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The impact of the coronavirus disease 2019 (COVID-19) pandemic on mental health is still being unravelled. It is important to identify which individuals are at greatest risk of worsening symptoms. This study aimed to examine changes in depression, anxiety and post-traumatic stress disorder (PTSD) symptoms using prospective and retrospective symptom change assessments, and to find and examine the effect of key risk factors.
Method
Online questionnaires were administered to 34 465 individuals (aged 16 years or above) in April/May 2020 in the UK, recruited from existing cohorts or via social media. Around one-third (n = 12 718) of included participants had prior diagnoses of depression or anxiety and had completed pre-pandemic mental health assessments (between September 2018 and February 2020), allowing prospective investigation of symptom change.
Results
Prospective symptom analyses showed small decreases in depression (PHQ-9: −0.43 points) and anxiety [generalised anxiety disorder scale – 7 items (GAD)-7: −0.33 points] and increases in PTSD (PCL-6: 0.22 points). Conversely, retrospective symptom analyses demonstrated significant large increases (PHQ-9: 2.40; GAD-7 = 1.97), with 55% reported worsening mental health since the beginning of the pandemic on a global change rating. Across both prospective and retrospective measures of symptom change, worsening depression, anxiety and PTSD symptoms were associated with prior mental health diagnoses, female gender, young age and unemployed/student status.
Conclusions
We highlight the effect of prior mental health diagnoses on worsening mental health during the pandemic and confirm previously reported sociodemographic risk factors. Discrepancies between prospective and retrospective measures of changes in mental health may be related to recall bias-related underestimation of prior symptom severity.
Anticholinergic medications block cholinergic transmission. The central effects of anticholinergic drugs can be particularly marked in patients with dementia. Furthermore, anticholinergics antagonise the effects of cholinesterase inhibitors, the main dementia treatment.
Objectives
This study aimed to assess anticholinergic drug prescribing among dementia patients before and after admission to UK acute hospitals.
Methods
352 patients with dementia were included from 17 hospitals in the UK. All were admitted to surgical, medical or Care of the Elderly wards in 2019. Information about patients’ prescriptions were recorded on a standardised form. An evidence-based online calculator was used to calculate the anticholinergic drug burden of each patient. The correlation between two subgroups upon admission and discharge was tested with Spearman’s Rank Correlation.
Results
Table 1 shows patient demographics. On admission, 37.8% of patients had an anticholinergic burden score ≥1 and 5.68% ≥3. At discharge, 43.2% of patients had an anticholinergic burden score ≥1 and 9.1% ≥3. The increase was statistically significant (rho 0.688; p=2.2x10-16). The most common group of anticholinergic medications prescribed at discharge were psychotropics (see Figure 1). Among patients prescribed cholinesterase inhibitors, 44.9% were also taking anticholinergic medications.
Conclusions
This multicentre cross-sectional study found that people with dementia are frequently prescribed anticholinergic drugs, even if also taking cholinesterase inhibitors, and are significantly more likely to be discharged with a higher anticholinergic drug burden than on admission to hospital.
Conflict of interest
This project was planned and executed by the authors on behalf of SPARC (Student Psychiatry Audit and Research Collaborative). We thank the National Student Association of Medical Research for allowing us use of the Enketo platform. Judith Harrison was su
Impulsivity is a central symptom of borderline personality disorder (BPD) and its neural basis may be instantiated in a frontoparietal network involved in response inhibition. However, research has yet to determine whether neural activation differences in BPD associated with response inhibition are attributed to attentional saliency, which is subserved by a partially overlapping network of brain regions.
Methods
Patients with BPD (n = 45) and 29 healthy controls (HCs; n = 29) underwent functional magnetic resonance imaging while completing a novel go/no-go task with infrequent odd-ball trials to control for attentional saliency. Contrasts reflecting a combination of response inhibition and attentional saliency (no-go > go), saliency processing alone (oddball > go), and response inhibition controlling for attentional saliency (no-go > oddball) were compared between BPD and HC.
Results
Compared to HC, BPD showed less activation in the combined no-go > go contrast in the right posterior inferior and middle-frontal gyri, and less activation for oddball > go in left-hemispheric inferior frontal junction, frontal pole, superior parietal lobe, and supramarginal gyri. Crucially, BPD and HC showed no activation differences for the no-go > oddball contrast. In BPD, higher vlPFC activation for no-go > go was correlated with greater self-rated BPD symptoms, whereas lower vlPFC activation for oddball > go was associated with greater self-rated attentional impulsivity.
Conclusions
Patients with BPD show frontoparietal disruptions related to the combination of response inhibition and attentional saliency or saliency alone, but no specific response inhibition neural activation difference when attentional saliency is controlled. The findings suggest a neural dysfunction in BPD underlying attention to salient or infrequent stimuli, which is supported by a negative correlation with self-rated impulsiveness.
Suicide is a serious phenomenon associated with psychiatric disorders.
Objectives
In the present study, we investigated factors that can predict follow-up at the psychiatric clinic after medical care at the emergency room (ER).
Methods
Medical records of the 145 patients treated at the ER following suicide attempt from Jan 1, 2009 to July 31, 2009 were reviewed. Age, sex, past psychiatric history, impulsiveness and medical severity of suicide attempt, risk-rescue rating scores, reasons for suicide attempt and methods of suicide were examined. Psychiatric diagnoses were made by psychiatrists at the initial interview with patients at ER.
Results
The mean age of the patients was 42.9 ± 15.7 years, and 68.3 % were women and 31.7% were men. Among the suicide methods, psychotropics were the most common (69%), and ingestion of pesticides was the second (19.3%). Interpersonal problems were the most common precipitating event (57.9%), and depression was the most common (89%). About a half had previous psychiatric disorders and about one third had previous suicide attempt. Fifteen patients (10.3%) attempted planned suicide and 124 patients (85.5%) attempted impulsively. Mean risk and rescue rating scores was 8.6 ±1.6 and 12.3 ± 2.2. About one third had a follow-up psychiatric visit. The most important predictor of psychiatric follow-up was risk rating scores.
Conclusions
This study suggests that women with interpersonal problems and depression should be carefully monitored to reduce suicide attempt. Patients commit less risky suicide attempts tend to more loss to psychiatric follow-up, thus, need more attention to prevent suicide re-attempts.
The COllaborative project of Development of Anthropometrical measures in Twins (CODATwins) project is a large international collaborative effort to analyze individual-level phenotype data from twins in multiple cohorts from different environments. The main objective is to study factors that modify genetic and environmental variation of height, body mass index (BMI, kg/m2) and size at birth, and additionally to address other research questions such as long-term consequences of birth size. The project started in 2013 and is open to all twin projects in the world having height and weight measures on twins with information on zygosity. Thus far, 54 twin projects from 24 countries have provided individual-level data. The CODATwins database includes 489,981 twin individuals (228,635 complete twin pairs). Since many twin cohorts have collected longitudinal data, there is a total of 1,049,785 height and weight observations. For many cohorts, we also have information on birth weight and length, own smoking behavior and own or parental education. We found that the heritability estimates of height and BMI systematically changed from infancy to old age. Remarkably, only minor differences in the heritability estimates were found across cultural–geographic regions, measurement time and birth cohort for height and BMI. In addition to genetic epidemiological studies, we looked at associations of height and BMI with education, birth weight and smoking status. Within-family analyses examined differences within same-sex and opposite-sex dizygotic twins in birth size and later development. The CODATwins project demonstrates the feasibility and value of international collaboration to address gene-by-exposure interactions that require large sample sizes and address the effects of different exposures across time, geographical regions and socioeconomic status.
The Antarctic Roadmap Challenges (ARC) project identified critical requirements to deliver high priority Antarctic research in the 21st century. The ARC project addressed the challenges of enabling technologies, facilitating access, providing logistics and infrastructure, and capitalizing on international co-operation. Technological requirements include: i) innovative automated in situ observing systems, sensors and interoperable platforms (including power demands), ii) realistic and holistic numerical models, iii) enhanced remote sensing and sensors, iv) expanded sample collection and retrieval technologies, and v) greater cyber-infrastructure to process ‘big data’ collection, transmission and analyses while promoting data accessibility. These technologies must be widely available, performance and reliability must be improved and technologies used elsewhere must be applied to the Antarctic. Considerable Antarctic research is field-based, making access to vital geographical targets essential. Future research will require continent- and ocean-wide environmentally responsible access to coastal and interior Antarctica and the Southern Ocean. Year-round access is indispensable. The cost of future Antarctic science is great but there are opportunities for all to participate commensurate with national resources, expertise and interests. The scope of future Antarctic research will necessitate enhanced and inventive interdisciplinary and international collaborations. The full promise of Antarctic science will only be realized if nations act together.
To evaluate an internet-based preapproval antimicrobial stewardship program for sustained reduction in antimicrobial prescribing and resulting cost savings.
Design.
Retrospective cohort study and cost analysis.
Methods.
Review of all doses and charges of antimicrobials dispensed to patients over 6 years (July 1, 2005–June 30, 2011) at a tertiary care pediatric hospital.
Results.
Restricted antimicrobials account for 26% of total doses but 81% of total antimicrobial charges. Winter months (November–February) and the oncology and infant and toddler units were associated with the highest antimicrobial charges. Five restricted drugs accounted for the majority (54%) of charges but only 6% of doses. With an average approval rate of 91.5% (95% confidence interval [CI], 91.1%–91.9%), the preapproval antibiotic stewardship program saved $103,787 (95% CI, $98,583–$109,172) per year, or $14,156 (95% CI, $13,446–$14,890) per 1,000 patient-days.
Conclusions.
A preapproval antimicrobial stewardship program effectively reduces the number of doses and subsequent charges due to restricted antimicrobials years after implementation. Hospitals with reduced resources for implementing postprescription review may benefit from a preapproval antimicrobial stewardship program. Targeting specific units, drugs, and seasons may optimize preapproval programs for additional cost savings.
A total of 245 patients with confirmed 2009 H1N1 influenza were admitted to the intensive-care units of 28 hospitals (South Korea). Their mean age was 55·3 years with 68·6% aged >50 years, and 54·7% male. Nine were obese and three were pregnant. One or more comorbidities were present in 83·7%, and nosocomial acquisition occurred in 14·3%. In total, 107 (43·7%) patients received corticosteroids and 66·1% required mechanical ventilation. Eighty (32·7%) patients died within 30 days after onset of symptoms and 99 (40·4%) within 90 days. Multivariate logistic regression analysis showed that the clinician's decision to prescribe corticosteroids, older age, Sequential Organ Failure Assessment score and nosocomial bacterial pneumonia were independent risk factors for 90-day mortality. In contrast with Western countries, critical illness in Korea in relation to 2009 H1N1 was most common in older patients with chronic comorbidities; nosocomial acquisition occurred occasionally but disease in obese or pregnant patients was uncommon.
We report on experiments aimed at the generation and characterization of solid density plasmas at the free-electron laser FLASH in Hamburg. Aluminum samples were irradiated with XUV pulses at 13.5 nm wavelength (92 eV photon energy). The pulses with duration of a few tens of femtoseconds and pulse energy up to 100 µJ are focused to intensities ranging between 1013 and 1017 W/cm2. We investigate the absorption and temporal evolution of the sample under irradiation by use of XUV and optical spectroscopy. We discuss the origin of saturable absorption, radiative decay, bremsstrahlung and atomic and ionic line emission. Our experimental results are in good agreement with simulations.
We present a new observational project to study the hierarchical triple stellar system Algol, concentrating on the semidetached eclipsing binary at the heart of the system. Over 140 high-resolution and high-S/N spectra have been secured, of which 80 are from FIES at the Nordic Optical Telescope, La Palma, and the remainder were obtained with BOES at the Bohyunsan Optical Astronomy Observatory in Korea. All three components were successfully detected by the method of spectral disentangling, which yields the individual spectra of the three stars and also high-quality spectroscopic elements for both the inner and outer orbits. We present a detailed abundance study for the mass-accreting component in the inner orbit, which holds information on the history of mass transfer in the close inner binary system. We also reveal the atmospheric parameters and chemical composition of the tertiary component in the outer orbit.
New CCD photometric observations of SZ Her were obtained between February and May 2008. More than 1,100 times of minimum light spanning more than one century were used for the period analysis. We find that the orbital period of SZ Her has varied due to a combination of two periodic variations, with cycle lengths of P3 = 85.8 yr and P4 = 42.5 yr and semi-amplitudes of K3 = 0.013 days and K4 = 0.007 days, respectively. The most reasonable explanation for them is a pair of light-time-travel (LTT) effects driven by the existence of two M-type companions with minimum masses of M3 = 0.22 M⊙ and M4 = 0.19 M⊙, located at nearly 2:1 mean motion resonance. Then, SZ Her is a quadruple system and the 3rd and 4th components would stay in the stable orbital resonance.
We present physical parameters for the detached eclipsing binary KIC3858884 which has a δ-Scuti type pulsating secondary component. To derive orbital elements from the radial-velocity curve, high resolution Echelle spectra were obtained at the Bohyunsan Optical Astronomy Observatory in Korea. The BOES spectra and Kepler photometric data were analyzed with well-known codes: JKTEBOP and Wilson-Devinney model for eclipsing light-curve synthesis, and Period04 for pulsation frequency analysis. After the iterative curve fitting, we determined the physical parameters of KIC3858884 as M1=2.02 ± 0.23M⊙, M2=2.02 ± 0.16M⊙, R1=3.61 ± 0.12R⊙, R2=2.84 ± 0.10R⊙, respectively.
The Filariasis Commission, composed as it was of British, Chinese, and Mohammedan members, was able to take a more extensive and a more representative survey of the incidence of filariasis than would have been possible in the case of a single investigator. Dr. Khalil had frequent invitations to local Mohammedan ceremonies, and as these were usually held at night, he was able to examine a large number of bloodfilms from East Indian immigrants. Dr. C. U. Lee was very hospitably received by the Chinese families of Georgetown, and collected statistics as to the filarial rate amongst them on a scale that was hitherto unattainable. The whole commission, working together, was able to undertake a survey of an institution such as Georgetown Prison, the Almshouse, or Christchurch Public School with little inconvenience to the children or inmates. Thus from hospitals, schools, prisons, asylums, and domiciliary visitations, the Commission collected details and examined blood-films from 4,215 inhabitants of British Guiana. The total number of examinations was made up as follows:—
Eight cases of Legionnaires' disease were identified among the 215 German passengers after a cruise to the Nordic Sea in August 2003. An unmatched case-control study was conducted to identify risk factors and the source of infection. In total, eight passengers fulfilled the case definition, one of these died. Forty-two passengers served as controls. The attack rate was 4%. The mean age was 60 years for cases and 62 years for controls. Prolonged exposure to the spa pool seemed to be a risk factor of infection (OR 4·85, P=0·09). Legionella pneumophila serogroup 1, monoclonal antibody (mAb) subgroup ‘Knoxville’ was isolated from clinical and environmental samples. DNA sequence-based typing revealed that these isolates were indistinguishable from each other. The investigation showed the importance of an interdisciplinary approach of microbiology and epidemiology as not all sites on the ship that tested positive for L. pneumophila actually posed a relevant risk for the passengers.
This study aimed to explore the effects of age, education and gender on the performance of eight tests in the Korean version of the CERAD neuropsychological assessment battery and to provide normative information on the tests in the Korean elderly. The battery was administered to 618 healthy volunteers aged from 60 to 90. People with serious neurological, medical and psychiatric disorders, including dementia, were excluded. Multiple linear regression analyses were performed to assess the relative contribution of the demographic factors on the score of each cognitive test. Age, education, and gender were found to have significant effects on the performance of many tests in the battery. Based on these results, 4 overlapping age normative tables (60 to 74, 65 to 79, 70 to 84, and 75 to 90 years of age) with 3 educational strata (0 to 3 years, 4 to 6 years, and 7 years and more) for both genders are presented. The normative information will be useful for a clinical interpretation of the CERAD neuropsychological battery in Korean elderly as well as for comparing the performance of the battery across countries. (JINS, 2004, 10, 72–81.)
Thin films of BaCe0.8Y0.2O3-δ (BCY) were prepared by colloidal spray deposition. Dense, crack-free BCY films having a grain size of 2–7 μm were successfully deposited on NiO/BCY substrates. Electrochemical hydrogen pumping with the BCY films showed that the maximum current density increased with temperature. The maximum current density was sensitive to the moisture in the cathode gas; the value obtained with a dry cathode gas was only half that with a wet cathode gas. A very high hydrogen-pumping current density of 3.4 A/cm2 was measured at 700°C with an applied voltage of 1.5 V.
We present new multiband photometric results for ROTSE-I δ Sct stars and the Fourier decomposition analysis. Our result shows that most of the stars classified as ROTSE-I δ Sct stars seem to be W UMa type eclipsing variable stars.
We present new photometric results of the Algol-type semidetached eclipsing binary AB Per which was recently discovered to have a Delta Scuti pulsating component.
Research on hydrogen separation membranes is motivated by the increasing demand for an environmentally benign, inexpensive technology for separating hydrogen from gas mixtures. Although most studies of hydrogen separation membranes have focused on proton-conducting oxides by themselves, the addition of metal to these oxides increases their hydrogen permeability and improves their mechanical stability. This study began by determining the electrical and hydrogen permeation properties of SrCe0.8Yb0.2O3−δ (SCYb). The results showed that the hydrogen permeation rate is limited by electron flow at the investigated temperatures (600 – 900°C). To further enhance hydrogen permeability, a cermet (i.e., ceramic-metal composite) membrane was made by adding Ni to the SCYb. The cermet showed no phase change after sintering in a reducing atmosphere. At 900°C, with 20% H2 /balance He as a feed gas (pH2O = 0.03 atm), the hydrogen permeation rate was 0.113 cm3/min-cm2 for Ni/SCYb (0.43-mm thick) and 0.008 cm3/min-cm2 for SCYb (0.7-mm thick). The dependences of hydrogen permeability on temperature, thickness, and hydrogen partial pressure gradients are also determined. The results demonstrate that adding Ni to SCYb considerably increases its hydrogen permeability by increasing its electron conductivity.