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Childhood abuse is a risk factor for poorer illness course in bipolar disorder, but the reasons why are unclear. Trait-like features such as affective instability and impulsivity could be part of the explanation. We aimed to examine whether childhood abuse was associated with clinical features of bipolar disorder, and whether associations were mediated by affective instability or impulsivity.
We analysed data from 923 people with bipolar I disorder recruited by the Bipolar Disorder Research Network. Adjusted associations between childhood abuse, affective instability and impulsivity and eight clinical variables were analysed. A path analysis examined the direct and indirect links between childhood abuse and clinical features with affective instability and impulsivity as mediators.
Affective instability significantly mediated the association between childhood abuse and earlier age of onset [effect estimate (θ)/standard error (SE): 2.49], number of depressive (θ/SE: 2.08) and manic episodes/illness year (θ/SE: 1.32), anxiety disorders (θ/SE: 1.98) and rapid cycling (θ/SE: 2.25). Impulsivity significantly mediated the association between childhood abuse and manic episodes/illness year (θ/SE: 1.79), anxiety disorders (θ/SE: 1.59), rapid cycling (θ/SE: 1.809), suicidal behaviour (θ/SE: 2.12) and substance misuse (θ/SE: 3.09). Measures of path analysis fit indicated an excellent fit to the data.
Affective instability and impulsivity are likely part of the mechanism of why childhood abuse increases risk of poorer clinical course in bipolar disorder, with each showing some selectivity in pathways. They are potential novel targets for intervention to improve outcome in bipolar disorder.
Pregnancy and childbirth are a period of high risk for women with bipolar disorder and involve difficult decisions particularly about continuing or stopping medications.
To explore what clinical predictors may help to individualise the risk of perinatal recurrence in women with bipolar disorder.
Information was gathered retrospectively by semi-structured interview, questionnaires and case-note review from 887 women with bipolar disorder who have had children. Clinical predictors were selected using backwards stepwise logistic regression, conditional permutation random forests and reinforcement learning trees.
Previous perinatal history of affective psychosis or depression was the most significant predictor of a perinatal recurrence (odds ratio (OR) = 8.5, 95% CI 5.04–14.82 and OR = 3.6, 95% CI 2.55–5.07 respectively) but even parous women with bipolar disorder without a previous perinatal mood episode were at risk following a subsequent pregnancy, with 7% developing postpartum psychosis.
Previous perinatal history of affective psychosis or depression is the most important predictor of perinatal recurrence in women with bipolar disorder and can be used to individualise risk assessments.
North American studies show bipolar disorder is associated with elevated
rates of problem gambling; however, little is known about rates in the
different presentations of bipolar illness.
To determine the prevalence and distribution of problem gambling in
people with bipolar disorder in the UK.
The Problem Gambling Severity Index was used to measure gambling problems
in 635 participants with bipolar disorder.
Moderate to severe gambling problems were four times higher in people
with bipolar disorder than in the general population, and were associated
with type 2 disorder (OR = 1.74, P = 0.036), history of
suicidal ideation or attempt (OR = 3.44, P = 0.02) and
rapid cycling (OR = 2.63, P = 0.008).
Approximately 1 in 10 patients with bipolar disorder may be at moderate
to severe risk of problem gambling, possibly associated with suicidal
behaviour and a rapid cycling course. Elevated rates of gambling problems
in type 2 disorder highlight the probable significance of modest but
unstable mood disturbance in the development and maintenance of such
To investigate GPs’ beliefs about complementary and alternative medicine (CAM) and its role in clinical practice.
Despite the prevalence of CAM in the United Kingdom, little is known about GPs beliefs regarding these alternative approaches to patient management and how they view it in relation to their clinical conduct and practice.
A qualitative study conducted on 19 GPs recruited from the North West of England. Semi-structured telephone interviews were analysed using an inductive thematic analysis.
Three themes emerged from the data: limited evidence base, patient demand and concerns over regulation.
Despite recognising the limited evidence base of CAM, GPs continue to see a role for it within clinical practice. This is not necessarily led by patient demand that is highly related to affluence. However, GPs raised concerns over the regulation of CAM practitioners and CAM therapies.
Multiple salmonellosis outbreaks have been linked to contaminated tomatoes. We investigated a multistate outbreak of Salmonella Typhimurium infections among 190 cases. For hypothesis generation, review of patients' food histories from four restaurant-associated clusters in four states revealed that large tomatoes were the only common food consumed by patients. Two case-control studies were conducted to identify food exposures associated with infections. In a study conducted in nine states illness was significantly associated with eating raw, large, round tomatoes in a restaurant [matched odds ratio (mOR) 3·1, 95% confidence interval (CI) 1·3–7·3]. In a Minnesota study, illness was associated with tomatoes eaten at a restaurant (OR 6·3, mid-P 95% CI 1·05–50·4, P=0·046). State, local and federal regulatory officials traced the source of tomatoes to Ohio tomato fields, a growing area not previously identified in past tomato-associated outbreaks. Because tomatoes are commonly eaten raw, prevention of tomato contamination should include interventions on the farm, during packing, and at restaurants.
Electroless (chemical) copper deposition, followed by electrolytic (galvanic) copper deposition, is used to construct electrical interconnects for electronic components on insulating substrate materials. As smooth substrates, such as glass or flexible materials like polyimide or polyethylene terephthalate, are used increasingly, achieving the required level of adhesion becomes more difficult. The film strain is one key variable that influences film adhesion. Standard X-ray diffraction based strain analysis was adapted for in situ strain monitoring during and after wet-chemical copper deposition. The results show that adding nickel suppresses an initial compressive strain that frequently appears in Ni-free baths. Adding ruthenium complexes to a standardized electroless copper formulation gradually shifts the strain from tensile to compressive. Spontaneous recrystallization at room temperature was monitored in detail for films obtained by direct current galvanic copper plating.
The potential of bio-dielectrics for thin film transistor applications was explored via the incorporation of titanium dioxide (TiO2) nanoparticles, rutile form, a high dielectric constant (ε) ceramic, in the deoxyribonucleic acid (DNA) bio-polymer. The DNA-ceramic hybrid films were fabricated from stable suspensions of the TiO2 nanoparticles in viscous, aqueous DNA solutions. Dielectric characterization revealed that the incorporation of TiO2 in DNA resulted in enhanced dielectric constant (14.3 at 1 kHz for 40 wt % TiO2) relative to that of DNA in the entire frequency range of 1 kHz-1 MHz. Variable temperature dielectric measurements, in the 20-80°C range, of the DNA-TiO2 films revealed that the ceramic additive stabilizes DNA against large temperature dependent variations in both ε and the dielectric loss factor tan δ. The bulk resistivity of the DNA-TiO2 hybrid films was measured to be two to three orders of magnitude higher than that of the control DNA films, indicating their potential for utilization as insulating dielectrics in transistor and capacitor applications.
Casadesus and colleagues make a case that hormonal changes associated with the dysregulation of the hypothalamic-pituitary-gonadal (HPG) axis following menopause/andropause are implicated in the pathogenesis of Alzheimer's disease (AD). Experimental support for this postulate has come from studies demonstrating an increase in amyloid-β (Aβ) deposition following ovariectomy/castration. Because sex steroids and gonadotropins are both part of the HPG feedback loop, decrements in sex steroids result in a proportionate increase in gonadotropins. They provide a review of the basic science relevant to luteinizing hormone (LH) and its receptor as a background for considering LH regulation of cognitive behaviors and AD pathology. Results of their analyses suggest that marked increases in serum LH following menopause/andropause is a physiologically relevant signal that could increase Aβ secretion and deposition in the aging brain. Suppression of the age-related increase in serum gonadotropins using anti-gonadotropin agents, such as leuprolide, is proposed as a novel therapeutic strategy for AD.
To determine the level of agreement between patients and expert physicians in whether criterion multisomatoform (MSD) symptoms are explained.
We systematically collected reports from 280 primary care patients about whether they had suffered from any of 15 criterion MSD symptoms in the past month and whether they had received a medical explanation from a physician for positive criterion symptoms. The research team compared MSD symptom diagnoses derived from patient report with MSD symptom diagnoses derived from an expert physician report.
MSD symptom diagnoses derived from patient report had 98.7% sensitivity, 97.9% specificity, 89.3% positive predictive value, and 99.7% negative predictive value compared with MSD symptom diagnoses derived from an expert physician report. Analysis demonstrated that 15.0% of patients met symptom criteria for MSD, according to patient and physician report; 83.0% failed to meet symptom criteria for MSD, according to patient and physician report; 1.8% of patients met symptom criteria for MSD, according to patient report but not physician report, while 0.2% met symptom criteria for MSD according to physician report but not by patient report.
Patients demonstrated high agreement with a physician expert in somatization about whether criterion MSD symptoms are explained, suggesting revised screeners may accurately identify somatizing patients.
In developing public policy on food safety, systematic identification and thorough investigation
of all general outbreaks is necessary in order to avoid bias towards highly publicised
outbreaks. In Wales, from 1986 to 1998, 87 general foodborne outbreaks of salmonellosis were
identified. Most outbreaks occurred at functions or were associated with small catering outlets
such as bakeries and sandwich bars. In 50 outbreaks, a vehicle of infection was confirmed
microbiologically and/or epidemiologically. The most common food vehicles were those
containing shell eggs. Salmonella enteritidis outbreaks were significantly more likely than
outbreaks of other serotypes to be associated with vehicles containing shell eggs, suggesting
that eggs were also the source of infection in many outbreaks. The routine use of analytical
epidemiological studies to identify vehicles in outbreaks is recommended.
Background. Chronic fatigue syndrome (CFS) patients often
complain that they are more
susceptible to acute mental fatigue. It is important to determine whether
this is observed using
objective tests of sustained attention and responding.
Methods. Sixty-seven patients who fulfilled the criteria for
CFS proposed by Sharpe et al. (1991)
were compared with 126 matched healthy controls. Acute fatigue was assessed
performance at the start and end of a lengthy test session and by examining
changes over the course
of individual tasks.
Results. CFS patients showed impaired performance compared
to the controls and these differences
increased as the volunteers developed acute fatigue. In addition, differences
between the two groups
were larger at the end of the test session.
Conclusions. The present results show that CFS patients are
more susceptible to acute fatigue than
healthy controls. This could reflect motor fatigue or an inability to compensate
for fatigue with
increased effort. This profile is consistent with previous research on
fatigue and suggests that
interpretation of certain aspects of CFS may be helped by considering it
as the end point of a
continuum of fatigue rather than a distinct disease.
The synthesis of high surface area (TiO2)0.18(SiO2)0.82xerogels has been achieved using the sol-gel route. Heptane washing was used before the drying stage to minimise capillary pressure and hence preserve pore structure and maximise the surface area. The as-prepared xerogels were tested for their catalytic activity using the epoxidation of cyclohexene with tert-butyl hydrogen peroxide (TBHP) as a test reaction. Surface areas up to 450 m2g-1 were achieved with excellent selectivities and reasonable percent conversions. SAXS data has identified that heptane washing during drying, in general, results in a preservation of the pore structure, and produces more effective catalysts with higher surface areas and larger pore diameters. Fr-IR spectroscopy has revealed that the catalytic activity is dependant upon the number of Si-O-Ti linkages, inferring intimate mixing of the precursors at the atomic level. XANES data reveals the presence of reversible 4/6-fold Ti sites that are thought to be ‘active’ catalytic sites. The most effective catalyst was produced with a calcination temperature of 500°C, and a heating rate of 5 °Cmin-l