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Metabolic syndrome (MetS) is associated with reduced life expectancy in patients with affective disorders, however, whether MetS also plays a role before the onset of affective disorder is unknown. We aimed to investigate whether MetS, inflammatory markers or oxidative stress act as risk factors for affective disorders, and whether MetS is associated with increased inflammation and oxidative stress.
We conducted a high-risk study including 204 monozygotic (MZ) twins with unipolar or bipolar disorder in remission or partial remission (affected), their unaffected co-twins (high-risk) and twins with no personal or family history of affective disorder (low-risk). Metabolic Syndrome was ascertained according to the International Diabetes Federation (IDF) criteria. Inflammatory markers and markers of oxidative stress were analyzed from fasting blood and urine samples, respectively.
The affected and the high-risk group had a significantly higher prevalence of MetS compared to the low-risk group (20% v. 15% v. 2.5%, p = 0.0006), even after adjusting for sex, age, smoking and alcohol consumption. No differences in inflammatory and oxidative markers were seen between the three groups. Further, MetS was associated with alterations in inflammatory markers, and oxidative stress was modestly correlated with inflammation.
Metabolic syndrome is associated with low-grade inflammation and may act as a risk factor and a trait marker for affective disorders. If confirmed in longitudinal studies, this suggests the importance of early intervention and preventive approaches targeted towards unhealthy lifestyle factors that may contribute to later psychopathology.
The global ageing population and the long prodromal period for the development of cognitive decline and dementia brings a need to understand the antecedents of both successful and impaired cognitive ageing. It is increasingly apparent that the trajectory of risk-factor change, as well as the level of the risk factor, may be associated with an increased or decreased risk of cognitive decline or dementia.
Our aim was to summarise the published evidence and to generate hypotheses related to risk-factor trajectories and risk of incident cognitive decline or dementia.
We collated data from longitudinal observational studies relating to trajectory of blood pressure, obesity and cholesterol and later cognitive decline or dementia using standard systematic review methodology. The databases MEDLINE, Embase and PsycINFO were searched from inception to 26 April 2018.
Thirteen articles were retained for inclusion. Analytical methods varied. Our summary of the current evidence base suggests that first body mass index and then blood pressure rises and then falls more steeply in those who go on to develop dementia. The evidence for cholesterol was less consistent.
Based on our review we present the hypothesis that weight falls around 10 years and blood pressure around 5 years before diagnosis. Confirmatory work is required. However, characterisation of risk according to combinations and patterns of risk factors may ultimately be integrated into the assessments used to identify those at risk of receiving a diagnosis of cognitive decline or dementia in late life.
In late summer, sometime between cal a.d. 340–405, a hoard of tightly packed, stacked copper-alloy vessels was deposited in the Vale of Pewsey, Wiltshire. The corrosion of the vessels allowed for the preservation of delicate plant macrofossils and pollen. Analysis of this material has provided insights into the date, season and context of this act of structured deposition. A second hoard of similar vessels was deposited in the fourth or fifth century only a few miles away at Wilcot. The hoards and their deposition relate to Romano-British lifeways, at a time when the region was on the cusp of a dramatic period of change. The distribution of late Roman coins and belt fittings offers further insights into the social and economic character of Wiltshire at their times of deposition.
This study explored the concept of ‘giving up’ from the perspective of care staff working in care homes, and their everyday communication and hidden knowledge concerning what they think about this taboo topic and the context it reflects. Moving to a care home is a major transition where cumulative losses can pose risks to mental health in later life. If not recognised, this vulnerability can lead to depression which extends to suicide ideation and behaviours in the form of self-harm and self-neglect. Care homes are a significant place of care until death, yet a discourse of silence means that self-harm and suicide is under-reported or not attended to with specialist expertise. The layperson's concept of an older person ‘giving up’ on life is hardly discussed in the literature. This co-produced qualitative study used an inductive approach to explore this phenomenon through focus groups with 33 care staff across four care homes in South-East England. Findings paint a complex picture, highlighting tensions in providing the right support and creating spaces to respond to such challenging situations. ‘Giving up’ requires skilled detailed assessment to respond to risks alongside improved training and support for paid carers, to achieve a more holistic strategy which capitalises on significant relationships within a wider context.
Despite the fact that urbanisation, population ageing and international migration constitute major societal developments of our time, little attention has been paid to studying them together in a comprehensive manner. In this paper, we argue that, when treating age and ethnicity as practical processes for addressing and identifying with social groups, it is necessary to do so from a ‘doing’ perspective. The question we ask focuses on which social memberships are made relevant or irrelevant in residential environments and how that relevance or irrelevance is established. Drawing upon a quantitative study among individuals of Turkish migrant origin living in Vienna, Austria, we find that it is rather common for the respondents to have been assigned to multiple intersecting social groups and that they were treated unfairly in their own neighbourhoods. However, such ascriptions do not necessarily correspond to objective categorisations of research or subjective identifications. Hence, the discrimination that is present in a neighbourhood does not necessarily lead to decreased place attachment or a diminishing sense of home. In fact, we find that the ‘satisfaction paradox’ is quite common in environmental gerontology and that it may actually intersect with the ‘immigration paradox’. Applying processual intersectionality is not only fruitful for research, it can also improve the conceptualisation of age-friendly cities.
Emerging genetic, ex-vivo, and clinical trial evidence indicates that calcium channel blockers (CCB) can improve mood and cognitive function. The objective of this study was to examine the effect of selective serotonin reuptake inhibitor (SSRI) therapy augmented with CCB on depression and cognitive decline in an elderly population with hypertension.
Prospective study of 296 persons treated with SSRI and antihypertensive drugs. Baseline and two year clinic assessments were used to categorize participants as users of SSRI + CCB (n = 53) or users of SSRI + other antihypertensives (n = 243). Clinic visits were performed up to four times in a ten-year period to assess depression and cognitive function.
The sample mean age was 75.2 ± 5.47 years and 78% of participants were female. At two year follow-up there was a significant group by time interaction showing lower Center for Epidemiological Studies-Depression (CESD) scores in the SSRI + CCB group, F(1,291) = 4.13, p = 0.043, η2p = 0.014. Over ten-years follow-up, SSRI + CCB use was associated with improved general cognitive function (Mini-Mental State Examination: β = 0.97; 95% CI 0.14 to 1.81, p = 0.023) and immediate visual memory (Boston Visual Retention Test: β = 0.69; 95% CI 0.06 to 1.32, p = 0.033).
The findings provide general population evidence that SSRI augmentation with CCB may improve depression and cognitive function.
Urban slums provide suitable conditions for infestation by rats, which harbour and shed a wide diversity of zoonotic pathogens including helminths. We aimed to identify risk factors associated with the probability and intensity of infection of helminths of the digestive tract in an urban slum population of Rattus norvegicus. Among 299 rats, eleven species/groups of helminths were identified, of which Strongyloides sp., Nippostrongylus brasiliensis and, the human pathogen, Angiostrongylus cantonensis were the most frequent (97, 41 and 39%, respectively). Sex interactions highlighted behavioural differences between males and females, as eg males were more likely to be infected with N. brasiliensis where rat signs were present, and males presented more intense infections of Strongyloides sp. Moreover, rats in poor body condition had higher intensities of N. brasiliensis. We describe a high global richness of parasites in R. norvegicus, including five species known to cause disease in humans. Among these, A. cantonensis was found in high prevalence and it was ubiquitous in the study area – knowledge which is of public health importance. A variety of environmental, demographic and body condition variables were associated with helminth species infection of rats, suggesting a comparable variety of risk factors for humans.
Dementia is a neurodegenerative disorder with global impact, with the largest proportion of cases occurring in low- and middle-income countries. It is estimated that there are 46.8 million cases globally with approximately 10 million new cases each year or a new case occurring every 3 sec (Prince et al., 2015). For comparison there are 36.7 million HIV cases with an estimated 2 million new cases each year (WHO, 2017). The rise in dementia prevalence is largely due to population ageing, with the oldest being at highest risk. To date there are no diseases modifying medications for Alzheimer's disease or the other causes of dementia. Academics and research groups are increasingly focused on prevention or delay of dementia (Brayne and Miller, 2017) and a number of organizations now prioritize dementia, indicating a strong and coherent international effort to address this problem. Examples include the World Health Organisation (WHO), which has established a Global Dementia Observatory; the World Dementia Council; the Organisation for Economic Co-operation and Development (OECD); the U.S. National Alzheimer's Project Act (NAPA); and the Global Council on Brain Health.
We report on extensive submillimetre wavelength observations in the CO J = 3-2 and 4-3 lines towards a sample of star formation regions. The observations have been obtained using the Queen Mary College Submillimetre Heterodyne Receiver at the UKIRT 3.8 m telescope. The data include observations and maps of NGC 2024, S88, W3, S140, CRL2591, NGC 2264, K3-50, G35.2-0.74, ρ Oph A, M17, W51, S68, S106, NGC 1333, DR21 and W49. Several new bipolar flow sources have been detected in NGC 2024, S88 and NGC 2264. Comparisons between the spectra in the CO J = 1-0, 2-1, 3-2 and 4-3 transitions will be discussed in terms of their excitation, in particular for the gas in the high velocity line wings, where we have attempted to estimate the densities and relative abundances of the flow material.
Understanding the drivers of recent change at Greenlandic tidewater glaciers is of great importance if we are to predict how these glaciers will respond to climatic warming. A poorly constrained component of tidewater glacier processes is the near-terminus subglacial hydrology. Here we present a novel method for constraining near-terminus subglacial hydrology with application to marine-terminating Kangiata Nunata Sermia in South-west Greenland. By simulating proglacial plume dynamics using buoyant plume theory and a general circulation model, we assess the critical subglacial discharge, if delivered through a single compact channel, required to generate a plume that reaches the fjord surface. We then compare catchment runoff to a time series of plume visibility acquired from a time-lapse camera. We identify extended periods throughout the 2009 melt season where catchment runoff significantly exceeds the discharge required for a plume to reach the fjord surface, yet we observe no plume. We attribute these observations to spatial spreading of runoff across the grounding line. Persistent distributed drainage near the terminus would lead to more spatially homogeneous submarine melting and may promote more rapid basal sliding during warmer summers, potentially providing a mechanism independent of ocean forcing for increases in atmospheric temperature to drive tidewater glacier acceleration.
Use of artificial light resulted in relative independence from the natural light–dark (LD) cycle, allowing human subjects to shift the timing of food intake and work to convenient times. However, the increase in artificial light exposure parallels the increase in obesity prevalence. Light is the dominant Zeitgeber for the central circadian clock, which resides within the hypothalamic suprachiasmatic nucleus, and coordinates daily rhythm in feeding behaviour and metabolism. Eating during inappropriate light conditions may result in metabolic disease via changes in the biological clock. In this review, we describe the physiological role of light in the circadian timing system and explore the interaction between the circadian timing system and metabolism. Furthermore, we discuss the acute and chronic effects of artificial light exposure on food intake and energy metabolism in animals and human subjects. We propose that living in synchrony with the natural daily LD cycle promotes metabolic health and increased exposure to artificial light at inappropriate times of day has adverse effects on metabolism, feeding behaviour and body weight regulation. Reducing the negative side effects of the extensive use of artificial light in human subjects might be useful in the prevention of metabolic disease.
This issue of Byzantine and Modern Greek Studies is special for two reasons: it celebrates forty years of our journal's publication, and it is the first issue to be produced by our new publisher, Cambridge University Press. The issue is dedicated to Anthony Bryer, who was appointed to teach Byzantine History at Birmingham in 1964. Bryer was one of the leading figures in the creation of the journal and has been a member of the editorial board ever since the first issue appeared in 1975; he also served as the Business Editor from 1984 to 1994.
Background: Transient ischemic attack (TIA) and minor stroke are associated with a substantial risk of subsequent stroke; however, there is uncertainty about whether such patients require admission to hospital for their initial management. We used data from a clinical stroke registry to determine the frequency and predictors of hospitalization for TIA or minor stroke across the province of Ontario, Canada. Methods: The Ontario Stroke Registry collects information on a population-based sample of all patients seen in the emergency department with acute stroke or TIA in Ontario. We identified patients with minor ischemic stroke or TIA included in the registry between April 1, 2008, and March 31, 2011, and used multivariable analyses to evaluate predictors of hospitalization. Results: Our study sample included 8540 patients with minor ischemic stroke or TIA, 47.2% of whom were admitted to hospital, with a range of 37.6% to 70.3% across Ontario’s 14 local health integration network regions. Key predictors of admission were preadmission disability, vascular risk factors, presentation with weakness, speech disturbance or prolonged/persistent symptoms, arrival by ambulance, and presentation on a weekend or during periods of emergency department overcrowding. Conclusions: More than one-half of patients with minor stroke or TIA were not admitted to the hospital, and there were wide regional variations in admission patterns. Additional work is needed to provide guidance to health care workers around when to admit such patients and to determine whether discharged patients are receiving appropriate follow-up care.
Psychological interventions may be beneficial in bipolar disorder.
To evaluate the efficacy of psychological interventions for adults with
A systematic review of randomised controlled trials was conducted.
Outcomes were meta-analysed using RevMan and confidence assessed using
the GRADE method.
We included 55 trials with 6010 participants. Moderate-quality evidence
associated individual psychological interventions with reduced relapses
at post-treatment (risk ratio (RR) = 0.66, 95% CI 0.48–0.92) and
follow-up (RR = 0.74, 95% CI 0.63–0.87), and collaborative care with a
reduction in hospital admissions (RR =0.68, 95% CI 0.49–0.94).
Low-quality evidence associated group interventions with fewer depression
relapses at post-treatment and follow-up, and family psychoeducation with
reduced symptoms of depression and mania.
There is evidence that psychological interventions are effective for
people with bipolar disorder. Much of the evidence was of low or very low
quality thereby limiting our conclusions. Further research should
identify the most effective (and cost-effective) interventions for each
phase of this disorder.
The Fezzan Project is investigating the last 10,000 years of human settlement, landscape evolution and climatic change in the Germa region in southern Libya. The second season in February–March 1998 comprised interdisciplinary research in archaeology and geography, centred around excavation and survey work carried out at the site of Old Germa. To date, three phases of mud brick buildings have been partially explored. In addition, wider geomorphological study and archaeological survey and fieldwalking were carried out elsewhere in the Germa/Twesh oasis and around el-Hatiya. Numerous sites were discovered, including a new hillfort of Zinchecra type and several valley centre ‘villages’ of Garamantian/Roman date. Artefactual studies were carried out on pottery and lithics, animal bones and seeds. Further work on the subterranean irrigation features, the foggaras, have confirmed their pre-Islamic origins.
The bran and particularly the aleurone fraction of wheat are high in betaine and other physiological methyl donors, which may exert beneficial physiological effects. We conducted two randomised, controlled, cross-over postprandial studies to assess and compare plasma betaine and other methyl donor-related responses following the consumption of minimally processed bran and aleurone fractions (study A) and aleurone bread (study B). For both studies, standard pharmacokinetic parameters were derived for betaine, choline, folate, dimethylglycine (DMG), total homocysteine and methionine from plasma samples taken at 0, 0·5, 1, 2 and 3 h. In study A (n 14), plasma betaine concentrations were significantly and substantially elevated from 0·5 to 3 h following the consumption of both bran and aleurone compared with the control; however, aleurone gave significantly higher responses than bran. Small, but significant, increases were also observed in DMG measures; however, no significant responses were observed in other analytes. In study B (n 13), plasma betaine concentrations were significantly and substantially higher following consumption of the aleurone bread compared with the control bread; small, but significant, increases were also observed in DMG and folate measures in response to consumption of the aleurone bread; however, no significant responses were observed in other analytes. Peak plasma betaine concentrations, which were 1·7–1·8 times the baseline levels, were attained earlier following the consumption of minimally processed aleurone compared with the aleurone bread (time taken to reach peak concentration 1·2 v. 2·1 h). These results showed that the consumption of minimally processed wheat bran, and particularly the aleurone fraction, yielded substantial postprandial increases in plasma betaine concentrations. Furthermore, these effects appear to be maintained when aleurone was incorporated into bread.
The central concern of the present chapter is with the question of why H. G. Adler's literary works failed to find a wider reading public during his own lifetime. My main focus is on the corpus of letters between Adler and Heinrich Böll which are held, respectively, in the German Literary Archive in Marbach, and the Historical Archives of the City of Cologne. Some of this correspondence has only come to light recently, during the process of review and re-archiving of material which survived the physical collapse of the latter institution in 2009. Following the suggestion of Adler's biographer, I also draw on Adler's correspondence with potential publishers. This material constitutes an interesting case study which offers complementary insights into the West German “literary field” of the 1950s and the two authors' interactions with it. I begin by tracing Böll's early career and in so doing refute the claims made by W. G. Sebald with respect to the later Nobel laureate's novel, Der Engel schwieg. This serves me to point up the insights that a consideration of the publication history of creative work can offer in the wider narrative of literary-historical trends and text reception, and, as a point particularly germane to the present chapter, how a writer's correspondence can be utilized in this regard as an invaluable storehouse of empirical material.