Detección de síntomas depresivos durante el postparto inmediato y el seguimiento a largo plazo: estabilidad temporal y factores asociados

Objetivos: describir la frecuencia de sintomatología depresiva compatible con el diagnóstico de depresión posparto durante el período perinatal, factores asociados y estabilidad temporal. Métodos: durante los años 2006-2007 fueron entrevistadas un total de 398 mujeres puérperas asistidas en el CEMIC, dentro de los 5 días posteriores al parto, utilizando la Escala de Depresión Posnatal de Edimburgo, así como un cuestionario socio-demográfico. Fue realizado un análisis de regresión logística a fin de identificar factores asociados a un screening positivo. Durante los 6-12 meses siguientes se realizó un seguimiento con dos grupos de similares características. Resultados: la frecuencia de sintomatología depresiva en el postparto inmediato fue de 17,8% (puntaje de corte = 10). Antecedentes depresivos y complicaciones en el recién nacido resultaron significativamente asociados con un screening positivo. De las 110 pacientes entrevistadas, 24 obtuvieron resultados positivos durante el seguimiento. Conclusión: la prevalencia de riesgo de sufrir depresión posparto en las pacientes encuestadas se encuentra dentro de los parámetros que reporta la literatura internacional. En un seguimiento en el período comprendido entre los 6 meses y los 12 meses posteriores al parto, resultaron positivas 6 mujeres asintomáticas en la primera evaluación. Se postula la existencia de cuadros de depresión posparto que se manifiestan hasta un año después del nacimiento.Aims: To describe the frequency of depressive symptoms compatible with a postpartum depression diagnosis, the associated factors and the temporal stability. Methods: During 2006-2007 398 hospitalized puerperal women who attended CEMIC were interviewed 5 days after childbirth using the Edinburg Postnatal Depression Scale and a socio-demographic questionnaire. A logistic regression analysis was performed to identify associated factors with a positive screening. During the following 6-12 months a follow up was carried with two groups of similar characteristics. Results: The frequency of depressive symptoms at post partum was 17.8% (cut off = 10). Depressive history and neonatal intensive care were significantly related to a positive screening. From the 110 interviewed women, 24 were positive in the follow-up. Conclusion: The prevalence of risk for postpartum depression in the sample of patients surveyed is within the parameters reported in international literature. At the 6 month follow up, 6 previously asymptomatic women during the first screening turned on positive. It is theorize the existence of potential postpartum depression cases that can manifest up to a year after childbirth.Fil: Rozic, Pablo R.. Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno"; ArgentinaFil: Schvartzman, Javier Alfonso. Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno"; ArgentinaFil: Paolini, Cynthia Inés. Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno"; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Gadow, Andrea. Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno"; ArgentinaFil: Calvo, Diego A.. Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno"; ArgentinaFil: Paesani, Fernando. Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno"; ArgentinaFil: Pieczanski, Pedro. Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno"; ArgentinaFil: Vázquez, Gustavo H.. Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno"; ArgentinaFil: Lolich, Maria. Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno"; Argentina. Universidad de Buenos Aires. Facultad de Psicología. Instituto de Investigaciones; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Krupitzki, Hugo Bernardo. Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno"; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Evenness mediates the global relationship between forest productivity and richness

1. Biodiversity is an important component of natural ecosystems, with higher species richness often correlating with an increase in ecosystem productivity. Yet, this relationship varies substantially across environments, typically becoming less pronounced at high levels of species richness. However, species richness alone cannot reflect all important properties of a community, including community evenness, which may mediate the relationship between biodiversity and productivity. If the evenness of a community correlates negatively with richness across forests globally, then a greater number of species may not always increase overall diversity and productivity of the system. Theoretical work and local empirical studies have shown that the effect of evenness on ecosystem functioning may be especially strong at high richness levels, yet the consistency of this remains untested at a global scale. 2. Here, we used a dataset of forests from across the globe, which includes composition, biomass accumulation and net primary productivity, to explore whether productivity correlates with community evenness and richness in a way that evenness appears to buffer the effect of richness. Specifically, we evaluated whether low levels of evenness in speciose communities correlate with the attenuation of the richness–productivity relationship. 3. We found that tree species richness and evenness are negatively correlated across forests globally, with highly speciose forests typically comprising a few dominant and many rare species. Furthermore, we found that the correlation between diversity and productivity changes with evenness: at low richness, uneven communities are more productive, while at high richness, even communities are more productive. 4. Synthesis. Collectively, these results demonstrate that evenness is an integral component of the relationship between biodiversity and productivity, and that the attenuating effect of richness on forest productivity might be partly explained by low evenness in speciose communities. Productivity generally increases with species richness, until reduced evenness limits the overall increases in community diversity. Our research suggests that evenness is a fundamental component of biodiversity–ecosystem function relationships, and is of critical importance for guiding conservation and sustainable ecosystem management decisions

European clinical guidelines for Tourette syndrome and other tic disorders. Part II: pharmacological treatment

To develop a European guideline on pharmacologic treatment of Tourette syndrome (TS) the available literature was thoroughly screened and extensively discussed by a working group of the European Society for the Study of Tourette syndrome (ESSTS). Although there are many more studies on pharmacotherapy of TS than on behavioral treatment options, only a limited number of studies meets rigorous quality criteria. Therefore, we have devised a two-stage approach. First, we present the highest level of evidence by reporting the findings of existing Cochrane reviews in this field. Subsequently, we provide the first comprehensive overview of all reports on pharmacological treatment options for TS through a MEDLINE, PubMed, and EMBASE search for all studies that document the effect of pharmacological treatment of TS and other tic disorders between 1970 and November 2010. We present a summary of the current consensus on pharmacological treatment options for TS in Europe to guide the clinician in daily practice. This summary is, however, rather a status quo of a clinically helpful but merely low evidence guideline, mainly driven by expert experience and opinion, since rigorous experimental studies are scarce

Enhanced Mechanical Properties in ED-Machinable Zirconia-Tungsten Carbide Composites with Yttria-Neodymia Co-Stabilized Zirconia Matrix

The electrical discharge machining-process (EDM) is a smart solution to optimize the manufacturing chain of customized and complex shaped ceramic components. To comply with the high requirements for the machine and mold design, it is necessary to improve the mechanical properties of ED-machinable ceramics. In this study, ceramic composites with a tetragonal zirconia matrix and tungsten carbide as electrically conductive dispersion were investigated. To improve the toughness of this high strength material, co-stabilized zirconia coated with yttria and neodymia as dopants were used in the compositions with 1.5/1.5 and 1.75/1.25 mol %. These recipes were compared to commercial 3Y-TZP as a reference matrix material combined with the same WC raw powder. The electrically conductive phase content was varied from 20 to 28 vol %. For all compositions, the ceramic blanks were hot pressed at identical dwell and pressure, but with various sintering temperatures (1300 °C to 1450 °C) and then tested with respect to the mechanical and electrical properties. By variation of the stabilizer system, a significantly higher toughness of up to 11.3 MPa√m compared to 5.3 MPa√m for 3Y-TZP-20WC is achieved while the bending strength stays at a comparable high level of >1500 MPa

Yttria Ceria Co-Stabilized Zirconia Reinforced with Alumina and Strontium Hexaaluminate

Zirconia materials are frequently used in dental applications due to their excellent strength and their tooth-like aspect. Standard yttria stabilized zirconia (Y-TZP) ceramics suffer, however, from moderate toughness and vulnerability to low-temperature degradation. In this study, 1Y6Ce-TZP materials reinforced with different amounts of alumina and/or strontium hexaaluminate were manufactured by slip casting and pressureless sintering at different temperatures to assess their mechanical properties, microstructure, phase composition, and low-temperature degradation stability. Results show that these materials exhibit a high fracture resistance of 10⁻12 MPa√m, a bending strength between 700⁻950 MPa, and a Vickers hardness of 1100⁻1200 HV10. Strontium hexaaluminate (SA6) precipitates were formed in situ by reaction of alumina and strontium zirconate. Although crack deflection at SA6 platelets was clearly visible, a net toughening was not observed. Accelerated ageing tests at 134 °C/3 bar water vapor pressure showed best results for mixed alumina/SA6 reinforcements and a sintering temperature of 1500 °C. Mehl-Avrami-Johnson plots used to describe the ageing kinetics showed clear indications of different ageing mechanisms due to the introduction of the SA6 phase

Compatibility of whole-stand and individual-tree models using composite estimators and disaggregation

a b s t r a c t This study presents a new approach in linking models with different levels of resolution. Data from 50 permanent sample plots installed in even-aged birch (Betula alba) dominated stands were used to develop both, a whole-stand growth model and an individual-tree model. In a first step, six disaggregation approaches to link number of trees per hectare with tree survival were combined with four disaggregation approaches to link stand basal area with tree basal area growth predictions. To analyze the effect of stand variable predictions on disaggregation estimates, two different methods to obtain these predictions were evaluated: (a) 1-fold cross-validation of the stand growth model and (b) a method involving composite estimators. Therefore, altogether 48 different approaches in linking models were analyzed in this first step. In a second step, two common methods based on the use of a threshold to translate the survival tree probabilities into a discrete event, i.e. dead or alive, were combined with the four disaggregation approaches to link stand basal area with tree basal area growth predictions and the two methods to obtain stand variable predictions. Therefore, altogether 16 different approaches in linking models were analyzed in this second step. Finally, the best combinations obtained in each step were compared. Regarding the disaggregation of predicted stand density, the approach based on considering the intercept of the logit function for tree survival as a specific parameter of each sample plot and optimizing its value produced the best results. Regarding the disaggregation of stand basal area among trees, the constrained least squares method was selected, since it showed the best results among four alternative approaches. The use of composite estimators instead of the 1-fold cross validation predictions improved the accuracy of both, tree survival and tree basal area estimates, although the differences were not significant. Finally, disaggregation approaches performed better than the methods based on the use of a threshold. The results show that the combination between composite estimators and disaggregation provided compatible and reliable predictions of stand density, tree survival, stand basal area and tree basal area. The main limitation of this new approach is the dependency of accurate stand growth predictions, therefore, it should be tested in future studies with more complicated stand structures, such as mixed and un-even aged forests, or to include the effect of silvicultural treatments

Detección de síntomas depresivos durante el postparto inmediato y el seguimiento a largo plazo: estabilidad temporal y factores asociados

Objetivos: describir la frecuencia de sintomatología depresiva compatible con el diagnóstico de depresión posparto durante el período perinatal, factores asociados y estabilidad temporal. Métodos: durante los años 2006-2007 fueron entrevistadas un total de 398 mujeres puérperas asistidas en el CEMIC, dentro de los 5 días posteriores al parto, utilizando la Escala de Depresión Posnatal de Edimburgo, así como un cuestionario socio-demográfico. Fue realizado un análisis de regresión logística a fin de identificar factores asociados a un screening positivo. Durante los 6-12 meses siguientes se realizó un seguimiento con dos grupos de similares características. Resultados: la frecuencia de sintomatología depresiva en el postparto inmediato fue de 17,8% (puntaje de corte = 10). Antecedentes depresivos y complicaciones en el recién nacido resultaron significativamente asociados con un screening positivo. De las 110 pacientes entrevistadas, 24 obtuvieron resultados positivos durante el seguimiento. Conclusión: la prevalencia de riesgo de sufrir depresión posparto en las pacientes encuestadas se encuentra dentro de los parámetros que reporta la literatura internacional. En un seguimiento en el período comprendido entre los 6 meses y los 12 meses posteriores al parto, resultaron positivas 6 mujeres asintomáticas en la primera evaluación. Se postula la existencia de cuadros de depresión posparto que se manifiestan hasta un año después del nacimiento.Aims: To describe the frequency of depressive symptoms compatible with a postpartum depression diagnosis, the associated factors and the temporal stability. Methods: During 2006-2007 398 hospitalized puerperal women who attended CEMIC were interviewed 5 days after childbirth using the Edinburg Postnatal Depression Scale and a socio-demographic questionnaire. A logistic regression analysis was performed to identify associated factors with a positive screening. During the following 6-12 months a follow up was carried with two groups of similar characteristics. Results: The frequency of depressive symptoms at post partum was 17.8% (cut off = 10). Depressive history and neonatal intensive care were significantly related to a positive screening. From the 110 interviewed women, 24 were positive in the follow-up. Conclusion: The prevalence of risk for postpartum depression in the sample of patients surveyed is within the parameters reported in international literature. At the 6 month follow up, 6 previously asymptomatic women during the first screening turned on positive. It is theorize the existence of potential postpartum depression cases that can manifest up to a year after childbirth.Fil: Rozic, Pablo R.. Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno"; ArgentinaFil: Schvartzman, Javier Alfonso. Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno"; ArgentinaFil: Paolini, Cynthia Inés. Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno"; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Gadow, Andrea. Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno"; ArgentinaFil: Calvo, Diego A.. Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno"; ArgentinaFil: Paesani, Fernando. Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno"; ArgentinaFil: Pieczanski, Pedro. Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno"; ArgentinaFil: Vázquez, Gustavo H.. Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno"; ArgentinaFil: Lolich, Maria. Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno"; Argentina. Universidad de Buenos Aires. Facultad de Psicología. Instituto de Investigaciones; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Krupitzki, Hugo Bernardo. Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno"; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Item Response Theory Analysis of ADHD Symptoms in Children With and Without ADHD

Item response theory (IRT) was separately applied to parent- and teacher-rated symptoms of attention-deficit/hyperactivity disorder (ADHD) from a pooled sample of 526 six- to twelve-year-old children with and without ADHD. The dimensional structure ADHD was first examined using confirmatory factor analyses, including the bifactor model. A general ADHD factor and two group factors, representing inattentive and hyperactive/impulsive dimensions, optimally fit the data. Using the graded response model, we estimated discrimination and location parameters and information functions for all 18 symptoms of ADHD. Parent- and teacher-rated symptoms demonstrated adequate discrimination and location values, although these estimates varied substantially. For parent ratings, the test information curve peaked between −2 and +2 SD, suggesting that ADHD symptoms exhibited excellent overall reliability at measuring children in the low to moderate range of the general ADHD factor, but not in the extreme ranges. Similar results emerged for teacher ratings, in which the peak range of measurement precision was from −1.40 to 1.90 SD. Several symptoms were comparatively more informative than others; for example, is often easily distracted (“Distracted”) was the most informative parent- and teacher-rated symptom across the latent trait continuum. Clinical implications for the assessment of ADHD as well as relevant considerations for future revisions to diagnostic criteria are discussed

Development of Alcohol and Drug Use in Youth With Manic Symptoms

OBJECTIVE: This analysis examined alcohol and drug use over a six-year follow-up of children in the Longitudinal Assessment of Manic Symptoms (LAMS) study. METHOD: LAMS screened 6- to 12.9-year-old children visiting 9 child outpatient mental health (MH) clinics, using the Parent General Behavior Inventory 10-item mania scale. All children with scores ≥12 and a matched group with scores ≤12 were invited to enroll. Children were assessed every 6 months. Assessments included demographics, family, MH history, child diagnoses, child stress, and alcohol and drug use. Univariate, bivariate, and interval censored survival analyses were conducted. RESULTS: Of those > 9 years at baseline, 34.9% used alcohol at least once with 11.9% regular users; 30.1% used drugs at least once with 16.2% regular users. Predictors of any alcohol use were parental marital status, older age at study entry, a primary diagnosis of disruptive behavior disorders at baseline, and number of impactful child life events. Predictors of regular alcohol use included parental marital status, age, and sustained high mania symptoms over the first 24 months of follow-up. Predictors of any drug use were single parent, parental substance use, and stressful child life events. Predictors of regular drug use were parental marital status, stressful child life events, and a baseline disruptive behavior disorder diagnosis. Baseline medications decreased the risk of regular drug use. CONCLUSION: Longitudinal data on youth with elevated manic symptoms suggest that comorbid disruptive behavior disorder, manic symptom burden, family environment, and stress are predictors of initiation and regular use of substances