Southwest Harvest for Health: An Adapted Mentored Vegetable Gardening Intervention for Cancer Survivors

Harvest for Health is a home-based vegetable gardening intervention that pairs cancer survivors with Master Gardeners from the Cooperative Extension System. Initially developed and tested in Alabama, the program was adapted for the different climate, growing conditions, and population in New Mexico. This paper chronicles the feasibility, acceptability, and preliminary efficacy of "Southwest Harvest for Health". During the nine-month single-arm trial, 30 cancer survivor-Master Gardener dyads worked together to establish and maintain three seasonal gardens. Primary outcomes were accrual, retention, and satisfaction. Secondary outcomes were vegetable and fruit (V and F) intake, physical activity, and quality of life. Recruitment was diverse and robust, with 30 survivors of various cancers, aged 50-83, roughly one-third minority, and two-thirds females enrolled in just 60 days. Despite challenges due to the COVID-19 pandemic, retention to the nine-month study was 100%, 93% reported "good-to-excellent" satisfaction, and 87% "would do it again." A median increase of 1.2 servings of V and F/day was documented. The adapted home-based vegetable gardening program was feasible, well-received, and resulted in increased V and F consumption among adult cancer survivors. Future studies are needed to evaluate the effectiveness of this program and to inform strategies to increase the successful implementation and further dissemination of this intervention.

Bottom-Up Copper Filling of Large Scale Through Silicon Vias for MEMS Technology

An electrodeposition process for void-free bottom-up filling of sub-millimeter scale through silicon vias (TSVs) with Cu is detailed. The 600 μm deep and nominally 125 μm diameter metallized vias were filled with Cu in less than 7 hours under potentiostatic control. The electrolyte is comprised of 1.25 mol/L CuSO4 -0.25 mol/L CH3SO3H with polyether and halide additions that selectively suppress metal deposition on the free surface and side walls. A brief qualitative discussion of the procedures used to identify and optimize the bottom-up void-free feature filling is presented.

The cost-effectiveness of paliperidone extended release in Spain

BACKGROUND

Paliperidone Extended Release OROS (ER) is a new atypical antipsychotic for the treatment of schizophrenia. The objective is, based on a previously published model, to analyze the clinical and economic effects of Paliperidone ER in a Spanish setting compared to olanzapine oral and aripiprazole.

METHODS

An existing discrete event simulation model was adapted to reflect the treatment of schizophrenia in Spain in terms of costs, resource use, and treatment patterns. Inputs for the model were derived from clinical trial data, literature research, database analysis and interviews with local clinical experts. The time horizon is 5 years and Spanish discount rate was applied. Outputs include direct medical costs and Quality Adjusted Life-Years (QALYs). Extensive sensitivity analyses were carried out to assess the robustness of the results, using ordinary least squares analysis and cost-effectiveness scatter plots.

RESULTS

The results show that the mean incremental QALYs (95% CI) compared to olanzpine is 0.033 [-0.143, 0.304] and compared to aripiprazole 0.029 [-0.107, 0.300]. The corresponding mean incremental costs and corresponding confidence intervals are -€1425 [-€10,247, €3084] and -€759 [-€10,479, €3404], respectively. The probability that paliperidone ER is cost-saving and health gaining compared to olanzapine and aripiprazole is 76% and 72%, respectively. Paliperidone ER was estimated to have 80% and 81% probability of being cost-effective compared to olanzapine at a willingness to pay of €20,000 and €30,000 and 73% and 74% compared to aripiprazole, respectively.

LIMITATIONS

Some of the modeled inter-relationships had to be based on expert opinion due to a lack of information. Also, foreign sources for the disutility of adverse events had been used due to a lack of Spanish data. Prolactin-related side-effects, indirect costs, and potential compliance advantages of paliperidone ER were not considered. It is unlikely that these limitations affected the conclusions.

CONCLUSION

Based on differences in drug acquisition costs, side-effects, and risk of relapse, the model predicts that, in the Spanish healthcare setting, paliperidone ER dominates oral olanzapine and aripiprazole, with a probability of 76% and 72%, respectively.

[Diagnostic errors and temporal stability in bipolar disorder]

INTRODUCTION

The diagnosis of bipolar disorder is frequently modified during the course of the illness.

MATERIAL AND METHODS

Diagnostic changes and associated errors are described for 1,153 patients diagnosed as bipolar disorder, aged over 18 years and with at least ten follow-up visits. Data was extracted from a clinical registry of out-patient care specialized in Psychiatry and psychiatric hospitalizations of 25,152 patients representative of an urban area of 240,000 inhabitants. Limit for diagnostic stability was established as the maintenance of the bipolar disorder diagnosis in at least 75% of the visits.

RESULTS

A total of 158 (46.1 %) out of 342 patients diagnosed as having a bipolar disorders in the first visit kept this diagnostic constant in subsequent evaluations. Infradiagnostic initial error was committed with 108 stable patients who were not diagnosed in the first visit. 184 patients diagnosed in the first visit with bipolar disorder had less than 75 % concordant diagnosis along the follow-up and could be considered as initial overdiagnosis. Two hundred and nine out of the 443 patients who were diagnosed as bipolar disorder in their last visit did not keep stability criteria in their follow-up and could be considered therefore as final overdiagnosis. Thirty two stable patients not diagnosed in their last visit could be considered as infradiagnosis final error. Diagnosis from schizophrenia spectrum (F2) appears in one of every four psychiatric visits of the patients included in this study. Overlap was seen in three other categories: anxiety disorders (F4), personality disorders (F6) and substance abuse disorders.

CONCLUSION

Initial course of bipolar disorder causes difficulties in the diagnosis.

[Gender differences in clinical profile, response and remission of depressive patients treated with venlafaxine extended release]

INTRODUCTION

The primary objectives of this study are to evaluate gender-specific differences in the clinical profile of primary care depressive patients as well as in the clinical response and remission to venlafaxine extended release.

METHODS

We have analyzed a sample of 6,719 adult outpatients (1,713 men and 4,925 women) with diagnosis of depressive syndrome with associated anxiety symptoms included in an observational, prospective, multicenter and open study. Venlafaxine extended release was administered for 24 weeks at a dosage of 75-225 mg/day.

RESULTS

In this study we have not found overall differences regarding the baseline severity of the depressive episode, as assessed by means of the HAM-D17 and Clinical Global Impression Scale of Severity (CGI-S). However, women showed higher scores on items of the HAM-D17 and HAM-A scales related with anxious and somatic complaints at baseline and endpoint. The percentage of remission on the HAM-D17 scale reached 75.4 % for men and 74.3 % for women (p = 0.4339) at week 24. In the case of HAM-A: 84.1% vs. 80.6% (men vs. women, p=0.004).

CONCLUSIONS

We did not observe baseline differences in the mean score of the HAM-D17 nor the remission rates between women and men (HAM-D17) at the final visit. Women showed lower anxiety remission rates (HAM-A) and maintained more anxious and somatic complaints throughout the study.

Ziprasidone: from pharmacology to the clinical practice. One year of experience

More than a year after the marketing of the atypical anti-psychotic ziprasidone, data from research studies and clinical practice have provided a fair amount of useful information for its practical use in the treatment of schizophrenia. Its pharmacodynamical characteristics and the results from clinical trials with a flexible dose seem to justify the need to administer doses in a range higher than what was initially foreseen, with an initial minimum of 120 mg per day and a fast titulation up to 160 mg per day. Such doses make it possible to achieve sufficient plasma concentrations to occupy at least 60 % of the D2 receptors from which the anti-psychotic effect derives. Moreover, its anti-depressive activity and its non-sedative profile have been confirmed, with a favorable effect on attention and other cognitive functions of the patient, according to its high affinity for 5HT1A and D1 receptors and the inhibition of serotonin and noradrenaline re-uptake. Finally, the low affinity of this drug for alpha-adrenergic, histaminergic and muscarinic receptors favors a good tolerability profile, with a neutral effect on weight, and a lack of anti-cholinergic effects. Results from different clinical trials show that the use of doses in the higher range is associated to a faster and more pronounced clinical improvement without adding a higher risk of adverse events.

[Impact of olanzapine on quality of life of patients with schizophrenia: one-year follow-up with the Seville Quality of Life Questionnaire]

INTRODUCTION

Our objective is to present the impact on quality of life of long-term olanzapine treatment in a significant number of schizophrenics as determined by the Seville Quality of Life Questionnaire (SQLQ), an instrument that addresses the aspects that particularly affect these patients, and to evaluate the sensitivity of this instrument to the changes induced by this treatment.

METHODS

Three hundred and seventy two patients with the diagnosis of schizophrenia as per the ICD-10 classification were evaluated in a 1 year prospective study after switching to olanzapine. The SQLQ, Lehman's structured interview and short version of the discapacity assessment scale were used to evaluate patient's subjective experience; in addition, other instruments were used to evaluate psychopathology.

RESULTS

Significant increases in the scores of the favorable scale and decreases in the unfavorable scale of the SQLQ were found. There were also significant improvements in quality of life as measured with Lehman's structured interview. This improvement continued until the end of the 1 year follow-up after switching to olanzapine. Both instruments show a good correlation. Changes in psychopathology were also remarkable, including the negative symptoms.

CONCLUSIONS

The SQLQ has proven to be a sensitive instrument to measure quality of life in schizophrenic patients treated with olanzapine. It focuses on aspects that are relevant for patients that were frequently overlooked by treating physicians. This drug has been proven to have a favorable subjective impact upon patients, besides improving psychopathology.

[Terrorist attacks and short-long time psychiatric morbidity]

BACKGROUND

The victims of terrorist attacks have a lower level of mental health than general population. However this effects has been only demonstrated in short term after the terrorist attack.

METHODS

2998 people from 544 families who have suffered a terrorist attacks. General Health Questionnaire-28 (GHQ-28) as a psychopathological screening was used in 1094 people. This sample was divided in direct victims (DV), direct victims' relatives (DVR) and people who meet these two conditions (DVRDV).

RESULTS

39.6% of the sample were probable psychiatric cases. Psychiatric prevalence was higher in DRVDV (54.5%) and DV (52.0%) than in DRV and general population (10-25%). The sample presented worse level of mental health than the general population in short term (0-2 years) (DVR 40%, DV 66.7%, DRVDR 75%) and in long term 18-20 años) (DVR 35.70%, DV 37%, DRVDR 37.5%).

CONCLUSION

Both those suffering a terrorist attack as well as their family members have worse levels of mental health than the general population in both the short and long term.

[Validation of the Spanish version of PRIME-MD: a procedure for diagnosing mental disorders in primary care]

INTRODUCTION

Psychiatric disorders occurs in at least 20% of patients attending Primary Care settings, however, only 50% of them are detected by primary care physicians. Therefore a tool is required which can help primary care physicians to detect and diagnose psychiatric disorders. PRIME-MD (Primary Care Evaluation of Mental Disorders) is a questionnaire designed with this aim. In this article the results of the validation study of the Spanish version of this questionnaire are presented.

MATERIALS AND METHODS

312 patients were interviewed by primary care physicians using PRIME-MD and by psychiatrists using SCAN (Schedules for Clinical Assessment in Neuropsychiatry).

RESULTS

The time most frequently spent in questionnaire application by the physician was 10 minutes. PRIME-MD detected the presence of at least one psychiatric disorder in 44.3% of patients. PRIME-MD diagnoses agree well with SCAN diagnoses for mood disorders (coefficient of agreement: 0.50) and for anxiety disorders (coefficient of agreement: 0.35), but not for somatoform disorders or alcohol-related disorders.

CONCLUSIONS

The Spanish version of PRIME-MD questionnaire in a useful tool to identify and diagnose mood and anxiety disorders in Primary Care settings.

[Seville Quality of Life Questionnaire: historic outlook of its establishment]

We describe how we developed a new instrument for measuring quality of life, the Seville Quality of Life Questionnaire (SQCQ), and the results we obtained when we applied it to a group of schizophrenic patients. The questionnaire was designed by a group of researchers who set out from the premise that the quality of life of schizophrenic patients is perceived differently from that of healthy people, and tried first of all to demarcate the kind of area which is abnormal in these patients. We then devised a set of items which were assessed for clarity and pertinence by a series of experts, and the questionnaire was assembled in the form of a set of statements, response to which is in the form of a Lickert-type 5-stage scale. The finished questionnaire was administered to 279 schizophrenic patients. At the same time, these patients were also evaluated using the AMDP Psychopathology Scale, the positive and negative symptoms evaluation scale (PANS), Lehman's structured quality of life interview (QOLY), Ruiz and Baca's quality of life questionnaire (QLQ), Camberwell's scale of needs analysis (CANr) and the WHO's handicap assessment scale (DDS). These questionnaires were used to judge the different types of validity of the Seville Questionnaire. The reliability of the questionnaire was measured using Cronbach's alpha coefficient (internal consistency: 0,85 scale of favourable aspects, 0,96 scale of unfavourable aspects). As far as validity was concerned, both scales of the questionnaire were found to have a high level of validity. We also examined the extent to which the psychopathological disorders affected the quality of the schizophrenic person's life, the extent to which his/her needs were being met by the health services, and the patient's degree of disability. From the results obtained, we can say that the SQCQ is a reliable and valid instrument, which is sufficiently sensitive to the clinical changes produced in the course of the natural history of the disease. The SQCQ stands out from the other quality of life questionnaires in that it takes into account aspects of the disease which the patient him/herself is aware of as affecting his/her quality of life.

Effects of Ixodes scapularis and Borrelia burgdorferi on modulation of the host immune response: induction of a TH2 cytokine response in Lyme disease-susceptible (C3H/HeJ) mice but not in disease-resistant (BALB/c) mice

Previous studies have demonstrated that both Ixodes scapularis saliva and Borrelia burgdorferi antigens modulated lymphokines and monokines in vitro. The studies presented here were designed to delineate the role of I. scapularis and B. burgdorferi in modulation of the host immune response in vivo. Infestation of C3H/HeJ mice with infected I. scapularis resulted in an up regulation of IL-4 as early as 8 days after tick infestation, while the levels of T helper cell type 1 (TH1) cytokines, interleukin-2 (IL-2) and gamma interferon (IFN-gamma), were significantly decreased by days 10 to 12. In contrast, the cytokine profile of BALB/c mice exposed to infected nymphal ticks resulted in only transient alterations in IL-4, IL-2, and IFN-gamma production throughout a 12-day period postinfestation. Although the IL-10 level was elevated in both C3H/HeJ and BALB/c mice infested with infected nymphal ticks, no significant difference in the levels of IL-10 was noted between the mouse strains. Flow-cytometric analysis demonstrated increases in the numbers of splenic B-cell and CD4+ lymphocytes in C3H/HeJ but not BALB/c mice exposed to infected ticks. Cell depletion experiments with C3H/HeJ mice demonstrated that CD4+ cells were the sole producers of IFN-gamma and IL-10 while both CD4+ and CD8+ splenocytes contributed to the production of IL-2 and IL-4. These findings suggest that B and CD4+ splenocytes are activated, increase in number, and produce a polarized TH2 response in C3H/HeJ mice exposed to infected I. scapularis. Given that C3H/HeJ mice are susceptible to Lyme disease and the initial TH2 polarization is not evident in BALB/c mice, effective control of this response may have ramifications for spirochete transmission in vivo.

[Disorders of feeding behavior and alexithymia]

The observations that led to the creation of the concept of alexithymia were originally conducted on patients suffering from classic psychosomatic illnesses. However, the latest research has displaced the idea of an exclusive link between alexithymia and psychosomatic illness, due to findings which indicate that subjects with a wide variety of psychiatric disorders can also present alexithymic characteristics. This paper reviews research in the eating disorders field which points to a relationship between psychological deficits and alexithymic traits in anorexia nervosa and bulimia.

"Doing battle": a metaphorical analysis of diabetes mellitus among Navajo people

Effective communication with patients and their family members forms the foundation of a therapeutic relationship. This is particularly important when the occupational therapist, other health professionals, and the patient are from different cultural backgrounds. This paper describes one aspect of the findings of a ethnographic study of chronic diabetes among the Navajo people (referred to here as Dine'). It focuses on the dominant metaphorical images that were used by the informants to describe their illness experiences. The data suggest that diabetes can be considered a metaphor for larger social changes in the life-style and traditions (e.g., away from sheepherding as a means of basic subsistence to obtaining urban-centered employment) of native Americans and their effects on the Dine'. Implications of our findings include the importance of metaphorical communication for perceptions of compliance, powerlessness, and patient and therapist satisfaction with the therapeutic relationship.

Specific treatment demand as a definitory trait of a typology in heroin addicts: differential profile of two subpopulations

Several sociodemographic, drug use pattern, and clinical variables were investigated in two groups of heroin addicts. Inclusion in one group or the other depended on the addict's attitude toward or against receiving treatment for the addiction. Those who rejected treatment differed significantly in the following: they were younger and belonged to larger families; they started cannabis and amphetamine use earlier, and used for a longer time; they used cocaine and heroin more frequently, and alcohol less frequently; and they suffered more often from a number of somatic and personality disorders. Implications for future research on the addiction are discussed.