Academic literature on the topic 'State Hospital (Raleigh, N.C.)'

Severe plant yellowing and decline were recently observed in two commercial fields of spinach (Spinacia oleracea cv. Polka) in Encinarejo (Córdoba), southern Spain. Disease surveys revealed severe infections of main and feeder roots and a large soil population of the southern root-knot nematode Meloidogyne incognita. The nematode population was extracted and quantified from soil and root samples according to Barker (1) and identified by female perineal pattern, phenotype esterases, and host-differential test (3,4). M. incognita was found in 100% of soil samples and 85.7% of root samples with nematode population densities ranging from 44 to 378 eggs and second-stage juveniles (J2s) per 100 cm3 of soil and 162 to 725 eggs and J2s per 5 g of fresh roots. Infected roots showed large, regular galls on root tips and also along the main root axis and secondary feeder roots. Galling of root tips prevents further root growth into deeper soil layers and induced proliferation of secondary roots. The severe infections in roots of spinach suggest that parasitism of spinach roots by the nematode must contribute to stunting, yellowing, and decline of spinach as previously reported (2). To our knowledge, this is the first report of M. incognita infecting spinach in Spain. References: (1) K. R. Barker. Nematode extraction and bioassays. Page 19 in: An Advanced Treatise on Meloidogyne. Vol. II, Methodology. K. R. Barker, C. C. Carter, and J. N. Sasser, eds. North Carolina State University Graphics, Raleigh, 1985. (2) J. C. Correll et al. Plant Dis. 78:653, 1994. (3) P. R. Esbenshade and A. C. Triantaphyllou. J. Nematol. 22:10, 1990. (4) K. M. Hartman and J. N. Sasser. Identification of Meloidogyne species on the basis of differential host test and perineal pattern. Page 69 in: An Advanced Treatise on Meloidogyne. Vol. II, Methodology. K. R. Barker, C. C. Carter, and J. N. Sasser, eds. North Carolina State University Graphics, Raleigh, 1985.

Background: Material management is co-ordinated activities comprising of planning, acquiring, storing and controlling the supply of various items for optimal use. Effective inventory management can bring about a substantial decrease in expenditure. ABC analysis categorizes all items based on their annual drug expenditure into three categories A, B and C for better control by different level managers.Methods: ABC analysis for anticancer drugs was done in ESIC Hospital, Basaidarapur which is a tertiary care hospital of ESI Corporation in Delhi. Total number of drugs analysed were 98 with total annual expenditure of Rupees 5.77 crores approximately.Results: 12.2% (n=12), 16.3% (n=16) and 71.4% (n=70) items were found to be in A, B and C categories respectively.Conclusions: ABC analysis identified the drugs which need more strict control by top level management. Inventory control techniques should be an integral part of any hospital store.

The Globodera tabacum complex infects tobacco (Nicotiana tabacum L.) fields in the United States. In August 2001, plants of flue-cured tobacco cv. K326 from a field of the La Vera Region of Spain displayed a premature wilting and yellowing of foliage, but the roots looked healthy. In the laboratory under the microscope, nematode cysts were observed on the roots. At harvest in September 2001, soil and root samples were collected to identify the nematode and to quantify the population in the soil. Identification of the nematode was based on morphological characteristics of second-stage juveniles collected from cysts and perineal patterns of cysts recovered from the roots (2). Cysts were collected from roots, and second-stage juveniles were extracted from crushed cysts. The nematode population was extracted from the soil and quantified as described by Barker (1). The nematode population was identified as Globodera tabacum. Soil density of the nematode was 5,307 cysts per liter of soil, 64,286 eggs per liter of soil, and 16,071 second-stage juveniles per liter of soil. To our knowledge, this is the first report of G. tabacum complex in Spain. References: (1) K. R. Barker. Nematode extraction and bioassays. Page 19 in: An Advanced Treatise on Meloidogyne. Vol II, Methodology. K. R. Barker, C. C. Carter, and J. N. Sasser, eds. North Carolina State University Graphics, Raleigh, 1985. (2) R. H. Mulvey and A. Morgan Golden, J. Nematol. 15:1, 1983.

Moth plant, Araujia sericifera, is native to South America and was exported to many other countries as an ornamental plant. However, it is now considered an invasive, perennial, noxious weed in Italy. Because of the ability of this plant to spread rapidly and invade natural ecosystems, A. sericifera has been included on the Alert list by the European and Mediterranean Plant Protection Organization (EPPO). In September 2013, numerous plants of A. sericifera with chlorotic leaves and large root-galls were observed in agricultural fields, gardens, and uncultivated locations in Nocera Inferiore, Salerno Province, Italy. Ten samples were collected from a vegetable farm (40°45′40.8″ N, 14°38′18.4″ E) and nematodes were extracted from soil and root samples using standard procedures (1). Meloidogyne sp. was found in all soil and root samples, with nematode population densities ranging from 420 to 1,270 eggs and J2s/10 cm3 of soil and 84 to 2,200 eggs and J2s/5 g of fresh roots. The morphological identification of the nematode was based on characterization of second-stage juveniles (J2s), males, eggs, and females (2). Measurements of J2s (n = 30) include: mean body length (L) = 403 ± 3.7 μm; L/maximum body width = 27.5 ± 0.3; L/esophageal length = 6.2 ± 0.1; stylet length = 12.8 ± 0.1 μm; L/tail length = 9.5 ± 0.1; tail length = 42.5 ± 0.3 μm. Males (n = 10): L = 1,491 ± 0.04 μm; L/maximum body width = 44.4 ± 0.8; L/esophageal length = 16.1 ± 0.3; stylet length = 22.1 ± 0.7 μm; spicules length = 30.1 ± 0.8 μm. Eggs (n = 30): length = 96.6 ± 1 μm; width = 45.1 ± 0.5 μm; length/width ratio = 2.1. Females (n = 20): L = 909.5 ± 38.4 μm; body width = 588.3 ± 19.3 μm; stylet length = 17.0 ± 0.2 μm. Perineal patterns of females had a high dorsal arch with wavy striae bending toward the lateral lines and the absence of distinct lateral line incisures. All measurements conformed to the description of Meloidogyne incognita (Kofoid & White, 1919) Chitwood 1949. DNA was extracted from five individual adult females from each sample and morphological identification was confirmed by a sequence-characterized amplified region (SCAR)-PCR technique using species-specific primers. The amplified product obtained was 1.2 kb in length, demonstrating proper amplification of the species-specific, length variant SCAR marker (3). Weeds are known to serve as hosts for nematodes in the absence of crop plants and to affect the success of nematode management programs. Meloidogyne spp. have been reported to survive and even thrive on weeds; among them, M. incognita is considered the most economically important agricultural nematode pest worldwide as it causes severe yield losses on many hosts. Thus, the invasive plant A. sericifera can be a potential reservoir for M. incognita in Italy and elsewhere. To our knowledge, this is the first report of M. incognita parasitizing A. sericifera. References: (1) K. R. Barker. Page 19 in: An Advanced Treatise on Meloidogyne. Vol. II, Methodology. K. R. Barker et al., eds. North Carolina State University Graphics, Raleigh, 1985. (2) J. D. Eisenback et al. A Guide to the Four Most Common Species of Root-Knot Nematodes (Meloidogyne spp.), with a Pictorial Key. North Carolina State University, Raleigh, 1981. (3) C. Zijlstra et al. Nematology 2:847, 2000.

Abstract Background: Cases of patients with combined DKA and HHS associated to COVID-19 are scarce but showed Hispanics patients tended to be associated with higher mortality. Clinical Case: A 51-year-old Mexican man with past medical history of T2DM presented to our hospital with 1-week history of fever, dyspnea, polydipsia, and nausea. Initial vital signs were notable for fever (axillary temperature 39°C) and low oxygen saturation (90% on room air). His examination was notable for a BMI of 31.2 kg/m2. Blood tests showed hyperglycemia (663 mg/dl, n 70–100 mg/dL), hypernatremia (146 mEq/L, n 135–145 mEq/L), hyperchloremia (113 mEq/L, n 95–110 mEq/L), elevated C-Reactive Protein [CRP] (18.7 mg/dl, n < 0.7 mg/dl), elevated lactate dehydrogenase [LDH] (672 U/L, n 100–170 U/L), high D-dimer (3420 ng/ml, n <400 ng/ml), elevated WBC count (13,200 cell/mm3, n 4600–10200 cells/mm3), high neutrophil count (11300 cells/mm3, n 2000–6900 cells/mm3) and low lymphocyte count (200 cells/mm3, n 600–3400 cells/mm3). Arterial blood gas analysis showed metabolic acidosis (pH 7.2 [n 7.35–7.45], bicarbonate 8mmol/L [22–28 mmol/L], anion gap 23.5 [8–16]) with ketones (100 mg/dl, n <5 mg/dl) in the urine analysis. Calculated serum osmolarity resulted of 328 mOsm/kg (n 278–305 mOsm/kg). Electrocardiogram showed no alterations. Chest X-ray revealed bilateral ground-glass opacities with bilateral infiltrates. Blood and urine cultures were negative. The patient tested positive for SARS-CoV-2. Intravenous fluids, insulin infusion with ceftriaxone i.v. (2 g daily) and clarithromycin p.o. (1 g daily) were initiated but did not result in clinical improvement, continuing with fever, hyperglycemia, metabolic acidosis and worsening of respiratory status. At first day of hospitalization, he presented acute respiratory distress syndrome and was intubated and sedated. He developed multi-organ failure and expired after 3 days of mechanical ventilation. Conclusion: DM is a predisposing factor leading to severe COVID-19 disease. Patient showed similar features reported in cases who died of combined DKA and HHS associated with COVID-19: male, Hispanic, poor blood glucose control, mechanical ventilation, elevated CRP with high LDH and D-dimer. In this patient, obesity was an additional feature that led to severe COVID- 19. Reference: Hoe Chan K, Thimmareddygari D, Ramahi A, Atallah L, Baranetsky NG, Slim J (2020) Clinical characteristics and outcome in patients with combined diabetic ketoacidosis and hyperosmolar hyperglycemic state associated with COVID-19: a retrospective, hospital-based observational case series. Diabetes Res Clin Pract 166:108279

Aim: To examine the validity of race/ethnicity-specific comorbidity adjustment scores in estimating in-hospital mortality. Materials & methods: Using 2007–2014 data from the State Inpatient Databases (SID), we compared the performance of derived race/ethnicity-specific composite scores to the existing scores and binary Elixhauser comorbidity measures at estimating in-hospital mortality. Results: In the overall validation sample (N = 9,564,277), our index (c = 0.80; 95% CI: 0.79–0.80) discriminated better than the van Walraven score (c = 0.79; 95% CI: 0.79–0.79), SID 29 (c = 0.78; 95% CI: 0.78–0.79) and SID 30 (c = 0.78; 95% CI: 0.78–0.78), but was not superior to the binary indicators (c = 0.80; 95% CI: 0.80–0.80). Similar findings were observed in individual populations of White and Black patients. All models showed weak calibration. Conclusion: Race/ethnicity-specific indexes discriminated slightly better than existing composite measures at modeling in-hospital mortality in individual subgroups of race/ethnicity.

Duboisia sp. is a small tree belonging to the family Solanaceae originating from the rainforest areas of the eastern coast of Australia. Dried leaves are used for the extraction of pharmaceutical alkaloids, making this a commercially viable crop. The root-knot nematode Meloidogyne incognita has been reported parasitizing Duboisia myoporoides (5); however, no information of other root-knot nematode species associated with this plant was found. Duboisia sp. is cultivated at Solana Farm, near Arapongas (23°25′08″ S, 51°25′26″ W), Paraná State, Brazil. During the renovation of a production field in this municipality, galled roots were observed on plants and samples were submitted to the Nematology Laboratory at Instituto Agronômico do Paraná, IAPAR, on December 2013. Plants did not exhibit any above-ground symptoms. The specimens were identified through perineal patterns and esterase phenotypes of 20 adult females extracted from dissected roots (2,3) and morphometrics of 10 second-stage juveniles extracted from roots using the blender-sieving method (1). Morphological characteristics were consistent with those described for M. javanica (4). Females had rounded perineal patterns with low, trapezoid shape dorsal arch, striae smooth interrupted by a pair of incisures on both sides, corresponding to lateral fields, clearly demarcated from striae by more or less parallel lines, tail whorl often distinct (4). The juvenile mean body length was 459.9 ± 28.7 μm and tail length averaged 51.6 ± 5.1 μm, with 10 to 16 μm long hyaline region and finely rounded tail tip (4). Results from the esterase electrophoresis were typical of M. javanica (2) with the J3 (Rm = 1.0, 1.3, and 1.4) phenotype being obtained. To our knowledge, this is the first report of M. javanica on Duboisia sp. in Brazil. This finding has great importance for Brazilian production since this nematode may damage plants, reduce yields, and control of this nematode on Duboisia sp. is difficult (5). Additional work is necessary in order to elucidate the losses caused by M. javanica on Duboisia sp. References: (1) J. I. Bonetti and S. Ferraz. Fitopatol. Bras. 6:533, 1981. (2) P. R. Esbenshade and A. C. Triantaphyllou. J. Nematol. 22:10, 1990. (3) K. M. Hartman and J. N. Sasser. Page 115 in: An Advanced Treatise on Meloidogyne. Volume II Methodology. K. R. Barker et al., eds. North Carolina State University Graphics, Raleigh, 1985. (4) D. J. Hunt and Z. A. Handoo. Page 55 in: Root-Knot Nematodes. R. N. Perry et al., eds. CABI International, Wallingford, UK, 2010. (5) A. M. Mello et al. Nematol. Bras. 22(2):12, 1998.

Teak (Tectona grandis Linn. F.) is one of the most important forest crops in Brazil, occupying areas in different regions, such as Goiás, Mato Grosso, Paraná, and São Paulo states. Teak wood is used for many purposes such as shipbuilding, rolling and plywood, firewood, and charcoal. In May 2011, teak symptomatic feeder root samples, exhibiting inconspicuous, small galls, were collected in the municipality of Piracicaba, São Paulo State, Brazil (22°41′46.90″S, 47°38′36.84″W). Specimens were identified through perineal patterns and esterase phenotypes of 20 adult females (1,2). Perineal patterns and esterase phenotypes were consistent with those described for Meloidogyne arenaria (Neal, 1889) Chitwood, 1949 and M. javanica (Treub, 1885) Chitwood, 1949. Perineal patterns of M. arenaria showed a low dorsal arch, compressed dorsolaterally, with lateral field marked by some forked and broken striae; no punctate markings between anus and tail terminus were observed. Perineal patterns of M. javanica were rounded, with low dorsal arch, striae smooth, lateral field distinct, clearly demarcated from striae by parallel lines. From the esterase electrophoresis we obtained A2 (Rm:1.2;1.3) and J3 (Rm:1.0;1.25;1.4) phenotypes, typical from M. arenaria and M. javanica, respectively. To our knowledge, this is the first report of M. arenaria parasitizing teak roots in Brazil and elsewhere (new host) and the first report of M. javanica infecting teak in the State of São Paulo. Previously, M. javanica was reported to be infecting teak-growing areas in the State of Mato Grosso (3). This finding has a great importance, not only by the inclusion of these parasites in teak pathological scenario, but also for predicting possible damage in plant species used in teak-based intercropping systems. References: (1) P. R. Esbenshade and A. C. Triantaphyllou. J. Nematol. 22:10, 1990. (2) K. M. Hartman and J. N. Sasser. 1985. Page 115 in: An Advanced Treatise on Meloidogyne. Volume II, Methodology. K. R. Barker et al., eds. North Carolina State University Graphics, Raleigh,1985. (3) R. A. Silva et al. Nematol. Bras. 27:261, 2003.

Clostridioides difficile is an anaerobic, Gram-positive bacterium widely present in the hospital environment due to its ability to generate spores. The transfer of spores to patients through the hands of medical personnel is one of the most frequent paths of C. difficile transmission. In paediatric patients burdened with a serious primary illness requiring long-term hospitalisation and antibiotic therapy, C. difficile may be a significant risk factor for antibiotic-associated diarrhoea. The goal of the study was to assess the state of hospital environments as a potential source of C. difficile spores and to establish the share of hyperepidemic strains at the two paediatric units. The survey for C. difficile was conducted with a C. diff Banana BrothTM medium, used to detect spores and to recover vegetative forms of the bacteria. Environmental samples (n = 86) and swabs from the clothing of medical personnel (n = 14) were collected at two units of a paediatric hospital, where the cases of antibiotic-associated diarrhoea with a C. difficile aetiology constitute a significant clinical problem. In 17 samples, a change in the broth’s colour was observed, indicating the presence of spores. Out of seven samples, C. difficile strains were cultured. The pathogenic isolates of C. difficile were obtained from swabs collected from elements of beds, a toilet, a door handle and a doctor’s uniform. In our study, we indicated points of increased risk of pathogen transmission, which could constitute a source of infection. The clothing of medical personnel may be a dangerous carrier of pathogenic spores. Periodical surveys of hospital environments with the use of specialist microbiological mediums successfully indicate the direction of corrective actions to be undertaken by the medical facility in order to increase patient safety.

Abstract Background The environmental contamination of Clostridium difficile in acute care hospital rooms is associated with increased risk of infection for subsequent patients. Patients that stay in a room following a patient with a C. difficile infection (CDI) have an increased risk of CDI compared with patients whose previous resident did not have CDI. The objective of this study was characterize the room movement of CDI patients in a Level 1 Trauma Medical Center. Methods A patient with CDI was defined as an inpatient with a positive C. difficile test through rapid serology, C. difficile polymerase chain reaction (PCR) or multiplex-stool PCR from March 2017 to March 2018. Patients were classified as either community-onset (CO, positive test <4 days after admission) or hospital-onset (HO, positive test ≥4 days after admission). Additionally, the number of rooms each CDI patient resided in during one admission following a positive C. difficile test was determined and the proportion of patients who stayed in one to two rooms or at least three rooms per visit was calculated. Results There were a total of 244 CDI patients identified (172: CO, 72: HO) between March 2017 and March 2018. The mean time from admission to positive test was 12.4 hours post-admission for CO-CDI patients and 251.1 hours for HO-CDI patients. Almost 40% of HO-CDI patients (36.1%, n = 72) stayed in at least three rooms during their hospital admission compared with <30% of CO-CDI patients (28.4%, n = 172). Conclusion The current state of room movement with CDI patients is suboptimal, resulting in increased infection risk for subsequent patients. A multi-faceted intervention to address this problem is essential to achieve an optimal goal of 1–2 rooms per hospital stay for a CDI patient. Quality improvement projects include (1) notification of patient movement to nursing leadership, (2) alerts to nursing supervisors of potential CDI patients before room transfer, and (3) earlier diagnosis of community-onset C. difficile. Disclosures All authors: No reported disclosures.

A cohort study is one in which the outcome (usually disease status) is ascertained for groups of individuals defined on the basis of their exposure. At the time exposure status is determined, all must be free of the disease. All eligible participants are then followed up over time. Since exposure status is determined before the occurrence of the outcome, a cohort study can clarify the temporal sequence between exposure and outcome, with minimal information bias. The historical and the population cohort study (Box 9.1) are efficient variants of the classical cohort study described above, which nevertheless retain the essential components of the cohort study design. The exposure can be dichotomous [i.e. exposed (to obstetric complications at birth) vs. not exposed], or graded as degrees of exposure (e.g. no recent life events, one to two life events, three or more life events). The use of grades of exposure strengthens the results of a cohort study by supporting or refuting the hypothesis that the incidence of the disease increases with increasing exposure to the risk factor; a so-called dose–response relationship. The essential features of a cohort study are: ♦ participants are defined by their exposure status rather than by outcome (as in case–control design); ♦ it is a longitudinal design: exposure status must be ascertained before outcome is known. The classical cohort study In a classical cohort study participants are selected for study on the basis of a single exposure of interest. This might be exposure to a relatively rare occupational exposure, such as ionizing radiation (through working in the nuclear power industry). Care must be taken in selecting the unexposed cohort; perhaps those working in similar industries, but without any exposure to radiation. The outcome in this case might be leukaemia. All those in the exposed and unexposed cohorts would need to be free of leukaemia (hence ‘at risk’) on recruitment into the study. The two cohorts would then be followed up for (say) 10 years and rates at which they develop leukaemia compared directly. Classical cohort studies are rare in psychiatric epidemiology. This may be in part because this type of study is especially suited to occupational exposures, which have previously been relatively little studied as causes of mental illness. However, this may change as the high prevalence of mental disorders in the workplace and their negative impact upon productivity are increasingly recognized. The UK Gulf War Study could be taken as one rather unusual example of the genre (Unwin et al. 1999). Health outcomes, including mental health status, were compared between those who were deployed in the Persian Gulf War in 1990–91, those who were later deployed in Bosnia, and an ‘era control group’ who were serving at the time of the Gulf war but were not deployed. There are two main variations on this classical cohort study design: they are popular as they can, depending on circumstances, be more efficient than the classical cohort design. The population cohort study In the classical cohort study, participants are selected on the basis of exposure, and the hypothesis relates to the effect of this single exposure on a health outcome. However, a large cohort or panel of subjects are sometimes recruited and followed up, often over many years, to study multiple exposures and outcomes. No separate comparison group is required as the comparison group is generally an unexposed sub-group of the panel. Examples include the British Doctor's Study in which over 30,000 British doctors were followed up for over 20 years to study the effects of smoking and other exposures on health (Doll et al. 1994), and the Framingham Heart Study, in which residents of a town in Massachusetts, USA have been followed up for 50 years to study risk factors for coronary heart disease (Wolf et al. 1988). The Whitehall and Whitehall II studies in the UK (Fuhrer et al. 1999; Stansfeld et al. 2002) were based again on an occupationally defined cohort, and have led to important findings concerning workplace conditions and both physical and psychiatric morbidity. Birth cohort studies, in which everyone born within a certain chronological interval are recruited, are another example of this type of study. In birth cohorts, participants are commonly followed up at intervals of 5–10 years. Many recent panel studies in the UK and elsewhere have been funded on condition that investigators archive the data for public access, in order that the dataset might be more fully exploited by the wider academic community. Population cohort studies can test multiple hypotheses, and are far more common than any other type of cohort study. The scope of the study can readily be extended to include mental health outcomes. Thus, both the British Doctor's Study (Doll et al. 2000) and the Framingham Heart Study (Seshadri et al. 2002) have gone on to report on aetiological factors for dementia and Alzheimer's Disease as the cohorts passed into the age groups most at risk for these disorders. A variant of the population cohort study is one in which those who are prevalent cases of the outcome of interest at baseline are also followed up effectively as a separate cohort in order (a) to study the natural history of the disorder by estimating its maintenance (or recovery) rate, and (b) studying risk factors for maintenance (non-recovery) over the follow-up period (Prince et al. 1998). Historical cohort studies In the classical cohort study outcome is ascertained prospectively. Thus, new cases are ascertained over a follow-up period, after the exposure status has been determined. However, it is possible to ascertain both outcome and exposure retrospectively. This variant is referred to as a historical cohort study (Fig. 9.1). A good example is the work of David Barker in testing his low birth weight hypothesis (Barker et al. 1990; Hales et al. 1991). Barker hypothesized that risk for midlife vascular and endocrine disorders would be determined to some extent by the ‘programming’ of the hypothalamo-pituitary axis through foetal growth in utero. Thus ‘small for dates’ babies would have higher blood pressure levels in adult life, and greater risk for type II diabetes (through insulin resistance). A prospective cohort study would have recruited participants at birth, when exposure (birth weight) would be recorded. They would then be followed up over four or five decades to examine the effect of birth weight on the development of hypertension and type II diabetes. Barker took the more elegant (and feasible) approach of identifying hospitals in the UK where several decades previously birth records were meticulously recorded. He then traced the babies as adults (where they still lived in the same area) and measured directly their status with respect to outcome. The ‘prospective’ element of such studies is that exposure was recorded well before outcome even though both were ascertained retrospectively with respect to the timing of the study. The historical cohort study has also proved useful in psychiatric epidemiology where it has been used in particular to test the neurodevelopmental hypothesis for schizophrenia (Jones et al. 1994; Isohanni et al. 2001). Jones et al. studied associations between adult-onset schizophrenia and childhood sociodemographic, neurodevelopmental, cognitive, and behavioural factors in the UK 1946 birth cohort; 5362 people born in the week 3–9 March 1946, and followed up intermittently since then. Subsequent onsets of schizophrenia were identified in three ways: (a) routine data: cohort members were linked to the register of the Mental Health Enquiry for England in which mental health service contacts between 1974 and 1986 were recorded; (b) cohort data: hospital and GP contacts (and the reasons for these contacts) were routinely reported at the intermittent resurveys of the cohort; (c) all cohort participants identified as possible cases of schizophrenia were given a detailed clinical interview (Present State examination) at age 36. Milestones of motor development were reached later in cases than in non-cases, particularly walking. Cases also had more speech problems than had noncases. Low educational test scores at ages 8,11, and 15 years were a risk factor. A preference for solitary play at ages 4 and 6 years predicted schizophrenia. A health visitor's rating of the mother as having below average mothering skills and understanding of her child at age 4 years was a predictor of schizophrenia in that child. Jones concluded ‘differences between children destined to develop schizophrenia as adults and the general population were found across a range of developmental domains. As with some other adult illnesses, the origins of schizophrenia may be found in early life’. Jones' findings were largely confirmed in a very similar historical cohort study in Finland (Isohanni et al. 2001); a 31 year follow-up of the 1966 North Finland birth cohort (n = 12,058). Onsets of schizophrenia were ascertained from a national hospital discharge register. The ages at learning to stand, walk and become potty-trained were each related to subsequent incidence of schizophrenia and other psychoses. Earlier milestones reduced, and later milestones increased, the risk in a linear manner. These developmental effects were not seen for non-psychotic outcomes. The findings support hypotheses regarding psychosis as having a developmental dimension with precursors apparent in early life. There are many conveniences to this approach for the contemporary investigator. ♦ The exposure data has already been collected for you. ♦ The follow-up period has already elapsed. ♦ The design maintains the essential feature of the cohort study, namely that information bias with respect to the assessment of the exposure should not be a problem. ♦ As with the Barker hypothesis example, historical cohort studies are particularly useful for investigating associations across the life course, when there is a long latency between hypothesized exposure and outcome. Despite these important advantages, such retrospective studies are often limited by reliance on historical data that was collected routinely for other purposes; often these data will be inaccurate or incomplete. Also information about possible confounders, such as smoking or diet, may be inadequate.

Patient «C», 51 years old, works as an oncologist in a hospital, mostly night duties. Complaints of anxiety; reduced mood; hopelessness, “all is bad: health, work, family”; guilt; weakness; apathy, suicidal thoughts; sleep disturbance; chronic back pain; feeling of incomplete bladder emptying. He associates the complaints with high stress at work and with the fact that he does not have time to recover from night duty, with a sense of hopelessness due to his inability to help some patients. He was observed by an interdisciplinary team of specialists including a psychotherapist, a urologist and a neurologist. Diagnosis: Emotional burnout syndrome (Z 73.0), Mixed anxiety and depressive reaction (F 43.22), Neurogenic bladder weakness (N 31.2), Dorsopathy at lumbarsacral level (М 51.1). Prescription: alfuzosin (alfuprost, Vertex, Russia) 10 mg per 24 hours, 3 months; tolperison hydrochloride (mydocalm, GEDEON RICHTER, Plc., Hungary), per os 150 mg in the evening, for 1 month; psychotherapy in Erickson's hypnosis modality: 2 in-person sessions – “Resource Vase” and “Compassion meditation”, and 10 sessions of neuro audio modules (NAM): Psychosomatic Session, Good Memory, House Building, Bird Flight, Body Comfort Bird, Health Bridge, Diaphragmatic Breathing, Transformation, Garden, Circulation of Transformations, River of Desire, they were held daily or every other day. NAM was broadcast against the background of meditative music and sounds of nature. Methods of self-regulation of psycho-emotional state are recommended. One month later after the beginning of the treatment: the level of anxiety decreased from 16 till 6 points, the level of depression – from 12 till 5 points (HADS). Back pains dimineshed from 8 till 3 points according to Visual Analog scale, 55% residual urine. The patient noted a significant improvement in the background mood, a surge of energy, increased working capacity, improvement in the relations with his loved ones. Thus, the clinical effectiveness of inclusion in the treatment of comorbid patient of combined Erickson's psychotherapy with the predominant use of NAM has been demonstrated. This approach increases the availability of psychotherapy, reduces labour efforts of a therapist and financial burden on a patient. Пациент «C», 51 г., работает врачом-онкологом в стационаре, преимущественно ночные дежурства. Обратился с жалобами: чувство тревоги; пониженный фон настроения; ощущение безнадежности, «все плохо: здоровье, работа, семья»; чувство вины; упадок сил; апатия, суицидальные мысли; нарушение ночного сна; хроническая боль в спине; чувство неполного опорожнения мочевого пузыря. Жалобы связывает с выраженным стрессом на работе и тем, что не успевает восстанавливаться после ночных дежурств, ощущением безысходности из-за невозможности помочь некоторым пациентам. Наблюдался междисциплинарной командой специалистов, включающей психотерапевта, уролога, невролога. Диагноз: Синдром эмоционального выгорания (Z 73.0), Смешанная тревожная и депрессивная реакция (F 43.22), Нейрогенная слабость мочевого пузыря (N 31.2), Дорсопатия на пояснично-крестцовом уровне (М 51.1). Назначения: алфузозин (алфупрост, Вертекс, Россия) 10 мг в сутки, 3 месяца; толперизона гидрохлорид (мидокалм, GEDEON RICHTER, Plc., Венгрия), внутрь 150 мг вечером, 1 месяц; психотерапия в модальности Эриксоновский гипноз: 2 сеанса очно – «Ваза 163 ресурсов» и «Медитация сострадания», и 10 сеансов нейроаудиомодулей (НАМ): Психосоматический сеанс, Приятное воспоминание, Строительство дома, Полет птицы, Птица телесного комфорта, Оздоровительный мост, Диафрагмальное дыхание, Трансформация, Сад, Круговорот преобразований, Река желания, которые проводили ежедневно или через день. НАМ транслировался на фоне медитативной музыки и звуков природы. Рекомендованы приемы саморегуляции психоэмоционального состояния. Через 1 месяц от начала лечения: уровень тревоги снизился с 16 до 6 баллов, депрессии – с 12 до 5 баллов (ГШТД). Уменьшились боль в спине по ВАШ с 8 до 3 баллов, объем остаточной мочи на 55%. Пациент отметил значительное улучшение фона настроения, прилив сил, повысилась работоспособность, улучшились отношения с близкими. Таким образом, продемонстрирована клиническая эффективность включения в курс лечения коморбидного пациента комбинированной эриксоновской психотерапии с преимущественным использованием НАМ. Данный подход повышает доступность к психотерапии, сокращает трудозатраты врача-психотерапевта и финансовую нагрузку на пациента.