Objective:To identify the most frequent gender-specific suicide methods in Europe.Design:Proportions of seven predominant suicide methods utilised in 16 countries participating in the European ...Alliance Against Depression (EAAD) were reported in total and cross-nationally. Relative risk (RR) relating to suicide methods and gender was calculated. To group countries by pattern of suicide methods, hierarchical clustering was applied.Setting and participants:Data on suicide methods for 119 122 male and 41 338 female cases in 2000–4/5 from 16 EAAD countries, covering 52% of European population were obtained.Results:Hanging was the most prevalent suicide method among both males (54.3%) and females (35.6%). For males, hanging was followed by firearms (9.7%) and poisoning by drugs (8.6%); for females, by poisoning by drugs (24.7%) and jumping from a high place (14.5%). Only in Switzerland did hanging rank as second for males after firearms. Hanging ranked first among females in eight countries, poisoning by drugs in five and jumping from a high place in three. In all countries, males had a higher risk than females of using firearms and hanging and a lower risk of poisoning by drugs, drowning and jumping. Grouping showed that countries might be divided into five main groups among males; for females, grouping did not yield clear results.Conclusions:Research on suicide methods could lead to the development of gender-specific intervention strategies. Nevertheless, other approaches, such as better identification and treatment of mental disorders and the improvement of toxicological aid should be put in place.
•Real-world data on treatment resistant depression (TRD) in Europe are lacking•No treatment consensus has been reached; in this study, treatments varied widely•After 6 months of routine clinical ...care, 73.5% of patients had not responded•At Month (M) 6, 16.7% of patients were in remission but 33.3% lost remission by M12•Despite low remission rates, 60.0% of patients had not changed treatment at M12
Treatment resistant depression (TRD) characterizes a subgroup of 10–30% of patients with major depressive disorder, and is associated with considerable morbidity and mortality. A consensus treatment for TRD does not exist, which often leads to wide variations in treatment strategies. Real-world studies on treatment patterns and outcomes in TRD patients in Europe are lacking and could help elucidate current treatment strategies and their efficacy.
This non-interventional cohort study of patients with TRD (defined as treatment failure on ≥2 oral antidepressants given at adequate dose and duration) with moderate to severe depression collected real-world data on treatment patterns and outcomes in several European countries. Patients were started on a new treatment for depression according to routine clinical practice.
Among 411 patients enrolled, after 6 months, only 16.7% achieved remission and 73.5% showed no response. At Month 12, while 19.2% achieved remission and 69.2% showed no response, 33.3% of those in remission at Month 6 were no longer in remission. Pharmacological treatments employed were heterogenous; 54 different drugs were recorded at baseline, and the top 5 treatment types according to drug classes accounted for 40.0% of patients. Even though remission rates were very low, at Month 12, 60.0% of patients had not changed treatment since enrolment.
The heterogeneity of treatments highlights a lack of consensus. Moreover, despite low response rates, patients often remained on treatments for substantial periods of time. These data further support existence of an unmet treatment need for TRD patients in Europe.
•Real-world evidence was used to assess unmet need in treatment resistant depression•Patients had experienced treatment failure on multiple and wide-ranging treatments•Treatment resistant depression ...(TRD) was associated with poor quality of life•Patients also had reduced function and productivity, in and outside of work•Treatment resistant depression has a high disease burden and clear unmet treatment need
Treatment resistant depression (TRD; failure to respond to ≥2 treatments) affects ~20% of patients with major depressive disorder (MDD). Real-world data could help describe patient characteristics and TRD disease burden, to assess the unmet needs of TRD patients in Europe.
This observational study collected data from adults with moderate to severe TRD initiating a new treatment for depression, according to local standards of care. At baseline, socio-demographic characteristics, medical history, prior and current treatments were recorded. Disease severity, health-related quality of life (HRQoL), functionality and productivity were assessed.
Overall, 411 eligible patients were enrolled across seven European countries. Mean (standard deviation SD) patient age was 51.0 (10.8) years; 62.3% were female. Long-term sick leave was reported by 19.0% of patients; 30.2% were unemployed. The mean (SD) duration of the current episode was 2.6 (3.9) years. At baseline, mean (SD) HRQoL scores for EuroQoL 5-dimension 5-level (UK tariff) and EQ-Visual Analog Scale were 0.41 (0.25) and 41.1 (18.7), respectively. The Work Productivity and Activity Impairment questionnaire demonstrated mean (SD) absenteeism of 57.0% (44.9%) and presenteeism of 54.7% (29.5%); mean (SD) overall work impairment was 60.5% (29.9%).
Key limitations are small cohort size, absence of a control group and generalizability to countries with different healthcare models.
TRD patients had a high disease burden, low HRQoL and reduced function and productivity, with a substantial proportion unable to work. This demonstrates an unmet treatment need in TRD patients that, if addressed, could reduce the heavy personal and societal burden.
Radiation resistant LGAD design Ferrero, M.; Arcidiacono, R.; Barozzi, M. ...
Nuclear instruments & methods in physics research. Section A, Accelerators, spectrometers, detectors and associated equipment,
03/2019, Letnik:
919
Journal Article
Recenzirano
Odprti dostop
In this paper, we report on the radiation resistance of 50-micron thick Low Gain Avalanche Diodes (LGAD) manufactured at the Fondazione Bruno Kessler (FBK) employing different dopings in the gain ...layer. LGADs with a gain layer made of Boron, Boron low-diffusion, Gallium, Carbonated Boron and Carbonated Gallium have been designed and successfully produced at FBK. These sensors have been exposed to neutron fluences up to ϕn∼3⋅1016n∕cm2 and to proton fluences up to ϕp∼9⋅1015p∕cm2 to test their radiation resistance. The experimental results show that Gallium-doped LGAD are more heavily affected by the initial acceptor removal mechanism than those doped with Boron, while the addition of Carbon reduces this effect both for Gallium and Boron doping. The Boron low-diffusion gain layer shows a higher radiation resistance than that of standard Boron implant, indicating a dependence of the initial acceptor removal mechanism upon the implant density.
In this paper we present the numerical simulation of silicon detectors with internal gain as the main tool for 4-dimensional (4D) particle trackers design and optimization. The Low-Gain Avalanche ...Diode (LGAD) technology and its present limitations are reviewed with the aim of introducing the Resistive AC-Coupled Silicon Detectors (RSD) paradigm as a case study of our investigation. Authors here present Spice-like and 2D/3D Technological Computer-Aided Design (TCAD) simulations to characterize sensors in terms of both their electrostatic behavior, capacitive (dynamic) coupling and radiation-hardness performances, showing the methodological approach used in order to extract the set of layout rules allowing the release of RSD1, the incoming production run at Fondazione Bruno Kessler (FBK) of next-generation silicon detectors for 4D tracking with intrinsic 100% fill-factor.
Rationale
Clozapine has proven to be superior to other antipsychotic drugs in the treatment of schizophrenia but is under-prescribed due to its potentially severe side effects. Clozapine-induced ...sialorrhea (CIS) is a frequent and extremely uncomfortable side effect, which remains understudied.
Objectives
To examine the prevalence of diurnal and nocturnal CIS in a sample of patients treated with clozapine, and to evaluate its impact on quality of life.
Methods
We conducted a cross-sectional, observational study of 130 patients with schizophrenia spectrum disorders treated with clozapine. The prevalence of CIS was evaluated via specific sialorrhea scales. None of the patients included in the study was receiving a specific treatment for hypersalivation during the study period. Possible associations between sialorrhea and clinical and quality of life variables were analyzed.
Results
Of 130 subjects, 120 (92.3%) suffered from CIS. Eighty-one (62.31%) suffered from diurnal CIS, 115 (88.56%) from nocturnal CIS, and 85 (65.38%) suffered from both. Significant positive associations between quality of life and diurnal CIS (
B
= 0.417;
p
= 2.1e − 6,
R
2
= 0.156) and nocturnal CIS (
B
= 0.411;
p
= 7.7e − 6,
R
2
= 0.139) were detected. Thirty per cent of the subjects reported a moderate to severe negative impact of sialorrhea on their quality of life.
Conclusions
The present study suggests that CIS is highly prevalent in patients with schizophrenia and has an important impact on quality of life in one-third of our sample. Therefore, the inclusion of a systematic evaluation and treatment of CIS in standard clinical practice is highly recommended.
Trial registration
Clinical Trials (
https://clinicaltrials.gov
) under reference NCT04197037.
Childhood trauma is intimately related with suicidal behaviour. Patients who have suffered childhood trauma develop impaired Reflective Functioning (RF), which refers to the capacity to understand ...ourselves and others in terms of intentional mental states. An improvement in RF has been associated with a reduction in suicidal attempts, but the mediating role of RF between childhood trauma and suicidal behaviour has not been addressed so far.
We aim to examine the potential mediating effect of RF among childhood trauma and suicide attempts.
We included 748 patients who had attempted suicide at least once. They were asked to complete the Reflective Functioning Questionnaire (RFQ-8), the Columbia-Suicide Severity Rating scale (CSSRS), and the Childhood Trauma Questionnaire-Short Form (CTQ-SF). We conducted linear regressions by simple mediating model to examine the role of RF in the indirect association between childhood trauma and the number of suicide attempts.
Our results show significant indirect effects through hypo and hypermentalizing between Emotional Abuse (EA) and Sexual Abuse (SA) in childhood and the number of suicide attempts in lifetime. These results indicate that ineffective RF significantly mediates the association between childhood trauma and suicidality.
This is the first study supporting the mediational role of RF in the relationship between EA and SA, and the number of suicide attempt in lifetime. These findings have important implications for reducing suicide rates and preventing future re-attempts. Further studies analysing this mediating role and focusing efforts on increasing RF-based interventions are required.
First FBK production of 50 μm ultra-fast silicon detectors Sola, V.; Arcidiacono, R.; Boscardin, M. ...
Nuclear instruments & methods in physics research. Section A, Accelerators, spectrometers, detectors and associated equipment,
04/2019, Letnik:
924
Journal Article
Recenzirano
Odprti dostop
Fondazione Bruno Kessler (FBK, Trento, Italy) has recently delivered its first 50 μm thick production of Ultra-Fast Silicon Detectors (UFSD), based on the Low-Gain Avalanche Diode design. These ...sensors use high resistivity Si-on-Si substrates, and have a variety of gain layer doping profiles and designs based on Boron, Gallium, Carbonated Boron and Carbonated Gallium to obtain a controlled multiplication mechanism. Such variety of gain layers will allow identifying the most radiation hard technology to be employed in the production of UFSD, to extend their radiation resistance beyond the current limit of ϕ∼ 1015 neq/cm2. In this paper, we present the characterisation, the timing performance, and the results on radiation damage tolerance of this new FBK production.
The proof of concept of a new device, capable of determining in a few seconds the energy of clinical proton beams by measuring the time of flight (ToF) of protons, is presented. The prototype ...consists of two thin ultra fast silicon detector (UFSD) pads, aligned along the beam direction in a telescope configuration and readout by a digitizer. The method developed for extracting the energy at the isocenter from the measured ToF, validated by Monte Carlo simulations, and the procedure used to calibrate the system are also presented and discussed in detail. The prototype was tested at the Centro Nazionale di Adroterapia Oncologica (CNAO, Pavia, Italy), at several beam energies, covering the entire clinical range, and using different distances between the sensors. The measured beam energies were benchmarked against the nominal CNAO energy values, obtained during the commissioning of the centre from the measured ranges in water. Deviations of few hundreds of keV have been achieved for all considered proton beam energies for distances between the two sensors larger than 60 cm, indicating a sensitivity to the corresponding beam range in water smaller than the clinical tolerance of 1 mm. Moreover, few seconds of irradiation were necessary to collect the required statistics. These preliminary results indicate that a telescope of UFSDs could achieve in a short time the accuracy required for the clinical application and therefore encourage further investigations towards the improvement and the optimization of the present prototype.
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