Hyperglycemia and diabetes in patients with schizophrenia or schizoaffective disorders

OBJECTIVE - Pharmacoepidemiological studies have shown an increased prevalence of diabetes in patients with schizophrenia. To address this issue, we decided to assess glucose metabolism in a population of patients With schizophrenia or schizoaffective disorder.RESEARCH DESIGN AND METHODS - Oral glucose tolerance tests (OGTTs) were performed in 200 unselected in- and outpatients. Insulin sensitivity and beta-cell function were assessed using the homeostasis model assessment (HOMA) indexes and 30-min glucose and insulin levels.RESULTS - The mainly Western European (87.7%) study population had a mean age of 40.8 years, was 70% male, and had a mean fasting glucose of 5.1 mmol/l and a mean fasting insulin of 1.4.8 mU/l. Hvperglycemia was present in 7% of the population: 1.5% with impaired fasting glucose and 5.5% with impaired glucose tolerance. The prevalence of diabetes was 14.5%, of which 8% was previously known and 6.5% was newly diagnosed. Compared with a 1.5% prevalence of diabetes in the age-matched general Dutch population, the prevalence of identified cases was significantly increased in the Study population. Comparable figures on the prevalence of hyperglycemia in the general population are not available. Insulin resistance was increased in the stud), population as a whole (HOMA of insulin resistance: 3.1-3.5), irrespective of the use of antipsychotic medication and, if used, irrespective of its type (typical or atypical). No indication of beta-cell defect was found, whereas a nonsignificant increased insulin resistance was found With antipsychotic medication.CONCLUSIONS - OGTTs in 200 mainly Caucasian patients with schizophrenia or schizoaffective disorder, mean age 41 years, showed that 7% suffered from hyperglycemia and 14.5% from diabetes. The prevalence of diabetes was significantly increased compared with the general population. No differential effect of antipsychotic monotherapy in diabetogenic effects was found. Therefore, a modification of the consensus statement on antipsychotic drugs, obesity, and diabetes is proposed, i.e., measurement of fasting glucose in all patients with schizophrenia, irrespective of prescribed antipsychotic drug.</p

Skewness Issues in Quantifying Efficiency : Insights from Stochastic Frontier Panel Models Based on Closed Skew Normal Approximations

Typically, the inefficiency term in stochastic frontier models is assumed to be positively skewed; however, efficiency scores are biased if this assumption is violated. This paper considers the case in which negative skewness is also allowed in the model. The paper discusses estimation of a stochastic frontier panel model with unobserved fixed effects without having to identify additional parameters that determine skewness of inefficiency. On the one hand, the parameters can be estimated via integrating out nuisance parameters by means of marginal maximum likelihood. On the other hand, we propose an approximation based on closed skew normal distributions, which turns out to be sufficiently accurate for maximum likelihood estimation. Simulations assess the finite sample performance of estimators and show that all model parameters and efficiency scores can be estimated consistently regardless of positive or negative inefficiency skewness. An empirical analysis to unravel inefficiencies in the German healthcare system demonstrates the practical relevance of the model

Efficacy and Safety of Pars Plana Vitrectomy for Primary Symptomatic Floaters:A Systematic Review with Meta-Analyses

Introduction: This study aimed to determine the efficacy and safety of pars plana vitrectomy (PPV) as treatment for patients with primary symptomatic vitreous floaters. Methods: We searched 12 databases for studies performing PPV for primary symptomatic vitreous floaters with at least 3 months follow-up. Two authors reviewed the studies and extracted data. Our main outcome of interest was patient satisfaction/reduction of symptoms/quality of life, but other measures of efficacy and safety were also extracted. Where possible, meta-analyses were performed to provide summary estimates. Results: We identified 18 eligible studies, which included 2077 eyes of 1789 patients. Studies reported that at least 90% of the patients were satisfied or had relief of symptoms. Best corrected visual acuity improved − 0.08 logMAR (95% CI − 0.10 to − 0.06 logMAR, P &lt; 0.0001). Contrast sensitivity improved − 2.26% (95% CI − 3.26 to − 1.26%, P &lt; 0.0001). After surgery, cataract occurred in 31.7% (95% CI 21.7–42.7%), retinal tears/breaks in 2.92% (95% CI 1.38–4.97%), vitreous hemorrhage in 1.97% (95% CI 0.83–3.54%), macular edema in 1.70% (95% CI 0.84–2.83%), retinal detachment in 1.54% (95% CI 0.62–2.82%), glaucoma in 1.04% (95% CI 0.53–1.73%), and endophthalmitis in 0.18% (95% CI 0.02–0.45%). Conclusions: Postoperative patient satisfaction is high after PPV for primary symptomatic vitreous floaters. However, the patient should be carefully counselled as what to expect from the treatment and understand the risks associated with PPV.</p

Modern dilemma in the therapy of the schizophrenia: neurocognition and social cognition

Recent research data make it evident that the last generations of antypsychotics being successful in elimination of the positive psychotic symptoms still seem to be incapable to sufficiently lower exacerbation frequency and to improve social functioning. The primary reason for that is considered to be an insufficient response of the patients’ cognitive deficit to the action of antipsychotics. The importance to differentiate between neurocognition and social cognition in view of the schizophrenia treatment general strategy optimization is discussed

The development of spontaneous facial responses to others’ emotions in infancy. An EMG study

Viewing facial expressions often evokes facial responses in the observer. These spontaneous facial reactions (SFRs) are believed to play an important role for social interactions. However, their developmental trajectory and the underlying neurocognitive mechanisms are still little understood. In the current study, 4- and 7-month old infants were presented with facial expressions of happiness, anger, and fear. Electromyography (EMG) was used to measure activation in muscles relevant for forming these expressions: zygomaticus major (smiling), corrugator supercilii (frowning), and frontalis (forehead raising). The results indicated no selective activation of the facial muscles for the expressions in 4-month-old infants. For 7-month-old infants, evidence for selective facial reactions was found especially for happy faces (leading to increased zygomaticus major activation) and fearful faces (leading to increased frontalis activation), while angry faces did not show a clear differential response. This suggests that emotional SFRs may be the result of complex neurocognitive mechanisms which lead to partial mimicry but are also likely to be influenced by evaluative processes. Such mechanisms seem to undergo important developments at least until the second half of the first year of life

Procesevaluatie observatieafdelingen Teylingereind

The two Units started up in 2009. The first unit carries out clinical observations on juvenile suspects for the purpose of decision diagnostic assessment, while the second unit performs clinical observations for the purpose of treatmen diagnostic assessment of juvenile delinquents on whom an 'institutional placement order' has been imposed. The central question of the process evaluation was: What is the background, the goal, the working method and the current functioning of the observation units in Teylingereind and is there an understanding of (measurement of)  the degree to which the goals of the units are achieved?In Forensisch Centrum Teylingereind, een particuliere, gesloten justitiële jeugdinrichting in Sassenheim, zijn in de loop van 2009 twee observatieafdelingen geopend. Eén ter observatie van potentiële PIJ-jongeren in het kader van de Pro Justitia rapportage, en één ter observatie van jongeren die al in de PIJ verblijven maar waarbij de behandeling stagneert of waar advies nodig is over verlenging. De gedachte achter de observatieafdelingen is dat jongeren door plaatsing op de observatieafdelingen sneller op de juiste plaats terechtkomen, en dat daarmee effectievere behandeling van jongeren mogelijk zou zijn. Dit onderzoek heeft betrekking op de procesevaluatie. De hoofdvraag van deze evaluatie is: Wat is de achtergrond, het doel, de werkwijze en de huidige werking van de observatieafdelingen in Teylingereind en bestaat er zicht op (meting van) de mate waarin de doelen van de afdelingen worden bereikt? INHOUD: 1. Inleiding 2. Methode 3. Resultaten fase 1: Achtergrond, doelen en werkwijze observatieafdelingen 4. Resultaten fase 2: De huidige werking van de observatieafdelingen 5. Resultaten fase 3: Ervaringen van gebruikers en het vervolgtraject 6. Conclusies en aandachtspunten voor verdere implementatie 7. Referentie

Stigma in patients with mental disorders- its manifestations and consequences

Inspite of the problems of sigma being widely discussed, there still continue the attempts to understand the ways and factors producing the self-stigmatizing and mechanisms obtruding the involvement of self-stigmatized patients into the treatment process. In the present study there took part 66 in-patients with severe mental disorders. There were used the questionnaire of self-stigmatizing, devaluation/discrimination part of the experienced stigmatizing questionnaire and motivation for treatment rating scale. Detected some significant factors in producing the self-stigmatizing and influence of the implicit self-stigmatizing, the severeness of which results in the development of the explicit self-stigmatization, which destruct the motivation for treatment

Rapid ecosystem-scale consequences of acute deoxygenation on a Caribbean coral reef

Loss of oxygen in the global ocean is accelerating due to climate change and eutrophication, but how acute deoxygenation events affect tropical marine ecosystems remains poorly understood. Here we integrate analyses of coral reef benthic communities with microbial community sequencing to show how a deoxygenation event rapidly altered benthic community composition and microbial assemblages in a shallow tropical reef ecosystem. Conditions associated with the event precipitated coral bleaching and mass mortality, causing a 50% loss of live coral and a shift in the benthic community that persisted a year later. Conversely, the unique taxonomic and functional profile of hypoxia-associated microbes rapidly reverted to a normoxic assemblage one month after the event. The decoupling of ecological trajectories among these major functional groups following an acute event emphasizes the need to incorporate deoxygenation as an emerging stressor into coral reef research and management plans to combat escalating threats to reef persistence

Rapid ecosystem-scale consequences of acute deoxygenation on a Caribbean coral reef

© The Author(s), 2021. This article is distributed under the terms of the Creative Commons Attribution License. The definitive version was published in Johnson, M. D., Scott, J. J., Leray, M., Lucey, N., Bravo, L. M. R., Wied, W. L., & Altieri, A. H. Rapid ecosystem-scale consequences of acute deoxygenation on a Caribbean coral reef. Nature Communications, 12(1), (2021): 4522, https://doi.org/10.1038/s41467-021-24777-3.Loss of oxygen in the global ocean is accelerating due to climate change and eutrophication, but how acute deoxygenation events affect tropical marine ecosystems remains poorly understood. Here we integrate analyses of coral reef benthic communities with microbial community sequencing to show how a deoxygenation event rapidly altered benthic community composition and microbial assemblages in a shallow tropical reef ecosystem. Conditions associated with the event precipitated coral bleaching and mass mortality, causing a 50% loss of live coral and a shift in the benthic community that persisted a year later. Conversely, the unique taxonomic and functional profile of hypoxia-associated microbes rapidly reverted to a normoxic assemblage one month after the event. The decoupling of ecological trajectories among these major functional groups following an acute event emphasizes the need to incorporate deoxygenation as an emerging stressor into coral reef research and management plans to combat escalating threats to reef persistence.M.D.J. was funded by postdoctoral fellow awards from the Smithsonian Institution’s Marine Global Earth Observatory (MarineGEO) and the Smithsonian Tropical Research Institute (STRI); M.L. and N.L. were funded by postdoctoral support from the STRI Office of Fellowships. J.J.S. was funded by a grant from the Gordon and Betty Moore Foundation awarded to STRI and UC Davis (doi:10.37807/GBMF5603). L.M.R.B., W.L.W., and A.H.A. were supported by MarineGEO, a private funder, and STRI funds to A.H.A. Many of the computations were conducted on the Smithsonian High-Performance Cluster (SI/HPC), Smithsonian Institution (doi:10.25572/SIHPC). We thank Rachel Collin for facilities support at the Bocas del Toro Research Station, Plinio Gondola and the research station staff for logistical support, Roman Barco for insight into the functional analyses, Sherly Castro for informative feedback, and Mike Fox for assistance with community analyses. Research permits were provided by the Autoridad Nacional del Ambiente de Panamá. This paper is the result of research funded by the National Oceanic and Atmospheric Administration’s National Centers for Coastal Ocean Science Competitive Research Program under award NA18NOS4780170 to A.H.A. and M.D.J. through the University of Florida. This is contribution 257 from the Coastal Hypoxia Research Program and 86 from the Smithsonian’s MarineGEO and Tennenbaum Marine Observatories Network