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Schizophrenia is a heterogeneous disorder with substantial heritability. The use of endophenotypes may help clarify its aetiology. Measures from the smooth pursuit and antisaccade eye movement tasks have been identified as endophenotypes for schizophrenia in twin and family studies. However, the genetic basis of the overlap between schizophrenia and these oculomotor markers is largely unknown. Here, we tested whether schizophrenia polygenic risk scores (PRS) were associated with oculomotor performance in the general population.
Analyses were based on the data of 2956 participants (aged 30–95) of the Rhineland Study, a community-based cohort study in Bonn, Germany. Genotyping was performed on Omni-2.5 exome arrays. Using summary statistics from a recent meta-analysis based on the two largest schizophrenia genome-wide association studies to date, we quantified genetic risk for schizophrenia by creating PRS at different p value thresholds for genetic markers. We examined associations between PRS and oculomotor performance using multivariable regression models.
Higher PRS were associated with higher antisaccade error rate and latency, and lower antisaccade amplitude gain. PRS showed inconsistent patterns of association with smooth pursuit velocity gain and were not associated with saccade rate during smooth pursuit or performance on a prosaccade control task.
There is an overlap between genetic determinants of schizophrenia and oculomotor endophenotypes. Our findings suggest that the mechanisms that underlie schizophrenia also affect oculomotor function in the general population.
Street working children are often poor, deprived of love and care, and lack supervision by responsible adults. The Kurdistan region of Iraq has experienced war conflicts for decades. Many families have been displaced and their children forced into the streets. However, little is known about mental health among the street working children in this region.
To explore mental health and trauma among street working boys in Duhok.
A cross sectional study was conducted on street working boys (n=100), eight to 16 years old in Duhok. A control group of age-matched school boys (n=100) were recruited. The Child Behaviour Checklist 6-18 was used for assessment of the children’s competences and behavioural problems. Mental disorders were assessed by using the Mini-International Neuropsychiatric Interview for Children and Adolescence. Experienced trauma was assessed by the Harvard-Uppsala Trauma Questionnaire for Children.
Sixty-one percent of the street working boys had at least one psychiatric disorder (57 % anxiety disorders). Street working boys reported more traumatic events than school boys, 96% vs 64% (X²= 32, p < 0.001), the largest effect size was found for torture (OR 28.4) and the smallest effect size for maltreatment or assault (OR 2.7). Also, they reported higher levels of internalising symptoms, T-score 59.4 (8.2). There was a significantly increased risk of more externalising symptoms with increasing working hours, OR 2.90 [95% CI 1.02; 8.29].
Internalizing symptoms, anxiety disorders and trauma were more common in street working boys compared to school boys. More working hours increased the risk for more externalising symptoms.
To demonstrate the feasibility of continuing cochlear implantation during the coronavirus disease 2019 crisis and to report on trends of referrals via the neonatal hearing screening programme.
A prospective case series was conducted on children who underwent cochlear implantation during the coronavirus disease 2019 crisis in the UK and a sample of referrals via the neonatal hearing screening programme. A step-by-step description of peri-operative management is included.
Regionally, between February and May 2020, 106 babies were referred via the neonatal hearing screening programme to paediatric audiology. Eleven children were operated on during the coronavirus disease 2019 study period. None of the 11 children developed coronavirus symptoms.
It is widely recognised that the demands of managing the current pandemic may compromise screening, clinical assessment and elective surgery. Time-sensitive issues such as cancer management have gained prominence, but a similar need exists for timely paediatric cochlear implantation.
Implantation in the paediatric population during the coronavirus disease 2019 pandemic is feasible with careful planning.
Tracheostomy for coronavirus disease 2019 pneumonitis patients requiring prolonged invasive mechanical ventilation remains a matter of debate. This study analysed the timing and outcomes of percutaneous tracheostomy, and reports our experience of a dedicated ENT–anaesthetics department led tracheostomy team.
A prospective single-centre observational study was conducted of patients undergoing tracheostomy, who had been diagnosed with coronavirus disease 2019 pneumonitis, between 21st March and 20th May 2020.
Eighty-one patients underwent tracheostomy after a median (interquartile range) of 16 (13–20) days of invasive mechanical ventilation. Median follow-up duration was 32 (23–40) days. Of patients, 86.7 per cent were successfully liberated from invasive mechanical ventilation in a median (interquartile range) of 12 (7–16) days. Moreover, 68.7 per cent were subsequently discharged from hospital. On univariate analysis, there was no difference in outcomes between early (before day 14) and late (day 14 or later) tracheostomy. The mortality rate was 8.6 per cent and no deaths were tracheostomy related.
Outcomes appear favourable when patients are carefully selected. Percutaneous tracheostomy performed via a multidisciplinary approach, with appropriate training, was safe and optimised healthcare resource utilisation.
The coronavirus disease 2019 (COVID-19) pandemic has led to significant strain on front-line healthcare workers.
In this multicentre study, we compared the psychological outcomes during the COVID-19 pandemic in various countries in the Asia-Pacific region and identified factors associated with adverse psychological outcomes.
From 29 April to 4 June 2020, the study recruited healthcare workers from major healthcare institutions in five countries in the Asia-Pacific region. A self-administrated survey that collected information on prior medical conditions, presence of symptoms, and scores on the Depression Anxiety Stress Scales and the Impact of Events Scale-Revised were used. The prevalence of depression, anxiety, stress and post-traumatic stress disorder (PTSD) relating to COVID-19 was compared, and multivariable logistic regression identified independent factors associated with adverse psychological outcomes within each country.
A total of 1146 participants from India, Indonesia, Singapore, Malaysia and Vietnam were studied. Despite having the lowest volume of cases, Vietnam displayed the highest prevalence of PTSD. In contrast, Singapore reported the highest case volume, but had a lower prevalence of depression and anxiety. In the multivariable analysis, we found that non-medically trained personnel, the presence of physical symptoms and presence of prior medical conditions were independent predictors across the participating countries.
This study highlights that the varied prevalence of psychological adversity among healthcare workers is independent of the burden of COVID-19 cases within each country. Early psychological interventions may be beneficial for the vulnerable groups of healthcare workers with presence of physical symptoms, prior medical conditions and those who are not medically trained.
All sperm accrue varying amounts of DNA damage during maturation and storage, a process that appears to be mediated through oxidative stress. The clinical significance of genetic damage in the male germ line depends upon severity and how that damage is distributed among the sperm population. In human reproduction, the embryo is capable of significant DNA repair, which occurs prior to the first cleavage event. However, when the magnitude of genomic damage reaches pathologic levels, reproductive outcomes begin to be affected. Evidence now exists linking excessive sperm DNA fragmentation with time to pregnancy for natural conception, pregnancy outcomes of intrauterine insemination and in vitro fertilization, and miscarriage rates when intracytoplasmic sperm injection is employed. This review will discuss the pathophysiology of sperm DNA damage, the studies linking it to impaired reproductive outcomes, and how clinicians may render treatment to optimize the chance of paternity for their patients.
Obstructive azoospermia (OA) is a common presenting condition of male infertility, resulting from either congenital or acquired blockage of the reproductive tract. Men facing a diagnosis of OA now have an array of treatment options, including definitive reconstruction and various forms of sperm retrieval. The optimum treatment decision for OA will depend on the goals, values, and expectations of the patient and his partner. In this review we will discuss the therapeutic approach to OA, stressing the requirement of a clear and thoughtful plan for staged intervention. Any proposed treatment strategy should optimize the chances of paternity while minimizing damage to the male genitourinary system. Special attention will be paid to the role of microdissection testicular sperm extraction (microTESE), as it is a useful and often underutilized rescue procedure for OA. Specifically, the advantages and disadvantages of microTESE will be evaluated, with particular focus on success rates and safety.
This study surveyed Malaysian aborigine people to determine the prevalence of alcohol abuse dependence, psychiatric morbidity and psychosocial correlates among Malaysians aborigines. Studies among minority group in developed nations repeatedly showed severe drinking problems (Lomnitz, 1976; Gordon, 1978; Karno et al, 1987; Yamamoto et al, 1993).
Household survey with informed consent taken. Selected household were chosen and orang asli (aborigines) age 18 above were interviewed in Kuala Betis areas. Alcohol screening used AUDIT questionnaires and Psychiatric morbidity measured by MINI. Odds ratio was used as measures of the association for the variables. The data analysis was done using SPSS version. 276 orang asli were interviewed during the study. Majority are within age group of 18-29 years of age (37%) with the mean age 36.51 years old. The M: F (50.7% and 49.3%). Senoi ethnic group is the majority (97.8%). 28% has no formal education and 58% received primary school education.
Majority are married (82.2%). Half of them are employed and more than half received less than RM 500 monthly (USD 150). Types of alcohol use mainly beer and whisky. 90.24% have AUDIT score less than 7.
Multivariate analysis showed only those employed are significantly associated with alcohol problems, Odds ratio= 0.089, 95% CI (0.033-0.246), P< 0.001.
Prevalence of alcohol use among orang asli is comparable with general population. Employed people may have more money to buy alcoholic beverages. Orang asli probably need more attention on awareness program and further interventions.
The aim of this study is to investigate the “Hospital Service providers” perception, attitude and actual practice in managing schizophrenia in Malaysia.
In this study, it was designed as a mixed -methods study. in the first phase, quantitative surveys have been implemented among 42 service providers. in the second phase, the descriptive qualitative study method was also used.
The questionnaires designed to gather the data relating to the respondent satisfied in managing Schizophrenia in Malaysia. Thirty five (or 83.3%) of the respondents are satisfied with the current Schizophrenic overall management, but twenty one (or 50.1%) of the respondents does not satisfy with current psychosocial interventions available in Malaysia. The qualitative found that, the psychiatrists responded that they are satisfied with current use of atypical antipsychotic in the hospitals but they are concerned with the lack of community services particularly in the university hospitals. The medical officers and general practitioners responded that they received many patients who were brought by their families to see them in outpatient clinic. However, many doctors failed to diagnose the disorder as they have a lack of training in diagnosing mental illness diseases. This is mainly due to misperception about mental illness particularly in rural areas among the Malay population.
The study concluded that more community awareness program needs to be done which emphasis on mental illness to reduce the duration of untreated illness and ensure active roles of family members in supervision of treatment.
Studies have shown higher rate of various psychiatric disorders among individuals with substance abuse / dependence. There is little data in developing countries, such as Pakistan, on prevalence of psychiatric co-morbidity in this population and impact on treatment.
To assess the psychiatric co-morbidity among individuals with substance dependence and to determine its demographic associations in patients with substance dependence in Pakistan.
This was a descriptive study conducted at a tertiary care hospital in Pakistan. Participants were 588 individuals with substance dependence admitted to a tertiary care hospital in Pakistan, mainly in male inpatient substance dependence unit. The patients were assessed for psychiatric co-morbidity using DSM IV criteria. Informed consent was obtained. The study was approved by the Institutional Research Committee. The results were obtained by using chi square test on SPSS 17.
Out of 588, 200 patients (34%) were found co-morbid with other psychiatric disorders along with substance dependence. Reason of first substance use and history of previous substance dependence were observed to be significantly associated with co-morbid psychiatric disorders, x2 (48, n = 549) = 112.396, p < 0.01 and x2 (18, n = 588) = 29.66, p = 0.041 respectively.
1. There was high rate of psychiatric co-morbidity among individuals with substance dependence in this sample.
2. Depression, personality disorders and anxiety disorders were the major co-morbid diagnosis among this population.
Cold dissection is the most commonly used tonsillectomy technique, with low post-operative haemorrhage rates. Coblation is an alternative technique that may cause less pain, but could have higher post-operative haemorrhage rates.
This study evaluated the peri-operative outcomes in paediatric tonsillectomy patients by comparing coblation and cold dissection techniques.
A systematic review was conducted of all comparative studies of paediatric coblation and cold dissection tonsillectomy, up to December 2018. Any studies with adults were excluded. Outcomes such as pain, operative time, and intra-operative, primary and secondary haemorrhages were recorded.
Seven studies contributed to the summative outcome. Coblation tonsillectomy appeared to result in less pain, less intra-operative blood loss (p < 0.01) and a shorter operative time (p < 0.01). There was no significant difference between the two groups for post-operative haemorrhage (p > 0.05).
The coblation tonsillectomy technique may offer better peri-operative outcomes when compared to cold dissection, and should therefore be offered in paediatric cases, before cold dissection tonsillectomy.
There is increasing interest in the clinical and aetiological overlap between autism spectrum disorders and schizophrenia spectrum disorders, reported to co-occur at both diagnostic and trait levels. Individually, sub-clinical autistic and psychotic traits are associated with poor clinical outcomes, including increased depressive symptomatology, self-harming behaviour and suicidality. However, the implications when both traits co-occur remain poorly understood. The study aimed to (1) examine the relationship between autistic and psychotic traits and (2) determine if their co-occurrence increases depressive symptomatology, self-harm and suicidality.
Cross-sectional data from a self-selecting (online and poster advertising) sample of the adult UK population (n = 653) were collected using an online survey. Validated self-report measures were used to assess sub-clinical autistic and psychotic traits, depressive symptomatology, self-harming behaviour and suicidality. Correlation and regression analyses were performed.
A positive correlation between sub-clinical autistic and positive psychotic traits was confirmed (rs = 0.509, p < 0.001). Overall, autistic traits and psychotic traits were, independently, significant predictors of depression, self-harm and suicidality. Intriguingly, however, depression was associated with a negative interaction between the autistic domain attention to detail and psychotic traits.
This study supports previous findings that sub-clinical autistic and psychotic traits are largely independently associated with depression, self-harm and suicidality, and is novel in finding that their combined presence has no additional effect on depression, self-harm or suicidality. These findings highlight the importance of considering both autistic and psychotic traits and their symptom domains in research and when developing population-based depression prevention and intervention strategies.
Simultaneous PET/MR/EEG (Positron Emission Tomography – Magnetic Resonance – Electroencephalography), a new tool for the investigation of neuronal networks in the human brain, is presented here within the framework of the European Union Project TRIMAGE. The trimodal, cost-effective PET/MR/EEG imaging tool makes use of cutting edge technology both in PET and in MR fields. A novel type of magnet (1.5T, non-cryogenic) has been built together with a PET scanner that makes use of the most advanced photodetectors (i.e., SiPM matrices), scintillators matrices (LYSO) and digital electronics. The combined PET/MR/EEG system is dedicated to brain imaging and has an inner diameter of 260 mm and an axial Field-of-View of 160 mm.
It enables the acquisition and assessment of molecular metabolic information with high spatial and temporal resolution in a given brain simultaneously. The dopaminergic system and the glutamatergic system in schizophrenic patients are investigated via PET, the same physiological/pathophysiological conditions with regard to functional connectivity, via fMRI, and its electrophysiological signature via EEG. In addition to basic neuroscience questions addressing neurovascular-metabolic coupling, this new methodology lays the foundation for individual physiological and pathological fingerprints for a wide research field addressing healthy aging, gender effects, plasticity and different psychiatric and neurological diseases.
The preliminary performances of two components of the imaging tool (PET and MR) are discussed. Initial results of the search of possible candidates for suitable schizophrenia biomarkers are also presented as obtained with PET/MR systems available to the collaboration.
There is a scarcity of specialist trainers and supervisors for psychosocial interventions in low- and middle-income countries. A cascaded model of training and supervision was developed to sustain delivery of an evidence-based peer-delivered intervention for perinatal depression (the Thinking Healthy Programme) in rural Pakistan. The study aimed to evaluate the model.
Mixed methods were employed as part of a randomised controlled trial of the intervention. Quantitative data consisted of the peers' competencies assessed during field training and over the implementation phase of the intervention, using a specially developed checklist. Qualitative data were collected from peers and their trainers through 11 focus groups during the second and third year of intervention rollout.
Following training, 43 peers out of 45 (95%) achieved at least a ‘satisfactory’ level of competency (scores of ⩾70% on the Quality and Competency Checklist). Of the cohort of 45 peers initially recruited 34 (75%) were retained over 3 years and showed sustained or improved competencies over time. Qualitatively, the key factors contributing to peers' competency were use of interactive training and supervision techniques, the trainer–peer relationship, and their cultural similarity. The partnership with community health workers and use of primary health care facilities for training and supervision gave credibility to the peers in the community.
The study demonstrates that lay-workers such as peers can be trained and supervised to deliver a psychological intervention using a cascaded model, thus addressing the barrier of scarcity of specialist trainers and supervisors.
Hill (Twin Research and Human Genetics, Vol. 21, 2018, 84–88) presented a critique of our recently published paper in Cell Reports entitled ‘Large-Scale Cognitive GWAS Meta-Analysis Reveals Tissue-Specific Neural Expression and Potential Nootropic Drug Targets’ (Lam et al., Cell Reports, Vol. 21, 2017, 2597–2613). Specifically, Hill offered several interrelated comments suggesting potential problems with our use of a new analytic method called Multi-Trait Analysis of GWAS (MTAG) (Turley et al., Nature Genetics, Vol. 50, 2018, 229–237). In this brief article, we respond to each of these concerns. Using empirical data, we conclude that our MTAG results do not suffer from ‘inflation in the FDR [false discovery rate]’, as suggested by Hill (Twin Research and Human Genetics, Vol. 21, 2018, 84–88), and are not ‘more relevant to the genetic contributions to education than they are to the genetic contributions to intelligence’.
UK guidelines recommend routine HIV testing in high prevalence emergency departments (ED) and targeted testing for HBV and HCV. The ‘Going Viral’ campaign implemented opt-out blood-borne virus (BBV) testing in adults in a high prevalence ED, to assess seroprevalence, uptake, linkage to care (LTC) rates and staff time taken to achieve LTC. Diagnosis status (new/known/unknown), current engagement in care, and severity of disease was established. LTC was defined as patient informed plus ⩾1 clinic visit. A total of 6211/24 981 ED attendees were tested (uptake 25%); 257 (4.1%) were BBV positive (15 co-infected), 84 (33%) required LTC. 100/147 (68%) HCV positives were viraemic; 44 (30%) required LTC (13 new, 16 disengaged). 26/54 (48%) HBV required LTC (seven new, 11 disengaged). 16/71 (23%) HIV required LTC (10 new, five disengaged). 26/84 (31%) patients requiring LTC had advanced disease (CD4 <350, APRI (AST-to-Platelet Ratio Index) >1, Fibroscan F3/F4 or liver cancer), including five with AIDS-defining conditions and three hepatocellular carcinomas. There were five BBV-related deaths. BBV prevalence was high (4.1%); most were HCV (2.4%). HIV patients were more successfully and quickly LTC than HBV or HCV patients. ED testing was valuable as one-third of those requiring LTC (new, disengaged or unknown status patients) had advanced disease.