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Functional Neurological Disorders (FND), also called hysteria or conversion disorder, have represented a challenge over the centuries in terms of comprehension of the mechanisms responsible for symptoms which mimic neurological diseases without organic damage. Charcot considered hysteria primarily a hereditary disorder, but also considered that environmental factors including physical and emotional stress served as provoking factors. The prevailing etiologic theories of FND are psychosocial and still strongly dominated by the Freudian concept of conversion – a psychologic symptom is converted into a somatic symptom as a way of dealing with the distress of the symptom. However, physiologic studies with fMRI are necessary to understand the neurological mechanisms involved in FND symptoms. Convergent neuroimaging findings have implicated abnormal limbic-motor interactions in response to emotional stimuli in FND patients, demonstrated a possible role of the limbic system (LS) in FND neurophysiology.
Objectives
Understand the role of LS in the neurophysiologic mechanisms involve in FND.
Methods
Systematic review of the literature published in PubMed, using the terms “Functional Neurological Disorders”, “Limbic System”, “Emotions”.
Results
Physiologic studies of functional weakness and sensory loss reveal normal functioning of primary motor and sensory cortex, but abnormalities of premotor cortex and association cortices. This suggests a top-down influence creating the dysfunction during the action control. Indeed, fMRI studies with FND motor patients show a hypoactivation of cortical and subcortical motor pathways, and a hyperactivity in limbic areas related with an abnormal limbic regulation with increased amygdala activity. In fact, studies have found a dysfunction in the medial prefrontal areas in FDN patients suggesting that they might have an abnormal affective representation (AR) of self-relevant information encoded in this region, which can later induce specific behavioral patterns of thought interaction with sensorimotor circuits. The abnormal AR could be influence by a dysfunction in LS regulation. Indeed, emotions are one of the major factors influencing movement choice. Moreover, limbic structures, such as the amygdala, can be influenced by genetic factors and/or early life stress. Thus, abnormal functioning of LS could lead to functional disorders by deranged top-down control.
Conclusions
In conclusion, FND patients may have an abnormal AR and/or emotion regulation mechanisms possibly due to prior experience or partly genetically determined which interact with lower-order functions leading to the production of the functional symptoms, where LS have an important role. However, much further empiric research is needed to better understand this fascinating and debilitating condition, as well as to derive new perspectives for more efficient therapeutic interventions in these patients.
There are numerous challenges pertaining to epilepsy care across Ontario, including Epilepsy Monitoring Unit (EMU) bed pressures, surgical access and community supports. We sampled the current clinical, community and operational state of Ontario epilepsy centres and community epilepsy agencies post COVID-19 pandemic. A 44-item survey was distributed to all 11 district and regional adult and paediatric Ontario epilepsy centres. Qualitative responses were collected from community epilepsy agencies. Results revealed ongoing gaps in epilepsy care across Ontario, with EMU bed pressures and labour shortages being limiting factors. A clinical network advising the Ontario Ministry of Health will improve access to epilepsy care.
Scaphanocephalus is a small trematode genus belonging to the family Opistorchiidae. The genus currently contains only three species associated with marine fish as intermediate hosts and fish-eating birds as definitive hosts. Here, specimens of Scaphanocephalus were collected from the Osprey, Pandion haliaetus, and the White mullet, Mugil curema in the Yucatán Peninsula, Mexico. We report for the first-time DNA sequences of adult specimens of Scaphanocephalus, particularly S. expansus, as well as a sequence of a different species sampled as metacercaria. Morphological comparisons of Scaphanocephalus expansus confirmed the identity of the adult specimens, with minor morphological variations; Scanning electron photomicrographs were included, and the species was re-described. Phylogenetic analysis based on 28S rDNA sequences showed that Scaphanocephalus is monophyletic within Opisthorchiidae and consists of three independent lineages. Sequences of adults are identical to those of S. expansus. Instead, the sequence of the metacercaria sampled from the mesentery of Mugil curema nested with specimens reported as Scaphanocephalus sp. from a labrid fish in the Mediterranean Sea, herein named it as Scaphanocephalus sp. 2.
For people with mental illness, internalized stigma, also referred to as self-stigma, is characterized by a subjective perception of devaluation, marginalization, secrecy, shame, and withdrawal. It has many adverse effects on individual’s psychological well-being and clinical outcomes. The iatrogenic effects it has during psychotherapeutic treatment can significantly reduce utilization of mental health care services, reduce quality of life and increase avoidant coping. Overall, internalized stigma is considered a risk factor for poorer mental health prognosis. Although some interventions have recently been developed to specifically intervene on this target as part of psychological recovery goals over the course of treatment, most clinicians are not yet aware or empowered to correctly address this.
Objectives
Description of a clinical case illustrating the relevance on addressing internalized mental illness related stigma during the recovery process.
Methods
Clinical case report and review of the literature on the subject.
Results
We present the case of a 47-year-old female patient, C.S., single, graduated in social work (currently unemployed), who was admitted at the Psychiatry Day Hospital, where she was referred by her Psychiatry Assistant because of abulia, social withdrawal and isolation, depressed mood, thoughts of shame, guilt and self-devaluation and work incapacity. She had been admitted in the Psychiatry ward one year earlier for a first psychotic breakthrough, presenting persecutory and grandiose delusions and auditory hallucinations. After three weeks of inpatient treatment with antipsychotics, a full remission of the symptoms was achieved, without any posterior relapse. Before that first psychotic episode, the patient had been taking anti-depressive medication (escitalopram 20 mg id) for many years, prescribed by her General Practitioner, for mild to moderate depressive symptoms. After being discharged from the Psychiatry ward, C. kept following an outpatient treatment with anti-depressives and behavioural activation-based psychotherapy. She started to believe she was mentally ill and therefore weak, uncapable, and less deserving than her peers or her previous self. These self-stigmatizing ideas were enhanced by the lack of family support and the beliefs that were fostered by her mother, with whom she started to live after the hospitalization. These factors led to a dysfunctional internalization of an illness behaviour, jeopardizing the patient’s ability to reach full recovery.
Conclusions
This case reinforces the importance of targeting mental illness related stigma during the recovery process. Also, involving the family is of extreme importance to achieve support and address shared beliefs and the interchange between social and internalized stigma.
Obsessive–Compulsive Disorder (OCD) is a disabling and chronic illness defined by the presence of obsessions and/or compulsions. Recently it has been proposed that the perinatal period may act as a trigger in this disorder, leading to its onset or exacerbation.
Objectives
Variations in pregnancy-related hormones are believed to be one of the main etiological theories for the development of perinatal OCD (pOCD). Perhaps for that reason research has been almost exclusively focused on the development of this disorder in mothers. We aim to investigate pOCD in fathers.
Methods
A non-systematic review was conducted via electronic searches of PubMed. The keywords used were “Perinatal”, “Father”, “OCD”, “Obsessive-compulsive disorder”.
Results
Unwanted intrusive thoughts are experienced with a similar prevalence in mothers and fathers. The same seems to be true regarding compulsions. However, it does appear that mothers are more distressed by these symptoms, which tend to be baby-related, usually concerning themes of suffocation, accidents or contamination. It is hypothesized that this seemingly different impact is related to the fact that mothers are more often the primary caregivers than fathers, thus feeling more distress because they are imbued with a greater responsibility. Accordingly, pOCD symptoms tend to be more severe in fathers who consider their baby-related obsessions meaningful, often confusing them as a desire to carry out such thoughts. These findings are consistent with the Cognitive-Behavioral Theory of OCD, highlighting that purely biological theories for the development of pOCD might not suffice.
Conclusions
Research indicates a similar presence of OCD symptoms in postnatal mothers and fathers, although it seems that mothers may experience more distress. Underlying dysfunctional beliefs seem to be responsible for the negative appraisal of these symptoms, predicting the development of the disorder in question. Further research of pOCD should seek to better characterize the onset or exacerbation of this disorder in fathers.
Chiniquodontidae is a family of nonmammaliaform probainognathian cynodonts with occurrences in the Middle to Late Triassic of Africa and South America (Brazil and Argentina). The history of the family is marked by changes in composition and revisions due to the poor preservation of the first discovered specimens. Currently, Chiniquodontidae includes two genera and six species. Here, we apply the computed tomography (CT-scan) method to describe and revise the morphology of one of the best-preserved chiniquodontid specimens (MCP 1600 PV, holotype of ‘Probelesodon’ kitchingi Sá-Teixeira, 1982) from Brazil, which allowed the visualization of sutures and the segmentation of each bone. The CT-scan data also revealed some previously undescribed traits due to the presence of matrix covering structures of the skull. In addition, the morphological comparisons revealed differences of MCP 1600 PV in relation to the other chiniquodontids, and eight discrete cranial features not related to ontogeny indicate that ‘Probelesodon’ kitchingi might not be included within Chiniquodon theotonicus Huene, 1936. Therefore, we consider the species valid but propose the new combination Chiniquodon kitchingi. Moreover, the results obtained highlighted the necessity of a reassessment of the family, as well as the description of new specimens, morphometric analyses, and use of CT-scan, when feasible.
Neurocognitive deficits amongst patients with schizophrenia are considered one of schizophrenia’s central features. These deficits appear to be present from the first episode of psychosis (FEP) and certain cognitive impairments could be components of a genetic vulnerability to schizophrenia. Regarding research on cannabis and cognition in schizophrenia, different studies have assessed neurocognitive functions: memory, attention/vigilance, processing speed, verbal learning, executive functions, and verbal fluency.
Objectives
The aim is to do a review of recent findings concerning the association of cannabis use with cognition in schizophrenia.
Methods
A literature review was conducted using the PubMed search database.
Results
Patients with schizophrenia and concomitant cannabis use are associated with worse performance in immediate verbal learning, and in some studies with worse working memory performance. There is an improvement of verbal memory when they cease the cannabis’ consumption. Regarding attention capacity and memory types assessed, the results are controversial. In FEP, heavy cannabis use during the previous year correlates with slower processing speed. Also, FEP-patients with cannabis use but no family history of psychosis perform worse in executive functions, while those with a family history of psychosis perform better.
Conclusions
The studies of psychosis, cannabis and cognition differ in relevant aspects, which might be connected to the result variability. Therefore, before solid conclusions can be reached, it is important to carry out longitudinal studies to understand the changes in the cognitive variables, which can depend on the pattern of cannabis’ use (concurrent or prior to the FEP). Possible confounding variables that might be present should be acknowledged.
This article is a clinical guide which discusses the “state-of-the-art” usage of the classic monoamine oxidase inhibitor (MAOI) antidepressants (phenelzine, tranylcypromine, and isocarboxazid) in modern psychiatric practice. The guide is for all clinicians, including those who may not be experienced MAOI prescribers. It discusses indications, drug-drug interactions, side-effect management, and the safety of various augmentation strategies. There is a clear and broad consensus (more than 70 international expert endorsers), based on 6 decades of experience, for the recommendations herein exposited. They are based on empirical evidence and expert opinion—this guide is presented as a new specialist-consensus standard. The guide provides practical clinical advice, and is the basis for the rational use of these drugs, particularly because it improves and updates knowledge, and corrects the various misconceptions that have hitherto been prominent in the literature, partly due to insufficient knowledge of pharmacology. The guide suggests that MAOIs should always be considered in cases of treatment-resistant depression (including those melancholic in nature), and prior to electroconvulsive therapy—while taking into account of patient preference. In selected cases, they may be considered earlier in the treatment algorithm than has previously been customary, and should not be regarded as drugs of last resort; they may prove decisively effective when many other treatments have failed. The guide clarifies key points on the concomitant use of incorrectly proscribed drugs such as methylphenidate and some tricyclic antidepressants. It also illustrates the straightforward “bridging” methods that may be used to transition simply and safely from other antidepressants to MAOIs.
The inoculation with Azospirillum brasilense has the potential to reduce the use of mineral fertilizers with efficient capacity to promote plant growth and yield. Most studies on the Azospirillum–plant association have been conducted on cereals and annual grasses. More studies are needed in perennial pastures, such as bermudagrass (Cynodon dactylon (L.) Pers.) that require substantial nitrogen (N) fertilization to maximize their production potential. Therefore, pastures based on Tifton 85 bermudagrass in association with annual ryegrass (Lolium multiflorum Lam.), which were inoculated with A. brasilense and fertilized with increasing amounts of N fertilizer and grazed by lactating Holstein cows were evaluated. Three grazing systems were evaluated: (i) Tifton 85, inoculated + 180 kg N/ha per year; (ii) Tifton 85 + 230 kg N/ha per year; and (iii) Tifton 85 + 280 kg N/ha per year. Forage samples were collected before and after grazing to evaluate the responses of the plants and animals. The forage yields of the systems were 21.0, 20.8 and 22.1 t DM/ha per year and the stocking rates were 3.9, 3.8 and 4.0 animal unit/ha per day, respectively. Crude protein, total digestible nutrients and neutral detergent fibre concentrations were 162, 560 and 667 g/kg, respectively. Inoculation in pastures planted with Tifton 85 bermudagrass in combination with ryegrass (plus 180 kg N/ha per year) had a positive effect, providing forage yield and nutritional value equivalent to those with fertilization with 230 kg N/ha per year.
The most common treatment for major depressive disorder (MDD) is antidepressant medication (ADM). Results are reported on frequency of ADM use, reasons for use, and perceived effectiveness of use in general population surveys across 20 countries.
Methods
Face-to-face interviews with community samples totaling n = 49 919 respondents in the World Health Organization (WHO) World Mental Health (WMH) Surveys asked about ADM use anytime in the prior 12 months in conjunction with validated fully structured diagnostic interviews. Treatment questions were administered independently of diagnoses and asked of all respondents.
Results
3.1% of respondents reported ADM use within the past 12 months. In high-income countries (HICs), depression (49.2%) and anxiety (36.4%) were the most common reasons for use. In low- and middle-income countries (LMICs), depression (38.4%) and sleep problems (31.9%) were the most common reasons for use. Prevalence of use was 2–4 times as high in HICs as LMICs across all examined diagnoses. Newer ADMs were proportionally used more often in HICs than LMICs. Across all conditions, ADMs were reported as very effective by 58.8% of users and somewhat effective by an additional 28.3% of users, with both proportions higher in LMICs than HICs. Neither ADM class nor reason for use was a significant predictor of perceived effectiveness.
Conclusion
ADMs are in widespread use and for a variety of conditions including but going beyond depression and anxiety. In a general population sample from multiple LMICs and HICs, ADMs were widely perceived to be either very or somewhat effective by the people who use them.
Goffman defined stigma as an “attribute that is deeply discrediting” and in the last two decades research on this subject grew substantially.Opioids were ranked as the second most common form of illicit drug used worldwide and there is consensus in the literature that opioid substitution therapy (OST), methadone or buprenorphine, are the most effective treatments, although remain underutilized. People with an history of substance use disorders (SUD) are widely stigmatized, a significant barrier to detection and treatment efforts. Care workers were cited as the second most common source of stigma.
Objectives
The aim is to do a review of the literature of stigma as a significant barrier to OST and present several potential strategies to reduce stigma.
Methods
Non-systematic review of the literature with selection of scientific articles published in the last 5 years; by searching the Pubmed and Medscape databases using the combination of MeSH descriptors. The following MeSH terms were used: Opioid Use Disorder; Stigma; Opioid Substitution Therapy
Results
OST providers should actively bring up the topic of stigma in clinic appointments to determine whether the patient is experiencing stigma, and if so, whether it is adversely affecting their ability to continue in the treatment. More active measures need to be taken to help reducing the stigma through public awareness campaigns at local levels, continuing education of health care providers regarding substance OST, and greater incorporation of family members into the program.
Conclusions
In conclusion, further research is required to understand and address this issue.
The pandemic caused by the SARS CoV-2 virus (COVID-19) has a profound effect in the health care system (HCS). The therapeutic effect of communication skills is well known. Psychiatric patients are a vulnerable population and remote care via telephone was one of the first implemented measures during the lockdown.
Objectives
The aim is to highlight the potential benefits and risks of remote follow up, according to the scientific evidence currently available.
Methods
Non-systematic review of the literature with the selection of scientific articles published in the last year. The search was performed in Pubmed database with the following Mesh terms: “COVID-19”, “psychiatry”, and “health communication”. Complementary references were also included.
Results
For those with a stable psychiatric condition, remote appointments may guarantee the adequate follow up in a safe way throughout the COVID-19 pandemic. However, telephonic appointments are associated with a limited ability to perform psychopathological examination. A better assessment can be achieved if video call is used. Also, data protection and the ability of giving informed consent by psychiatric patients should be addressed. Additional training should be considered. A subgroup of patients with severe mental illness may require face-to-face visits.
Conclusions
COVID-19 pandemic is an unprecedented crisis and telemedicine is now emerging as an alternative. Remote consultation has advantages and, in some situations, it may replace or complement the in-person visits. Since social isolation is one of the most effective measures, digital means constitute a window of opportunity for the HCS.
The mental health effects of Coronavirus2019(COVID-19) outbreak might be profound, including higher suicide rates.This phenomena is likely to become a more pressing concern as the pandemic spreads.While remarkable social distancing interventions have been implemented to reduce the rate of new infections,the potential for adverse outcomes on suicide risk is high, especially among vulnerable populations.
Objectives
The aim is to do a review of the literature of suicide prevention during the COVID-19 outbreak.
Methods
Non-systematic review of the literature with selection of scientific articles published in the last 7 months; by searching the Pubmed databases, the following MeSH terms were used: Suicide prevention; COVID-19
Results
In order to prevent suicide, urgent consideration must be extend beyond general mental health approaches. A wide-ranging interdisciplinary response that recognises how the pandemic might heighten risk is needed. The application of knowledge about effective suicide prevention is the key. Mental health services should develop clear remote assessment and care pathways, and staff training to support new ways of dealing with. Publications on mental health and psychological effects of COVID-19 outbreak provide important information and recommendations for all three levels of suicide prevention: primary, secondary, and tertiary.
Conclusions
The challenge of the COVID-19 outbreak might bring with it an opportunity to advance the field of suicide prevention and, thus, to save lives, which also represent a public health priority. The mental health community, backed by active vigilance and international collaboration, should be prepared and can use this challenging period to advance suicide prevention.
Suicide is a phenomenon that is increasing in prevalence. Exposure to suicide by a loved one can be experienced as a traumatic event, capable of precipitating or aggravating preexisting psychiatric conditions. As much as we are clinically aware of gravity situation experienced by suicide survivors, there is a marked lack of studies on psychotherapeutic interventions in this population group.
Objectives
The present work aims to review the literature on the psychodynamic treatment of suicide survivors, considering their theoretical and technical aspects.
Methods
Narrative review of psychiatric and psychoanalytic literature.
Results
The initial reaction described on becoming aware of the suicide of someone close to you is of disbelief, shock and helplessness. This is followed by ambivalent feelings of hate and guilt, shame and hopelessness. Sometimes, a chronic depressive state expressed by the survivor’s guilt can emerge. The mourning work will initially encounter resistance to face the loss of the object, through mechanisms such as denial, repression and psychotic fantasies. The lost suicide has a traumatic impact, modifying relational patterns and it is commonly associated with important isolation. The survivor will be able to transfer via fear the death of the therapist and even fantasize that he will also kill himself.
Conclusions
Psychodynamic psychotherapy with suicide survivors finds theoretical and practical foundations in the literature, mainly through discussions of reports clinical and theoretical reviews on the topic. Through transfer and therapeutic alliance, new patterns of object relation can be sketched, in a context of mourning so often complicated by shutdown pressures and loneliness.
Warfare on the periphery of Europe and across cultural boundaries is a particular focus of this volume. One article, on Castilian seapower, treats the melding of northern and southern naval traditions; another clarifies the military roles of the Ayyubid and Mamluk miners and stoneworkers in siege warfare; a third emphasizes cultural considerations in an Icelandic conflict; a fourth looks at how an Iberian prelate navigated the line between ecclesiastical and military responsibilities; and a fifth analyzes the different roles of early gunpowder weapons in Europe and China, linking technological history with the significance of human geography. Further contributions also consider technology, two dealing with fifteenth-century English artillery and the third with prefabricated mechanical artillery during the Crusades. Another theme of the volume is source criticism, with re-examinations of the sources for Owain Glyndwr's (possible) victory at Hyddgen in 1401, a (possible) Danish attack on England in 1128, and the role of non-milites in Salian warfare. Contributors: Nicolas Agrait, Tonio Andrade, David Bachrach, Oren Falk, Devin Fields, Michael S. Fulton, Thomas K. Heeboll-Holm, Rabei G. Khamisy, Michael Livingstone, Dan Spencer, L.J. Andrew Villalon
Depressive and anxiety disorders are highly comorbid, which has been theorized to be due to an underlying internalizing vulnerability. We aimed to identify groups of participants with differing vulnerabilities by examining the course of internalizing psychopathology up to age 45.
Methods
We used data from 24158 participants (aged 45+) in 23 population-based cross-sectional World Mental Health Surveys. Internalizing disorders were assessed with the Composite International Diagnostic Interview (CIDI). We applied latent class growth analysis (LCGA) and investigated the characteristics of identified classes using logistic or linear regression.
Results
The best-fitting LCGA solution identified eight classes: a healthy class (81.9%), three childhood-onset classes with mild (3.7%), moderate (2.0%), or severe (1.1%) internalizing comorbidity, two puberty-onset classes with mild (4.0%) or moderate (1.4%) comorbidity, and two adult-onset classes with mild comorbidity (2.7% and 3.2%). The childhood-onset severe class had particularly unfavorable sociodemographic outcomes compared to the healthy class, with increased risks of being never or previously married (OR = 2.2 and 2.0, p < 0.001), not being employed (OR = 3.5, p < 0.001), and having a low/low-average income (OR = 2.2, p < 0.001). Moderate or severe (v. mild) comorbidity was associated with 12-month internalizing disorders (OR = 1.9 and 4.8, p < 0.001), disability (B = 1.1–2.3, p < 0.001), and suicidal ideation (OR = 4.2, p < 0.001 for severe comorbidity only). Adult (v. childhood) onset was associated with lower rates of 12-month internalizing disorders (OR = 0.2, p < 0.001).
Conclusions
We identified eight transdiagnostic trajectories of internalizing psychopathology. Unfavorable outcomes were concentrated in the 1% of participants with childhood onset and severe comorbidity. Early identification of this group may offer opportunities for preventive interventions.
In Brazil, the buffalo milk market has been growing. However, identity and quality standards have not been established for this raw material, nor have proper distinctions between buffalo milk and bovine milk been defined. Currently, the State of Rio Grande do Sul (RS) has only three producers that supply raw material for officially marketed derivatives. The aim of this study was to determine the identity and quality standards of raw buffalo milk in this region. Samples were obtained biweekly from three farm cooling tanks between June 2017 and August 2018, to reach a total of 69 samples. The averages for the results of the physicochemical parameters fat, protein, lactose, total solids, SNF (solids-not-fat), calcium, density, FP, acidity and SCC were 5.5 g/100 g, 4.06 g/100 g, 5.07 g/100 g, 15.5 g/100 g, 9.96 g/100 g, 0.161 g/100 g, 1.034 g/ml, −0.527°C, 16°D and 95 × 103 cells/ml, respectively. With reference to the microbiological parameters, the mean of the Standard Plate Count (SPC) and thermotolerant coliforms were 9,0 × 104 CFU/ml and 1.6 × 102 MPN/ml, respectively. Regarding coagulase-positive staphylococci, 36 samples tested positive (52% of total). Neither Salmonella spp. nor Listeria monocytogenes, nor antibiotic or antiparasitic residues were detected in any sample. In conclusion, the buffalo milk used as raw material for dairy products in southern Brazil demonstrated satisfactory physicochemical and microbiological characteristics, in accordance with recent scientific literature.
This is a cross-sectional analysis of data obtained in the baseline of the Longitudinal Study on the Lifestyle and Health of University Students (n 685) carried out in a public Brazilian university. Food intake was assessed using a 24-h dietary recall. Dietary patterns (DP) for breakfast, lunch and dinner were identified using principal component analysis. Generalised linear models were used to analyse the variables associated with each DP. Three DP were extracted for each meal: breakfast: ‘White bread and butter/margarine’, ‘Coffee and tea’ and ‘Sausages, whole wheat bread and cheese’; lunch: ‘Traditional’, ‘Western’ and ‘Vegetarian’ and dinner: ‘Beans, rice and processed juice’, ‘White bread and butter/margarine’ and ‘White meat, eggs and natural juice’. Students who had meals at the campus showed greater adherence to the ‘White bread and butter/margarine’ (exp (βadj) = 1·15, 95 % CI 1·11, 1·19) and ‘Coffee and tea’ (exp (βadj) = 1·06, 95 % CI 1·02, 1·10) breakfast patterns; ‘Western’ lunch pattern (exp (βadj) = 1·04, 95 % CI 1·01, 1·08) and to the ‘Beans, rice and processed juice’ dinner pattern (exp (βadj) = 1·10, 95 % CI 1·06, 1·14). Having meals at the campus was associated with lower adherence to the ‘Sausages, whole wheat bread and cheese’ breakfast pattern (exp (βadj) = 0·93, 95 % CI 0·89, 0·97), ‘Traditional’ lunch pattern (exp (βadj) = 0·96, 95 % CI 0·93, 0·99) and to the ‘White bread and butter/margarine’ (exp (βadj) = 0·96, 95 % CI 0·93, 0·99) and ‘White meat, eggs and natural juice’ (exp (βadj) = 0·96, 95 % CI 0·93, 0·99) dinner pattern. The food environment at campus may influence students’ DP. Recognising meal eating patterns is important to support healthy eating promotion strategies on campus. Adjustments in the University Canteen menu could contribute to healthier eating choices among students.
This study aimed to analyse the trend and spatial–temporal clusters of risk of transmission of COVID-19 in northeastern Brazil. We conducted an ecological study using spatial and temporal trend analysis. All confirmed cases of COVID-19 in the Northeast region of Brazil were included, from 7 March to 22 May 2020. We used the segmented log-linear regression model to assess time trends, and the local empirical Bayesian estimator, the global and local Moran indexes for spatial analysis. The prospective space–time scan statistic was performed using the Poisson probability distribution model. There were 113 951 confirmed cases of COVID-19. The average incidence rate was 199.73 cases/100 000 inhabitants. We observed an increasing trend in the incidence rate in all states. Spatial autocorrelation was reported in metropolitan areas, and 178 municipalities were considered a priority, especially in the states of Ceará and Maranhão. We identified 11 spatiotemporal clusters of COVID-19 cases; the primary cluster included 70 municipalities from Ceará state. COVID-19 epidemic is increasing rapidly throughout the Northeast region of Brazil, with dispersion towards countryside. It was identified high risk clusters for COVID-19, especially in the coastal side.
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.