RESUMEN
BACKGROUND: Because wide variations in mental health care utilization exist throughout the world, determining long-term effectiveness of psychotropic medications in a real-world setting would be beneficial to physicians and patients. The purpose of this analysis was to describe the effectiveness of injectable risperidone long-acting therapy (RLAT) for schizophrenia across countries. METHODS: This was a pragmatic analysis of data from two prospective observational studies conducted in the US (Schizophrenia Outcomes Utilization Relapse and Clinical Evaluation [SOURCE]; ClinicalTrials.gov registration number for the SOURCE study: NCT00246194) and Spain, Australia, and Belgium (electronic Schizophrenia Treatment Adherence Registry [eSTAR]). Two separate analyses were performed to assess clinical improvement during the study and estimate psychiatric hospitalization rates before and after RLAT initiation. Clinical improvement was evaluated using the Clinical Global Impressions-Severity (CGI-S) and Global Assessment of Functioning (GAF) scales, and change from baseline was evaluated using paired t tests. Psychiatric hospitalization rates were analyzed using incidence densities, and the bootstrap resampling method was used to examine differences between the pre-baseline and post-baseline periods. RESULTS: The initial sample comprised 3,069 patients (US, n = 532; Spain, n = 1,345; Australia, n = 784; and Belgium, n = 408). In all, 24 months of study participation, completed by 39.3% (n = 209), 62.7% (n = 843), 45.8% (n = 359), and 64.2% (n = 262) of patients from the US, Spain, Australia, and Belgium, respectively, were included in the clinical analysis. Improvements compared with baseline were observed on both clinical assessments across countries (P < 0.001 at all post-baseline visits). The mean improvement was approximately 1 point on the CGI-S and 15 points on the GAF. A total of 435 (81.8%), 1,339 (99.6%), 734 (93.6%), and 393 (96.3%) patients from the US, Spain, Australia, and Belgium, respectively, had ≥1 post-baseline visit and were included in the analysis of psychiatric hospitalization rates. Hospitalization rates decreased significantly in all countries regardless of hospitalization status at RLAT initiation (P < 0.0001) and decreased significantly in the US and Spain (P < 0.0001) when the analysis was limited to outpatients only. CONCLUSIONS: RLAT in patients with schizophrenia was associated with improvements in clinical and functional outcomes and decreased hospitalization rates in the US, Spain, Australia, and Belgium, despite differences in health care delivery systems.
RESUMEN
OBJECTIVE: To estimate the processing time and neuromuscular delay required to extract and process sensory information from the ankle in order to coordinate an upper extremity movement sequence. METHODS: Nineteen able-bodied subjects were tested on their ability to perform a motor task that involved extension of their left index finger when their left ankle was passively plantar flexed at random velocities through a predetermined target angle. RESULTS: We found that the able-bodied subjects were able to adjust their finger responses up to ankle velocities of 70 degrees /s (300 ms). Reaction time, defined as the delay between onset of ankle rotation and how quickly the index finger could be extended, was 215 ms. The processing time and conduction delay was estimated to be approximately 85 ms. CONCLUSIONS: These results indicate that the nervous system processes kinesthetic input related to joint rotation of the ankle with the central mechanisms to execute a planned coordinated task with the upper extremity. SIGNIFICANCE: The time required to process proprioceptive information from the leg to perform a coordinated task with the upper extremity may vary throughout the lifespan. Understanding the effects of age, exercise, or injury on proprioceptive processing time may have important clinical implications.
