that are emerging as potentially useful for selected populations with anxiety include atypical neuroleptics and anticonvulsants. Cognitive-behavioral therapy (CBT) is at least as effective as medication for many patients with anxiety disorders and facilitates maintenance of benefit over the long term. Resilience, the capacity to bounce back from adversity, can be reliably measured with a psychometrically valid scale, the Connor-Davidson Resilience Scale. Compared with the general population, individuals with anxiety disorders exhibit decreased resilience. Studies have shown that pharmacologic treatment combined with CBT may increase resilience within 2–3 months. Emerging neurobiologic research indicates that noradrenergic pathways and 5-HT2 transporter efficiency may mediate effects on resiliency.
The extent of premorbid changes associated with the onset of schizophrenia are debated.
The study examined cognitive and behavioural functioning prior to, and after, first hospitalisation for schizophrenia.
Data from the Israeli Draft Board Register of intelligence, social functioning and behaviour testing for all Israeli males aged 16–17 was linked with data from the National Psychiatric Hospitalisation Case Register. This identified 692 men who had been admitted to hospital for schizophrenia. Cases and non-cases matched on age and school were compared, as were cases aggregated by the time that had elapsed between testing and first admission to hospital.
Cases performed worse than non-cases on all measures. On Social Functioning and on Raven's Progressive Matrices–R, differences between cases and non-cases were progressively greater for cases admitted closer to the time of testing. These differences were greatest for persons tested after first psychiatric hospitalisation.
The results confirm premorbid deficits associated with schizophrenia and support the hypothesis that decline is progressive.
Behavioral and psychological symptoms of dementia (BPSD) have a significant impact on patients and their families. These symptoms affect quality of life and medical and social service utilization, and determine time of institutionalization. Over the past three decades, academic-based clinical investigators have conducted trials of almost all classes of marketed psychotropics in an attempt to ameliorate these symptoms. With few exceptions, these studies suffered from serious methodologic shortcomings, such as small patient populations or too many outcome measurements (Stern et al., 1997). Despite these flaws and equivocal findings, a consensus has emerged, and antipsychotics have become the most commonly prescribed drugs for this condition (see consensus statement in this issue). Unfortunately, a meta-analysis of trials of conventional neuroleptics has revealed that this class of drugs is barely superior to placebo (see article by Lon Schneider in this issue). In addition, conventional neuroleptics cause extrapyramidal adverse effects, tardive dyskinesia, sedation, and cardiovascular instability, adverse effects to which the elderly are particularly vulnerable.
Thin films of zinc sulfide (ZnS) doped with Mn, were deposited using magnetron sputter source. The electroluminescent properties of the as-deposited films were relatively poor. Post- deposition rapid thermal annealing (RTA) with and without co-dopants was studied. Significant changes in microstructure and EL performance were observed on the samples after post-sputter processing. Transmission electron microscopy (TEM) and high-resolution transmission electron microscopy (HRTEM) were employed to characterize the microstructure. Both inter-grain and intra-grain distributions of the co-dopants were measured using energy dispersive X-ray spectra (EDX) and the distribution versus thickness was determined by dynamic secondary ion mass spectrometry (SIMS). A correlation between electroluminescent properties and the microstructure is obtained.
Determining the prevalence of psychiatric disorders among remand populations has been made a priority in England and Wales. Differences in legal process and psychiatric services in Scotland make similar research there important.
Demographic data were collected on 389 prisoners, the Clinical Interview Schedule was completed and cognitive function assessed.
The prevalence of major psychiatric disorders was low. Less severe symptoms were more common. The sample was of average IQ, but low educational attainment. Reported drug abuse was high.
Few of those interviewed required hospital care, but other symptoms and drug-related problems may place heavy demands on prison medical and psychiatric services.
Hemoglobin (Hb) and myoglobin (Mb) were encapsulated in transparent silica glasses prepared by the sol-gel method. The preparation of the silica glasses was tailored so that when proteins were entrapped in the pores of the inorganic matrix, they retained their biochemical activity, i.e. they could bind ligands reversibly. Using optical spectroscopy to monitor ligand binding, we studied the binding of O2, CO, and NO with these two heme proteins encapsulated in silica glasses and compared them to heme proteins in aqueous buffer. Both Hb and Mb in the sol-gel glass bound O2, CO, and NO, producing the same spectroscopic properties as those in aqueous buffer. In addition, silica encapsulated Mb was used to evaluate the rate of ligand (O2) transport through the pores of the glass. When varying oxygen concentration and measuring the time required for full conversion of deoxyMb to MbO2 in the silica gel, the time vs. concentration data followed an exponential trend, as expected for diffusion controlled processes.
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