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Background: There is little data to inform the treatment of severe obsessive compulsive disorder (OCD) in an inpatient or residential setting. Aims: This paper aimed to: a) describe treatment outcomes at a residential unit over 11 years; b) investigate whether treatment was successful for a subset of severe treatment refractory residents; c) compare an intensive treatment programme to a “standard” treatment programme; and d) find predictors of self or early discharge from the unit. Method: We compared treatment outcomes for (i) a minimum 12-week treatment (hereafter “standard”) programme versus a 2-week intensive programme and (ii) for severe treatment refractory cases on the standard programme. We identified 472 residents with OCD admitted to the Anxiety Disorders Residential Unit at the Bethlem Royal Hospital between 2001 and 2012. Outcomes were measured with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Obsessive Compulsive Inventory (OCI), Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) obtained throughout treatment and up to one year after discharge. Results: Although residents had very severe OCD on admission, sequential assessment with the Y-BOCS, OCI, BAI and BDI demonstrated that scores on all outcome measures significantly decreased from pre to posttreatment and were generally maintained at follow-up. There was no significant difference between those on the standard or the 2-week intensive programme. Sixty-nine per cent of residents with OCD made significant improvements, with at least a 25% reduction on the Y-BOCS. There were predictors of self or early discharge but none for outcome on the Y-BOCS. Conclusions: The data support the principle of stepped care for severe OCD.
The Generalized Anxiety Inventory (GAI) has been developed for use in the assessment of anxiety symptoms in older adults (≥ 65 years), but previous validation work has not examined the psychometric qualities of the instrument in relation to treatment. The objective of this study was to examine the performance of the GAI for its internal reliability, convergent and divergent validity, and its sensitivity to treatment.
Elderly patients with generalized anxiety disorder (GAD) participated in a 10-week double-blind study of duloxetine treatment for patients with GAD. Anxiety symptoms were assessed with the Hamilton Anxiety Rating Scale (HAMA), the Hospital Anxiety and Depression Scale (HADS) anxiety and depression subscales, and the GAI. Internal reliability of the GAI was assessed with Cronbach's α. Correlations among the HAMA, HADS, and GAI scores were analyzed to determine convergent and divergent validity. Patients were also compared on remission status using recommended cut-off scores for the GAI.
Patients with GAD, who were at least 65 years of age, were randomly assigned to double-blind treatment with either duloxetine (N = 151) or placebo (N = 140) for 10 weeks acute therapy. The mean change on the GAI was significantly greater with duloxetine compared with placebo treatment (−8.36 vs. −4.96, respectively, p ≤ 0.001). The GAI demonstrated good internal consistency, good convergent and divergent validity, but suggested cut-off values for caseness with the GAI did not correspond to remission status as measured by the HAMA.
Within an elderly patient population with GAD, the GAI demonstrated sound psychometric qualities and sensitivity to change with treatment.
Sufficient dairy food consumption during adolescence is necessary for preventing disease. While socio-economically disadvantaged adolescents tend to consume few dairy foods, some eat quantities more in line with dietary recommendations despite socio-economic challenges. Socio-economic variations in factors supportive of adolescents’ frequent dairy consumption remain unexplored. The present study aimed to identify cross-sectional and longitudinal associations between intrapersonal, social and environmental factors and adolescents’ frequent dairy consumption at baseline and two years later across socio-economic strata, and to examine whether socio-economic position moderated observed effects.
Online surveys completed at baseline (2004–2005) and follow-up (2006–2007) included a thirty-eight-item FFQ and questions based on social ecological models examining intrapersonal, social and environmental dietary influences.
Thirty-seven secondary schools in Victoria, Australia.
Australian adolescents (n 1201) aged 12–15 years, drawn from a sub-sample of 3264 adolescents (response rate=33 %).
While frequent breakfast consumption was cross-sectionally associated with frequent dairy consumption among all adolescents, additional associated factors differed by socio-economic position. Baseline dairy consumption longitudinally predicted consumption at follow-up. No further factors predicted frequent consumption among disadvantaged adolescents, while four additional factors were predictive among advantaged adolescents. Socio-economic position moderated two predictors; infrequently eating dinner alone and never purchasing from school vending machines predicted frequent consumption among advantaged adolescents.
Nutrition promotion initiatives aimed at improving adolescents’ dairy consumption should employ multifactorial approaches informed by social ecological models and address socio-economic differences in influences on eating behaviours; e.g. selected intrapersonal factors among all adolescents and social factors (e.g. mealtime rules) among advantaged adolescents.
Most studies of post-traumatic stress disorder (PTSD) in low- and
middle-income countries (LMICs) have focused on ‘high-risk’ populations
defined by exposure to trauma.
To estimate the prevalence of post-traumatic stress disorder (PTSD) in a
LMIC, the conditional probability of PTSD given a traumatic event and the
strength of associations between traumatic events and other psychiatric
Our sample contained a mix of 3995 twins and 2019 non-twins. We asked
participants about nine different traumatic exposures, including the
category ‘other’, but excluding sexual trauma.
Traumatic events were reported by 36.3% of participants and lifetime PTSD
was present in 2.0%. Prevalence of non-PTSD lifetime diagnosis was 19.1%.
Of people who had experienced three or more traumatic events, 13.3% had
lifetime PTSD and 40.4% had a non-PTSD psychiatric diagnosis.
Despite high rates of exposure to trauma, this population had lower rates
of PTSD than high-income populations, although the prevalence might have
been slightly affected by the exclusion of sexual trauma. There are high
rates of non-PTSD diagnoses associated with trauma exposure that could be
considered in interventions for trauma-exposed populations. Our findings
suggest that there is no unique relationship between traumatic
experiences and the specific symptomatology of PTSD.
Compare the severity of illnesses associated with influenza and noninfluenza acute respiratory illness (ARI) in healthcare personnel (HCP).
Prospective observational cohort.
HCP at 2 healthcare organizations with direct patient contact were enrolled prior to the 2010–2011 influenza season.
HCP who were fewer than 8 days from the start of fever/feverishness/chills and cough were eligible for real-time reverse-transcription polymerase chain reaction influenza virus testing of respiratory specimen. Illness severity was assessed by the sum of self-rated severity (0, absent; 3, severe) of 12 illness symptoms, subjective health (0, best health; 9, worst health), activities of daily living impairment (0, able to perform; 9, unable to perform), missed work, and duration of illness.
Of 1,701 HCP enrolled, 267 were tested for influenza, and 58 (22%) of these tested positive. Influenza compared with noninfluenza illnesses was associated with higher summed 12-symptom severity score (mean [standard deviation], 17.9 [5.4] vs 14.6 [4.8]; P < .001), worse subjective health (4.5 [1.8] vs 4.0 [1.8]; P < .05), greater impairment of activities of daily living (4.9 [2.5] vs 3.8 [2.5]; P < .01), and more missed work (12.1 [10.5] vs 7.8 [10.5] hours; P < .01). Differences in symptom severity, activities of daily living, and missed work remained significant after adjusting for illness and participant characteristics.
Influenza had a greater negative impact on HCP than noninfluenza ARIs, indicated by higher symptom severity scores, less ability to perform activities of daily living, and more missed work. These results highlight the importance of efforts to prevent influenza infection in HCP.
Findings from research that has assessed the influence of dietary factors on child obesity have been equivocal. In the present study, we aimed to test the hypothesis that a positive change in diet quality is associated with favourable changes in BMI z-scores (zBMI) in schoolchildren from low socio-economic backgrounds and to examine whether this effect is modified by BMI category at baseline. The present study utilised data from a subsample (n 216) of the Resilience for Eating and Activity Despite Inequality study, a longitudinal cohort study with data collected in 2007–8 (T1) and 2010–11 (T2) in socio-economically disadvantaged women and children (5–12 years at T1). Dietary data were collected using a FFQ and diet quality index (DQI) scores derived at both time points. The objective measures of weight, height and physical activity (accelerometers) were included. The other variables were reported in the questionnaires. We examined the association between change in DQI and change in zBMI, using linear regression analyses adjusted for physical activity, screen sedentary behaviour and maternal education level both in the whole sample and in the sample stratified by overweight status at baseline. After accounting for potential covariates, change in diet quality was found to be inversely associated with change in zBMI only in children who were overweight at baseline (P= 0·035), thus supporting the hypothesis that improvement in diet quality is associated with a concurrent improvement in zBMI among already overweight children, but not among those with a normal BMI status. The identification of modifiable behaviours such as diet quality that affect zBMI longitudinally is valuable to inform future weight gain prevention interventions in vulnerable groups.
While socio-economically disadvantaged adolescents tend to have poor dietary intakes, some manage to eat healthily. Understanding how some disadvantaged adolescents restrict high-energy foods and beverages may inform initiatives promoting healthier diets among this population. The present investigation aimed to: (i) identify disadvantaged adolescents’ high-energy food and beverage intakes; and (ii) explore cross-sectional and longitudinal associations between intrapersonal, social and environmental factors and disadvantaged adolescents’ high-energy food intakes.
Longitudinal online surveys were completed at baseline (2004–2005) and follow-up (2006–2007), each comprising a thirty-eight-item FFQ and questions examining intrapersonal, social and environmental factors.
Thirty-seven secondary schools in metropolitan and non-metropolitan Victoria, Australia.
Of 1938 adolescents aged 12–15 years participating at both time points, 529 disadvantaged adolescents (whose mothers had low education levels) were included in the present investigation.
At baseline and follow-up, respectively 32 % and 39 % of adolescents consumed high-energy foods less frequently (≤2 high-energy food meals/week); 61 % and 65 % consumed high-energy beverages less frequently (≤1 time/d). More girls than boys had less frequent high-energy food intakes, and baseline consumption frequency predicted consumption frequency at follow-up. Adolescents with less frequent consumption of high-energy foods and beverages seldom ate fast food for main meals, reported reduced availability of high-energy foods at home and were frequently served vegetables at dinner.
Nutrition promotion initiatives could help improve disadvantaged adolescents’ eating behaviours by promoting adolescents and their families to replace high-energy meals with nutritious home-prepared meals and decrease home availability of high-energy foods in place of more nutritious foods.
Progress has been made in designing an anode electrode that can tolerate CO levels of several thousand ppm which are a typical output of a fuel processor consisting of a reformer and water-gas-shift unit only. The combination of a PtMo catalyst that is capable of electrochemically oxidising CO and a PtRu catalyst that can tolerate high levels of CO2 arranged in a bilayer configuration, has been shown to tolerate 2000 ppm CO in H2 with a relatively small loss in fuel cell performance. Further improvements in the ability to tolerate higher levels of CO with lower performance losses are expected due to improved PtMo catalyst design.
The only microchiropteran endemic to the granitic Seychelles, the sheath-tailed bat Coleura seychellensis, is categorized as Critically Endangered on the IUCN Red List. Using bat detectors, the islands of Mahé, Praslin and La Digue were surveyed to establish the current distribution of this species. Although two new roosts were discovered on Mahé, no bats were observed on Praslin and La Digue, and the range of C. seychellensis appears to have further contracted in the last 2 decades. A total of 19 C. seychellensis were counted emerging from or entering three roosts in boulder caves on Mahé during 18 evenings of observations. The bats foraged in open coastal habitat, some of it anthropogenic, and their echolocation calls were also characteristic of bats feeding in open habitat. This study provides no evidence that C. seychellensis is dependent on forest or wetland for foraging. Dietary analysis indicated that C. seychellensis feeds on Coleoptera, Lepidoptera and Diptera. A public education programme to highlight the conservation status of the bat and the consequences of roost disturbance is recommended, together with the urgent need for legal protection of the bats and their roosts.
In his recent exhibit, “Migrations,” photographer Sebastiao Salgado (2000) looks through his camera's eye to tell what he calls “a story of our times,” a story of massive and global movements of people. Most often these people are migrating because they seek refuge from rural poverty, or because they are refugees or displaced persons whose movements are caused by war or other political, ethnic, or religious conflict. Salgado presents haunting images of outstretched hands reaching for a new life that is just out of grasp, hungry children in parched landscapes that yield no food, masses on the move with nowhere to go. These images come from Asia, Africa, Europe, and the Americas. These are not the typical media images of globalization, which associate modernity with progress and prosperity, new technologies, and high-speed travel. We acknowledge the typical modern images, but we also think it critical not to forget Salgado's more disturbing images, which are also images of our times.
Salgado could just as easily have fixed his lens on disturbing scenes in the United States: the hungry and homeless who migrate from shelter to street in search of spare change or a bite to eat, undernourished school children moving from home to school on unsafe streets, gangs of teenagers crossing neighborhood boundaries to mark territory and engage in seemingly senseless battles. In everyday life, these scenes occur in the context of great wealth and plenty that often exists right around the corner.