Clinical management and burden of bipolar disorder: a multinational longitudinal study (WAVE-bd Study)

BACKGROUND: Studies in bipolar disorder (BD) to date are limited in their ability to provide a whole-disease perspective--their scope has generally been confined to a single disease phase and/or a specific treatment. Moreover, most clinical trials have focused on the manic phase of disease, and not on depression, which is associated with the greatest disease burden. There are few longitudinal studies covering both types of patients with BD (I and II) and the whole course of the disease, regardless of patients' symptomatology. Therefore, the Wide AmbispectiVE study of the clinical management and burden of Bipolar Disorder (WAVE-bd) (NCT01062607) aims to provide reliable information on the management of patients with BD in daily clinical practice. It also seeks to determine factors influencing clinical outcomes and resource use in relation to the management of BD. METHODS: WAVE-bd is a multinational, multicentre, non-interventional, longitudinal study. Approximately 3000 patients diagnosed with BD type I or II with at least one mood event in the preceding 12 months were recruited at centres in Austria, Belgium, Brazil, France, Germany, Portugal, Romania, Turkey, Ukraine and Venezuela. Site selection methodology aimed to provide a balanced cross-section of patients cared for by different types of providers of medical aid (e.g. academic hospitals, private practices) in each country. Target recruitment percentages were derived either from scientific publications or from expert panels in each participating country. The minimum follow-up period will be 12 months, with a maximum of 27 months, taking into account the retrospective and the prospective parts of the study. Data on demographics, diagnosis, medical history, clinical management, clinical and functional outcomes (CGI-BP and FAST scales), adherence to treatment (DAI-10 scale and Medication Possession Ratio), quality of life (EQ-5D scale), healthcare resources, and caregiver burden (BAS scale) will be collected. Descriptive analysis with common statistics will be performed. DISCUSSION: This study will provide detailed descriptions of the management of BD in different countries, particularly in terms of clinical outcomes and resources used. Thus, it should provide psychiatrists with reliable and up-to-date information about those factors associated with different management patterns of BD. TRIAL REGISTRATION NO: ClinicalTrials.gov: NCT01062607.

Eugeniamyia dispar em pitangueira: parasitoides associados, dinâmica populacional e distribuição de galhas na planta

A pitangueira Eugenia uniflora L. (Myrtaceae) é uma frutífera nativa da América do Sul, podendo ser encontrada em quase todo o território brasileiro, bem como no Paraguai, no Uruguai e na Argentina. Nas folhas dessa planta, são encontradas galhas induzidas por Eugeniamyia dispar (Diptera: Cecidomyiidae). O objetivo deste trabalho foi determinar os parasitoides associados a E. dispar, a dinâmica populacional de E. dispar e dos parasitoides e a distribuição de galhas na planta. Ramos e folhas foram coletados quinzenalmente, durante as safras agrícolas de 2007/2008 e 2008/2009, em pomares de pitangueira localizados no município de Pelotas-RS, e transportados para o laboratório para a contagem do número de galhas. Do material coletado, foram individualizadas dez folhas em recipientes plásticos (200 mL) contendo 30 mL de uma solução à base de ágar-água (2%) e metilpara-hidroxibenzoato (nipagin) (0,2%). Os recipientes foram fechados e mantidos sob condições controladas de temperatura (24±2ºC), umidade relativa (70±10%) e fotofase (14h), sendo registrado, diariamente, o número de insetos emergidos. Obteve-se uma espécie de Hymenoptera, Rileya hegeli (Eurytomidae), como parasitoide de E. dispar. Quanto à dinâmica populacional de E. dispar e de R. hegeli, foi observado, nos dois anos de avaliação, que a população de ambos aumentou a partir de outubro, atingindo as maiores populações nos meses de dezembro, janeiro e fevereiro, decrescendo posteriormente. O número de galhas por folha variou de zero a 23, sendo que 61,19% das folhas apresentavam de uma a oito galhas e que o número de folhas com galhas por ramo variou de uma a nove, sendo que 63,00% dos ramos apresentaram de uma a três folhas infestadas.

Distribuição de raízes de bananeira 'Prata-Anã' no segundo ciclo de produção sob três sistemas de irrigação

A informação da distribuição radicular de uma planta permite definir áreas do solo ao redor desta, mais propícia para aplicação de fertilizantes e instalação de sensores de umidade, para melhor monitoramento da irrigação. O presente trabalho teve como objetivo avaliar a distribuição do sistema radicular de bananeira 'Prata-Anã', sob diferentes sistemas de irrigação, durante o segundo ciclo de produção. O delineamento experimental foi em blocos casualizados, com parcelas subdivididas, com três repetições, em que as fontes de variação se constituíram de três sistemas de irrigação (gotejamento, microaspersão e aspersão convencional), seis distâncias da planta (0,15; 0,30; 0,45; 0,60; 0,75 e 1,00 m) e cinco camadas do solo (0,0 - 0,20; 0,20 - 0,40; 0,40- 0,60; 0,60 - 0,80 e 0,80-1,00 m). A bananeira apresentou maior predominância do sistema radicular próxima à superfície do solo, com 80% deste a 0,61 m, 0,51 m e 0,61 m e à distância efetiva de 0,63 m, 0,66 m e 0,79 m do pseudocaule da planta, para os sistemas de irrigação por gotejamento, microaspersão e aspersão convencional, respectivamente. Em geral, predominaram as raízes com diâmetros inferiores a 2 mm, em toda a zona radicular avaliada. As raízes com maior diâmetro tenderam a concentrar-se próximo ao pseudocaule da planta com profundidades inferiores a 0,40 m da superfície do solo.

Resposta das videiras a diferentes modos de distribuição de composto orgânico no solo

O trabalho objetivou avaliar o estado nutricional, a produção e a composição do mosto de uvas em videiras submetidas a diferentes modos de distribuição de composto orgânico no solo. O experimento foi conduzido em um vinhedo da cv. Cabernet Sauvignon, com plantas enxertadas sobre o porta-enxerto 'Paulsen 1103' em um solo Neossolo Litólico, em Bento Gonçalves (RS). Em agosto de 2006, foram implantados os tratamentos (T1) testemunha; (T2) aplicação de composto orgânico na superfície do solo sempre no mesmo lado da linha de plantio; (T3) aplicação de composto em lados alternados da linha de plantio ao longo dos anos; (T4) aplicação de composto em covas sempre do mesmo lado da linha de plantio, e (T5) aplicação de composto em covas em lados alternados na linha de plantio ao longo dos anos. Nas safras de 2006/2007, 2007/2008 e 2008/2009, os ramos da poda de inverno e o tecido da poda de verão foram secos e determinada a produção de matéria seca. Folhas completas foram coletadas, secas, moídas e submetidas à análise do teor total de N, P, K, Ca e Mg. Na maturação, foi contado o número de cachos e pesados, e, em seguida, bagas foram coletadas e determinados os valores de sólidos solúveis, pH, acidez titulável, ácido tartárico e málico. A distribuição de composto em covas sempre do mesmo lado da linha de plantio ou em lados alternados ao longo dos anos aumentou a quantidade de matéria seca dos ramos podados no inverno, especialmente, nas primeiras safras depois de sua aplicação. A aplicação e o modo de distribuição do composto na superfície do solo ou incorporado, anualmente no mesmo lado da linha de plantio ou alternado entre os lados ao longo dos anos, não afetaram a produção de uva, o estado nutricional e a composição do mosto, e, quando necessário, o composto orgânico deve ser aplicado na superfície do solo sem incorporação, em um mesmo lado da linha de plantio ou alternado entre os lados ao longo dos anos.

Longitudinal study of informed consent in innovative therapy research: experience and provisional recommendations from a multicenter trial of intracerebral grafting.

BACKGROUND: There is an urgent need to assess and improve the consent process in clinical trials of innovative therapies for neurodegenerative disorders. METHODS: We performed a longitudinal study of the consent of Huntington's disease patients during the Multicenter Fetal Cell Intracerebral Grafting Trial in Huntington's Disease (MIG-HD) in France and Belgium. Patients and their proxies completed a consent questionnaire at inclusion, before signing the consent form and after one year of follow-up, before randomization and transplantation. The questionnaire explored understanding of the protocol, satisfaction with the information delivered, reasons for participating in the trial and expectations regarding the transplant. Forty-six Huntington's disease patients and 27 proxies completed the questionnaire at inclusion, and 27 Huntington's disease patients and 16 proxies one year later. RESULTS: The comprehension score was high and similar for Huntington's disease patients and proxies at inclusion (72.6% vs 77.8%; P > 0.1) but only decreased in HD patients after one year. The information satisfaction score was high (73.5% vs 66.5%; P > 0.1) and correlated with understanding in both patients and proxies. The motivation and expectation profiles were similar in patients and proxies and remained unchanged after one year. CONCLUSIONS: Cognitively impaired patients with Huntington's disease were capable of consenting to participation in this trial. This consent procedure has presumably strengthened their understanding and should be proposed before signing the consent form in future gene or cell therapy trials for neurodegenerative disorders. Because of the potential cognitive decline, proxies should be designated as provisional surrogate decision-makers, even in competent patients.

Dynamic Criteria: a Longitudinal Analysis of Professional Basketball Players" Outcomes

This paper describes the fluctuations of temporal criteria dynamics in the context of professional sport. Specifically, we try to verify the underlying deterministic patterns in the outcomes of professional basketball players. We use a longitudinal approach based on the analysis of the outcomes of 94 basketball players over ten years, covering practically players" entire career development. Time series were analyzed with techniques derived from nonlinear dynamical systems theory. These techniques analyze the underlying patterns in outcomes without previous shape assumptions (linear or nonlinear). These techniques are capable of detecting an intermediate situation between randomness and determinism, called chaos. So they are very useful for the study of dynamic criteria in organizations. We have found most players (88.30%) have a deterministic pattern in their outcomes, and most cases are chaotic (81.92%). Players with chaotic patterns have higher outcomes than players with linear patterns. Moreover, players with power forward and center positions achieve better results than other players. The high number of chaotic patterns found suggests caution when appraising individual outcomes, when coaches try to find the appropriate combination of players to design a competitive team, and other personnel decisions. Management efforts must be made to assume this uncertainty.

Genetic origin of the relationship between parental negativity and behavior problems from early childhood to adolescence: A longitudinal genetically sensitive study.

Little is known about how genetic and environmental factors contribute to the association between parental negativity and behavior problems from early childhood to adolescence. The current study fitted a cross-lagged model in a sample consisting of 4,075 twin pairs to explore (a) the role of genetic and environmental factors in the relationship between parental negativity and behavior problems from age 4 to age 12, (b) whether parent-driven and child-driven processes independently explain the association, and (c) whether there are sex differences in this relationship. Both phenotypes showed substantial genetic influence at both ages. The concurrent overlap between them was mainly accounted for by genetic factors. Causal pathways representing stability of the phenotypes and parent-driven and child-driven effects significantly and independently account for the association. Significant but slight differences were found between males and females for parent-driven effects. These results were highly similar when general cognitive ability was added as a covariate. In summary, the longitudinal association between parental negativity and behavior problems seems to be bidirectional and mainly accounted for by genetic factors. Furthermore, child-driven effects were mainly genetically mediated, and parent-driven effects were a function of both genetic and shared-environmental factors.

DISTRIBUIÇÃO ESPACIAL DO BICHO-FURÃO,Gymnandrosoma aurantiana (Lima, 1927)(LEPIDOPTERA: TORTRICIDAE),EM CITROS UTILIZANDO GEOESTATÍSTICA

RESUMO O bicho-furão, Gymnandrosoma aurantiana (Lima, 1927), é uma das principais pragas da citricultura brasileira, pois os frutos atacados pelas lagartas tornam-se inviáveis para o consumo in natura e processamento industrial. Objetivou-se estudar a distribuição espacial dos danos causados por G. aurantiana utilizando geoestatística. Para tanto, foi conduzido um experimento em um pomar de laranjeira-doce da variedade ‘Valência’, enxertado sobre limoeiro ‘Cravo’, localizado em Taquaritinga-SP, Brasil. A área foi dividida em 88 parcelas, sendo cada parcela formada por 30 plantas dispostas em três linhas de 10 plantas, e em seguida foi obtido o número de frutos atacados para os anos de 2007 e 2008. A distribuição dos frutos atacados pela praga foi agregada ao longo das avaliações, com variância maior que a média para todas as amostragens. Os dados apresentaram ajuste adequado segundo o modelo esférico, e o alcance da dependência espacial (a) variou entre 40,66 e 135,40 m. A estimativa de frutos atacados nas áreas não amostradas foi obtida pela krigagem, e os principais focos da praga foram observados nas parcelas próximas aos limites da área experimental.

DISTRIBUIÇÃO POTENCIAL DE OLIVEIRAS NO BRASIL E NO MUNDO

RESUMO A demanda pelo azeite de oliva tem sido crescente no mundo, principalmente no Brasil,aumentando a necessidade de expansão da área de plantio. Contudo, nas regiões que são tradicionalmente produtoras, não existe mais espaço, havendo necessidade de procurar novas áreas para plantio no mundo. Neste trabalho, foram identificadas áreas marginais para plantio no Brasil, utilizando modelagem de nicho ecológico, baseando-se em pontos de ocorrência levantados nas regiões produtoras da Europa, Estados Unidos, Austrália e América Latina (Chile, Argentina e Uruguai). Foram usados 346 pontos georreferenciados de ocorrência e planos de informação com dados climáticos (média de temperatura mínima do ar, média de temperatura máxima do ar - em oC - e total de precipitação pluviométrica - em mm) estacionais (primavera, verão, outono e inverno) do mundo, baixados do site do Worldclim. Os dados foram organizados e formatados em sistemas de informações geográficas, usando ArcGIS 10. Finalmente, foram elaborados mapas com a probabilidade de ocorrência de oliveiras no mundo. Foi feito também um mapa apenas da América do Sul, em que são apresentadas as zonas com maior potencial de ocorrência de oliveiras.

Implantação de um mini-pacs (sistema de arquivamento e distribuição de imagens) em hospital universitário

Este trabalho apresenta a implementação de um mini-PACS (sistema de arquivamento e comunicação de imagens) que está sendo estruturado junto ao Serviço de Radiodiagnóstico do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, como parte do projeto de um serviço de radiologia digital ("filmless").

Stability and consistency of coping in adolescence: A longitudinal study

This study analyzed stability and consistency of coping among adolescents. The objectives were twofold: a) to analyze temporal stability and cross-situational consistency of coping responses after a 17- month interval, taking into account gender, age and type of stressor. b) To analyze the relative weight of contextual versus dispositional factors in predicting future coping. A cohort of 341 adolescents (51% girls and 49% boys aged between 12 and 16) were assessed twice by means of the Coping Responses Inventory - Youth. The results indicated that the coping responses were quite stable over time at the group level, but with important within-subject differences. Girls showed slightly more stability than boys. Among the girls, Avoidance coping showed as much stability as consistency and Approach coping showed more stability than consistency. Among the boys, Avoidance coping showed more stability than consistency, and Approach coping showed both low stability and low consistency. Among the boys, the coping used at Time 1 barely predicted that used at Time 2; in contrast, among the girls, the type of coping used in the past, especially Avoidance coping, predicted the coping that would be used in the future.

Cannabis use and other predictors of the onset of daily cigarette use in young men: what matters most? Results from a longitudinal study.

BACKGROUND: According to the gateway hypothesis, tobacco use is a gateway of cannabis use. However, there is increasing evidence that cannabis use also predicts the progression of tobacco use (reverse gateway hypothesis). Unfortunately, the importance of cannabis use compared to other predictors of tobacco use is less clear. The aim of this study was to examine which variables, in addition to cannabis use, best predict the onset of daily cigarette smoking in young men. METHODS: A total of 5,590 young Swiss men (mean age = 19.4 years, SD = 1.2) provided data on their substance use, socio-demographic background, religion, health, social context, and personality at baseline and after 18 months. We modelled the predictors of progression to daily cigarette smoking using logistic regression analyses (n = 4,230). RESULTS: In the multivariate overall model, use of cannabis remained among the strongest predictors for the onset of daily cigarette use. Daily cigarette use was also predicted by a lifetime use of at least 50 cigarettes, occasional cigarette use, educational level, religious affiliation, parental situation, peers with psychiatric problems, and sociability. CONCLUSIONS: Our results highlight the relevance of cannabis use compared to other potential predictors of the progression of tobacco use and thereby support the reverse gateway hypothesis.

New method for measuring longitudinal fuctuations and directed flow in ultrarelativistic heavy ion reactions

It has been shown in recent ALICE@LHC measurements that the odd flow harmonics, in particular, a directed flow v1, occurred to be weak and dominated by random fluctuations. In this work we propose a new method, which makes the measurements more sensitive to the flow patterns showing global collective symmetries. We demonstrate how the longitudinal center of mass rapidity fluctuations can be identified, and then the collective flow analysis can be performed in the event-by-event center of mass frame. Such a method can be very effective in separating the flow patterns originating from random fluctuations, and the flow patterns originating from the global symmetry of the initial state.

Pneumococcal polysaccharide vaccination in adults undergoing immunosuppressive treatment for inflammatory diseases - a longitudinal study.

INTRODUCTION: Patients undergoing immunosuppressive therapy are at increased risk of infection. Community-acquired pneumonia and invasive pneumococcal disease account for substantial morbidity and mortality in this population and may be prevented by vaccination. Ideally, immunization to pneumococcal antigens should take place before the start of immunosuppressive treatment. Often, however, the treatment cannot be delayed. Little is known about the efficacy of pneumococcal vaccines during immunosuppressive treatment. The objectives of this study were to determine the percentage of vaccine-naïve, immunosuppressed adults with inflammatory diseases seroprotected against Streptococcus pneumoniae and to assess factors associated with the immunogenicity, clinical impact and safety of 23-valent pneumococcal polysaccharide vaccine (PPV) in seronegative subjects. METHODS: This observational study included patients 18 years of age and older who were receiving prednisone ≥20 mg/day or other immunosuppressive drugs. Exclusion criteria were PPV administration in the previous 5 years, intravenous immunoglobulins and pregnancy. Serum immunoglobulin G (IgG) antibody levels against six pneumococcal serotypes were measured. Seropositivity was defined as IgG of 0.5 μg/ml or greater for at least four of six serotypes. Seronegative patients received PPV, and seropositive patients were included as a comparison group. Vaccine response and tolerance were assessed after 4-8 weeks. Disease activity was evaluated on the basis of the Physician Global Assessment scores. Serology was repeated after 1 year, and information on any kind of infection needing medical attention was collected. Outcomes were the proportion of seropositivity and infections between vaccinated and unvaccinated patients. RESULTS: Of 201 included patients, 35 received high-dose corticosteroids and 181 were given immunosuppressive drugs. Baseline seronegativity in 60 (30 %) patients was associated with corticotherapy and lower total IgG. After PPV, disease activity remained unchanged or decreased in 81 % of patients, and 87 % became seropositive. After 1 year, 67 % of vaccinated compared with 90 % of observed patients were seropositive (p < 0.001), whereas the rate of infections did not differ between groups. Those still taking prednisone ≥10 mg/day tended to have poorer serological responses and had significantly more infections. CONCLUSIONS: PPV was safe and moderately effective based on serological response. Seropositivity to pneumococcal antigens significantly reduced the risk of infections. Sustained high-dose corticosteroids were associated with poor vaccine response and more infections.