A Mediterranean-style dietary intervention supplemented with fish oil improves diet quality and mental health in people with depression: A randomized controlled trial (HELFIMED)

Objectives: We investigated whether a Mediterranean-style diet (MedDiet) supplemented with fish oil can improve mental health in adults suffering depression.

Methods: Adults with self-reported depression were randomized to receive fortnightly food hampers and MedDiet cooking workshops for 3 months and fish oil supplements for 6 months, or attend social groups fortnightly for 3 months. Assessments at baseline, 3 and 6 months included mental health, quality of life (QoL) and dietary questionnaires, and blood samples for erythrocyte fatty acid analysis.

Results: n?=?152 eligible adults aged 18–65 were recruited (n?=?95 completed 3-month and n?=?85 completed 6-month assessments). At 3 months, the MedDiet group had a higher MedDiet score (t?=?3.95, P?<?0.01), consumed more vegetables (t?=?3.95, P?<?0.01), fruit (t?=?2.10, P?=?0.04), nuts (t?=?2.29, P?=?0.02), legumes (t?=?2.41, P?=?0.02) wholegrains (t?=?2.63, P?=?0.01), and vegetable diversity (t?=?3.27, P?<?0.01); less unhealthy snacks (t?=??2.10, P?=?0.04) and red meat/chicken (t?=??2.13, P?=?0.04). The MedDiet group had greater reduction in depression (t?=??2.24, P?=?0.03) and improved mental health QoL scores (t?=?2.10, P?=?0.04) at 3 months. Improved diet and mental health were sustained at 6 months. Reduced depression was correlated with an increased MedDiet score (r?=??0.298, P?=?0.01), nuts (r?=??0.264, P?=?0.01), and vegetable diversity (r?=??0.303, P?=?0.01). Other mental health improvements had similar correlations, most notably for increased vegetable diversity and legumes. There were some correlations between increased omega-3, decreased omega-6 and improved mental health.

Discussion: This is one of the first randomized controlled trials to show that healthy dietary changes are achievable and, supplemented with fish oil, can improve mental health in people with depression.     

Macular pigment optical density is positively associated with academic performance among preadolescent children

Objective: Macular pigment optical density (MPOD) – a non-invasive indicator of retinal xanthophylls and correlate of brain lutein – has been associated with superior cognitive function among adult populations. Given that lutein accumulation in the brain occurs in early life, it is possible that the cognitive implications of greater MPOD may be evident in childhood.

Methods: Participants aged 8–9 years (n?=?56) completed MPOD measurements via heterochromatic flicker photometry. Academic performance was assessed using the Kaufman Test of Academic and Educational Achievement II (KTEA). Habitual dietary intake of L and Z was measured among a subsample of participants (n?=?35) using averaged 3-day food records. Stepwise hierarchical regression models were developed to determine the relationship between MPOD and academic achievement tests, following the adjustment of key covariates including sex, aerobic fitness, body composition, and intelligence quotient (IQ).

Results: The regression analyses revealed that MPOD improved the model, beyond the covariates, for overall academic achievement (ΔR²?=?0.10, P?R²?=?0.07, P?=?0.02), and written language composite standard scores (ΔR²?=?0.15, P?Discussion: This is the first study to demonstrate that retinal L and Z, measured as MPOD, is positively related to academic achievement in children, even after accounting for the robust effects of IQ and other demographic factors. These findings extend the positive associations observed between MPOD and cognitive abilities to a pediatric population.

Trail registration: The Fitness Improves Thinking in Kids 2 (FITKids2) trial was registered at www.clinicaltrials.gov as NCT01619826.     

Evaluation of dietary intake in children and college students with and without attention-deficit/hyperactivity disorder

Objectives: To evaluate dietary intake among individuals with and without attention-deficit hyperactivity disorder (ADHD), to evaluate the likelihood that those with ADHD have inadequate intakes.

Methods: Children, 7–12 years old, with (n?=?23) and without (n?=?22) ADHD, and college students, 18–25 years old, with (n?=?21) and without (n?=?30) ADHD comprised the samples. Children’s dietary intake was assessed by a registered dietitian using 24-hour recalls over 3 days. College students kept a detailed food record over three days. Dietary information for both groups was entered into the Nutrition Data Systems for Research database, and output was analyzed using SAS 9.4. Nutrient analyses included the Healthy Eating Index-2010, Micronutrient Index (as a measure of overall micronutrient intake), and individual amino acids necessary for neurotransmission. Logistic regression was used to model the association of nutrient intake with ADHD. Models were adjusted for age, sex, IQ (or GPA), and energy intake (or total protein intake) as appropriate. Significance was evaluated at P?=?0.05, and using the Benjamini–Hochberg corrected P-value for multiple comparisons.

Results: No evidence existed for reduced nutrient intake among those with ADHD compared to controls in either age group. Across both groups, inadequate intakes of vitamin D and potassium were reported in 95% of participants. Children largely met nutrient intake guidelines, while college students failed to meet these guidelines for nine nutrients. In regards to amino acid intake in children, an increased likelihood of having ADHD was associated with higher consumption of aspartate, OR?=?12.61 (P?=?0.01) and glycine OR?=?11.60 (P?=?0.05); and a reduced likelihood of ADHD with higher intakes of glutamate, OR?=?0.34 (P?=?0.03). Among young adults, none of the amino acids were significantly associated with ADHD, though glycine and tryptophan approached significance.

Discussion: Results fail to support the hypothesis that ADHD is driven solely by dietary micronutrient inadequacy. However, amino acids associated with neurotransmission, specifically those affecting glutamatergic neurotransmission, differed by ADHD status in children. Amino acids did not reliably vary among college students. Future larger scale studies are needed to further examine whether or not dietary intake of amino acids may be a modulating factor in ADHD.     

Does Child Care in the First Year of Life Pose a Risk for Concurrent and Future Ear Infections?

ABSTRACT

Child care centre attendance is associated with an increased risk of concurrent ear infections, but what is less clear is whether there are any positive or negative long-term effects of early child care attendance on the incidence of ear infections in later childhood. This research assessed the impact of early child care attendance on concurrent and long-term risk of ear infections. Complete sets of relevant wave 1–5 data from the Longitudinal Study of Australian Children were available for 3513 children (1822 boys) who had a median age of 9 months (M?=?8.7, SD?=?2.6) at wave 1, 34 months (M?=?33.8, SD?=?2.9) at wave 2, 57 months (M?=?57.5, SD?=?2.8) at wave 3, 82 months (M?=?81.8, SD?=?3.5) at wave 4, and 107 months (M?=?107.1, SD?=?3.6) at wave 5. At waves 1 and 2, children who attended child care centres had a significantly increased risk of concurrent ear infections than children with exclusive parental care. The longitudinal analyses found no evidence of increased (or decreased) long-term risk of ear infections in subsequent waves associated with attending a child care centre in the first 12 months (or the first 30 months) of life. However, having ear infections at wave 1 was a significant risk factor for ear infections at subsequent waves. Future research is needed to design and investigate appropriate interventions to ameliorate these increased risks.     

Associations among Omega-3 Fatty Acid Status,Anxiety, and Mental Toughness in Female Collegiate Athletes

Objective: Poor omega-3 fatty acid status has been linked to anxiety in the general population, but scarce data are available describing omega-3 fatty acid levels in athletes and their associations with anxiety and mental toughness.

Methods: Whole blood samples were obtained from 54 female collegiate athletes and analyzed for fatty acids as a part of this cross-sectional observational study. Participants also completed a food frequency questionnaire on the intake of omega-3 fatty acids, as well as the Beck Anxiety Inventory (BAI), Sport Anxiety Scale (SAS)-2, and Mental Toughness Scale (MTS). Measures were collected during the athletes' off-season. Spearman's rho coefficients were used to examine the associations between fatty acid levels and psychological scores.

Results: Blood levels of the HS-Omega-3 Index® (rho = ?0.32, p = 0.02), eicosapentaenoic acid (rho = ?0.40, p = 0.003), and docosapentaenoic acid (rho = ?0.33, p = 0.02) were negatively correlated with BAI scores. Likewise, dietary intakes of eicosapentaenoic acid (rho = ?0.38, p = 0.007) and docosahexaenoic acid (rho = ?0.35, p = 0.02) were negatively correlated with BAI scores. Blood docosapentaenoic acid was positively correlated with MTS (rho = 0.27, p = 0.049). None of the dietary or blood fatty acids were significantly correlated with SAS-2 scores.

Conclusions: Both blood and dietary omega-3 fatty acid levels are associated with general but not sport-specific anxiety in female collegiate athletes during an off-season period. Randomized trials should be conducted to evaluate the effects of omega-3 fatty acid supplementation on anxiety and mental toughness in athletes.     

The influence of supplemental lutein and docosahexaenoic acid on serum, lipoproteins, and macular pigmentation

BACKGROUND: Lutein and docosahexaenoic acid (DHA) may protect against age-related macular degeneration (AMD). Lutein is a component of macular pigment. DHA is in the retina. OBJECTIVE: The objective of this 4-mo study was to determine the effects of lutein (12 mg/d) and DHA (800 mg/d) on their serum concentrations and macular pigment optical density (MPOD). DESIGN: Forty-nine women (60-80 y) were randomly assigned to placebo, DHA, lutein, or lutein + DHA supplement. Serum was analyzed for lutein and DHA (0, 2, and 4 mo). MPOD was determined (0 and 4 mo) at 0.4, 1.5, 3, and 5 degrees temporal retinal eccentricities. Serum was analyzed for lipoproteins (4 mo). RESULTS: There was no interaction between lutein and DHA supplementations for serum lutein and MPOD. The lutein supplementation x DHA supplementation x month interaction was significant for serum DHA response (P < 0.05). In the lutein group, serum lutein increased from baseline at 2 and 4 mo (P < 0.001), and MPOD increased at 3.0 degrees (P < 0.01). In the DHA group, serum DHA increased at 2 and 4 mo (P < 0.0001), and MPOD increased at 0.4 degrees (P < 0.05). In the lutein + DHA group, serum lutein and DHA increased at 2 and 4 mo (P < 0.01), and MPOD increased at 0.4, 1.5, and 3 degrees (P = 0.06, 0.08, and 0.09, respectively). Differences from placebo in lipoprotein subfractions were greatest for the lutein + DHA group (4 mo). CONCLUSIONS: Lutein supplementation increased MPOD eccentrically. DHA resulted in central increases. These results may be due to changes in lipoproteins. Lutein and DHA may aid in prevention of age-related macular degeneration.     

Levels and patterns of physical activity and sedentary time among superdiverse adolescents in East London: a cross-sectional study

Objectives: Little is known about the physical activity (PA) and sedentary time (ST) habits of adolescents from superdiverse communities in the UK. The objectives of this study are to examine and report the patterns of PA/ST among adolescents in East London living in superdiverse communities, to identify opportunities/barriers to PA and inform policy/practice.

Design: A total of 1260 young people (aged 11–13 years) from seven secondary schools in East London completed a questionnaire on PA/ST over the past seven days as part of the Newham’s Every Child a Sports Person (NECaSP) intervention. Socio-demographic and anthropometric data were obtained. Significance tests were conducted to determine differences between socio-demographic and anthropometric predictors and PA/ST. Multinomial logit regression was used to explore the effects of ethnicity, sex, and body mass index (BMI) on PA levels.

Results: Males were significantly more likely to engage in PA at least five times during school in the past week (U?=?5.07, z?=??11.76, p?U?=?4.11, z?=?1.17, p?U?=?5.08, z?=??1.92, p?b?=?.11, Wald X²(1)?=?9.81, p?Conclusion: Engaging girls in PA during and after school is important and making sports clubs and activities available and attractive to this target group may help increase engagement in PA and reduce ST. Findings support the need for more sex-specific and culturally responsive pedagogy in schools with curricula that respects diversity and individuality and has meaning and value amongst superdiverse young people. Finally, we need to extend current work presented and provide substantial evidence of the ways young people from minority ethnic groups process and act on the public health policy and the ways they understand and enact PA.     

Communication development and characteristics of influencing factors: a follow-up study from 8 to 36 months

In this follow-up study, we evaluated children's communication development at the ages of 8 (n?=?50), 18 (n?=?46), 24 (n?=?44) and 36 months (n?=?36) using the Finnish version of the MacArthur Communicative Developmental Inventories (MCDI). A sample of children (n?=?14) received family-based intervention 10 times in five months and mother–infant relationship was examined using the Parent-Child Early Relational Assessment (PC-ERA) before (at the age of 9–12 months) and after (at the age of 15–18 months) the intervention. The infants' communication skills developed from the use of few words and signs of understanding to that of longer sentences and better grammar during the study period. Specifically, girls scored higher than the boys on the 24-month MCDI. Eight-month-old infants with siblings in the family were more competent than those without siblings, measured using the PC-ERA infant variables. However, there were no significant differences in the MCDI or PC-ERA scores between children with and without intervention.     

Sexual Function,Anxiety, Depression and Coping After Myocardial Infarction: An Exploratory Study

Background

Myocardial infarction (MI) may decrease sexual function and satisfaction in men and can be influenced by anxiety, depression, and sexual fear. However, few studies have examined short-term changes in sexual function over time in a post-MI population. This study aimed to longitudinally describe changes in sexual function and satisfaction in a sample of men post-MI.

Methods

Eighteen patients were recruited from a Midwestern United States hospital. Surveys were mailed two weeks and three months post discharge. Sexual function was measured with the Male Sexual Function Index. Other variables collected included sexual fear (Multidimensional Sexuality Questionnaire), anxiety and depressive symptoms (Patient-Reported Outcomes Measurement Information System Anxiety and Depression 4a), and use of coping strategies (Coping Strategy Indicator).

Results

Sexual function scores increased in the entire sample from 8.9 (SD 7.3) at two weeks to 14.6 (SD 8.9) at three months (18.8?% improvement, p?=?0.04). Men who were sexually active improved their scores by 27.3?% (p?=?0.01), while those who were not sexually active decreased their scores by 2.3?% (p?=?0.5). Depressive symptoms and anxiety scores were low and largely stable across timepoints, though there were some improvements among men who were sexually active compared to those who were not. Decreased utilization of avoidance coping strategies was reported in sexually active versus inactive men.

Conclusions

While sexual function improved within a short-time period post discharge among sexually active men post-MI, further research is needed with a larger sample to understand these changes across a longer period. Additional research is also warranted to examine any potential influence of psychosocial predictors.

     

The relationship between dietary quality,serum brain-derived neurotrophic factor (BDNF) level,and the Val66met polymorphism in predicting depression

Background: Brain-derived neurotrophic factor (BDNF), a neurotrophic factor implicated in the pathogenesis of depression, may be influenced by dietary quality. Both dietary quality and serum BDNF have been researched independently in regard to their effect on depression; however, there is limited research investigating the relationship between the two factors and how they interact in depression. Additionally, a single-nucleotide polymorphism (SNP) (Val66Met) in the BDNF gene, which has been implicated in BDNF levels and depression, may contribute to the complex relationship between depression, dietary quality, and BDNF level.

Methods: One hundred and eighty-seven participants with major depressive disorder and 55 non-depressed healthy controls were recruited for this case–control analysis. The relationship between dietary quality and depression was assessed via a novel dietary quality score (the Australian Dietary Quality Score). Serum BDNF levels were measured and the Val66Met SNP was genotyped.

Results: Healthy controls had a significantly higher diet quality than depressed participants (t?=?2.435, P?=?0.016). A logistic regression model investigating age, sex, serum BDNF levels, dietary quality and depression, as well as any interactions, found that lower dietary quality, and surprisingly, higher BDNF levels, were associated with increased depression risk, P?=?0.037 and P?<?0.001, respectively. Neither seasonality (at the time of recruitment) nor the Val66Met polymorphism was associated with BDNF levels in this sample. Furthermore, there was no evidence of interaction between the Val66Met polymorphism, BDNF levels, dietary quality, and depression.

Conclusion: Higher dietary quality was associated with both decreased depression incidence and severity in this cross-sectional analysis. The Val66Met polymorphism did not appear to predict BDNF levels, depression incidence, or modify the relationship between dietary quality and BDNF. Further studies utilizing a larger sample size are needed to confirm this finding.     

Psychological factors influence the gastroesophageal reflux disease (GERD) and their effect on quality of life among firefighters in South Korea

Objectives: The purpose of this study was to examine psychosocial factors related to gastroesophageal reflux disease (GERD) and their effects on quality of life (QOL) in firefighters.

Methods: Data were collected from 1217 firefighters in a Korean province. We measured psychological symptoms using the scale. In order to observe the influence of the high-risk group on occupational stress, we conduct logistic multiple linear regression. The correlation between psychological factors and QOL was also analyzed and performed a hierarchical regression analysis.

Results: GERD was observed in 32.2% of subjects. Subjects with GERD showed higher depressive symptom, anxiety and occupational stress scores, and lower self-esteem and QOL scores relative to those observed in GERD – negative subject. GERD risk was higher for the following occupational stress subcategories: job demand, lack of reward, interpersonal conflict, and occupational climate. The stepwise regression analysis showed that depressive symptoms, occupational stress, self-esteem, and anxiety were the best predictors of QOL.

Conclusions: The results suggest that psychological and medical approaches should be combined in GERD assessment.     

Ethnic differences in types of social support from multiple sources after breast cancer surgery

Objectives. Diagnosis of and treatment for breast cancer (BCa) may require psychological adaptation and often involve heightened distress. Several types of social support positively relate to psychological adaptation to BCa, and negative support is associated with poorer adaptation. Although Hispanic women report greater distress than non-Hispanic White (NHW) women after diagnosis of BCa, no studies have examined ethnic differences in types of social support received from varying sources after surgery for BCa.

Design. Hispanic (N?=?61) and NHW (N?=?150) women diagnosed with early-stage BCa self-reported emotional, informational, instrumental, and negative support from five sources. Ethnic differences in levels of social support were compared using multiple regression analysis.

Results. When controlling for age, income, days since surgery, and stage of disease in multivariable models there were no ethnic differences in levels of emotional support from any source. Hispanic women reported greater informational support from adult women family members and children and male adult family members than did NHW women. Instrumental support from adult women family members was also greater among Hispanic than NHW women. Hispanic women reported higher negative support from husbands/partners and from children and male adult family members. When the number of years in the USA was controlled, Hispanic women showed greater informational support from adult women family members, children and male adult family members, and friends. Instrumental support from adult women family members remained greater in Hispanic women, but negative support no longer differed.

Conclusion. Family is a greater source of informational and instrumental support for Hispanic than NHW women. Hispanic women reported higher negative support from male sources than did NHW women. Level of support from different sources may also depend on time spent in the USA. Longitudinal studies are needed to determine whether patterns and sources of social support shift over the course of BCa treatment.     

Dark and sick,light and healthy: black women’s complexion-based health disparities

Objective: Although research on skin tone inequalities suggest that darker-skinned Black women should experience worse health outcomes than lighter-skinned women, findings have been mixed. The present study investigates the possibility that the manner that stress and health are measured (i.e. global versus count measures) may explain the conflicting findings.

Design: Black American women of different skin tones were investigated in two cross-sectional samples: the National Longitudinal Study of Adolescent to Adult Health (N?=?571) and the Detroit Area Study (N?=?290). Women’s skin tone health disparities were examined using both objective (i.e. directly measured) or count measures (i.e. number of diagnosed chronic health conditions) as well as a global measure of health (i.e. self-rated health – SRH). Additionally, in the Detroit Area Study (DAS), disparities in stress exposure were examined using count and global measures.

Results: Skin tone did not predict global measures of health (i.e. SRH) in both samples. In contrast, skin tone predicted objective and count measures of health in both samples, and the disparities between dark- and light-skinned women were starker among higher SES populations. Furthermore, DAS analyses of stress measures indicated that skin tone did not predict a global measure of stress but significantly predicted a count measure of stress (i.e. life events) since dark-skinned women reported worse outcomes.

Conclusions: Health disparities research will benefit from accounting for Black women’s skin tones as an important social determinant of health. Additionally, use of subjective measurements of health (e.g. SRH) may conceal within-race health disparities across complexions as well as obscure the magnitude of disparities across race.     

The Effects of a Multivitamin/Mineral Supplement on Micronutrient Status,Antioxidant Capacity and Cytokine Production in Healthy Older Adults Consuming a Fortified Diet

Background: Inadequate micronutrient intake among older adults is common despite the increased prevalence of fortified/enriched foods in the American diet. Although many older adults take multivitamin supplements in an effort to compensate, studies examining the benefits of this behavior are absent.

Objective: To determine whether a daily multivitamin/mineral supplement can improve micronutrient status, plasma antioxidant capacity and cytokine production in healthy, free-living older adults already consuming a fortified diet.

Methods: An eight-week double-blind, placebo-controlled clinical trial among 80 adults aged 50 to 87 years (mean=66.5±8.6 years).

Results: Multivitamin treatment significantly increased (p<0.01, compared to placebo) plasma concentrations of vitamins D (77 to 100 nmol/L), E (27 to 32 μmol/L), pyridoxal phosphate (55.1 to 75.2 nmol/L), folate (23 to 33 nmol/L), B12 (286 to 326 pmol/L)), C (55 to 71 μmol/L), and improved the riboflavin activity coefficient (1.23 to 1.15), but not vitamins A and thiamin. The multivitamin reduced the prevalence of suboptimal plasma levels of vitamins E (p=0.003), B12 (p=0.004), and C (p=0.08). Neither glutathione peroxidase activity nor antioxidant capacity (ORAC) were affected. No changes were observed in interleukin?2, ?6 or ?10 and prostaglandin E₂, proxy measures of immune responses.

Conclusions: Supplementation with a multivitamin formulated at about 100% Daily Value can decrease the prevalence of suboptimal vitamin status in older adults and improve their micronutrient status to levels associated with reduced risk for several chronic diseases.     

Effects of Dietary Fat and Endurance Exercise on Plasma Cortisol,Prostaglandin E2, Interferon-γ and Lipid Peroxides in Runners

Objective: Exercise and the neuroendocrine and oxidative stress it elicits on immune function is modulated by dietary fat intake. The effects of increasing dietary fat on endurance exercise-induced alterations (80% of V?O_2max for 2 hours) in the plasma levels of cortisol and prostaglandin E₂ (PGE₂), interferon-γ (IFN-γ) and lipid peroxides were investigated. As higher levels of cortisol, PGE₂ and lipid peroxides could be immunosuppressive, the effects of different levels of dietary fat on these measures in runners were determined.

Methods: Healthy trained runners (males and females) consumed serially 15% fat diet (of daily energy), 30% fat diet and 40% fat diets for four weeks each. In the last week of each diet period the subjects ran to exhaustion at 80% of their V?O_2max and blood was drawn pre- and post-run. Cortisol, IFN-γ, PGE₂ and lipid peroxides were determined using standard techniques.

Results: Pre-exercise levels of plasma cortisol were elevated, IFN-γ was unchanged and PGE₂ and lipid peroxides decreased on the 40%F diet compared to 30%F and 15%F. Post-exercise levels of plasma cortisol (p < 0.004), PGE₂ (p < 0.0057) and lipid peroxide levels increased (p < 0.0001) after endurance exercise on all diets. The rates of increase of plasma cortisol levels during exercise were similar on all three diets. Although absolute cortisol levels were higher in the high fat group, the rate of increase of plasma cortisol level during exercise was similar on each diet. The dietary fat levels did not affect IFN-γ, however, PGE₂ and lipid peroxides decreased with increasing fat at baseline at 40%F level (p < 0.01; 30%F vs. 40%F: p < 0.002; 15%F vs. 40%F: p < 0.007).

Conclusions: Data from the present study suggest that higher levels of fat in the diet, up to 40%, increase endurance running time without adverse effects on plasma cortisol, IFN-γ, and lipid peroxide levels.     

Relationships between perceived workload, stress and oxidative DNA damage

Objectives: The present study was performed to investigate the relationship between work-related factors, including psychological stress, and the formation of a type of oxidative DNA damage, 8-hydroxydeoxyguanosine (8-OH-dG), in order to examine their possible risk factor for occupational carcinogenesis. Methods: A total of 54 healthy workers (27 male and 27 female, aged 41.2 ± 12.5 years) in a company were investigated for 8-OH-dG levels in the peripheral blood leukocytes at the time of a questionnaire survey regarding several factors, such as working hours, workload, fatigue, sleep, psychological stress and the prospect of alleviating it. Subjects were limited to non-smoking and non-drinking workers to exclude the influence of cigarette smoking and alcohol drinking, which have been reported to have associations with the formation of 8-OH-dG. Results: The levels of 8-OH-dG in female subjects were significantly related to the perceived workload (F=5.56, P=0.010), the perceived psychological stress (F=6.15, P=0.007), and the impossibility of alleviating stress (F=3.82, P=0.048). No associations were observed in male subjects. Conclusions: Psychological stress and perceived overwork appear to be related to the pathogenesis of cancer via the formation of 8-OH-dG, particularly in female workers. Received: 9 December 1999 / Accepted: 11 October 2000     

The impact of transvenous cardioverter-defibrillator implantation on quality of life,depression and optimism in dialysis patients: report on the secondary outcome of QOL in the randomized controlled ICD2 trial

Rationale

The impact of prophylactic implantable cardioverter-defibrillator (ICD) implantation on the psychological well-being of patients on dialysis is unknown.

Objective

We aimed to identify the effect of primary ICD implantation on quality of life (QoL), mood and dispositional optimism in patients undergoing dialysis.

Methods and results

We performed a prespecified subanalysis of the randomized controlled ICD2 trial. In total, 177 patients on chronic dialysis, with an age of 55–81 years, and a left ventricular ejection fraction of?≥?35%, were included in the per-protocol analysis. Eighty patients received an ICD for primary prevention, and 91 patients received standard care. The Short Form-36 (SF-36), Geriatric Depression Scale-15 (GDS-15), Revised Life Orientation Test (LOT-R) questionnaires were administered prior to ICD implantation (T0), and at 1-year follow-up (T1) to assess QoL, depression and optimism, respectively. The patients were predominantly male (76.0%), with a median age of 67 years. Hemodialysis was the predominant mode of dialysis (70.2%). The GDS-15 score difference (T1 ? T0) was 0.5 (2.1) in the ICD group compared with 0.3 (2.2) in the control group (mean difference ? 0.3; 95% CI ? 1.1 to 0.6; P?=?0.58). The LOT-R score difference was ? 0.2 (4.1) in the ICD group compared with ? 1.5 (4.0) in the control group (mean difference ? 1.1 (0.8); 95% CI ? 2.6 to 0.4; P?=?0.17). The mean difference scores of all subscales of the SF-36 were not significantly different between randomization groups.

Conclusions

In our population of patients on dialysis, ICD implantation did not affect QoL, mood or dispositional optimism significantly during 1-year follow-up.

Clinical Trial Registration

Unique identifier: ISRCTN20479861. http://www.controlled-trials.com.

     

Antiepileptic effect of fisetin in iron-induced experimental model of traumatic epilepsy in rats in the light of electrophysiological,biochemical, and behavioral observations

Background: Traumatic epilepsy is defined by episodes of recurring seizures secondary to severe brain injury. Though drugs are found effective to control seizures, their long-term use have been observed to increase reactive oxygen species in animals. Flavonoid fisetin, a natural bioactive phytonutrient reported to exert anticonvulsive effect in experimental seizure models. But, trauma-induced seizures could not be prevented by anticonvulsants was reported in some clinical studies.

Objective: To study the effect of fisetin on epileptiform electrographic activity in iron-induced traumatic epilepsy and also the probable reason behind the effect in rats.

Methods: Fisetin pretreatment (20?mg/kg body wt., p.o.) of rats for 12 weeks were chosen followed by injecting iron (5?µl, 100?mM) stereotaxically to generate iron-induced epilepsy. Experimental design include electrophysiological study (electroencephalograph in correlation with multiple unit activity (MUA) in the cortex and CA1 subfield of the hippocampus; spectral analysis of seizure and seizure-associated behavioral study (Morris water maze for spatial learning, open-field test for anxiety) and biochemical study (lipid peroxidation, Na⁺,K⁺-ATPase activity) in both the cortex and the hippocampus.

Results: Fisetin pretreatment was found to prevent the development of iron-induced electrical seizure and decrease the corresponding MUA in the cortex (*P?0.05) as well as in the hippocampus (***P?0.001). Fisetin pretreatment decreased the lipid peroxides (*P?0.05) and retained the Na⁺,K⁺-ATPase activity (*P?0.05) which was found altered in the epileptic animals and also found to attenuate the seizure-associated cognitive dysfunctions.

Conclusion: This study demonstrated the antiepileptic action of fisetin in iron-induced model of epileptic rats by inhibiting oxidative stress.