Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 31
Filtrar
Mais filtros

País/Região como assunto
Tipo de documento
Intervalo de ano de publicação
1.
J Antimicrob Chemother ; 79(6): 1234-1247, 2024 06 03.
Artigo em Inglês | MEDLINE | ID: mdl-38507232

RESUMO

OBJECTIVES: To identify and assess the effectiveness of national antibiotic optimization interventions in primary and secondary care in England (2013-2022). METHODS: A systematic scoping review was conducted. Literature databases (Embase and Medline) were used to identify interventions and evaluations. Reports included the UK AMR Strategy (2013-2018), National Action Plan (2019-2024) and English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) reports (2014-2022). The design, focus and quality of evaluations and the interventions' effectiveness were extracted. FINDINGS: Four hundred and seventy-seven peer-reviewed studies and 13 reports were screened. One hundred and three studies were included for review, identifying 109 interventions in eight categories: policy and commissioning (n = 9); classifications (n = 1); guidance and toolkits (n = 22); monitoring and feedback (n = 17); professional engagement and training (n = 19); prescriber tools (n = 12); public awareness (n = 17); workforce and governance (n = 12).Most interventions lack high-quality effectiveness evidence. Evaluations mainly focused on clinical, microbiological or antibiotic use outcomes, or intervention implementation, often assessing how interventions were perceived to affect behaviour. Only 16 interventions had studies that quantified effects on prescribing, of which six reported reductions. The largest reduction was reported with structural-level interventions and attributed to a policy and commissioning intervention (primary care financial incentives). Behavioural interventions (guidance and toolkits) reported the greatest impact in hospitals. CONCLUSIONS: Many interventions have targeted antibiotic use, each pulling different levers across the health system simultaneously. On the basis of these studies, structural-level interventions may have the greatest impact. Collectively, the combination of interventions may explain England's decline in prescribing but direct evidence of causality is unavailable.


Assuntos
Antibacterianos , Gestão de Antimicrobianos , Política de Saúde , Inglaterra , Humanos , Antibacterianos/uso terapêutico , Atenção Primária à Saúde , Atenção Secundária à Saúde , Uso de Medicamentos/normas , Uso de Medicamentos/estatística & dados numéricos
2.
Bull World Health Organ ; 98(3): 177-187C, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-32132752

RESUMO

OBJECTIVE: To assess antibiotic availability and use in health facilities in low- and middle-income countries, using the service provision assessment and service availability and readiness assessment surveys. METHODS: We obtained data on antibiotic availability at 13 561 health facilities in 13 service provision assessment and 8 service availability and readiness assessment surveys. In 10 service provision assessment surveys, child consultations with health-care providers were observed, giving data on antibiotic use in 22 699 children. Antibiotics were classified as access, watch or reserve, according to the World Health Organization's AWaRe categories. The percentage of health-care facilities across countries with specific antibiotics available and the proportion of children receiving antibiotics for key clinical syndromes were estimated. FINDINGS: The surveys assessed the availability of 27 antibiotics (19 access, 7 watch, 1 unclassified). Co-trimoxazole and metronidazole were most widely available, being in stock at 89.5% (interquartile range, IQR: 11.6%) and 87.1% (IQR: 15.9%) of health facilities, respectively. In contrast, 17 other access and watch antibiotics were stocked, by fewer than a median of 50% of facilities. Of the 22 699 children observed, 60.1% (13 638) were prescribed antibiotics (mostly co-trimoxazole or amoxicillin). Children with respiratory conditions were most often prescribed antibiotics (76.1%; 8972/11 796) followed by undifferentiated fever (50.1%; 760/1518), diarrhoea (45.7%; 1293/2832) and malaria (30.3%; 352/1160). CONCLUSION: Routine health facility surveys provided a valuable data source on the availability and use of antibiotics in low- and middle-income countries. Many access antibiotics were unavailable in a majority of most health-care facilities.


Assuntos
Antibacterianos/provisão & distribuição , Infecções Bacterianas/tratamento farmacológico , Instalações de Saúde/estatística & dados numéricos , Serviços de Saúde/estatística & dados numéricos , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Países em Desenvolvimento , Humanos , Lactente , Organização Mundial da Saúde
3.
Circ Res ; 122(4): 555-559, 2018 02 16.
Artigo em Inglês | MEDLINE | ID: mdl-29298774

RESUMO

RATIONALE: The balance between vascular prostacyclin, which is antithrombotic, and platelet thromboxane A2, which is prothrombotic, is fundamental to cardiovascular health. Prostacyclin and thromboxane A2 are formed after the concerted actions of cPLA2α (cytosolic phospholipase A2) and COX (cyclooxygenase). Urinary 2,3-dinor-6-keto-PGF1α (PGI-M) and 11-dehydro-TXB2 (TX-M) have been taken as biomarkers of prostacyclin and thromboxane A2 formation within the circulation and used to explain COX biology and patient phenotypes, despite concerns that urinary PGI-M and TX-M originate in the kidney. OBJECTIVE: We report data from a remarkable patient carrying an extremely rare genetic mutation in cPLA2α, causing almost complete loss of prostacyclin and thromboxane A2, who was transplanted with a normal kidney resulting in an experimental scenario of whole-body cPLA2α knockout, kidney-specific knockin. By studying this patient, we can determine definitively the contribution of the kidney to the productions of PGI-M and TX-M and test their validity as markers of prostacyclin and thromboxane A2 in the circulation. METHODS AND RESULTS: Metabolites were measured using liquid chromatography-tandem mass spectrometry. Endothelial cells were grown from blood progenitors. Before kidney transplantation, the patient's endothelial cells and platelets released negligible levels of prostacyclin (measured as 6-keto-prostaglandin F1α) and thromboxane A2 (measured as TXB2), respectively. Likewise, the urinary levels of PGI-M and TX-M were very low. After transplantation and the establishment of normal renal function, the levels of PGI-M and TX-M in the patient's urine rose to within normal ranges, whereas endothelial production of prostacyclin and platelet production of thromboxane A2 remained negligible. CONCLUSIONS: These data show that PGI-M and TX-M can be derived exclusively from the kidney without contribution from prostacyclin made by endothelial cells or thromboxane A2 by platelets in the general circulation. Previous work relying on urinary metabolites of prostacyclin and thromboxane A2 as markers of whole-body endothelial and platelet function now requires reevaluation.


Assuntos
6-Cetoprostaglandina F1 alfa/análogos & derivados , Aloenxertos/metabolismo , Transplante de Rim , Rim/metabolismo , Mutação com Perda de Função , Fosfolipases A2 Citosólicas/genética , Tromboxano B2/análogos & derivados , 6-Cetoprostaglandina F1 alfa/metabolismo , 6-Cetoprostaglandina F1 alfa/urina , Biomarcadores/urina , Células Cultivadas , Feminino , Humanos , Pessoa de Meia-Idade , Fenótipo , Fosfolipases A2 Citosólicas/metabolismo , Prostaglandina-Endoperóxido Sintases/metabolismo , Tromboxano B2/metabolismo , Tromboxano B2/urina
4.
Arterioscler Thromb Vasc Biol ; 37(5): 949-956, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28279968

RESUMO

OBJECTIVE: Aspirin together with thienopyridine P2Y12 inhibitors, commonly clopidogrel, is a cornerstone of antiplatelet therapy. However, many patients receiving this therapy display high on-treatment platelet reactivity, which is a major therapeutic hurdle to the prevention of recurrent thrombotic events. The emergence of uninhibited platelets after thrombopoiesis has been proposed as a contributing factor to high on-treatment platelet reactivity. Here, we investigate the influences of platelet turnover on platelet aggregation in the face of different dual-antiplatelet therapy strategies. APPROACH AND RESULTS: Traditional light transmission aggregometry, cytometry, advanced flow cytometric imaging, and confocal microscopy were used to follow the interactions of populations of platelets from healthy volunteers and patients with stable cardiovascular disease. Newly formed, reticulated platelets overproportionately contributed to, and clustered at, the core of forming aggregates. This phenomenon was particularly observed in samples from patients treated with aspirin plus a thienopyridine, but was absent in samples taken from patients treated with aspirin plus ticagrelor. CONCLUSIONS: Reticulated platelets are more reactive than older platelets and act as seeds for the formation of platelet aggregates even in the presence of antiplatelet therapy. This is coherent with the emergence of an uninhibited subpopulation of reticulated platelets during treatment with aspirin plus thienopyridine, explained by the short pharmacokinetic half-lives of these drugs. This phenomenon is absent during treatment with ticagrelor, because of its longer half-life and ability to act as a circulating inhibitor. These data highlight the important influences of pharmacokinetics on antiplatelet drug efficacies, especially in diseases associated with increased platelet turnover.


Assuntos
Adenosina/análogos & derivados , Aspirina/farmacocinética , Plaquetas/efeitos dos fármacos , Doença da Artéria Coronariana/tratamento farmacológico , Inibidores da Agregação Plaquetária/farmacocinética , Antagonistas do Receptor Purinérgico P2Y/farmacocinética , Tienopiridinas/farmacocinética , Trombopoese , Adenosina/administração & dosagem , Adenosina/farmacocinética , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Aspirina/administração & dosagem , Plaquetas/metabolismo , Estudos de Casos e Controles , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/diagnóstico , Quimioterapia Combinada , Meia-Vida , Humanos , Masculino , Pessoa de Meia-Idade , Agregação Plaquetária/efeitos dos fármacos , Inibidores da Agregação Plaquetária/administração & dosagem , Testes de Função Plaquetária , Antagonistas do Receptor Purinérgico P2Y/administração & dosagem , Antagonistas do Receptor Purinérgico P2Y/efeitos adversos , Tienopiridinas/administração & dosagem , Ticagrelor , Adulto Jovem
5.
Platelets ; 29(2): 162-170, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28503981

RESUMO

Despite the interwoven nature of platelet activation and the coagulation system in thrombosis, few studies relate both analysis of protein and cellular parts of coagulation in the same population. In the present study, we use matched ex vivo samples to determine the influences of standard antiplatelet therapies on platelet function and use advanced rheological analyses to assess clot formation. Healthy volunteers were recruited following fully informed consent then treated for 7 days with single antiplatelet therapy of aspirin (75 mg) or prasugrel (10 mg) or with dual antiplatelet therapy (DAPT) using aspirin (75 mg) plus prasugrel (10 mg) or aspirin (75 mg) plus ticagrelor (90 mg). Blood samples were taken at day 0 before treatment and at day 7 following treatment. We found that aspirin plus prasugrel or aspirin plus ticagrelor inhibited platelet responses to multiple agonists and reduced P-selectin expression. Significant platelet inhibition was coupled with a reduction in fractal dimension corresponding to reductions in mean relative mass both for aspirin plus prasugrel (-35 ± 16% change, p = 0.04) and for aspirin plus ticagrelor (-45 ± 14% change, p = 0.04). Aspirin alone had no effect upon measures of clot structure, whereas prasugrel reduced fractal dimension and mean relative mass. These data demonstrate that platelets are important determinants of clot structure as assessed by fractal dimension (df) and that effective platelet inhibition is associated with a weaker, more permeable fibrin network. This indicates a strong association between the therapeutic benefits of antiplatelet therapies and their abilities to reduce thrombus density that may be useful in individual patients to determine the functional relationship between platelet reactivity, eventual clot quality, and clinical outcome. df could represent a novel risk stratification biomarker useful in individualizing antiplatelet therapies.


Assuntos
Coagulação Sanguínea/efeitos dos fármacos , Plaquetas/metabolismo , Ativação Plaquetária/efeitos dos fármacos , Trombose/metabolismo , Feminino , Fractais , Humanos , Masculino
6.
Circulation ; 131(7): 633-42, 2015 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-25492024

RESUMO

BACKGROUND: Cardiovascular side effects associated with cyclooxygenase-2 inhibitor drugs dominate clinical concern. Cyclooxygenase-2 is expressed in the renal medulla where inhibition causes fluid retention and increased blood pressure. However, the mechanisms linking cyclooxygenase-2 inhibition and cardiovascular events are unknown and no biomarkers have been identified. METHODS AND RESULTS: Transcriptome analysis of wild-type and cyclooxygenase-2(-/-) mouse tissues revealed 1 gene altered in the heart and aorta, but >1000 genes altered in the renal medulla, including those regulating the endogenous nitric oxide synthase inhibitors asymmetrical dimethylarginine (ADMA) and monomethyl-l-arginine. Cyclo-oxygenase-2(-/-) mice had increased plasma levels of ADMA and monomethyl-l-arginine and reduced endothelial nitric oxide responses. These genes and methylarginines were not similarly altered in mice lacking prostacyclin receptors. Wild-type mice or human volunteers taking cyclooxygenase-2 inhibitors also showed increased plasma ADMA. Endothelial nitric oxide is cardio-protective, reducing thrombosis and atherosclerosis. Consequently, increased ADMA is associated with cardiovascular disease. Thus, our study identifies ADMA as a biomarker and mechanistic bridge between renal cyclooxygenase-2 inhibition and systemic vascular dysfunction with nonsteroidal anti-inflammatory drug usage. CONCLUSIONS: We identify the endogenous endothelial nitric oxide synthase inhibitor ADMA as a biomarker and mechanistic bridge between renal cyclooxygenase-2 inhibition and systemic vascular dysfunction.


Assuntos
Anti-Inflamatórios/efeitos adversos , Arginina/análogos & derivados , Doenças Cardiovasculares/sangue , Inibidores de Ciclo-Oxigenase 2/efeitos adversos , Ciclo-Oxigenase 2/deficiência , Adulto , Animais , Arginina/sangue , Biomarcadores/sangue , Doenças Cardiovasculares/tratamento farmacológico , Feminino , Humanos , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Técnicas de Cultura de Órgãos , Adulto Jovem
7.
Br J Clin Pharmacol ; 81(4): 621-33, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26561399

RESUMO

AIMS: In vivo platelet function is a product of intrinsic platelet reactivity, modifiable by dual antiplatelet therapy (DAPT), and the extrinsic inhibitory endothelial mediators, nitric oxide (NO) and prostacyclin (PGI2 ), that are powerfully potentiated by P2Y12 receptor blockade. This implies that for individual patients endothelial mediator production is an important determinant of DAPT effectiveness. Here, we have investigated this idea using platelets taken from healthy volunteers treated with anti-platelet drugs. METHODS: Three groups of male volunteers (n = 8) received either prasugrel (10 mg), aspirin (75 mg) or DAPT (prasugrel + aspirin) once daily for 7 days. Platelet reactivity in the presence of diethylammonium (Z)-1-(N,N-diethylamino)diazen-1-ium-1,2-diolate (DEA/NONOate) and PGI2 was studied before and following treatment. RESULTS: Ex vivo, PGI2 and/or DEA/NONOate had little inhibitory effect on TRAP-6-induced platelet reactivity in control conditions. However, in the presence of DAPT, combination of DEA/NONOate + PGI2 reduced platelet aggregation (74 ± 3% to 19 ± 6%, P < 0.05). In vitro studies showed even partial (25%) P2Y12 receptor blockade produced a significant (67 ± 2% to 39 ± 10%, P < 0.05) inhibition when DEA/NONOate + PGI2 was present. CONCLUSIONS: We have demonstrated that PGI2 and NO synergize with P2Y12 receptor antagonists to produce powerful platelet inhibition. Furthermore, even with submaximal P2Y12 blockade the presence of PGI2 and NO greatly enhances platelet inhibition. Our findings highlight the importance of endothelial mediator in vivo modulation of P2Y12 inhibition and introduces the concept of refining ex vivo platelet function testing by incorporating an assessment of endothelial function to predict thrombotic outcomes better and adjust therapy to prevent adverse outcomes in individual patients.


Assuntos
Aspirina/farmacologia , Epoprostenol/farmacologia , Óxido Nítrico/farmacologia , Ativação Plaquetária/efeitos dos fármacos , Cloridrato de Prasugrel/farmacologia , Antagonistas do Receptor Purinérgico P2Y/farmacologia , Adolescente , Adulto , Aspirina/administração & dosagem , Plaquetas/efeitos dos fármacos , Sinergismo Farmacológico , Epoprostenol/administração & dosagem , Epoprostenol/metabolismo , Voluntários Saudáveis , Humanos , Técnicas In Vitro , Masculino , Óxido Nítrico/administração & dosagem , Óxido Nítrico/metabolismo , Doadores de Óxido Nítrico/farmacologia , Agregação Plaquetária/efeitos dos fármacos , Cloridrato de Prasugrel/administração & dosagem , Antagonistas do Receptor Purinérgico P2Y/administração & dosagem , Adulto Jovem
9.
Cogn Neuropsychiatry ; 20(2): 109-21, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25384453

RESUMO

INTRODUCTION: A preliminary cognitive model of grandiose delusions has been put forward suggesting that persecutory and grandiose delusions shared distinct, yet overlapping psychological processes. This study aims to test this model and hypothesises that participants experiencing grandiose delusions may demonstrate a theory of mind (ToM) impairment and differences in attributional style compared to a control group. METHODS: A cross-sectional design compared the performance of 18 individuals with grandiose delusions to a control group of 14 participants with depression. ToM was measured using a non-verbal joke appreciation task and a verbal stories task. Attributional style was measured using the internal, personal and situational attributions questionnaire. RESULTS: Participants experiencing grandiose delusions performed significantly worse on both ToM tasks compared to controls. Furthermore, these participants provided significantly more atypical answers when explaining the joke behind the ToM cartoons. No differences for subjective funniness ratings or attributional style were found. CONCLUSIONS: This preliminary study indicated participants experiencing grandiose delusions have ToM impairments which may contribute to the maintenance of this symptom.


Assuntos
Transtorno Bipolar/psicologia , Delusões/psicologia , Transtornos Psicóticos/psicologia , Esquizofrenia , Psicologia do Esquizofrênico , Percepção Social , Teoria da Mente , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Estudos Transversais , Transtorno Depressivo/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Psicológicos , Inquéritos e Questionários , Adulto Jovem
10.
Am J Geriatr Psychiatry ; 21(9): 898-905, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23567389

RESUMO

OBJECTIVE: Between 7% and 40% of people with Alzheimer disease (AD) experience persecutory delusions (PDs) during the course of their dementia. Although attributional style and theory of mind processes have been linked with PDs in people with psychosis, they have not yet been examined in those with AD and PDs. The objective of this study was, hence, to explore the role of these cognitive processes in groups of participants with AD with and without PDs, as well as a nonclinical comparison group. METHOD: Measures of attributional style and theory of mind were administered to three groups: people with AD and PDs (n = 22), people with AD without PDs (n = 22), and a nonclinical group (n = 23). RESULTS: Although no clear differences in attributional style between the three groups were found, the group with AD and PDs were found to perform worse on the first-order (but not second-order) theory of mind task than the other two groups. CONCLUSIONS: Interventions designed to enhance theory of mind skills might be beneficial for individuals with AD and PDs.


Assuntos
Doença de Alzheimer/psicologia , Delusões/psicologia , Percepção Social , Teoria da Mente/fisiologia , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/fisiopatologia , Estudos de Casos e Controles , Delusões/fisiopatologia , Feminino , Humanos , Masculino
11.
Front Psychiatry ; 14: 1224376, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37547196

RESUMO

Background: Access to prescribed interventions and retention in treatment services are associated with improved health outcomes and reduced premature mortality rates for people living with opioid use disorder (OUD). In Leeds, transactional sex-workers frequently cycled in and out of treatment for OUD such that they never reached a level of engagement that permitted opportunities to meet their healthcare or housing needs. Barriers to accessing care provision include an itinerant lifestyle, difficulties with travel at unpredictable hours, impacting upon adherence to medication regimens including daily supervised consumption. Objectives: To use a co-produced, "health at the margins" approach, to reach the sex-working population in Leeds, and support informed choices about the potential to receive buprenorphine prolonged-release injection (BPRI) as a treatment option for OUD. Methods: BPRI was introduced using a theory of change model and improvements in sex-worker care delivery was reviewed. Strategies included buprenorphine micro-induction, shared decision-making, collaborative multi-agency working and supporting a strengths-based and trauma-informed approach. Results: Benefits of BPRI included removal of the need for daily pharmacy visits, reducing the risk of diversion, improved medication adherence, stability and engagement with treatment and supportive services. Conclusion: BPRI may offer an additional option for pharmacological interventions for people with OUD where there may be increased barriers to accessing treatment for example due to sex-working. Strategies for effective BPRI include micro-induction, shared decision-making, collaborative multi-agency working and supporting a strengths-based approach.

12.
Lancet Planet Health ; 7(6): e527-e536, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-37286249

RESUMO

Climate-sensitive infectious disease modelling is crucial for public health planning and is underpinned by a complex network of software tools. We identified only 37 tools that incorporated both climate inputs and epidemiological information to produce an output of disease risk in one package, were transparently described and validated, were named (for future searching and versioning), and were accessible (ie, the code was published during the past 10 years or was available on a repository, web platform, or other user interface). We noted disproportionate representation of developers based at North American and European institutions. Most tools (n=30 [81%]) focused on vector-borne diseases, and more than half (n=16 [53%]) of these tools focused on malaria. Few tools (n=4 [11%]) focused on food-borne, respiratory, or water-borne diseases. The under-representation of tools for estimating outbreaks of directly transmitted diseases represents a major knowledge gap. Just over half (n=20 [54%]) of the tools assessed were described as operationalised, with many freely available online.


Assuntos
Doenças Transmissíveis , Malária , Estados Unidos , Humanos , Doenças Transmissíveis/epidemiologia , Surtos de Doenças , Saúde Pública , Malária/epidemiologia , Software
13.
Kidney Int Rep ; 8(6): 1231-1238, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-37284684

RESUMO

Introduction: Through the production of prostacyclin, cyclooxygenase (COX)-2 protects the cardiorenal system. Asymmetric dimethylarginine (ADMA), is a biomarker of cardiovascular and renal disease. Here we determined the relationship between COX-2/prostacyclin, ADMA, and renal function in mouse and human models. Methods: We used plasma from COX-2 or prostacyclin synthase knockout mice and from a unique individual lacking COX-derived prostaglandins (PGs) because of a loss of function mutation in cytosolic phospholipase A2 (cPLA2), before and after receiving a cPLA2-replete transplanted donor kidney. ADMA, arginine, and citrulline were measured using ultra-high performance liquid-chromatography tandem mass spectrometry. ADMA and arginine were also measured by enzyme-linked immunosorbent assay (ELISA). Renal function was assessed by measuring cystatin C by ELISA. ADMA and prostacyclin release from organotypic kidney slices were also measured by ELISA. Results: Loss of COX-2 or prostacyclin synthase in mice increased plasma levels of ADMA, citrulline, arginine, and cystatin C. ADMA, citrulline, and arginine positively correlated with cystatin C. Plasma ADMA, citrulline, and cystatin C, but not arginine, were elevated in samples from the patient lacking COX/prostacyclin capacity compared to levels in healthy volunteers. Renal function, ADMA, and citrulline were returned toward normal range when the patient received a genetically normal kidney, capable of COX/prostacyclin activity; and cystatin C positively correlated with ADMA and citrulline. Levels of ADMA and prostacyclin in conditioned media of kidney slices were not altered in tissue from COX-2 knockout mice compared to wildtype controls. Conclusion: In human and mouse models, where renal function is compromised because of loss of COX-2/PGI2 signaling, ADMA levels are increased.

14.
Conscious Cogn ; 21(3): 1375-81, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22850327

RESUMO

The use of visual mental imagery has been proposed to be a risk factor for the development of bipolar disorder, due to its potential to amplify affective states. This study examined the relation between visual imagery (both trait usage and intrusive experiences of such imagery), intrusive verbal thought, and hypomania, as assessed by self-report questionnaires, in a sample of young adults (N=219). Regression analyses found (after controlling for anxiety, depression, and positive and negative affect) that levels of intrusive visual imagery predicted levels of hypomania, but that neither trait use of visual imagery nor intrusive verbal thought did. These results were consistent with the proposal that being a 'visualiser', as opposed to a 'verbaliser', is a risk factor for bipolar disorder, with the caveat that it is specifically intrusive experiences of imagery, rather than the tendency to utilize imagery per se, that acts as a risk factor.


Assuntos
Transtorno Bipolar/psicologia , Imaginação , Personalidade , Adolescente , Adulto , Cognição , Feminino , Humanos , Masculino , Inventário de Personalidade , Escalas de Graduação Psiquiátrica , Testes Psicológicos , Fatores de Risco , Inquéritos e Questionários , Adulto Jovem
16.
Clin Psychol Psychother ; 18(5): 397-410, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21887813

RESUMO

OBJECTIVES: This paper aims to study dysfunctional self-schematic processes, abnormal coping styles, over-responsiveness to reward stimuli (indicative of an over-sensitive behavioural activation system) and stability of self-esteem in relation to subclinical hypomania. DESIGN: Three cross-sectional studies were conducted on selected students on the basis of their scores on the Hypomanic Personality Scale (HPS) (study 1) and on elevated HPS and Dysfunctional Attitude Scale scores (studies 2 and 3). METHODS: In studies 1 and 2, participants completed questionnaires and kept a self-esteem diary for 6 days. In study 3, the experience sampling method was used to assess momentary self-esteem, emotion and use of different coping styles over a 6-day period. RESULTS: Study 1 demonstrated that hypomanic traits are associated with high fluctuations in self-esteem. In study 2, high scores on both the HPS and the Dysfunctional Attitude Scale, but not the HPS alone, were associated with bipolar spectrum symptoms. These participants showed more evidence of alcohol and substance abuse, greater self-esteem fluctuation and dysfunctional coping styles (rumination and risk-taking) compared with controls. Changes in self-esteem were related to the use of these strategies. CONCLUSIONS: Vulnerability to bipolar disorder is associated with a combination of depression-related and reward-related processes.


Assuntos
Adaptação Psicológica , Afeto , Transtorno Bipolar/psicologia , Personalidade , Autoimagem , Adulto , Estudos Transversais , Depressão/psicologia , Inglaterra , Feminino , Humanos , Entrevista Psicológica , Modelos Lineares , Masculino , Análise Multivariada , Teoria Psicológica , Inibição Reativa , Recompensa , Estresse Psicológico/psicologia
17.
J Am Heart Assoc ; 10(9): e019337, 2021 05 04.
Artigo em Inglês | MEDLINE | ID: mdl-33870707

RESUMO

Background There is debate whether body mass index is a good predictor of health outcomes because different tissues, namely skeletal muscle mass (SMM) and fat mass (FM), may be differentially associated with risk. We investigated the association of appendicular SMM (aSMM) and FM with fatal and nonfatal cardiovascular disease (CVD) and all-cause mortality. We compared their prognostic value to that of body mass index. Methods and Results We studied 356 590 UK Biobank participants aged 40 to 69 years with bioimpedance analysis data for whole-body FM and predicted limb muscle mass (to calculate aSMM). Associations between aSMM and FM with CVD and all-cause mortality were examined using multivariable Cox proportional hazards models. Over 3 749 501 person-years of follow-up, there were 27 784 CVD events and 15 844 all-cause deaths. In men, aSMM was positively associated with CVD incidence (hazard ratio [HR] per 1 SD 1.07; 95% CI, 1.06-1.09) and there was a curvilinear association in women. There were stronger positive associations between FM and CVD with HRs per SD of 1.20 (95% CI, 1.19-1.22) and 1.25 (95% CI, 1.23-1.27) in men and women respectively. Within FM tertiles, the associations between aSMM and CVD risk largely persisted. There were J-shaped associations between aSMM and FM with all-cause mortality in both sexes. Body mass index was modestly better at discriminating CVD risk. Conclusions FM showed a strong positive association with CVD risk. The relationship of aSMM with CVD risk differed between sexes, and potential mechanisms need further investigation. Body fat and SMM bioimpedance measurements were not superior to body mass index in predicting population-level CVD incidence or all-cause mortality.


Assuntos
Tecido Adiposo/fisiopatologia , Bancos de Espécimes Biológicos/estatística & dados numéricos , Doenças Cardiovasculares/epidemiologia , Músculo Esquelético/fisiopatologia , Adulto , Idoso , Índice de Massa Corporal , Causas de Morte/tendências , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Reino Unido/epidemiologia
18.
Crit Care Med ; 37(1): 184-91, 2009 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-19050634

RESUMO

OBJECTIVE: To evaluate the effect of a prospective diary intervention on levels of anxiety and depression in a group of intensive care unit survivors. DESIGN: Pragmatic randomized controlled trial. SETTING: Adult intensive care unit, medical/surgical wards of a district general hospital and community bases. PATIENTS: A total of 36 patients who were admitted to the intensive care unit between March 2006 and March 2007 for a minimum of 48 hrs. INTERVENTIONS: Prospective diary kept by nursing staff for the duration of the patient's stay on intensive care unit, containing daily information about their physical condition, procedures and treatments, events occurring on the unit, and significant events from outside the unit. MEASUREMENT AND MAIN RESULTS: At initial assessment, almost half of patients fell into the "disorder likely" category on the Hospital Anxiety and Depression Scale (44% for anxiety and 47.2% for depression). Paired-samples Student's t tests to compare the Hospital Anxiety and Depression Scale scores at time 1 and time 2 in the two participant groups revealed that the experimental group displayed statistically significant decreases in both anxiety (t (1,17) = 2.65, p < 0.05) and depression (t (1,17) = 3.33, p < 0.005) scores, while the control group did not, a difference attributed to the diary intervention. CONCLUSIONS: Survivors of critical illnesses are likely to experience clinically significant symptoms of anxiety and depression following their discharge from hospital. The prospective diary intervention designed to help patients understand what happened to them in intensive care and it has a significant positive impact on anxiety and depression scores almost 2 months after patients' discharge from intensive care unit. Attempts to replicate these results using larger samples are therefore encouraged, with the aim of informing best practice guidelines.


Assuntos
Ansiedade/prevenção & controle , Depressão/prevenção & controle , Unidades de Terapia Intensiva , Prontuários Médicos , Sobreviventes/psicologia , Feminino , Humanos , Masculino
19.
Psychol Psychother ; 82(Pt 3): 261-6, 2009 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-19254449

RESUMO

OBJECTIVE: The present study uses an indirect measure to explore whether dysfunctional attitudes are characteristic of all phases of bipolar disorder. Previous studies with bipolar patients using indirect measurements have uncovered depression-like responses that were otherwise undetected. DESIGN: A cross-sectional study design was adopted to explore the presence of dysfunctional attitudes within each phase of the illness. METHOD: Manic patients, depressed bipolar patients, remitted bipolar patients, and healthy controls were compared on a sentence stem completion task designed to implicitly assess dysfunctional attitudes. RESULTS: The manic, depressed, and remitted patients all exceeded the controls on implicit measures of dysfunctional attitudes. CONCLUSIONS: The findings are consistent with the hypothesis that all phases of bipolar disorder are associated with depressogenic dysfunctional attitudes.


Assuntos
Atitude , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/psicologia , Adulto , Análise de Variância , Estudos Transversais , Feminino , Humanos , Masculino , Autonomia Pessoal , Leitura , Análise e Desempenho de Tarefas
20.
Pharmacol Ther ; 193: 83-90, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30081048

RESUMO

For many millions of patients at secondary risk of coronary thrombosis pharmaceutical protection is supplied by dual anti-platelet therapy. Despite substantial therapeutic developments over the last decade recurrent thrombotic events occur, highlighting the need for further optimisation of therapies. Importantly, but often ignored, anti-platelet drugs interact with cyclic nucleotide systems in platelets and these are the same systems that mediate key endogenous pathways of platelet regulation, notably those dependent upon the vascular endothelium. The aim of this review is to highlight interactions between the anti-platelet drugs, aspirin and P2Y12 receptor antagonists and endogenous pathways of platelet regulation at the level of cyclic nucleotides. These considerations are key to concepts such as anti-platelet drug resistance and individualized anti-platelet therapy which cannot be understood by study of platelets in isolation from the circulatory environment. We also explore novel and emerging therapies that focus on preserving haemostasis and how the concepts outlined in this review could be exploited therapeutically to improve anti-thrombotic efficacy whilst reducing bleeding risk.


Assuntos
Aspirina/farmacologia , Plaquetas/efeitos dos fármacos , Inibidores da Agregação Plaquetária/farmacologia , Antagonistas do Receptor Purinérgico P2Y/farmacologia , Animais , Plaquetas/metabolismo , Endotélio Vascular/efeitos dos fármacos , Humanos , Nucleotídeos Cíclicos/metabolismo
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA