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This paper provides specific guidelines for the neurodevelopmental evaluation of children aged birth through 5 years with complex congenital heart disease. There is wide recognition that children with congenital heart disease are at high risk for neurodevelopmental impairments that are first apparent in infancy and often persist as children mature. Impairments among children with complex congenital heart disease cross developmental domains and affect multiple functional abilities. The guidelines provided are derived from the substantial body of research generated over the past 30 years describing the characteristic developmental profiles and the long-term trajectories of children surviving with complex congenital heart conditions. The content and the timing of the guidelines are consistent with the 2012 American Heart Association and the American Academy of Pediatrics scientific statement documenting the need for ongoing developmental monitoring and assessment from infancy through adolescence. The specific guidelines offered in this article were developed by a multidisciplinary clinical research team affiliated with the Cardiac Neurodevelopmental Outcome Collaborative, a not-for-profit organisation established to determine and implement best neurodevelopmental practices for children with congenital heart disease. The guidelines are designed for use in clinical and research applications and offer an abbreviated core protocol and an extended version that expands the scope of the evaluation. The guidelines emphasise the value of early risk identification, use of evidence-based assessment instruments, consideration of family and cultural preferences, and the importance of providing multidimensional community-based services to remediate risk.
During the first months of the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) epidemic in 2020, Spain implemented an initial lockdown period on 15 March followed by a strengthened lockdown period on 30 March when only essential workers continued to commute to work. However, little is known about the epidemic dynamics in different age groups during these periods.
We used the daily number of coronavirus 2019 cases (by date of symptom onset) reported to the National Epidemiological Surveillance Network among individuals aged 15–19 years through 65–69 years. For each age group g, we computed the proportion PrE(g) of individuals in age group g among all reported cases aged 15–69 years during the pre-lockdown period (1−10 March 2020) and the corresponding proportion PrL(g) during two lockdown periods (initial: 25 March−3 April; strengthened: 8–17 April 2020). For each lockdown period, we computed the proportion ratios PR(g) = PrL(g)/PrE(g). For each pair of age groups g1, g2, PR(g1)>PR(g2) implies a relative increase in the incidence of detected SARS-CoV-2 infection in the age group g1 compared with g2 for the lockdown period vs. the pre-lockdown period.
For the initial lockdown period, the highest PR values were in age groups 50–54 years (PR = 1.21; 95% CI: 1.12,1.30) and 55–59 years (PR = 1.19; 1.11,1.27). For the second lockdown period, the highest PR values were in age groups 15–19 years (PR = 1.26; 0.95,1.68) and 50–54 years (PR = 1.20; 1.09,1.31).
Our results suggest that different outbreak control measures led to different changes in the relative incidence by age group. During the initial lockdown period, when non-essential work was allowed, individuals aged 40–64 years, particularly those aged 50–59 years, had a higher relative incidence compared with the pre-lockdown period. Younger adults/older adolescents had an increased relative incidence during the later, strengthened lockdown. The role of different age groups during the epidemic should be considered when implementing future mitigation efforts.
One hypothesis proposed to underlie formal thought disorder (FTD), the incoherent speech is seen in some patients with schizophrenia, is that it reflects impairment in frontal/executive function. While this proposal has received support in neuropsychological studies, it has been relatively little tested using functional imaging. This study aimed to examine brain activations associated with FTD, and its two main factor-analytically derived subsyndromes, during the performance of a working memory task.
Seventy patients with schizophrenia showing a full range of FTD scores and 70 matched healthy controls underwent fMRI during the performance of the 2-back version of the n-back task. Whole-brain corrected, voxel-based correlations with FTD scores were examined in the patient group.
During 2-back performance the patients showed clusters of significant inverse correlation with FTD scores in the inferior frontal cortex and dorsolateral prefrontal cortex bilaterally, the left temporal cortex and subcortically in the basal ganglia and thalamus. Further analysis revealed that these correlations reflected an association only with ‘alogia’ (poverty of speech, poverty of content of speech and perseveration) and not with the ‘fluent disorganization’ component of FTD.
This study provides functional imaging support for the view that FTD in schizophrenia may involve impaired executive/frontal function. However, the relationship appears to be exclusively with alogia and not with the variables contributing to fluent disorganization.
To determine the association between functional impairment, as reported in a lay-administered structured interview (CIDI), and severity of depression, depressive symptoms and risk factors for depression.
We undertook a cross-sectional study of 5442 consecutive attendees at general practices in seven Spanish provinces participating in the PredictD-Spain study on predictors of depression. Participants were administered the depression section of the Composite International Diagnostic Interview (WHO-CIDI 2.1), allowing diagnoses by the ICD-10 and DSM-IV classifications for depressive episodes. Impairment was measured using the CIDI question about whether symptoms seriously interfered with important areas of functioning, such as work or looking after the house and family. We measured a set of 39 known risk factors for depression.
Firstly, the 6-month prevalence of a depressive episode according to ICD-10 was 28.7% (1563) and of major depression according to DSM-IV it was 13.6% (742). Secondly, out of the 1563 patients with a depressive episode according to ICD-10, nearly half (47.9%; n=749) had no impairment in important areas of functioning.
As the ICD-10 criteria for depressive diagnoses do not include the criteria that symptoms cause impairment in social, occupational or other important areas of functioning, a large number of false positive cases are included in reported prevalence rates; and secondly, the measurement of functional impairment, at least operationalized using a lay-administered structured interview such as CIDI, is not enough, in epidemiological research studies, to assess the clinical importance of depressive symptoms.
Functional brain activity has been only studied marginally in schizoaffective disorder (SAD), a disorder whose nosological status is controversial. The present study investigated the prefrontal cortex (PFC) activity of schizomanic patients during performance of a working memory task.
13 schizoaffective patients, with current schizomanic episode (Young> 18); and 26 sex- and age-matched healthy controls underwent functional magnetic resonance imaging (fMRI) while performing baseline, 1-back and 2-back versions of the n-back task. Linear models were used to obtain maps of activations and deactivations in the groups.
During performance of the n-back task, controls showed activation in a cluster of frontal areas and de-activation in the medial orbitofrontal and anterior cingulate cortex. The SAD patients showed significantly less activation in prefrontal areas than the controls. They also showed a marked failure to de-activate in medial frontal cortex. The SAD patients’ impaired task performance was associated with both reduced activation of the dorsolateral PFC and reduced de-activation of the medial frontal areas.
Schizomanic patients show failure of activation in a network of cortical regions, and also a failure to de-activate the ventromedial PFC and anterior cingulate cortex. This latter area corresponds to the one of the components of the 'default mode network´. This pattern of abnormality is similar to that found by our group to characterise schizophrenia (failure to activate and failure to de-activate), but different from that which characterises manic patients (failure to de-activate only).
To describe validation process of the new apathy scale for institutionalized dementia patients (APADEM-NH).
100 elderly, institutionalized patients with diagnosis of probable Alzheimer Disease (AD) (57%), possible AD (13%), AD with cerebral vascular disease (CVD) (17%), Lewy Bodies Dementia (11%) and Parkinson associated to dementia (PDD) (2%). All stages of the disease severity according to the Global Deterioration Scale (GDS) and Clinical Dementia Rating (CDR) were assessed. The Apathy Inventory (AI), Neuropsychiatric Inventory (NPI), Cornell scale for depression, and the tested scale were applied. Re-test and inter-rater reliability was carried out in 50 patients. The feasibility and acceptability, reliability, validity, and measurement precision were analyzed.
APADEM-NH final version consists of 26 items and 3 dimensions: Deficit of Thinking and Self-Generated behaviors (DT): 13 items, Emotional Blunting (EB): 7 items, and Cognitive Inertia (CI): 6 items. Mean application time was 9.56 minutes and 74% of applications were fully computable. All subscales showed floor and ceiling effect lower than 15%. Internal consistency was excellent for each dimension (Cronbach’s α DT = 0.88, α EB = 0.83, α CI= 0.88);Test-retest reliability for the items was kW=0,48-0,92; Inter-rater reliability reached kW values 0.84-1.00; The APADEM-NH total score showed a low/moderate correlation with apathy scales (Spearman ρ, AI =0.33; NPI-Apathy= 0,31), no correlation with depression scales (NPI-Dementia = -0.003; Cornell= 0,10), and high internal validity (ρ =0.69 0.80).
APADEM-NH is a brief, psychometrically acceptable, and valid scale to assess apathy in patients from mild to severe dementia and discerning between apathy and depression.
Depression occurs in a quarter of general practice attendees, relapse is frequent five to 10 years from first presentation and residual disability is common. Estimating overall risk across a range of putative risk factors is fundamental to prevention of depression.
This is a prospective study. As part of the European Predict study, in Málaga (Spain), 9 general practices were recruited. Consecutive attendees aged 18 to 75 were recruited and undertook a detailed interview. Subjects were administered the Composite International Diagnostic Interview (CIDI) depression subscale allowing diagnoses using ICD-10 criteria for depressive episode. For risk factors the interviews included individual-level risk factors and environmental risk factors. All participants completed baseline and follow up assessments at six and 12 months.
A total of 1276 patients were interviewed in the first assessment of the PREDICT study, in Málaga, (Spain) and the response rate of the study one year later was 88%. Out of 1276, 70.5% of the sample is women whilst only 29.5% were men. The sample's mean age was 49 years (SD=15.3). Depression was common amongst this sample of primary care attendees, although point prevalence values varied slightly according to the diagnostic criteria used. The prevalence of ICD-10 Depressive Episode was 38.2% while ICD-10 depressive episode of mild was 3.4% moderate 12% and severe intensity 22.8%.
The high prevalence we found shows that the depressive disorders are a very common problem with the primary care attendees in our area.
The refugee population has been a growing concern to the developed countries in general and to Europe in particular. The recent mass migrations are changing the population that is getting to the psychiatric hospitals, not only culturally but also pathologically. The aim of this study is to characterize the refugee population that contacts with the clinic of transcultural psychiatry in Centro Hospitalar Psiquiátrico de Lisboa, understanding the most frequent pathologies and nationalities. The methods used consisted in analyzing the refugee population that attended a psychotherapeutic group and consultation in the Transcultural clinic of Centro Hospitalar Psiquiátrico de Lisboa during the past year. Analyzing the population, 66 refugees were in contact with the transcultural clinic, 44 of which were men, being the other 22 women, representing a total of 23 countries. The more frequent nationality was Iranian (20) and the most frequent diagnosis was “adjustment disorder and anxiety” (38). We can reach the conclusion that more refugee men contact with our psychiatric hospital than women, accounting for 66, 6% of the total; 30, 3% of the refugees were from Iran, followed by Pakistan with 10, 6%. The fact that the most frequent diagnosis is adjustment disorder and anxiety, accounting for 57, 6% of the sample, seems to point out the extreme stress refugees undergo.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Anorexia nervosa is a disorder of eating behavior that is a major health problem on our society. It is characterized by three main criteria: self-induced starvation, desire for thinness or fear of obesity, and the presence of medical signs and symptoms due to improper feeding. This work is focused on its treatment. The biopsychosocial approach allows the design and application of effective therapeutic strategies and a multidisciplinary team collaboration is essential.
Research of current pharmacological and psychotherapy treatments options of the disease.
Material and methods
Literature review based on articles and publications on this topic.
In anorexia nervosa, it is necessary to establish a therapeutic alliance between doctor and patient. Patient usually feels no motivation to improve. The different treatments options to combine, in terms of the patient status, are: nutritional rehabilitation, cognitive-behavioral, family and interpersonal psychotherapies and pharmacological treatment. It can be carried out at the ambulatory, at the day-hospital or by medical stay, even beyond patient will.
Nowadays, the nutritional rehabilitation is the best treatment established and it is the core treatment. About the psychotherapies, the cognitive-behavioral is the most used because it has exposed better results in all different studies proved and in clinical practices, followed by the family therapy which is the responsible of the patient family's treatment. Pharmacological treatment should not be used systematically and its exclusive use is not enough to resolve anorexia nervosa as there are needed also other treatments combined.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Predictive associations were estimated between socioemotional dispositions measured at 10–17 years using the Child and Adolescent Dispositions Scale (CADS) and future individual differences in white matter microstructure measured at 22–31 years of age. Participants were 410 twins (48.3% monozygotic) selected for later neuroimaging by oversampling on risk for psychopathology from a representative sample of child and adolescent twins. Controlling for demographic covariates and total intracranial volume (TICV), each CADS disposition (negative emotionality, prosociality, and daring) rated by one of the informants (parent or youth) significantly predicted global fractional anisotropy (FA) averaged across the major white matter tracts in brain in adulthood, but did so through significant interactions with sex after false discovery rate (FDR) correction. In females, each 1 SD difference in greater parent-rated prosociality was associated with 0.43 SD greater FA (p < 0.0008). In males, each 1 SD difference in greater parent-rated daring was associated with 0.24 SD lower FA (p < 0.0008), and each 1 SD difference in greater youth-rated negative emotionality was associated with 0.18 SD greater average FA (p < 0.0040). These findings suggest that CADS dispositions are associated with FA, but associations differ by sex. Exploratory analyses suggest that FA may mediate the associations between dispositions and psychopathology in some cases. These associations over 12 years could reflect enduring brain–behavior associations in spite of transactions with the environment, but could equally reflect processes in which dispositional differences in behavior influence the development of white matter. Future longitudinal studies are needed to resolve the causal nature of these sex-moderated associations.
We present the main results from the analysis of the Hα-[NII] emission lines with integral field spectroscopy observations gathered with MEGARA at the GTC of the nearby Seyfert 1.5 galaxy NGC7469. We obtained maps of the ionised gas in the inner 12.5 arcsec × 11.3 arcsec, at spatial scales of 0.62 arcsec, with an unprecedented spectral resolution (R ˜ 20 000). We characterized the kinematics and ionisation mechanism of the distinct kinematic components (Cazzoli et al.2019).
Getting a better understanding of the evolution and nucleosynthetic yields of the most metal-poor stars (Z ≲ 10−5) is critical because they are part of the big picture of the history of the primitive universe. Yet many of the remaining unknowns of stellar evolution lie in the birth, life, and death of these objects. We review stellar evolution of intermediate-mass Z ≤ 10−5 models existing in the literature, with a particular focus on the problem of their final fates. We emphasise the importance of the mixing episodes between the stellar envelope and the nuclearly processed core, which occur after stars exhaust their central He (second dredge-up and dredge-out episodes). The depth and efficiency of these episodes are critical to determine the mass limits for the formation of electron-capture SNe. Our knowledge of these phenomena is not complete because they are strongly affected by the choice of input physics. These uncertainties affect stars in all mass and metallicity ranges. However, difficulties in calibration pose additional challenges in the case of the most metal-poor stars. We also consider the alternative SN I1/2 channel to form SNe out of the most metal-poor intermediate-mass objects. In this case, it is critical to understand the thermally pulsing Asymptotic Giant Branch evolution until the late stages. Efficient second dredge-up and, later, third dredge-up episodes could be able to pollute stellar envelopes enough for the stars to undergo thermal pulses in a way very similar to that of higher initial Z objects. Inefficient second and/or third dredge-up may leave an almost pristine envelope, unable to sustain strong stellar winds. This may allow the H-exhausted core to grow to the Chandrasekhar mass before the envelope is completely lost, and thus let the star explode as an SN I1/2. After reviewing the information available on these two possible channels for the formation of SNe, we discuss existing nucleosynthetic yields of stars of metallicity Z ≤ 10−5 and present an example of nucleosynthetic calculations for a thermally pulsing Super-Asymptotic Giant Branch star of Z = 10−5. We compare theoretical predictions with observations of the lowest [Fe/H] objects detected. The review closes by discussing current open questions as well as possible fruitful avenues for future research.
Suckling lamb meat is traditionally produced in Mediterranean Europe. Breed can affect the quality of the lamb carcass and meat. This study is aimed at comparing the carcass and meat quality between suckling lambs from a local and a non-native dairy breed, Churra and Assaf. Churra is included in the Spanish Protected Geographical Indication (PGI) ‘Lechazo de Castilla y León’, whereas Assaf is not. However, Assaf breeders have requested the inclusion of the breed in the PGI. Carcasses and meat from 16 male lambs (eight Churra and eight Assaf) were used in this study. The lambs were all raised under an intensive rearing system and fed on a milk substitute to minimise maternal influence. The carcasses were evaluated for conformation, fatness, joint and leg tissue proportions and the meat was analysed for composition (i.e. proximate composition, iron, haematin, fatty acids and volatiles) and technological quality traits (i.e. texture, water holding capacity, colour and lipid stability). Churra carcasses were larger than Assaf carcasses. However, the proportions of commercial joints and main tissues did not differ between breeds. Cavity and intermuscular leg fat, but not total leg fat, were higher in Churra carcasses. Churra meat showed a higher proportion of n-6 fatty acids, higher redness and better colour stability during aerobic storage. In contrast, Assaf lamb was more resistant to lipid oxidation after cooking. This is a preliminary study to measure the influence of breed on a wide range of quality characteristics in Churra and Assaf suckling lamb carcass and meat. It may be of relevance for breeders, consumers and food policy makers, setting the basis for future studies that include larger commercial populations.
By means of an endogenous growth model of directed technical change with vertical and horizontal R&D, we study a transitional-dynamics mechanism that is consistent with the changes in the shares of the high- versus the low-tech sectors found in recent European data. Under the hypothesis of a positive shock in the proportion of high-skilled labor, the technological-knowledge bias channel leads to unbalanced sectoral growth with a noticeable shift of resources across sectors. A calibration exercise suggests that the model is able to account for up to from 50 to about 100 percent of the increase in the share of the high-tech sector observed in the data from 1995 to 2007. However, the model predicts that the dynamics of the share of the high-tech sector has no significant impact on the dynamics of the economic growth rate.
Understanding stellar birth requires observations of the clouds in which they form. These clouds are dense and self-gravitating, and in all existing observations, they are molecular with H2 the dominant species and CO the best available. When the abundances of carbon and oxygen are low compared to hydrogen, and the opacity from dust is also low, as in primeval galaxies and local dwarf irregular galaxies CO forms slowly and is easily destroyed, so it cannot accumulate inside dense clouds. Then we lose our ability to trace the gas in regions of star formation and we lose critical information on the temperatures, densities, and velocities of the material that collapses. I will report on high resolution observations with ALMA of CO clouds in the local group dwarf irregular galaxy WLM, which has a metallicity that is 13% of the solar value and 50% lower than the previous CO detection threshold and the properties derived of very small dense CO clouds mapped..
Disk galaxies in cosmological numerical simulations grow by accreting gas from the cosmic web. This gas reaches the external disk, and then spirals in dragged along by tidal forces and/or disk instabilities. The importance of gas infall is as clear from numerical simulations as it is obscure to observations. Extremely metal poor (XMP) galaxies seem to be the best example we have of the gas accretion process at work. They have large off-center starbursts which show significant metallicity drop compared with the host galaxy. This observation is naturally explained as a gas accretion event caught in the act. We present preliminary results of the kinematical properties of the metal poor starbursts in XMPs, which suggest that the starbursts are kinematically decoupled entities within the host galaxy.
Making use of a fiducial set of simulated disc galaxies spanning a wide range of mass, we examine the influence of stellar mass in the radial metallicity gradients and compare to observational trends from Ho et al. (2015).
Interstellar dust is still a dominant uncertainty in Astronomy, limiting precision in e.g., cosmological distance estimates and models of how light is re-processed within a galaxy. When a foreground galaxy serendipitously overlaps a more distant one, the latter backlights the dusty structures in the nearer foreground galaxy.
Such an overlapping or occulting galaxy pair can be used to measure the distribution of dust in the closest galaxy with great accuracy. The STARSMOG program uses Hubble to map the distribution of dust in foreground galaxies in fine (<100 pc) detail. Integral Field Unit (IFU) observations will map the effective extinction curve, disentangling the role of fine-scale geometry and grain composition on the path of light through a galaxy.
The overlapping galaxy technique promises to deliver a clear understanding of the dust in galaxies: geometry, a probability function of dimming as a function of galaxy mass and radius, and its dependence on wavelength.
Models of galaxy formation in a hierarchical universe predict substantial scatter in the halo-to-halo stellar properties, owing to stochasticity in galaxies’ merger histories. Currently, only few detailed observations of galaxy’s halos are available, mainly for the Milky Way and M31. The Galaxy Halos, Outer disks, Substructure, Thick disks and Star clusters (GHOSTS) HST survey is the largest study to date of the resolved stellar populations in the outskirts of disk galaxies and its observations offer a direct test of model predictions. Here we present the results we obtain for six highly inclined nearby Milky Way-mass spiral galaxies. We find a great diversity in the properties of their stellar halos.