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Selective serotonin reuptake inhibitors (SSRIs) are the first-line treatment for major depressive disorder (MDD), but initial outcomes can be modest.
Aims
To compare SSRI dose optimisation with four alternative second-line strategies in MDD patients unresponsive to an SSRI.
Method
Of 257 participants, 51 were randomised to SSRI dose optimisation (SSRI-Opt), 46 to lithium augmentation (SSRI+Li), 48 to nortriptyline combination (SSRI+NTP), 55 to switch to venlafaxine (VEN) and 57 to problem-solving therapy (SSRI+PST). Primary outcomes were week-6 response/remission rates, assessed by blinded evaluators using the 17-item Hamilton Depression Rating Scale (HDRS-17). Changes in HDRS-17 scores, global improvement and safety outcomes were also explored. EudraCT No. 2007-002130-11.
Results
Alternative second-line strategies led to higher response (28.2% v. 14.3%, odds ratio = 2.36 [95% CI 1.0–5.6], p = 0.05) and remission (16.9% v. 12.2%, odds ratio = 1.46, [95% CI 0.57–3.71], p = 0.27) rates, with greater HDRS-17 score reductions (−2.6 [95% CI −4.9 to −0.4], p = 0.021]) than SSRI-Opt. Significant/marginally significant effects were only observed in both response rates and HDRS-17 decreases for VEN (odds ratio = 2.53 [95% CI 0.94–6.80], p = 0.067; HDRS-17 difference: −2.7 [95% CI −5.5 to 0.0], p = 0.054) and for SSRI+PST (odds ratio = 2.46 [95% CI 0.92 to 6.62], p = 0.074; HDRS-17 difference: −3.1 [95% CI −5.8 to −0.3], p = 0.032). The SSRI+PST group reported the fewest adverse effects, while SSRI+NTP experienced the most (28.1% v. 75%; p < 0.01), largely mild.
Conclusions
Patients with MDD and insufficient response to SSRIs would benefit from any other second-line strategy aside from dose optimisation. With limited statistical power, switching to venlafaxine and adding psychotherapy yielded the most consistent results in the DEPRE'5 study.
Prolonged childhood and adolescent loneliness (CAL) is linked to various adverse mental health outcomes, yet its impact on schizophrenia spectrum disorders (SSD) has been understudied. While loneliness is associated with psychosis and worsens symptoms in SSD, few studies have explored the long-term effects of early loneliness on SSD risk. Understanding how CAL interacts with genetic liability to schizophrenia is essential for identification of high-risk individuals.
Aims
This study evaluated whether prolonged CAL is associated with increased SSD risk and examined the interaction between CAL and genetic liability for schizophrenia. Gender differences in these associations were also explored.
Method
Data from the European Gene–Environment Interactions in Schizophrenia (EU-GEI) study were analysed, including 1261 individuals with SSD, 1282 unaffected siblings and 1525 healthy controls. CAL was retrospectively assessed for periods before age 12 years and age 12–16 years. Genetic risk was measured using polygenic risk scores for schizophrenia. Logistic regression models and the Relative Excess Risk due to Interaction (RERI) method were used to examine gene–environment interactions, with stratification by gender.
Results
Prolonged CAL was associated with higher odds of SSD (odds ratio [95% CI] = 5.20 [3.85−7.01] for loneliness before age 12; odds ratio [95% CI] = 7.26 [5.63−9.38] for loneliness during adolescence). The interaction between CAL and genetic risk was strongest during adolescence (RERI [95% CI] = 23.46 [10.75−53.53]). Females showed a greater effect (odds ratio [95 %CI] = 10.04 [6.80−14.94]) than males (odds ratio [95% CI] = 5.50 [3.95−7.66]). Incorporating CAL and genetic interaction increased predictive values to 17% for SSD risk − rising to 22.5% in females − compared with 2.6 and 2.8%, respectively, for genetic risk alone.
Conclusions
Prolonged CAL significantly increases SSD risk, particularly in females. The inclusion of CAL alongside genetic risk substantially enhances predictive accuracy. Early identification of CAL could inform preventive strategies, especially in genetically vulnerable populations.
Our analysis covers 122 scientific publications about health issues in free-ranging Neotropical ungulates produced between 1990 and 2022, with an emphasis on the epidemiology of infectious diseases and parasites. Most studies focus on parasitology (43.4%) and bacteriology (15.6%), while body condition (0.8%), toxicology (1.6%), virology (6.6%), and health assessments (6.6%) are less studied. Brocket deer (Mazama americana and M. gouazoubira), followed by peccaries (Pecari tajacu and Tayassu pecari), and the lowland tapir (Tapirus terrestris) were the most frequent species surveyed (61.4% of all publications). We detected considerably higher numbers of studies and health topics covered in Brazil (n = 64; 52.5% of the total) compared to other Latin American countries. We emphasize the need for further research focused on poorly known health aspects of Neotropical ungulates that have received little attention in the past, especially the Chacoan peccary (Catagonus wagneri), taruca deer (Hippocamelus antisensis), Northern pudu (Pudu mephistopheles), and the least known Mazama species. Ecotoxicology and pathology studies are necessary to evaluate the impact of agrochemicals and other human disturbances on Neotropical ungulate populations in the wild. We encourage further research on the human impacts and trends of change in the epidemiology of infectious diseases, parasites, and health status of Neotropical wild ungulate populations.
Malnutrition is a relevant prognostic factor in cardiovascular disease. However, it has not been studied in adults with CHD and Fontan circulation.
Methods:
Retrospective, single-centre cohort study including all consecutive adults with Fontan circulation. Objectives: 1. To evaluate the prevalence of malnutrition, defined according to Controlling Nutritional Status score, which includes albumin, lymphocytes, and cholesterol and 2. To assess its utility as a prognostic marker.
Results:
We included 93 patients (55.9% male) with a mean age of 32.7 ± 8.3 years. After a median follow-up of 5.5 years (interquartile range 2.2 – 10.6), 14 patients met the combined primary outcome of death or heart transplant (15.1%). Moderate or severe malnutrition (Controlling Nutritional Status score ≥ 5) was detected in 18.3%. Overweight was found in 21.5% of patients, obesity in 4.3%, and low weight in 8.6%, with no significant differences in malnutrition parameters across weight categories. Patients with malnutrition had worse functional capacity (58.8% in New York Heart Association—NYHA-class III–IV, vs. 33.3% in patients without malnutrition, p = 0.05).
In univariate analysis, malnutrition was associated with a worse prognosis (death or heart transplant) with a hazard ratio of 3.7 (95% confidence interval 1.3 to 10.7, p = 0.01). In the adjusted model including cyanosis, functional class, and protein-losing enteropathy, malnutrition did not reach statistical significance (p = 0.81).
Conclusion:
Malnutrition as defined by Controlling Nutritional Status score is common in adults with Fontan circulation and represents a strong prognostic marker. Controlling Nutritional Status scale could be used in Fontan patients as a simple tool to identify a high-risk population.
Two new sites, identified during a survey of the Tajuña River Valley, central Iberia, show evidence of both flint extraction and working, specifically for the production of long blades. These are an important addition to the limited number of such sites known in Eurasia.
Living with major depressive disorder (MDD) reduces life expectancy, with respiratory disease being a significant threat. However, evidence on respiratory disease in this population has not yet been meta-analyzed.
Methods
This meta-analysis examines respiratory disease prevalence and odds ratio (OR) in patients with MDD and treatment resistant depression (TRD). A systematic literature search was conducted, with a snowball search of reference and citation lists. Inclusion criteria covered studies in MDD and TRD patients with confirmed diagnoses of respiratory diseases (asthma, chronic obstructive pulmonary disease [COPD], pneumonia, lung cancer, and tuberculosis), comparing with a control group when possible.
Results
From 4,138 retrieved articles, 15 (including 476,927 individuals with MDD, 50,680 with TRD, and 1,108,979 control group) met the inclusion criteria. In MDD patients, COPD prevalence was 9.0% (95% CI: 3.8–19.6%), asthma 8.6% (95% CI: 5.7–12.8%), and pneumonia 2.5% (95% CI: 2.2–2.9%). In TRD patients, COPD prevalence was 9.9% (95% CI: 4.2–21.9%) and asthma 10.9% (95% CI: 10.7–11.2%), but meta-analysis limited to those diseases showed no significant relative risk differences. Compared to the general population, individuals with MDD had significantly higher rates of COPD (OR 1.79, 95% CI: 1.49–2.16), even higher in younger populations (1.85 [95% CI: 1.74–1.97]) and more prevalent in women.
Conclusions
This first meta-analysis on this topic shows that MDD is associated with an increased risk of respiratory illness compared to the general population. The prevalence of asthma doubles the mean described in the general population worldwide, and in COPD, women and younger people are at particular risk. Prevention policies are urgently needed.
The Nasrid emirate of southern Iberia emanated power through architecture; this project aims to better understand how this was made possible, via an interdisciplinary exploration of the Alhambra monument and other Al-Andalus constructions. Initial results of archaeological campaigns, structure chronologies and communication plans undertaken in 2021 and 2022 are presented.
The European Union receives thousands of unaccompanied irregular migrant minors every year, but little is known about their life experiences during the migration process. The aim of this study is to describe their experiences as minors when they arrived in Spain in small boats, which will help to understand their psychosocial and health needs. A descriptive qualitative study was undertaken. In-depth interviews were conducted with 18 unaccompanied irregular migrants (15 men and 3 women) from different African countries with a mean age of 20.05 years (SD = 2.77). Thematic analysis was used to analyse the data. Three main themes emerged such as (1) unaccompanied irregular migrant minors: risking it all for a better life; (2) redefining your identity as a means of adaptation and (3) obtaining legal status to avoid deportation. Unaccompanied migrant minors risk their lives on the migration journey, but do not always find better conditions in the destination country. The unaccompanied irregular migrant minors are forced to rebuild their lives at a high cost; they experience rejection from the host society and their culture of origin, which has a negative impact on their physical and psychological health over time.
Ecuador is a key area in South America when it comes to understanding the economic, social and archaeological aspects of pre-Hispanic cultures in the northwestern region of the Andes. Among the most complex societies to have inhabited this territory is the so-called Manteño culture (AD ∼800–1530), which spanned across most of Ecuador’s central Pacific coast. Ongoing research at the site of Ligüiqui (Manta, Manabí) has enabled us to obtain a more complete overview of the chronological sequence of the Manteño period as well as contributing further data on the advanced stage of social development reached during the period; characterized by the hierarchical arrangement of sites, the use of extensive settlement models, and semi-circular stone fish traps (corrales). In order to understand the role played by this coastal site in the complex Manteño culture, a detailed radiocarbon study was performed in the sequence of the Ligüiqui site. In addition, using a detailed review of available Manteño settlement radiocarbon data (13 sites and 64 dates), we established a chronostratigraphic framework for the culture. Our data indicate that Ligüiqui probably acted as a supply centre for marine-origin products from the twelfth century onwards with activity peaking during the Late Manteño period. A multisite comparison using Bayesian modeling indicates an early onset of the Manteño culture in Ligüiqui around AD 700, and a general demise in most of the sites AD ∼1500 or slightly before. This culture finally collapsed before AD ∼1600 during the early Spanish colonial period. Only one site, La Libertad, shows potential evidence of having remained a Manteño settlement after that date.
This study provides a holistic approach to the potential drivers of corporate environmental policy. Institutional and/or stakeholder theories are used to explain any influence on this type of policy in situations with different characteristics. Specifically, the analysis considers country-, industry-, and firm-level determinants of an international sample of listed companies. Exploratory factor analysis was first applied to the variables at the country level because their underlying interrelationships were unknown. Using ordered probit models clustered at the firm level, we found that some environmental characteristics of a country and some macro-level variables considered together affect corporate environmental policy, along with pressure from industry peers. Moreover, we observed that companies with better policies for stakeholders, greater board independence, and greater gender diversity tended to develop better environmental policies. This study offers insight into fostering environmental responsibility through policy incentives and effective corporate governance structures.
The aim of this study was to compare the levels of reactive oxygen species (ROS) in Bos taurus and Bos indicus in vitro embryos cryopreserved using either slow freezing or vitrification. Embryos were divided into four groups based on subspecies and freezing method: Bos indicus slow freezing (BiSF; n = 8), Bos indicus vitrification (BiVT; n = 10), Bos taurus slow freezing (BtSF; n = 9), and Bos taurus vitrification (BtVT; n = 6). After thawing, the embryos were incubated with CellRox Green and images were obtained using a confocal microscope. The fluorescence intensity of each cell was measured and expressed as arbitrary units of fluorescence (auf) and compared using a multiple regression and unpaired t-test with α = 0.05. Results showed that subspecies and the freezing method significantly affected auf (P < 0.001; R2 = 0.1213). Bos indicus embryos had higher auf than Bos taurus embryos, whether frozen by slow freezing (67.05 ± 23.18 vs 51.30 ± 16.84, P < 0.001) or vitrification (64.44 ± 23.32 vs 47.86 ± 17.53, P < 0.001). Slow freezing induced higher auf than vitrification in both Bos taurus (51.30 ± 16.84 vs 47.86 ± 17.53, P < 0.001) and Bos indicus (67.05 ± 23.18 vs 64.44 ± 23.32, P < 0.014). In conclusion, Bos taurus embryos had lower ROS levels when frozen using vitrification, while Bos indicus embryos had consistent ROS patterns regardless of the freezing method. However, Bos indicus embryos frozen by slow freezing tended to have a higher number of cells with elevated ROS levels.
Background: Aztreonam (AZT) is frequently used for the treatment of Enterobacterales-related infections, particularly for patients with penicillin allergy. We aimed to analyze the impact over time of changes in AZT Days of therapy (DOTs) on AZT susceptibility from some Enterobacterales after a multifaceted intervention to improve antibiotic management at a University Hospital in Florida. Methods: The study took place at a 560-lbed academic hospital in Miami, FL. A multifaceted intervention was implemented in this hospital to improve antibiotic management of patients with reported allergies to penicillin. The intervention included use of algorithm-based guidance, education, and feedback to providers. The analysis period spans from 2018 (pre-intervention) through 2022 (post intervention); 2019 was considered the wash-out period (Figure 1). Quarterly data for AZT-DOT and percentage of resistance to AZT for Enterobacterales were collected as part of the normal operations of the antimicrobial stewardship program (ASP) using the infection control module integrated in the electronic medical record (Epic Bugsy). DOT and Enterobacterales antibiotic resistance to AZT was analyzed using linear regression in SPSS. Results: We identified a decrease in DOT AZT and percentage of AZT resistance from E. coli during the study period (Table 1). This intervention led to AZT DOT’s decrease from a quarterly average of 24 DOTs in 2018 levels to a sustained quarterly average of 4.3 DOTs for 2020 to Q2 2023 (decrease 80%) Antibiotic resistance to E. coli AZT changed from a 26.6% to 21.5% (19% decrease) (Table1). Simple linear regression identified a decrease in percentage of E. coli resistance to AZT associated with a decrease on AZT DOT (P-value 0.003), there was no association for other Enterobacterales. For each unit of decrease in AZT DOT there was 0.3% decrease in percentage of E. coli resistance to AZT (Table 2.) Conclusions: A decrease in AZT DOT during the observation period was associated with a decrease in E. coli resistance to AZT. Interventions aimed to decrease inappropriate antibiotic use are pivotal part of the fight against antimicrobial resistance; in our study we report a decrease in E. coli resistance to aztreonam related to decrease in the use of this antibiotic using education, guidance, and feedback to providers.
This study aims to determine the chronological sequence of the collective burials in the hypogea of the prehistoric cemetery of La Beleña (Cabra, Córdoba) through Bayesian analyses of 14C dates obtained from human remains. The data from this site are not only key to grasping the phenomenon of the introduction and spread of hypogea throughout the western Mediterranean, but to gain insight into multi-stage funerary practices during the Late Neolithic/Chalcolithic. The dataset comprises 14C dates of 71 of the 79 individuals placed in five of La Beleña’s six hypogea. The findings suggest: (i) La Beleña is one of the oldest assemblages of hypogea in Iberia, (ii) that this type of collective burial spread rapidly throughout the western Mediterranean area, (iii) that La Beleña is marked by two main phases of funerary activity interspersed by brief burial surges, (iv) funerary intensity at La Beleña increased between cal BC 3400–2900 (2σ), and (v) the cemetery saw a very brief surge of burials potentially related to a catastrophic event. The results of this analysis thus shed light on the little-known chronological sequence of prehistoric hypogea or rock-cut tombs in Iberia, their spread, and their relation to other Late Neolithic collective burials in western Europe.
Many European farmland bird populations are rapidly declining because of agricultural intensification and land-use changes. Robust estimates of population sizes and trends, habitat use, and protected area coverage within the distribution range are crucial to inform the conservation and management of threatened species. Here we report on the results of the 2019 Black-bellied Sandgrouse Pterocles orientalis (BBS) survey promoted and coordinated by SEO/BirdLife to update its breeding distribution, population size, and trends in continental Spain. A total of 660 grid cells, 10 × 10 km, Universal Transverse Mercator (UTM), were surveyed (81% of the distribution area), with 2,257 visits to 1,750 walked transects (7,001 km in total; 10.6 km per UTM). BBS was detected in 43% of sampled UTMs. At transect level, occupancy was 11% higher inside protected areas. At UTM level, occupancy was estimated at 0.58 (Bayesian credible interval [BCI] 95%: 0.55–0.61), revealing that BBS occupied about half of its previous breeding range (2003–2005). Using hierarchical distance sampling modelling, we estimated an average density of 1.33 individuals/km2 in occupied areas, and a population of 4,025 individuals (confidence interval: 1,840–7,609) within sampled areas, with an additional 697 individuals (confidence interval 461–1,075) in areas that were not surveyed. Further, the relative abundance of BBS (Kilometric Abundance Index) declined by 63% between 2005 and 2019 (annual decline rate of 4.5%). BBS used agricultural habitats (73%) and unprotected areas (54%) despite a higher occupancy within protected areas. Given the recent decline rate and persistent threats, the BBS conservation status should be upgraded to “Endangered” in peninsular Spain. Its future depends on land-use changes and agricultural practices, in particular the maintenance of fallows, semi-natural habitats, and pastures for extensive grazing. Better protection of important areas and targeted conservation initiatives should be promoted to halt and reverse the population decline in this key western Palearctic stronghold.
Ermeloite is a new aluminium phosphate mineral from Galicia, Spain, in the northwest of the Iberian Peninsula. It is the third formally recognised mineral discovered in Galicia since morenosite and cervantite in the 19th Century. The name and symbol (Erm) were approved by the Commission on New Minerals, Nomenclature and Classification of the International Mineralogical Association (IMA2021–017a) in recognition of the geographical location where it was found. The mineral occurs as a light blue to white fine aggregate over quartz and microcline associated with wardite. Crystals of ~0.04 mm are transparent and have a waxy lustre. The simplified empirical formula determined using electron microprobe analysis is Al1.02P0.95F0.06O3.88⋅1.06 H2O, which is near to the ideal formula Al(PO4)⋅H2O. The mineral is an alteration product within a phosphate pegmatite. Ermeloite is the second phosphate isostructural with the sulfates of the kieserite group. Single-crystal X-ray diffraction showed that ermeloite crystallises in the monoclinic C2/c space group with cell parameters a = 6.5371(4) Å, b = 7.5670(5) Å, c = 7.1146(5) Å, β = 115.335(2)°, V = 318.08(4) Å3 and Z = 4 at room temperature. Comparative analysis of the crystallographic data, with isostructural phosphates, revealed an interesting behaviour for these compounds.
Suicide is one of the main external causes of death worldwide. People who have already attempted suicide are at high risk of new suicidal behavior. However, there is a lack of information on the risk factors that facilitate the appearance of reattempts. The aim of this study was to calculate the risk of suicide reattempt in the presence of suicidal history and psychosocial risk factors and to estimate the effect of each individual risk factor.
Methods
This systematic review and meta-analysis were conducted following the PRISMA-2020 guidelines. Studies on suicide reattempt that measured risk factors were searched from inception to 2022. The risk factors studied were those directly related to suicide history: history of suicide prior to the index attempt, and those that mediate the transition from suicidal ideation to attempt (alcohol or drug misuse, impulsivity, trauma, and non-suicidal self-injury).
Results
The initial search resulted in 11 905 articles. Of these, 34 articles were selected for this meta-analysis, jointly presenting 52 different effect sizes. The pooled effect size across the risk factors was significant (OR 2.16). Reattempt risk may be increased in presence of any of the following risk factors: previous history, active suicidal ideation, trauma, alcohol misuse, and drug misuse. However, impulsivity, and non-suicidal self-injury did not show a significant effect on reattempt.
Conclusion
Most of the risk factors traditionally associated with suicide are also relevant when talking about suicide reattempts. Knowing the traits that define reattempters can help develop better preventive and intervention plans.
As evidence supporting the effectiveness of mental health and psychosocial interventions grows, more research is needed to understand optimal strategies for improving their implementation in diverse contexts. We conducted a qualitative process evaluation of a multicomponent psychosocial intervention intended to promote well-being among refugee, migrant and host community women in three diverse contexts in Ecuador and Panamá. The objective of this study is to describe the relationships among implementation determinants, strategies and outcomes of this community-based psychosocial intervention. The five implementation strategies used in this study included stakeholder engagement, promoting intervention adaptability, group and community-based delivery format, task sharing and providing incentives. We identified 10 adaptations to the intervention and its implementation, most of which were made during pre-implementation. Participants (n = 77) and facilitators (n = 30) who completed qualitative interviews reported that these strategies largely improved the implementation of the intervention across key outcomes and aligned with the study’s intervention and implementation theory of change models. Participants and facilitators also proposed additional strategies for improving reach, implementation and maintenance of this community-based psychosocial intervention.
Interaction between n-butylammonium (BA) chloride and vermiculite from Santa Olalla (Spain) has been studied in large flake (5 × 5 × 0.1 mm) or ground powder (≤80 µm) samples. The differences in adsorption and decomposition of BA ions in both particle sizes have been established. In the interlamellar space, the BA ion remains unaltered in powder samples, but is degraded in flakes. The experimental results suggest decomposition of the BA in the interlamellar space of vermiculite flakes by breaking of the C-N bond. The degradation of BA takes place over a short period. The variety with BA in the interlamellar space is transformed into a new one, due to the degradation of alkylammonium. The transformation occurs through an interstratified phase formed between BA-vermiculite and NH4-vermiculite, and finally a phase appears in which only ammonium is present in the interlamellar space. Due to the many industrial applications of alkylammonium-clays, determination of the stability of alkylammonium in the interlamellar space of clay minerals is of great importance.