On the relationship between valence and arousal in samples across the globe

Affect is involved in many psychological phenomena, but a descriptive structure, long sought, has been elusive. Valence and arousal are fundamental, and a key question-the focus of the present study-is the relationship between them. Valence is sometimes thought to be independent of arousal, but, in some studies (representing too few societies in the world) arousal was found to vary with valence. One common finding is that arousal is lowest at neutral valence and increases with both positive and negative valence: a symmetric V-shaped relationship. In the study reported here of self-reported affect during a remembered moment (N = 8,590), we tested the valence-arousal relationship in 33 societies with 25 different languages. The two most common hypotheses in the literature-independence and a symmetric V-shaped relationship-were not supported. With data of all samples pooled, arousal increased with positive but not negative valence. Valence accounted for between 5% (Finland) and 43% (China Beijing) of the variance in arousal. Although there is evidence for a structural relationship between the two, there is also a large amount of variability in this relation. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Perceived helpfulness of treatment for social anxiety disorder: findings from the WHO World Mental Health Surveys

PURPOSE

To investigate the prevalence and predictors of perceived helpfulness of treatment in persons with a history of DSM-IV social anxiety disorder (SAD), using a worldwide population-based sample.

METHODS

The World Health Organization World Mental Health Surveys is a coordinated series of community epidemiological surveys of non-institutionalized adults; 27 surveys in 24 countries (16 in high-income; 11 in low/middle-income countries; N = 117,856) included people with a lifetime history of treated SAD.

RESULTS

In respondents with lifetime SAD, approximately one in five ever obtained treatment. Among these (n = 1322), cumulative probability of receiving treatment they regarded as helpful after seeing up to seven professionals was 92.2%. However, only 30.2% persisted this long, resulting in 65.1% ever receiving treatment perceived as helpful. Perceiving treatment as helpful was more common in female respondents, those currently married, more highly educated, and treated in non-formal health-care settings. Persistence in seeking treatment for SAD was higher among those with shorter delays in seeking treatment, in those receiving medication from a mental health specialist, and those with more than two lifetime anxiety disorders.

CONCLUSIONS

The vast majority of individuals with SAD do not receive any treatment. Among those who do, the probability that people treated for SAD obtain treatment they consider helpful increases considerably if they persisted in help-seeking after earlier unhelpful treatments.

A global field study of the international classification of diseases (ICD-11) mood disorders clinical descriptions and diagnostic guidelines

BACKGROUND

We report results of an internet-based field study evaluating the diagnostic guidelines for ICD-11 mood disorders. Accuracy of clinicians' diagnostic judgments applying draft ICD-11 as compared to the ICD-10 guidelines to standardized case vignettes was assessed as well as perceived clinical utility.

METHODS

1357 clinician members of the World Health Organization's Global Clinical Practice Network completed the study in English, Spanish, Japanese or Russian. Participants were randomly assigned to apply ICD-11 or ICD-10 guidelines to one of eleven pairs of case vignettes.

RESULTS

Clinicians using the ICD-11 and ICD-10 guidelines achieved similar levels of accuracy in diagnosing mood disorders depicted in vignettes. Those using the ICD-11 were more accurate in identifying depressive episode in recurrent depressive disorder. There were no statistically significant differences detected across classifications in the accuracy of identifying dysthymic or cyclothymic disorder. Circumscribed problems with the proposed ICD-11 guidelines were identified including difficulties differentiating bipolar type I from bipolar type II disorder and applying revised severity ratings to depressive episodes. Clinical utility of ICD-11 bipolar disorders was found to be significantly lower than for ICD-10 equivalent categories.

LIMITATIONS

Standardized case vignettes were manipulated to evaluate specific changes. The degree of accuracy of clinicians' diagnostic judgments may not reflect clinical decision-making with patients.

CONCLUSIONS

Alignment of the ICD-11 with current research appears to have been achieved without sacrificing diagnostic accuracy or clinical utility though specific training may be necessary as ICD-11 is implemented worldwide. Areas in which the ICD-11 guidelines did not perform as intended resulted in further revisions.

Primary results from IMpassion131, a double-blind, placebo-controlled, randomised phase III trial of first-line paclitaxel with or without atezolizumab for unresectable locally advanced/metastatic triple-negative breast cancer

BACKGROUND

In the phase III IMpassion130 trial, combining atezolizumab with first-line nanoparticle albumin-bound-paclitaxel for advanced triple-negative breast cancer (aTNBC) showed a statistically significant progression-free survival (PFS) benefit in the intention-to-treat (ITT) and programmed death-ligand 1 (PD-L1)-positive populations, and a clinically meaningful overall survival (OS) effect in PD-L1-positive aTNBC. The phase III KEYNOTE-355 trial adding pembrolizumab to chemotherapy for aTNBC showed similar PFS effects. IMpassion131 evaluated first-line atezolizumab-paclitaxel in aTNBC.

PATIENTS AND METHODS

Eligible patients [no prior systemic therapy or ≥12 months since (neo)adjuvant chemotherapy] were randomised 2:1 to atezolizumab 840 mg or placebo (days 1, 15), both with paclitaxel 90 mg/m² (days 1, 8, 15), every 28 days until disease progression or unacceptable toxicity. Stratification factors were tumour PD-L1 status, prior taxane, liver metastases and geographical region. The primary endpoint was investigator-assessed PFS, tested hierarchically first in the PD-L1-positive [immune cell expression ≥1%, VENTANA PD-L1 (SP142) assay] population, and then in the ITT population. OS was a secondary endpoint.

RESULTS

Of 651 randomised patients, 45% had PD-L1-positive aTNBC. At the primary PFS analysis, adding atezolizumab to paclitaxel did not improve investigator-assessed PFS in the PD-L1-positive population [hazard ratio (HR) 0.82, 95% confidence interval (CI) 0.60-1.12; P = 0.20; median PFS 6.0 months with atezolizumab-paclitaxel versus 5.7 months with placebo-paclitaxel]. In the PD-L1-positive population, atezolizumab-paclitaxel was associated with more favourable unconfirmed best overall response rate (63% versus 55% with placebo-paclitaxel) and median duration of response (7.2 versus 5.5 months, respectively). Final OS results showed no difference between arms (HR 1.11, 95% CI 0.76-1.64; median 22.1 months with atezolizumab-paclitaxel versus 28.3 months with placebo-paclitaxel in the PD-L1-positive population). Results in the ITT population were consistent with the PD-L1-positive population. The safety profile was consistent with known effects of each study drug.

CONCLUSION

Combining atezolizumab with paclitaxel did not improve PFS or OS versus paclitaxel alone. CLINICALTRIALS.GOV: NCT03125902.

POS1242 FACTORS ASSOCIATED WITH MORTALITY IN PATIENTS WITH RHEUMATIC DISEASES AND COVID-19 IN MEXICO

Background:

As of the 25th of January 2021, more than 150 thousand deaths as consequence of COVID-19 have been reported in Mexico [1]. Advanced age, male gender and comorbidities have been described as risk factors for severe disease and mortality in general population [2]. COVID-19 mortality in Mexican patients with rheumatic and musculoskeletal diseases (RMDs) is unknown.

Objectives:

To describe characteristics of Mexican patients with RMDs and COVID-19, and to analyse factors associated with mortality.

Methods:

The Global Rheumatology Alliance COVID-19 (GRA) physician reported registry, is an international effort to collect information on COVID19 in adult patients with RMDs. GRA is an observational registry. The first patient from Mexico was registered on April 17, 2020. All Mexican patients registered in GRA until October 30, 2020 were included in this analysis. The association of mortality with demographic and clinical variables was estimated using logistic regression analysis.

Results:

A total of 323 patients were registered, with a median age of 52 (IQR 41-61) years old, 166 (51.4%) patients lived in Mexico City. The most frequent RMDs were rheumatoid arthritis, 149 (46.1%) and systemic lupus erythematosus, 24 (19.8%). Over a third of patients with RMDs and COVID-19 (119 (36.8%)) were hospitalized, and 43 (13.3%) died. Table 1 shows clinical and demographic characteristics. In the univariable analysis, the absence of comorbidities was a protective factor, OR 0.3 (95% CI 0.1-0.6). Factors associated with mortality at COVID-19 diagnosis were age over 65 years old, having type 2 diabetes, chronic renal insufficiency, treatment at COVID-19 diagnosis with corticosteroids or with CD20 inhibitors. In the multivariable adjusted analysis, these factors remained independently associated with mortality. No associations with other treatments or comorbidities at COVID-19 diagnosis were found.

Conclusion:

Mexican patients with RMDs and COVID-19 in the GRA physician reported registry had a mortality of 13.3%. Factors associated with mortality were those described in the general population, such as older age and being on corticosteroids and CD20 inhibitors treatment at COVID-19 diagnosis.

References:

[1]WHO. Coronavirus disease (COVID-19) pandemic. https://www.who.int/emergencies/diseases/novel-coronavirus-2019. (accessed 26 January, 2021).

[2]Zhou F, et al. Lancet 2020;395(10229):1054-62.

Table 1.

Clinical and demographic characteristics of patients with rheumatic diseases and COVID-19 in Mexico and mortality.

Characteristics at COVID-19 diagnosisTotalN=323Death43 (13.3)Survivors280 (86.7)UnivariableOR (95% CI)MultivariableOR (95% CI)Women, n(%)268 (82.9)33 (76.7)235 (83.9)0.6 (0.3-1.4)0.5 (0.2-1.3)Age >65 years old, n(%)62 (19.2)18 (41.9)44 (15.7)3.9 (1.9-7.7)3.9 (1.9-8.3)RMDs* n(%)-Rheumatoid arthritis149 (46.1)23 (53.5)126 (45.0)1.6 (0.7-3.7)-Systemic Lupus Erythemathosus64 (19.8)10 (23.3)54 (19.3)1.6 (0.6-4.3)-Spondyloarthritis (axial and others)33 (10.2)2 (4.7)31 (11.1)0.1 (0.1-2.8)-Others77 (23.8)8 (18.6)69 (24.6)1-Moderate/High disease activity1, n(%)57 (18.6)7 (17.9)50 (18.7)1.0 (0.4-2.5)-None comorbidities, n(%)136 (42.1)8 (18.6)128 (45.7)0.3 (0.1-0.6)-Hypertension*, n(%)88 (27.2)12 (27.9)76 (27.1)1.0 (0.5-2.1)-Type 2 Diabetes*, n(%)49 (15.2)13 (30.2)36 (12.9)2.9 (1.4-6.1)2.4 (1.1-5.4)Obesity*, n(%)21 (6.5)3 (6.9)18 (6.4)1.1 (0.3-3.9)-Chronic obstructive pulmonary disease*, n(%)15 (4.6)1 (2.3)14 (5.0)0.5 (0.1-3.5)-Chronic renal insufficiency*, n(%)17 (5.2)6 (13.9)11 (3.9)3.9 (1.4-11.4)3.4 (1.1-10.4)Cardiovascular diseases*, n(%)14 (4.3)2 (4.7)12 (4.3)1.1 (0.2-5.0)-Corticosteroids*, n(%)171 (52.9)30 (69.7)141 (50.3)2.3 (1.1-4.5)3.0 (1.4-6.5)CsDMARD*, n(%)247 (76.5)33 (16.3)214 (76.4)1.0 (0.5- 2.2)-CD20 inhibitor*, n(%)21 (6.5)7 (16.3)14 (5.0)3.7 (1.4-9.9)4.9 (1.7-14.5)

*Overlapped, 1 307 patients.

Disclosure of Interests:

None declared

Cryptosporidium spp. in groundwater supplies intended for human consumption - A descriptive review of global prevalence, risk factors and knowledge gaps

Cryptosporidiosis is one of the leading causes of diarrhoeal illness and mortality induced by protozoan pathogens worldwide. As a largely waterborne disease, emphasis has been given to the study of Cryptosporidium spp. in surface waters, readily susceptible to pathogenic contamination. Conversely, the status of Cryptosporidium in potable groundwater sources, generally regarded as a pristine and "safe" drinking-water supply owing to (sub)-soil protection, remains largely unknown. As such, this investigation presents the first literature review aimed to ascertain the global prevalence of Cryptosporidium in groundwater supply sources intended for human consumption. Thirty-seven peer-reviewed studies were identified and included in the review. Groundwater sample and supply detection rates (estimated 10-20%) indicate Cryptosporidium is frequently present in domestic groundwater sources, representing a latent health concern for groundwater consumers. Specifically, sample (10.4%) and source (19.1%) detection rates deriving from comprehensive "temporal" investigations are put forward as representative of a contamination 'baseline' for Cryptosporidium in 'domestic' groundwater supplies. Proposed 'baseline' prevalence figures are largely applicable in preventive risk-based catchment and groundwater quality management including the formulation of Quantitative Microbial Risk Assessment (QMRA). Notwithstanding, a large geographical disparity in available investigations and lack of standardized reporting restrict the transferability of research findings. Overall, the mechanisms responsible for Cryptosporidium transport and ingress into groundwater supplies remain ambiguous, representing a critical knowledge gap, and denoting a distinctive lack of integration between groundwater and public-health sub-disciplines among investigations. Key recommendations and guidelines are provided for prospective studies directed at more integrative and multi-disciplinary research.

Evaluation of the Physico-mechanical Properties and Electrostatic Charging Behavior of Different Capsule Types for Inhalation Under Distinct Environmental Conditions

Capsule-based dry powder inhaler (DPI) products can be influenced by a multitude of interacting factors, including electrostatic charging. Tribo-charging is a process of charge transfer impacted by various factors, i.e., material surface characteristics, mechanical properties, processing parameters and environmental conditions. Consequently, this work aimed to assess how the charging behavior of capsules intended for inhalation might be influenced by environmental conditions. Capsules having different chemical compositions (gelatin and hydroxypropyl methylcellulose (HPMC)) and distinct inherent characteristics from manufacturing (thermally and cold-gelled) were exposed to various environmental conditions (11%, 22% and 51% RH). Their resulting properties were characterized and tribo-charging behavior was measured against stainless steel and PVC. It was observed that all capsule materials tended to charge to a higher extent when in contact with PVC. The tribo-charging of the thermally gelled HPMC capsules (Vcaps^® Plus) was more similar to the gelatin capsules (Quali-G™-I) than to their HPMC cold-gelled counterparts (Quali-V^®-I). The sorption of water by the capsules at different relative humidities notably impacted their properties and tribo-charging behavior. Different interactions between the tested materials and water molecules were identified and are proposed to be the driver of distinct charging behaviors. Finally, we showed that depending on the capsule types, distinct environmental conditions are necessary to mitigate charging and assure optimal behavior of the capsules.

Retirement and Meaning Attribution: A study with Active Workers in Brazil

Abstract The aim of this study was to investigate the meanings attributed to retirement by active workers. For this purpose, the Retirement Meaning Scale was constructed and administered to 275 active workers (53.5% women) aged 22 to 67 years. The results reveal an ambiguous meaning attribution to the phenomenon: on one hand, there is a positive idea of freedom; on the other hand, the workers report experiences of anguish and insecurity related to retirement. Among the variables investigated, the proximity to retirement was especially relevant to the perception of the phenomenon, which influenced three of the four factors identified. This study has implications for policies and programs that aim to promote healthy experiences in retirement.

Assessment of two behavioural models (HBM and RANAS) for predicting health behaviours in response to environmental threats: Surface water flooding as a source of groundwater contamination and subsequent waterborne infection in the Republic of Ireland

Extreme weather events (EWEs) are increasing in frequency, posing a greater risk of adverse human health effects. As such, developing sociological and psychological based interventions is paramount to empowering individuals and communities to actively protect their own health. Accordingly, this study compared the efficacy of two established social-cognitive models, namely the Health Beliefs Model (HBM) and Risks-Attitudes-Norms-Abilities-Self-regulation (RANAS) framework, in predicting health behaviours following EWEs. Surface water flooding was used as the exemplar EWE in the current study, due to the increasing incidence of these events in the Republic of Ireland over the past decade. Levels of prior experience with flooding were considered for analyses and comparative tools included a number of variables predicting health behaviours and intervention potential scores (i.e. measure of impact of targeting each model element). Results suggest that the RANAS model provides a robust foundation for designing interventions for any level of experience with an extreme weather event, however, use of the simpler HBM may be more cost-effective among participants unacquainted with an EWE and in relatively infrequent health threat scenarios. Results provide an evidence base for researchers and policymakers to appropriately engage with populations about such threats and successfully promote spatiotemporally appropriate health behaviours in a changing climate.

Twelve-month mental health service use in six countries of the Americas: A regional report from the World Mental Health Surveys

AIMS

To provide cross-national data for selected countries of the Americas on service utilization for psychiatric and substance use disorders, the distribution of these services among treatment sectors, treatment adequacy and factors associated with mental health treatment and adequacy of treatment.

METHODS

Data come from data collected from 6710 adults with 12 month mental disorder surveys across seven surveys in six countries in North (USA), Central (Mexico) and South (Argentina, Brazil, Colombia, Peru) America who were interviewed 2001-2015 as part of the World Health Organization (WHO) World Mental Health (WMH) Surveys. DSM-IV diagnoses were made with the WHO Composite International Diagnostic Interview (CIDI). Interviews also assessed service utilization by the treatment sector, adequacy of treatment received and socio-demographic correlates of treatment.

RESULTS

Little over one in four of respondents with any 12 month DSM-IV/CIDI disorder received any treatment. Although the vast majority (87.1%) of this treatment was minimally adequate, only 35.3% of cases received treatment that met acceptable quality guidelines. Indicators of social-advantage (high education and income) were associated with higher rates of service use and adequacy, but a number of other correlates varied across survey sites.

CONCLUSIONS

These results shed light on an enormous public health problem involving under-treatment of common mental disorders, although the problem is most extreme among people with social disadvantage. Promoting services that are more accessible, especially for those with few resources, is urgently needed.

Early Suppression of Macrophage Gene Expression by Leishmania braziliensis

Leishmania braziliensis is an intracellular parasite that resides mostly in macrophages. Both the parasite genome and the clinical disease manifestations show considerable polymorphism. Clinical syndromes caused by L. braziliensis include localized cutaneous (CL), mucosal (ML), and disseminated leishmaniasis (DL). Our prior studies showed that genetically distinct L. braziliensis clades associate with different clinical types. Herein, we hypothesized that: (1) L. braziliensis induces changes in macrophage gene expression that facilitates infection; (2) infection of macrophages with strains associated with CL (clade B), ML (clade C), or DL (clade A) will differentially affect host cell gene expression, reflecting their different pathogenic mechanisms; and (3) differences between the strains will be reflected by differences in macrophage gene expression after initial exposure to the parasite. Human monocyte derived macrophages were infected with L. braziliensis isolates from clades A, B, or C. Patterns of gene expression were compared using Affymetrix DNA microarrays. Many transcripts were significantly decreased by infection with all isolates. The most dramatically decreased transcripts encoded proteins involved in signaling pathways, apoptosis, or mitochondrial oxidative phosphorylation. Some transcripts encoding stress response proteins were up-regulated. Differences between L. braziliensis clades were observed in the magnitude of change, rather than the identity of transcripts. Isolates from subjects with metastatic disease (ML and DL) induced a greater magnitude of change than isolates from CL. We conclude that L. braziliensis enhances its intracellular survival by inhibiting macrophage pathways leading to microbicidal activity. Parasite strains destined for dissemination may exert a more profound suppression than less invasive L. braziliensis strains that remain near the cutaneous site of inoculation.

Reduction of Breast Cancer Treatment Delay as a Result of Efforts Carried Out by Two Brazilian NGOs

Background: Brazilian breast cancer patients present disease often at advanced stages (III, IV). Previous studies indicated that system delay is a causal factor of bad prognosis and increased mortality rate. In the state of Paraíba, northeast of Brazil, two non-governmental organizations (NGOs) Américas Amigas and Mulheres de Peito de Campina Grande (MLDP), promote faster access to treatment by donating diagnostic mammography and biopsies as well as anatomo-histopathological and immunohistochemical analysis. Aim: The current study aimed at evaluating the effectiveness of the assistance provided by both NGOs and comparing patient flow between HNL and FAP, two reference cancer centers in João Pessoa and Campina Grande, respectively. Methods: Time-to-treatment was analyzed for different time intervals between first medical consultation and initiation of treatment. Comparison was performed between three groups of patients: 40 patients from Hospital Napoleão Laureano (HNL) in João Pessoa; 80 patients from Fundação Assistencial da Paraíba (FAP) in Campina Grande and 15 patients from FAP, who received support from the NGOs. Kaplan-Meier analysis was performed to compare time-intervals among the groups. To estimate the impact of socioeconomic variables Cox regression analysis was performed. Results: Mean time-interval between first medical consultation and hospital admission was 135 (SD=21.0), 370 (SD=73.7) and 515 (SD=36.6) days, for patients of HNL, MLDP and FAP, respectively ( P = 0.0021). Time intervals analyzed for patients within the FAP hospital, between first medical consultation and hospital admission, tended to be shorter for patients who were assisted by the NGOs, compared with those who did not receive any assistance from the NGOs. Patients who had consulted specialized oncological health services beforehand had an increased chance (HZ=2.32; 95% CI: 1.17-4.60; P = 0.016) of being admitted at the reference hospital within 90 days after the first medical consultation, compared with those who had not consulted such specialized services. There were no significant differences between HNL and FAP, regarding the time interval between hospital admission and treatment initiation ( P = 0.21). Conclusion: The assistance to patients provided by the two NGOs, aimed at speeding up the diagnosis process, accelerated patient flow between first medical consultation and admission at the hospitals. Regarding HNL, patients from the inland had been sent by primary health units in their municipalities, directly to the cancer reference hospital in João Pessoa, without being referred to an in-between health service. Such procedure explains the variation of time intervals when admissions at FAP and HNL are compared. The results of the current study indicate that by providing faster breast cancer diagnosis, the NGOs’ mediation can significantly improve patient flow.

Surface water flooding, groundwater contamination, and enteric disease in developed countries: A scoping review of connections and consequences

Significant volumes of research over the past four decades has sought to elucidate the social, infrastructural, economic, and human health effects of climate change induced surface flooding. To date, epidemiological and public health studies of flooding events have focused on mental health effects, vector-borne diseases, and infectious enteric disease due to floodwater contact (i.e. typically low consumption rates). The inherent nature of groundwater (i.e. out of sight, out of mind) and the widely held belief that aquifers represent a pristine source of drinking water due to natural attenuation may represent the "perfect storm" causing direct consumption of relatively large volumes of surface flood-contaminated groundwater. Accordingly, the current study sought to systematically identify and synthesize all available peer-reviewed literature pertaining to the nexus between surface flooding, groundwater contamination and human gastroenteric outcomes. Just 14 relevant studies were found to have been published during the period 1980-2017, thus highlighting the fact that this potentially significant source of climate-related exposure to environmental infection has remained understudied to date. Studies differed significantly in terms of type and data reporting procedures, making it difficult to discern clear trends and patterns. Approximately 945 confirmed cases of flood-related enteric disease were examined across studies; these concurred with almost 10,000 suspected cases, equating to approximately 20 suspected cases per confirmed case. As such, no regional, national or global estimates are available for the human gastrointestinal health burden of flood-related groundwater contamination. In light of the demonstrable public health significance of the concurrent impacts of groundwater susceptibility and climate change exacerbation, strategies to increase awareness about potential sources of contamination and motivate precautionary behaviour (e.g. drinking water testing and treatment, supply interruptions) are necessary. Mainstreaming climate adaptation concerns into planning policies will also be necessary to reduce human exposure to waterborne sources of enteric infection.

Undertreatment of people with major depressive disorder in 21 countries

BACKGROUND

Major depressive disorder (MDD) is a leading cause of disability worldwide.

AIMS

To examine the: (a) 12-month prevalence of DSM-IV MDD; (b) proportion aware that they have a problem needing treatment and who want care; (c) proportion of the latter receiving treatment; and (d) proportion of such treatment meeting minimal standards.

METHOD

Representative community household surveys from 21 countries as part of the World Health Organization World Mental Health Surveys.

RESULTS

Of 51 547 respondents, 4.6% met 12-month criteria for DSM-IV MDD and of these 56.7% reported needing treatment. Among those who recognised their need for treatment, most (71.1%) made at least one visit to a service provider. Among those who received treatment, only 41.0% received treatment that met minimal standards. This resulted in only 16.5% of all individuals with 12-month MDD receiving minimally adequate treatment.

CONCLUSIONS

Only a minority of participants with MDD received minimally adequate treatment: 1 in 5 people in high-income and 1 in 27 in low-/lower-middle-income countries. Scaling up care for MDD requires fundamental transformations in community education and outreach, supply of treatment and quality of services.

Pharmacokinetic Bioequivalence of Two Inhaled Tiotropium Bromide Formulations in Healthy Volunteers

Background and Objective

A novel tiotropium bromide monodose capsule dry powder inhaler (DPI) formulation and device have been developed. The formulation was based on a spray-dried matrix that enhances the aerosolizaton properties, allowing a less active tiotropium metered dose (13 µg/capsule) while maintaining the same delivered dose (10 µg/actuation). This study describes the pharmacokinetic bioequivalence to the reference product.

Methods

This randomized, two-stage, crossover, semi-replicate (three-way) study was performed in healthy volunteers. In each study period, subjects received a single dose of two capsules (20 μg delivered dose) of the study medication, separated by a 14-day washout period: tiotropium 10 μg delivered dose (Laboratorios Liconsa, Spain) and Spiriva HandiHaler^® (Boehringer Ingelheim Pharma GmbH & Co KG, Germany). Blood samples were obtained up to 48 h post-dose to evaluate the comparative bioavailability. Tiotropium was measured in plasma by means of dual stage liquid–liquid extraction followed by the two-dimensional ultra-high performance liquid chromatography sensitive sub-pg/mL bioanalytical method. The main pharmacokinetic parameters were maximum plasma concentration (C_max), area under the concentration–time curve (AUC) from time zero hours to the last observed concentration at time t (AUC_t), and AUC from time zero hours to 30 min (AUC_0.5). Bioequivalence was accepted if the 90.20 % confidence interval (CI) for the ratio test/reference of the primary pharmacokinetic parameters lay within the acceptance range of 80–125 %. Safety assessment was a secondary endpoint.

Results

A total of 30 subjects were randomized and bioequivalence was demonstrated for all primary pharmacokinetic parameters: C_max (CI 87.26–106.60 %), AUC_t (CI 101.33–111.64 %), and AUC_0.5 (CI 97.95–113.49 %). Both study treatments were well tolerated (four non-serious adverse events [AEs] were reported in four subjects: one AE before any product administration, two AEs after test product administration; and one AE after reference product administration).

Conclusions

Both products containing tiotropium 10 µg delivered-dose DPI were bioequivalent and showed good tolerability and a similar safety profile.

The Bidirectional Associations Between Psychotic Experiences and DSM-IV Mental Disorders

OBJECTIVE

While it is now recognized that psychotic experiences are associated with an increased risk of later mental disorders, we lack a detailed understanding of the reciprocal time-lagged relationships between first onsets of psychotic experiences and mental disorders. Using data from World Health Organization World Mental Health (WMH) Surveys, the authors assessed the bidirectional temporal associations between psychotic experiences and mental disorders.

METHOD

The WMH Surveys assessed lifetime prevalence and age at onset of psychotic experiences and 21 common DSM-IV mental disorders among 31,261 adult respondents from 18 countries. Discrete-time survival models were used to examine bivariate and multivariate associations between psychotic experiences and mental disorders.

RESULTS

Temporally primary psychotic experiences were significantly associated with subsequent first onset of eight of the 21 mental disorders (major depressive disorder, bipolar disorder, generalized anxiety disorder, social phobia, posttraumatic stress disorder, adult separation anxiety disorder, bulimia nervosa, and alcohol abuse), with odds ratios ranging from 1.3 (95% CI=1.2-1.5) for major depressive disorder to 2.0 (95% CI=1.5-2.6) for bipolar disorder. In contrast, 18 of 21 primary mental disorders were significantly associated with subsequent first onset of psychotic experiences, with odds ratios ranging from 1.5 (95% CI=1.0-2.1) for childhood separation anxiety disorder to 2.8 (95% CI=1.0-7.8) for anorexia nervosa.

CONCLUSIONS

While temporally primary psychotic experiences are associated with an elevated risk of several subsequent mental disorders, these data show that most mental disorders are associated with an elevated risk of subsequent psychotic experiences. Further investigation of the underlying factors accounting for these time-order relationships may shed light on the etiology of psychotic experiences.

Age of Onset and Lifetime Projected Risk of Psychotic Experiences: Cross-National Data From the World Mental Health Survey

BACKGROUND

Given the early age of onset (AOO) of psychotic disorders, it has been assumed that psychotic experiences (PEs) would have a similar early AOO. The aims of this study were to describe (a) the AOO distribution of PEs, (b) the projected lifetime risk of PEs, and (c) the associations of PE AOO with selected PE features.

METHODS

Data came from the WHO World Mental Health (WMH) surveys. A total of 31 261 adult respondents across 18 countries were assessed for lifetime prevalence of PE. Projected lifetime risk (at age 75 years) was estimated using a 2-part actuarial method. AOO distributions were described for the observed and projected estimates. We examined associations of AOO with PE type metric and annualized PE frequency.

RESULTS

Projected lifetime risk for PEs was 7.8% (SE = 0.3), slightly higher than lifetime prevalence (5.8%, SE = 0.2). The median (interquartile range; IQR) AOO based on projected lifetime estimates was 26 (17-41) years, indicating that PEs commence across a wide age range. The AOO distributions for PEs did not differ by sex. Early AOO was positively associated with number of PE types (F = 14.1, P < .001) but negatively associated with annualized PE frequency rates (F = 8.0, P < .001).

DISCUSSION

While most people with lifetime PEs have first onsets in adolescence or young adulthood, projected estimates indicate that nearly a quarter of first onsets occur after age 40 years. The extent to which late onset PEs are associated with (a) late onset mental disorders or (b) declining cognitive and/or sensory function need further research.

Pediatric-Onset and Adult-Onset Separation Anxiety Disorder Across Countries in the World Mental Health Survey

OBJECTIVE

The age-at-onset criterion for separation anxiety disorder was removed in DSM-5, making it timely to examine the epidemiology of separation anxiety disorder as a disorder with onsets spanning the life course, using cross-country data.

METHOD

The sample included 38,993 adults in 18 countries in the World Health Organization (WHO) World Mental Health Surveys. The WHO Composite International Diagnostic Interview was used to assess a range of DSM-IV disorders that included an expanded definition of separation anxiety disorder allowing onsets in adulthood. Analyses focused on prevalence, age at onset, comorbidity, predictors of onset and persistence, and separation anxiety-related role impairment.

RESULTS

Lifetime separation anxiety disorder prevalence averaged 4.8% across countries (interquartile range [25th-75th percentiles]=1.4%-6.4%), with 43.1% of lifetime onsets occurring after age 18. Significant time-lagged associations were found between earlier separation anxiety disorder and subsequent onset of internalizing and externalizing DSM-IV disorders and conversely between these disorders and subsequent onset of separation anxiety disorder. Other consistently significant predictors of lifetime separation anxiety disorder included female gender, retrospectively reported childhood adversities, and lifetime traumatic events. These predictors were largely comparable for separation anxiety disorder onsets in childhood, adolescence, and adulthood and across country income groups. Twelve-month separation anxiety disorder prevalence was considerably lower than lifetime prevalence (1.0% of the total sample; interquartile range=0.2%-1.2%). Severe separation anxiety-related 12-month role impairment was significantly more common in the presence (42.4%) than absence (18.3%) of 12-month comorbidity.

CONCLUSIONS

Separation anxiety disorder is a common and highly comorbid disorder that can have onset across the lifespan. Childhood adversity and lifetime trauma are important antecedents, and adverse effects on role function make it a significant target for treatment.

Modeling the Growth Kinetics of Anodic TiO2 Nanotubes

The fundamental understanding of the barrier layer (δ(b)) growth in TiO2 nanotubes (NTs) is here established and compared with the classical metal oxidation theory from Mott and Cabrera. The role of δ(b) in the anodization of TiO2 NTs under different applied potentials and times was analyzed using scanning transmission electron microscopy (STEM). Contrary to the well-known case of anodic aluminum oxide, we found that δ(b) of TiO2 NTs progressively grows over time due to the nonsteady anodization regime. We then establish a relation between the phenomenological growth of the barrier layer with time and applied voltage, δ(b)(V,t) using the high-field Mott and Cabrera conduction theory. The developed model was found to be in excellent agreement with the experimental data from both STEM and anodization curves. On the basis of these results, the relationship between δ(b) and the anodization time and potential can now be quantitatively understood.

Role of temperature in the recombination reaction on dye-sensitized solar cells

The DSC recombination kinetics was studied up to 100 °C without electrolyte leakage or external contamination using a unique laser assisted glass sealing process. In addition to temperature having a strong influence on the recombination reaction rate, the energy of the exited electrons was found to be critical for determining the recombination activation energy.

Tailoring the Ti surface via electropolishing nanopatterning as a route to obtain highly ordered TiO2 nanotubes

Highly ordered TiO2 nanotubes (NTs) were synthesized by the electrochemical anodization of Ti foils subjected to electropolishing (EP) pre-treatment. We found that the Ti surface roughness plays an important role in the onset of pore nucleation in enhancing the local focusing effect of the electrical field. Additionally, EP induces the formation of dimple structures on the metal surface, which can work as a pre-pattern prior to anodization. These shallow ripples lead to a preferentially ordered pore nucleation, offering an organizational improvement of the anodic oxide NTs. We found that, depending on the EP applied potential, the roughness and the spatial period of the ripple-like structures varies from 8-2 nm and from 122-30 nm, respectively. Such tuning allowed us to focus on the influence of the initial Ti pre-surface topography features on the NTs' length, organization, and hexagonal arrangement quality, as well as diameter and density. Our results show that an EP under 10 V is the most suitable to obtain a small Ti surface roughness, the largest NT length (40% enhancement), and the effective improvement of the ordered hexagonal NTs' arrays over larger areas. Furthermore, the NTs' dimensions (pore diameters and density) were also found to depend on the initial Ti surface topography. The use of optimized EP allows us to obtain highly hexagonal self-ordered samples at a reduced time and cost.

Development of lifetime comorbidity in the World Health Organization world mental health surveys

CONTEXT

Although numerous studies have examined the role of latent variables in the structure of comorbidity among mental disorders, none has examined their role in the development of comorbidity.

OBJECTIVE

To study the role of latent variables in the development of comorbidity among 18 lifetime DSM-IV disorders in the World Health Organization World Mental Health Surveys.

DESIGN

Nationally or regionally representative community surveys.

SETTING

Fourteen countries.

PARTICIPANTS

A total of 21 229 survey respondents.

MAIN OUTCOME MEASURES

First onset of 18 lifetime DSM-IV anxiety, mood, behavior, and substance disorders assessed retrospectively in the World Health Organization Composite International Diagnostic Interview.

RESULTS

Separate internalizing (anxiety and mood disorders) and externalizing (behavior and substance disorders) factors were found in exploratory factor analysis of lifetime disorders. Consistently significant positive time-lagged associations were found in survival analyses for virtually all temporally primary lifetime disorders predicting subsequent onset of other disorders. Within-domain (ie, internalizing or externalizing) associations were generally stronger than between-domain associations. Most time-lagged associations were explained by a model that assumed the existence of mediating latent internalizing and externalizing variables. Specific phobia and obsessive-compulsive disorder (internalizing) and hyperactivity and oppositional defiant disorders (externalizing) were the most important predictors. A small number of residual associations remained significant after controlling the latent variables.

CONCLUSIONS

The good fit of the latent variable model suggests that common causal pathways account for most of the comorbidity among the disorders considered herein. These common pathways should be the focus of future research on the development of comorbidity, although several important pairwise associations that cannot be accounted for by latent variables also exist that warrant further focused study.

Hypomagnesemia is a risk factor for nonrecovery of renal function and mortality in AIDS patients with acute kidney injury

The objective of the present study was to determine the prevalence of electrolyte disturbances in AIDS patients developing acute kidney injury in the hospital setting, as well as to determine whether such disturbances constitute a risk factor for nephrotoxic and ischemic injury. A prospective, observational cohort study was carried out. Hospitalized AIDS patients were evaluated for age; gender; coinfection with hepatitis; diabetes mellitus; hypertension; time since HIV seroconversion; CD4 count; HIV viral load; proteinuria; serum levels of creatinine, urea, sodium, potassium and magnesium; antiretroviral use; nephrotoxic drug use; sepsis; intensive care unit (ICU) admission, and the need for dialysis. Each of these characteristics was correlated with the development of acute kidney injury, with recovery of renal function and with survival. Fifty-four patients developed acute kidney injury: 72% were males, 59% had been HIV-infected for >5 years, 72% had CD4 counts <200 cells/mm(3), 87% developed electrolyte disturbances, 33% recovered renal function, and 56% survived. ICU admission, dialysis, sepsis and hypomagnesemia were all significantly associated with nonrecovery of renal function and with mortality. Nonrecovery of renal function was significantly associated with hypomagnesemia, as was mortality in the multivariate analysis. The risks for nonrecovery of renal function and for death were 6.94 and 6.92 times greater, respectively, for patients with hypomagnesemia. In hospitalized AIDS patients, hypomagnesemia is a risk factor for nonrecovery of renal function and for in-hospital mortality. To determine whether hypomagnesemia is a determinant or simply a marker of critical illness, further studies involving magnesium supplementation in AIDS patients are warranted.

Rapid-cycling bipolar disorder: cross-national community study

BACKGROUND

The epidemiology of rapid-cycling bipolar disorder in the community is largely unknown.

AIMS

To investigate the epidemiological characteristics of rapid-cycling and non-rapid-cycling bipolar disorder in a large cross-national community sample.

METHOD

The Composite International Diagnostic Interview (CIDI version 3.0) was used to examine the prevalence, severity, comorbidity, impairment, suicidality, sociodemographics, childhood adversity and treatment of rapid-cycling and non-rapid-cycling bipolar disorder in ten countries (n = 54 257).

RESULTS

The 12-month prevalence of rapid-cycling bipolar disorder was 0.3%. Roughly a third and two-fifths of participants with lifetime and 12-month bipolar disorder respectively met criteria for rapid cycling. Compared with the non-rapid-cycling, rapid-cycling bipolar disorder was associated with younger age at onset, higher persistence, more severe depressive symptoms, greater impairment from depressive symptoms, more out-of-role days from mania/hypomania, more anxiety disorders and an increased likelihood of using health services. Associations regarding childhood, family and other sociodemographic correlates were less clear cut.

CONCLUSIONS

The community epidemiological profile of rapid-cycling bipolar disorder confirms most but not all current clinically based knowledge about the illness.