Lurasidone in the Treatment of Bipolar Depression: : Systematic Review of Systematic Reviews

Copyright © 2017 Michele Fornaro et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Introduction. A burgeoning number of systematic reviews considering lurasidone in the treatment of bipolar depression have occurred since its Food and Drug Administration extended approval in 2013. While a paucity of available quantitative evidence still precludes preliminary meta-analysis on the matter, the present quality assessment of systematic review of systematic reviews, nonetheless, aims at highlighting current essential information on the topic. Methods. Both published and unpublished systematic reviews about lurasidone mono- or adjunctive therapy in the treatment of bipolar depression were searched by two independent authors inquiring PubMed/Cochrane/Embase/Scopus from inception until October 2016. Results. Twelve included systematic reviews were of moderate-to-high quality and consistent in covering the handful of RCTs available to date, suggesting the promising efficacy, safety, and tolerability profile of lurasidone. Concordance on the drug profile seems to be corroborated by a steadily increasing number of convergent qualitative reports on the matter. Limitations. Publication, sponsorship, language, citation, and measurement biases. Conclusions. Despite being preliminary in nature, this overview stipulates the effectiveness of lurasidone in the acute treatment of Type I bipolar depression overall. As outlined by most of the reviewed evidence, recommendations for future research should include further controlled trials of extended duration.Peer reviewe

Adhesión a los antiretrovirales en personas coinfectadas por el virus de la inmunodeficiencia humana y tuberculosis

Objetivo: evaluar los niveles de adhesión a la terapia antiretroviral en coinfectados por el VIH/tuberculosis y correlacionar esos niveles con las variables sociodemográficas e clínicas de la población estudiada. Método: estudio trasversal con 74 personas adultas, de ambos sexos, coinfectadas por HIV/tuberculosis. Fue utilizado para recolectar los datos un formulario de evaluación sociodemográfica y clínica y el Cuestionario de Evaluación de la Adhesión al Tratamiento Antirretroviral. El análisis de los datos fue efectuado con el uso de STATA, versión 11, mediante estadística descriptiva, la prueba ji-cuadrado exacto de Fisher y de probabilidad. Resultados: predominaron hombres (79,7%), con edad entre 30 y 39 años (35,1%), baja renta (75,7%) y tuberculosis pulmonar (71,6%). La adhesión a la terapia antiretroviral se mostró inadecuada en 78,1% de los hombres; 61,0% de los solteros; 47,0% de los desempleados y 76,5% entre personas con renta inferior a un salario-mínimo. Se observó diferencia significativa entre la adhesión y el tiempo de uso de los antiretrovirales (p=0,018), orientación sexual (p=0,024) y número de hijos (p=0,029). Conclusión: los coinfectados presentaron adhesión inadecuada a los antiretrovirales, hecho que influye negativamente en las condiciones de salud de las personas que viven con la coinfección HIV/tuberculosis. Se constató correlación estadísticamente significante entre los niveles de adhesión y algunas características sociodemográficas y clínicas.Objetivo: avaliar os níveis de adesão à terapia antirretroviral em coinfectados pelo HIV/tuberculose e correlacionar esses níveis com as variáveis sociodemográficas e clínicas da população em estudo. Método: estudo transversal, com 74 pessoas adultas, de ambos os sexos, coinfectadas por HIV/tuberculose. Utilizou-se, para coleta de dados, um formulário de avaliação sociodemográfica e clínica e o Questionário de Avaliação da Adesão ao Tratamento Antirretroviral. A análise dos dados ocorreu mediante o uso do STATA, versão11, por meio de estatística descritiva, do teste qui-quadrado exato de Fisher e de probabilidade. Resultados: predominaram homens (79,7%), com idade entre 30 e 39 anos (35,1%), com baixa renda (75,7%) e tuberculose pulmonar (71,6%). A adesão à terapia antirretroviral mostrou-se inadequada em 78,1% dos homens; 61,0% dos solteiros; 47,0% dos desempregados e 76,5% entre pessoas com renda inferior a um salário-mínimo. Observou-se diferença significativa entre a adesão e o tempo de uso dos antirretrovirais (p=0,018), orientação sexual (p=0,024) e número de filhos (p=0,029). Conclusão: os coinfectados apresentaram adesão inadequada aos antirretrovirais, fato que repercute de modo negativo nas condições de saúde das pessoas que vivem com a coinfecção HIV/tuberculose. Constatou-se correlação estatisticamente significante entre os níveis de adesão e algumas características sociodemográficas e clínicas.Objective: assess the adherence levels to antiretroviral therapy in people coinfected with HIV/tuberculosis and correlate these levels with the sociodemographic and clinical variables of the study population. Method: cross-sectional study involving 74 male and female adults coinfected with HIV/tuberculosis. For the data collection, a sociodemographic and clinical assessment form and the Antiretroviral Treatment Adherence Assessment Questionnaire were used. For the data analysis, the software STATA version 11 was used, through descriptive statistics, Fisher's chi-square exact test and the probability test. Results: men were predominant (79.7%), between 30 and 39 years of age (35.1%), low income (75.7%) and pulmonary tuberculosis (71.6%). Adherence to antiretroviral therapy was inappropriate in 78.1% of the men; 61.0% of single people; 47.0% unemployed and 76.5% among people gaining less than one minimum wage. A significant difference was observed between compliance and length of use of antiretrovirals (p=0.018), sexual orientation (p=0.024) and number of children (p=0.029). Conclusion: the coinfected patients presented inappropriate adherence to the antiretrovirals, a fact that negatively affects the health conditions of the people living with HIV/tuberculosis coinfection. A statistically significant correlation was found between the levels of adherence and some sociodemographic and clinical characteristics

Validação da versão brasileira da escala de religiosidade de Duke (DUREL)

BACKGROUND: There is a shortage of validated instruments for the study of religiousness in Brazilian samples. A recent study in a community sample pointed to an adequate validity for the Brazilian Portuguese version of the Duke Religiosity Index (P-DUREL). Nevertheless, no study to date has investigated the psychometric properties of the P-DUREL in psychiatric and/or university student samples. OBJECTIVE: To determine the internal consistency, the test-retest reliability and the convergent-discriminant validity of the P-DUREL in two distinct samples. METHODS: Sample 1: university students (n = 323). Sample 2: psychiatric patients (n = 102). The P-DUREL and the World Health Organization's Quality of Life Instrument—Spirituality, Religion and Personal Beliefs module (WHOQOL-SRPB); psychological distress symptoms were measured by means the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI) in sample 1, and the Hospital Anxiety and Depression Scale (HADS) in sample 2. RESULTS: The P-DUREL had adequate internal consistency (Cronbach's α > 0.80) and test-retest reliability (Intraclass Correlation Coefficient > 0.90) in both samples. Moderate correlations (0.58 < r < 0.71) between the P-DUREL subscales were observed. Furthermore, significant correlations between the P-DUREL scores with the general WHOQOL-SRPB scores as well as with psychological distress symptoms measures were observed in both samples. DISCUSSION: The present study opens perspective for the use of P-DUREL for the investigation of religiousness dimensions in Brazilian samples with diverse socio-demographic backgrounds.CONTEXTO: Há escassez de instrumentos validados para o estudo da religiosidade em amostras brasileiras. Um recente estudo realizado em uma amostra comunitária sugeriu adequada validade para a versão em português brasileiro do índice de Religiosidade de Duke (P-DUREL). Entretanto, as propriedades psicométricas do P-DUREL não foram estudadas em amostras psiquiátricas e/ou de estudantes universitários. OBJETIVO: Determinar a consistência interna, a confiabilidade teste-reteste e a validade convergente-discriminante do P-DUREL em duas amostras distintas. MÉTODOS: Amostra 1: estudantes universitários (n = 323). Amostra 2: pacientes psiquiátricos (n = 102). Foram aplicados o P-DUREL e o Instrumento de Qualidade de Vida da Organização Mundial da Saúde - Módulo Espiritualidade, Religiosidade e Crenças Pessoais (WHOQOL-SRPB) em ambas as amostras; os sintomas psicológicos foram medidos por meio do Inventário Beck de Depressão (IDB) e do Inventário Beck de Ansiedade (IAB) na amostra 1 e da Escala Hospitalar de Ansiedade e Depressão (HADS) na amostra 2. RESULTADOS: O P-DUREL teve adequada consistência interna (α de Cronbach > 0,80) e confiabilidade teste-reteste (Coeficiente de Correlação Intraclasse > 0,90) em ambas as amostras. Correlações moderadas entre as subescalas da P-DUREL (0,58 < r < 0,71) foram observadas. Além disso, correlações significantes entre os escores do P-DUREL com o escore geral do WHOQOL-SRPB, bem como com medidas de sintomas psicológicos, foram observadas em ambas as amostras. CONCLUSÃO: O presente estudo abre perspectivas para o uso do P-DUREL para a investigação das dimensões da religiosidade em amostras brasileiras com características sociodemográficas diversas

Validity of the Brazilian version of the Duke Religious Index (DUREL)

CONTEXTO: Há escassez de instrumentos validados para o estudo da religiosidade em amostras brasileiras. Um recente estudo realizado em uma amostra comunitária sugeriu adequada validade para a versão em português brasileiro do índice de Religiosidade de Duke (P-DUREL). Entretanto, as propriedades psicométricas do P-DUREL não foram estudadas em amostras psiquiátricas e/ou de estudantes universitários. OBJETIVO: Determinar a consistência interna, a confiabilidade teste-reteste e a validade convergente-discriminante do P-DUREL em duas amostras distintas. MÉTODOS: Amostra 1: estudantes universitários (n = 323). Amostra 2: pacientes psiquiátricos (n = 102). Foram aplicados o P-DUREL e o Instrumento de Qualidade de Vida da Organização Mundial da Saúde - Módulo Espiritualidade, Religiosidade e Crenças Pessoais (WHOQOL-SRPB) em ambas as amostras; os sintomas psicológicos foram medidos por meio do Inventário Beck de Depressão (IDB) e do Inventário Beck de Ansiedade (IAB) na amostra 1 e da Escala Hospitalar de Ansiedade e Depressão (HADS) na amostra 2. RESULTADOS: O P-DUREL teve adequada consistência interna (&#945; de Cronbach &gt; 0,80) e confiabilidade teste-reteste (Coeficiente de Correlação Intraclasse &gt; 0,90) em ambas as amostras. Correlações moderadas entre as subescalas da P-DUREL (0,58 < r < 0,71) foram observadas. Além disso, correlações significantes entre os escores do P-DUREL com o escore geral do WHOQOL-SRPB, bem como com medidas de sintomas psicológicos, foram observadas em ambas as amostras. CONCLUSÃO: O presente estudo abre perspectivas para o uso do P-DUREL para a investigação das dimensões da religiosidade em amostras brasileiras com características sociodemográficas diversas.BACKGROUND: There is a shortage of validated instruments for the study of religiousness in Brazilian samples. A recent study in a community sample pointed to an adequate validity for the Brazilian Portuguese version of the Duke Religiosity Index (P-DUREL). Nevertheless, no study to date has investigated the psychometric properties of the P-DUREL in psychiatric and/or university student samples. OBJECTIVE: To determine the internal consistency, the test-retest reliability and the convergent-discriminant validity of the P-DUREL in two distinct samples. METHODS: Sample 1: university students (n = 323). Sample 2: psychiatric patients (n = 102). The P-DUREL and the World Health Organization's Quality of Life Instrument-Spirituality, Religion and Personal Beliefs module (WHOQOL-SRPB); psychological distress symptoms were measured by means the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI) in sample 1, and the Hospital Anxiety and Depression Scale (HADS) in sample 2. RESULTS: The P-DUREL had adequate internal consistency (Cronbach's &#945; &gt; 0.80) and test-retest reliability (Intraclass Correlation Coefficient &gt; 0.90) in both samples. Moderate correlations (0.58 < r < 0.71) between the P-DUREL subscales were observed. Furthermore, significant correlations between the P-DUREL scores with the general WHOQOL-SRPB scores as well as with psychological distress symptoms measures were observed in both samples. DISCUSSION: The present study opens perspective for the use of P-DUREL for the investigation of religiousness dimensions in Brazilian samples with diverse socio-demographic backgrounds

Com o diabo no corpo: os terríveis papagaios do Brasil colônia

Desde a Antiguidade, papagaios, periquitos e afins (Psittacidae) fascinaram os europeus por seu vivo colorido e uma notável capacidade de interação com seres humanos. A descoberta do Novo Mundo nada faria além de acrescentar novos elementos ao tráfico de animais exóticos há muito estabelecido pelos europeus com a África e o Oriente. Sem possuir grandes mamíferos, a América tropical participaria desse comércio com o que tinha de mais atrativo, essencialmente felinos, primatas e aves - em particular os papagaios, os quais eram embarcados em bom número. Contudo, a julgar pelos documentos do Brasil colônia, esses voláteis podiam inspirar muito pouca simpatia, pois nenhum outro animal - exceto as formigas - foi tantas vezes mencionado como praga para a agricultura. Além disso, alguns psitácidas mostravam-se tão loquazes que inspiravam a séria desconfiança de serem animais demoníacos ou possessos, pois só três classes de entidades - anjos, homens e demônios - possuíam o dom da palavra. Nos dias de hoje, vários representantes dos Psittacidae ainda constituem uma ameaça para a agricultura, enquanto os indivíduos muito faladores continuam despertando a suspeita de estarem possuídos pelo demônio. Transcendendo a mera curiosidade, essa crença exemplifica o quão intrincadas podem ser as relações do homem com o chamado “mundo natural”, revelando um universo mais amplo e multifacetado do que se poderia supor a princípio. Nesse sentido, a existência de aves capazes de falar torna essa relação ainda mais complexa e evidencia que as dificuldades de estabelecer o limite entre o animal e o humano se estendem além dos primatas e envolvem as mais inusitadas espécies zoológicas.Since ancient times, parrots and their allies (Psittacidae) have fascinated Europeans by their striking colors and notable ability to interact with human beings. The discovery of the New World added new species to the international exotic animal trade, which for many centuries had brought beasts to Europe from Africa and the Orient. Lacking large mammals, tropical America participated in this trade with its most appealing species, essentially felines, primates and birds - especially parrots - which were shipped in large numbers. It should be noted, however, that at times these birds were not well liked. In fact, according to documents from colonial Brazil, only the ants rank higher than parrots as the animals most often mentioned as agricultural pests. On the other hand, some of these birds were so chatty that people suspected them to be demonic or possessed animals, since only three classes of beings - angels, men and demons - have the ability to speak. Nowadays, several Psittacidae still constitute a threat to agriculture, and the suspicion that extremely talkative birds were demon possessed has also survived. More than a joke or a mere curiosity, this belief exemplifies how intricate man’s relationships with the “natural world” may be. In this sense, the existence of birds that are able to speak adds a further twist to these relationships, demonstrating that the problem of establishing a boundary between the animal and the human does not only involve primates, but also includes some unusual zoological species

Termite sensitivity to temperature affects global wood decay rates.

Deadwood is a large global carbon store with its store size partially determined by biotic decay. Microbial wood decay rates are known to respond to changing temperature and precipitation. Termites are also important decomposers in the tropics but are less well studied. An understanding of their climate sensitivities is needed to estimate climate change effects on wood carbon pools. Using data from 133 sites spanning six continents, we found that termite wood discovery and consumption were highly sensitive to temperature (with decay increasing >6.8 times per 10°C increase in temperature)-even more so than microbes. Termite decay effects were greatest in tropical seasonal forests, tropical savannas, and subtropical deserts. With tropicalization (i.e., warming shifts to tropical climates), termite wood decay will likely increase as termites access more of Earth's surface

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants

Background Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. Methods We used data from 1990 to 2019 on people aged 30–79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. Findings The number of people aged 30–79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306–359) million women and 317 (292–344) million men in 1990 to 626 (584–668) million women and 652 (604–698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55–62) of women and 49% (46–52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43–51) of women and 38% (35–41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20–27) for women and 18% (16–21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. Interpretation Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions