Recent trends in the incidence of anxiety diagnoses and symptoms in primary care.

Anxiety is common, with significant morbidity, but little is known about presentations and recording of anxiety diagnoses and symptoms in primary care. This study aimed to determine trends in incidence and socio-demographic variation in General Practitioner (GP) recorded diagnoses of anxiety, mixed anxiety/depression, panic and anxiety symptoms

Trends in incidence, prevalence and prescribing in type 2 diabetes mellitus between 2000 and 2013 in primary care: a retrospective cohort study

OBJECTIVE: To investigate trends in incident and prevalent diagnoses of type 2 diabetes mellitus (T2DM) and its pharmacological treatment between 2000 and 2013. DESIGN: Analysis of longitudinal electronic health records in The Health Improvement Network (THIN) primary care database. SETTING: UK primary care. PARTICIPANTS: In total, we examined 8 838 031 individuals aged 0-99 years. OUTCOME MEASURES: The incidence and prevalence of T2DM between 2000 and 2013, and the effect of age, sex and social deprivation on these measures were examined. Changes in prescribing patterns of antidiabetic therapy between 2000 and 2013 were also investigated. RESULTS: Overall, 406 344 individuals had a diagnosis of T2DM, of which 203 639 were newly diagnosed between 2000 and 2013. The incidence of T2DM rose from 3.69 per 1000 person-years at risk (PYAR) (95% CI 3.58 to 3.81) in 2000 to 3.99 per 1000 PYAR (95% CI 3.90 to 4.08) in 2013 among men; and from 3.06 per 1000 PYAR (95% CI 2.95 to 3.17) to 3.73 per 1000 PYAR (95% CI 3.65 to 3.82) among women. Prevalence of T2DM more than doubled from 2.39% (95% CI 2.37 to 2.41) in 2000 to 5.32% (95% CI 5.30 to 5.34) in 2013. Being male, older, and from a more socially deprived area was strongly associated with having T2DM, (p<0.001). Prescribing changes over time reflected emerging clinical guidance and novel treatments. In 2013, metformin prescribing peaked at 83.6% (95% CI 83.4% to 83.8%), while sulfonylureas prescribing reached a low of 41.4% (95% CI 41.1% to 41.7%). Both remained, however, the most commonly used pharmacological treatments as first-line agents and add-on therapy. Thiazolidinediones and incretin based therapies (gliptins and GLP-1 analogues) were also prescribed as alternate add-on therapy options, however were rarely used for first-line treatment in T2DM. CONCLUSIONS: Prevalent cases of T2DM more than doubled between 2000 and 2013, while the number of incident cases increased more steadily. Changes in prescribing patterns observed may reflect the impact of national policies and prescribing guidelines on UK primary care

Novel methodology to examine cognitive and experiential factors in language development: combining eye-tracking and LENA technology

Developmental systems theory posits that development cannot be segmented by influences acting in isolation, but should be studied through a scientific lens that highlights the complex interactions between these forces over time (Overton, 2013a). This poses a unique challenge for developmental psychologists studying complex processes like language development. In this paper, we advocate for the combining of highly sophisticated data collection technologies in an effort to move toward a more systemic approach to studying language development. We investigate the efficiency and appropriateness of combining eye-tracking technology and the LENA (Language Environment Analysis) system, an automated language analysis tool, in an effort to explore the relation between language processing in early development, and external dynamic influences like parent and educator language input in the home and school environments. Eye-tracking allows us to study language processing via eye movement analysis; these eye movements have been linked to both conscious and unconscious cognitive processing, and thus provide one means of evaluating cognitive processes underlying language development that does not require the use of subjective parent reports or checklists. The LENA system, on the other hand, provides automated language output that describes a child’s language-rich environment. In combination, these technologies provide critical information not only about a child’s language processing abilities but also about the complexity of the child’s language environment. Thus, when used in conjunction these technologies allow researchers to explore the nature of interacting systems involved in language development

The Patient Health Questionnaire-9 for detection of major depressive disorder in primary care: consequences of current thresholds in a crosssectional study

Background: There is a need for brief instruments to ascertain the diagnosis of major depressive disorder. In this study, we present the reliability, construct validity and accuracy of the PHQ-9 and PHQ-2 to detect major depressive disorder in primary care.Methods: Cross-sectional analyses within a large prospective cohort study (PREDICT-NL). Data was collected in seven large general practices in the centre of the Netherlands. 1338 subjects were recruited in the general practice waiting room, irrespective of their presenting complaint. The diagnostic accuracy (the area under the ROC curve and sensitivities and specificities for various thresholds) was calculated against a diagnosis of major depressive disorder determined with the Composite International Diagnostic Interview (CIDI).Results: The PHQ-9 showed a high degree of internal consistency (ICC = 0.88) and test-retest reliability (correlation = 0.94). With respect to construct validity, it showed a clear association with functional status measurements, sick days and number of consultations. The discriminative ability was good for the PHQ-9 (area under the ROC curve = 0.87, 95% CI: 0.84-0.90) and the PHQ-2 (ROC area = 0.83, 95% CI 0.80-0.87). Sensitivities at the recommended thresholds were 0.49 for the PHQ-9 at a score of 10 and 0.28 for a categorical algorithm. Adjustment of the threshold and the algorithm improved sensitivities to 0.82 and 0.84 respectively but the specificity decreased from 0.95 to 0.82 (threshold) and from 0.98 to 0.81 (algorithm). Similar results were found for the PHQ-2: the recommended threshold of 3 had a sensitivity of 0.42 and lowering the threshold resulted in an improved sensitivity of 0.81.Conclusion: The PHQ-9 and the PHQ-2 are useful instruments to detect major depressive disorder in primary care, provided a high score is followed by an additional diagnostic work-up. However, often recommended thresholds for the PHQ-9 and the PHQ-2 resulted in many undetected major depressive disorders

Are multiple primary outcomes analysed appropriately in randomised controlled trials? A review

To review how multiple primary outcomes are currently considered in the analysis of randomised controlled trials. We briefly describe the methods available to safeguard the inferences and to raise awareness of the potential problems caused by multiple outcomes

A New Biomarker to Examine the Role of Hippocampal Function in the Development of Spatial Reorientation in Children: A Review

Spatial navigation is an adaptive skill that involves determining the route to a particular goal or location, and then traveling that path. A major component of spatial navigation is spatial reorientation, or the ability to reestablish a sense of direction after being disoriented. The hippocampus is known to be critical for navigating, and has more recently been implicated in reorienting in adults, but relatively little is known about the development of the hippocampus in relation to these large-scale spatial abilities in children. It has been established that, compared to school-aged children, preschool children tend to perform poorly on certain spatial reorientation tasks, suggesting that their hippocampi may not be mature enough to process the demands of such a task. Currently, common techniques used to examine underlying brain activity, such as electroencephalography (EEG) and functional magnetic resonance imaging (fMRI), are not suitable for examining hippocampal development in young children. In the present paper, we argue instead for the use of eyeblink conditioning (EBC), a relatively under-utilized, inexpensive, and safe method that is easy to implement in developing populations. In addition, EBC has a well defined neural circuitry, which includes the hippocampus, making it an ideal tool to indirectly measure hippocampal functioning in young children. In this review, we will evaluate the literature on EBC and its relation to hippocampal development, and discuss the possibility of using EBC as an objective measure of associative learning in relation to large-scale spatial skills. We support the use of EBC as a way to indirectly access hippocampal function in typical and atypical populations in order to characterize the neural substrates associated with the development of spatial reorientation abilities in early childhood. As such, EBC is a potential, simple biomarker for success in tasks that require the hippocampus, including spatial reorientation

First cases of exclusive paternal care in stink bugs (Hemiptera: Pentatomidae)

We describe paternal care in two pentatomid bugs, Lopadusa (Lopadusa) augur Stål, 1860 and Edessa nigropunctata Berg, 1884. Field and laboratory observations showed that males remain with their eggs and early hatched nymphs, while females abandon the eggs after oviposition. Guarding males defensive behaviors towards their clutches were similar to those described for guarding females of pentatomids. Since there is no detailed information on the internal phylogeny of Pentatomidae, it is not possible to make a robust inference on whether paternal care in L. augur and E. nigropunctata has arisen independently or not. If the latter, the two new cases of paternal care we describe here represent the fifth event of independent evolution of this rare behavioral trait in Heteroptera.FAPESPCoordenacao de Aperfeicoamento de Pessoal de Nivel Superior (CAPES)CNP

Relative risks of cardiovascular disease in people prescribed olanzapine, risperidone and quetiapine

ABSTRACT: Antipsychotics may confer long term benefits and risks, including cardiovascular disease (CVD) risk. Several studies using routine clinical data have reported associations between antipsychotics and CVD but potential confounding factors and unclear classification of drug exposure limits their interpretation. METHOD: We used data from The Health Improvement Network, a large UK primary care database to determine relative risks of (CVD) comparing similar groups of people only prescribed olanzapine versus either risperidone or quetiapine. We included participants over 18 between 1995 and 2011. To assess confounding factors we created propensity scores for being prescribed each antipsychotic. We used propensity score matching and Poisson regression to calculate the CVD incidence rate ratios for olanzapine versus the other two drugs. RESULTS: We identified 18,319 people who received a single antipsychotic during follow-up (n = 5090 risperidone, 7797 olanzapine and 4613 quetiapine). In unmatched analyses, the CVD incidence rate ratio (IRR) for olanzapine versus risperidone was 0.63 (0.51–0.77) but the propensity score matched IRR was 0.78 (0.61–1.02). In the unmatched olanzapine versus quetiapine analysis the IRR adjusted for age and sex for olanzapine was 1.52 (1.16–1.98) but the propensity score matched analysis gave an IRR of 1.08 (0.79–1.46). CONCLUSIONS: After propensity score matching, we found no statistical differences in CVD incidence between olanzapine and either risperidone or quetiapine. Analyses which did not account for confounding factors produced very different results. Researchers must address confounding factors when designing observational studies to assess adverse outcomes of drugs, including antipsychotics

Evaluation of Returns and Risks in the Forms of Garlic Market: Seed Versus in Natura

The garlic plant hortense Liliaceae, very used as spice, giving flavor to food and can be used in medicinal treatment. Its cultivation is an annual crop with all its processes since the preparation of the earth to their harvest. The context of this work was to evaluate their production, their use, their risks and seed and its consumption in natura. Their samplings were selected in Três Barras Town, Santa Catarina in 2014 harvest period. Among the seed (bulb) and in natura even with the risk of losses with fungal or bacterial their culture is considered a good harvest, because the climate is very favorable to its cultivation, detailing its costs of production and the difference between the crop seed and in natura. This study has used the Multi-index methodology to the analyzes and calculations for the comprehensive, such as: analysis of the 8.25% ROIA for garlic in natura and 7.44% in garlic seed on the initial investment. The cash flow based on monthly statements, involving expenditure on machinery, preparation of the land, among others. An initial investment of R$39.756,64 for both harvests. Getting a VPL R$63.188,55 for garlic in natura and R$54.303,99 for garlic seed, its IBC considering the values of 2.59% for garlic in natura and 2.37 for garlic seed. The information about TMA/TRI were well satisfactory for the return of the harvest, as all cultures have risks, this harvest is approximately 50% for both types being in the seed and in natura. The data was passed by the Crystal Ball for attesting and validation of calculations where is approved investment in agribusiness