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To examine the cross-sectional and longitudinal (2-year follow-up) associations between dietary diversity (DD) and depressive symptoms.
Design:
An energy-adjusted dietary diversity score (DDS) was assessed using a validated FFQ and was categorised into quartiles (Q). The variety in each food group was classified into four categories of diversity (C). Depressive symptoms were assessed with Beck Depression Inventory-II (Beck II) questionnaire and depression cases defined as physician-diagnosed or Beck II >= 18. Linear and logistic regression models were used.
Setting:
Spanish older adults with metabolic syndrome (MetS).
Participants:
A total of 6625 adults aged 55–75 years from the PREDIMED-Plus study with overweight or obesity and MetS.
Results:
Total DDS was inversely and statistically significantly associated with depression in the cross-sectional analysis conducted; OR Q4 v. Q1 = 0·76 (95 % CI (0·64, 0·90)). This was driven by high diversity compared to low diversity (C3 v. C1) of vegetables (OR = 0·75, 95 % CI (0·57, 0·93)), cereals (OR = 0·72 (95 % CI (0·56, 0·94)) and proteins (OR = 0·27, 95 % CI (0·11, 0·62)). In the longitudinal analysis, there was no significant association between the baseline DDS and changes in depressive symptoms after 2 years of follow-up, except for DD in vegetables C4 v. C1 = (β = 0·70, 95 % CI (0·05, 1·35)).
Conclusions:
According to our results, DD is inversely associated with depressive symptoms, but eating more diverse does not seem to reduce the risk of future depression. Additional longitudinal studies (with longer follow-up) are needed to confirm these findings.
The aim of the study was to investigate the association between pre-gestational carbohydrate quality index (CQI) and the incidence of gestational diabetes mellitus (GDM). Data from the ‘Seguimiento Universidad de Navarra’ (SUN) cohort were used, which includes 3827 women who notified at least one pregnancy between December 1999 and December 2019. We used a validated semi-quantitative 136-item FFQ to evaluate dietary exposures at baseline and at 10-year follow-up. The CQI was defined by four criteria: glycaemic index, whole-grain/total-grain carbohydrate, dietary fibre intake and solid/total carbohydrate ratio. We fitted generalised estimating equations with repeated measurements of the CQI to assess its relationship with incident GDM. A total of 6869 pregnancies and 202 new cases of incident GDM were identified. The inverse association between the global quality of carbohydrate and the development of GDM was not statistically significant: OR the highest v. the lowest CQI category: 0·67, 95 % CI (0·40, 1·10), Pfor trend = 0·10. Participants at the highest CQI category and with daily carbohydrate amounts ≥50 % of total energy intake had the lowest incidence of GDM (OR = 0·29 (95 % CI (0·09, 0·89)) compared with those with the lowest quality (lowest CQI) and quantity (≤40 %). Further studies are needed to overcome the limitations of our study. Those studies should jointly consider the quality and the quantity of dietary carbohydrates, as the quality might be of importance, especially in women with a higher intake of carbohydrates.
The coronavirus disease 2019 (COVID-19) pandemic has been a global challenge. High mortality rates have been reported in some risk groups, including patients with pre-existing mental disorders.
Methods
We used electronic health records to retrospectively identify people infected due to COVID-19 (between March 2020 and March 2021) in the three territories of the Basque Country. COVID-19 cases were defined as individuals who had tested positive on a reverse transcription-polymerase chain reaction (PCR) test. Univariate and multivariate logistic regression models and multilevel analyses with generalized estimated equations were used to determine factors associated with COVID-19-related mortality and hospital admission.
Results
The COVID-19 mortality rate was increased for patients with psychotic disorders [odds ratio (OR) adjusted: 1.45, 95% confidence interval (CI) (1.09–1.94), p = 0.0114] and patients with substance abuse [OR adjusted: 1.88, 95% CI (1.13–3.14, p < 0.0152)]. The mortality rate was lower for patients with affective disorders [OR adjusted: 0.80, 95% CI (0.61–0.99), p = 0.0407]. Hospital admission rates due to COVID-19 were higher in psychosis [OR adjusted: 2.90, 95% CI (2.36–3.56), p < 0.0001] and anxiety disorder groups [OR adjusted: 1.54, 95% CI (1.37–1.72), p < 0.0001]. Among admitted patients, COVID-19 mortality rate was decreased for those with affective disorders rate [OR adjusted: 0.72, 95% CI (0.55–0.95), p = 0.0194].
Conclusions
COVID-19-related mortality and hospitalizations rates were higher for patients with a pre-existing psychotic disorder.
Healthcare workers (HCWs) exposed to coronavirus 19 (COVID-19) are at high risk of developing mental health concerns across several domains. The aim of this study is to determine the updated, global frequency of these outcomes.
Methods
A multistep literature search was performed from database inception until March 1, 2021. PRISMA/MOOSE-compliant systematic review and PROSPERO protocol were used to identify studies reporting on depression, anxiety, acute stress, post-traumatic symptoms, insomnia, and burnout in HCWs exposed to COVID-19. A quantitative meta-analysis with random effects was conducted to analyze the proportion rate of the mental health disorders. Sensitivity analyses were performed to investigate the effect of the different continents and scales. Meta-regression analyses were conducted to examine the effect of gender, age, and work position.
Results
239 articles were included (n = 271,319 HCWs, mean age = 36.08 ± 8.33 (66.99% female). 33% HCWs exposed to COVID-19 reported depressive symptoms (95% confidence intervals [CI] = 28–38%), 42% anxiety features (95% CI = 35–48), 40% acute stress (95% CI = 32–47), 32% post-traumatic symptoms (95% CI = 26–37%), 42% insomnia (95% CI = 36–48), 37% burnout (95% CI = 31–42). Sensitivity analyses did not show statistically significant differences. Meta-regressions found a statistically significant lower prevalence of post-traumatic symptoms in Asia.
Conclusions
HCWs exposed to COVID-19 were found to have a significant prevalence of mental health concerns in all domains analyzed. The effects of COVID-19 on HCWs’ mental health could be underestimated and the future consequences dismissed.
The Roca San Miguel (RSM) archaeological site was occupied during Mousterian times. Here we present a geoarchaeological and paleoenvironmental reconstruction of the site. Five stratigraphic units (A to E) formed by different archaeological levels are identified. Three optically stimulated luminescence (OSL) ages show that Unit A dates to between 169.6 ± 9.1 and 151.9 ± 11.1 ka, during the penultimate glacial period (PGP), and contains numerous signs of recurring hearths. Unit B is unexcavated. Unit C dates to between 118.9 ± 11.5 and 103.4 ± 6.9 ka (late Eemian–marine isotope stage (MIS) 5d) and shows an abundance of lithic remains as well as some faunal elements. Unit C is covered by Unit D, which incorporates materials moved downslope, and is dated at 81.2 ± 4.7 ka. These OSL ages concur with U/Th ages (129.3 ± 1.5 and 123.6 ± 0.6 ka) derived from a flowstone covered by both -C and D- post-flowstone units. Finally, Unit E covers the archaeological site, which was partially eroded during MIS2. The robust and well-constrained chronology of the RSM site and surroundings enables the establishment of its evolutionary model from the PGP to the last glacial cycle. The RSM site is the oldest Neanderthal occupation accurately dated in the Pre-Pyrenean region.
Money laundering repression and asset recovery are tools that share a very relevant preventive–general role. Both measures in Criminal Law seek to inhibit the monetary stimulus to commit offenses. The former does so by hampering the flow of earnings from illicit sources, and the latter by confiscating the earnings from their beneficiaries. These interlinked goals prove to be most useful from a criminal policy standpoint in the fight against organized crime since they are oriented to the economic disabling of their agents, blockading their financial movement and depriving them of the profits thus generated. This article explains the status of Paraguayan law and its application on these issues.
The burden of depression is increasing worldwide, specifically in older adults. Unhealthy dietary patterns may partly explain this phenomenon. In the Spanish PREDIMED-Plus study, we explored (1) the cross-sectional association between the adherence to the Prime Diet Quality Score (PDQS), an a priori-defined high-quality food pattern, and the prevalence of depressive symptoms at baseline (cross-sectional analysis) and (2) the prospective association of baseline PDQS with changes in depressive symptomatology after 2 years of follow-up. After exclusions, we assessed 6612 participants in the cross-sectional analysis and 5523 participants in the prospective analysis. An energy-adjusted high-quality dietary score (PDQS) was assessed using a validated FFQ. The cross-sectional association between PDQS and the prevalence of depression or presence of depressive symptoms and the prospective changes in depressive symptoms were evaluated through multivariable regression models (logistic and linear models and mixed linear-effects models). PDQS was inversely associated with depressive status in the cross-sectional analysis. Participants in the highest quintile of PDQS (Q5) showed a significantly reduced odds of depression prevalence as compared to participants in the lowest quartile of PDQS (Q1) (OR (95 %) CI = 0·82 (0·68, 0·98))). The baseline prevalence of depression decreased across PDQS quintiles (Pfor trend = 0·015). A statistically significant association between PDQS and changes in depressive symptoms after 2-years follow-up was found (β (95 %) CI = −0·67 z-score (–1·17, −0·18). A higher PDQS was cross-sectionally related to a lower depressive status. Nevertheless, the null finding in our prospective analysis raises the possibility of reverse causality. Further prospective investigation is required to ascertain the association between PDQS and changes in depressive symptoms along time.
This paper explores the innovative socio-educational experience of Huerto Alegre (Spain), linking it to a critical perspective of Education for Sustainable Development (ESD). Going beyond the ‘pluralist practices’ associated with the ESD, our case study seeks to redefine ESD from a critical and ecocentric perspective within the context of the Earth Charter (EC). Huerto Alegre’s social-educational programme is aimed at children and young people with the objective of creating critical thinking and fostering connections between school and the natural environment by working collaboratively with teaching professionals. The methodology of the paper focuses on a content analysis of the centre’s key documents and on the narratives of students, in addition to an in-depth interview with its director. It also presents a critical reconstruction of the subject. This complements, and gives meaning to, the theoretical debates surrounding ESD — debates that call for structural changes to our current model of society.
We use the SPace Infrared telescope for Cosmology and Astrophysics (SPICA) project as a template to demonstrate how deep spectrophotometric surveys covering large cosmological volumes over extended fields (1–
$15\, \rm{deg^2}$
) with a mid-IR imaging spectrometer (17–
$36\, \rm{\rm{\upmu m}}$
) in conjunction with deep
$70\, \rm{\rm{\upmu m}}$
photometry with a far-IR camera, at wavelengths which are not affected by dust extinction can answer the most crucial questions in current galaxy evolution studies. A SPICA-like mission will be able for the first time to provide an unobscured three-dimensional (3D, i.e. x, y, and redshift z) view of galaxy evolution back to an age of the universe of less than
$\sim$
2 Gyrs, in the mid-IR rest frame. This survey strategy will produce a full census of the Star Formation Rate (SFR) in the universe, using polycyclic aromatic hydrocarbons (PAH) bands and fine-structure ionic lines, reaching the characteristic knee of the galaxy luminosity function, where the bulk of the population is distributed, at any redshift up to
$z \sim 3.5$
. Deep follow-up pointed spectroscopic observations with grating spectrometers onboard the satellite, across the full IR spectral range (17–
$210\, \rm{\rm{\upmu m}}$
), would simultaneously measure Black Hole Accretion Rate (BHAR), from high-ionisation fine-structure lines, and SFR, from PAH and low- to mid-ionisation lines in thousands of galaxies from solar to low metallicities, down to the knee of their luminosity functions. The analysis of the resulting atlas of IR spectra will reveal the physical processes at play in evolving galaxies across cosmic time, especially its heavily dust-embedded phase during the activity peak at the cosmic noon (
$z \sim 1$
–3), through IR emission lines and features that are insensitive to the dust obscuration.
To assess the association between pregestational BMI and offspring’s risk of overweight/obesity after accounting for the most important confounders, especially maternal smoking habit.
Design:
Prospective cohort study.
Setting:
The Seguimiento Universidad de Navarra (SUN) study is a prospective cohort of Spanish graduates with more than 22 000 participants nationwide. Recruitment started in 1999, and it is permanently open. Data on diet, lifestyle and clinical diagnoses are collected at baseline and every 2 years.
Participants:
Women from the SUN cohort who reported at least one pregnancy during follow-up (n 3496) were invited to this study. Among them, 1527 agreed to participate and completed an additional more detailed online questionnaire on their pregnancy history and their offspring’s nutritional status.
Results:
After excluding 165 children, we analysed data of 2791 participants born to 1485 mothers and observed that each 5 kg/m2 increase in pregestational BMI was associated with a 0·22 (95 % CI 0·15, 0·29) higher z-score in offspring’s BMI and higher risk of overweight/obesity (multivariable-adjusted relative risk (RR) 1·57 (95 % CI 1·39, 1·77)) in childhood or adolescence. Furthermore, we observed stronger association in children born to smoker mothers (RR 1·91; 95 % CI 1·48, 2·46) than from non-smoker mothers (RR 1·51; 95 % CI 1·31, 1·73) (Pfor interaction = 0·02).
Conclusions:
We found a synergistic interaction between pregestational BMI and maternal smoking habit on offspring’s z-score of the BMI and in their risk of overweight/obesity. Although further research is needed to analyse dose–response relationships, these findings reinforce the importance of promoting healthy lifestyles in pregnant women in order to prevent childhood obesity.
The northern bald ibis Geronticus eremita was once widespread throughout the Middle East, northern Africa, and southern and central Europe. Habitat destruction, persecution and the impacts of pesticides have led to its disappearance from most of its former range. It disappeared from central Europe > 400 years ago, but has persisted as a relict and slowly growing breeding population in Morocco, where c. 700 wild birds of all ages remain. In Algeria, the last confirmed breeding was in 1984; in Turkey the fully wild population disappeared in 1989, but a population remains in semi-wild conditions. In Syria a small population was rediscovered in 2002, only to subsequently decline to functional extinction. Restoration programmes have been initiated independently in several locations, with over 300 free-flying birds resulting from reintroduction projects in Austria, Germany, Spain and Turkey, to restore both sedentary and fully migratory populations. Maintaining current efforts in Morocco remains a high conservation priority.
Brown bears Ursus arctos were historically persecuted and almost eradicated from southern Europe in the twentieth century as a result of hunting and direct persecution. The effects of human-induced mortality were exacerbated by other threats, such as habitat loss and fragmentation, due to the expansion of human populations. As a result, nowadays there are only small fragmented populations of bears in southern Europe. Brown bears in the Cantabrian (north-western Spain), Apennine (central Italy), and Pindos (north-western Greece) mountains represent three examples of small and threatened bear populations in human-modified landscapes. Most of their range is characterized by high human densities, widespread agricultural activities, livestock raising and urban development, connected by dense networks of transport infrastructures. This has resulted in a reduction of continuous habitat suitable for the species. Here, we summarize the past and present histories and fates of these three populations as examples on how the coexistence of bears and people in human-modified landscapes can take different turns depending on human attitudes.
The mating system and mating strategies of a species refer to the behavioral strategies used to obtain reproductive partners and ensure reproductive success. Common determining factors of mating systems and strategies are: the manner of mate acquisition, the number of mates obtained by an individual, as well as the absence or presence and duration of parental care. In mammals, the energetic investments in gametes and rearing offspring are typically larger for females than for males. Mate selection is thus a much more important decision for females than for the rather indiscriminate males. This dichotomy results in sexual selection, which in turn is determined by male–male competition for access to females, as well as female mate choice. Because receptive females are generally considered the limiting resource in reproduction, males face intrasexual competition for mates. In a multitude of mammalian species, including bears, this has resulted in pronounced sexual size dimorphism and polygamous mating systems. Despite common characteristics (e.g. sexual size dimorphism, polygamy), variation in mating systems and strategies occur among bear populations and species.
Pulses such as peas, beans or lentils are one of the most complete foods at the nutritional level; however, they are one of the most often neglected foods in the diets of university students. Entrance to university translates into a major lifestyle change for many young people, and the habits acquired or cemented at this time will remain into adulthood. The objective of this study is to analyse the association between personal/sociodemographic factors, dietary intake of other food groups and the consumption of pulses in first-year university students. This cross-sectional study is part of the UniHcos project, a multicentre study of multipurpose prospective cohorts in eleven Spanish universities. Data from 9862 university students were collected through an online self-questionnaire completed by all students who met the selection criteria and agreed to participate in the project during the 2011–2018 academic years. Of students, 75·8 % presented an inadequate (≤2 times/week) consumption of pulses. Living outside the family home in either a student residence (OR 0·76; 95 % CI 0·69, 0·84) or rental (OR 0·81; 95 % CI 0·70, 0·95) decreased the compliance with recommendations on the consumption of pulses. Low consumption of pulses is seemingly not restricted to a specific profile or dietary pattern among university students, and no specific focus group for intervention can be identified. Policies promoting the consumption of pulses among the university population as a whole are necessary to increase compliance rates with the dietary recommendations.
The global growing rates of cognitive decline and dementia, together with the absence of curative therapies for these conditions, support the interest in researching potential primary prevention interventions, with particular focus on dietary habits. The aim was to assess the association between polyphenol intake and 6-year change in cognitive function in the ‘Seguimiento Universidad de Navarra’ (SUN) Project, a Spanish prospective cohort study. Changes (final – initial) in cognitive function were evaluated in a subsample of 806 participants (mean age 66 (sd 5) years, 69·7 % male) of the SUN Project using the validated Spanish Telephone Interview for Cognitive Status-modified score. Polyphenol intake was derived from a validated semi-quantitative FFQ and matching food composition data from the Phenol-Explorer database. Multivariable linear regression models were used to evaluate the association between total polyphenol intake, polyphenol subclasses and cognitive changes. No significant association between total polyphenol intake and changes in cognitive function was found. However, a higher intake of lignans (βQuintile (Q) 5 v. Q1 0·81; 95 % CI 0·12, 1·51; Ptrend = 0·020) and stilbenes (βQ5 v. Q1 0·82; 95 % CI 0·15, 1·49; Ptrend = 0·028) was associated with more favourable changes in cognitive function over time, particularly with respect to immediate memory and language domains. Olive oil and nuts were the major sources of variability in lignan intake, and wine in stilbene intake. The results suggest that lignan and stilbene intake was associated with improvements in cognitive function.
Unwanted loneliness is a public health issue due to its high prevalence among elderly people (20-40%) and its relation with morbidity and mortality. There is no clear strategy for addressing this problem given the diversity of needs and resources people with feelings of loneliness have.
Objective:
Identify the needs and resources of elderly people with chronic conditions and feelings of loneliness by comparing the patient’s outlook with that of their primary healthcare professional.
Methods:
Observational, cross-sectional, descriptive pilot study using theoretical convenience sampling at 5 health facilities in Barcelona (Spain), performed between October and May 2020. Of 159 people selected, 42 were identified to have feelings of loneliness (UCLA < 30) who agreed to participate in the study and their care needs were analysed using the Camberwell Assessment of Need for the Elderly (CANE) questionnaire. A descriptive and comparative analysis (Kappa coefficient and discrepancy percentage) of needs was performed using the outlook of the patients and their healthcare professionals. Data was analysed using SAS assuming a 5% significance level. A qualitative analysis was also performed to understand the relation between the feeling of loneliness and needs across 24 care areas (environmental, social, psychological, and physical). The study was approved by the IDIAP Jordi Gol Healthcare Ethics Committee (19/138-P).
Findings:
The needs perceived focused on physical health, distress, companionship, and relationships (30% to 41.7%). Professionals showed a severe lack of knowledge regarding housing, home care, relationships, and social services (22% to 48%). The qualitative analysis revealed the relation between the feeling of loneliness and the irreversible losses of those close to the patient, along with insufficient support and understanding during the aging process, and feelings of abandonment and guilt. Meanwhile, other notable aspects include the need of independence and resistance towards starting activities requiring commitment and travel. Caring for others and mobility and sensory restrictions act as extra barriers.
Conclusions:
This study enables the needs of people with feelings of loneliness to be identified. Discrepancies between them and their healthcare professionals were recorded, in turn providing direction regarding which areas need to be improved when designing patient-focused primary healthcare approaches.
Less is known about the relationship between conduct disorder (CD), callous–unemotional (CU) traits, and positive and negative parenting in youth compared to early childhood. We combined traditional univariate analyses with a novel machine learning classifier (Angle-based Generalized Matrix Learning Vector Quantization) to classify youth (N = 756; 9–18 years) into typically developing (TD) or CD groups with or without elevated CU traits (CD/HCU, CD/LCU, respectively) using youth- and parent-reports of parenting behavior. At the group level, both CD/HCU and CD/LCU were associated with high negative and low positive parenting relative to TD. However, only positive parenting differed between the CD/HCU and CD/LCU groups. In classification analyses, performance was best when distinguishing CD/HCU from TD groups and poorest when distinguishing CD/HCU from CD/LCU groups. Positive and negative parenting were both relevant when distinguishing CD/HCU from TD, negative parenting was most relevant when distinguishing between CD/LCU and TD, and positive parenting was most relevant when distinguishing CD/HCU from CD/LCU groups. These findings suggest that while positive parenting distinguishes between CD/HCU and CD/LCU, negative parenting is associated with both CD subtypes. These results highlight the importance of considering multiple parenting behaviors in CD with varying levels of CU traits in late childhood/adolescence.
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.
Methods
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.
Results
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.
Conclusions
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.