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Despite their documented efficacy, substantial proportions of patients discontinue antidepressant medication (ADM) without a doctor's recommendation. The current report integrates data on patient-reported reasons into an investigation of patterns and predictors of ADM discontinuation.
Face-to-face interviews with community samples from 13 countries (n = 30 697) in the World Mental Health (WMH) Surveys included n = 1890 respondents who used ADMs within the past 12 months.
10.9% of 12-month ADM users reported discontinuation-based on recommendation of the prescriber while 15.7% discontinued in the absence of prescriber recommendation. The main patient-reported reason for discontinuation was feeling better (46.6%), which was reported by a higher proportion of patients who discontinued within the first 2 weeks of treatment than later. Perceived ineffectiveness (18.5%), predisposing factors (e.g. fear of dependence) (20.0%), and enabling factors (e.g. inability to afford treatment cost) (5.0%) were much less commonly reported reasons. Discontinuation in the absence of prescriber recommendation was associated with low country income level, being employed, and having above average personal income. Age, prior history of psychotropic medication use, and being prescribed treatment from a psychiatrist rather than from a general medical practitioner, in comparison, were associated with a lower probability of this type of discontinuation. However, these predictors varied substantially depending on patient-reported reasons for discontinuation.
Dropping out early is not necessarily negative with almost half of individuals noting they felt better. The study underscores the diverse reasons given for dropping out and the need to evaluate how and whether dropping out influences short- or long-term functioning.
The hibernation sites of the monarch butterfly (Danaus plexippus, L.) were discovered in central Mexico in 1975 and, following the decree of a protected area in 1986, processes of deforestation and forest degradation were triggered on the socially owned land in question. Further deterioration has occurred since the expansion and designation of the area as the Monarch Butterfly Biosphere Reserve in 2000. An innovative programme of economic incentives was established to compensate the affected properties in the core zone for curtailment of their forest use and to pay for environmental services; however, some of the agrarian communities were in disagreement with this programme. Orthophotographs from 1994 were compared with high-resolution satellite images from 2017 in order to determine forest-cover trends in the areas incentivized by Payment for Environmental Services to avoid deforestation and those areas that were not incentivized. The results show an overall recovery of 2% in forest area between 1994 and 2017, while a 5% increase in the deforested area is notable in the core zone. The findings indicate that, for the establishment of an effective protected area on social property lands, consensus must be achieved across all of the communities in order to avoid subsequent forest loss.
During the second half of the 20th century, the Antarctic Peninsula region has undergone a long and sustained warming period, followed by a shorter but also sustained cooling period, and then a very recent return to warming conditions. All of these have profoundly impacted the glaciers peripheral to the Antarctic Peninsula. This paper focuses on the analysis of the surface mass balance monitoring of such glaciers by the glaciological method, complemented by the analysis of mass-balance estimates by geodetic methods, as well as frontal ablation estimates. We aim to summarize the current knowledge and outline the main challenges faced by investigating the mass balance of such peripheral glaciers and their current contribution to sea-level rise.
Callous Unemotional (CU) traits are associated with different environmental risk factors, such as negative stressful life events (SLE). The most common studied SLE associated with CU trait has been childhood maltreatment, but less is known about how other SLE impact the development of CU traits. Therefore, this work examines risk factors, personal factors (executive functioning), and mental health outcomes associated with the trajectories of Callous Unemotional (CU) traits and Stressful Life Events (SLE) in a community sample of children. A cohort of 377 preschoolers were followed up between ages 3 and 10. Several risk factors and outcomes for three trajectory groups (high CU/SLE; high CU/low SLE; and the reference group with low CU/SLE) were analyzed by using multiple post-hoc comparisons. We hypothesized that children with high CU/SLE would face more contextual risk factors, more executive functioning difficulties and more mental health problems than children with high CU/low SLE or the reference group. At the age of 3, children who showed high CU/SLE faced more early contextual adversity, including socioeconomic difficulties and maternal antisocial behavior than the other groups of children. At the age of 10, children with high CU/SLE presented more peer problems and higher psychopathology symptoms than the reference group, but no differences on mental health outcomes in comparison to the high CU/low SLE group. These results have potential implications for clinical practice and studies attempting to identify different CU subtypes in children.
OBJECTIVES/GOALS: The Title V Coop developed CRESCO, a physical and virtual space in the libraries of the two cooperating institutions. Adopting a flexible and transformational approach, it offers services to support the development of research and information skills of undergraduate students and faculty who receive clinical-translational research (CTR) training. METHODS/STUDY POPULATION: Since 2016, CRESCO has been staffed by a multidisciplinary team composed of three librarians, a statistician, an instructional designer, and an IT specialist. The physical facilities of the two libraries were remodeled and equipped, and a central portal was created to provide services and access to resources on a 7/24 basis. Online tutorials, workshops, and mentoring services have been offered that address topics in statistics, literature search, plagiarism, and the use of several research software. Services statistics are collected, and a questionnaire is administered to evaluate the workshops. RESULTS/ANTICIPATED RESULTS: The main results include 12 online tutorials created in CTR areas and available in the CRESCO hub portal; 14,660 mentoring/consultations offered in statistics, the use of research-related software, and the search for scientific literature search; and 6 online workshops created in CTR areas, with 463 attendees. When evaluating online workshops, participants considered that their acquired learning was high or extremely high on the following topics: use of Intellectus Statistics (88%, n = 96); selection of statistical tests (81%, n = 92); use of Turnitin (85%, n = 76); literature search (91%, n = 58); and citations and references in Mendeley (90%, n = 67). DISCUSSION/SIGNIFICANCE: These results suggest that the flexible, multidisciplinary, and transformational approach of CRESCO has been successful in helping undergraduate students and faculty develop the skills necessary to conduct CTR projects.
Major depressive disorder (MDD) is characterised by a recurrent course and high comorbidity rates. A lifespan perspective may therefore provide important information regarding health outcomes. The aim of the present study is to examine mental disorders that preceded 12-month MDD diagnosis and the impact of these disorders on depression outcomes.
Data came from 29 cross-sectional community epidemiological surveys of adults in 27 countries (n = 80 190). The Composite International Diagnostic Interview (CIDI) was used to assess 12-month MDD and lifetime DSM-IV disorders with onset prior to the respondent's age at interview. Disorders were grouped into depressive distress disorders, non-depressive
distress disorders, fear disorders and externalising disorders. Depression outcomes included 12-month suicidality, days out of role and impairment in role functioning.
Among respondents with 12-month MDD, 94.9% (s.e. = 0.4) had at least one prior disorder (including previous MDD), and 64.6% (s.e. = 0.9) had at least one prior, non-MDD disorder. Previous non-depressive distress, fear and externalising disorders, but not depressive distress disorders, predicted higher impairment (OR = 1.4–1.6) and suicidality (OR = 1.5–2.5), after adjustment for sociodemographic variables. Further adjustment for MDD characteristics weakened, but did not eliminate, these associations. Associations were largely driven by current comorbidities, but both remitted and current externalising disorders predicted suicidality among respondents with 12-month MDD.
These results illustrate the importance of careful psychiatric history taking regarding current anxiety disorders and lifetime externalising disorders in individuals with MDD.
In the ablation zone of glacier habitats, cryoconite holes are known to harbor diverse microbial communities, including unique diatom floras distinct from those of surrounding aquatic and terrestrial systems. Besides descriptive studies, little is known about the diversity of cryoconite diatoms and their response to environmental stressors, particularly in low-latitude glaciers. This paper documents an extremely diversified diatom community in Antisana Glacier (Ecuador), reporting 278 taxa found in 54 surface holes, although with low individual abundances. Contrary to our expectations, assemblage structure did not respond to water physical or chemical characteristics, nor to cryoconite hole morphology, but to elevation. We demonstrate that elevation is a driver of diatom assemblages. Both alpha diversity (measured as Fisher's index) and species richness (corrected for unequal sample sizes) correlated negatively with elevation, suggesting a replacement toward simplified, poorer communities along this gradient. The taxonomic composition also changed significantly, as revealed by multivariate statistics. In summary, cryoconite holes are sites of high taxonomic diversity composed of taxa that are allochthonous in origin.
The most common treatment for major depressive disorder (MDD) is antidepressant medication (ADM). Results are reported on frequency of ADM use, reasons for use, and perceived effectiveness of use in general population surveys across 20 countries.
Face-to-face interviews with community samples totaling n = 49 919 respondents in the World Health Organization (WHO) World Mental Health (WMH) Surveys asked about ADM use anytime in the prior 12 months in conjunction with validated fully structured diagnostic interviews. Treatment questions were administered independently of diagnoses and asked of all respondents.
3.1% of respondents reported ADM use within the past 12 months. In high-income countries (HICs), depression (49.2%) and anxiety (36.4%) were the most common reasons for use. In low- and middle-income countries (LMICs), depression (38.4%) and sleep problems (31.9%) were the most common reasons for use. Prevalence of use was 2–4 times as high in HICs as LMICs across all examined diagnoses. Newer ADMs were proportionally used more often in HICs than LMICs. Across all conditions, ADMs were reported as very effective by 58.8% of users and somewhat effective by an additional 28.3% of users, with both proportions higher in LMICs than HICs. Neither ADM class nor reason for use was a significant predictor of perceived effectiveness.
ADMs are in widespread use and for a variety of conditions including but going beyond depression and anxiety. In a general population sample from multiple LMICs and HICs, ADMs were widely perceived to be either very or somewhat effective by the people who use them.
Analyze whether the content of three moral messages (deontological, ethical utilitarianism, ethical virtue) and a control message differentially affect the probability of engaging in four behaviors: Washing their hands, participating in public gatherings, staying at home/avoiding social contact, and forwarding the message to inform more people. In our study, the sender of the message is a university professor. These variables are measured in terms of their behavioral intentions and others’ behavioral intentions (beliefs about others’ behavior). Randomized Controlled Trial. Our study includes the analysis of the possible moderating effect of the country of residence (Spain n = 1,122, Chile n = 1,107, and Colombia n = 1,433). The message with content referring to ethical virtue and staying at home obtains statistically significant lower scores on the probability of carrying out public health behaviors and sharing the message received. Regarding beliefs about the behavior of others, the message of ethical virtue has the same negative effect, but only on the likelihood of other people washing their hands, staying at home, and sharing the public health message. Institutional messages aimed at promoting public health behaviors are necessary in a pandemic situation. Our recommendation is to use deontological and utilitarian, or non-moral, content.
We surveyed 348 Psychology and Education researchers within Spain, on issues such as their perception of a crisis in Science, their confidence in the quality of published results, and the use of questionable research practices (QRP). Their perceptions regarding pressure to publish and academic competition were also collected. The results indicate that a large proportion of the sample of Spanish academics think there is a crisis in Science, mainly due to a lack of economic investment, and doubts the quality of published findings. They also feel strong pressure to publish in high impact factor journals and a highly competitive work climate.
The study of the distributions of sums of dependent risks is a key topic in actuarial sciences, risk management, reliability and in many branches of applied and theoretical probability. However, there are few results where the distribution of the sum of dependent random variables is available in a closed form. In this paper, we obtain several analytical expressions for the distribution of the aggregated risks under dependence in terms of copulas. We provide several representations based on the underlying copula and the marginal distribution functions under general hypotheses and in any dimension. Then, we study stochastic comparisons between sums of dependent risks. Finally, we illustrate our theoretical results by studying some specific models obtained from Clayton, Ali-Mikhail-Haq and Farlie-Gumbel-Morgenstern copulas. Extensions to more general copulas are also included. Bounds and the limiting behavior of the hazard rate function for the aggregated distribution of some copulas are studied as well.
Depressive and anxiety disorders are highly comorbid, which has been theorized to be due to an underlying internalizing vulnerability. We aimed to identify groups of participants with differing vulnerabilities by examining the course of internalizing psychopathology up to age 45.
We used data from 24158 participants (aged 45+) in 23 population-based cross-sectional World Mental Health Surveys. Internalizing disorders were assessed with the Composite International Diagnostic Interview (CIDI). We applied latent class growth analysis (LCGA) and investigated the characteristics of identified classes using logistic or linear regression.
The best-fitting LCGA solution identified eight classes: a healthy class (81.9%), three childhood-onset classes with mild (3.7%), moderate (2.0%), or severe (1.1%) internalizing comorbidity, two puberty-onset classes with mild (4.0%) or moderate (1.4%) comorbidity, and two adult-onset classes with mild comorbidity (2.7% and 3.2%). The childhood-onset severe class had particularly unfavorable sociodemographic outcomes compared to the healthy class, with increased risks of being never or previously married (OR = 2.2 and 2.0, p < 0.001), not being employed (OR = 3.5, p < 0.001), and having a low/low-average income (OR = 2.2, p < 0.001). Moderate or severe (v. mild) comorbidity was associated with 12-month internalizing disorders (OR = 1.9 and 4.8, p < 0.001), disability (B = 1.1–2.3, p < 0.001), and suicidal ideation (OR = 4.2, p < 0.001 for severe comorbidity only). Adult (v. childhood) onset was associated with lower rates of 12-month internalizing disorders (OR = 0.2, p < 0.001).
We identified eight transdiagnostic trajectories of internalizing psychopathology. Unfavorable outcomes were concentrated in the 1% of participants with childhood onset and severe comorbidity. Early identification of this group may offer opportunities for preventive interventions.
Major depressive disorder (MDD) is a leading cause of morbidity and mortality. Shortfalls in treatment quantity and quality are well-established, but the specific gaps in pharmacotherapy and psychotherapy are poorly understood. This paper analyzes the gap in treatment coverage for MDD and identifies critical bottlenecks.
Seventeen surveys were conducted across 15 countries by the World Health Organization-World Mental Health Surveys Initiative. Of 35 012 respondents, 3341 met DSM-IV criteria for 12-month MDD. The following components of effective treatment coverage were analyzed: (a) any mental health service utilization; (b) adequate pharmacotherapy; (c) adequate psychotherapy; and (d) adequate severity-specific combination of both.
MDD prevalence was 4.8% (s.e., 0.2). A total of 41.8% (s.e., 1.1) received any mental health services, 23.2% (s.e., 1.5) of which was deemed effective. This 90% gap in effective treatment is due to lack of utilization (58%) and inadequate quality or adherence (32%). Critical bottlenecks are underutilization of psychotherapy (26 percentage-points reduction in coverage), underutilization of psychopharmacology (13-point reduction), inadequate physician monitoring (13-point reduction), and inadequate drug-type (10-point reduction). High-income countries double low-income countries in any mental health service utilization, adequate pharmacotherapy, adequate psychotherapy, and adequate combination of both. Severe cases are more likely than mild-moderate cases to receive either adequate pharmacotherapy or psychotherapy, but less likely to receive an adequate combination.
Decision-makers need to increase the utilization and quality of pharmacotherapy and psychotherapy. Innovations such as telehealth for training and supervision plus non-specialist or community resources to deliver pharmacotherapy and psychotherapy could address these bottlenecks.
This study explored the effect of the perceived social content of affective pictures on the subjective evaluation of affective valence and arousal. For this purpose, we established three categories of social content (pictures without people, with one person and with two or more people). A sample of 161 subjects rated 200 pictures varying in affective valence (unpleasant, neutral, and pleasant), arousal and social content. Results of two-factor analysis of variance, F(4, 157) = 71.7, p < .001, ηp2 = .31, showed that perceived social content influenced the ratings of affective valence, specially for unpleasant pictures, with the greatest social content (two or more people) leading subjects to rate unpleasant pictures with the lowest ratings (all pairwise comparisons’ p < .001). Regarding arousal, F(4, 157) = 64.0, p < .001, ηp2 = .29), the higher the social content, the higher the arousal ratings, but only for pleasant (all pairwise comparisons’ p < .007) and unpleasant (all pairwise comparisons’ p < .001) pictures. Overall, this study demonstrated an effect of the perceived social content on the subjective evaluation of affective valence and arousal of emotional stimuli.
There is a substantial proportion of patients who drop out of treatment before they receive minimally adequate care. They tend to have worse health outcomes than those who complete treatment. Our main goal is to describe the frequency and determinants of dropout from treatment for mental disorders in low-, middle-, and high-income countries.
Respondents from 13 low- or middle-income countries (N = 60 224) and 15 in high-income countries (N = 77 303) were screened for mental and substance use disorders. Cross-tabulations were used to examine the distribution of treatment and dropout rates for those who screened positive. The timing of dropout was examined using Kaplan–Meier curves. Predictors of dropout were examined with survival analysis using a logistic link function.
Dropout rates are high, both in high-income (30%) and low/middle-income (45%) countries. Dropout mostly occurs during the first two visits. It is higher in general medical rather than in specialist settings (nearly 60% v. 20% in lower income settings). It is also higher for mild and moderate than for severe presentations. The lack of financial protection for mental health services is associated with overall increased dropout from care.
Extending financial protection and coverage for mental disorders may reduce dropout. Efficiency can be improved by managing the milder clinical presentations at the entry point to the mental health system, providing adequate training, support and specialist supervision for non-specialists, and streamlining referral to psychiatrists for more severe cases.
Several studies have shown that the Brazilian Northeast is a region with high rates of inbreeding as well as a high incidence of autosomal recessive diseases. The elaboration of public health policies focused on the epidemiological surveillance of congenital anomalies and rare genetic diseases in this region is urgently needed. However, the vast territory, socio-demographic heterogeneity, economic difficulties and low number of professionals with expertise in medical genetics make strategic planning a challenging task. Surnames can be compared to a genetic system with multiple neutral alleles and allow some approximation of population structure. Here, surname analysis of more than 37 million people was combined with health and socio-demographic indicators covering all 1794 municipalities of the nine states of the region. The data distribution showed a heterogeneous spatial pattern (Global Moran Index, GMI = 0.58; p < 0.001), with higher isonymy rates in the east of the region and the highest rates in the Quilombo dos Palmares region – the largest conglomerate of escaped slaves in Latin America. A positive correlation was found between the isonymy index and the frequency of live births with congenital anomalies (r = 0.268; p < 0.001), and the two indicators were spatially correlated (GMI = 0.50; p < 0.001). With this approach, quantitative information on the genetic structure of the Brazilian Northeast population was obtained, which may represent an economical and useful tool for decision-making in the medical field.
We present a detailed overview of the cosmological surveys that we aim to carry out with Phase 1 of the Square Kilometre Array (SKA1) and the science that they will enable. We highlight three main surveys: a medium-deep continuum weak lensing and low-redshift spectroscopic HI galaxy survey over 5 000 deg2; a wide and deep continuum galaxy and HI intensity mapping (IM) survey over 20 000 deg2 from
$z = 0.35$
to 3; and a deep, high-redshift HI IM survey over 100 deg2 from
$z = 3$
to 6. Taken together, these surveys will achieve an array of important scientific goals: measuring the equation of state of dark energy out to
$z \sim 3$
with percent-level precision measurements of the cosmic expansion rate; constraining possible deviations from General Relativity on cosmological scales by measuring the growth rate of structure through multiple independent methods; mapping the structure of the Universe on the largest accessible scales, thus constraining fundamental properties such as isotropy, homogeneity, and non-Gaussianity; and measuring the HI density and bias out to
$z = 6$
. These surveys will also provide highly complementary clustering and weak lensing measurements that have independent systematic uncertainties to those of optical and near-infrared (NIR) surveys like Euclid, LSST, and WFIRST leading to a multitude of synergies that can improve constraints significantly beyond what optical or radio surveys can achieve on their own. This document, the 2018 Red Book, provides reference technical specifications, cosmological parameter forecasts, and an overview of relevant systematic effects for the three key surveys and will be regularly updated by the Cosmology Science Working Group in the run up to start of operations and the Key Science Programme of SKA1.
The Ecuadorian coast has two main types of forests, which are differentiated by their phenology: dry forests are deciduous and more humid forests are evergreen. Less of the dry forests on the Ecuadorian coast is protected (13% of its area) than the evergreen forests (28%), and the area devoted to the protection of dry forests (1069 km2) is substantially less than the area devoted to the protection of evergreen forests (2800 km2). Yet the conservation status of dry forests is more critical, with 83% of their area classified as having very low connectivity, 70% as being highly fragile and 86% as being highly threatened. In addition, the dry forests have fewer protected areas than the evergreen forests. It is therefore necessary to increase the protection of deciduous ecosystems as part of a comprehensive national strategy because they support high levels of biodiversity and many endemic species.
Healthy lifestyle habits are the cornerstone in the management of familial hypercholesterolaemia (FH). Nevertheless, dietary studies on FH-affected populations are scarce. The present study analyses dietary habits, adherence to a Mediterranean diet pattern and physical activity in an adult population with FH and compares them with their non-affected relatives.
Data came from SAFEHEART, a nationwide study in Spain.
Individuals (n 3714) aged ≥18 years with a genetic diagnosis of FH (n2736) and their non-affected relatives (n 978). Food consumption was evaluated using a validated FFQ.
Total energy intake was lower in FH patients v. non-affected relatives (P<0·005). Percentage of energy from fats was also lower in the FH population (35 % in men, 36 % in women) v. those non-affected (38 % in both sexes, P<0·005), due to the lower consumption of saturated fats (12·1 % in FH patients, 13·2 % in non-affected, P<0·005). Consumption of sugars was lower in FH patients v. non-affected relatives (P<0·05). Consumption of vegetables, fish and skimmed milk was higher in the FH population (P<0·005). Patients with FH showed greater adherence to a Mediterranean diet pattern v. non-affected relatives (P<0·005). Active smoking was lower and moderate physical activity was higher in people with FH, especially women (P<0·005).
Adult patients with FH report healthier lifestyles than their non-affected family members. They eat a healthier diet, perform more physical activity and smoke less. However, this patient group’s consumption of saturated fats and sugars still exceeds guidelines.