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1.
J Neurooncol ; 161(1): 57-66, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-36509907

RESUMEN

PURPOSE: Infrared (IR) spectroscopy has the potential for tumor delineation in neurosurgery. Previous research showed that IR spectra of brain tumors are generally characterized by reduced lipid-related and increased protein-related bands. Therefore, we propose the exploitation of these common spectral changes for brain tumor recognition. METHODS: Attenuated total reflection IR spectroscopy was performed on fresh specimens of 790 patients within minutes after resection. Using principal component analysis and linear discriminant analysis, a classification model was developed on a subset of glioblastoma (n = 135) and non-neoplastic brain (n = 27) specimens, and then applied to classify the IR spectra of several types of brain tumors. RESULTS: The model correctly classified 82% (517/628) of specimens as "tumor" or "non-tumor", respectively. While the sensitivity was limited for infiltrative glioma, this approach recognized GBM (86%), other types of primary brain tumors (92%) and brain metastases (92%) with high accuracy and all non-tumor samples were correctly identified. CONCLUSION: The concept of differentiation of brain tumors from non-tumor brain based on a common spectroscopic tumor signature will accelerate clinical translation of infrared spectroscopy and related technologies. The surgeon could use a single instrument to detect a variety of brain tumor types intraoperatively in future clinical settings. Our data suggests that this would be associated with some risk of missing infiltrative regions or tumors, but not with the risk of removing non-tumor brain.


Asunto(s)
Neoplasias Encefálicas , Glioblastoma , Glioma , Humanos , Glioblastoma/cirugía , Glioblastoma/patología , Espectrofotometría Infrarroja/métodos , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/cirugía , Neoplasias Encefálicas/patología , Glioma/patología , Encéfalo/patología , Espectroscopía Infrarroja por Transformada de Fourier/métodos
2.
Anal Bioanal Chem ; 415(4): 603-613, 2023 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-36462048

RESUMEN

The in ovo sexing of chicken eggs is a current task and a prerequisite to overcome the mass killing of male day-old chicks from laying lines. Although various methods have been developed and tested in recent years, practicable methods for sex determination are still missing which can be applicated in poultry hatcheries before the chicken embryo is capable of nociception and pain sensation. Optical spectroscopic methods enable an early determination of the sex. In this study, a novel method based on two-wavelength in ovo fluorescence excitation is described. More than 1600 eggs were examined. In ovo fluorescence was sequentially excited at 532 nm and 785 nm. The fluorescence intensities of the spectral regions behave inversely with respect to sex. It is shown that the observed sex-related differences in the fluorescence intensities are based on the embryonic hemoglobin synthesis. The accuracy of sex determination is 96% for both sexes. The hatching rate is not reduced compared to an equivalent reference group.


Asunto(s)
Pollos , Análisis para Determinación del Sexo , Femenino , Embrión de Pollo , Animales , Masculino , Espectrometría de Fluorescencia/métodos , Análisis para Determinación del Sexo/métodos , Huevos , Óvulo
3.
Brain Topogr ; 36(1): 1-9, 2023 01.
Artículo en Inglés | MEDLINE | ID: mdl-36446998

RESUMEN

The determination of exact tumor boundaries within eloquent brain regions is essential to maximize the extent of resection. Recent studies showed that intraoperative optical imaging (IOI) combined with median nerve stimulation is a helpful tool for visualization of the primary sensory cortex (PSC). In this technical note, we describe a novel approach of using IOI with painless tactile irritation to demonstrate the feasibility of topographic mapping of different body regions within the PSC. In addition, we compared the IOI results with preoperative functional MRI (fMRI) findings. In five patients with tumors located near the PSC who received tumor removal, IOI with tactile irritation of different body parts and fMRI was applied. We showed that tactile irritation of the hand in local and general anesthesia leads to reliable changes of cerebral blood volume during IOI. Hereby, we observed comparable IOI activation maps regarding the median nerve stimulation, fMRI and tactile irritation of the hand. The tactile irritation of different body areas revealed a plausible topographic distribution along the PSC. With this approach, IOI is also suitable for awake surgeries, since the tactile irritation is painless compared with median nerve stimulation and is congruent to fMRI findings. Further studies are ongoing to standardize this method to enable a broad application within the neurosurgical community.


Asunto(s)
Neoplasias Encefálicas , Glioma , Humanos , Neoplasias Encefálicas/cirugía , Glioma/cirugía , Mapeo Encefálico/métodos , Encéfalo , Imagen por Resonancia Magnética/métodos , Corteza Cerebral
4.
Hum Brain Mapp ; 43(2): 598-615, 2022 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-34590384

RESUMEN

Alterations within cerebral hemodynamics are the intrinsic signal source for a wide variety of neuroimaging techniques. Stimulation of specific functions leads due to neurovascular coupling, to changes in regional cerebral blood flow, oxygenation and volume. In this study, we investigated the temporal characteristics of cortical hemodynamic responses following electrical, tactile, visual, and speech activation for different stimulation paradigms using Intraoperative Optical Imaging (IOI). Image datasets from a total of 22 patients that underwent surgical resection of brain tumors were evaluated. The measured reflectance changes at different light wavelength bands, representing alterations in regional cortical blood volume (CBV), and deoxyhemoglobin (HbR) concentration, were assessed by using Fourier-based evaluation methods. We found a decrease of CBV connected to an increase of HbR within the contralateral primary sensory cortex (SI) in patients that were prolonged (30 s/15 s) electrically stimulated. Additionally, we found differences in amplitude as well as localization of activated areas for different stimulation patterns. Contrary to electrical stimulation, prolonged tactile as well as prolonged visual stimulation are provoking increases in CBV within the corresponding activated areas (SI, visual cortex). The processing of the acquired data from awake patients performing speech tasks reveals areas with increased, as well as areas with decreased CBV. The results lead us to the conclusion, that the CBV decreases in connection with HbR increases in SI are associated to processing of nociceptive stimuli and that stimulation type, as well as paradigm have a nonnegligible impact on the temporal characteristics of the following hemodynamic response.


Asunto(s)
Neoplasias Encefálicas/cirugía , Corteza Cerebral/diagnóstico por imagen , Corteza Cerebral/fisiología , Circulación Cerebrovascular/fisiología , Monitorización Neurofisiológica Intraoperatoria , Neuroimagen , Imagen Óptica , Percepción/fisiología , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nocicepción/fisiología , Percepción del Habla/fisiología , Percepción del Tacto/fisiología , Percepción Visual/fisiología , Adulto Joven
5.
J Public Health (Oxf) ; 44(1): e106-e116, 2022 03 07.
Artículo en Inglés | MEDLINE | ID: mdl-33948665

RESUMEN

BACKGROUND: With the coronavirus disease 2019 (COVID-19) pandemic surging and new mutations evolving, trust in vaccines is essential. METHODS: We explored correlates of vaccine hesitancy, considering political believes and psychosocial concepts, conducting a non-probability quota-sampled online survey with 1007 Austrians. RESULTS: We identified several important correlates of vaccine hesitancy, ranging from demographics to complex factors such as voting behavior or trust in the government. Among those with hesitancy towards a COVID-19 vaccine, having voted for opposition parties (opp) or not voted (novote) were (95% Confidence Intervall (CI)opp, 1.44-2.95) to 2.25-times (95%CInovote, 1.53-3.30) that of having voted for governing parties. Only 46.2% trusted the Austrian government to provide safe vaccines, and 80.7% requested independent scientific evaluations regarding vaccine safety to increase willingness to vaccine. CONCLUSIONS: Contrary to expected, psychosocial dimensions were only weakly correlated with vaccine hesitancy. However, the strong correlation between distrust in the vaccine and distrust in authorities suggests a common cause of disengagement from public discourse.


Asunto(s)
Vacunas contra la COVID-19 , COVID-19 , Austria , COVID-19/prevención & control , Vacunas contra la COVID-19/uso terapéutico , Gobierno , Humanos , SARS-CoV-2 , Encuestas y Cuestionarios , Confianza , Vacilación a la Vacunación
6.
Int Arch Occup Environ Health ; 94(8): 1823-1837, 2021 11.
Artículo en Inglés | MEDLINE | ID: mdl-33877416

RESUMEN

OBJECTIVES: To explore changes in quality of life and perceived productivity, focusing on the effects of working from home during the first COVID-19 50-day mitigation period in Austria. METHODS: We conducted an Austrian-representative online survey (N = 1010) of self-reported life- and work-related changes during the first COVID-19 50-day mitigation period (March 16 through May 1 2020) compared to the situation before. We used multinominal logistic regression models to identify correlates of improved/decreased quality of life in the entire sample, and of improved/decreased productivity in a subsample of the working population (N = 686). We also calculated age- and multivariable-adjusted ORs and 95% CIs of an improved/decreased quality of life and an improved/decreased productivity by work from home status. RESULTS: During the COVID-19 mitigation period, quality of life improved in 17.5%, but decreased in 20.7% of the general Austrian population; perceived productivity at work increased in 12.7%, but decreased in 30.2% of the working population. Working from home during the mitigation period was associated with an increased quality of life (vs. none, partially: OR 2.07, 95% CI 1.09-3.91; all the time: 3.69, 1.86-7.29). In contrast, perceived productivity seemed to decrease when people worked from home (vs. none, partially: 1.42, 0.86-2.35; all the time: 1.48, 0.85-2.58). Working from home and related benefits were not equally distributed among gender, age, and educational attainment. CONCLUSIONS: A transition to more flexibility of workplace and working hours for employees could have important positive consequences for family and professional life, for stakeholders, for public health, and ultimately for the environment.


Asunto(s)
COVID-19/prevención & control , Eficiencia , Calidad de Vida , Teletrabajo , Adulto , Austria/epidemiología , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven
7.
Hist Philos Life Sci ; 43(2): 59, 2021 Apr 16.
Artículo en Inglés | MEDLINE | ID: mdl-33864155

RESUMEN

COVID-19 has revealed that science needs to learn how to better deal with the irreducible uncertainty that comes with global systemic risks as well as with the social responsibility of science towards the public good. Further developing the epistemological principles of new theories and experimental practices, alternative investigative pathways and communication, and diverse voices can be an important contribution of history and philosophy of science and of science studies to ongoing transformations of the scientific enterprise.


Asunto(s)
Diversidad Cultural , Conocimiento , Ciencia , Responsabilidad Social , COVID-19/prevención & control , Comunicación , Humanos , SARS-CoV-2 , Incertidumbre
8.
Neurosurg Focus ; 48(2): E3, 2020 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-32006940

RESUMEN

Intraoperative optical imaging (IOI) is a marker-free, contactless, and noninvasive imaging technique that is able to visualize metabolic changes of the brain surface following neuronal activation. Although it has been used in the past mainly for the identification of functional brain areas under general anesthesia, the authors investigated the potential of the method during awake surgery. Measurements were performed in 10 patients who underwent resection of lesions within or adjacent to cortical language or motor sites. IOI was applied in 3 different scenarios: identification of motor areas by using finger-tapping tasks, identification of language areas by using speech tasks (overt and silent speech), and a novel approach-the application of IOI as a feedback tool during direct electrical stimulation (DES) mapping of language. The functional maps, which were calculated from the IOI data (activity maps), were qualitatively compared with the functional MRI (fMRI) and the electrophysiological testing results during the surgical procedure to assess their potential benefit for surgical decision-making.The results reveal that the intraoperative identification of motor sites with IOI in good agreement with the preoperatively acquired fMRI and the intraoperative electrophysiological measurements is possible. Because IOI provides spatially highly resolved maps with minimal additional hardware effort, the application of the technique for motor site identification seems to be beneficial in awake procedures. The identification of language processing sites with IOI was also possible, but in the majority of cases significant differences between fMRI, IOI, and DES were visible, and therefore according to the authors' findings the IOI results are too unspecific to be useful for intraoperative decision-making with respect to exact language localization. For this purpose, DES mapping will remain the method of choice.Nevertheless, the IOI technique can provide additional value during the language mapping procedure with DES. Using a simple difference imaging approach, the authors were able to visualize and calculate the spatial extent of activation for each stimulation. This might enable surgeons in the future to optimize the mapping process. Additionally, differences between tumor and nontumor stimulation sites were observed with respect to the spatial extent of the changes in cortical optical properties. These findings provide further evidence that the method allows the assessment of the functional state of neurovascular coupling and is therefore suited for the delineation of pathologically altered tissue.


Asunto(s)
Mapeo Encefálico/métodos , Monitorización Neurofisiológica Intraoperatoria/métodos , Lenguaje , Corteza Motora/diagnóstico por imagen , Destreza Motora/fisiología , Procedimientos Neuroquirúrgicos/métodos , Imagen Óptica/métodos , Adulto , Anciano , Neoplasias Encefálicas/diagnóstico por imagen , Neoplasias Encefálicas/cirugía , Femenino , Glioma/diagnóstico por imagen , Glioma/cirugía , Humanos , Masculino , Persona de Mediana Edad , Corteza Motora/cirugía , Vigilia/fisiología
9.
Anal Bioanal Chem ; 416(5): 1103-1104, 2024 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-38227014
10.
Anal Bioanal Chem ; 411(1): 63-77, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30283998

RESUMEN

Diabetes mellitus is a widespread disease with greatly rising patient numbers expected in the future, not only for industrialized countries but also for regions in the developing world. There is a need for efficient therapy, which can be via self-monitoring of blood glucose levels to provide tight glycemic control for reducing the risks of severe health complications. Advancements in diabetes technology can nowadays offer different sensor approaches, even for continuous blood glucose monitoring. Non-invasive blood glucose assays have been promised for many years and various vibrational spectroscopy-based methods of the skin are candidates for achieving this goal. Due to the small spectral signatures of the glucose hidden among a largely variable background, the largest signal-to-noise ratios and multivariate calibration are essential to provide the method applicability for self-monitoring of blood glucose. Besides multiparameter approaches, recently presented devices based on photoplethysmography with wavelengths in the visible and near-infrared range are evaluated for their potential of providing reliable blood glucose concentration predictions. Graphical abstract ᅟ.


Asunto(s)
Automonitorización de la Glucosa Sanguínea/métodos , Glucemia/análisis , Piel , Análisis Espectral/métodos , Calibración , Diabetes Mellitus/sangre , Humanos , Fotopletismografía/métodos , Sensibilidad y Especificidad
11.
Sensors (Basel) ; 19(7)2019 Apr 05.
Artículo en Inglés | MEDLINE | ID: mdl-30959734

RESUMEN

Glass flexural resonators have established themselves as one of the de-facto standard methods for measuring the density of liquids in a laboratory environment. The core of this sensor is a U-Tube measuring cell whose oscillator's resonance frequency changes with the mass of the liquid within the tube. This relationship can be used to derive the density of liquids in a fast and reliable way. In order to achieve the highest accuracy for the density measurement multiple physical effects (e.g., damping due to viscosity effects) need to be taken into account. For a reliable correction, additional measurements are required. The pulsed excitation method is able to produce these additional parameters along with a superior measurement performance compared to previous techniques.

12.
J Neurooncol ; 139(2): 261-268, 2018 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-29761368

RESUMEN

INTRODUCTION: Mutations in the isocytrate dehydrogenase 1 (IDH1) gene are early genetic events in glioma pathogenesis and cause profound metabolic changes. Because this genotype is found in virtually every tumor cell, therapies targeting mutant IDH1 protein are being developed. The intraoperative administration of those therapies would require fast technologies for the determination of IDH1 genotype. As of today, there is no such diagnostic test available. Recently, infrared spectroscopy was shown to bridge this gap. Here, we tested Raman spectroscopy for analysis of IDH1 genotype in glioma, which constitutes an alternative contact-free technique with the potential of being applicable in situ. METHODS: Human glioma samples (n = 36) were obtained during surgery and cryosections were prepared. IDH1 mutations were assessed using DNA sequencing and 100 Raman spectra were obtained for each sample. RESULTS: Analysis of Raman spectra revealed increased intensities in spectral bands related to DNA in IDH1 mutant glioma while bands assigned to molecular vibrations of lipids were significantly decreased. Moreover, intensities of Raman bands assigned to proteins differed in IDH1 mutant and IDH1 wild-type glioma, suggesting alterations in the protein profile. The selection of five bands (498, 826, 1003, 1174 and 1337 cm-1) allowed the classification of Raman spectra according to IDH1 genotype with a correct rate of 89%. CONCLUSION: Raman spectroscopy constitutes a simple, rapid and safe procedure for determination of the IDH1 mutation that shows great promise for clinically relevant in situ diagnostics.


Asunto(s)
Neoplasias Encefálicas/diagnóstico , Glioma/diagnóstico , Isocitrato Deshidrogenasa/genética , Mutación , Espectrometría Raman/métodos , Neoplasias Encefálicas/genética , Glioma/genética , Humanos , Pronóstico
13.
Epilepsia ; 58(1): e1-e5, 2017 01.
Artículo en Inglés | MEDLINE | ID: mdl-28064458

RESUMEN

The properties and structure of tissue can be visualized without labeling or preparation by multiphoton microscopy combining coherent anti-Stokes Raman scattering (CARS), addressing lipid content, second harmonic generation (SHG) showing collagen, and two-photon excited fluorescence (TPEF) of endogenous fluorophores. We compared samples of sclerotic and nonsclerotic human hippocampus to detect pathologic changes in the brain of patients with pharmacoresistant temporomesial epilepsy (n = 15). Multiphoton microscopy of cryosections and bulk tissue revealed hippocampal layering and micromorphologic details in accordance with reference histology: CARS displayed white and gray matter layering and allowed the assessment of axonal myelin. SHG visualized blood vessels based on adventitial collagen. In addition, corpora amylacea (CoA) were found to be SHG-active. Pyramidal cell bodies were characterized by intense cytoplasmic endogenous TPEF. Furthermore, diffuse TPEF around blood vessels was observed that co-localized with positive albumin immunohistochemistry and might indicate degeneration-associated vascular leakage. We present a label-free and fast optical approach that analyzes pathologic aspects of HS. Hippocampal layering, loss of pyramidal cells, and presence of CoA indicative of sclerosis are visualized. Label-free multiphoton microscopy has the potential to extend the histopathologic armamentarium for ex vivo assessment of changes of the hippocampal formation on fresh tissue and prospectively in vivo.


Asunto(s)
Epilepsia del Lóbulo Temporal/patología , Hipocampo/patología , Neuronas/patología , Adulto , Epilepsia del Lóbulo Temporal/complicaciones , Femenino , Hipocampo/metabolismo , Humanos , Masculino , Microscopía de Fluorescencia por Excitación Multifotónica/métodos , Persona de Mediana Edad , Esclerosis/etiología , Esclerosis/patología , Espectrometría Raman , Adulto Joven
14.
Anal Bioanal Chem ; 409(5): 1185-1194, 2017 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-27966169

RESUMEN

Culling of day-old male chicks in production of laying hen strains involves several millions of animals every year worldwide and is ethically controversial. In an attempt to provide an alternative, optical spectroscopy was investigated to determine nondestructively in ovo the sex of early embryos of the domestic chicken. The extraembryonic blood circulation system was accessed by producing a window in the egg shell and the flowing blood was illuminated with a near-infrared laser. The strong fluorescence and the weak Raman signals were acquired and spectroscopically analyzed between 800 and 1000 nm. The increase of fluorescence intensity between 3.5 and 11.5 days of incubation was found to be in agreement with the erythropoietic stages, thus enabling to identify hemoglobin as fluorescence source. Sex-related differences in the fluorescence spectrum were found at day 3.5, and principal component (PC) analysis showed that the blood of males was characterized by a specific fluorescence band located at ∼910 nm. Supervised classification of the PC scores enabled the determination of the sex of 380 eggs at day 3.5 of incubation with a correct rate up to 93% by combining the information derived from both fluorescence and Raman scattering. Graphical abstract The fluorescence of blood obtained in ovo by illumination of embryonic vessels with a IR laser displays spectral differences that can be employed for sexing of eggs in early stage of incubation, before onset of embryo sensitivity and without hindering its development into a healthy chick.


Asunto(s)
Huevos , Análisis para Determinación del Sexo/métodos , Espectrometría de Fluorescencia/métodos , Animales , Pollos , Femenino , Masculino
15.
Anal Chem ; 88(17): 8657-63, 2016 09 06.
Artículo en Inglés | MEDLINE | ID: mdl-27512829

RESUMEN

Male birds of egg-laying hen strains have no commercial value and are culled immediately after hatching, raising concerns for animal welfare. Existing experimental methods for in ovo sexing require taking samples and are applicable after embryos' sexual differentiation. We demonstrate that Raman spectroscopy enables contactless in ovo sex determination of the domestic chicken (Gallus gallus f. dom.) already at day 3.5 of egg incubation. A sexing accuracy of 90% was obtained by analyzing the spectra of blood circulating in the extraembryonic vessels. The measurement is damage-free and barely affects the hatching rate. Sex recognition is achieved before the onset of sensitivity. Therefore, Raman spectroscopy provides an alternative to the culling of 1-day-old male chicks in laying hen production.


Asunto(s)
Pollos , Análisis para Determinación del Sexo/métodos , Espectrometría Raman , Cigoto , Animales , Embrión de Pollo , Femenino , Masculino
17.
Environ Sci Technol ; 54(3): 1287-1289, 2020 02 04.
Artículo en Inglés | MEDLINE | ID: mdl-31940185

Asunto(s)
Uranio , Fosfatos
18.
Anal Bioanal Chem ; 412(1): 7-8, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31758200
19.
Anal Bioanal Chem ; 406(1): 21-5, 2014 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-24136252

RESUMEN

Molecular analytical methods are increasingly needed for a quick and reliable analysis of tissue in an operating room to provide more information during operations. In this Trends article, we highlight the current state and the developments of optical spectroscopic methods as intra operative tools. The clinical problem and challenges are illustrated on the example of brain tumor surgery. While fluorescence microscopy is already used, vibrational spectroscopy techniques will complement the standard method for brain tissue diagnostics. New portable instruments are currently available and can be stationed in the operating room for quick evaluation of tissue. The promise and limitations of fluorescence and vibrational spectroscopy as intraoperative tools are surveyed in this report.


Asunto(s)
Neoplasias Encefálicas/diagnóstico , Glioblastoma/diagnóstico , Cuidados Intraoperatorios/instrumentación , Espectroscopía Infrarroja por Transformada de Fourier/instrumentación , Adulto , Anciano , Encéfalo/patología , Encéfalo/cirugía , Neoplasias Encefálicas/patología , Neoplasias Encefálicas/cirugía , Glioblastoma/patología , Glioblastoma/cirugía , Humanos , Masculino , Persona de Mediana Edad , Sistemas de Atención de Punto , Espectroscopía Infrarroja por Transformada de Fourier/métodos , Espectrometría Raman/instrumentación , Espectrometría Raman/métodos
20.
Eur J Investig Health Psychol Educ ; 14(8): 2157-2174, 2024 Jul 30.
Artículo en Inglés | MEDLINE | ID: mdl-39194938

RESUMEN

Considerable evidence links the "Big Five" personality traits (neuroticism, extroversion, conscientiousness, agreeableness, and openness) with depression. However, potential mediating and moderating factors are less well understood. We utilized data from a cross-sectional survey of 3065 German-speaking adults from the D-A-CH region to estimate multivariable-adjusted odds ratios and 95% confidence intervalsbetween personality traits and lifetime prevalence of depression (overall and stratified by sex and age). We further explored proportions mediated by psychosocial factors optimism, empathy, perspective-taking, work-life balance, and interpersonal trust. High levels of neuroticism were associated with more than two-fold higher odds of depression, whereas higher levels of conscientiousness were associated with approximately 30% lower odds of depression. The association with neuroticism persisted in all investigated subgroups; apparently, stronger associations for females and participants aged ≥60 years did not correspond to statistically significant interactions. Overall and across all strata, the association of neuroticism with depression appeared to be mediated in part by the considered psychosocial factors; optimism explained the largest proportion of the association. Our results provide empirical evidence for the dynamic predisposition model. Further investigations of these relationships are warranted in longitudinal data with more precise outcome assessments.

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