Search results for: depressive symptoms

Authors: Ashenafi Ayele, Shewit Haftu, Tesfalem Araya

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Background: “Post-psychotic depression”, “post schizophrenic depression”, and “secondary depression” have been used to describe the occurrence of depressive symptoms during the chronic phase of schizophrenia. Post-psychotic depression is the most common cause of death due to suicide in schizophrenia patients. Overall lifetime risk for patients with schizophrenia is 50% for suicide attempts and 9-13% lifetime risk for completed suicide and also it is associated with poor prognosis and poor quality of life. Objective: To assess determinant of post psychotic depression in schizophrenia patients ACSH and Mekelle General Hospital, Tigray Ethiopia 2019. Methods: An institutional based unmatched case control study was conducted among 69 cases and 138 controls with the ratio of case to control 1 ratio 2. The sample is calculated using epi-info 3.1 to assess the determinant factors of post-psychotic depression in schizophrenia patients. The cases were schizophrenia patients who have been diagnosed at least for more than one-year stable for two months, and the controls are any patients who are diagnosed as schizophrenia patients. Study subjects were selected using a consecutive sampling technique. The Calgary depression scale for schizophrenia self-administered questionnaire was used. Before the interview, it was assessed the client’s capacity to give intended information using a scale called the University of California, San Diego Brief Assessment of Capacity to Consent (UBACC). Bivariant and multiple Logistic regression analysis was performed to determine between the independent and dependent variables. The significant independent predictor was declared at 95% confidence interval and P-value of less than 0.05. Result: Females were affected by post psychotic depression with the (AOR=2.01, 95%CI: 1.003- 4.012, P= 0.49).Patients who have mild form of positive symptom of schizophrenia affected by post psychotic depression with (AOR =4.05, 95%CI: 1.888- 8.7.8, P=0001).Patients who have minimal form of negative symptom of schizophrenia are affected by post psychotic depression with (AOR =4.23, 95%CI: 1.081-17.092, P=.038). Conclusion: In this study, sex (female) and presence of positive and negative symptoms of schizophrenia were significantly associated. It is recommended that the post psychotic depression should be assessed in every schizophrenia patient to decrease the severity of illness, and to improve patient’s quality of life.

Keywords: determinants, post-psychotic depression, Mekelle city

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Authors: Fakhr Eddin Alnaal, Angela Dahdal, Duaa Aladib, Sabeen Ibrahim, Ibrahim Ghoraibi, Bissan Ahmed

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Dementia is one of the diseases which had several stages and Alzheimer’s term was selected in respect for the first doctor Alzheimer who defined the first symptoms of this diseases in a woman whom was well treated by him. The fact that this is a type of a silent disease on which you have a long-term process of neurological degradation and suddenly gives symptoms which are most often irreversible, on clinical level likely we can consider it as a malignancy, one in terms of that it is sudden shocking irreversible and on the level of behavior and some mortality beside the lack of early detection tools for diagnosis. Therefore, the goal of our project is to test the concept of the ability of Statin in prevention of such disease and we investigated that both on experimental level and most importantly on clinical one, the clinical part was performed in a recognized house of aged people who had accidently a high cholesterol and were for years given Statin to treat that elevation, however after the symptoms of Alzheimer’s appeared and when diagnosed, they were well treated and rapidly recovered compared to Alzheimer’s patients in the same house who did not receive Statin had a mild improvement in their symptoms after the therapy, on the other hand we confirmed such observation by a well-organized experimental work.

Keywords: Alzheimer's, dementia, silent disease, statin

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Authors: Nervana Elbakary, Sami Ouanes, Sadaf Riaz, Oraib Abdallah, Islam Mahran, Noriya Al-Khuzaei, Yassin Eltorki

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Major Depressive Disorder (MDD) requires therapeutic interventions during the initial month after being diagnosed for better disease outcomes. International guidelines recommend a duration of 4–12 weeks for an initial antidepressant (IAD) trial at an optimized dose to get a response. If depressive symptoms persist after this duration, guidelines recommend switching, augmenting, or combining strategies as the next step. Most patients with MDD in the mental health setting have been labeled incorrectly as treatment-resistant where in fact they have not been subjected to an adequate trial of guideline-recommended therapy. Premature discontinuation of IAD due to ineffectiveness can cause unfavorable consequences. Avoiding irrational practices such as subtherapeutic doses of IAD, premature switching between the ADs, and refraining from unjustified polypharmacy can help the disease to go into a remission phase We aimed to determine the prevalence and the patterns of strategies applied after an IAD was changed because of a suboptimal response as a primary outcome. Secondary outcomes included the median survival time on IAD before any change; and the predictors that were associated with IAD change. This was a retrospective cross- sectional study conducted in Mental Health Services in Qatar. A dataset between January 1, 2018, and December 31, 2019, was extracted from the electronic health records. Inclusion and exclusion criteria were defined and applied. The sample size was calculated to be at least 379 patients. Descriptive statistics were reported as frequencies and percentages, in addition, to mean and standard deviation. The median time of IAD to any change strategy was calculated using survival analysis. Associated predictors were examined using two unadjusted and adjusted cox regression models. A total of 487 patients met the inclusion criteria of the study. The average age for participants was 39.1 ± 12.3 years. Patients with first experience MDD episode 255 (52%) constituted a major part of our sample comparing to the relapse group 206(42%). About 431 (88%) of the patients had an occurrence of IAD change to any strategy before end of the study. Almost half of the sample (212 (49%); 95% CI [44–53%]) had their IAD changed less than or equal to 30 days. Switching was consistently more common than combination or augmentation at any timepoint. The median time to IAD change was 43 days with 95% CI [33.2–52.7]. Five independent variables (age, bothersome side effects, un-optimization of the dose before any change, comorbid anxiety, first onset episode) were significantly associated with the likelihood of IAD change in the unadjusted analysis. The factors statistically associated with higher hazard of IAD change in the adjusted analysis were: younger age, un-optimization of the IAD dose before any change, and comorbid anxiety. Because almost half of the patients in this study changed their IAD as early as within the first month, efforts to avoid treatment failure are needed to ensure patient-treatment targets are met. The findings of this study can have direct clinical guidance for health care professionals since an optimized, evidence-based use of AD medication can improve the clinical outcomes of patients with MDD; and also, to identify high-risk factors that could worsen the survival time on IAD such as young age and comorbid anxiety

Keywords: initial antidepressant, dose optimization, major depressive disorder, comorbid anxiety, combination, augmentation, switching, premature discontinuation

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Authors: Pellecchia M. T., Savarese G., Carpinelli L., Calabrese M.

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Introduction: Parkinson's disease (PD) is characterized by a progressive loss of autonomy which undoubtedly has a significant impact on the quality of life of caregivers, and parents are the main informal caregivers. Caring for a person with PD is associated with an increased risk of psychiatric morbidity and persistent anxiety-depressive distress. The aim of the study is to investigate the burden on caregivers of patients with PD, through the use of multidimensional scales and to identify their personological and environmental determinants. Methods: The study has been approved by the Ethic Committee of the University of Salerno and informed consent for participation to the study was obtained from patients and their caregivers. The study was conducted at the Neurology Department of the A.O.U. "San Giovanni di Dio and Ruggi D’Aragona" of Salerno between September 2020 and May 2021. Materials: The questionnaires used were: a) Caregiver Burden Inventory - CBI a questionnaire of 24 items that allow identifying five sub-categories of burden (objective, psychological, physical, social, emotional); b) Depression Anxiety Stress Scales Short Version - DASS-21 questionnaire consisting of 21 items and valid in examining three distinct but interrelated areas (depression, anxiety and stress); c) Family Strain Questionnaire Short Form - FSQ-SF is a questionnaire of 30 items grouped in areas of increasing psychological risk (OK, R, SR, U); d) Zarit Caregiver Burden Inventory - ZBI, consisting of 22 items based on the analysis of two main factors: personal stress and pressure related to his role; e) Life Satisfaction, a single item that aims to evaluate the degree of life satisfaction in a global way using a 0-100 Likert scale. Findings: N ° 29 caregivers (M age = 55.14, SD = 9.859; 69% F) participated in the study. 20.6% of the sample had severe and severe burden (CBI score = M = 26.31; SD = 22.43) and 13.8% of participants had moderate to severe burden (ZBI). The FSQ-SF highlighted a minority of caregivers who need psychological support, in some cases urgent (Area SR and Area U). The DASS-21 results show a prevalence of stress-related symptoms (M = 10.90, SD = 10.712) compared to anxiety (M = 7.52, SD = 10.752) and depression (M = 8, SD = 10.876). There are significant correlations between some specific variables and mean test scores: retired caregivers report higher ZBI scores (p = 0.423) and lower Life Satisfaction levels (p = -0.460) than working caregivers; years of schooling show a negative linear correlation with the ZBI score (p = -0.491). The T-Test indicates that caregivers of patients with cognitive impairment are at greater risk than those of patients without cognitive impairment. Conclusions: It knows the factors that affect the burden the most would allow for early recognition of risky situations and caregivers who would need adequate support.

Keywords: anxious-depressive axis, caregivers’ burden, Parkinson’ disease, psychological risks

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Authors: Patricia Abigail B. Miranda, Imelda A. Luna

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Introduction: COVID-19 infection is a novel viral illness that began as a local epidemic in December 2019 in Wuhan, China which quickly emerged into a pandemic by February 2020. The virus causes a spectrum of signs and symptoms, ranging from mild upper respiratory symptoms to acute respiratory distress syndrome, which may lead to death. Among children and neonates, those afflicted with the disease may present asymptomatically or with mild symptoms. To date, there has been limited local data that describes the outcomes of the growing number of COVID-19 cases, specifically in neonates. Methods: A cross-sectional study was conducted to determine the outcomes of neonates born to COVID-19 Positive Mothers from March 2020 until June 2022. The prevalence of COVID-19 among these neonates was also determined. Results: COVID-positive prevalence after 24 hours of life is at 8%, while prevalence after 48 hours among those who still underwent testing was at 13.51%. Moreover, among those COVID-19-negative neonates who had symptoms, they mostly presented with tachypnea (5.7%). The prevalence of complications among COVID-19-negative neonates delivered to COVID-19-positive mothers is 22.7%. Conclusion: Neonates born to COVID-19-positive mothers who yielded positive COVID-19 results are generally asymptomatic. Moreover, there are no associated mortalities among those who yielded positive results.

Keywords: COVID-19, neonates, outcomes, clinical profile

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Authors: Margareth Guimaraes Lima, Marilisa Berti A. Barros, Deborah Carvalho Malta

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The relationship between physical activity (PA) and depression has been investigated, in both, observational and clinical studies: PA can integrate the treatments for depression; the physical inactivity (PI) may contribute to increase depression symptoms; and on the other hand, emotional problems can decrease PA. The main of this study was analyze the association among leisure and transportation PI and time watching television (TV) according to depression (minor and major), evaluated with the Patient Health Questionnaire (PHQ-9). The association was also analyzed by gender. This is a cross-sectional study. Data were obtained from the National Health Survey 2013 (PNS), performed with representative sample of the Brazilian adult population, in 2013. The PNS collected information from 60,202 individuals, aged 18 years or more. The independent variable were: leisure time physical inactivity (LTPI), considering inactive or insufficiently actives (categories were linked for analyzes), those who do not performed a minimum of 150 or 74 minutes of moderate or vigorous LTPA, respectively, by week; transportation physical inactivity (TPI), individuals who did not reached 150 minutes, by week, travelling by bicycle or on foot to work or other activities; daily time watching TV > 5 hours. The principal independent variable was depression, identified by PHQ-9. Individuals were classified with major depression, with > 5 symptoms, more than seven days, but one of the symptoms was “depressive mood” or “lack of interest or pleasure”. The others had minor depression. The variables used to adjustment were gender, age, schooling and chronic disease. The prevalence of LTPI, TPI and TV time were estimated according to depression, and differences were tested with Chi-Square test. Adjusted prevalence ratios were estimated using multiple Poisson regression models. The analyzes also had stratification by gender. Mean age of the studied population was 42.9 years old (CI95%:42.6-43.2) and 52.9% were women. 77.5% and 68.1% were inactive or insufficiently active in leisure and transportation, respectively and 13.3% spent time watching TV 5 > hours. 6% and 4.1% of the Brazilian population were diagnosed with minor or major depression. LTPI prevalence was 5% and 9% higher among individuals with minor and major depression, respectively, comparing with no depression. The prevalence of TPI was 7% higher in those with major depression. Considering larger time watching TV, the prevalence was 45% and 74% higher among those with minor and major depression, respectively. Analyzing by gender, the associations were greater in men than women and TPI was note be associated, in women. The study detected the higher prevalence of leisure time physical inactivity and, especially, time spent watching TV, among individuals with major and minor depression, after to adjust for a number of potential confounding factors. TPI was only associated with major disorders and among men. Considering the cross-sectional design of the research, these associations can point out the importance of the mental problems control of the population to increase PA and decrease the sedentary lifestyle; on the other hand, the study highlight the need of interventions by encouraging people with depression, to practice PA, even to transportation.

Keywords: depression, physical activity, PHQ-9, sedentary lifestyle

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Authors: Amina Merghad, Cherif Abdennour

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Solvents are widely used in paint industry, where humans are highly exposed, especially from inhalation. A case report describes how paint affects reproductive markers and the health of workers. Sixty four subjects were chosen and divided into two groups; a control and an exposed group. A questionnaire was given to male workers from similar socio-economic status in order to know their ages, working conditions, clinical symptoms, working period, smoking history, shift, medical history and nutrition. Blood was withdrawn in the morning from volunteers. The measurement of blood testosterone and prolactin concentrations was then carried out. Results showed that the ages of the two groups were almost similar and were up to 47 and 43 years. The period of employment was 17 years and 14 years for the control and the exposed workers, respectively. Concerning clinical symptoms, the frequency of neuropsychological symptoms of the two groups are presented. It is clear that the symptom of memory loss, headaches are the highest among exposed workers followed by poor coordination, poor concentration and insomnia. On the other hand, the symptoms’ frequency in the control was less than that of the exposed group. Testosterone concentration has significantly decreased in group 2 (4.61±2,005 ng/ml) and group 3 (4.25±1.67 ng/ml) of exposed workers. On the other hand, prolactin concentration was higher in group 3 compared to other groups. To conclude, paint industry has disturbed reproductive markers and created high frequency of neuropsychological symptoms.

Keywords: blood, paint, prolactin, occupational exposure, organic solvent, reproductive toxicity, testosterone

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Authors: Pamela-Zoe Topalli, Niina Junttila, Päivi M. Niemi, Klaus Ranta

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Adolescents’ biased perceptions about their social competence (SC), whether negatively or positively, serve to influence their socioemotional adjustment such as early feelings of social phobia (nowadays referred to as Social Anxiety Disorder-SAD). Despite the importance of biased self-perceptions in adolescents’ psychosocial adjustment, the extent to which discrepancies between self- and others’ evaluations of one’s SC are linked to social phobic symptoms remains unclear in the literature. This study examined the perceptual discrepancy profiles between self- and peers’ as well as between self- and teachers’ evaluations of adolescents’ SC and the interrelations of these profiles with self-reported social phobic symptoms. The participants were 390 3^rd graders (15 years old) of Finnish lower secondary school (50.8% boys, 49.2% girls). In contrast with variable-centered approaches that have mainly been used by previous studies when focusing on this subject, this study used latent profile analysis (LPA), a person-centered approach which can provide information regarding risk profiles by capturing the heterogeneity within a population and classifying individuals into groups. LPA revealed the following five classes of discrepancy profiles: i) extremely negatively biased perceptions of SC, ii) negatively biased perceptions of SC, iii) quite realistic perceptions of SC, iv) positively biased perceptions of SC, and v) extremely positively biased perceptions of SC. Adolescents with extremely negatively biased perceptions and negatively biased perceptions of their own SC reported the highest number of social phobic symptoms. Adolescents with quite realistic, positively biased and extremely positively biased perceptions reported the lowest number of socio-phobic symptoms. The results point out the negatively and the extremely negatively biased perceptions as possible contributors to social phobic symptoms. Moreover, the association of quite realistic perceptions with low number of social phobic symptoms indicates its potential protective power against social phobia. Finally, positively and extremely positively biased perceptions of SC are negatively associated with social phobic symptoms in this study. However, the profile of extremely positively biased perceptions might be linked as well with the existence of externalizing problems such as antisocial behavior (e.g. disruptive impulsivity). The current findings highlight the importance of considering discrepancies between self- and others’ perceptions of one’s SC in clinical and research efforts. Interventions designed to prevent or moderate social phobic symptoms need to take into account individual needs rather than aiming for uniform treatment. Implications and future directions are discussed.

Keywords: adolescence, latent profile analysis, perceptual discrepancies, social competence, social phobia

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Authors: Georgia Hopley, Andrew Murray, Alan Macpherson

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Objectives: This study aims to (i) assess the prevalence of symptoms of mental health disorders among a cohort of professional golfers, (ii) compare prevalence values with data from the general population and other elite athlete cohorts, and (iii) assess how players cope with mental health problems and players’ opinions on the mental health support services available to them. Methods: Players competing on the 2020 Challenge Tour (n=261) were sent a questionnaire that assessed symptoms of depression, distress, anxiety, sleep disturbance, and obsessive-compulsive disorder. Questions were also included to assess coping behaviors and opinions on current support measures. Results: The two-week symptom prevalence was 10.3% for depression, 51.7% for distress, 8.6% for anxiety, 10.3% for sleep disturbance, 13.8% for obsessive thoughts, and 27.6% for compulsive behavior. The prevalence of symptoms is comparable with other elite athlete cohorts, and symptoms of anxiety and distress were reported more frequently than in the general population. 67% of players who had experienced a mental health issue did not seek professional help at the time, and 61% of players did not think sufficient support was available to them. Conclusion: Mental health problems are prevalent among elite golfers; however, this study demonstrates that the majority of players do not seek help from professionally accredited practitioners. Following the discussion of this study, the European Tour Group now provides a 24/7 mental health crisis hotline for players and has educated staff members on how to identify players with mental health issues and signpost them to the appropriate support.

Keywords: elite athletes, golf, mental health, sport science, sport psychiatry

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Authors: R. R. Billones, N. Lukkahatai, L. N. Saligan

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Mindfulness based interventions (MBIs) have been used in medically unexplained symptoms (MUS). This systematic review describes the literature investigating the general effect of MBIs on MUS and identifies the effects of specific MBIs on specific MUS conditions. The preferred reporting items for systematic reviews and meta-analysis guidelines (PRISMA) and the modified Oxford quality scoring system (JADAD) were applied to the review, yielding an initial 1,556 articles. The search engines included PubMed, ScienceDirect, Web of Science, Scopus, EMBASE, and PsychINFO using the search terms: mindfulness, or mediations, or mindful or MBCT or MBSR and medically unexplained symptoms or MUS or fibromyalgia or FMS. A total of 24 articles were included in the final systematic review. MBIs showed large effects on socialization skills for chronic fatigue syndrome (d=0.65), anger in fibromyalgia (d=0.61), improvement of somatic symptoms (d=1.6) and sleep (d=1.12) for painful conditions, physical health for chronic back pain (d=0.51), and disease intensity for irritable bowel disease/syndrome (d=1.13). A manualized MBI that applies the four fundamental elements present in all types of interventions were critical to efficacy. These elements were psycho-education sessions specific to better understand the medical symptoms, the practice of awareness, the non-judgmental observance of the experience at the moment, and the compassion to ones’ self. The effectiveness of different mindfulness interventions necessitates giving attention to improve the gaps that were identified related to home-based practice monitoring, competency training of mindfulness teachers, and sound psychometric properties to measure the mindfulness practice.

Keywords: mindfulness-based interventions, medically unexplained symptoms, mindfulness-based cognitive therapy, mindfulness-based stress reduction, fibromyalgia, irritable bowel syndrome

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Authors: Klary Geisler, Dalit Lev-Arey, Yael Hacohen

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It is a well-known fact that exercise has favorable effects on people's physical health, as well as mental well-being. However, as for as excessive exercise, it may likely elevate negative consequences (e.g., physical injuries, negligence of everyday responsibilities such as work, family life). Lately, there is a growing interest in exercise addiction, sometimes referred to as exercise dependence, which is defined as a craving for physical activity that results in extreme work-out sessions and generates negative physiological and psychological symptoms (e.g., withdrawal symptoms, tolerance, social conflict). Exercise addiction is considered a behavioral addiction, yet it was not included in the latest editions of the diagnostic and statistical manual of mental disorders (DSM-IV), due to lack of significant research. Specifically, there is scarce research on the relationship between exercise addiction and personality dimensions. The purpose of the current research was to examine the relationship between primary exercise addiction symptoms and the big five dimensions, perfectionism (high performance expectations and self-critical performance evaluations) and subjective affect. participants were 152 trainees on a variety of aerobic sports activities (running, cycling, swimming) that were recruited through sports groups and trainers. 88% of participants trained for at least 5 hours per week, 24% of the participants trained above 10 hours per week. To test the predictive ability of the IVs a hierarchical linear regression with forced block entry was performed. It was found that Neuroticism significantly predicted exercise addiction symptoms (20% of the variance, p<0.001), while consciousness was negatively correlated with exercise addiction symptoms (14% of variance p<0.05); both had a unique contribution. Other dimensions of the big five (agreeableness, openness and extraversion) did not have any contribution to the dependent. Moreover, maladaptive perfectionism (self-critical performance evaluations) significantly predicted exercise addiction symptoms as well (10% of the variance P < 0.05). The overall regression model explained 54% of variance.

Keywords: big five, consciousness, excessive exercise, exercise addiction, neuroticism, perfectionism, personality

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Authors: A. Cagnacci, D. F. Barattini, E. Casolati, M. Mangrella, E. Piccolo, S. Rosu, L. C. Pătrașcu

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This Triple study aimed to evaluate the efficacy of polycarbophil vaginal gel (PCV) in treating symptoms of vaginal atrophy (VA) in peri- and post-menopausal women. Women in peri- (n=29) and postmenopause (n=54) diagnosed with VA were progressively enrolled and treated once a day for 30 days. Thereafter, those wishing to continue (n=73) received the PCV treatment for an additional 180 days. The vaginal health index (VHI) and vaginal dryness, irritation, and pain at intercourse, along with treatment safety, were evaluated at baseline, 30 days of treatment, and after additional 180 days. At baseline, the VHI (p<0.056) and VAS of vaginal dryness (p=0.0001,) irritation (p=0.002), and pain at intercourse (p=0.0001) were worse in postmenopausal women than in perimenopausal women. VHI and VA symptoms improved in all women, and after 30 days of PCV administration, they were similar between peri-and postmenopausal women. After an additional 180 days of treatment, VHI further increased (p=0.0001), VAS of all symptoms (P=0.0001) and the Global Symptom Score (P=0.0001) further decreased. The treatment was safe. Treatment with PCV improves VA symptoms in both peri- and post-menopausal women. Prolongation of treatment up to 6 months increases the efficacy of treatment with no side effects.

Keywords: late menopausal transition, postmenopause, polycarbophil, sexuality, vaginal dryness

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Authors: Rosanna M. Rooney, Sharinaz Hassan, Maryanne McDevitt, Jacob D. Peckover, Robert T. Kane

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Anxiety and depression are the most common mental health problems experienced by Australian children and adolescents. Research into youth mental health points to the importance of considering emotional competence, parental influence on the child’s emotional development, and the fact that cognitions are still developing in childhood when designing and implementing positive psychology interventions. Additionally, research into such interventions has suggested the inclusion of a coaching component aimed at supporting those implementing the intervention enhances the effects of the intervention itself. In light of these findings and given the burden of anxiety and depression in the longer term, it is necessary to enhance the Aussie Optimism Positive Thinking Skills program and evaluate its efficacy in terms of children’s mental health outcomes. It was expected that the enhancement of the emotional and cognitive aspects of the Aussie Optimism Positive Thinking Skills program, the addition of coaching, and the inclusion of a parent manual would lead to significant prevention effects in internalizing problems at post-test, 6- and 18-months after the completion of the intervention. 502 students (9-11 years old) were randomly assigned to the intervention group (n = 347) or control group (n = 155). At each time point (baseline, post-test, 6-month follow-up, and 18-month follow-up), students completed a battery of self-report measures. The ten intervention sessions making up the enhanced Aussie Optimism Positive Thinking Skills program were run weekly. At post-test and 6-month follow-up, the intervention group reported significantly lower depression than the control group, with no group differences at the 18-month follow-up. The intervention group reported significantly lower anxiety than the control group only at the 6-month follow-up, with no group differences in the post-test or at the 18-month follow-up. Results suggest that the enhanced Aussie Optimism Positive Thinking Skills program can reduce depressive and anxious symptoms in the short term and highlight the importance of universally implemented positive psychology interventions.

Keywords: positive psychology, emotional competence, internalizing symptoms, universal implementation

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Authors: Medina Kadiri

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Nigeria has an extensive coastline of 853 km long between latitude 4°10′ to 6°20′ N and longitude 2°45′ to 8°35′ E and situated in the Gulf of Guinea within the Guinea Current Large Marine Ecosystem. There is a substantial coastal community relying on this region for their livelihood of fishing, aquaculture, mariculture for various sea foods either for consumption or economic sustenance or both. Socio-economic study was conducted, using questionnaires and interview, to investigate the health symptoms of harmful algae experienced by these communities on consumption of sea foods. Eighteen symptoms were recorded. Of the respondents who experienced symptoms after consumption of sea foods, overall, more people (33.5%) experienced vomiting as a symptom, followed by nausea (14.03%) and then diarrhea (13.57%). Others were headache (9.95%), mouth tingling (8.6%) and tiredness (7.24%).The least were muscle pain, rashes, confusion, chills, burning sensation, breathing difficulty and balance difficulty which represented 0.45% each and the rest (dizziness, digestive tract tumors, itching, memory loss, & stomach pain) were less than 3% each. In terms of frequency, the most frequent symptom was diarrhea with 87.5% occurrence, closely followed by vomiting with 81.3%. Tiredness was 75% while nausea was 62.5% and headache 50%. Others such as dizziness, itching, memory loss, mouth tingling and stomach pain had about 40% occurrence or less. The least occurring symptoms were muscle pain, rashes, confusion, chills and balance difficulty and burning sensation occurring only once i.e 6.3%. Breathing difficulty was last but one with 12.5%. Visible symptom from seafood and the particular seafood consumed that prompted the visible symptoms, shows that 3.5% of the entire respondents who ate crab experienced various symptoms ranging from vomiting (2.4%), itching (0.5%) and headache (0.4%). For periwinkle, vomiting had 1.7%, while 1.2% represented diarrhea and nausea symptom comprised 0.8% of all the respondents who ate periwinkle. Some respondents who consumed fish shows that 0.4% of the respondents had Itching. From the respondents who preferred to consume shrimps/crayfish and crab, shrimps/crayfish, crab and periwinkle, the most common illness was tiredness (1.2%), while 0.5% had experienced diarrhea and many others. However, for most respondents who claimed to have no preference for any seafood, with 55.7% affirming this with vomiting being the highest (6.1%), followed closely by mouth tingling/ burning sensation (5.8%). Examining the seasonal influence on visible symptoms revealed that vomiting occurred more in the month of January with 5.5%, while headache and itching were predominant in October with (2.8%). Nausea has 3.1% in January than any season of the year, 2.6% of the entire respondents opined to have experience diarrhea in October than in any other season of the year. Regular evaluation of harmful algal poisoning symptoms is recommended for coastal communities.

Keywords: coastal, harmful algae, human poisoning symptoms, Nigeria, phycotoxins

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Authors: Jun Hong Lee

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Background: Many dementia patients complain insomnia and depressive mood, and hypnotics and antidepressants are being prescribed. As prevalence of dementia is increasing, insomnia and depressive mood are becoming more important. Objective: We evaluated insomnia and depression in outpatients of dementia center. Patients and Methods/Material and Methods: We reviewed medical records of the patients who visited outpatients clinic of NHIS Ilsan Hospital Dementia Center during 2016. Results: Total 716 patients are included; Subjective Memory Impairment (SMI) : 143 patients (20%), non-amnestic Mild Cognitive Impairment (MCI): single domain 70 (10%), multiple domain 34 (5%), amnestic MCI: single domain 74 (10%), multiple domain 159 (22%), Early onset Alzheimer´s disease (AD): 9 (1%), AD 121 (17%), Vascular dementia: 62 (9%), Mixed dementia 44 (6%). Hypnotics and antidepressants are prescribed as follows; SMI : hypnotics 14 patients (10%), antidepressants 27 (19%), non-amnestic MCI: single domain hypnotics 9 (13%), antidepressants 12 (17%), multiple domain hypnotics 4 (12%), antidepressants 6 (18%), amnestic MCI: single domain hypnotics 10 (14%), antidepressants 16 (22%), multiple domain hypnotics 22 (14%), antidepressants 24 (15%), Early onset Alzheimer´s disease (AD): hypnotics 1 (11%), antidepressants 2 (22%), AD: hypnotics 10 (8%), antidepressants 36 (30%), Vascular dementia: hypnotics 8 (13%), antidepressants 20 (32%), Mixed dementia: hypnotics 4 (9%), antidepressants 17 (39%). Conclusion: Among the outpatients of Dementia Center, MCI and SMI are majorities, and the number of MCI patients are almost half. Depression is more prevalent in AD, and Vascular dementia than MCI and SMI, and about 22% of patients are being prescribed by antidepressants and 11% by hypnotics.

Keywords: insomnia, depression, dementia, antidepressants, hypnotics

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Authors: Arezou Hajhashemi, Karim Asgari, Masoud Etemadifar, Maryam Keyvani, Ali Hekmatnia

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Multiple Sclerosis (MS) is one of the most prevalent demyelinating diseases in CNS. As in other chronic cerebral diseases, impairment in cognitive functioning and in memory is popular. Because of the inflammatory and demyelinating nature of the disease, the localization of plaques in different parts of the Prefrontal and Limbic System, may lead to memorial symptoms. This investigation was intended to study relationship between frequency of plaques and memorial symptoms arising from dysfunction limbic system and prefrontal of patients with MS. The sample was selected randomly from patients with MS with memory problem, who have been referred to Isfahan Multiple Sclerosis Society. Brain System Test and Memory Test was administered to the sample, and their MRI's were analyzed by specialist in order to indentify two different parts of plaques. The data was analyzed by SPSS. The results showed that there were significant relationship between MS plaques and prefrontal's dysfunction and memorial symptom related to prefrontal area; however, there were no significant relationship between MS plaques and limbic system's dysfunction and memorial symptoms related to limbic system area. The results of this study suggest that memorial symptoms due to injury regions of the brain have the most significant relationship to prefrontal. Better judgment about these results needs more studies in future.

Keywords: multiple sclerosis, magnetic image, brain injury, behavior disorder

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Authors: Noah Wayne, Andrea Tuka, Adrian Norbash, Bryan Garber, Paul Ritvo

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Program/Intervention Description: The Canadian Armed Forces(CAF) Mental Health Clinicstreat a full spectrum of mental disorder, addictions, and psychosocial issues that include Major Depressive Disorder, Post-Traumatic Stress Disorder, Generalized Anxiety Disorder, and other diagnoses. We evaluated the feasibility of an online health coach interventiondelivering mindfulness based cognitive behavioral therapy (M-CBT) and behaviour changesupport for individuals receiving treatment at CAF Clinics. Participants were provided accounts on NexJ Connected Wellness, a digital health platform, and 16 weeks of phone-based health coaching,emphasizingmild to moderate aerobic exercise, a healthy diet, and M-CBT content. The primary objective was to assess the feasibility of the online deliverywith CAF members. Evaluation Methods: Feasibility was evaluated in terms of recruitment, engagement, and program satisfaction. Weadditionallyevaluatedhealth behavior change, program completion, and mental health symptoms (i.e. PHQ-9, GAD-7, PCL-5) at three time points. Results: Service members were referred from Vancouver, Esquimalt, and Edmonton CAF bases between August 2020 and January 2021. N=106 CAF personnel were referred, and n=77 consented.N=66 participated, and n=44 completed 4-month and follow-up measures. The platform received a mean rating of76.5 on the System Usability Scale, and health coaching was judged the most helpful program feature (95.2% endorsement), while reminders (53.7%), secure messaging (51.2%), and notifications (51.2%) were also identified. Improvements in mental health status during active interventions were observed on the PHQ-9 (-5.4, p<0.001), GAD-7 (-4.0, p<0.001), and PCL-5 (-4.1, p<0.05). Conclusion: Online health coaching was well-received amidst the COVID-19 pandemic and related lockdowns. Uptake and engagement were positively reported. Participants valuedcontacts and reported strong therapeutic alliances with coaches. Healthy diet, regular exercise, and mindfulness practice are important for physical and mental health. Engagements in these behaviors are associated with reduced symptoms. An online health coach program appears feasible for assisting Canadian Armed Forces personnel.

Keywords: coaching, CBT, military, depression, mental health, digital

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Authors: Zakieh Piri, Shahla Damanabi, Peyman Rezaii Hachesoo

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Introduction: Healthcare organizations like other organizations suffer from a number of disorders such as Business Sponsor Disorder, Business Acceptance Disorder, Cultural/Political Disorder, Data Disorder, etc. As quality in healthcare care mostly depends on the quality of data, we aimed to identify data disorders and its symptoms in two teaching hospitals. Methods: Using a self-constructed questionnaire, we asked 20 questions in related to quality and usability of patient data stored in patient records. Research population consisted of 150 managers, physicians, nurses, medical record staff who were working at the time of study. We also asked their views about the symptoms and treatments for any data disorders they mentioned in the questionnaire. Using qualitative methods we analyzed the answers. Results: After classifying the answers, we found six main data disorders: incomplete data, missed data, late data, blurred data, manipulated data, illegible data. The majority of participants believed in their important roles in treatment of data disorders while others believed in health system problems. Discussion: As clinicians have important roles in producing of data, they can easily identify symptoms and disorders of patient data. Health information managers can also play important roles in early detection of data disorders by proactively monitoring and periodic check-ups of data.

Keywords: data disorders, quality, healthcare, treatment

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Authors: Soudeh Tabashi, Soudabeh Fazeli Dehkordy, Masood Movahedi, Nasrin Behniafard

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Introduction: Food allergy has increased in three last decades. Since wheat is one of the major constituents of daily meal in many regions throughout the world, wheat allergy is one of the most important allergies ranking among the 8 most common types of food allergies. Our information about epidemiology and etiology of food allergies are limited. Therefore, in this study we sought to evaluate the symptoms and laboratory findings in children with wheat allergy. Materials and methods: There were 23 patients aged up to 18 with the diagnosis of IgE mediated wheat allergy that were included enrolled in this study. Using a questionnaire .we collected their information and organized them into 4 groups categories of: demographic data identification, signs and symptoms, comorbidities, and laboratory data. Then patients were followed up for 6 month and their lab data were compared together. Results: Most of the patients (82%) presented the symptoms of wheat allergy in the first year of their life. The skin and the respiratory system were the most commonly involved organs with an incidence of 86% and 78% respectively. Most of the patients with wheat allergy were also sensitive to the other type of foods and their sensitivity to egg were most common type (47%). in 57% of patients, IgE levels were decreased during the 6 month follow-up period. Conclusion: We do not have enough information about data on epidemiology and response to therapy of wheat allergy and to best of our knowledge no study has addressed this issue in Iran so far. This study is the first source of information about IgE mediated wheat allergy in Iran and It can provide an opening for future studies about wheat allergy and its treatments.

Keywords: wheat allergy, food allergy, IgE, food allergy

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Authors: Mariam Anwaar, Kiran B. Ahmad

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Borderline Personality Disorder (BPD) is an invasive presence of affect instability, disturbance in self-concept and attachment in relationships. The profound indicator is the dichotomous approach of the world in which the ego categorizes individuals, especially their significant others, into secure or threatful beings, leaving little room for a complex combination of characteristics in one person. This defense mechanism of splitting their world has been described through the explanatory model of unconscious conflict theorized by Sigmund Freud’s Electra Complex in the Phallic Stage. The central role is of the father with whom the daughter experiences penis envy, thus identifying with the mother’s characteristics to receive the father’s attention. However, Margret Mahler, an object relation theorist, elucidates the central role of the mother and that the split occurs during the pre-Electra complex stage. Amid the 14 and 24 months of the infant, it acknowledges the world away from the mother as they have developed milestones such as crawling. In such novelty, the infant crawls away from the mother creating a sense of independence (individuation). On the other hand, being distant causes anxiety, making them return to their original object of security (separation). In BPD, the separation-individuation stage is disrupted, due to contradictory actions of the caregiver, which results in splitting the object into negative and positive aspects, repressing the former and adhering to the latter for survival. Thus, with time, the ego distorts the reality into dichotomous categories, using the splitting defenses, and the mental representation of the self is distorted due to the internalization of the negative objects. The explanatory model was recognized in the case study of Fizza, at 21-year-old Pakistani female, residing in Karachi. Her marital status is single with an occupation being a dental student. Fizza lives in a nuclear family but is surrounded by her extended family as they all are in close vicinity. She came with the complaints of depressive symptoms for two-years along with self-harm due to severe family conflicts. Through the intervention of Dialectical Behavior Therapy (DBT), the self-harming actions were reduced, however, this libidinal energy transformed into claustrophobic symptoms and, along with this, Fizza has always experienced vivid dreams. A retrospective method of Jungian dream-analysis was applied to locate the origins of the splitting in the unconscious. The result was the revelation of a sexual harassment trauma at the age of six-years which was displaced in the form of self-harm. In addition to this, the presence of a conflict at the separation-individuation stage was detected during the dream-analysis, and it was the underlying explanation of the claustrophobic symptoms. This qualitative case study implicates the use of a patient’s subjective experiences, such as dreams, to journey through the spiral of the unconscious in order to not only detect repressed memories but to use them in psychotherapy as a means of healing the patient.

Keywords: borderline personality disorder, dream-analysis, Electra complex, separation-individuation, splitting, unconscious

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Authors: Arij Yehya, Suhaila Ghuloum, Abdlmoneim Abdulhakam, Azza Al-Mujalli, Mark Opler, Samer Hammoudeh, Yahya Hani, Sundus Mari, Reem Elsherbiny, Ziyad Mahfoud, Hassen Al-Amin

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Introduction: The Positive and Negative Syndrome Scale (PANSS) is a valid instrument developed by Kay and colleagues6 to assess symptoms of patients with schizophrenia. It consists of 30 items that factor the symptoms into three subscales: positive, negative and general psychopathology. This scale has been translated and validated in several languages. Objective: This study aims to determine the validity and psychometric properties of the Arabic version of the PANSS. Methods: A standardized translation and cultural adaptation method was adopted. Patients diagnosed with schizophrenia (n=98), according to psychiatrist’s diagnosis based on DSM-IV criteria, were recruited from the Psychiatry Department at Rumailah Hospital, Qatar. A first rater confirmed the diagnosis using the Arabic version of Mini International Neuropsychiatric Interview (MINI 6). A second and independent rater-administered the Arabic version of PANSS. Also, a control group (n=101), with no history of psychiatric disorder was recruited from the family and friends of the patients and from primary health care centers in Qatar. Results: There were more males than females in our sample of patients with schizophrenia (68.9% and 31.6%, respectively). On the other hand, in the control group the number of females outweighed that of males (58.4% and 41.6% respectively). The scale had a good internal consistency with Cronbach’s alpha 0.91. There was a significant difference between the scores on the three subscales of the PANSS. Patients with schizophrenia scored significantly higher (p<.0001) than the control subjects on subscales for positive symptoms 20.01(SD=7.21) and 7.30(SD=1.38), negative symptoms 18.89(SD=8.88) and 7.37(SD=2.38) and general psychopathology 34.41 (SD=11.56) and 16.93 (SD=3.93), respectively. Factor analysis and ROC curve were carried out to further test the psychometrics of the scale. Conclusions: The Arabic version of PANSS is a reliable and valid tool to assess both positive and negative symptoms of patients with schizophrenia in a balanced manner. In addition to providing the Arab population with a standardized tool to monitor symptoms of schizophrenia, this version provides a gateway to compare the prevalence of positive and negative symptoms in the Arab world which can be compared to others done elsewhere.

Keywords: Arabic version, assessment, diagnosis, schizophrenia, validation

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Authors: Shian-Ling Keng, Onn Siong Yim, Poh San Lai, Soo Chong Chew, Anne Chong, Richard Ebstein

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Research has demonstrated a positive association between mindfulness meditation and physical health. Little work, however, has examined the association between trait mindfulness and leukocyte telomere length (LTL), an emerging marker of cellular aging. The present study aimed to examine whether facets of trait mindfulness are correlated with longer LTL in a Singaporean Han Chinese sample and whether these facets may mediate the association between psychological symptoms and LTL. 158 adults (mean age = 27.24 years) completed measures assessing trait mindfulness and psychological symptoms (i.e., depression and stress) and provided blood samples for analyses of LTL using qPCR. Multiple regression analyses were conducted to assess the association between facets of trait mindfulness and LTL. Bootstrapping-based mediational analyses were run to examine the role of trait mindfulness as a mediator of the association between psychological symptoms and LTL. Of five facets of trait mindfulness (describe, act with awareness, observe, nonreactivity, and nonjudging), nonreactivity was significantly associated with LTL, after controlling for the effects of age, gender, and education, β = .21, p = .006. Further, there was a trend for overall trait mindfulness, β = .15, p = .06, and nonjudging, β = .13, p = .095, to each predict longer LTL. Nonreactivity significantly mediated the association between depression and LTL, BCa 95% CI [-.004, -.0004], p=.03, as well as the association between stress and LTL, BCa 95% CI [-.004, -.0004], p=.04. The results provide preliminary evidence for a positive association between selected facets of trait mindfulness and slower cellular aging, indexed by LTL. The findings suggest that individuals who are high on equanimity may experience slower aging at the cellular level, presumably through engaging in more effective coping mechanisms and modulation of stress. The findings also highlight the role of nonreactivity as a potential mechanism that underlies the association between LTL and psychological symptoms.

Keywords: depression, mindfulness, stress, telomere length

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Authors: Einat Waizbard, Emilio Ferrer, Meghan Miller, Brianna Heath, Derek S. Andrews, Sally J. Rogers, Christine Wu Nordahl, Marjorie Solomon, David G. Amaral

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Background: Autism symptoms are comprised of social-communication deficits and restricted/repetitive behaviors (RRB). The severity of these symptoms can change during childhood, with differences between boys and girls. From the literature, it was found that young autistic girls show a stronger tendency to decrease and a weaker tendency to increase their overall autism symptom severity levels compared to young autistic boys. It is not clear, however, which symptoms are driving these sex differences across childhood. In the current study, we evaluated the trajectories of independent autism symptoms across childhood and compared the patterns of change in such symptoms between boys and girls. Method: The study included 183 children diagnosed with autism (55 girls) evaluated three times across childhood, at ages 3, 6 and 11. We analyzed 22 independent items from the Autism Diagnostic Observation Scheudule-2 (ADOS-2), the gold-standard assessment tool for autism symptoms, each item representing a specific autism symptom. First, we used latent growth curve models to estimate the trajectories for the 22 ADOS-2 items for each child in the study. Second, we extracted the factor scores representing the individual slopes for each ADOS-2 item (i.e., slope representing that child’s change in that specific item). Third, we used factor analysis to identify common patterns of change among the ADOS-2 items, separately for boys and girls, i.e., which autism symptoms tend to change together and which change independently across childhood. Results: The best-emerging patterns for both boys and girls identified four common factors: three factors representative of changes in social-communication symptoms and one factor describing changes in RRB. Boys and girls showed the same pattern of change in RRB, with four items (e.g., speech abnormalities) changing together across childhood and three items (e.g., mannerisms) changing independently of other items. For social-communication deficits in boys, three factors were identified: the first factor included six items representing initiating and engaging in social-communication (e.g., quality of social overtures, conversation), the second factor included five items describing responsive social-communication (e.g., response to name) and the third factor included three items related to different aspects of social-communication (e.g., level of language). Girls’ social-communications deficits also loaded onto three factors: the first factor included five items (e.g., unusual eye contact), the second factor included six items (e.g., quality of social response), and the third factor included four items (e.g., showing). Some items showed similar patterns of change for both sexes (e.g., responsive joint attention), while other items showed differences (e.g., shared enjoyment). Conclusions: Girls and boys had different patterns of change in autism symptom severity across childhood. For RRB, both sexes showed similar patterns. For social-communication symptoms, however, there were both similarities and differences between boys and girls in the way symptoms changed over time. The strongest patterns of change were identified for initiating and engaging in social communication for boys and responsive social communication for girls.

Keywords: autism spectrum disorder, autism symptom severity, symptom trajectories, sex differences

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Authors: Aline Woine, Moïra Mikolajczak, Virginie Dardier, Isabelle Roskam

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Background information: Becoming a parent is said to be the happiest event one can ever experience in one’s life. This popular (and almost absolute) truth–which no reasonable and decent human being would ever dare question on pain of being singled out as a bad parent–contrasts with the nuances that reality offers. Indeed, while many parents do thrive in their parenting role, some others falter and become progressively overwhelmed by their parenting role, ineluctably caught in a spiral of exhaustion. Parental burnout (henceforth PB) sets in when parental demands (stressors) exceed parental resources. While it is now generally acknowledged that PB affects the parent’s behavior in terms of neglect and violence toward their offspring, little is known about the impact that the syndrome might have on the children’s internalized (anxious and depressive symptoms, somatic complaints, etc.) and/or externalized (irritability, violence, aggressiveness, conduct disorder, oppositional disorder, etc.) behaviors. Furthermore, at the time of writing, to our best knowledge, no research has yet tested the reverse effect, namely, that of the child's internalized and/or externalized behaviors on the onset and/or maintenance of parental burnout symptoms. Goals and hypotheses: The present pioneering research proposes to fill an important gap in the existing literature related to PB by investigating the bidirectional effect between PB and the child’s internalized and/or externalized behaviors. Relying on a cross-lagged longitudinal study with three waves of data collection (4 months apart), our study tests a transactional model with bidirectional and recursive relations between observed variables and at the three waves, as well as autoregressive paths and cross-sectional correlations. Methods: As we write this, wave-two data are being collected via Qualtrics, and we expect a final sample of about 600 participants composed of French-speaking (snowball sample) and English-speaking (Prolific sample) parents. Structural equation modeling is employed using Stata version 17. In order to retain as much statistical power as possible, we use all available data and therefore apply the maximum likelihood with a missing value (mlmv) as the method of estimation to compute the parameter estimates. To limit (in so far is possible) the shared method variance bias in the evaluation of the child’s behavior, the study relies on a multi-informant evaluation approach. Expected results: We expect our three-wave longitudinal study to show that PB symptoms (measured at T1) raise the occurrence/intensity of the child’s externalized and/or internalized behaviors (measured at T2 and T3). We further expect the child’s occurrence/intensity of externalized and/or internalized behaviors (measured at T1) to augment the risk for PB (measured at T2 and T3). Conclusion: Should our hypotheses be confirmed, our results will make an important contribution to the understanding of both PB and children’s behavioral issues, thereby opening interesting theoretical and clinical avenues.

Keywords: exhaustion, structural equation modeling, cross-lagged longitudinal study, violence and neglect, child-parent relationship

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Authors: Meltem Kürtüncü, Işın Alkan

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Objective: This study was carried out with an experimental design in order to determine whether the lullaby, which was listened from mother’s voice and a stranger’s voice to the babies born at term and hospitalized in neonatal intensive care unit, had an effect on stress and relaxation symptoms of the infants. Method: Data from the study were obtained from 90 newborn babies who were hospitalized in Neonatal Intensive Care Unit of Zonguldak Maternity And Children Hospital between September 2015-January 2016 and who met the eligibility criteria. Lullaby concert was performed by choosing one of the suitable care hours. Stress and relaxation symptoms were recorded by the researcher on “Newborn response follow-up form” at pre-care and post-care. Results: After lullaby concert when stress symptoms compared to infants in the experimental and control groups before the care was not detected statistically significant difference between crying, contraction, facial grimacing, flushing, cyanosis and the rates of increase in temperature. After care, crying, contractions, facial grimacing, flushing, and restlessness revealed a statistically significant difference between the groups, but as the cyanosis and temperature increased stress responses did not result in a significant difference between the groups. In the control group babies the crying, contraction, facial grimacing, flushing, and restlessness behaviors rates were found to be significantly higher than experimental group babies. After lullaby concert when relaxation symptoms compared to infants in the experimental and control groups before the care, eye contact rates who listen to lullaby from mother’s voice was found to be significantly higher than infants who listen to lullaby from stranger’s voice and infants in the control group. After care as eye contact, smiling, sucking/searching, yawning, non-crying and sleep behaviors relaxation symptoms revealed statistically significant results. In the control group, these behaviors were found statistically lower degree than the experimental groups. Conclusion: Lullaby concerts as masking the ambient noise, reducing the stress symptoms and increasing the relaxation symptoms, and also for soothing and stimulant affects, due to ease the transition to the sleep state should be preferred in the neonatal intensive care units.

Keywords: lullaby, mother voice, relaxation, stress

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Authors: Matthew T. McCarthy, Sarah Janse, Natalie M. Pizzimenti, Anthony K. Savino, Brian Crosser, Sean C. Rose

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Concussion is diagnosed clinically using a comprehensive history and exam, supported by ancillary testing. Frequently, symptom checklists are used as part of the evaluation of concussion. Existing symptom scales are based on a subjective Likert scale, without relation of symptoms to clinical or functional impairment. This is a retrospective review of 133 patients under age 30 seen in an outpatient neurology practice within 30 days of a probable or definite concussion. Each patient completed 2 symptom checklists at the initial visit – the SCAT-3 symptom evaluation (22 symptoms, 0-6 scale) and a scale based on the degree of clinical impairment for each symptom (22 symptoms, 0-3 scale related to functional impact of the symptom). Final clearance date was determined by the treating physician. 60.9% of patients were male with mean age 15.7 years (SD 2.3). Mean time from concussion to first visit was 6.9 days (SD 6.2), and 101 patients had definite concussions (75.9%), while 32 were diagnosed as probable (24.1%). 94 patients had a known clearance date (70.7%) with mean clearance time of 20.6 days (SD 18.6) and median clearance time of 19 days (95% CI 16-21). Mean total symptom score was 27.2 (SD 22.9) on the SCAT-3 and 14.7 (SD 11.9) for the functional impairment scale. Pearson’s correlation between the two scales was 0.98 (p < 0.001). After adjusting for patient and injury characteristics, an equivalent increase in score on each scale was associated with longer time to clearance (SCAT-3 hazard ratio 0.885, 95%CI 0.835-0.938, p < 0.001; functional impairment scale hazard ratio 0.851, 95%CI 0.802-0.902, p < 0.001). A concussion symptom scale based on degree of functional impairment correlates strongly with the SCAT-3 scale and demonstrates a similar association with time to clearance. By assessing the degree of impact on clinical functioning, this symptom scale reflects a more intuitive approach to rating symptoms and can be used in the management of concussion.

Keywords: checklist, concussion, neurology, scale, sports, symptoms

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Authors: Athena Pedro, Gina Stockingt

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This study aimed to explore current management strategies used by Grade 1 educators working with learners presenting with Attention Deficit Hyperactivity Disorder (ADHD) symptoms in mainstream schools in the Western Cape. A sample of grade 1 educators were selected for the study. The sample comprised of twelve grades 1 educators from four local schools in the Western Cape. All twelve educators were individually interviewed and discussed the management strategies used in the classroom when working with learner presenting with ADHD symptoms. The data was analysed qualitatively with a focus in identifying, sorting and analyse meaning according to the subjective perception, understanding and behaviour of the grade 1 educators within their context. Furthermore, the social, cultural, political and physical environment of the participants were taken into consideration to explore and interpret the link between these elements. The findings were as follows: many educators felt that they did not receive enough training on Attention Deficit Hyperactivity Disorder, therefore lacking knowledge on how to apply management strategies to address this. Managing a diverse range of learners, lack of resources, lack of parental involvement, lack of assistance in the classroom, as well as distracted and disorganised children posed as challenges for educators working with learners presenting with Attention Deficit Hyperactivity Disorder symptoms.

Keywords: ADHD, Grade 1 educators, Learners, Management strategies

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Authors: Sujen Man Shrestha, Kanchan Thapa, Tista Prasai Joshi

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Background: The present study was carried out to determine suspended particles and respirable particles of diameter less than 1 micrometers (PM1) on road side and some distance of outside from road; and to compare the respiratory symptoms between traffic police men and shop keepers directly 'exposed' to traffic fumes and office worker stay in 'protected' enclosed environment. Methods: Semi structured questionnaire was used to collect the data among case and control after getting verbal informed consent among the convenience sample of traffic police, shopkeepers and officials in three different locations in Kathmandu. Secondary data analysis of hospital data of three hospitals of Kathmandu was also performed. The data on air Particulate Matter was taken by Haz Dust. Results: The result showed air quality of road side traffic is unhealthy and there was increasing trends of respiratory illness in hospital outpatient department (OPD). The people who were exposed found to have more risk of developing respiratory diseases symptoms. Conclusions: The study concluded that air pollution level is strong contributing factor for respiratory diseases and further recommended strong, epidemiological studies with larger sample size, less bias, and also measuring other significant physical and chemicals parameters of air pollution.

Keywords: heavy traffic cities, Kathmandu, particulate pollution, respiratory symptoms

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Authors: Michael Stevens

Abstract:

David Hunter, a musicologist, has suggested that both Beethoven and Handel had chronic lead poisoning from the wine that they drank. These two eminent musical composers had some striking similarities. Beethoven had alcohol dependency and preferred wine, to which lead had been added to improve the taste. Handel was obese due to an eating disorder that included drinking tainted wine after large meals. They both had paresthesia of their extremities that they interpreted as rheumatism. This is a common sensory symptom from chronic lead poisoning. Their differences are marked in that Beethoven was profoundly deaf by the end of his life, whereas Handel had remarkably good hearing. Handel had paresis of three fingers of his right hand, whereas Beethoven lacked any motor symptoms. Beethoven reported recurrent abdominal pain suggestive of lead colic, whereas it can only be inferred that this symptom was present in Handel. Lead poisoning is likely in Handel because his paralysis was consistent with radial nerve involvement in the dominant hand. In addition, it was cured by hot baths, which have been shown to reduce total body lead content by exchanging with iron and calcium ions in water. Although lead produces predominantly motor symptoms in classic or subacute lead poisoning, and sensory symptoms in chronic lead poisoning, lead poisoning causes a variety of symptoms that depending on duration and level of exposure, are extremely variable from person to person. It therefore seems likely that Handel had lead poisoning, but extremely likely that Beethoven did because of the confirmatory finding of high levels of lead deep in his skull bone, which is a good measure of total body burden.

Keywords: beethoven, handel, lead, poisoning

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Authors: Kalpana Poudel-Tandukar

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Background: Human Immunodeficiency Virus (HIV) infection has been frequently associated with vitamin D deficiency and depression. Vitamin D deficiency increases the risk of depression in people without HIV. We assessed the cross-sectional and prospective associations between serum concentrations of 25-hydroxyvitamin D (25[OH]D) and depression in a HIV-positive people. Methods: A survey was conducted among 316 HIV-positive people aged 20-60 years residing in Kathmandu, Nepal for a cross-sectional association at baseline, and among 184 participants without depressive symptoms at baseline who responded to both baseline (2010) and follow-up (2011) surveys for prospective association. The competitive protein-binding assay was used to measure 25(OH)D levels and the Beck Depression Inventory-Ia method was used to measure depression, with cut off score 20 or higher. Relationships were assessed using multiple logistic regression analysis with adjustment of potential confounders. Results: The proportion of participants with 25(OH)D level of <20ng/mL, 20-30ng/mL, and >30ng/mL were 83.2%, 15.5%, and 1.3%, respectively. Only four participants with 25(OH)D level of >30ng/mL were excluded in the further analysis. The mean 25(OH)D level in men and women were 15.0ng/mL and 14.4ng/mL, respectively. Twenty six percent of participants (men:23%; women:29%) were depressed. Participants with 25(OH)D level of < 20 ng/mL had a 1.4 fold higher odds of depression in a cross-sectional and 1.3 fold higher odds of depression after 18 months of baseline compared to those with 25(OH)D level of 20-30ng/mL (p=0.40 and p=0.78, respectively). Conclusion: Vitamin D may not have significant impact against depression among HIV-positive people with 25(OH)D level below normal ( > 30ng/mL).

Keywords: depression, HIV, Nepal, vitamin D

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