Depression und Suizidalität

Even if the freedom to suicide is part of our human existence, about 90% of all suicides occur in the context of psychiatric disorders and thus in states of limited power of judgment. Depressive disorders represent the most frequent cause for suicides. Thus, optimization of medical care for depressive patients is one of the most promising strategies to prevent suicides. In the context of the `Nuremberg Alliance Against Depression' it came to an obvious reduction of suicidal acts compared to a baseline year and compared to the control region of Wurzburg. The reduction could be reached by a cooperation with GPs, multipliers such as teachers, priests, geriatric caregivers and the media, through intensive public relations work and through support of self help activities. This approach is carried forward within the Germany-wide `Alliance Against Depression' and within the `European Alliance Against Depression' ( EAAD) which is funded by the European Commission. In the last part of the article the suicide- preventive, but also the possible suicide-inducing effect of antidepressants is discussed

Responsiveness of SF-36 Health Survey and Patient Generated Index in people with chronic knee pain commenced on oral analgesia: analysis of data from a randomised controlled clinical trial

Purpose. (1) to assess the responsiveness of the Short Form 36 Health Survey (SF-36) and Patient Generated Index (PGI) in people with knee pain who were given oral analgesics; and (2) to perform content analysis of the SF-36 and PGI aiming to identify differences between the instruments and causes of different responsiveness. Methods. An observational study nested within a randomised controlled trial comparing oral paracetamol, ibuprofen or a combination of the two in 884 community-derived people with chronic knee pain. Each participant was given the SF-36 and PGI questionnaires to fill out at baseline, day 10, week 7 and week 13 after commencement on analgesia. Responsiveness was measured as a standardised response mean from baseline and contents of the instruments were analysed. Results. The PGI showed the greater responsiveness to analgesics than the SF-36 throughout the study period. Only the Bodily Pain Score of the SF-36 showed comparable responsiveness to the PGI. The standardised response mean of the PGI at 13 weeks was 0.61 (95% confidence interval 0.51 to 0.72), and that of the Bodily Pain Score of the SF-36 was 0.49 (95% confidence interval 0.39 to 0.58). Content analysis of the PGI identified multiple areas which are not represented in the SF-36 which may help explain its performance. Conclusions. Overall the PGI is more responsive than the SF-36 to commonly used oral analgesics taken for knee pain. The PGI is able to elicit areas of individualised health related quality of life which are not captured by the SF-36

On group strategy-proof mechanisms for a many-to-one matching model

For the many-to-one matching model in which firms have substitutable and quota q-separable preferences over subsets of workers we show that the workers-optimal stable mechanism is group strategy-proof for the workers. In order to prove this result, we also show that under this domain of preferences (which contains the domain of responsive preferences of the college admissions problem) the workers-optimal stable matching is weakly Pareto optimal for the workers and the Blocking Lemma holds as well. We exhibit an example showing that none of these three results remain true if the preferences of firms are substitutable but not quota q-separable.The work of R. Martínez, A. Neme, and J. Oviedo is partially supported by Research Grant 319502 from the Universidad Nacional de San Luis (Argentina). The work of J. Massó is partially supported by Research Grants BEC2002-2130 from the Dirección General de Investigación Científica y Técnica (Spanish Ministry of Science and Technology) and 2001SGR-00162 from the Departament d’Universitats, Recerca i Societat de la Informació (Generalitat de Catalunya)

A Review of Corrosion and Protection of Steel in Concrete

Corrosion of reinforcement is one of the major durability challenges which leads to a reduction in the design life of reinforced concrete. Due to an increasing demand for longer service lives of infrastructure (typically 100-120 years) and the high cost involved in building and maintaining it, the repair of concrete structures has become extremely important. This paper discusses mechanism of corrosion in reinforced concrete and its thermodynamic and kinetic behaviour. It also presents and compares different corrosion prevention and protection techniques available and recommended by BS 1504-9:2008; including the use of corrosion inhibitors, alternative reinforcement, steel and concrete coating and electrochemical techniques. It is concluded that the electrochemical techniques are more effective than conventional methods

Mood instability and irritability as core symptoms of major depression : an exploration using Rasch analysis

Background: Mood instability (MI) and irritability are related to depression but are not considered core symptoms. Instruments typically code clusters of symptoms that are used to define syndromic depression, but the place of MI and irritability has been under-investigated. Whether they are core symptoms can be examined using Rasch analysis. Method: We used the UK Psychiatric Morbidity Survey 2000 data (n = 8,338) to determine whether the nine ICD/DSM symptoms, plus MI and irritability, constitute a valid depression scale. Rasch analysis was used, a method concerned with ensuring that items constitute a robust scale and tests whether the count of symptoms reflects an underlying interval-level measure. Two random samples of 500 were drawn, serving as calibration and validation samples. As part of the analysis, we examined whether the candidate symptoms were unidimensional, followed a Guttman pattern, were locally independent, invariant with respect to age and sex, and reliably distinguished different levels of depression severity. Results: A subset of five symptoms (sad, no interest, sleep, cognition, suicidal ideas) together with mood instability and irritability satisfactorily fits the Rasch model. However, these seven symptoms do not separate clinically depressed persons from the rest of the population with adequate reliability (Cronbach α = 0.58; Person Separation Index = 0.35), but could serve as a basis for scale development. Likewise, the original nine DSM depression symptoms failed to achieve satisfactory reliability (Cronbach α = 0.67; Person Separation Index = 0.51). Limitations: The time frame over which symptoms were experienced varied, and some required recall over the last year. Symptoms other than those examined here might also be core depression symptoms. Conclusion: Mood instability and irritability are candidate core symptoms of the depressive syndrome and should be part of its clinical assessment

The Bipolar Illness Onset study: research protocol for the BIO cohort study

Introduction Bipolar disorder is an often disabling mental illness with a lifetime prevalence of 1%–2%, a high risk of recurrence of manic and depressive episodes, a lifelong elevated risk of suicide and a substantial heritability. The course of illness is frequently characterised by progressive shortening of interepisode intervals with each recurrence and increasing cognitive dysfunction in a subset of individuals with this condition. Clinically, diagnostic boundaries between bipolar disorder and other psychiatric disorders such as unipolar depression are unclear although pharmacological and psychological treatment strategies differ substantially. Patients with bipolar disorder are often misdiagnosed and the mean delay between onset and diagnosis is 5–10 years. Although the risk of relapse of depression and mania is high it is for most patients impossible to predict and consequently prevent upcoming episodes in an individual tailored way. The identification of objective biomarkers can both inform bipolar disorder diagnosis and provide biological targets for the development of new and personalised treatments. Accurate diagnosis of bipolar disorder in its early stages could help prevent the long-term detrimental effects of the illness. The present Bipolar Illness Onset study aims to identify (1) a composite blood-based biomarker, (2) a composite electronic smartphone-based biomarker and (3) a neurocognitive and neuroimaging-based signature for bipolar disorder. Methods and analysis The study will include 300 patients with newly diagnosed/first-episode bipolar disorder, 200 of their healthy siblings or offspring and 100 healthy individuals without a family history of affective disorder. All participants will be followed longitudinally with repeated blood samples and other biological tissues, self-monitored and automatically generated smartphone data, neuropsychological tests and a subset of the cohort with neuroimaging during a 5 to 10-year study period. Ethics and dissemination The study has been approved by the Local Ethical Committee (H-7-2014-007) and the data agency, Capital Region of Copenhagen (RHP-2015-023), and the findings will be widely disseminated at international conferences and meetings including conferences for the International Society for Bipolar Disorders and the World Federation of Societies for Biological Psychiatry and in scientific peer-reviewed papers

Progressão de cárie e necessidade de reintervenção em lesões oclusais ICDAS 4 após diferentes tratamentos : um estudo retrospectivo de base universitária

Objective: To assess the caries progression and the need for reintervention on occlusal ICDAS 4 lesions after different treatments. Material and Methods: The sample consisted of records of children treated in a public setting who had at least an occlusal ICDAS 4 lesion in primary and/or permanent molars. The radiographic images of ICDAS 4 lesions at the first and last appointments were classified as absence of radiolucency, radiolucent image at the enamel–dentin junction, at the outer half or inner of the dentin. The need for retreatment after different treatments (non-invasive - topical fluoride applications, oral hygiene instructions and dietary guidance, micro-invasive - resin-based sealant, or invasive - restoration) was assessed by reviewing clinical and radiographic records. The need for retreatment was defined as any complication requiring mending (e.g., caries progression, total loss of sealant, or restoration failure). The Poisson regression model was used to investigate the association between individual and tooth-related variables and the outcome. Results: Among the 111 lesions in 81 patients, most (73.0%) lesions were in primary molars. Most lesions (52.3%) did not exhibit radiolucency, whereas 29.7% had radiolucency at the outer half of the dentin. The mean follow-up was 18.8 ± 6.5 months. After follow-up, 82.9% of the lesions did not require retreatment. The prevalence of ICDAS 4 lesions that did not need retreatment was higher among lesions with radiolucency at dentin (p=0.01). Conclusion: Most occlusal ICDAS 4 lesions did not require reintervention, especially those exhibiting radiolucency in the outer half of the dentin.Objetivo: Avaliar a progressão de cárie e a necessidade de reintervenção em lesões oclusais ICDAS 4 após diferentes tratamentos. Material e Métodos: A amostra consistiu de prontuários de crianças atendidas em ambiente público que apresentavam pelo menos uma lesão oclusal ICDAS 4 em molares decíduos e/ou permanentes. As imagens radiográficas de lesões ICDAS 4 na primeira e última consultas foram classificadas como ausência de radiolucidez, imagem radiolúcida na junção esmalte-dentina, em metade externa ou interna da dentina. A necessidade de retratamento após diferentes tratamentos (não invasivo – aplicações tópicas de flúor, orientações de higiene e dieta, micro-invasivo – selante resinoso ou invasivo – restauração) foi avaliada por meio da revisão dos registros clínicos e radiográficos. A necessidade de retratamento foi definida como qualquer complicação que requer intervenção (por exemplo, progressão da lesão, perda total do selante ou falha na restauração). O modelo de regressão de Poisson foi utilizado para investigar a associação entre as variáveis individuais e dentárias e o desfecho. Resultados: Entre as 111 lesões em 81 pacientes, a maioria (73,0%) das lesões eram em molares decíduos. A maioria das lesões (52,3%) não exibiu radiolucidez, enquanto que 29,7% apresentaram radiolucidez em metade externa de dentina. O tempo de acompanhamento médio foi de 18,8 ± 6,5 meses. Após o acompanhamento, 82,9% das lesões não necessitaram de retratamento. A prevalência de lesões ICDAS 4 que não necessitaram de retratamento foi maior entre as lesões com radiolucidez em dentina (p=0,01). Conclusão: A maioria das lesões oclusais ICDAS 4 não requerem reintervenção, especialmente aquelas que exibem radiolucidez em metade externa da dentina

Práticas parentais percebidas, autoestima, otimismo e resiliência em futuros professores

The first expectations created by adolescents regarding their professional future arise based on their family context. At this moment in life, adolescents decide about their future and make their decisions with the help of their families. The purpose of this study was to investigate relationships between perceived parenting practices and choice of profession, self-esteem, optimism and resilience in adolescents attending a technical teacher training course. Two hundred adolescents with an average age of 15.8 years took part in this study. The instruments used were: a sociodemographic questionnaire, the Rosenberg Self-Esteem scale, the Life Orientation Test, the Resilience Scale and the Family Interaction Quality Scales. The majority of students in this study are female, have few siblings and live with their parents. When asked about the university course they would like to take in the future, the absolute majority (51%) chose degree courses providing teacher training.With regard to the reason why they chose to take a technical teacher training course, “making a dream come true” was the most frequent answer given by the respondents, followed by identification with this area. When asked about the characteristics of a good teacher, they mentioned dedication to the profession, dedication to students (involving aspects such as patience and affection).With regard to behaviours to be avoided by teachers, emphasis was placed on behaviours such as shouting, sarcasm, lack of teaching ability and arrogance. Significant and positive correlations were found between parenting practices perceived by the adolescents and scores for optimism, resilience and self-esteem, thus revealing the importance of parent involvement for the development of the personal strengths of these young people who, from an early age, defined an objective in life and are on their way to achieving it.As primeiras expectativas criadas pelos adolescentes acerca do seu futuro profissional são tomadas com base no contexto familiar. Esta pesquisa objetivou investigar relações entre as práticas educativas parentais percebidas e a escolha profissional, a autoestima, o otimismo e a resiliência em adolescentes que frequentam um curso técnico de formação de professores. Participaram 200 adolescentes, maioria do sexo feminino e idade média de 15,8 anos. Os instrumentos foram: questionário sociodemográfico, Escala de autoestima de Rosenberg, Life Orientation Test, Escala de Resiliência, Escalas de Qualidade na Interação Familiar. Os dados mostram que os jovens têm interesse em cursos universitários de licenciaturas e revelam identificação com a área do magistério.Sobre características boas de um professor, a maioria indicou comportamentos ligados à interação, seguido de cuidado com a profissão, e comportamentos relacionados ao domínio do conteúdo e didática. No caso dos comportamentos do professor a serem evitados, os mais citados foram o controle aversivo, a seguir foram comportamentos do professor que pudessem comprometer a aprendizagem, como a falta de planejamento e desorganização. Foram encontradas correlações significativas e positivas entre as práticas parentais percebidas pelos adolescentes e os escores de otimismo, resiliência e autoestima, revelando a importância do envolvimento dos pais para o desenvolvimento de forças pessoais desses jovens que, desde cedo, definiram um objetivo de vida e estão no caminho para realizá-lo

Bipolar disorder prevalence: a systematic review and meta-analysis of the literature

Objective:Bipolar disorder (BD) is common in clinical psychiatric practice, and several studies have estimated its prevalence to range from 0.5 to 5% in community-based samples. However, no systematic review and meta-analysis of the prevalence of BD type 1 and type 2 has been published in the literature. We carried out a systematic review and meta-analysis of the lifetime and 1-year prevalence of BD type 1 and type 2 and assessed whether the prevalence of BD changed according to the diagnostic criteria adopted (DSM-III, DSM-III-R vs. DSM-IV).Methods:We searched MEDLINE, Scopus, Web of Science, PsycINFO, and the reference lists of identified studies. The analyses included 25 population- or community-based studies and 276,221 participants.Results:The pooled lifetime prevalence of BD type 1 was 1.06% (95% confidence interval [95%CI] 0.81-1.31) and that of BD type 2 was 1.57% (95%CI 1.15-1.99). The pooled 1-year prevalence was 0.71% (95%CI 0.56-0.86) for BD type 1 and 0.50% (95%CI 0.35-0.64) for BD type 2. Subgroup analysis showed a significantly higher lifetime prevalence of BD type 1 according to the DSM-IV criteria compared to the DSM-III and DSM-IIIR criteria (p < 0.001).Conclusion:This meta-analysis confirms that estimates of BD type 1 and type 2 prevalence are low in the general population. The increase in prevalence from DSM-III and DSM-III-R to DSM-IV may reflect different factors, such as minor changes in diagnostic operationalization, use of different assessment instruments, or even a genuine increase in the prevalence of BD

Differences in pain, function and coping in Multidimensional Pain Inventory subgroups of chronic back pain: a one-group pretest-posttest study

Contains fulltext : 97819.pdf (publisher's version ) (Open Access)BACKGROUND: Patients with non-specific back pain are not a homogeneous group but heterogeneous with regard to their bio-psycho-social impairments. This study examined a sample of 173 highly disabled patients with chronic back pain to find out how the three subgroups based on the Multidimensional Pain Inventory (MPI) differed in their response to an inpatient pain management program. METHODS: Subgroup classification was conducted by cluster analysis using MPI subscale scores at entry into the program. At program entry and at discharge after four weeks, participants completed the MPI, the MOS Short Form-36 (SF-36), the Hospital Anxiety and Depression Scale (HADS), and the Coping Strategies Questionnaire (CSQ). Pairwise analyses of the score changes of the mentioned outcomes of the three MPI subgroups were performed using the Mann-Whitney-U-test for significance. RESULTS: Cluster analysis identified three MPI subgroups in this highly disabled sample: a dysfunctional, interpersonally distressed and an adaptive copers subgroup. The dysfunctional subgroup (29% of the sample) showed the highest level of depression in SF-36 mental health (33.4 +/- 13.9), the interpersonally distressed subgroup (35% of the sample) a modest level of depression (46.8 +/- 20.4), and the adaptive copers subgroup (32% of the sample) the lowest level of depression (57.8 +/- 19.1). Significant differences in pain reduction and improvement of mental health and coping were observed across the three MPI subgroups, i.e. the effect sizes for MPI pain reduction were: 0.84 (0.44-1.24) for the dysfunctional subgroup, 1.22 (0.86-1.58) for the adaptive copers subgroup, and 0.53 (0.24-0.81) for the interpersonally distressed subgroup (p = 0.006 for pairwise comparison). Significant score changes between subgroups concerning activities and physical functioning could not be identified. CONCLUSIONS: MPI subgroup classification showed significant differences in score changes for pain, mental health and coping. These findings underscore the importance of assessing individual differences to understand how patients adjust to chronic back pain