Major depression has become one of the most frequent diagnoses in Germany. It is also quite prominent in cases referred for medicolegal assessment in insurance, compensation or disability claims. ...This report evaluates the validity of clinicians’ diagnoses of major depression in a sample of claimants. In 2015, n = 127 consecutive cases were examined for medicolegal assessment. All had been diagnosed with major depression by clinicians. All testees underwent a psychiatric interview, a physical examination, they answered questionnaires for depressive symptoms according to DSM-5, embitterment disorder, post-concussion syndrome (PCS) and unspecific somatic complaints. Performance and symptom validity tests were administered. Only 31% of the sample fulfilled the diagnostic criteria for DSM-5 major depression according to self-report, while none did so according to psychiatric assessment. Negative response bias was found in 64% of cases, feigned neurologic symptoms in 22%. Symptom exaggeration was indiscriminate rather than depression-specific. By self-report (i.e. symptom endorsement in questionnaires), 64% of the participants qualified for embitterment disorder and 93% for PCS. In conclusion, clinicians’ diagnoses of depression seem frequently erroneous. The reasons are improper assessment of the diagnostic criteria, confusion of depression with bereavement or embitterment and a failure to assess for response bias.
Disclosure
No significant relationships.
Global, regional, and national estimates of prevalence of and tends in infertility are needed to target prevention and treatment efforts. By applying a consistent algorithm to demographic and ...reproductive surveys available from developed and developing countries, we estimate infertility prevalence and trends, 1990 to 2010, by country and region.
We accessed and analyzed household survey data from 277 demographic and reproductive health surveys using a consistent algorithm to calculate infertility. We used a demographic infertility measure with live birth as the outcome and a 5-y exposure period based on union status, contraceptive use, and desire for a child. We corrected for biases arising from the use of incomplete information on past union status and contraceptive use. We used a Bayesian hierarchical model to estimate prevalence of and trends in infertility in 190 countries and territories. In 2010, among women 20-44 y of age who were exposed to the risk of pregnancy, 1.9% (95% uncertainty interval 1.7%, 2.2%) were unable to attain a live birth (primary infertility). Out of women who had had at least one live birth and were exposed to the risk of pregnancy, 10.5% (9.5%, 11.7%) were unable to have another child (secondary infertility). Infertility prevalence was highest in South Asia, Sub-Saharan Africa, North Africa/Middle East, and Central/Eastern Europe and Central Asia. Levels of infertility in 2010 were similar to those in 1990 in most world regions, apart from declines in primary and secondary infertility in Sub-Saharan Africa and primary infertility in South Asia (posterior probability pp ≥0.99). Although there were no statistically significant changes in the prevalence of infertility in most regions amongst women who were exposed to the risk of pregnancy, reduced child-seeking behavior resulted in a reduction of primary infertility among all women from 1.6% to 1.5% (pp=0.90) and a reduction of secondary infertility among all women from 3.9% to 3.0% (pp>0.99) from 1990 to 2010. Due to population growth, however, the absolute number of couples affected by infertility increased from 42.0 million (39.6 million, 44.8 million) in 1990 to 48.5 million (45.0 million, 52.6 million) in 2010. Limitations of the study include gaps in survey data for some countries and the use of proxies to determine exposure to pregnancy.
We analyzed demographic and reproductive household survey data to reveal global patterns and trends in infertility. Independent from population growth and worldwide declines in the preferred number of children, we found little evidence of changes in infertility over two decades, apart from in the regions of Sub-Saharan Africa and South Asia. Further research is needed to identify the etiological causes of these patterns and trends.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Falls often cause severe injuries and are one of the most costly health conditions among older adults. Yet, many falls are preventable. The number of preventable medically treated falls and ...associated costs averted were estimated by applying evidence-based fall interventions in clinical settings.
A review of peer-reviewed literature was conducted in 2017 using literature published between 1994 and 2017, the authors estimated the prevalence of seven fall risk factors and the effectiveness of seven evidence-based fall interventions. Then authors estimated the number of older adults (aged ≥65 years) who would be eligible to receive one of seven fall interventions (e.g., Tai Chi, Otago, medication management, vitamin D supplementation, expedited first eye cataract surgery, single-vision distance lenses for outdoor activities, and home modifications led by an occupational therapist). Using the reported effectiveness of each intervention, the number of medically treated falls that could be prevented and the associated direct medical costs averted were calculated.
Depending on the size of the eligible population, implementing a single intervention could prevent between 9,563 and 45,164 medically treated falls and avert $94–$442 million in direct medical costs annually. The interventions with the potential to help the greatest number of older adults were those that provided home modification delivered by an occupational therapist (38.2 million), and recommended daily vitamin D supplements (16.7 million).
This report is the first to estimate the number of medically treated falls that could be prevented and the direct medical costs that could be adverted. Preventing falls can benefit older adults substantially by improving their health, independence, and quality of life.
This study sought to estimate the incidence, average cost, and total direct medical costs for fatal and non-fatal fall injuries in hospital, ED, and out-patient settings among U.S. adults aged 65 or ...older in 2012, by sex and age group and to report total direct medical costs for falls inflated to 2015 dollars.
Incidence data came from the 2012 National Vital Statistics System, 2012 Healthcare Cost and Utilization Project-Nationwide Inpatient Sample, 2012 Health Care Utilization Program National Emergency Department Sample, and 2007 Medical Expenditure Panel Survey. Costs for fatal falls were derived from the Centers for Disease Control and Prevention's Web-based Injury Statistics Query and Reporting System; costs for non-fatal falls were based on claims from the 1998/1999 Medicare fee-for-service 5% Standard Analytical Files. Costs were inflated to 2015 estimates using the health care component of the Personal Consumption Expenditure index.
In 2012, there were 24,190 fatal and 3.2 million medically treated non-fatal fall related injuries. Direct medical costs totaled $616.5 million for fatal and $30.3 billion for non-fatal injuries in 2012 and rose to $637.5 million and $31.3 billion, respectively, in 2015. Fall incidence as well as total cost increased with age and were higher among women.
Medically treated falls among older adults, especially among older women, are associated with substantial economic costs.
Widely implementing evidence-based interventions for fall prevention is essential to decrease the incidence and healthcare costs associated with these injuries.
Insufficient physical activity is a leading risk factor for non-communicable diseases, and has a negative effect on mental health and quality of life. We describe levels of insufficient physical ...activity across countries, and estimate global and regional trends.
We pooled data from population-based surveys reporting the prevalence of insufficient physical activity, which included physical activity at work, at home, for transport, and during leisure time (ie, not doing at least 150 min of moderate-intensity, or 75 min of vigorous-intensity physical activity per week, or any equivalent combination of the two). We used regression models to adjust survey data to a standard definition and age groups. We estimated time trends using multilevel mixed-effects modelling.
We included data from 358 surveys across 168 countries, including 1·9 million participants. Global age-standardised prevalence of insufficient physical activity was 27·5% (95% uncertainty interval 25·0–32·2) in 2016, with a difference between sexes of more than 8 percentage points (23·4%, 21·1–30·7, in men vs 31·7%, 28·6–39·0, in women). Between 2001, and 2016, levels of insufficient activity were stable (28·5%, 23·9–33·9, in 2001; change not significant). The highest levels in 2016, were in women in Latin America and the Caribbean (43·7%, 42·9–46·5), south Asia (43·0%, 29·6–74·9), and high-income Western countries (42·3%, 39·1–45·4), whereas the lowest levels were in men from Oceania (12·3%, 11·2–17·7), east and southeast Asia (17·6%, 15·7–23·9), and sub-Saharan Africa (17·9%, 15·1–20·5). Prevalence in 2016 was more than twice as high in high-income countries (36·8%, 35·0–38·0) as in low-income countries (16·2%, 14·2–17·9), and insufficient activity has increased in high-income countries over time (31·6%, 27·1–37·2, in 2001).
If current trends continue, the 2025 global physical activity target (a 10% relative reduction in insufficient physical activity) will not be met. Policies to increase population levels of physical activity need to be prioritised and scaled up urgently.
None.
The possible transition to the so-called ultimate regime, wherein both the bulk and the boundary layers are turbulent, has been an outstanding issue in thermal convection, since the seminal work by ...Kraichnan Phys. Fluids 5, 1374 (1962)PFLDAS0031-917110.1063/1.1706533. Yet, when this transition takes place and how the local flow induces it is not fully understood. Here, by performing two-dimensional simulations of Rayleigh-Bénard turbulence covering six decades in Rayleigh number Ra up to 10^{14} for Prandtl number Pr=1, for the first time in numerical simulations we find the transition to the ultimate regime, namely, at Ra^{*}=10^{13}. We reveal how the emission of thermal plumes enhances the global heat transport, leading to a steeper increase of the Nusselt number than the classical Malkus scaling Nu∼Ra^{1/3} Proc. R. Soc. A 225, 196 (1954)PRLAAZ1364-502110.1098/rspa.1954.0197. Beyond the transition, the mean velocity profiles are logarithmic throughout, indicating turbulent boundary layers. In contrast, the temperature profiles are only locally logarithmic, namely, within the regions where plumes are emitted, and where the local Nusselt number has an effective scaling Nu∼Ra^{0.38}, corresponding to the effective scaling in the ultimate regime.
Everyday circumstances require efficient updating of behavior. Brain systems in the right inferior frontal cortex have been identified as critical for some aspects of behavioral updating, such as ...stopping actions. However, the precise role of these neural systems is controversial. Here we examined how the inferior frontal cortex updates behavior by combining reversible cortical interference (transcranial magnetic stimulation) with an experimental task that measures different types of updating. We found that the right inferior frontal cortex can be functionally segregated into two subregions: a dorsal region, which is critical for visual detection of changes in the environment, and a ventral region, which updates the corresponding action plan. This dissociation reconciles competing accounts of prefrontal organization and casts light on the neural architecture of human cognitive control.
The logarithmic law for the mean velocity in turbulent boundary layers has long provided a valuable and robust reference for comparison with theories, models and large-eddy simulations (LES) of ...wall-bounded turbulence. More recently, analysis of high-Reynolds-number experimental boundary-layer data has shown that also the variance and higher-order moments of the streamwise velocity fluctuations
$\def \xmlpi #1{}\def \mathsfbi #1{\boldsymbol {\mathsf {#1}}}\let \le =\leqslant \let \leq =\leqslant \let \ge =\geqslant \let \geq =\geqslant \def \Pr {\mathit {Pr}}\def \Fr {\mathit {Fr}}\def \Rey {\mathit {Re}}u^{\prime +}$
display logarithmic laws. Such experimental observations motivate the question whether LES can accurately reproduce the variance and the higher-order moments, in particular their logarithmic dependency on distance to the wall. In this study we perform LES of very high-Reynolds-number wall-modelled channel flow and focus on profiles of variance and higher-order moments of the streamwise velocity fluctuations. In agreement with the experimental data, we observe an approximately logarithmic law for the variance in the LES, with a ‘Townsend–Perry’ constant of
$A_1\approx 1.25$
. The LES also yields approximate logarithmic laws for the higher-order moments of the streamwise velocity. Good agreement is found between
$A_p$
, the generalized ‘Townsend–Perry’ constants for moments of order
$2p$
, from experiments and simulations. Both are indicative of sub-Gaussian behaviour of the streamwise velocity fluctuations. The near-wall behaviour of the variance, the ranges of validity of the logarithmic law and in particular possible dependencies on characteristic length scales such as the roughness length
$z_0$
, the LES grid scale
$\Delta $
, and subgrid scale mixing length
$C_s\Delta $
are examined. We also present LES results on moments of spanwise and wall-normal fluctuations of velocity.
In recent decades, the prevalence of obesity in children has increased dramatically. This worldwide epidemic has important consequences, including psychiatric, psychological and psychosocial ...disorders in childhood and increased risk of developing non-communicable diseases (NCDs) later in life. Treatment of obesity is difficult and children with excess weight are likely to become adults with obesity. These trends have led member states of the World Health Organization (WHO) to endorse a target of no increase in obesity in childhood by 2025.
Estimates of overweight in children aged under 5 years are available jointly from the United Nations Children's Fund (UNICEF), WHO and the World Bank. The Institute for Health Metrics and Evaluation (IHME) has published country-level estimates of obesity in children aged 2-4 years. For children aged 5-19 years, obesity estimates are available from the NCD Risk Factor Collaboration. The global prevalence of overweight in children aged 5 years or under has increased modestly, but with heterogeneous trends in low and middle-income regions, while the prevalence of obesity in children aged 2-4 years has increased moderately. In 1975, obesity in children aged 5-19 years was relatively rare, but was much more common in 2016.
It is recognised that the key drivers of this epidemic form an obesogenic environment, which includes changing food systems and reduced physical activity. Although cost-effective interventions such as WHO 'best buys' have been identified, political will and implementation have so far been limited. There is therefore a need to implement effective programmes and policies in multiple sectors to address overnutrition, undernutrition, mobility and physical activity. To be successful, the obesity epidemic must be a political priority, with these issues addressed both locally and globally. Work by governments, civil society, private corporations and other key stakeholders must be coordinated.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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