Identification of primary care patients at risk of nonadherence to antidepressant treatment

Ann-Charlotte Åkerblad1, Finn Bengtsson2, Margareta Holgersson3, Lars von Knorring1, Lisa Ekselius11Department of Neuroscience, Psychiatry, Uppsala University Hospital, Uppsala University, Uppsala, Sweden; 2Division of Clinical Pharmacology, Medicine and Care, Faculty of Health Sciences, Linköping University, Linköping, Sweden; 3Quintiles AB, Uppsala, SwedenIntroduction: Poor adherence to antidepressant treatment is common, and results in increased disability and costs. Several factors are thought to influence patients’ ability and willingness to adhere. So far, however, consensus is lacking regarding patient characteristics that predict nonadherence. The purpose of this study was to identify predictors of nonadherence to antidepressant treatment that can be ascertained at treatment start.Method: The present study used data from a randomized controlled trial with the main objective of studying the effect of two different compliance-enhancing programs on treatment adherence and treatment response in 1031 primary care patients with major depression. In this study, logistic regression analyses were performed to examine patient- and illness-related characteristics potentially associated with nonadherence.Results: Nonadherence to antidepressant treatment was predicted by age under 35 or over 64 years, presence of personality disorder, sensation-seeking personality traits, substance abuse, and absence of concomitant medications.Conclusion: Certain patient- and illness-related characteristics may imply an increased risk of nonadherence to antidepressant treatment. Giving special attention to subjects with such characteristics may improve adherence.Keywords: unipolar depression, antidepressant, adherence, compliance, SSRI, predictor

Innan staden drunknar

Genom användningen av fossila bränslen har klimatet förändrats, vilket bland annat resulterat i ökad risk för skyfall. De kraftiga skyfall som inträffat de senaste åren har inneburit förödande konsekvenser med flertalet dödsoffer och svåra skador på infrastruktur. Översvämningar i källare, viadukter och av viktiga samhällsfunktioner innebär stora kostnader för samhället och för den enskilda individen. I takt med att fler människor flyttar till städerna skapar förtätningen mer hårdgjorda ytor som inte kan infiltrera nederbörd, vilket förstärker problematiken vid kraftiga regn. Den tidigare hanteringen av nederbörd har bestått av att leda vattnet i rör under mark, vilket begränsat mängden vatten ledningen kan ta emot. Genom att frigöra plats för vattnet ovan mark kan ledningsnätet avlastas och översvämningsrisken minskas. Vattnet kan då kontrollerat ledas till grönytor och tilltänkta översvämningsplatser. Grönblå lösningar innebär inte enbart att regnvatten tas omhand utan även att vattnet renas och inte belastar reningsverk. Dessa lösningar ger dessutom möjligheter att skapa attraktiva platser i staden. De upplevelsemässiga värdena är viktiga för att en plats ska användas och uppskattas. Tillgänglighet, trygghet, rumslighet och estetik är viktiga faktorer för att skapa offentliga miljöer där människor vill vistas. Genom att ta hänsyn till dessa upplevelsemässiga värdena kan en attraktiv utemiljö skapas. Syftet med studien har varit att skapa intresse och medvetenhet kring hur anpassning till skyfall kan ske samtidigt som de upplevelsemässiga värdena tillgodoses. Studien har resulterat i ett gestaltningsförslag som ska visa hur skyfallshanterande lösningar och upplevelsemässiga värden kan integreras för att skapa trivsamma miljöer som samtidigt kan bidra till ett samhälle rustat för dagens och framtidens skyfallsutmaningar. Resultatet visade särskilt på vikten av att öka medvetenheten kring skyfallslösningar genom att synliggöra vattnet i det offentliga rummet och att med hjälp av exempelvis skyltning skapa positiva associationer till vatten i det urbana landskapet. Gestaltningsförslaget har även skapat förutsättningar för att öka ekosystemtjänsterna i området. Genom att bland annat öka mängden vegetation, belysning, öppet vatten och nya gångstråk förhöjs de upplevelsemässiga värdena i området.Due to the use of fossil fuels the climate has changed which, among other things, has led to an increase in risk of extreme cloudbursts. The extreme rainfalls that have occurred in recent years have led to devestating consequences such as many deaths and severe damage to infrastructure. Floods in basements, viaducts and important societal functions means high costs both to society and the people living there. As more people move to cities, the densification creates more hardened surfaces that cannot infiltrate precipitation, which enhances the problem of heavy rainfall. Historically water has been taken care of in underground pipes, which limits the amount of water the pipe can receive. By making space for water on the ground, the pipe network can be relieved and the flood risk reduced. The water can then be led in a controlled way to green areas and areas that are intended to get flooded. Green-blue solutions not only take care of the rainwater, but also purifies and eases the burden of underground pipes, as well as creating attractive environments in the city. For a place to be used and appreciated, the experiential values are important. Accessibility, security, spaciousness and aesthetics are important factors in creating public environments where people want to stay. By taking these experiential values into account, an attractive outdoor environment can be created. The purpose of the study has been to create interest and awareness of how adaptation to cloudbursts can be managed at the same time as the experiential values are met. The study has resulted in a design proposal that will show how rainfall management solutions and experiential values can be integrated to create pleasant environments that can also contribute to a society adapted to today’s and future rainfall challenges. The results showed in particular the importance of raising awareness of rainfall solutions by making the water visible in the public space and, with the help of signs, for example, creating positive associations with water in the urban landscape. The design proposal has also created opportunities for increasing ecosystem services in the area. By, among other things, enhancing the amount of vegetation, lighting, open water and new walkways, the experiential values in the area are increased

Effects of the ICE-T Microphysics Scheme in HARMONIE-AROME on Estimated Ice Loads on Transmission Lines

In-cloud icing can cause damage to infrastructure and is challenging to forecast due to lack of a good representation of supercooled liquid water (SLW) in numerical weather prediction (NWP) models. We validate the new microphysics scheme, ICE-T, implemented into the NWP model HARMONIE-AROME, in full 3D simulations running over a 3 month period from December 1st 2016 to February 28th 2017. Output from the model simulations are first compared with conventional observations to evaluate the overall quality, and then used as input to an ice accretion model (IAM) and compared against measured ice loads at the two test sites Hardingnuten and Ålvikfjellet. The results show a clear shift towards more cloud water and snow, and less graupel and cloud ice. This shift leads to less precipitation along the coast and more inland. The estimated ice loads based on the cloud water from the simulations are generally increased. We also focus on two different icing events during January 9–18 and February 1–14. During the first event, both the run in its original configuration and the run with ICE-T overestimated the ice loads, while the second event was underestimated. For Ålvikfjellet ICE-T gives the best estimates, while for Hardingnuten the ice loads are overestimated when the wind direction is from the southeast. This is due to local terrain shielding not captured by the model. During the Feb 1–14 event, the wind direction was generally easterly, which makes comparison between the simulations and the observations more reliable. In this case, ICE-T gives a better ice load estimate. Although there are major uncertainties, especially concerning the number concentration of cloud droplets, and local terrain effects, ICE-T appears to give a better estimate of the ice loads.publishedVersio

Improving the representation of supercooled liquid water in the HARMONIE-AROME weather forecast model

A realistic representation of mixed-phase clouds in weather and climate models is essential to accurately simulate the model&rsquo;s radiative balance and water cycle. In addition, it is important for providing downstream applications with physically realistic model data for computation of, for instance, atmospheric icing on societal infrastructure and aircraft. An important quantity for forecasts of atmospheric icing is to model accurately supercooled liquid water (SLW). In this study, we implement elements from the Thompson cloud microphysics scheme into the numerical weather prediction model HARMONIE-AROME, with the aim to improve its ability to predict SLW. We conduct an idealised process-level evaluation of microphysical processes, and analyse the water phase budget of clouds and precipitation to compare the modified and original schemes, and also identify the processes with the most impact to form SLW. Two idealised cases representing orographic lift and freezing drizzle, both known to generate significant amounts of SLW, are setup in a 1&thinsp;D column version of HARMONIE-AROME. The experiments show that the amount of SLW is largely sensitive to the ice initiation processes, snow and graupel collection of cloud water, and the rain size distribution. There is a doubling of the cloud water maximum mixing ratio, in addition to a prolonged existence of SLW, with the modified scheme compared with the original scheme. The spatial and temporal extent of cloud ice and snow are reduced, due to stricter conditions for ice nucleation. The findings are important as the HARMONIE-AROME models is used for operational forecasting in many countries in northern Europe having a colder climate, as well as for climate assessments over the Arctic region.</p

Antibiotic Resistance in Escherichia coli from Pigs in Organic and Conventional Farming in Four European Countries

Organic pig production differs in many ways from conventional production of pigs, e.g., in antibiotic use, herd structure, feeding regimes, access to outdoor areas and space allowance per pig. This study investigated if these differences result in a lower occurrence of antibiotic resistance in organic slaughter pigs in Denmark, France, Italy and Sweden. Samples were taken from the colon content and/or faeces and minimum inhibitory concentrations (MIC) of ten antibiotics were determined in isolates of Escherichia coli. In addition, the proportion of tetracycline (TET) resistant E. coli in colon content and/or faeces from individual pigs was determined. In all four countries the percentage resistance to ampicillin, streptomycin, sulphonamides or trimethoprim was significantly lower in E. coli from organic pigs. In France and Italy, the percentage of isolates resistant to chloramphenicol, ciprofloxacin, nalidixic acid or gentamicin was also significantly lower in the E. coli from organic pigs. Resistance to cefotaxime, was not found in any country. The percentage of E. coli isolates resistant to TET as well as the proportion of TET-resistant E. coli was significantly lower in organic than in conventional pigs, except in Sweden where TET-resistance was equally low in both production types. There were also differences between countries within production type in the percentage resistance to individual antibiotics as well as the proportion of TET-resistant E. coli with lower median proportions in Sweden and Denmark compared to France and Italy. The study shows that in each of the four countries resistance in intestinal E. coli was less common in organic than in conventional pigs, but that there were also large differences in resistance between countries within each production type, indicating that both country- and production-specific factors influence the occurrence of resistance

A Stochastic Parameterization of Organized Tropical Convection Using Cellular Automata for Global Forecasts in NOAA's Unified Forecast System

In the atmosphere, convection can organize from smaller scale updrafts into more coherent structures on various scales. In bulk-plume cumulus convection parameterizations, this type of organization has to be represented in terms of how the resolved flow would &ldquo;feel&rdquo; convection if more coherent structures were present on the subgrid. This type of subgrid organization acts as building blocks for larger scale tropical convective organization known to modulate local and remote weather. In this work a parameterization for subgrid (and cross-grid) organization in a bulk-plume convection scheme is proposed using the stochastic, self-organizing, properties of cellular automata (CA). We investigate the effects of using a CA which can interact with three different components of the bulk-plume scheme that modulate convective activity: entrainment, triggering, and closure. The impacts of the revised schemes are studied in terms of the model's ability to organize convectively coupled equatorial waves (CCEWs). The differing impacts of adopting the stochastic CA scheme, as compared to the widely used Stochastically Perturbed Physics Tendency (SPPT) scheme, are also assessed. Results show that with the CA scheme, precipitation is more spatially and temporally organized, and there is a systematic shift in equatorial wave phase speed not seen with SPPT. Previous studies have noted a linear relationship between Gross Moist Stability (GMS) and Kelvin wave phase speed. Analysis of GMS in this study shows an increase in Kelvin wave phase speed and an increase in GMS with the CA scheme, which is tied to a shift from large-scale precipitation to convective precipitation. </div

The effect on women's health of extending parental leave: a quasi-experimental registry-based cohort study

BACKGROUND: Parental leave policies have been hypothesized to benefit mothers' mental health. We assessed the impact of a 6-week extension of parental leave in Denmark on maternal mental health. METHODS: We linked individual-level data from Danish national registries on maternal sociodemographic characteristics and psychiatric diagnoses. A regression discontinuity design was applied to study the increase in parental leave duration after 26 March 1984. We included women who had given birth between 1 January 1981 and 31 December 1987. Our outcome was a first psychiatric diagnosis following the child's birth, ascertained as the first day of inpatient hospital admission for any psychiatric disorder. We presented cumulative incidences for the 30-year follow-up period and reported absolute risk differences between women eligible for the reform vs not, in 5-year intervals. RESULTS: In all, 291 152 women were followed up until 2017, death, emigration or date of first psychiatric diagnosis. The median follow-up time was 29.99 years, corresponding to 10 277 547 person-years at risk. The cumulative incidence of psychiatric diagnoses at 30 years of follow-up was 59.5 (95% CI: 57.4 to 61.6) per 1000 women in the ineligible group and 57.5 (95% CI: 55.6 to 59.4) in the eligible group. Eligible women took on average 32.85 additional days of parental leave (95% CI: 29.20 to 36.49) and had a lower probability of having a psychiatric diagnosis within 5 years [risk difference (RD): 2.4 fewer diagnoses per 1000 women, 95% CI: 1.5 to 3.2] and up to 20 years after the birth (RD: 2.3, 95% CI: 0.4 to 4.2). In subgroup analyses, the risk reduction was concentrated among low-educated, low-income and single women. CONCLUSIONS: Longer parental leave may confer mental health benefits to women, in particular to those from disadvantaged backgrounds