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Journal articles on the topic 'Bipolar disorder, burden, course'

Author: Grafiati

Published: 4 June 2021

Last updated: 1 February 2022

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1

Treuer, T., and M. Tohen. "Predicting the course and outcome of bipolar disorder: A review." European Psychiatry 25, no. 6 (2010): 328–33. http://dx.doi.org/10.1016/j.eurpsy.2009.11.012.

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AbstractDespite of advances in pharmacological and non-pharmacological treatments, bipolar disorder often entails multiple relapses and impaired psychological functioning. The extent to which modern treatments have influenced the natural course of a mental disorder is uncertain. Prediction of the course and outcome of bipolar disorders continues to be challenging, despite the multiple research efforts worldwide. Due to a lack of laboratory diagnostic tests and biomarkers, psychiatric interview and examination provide the basis for outcome prediction. While considered to have more favorable pro

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2

Wittchen, Hans-Ulrich, Stephan Mühlig, and Lukas Pezawas. "Natural course and burden of bipolar disorders." International Journal of Neuropsychopharmacology 6, no. 2 (2003): 145–54. http://dx.doi.org/10.1017/s146114570300333x.

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McIntyre, Roger. "Bipolar Disorder and ADHD: Clinical Concerns." CNS Spectrums 14, S6 (2009): 8–9. http://dx.doi.org/10.1017/s1092852900024822.

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During the past decade, a similar composite has emerged for both bipolar disorder and adult attention-deficit/hyperactive disorder (ADHD). First, both conditions have a relatively high prevalence, a low case detection, a protracted illness course, a high rate of comorbidity, multifactorial ideology, substantial heritable liability, and tremendous burden of illness in economic cost as well as interpersonal and vocational maladjustments. What has also been interesting along with these reports is that there has been emerging scientific studies implicating common brain regions and neural circuits

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4

Bermúdez-Ampudia, C., A. García-Alocén, M. Martínez-Cengotitabengoa, et al. "Mixed-effects models: Family burden and functionality in patients with bipolar disorder." European Psychiatry 33, S1 (2016): S331. http://dx.doi.org/10.1016/j.eurpsy.2016.01.1147.

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IntroductionThe bipolar disorder (BD) has an important effect over the lives of patients and families. The attitude of the family is a modifiable factor through specific interventions and it has been related with BD prognosis.ObjectivesStudy a sample of families and patients with BD.AimsCompare between two groups its course of burden of caring for family members with BD. Also, we will see the course of the functionality in patients.MethodsSample of 148 individuals who caring a familiar with BD. Seventy-six of these followed psychoeducation session are going to be experimental group (EG), and t

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5

Forty, Liz, Anna Ulanova, Lisa Jones, et al. "Comorbid medical illness in bipolar disorder." British Journal of Psychiatry 205, no. 6 (2014): 465–72. http://dx.doi.org/10.1192/bjp.bp.114.152249.

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BackgroundIndividuals with a mental health disorder appear to be at increased risk of medical illness.AimsTo examine rates of medical illnesses in patients with bipolar disorder (n = 1720) and to examine the clinical course of the bipolar illness according to lifetime medical illness burden.MethodParticipants recruited within the UK were asked about the lifetime occurrence of 20 medical illnesses, interviewed using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and diagnosed according to DSM-IV criteria.ResultsWe found significantly increased rates of several medical illnesses

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Coryell, W., J. Fiedorowicz, D. Solomon, and J. Endicott. "Age transitions in the course of bipolar I disorder." Psychological Medicine 39, no. 8 (2009): 1247–52. http://dx.doi.org/10.1017/s0033291709005534.

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BackgroundThis analysis aimed to show whether symptoms of either pole change in their persistence as individuals move through two decades, whether such changes differ by age grouping, and whether age of onset plays an independent role in symptom persistence.MethodParticipants in the National Institute of Mental Health (NIMH) Collaborative Depression Study (CDS) who completed at least 20 years of follow-up and who met study criteria for bipolar I or schizo-affective manic disorder, before intake or during follow-up, were divided by age at intake into youngest (18–29 years, n=56), middle (30–44

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Rakofsky, Jeffrey J., Steven T. Levy, and Boadie W. Dunlop. "Conceptualizing Treatment Nonadherence in Patients with Bipolar Disorder and PTSD." CNS Spectrums 16, no. 1 (2011): 11–20. http://dx.doi.org/10.1017/s1092852912000119.

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AbstractTreatment nonadherence is a concern among patients with bipolar disorder and posttraumatic stress disorder (PTSD). PTSD is common among patients with bipolar disorder and those with this comorbidity often have a more severe course of illness. While many factors have been associated with nonadherence in bipolar disorder patients and in PTSD patients, almost no research has focused on the factors associated with non-adherence in bipolar disorder patients with comorbid PTSD. Studies in primary bipolar disorder samples reveal patient, illness, drug and clinician characteristics associated

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8

GOIKOLEA, J. M., F. COLOM, A. MARTÍNEZ-ARÁN, et al. "Clinical and prognostic implications of seasonal pattern in bipolar disorder: a 10-year follow-up of 302 patients." Psychological Medicine 37, no. 11 (2007): 1595–99. http://dx.doi.org/10.1017/s0033291707000864.

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ABSTRACTBackgroundMore than 20% of bipolar patients may present with seasonal pattern (SP). Seasonality can alter the course of bipolar disorder. However, to date, long-term follow-up studies of bipolar patients presenting with SP are scarce. We present a 10-year follow-up study comparing clinical and demographic features of bipolar patients with and without SP.MethodThree hundred and twenty-five bipolar I and II patients were followed up for at least 10 years. SP was defined according to DSM-IV criteria. Clinical variables were obtained from structured interviews with the patients and their r

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9

Muralidharan, Kesavan, Ivan J. Torres, Leonardo E. Silveira, et al. "Impact of depressive episodes on cognitive deficits in early bipolar disorder: data from the Systematic Treatment Optimization Programme for Early Mania (STOP-EM)." British Journal of Psychiatry 205, no. 1 (2014): 36–43. http://dx.doi.org/10.1192/bjp.bp.113.135525.

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BackgroundAlthough manic episodes reportedly contribute to cognitive deficits in bipolar I disorder, the contribution of depressive episodes is poorly researched.AimsWe investigated the impact of depressive episodes on cognitive function early in the course of bipolar I disorder.MethodA total of 68 patients and 38 controls from the Systematic Treatment Optimization Programme for Early Mania (STOP-EM) first-episode mania programme were examined. We conducted (a) a cross-sectional analysis of the impact of prior depressive episodes on baseline cognitive function and (b) a prospective analysis as

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10

Bilska, Karolina, Joanna Pawlak, Paweł Kapelski, et al. "Differences in the Clinical Picture in Women with a Depressive Episode in the Course of Unipolar and Bipolar Disorder." Journal of Clinical Medicine 10, no. 4 (2021): 676. http://dx.doi.org/10.3390/jcm10040676.

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Due to current depression prevalence, it is crucial to make the correct diagnosis as soon as possible. The study aimed to identify commonly available, easy to apply, and quick to interpret tools allowing for a differential diagnosis between unipolar and bipolar disorder. The study group includes women with long duration of unipolar (UP, N = 34) and bipolar (BP, N = 43) affective disorder. The diagnosis was established according to the DSM criteria using SCID questionnaire. Additional questionnaires were used to differentiate between UP and BP. BP patients had an earlier age of onset, were hosp

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11

Karpov, B., G. Joffe, K. Aaltonen, et al. "Level of functioning, perceived work ability, and work status among psychiatric patients with major mental disorders." European Psychiatry 44 (July 2017): 83–89. http://dx.doi.org/10.1016/j.eurpsy.2017.03.010.

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AbstractBackground:Major mental disorders are highly disabling conditions that result in substantial socioeconomic burden. Subjective and objective measures of functioning or ability to work, their concordance, or risk factors for them may differ between disorders.Methods:Self-reported level of functioning, perceived work ability, and current work status were evaluated among psychiatric care patients with schizophrenia or schizoaffective disorder (SSA, n = 113), bipolar disorder (BD, n = 99), or depressive disorder (DD, n = 188) within the Helsinki University Psychiatric Consortium Study. Corr

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12

Baldwin, D. "Manifesto for a European anxiety disorders research network." European Psychiatry 26, S2 (2011): 2094. http://dx.doi.org/10.1016/s0924-9338(11)73797-x.

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Anxiety disorders are common, have an early onset, run a long course, cause substantial distress, impair overall function, reduce quality of life and impose a major economic burden, and therefore represent an important public health problem. Many patients do not present or are not recognized, the standard of care is often sub-optimal, and the effectiveness of interventions in real-world practice can be disappointing: there is considerable room for improvement in recognition, care and treatment.The causes remain largely unknown and this hinders accurate diagnosis, prediction of prognosis, and d

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13

Ramadan, Abdullah Mohammed, and Islam Ahmed Mansour. "Could ketamine be the answer to treating treatment-resistant major depressive disorder?" General Psychiatry 33, no. 5 (2020): e100227. http://dx.doi.org/10.1136/gpsych-2020-100227.

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Major depressive disorder (MDD) is a common, serious, debilitating condition affecting 350 million people worldwide, which remains to be unsatisfactorily treated with 53% of patients still complaining of symptoms after completing their courses with the correct dosage. Ketamine, which was approved by the Food and Drug Administration in 2019, is a potential treatment option for those recalcitrant cases. The mechanism of ketamine is not fully understood, but as type it is classified as an N-methyl-D-aspartate (NMDA) glutamate receptor antagonist, and can be given intravenously, intranasally and o

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14

Alonso, Pino, Brian Price, Abdul R. Conteh, et al. "Where there is no psychiatrist: A mental health programme in Sierra Leone." South African Journal of Psychiatry 20, no. 3 (2014): 6. http://dx.doi.org/10.4102/sajpsychiatry.v20i3.498.

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<p><strong>Background.</strong> For most low- and middle-income countries, mental health remains a neglected area, despite the recognised burden associated with neuropsychiatric conditions and the inextricable link to other public health priorities.</p><p><strong>Objectives.</strong> To describe the results of a free outpatient mental health programme delivered by non-specialist health workers in Makeni, Sierra Leone between July 2008 and May 2012. </p><p><strong>Methods.</strong> A nurse and two counsellors completed an 8-week

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15

Saunders, Kate E. A., and Guy M. Goodwin. "The course of bipolar disorder." Advances in Psychiatric Treatment 16, no. 5 (2010): 318–28. http://dx.doi.org/10.1192/apt.bp.107.004903.

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SummaryBipolar disorder is arguably a pivotal diagnosis in adult psychiatry bounded by schizophrenia on one side and unipolar depression on the other. It represents a wide spectrum of disorders, all sharing common features of elated and depressed mood. The early descriptions of symptom-free euthymia have long been dismissed and the chronic and enduring deficits associated with the disorder are beginning to be better understood. We review the current literature with regard to the course of the disorder, factors that may influence prognosis and common comorbidities.

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16

Kotzian, Bruno, Ives Cavalcante Passos, and Flávio Kapczinski. "Longitudinal course of bipolar disorder." Revista Debates em Psiquiatria Ano 6 (October 1, 2016): 6–8. http://dx.doi.org/10.25118/2236-918x-6-5-1.

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17

Barcellini, Wilma, Elisa Scola, Silvia Lanfranconi, et al. "Brain MRI Findings and Neuro-Psychiatric Involvement in Paroxysmal Nocturnal Hemoglobinuria (PNH)." Blood 128, no. 22 (2016): 4800. http://dx.doi.org/10.1182/blood.v128.22.4800.4800.

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Abstract PNH is a rare disorder characterized by hemolytic anemia, marrow failure and thrombosis, due to a deficiency in GPI-anchored proteins. Thrombotic events in PNH are commonly described in hepatic, portal, mesenteric, splenic, and renal veins, along with anecdotic case reports of cerebral venous sinus thrombosis and arterial ischemic strokes. This study was aimed at investigate brain involvement in 19 asymptomatic PNH patients by non-enhanced cerebral magnetic resonance imaging (MRI), and by intracranial arterial and venous angio-MRI. Neuroradiological findings were completed with a neur

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18

Goodwin, G. "Bipolar disorder." European Psychiatry 26, S2 (2011): 2184. http://dx.doi.org/10.1016/s0924-9338(11)73887-1.

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Bipolar disorder is rapidly becoming the primary diagnosis in adult psychiatry. It represents a wide spectrum of disorder all sharing common features of elated and depressed mood. The early descriptions of symptom-free euthymia have long been dismissed and the chronic and enduring deficits associated with the disorder are beginning to be better understood. The course of the disorder remains uncertain especially in light of the recently observed increases in children receiving the diagnosis. There is growing interest in the elated states seen as a common adolescent phenotype.There is a simplifi

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19

Maleki, Nayereh, Effat Sadeghian, Farshid Shamsaei, Lily Tapak, and Ali Ghaleiha. "Comparative Analysis of Spouse’s Burden and Quality of Life in Major Depressive Disorder and Bipolar I Disorder." Current Psychiatry Research and Reviews 15, no. 3 (2019): 193–98. http://dx.doi.org/10.2174/1874464812666190819151039.

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Background: Spouses of patients with bipolar disorder may experience a different quality of life and burden than seen with major depressive disorder. Objective: This study was conducted to comparatively analyse spouse’s burden and quality of life in major depressive and bipolar disorders. Methods: This cross-sectional study was conducted on 220 spouses of patients with major depressive and bipolar disorders in the city of Hamadan in Iran, in 2018. Data collection tools included Zarit Burden and QOL-BREF questionnaires. Data were analyzed by a t-test using SPSS -16. Results: The findings showed

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20

Kupfer, David J. "The Increasing Medical Burden in Bipolar Disorder." JAMA 293, no. 20 (2005): 2528. http://dx.doi.org/10.1001/jama.293.20.2528.

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21

Perlick, Deborah A., Robert A. Rosenheck, David J. Miklowitz, et al. "Caregiver Burden and Health in Bipolar Disorder." Journal of Nervous and Mental Disease 196, no. 6 (2008): 484–91. http://dx.doi.org/10.1097/nmd.0b013e3181773927.

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22

Angst, J., F. Angst, R. Sellaro, and H. Zhang. "S27.01 Longterm course of bipolar disorder." European Psychiatry 15, S2 (2000): 267s. http://dx.doi.org/10.1016/s0924-9338(00)94155-5.

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23

Birmaher, Boris. "Longitudinal Course of Pediatric Bipolar Disorder." American Journal of Psychiatry 164, no. 4 (2007): 537–39. http://dx.doi.org/10.1176/ajp.2007.164.4.537.

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24

Solomon, David A., Andrew C. Leon, William H. Coryell, et al. "Longitudinal Course of Bipolar I Disorder." Archives of General Psychiatry 67, no. 4 (2010): 339. http://dx.doi.org/10.1001/archgenpsychiatry.2010.15.

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25

Miller, Ivan W., Lisa A. Uebelacker, Gabor I. Keitner, Christine E. Ryan, and David A. Solomon. "Longitudinal course of bipolar I disorder." Comprehensive Psychiatry 45, no. 6 (2004): 431–40. http://dx.doi.org/10.1016/j.comppsych.2004.07.005.

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26

Titmarsh, Steve. "The burden of bipolar disorder in the UK." Progress in Neurology and Psychiatry 16, no. 5 (2012): 25–26. http://dx.doi.org/10.1002/pnp.250.

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27

Fagiolini, Andrea, Rocco Forgione, Mauro Maccari, et al. "Prevalence, chronicity, burden and borders of bipolar disorder." Journal of Affective Disorders 148, no. 2-3 (2013): 161–69. http://dx.doi.org/10.1016/j.jad.2013.02.001.

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28

Biederman, J., and E. Mick. "Longitudinal course of pediatric-onset bipolar disorder." European Neuropsychopharmacology 12 (October 2002): 221. http://dx.doi.org/10.1016/s0924-977x(02)80253-x.

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29

Strakowski, Stephen M., David E. Fleck, Melissa P. DelBello, et al. "Impulsivity across the course of bipolar disorder." Bipolar Disorders 12, no. 3 (2010): 285–97. http://dx.doi.org/10.1111/j.1399-5618.2010.00806.x.

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30

Almeida, Osvaldo P. "Does bipolar disorder have a benign course?" International Psychogeriatrics 28, no. 11 (2016): 1755–57. http://dx.doi.org/10.1017/s1041610216001423.

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Written records have been describing extreme states of emotions since ancient Greece (Angst and Marneros, 2001), but Aretaeus of Cappadocia (which is geographically located in modern Turkey) was probably the first to outline the close relationship between depression and mania nearly 2000 years ago: “I think that melancholia is the beginning and a part of mania. . . The development of mania is really a worsening of the disease rather than a change into another disease. . . In most of them the sadness became better after various lengths of time and changed into happiness; the patients then devel

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31

Khanna, R., N. Gupta, and S. Shanker. "Course of bipolar disorder in eastern India." Journal of Affective Disorders 24, no. 1 (1992): 35–41. http://dx.doi.org/10.1016/0165-0327(92)90058-e.

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32

Gilbert, Kirsten E., Jessica H. Kalmar, Fay Y. Womer, et al. "Impulsivity in adolescent bipolar disorder." Acta Neuropsychiatrica 23, no. 2 (2011): 57–61. http://dx.doi.org/10.1111/j.1601-5215.2011.00522.x.

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Objective: Increased impulsivity has been shown to be a trait feature of adults with bipolar disorder (BD), yet impulsivity has received little study in adolescents with BD. Thus, it is unknown whether it is a trait feature that is present early in the course of the disorder. We tested the hypotheses that self-reported impulsiveness is increased in adolescents with BD, and that it is present during euthymia, supporting impulsiveness as an early trait feature of the disorder.Methods: Impulsiveness was assessed in 23 adolescents with BD and 23 healthy comparison (HC) adolescents using the self-r

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33

Frank, E. "C.19.02 The increasing medical burden in bipolar disorder." European Neuropsychopharmacology 16 (January 2006): S590. http://dx.doi.org/10.1016/s0924-977x(06)70869-0.

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34

Vieta, Eduard, Maria Luisa Figueira, Frank Bellivier, et al. "Clinical and healthcare burden in patients with bipolar disorder." International Clinical Psychopharmacology 26 (September 2011): e44. http://dx.doi.org/10.1097/01.yic.0000405705.91360.6d.

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35

Casalini, F., S. Belletti, N. Mosti, et al. "Burden of metabolic diseases in patients with bipolar disorder." International Clinical Psychopharmacology 28 (December 2012): e61-e62. http://dx.doi.org/10.1097/01.yic.0000423353.38579.1d.

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36

Birnbaum, HG, E. Dial, EF Oster, PE Greenberg, and L. Shi. "PMH29: ECONOMIC BURDEN OF NOT RECOGNIZING BIPOLAR DISORDER PATIENTS." Value in Health 6, no. 3 (2003): 353. http://dx.doi.org/10.1016/s1098-3015(10)64231-3.

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37

Stimmel, Glen L. "Economic Grand Rounds: The Economic Burden of Bipolar Disorder." Psychiatric Services 55, no. 2 (2004): 117–18. http://dx.doi.org/10.1176/appi.ps.55.2.117.

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38

Dols, Annemiek, Carisha Thesing, Martijn Wouters, et al. "Burden on caregivers of older patients with bipolar disorder." Aging & Mental Health 22, no. 5 (2017): 686–91. http://dx.doi.org/10.1080/13607863.2017.1297360.

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39

Axelson, David A., Boris Birmaher, Michael A. Strober, et al. "Course of Subthreshold Bipolar Disorder in Youth: Diagnostic Progression From Bipolar Disorder Not Otherwise Specified." Journal of the American Academy of Child & Adolescent Psychiatry 50, no. 10 (2011): 1001–16. http://dx.doi.org/10.1016/j.jaac.2011.07.005.

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40

Preisig, M., and F. Ferrero. "Familial Risk Factors for the Course of Bipolar Disorder." European Psychiatry 24, S1 (2009): 1. http://dx.doi.org/10.1016/s0924-9338(09)70292-5.

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Aims:The major aims of the present paper were to:1.assess associations between the course of bipolar-I disorder in probands and the presence and course characteristics of mood disorders in their relatives and2.assess associations between manic and depressive symptoms in probands and relatives.Methods:A family study including 125 bipolar-I patients and all available first-degree relatives has been conducted at two Swiss sites. All participants were evaluated using the Diagnostic Interview for Genetic Studies. Assessed course variables included the age of onset, the number of episodes and social

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41

Leibenluft, Ellen. "Gender Differences in Major Depressive Disorder and Bipolar Disorder." CNS Spectrums 4, no. 10 (1999): 25–33. http://dx.doi.org/10.1017/s1092852900012335.

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AbstractThis paper reviews the literature on gender differences in major depressive disorder (MDD) and bipolar disorder (BPD). Beginning in adolescence, women are at a higher risk than men of becoming depressed. Avenues of investigation that might ultimately help to explain this phenomenon include studies of gender differences in the processing of emotional stimuli, the psychotropic effects of gonadal steroids, and environment/gene interactions in men and women. With the exception of the elevated suicide rate among men, consistent gender differences in the course and symptoms of MDD have not b

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Chopra, MohitP, KV Kishore Kumar, DK Subbakrishna, Sanjeev Jain, and RSrinivasa Murthy. "The course of bipolar disorder in rural India." Indian Journal of Psychiatry 48, no. 4 (2006): 254. http://dx.doi.org/10.4103/0019-5545.31559.

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Gjerris, A., E. M. Christensen, and J. K. Larsen. "The course and outcome in bipolar affective disorder." European Psychiatry 13, S4 (1998): 188s. http://dx.doi.org/10.1016/s0924-9338(99)80205-3.

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Johnson, Sheri L., Carol A. Winett, Bjorn Meyer, William J. Greenhouse, and Ivan Miller. "Social support and the course of bipolar disorder." Journal of Abnormal Psychology 108, no. 4 (1999): 558–66. http://dx.doi.org/10.1037/0021-843x.108.4.558.

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Budde, Monika, and Thomas G. Schulze. "Neurocognitive Correlates of the Course of Bipolar Disorder." Harvard Review of Psychiatry 22, no. 6 (2014): 342–47. http://dx.doi.org/10.1097/hrp.0000000000000016.

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46

Birmaher, B. "Pediatric bipolar disorder- clinical picture and longitudinal course." International Clinical Psychopharmacology 28 (December 2012): e27. http://dx.doi.org/10.1097/01.yic.0000423279.42220.b7.

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47

Faedda, Gianni L., Ross J. Baldessarini, Ira P. Glovinsky, and Nancy B. Austin. "Pediatric bipolar disorder: phenomenology and course of illness." Bipolar Disorders 6, no. 4 (2004): 305–13. http://dx.doi.org/10.1111/j.1399-5618.2004.00128.x.

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48

Rizvi, Syed Naveed Asif, Marie Whitty, and Robert Daly. "Hydrocephalus and bipolar affective disorder." Irish Journal of Psychological Medicine 28, no. 4 (2011): 222–23. http://dx.doi.org/10.1017/s0790966700011708.

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AbstractBipolar disorder can emerge in the context of organic brain pathology. In the case presented, long-standing hydrocephalus was diagnosed in a man with relatively late-onset bipolar illness who presented initially with somewhat atypical, treatment-resistant depressive symptoms. Hypomania, followed by a rapid-cycling bipolar course, subsequently developed. This report reviews the association between bipolar disorder and hydrocephalus, and examines possible neurobiological mechanisms implicated in both conditions.

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Bardenshteyn, Leonid M., N. N. Osipova, Ya M. Slavgorodsky, N. I. Beglyankin, G. A. Aleshkina, and M. M. Turansky. "THE BIPOLAR AFFECTIVE DISORDER TYPE II." Medical Journal of the Russian Federation 24, no. 3 (2018): 157–62. http://dx.doi.org/10.18821/0869-2106-2018-24-3-157-162.

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The article presents review of modern publications concerning studies of bipolar affective disorder type II. The materials are summing up concerning national and international studies of characteristics of clinical course of depressions and hypo-maniacal states within the framework of bipolar affective disorder type II, problems of differential diagnostic of bipolar affective disorder within spectrum of affective pathology. The significance of studying of pre-morbid background in case of bipolar affective disorder type II, co-morbid states for prognosis of course of disease is demonstrated. Th

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Perlick, Deborah, Robert R. Rosenheck, John F. Clarkin, et al. "Burden experienced by care-givers of persons with bipolar affective disorder." British Journal of Psychiatry 175, no. 1 (1999): 56–62. http://dx.doi.org/10.1192/bjp.175.1.56.

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BackgroundFamily members of patients with schizophrenia frequently report burdens associated with caring for their relatives.AimsWe evaluate the impact of illness beliefs on the burden reported by family care-givers of people with bipolar illness.MethodThe multivariate relationships between patient symptomatology and family illness beliefs and report of burden were examined at baseline among care-givers of 266 patients with Research Diagnostic Criteria-diagnosed bipolar illness who were subsequently followed for 15 months.ResultsAt baseline, 93% of care-givers reported moderate or greater dist

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