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Depression, anxiety and lack of impulse control are common neuropsychiatric symptoms in neurocognitive disorders and have been strongly associated with suicidality.
The aim of this study was to explore suicide rates in three major neuropsychiatric conditions including various degenerative neurocognitive disorders (DND), alcohol related neurocognitive disorders (ARND), and traumatic brain injuries (TBI).
The register cohort data of 231 817 patients with a diagnosis of degenerative dementias, ARND, or TBI, and their mortality data were collected from Finnish nationwide registers between 1998 and 2018. We calculated incidences of suicides, types of suicides, and suicide rates compared with the age- and sex matched general population (Standardized Mortality Ratio, SMR).
In fifteen years since diagnosis, 0.3% (95% CI: 0.2 to 0.5) of patients with DND, 1.1% (0.7 to 1.8) of patients with ARND, and 1.0% (0.7 to 1.3) of patients with TBI died from suicide (Figure). Men died from suicide more often than women [58.9 (51.3 to 67.4) vs. 9.8 (7.5 to 12.5) per 100 000 person-years]. Of all three groups of patients, the highest number of suicides per 100 000 was in ARND (98.8; 65.1 to 143.8), then in TBI (82.0; 62.4 to 105.8), and then in DND (21.2; 18.3 to 24.5). The most common cause of death per 100 000 person-years was self-inflicted injury by hanging, strangulation or suffocation and drowning (12.4, 10.3 to 14.8), the second highest incidence self-inflicted poisoning (5.7, 4.3 to 7.4), and then self-inflicted injury by firearms, explosives, smoke, fire, flames, steam, hot vapours or hot objects (4.7, 3.4 to 6.2). The SMRs (95% CI) in the DND group were 1.31 (1.13 to 1.51) for the whole group, 1.21 (0.90-1.62) for women, and 1.34 (1.14-1.58) for men. The SMRs in the ARND group were 3.69 (2.53-5.38), 5.05 (1.90 to 13.46), and 3.52 (2.34 to 5.30), and in the TBI group 2.99 (2.31 to 3.86), 5.68 (3.22 to 10.00), and 2.66 (2.00 to 3.55), respectively.
Suicide rates were higher in all three patient groups compared with the same-aged general population. Risk for death from suicide remained elevated for more than ten years after the initial diagnosis. Men committed more suicides than women, but there was no difference between sexes in comparison with the age-matched general population. The suicide methods were mostly violent.
Disclosure of Interest
T. Talaslahti Grant / Research support from: Helsinki University Hospital, grant no 212 9003, M. Ginters: None Declared, H. Kautiainen: None Declared, R. Vataja: None Declared, A. Palm: None Declared, H. Elonheimo: None Declared, J. Suvisaari: None Declared, H. Koponen: None Declared, N. Lindberg: None Declared
Compulsory admission procedures of patients with mental disorders vary between countries in Europe. The Ethics Committee of the European Psychiatric Association (EPA) launched a survey on involuntary admission procedures of patients with mental disorders in 40 countries to gather information from all National Psychiatric Associations that are members of the EPA to develop recommendations for improving involuntary admission processes and promote voluntary care.
The survey focused on legislation of involuntary admissions and key actors involved in the admission procedure as well as most common reasons for involuntary admissions.
We analyzed the survey categorical data in themes, which highlight that both medical and legal actors are involved in involuntary admission procedures.
We conclude that legal reasons for compulsory admission should be reworded in order to remove stigmatization of the patient, that raising awareness about involuntary admission procedures and patient rights with both patients and family advocacy groups is paramount, that communication about procedures should be widely available in lay-language for the general population, and that training sessions and guidance should be available for legal and medical practitioners. Finally, people working in the field need to be constantly aware about the ethical challenges surrounding compulsory admissions.
Aggressive and disruptive behaviors often precede the onset of schizophrenia. In this register-based follow-up study with a case-control design, we wanted to investigate if serious delinquency was associated with future diagnoses of schizophrenia or schizoaffective disorder (here, broadly defined schizophrenia) among a nationwide consecutive sample of 15- to 19-year-old Finnish delinquents sent for a forensic psychiatric examination in 1989–2010.
The sample comprised 313 delinquents with no past or current psychotic disorder. For each delinquent, four age-, gender- and place of birth -matched controls were randomly selected from the Central Population Register. Five controls (0.4%) had been treated for schizophrenia before their respective index-dates and were thus excluded from further analysis, leaving us with a control population of 1247 individuals. The subjects were followed till death, emigration or the end of 2015, whichever occurred first. Diagnoses were obtained from the Care Register for Health Care.
Forty (12.8%) of the delinquents and 11 (0.9%) of the controls were diagnosed with schizophrenia later in life (HR 16.6, 95% CI 8.53–32.39, P < 0.001). Almost half of the pretrial adolescents with later schizophrenia were diagnosed within 5 years of the forensic psychiatric examination, but latency was longer among the other half of the sample, reaching up to 20.5 years.
The study supports the previous research indicating a potential link between serious delinquency and later schizophrenia. Accurate psychiatric assessments should be made in correctional services but also later in life so that any possible psychotic symptoms can be detected in individuals with a history of serious delinquency even if there were no signs of psychosis before or at the time of the crime. Future research should explore which factors influence the delinquent's risk of developing later schizophrenia.
Structured self-reports, such as Beck's Depression Inventory (BDI) are widely used in assessing adolescents’ psychological wellbeing.
To investigate what factors are associated with discrepancies between BDI scores and diagnostic assessment in adolescent psychiatric patients and general population.
To recognize what factors may contribute to high BDI scores besides depressive symptoms.
The study population consisted of 206 adolescents (13–17 years old) who were hospitalised for the first time in adolescent psychiatry and 203 age and gender matched adolescents recruited from schools in the same region. Study subjects filled self-reports on depression symptoms (BDI-21), substance misuse (AUDIT), psychiatric symptoms (SCL-90), defense styles (DSQ-40) and self-image (OSIQ). Diagnostics was based on K-SADS-PL interview, and/or clinical interview and clinical records when available. Information on background and life events was gathered from study subjects.
We compared subjects who scored in BDI-21 either 0–15 points or 16–63 points firstly among subjects who did not fill diagnostic criteria for current unipolar depression and secondly among those who did fulfill the diagnostic criteria. High BDI-21 scores in subjects without depression diagnosis were associated with female sex, older age, several adverse life events, higher psychiatric co-morbidity, worse self-image and more immature, neurotic and image-distorting defense styles (and less mature defense style). Low BDI-21 scores among subjects with depression diagnosis were associated with male sex, more positive self-image and less immature defense style.
High BDI-21 scores may reflect a broad range of challenges in an adolescent's psychological development even in the absence of depression.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Animal health surveillance enables the detection and control of animal diseases including zoonoses. Under the EU-FP7 project RISKSUR, a survey was conducted in 11 EU Member States and Switzerland to describe active surveillance components in 2011 managed by the public or private sector and identify gaps and opportunities. Information was collected about hazard, target population, geographical focus, legal obligation, management, surveillance design, risk-based sampling, and multi-hazard surveillance. Two countries were excluded due to incompleteness of data. Most of the 664 components targeted cattle (26·7%), pigs (17·5%) or poultry (16·0%). The most common surveillance objectives were demonstrating freedom from disease (43·8%) and case detection (26·8%). Over half of components applied risk-based sampling (57·1%), but mainly focused on a single population stratum (targeted risk-based) rather than differentiating between risk levels of different strata (stratified risk-based). About a third of components were multi-hazard (37·3%). Both risk-based sampling and multi-hazard surveillance were used more frequently in privately funded components. The study identified several gaps (e.g. lack of systematic documentation, inconsistent application of terminology) and opportunities (e.g. stratified risk-based sampling). The greater flexibility provided by the new EU Animal Health Law means that systematic evaluation of surveillance alternatives will be required to optimize cost-effectiveness.
The impact of fibre level and fibre source on digestibility, gastrointestinal tract (GIT) development, total tract mean retention time (MRT) and growth performance was studied in indigenous Mong Cai (MC) and exotic Landrace × Yorkshire (LY) pigs. The diets were based on maize, rice bran, soyabean meal, fish meal and soyabean oil, and cassava residue (CR) or brewer's grain (BG) as fibrous ingredient sources in the high-fibre diets (HF) and were fed ad libitum. A low-fibre diet (LF), containing around 200 g NDF/kg dry matter (DM), was formulated without CR and BG as feed ingredients. The HF diets (HF-CR and HF-BG) were formulated to contain around 270 g NDF/kg DM. The experiment was arranged as a 2 × 3 factorial completely randomized design with six replications, and lasted 27 days. Increased dietary fibre level resulted in a reduction (P < 0.05) in average daily gain, digestibility of organic matter (OM), CP and gross energy (GE) at the ileum and in the total tract, and in MRT, and an increase (P < 0.05) in the feed conversion ratio and in the weight of the GIT (except for small intestine and caecum). The coefficients of total tract digestibility of fibre fractions were higher in HF diets than in the LF diet, with highest values for diet HF-CR, which had a high proportion of soluble non-starch polysaccharides. MC pigs had longer MRT of digesta than LY pigs (P < 0.05), resulting in higher digestibility at the ileum and in the total tract. Across diets and breeds, the total tract apparent digestibility of OM, CP and GE was positively related (R2 = 0.80 to 0.84) to the MRT of solids, whereas the MRT was negatively related to the DM intake (R2 = 0.60).
The Advanced Photon Source at Argonne National Laboratory is developing a low-emittance thermionic gun for a proposed X-ray free-electron laser oscillator (XFEL-O) that will use a laser pulse-heated cathode. The cathode must operate at or slightly above 1500 °C for several nanoseconds and then cool down several hundred °C in approximately the same amount of time, with a 1-MHz heating–cooling cycle. A transient thermal analysis was performed to optimize the laser pulse shape needed to provide the desired temperature response of the cathode for several possible cathode materials. In addition, thermal stresses developed in the cathode during heating–cooling cycles were analysed. Both transient thermal analysis and thermal stress computations were performed using the ANSYS12 code. The computed temperature distribution and thermal stresses were utilized in the optimization of the cathode design. The results of the analysis are presented.
An enzyme immunoassay, with phenol–water-extracted lipopolysaccharide (LPS) from Brucella abortus as antigen, was used to detect the class-specific antibody response in sera from 173 patients with B. abortus, B. melitensis or B. suis infection. Sera from 30 patients with salmonellosis, yersiniosis or tularaemia and from 25 healthy individuals served as controls. The B. abortus LPS antigen permitted a safe diagnosis of acute and chronic brucellosis with high IgM and rising IgG titres in sera collected in the acute stage of the disease, and with elevated IgG titres only in the chronic stage. The B. abortus LPS antigen also permitted a specific diagnosis with the exception of the high titres estimated in sera from patients with Yersinia enterocolitica 09 infection. The problem with that well-known reciprocal cross-reactivity was overcome by using two additional antigens: Y. enterocolitica 09 native and periodate oxidized and borohydride reduced LPS preparations. In sera from patients with brucellosis high titres were estimated against all three antigens, whereas in sera from patients with yersiniosis caused by serotype 09 high titres were measurable only with the B. abortus and the Y. enterocolitica native LPS antigens. These data suggest that the B. abortus and Y. enterocolitica 09 LPS share one antigenic determinant resistant to periodate oxidation and borohydride reduction, and that in addition the Y. enterocolitica 09 LPS has a determinant which is sensitive to periodate oxidation and borohydride reduction.
The aim of this study was to elucidate the regulatory responses and the long-term effect of praziquantel treatment in chronically Schistosoma bovis-infected West African Dwarf goats. Forty-two goats were used and the design comprised a primary infection followed by treatment at week 13, challenge infection at week 36 and termination at week 52. Dependent variables included clinico-pathological data, worm numbers, faecal and tissue egg counts, and gross pathology of the liver. The results showed that primary infections remained suppressed for up to 52 weeks and, although challenge infections imposed on 36-week-old primary infections established fully, the impairment of their egg production capacity provided protection against clinico-pathological consequences measured by body weight and haemoglobin levels. The study also confirmed a high efficacy (97·7%) of praziquantel for treatment of S. bovis infection in goats and showed that anthelminthic removal of primary infections does not interfere with the ability of the goat to elicit a marked resistance to a subsequent challenge infection. Although treated goats had more fibrous scarring of livers than untreated goats, no negative effects of liver lesions were reflected in weight gains of treated goats. This study provides strong evidence for the beneficial effects of anthelminthic treatment of young domestic stock as an element of treatment and preventive programmes.
Growing pigs fitted with post-valve T-caecum cannulas were used in a change-over design experiment (5 ✕ 5) to determine the ileal and total tract apparent digestibility and hindgut disappearance of dietary components and energy in a cassava root and soya-bean meal-based diet with an inclusion rate at 0·15 of the dry matter (DM) of either cassava leaf meal, ensiled cassava leaves, groundnut foliage, or leucaena leaves.
The ileal and total tract apparent digestibilities of organic matter (OM), crude protein, nitrogen-free extractives and energy of the diets were significantly reduced with inclusion of the foliages (P < 0·05). The digestibility of neutral-detergent fibre (NDF) and crude fibre was improved when groundnut foliage was included in the diet (P < 0·05).
The dietary content of NDF was a better predictor of the total tract digestibility of OM (R2 = 0·87) and energy (R2 = 0·90) than the content of crude fibre (R2 = 0·68 for OM digestibility and R2 = 0·72 for energy digestibility).
The disappearance of OM and energy in the hindgut of the foliage diets was 0·36 (s.d. 0·02) and 0·31 (s.d. 0·02), respectively, which was significantly lower (P < 0·05) than on the control diet (0·48 and 0·46, respectively).
Ileal as well as total tract digestibilities of OM in groundnut foliage were higher than for the other leaf products (ileal, 0·55 and 0·42; and total tract, 0·64 and 0·55, respectively). For foliage products of cassava and leucaena an average digestible energy value of 11·4 MJ/kg DM was calculated, whereas for groundnut foliage the corresponding value was 10·9 MJ/kg DM.
It was concluded that, inclusion of foliages in pig diets will reduce the dietary energy content, due to a high fibre content. However, under tropical conditions foliage at low levels of inclusion may be useful in low fibre diets for growing pigs to improve the dietary protein supply.
This volume reports the findings of a project on the Governance of the American Economy convened at the University of Wisconsin–Madison by J. Rogers Hollingsworth and Leon N. Lindberg. The purpose of the project was to understand the forces producing major changes in the structure of the institutions of governance – or control – in individual sectors and in the production process more generally. We were interested in recording the variety of the institutional conditions of economic exchange in the American economy and how these are transformed through time. We felt a need to thereby correct some common misperceptions about the institutional characteristics of the American economy and about the relations between the state and the economy in the United States.
Initial concepts and theoretical orientations for the project were developed in a seminar cotaught by Hollingsworth and Lindberg in the Fall of 1984. These were formalized in their paper, “The Governance of the American Economy: The Role of Markets, Clans, Hierarchies, and Associative Behavior” (1985), and a paper by Lindberg, “Political Economy, Economic Governance, and the Coordination of Economic Activities” (1986). On the basis of these ideas, a Workshop on the Governance of the American Economy, consisting primarily of graduate students at the University of Wisconsin–Madison (many of whom had been in the seminar) met regularly from the Fall of 1984 until the Summer of 1986. Each graduate student participant tried to analyze the history of a particular sector of the American economy with the conceptual apparatus provided.
The institutions that govern economic activity in the United States have changed dramatically since the late nineteenth century and continue to do so as politicians, business leaders, and others scramble to cope with sluggish productivity, rapid technological change, volatile markets, increasing international competition, trade deficits, and a host of other problems that plague the economy. This book explains how and why these transformations in governance, the political and economic processes that coordinate activity among economic actors, occurred in different industries and industrial sectors. Although we seek to understand the dynamics of the U.S. economy, we also address questions about the governance of modern capitalist economies in general by focusing on the emergence and rearrangement of several common institutional forms of governance, or governance mechanisms, which include markets, bureaucratic hierarchies, associations, and informal networks. We add further breadth to the analysis by discussing the unique role that the state plays in the governance transformation process.
Of course, social scientists have adopted a wide-ranging set of theoretical positions to explain transformations in governance. Those following Adam Smith, John Stuart Mill, and the neoclassical economic tradition adopted a utilitarian view and suggested that governance transformations occur when rationally calculating economic actors see that alternative forms of governance offer more profitable ways of doing business than those already in place (e.g., Williamson 1975, 1985, 1986). Others followed an organizational approach, reminiscent of Max Weber, and suggested that a broader set of motivations and organizational goals, such as a sense of community and reciprocity, also influence governance transformations (e.g., Granovetter 1985).