A state level analyses of suicide and the COVID-19 pandemic in Mexico.

BACKGROUND: While suicide rates in high- and middle-income countries appeared stable in the early stages of the pandemic, we know little about within-country variations. We sought to investigate the impact of COVID-19 on suicide in Mexico's 32 states and to identify factors that may have contributed to observed variations between states. METHODS: Interrupted time-series analysis to model the trend in monthly suicides before COVID-19 (from Jan 1, 2010, to March 31, 2020), comparing the expected number of suicides derived from the model with the observed number for the remainder of the year (April 1 to December 31, 2020) for each of Mexico's 32 states. Next, we modeled state-level trends using linear regression to study likely contributing factors at ecological level. RESULTS: Suicide increased slightly across Mexico during the first nine months of the pandemic (RR 1.03; 95%CI 1.01-1.05). Suicides remained stable in 19 states, increase in seven states (RR range: 1.12-2.04) and a decrease in six states (RR range: 0.46-0.88). Suicide RR at the state level was positively associated with population density in 2020 and state level suicide death rate in 2019. CONCLUSIONS: The COVID-19 pandemic had a differential effect on suicide death within the 32 states of Mexico. Higher population density and higher suicide rates in 2019 were associated with increased suicide. As the country struggles to cope with the ongoing pandemic, efforts to improve access to primary care and mental health care services (including suicide crisis intervention services) in these settings should be given priority.

The associations of earlier trauma exposures and history of mental disorders with PTSD after subsequent traumas.

Although earlier trauma exposure is known to predict posttraumatic stress disorder (PTSD) after subsequent traumas, it is unclear whether this association is limited to cases where the earlier trauma led to PTSD. Resolution of this uncertainty has important implications for research on pretrauma vulnerability to PTSD. We examined this issue in the World Health Organization (WHO) World Mental Health (WMH) Surveys with 34 676 respondents who reported lifetime trauma exposure. One lifetime trauma was selected randomly for each respondent. DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition) PTSD due to that trauma was assessed. We reported in a previous paper that four earlier traumas involving interpersonal violence significantly predicted PTSD after subsequent random traumas (odds ratio (OR)=1.3-2.5). We also assessed 14 lifetime DSM-IV mood, anxiety, disruptive behavior and substance disorders before random traumas. We show in the current report that only prior anxiety disorders significantly predicted PTSD in a multivariate model (OR=1.5-4.3) and that these disorders interacted significantly with three of the earlier traumas (witnessing atrocities, physical violence victimization and rape). History of witnessing atrocities significantly predicted PTSD after subsequent random traumas only among respondents with prior PTSD (OR=5.6). Histories of physical violence victimization (OR=1.5) and rape after age 17 years (OR=17.6) significantly predicted only among respondents with no history of prior anxiety disorders. Although only preliminary due to reliance on retrospective reports, these results suggest that history of anxiety disorders and history of a limited number of earlier traumas might usefully be targeted in future prospective studies as distinct foci of research on individual differences in vulnerability to PTSD after subsequent traumas.

Recovery from DSM-IV post-traumatic stress disorder in the WHO World Mental Health surveys.

BACKGROUND: Research on post-traumatic stress disorder (PTSD) course finds a substantial proportion of cases remit within 6 months, a majority within 2 years, and a substantial minority persists for many years. Results are inconsistent about pre-trauma predictors. METHODS: The WHO World Mental Health surveys assessed lifetime DSM-IV PTSD presence-course after one randomly-selected trauma, allowing retrospective estimates of PTSD duration. Prior traumas, childhood adversities (CAs), and other lifetime DSM-IV mental disorders were examined as predictors using discrete-time person-month survival analysis among the 1575 respondents with lifetime PTSD. RESULTS: 20%, 27%, and 50% of cases recovered within 3, 6, and 24 months and 77% within 10 years (the longest duration allowing stable estimates). Time-related recall bias was found largely for recoveries after 24 months. Recovery was weakly related to most trauma types other than very low [odds-ratio (OR) 0.2-0.3] early-recovery (within 24 months) associated with purposefully injuring/torturing/killing and witnessing atrocities and very low later-recovery (25+ months) associated with being kidnapped. The significant ORs for prior traumas, CAs, and mental disorders were generally inconsistent between early- and later-recovery models. Cross-validated versions of final models nonetheless discriminated significantly between the 50% of respondents with highest and lowest predicted probabilities of both early-recovery (66-55% v. 43%) and later-recovery (75-68% v. 39%). CONCLUSIONS: We found PTSD recovery trajectories similar to those in previous studies. The weak associations of pre-trauma factors with recovery, also consistent with previous studies, presumably are due to stronger influences of post-trauma factors.

Psychotic experiences and religiosity: data from the WHO World Mental Health Surveys.

OBJECTIVES: Religiosity is often associated with better health outcomes. The aim of the study was to examine associations between psychotic experiences (PEs) and religiosity in a large, cross-national sample. METHODS: A total of 25 542 adult respondents across 18 countries from the WHO World Mental Health Surveys were assessed for PEs, religious affiliation and indices of religiosity, DSM-IV mental disorders and general medical conditions. Logistic regression models were used to estimate the association between PEs and religiosity with various adjustments. RESULTS: Of 25 542 included respondents, 85.6% (SE = 0.3) (n = 21 860) respondents reported having a religious affiliation. Overall, there was no association between religious affiliation status and PEs. Within the subgroup having a religious affiliation, four of five indices of religiosity were significantly associated with increased odds of PEs (odds ratios ranged from 1.3 to 1.9). The findings persisted after adjustments for mental disorders and/or general medical conditions, as well as religious denomination type. There was a significant association between increased religiosity and reporting more types of PEs. CONCLUSIONS: Among individuals with religious affiliations, those who reported more religiosity on four of five indices had increased odds of PEs. Focussed and more qualitative research will be required to unravel the interrelationship between religiosity and PEs.

A meta-analysis of acute use of alcohol and the risk of suicide attempt.

BACKGROUND: No review has used a meta-analytic approach to estimate common odds ratios (ORs) for the effect of acute use of alcohol (AUA) on suicide attempts. We aim to report the results of the first meta-analysis of controlled epidemiological studies on AUA and suicide attempt. METHOD: The English-language literature on Medline, PsycINFO and Google Scholar was searched for original articles and critical review on AUA and suicide attempt (period 1996-2015). Studies had to report an OR estimate for this association. Common ORs and 95% confidence intervals (CIs) from random effects in meta-analyses for any AUA and two levels of alcohol use on suicide attempt were calculated. RESULTS: In all, seven studies provided OR estimates for the likelihood of suicide attempt by AUA, compared with those who did not drink alcohol. Studies used case-control (n 3) and case-crossover designs (n 4). Meta-analysis revealed a common OR of 6.97 (95% CI 4.77-10.17) for any AUA. Using four studies, 'low levels of acute drinking' resulted in an OR of 2.71 (95% CI 1.56-4.71) and 'high levels' had an OR of 37.18 (95% CI 17.38-79.53). CONCLUSIONS: AUA is associated with increased likelihood of a suicide attempt, particularly at high doses. Such data should be incorporated into estimates of the burden of disease associated with alcohol use, which are currently limited by a consideration of only alcohol's chronic effects. Future research should focus on the mechanisms through which AUA confers risk for attempt.

Hazardous drinking and exposure to interpersonal and community violence on both sides of the U.S. -Mexico border.

Objective: Different patterns of heavy drinking occur by country and proximity to the U.S. Mexico border. Few studies describe the impact of violence on drinking between countries and along the border. Methods: Survey data is from U.S. Mexican origin adults living in Texas and Mexican border and non-border cities, N=4,796. Participants were asked about alcohol consumption, interpersonal physical violence (IPV) and exposure to community violence. Monthly hazardous drinking (5+/4+ for men/women) was the primary outcome. Multivariate logistic regression model comparisons identified best predictors. Results: In the U.S. hazardous drinking was associated with past year IPV (ORadj=2.5; 1.8-3.5) and community violence (ORadj=1.4; 1.1-1.8). In Mexico, IPV (ORadj=3.9; 2.0-7.4) and border proximity (ORadj=0.5; 0.4-0.8) were associated with hazardous drinking but not community violence. Conclusion: Hazardous drinking is associated with IPV in both countries, but violence did not explain border hazardous drinking differences where they existed in Mexico.

Barriers to mental health treatment: results from the WHO World Mental Health surveys.

BACKGROUND: To examine barriers to initiation and continuation of mental health treatment among individuals with common mental disorders. METHOD: Data were from the World Health Organization (WHO) World Mental Health (WMH) surveys. Representative household samples were interviewed face to face in 24 countries. Reasons to initiate and continue treatment were examined in a subsample (n = 63,678) and analyzed at different levels of clinical severity. RESULTS: Among those with a DSM-IV disorder in the past 12 months, low perceived need was the most common reason for not initiating treatment and more common among moderate and mild than severe cases. Women and younger people with disorders were more likely to recognize a need for treatment. A desire to handle the problem on one's own was the most common barrier among respondents with a disorder who perceived a need for treatment (63.8%). Attitudinal barriers were much more important than structural barriers to both initiating and continuing treatment. However, attitudinal barriers dominated for mild-moderate cases and structural barriers for severe cases. Perceived ineffectiveness of treatment was the most commonly reported reason for treatment drop-out (39.3%), followed by negative experiences with treatment providers (26.9% of respondents with severe disorders). CONCLUSIONS: Low perceived need and attitudinal barriers are the major barriers to seeking and staying in treatment among individuals with common mental disorders worldwide. Apart from targeting structural barriers, mainly in countries with poor resources, increasing population mental health literacy is an important endeavor worldwide.

Analysis of disease-free survival and overall survival in patients with luminal a breast cancer stratified according to TNM.

BACKGROUND AND AIM: The TNM classification of malignant tumours is the most commonly used system to assess the stage as well as the prognosis of cancer. However, one of the biggest challenges in treatment of breast cancer is the understanding of tumour heterogeneity typical of these carcinomas. The aim of this study was to analyse the disease-free survival and overall survival in patients with luminal A subtype of breast cancer, stratified by TNM staging system. METHODS AND STUDY DESIGN: A total of 363 medical records from January 2001 to May 2006 were evaluated for data collection. There were 136 patients with luminal A breast cancer, selected for the cohort. The main objective was the analysis of disease-free survival (DFS) and overall survival (OS) in patients with luminal A breast cancer, stratified according to the TNM classification. RESULTS: The group of 136 patients with immunohistochemically defined luminal A subtype represented 53% of the 253 patients with breast cancer. There was no significant difference in the number and type of patients as for TNM stage and histological grading among patients treated with chemotherapy and HT in comparison to patients treated with HT alone. CONCLUSION: Our analysis did not prove any significant difference in survival of patients treated with chemotherapy followed by hormone therapy in comparison to patients treated with HT alone. We suggest that the IHC luminal A subtype of breast cancer generally warrants a good prognosis independently on other prognostic factors such as TNM stage. We conclude that patients might not benefit of adding a chemotherapy to hormonal therapy in adjuvant settings.

Effects of surface treatments, thermocycling, and cyclic loading on the bond strength of a resin cement bonded to a lithium disilicate glass ceramic.

SUMMARY Objectives : The aim of this present study was to investigate the effect of two surface treatments, fatigue and thermocycling, on the microtensile bond strength of a newly introduced lithium disilicate glass ceramic (IPS e.max Press, Ivoclar Vivadent) and a dual-cured resin cement. Methods : A total of 18 ceramic blocks (10 mm long × 7 mm wide × 3.0 mm thick) were fabricated and divided into six groups (n=3): groups 1, 2, and 3-air particle abraded for five seconds with 50-µm aluminum oxide particles; groups 4, 5, and 6-acid etched with 10% hydrofluoric acid for 20 seconds. A silane coupling agent was applied onto all specimens and allowed to dry for five seconds, and the ceramic blocks were bonded to a block of composite Tetric N-Ceram (Ivoclar Vivadent) with RelyX ARC (3M ESPE) resin cement and placed under a 500-g static load for two minutes. The cement excess was removed with a disposable microbrush, and four periods of light activation for 40 seconds each were performed at right angles using an LED curing unit (UltraLume LED 5, Ultradent) with a final 40 second light exposure from the top surface. All of the specimens were stored in distilled water at 37°C for 24 hours. Groups 2 and 5 were submitted to 3,000 thermal cycles between 5°C and 55°C, and groups 3 and 6 were submitted to a fatigue test of 100,000 cycles at 2 Hz. Specimens were sectioned perpendicular to the bonding area to obtain beams with a cross-sectional area of 1 mm(2) (30 beams per group) and submitted to a microtensile bond strength test in a testing machine (EZ Test) at a crosshead speed of 0.5 mm/min. Data were submitted to analysis of variance and Tukey post hoc test (p≤0.05). Results : The microtensile bond strength values (MPa) were 26.9 ± 6.9, 22.2 ± 7.8, and 21.2 ± 9.1 for groups 1-3 and 35.0 ± 9.6, 24.3 ± 8.9, and 23.9 ± 6.3 for groups 4-6. For the control group, fatigue testing and thermocycling produced a predominance of adhesive failures. Fatigue and thermocycling significantly decreased the microtensile bond strength for both ceramic surface treatments when compared with the control groups. Etching with 10% hydrofluoric acid significantly increased the microtensile bond strength for the control group.

Pharmacological PI3K inhibition in head and neck squamous cell carcinoma: A systematic review.

BACKGROUND: This systematic review aimed to investigate the in vitro and in vivo effects of phosphatidylinositol-3-kinase (PI3K) inhibitors on head and neck squamous cell carcinoma (HNSCC). Considering the role of PI3K and its downstream effectors in cell proliferation, invasion, and survival, it is reasonable to expect that treatment with PI3K inhibitors could control HNSCC onset and progression. Thus, the research question for our review was whether pharmacological inhibition of PI3K affects HNSCC progression. METHODS: In vitro and in vivo studies were selected from six databases. We collected data regarding cell viability, apoptosis, and the regulation of protein expression levels from in vitro studies. For the in vivo studies, we analyzed the reduction in tumor size or gene and protein expression. RESULTS: The included studies showed reduced cell proliferation and apoptosis after treatment with PI3K inhibitors. PI3K inhibitors in combination with other drugs had an enhanced anticancer effects compared to those of single-drug treatments. CONCLUSIONS: The results support the potential of PI3K inhibitors as candidates for clinical trials in HNSCC.

Barriers to patient recruitment in a poststroke neurorehabilitation multicenter trial in Brazil.

There is a high demand for stroke rehabilitation in the Brazilian public health system, but most studies that have addressed rehabilitation for unilateral spatial neglect (USN) after stroke have been performed in high-income countries. Therefore, the aim of this study was to analyze USN patient recruitment in a multicenter noninvasive brain stimulation clinical trial performed in Brazil and to provide study design recommendations for future studies. We evaluated the reasons for exclusion of patients from a multicenter, randomized, double-blinded clinical trial of rehabilitation of USN patients after stroke. Clinical and demographic variables were compared between the included and excluded patients. A descriptive statistical analysis was performed. Only 173 of the 1953 potential neglect patients (8.8%) passed the initial screening. After screening evaluation, 87/173 patients (50.3%) were excluded for clinical reasons. Cognitive impairment led to the exclusion of 21/87 patients (24.1%). Low socioeconomic status led to the exclusion of 37/173 patients (21.4%). Difficulty obtaining transportation to access treatment was the most common reason for their exclusion (16/37 patients, 43.3%). The analyzed Brazilian institutions have potential for conducting studies of USN. The recruitment of stroke survivors with USN was restricted by the study design and limited financial support. A history of cognitive impairment, intracranial stenting or craniectomy, and lack of transportation were the most common barriers to participating in a multicenter noninvasive brain stimulation trial among patients with USN after stroke.

Suicidality, ethnicity and immigration in the USA.

BACKGROUND: Suicide is the 11th leading cause of death in the USA. Suicide rates vary across ethnic groups. Whether suicide behavior differs by ethnic groups in the USA in the same way as observed for suicide death is a matter of current discussion. The aim of this report was to compare the lifetime prevalence of suicide ideation and attempt among four main ethnic groups (Asians, Blacks, Hispanics, and Whites) in the USA. METHOD: Suicide ideation and attempts were assessed using the World Mental Health version of the Composite International Diagnostic Interview (WMH-CIDI). Discrete time survival analysis was used to examine risk for lifetime suicidality by ethnicity and immigration among 15 180 participants in the Collaborative Psychiatric Epidemiological Surveys (CPES), a group of cross-sectional surveys. RESULTS: Suicide ideation was most common among Non-Hispanic Whites (16.10%), least common among Asians (9.02%) and intermediate among Hispanics (11.35%) and Non-Hispanic Blacks (11.82%). Suicide attempts were equally common among Non-Hispanic Whites (4.69%), Hispanics (5.11%) and Non-Hispanic Blacks (4.15%) and less common among Asians (2.55%). These differences in the crude prevalence rates of suicide ideation decreased but persisted after control for psychiatric disorders, but disappeared for suicide attempt. Within ethnic groups, risk for suicidality was low among immigrants prior to migration compared to the US born, but equalized over time after migration. CONCLUSIONS: Ethnic differences in suicidal behaviors are explained partly by differences in psychiatric disorders and low risk prior to arrival in the USA. These differences are likely to decrease as the US-born proportion of Hispanics and Asians increases.

Parental psychopathology and the risk of suicidal behavior in their offspring: results from the World Mental Health surveys.

Previous research suggests that parental psychopathology predicts suicidal behavior among offspring; however, the more fine-grained associations between specific parental disorders and distinct stages of the pathway to suicide are not well understood. We set out to test the hypothesis that parental disorders associated with negative mood would predict offspring suicide ideation, whereas disorders characterized by impulsive aggression (for example, antisocial personality) and anxiety/agitation (for example, panic disorder) would predict which offspring act on their suicide ideation and make a suicide attempt. Data were collected during face-to-face interviews conducted on nationally representative samples (N=55 299; age 18+) from 21 countries around the world. We tested the associations between a range of parental disorders and the onset and persistence over time (that is, time since most recent episode controlling for age of onset and time since onset) of subsequent suicidal behavior (suicide ideation, plans and attempts) among offspring. Analyses tested bivariate and multivariate associations between each parental disorder and distinct forms of suicidal behavior. Results revealed that each parental disorder examined increased the risk of suicide ideation among offspring, parental generalized anxiety and depression emerged as the only predictors of the onset and persistence (respectively) of suicide plans among offspring with ideation, whereas parental antisocial personality and anxiety disorders emerged as the only predictors of the onset and persistence of suicide attempts among ideators. A dose-response relation between parental disorders and respondent risk of suicide ideation and attempt was also found. Parental death by suicide was a particularly strong predictor of persistence of suicide attempts among offspring. These associations remained significant after controlling for comorbidity of parental disorders and for the presence of mental disorders among offspring. These findings should inform future explorations of the mechanisms of intergenerational transmission of suicidal behavior.

Influence of glazed zirconia on dual-cure luting agent bond strength.

The current study evaluated the influence of a novel surface treatment that uses a low-fusing porcelain glaze for promoting a bond between zirconia-based ceramic and a dual-cure resin luting agent. Bond strengths were compared with those from airborne particle abrasion, hydrofluoric acid etching, and silanization-treated surfaces. Twenty-four yttrium-stabilized tetragonal zirconia (Cercon Smart Ceramics, Degudent, Hanau, Germany) discs were fabricated and received eight surface treatments: group 1: 110 µm aluminum oxide air-borne particle abrasion; group 2: 110 µm aluminum oxide airborne particle abrasion and silane; group 3: 50 µm aluminum oxide airborne particle abrasion; group 4: 50 pm aluminum oxide airborne particle abrasion and silane; group 5: glaze and hydrofluoric acid;group 6: glaze, hydrofluoric acid, and silane;group 7: glaze and 50 pm aluminum oxide airborne particle abrasion; and group 8: glaze,50 pm aluminum oxide airborne particle abrasion and silane. After treatment, Enforce resin cement (Dentsply, Caulk, Milford, DE, USA) was used to fill an iris cut from microbore Tygontubing that was put on the ceramic surface to create 30 cylinders of resin cement in each treatment group (n=30). Micro shear bond test-ing was performed at a cross head speed of 0.5mm/min. One-way analysis of variance, and multiple comparisons were made using Tukey's test (p<0.5). The bond strength was affected only by surface treatments other than silanization. The groups that utilized the low-fusing porcelain glaze with airborne particle abrasion or hydrofluoric acid showed bond strength values statistically superior to groups that utilized conventional airborne particle abrasion treatments with 50 or 110 pm aluminum oxide (p<0.001). The treatment that utilized low-fusing porcelain glaze and hydrofluoric acid showed bond strength values statistically superior to remaining groups (p<0.001). Treatment of zirconia ceramic surfaces with a glaze of low-fusing porcelain significantly increased the bond strength of a dual-cure resin luting agent to the ceramic surface.

Retention of Manually or CAD/CAM-customized Fiberglass Posts Luted to Enlarged Root Canals with Different Resin Cements.

The aim of this laboratory study was to evaluate the pull-out force of a prefabricated fiberglass post (PP), relined fiberglass post (RP), or milled fiberglass post (MP) luted with Multilink N (MN), RelyX Unicem 2 (RXU2) or RelyX Ultimate (RU) to enlarged root canals. The thickness of the resin cements and the presence of voids in the resin cement film were observed. The root canals of 90 bovine incisors were enlarged, endodontically treated, and randomly divided into 9 groups (n=10) according to the post type and resin cement. The specimens were scanned using micro-CT to analyze the thickness of the resin cement and the presence of voids. The specimens were submitted to mechanical cyclic loading (500,000 cycles at 50 N load) and subjected to pull-out force testing. Two-way ANOVA and Tukey's test analyzed the pull-out force and resin cement thickness data. Kruskal-Wallis and Bonferroni tests analyzed the void scores. The interaction between factors (post × resin cement) was significant (p=0.0001) for the pull-out force. Higher pull-out forces were obtained for RP and MP compared to PP. The post factor was significant (p=0.0001) for resin cement thickness, which was higher for PP (1054 µm), followed by MP (301 µm) and RP (194 µm). More void formation occurred for PP, being less for RP, differing significantly among the posts. Post customization (RP and MP) decreased resin cement thickness and void formation, favoring a higher pull-out force. Resin cements requiring an adhesive application (MN and RU) favored higher pull-out force than self-adhesive resin cement (RXU2).

The influence of surface standardization of lithium disilicate glass ceramic on bond strength to a dual resin cement.

In vitro studies to assess bond strength between resins and ceramics have used surfaces that have been ground flat to ensure standardization; however, in patients, ceramic surfaces are irregular. The effect of a polished and unpolished ceramic on bond strength needs to be investigated. Sixty ceramic specimens (20×5×2 mm) were made and divided into two groups. One group was ground with 220- to 2000-grit wet silicon carbide paper and polished with 3-, 1-, and »-µm diamond paste; the other group was neither ground nor polished. Each group was divided into three subgroups: treated polished controls (PC) and untreated unpolished controls (UPC), polished (PE) and unpolished specimens (UPE) etched with hydrofluoric acid, and polished (PS) and unpolished specimens (UPS) sandblasted with alumina. Resin cement cylinders were built over each specimen. Shear bond strength was measured, and the fractured site was analyzed. Analysis of variance (ANOVA) and Tukey post hoc tests were performed. PE (44.47 ± 5.91 MPa) and UPE (39.70 ± 5.46 MPa) had the highest mean bond strength. PS (31.05 ± 8.81 MPa), UPC (29.11 ± 8.11 MPa), and UPS (26.41 ± 7.31 MPa) were statistically similar, and PC (24.96 ± 8.17 MPa) was the lowest. Hydrofluoric acid provides the highest bond strength regardless of whether the surface is polished or not.

The role of ageing in the wish to be dead: disentangling age, period and cohort effects in suicide ideation in European population.

AIMS: To investigate potential age, period and birth cohort effects in the prevalence of suicide ideation in European ageing population. METHODS: A total of 50 782 community-dwelling adults (aged + 50) from 20 different European countries were collected in the Survey Health Ageing and Retirement study. A multilevel logistic regression model of repeated measures was modelled to assess the effects of age and other variables, including the variability of observations over three levels: birth cohort groups, time period assessment and individual differences. RESULTS: The larger effect of variability was attributed to individual-level factors (57.8%). Youngest-old people (65-79 years) showed lower suicide ideation than middle-aged people (50-64 years). No significative differences were found for suicide ideation between middle-aged people and oldest-old (80 + years). Only 0.85% and 0.13% of the total variability of suicide ideation accounted for birth cohort and period effects, respectively. Cohorts born between 1941 and 1944 possessed the lowest estimates of suicide ideation. Conversely, suicide ideation started to rise with post-War generations and reached a significant level for people born from 1953-1957 to 1961-1964. Regarding the time period, participants assessed in 2006-2007 showed a lower likelihood of suicide ideation. The rest of the cohorts and period groups did not show any significant effect on the prevalence of suicide ideation. CONCLUSIONS: Our results suggest that age and suicide ideation relationship is not linear in middle and older age. The European Baby boomers born from 50s to mid-60s might report higher suicide ideation than their ancestors. This scenario would imply a greater need for mental healthcare services for older people in the future.

The association between smoking and subsequent suicide-related outcomes in the National Comorbidity Survey panel sample.

Controversy exists about whether the repeatedly documented associations between smoking and subsequent suicide-related outcomes (SROs; ideation, plans, gestures and attempts) are due to unmeasured common causes or to causal effects of smoking on SROs. We address this issue by examining associations of smoking with subsequent SROs with and without controls for potential explanatory variables in the National Comorbidity Survey (NCS) panel. The latter consists of 5001 people who participated in both the 1990-2002 NCS and the 2001-2003 NCS follow-up survey. Explanatory variables include sociodemographics, potential common causes (parental history of mental-substance disorders; other respondent childhood adversities) and potential mediators (respondent history of Diagnostic and Statistical Manual of Mental Disorders, 3rd edn, revised mental-substance disorders). Small gross (that is, without controls) prospective associations are found between history of early-onset nicotine dependence and both subsequent suicide ideation and, among ideators, subsequent suicide plans. None of the baseline smoking measures, though, predicts subsequent suicide gestures or attempts among ideators. The smoking-ideation association largely disappear, but the association of early-onset nicotine dependence with subsequent suicide plans persists (odds ratio=3.0), after adjustment for control variables. However, the latter association is as strong with remitted as active nicotine dependence, arguing against a direct causal effect of nicotine dependence on suicide plans. Decomposition of the control variable effects, furthermore, suggests that these effects are due to common causes more than to mediators. These results refine our understanding of the ways in which smoking is associated with later SROs and for the most part argue against the view that these associations are due to causal effects of smoking.

Effect of pH Cycling Followed by Simulated Toothbrushing on the Surface Roughness and Bacterial Adhesion of Bulk-fill Composite Resins.

The aim was to evaluate, in vitro, quantitatively and qualitatively, the effect of pH cycling and simulated toothbrushing on surface roughness (Ra) and bacterial adhesion (Cn) of bulk-fill composite resins. Thirty specimens of each composite resin, 5 mm wide and 4 mm high, were obtained: group 1 (control): Filtek Z250 (Z250); group 2: Filtek Bulk-Fill (FTK); group 3: Tetric N-Ceram Bulk-Fill (TTC); and group 4: Aura Bulk-Fill (AUR). After 24 hours, the specimens were polished and then alternated with demineralization/remineralization solutions for 15 cycles of 24 hours each at 37°C. Then the specimens were submitted to simulated toothbrushing. The Ra and Cn measurements were quantitatively analyzed in three stages: after polishing (Ra0 and Cn0), after pH cycling (Ra1 and Cn1), and after simulated toothbrushing (Ra2 and Cn2). The Ra values were submitted to two-way analysis of variance, followed by the Tukey test (α=0.05). The Kruskal-Wallis test, followed by multiple comparisons, was applied for Cn analysis. Surface topography and bacterial adhesion were observed by scanning electron microscopy (SEM). Z250, FTK, and TTC showed no significant change in Ra regardless of the treatment performed; AUR obtained increased Ra at Ra2 (p<0.05). FTK differed from the others at Cn0 and Cn1 (p<0.05). At Cn2, there was no difference among the composite resins. SEM images showed the exposure of fillers and microcavities at Ra1 and Ra2. There was greater bacterial adhesion at Cn1 for Z250 and FTK. It was concluded that the pH cycling caused surface degradation of all composite resins, which was potentiated by simulated toothbrushing. However, only AUR presented an increased Ra. Bacterial adhesion occurred on all composite resins after pH cycling; however, after simulated toothbrushing, adhesion of dispersed bacteria was similar for all the composite resin groups.

Mental disorders and termination of education in high-income and low- and middle-income countries: epidemiological study.

BACKGROUND: Studies of the impact of mental disorders on educational attainment are rare in both high-income and low- and middle-income (LAMI) countries. AIMS: To examine the association between early-onset mental disorder and subsequent termination of education. METHOD: Sixteen countries taking part in the World Health Organization World Mental Health Survey Initiative were surveyed with the Composite International Diagnostic Interview (n=41 688). Survival models were used to estimate associations between DSM-IV mental disorders and subsequent non-attainment of educational milestones. RESULTS: In high-income countries, prior substance use disorders were associated with non-completion at all stages of education (OR 1.4-15.2). Anxiety disorders (OR=1.3), mood disorders (OR=1.4) and impulse control disorders (OR=2.2) were associated with early termination of secondary education. In LAMI countries, impulse control disorders (OR=1.3) and substance use disorders (OR=1.5) were associated with early termination of secondary education. CONCLUSIONS: Onset of mental disorder and subsequent non-completion of education are consistently associated in both high-income and LAMI countries.