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This paper discusses a rare Late Ming blue and white porcelain bowl with five cartouches depicting scenes of sexual intercourse, which was found during archaeological excavations in the Santana convent, a former Franciscan nunnery located in Lisbon founded in 1562. The paper begins with a description of the bowl, the context of its recovery and its significance, highlighting its extreme rarity among Chinese export porcelains. The second section discusses Chinese sexuality and the production of erotica during the Late Ming period, namely porcelains with erotic and sexual imagery, a subject that has been overlooked by mainstream scholarship. The last section proposes an explanation for the presence of this bowl in the Santana nunnery, emphasising the gap between the ideals of Iberian Catholic monastic life and the worldly practices conducted by the members of these religious orders in the Baroque era.
The coronavirus disease 2019 (COVID-19) has serious physiological and psychological consequences. The long-term (>12 weeks post-infection) impact of COVID-19 on mental health, specifically in older adults, is unclear. We longitudinally assessed the association of COVID-19 with depression symptomatology in community-dwelling older adults with metabolic syndrome within the framework of the PREDIMED-Plus cohort.
Methods
Participants (n = 5486) aged 55–75 years were included in this longitudinal cohort. COVID-19 status (positive/negative) determined by tests (e.g. polymerase chain reaction severe acute respiratory syndrome coronavirus 2, IgG) was confirmed via event adjudication (410 cases). Pre- and post-COVID-19 depressive symptomatology was ascertained from annual assessments conducted using a validated 21-item Spanish Beck Depression Inventory-II (BDI-II). Multivariable linear and logistic regression models assessed the association between COVID-19 and depression symptomatology.
Results
COVID-19 in older adults was associated with higher post-COVID-19 BDI-II scores measured at a median (interquartile range) of 29 (15–40) weeks post-infection [fully adjusted β = 0.65 points, 95% confidence interval (CI) 0.15–1.15; p = 0.011]. This association was particularly prominent in women (β = 1.38 points, 95% CI 0.44–2.33, p = 0.004). COVID-19 was associated with 62% increased odds of elevated depression risk (BDI-II ≥ 14) post-COVID-19 when adjusted for confounders (odds ratio; 95% CI 1.13–2.30, p = 0.008).
Conclusions
COVID-19 was associated with long-term depression risk in older adults with overweight/obesity and metabolic syndrome, particularly in women. Thus, long-term evaluations of the impact of COVID-19 on mental health and preventive public health initiatives are warranted in older adults.
ABSTRACT IMPACT: Understanding the needs and barriers or facilitators to participation in research, especially among minority communities is critical not only for COVID-19 research but also for future clinical and translational research and health disparities studies. OBJECTIVES/GOALS: The overall goal of this project is to enhance education, awareness, access, and inclusion of underserved communities across Florida in COVID-19 research, especially among Black and Hispanic minority groups that are disproportionately affected by COVID-19. METHODS/STUDY POPULATION: Through strategic partnership among five academic institutions and community-based organizations across the state of Florida, the FL-CEAL team will implement focus groups and surveys in minority communities in Florida to gauge the awareness and understanding of COVID-19, and the barriers and facilitators for participation in COVID-19 research studies. These communities include but are not limited to Latinx and Black populations in South and Central Florida, and Black communities in North Florida. The outcomes will help shape strategies for outreach and dissemination activities and minority recruitment plans to promote participation of minorities into vaccine and therapeutic trials. RESULTS/ANTICIPATED RESULTS: An estimated 75-125 participants will be recruited for focus groups. Four focus groups with minority communities have been conducted and the results are being analyzed. A common Community-Based Needs Assessment survey is being finalized and will be deployed across the 11 states that are part of the national CEAL consortium. Community Health Workers are being engaged to support outreach and dissemination to educate targeted communities on COVID-19 research and the importance of participation in COVID trials. To date, 243 CHWs and 880 community members have been engaged. Minority participation in COVID-19 vaccine trials at University of Miami has been higher than the national average. DISCUSSION/SIGNIFICANCE OF FINDINGS: The FL-CEAL Alliance has successfully demonstrated a coordinated effort to engage minority communities affected by COVID. Through strategic geographic partnerships, FL-CEAL will positively impact minority communities throughout the state that has one of the most diverse populations in the nation.
Mild cognitive impairment (MCI) and Alzheimer’s Disease (AD) prevalence is expected to continue to increase, due to the population ageing. MCI and AD may impact patients’ decision-making capacities, which should be assessed through the disease course. These medical conditions can affect the various areas of decision-making capacity in different ways. Decision-making capacity in healthcare is particularly relevant among this population. Elders often suffer from multimorbidity and are frequently asked to make healthcare decisions, which can vary from consenting a routine diagnostic procedure to decide receiving highly risk treatments.
To assess this capacity in elders with MCI or AD, we developed the Healthcare Decision-Making Capacity Assessment Instrument (IACTD-CS - Instrumento de Avaliação da Capacidade de Tomada de Decisão em Cuidados de Saúde). This project is funded by Portuguese national funding agency for science, research and technology, FCT (SFRH/BD/139344/2018). IACTD-CS was developed based on Appelbaum and Grisso four abilities model, literature review and review of international assessment instruments. After IACTD-CS first version development, an exploratory study with focus groups was conducted. This study included focus groups with healthcare professionals and nursing homes’ professionals.
The focus groups main goals were: 1) understand the participants perception regarding healthcare decision-making capacity, 2) distinguish relevant aspects of decision-making, 3) discuss the abilities and items included in IACTD-CS and 4) identify new aspects or items to be added to IACTD-CS. A content analysis of the focus groups results, with resource to MAXQDA, was conducted afterwards. This exploratory study allowed to identify professionals’ perceptions on healthcare decision-making and its results were a significant contribute to IACTD-CS development. The proposed communication aims to describe the methodology used and present the results of content analysis.
The decision to adopt forced medication in psychiatric care is particularly relevant from a clinical and ethical viewpoint. The European Commission has funded the EUNOMIA study in order to develop European recommendations for good clinical practice on coercive measures, including forced medication.
Methods:
The recommendations on forced medication have been developed in 11 countries with the involvement of national clinical leaders, key-professionals and stakeholders’ representatives. The national recommendations have been subsequently summarized into a European shared document.
Results:
Several cross-national differences exist in the use of forced medication. These differences are mainly due to legal and policy making aspects, rather than to clinical situations. In fact, countries agreed that forced medication can be allowed only if the following criteria are present: 1) a therapeutic intervention is urgently needed; 2) the voluntary intake of medications is consistently rejected; 3) the patient is not aware of his/her condition. Patients’ dignity, privacy and safety shall be preserved at all times.
Conclusion:
The results of our study show the need of developing guidelines on the use of forced medication in psychiatric practice, that should be considered as the last resort and only when other therapeutic option have failed.
A major shift in the gender of the medical-doctor workforce is now underway, and all over the world it is expected that an average 65% of the medical workforce will be women by 2030. In addition, an aging population means that chronic diseases, such as diabetes, are becoming more prevalent and the demand for care is rising. There is growing evidence of female physicians performing better than male physicians.
Aim
Our study aimed to investigate whether any differences in diabetes process indicators are associated with gender, and/or the interaction between gender and different organizational models.
Design and setting
A population-based cross-sectional analysis was conducted on a large data set obtained by processing the public health administration databases of seven Italian local health units (LHUs). The seven LHUs, distributed all over the Italian peninsula in seven different regions, took part in a national project called MEDINA, with the focus on chronic disease management in primary care (PC).
Methods
A total score was calculated for the average performance in the previously listed five indicators, representing global adherence to a quality management of patients with diabetes. A multilevel analysis was applied to see how LHUs affected the outcome. A quantile regression model was also fitted.
Results
Our study included 2287 Italian general practitioners (586 of them female) caring for a total of 2 646 059 patients. Analyzing the performance scores confirmed that female general practitioners obtained better results than males. The differences between males and females were stronger on the 25th and 75th percentiles of the score than on the median values. The interaction between gender and LHU was not significant.
Conclusion
Our study evidenced that female physicians perform better than males in providing PC for diabetes independently by the different organizational models. Further research to understand the reasons for these gender differences is needed.
Early-onset familial Alzheimer's disease (EOFAD) is a condition characterized by early onset dementia (age at onset < 65 years) and a positive family history for dementia. To date, 230 mutations in presenilin (PS1, PS2) and amyloid precursor protein (APP) genes have been identified in EOFAD. The mutations within these three genes (PS1/PS2/APP) affect a common pathogenic pathway in APP synthesis and proteolysis, which lead to excessive production of amyloid β. Compared with sporadic Alzheimer's disease (AD), EOFAD has some distinctive features including early age at onset, positive familial history, a variety of non-cognitive neurological symptoms and signs, and a more aggressive course. There is marked phenotypic heterogeneity among different mutations of EOFAD. Studies in presymptomatic mutation carriers reveal biomarkers abnormalities. EOFAD diagnosis is based on clinical and family history, neurological symptoms and examination, biomarker features, as well as genotyping in some cases. New therapeutic agents targeting amyloid formation may benefit EOFAD individuals.
Objective – Description of the opinions about causes and psychosocial consequences of schizophrenia in a sample of psychiatric professionals, recruited in 29 Italian Mental Health Centres (MHC). Design – Each professional was asked to read a case-vignette describing a patient who met the ICD-10 criteria for schizophrenia. Referring to case-vignette, he/she was asked to fill the Questionnaire on the Opinions about Mental Illness – Professionals' version (QO-P). Professionals' opinions were explored in relation to: a) their socio-demographic variables and professional background; b) geographic location of the MHC. Setting – 29 MHC stratified by geographic area (Northern, Central, Southern Italy) and population density of their catchment areas (> 100000 inhabitants; between 100000 and 25000 inhabitants; < 25000 inhabitants) and randomly selected. Results – Data on 465 professionals were collected. 75% of the sample identified in the vignette a case of schizophrenia, 22% of depression/anxiety disorder. Factors most frequently mentioned as causes of the detected disorder were heredity (68%), stress (61%), family difficulties (46%). More pessimistic opinions about psychosocial consequences of schizophrenia were found among nurses and among professionals of Southern Italy, among those with lower educational level, older age and among those working longer in psychiatry. No statistical difference in the opinions about psychosocial consequences of schizophrenia was found among staff who referred the case-vignette to schizophrenia and those who did not. Conclusions – The results of this study outline the need to: a) include issues such as disability and psychosocial consequences of mental disorders in the basic training of professionals; b) increase the number of professionals trained in evidence-based psychosocial interventions.
Mental health policies emphasise that caregivers' views of involuntary psychiatric treatment should be taken into account. However, there is little evidence on how caregivers view such treatment.
Aims
To explore caregivers' satisfaction with the involuntary hospital treatment of patients and what factors are associated with caregivers' appraisals of treatment.
Method
A multicentre prospective study was carried out in eight European countries. Involuntarily admitted patients and their caregivers rated their appraisal of treatment using the Client Assessment of Treatment Scale 1 month after admission.
Results
A total of 336 patients and their caregivers participated. Caregivers' appraisals of treatment were positive (mean of 8.5 on a scale from 0 to 10) and moderately correlated with patients' views. More positive caregivers' views were associated with greater patients' symptom improvement.
Conclusions
Caregivers' appraisals of involuntary in-patient treatment are rather favourable. Their correlation with patients' symptom improvement may underline their relevance in clinical practice.
To assess food and nutrient intakes and compliance with nutritional recommendations in pregnant women according to selected sociodemographic characteristics.
Design
Cross-sectional study based on data from the INMA-Valencia cohort (Spain), which recruited pregnant women between 2004 and 2005. Information on maternal sociodemographics and anthropometry was collected. Dietary intake was assessed through an FFQ. Intakes of foods were compared with Spanish food-based dietary guidelines. Intake inadequacy for nutrients was assessed using the Dietary Reference Intakes of the US Institute of Medicine.
Setting
Valencia, Spain.
Subjects
We studied 822 pregnant women who had information on dietary intake during their first trimester of pregnancy.
Results
More than 50 % of pregnant women did not meet the guidelines for cereals and legumes; reported intakes of carbohydrates, n-3 and n-6 fatty acids were below recommendations and exceeded the total fat intake according to dietary references. Dietary inadequacy for folate, Fe and vitamin E ranged from 99 % to 68 %. Vegetable intake was related to age only. Younger and less educated women showed lower intakes of protein and n-3 fatty acids and higher intakes of trans-fatty acids as well as greater inadequacy for micronutrients. Spanish women reported lower intakes of fruit and carbohydrates and higher intakes of protein, total fat, SFA, MUFA and n-3 fatty acids compared with their foreign-born counterparts.
Conclusions
Women in the studied area have inadequate intakes of several nutrients relevant during pregnancy. Age, education and country of origin are factors significantly related to dietary intake and adequacy.
Case studies contribute more focused analyses which, in the context of human loss and damage, demonstrate the effectiveness of response strategies and prevention measures and identify lessons about success in disaster risk reduction and climate change adaptation. The case studies were chosen to complement and be consistent with the information in the preceding chapters, and to demonstrate aspects of the key messages in the Summary for Policymakers and the Hyogo Framework for Action Priorities.
The case studies were grouped to examine types of extreme events, vulnerable regions, and methodological approaches. For the extreme event examples, the first two case studies pertain to events of extreme temperature with moisture deficiencies in Europe and Australia and their impacts including on health. These are followed by case studies on drought in Syria and dzud, cold-dry conditions in Mongolia. Tropical cyclones in Bangladesh, Myanmar, and Mesoamerica, and then floods in Mozambique are discussed in the context of community actions. The last of the extreme events case studies is about disastrous epidemic disease, using the case of cholera in Zimbabwe, as the example.
The case studies chosen to reflect vulnerable regions demonstrate how a changing climate provides significant concerns for people, societies, and their infrastructure. These are: Mumbai as an example of a coastal megacity; the Republic of the Marshall Islands, as an example of small island developing states with special challenges for adaptation; and Canada's northern regions as an example of cold climate vulnerabilities focusing on infrastructures.
Aims – This study aims to explore: a) the feasibility of psycho-educational interventions for families of users with schizophrenia in clinical practice by trained staff; b) the benefits and problems encountered by professionals in the use of these interventions. Methods – 46 professionals from 23 Italian Mental Health Sen'ices (MHS) attended at a three-module training course in psycho-educational interventions and four supervisions in the subsequent year. Following the course, participants provided the intervention to families of users with schizophrenia. The difficulties and benefits encountered by trainees to use the intervention were registered on the Family Intervention Schedule.Results – 83% of the participants completed the training course. Following the course, the intervention started in 71 families from 17 MHS. 76% of trainees provided the intervention to 2-5 families, while 13% of them only held informative sessions on schizophrenia. During the supervision period, the organisational difficulties experienced by the professionals were stable, while the benefits increased. Differences in benefits and difficulties were detected in relation to the trainees’ experience and professional roles. Conclusions – It is possible to introduce psycho-educational interventions in MHS after a relatively brief period of training and supervision of the staff. Organisational difficulties need to be addressed to increase the dissemination of these interventions on a large scale.
Declaration of Interest: None of the authors has had any interest or he/she has received any form of support, including that from drug companies and honoraria for lectures and consultancies, potentially in conflict with this scientific work. None of the authors has received any form of fee for his/her participation in this study. This study was supported by grants received from the “M. Lugli” Foundation (grant n. 2/18/8) and from the National Institute of Health, Italy (grant no. 1AL/F3).
Aims – To describe in a sample of 646 relatives of patients with physical long-term illnesses: a) the relatives' burden of care; b) the relatives' attitudes towards the patients; c) the social and professional support received by the families. Methods – The study has been carried out in 30 Italian geographic areas randomly selected taking into account geographic location and population density. The sample has been consecutively recruited in 139 specialised units for the treatment of chronic heart, brain, diabetes, kidney, and lung diseases. Family burden was evaluated in relation to: a) family's socio-demographic variables and patients' clinical variables; b) relatives' attitudes toward the patient; c) social and professional support; d) geographic area and population density. Outcome measures – Family Problems Questionnaire, physical illness version (QPF-O) and Social Network Questionnaire (QRS). Results – The consequences of caregiving most frequently reported were constraints in social and recreational activities, and feelings of loss. Burden was more marked in relatives of patients with higher physical disabilities, with neurological illnesses, and in relatives with lower support by their social network. Conclusions – These data highlight the need to provide psychological and practical support to caregivers of patients with long-term physical diseases on the basis of the evaluation of their needs for care.
Declaration of Interest: none of the five authors has had any interest or received any form of support, including that from drug companies and honoraria for lectures and consultancies, potentially in conflict with this scientific work, in the last 2 years.
Objective – Description of opinions on schizophrenia and its psychosocial consequences in a sample of general population. Methods – The study has been carried out in 29 GP units stratified by geographic area and population density of their catchment areas and randomly selected. Each respondent was asked to read a case-vignette describing a patient who met ICD-10 criteria for schizophrenia, and then to fill the Questionnaire on the Opinions about Mental Illness General Population's version (QO-GP). Results – Data on 714 respondents were collected. 21% of the sample identified a case of schizophrenia, 66% of depression/anxiety disorder, and 13% of “nervous breakdown”. Factors most frequently mentioned as causes of detected disorder were stress (72%), heredity (62%), family difficulties and psychological traumas (45%). More pessimistic opinions about psychosocial consequences of schizophrenia were found among respondents with lower educational level and older age. Respondents who referred the case-vignette to schizophrenia reported more pessimistic opinions about psychosocial consequences of detected disorder. Conclusions – The results of this study outline the need to plan educational campaigns on mental illnesses, which take into account the socio-cultural characteristics of the target populations.
Declaration of interest: none of the seven authors has had any interest or received any form of support, including that from drug companies and honoraria for lectures and consultancies, potentially in conflict with this scientific work, in the last 2 years.
Objective — This study explored the effectiveness of a psychoeducational family intervention for schizophrenia on patients' clinical status and disability and relatives' burden and perceived support. Methods — The study has been carried out in 17 mental health centres. In each of them, 2 professionals were trained in a psychoeducational intervention and applied it for six months with families of users with schizophrenia. At baseline and six months later, patients' clinical status and disability, and relatives' burden, social network and professional support were assessed by validated tools. Results — Of the seventy-one recruited families, 48 (68%) completed the intervention. At six months, a significant improvement was found in patients' clinical status and social functioning, as well as in relatives' burden and social and professional support. In particular, the percentage of patients with poor or very poor global social functioning dropped from 50% to 27% at six months. Forty percent of patients and 45% of relatives reported a significant improvement in their social contacts over the intervention period. Conclusions — The results of this study confirm the hypothesis that psychoeducational family interventions may have a significant effect on social outcome and family burden in schizophrenia when provided in routine conditions.
Declaration of Interest: none of the authors has had any interest or he/she has received any form of support, including that from drug companies and honoraria for lectures and consultancies, potentially in conflict with this scientific work. None of the authors has received any form of fee for his/her participation in this study. This study was supported by grants received from the “M. Lugli” Foundation (grant n. 2/18/8) and from the National Institute of Health, Italy (grant no. 1AL/F3).