RESUMO
Background The annual prevalence of mental disorders is 20% whereas the Dutch mental health care system annually can cater no more than 7%. This suggests a need for public mental health care, parallel to traditional one-on-one treatment services. Multi-expert eCommunities are a novel phenomenon that appear to meet part of the public mental health care need. Aim The current analysis is a case study of PsychoseNet.nl, a multi-expert eCommunity that was launched in 2015 and now has 1.5 million annual visitors. It presents a range of static and dynamic content in the realm of psychoeducation, recovery narratives, self-management, empowerment, building resilience, interactive platforms and online consulting. Methods We describe explorative and descriptive analyses on usage and functionality of PsychoseNet.nl, using the Google Analytics framework. Results PsychoseNet.nl was visited by more than three million users, generating more than 13 million pageviews. Users mainly originated from the Netherlands and Belgium. Popular sections of the website were online counseling, chat, forum and blogs. Conclusion eCommunities such as PsychoseNet.nl appear to fill a gap, and further research is required on health impact and the place of public mental health initiatives in the system of mental health services. An English version of the site was recently started as Psychosisnet.com. Tijdschrift voor Psychiatrie 63(2021)1, 56-63.
Assuntos
Internet/estatística & dados numéricos , Transtornos Mentais , Saúde Mental , Autogestão , Telemedicina/estatística & dados numéricos , Bélgica , Humanos , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Países Baixos , PsiquiatriaRESUMO
OBJECTIVE: To compare rates of drug survival and clinical response during 2 years of follow-up in ankylosing spondylitis (AS) patients treated with etanercept or adalimumab in routine care. METHOD: Biological-naïve consecutive AS patients treated with etanercept (n = 163) or adalimumab (n = 82) were followed. Treatment discontinuation was due to inefficacy, adverse events, loss to follow-up, planning a pregnancy, or uveitis. Disease activity was assessed by the Ankylosing Spondylitis Disease Activity Score using C-reactive protein (ASDAS-CRP). Moderate disease activity was defined as an ASDAS-CRP < 2.1. RESULTS: Twenty-seven patients (32.9%) treated with adalimumab and 30 (18.4%) with etanercept discontinued treatment. Cox regression analysis demonstrated a significant difference in survival rate between discontinuation of the drug in adalimumab patients compared with etanercept patients [hazard ratio (HR) 2.1, 95% confidence interval (CI) 1.3-4.5, p = 0.005; corrected for confounding factors: HR 2.5, 95% CI 1.3-4.5, p = 0.006]. There was no significant difference at 2 years of follow-up between the adalimumab- and the etanercept-treated patients in mean ± sd ASDAS-CRP (1.9 ± 1.1 and 2.0 ± 0.9, respectively, p = 0.624), and 23 out of 34 (67.6%) compared to 71 out of 117 (60.7%) reached ASDAS-CRP moderate disease activity (odds ratio 0.738, 95% CI 0.329-1.657, p = 0.530). CONCLUSION: No significant difference was found between AS patients treated with etanercept and those treated with adalimumab in mean ASDAS-CRP and reaching ASDAS-CRP minimal disease activity at 2 year follow-up. Drug survival rate was higher in etanercept- compared to adalimumab-treated patients. However, this should be interpreted cautiously as the risk of allocation bias cannot be excluded.
Assuntos
Adalimumab/uso terapêutico , Antirreumáticos/uso terapêutico , Etanercepte/uso terapêutico , Espondilite Anquilosante/tratamento farmacológico , Adulto , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Taxa de Sobrevida , Resultado do TratamentoAssuntos
Adalimumab/uso terapêutico , Antirreumáticos/uso terapêutico , Espondilite Anquilosante/tratamento farmacológico , Adalimumab/sangue , Adulto , Antirreumáticos/sangue , Estudos de Coortes , Monitoramento de Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fenômenos Farmacológicos , Estudos ProspectivosRESUMO
The surprising discrepancy between results from different methods for measuring the proton charge radius is referred to as the proton radius puzzle. In particular, measurements using electrons seem to lead to a different radius compared with those using muons. Here, a direct measurement of the n = 2 Lamb shift of atomic hydrogen is presented. Our measurement determines the proton radius to be r p = 0.833 femtometers, with an uncertainty of ±0.010 femtometers. This electron-based measurement of r p agrees with that obtained from the analogous muon-based Lamb shift measurement but is not consistent with the larger radius that was obtained from the averaging of previous electron-based measurements.
RESUMO
OBJECTIVE: To evaluate within the Traditional Chinese Medicine (TCM) setting, the effect of CHM-formulae on menopausal symptoms. DESIGN: A double-blind and double-dummy randomised placebo-controlled trial. METHOD: Between February and June 2002 and June and October 2004, 31 peri- and postmenopausal Dutch women were recruited to complete 12 weeks of treatment with either CHM formulae (n=10), HRT (n=11) or placebo (n=10) medications plus 4 weeks of non-treatment follow-up observation. Hereby a double-dummy setting is applied, i.e. the medications and placebo's taken were both capsules and liquid extracts. Appropriate to the TCM setting, the CHM-prescriptions could be adjusted according to the symptoms and signs of the individuals for that moment. MAIN OUTCOME MEASURES: The primary end-point was the reduction in frequency of vasomotor symptoms (hot flushes and night sweats). Secondary end-point were the improvements measured in quality of life questionnaire SF-36 and other symptoms and signs related to the peri- and postmenopausal period. RESULTS: Placebo had a score of 30%. Compared to Placebo, on average CHM is 29% significantly (p<0.05) more effective in reducing the amount of hot flushes, while HRT is almost 50%. Although quantitatively there was a significant difference in the reduction of hot flushes between groups, qualitatively there was no overall improvement. CONCLUSIONS: This pilot study proved clearly that CHM could help women with their menopausal problems. The chosen trial methodology with its TCM differential diagnosis after orthodox medicine diagnosis is fully compatible with TCM practice and hence acceptable for western and Chinese medical practitioners. For a place in the western health care system, we need to conduct a larger trial with a more menopause specific questionnaire.
Assuntos
Medicamentos de Ervas Chinesas/administração & dosagem , Terapia de Reposição de Estrogênios , Estrogênios Conjugados (USP)/administração & dosagem , Fogachos/tratamento farmacológico , Menopausa , Pós-Menopausa/efeitos dos fármacos , Saúde da Mulher , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Humanos , Pessoa de Meia-Idade , Países Baixos , Qualidade de Vida , Inquéritos e QuestionáriosRESUMO
Aberrant function of glutamatergic pathways is likely to underlie the pathology of schizophrenia. Evidence of oxidative stress in the disease pathology has also been reported. N-Acetylaspartate (NAA) is metabolically linked to both cascades and may be a key marker in exploring the interconnection of glutamatergic pathways and oxidative stress. Several studies have reported positive correlation between the levels of NAA and Glx (the sum of glutamate and glutamine) in several brain regions in healthy subjects, by using proton magnetic resonance spectroscopy ([(1)H]MRS). Interestingly, one research group recently reported decoupling of the relationship between NAA and Glx in the hippocampus of patients with schizophrenia. Here we report levels of NAA and Glx measured using [(1)H]MRS, relative to the level of creatine (Cr) as an internal control. The dorsolateral prefrontal cortex (DLPFC) and anterior cingulate cortex (ACC) in 25 patients with schizophrenia and 17 matched healthy controls were studied. In DLPFC, NAA/Cr and Glx/Cr were significantly positively correlated in healthy controls after correction for the effect of age and smoking status and after correction for multiple comparisons (r= 0.627, P= 0.017). However, in patients with schizophrenia, the positive correlation between NAA/Cr and Glx/Cr was not observed even after correcting for these two variables (r= -0.330, P= 0.124). Positive correlation between NAA/Cr and Glx/Cr was not observed in the ACC in both groups. Decoupling of NAA and Glx in the DLPFC may reflect the interconnection of glutamatergic pathways and oxidative stress in the pathology of schizophrenia, and may possibly be a biomarker of the disease.
Assuntos
Ácido Aspártico/análogos & derivados , Ácido Glutâmico/metabolismo , Giro do Cíngulo/metabolismo , Córtex Pré-Frontal/metabolismo , Esquizofrenia/diagnóstico , Esquizofrenia/metabolismo , Adulto , Ácido Aspártico/metabolismo , Estudos de Casos e Controles , Creatina/metabolismo , Feminino , Glutamina/metabolismo , Giro do Cíngulo/patologia , Humanos , Masculino , Testes Neuropsicológicos , Estresse Oxidativo , Córtex Pré-Frontal/patologia , Espectroscopia de Prótons por Ressonância Magnética , Esquizofrenia/patologiaRESUMO
Enhanced understanding of light non-aqueous phase liquid (LNAPL) infiltration into heterogeneous porous media is important for the effective design of remediation strategies. We used a 2-D experimental facility that allows for visual observation of LNAPL contours in order to study LNAPL redistribution in a layered porous medium. The layers are situated in the unsaturated zone near the watertable and they are inclined to be able to observe the effect of discontinuities in capillary forces and relative permeabilities. Two experiments were performed. The first experiment consisted of LNAPL infiltration into a fine sand matrix with a coarse sand layer, and the second experiment consisted of a coarse sand matrix and a fine sand layer. The numerical multi-phase flow model STOMP was validated with regard to the experimental results. This model is able to adequately reproduce the experimental LNAPL contours. Numerical sensitivity analysis was also performed. The capillarity contrast between sands was found to be the main controlling factor determining the final LNAPL distribution.
Assuntos
Modelos Teóricos , Poluentes do Solo/análise , Poluentes da Água/análise , Poluição Ambiental/prevenção & controle , Filtração , Teste de Materiais , Porosidade , Movimentos da ÁguaAssuntos
Artralgia/etiologia , Artrite Infecciosa/diagnóstico , Osteoartrite do Quadril/complicações , Infecções Estafilocócicas/microbiologia , Infecções Estreptocócicas/microbiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Artrite Infecciosa/complicações , Artrite Infecciosa/microbiologia , Diagnóstico Diferencial , Feminino , Humanos , Staphylococcus aureus/isolamento & purificação , Streptococcus pyogenes/isolamento & purificaçãoRESUMO
Trapeziometacarpal osteoarthritis is a common entity, often bilateral and predominantly affecting postmenopausal women. In the case of failure of conservative treatment, surgery is a good option. The aim of this study was to compare three surgical procedures. 63 patients (74 thumbs) with osteoarthritis of the trapezio-metacarpal joint were surgically treated; 54 patients were seen for follow-up, 7 had died and 2 were lost to follow-up. The patients were stratified according to treatment; resection arthroplasty (the joint surface's of the metacarpal and the trapezium are resected) (18 thumbs), trapeziectomy with tendon interposition (17 thumbs) or trapezio-metacarpal arthrodesis (28 thumbs). Baseline characteristics were comparable in the three groups for mean age at operation, Eaton classification, left right distribution and dominant hands operated. The average follow-up was 13 years for the resection group, 8 years for the trapeziectomy group and 9 years for the arthrodesis group. No statistically significant difference between the three groups was found for the visual analogue pain and satisfaction scale, pain frequency nor DASH score. Patients in the trapeziectomy group had significantly less pain compared to the arthrodesis group (p=0.025). Statistically, radial abduction was significantly better after trapeziectomy compared to resection arthroplasty (p<0.01) or arthrodesis (p=0.01). There was no difference among the three groups in grip and tip pinch strength nor in pain on palpation. None of the patients in the trapeziectomy group needed a re-operation, one patient in the resection arthroplasty group had a re-operation, and 22 patients in the arthrodesis group had one or more re-operations for hardware removal or because of a complication. This study shows that the resection arthroplasty has equally good long term results compared to trapeziectomy combined with tendon interposition or arthrodesis. Resection arthroplasty is performed through a single incision and is technically simple. In our clinic resection arthroplasty is therefore the preferred technique for the treatment of osteoarthritis of the trapeziometacarpal joint.