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Research of COVID-19-Pandemic mental health impact focus on three groups: the general population, (2) so called vulnerable groups (e.g. individuals with mental disorders) and (3) individuals suffering COVID-19 including Long-COVID syndromes.
We investigate whether individuals with a history of depression in the past, react to the COVID-19 pandemic with increased depressive symptoms.
Longitudinal Data stem from the NAKO-Baseline-Assessment (2014-2019, 18 study centers in Germany, representative sampled individuals from 20 to 74 years) and the subsequent NAKO-COVID-Assessment (5-11/2020). The sample for analysis comprises 115.519 individuals. History of psychiatric disorder was operationalized as lifetime self-report for physician-diagnosed depression. Depressive symptoms were measured with the PHQ 9.
Mean age of the sample at baseline was 49.95 (SD 12.53). It comprised 51.70 women; 14 % of the individuals had a history of
physician-diagnosed depression. Considering a PHQ-Score with cut-off 10 as a clinical relevant depression, 3.65 % of the individuals without history of depression and 24.19 % of those with a history of depression were depressed at baseline. The NAKO-COVID-Assessment revealed 6.53 % depressed individuals without any history of depression and a similar rate of 23.29 % in those with history of depression.
In contrast to that what we expected, individuals with a history of a physician-diagnosed depression, did not react with increasing depressiveness during the first phase of the pandemic in Germany. Several reasons could be discussed. Whether there medium and long-term impact remains open.
Tokamak start-up is characterized by low electron densities and strong electric fields, in order to quickly raise the plasma current and temperature, allowing the plasma to fully ionize and magnetic flux surfaces to form. Such conditions are ideal for the formation of superthermal electrons, which may reduce the efficiency of ohmic heating and prevent the formation of a healthy thermal fusion plasma. This is of particular concern in ITER where engineering limitations put restrictions on the allowable electric fields and limit the prefill densities during start-up. In this study, we present a new 0D burn-through simulation tool called STREAM (STart-up Runaway Electron Analysis Model), which self-consistently evolves the plasma density, temperature and electric field, while accounting for the generation and loss of relativistic runaway electrons. After verifying the burn-through model, we investigate conditions under which runaway electrons can form during tokamak start-up as well as their effects on the plasma initiation. We find that Dreicer generation plays a crucial role in determining whether a discharge becomes runaway-dominated or not, and that a large number of runaway electrons could limit the ohmic heating of the plasma, thus preventing successful burn-through or further ramp-up of the plasma current. The runaway generation can be suppressed by raising the density via gas fuelling, but only if done sufficiently early. Otherwise a large runaway seed may have already been built up, which can avalanche even at relatively low electric fields and high densities.
Background: Sensory ganglionopathy (SG) is a rare form of neuropathy affecting the dorsal root ganglia and leading to non-length-dependent sensory abnormalities. Although balance problems are frequently reported by patients, a comprehensive balance assessment in SG has not been conducted. This study quantifies balance deficits in SG and examines their relation to patient-reported outcome measures (PROMs). Methods: Prospective data was collected from five participants with SG. Balance assessments included Fullerton Advanced Balance scale, Berg Balance scale, and 360 degree turn. Participants completed PROMs assessing balance confidence (ABC scale), pain, fatigue, quality of life (QoL), and daily activity and participation. Assessment also included neurological exam, nerve conduction studies (NCS) and posturography. Results: All participants had severe SG on NCS with normal strength and significant sensory abnormalities. Balance scores indicated severe balance deficits in all participants and aligned with posturography and truncal sway measures. PROMs revealed low confidence in balance, high levels of pain and fatigue, difficulties with daily activities, and reduced QoL. Conclusions: Although balance testing is not part of routine clinical practice, PROMs and targeted assessment may help monitor patients with SG and their response to treatment. Larger sample sizes are needed to understand the impact of balance on PROMs and optimize bedside balance testing.
Companies offer products in different variants to reach more customers. This increases internal variety and cost. However, reducing those cost is difficult due to complexity. Complexity arises from: combinatorics; many design variables interacting with each other; coupling of technical and economical perspectives. This paper presents an approach based on (1) building a complex system model of modular models; (2) identifying the potential for standardization from a technical perspective; (3) cost-optimizing the degree of standardization. A product family of electric vehicles was optimized.
Radiogenic strontium isotopes (87Sr/86Sr) of vein carbonates play a central role in the tectonometamorphic study of fold-and-thrust belts and accretionary wedges and have been used to document fluid sources and fluxes, for example, along major fault zones. In addition, the 87Sr/86Sr ratios of vein carbonates can trace the diagenetic to metamorphic evolution of pore fluids in accreted sediments. Here we present 87Sr/86Sr ratios of vein carbonates from the Infrahelvetic flysch units of the central European Alps (Glarus Alps, Switzerland), which were accreted to the North Alpine fold-and-thrust belt during the early stages of continental collision. We show that the vein carbonates trace the Sr isotopic evolution of pore fluids from an initial seawater-like signature towards the Sr isotopic composition of the host rock with increasing metamorphic grade. This relationship reflects the progressive equilibration of the pore fluid with the host rock and allows us to constrain the diagenetic to low-grade metamorphic conditions of deformation events, including bedding-parallel shearing, imbricate thrusting, folding, cleavage development, tectonic mélange formation and extension. The strontium isotope systematics of vein carbonates provides new insights into the prograde to early retrograde tectonic evolution of the Alpine fold-and-thrust belt and helps to understand the relative timing of deformation events.
Bioarchaeological research provides unique insights on human adaptation, diet, lifestyle and epidemiology. The Mogou Bioarchaeology Project explores how health was affected by the Bronze Age transition in north-west China. Preliminary results reveal that the inhabitants experienced substantial physiological stress, infectious disease and lethal trauma.
Regular evaluation of physical capacity takes a crucial part in long-term follow-up in patients with congenital heart disease (CHD). This study aims to examine the accuracy of self-estimated exercise capacity compared to objective assessments by cardiopulmonary exercise testing in patients with CHD of various complexity.
We conducted a single centre, cross-sectional study with retrospective analysis on 382 patients aged 8–68 years with various CHD who completed cardiopulmonary exercise tests. Peak oxygen uptake was measured. Additionally, questionnaires covering self-estimation of exercise capacity were completed. Peak oxygen uptake was compared to patient’s self-estimated exercise capacity with focus on differences between complex and non-complex defects.
Peak oxygen uptake was 25.5 ± 7.9 ml/minute/kg, corresponding to 75.1 ± 18.8% of age- and sex-specific reference values. Higher values of peak oxygen uptake were seen in patients with higher subjective rating of exercise capacity. However, oxygen uptake in patients rating their exercise capacity as good (mean oxygen uptake 78.5 ± 1.6%) or very good (mean oxygen uptake 84.8 ± 4.8%) was on average still reduced compared to normal. In patients with non-complex cardiac defects, we saw a significant correlation between peak oxygen uptake and self-estimated exercise capacity (spearman-rho −0.30, p < 0.001), whereas in patients with complex cardiac defects, no correlation was found (spearman-rho −0.11, p < 0.255).
The mismatch between self-estimated and objectively assessed exercise capacity is most prominent in patients with complex CHD.
Registration number at Charité Universitätsmedizin Berlin Ethics Committee: EA2/106/14.
N-terminal pro-brain natriuretic peptide has an established role in the diagnosis and prognosis of heart failure. In Fontan patients, this peptide is often increased, but its diagnostic value in this particular non-physiologic, univentricular circulation is unclear. We investigated whether N-terminal pro-brain natriuretic peptide represents ventricular function or other key variables in Fontan patients.
Methods and results:
Ninety-five consecutive Fontan patients ≥10 years old who attended the outpatient clinic of the Center for Congenital Heart Diseases in 2012–2013 were included. Time since Fontan completion was 16 ± 9 years. Median N-terminal pro-brain natriuretic peptide was 114 (61–264) ng/l and was higher than gender-and age-dependent normal values in 54% of the patients. Peptide Z-scores were higher in patients in NYHA class III/IV compared to those in class I/II, but did not correlate with ventricular function assessed by MRI and echocardiography, nor with peak exercise capacity. Instead, peptide Z-scores significantly correlated with follow-up duration after Fontan completion (p < 0.001), right ventricular morphology (p = 0.004), indexed ventricular mass (p = 0.001), and inferior caval vein diameter (p < 0.001) (adjusted R2 = 0.615).
N-terminal pro-brain natriuretic peptide levels in Fontan patients correlate with functional class, but do not necessarily indicate ventricular dysfunction. Increased peptide levels were associated with a longer existence of the Fontan circulation, morphologic ventricular characteristics, and signs of increased systemic venous congestion. Since the latter are known to be key determinants of the performance of the Fontan circulation, these findings suggest increase in N-terminal pro-brain natriuretic peptide levels to indicate attrition of the Fontan circulation, independent of ventricular function.
Nerve transfer surgery for patients with nerve and spinal cord injuries can result in dramatic functional improvements. As a result, interdisciplinary complex nerve injury programs (CNIPs) have been established in many Canadian centers, providing electrodiagnostic and surgical consultations in a single encounter. We sought to determine which allied health care services are included in Canadian CNIPs, at the 3rd Annual Canadian Peripheral Nerve Symposium. Twenty CNIPs responded to a brief survey and reported access as follows: occupational therapy = 60%, physiotherapy = 40%, social work = 20%, and mental health = 10%. Access to allied health services is variable in CNIPs across Canada, possibly resulting in heterogeneity in patient care.
Long-term lithium-treatment has been associated with deficits in several cognitive domains in euthymic bipolar patients. At the same time, long-term lithium treatment is also associated with an increase in parathyroid levels, often without a concomitant increase in calcium levels. Such an isolated increase in parathyroid levels has been linked to depressive symptoms and cognitive deficits in otherwise healthy individuals.
To investigate whether increased parathyroid levels are associated with cognitive deficits in euthymic bipolar patients.
We plan to recruit 30 euthymic bipolar patients on lithium treatment for this study. Patients will take part in several neuropsychological tests, covering executive functioning, memory and attention. In parallel, blood levels of lithium, parathyroid hormone, 25-hydroxyvitamin D, creatinine, calcium and phosphate will be assessed, besides clinical chemistry and blood cell count. In addition, to account for potential confounders, a variety of clinical variables will be recorded, including established mood rating scales and demographic variables as well as further parameters relevant to the course of the illness.
As the study is still ongoing results are not available yet at this moment.
Results will be discussed in the context of previous studies examining the impact of lithium and parathyroid hormone on mood and cognition in healthy individuals and patients with bipolar disorder, respectively. Dependent on the outcome of this study, potential future studies, including intervention trials aiming at lowering increased PTH levels in bipolar patients on lithium will be outlined.
With respect to mental health disorders, there are cultural and migration-related differences in the personal experience and the way of dealing with them. However, the association between migration experiences and the development and the continuation of mental health disorders respectively, remain unclear. Epidemiological studies on mental health disorders of migrants rarely exist, even though such information is decisive for the appropriate medical care of this target group. We therefore conducted a cross-sectional survey regarding mental health of immigrants in Germany attending in non-health specific counseling agencies of welfare associations. Besides somatization symptoms (Beschwerdeliste (BL)) and symptoms of mental disorders (depression: patients’ health questionnaire (PHQ-D); anxiety: GAD-7; hazardous alcohol consumption: AUDIT), data on the social and occupational situation, as well as on the migration background was acquired. Data of n= 506 immigrants (55.5% female) were analyzed (age: 54.7 ± 12.4). The immigrants stems from the states of the former Soviet Union (n= 196), Turkey (n= 77), Italy (n= 95) and Spain (n= 67). Overall, 27.1% show evidence for a somatization disorder, 15.8% for a depressive disorder and 23.1% for increased anxiety (GAD-7 ≥ 5). 16.0% of the respondents show evidence of hazardous alcohol consumption. The study provides empirically profound information about the mental health of immigrants, who attend non-health specific counseling agencies. The analysis, subject to the migration status and socio-demographic factors, allows the development of measures of the enhancement of health care for this group regarding mental health.
Previous studies have observed reduced vagal modulation in patients with acute schizophrenia and their first degree relatives, thus suggesting a genetic predisposition.
To investigate vagal modulation at brain stem level, we investigated the coupling between heart rate and breathing as a putative measure of central autonomic function in 19 patients, 19 of their relatives and 19 matched control subjects. The interaction of heart rate and breathing was investigated in all groups applying the non-linear parameter cross-ApEn, indicating the asynchrony between both time series.
The main finding of our study is a significantly increased cross-ApEn value, indicating reduced central vagal modulation both in relatives and patients suffering from schizophrenia.
Our results suggest that autonomic dysfunction in schizophrenia is present in first-degree relatives not only at the target organs as shown previously, but also affects the central vagal component.
A carefully planned comprehensive and integrated care model of in- and outpatient depression treatment is a promising way to achieve improvements in care. Within the framework of the Freiburg Model of integrated care for depressive disorders a network of psychiatrists and primary care physicians offers in collaboration with the Department of Psychiatry and Psychotherapy of the University of Freiburg a coordinated treatment for patients with depressive disorders. Complementary to an evidence-based outpatient treatment the department of Psychiatry and Psychotherapy offers a complex treatment where patients can use the different inpatient measures during their outpatient treatment. In addition patients with a chronic depression can make use of a specific treatment program.
Decreased levels of polyunsaturated membrane fatty acids (PUFA) and increased activity of cytosolic phospholipase A2 (PLA2) enzymes (key regulating enzymes of membrane remodelling and PUFA availability) are supporting pillars of the “membrane phospholipids concept of schizophrenia”. Assuming that membrane PUFA profile and PLA2 activity are altered during the at risk phase of disorder and influenced by fatty acid supplementation, we investigated PUFA profiles and PLA2 activity simultaneously in ultra high-risk (UHR) subjects before and after (n-3) fatty acids supplementation.
In 81 UHR patients (aged between 13 and 25 years) PUFA levels were assessed in erythrocyte membranes using gas chromatography, and cytosolic PLA2 activity was measured in blood serum using a fluorometric HPTLC-based assay. Measurements were performed before and after a 6 month interval of placebo-controlled supplementation with n-3 fatty acids.
At baseline significant associations were found between (n-9) and (n-6)-PUFA levels and psychopathology (especially in negative symptoms) assessed by the PANSS according to PACE criteria. (n-3)-PUFA supplementation caused significant changes in (n-3)- and (n-6)-PUFA levels and a significant decrease of PLA2 activity.
Our results support associations between membrane biochemistry and psychopathology (especially negative symptoms) in people at risk to develop psychosis. Supplementation of n-3 PUFA increases PUFA availability at membrane level and modulates membrane repair and remodelling processes. Assuming that PLA2 activity reflects neuronal damage, PUFA supplementation might unfold neuroprotective effects.
The aim of this study was to examine the long-term efficacy and safety of a monotherapy with quetiapine or sodium valproate (VPA) in patients with rapid cycling bipolar disorder.
This open-label trial was conducted at three German centers. A sample of 38 remitted or partly remitted bipolar patients with rapid cycling (quetiapine n = 22; VPA n = 16) were treated with quetiapine or VPA (flexible-dose design) up to 12 months. Analyses were based on the ITT-LOCF principle.
41 % of the patients with quetiapine and 50 % with VPA completed the trial. According to the Clinical Global Impression Scale responder rates tended to be higher for quetiapine than for VPA: i.e. 43 % vs. 25 % (depression), 48 % vs. 36 % (mania), and 43 % vs. 19 % (improvement in both mania and depression). There were no differences found between the treatment groups evaluating the HRSD, MADRS and YMRS. In contrast, Life Chart Method data showed that patients being treated with quetiapine had significantly less depressive days than patients on VPA whilst they did not differ in the number of days with manic symptoms. The incidence of adverse events, especially of orthostatic dysregulation and sedation was higher in the quetiapine group.
Quetiapine may be more effective than VPA regarding depressive symptoms and as effective as VPA in the treatment of manic symptoms in the long-term treatment of rapid cycling bipolar disorder. The side effect profile of quetiapine tends to be less favorable than the one of VPA.
Although there are instruments for the assessment of DSM-IV mental disorders in primary care, there is no brief instrument to assess mental disorders in primary care according to the ICD-10.
The aim of the study was to assess the reliability of a new diagnostic interview, the TRIPS, designed for the assessment of anxiety-, mood-, and alcohol related disorders according to ICD-10 by non-mental health professionals.
At first, all Patients completed a screening questionnaire and were subsequently assessed by the staff of somatic departments of a Vienna General Hospital with the TRIPS. Within a week, patients were re-assessed by psychiatrists of the department of psychiatry with the Composite International Diagnostic Interview (CIDI).
Finally, 290 patients could be assessed with both instruments. With the CIDI, 106 out of 290 patients (37%) got any diagnosis of a mental disorder, 74 (26%) had a mood disorder, 64 (22%) an anxiety disorder and 10 patients (3%) an alcohol-related disorder.
Sensitivity of the TRIPS was 88%, specificity was 76% and diagnostic accuracy was 80% for any disorder, and 88%, 83%, and 84% respectively for any mood disorder, 72%, 88%, and 84% for any anxiety disorder, and 60%, 98%, and 97% for alcohol related disorders.
The results show that the TRIPS is a useful instrument with sufficient reliability to detect anxiety disorders and mood disorders in patients with somatic disorders by health professionals without psychiatric training. Due to the low base rate the test criteria for alcohol-related disorders cannot be interpreted sufficiently.