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It is unclear if – after symptom onset of a primary case of coronavirus disease-2019 (COVID-19) in a household – ensuing chains of transmissions among household members occur and if household epidemiology of COVID-19 is modified by the different circulating variants. We analysed data of 52 774 household clusters to investigate the day of symptom onset of ensuing cases in households relative to the symptom onset of the primary case within the household. Irrespective of cluster size or age of the primary case, 95% of all secondary household cases had symptom onset within 14 days after the symptom onset of the primary case. Stratification by variant showed that the mean interval from symptom onset of the primary case to the symptom onset of secondary cases decreased significantly from 4.8 days (wildtype) to 4.5 days (alpha) and 4.0 days (delta). Similarly, the cumulative proportion of 95% of secondary cases occurred within 14 days (wild type), 12 days (alpha) and 10 days (delta). Our findings suggest that during dominant delta circulation – apart from rare individual constellations – a 10-day household quarantine after symptom onset of the primary case is sufficient for household contacts who remain COVID-free.
Given the high prevalence and adverse outcomes associated with generalized anxiety disorder (GAD), development and expansion of effective treatment modalities are important. The present study compared the effectiveness of cognitive behavior therapy targeting intolerance of uncertainty (CBT-IU) and selective serotonin reuptake inhibitors (SSRIs) for treating GAD. A total of 30 Iranian patients with GAD (Mage = 25.16 ± 6.73) were randomised to receive either CBT-IU (n = 15) or SSRI (n = 15). Measures included the Structured Clinical Interview for DSM-5 (SCID-5), Penn State Worry Questionnaire (PSWQ), Why Worry-II (WW-II), Intolerance of Uncertainty Scale (IUS), and Negative Problem Orientation Questionnaire (NPOQ). Repeated measures analysis of variance tested differential treatment outcomes. The results of intention-to-treat (ITT) analysis indicated that although both CBT-IU and SSRI were effective treatments for GAD, CBT-IU produced significantly better results than SSRI at post-treatment. This clinical trial provides preliminary cross-cultural support for the treatment of GAD using CBT-IU, with findings suggesting that this non-medication intervention reduces GAD symptoms.
This research reports for the first time the anatomical characteristics of all species belonging to Baccharis subgenus Coridifoliae (Asteraceae). The anatomy and micro-morphology of aerial vegetative organs of ten species: B. albilanosa, B. artemisioides, B. bicolor, B. coridifolia, B. erigeroides, B. napaea, B. ochracea, B. pluricapitulata, B. scabrifolia, and B. suberectifolia are investigated by light and scanning electron microscopy. The number of secretory ducts, crystal morphology, presence or absence of conical nonglandular trichomes, leaves cross-section shape, margin morphology, anticlinal epidermal cell walls shape, and cuticle structure were identified as characters with diagnostic value for species. Similarity cluster analysis allows the formation of three groups based on a percentage of similarity between 45 and 84%. Some species showed differential characteristics as the presence of up to four secretory ducts in the midrib in B. albilanosa; smooth cuticles onboth sides of the leaf epidermis in B. erigeroides; flat midrib shape on both sides of the leaves in B. napaea; and convex–flat midrib shape in B. suberectifolia. The remaining species can be differentiated by a set of anatomical features. Anatomical and histochemical characteristics of stems and leaves provided data to support species identification.
In 2009, the Robert Koch Institute (RKI) and the 16 German federal state public health authorities (PHAs) established a weekly epidemiological teleconference (EpiLag) to discuss infectious disease (ID) events and foster horizontal and vertical information exchange. We present the procedure, discussed ID topics and evaluation results of EpiLag after 10 years. We analysed attendance, duration of EpiLag and the frequency of reported events. Participants (RKI and state PHA) were surveyed regarding their satisfaction with logistics, contents and usefulness of EpiLag (Likert scales). Between 2009 and 2018, RKI hosted 484 EpiLag conferences with a mean duration of 25 min (range: 4–60) and high participation (range: 9–16; mean: 15 PHAs). Overall, 2975 ID events (39% international, 9% national and 52% subnational) were presented (mean: 6.1 per EpiLag), most frequently on measles (18%), salmonellosis (8%) and influenza (5%). All responding participants (14/16 PHAs and 9/9 at RKI) were satisfied with the EpiLag's organization and minutes and deemed EpiLag useful for an overview and information distribution on ID events relevant to Germany. EpiLag is time efficient, easily applicable and useful for a low-threshold event communication. It supports PHAs in crises and strengthens the network of surveillance stakeholders. We recommend its implementation to other countries or sectors.
Expansion of cultivated lands and field management impacts greenhouse gas (GHG) emissions from agriculture soils. Soils naturally cycle GHGs and can be sources or sinks depending on physical and chemical properties affected by cultivation and management status. We looked at how cultivation history influences GHG emissions from subtropical soils. We measured CO2, N2O, and CH4 fluxes, and soil properties from newly converted and continuously cultivated lands during the summer rainy season in calcareous soils from south Florida. Newly converted soils had more soil organic matter (OM), more moisture, higher porosity, and lower bulk density, leading to more GHG emissions compared to historically cultivated soils. Although more nutrients make newly converted lands more desirable for cultivation, conversion of new areas for agriculture was shown to release more GHGs than cultivated lands. Our data suggest that GHG emissions from agricultural soils may decrease over time with continued cultivation.
Intensive care at a psychiatric intensive care unit (PICU) traditionally includes the treatment of severely ill psychiatric patients with suicidal or violent behavior .
A chart review was performed including 100 consecutive inpatients (52% females, age: 45.7 ± 17.8 years) treated at the Viennese PICU between 2008–2009.
Psychopharmacotherapy and the rate of electroconvulsive therapy (ECT) in these patients is reported here.
87% of patients were treated with antipsychotics: 44% with quetiapine (447.7 ± 421 mg), 32% with risperidone (4.3 ± 2.3 mg), 25% with olanzapine (16.9 ± 7.5 mg), 20% with haloperidol (10.5 ± 5.4 mg), 16% with aripiprazole (15 ± 8.4 mg), 6% clozapine (416.7 ± 147.2 mg) and 3% ziprasidone (120 ± 56.6 mg). 36% of patients received treatment with mood stabilizers: 15% with valproic acid, 8% with lamotrigine, 6% with lithium, 4% with pregabaline, 3% with topiramate, 2% with gabapentine and 2% with oxcarbazepine. In 49% of patients antidepressants were prescribed: in 23% selective serotonin reuptake inhibitors, in 12% selective dual acting reuptake inhibitors, in 5% tricyclic antidepressants and in 33% other antidepressants (mostly trazodone or mirtazapine). 84% of patients were treated with benzodiazepines (30.3 ± 22.4 mg diazepam equivalents), in 17% the opioid nalbuphin was applied. Intravenous psychopharmacotherapy was used in 31% of cases. 10% of patients received ECT.
Psychotropic compounds with sedative properties are frequently used at the Viennese PICU. However, the dosages for antipsychotics do not appear to be higher than on normal psychiatric wards.
Tricyclic antidepressants (TCAs) are more likely to cause cardiovascular and neurological toxicity than compared to Selective Serotonin Reuptake Inhibitors (SSRIs).
In a prospective hospital-based cohort study, we addressed the question of severity and outcome of antidepressant self-poisonings in patients who attended the Loghman-Hakim Hospital Poison Center. The severity was judged by impairment of consciousness, the outcome criteria were the requirement of inpatient treatment and endotracheal intubation as well as mortality. The aim of the study was to find out if TCA intoxications require more therapeutic efforts than SSRI intoxications.
From 28 March to 20 May 20 2006, all patients presented to the Poison Center were documented using preformatted forms by three trained nurses blinded to any study hypotheses. From 3.578 intoxications, a number of 334 patients with antidepressant or lithium self-poisoning was identified (9.3% of all poisoning cases; 233 females, 101 males; median age 24 years, min 13, max 70).
As compared to SSRI single-substance intoxications (n = 17), TCA single-substance intoxications (n = 73) were associated with (1) a significantly lower level of consciousness (p = 0.005); (2) a significantly higher admission frequency (80.8% vs. 35.3%; p < 0.001) and (3) a higher intubation frequency (13.7% vs. 0%; p = ns). SSRI multiple-substance intoxications were associated with a significantly lower level of consciousness than SSRI single-substance intoxications (p = 0.042), while there was no significant difference between TCA multiple- and single-substance intoxications.
This study suggests that an overdose with SSRIs results in a more favorable clinical outcome than an overdose with TCAs.
Psychiatric intensive care is supposed to offer treatment and to hold patients with psychiatric illness, if they pose a threat to themselves or to others. Besides treating the underlying psychiatric diagnoses, it is also necessary to take care of severe somatic comorbidity, which is often impeded by patients’ limited ability to cooperate. Treatment often requires the administration of sedative medication and occasionally the use of medical restraints. Involuntary commitment, involuntary treatment and the usage of physical restraints is regulated by national mental health laws. Medical professionals working in the field of psychiatric intensive care must have expert knowledge in the fields of psychopharmacology and intensive care medicine. Treatment concepts should be aimed to provide optimized care for psychiatric inpatients in a potentially life-threatening phase of their illness. This article outlines current clinical practice at the psychiatric intensive care unit of the Medical University of Vienna (Austria). Furthermore, we present diagnoses, diagnostic procedures and specific treatments of a sample of 100 consecutive inpatients treated in the years 2008 and 2009 at this ward.
Psychiatric disorders per se or treatment resistance can cause life-threatening conditions. More than 25 years have passed since the term “psychiatric intensive care unit” (PICU) was introduced in the United Kingdom. This system is comprised of security units for psychiatric patients with suicidal or violent behaviour, providing a locked environment with more resources regarding personnel and care. The PICU concept at the Department of Psychiatry and Psychotherapy in Vienna, Austria, represents a progress towards optimal care of patients with serious psychiatric illnesses who also have critical somatic illnesses. One third of the patients are transferred from inpatient facilities of medical departments such as internal medicine, emergency medicine, trauma surgery or anesthesiology. Our PICU is dedicated to somatically, critically ill patients who have psychiatric symptoms (e.g., agition, aggression, impulsivity, delusions, catatonia, confusion, reduced consciousness, impaired self-reliance) complicating recovery from their critical, somatic condition. Generally, the dosages for antipsychotics are not higher than those at normal psychiatric wards. Benzodiazepine dosages of about 30mg diazepam equivalents per day are frequently used. In the years 2008 and 2009, 10% of all patients at the Viennese PICU were treated with electroconvulsive therapy. Delirium requires immediate therapy of underlying intracerebral pathologies, extracerebral illnesses or toxic features. Involuntary commitment, physical restraints and urinary catheterization were applied in approximately 50% of the patients, nasogastric tube or central venous catheter in 20%. In every case, intensive care nursing, monitoring of vital functions and specific experience at the interface between psychiatry and somatic medicine are required.