The 12-item WHO Disability Assessment Schedule II as an outcome measure for treatment of common mental disorders.

BACKGROUND: Common mental disorders (CMD) are among the most significant contributors to disability worldwide. Patient-reported disability outcomes should be included as a key metric in the comparative assessment of value across global mental health interventions. This study aims to evaluate the validity of a widely used, cross-cultural tool - the 12-item World Health Organization Disability Assessment Schedule II (WHODAS) - as a functional outcome measure for CMD treatment. METHODS: The study population includes 1024 participants with CMD enrolled in the MANAS trial in India. CMD was assessed using the Revised Clinical Interview Schedule (CIS-R). Disability was assessed using the 12-item WHODAS II plus a measure of disability days. This analysis presents the correlations between these disability items and CMD symptom severity at 2 months after enrollment (convergent validity) and the items' associations with CMD recovery 4 months later (external responsiveness). RESULTS: All items showed a positive correlation of disability with CMD symptom severity (p < 0.001). The WHODAS items of 'standing,' 'household responsibilities,' and 'emotional disturbance' explained the most variance in CMD symptom severity. Improvements in 'disability days,' 'emotional disturbance,' 'standing,' 'household responsibilities,' 'day-to-day work,' and 'concentrating' were significantly associated with CMD recovery over follow-up. CONCLUSIONS: Further research is recommended on a CMD-specific WHODAS subscale comprised of the six WHODAS items found to be most strongly associated with CMD severity and recovery. This shorter, CMD-specific disability subscale would critically serve as a common metric to compare intervention impact on patient-centered outcomes and, in turn, to allocate global mental health resources efficiently

Developments in circular external fixators: a review

Circular external fixators (CEFs) are successfully used in orthopedics owing to their highly favorable stiffness characteristics which promote distraction osteogenesis. Although there are different designs of external fixators, how these features produce optimal biomechanics through structural and component designs is not well known. Therefore, the aim of this study was to conduct a review on CEFs following the PRISMA statement. A search for relevant research articles was performed on Scopus and PubMed databases providing the related keywords. Furthermore, a patent search was conducted on the Google Patent database. 126 records were found to be eligible for the review. Different designs of CEFs were summarized and tabulated based on their specific features. A bibliometric analysis was also performed on the eligible research papers. Based on the findings, the developments of CEFs in terms of materials, automation, adjustment methods, component designs, wire-clamping, and performance evaluation have been extensively discussed. The trends of the CEF design and future directions are also discussed in this review. Significant research gaps include a lack of consideration towards ease of assembly, effective wire-clamping methods, and CEFs embedded with online patient-monitoring systems, among others. An apparent lack of research interest from low-middle and low-income countries was also identified

Síndrome Inflamatória Multissistémica em Crianças Associada a COVID-19 num Hospital de Nível III em Portugal

Introduction: Multisystem inflammatory syndrome in children (MIS-C) is a rare and severe manifestation of coronavirus disease 2019 (COVID-19). The aim of this study was to describe the characteristics of children with MIS-C admitted to a pediatric tertiary hospital in Portugal. Material and methods: Observational descriptive study of MIS-C patients admitted between April 2020 and April 2021. Demographic and clinical characteristics, diagnostic tests, and treatment data were collected. The diagnosis of MIS-C was based on the World Health Organization and Centers for Disease Control and Prevention criteria. Results: We reported 45 children with MIS-C. The median age was seven years (IQR 4 - 10 years) and 60.0% were previously healthy. SARS-CoV-2 infection was confirmed in 77.8% by RT-PCR or antibody testing for SARS-CoV-2, and in 73.3%, an epidemiological link was confirmed. All the patients had a fever and organ system involvement: hematologic (100%), cardiovascular (97.8%), gastrointestinal (97.8%), mucocutaneous (86.7%), respiratory (26.7%), neurologic (15.6%), and renal (13.3%) system. Neurological (p = 0.035) and respiratory (p = 0.035) involvement were observed in patients with a more severe presentation. There was a significant difference of medians when comparing disease severity groups, namely in the values of hemoglobin (p = 0.015), lymphocytes (p = 0.030), D-dimer (p = 0.019), albumin (p < 0.001), NT-proBNP (p = 0.005), ferritin (p = 0.048), CRP (p = 0.006), procalcitonin (p = 0.005) and IL-6 (p = 0.002). From the total number of children, 93.3% received intravenous immunoglobulin, 91.1% methylprednisolone, and one patient (2.2%) received anakinra. Thirteen patients (28.8%) required intensive care and there were no deaths. Of the 21 patients evaluated, 90.4% had reduction of exercise capacity and of the 15 patients who underwent cardiac magnetic resonance, 53.3% had sequelae of cardiac injury. Conclusion: We observed a large spectrum of disease presentation in a group of patients where most were previously healthy. A small percentage of patients (28.9%) had a severe presentation of the disease. MIS-C is a challenge in current clinical practice and its diagnosis requires a high level of clinical suspicion as the timely initiation of therapy is essential to prevent complications. However, there is no scientific consensus on the treatment and follow-up of these patients.info:eu-repo/semantics/publishedVersio

The body as a brand in social media : analyzing digital fitness influencers as product endorsers

New social actors have emerged with the social media. Among them, we highlighted the digital influencers, people who have millions of online followers, and induce them in favor or against products and brands to be consumed. Therefore, we aimed to analyze this endorsement process carried out by digital influencers in their online profiles, having as research field the fitness market that encourages people to evaluate and work tirelessly in their bodies. We used the Semiotic Image Analysis to investigate the postings of three Brazilian digital fitness influencers and identified four categories that configure the post format: body exposure, body extension, interaction between influencer and brand/product, and interaction between influencer and followers. By means of these categories, we identified that these influencers act as brand avatars, creating an intense link with these products, exposing their bodies in advertisements and extending the meanings of their good shape to endorsed goods and services

The effect of rural-to-urban migration on social capital and common mental disorders: PERU MIGRANT study

OBJECTIVE: This study aims to investigate whether there are differences in the prevalence of common mental disorders and social capital between migrant and non-migrant groups in Peru. METHODOLOGY: The PERU MIGRANT study is a cross-sectional study comprising three groups: an urban group from a shanty town in Lima; a rural group from a community in Ayacucho-Peru; and a migrant group originally from Ayacucho currently living in the same urban shanty town. Common mental disorders were assessed using the General Health Questionnaire (GHQ-12), and social capital was assessed using the Short Social Capital Assessment Tool (SASCAT). Poisson regression with robust standard errors was used to estimate prevalence ratios. RESULTS: The overall prevalence of common mental disorders was 39.4%; the highest prevalence was observed in the rural group. Similar patterns were observed for cognitive social capital and structural social capital. However after adjustment for sex, age, family income and education, all but one of the significant relationships was attenuated, suggesting that in this population migration per se does not impact on common mental health disorders or social capital. CONCLUSIONS: In the PERU MIGRANT study, we did not observe a difference in the prevalence of common mental disorders, cognitive and structural social capital between migrant and urban groups. This pattern of associations was also similar in rural and urban groups, except that a higher prevalence ratio of structural social capital was observed in the rural group

Validated Screening Tools for Common Mental Disorders in Low and Middle Income Countries: A Systematic Review

BACKGROUND: A wide range of screening tools are available to detect common mental disorders (CMDs), but few have been specifically developed for populations in low and middle income countries (LMIC). Cross-cultural application of a screening tool requires that its validity be assessed against a gold standard diagnostic interview. Validation studies of brief CMD screening tools have been conducted in several LMIC, but until now there has been no review of screening tools for all CMDs across all LMIC populations. METHODS: A systematic review with broad inclusion criteria was conducted, producing a comprehensive summary of brief CMD screening tools validated for use in LMIC populations. For each validation, the diagnostic odds ratio (DOR) was calculated as an easily comparable measure of screening tool validity. Average DOR results weighted by sample size were calculated for each screening tool, enabling us to make broad recommendations about best performing screening tools. RESULTS: 153 studies fulfilled our inclusion criteria. Because many studies validated two or more screening tools, this corresponded to 273 separate validations against gold standard diagnostic criteria. We found that the validity of every screening tool tested in multiple settings and populations varied between studies, highlighting the importance of local validation. Many of the best performing tools were purposely developed for a specific population; however, as these tools have only been validated in one study, it is not possible to draw broader conclusions about their applicability in other contexts. CONCLUSIONS: Of the tools that have been validated in multiple settings, the authors broadly recommend using the SRQ-20 to screen for general CMDs, the GHQ-12 for CMDs in populations with physical illness, the HADS-D for depressive disorders, the PHQ-9 for depressive disorders in populations with good literacy levels, the EPDS for perinatal depressive disorders, and the HADS-A for anxiety disorders. We recommend that, wherever possible, a chosen screening tool should be validated against a gold standard diagnostic assessment in the specific context in which it will be employed.Grand Challenges Canada EPPHZG35-10 http://www.grandchallenges.ca

Bridging Time Scales in Cellular Decision Making with a Stochastic Bistable Switch

Cellular transformations which involve a significant phenotypical change of the cell's state use bistable biochemical switches as underlying decision systems. In this work, we aim at linking cellular decisions taking place on a time scale of years to decades with the biochemical dynamics in signal transduction and gene regulation, occuring on a time scale of minutes to hours. We show that a stochastic bistable switch forms a viable biochemical mechanism to implement decision processes on long time scales. As a case study, the mechanism is applied to model the initiation of follicle growth in mammalian ovaries, where the physiological time scale of follicle pool depletion is on the order of the organism's lifespan. We construct a simple mathematical model for this process based on experimental evidence for the involved genetic mechanisms. Despite the underlying stochasticity, the proposed mechanism turns out to yield reliable behavior in large populations of cells subject to the considered decision process. Our model explains how the physiological time constant may emerge from the intrinsic stochasticity of the underlying gene regulatory network. Apart from ovarian follicles, the proposed mechanism may also be of relevance for other physiological systems where cells take binary decisions over a long time scale.Comment: 14 pages, 4 figure

MOBP and HIP1 in multiple system atrophy: new α‐synuclein partners in glial cytoplasmic inclusions implicated in the disease pathogenesis

Aims: MSA is a fatal neurodegenerative disease. Similar to Parkinson’s disease (PD), MSA is an α‐synucleinopathy, and its pathological hallmark consists of glial cytoplasmic inclusions (GCIs) containing α‐synuclein in oligodendrocytes. We previously identified consistent changes in MOBP and HIP1 DNA methylation status in MSA. We hypothesized that if differential DNA methylation at these loci is mechanistically relevant for MSA, it should have downstream consequences on gene regulation. / Methods: We investigated the relationship between MOBP and HIP1 DNA methylation and mRNA levels in cerebellar white matter from MSA and healthy controls. Additionally, we analysed protein expression using western blotting, immunohistochemistry and proximity ligation assays. / Results: We found decreased MOBP mRNA levels significantly correlated with increased DNA methylation in MSA. For HIP1, we found a distinct relationship between DNA methylation and gene expression levels in MSA compared to healthy controls, suggesting this locus may be subjected to epigenetic remodelling in MSA. Although soluble protein levels for MOBP and HIP1 in cerebellar white matter were not significantly different between MSA cases and controls, we found striking differences between MSA and other neurodegenerative diseases, including PD and Huntington’s disease. We also found that MOBP and HIP1 are mislocalized into the GCIs in MSA, where they appear to interact with α‐synuclein. / Conclusions: This study supports a role for DNA methylation in downregulation of MOBP mRNA in MSA. Most importantly, the identification of MOBP and HIP1 as new constituents of GCIs emphasizes the relevance of these two loci to the pathogenesis of MSA