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UK Biobank is a well-characterised cohort of over 500 000 participants including genetics, environmental data and imaging. An online mental health questionnaire was designed for UK Biobank participants to expand its potential.
Describe the development, implementation and results of this questionnaire.
An expert working group designed the questionnaire, using established measures where possible, and consulting a patient group. Operational criteria were agreed for defining likely disorder and risk states, including lifetime depression, mania/hypomania, generalised anxiety disorder, unusual experiences and self-harm, and current post-traumatic stress and hazardous/harmful alcohol use.
A total of 157 366 completed online questionnaires were available by August 2017. Participants were aged 45–82 (53% were ≥65 years) and 57% women. Comparison of self-reported diagnosed mental disorder with a contemporary study shows a similar prevalence, despite respondents being of higher average socioeconomic status. Lifetime depression was a common finding, with 24% (37 434) of participants meeting criteria and current hazardous/harmful alcohol use criteria were met by 21% (32 602), whereas other criteria were met by less than 8% of the participants. There was extensive comorbidity among the syndromes. Mental disorders were associated with a high neuroticism score, adverse life events and long-term illness; addiction and bipolar affective disorder in particular were associated with measures of deprivation.
The UK Biobank questionnaire represents a very large mental health survey in itself, and the results presented here show high face validity, although caution is needed because of selection bias. Built into UK Biobank, these data intersect with other health data to offer unparalleled potential for crosscutting biomedical research involving mental health.
UK Biobank is a well-characterised cohort of over 500 000 participants that offers unique opportunities to investigate multiple diseases and risk factors.
An online mental health questionnaire completed by UK Biobank participants was expected to expand the potential for research into mental disorders.
An expert working group designed the questionnaire, using established measures where possible, and consulting with a patient group regarding acceptability. Case definitions were defined using operational criteria for lifetime depression, mania, anxiety disorder, psychotic-like experiences and self-harm, as well as current post-traumatic stress and alcohol use disorders.
157 366 completed online questionnaires were available by August 2017. Comparison of self-reported diagnosed mental disorder with a contemporary study shows a similar prevalence, despite respondents being of higher average socioeconomic status than the general population across a range of indicators. Thirty-five per cent (55 750) of participants had at least one defined syndrome, of which lifetime depression was the most common at 24% (37 434). There was extensive comorbidity among the syndromes. Mental disorders were associated with high neuroticism score, adverse life events and long-term illness; addiction and bipolar affective disorder in particular were associated with measures of deprivation.
The questionnaire represents a very large mental health survey in itself, and the results presented here show high face validity, although caution is needed owing to selection bias. Built into UK Biobank, these data intersect with other health data to offer unparalleled potential for crosscutting biomedical research involving mental health.
Declaration of interest
G.B. received grants from the National Institute for Health Research during the study; and support from Illumina Ltd. and the European Commission outside the submitted work. B.C. received grants from the Scottish Executive Chief Scientist Office and from The Dr Mortimer and Theresa Sackler Foundation during the study. C.S. received grants from the Medical Research Council and Wellcome Trust during the study, and is the Chief Scientist for UK Biobank. M.H. received grants from the Innovative Medicines Initiative via the RADAR-CNS programme and personal fees as an expert witness outside the submitted work.
Fat transplantation can be used to fill subcutaneous defects ranging in size from major to minor. Today, many patients are interested in ambulatory procedures with minimal downtime. Small-volume fat transplantation can easily be performed under local anesthesia, allowing the patient to return to public life within one or two days. Although the term may mean different things to different surgeons, small-volume fat transplantation might include augmentation of the malar, nasojugal, and nasolabial areas. These minor lipoaugmentation procedures can be repeated monthly or bimonthly, eventually leading to a significant improvement with minimal time dedicated to recovery.
Small-volume fat transplantation can be performed all over the body but is most commonly used for facial atrophy due to trauma and aging or for traumatic fat dents of the thighs resulting from liposuction or accidents. It is also useful for augmentation of aging hands. Since several small-volume procedures are needed to obtain the best results, patients must be forewarned that they will often see minimal improvement after the first procedure. Augmentation of subcutaneous defects also requires many times the volume of augmentation of cutaneous defects. The comparatively dense dermis requires very little filling volume to achieve a visual improvement, compared to subcutaneous tissue, which often seems to act as a black hole, soaking up filling materials. The physician who moves from injecting dermal fillers into using subcutaneous fillers learns this very quickly.
Small-volume fat transplantation can also be used as part of a combination approach.
In this article we report on reading ability of twin children in kindergarten to Grade 2 as a function of whether members of the pairs are assigned to the same or different classrooms. All analyses were run using mixed model regressions to account for the interdependence between twin pairs. The samples, total N = 1505, are from Australia and the United States. We found a close-to-significant difference in favor of same-class children in kindergarten and Grade 1. However, when results were adjusted to take account of pre-existing differences in disruptive behavior and in preliteracy ability, the class assignment effects disappeared. We suggest that these pre-existing differences, particularly disruptive behavior, are influencing decisions about whether to separate twins or not and also affecting early reading performance, a conclusion supported by significant correlations between the behavioral measures, preliteracy, and school-based reading. We conclude that, on average, early literacy in twins is not directly affected by their assignment to the same or different classrooms.
This study examined implicit semantic and rhyming cues on perception
of auditory stimuli among nonaphasic participants who suffered a lesion of
the right cerebral hemisphere and auditory neglect of sound perceived by
the left ear. Because language represents an elaborate processing of
auditory stimuli and the language centers were intact among these
patients, it was hypothesized that interactive verbal stimuli presented in
a dichotic manner would attenuate neglect. The selected participants were
administered an experimental dichotic listening test composed of six types
of word pairs: unrelated words, synonyms, antonyms, categorically related
words, compound words, and rhyming words. Presentation of word pairs that
were semantically related resulted in a dramatic reduction of auditory
neglect. Dichotic presentations of rhyming words exacerbated auditory
neglect. These findings suggest that the perception of auditory
information is strongly affected by the specific content conveyed by the
auditory system. Language centers will process a degraded stimulus that
contains salient language content. A degraded auditory stimulus is
neglected if it is devoid of content that activates the language centers
or other cognitive systems. In general, these findings suggest that
auditory neglect involves a complex interaction of intact and impaired
cerebral processing centers with content that is selectively processed by
these centers (JINS, 2006, 12, 649–656.)
Distant Proximities: Dynamics Beyond Globalization. By James
N. Rosenau. Princeton: Princeton University Press, 2003. 448p. $65.00
cloth, $24.95 paper.
In this book, James N. Rosenau draws together in a helpful,
systematic way much of his thinking on global governance and
globalization from the past decade. As with other aspects of his work,
it is conceptually creative, detailed, and normative. He believes that
political science needs to move beyond conceptual frameworks where the
nation-state provides the central focus. He justifies this position by
arguing that the “the best way to grasp world affairs today
requires viewing them as an endless series of distant proximities in
which the forces pressing for greater globalization and those inducing
greater localization interactively play themselves out” (p. 2).
Putting these “distant proximities” at the center of our
analysis will challenge distinctions like those between domestic and
foreign affairs or comparative politics and international relations.
This article examines the conditions under which policy discourses can serve as contributing factors to policy change, even in the absence of changes in institutions and interests. It begins with a discussion of the role of ideas in policy analysis and how they can play a "constitutive role" as frames for policy. Drawing on a distinction between "augmentative" discourses that serve to reinforce an existing policy framework and "transformative discourses" that seek to persuade various publics of the need for significant policy change, four types of policy discourse are defined and a methodology is suggested for identifying these types. Two of these types, "challenging" and "truth-seeking," are hypothesized to be more conducive to the occurrence of significant policy change. Drawing then on case studies of policy change in Canada and Germany respectively, the article shows that a "challenging" discourse emerges in both countries, but leads to significant policy change only in Germany. Based on the comparison of the two cases, it is argued that three factors are relevant to whether a challenging discourse is successful or not: a broad consensus among core policy actors on the nature and gravity of the policy problem; the consistency of the discourse with broadly held normative values; and the persuasiveness of the "social facts" brought to bear in favour of proposed new solutions.
The creation and spectacular growth of global, over-the-counter derivatives markets pose a very stern challenge to traditional modes of regulation by nation-states of financial markets. These markets are truly global in that they transcend borders. In fact, derivatives are financial instruments whose very purpose is to take some of the financial risks out of investing across borders. Many derivatives markets do not fall within the jurisdiction of one nation-state alone, but are the potential responsibility of any number of nation-states. Moreover, a relatively small number of complex, global financial services firms dominate these markets, while being active in most of the principal financial centres of the developed and developing world.
Prudential supervision and regulation of these firms and markets thus pose a singular challenge for any given nation-state. If that state is capable only of supervising and regulating the activities of the given global firm within its own territory, it will have a very partial, and arguably, inadequate view of the financial health of that firm. What is more, the nation-state might worry that if its supervision and regulation were to appear too demanding to a given number of global firms, they might simply transfer aspects of their business to another financial centre where the regulatory touch was more to their liking. The signing and execution of over-the-counter derivatives contracts can be physically located in any number of places.
This chapter investigates how two nation-states, the United Kingdom and the US, have responded to the challenge of global derivatives markets.