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It is large known that Coronavirus outbreak has had a psychological impact on the general population, specifically on those with a mental disease as Borderline Personality Disorder (BPD) and their relatives.
The aim of the study is to identify and examine the individual and familiar impact of the coronavirus outbreak on patients diagnosed with BPD and their parents.
A qualitative research design using focus groups was selected to identify and discuss participants’ experiences, beliefs, perceptions and attitudes. The target population consisted of patients with BPD and their parents. Participants were recruited from the BPD psychiatric service from the Hospital Universitari de la Vall de Hebron (Barcelona, Spain). Data was collected via two focus groups, one with patients with BPD and other with their parents. Content analysis was used to determine categories and themes.
The qualitative analysis of participants’ perceptions are presented using the following themes: changes and difficulties during lockdown, after lockdown concerns and challenges, general learning, and future needs. Results identify factors associated with the COVID-19 outbreak and other factors already present as family dynamics and individual difficulties.
Findings have been discussed focusing on individual and familiar impact, and allows us to consider challenges precipitated by the COVID-19 pandemic. The study evidence that a family intervention approach is essential to enhance BPD treatment.
To investigate the prevalence of suicidal thoughts and behaviours (STB; i.e. suicidal ideation, plans or attempts) in the Spanish adult general population during the first wave of the Spain coronavirus disease 2019 (COVID-19) pandemic (March−July, 2020), and to investigate the individual- and population-level impact of relevant distal and proximal STB risk factor domains.
Cross-sectional study design using data from the baseline assessment of an observational cohort study (MIND/COVID project). A nationally representative sample of 3500 non-institutionalised Spanish adults (51.5% female; mean age = 49.6 [s.d. = 17.0]) was taken using dual-frame random digit dialing, stratified for age, sex and geographical area. Professional interviewers carried out computer-assisted telephone interviews (1–30 June 2020). Thirty-day STB was assessed using modified items from the Columbia Suicide Severity Rating Scale. Distal (i.e. pre-pandemic) risk factors included sociodemographic variables, number of physical health conditions and pre-pandemic lifetime mental disorders; proximal (i.e. pandemic) risk factors included current mental disorders and a range of adverse events-experiences related to the pandemic. Logistic regression was used to investigate individual-level associations (odds ratios [OR]) and population-level associations (population attributable risk proportions [PARP]) between risk factors and 30-day STB. All data were weighted using post-stratification survey weights.
Estimated prevalence of 30-day STB was 4.5% (1.8% active suicidal ideation; n = 5 [0.1%] suicide attempts). STB was 9.7% among the 34.3% of respondents with pre-pandemic lifetime mental disorders, and 1.8% among the 65.7% without any pre-pandemic lifetime mental disorder. Factors significantly associated with STB were pre-pandemic lifetime mental disorders (total PARP = 49.1%) and current mental disorders (total PARP = 58.4%), i.e. major depressive disorder (OR = 6.0; PARP = 39.2%), generalised anxiety disorder (OR = 5.6; PARP = 36.3%), post-traumatic stress disorder (OR = 4.6; PARP = 26.6%), panic attacks (OR = 6.7; PARP = 36.6%) and alcohol/substance use disorder (OR = 3.3; PARP = 5.9%). Pandemic-related adverse events-experiences associated with STB were lack of social support, interpersonal stress, stress about personal health and about the health of loved ones (PARPs 32.7–42.6%%), and having loved ones infected with COVID-19 (OR = 1.7; PARP = 18.8%). Up to 74.1% of STB is potentially attributable to the joint effects of mental disorders and adverse events−experiences related to the pandemic.
STB at the end of the first wave of the Spain COVID-19 pandemic was high, and large proportions of STB are potentially attributable to mental disorders and adverse events−experiences related to the pandemic, including health-related stress, lack of social support and interpersonal stress. There is an urgent need to allocate resources to increase access to adequate mental healthcare, even in times of healthcare system overload.
Chronic pain is associated with opioid prescription. Chronic pain, as well as mental disorders are associated with initiation and use of prescribed opioid in the general population. Furthermore, psychiatric disorders are associated with increased physical symptoms and may be associated with opioid use (Sullivan et al., 2005).
To report a case in order to underline the relationship between chronic pain, depression and opioids misuse.
Case study and description of a patient admitted in a General Hospital.
A literature's review about chronic pain, depression and opioids misuse in elderly people was made through PubMed.
A 73 year old woman was admitted in a General Hospital's emergency room for renal failure related to opioid abuse. The patient was prescribed opioid 10 years ago, to treat spinal cord pain, which she followed until 2 years ago. At that time, she began to misuse her treatment. The case review showed that the patient had been suffering from an under diagnosed depression. The depression may have diminished her pain tolerance threshold, inducing opioid misuse.
In patients with chronic pain, there is a need to deal with patient's psychopathology when considering opioid treatment.
Pain tolerance threshold may diminish when patient suffers from a mental disorder.
When opioid medication is less effective, psychiatric comorbidities should be evaluated, instead of increasing opioid medication.
As many elderly patients suffer from chronic pain, it's recommended that they are evaluated for opioid misuse, especially when presenting with an unexpected clinical profile.
The available information on the cost of illness of Borderline Personality Disorder (BPD) is overtly insufficient for policy planning. Our aim was to estimate the costs of illness for BPD in Catalonia (Spain) for 2006.
This is a multilevel cross-design synthesis study combining a qualitative nominal approach, quantitative ‘top-down’ analysis of multiple health databases, and ‘bottom-up’ data of local surveys. Both direct and indirect costs have been estimated from a governmental and societal perspective.
Estimated year-prevalence of BPD was 0.7% (41,921 cases), but only 9.6% of these cases were treated in the mental health system (4033 cases). The baseline of the total cost of BPD in Catalonia was 45.6 million €, of which 15.8 million € (34.7%) were direct costs related to mental health care. The cost distribution was 0.4% in primary care; 4% in outpatient mental health care; 4.7% in hospitalisation; 0.7% in emergency care; and 24.9% in pharmacotherapy. Additionally, the cost of drug addiction treatment for persons with BPD was 11.2%; costs associated with sheltered employment were 23.9% and those of crime and justice were 9.7%. Indirect costs – including temporary sick leave and premature death (suicide) – represented 20.5% of total costs. The average annual cost per patient was 11,308 €.
An under-reporting of BPD was identified by the experts in all health databases and official registries. Most of the BPD costs were not related to mental health care. Amongst the direct cost categories, pharmacotherapy had the largest proportion despite the lack of specificity for BPD. This distribution of costs reinforces the idea of BPD complexity related to an inadequate and inefficient use of health resources.
A priority focus on palliative and supportive care is helping the 43.5 million caregivers who care for individuals with serious illness. Lacking support may lead to caregiver distress and poorer care delivery to patients with serious illness. We examined the potential of instrumental support (assistance with material and task performance) to mitigate distress among caregivers.
We analyzed data from the nationally representative Health Information National Trends Survey (HINTS V2, 2018). Informal/family caregivers were identified in HINTS V2 if they indicated they were caring for or making healthcare decisions for another adult with a health problem. We used the PROMIS® instrumental support four-item short-form T-scores and the Patient Health Questionnaire (PHQ-4) for distress. We examined multivariable linear regression models for associations between distress and instrumental support, adjusted for sampling weights, socio-demographics, and caregiving variables (care recipient health condition(s), years caregiving (≥2), relationship to care recipient, and caregiver burden). We examined interactions between burden and instrumental support on caregiver distress level.
Our analyses included 311 caregivers (64.8% female, 64.9% non-Hispanic White). The unweighted mean instrumental support T-score was 50.4 (SD = 10.6, range = 29.3–63.3); weighted mean was 51.2 (SE = 1.00). Lower instrumental support (p < 0.01), younger caregiver age (p < 0.04), higher caregiving duration (p = 0.008), and caregiver unemployment (p = 0.006) were significantly associated with higher caregiver distress. Mean instrumental support scores by distress levels were 52.3 (within normal limits), 49.4 (mild), 48.9 (moderate), and 39.7 (severe). The association between instrumental support and distress did not differ by caregiver burden level.
Poor instrumental support is associated with high distress among caregivers, suggesting the need for palliative and supportive care interventions to help caregivers leverage instrumental support.
Taenia solium is the most common parasite infection of the brain, causing neurocysticercosis and typically found in rural communities with free-ranging pigs. Identification of transmission in rural areas is essential for its control. Risk factors and transmission of the parasite were evaluated in three rural Venezuelan communities (Valle del Rio and Potrero Largo, Cojedes state; and Palmarito, Portuguesa state) by a questionnaire (112 households) and coprological (492 samples) and serological (433 human and 230 porcine sera) analysis, respectively. Typical risk factors were found in all three communities: free-foraging pig husbandry, deficient sanitary conditions, high open defecation and ignorance of the parasite life cycle. Coprological examinations revealed a high level of soil-transmitted parasites. Importantly, two T. solium adult worm carriers were identified in each of the three communities. Anti-metacestode antibodies and the HP10 secreted metacestode glycoprotein were detected at significant levels in human and porcine sera in Valle del Rio, Potrero Largo and Palmarito. In conclusion, these communities may be considered to be endemic for taeniasis/cysticercosis, and the instigation of an appropriate control programme is recommended.
There is a long history of exploitation of the South American river turtle Podocnemis expansa. Conservation efforts for this species started in the 1960s but best practices were not established, and population trends and the number of nesting females protected remained unknown. In 2014 we formed a working group to discuss conservation strategies and to compile population data across the species’ range. We analysed the spatial pattern of its abundance in relation to human and natural factors using multiple regression analyses. We found that > 85 conservation programmes are protecting 147,000 nesting females, primarily in Brazil. The top six sites harbour > 100,000 females and should be prioritized for conservation action. Abundance declines with latitude and we found no evidence of human pressure on current turtle abundance patterns. It is presently not possible to estimate the global population trend because the species is not monitored continuously across the Amazon basin. The number of females is increasing at some localities and decreasing at others. However, the current size of the protected population is well below the historical population size estimated from past levels of human consumption, which demonstrates the need for concerted global conservation action. The data and management recommendations compiled here provide the basis for a regional monitoring programme among South American countries.
Exposure to threat increases the risk for internalizing problems in adolescence. Deficits in integrating bodily cues into representations of emotion are thought to contribute to internalizing problems. Given the role of the medial prefrontal cortex in regulating bodily responses and integrating them into representations of emotional states, coordination between activity in the medial prefrontal cortex and autonomic nervous system responses may be influenced by past threat exposure with consequences for the emergence of internalizing problems. A sample of 179 Mexican-origin adolescents (88 female) reported on neighborhood and school crime, peer victimization, and discrimination when they were 10–16 years old. At age 17, participants underwent a functional neuroimaging scan during which they viewed pictures of emotional faces while respiratory sinus arrhythmia (RSA) and skin conductance responses were measured. Adolescents also reported symptoms of internalizing problems. Greater exposure to threats across adolescence was associated with more internalizing problems. Threat exposure was also associated with stronger negative coupling between the ventromedial prefrontal cortex and RSA. Stronger negative ventromedial prefrontal cortex–RSA coupling was associated with fewer internalizing problems. These results suggest the degree of coordinated activity between the brain and parasympathetic nervous system is both enhanced by threat experiences and decreased in adolescents with more internalizing problems.
We report four cases of Taenia saginata taeniasis in different urban communities of Aragua state, Venezuela. After subsequent treatment with praziquantel and a saline purge, adult tapeworms were collected from all four patients and demonstrated to be T. saginata by morphological and molecular characterization. The finding of T. saginata in four distinct and separate urban municipalities of the Aragua state indicates the pertinence of rigorous meat inspection, and the importance of establishing parasite prevalence in human and bovine Venezuelan populations.
Hypothyroidism is a common complication when radiotherapy is part of the treatment for head and neck tumours. This study aimed to show the incidence of hypothyroidism and possible risk factors in these patients.
Factors related to the population, tumour, treatment and occurrence of hypothyroidism were analysed in 241 patients diagnosed with head and neck carcinoma.
Approximately 53 per cent of patients were diagnosed with radiation-induced hypothyroidism. Its occurrence was related to: tumour location, laryngeal surgery type, neck dissection type, post-operative complications, cervical radiotherapy and radiotherapy unit type (linear particle accelerator or telecobalt therapy technology).
Control of thyroid function should be standardised for several years after treatment, particularly in patients with risk factors, such as those treated with telecobalt therapy, those with post-operative complications and for whom the thyroid parenchyma is included in the irradiated area (laryngeal or pharyngeal location and bilateral cervical radiation).
This paper presents limits for stability of projection type schemes when using high order pressure-velocity pairs of same degree. Two high order h/p variational methods encompassing continuous and discontinuous Galerkin formulations are used to explain previously observed lower limits on the time step for projection type schemes to be stable , when h- or p-refinement strategies are considered. In addition, the analysis included in this work shows that these stability limits do not depend only on the time step but on the product of the latter and the kinematic viscosity, which is of particular importance in the study of high Reynolds number flows. We show that high order methods prove advantageous in stabilising the simulations when small time steps and low kinematic viscosities are used.
Drawing upon this analysis, we demonstrate how the effects of this instability can be reduced in the discontinuous scheme by introducing a stabilisation term into the global system. Finally, we show that these lower limits are compatible with Courant-Friedrichs-Lewy (CFL) type restrictions, given that a sufficiently high polynomial order or a mall enough mesh spacing is selected.
Schistosomiasis is a disease caused by parasitic flatworms of the genus Schistosoma, whose diagnosis has limitations, such as the low sensitivity and specificity of parasitological and immunological methods, respectively. In the present study an alternative molecular technique requiring previous standardization was carried out using the polymerase chain reaction (PCR) for the amplification of a 121-bp highly repetitive sequence for Schistosoma mansoni. DNA was extracted from eggs of S. mansoni by salting out. Different conditions were standardized for the PCR technique, including the concentration of reagents and the DNA template, annealing temperature and number of cycles, followed by the determination of the analytical sensitivity and specificity of the technique. Furthermore, the standardized PCR technique was employed in DNA extracted, using Chelex®100, from samples of sera of patients with an immunodiagnosis of schistosomiasis. The optimal conditions for the PCR were 2.5 mm MgCl2, 150 mm deoxynucleoside triphosphates (dNTPs), 0.4 μm primers, 0.75 U DNA polymerase, using 35 cycles and an annealing temperature of 63°C. The analytical sensitivity of the PCR was 10 attograms of DNA and the specificity was 100%. The DNA sequence was successfully detected in the sera of two patients, demonstrating schistosomiasis transmission, although low, in the community studied. The standardized PCR technique, using smaller amounts of reagents than in the original protocol, is highly sensitive and specific for the detection of DNA from S. mansoni and could be an important tool for diagnosis in areas of low endemicity.
We have observed 12 interacting galaxies using the Fabry-Perot interferometer GHαFaS (Galaxy Hα Fabry-Perot system) on the 4.2m William Herschel Telescope (La Palma). We have extracted the physical properties (sizes, Hα luminosity and velocity dispersion) of 236 HII regions for the full sample of interacting galaxies. We have derived the physical properties of 664 HII regions for a sample of 28 isolated galaxies observed with the same instrument in order to compare both populations of HII regions, finding that there are brighter and denser star forming regions in the interacting galaxies compared with the isolated galaxies sample.
Optical properties of ZnO-CdTe electrochemically prepared on a core-shell nanostructure (NS) were studied. Numerical simulations based on effective medium approximation give higher absorption than ZnO-CdS samples and a sensitive dependence on CdTe content. The absorption edges for deep black samples found by transmittance (T(λ)) and diffuse reflectance (Rdiff(λ)) measurements were at 1.33eV and 1.55eV, respectively. A split-off band edge was also found by Rdiff(λ) at ∼2.5eV. The red shift observed in T(λ), previously observed in ZnO-CdS, and may confirm the enhancement of sub-bandgap absorption due to the NS nature of samples.
Using the solutions of the gap equations of the magnetic-color-flavor-locked (MCFL) phase of paired quark matter in a magnetic field, and taking into consideration the separation between the longitudinal and transverse pressures due to the field-induced breaking of the spatial rotational symmetry, the equation of state (EoS) of the MCFL phase is self-consistently determined. Implications for stellar models of magnetized (self-bound) strange stars and hybrid (MCFL core) stars are discussed.
We have used the package CLOUDPROPS (Rosolowsky & Leroy 2008) in order to identify clouds, which are contained in data cubes of molecular/Hα line emission, and extract their properties. The molecular data cube is taken from the ALMA public archive and the ionized hydrogen data cube was obtained with the Fabry-Perot interferometer, GHαFaS, on the 4.2 m WHT in La Palma. In our study of the overlap region of the Antennae galaxies we have identified two populations of molecular clouds, above and below log M/M⊙ = 6.75 (in agreement with Wei et al. 2012 who find the break in mass at log M/M⊙ = 6.5) and two different populations of ionized gas clouds; the break in the luminosity occurs near log L = 37.6 (see Fig. 1). We have measured the masses, velocity dispersions and luminosities of the clouds, and derived relation between them for each population. Population II clouds (both molecular and ionized) tend to be located in the most luminous regions, while population I clouds can be found in the outskirts. This work will be published in Font et al. (2013).
We present a study of the morphology, kinematics and star formation of a sample of 27 isolated spiral galaxies in the Spitzer Survey of Stellar Structure in Galaxies (S4G), on the basis of Hα Fabry-Perot (FP) data from the GHαFaS instrument at the William Herschel Telescope (WHT) in La Palma, complemented with images at 3.6 micron from the Spitzer Space Telescope, and with images in the R-band and in Hα taken with the ACAM instrument mounted on the WHT. With the FP data we can investigate the gas kinematics in terms of velocity maps and position-velocity diagrams, keys to constrain the secular evolution processes. We can also analyse the morphology and compute the star formation rate (SFR) with the ancillary data.
We present a study of the kinematics of a sample of isolated spiral galaxies in the Spitzer Survey of Stellar Structure in Galaxies (S4G). We use Hα Fabry-Perot data from the GHαFaS instrument at the William Herschel Telescope (WHT) in La Palma, complemented with images at 3.6 microns, in the R band and in the Hα filter. The resulting data cubes and velocity field maps allow a complete study of the kinematics of a galaxy, including in-depth investigations of the rotation curve, velocity moment maps, velocity residual maps, gradient maps and position-velocity (PV) diagrams. We find clear evidence of the secular evolution processes going on in these galaxies, such as asymmetries in the velocity field in the bar zone, and non-circular motions, probably in response to the potential of the structural components of the galaxies, or to past or present interactions.
Before-after prospective surveillance study to assess the efficacy of the International Nosocomial Infection Control Consortium (INICC) multidimensional infection control program to reduce the rate of occurrence of ventilator-associated pneumonia (VAP).
Neonatal intensive care units (NICUs) of INICC member hospitals from 15 cities in the following 10 developing countries: Argentina, Colombia, El Salvador, India, Mexico, Morocco, Peru, Philippines, Tunisia, and Turkey.
VAP rates were determined during a first period of active surveillance without the implementation of the multidimensional approach (phase 1) to be then compared with VAP rates after implementation of the INICC multidimensional infection control program (phase 2), which included the following practices: a bundle of infection control interventions, education, outcome surveillance, process surveillance, feedback on VAP rates, and performance feedback on infection control practices. This study was conducted by infection control professionals who applied National Health Safety Network (NHSN) definitions for healthcare-associated infections and INICC surveillance methodology.
During phase 1, we recorded 3,153 mechanical ventilation (MV)–days, and during phase 2, after the implementation of the bundle of interventions, we recorded 15,981 MV-days. The VAP rate was 17.8 cases per 1,000 MV-days during phase 1 and 12.0 cases per 1,000 MV-days during phase 2 (relative risk, 0.67 [95% confidence interval, 0.50–0.91]; P = .001 ), indicating a 33% reduction in VAP rate.
Our results demonstrate that an implementation of the INICC multidimensional infection control program was associated with a significant reduction in VAP rate in NICUs in developing countries.