Early clinical predictors and correlates of long-term morbidity in bipolar disorder

OBJECTIVES: Identifying factors predictive of long-term morbidity should improve clinical planning limiting disability and mortality associated with bipolar disorder (BD). METHODS: We analyzed factors associated with total, depressive and mania-related long-term morbidity and their ratio D/M, as %-time ill between a first-lifetime major affective episode and last follow-up of 207 BD subjects. Bivariate comparisons were followed by multivariable linear regression modeling. RESULTS: Total % of months ill during follow-up was greater in 96 BD-II (40.2%) than 111 BD-I subjects (28.4%; P=0.001). Time in depression averaged 26.1% in BD-II and 14.3% in BD-I, whereas mania-related morbidity was similar in both, averaging 13.9%. Their ratio D/M was 3.7-fold greater in BD-II than BD-I (5.74 vs. 1.96; P<0.0001). Predictive factors independently associated with total %-time ill were: [a] BD-II diagnosis, [b] longer prodrome from antecedents to first affective episode, and [c] any psychiatric comorbidity. Associated with %-time depressed were: [a] BD-II diagnosis, [b] any antecedent psychiatric syndrome, [c] psychiatric comorbidity, and [d] agitated/psychotic depressive first affective episode. Associated with %-time in mania-like illness were: [a] fewer years ill and [b] (hypo)manic first affective episode. The long-term D/M morbidity ratio was associated with: [a] anxious temperament, [b] depressive first episode, and [c] BD-II diagnosis. CONCLUSIONS: Long-term depressive greatly exceeded mania-like morbidity in BD patients. BD-II subjects spent 42% more time ill overall, with a 3.7-times greater D/M morbidity ratio, than BD-I. More time depressed was predicted by agitated/psychotic initial depressive episodes, psychiatric comorbidity, and BD-II diagnosis. Longer prodrome and any antecedent psychiatric syndrome were respectively associated with total and depressive morbidity

Melancholia agitata and mixed depression

OBJECTIVE: The diagnostic entity of major depressive episode includes both simple and agitated or mixed depression. Mixed depression is characterized by a full depressive episode with several symptoms of excitatory nature. Mixed depressions worsen if treated with antidepressants. METHOD: We have reviewed the clinical charts of the 2141 patients treated at the Centro Lucio Bini of Rome from January 1999 to June 2006. These patients were diagnosed according to DSM-IV criteria. Research diagnostic criteria were applied for agitated depression with motor agitation and Author's diagnostic criteria for agitated depression without motor agitation. RESULTS: One thousand and twenty-six patients had a depressive episode as index episode. Three hundred and forty six (33%) were mixed depressive states. One hundred and thirty eight (44%) of them were spontaneous; in 173 cases, the onset of the mixed depression was associated with antidepressants. CONCLUSION: Psychic and motor agitation are considered equally important for the definition of agitated depression. Treating agitated depression with antidepressants worsens the clinical picture. The use of Electroconvulsive Therapy (ECT), neuroleptics and anticonvulsants are recommended. The term Melancholia Agitata is proposed for agitated (mixed) depression

Deterrence of online child sexual abuse and exploitation

Abstract ‘Cyberspace’ has added a dimension to the ecology of the child and should be a starting point for practitioners (including police) to think about digital media in the context of child sexual abuse. While there is no evidence to suggest that online abuse and exploitation is a more serious offence than crimes occurring offline, the behaviours enabled by social media may present a significant risk factor for some children. This article gives a brief overview of the phenomena and prevalence of online child sexual abuse and exploitation and the role that the Internet may play. This is considered in relation to deterrence, prevention and management of these crimes, and further develops a public health approach to online child abuse and exploitation. Finally, the article critically considers emerging evidence to support this interaction between the individual and the online environment.</jats:p

Integrated Marketing Communications: Pushing the Boundaries through Digital Technologies

The evolving nature of Digital Technologies and the continuous diffusion and adoption of innovative technological tools and applications, provide challenging research and business opportunities. Following these evolutions, this study explores the role of Digital Technologies in Integrated Marketing Communications (IMC) in the context of Strategic Marketing Planning. The paper briefly presents the latest developments in the field of IMC through a technological perspective and reviews the dynamics and features of three major technologies (Chatbots, Quick Response codes and Augmented and Virtual Reality) as promising tools and methods for effectively applying IMC initiatives. The paper attempts to provide an initial argumentation regarding the role of these technologies in the design and implementation of IMC. Implications for research and practice are provided throughout the paper

Καταγραφή και αξιολόγηση εκπαιδευτικών αναγκών των πιστοποιημένων εκπαιδευτών του εκπαιδευτικού προγράμματος Pre Hospital Trauma Life Support – PHTLS στην Ελλάδα

Σε μια εποχή όπου η εξειδικευμένη γνώση βελτιώνει σημαντικά το προσδοκώμενο αποτέλεσμα, η στοχευμένη εκπαίδευση κατέχει σημαντική θέση στον σχεδιασμό μοντέλων εκπαίδευσης. Σκοπός της παρούσας μελέτης αποτελεί η καταγραφή και η αξιολόγηση των πιστοποιημένων εκπαιδευτών του Pre Hospital Trauma Life Support – PHTLS ως πιστοποιημένου εκπαιδευτικού προγράμματος της National Association of Emergency Medical Technician – NAEMT στην Ελλάδα. Αρχικά θα διεξαχθεί μια αδρή περιγραφή της προ – νοσοκομειακής φροντίδας και της αναγκαιότητας δημιουργίας στοχευμένων πιστοποιημένων εκπαιδευτικών προγραμμάτων, ανατρέχοντας στην διεθνή βιβλιογραφία, αναλύοντας και προβάλλοντας τις ανάγκες, όπως αυτές έχουν πλέον διαμορφωθεί. Στην συνέχεια περιγράφοντας τον τρόπο υλοποίησης του εκπαιδευτικού προγράμματος PHTLS καθώς και της διαδικασίας επιλογής των νέων εκπαιδευτών, θα αναλυθεί η πρόοδος και η εξέλιξη της διαδικασίας στοχεύοντας στην βελτίωση τους ποσοστού επιβίωσης των κρίσιμων αιφνιδίως ασθενών μέσω της τεχνογνωσίας που αποκομίζετε από την πιστοποιημένη εκπαίδευση. Στα πλαίσια της διπλωματικής αυτής διαμορφώθηκε ένα ερωτηματολόγιο, το οποίο σχεδιάστηκε εξ’ ολοκλήρου και αποκλειστικά για τους εν ενεργεία πιστοποιημένους εκπαιδευτές του PHTLS στην Ελλάδα, προκειμένου να χαρτογραφηθεί το εκπαιδευτικό και επαγγελματικό τους προφίλ. Στη συνέχεια με έναν ερευνητικό συσχετισμό ποιοτικών και ποσοτικών δεικτών, θα τεκμηριωθεί αφ’ ενός πως μπορεί η στοχευμένη εκπαιδευτική δραστηριότητα του PHTLS να βελτιώσει το επίπεδο γνώσεων των πιστοποιημένων εκπαιδευτών και αφ’ ετέρου πως αυτή η ενέργεια θα επηρεάσει την βελτίωση της παροχής προ – νοσοκομειακής φροντίδας στην Ελλάδα. Απώτερος σκοπός της παρούσας διπλωματικής εργασίας είναι η συμβολή της στην βελτίωση του σχεδιασμού των νεότερων εκπαιδευτικών προγραμμάτων που θα επηρεάσουν σημαντικά την ποιότητα παροχής υπηρεσιών προ – νοσοκομειακής φροντίδας σε βαρέως πάσχοντες ασθενείς.At a time when specialized knowledge is significantly improving the expected result, targeted education holds an important place in the design of educational models. The purpose of this study is to record and evaluate certified trainers of Pre Hospital Trauma Life Support - PHTLS as a certified training program of the National Association of Emergency Medical Technician - NAEMT in Greece. Initially, a rough description of pre-hospital care and the need to create targeted certified educational programs will be conducted, looking back at the international literature, analyzing and projecting the needs as they have now been shaped. Then, describing the implementation of the PHTLS training program and the process of selecting new trainers, the progress and development of the process will be analyzed, aiming to improve the survival rate of critical sudden patients through the know-how you gain from certified training. In the framework of this diploma, a questionnaire was developed, which was designed entirely and exclusively for the currently certified PHTLS instructors in Greece, in order to map their educational and professional profile. Then, with a research correlation between qualitative and quantitative indicators, it will be documented on the one hand that the targeted educational activity of PHTLS can improve the level of knowledge of certified trainers and on the other hand that this action will improve the provision of pre-hospital care. in GREECE. The ultimate goal of this dissertation is to improve the design of newer educational programs that will significantly affect the quality of pre-hospital care services for critically ill patients

Accessibility in digital health : virtual conversational agents and mental health services

Recent advances in Artificial Intelligence have led changes to the operation, the capabilities and the performance of a number of industries. Provision of Mental Health Services is expected to experience a paradigm shift, with the introduction of Artificial Intelligence-driven Virtual Conversational Agents (VCAs). This is a conceptual paper, focusing on the use of Personalised Anthropomorphic VCAs (PAVCAs), which we introduce as a term. We suggest the use of PAVCAs to support people suffering from Prolonged Grief Disorder (PGD). For such an application to be able to drive meaningful change for the users and to deliver economic value and utility, we argue that the PAVCAs are configured to the known and public characteristics (e.g. personal linguistic peculiarities, moral principles, stated tastes and preferences across a range of themes) of the users beloved deceased ones. Such digital services aim to offer to service users solace, comfort and companion. We explore the options of having such applications personalized pre-mortem or post-mortem, and the source for information being affected by data limitations. Using two models, we suggest that the use of these platforms can comprise a reactive approach to the diagnosis of PGD; as well as a proactive approach, dealing with grief before PDG is manifested

Deterrents to viewing indecent images of children online:A protocol for a meta-narrative review

BACKGROUND: Evidence indicates that the viewing of indecent images of children (IIOC) has increased due to the emergence of, and increased access to, the Internet. Over the last 20 years there has been a high level of collaboration between various stakeholders to prevent and restrict access to IIOC. Nevertheless, there is no comprehensive review of these approaches or their effect as deterrents to viewing IIOC. METHODS/DESIGN: This paper presents a protocol for a meta narrative review of the deterrents to viewing indecent images of children (IIOC) online. The meta narrative review methodology allows researchers to systematically identify and review different understandings, or narratives, of a subject across a range of disciplines, with the aim of synthesising this diverse literature and providing recommendations to researchers, practitioners and policymakers. We outline the authors’ approach to the review, focusing on six methodological steps: planning the review scope, questions and outputs, systematic searching of academic and grey literature, mapping the identified articles according to disciplines and their narratives, appraising the evidence within narratives, then synthesising the conceptualisations and evidence from the different disciplines to generate overarching narratives and recommendations to stakeholders. DISCUSSION: The discussion considers the anticipated benefits and challenges of conducting the review, and makes recommendations for other researchers embarking on this type of review