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Studying phenotypic and genetic characteristics of age at onset (AAO) and polarity at onset (PAO) in bipolar disorder can provide new insights into disease pathology and facilitate the development of screening tools.
To examine the genetic architecture of AAO and PAO and their association with bipolar disorder disease characteristics.
Genome-wide association studies (GWASs) and polygenic score (PGS) analyses of AAO (n = 12 977) and PAO (n = 6773) were conducted in patients with bipolar disorder from 34 cohorts and a replication sample (n = 2237). The association of onset with disease characteristics was investigated in two of these cohorts.
Earlier AAO was associated with a higher probability of psychotic symptoms, suicidality, lower educational attainment, not living together and fewer episodes. Depressive onset correlated with suicidality and manic onset correlated with delusions and manic episodes. Systematic differences in AAO between cohorts and continents of origin were observed. This was also reflected in single-nucleotide variant-based heritability estimates, with higher heritabilities for stricter onset definitions. Increased PGS for autism spectrum disorder (β = −0.34 years, s.e. = 0.08), major depression (β = −0.34 years, s.e. = 0.08), schizophrenia (β = −0.39 years, s.e. = 0.08), and educational attainment (β = −0.31 years, s.e. = 0.08) were associated with an earlier AAO. The AAO GWAS identified one significant locus, but this finding did not replicate. Neither GWAS nor PGS analyses yielded significant associations with PAO.
AAO and PAO are associated with indicators of bipolar disorder severity. Individuals with an earlier onset show an increased polygenic liability for a broad spectrum of psychiatric traits. Systematic differences in AAO across cohorts, continents and phenotype definitions introduce significant heterogeneity, affecting analyses.
Agoraphobic avoidance of everyday situations is a common feature in many mental health disorders. Avoidance can be due to a variety of fears, including concerns about negative social evaluation, panicking, and harm from others. The result is inactivity and isolation. Behavioural avoidance tasks (BATs) provide an objective assessment of avoidance and in situ anxiety but are challenging to administer and lack standardisation. Our aim was to draw on the principles of BATs to develop a self-report measure of agoraphobia symptoms.
The scale was developed with 194 patients with agoraphobia in the context of psychosis, 427 individuals in the general population with high levels of agoraphobia, and 1094 individuals with low levels of agoraphobia. Factor analysis, item response theory, and receiver operating characteristic analyses were used. Validity was assessed against a BAT, actigraphy data, and an existing agoraphobia measure. Test–retest reliability was assessed with 264 participants.
An eight-item questionnaire with avoidance and distress response scales was developed. The avoidance and distress scales each had an excellent model fit and reliably assessed agoraphobic symptoms across the severity spectrum. All items were highly discriminative (avoidance: a = 1.24–5.43; distress: a = 1.60–5.48), indicating that small increases in agoraphobic symptoms led to a high probability of item endorsement. The scale demonstrated good internal reliability, test–retest reliability, and validity.
The Oxford Agoraphobic Avoidance Scale has excellent psychometric properties. Clinical cut-offs and score ranges are provided. This precise assessment tool may help focus attention on the clinically important problem of agoraphobic avoidance.
This is the first report on the association between trauma exposure and depression from the Advancing Understanding of RecOvery afteR traumA(AURORA) multisite longitudinal study of adverse post-traumatic neuropsychiatric sequelae (APNS) among participants seeking emergency department (ED) treatment in the aftermath of a traumatic life experience.
We focus on participants presenting at EDs after a motor vehicle collision (MVC), which characterizes most AURORA participants, and examine associations of participant socio-demographics and MVC characteristics with 8-week depression as mediated through peritraumatic symptoms and 2-week depression.
Eight-week depression prevalence was relatively high (27.8%) and associated with several MVC characteristics (being passenger v. driver; injuries to other people). Peritraumatic distress was associated with 2-week but not 8-week depression. Most of these associations held when controlling for peritraumatic symptoms and, to a lesser degree, depressive symptoms at 2-weeks post-trauma.
These observations, coupled with substantial variation in the relative strength of the mediating pathways across predictors, raises the possibility of diverse and potentially complex underlying biological and psychological processes that remain to be elucidated in more in-depth analyses of the rich and evolving AURORA database to find new targets for intervention and new tools for risk-based stratification following trauma exposure.
Children with congenital heart disease are at high risk for malnutrition. Standardisation of feeding protocols has shown promise in decreasing some of this risk. With little standardisation between institutions’ feeding protocols and no understanding of protocol adherence, it is important to analyse the efficacy of individual aspects of the protocols.
Adherence to and deviation from a feeding protocol in high-risk congenital heart disease patients between December 2015 and March 2017 were analysed. Associations between adherence to and deviation from the protocol and clinical outcomes were also assessed. The primary outcome was change in weight-for-age z score between time intervals.
Increased adherence to and decreased deviation from individual instructions of a feeding protocol improves patients change in weight-for-age z score between birth and hospital discharge (p = 0.031). Secondary outcomes such as markers of clinical severity and nutritional delivery were not statistically different between groups with high or low adherence or deviation rates.
High-risk feeding protocol adherence and fewer deviations are associated with weight gain independent of their influence on nutritional delivery and caloric intake. Future studies assessing the efficacy of feeding protocols should include the measures of adherence and deviations that are not merely limited to caloric delivery and illness severity.
This descriptive paper aims to describe the design and implementation of a community engaged primary healthcare strategy in rural Australia, the Primary Healthcare Registered Nurse: Schools-Based strategy. This strategy seeks to address the health, education and social inequities confronting children and adolescents through community engaged service provision and nursing practice.
There have been increasing calls for primary healthcare approaches to address rural health inequities, including contextualised healthcare, enhanced healthcare access, community engagement in needs and solutions identification and local-level collaborations. However, rural healthcare can be poorly aligned to community contexts and needs and be firmly entrenched in health systems, marginalising community participation.
This strategy has been designed to enhance nursing service and practice responsiveness to the rural context, primary healthcare principles, and community experiences and expectations of healthcare. The strategy is underpinned by a cross-sector collaboration between a local health district, school education and a university department of rural health. A research framework is being developed to explore strategy impacts for service recipients, cross-sector systems, and the establishment and maintenance of a primary healthcare nursing workforce.
Although in the early stages of implementation, key learnings have been acquired and strategic, relationship, resource and workforce gains achieved.
Beaches and dunes of the open coast form one of the globe’s longest ecological interfaces, linking the oceans with the land. These systems are of great importance to society as prime sites for housing and recreation, buffers against storms, and providers of fisheries and mineral resources. By contrast, their unique ecological attributes and biodiversity are much less recognized. In this chapter, we provide a synthesis of the key ecological features and functions of beaches and dunes, outline the main elements of their faunal biodiversity, examine human threats and their biological consequences, and sketch some salient issues in management to achieve conservation of these unique ecosystems. It is apparent that the range of ecosystem goods and services is broad, but nutrient cycling, water filtration, and the provision of habitat and prey for a diverse range of animals are often the key ecological traits. Contrary to common perceptions, beaches and dunes contain a diverse and unique set of species, many of which are found nowhere else. In addition to the complement of highly adapted invertebrates, many wildlife species (e.g. birds, turtles, fishes) are dependent on beaches and dunes for nesting and feeding, and they use these habitats extensively. Human pressures on sandy shorelines and their biodiversity are numerous. Coastal squeeze is, however, the most pervasive, trapping beaches and their biota between the pressures of development from the terrestrial side and the consequences of climate change from the marine side. Beaches are also naturally malleable habitats whose interlinkages, including the exchange of organisms, with the abutting dunes and surf zones are essential to their functioning. Unfortunately, human actions intended to arrest the dynamics of beach habitats, such as seawalls and dune stabilizations, run counter to these natural dynamics and generally produce negative environmental outcomes. These present a set of formidable management challenges when the primary goal is to conserve intact ecosystems and biodiversity, calling for more systematic approaches in conservation design and implementation for beach and dune ecosystems.
Predatory insects and spiders were collected from apple orchards in two
geographic regions of Central Washington State, United States of America to
assess seasonal phenology and diversity of the generalist predator
community. Arthropods were collected from orchard canopy every 3–7 days over
two growing seasons (March–October) at seven organically managed and two
insecticide-free orchards. Over 35 000 specimens and 80 species of spiders
(Araneae), ladybeetles (Coleoptera: Coccinellidae), lacewings (Neuroptera),
and predatory true bugs (Hemiptera) were collected. Composition of insect
and spider communities differed between the two geographic regions.
Indicator species analysis identified several species that had a significant
association with one of the two regions. Counts of the most common taxa were
examined in detail on a calendar date basis to determine seasonal phenology
of adult and immature stages. We observed substantial differences among taxa
in number of generations, seasonal timing of first appearance in orchards,
overwintering stages, and seasonal occurrence of the adult and immature life
stages in orchards. Understanding seasonal phenology of natural enemies in
orchards is a core requirement in integrated pest management programs for
apple pests, and results of this study provide this information for the
generalist predator community of orchards in the Pacific Northwest.