Primary care management of major depression in patients aged ≥55 years:: outcome of a randomised clinical trial

Background

Late-life depression is associated with chronic illness, disability, and a poor prognosis. Primary care management may be in need of improvement.

Aim

To compare the effects of an intervention programme that aims to improve the identification, diagnosis, and treatment of depression in patients aged ≥55 years with the effects of usual care.

Design of study

Cluster randomised controlled trial.

Setting

General practices in the Netherlands.

Method

Trained GPs performed the intervention and their practice assistants conducted the screenings. Patients were screened with the 15-item Geriatric Depression Scale (GDS-15) and given a consultation with the GP who diagnosed depression with the mood module of the Primary Care Evaluation of Mental Disorders (PRIME-MD). Antidepressant treatment was proposed. Primary outcomes were measured with the Montgomery Åsberg Depression Rating Scale (MÅDRS). Trained independent research assistants performed independent evaluations in both arms.

Results

Eighteen practices (23 GPs) were allocated to the intervention and 16 practices (20 GPs) to usual care. From June 2000 to September 2002, 3937 patients were screened; 579 patients had a positive score on the GDS-15, 178 had major depression, of whom 145 participated in the trial. MÅDRS scores for the intervention group dropped from 21.66 at baseline to 9.23 at 6 months, and the usual care group from 20.94 at baseline to 11.45 at 6 months. MÅDRS scores decreased during the year in both arms. For the intervention group, these scores increased between 6 and 12 months.

Conclusion

The programme resulted in lower MÅDRS scores in the intervention group than in the usual care group, but only at the end of the intervention, at 6 months after baseline.     

Developmental change associated with human immunodeficiency virus infection in school‐age children with hemophilia

This study was designed to examine (a) developmental change associated with human immunodeficiency virus (HIV) infection in hemophilic boys ages 6 to 16 years and (b) whether age at infection was a critical variable in developmental change for children with HIV disease. Of the 11 subjects, 5 were HIV‐seronegative (HIV‐), and 6 were HIV‐seropositive (HIV+). The HIV+ children were asymptomatic at entry, but by the end of the study, one child had received a diagnosis of AIDS. All subjects were medically well at each time of assessment Standardized measures of general intelligence, academic achievement, neurological development, and problem behaviors were administered to each child every 6 months for 2 years. Both the HIV‐ and HIV+ children performed within age expectations at each time of assessment, and their parents reported very few behavior problems, indicating that the children were adjusting well to chronic illness. Both groups obtained lower achievement test scores than expected for their level of general intellectual ability. Differences were found in the pattern of retest effects for the two groups. There were improvements in Wechsler intelligence test performance over time for the HIV‐ children, but the HIV+ children demonstrated subtle declines in performance on measures of verbal and perceptual abilities. The HIV+ children infected at a younger age (M = 3 years, 11 months) performed more poorly on measures of perceptually related skills and demonstrated more deficient retest effects generally on tasks requiring visual‐motor coordination and perceptual organization than those infected at an older age (M = 9 years, 4 months). In addition, they exhibited more frequent signs of neurological problems than those infected later in life. The findings are discussed in terms of percolation theory, and implications for the children's educational planning are considered.     

Blood pressure effects of adiposity in non-overweight children aged 6–17 years

Background: Obesity is a well-established risk factor of elevated blood pressure; however, the relationships between normal weight status and the risk of hypertension and pre-hypertension are not clear.

Aim: The aim of this study is to describe the blood pressure effects of adiposity in non-overweight children.

Methods and results: In total, 588 097 non-overweight children aged 6–17?years were included from the National Surveys on Students’ Constitution and Health. A non-linear relationship was found between age- and gender-standardised body mass index (BMI) z-score and pre-hypertension and hypertension, respectively. The odds ratios and 95% confidence intervals [ORs (95% CIs)] of pre-hypertension were 0.61 (0.59–0.63), 0.67 (0.65–0.68), 0.83 (0.83–0.84), 1.00 (reference), 1.13 (1.12–1.14), 1.18 (1.16–1.20) and 1.20 (1.18–1.22) for BMI z-scores of ?1.2, ?1.0, ?0.5, 0 (reference), 0.5, 0.7 and 0.8, respectively. The ORs (95% CIs) of hypertension were 0.56 (0.54–0.58), 0.62 (0.61–0.64), 0.81 (0.80–0.82), 1.00 (reference), 1.17 (1.16–1.18), 1.23 (1.22–1.5) and 1.27 (1.24–1.29) for BMI z-scores of ?1.2, ?1.0, ?0.5, 0 (reference), 0.5, 0.7 and 0.8, respectively. The above-mentioned associations were consistent in sub-group analysis by age, gender and height.

Conclusions: Non-linear relationships of BMI z-scores with pre-hypertension and hypertension were found in non-overweight children. Interventions to control blood pressure are also important in non-overweight children.     

Urban–rural contrasts in the growth status of school children in Oaxaca,Mexico

Objectives:?The growth status of school children resident in an urban colonia and in a rural indigenous community in Oaxaca, southern Mexico, was considered in the context of two objectives, current status and the magnitude of urban–rural differences over a span of about 30 years. Both communities were initially surveyed in 1968 and 1972.

Materials and methods:?Height, body mass, segment lengths, skeletal breadths, limb circumferences, and subcutaneous fatness were taken on 361 rural (177 boys, 184 girls) and 339 urban (173 boys, 166 girls) school children, aged 6–13 years. Additional variables were derived.

Results:?Height and body mass were significantly greater in urban compared with rural children. Sitting height, estimated leg length and skeletal breadths on the trunk were also larger in urban than in rural school children, but only the difference in skeletal breadths was significant after age and body size were statistically controlled. Urban and rural children did not consistently differ in skeletal breadths on the extremities and limb circumferences. Subcutaneous fatness was more variable. After controlling for age and body size, rural girls had thicker skinfolds. The magnitude of the urban–rural difference in boys in 2000 was greater for body mass, BMI and triceps skinfold, and reduced for height, sitting height, leg length, and arm and estimated arm muscle circumferences compared with 1970. The magnitude of the urban–rural difference in girls was greater in 2000 than 30 years earlier for body mass, height, sitting height, leg length and BMI. Urban–rural differences for arm and arm muscle circumferences and the triceps skinfold were slightly smaller over the interval.

Conclusions:?Children resident in an urban colonia were taller and heavier than children resident in a rural indigenous community. After controlling for age and body size, urban–rural differences in skeletal breadths and limb circumferences were reduced or eliminated, but skinfold thicknesses were greater in rural girls. The magnitude of urban–rural differences in body size has decreased over approximately 30 years in boys, but has increased in girls.     

Open‐ and closed‐loop smooth‐pursuit eye movements in normal children: An analysis of a step‐ramp task

We previously reported that the visual ability to track a moving target (smooth‐pursuit tracking) improves as children age from 8 to 15 years old. This study used infrared oculography during step‐ramp tasks to determine whether the age‐related improvement in smooth‐pursuit tracking is due to developmental changes in the ability to perceive and match eye velocity to target velocity (open‐loop tracking). Infrared oculography was used to assess the ability to track a moving stimulus (smooth‐pursuit tracking) during step‐ramp tasks in 51 normal children between 8 and 15 years old. The first 100 msec of tracking (initial pursuit) occurs before any visual feedback (open‐loop tracking) and represents sensorimotor transformation. Ongoing pursuit (measured by smooth‐pursuit gain) includes feedback information as to the success of pursuit (closed‐loop pursuit) and depends on sensorimotor transformation as well as higher order abilities, including the ability to sustain focused attention. Open‐loop pursuit is not affected by age of the subject. In contrast, during closed‐loop pursuit, when target step and target motion are in opposite directions, age is significantly correlated with closed‐loop pursuit gain, Spearman's R = 0.40, p < .003. The ability to perceive and match eye velocity to target velocity is fully developed by 8 years of age.     

An assessment of hemineglect in children with attention‐deficit hyperactivity disorder

Voeller and Heilman (1988a) have produced evidence suggesting a right‐hemisphere dysfunction associated with attention‐deficit hyperactivity disorder (ADHD): ADHD‐related hemineglect. The present study is a constructive replication, using carefully screened children with ADHD for a number of compromising factors (e.g., no lateralized brain damage, handedness, eyedness). Each child received two tests: Line Bisection and Visual Target Cancellation Test. In addition, their performance was assessed in both binocular and monocular viewing conditions. While the ADHD children performed generally worse than the controls on target cancellation (i.e., exhibiting higher inattention), there was no evidence for hemineglect. To complicate matters, a reversed right‐left imbalance was tapped using a structured task array for this test, for left‐eye dominant ADHD children not on medication. Besides drawing attention to the role of the dominant eye in the scanning of children with ADHD, we suggest that no firm conclusions regarding an ostensible ADHD‐related hemineglect may be drawn.     

The active‐passive test: An age‐referenced clinical test of syntactic discrimination

The construction and use of a test of syntactic discrimination are described. Fifty children (10 each at 6, 8,10,12, and 14 years of age), selected for median scholastic class performance, were tested. The number of correct syntactic discriminations and response latencies were calculated for each of the four sentence forms: active affirmative, passive affirmative, active negative, and passive negative. Comprehension of the sentences improved with age, although even the youngest children identified forms like the passive affirmative at a better‐than‐chance level. Age‐related improvements in test performance were nonlinear and varied with sentence form. Several factors influenced test performance: the semantic relations expressed by different verbs, surface syntactic features, and the degree of syntactic complexity. The effect of a given factor varied with both the age of the child and the performance measure. After age 6, increased skill was associated with the selective allocation of processing time to sentences on the basis of syntactic complexity.     

Relationship of auditory discrimination ability to WISC‐R subtest performance in learning‐disabled children

We examined the relationship of auditory discrimination ability, as measured by the Speech Sounds Perception and the Seashore Rhythm tests of the Halstead‐Reitan Neuropsychological Battery (HRNB), to Wechsler Intelligence Scale for Children‐Revised (WISC‐R) subtest performance with 1,024 children referred for learning difficulties. Results of a canonical analysis for the HRNB auditory discrimination measures with the WISC‐R subtests yielded two significant canonical correlations. Interpretable WISC‐R subtests included Digit Span, Arithmetic, Information, and Block Design for the first canonical correlation. The Similarities and Information subtests were interpretable variables in the second canonical correlation. Results are discussed in view of the underlying constructs of the interpretable subtests’ relationship to auditory discrimination ability. These data suggest that examination of specific WISC‐R subtests is useful in evaluating children referred for learning disabilities.     

Comparative clinical efficacy of polymethyl methacrylate and self-solidifying calcium phosphate cement in vertebroplasty: A meta-analysis北大核心

OBJECTIVE: Vertebroplasty is widely used in the treatment of osteoporotic vertebral fractures. At present, polymethyl methacrylate is still the most commonly used filling material for strengthening vertebral body, but it is not the most ideal filling material. Self-curing calcium phosphate cement is a new filling material developed in recent years, which can naturally heal with bone tissue and be absorbed and replaced by the human body. This meta-analysis systematically analyzed the clinical efficacy and safety of polymethyl methacrylate and self-solidifying calcium phosphate cement in vertebroplasty. METHODS: China National Knowledge Infrastructure, Wanfang database, Chinese Biomedical Medicine database, PubMed, EMbase, and Cochrane Library database were retrieved for clinical control studies regarding with polymethyl methacrylate and self-solidifying calcium phosphate cement treatment of osteoporotic vertebral compression fracture. The retrieval period was from the database inception to July 2020. The visual analogue scale score, vertebral kyphosis Cobb angle, vertebral body height, bone cement leakage rate, adjacent vertebral fracture rate, Oswestry dysfunction index, and clinical curative effect were used as the outcome indexes. All the literature screening, data extraction and research quality evaluation were carried out independently by two reviewers. In addition, the Cochrane Collaboration tool and the Newcastle-Ottawa scale were used to evaluate the quality of randomized controlled trials and cohort studies, respectively. RevMan 5.4 software was used for meta-analysis. RESULTS: (1) A total of nine studies involving 593 patients were included in the meta-analysis; five of which were randomized controlled trials, and four were retrospective cohort studies. All of the selected studies were of high quality. (2) Meta-analysis results showed that there was no significant difference between the two filling materials in the following aspects, including visual analogue scale score (SMD=-0.45, 95%CI:-1.10-0.21, P=0.18), Cobb angle of vertebral kyphosis (MD=-0.16, 95%CI:-0.43-0.11, P=0.24), height of vertebral body (SMD=0.13, 95%CI:-0.12-0.37, P=0.32), leakage rate of bone cement (OR=1.30, 95%CI:0.67-2.54, P=0.44), Oswestry disability index (MD=3.31, 95%CI:-1.34-7.97, P=0.16), and clinical effective rate (OR=1.00, 95%CI:0.14-7.27, P=1.00). However, in terms of new fractures of adjacent vertebrae, the calcium phosphate cement group was significantly better than the polymethyl methacrylate group (OR=2.17, 95%CI:1.04-4.51, P=0.04). CONCLUSION: The application of calcium phosphate cement in vertebroplasty has a significant advantage in reducing adjacent vertebral fractures compared with polymethyl methacrylate. The curative effect is similar in pain visual analogue scale score, vertebral kyphosis Cobb angle, vertebral body height, bone cement leakage rate, and Oswestry dysfunction index. However, more high-quality randomized controlled trials are needed to provide more sufficient evidence. © 2022, Publishing House of Chinese Journal of Tissue Engineering Research. All rights reserved.     

Long‐term efficacy of cognitive training for age‐associated memory impairment: A six‐month follow‐up study

The purpose of this investigation was to assess the impact of pretraining on the long‐term effect of an imagery‐based mnemonic in persons with age‐associated memory impairment (AAMI). Eighty‐two participants were randomly assigned to one of six groups: (1) verbal judgment pretraining plus mnemonic training, (2) visual imagery elaboration pretraining plus mnemonic training, (3) relaxation pretraining plus mnemonic training, (4) nonspecific pretraining plus mnemonic training, (5) nonspecific training, and (6) wait list. Participants receiving the three specific pretraining techniques along with mnemonic training (Groups I to 3) recalled more than those receiving nonspecific pretraining with mnemonic training (Group 4) or nonspecific pretraining without mnemonics (Group 5). Participants receiving mnemonic training (Groups 1 to 4) did not differ from nonmnemonic controls (Group 5) at 6 months. The results suggest that specific pretraining strategies can help maintain beneficial effects of imagery‐based mnemonics over time.     

A normative‐developmental study of executive function: A window on prefrontal function in children

Normative‐developmental performance on a battery of executive function tasks was investigated. Executive function was defined as goal‐directed behavior, including planning, organized search, and impulse control. Measures were drawn from clinical neuropsychology (visual search, verbal fluency, motor sequencing, and Wisconsin Card Sorting Task [WCST]) and from developmental psychology (Tower of Hanoi [TOH] and Matching Familiar Figures Test [MFFT]). A discriminant task, recognition memory, was administered, and IQ scores were available on a subset of the sample. One hundred subjects ranging from 3 to 12 years old participated; an adult group was also studied. Three major results were found: (a) adult‐level performance on different subsets of the executive function tasks was achieved at three different ages—6 years old, 10 years old, and adolescence; (b) the measures clustered into three different factors reflecting speeded responding, set maintenance, and planning; and (c) most of the executive function tasks were uncorrelated with IQ. The implications of these results for our understanding of the development of prefrontal lobe functions are discussed.     

The use of discriminant analysis to define obesity in children aged 7–11 years

All the elementary schoolchildren (ages 7–11 years) in the city of Aosta were diagnosed clinically for obesity and measured for height, weight and triceps and subscapular skinfolds. A statistical discriminant analysis revealed that, on the basis of these measurements, this population of children could be divided into a group of normal children and one or more distinct populations of obese children. To the extent that these groups reveal qualitative phenotypic differences, they should simplify genetic studies of obesity.     

Association of leg length with overweight and obesity in children aged 5–15 years: A cross-sectional study

Background: Short leg length (LL) and childhood obesity have been independently associated with a higher risk for adult disease. However, the contribution of relative LL to overweight and obesity in children remains an under-researched area.

Aim: To utilize data from a large cross-sectional anthropometric survey to assess the association of LL to height ratio (LLHR, leg length/height) with measures of overweight and obesity in British children.

Methods: Children were analysed from the bottom and top body mass index (BMI) standard deviation score (SDS) quartiles (3825 children, boys=1686) or waist circumference (WC) SDS quartiles (3824 children, boys=1687). The top quartile was defined as the ‘high’ BMI or WC SDS group and the lower bottom quartile as the ‘low’ BMI or WC SDS group. Height and LL were expressed as SDSs using current references and LLHR was calculated.

Results: Children in the ‘high’ groups were taller with longer legs but had a lower LLHR across most ages. The magnitude of the difference was greater for BMI than WC in both genders.

Conclusion: Altered body dimensions appear to be linked to measures of overweight and obesity in children but longitudinal studies are needed to confirm this suggestion.     

Epidemiological profile of the schistosomiasis in school children in the Agneby Region (south-east of Côte-d'Ivoire)

A parasitological survey was conducted in the Agnéby region (south-east C?te-d'Ivoire) from November 2000 to February 2001 in order to establish the epidemiological profile of schistosomiasis in school children in this region. Stools and urines of 724 school children were examined. Faeces were examined by direct analysis completed by Kato and Ritchie methods. Analysis of urine samples was made through the technique of centrifugation (2.000 g for 10 minutes). This survey revealed the importance of schistosomiasis. 20.6% of the subjects were found carriers of Schistosoma mansoni eggs, 12.6% carriers of Schistosoma haematobium eggs and 3.2% were found carriers of eggs of two Schistosoma species. Prevalence was higher in Adzope than in Agboville and Schistosoma mansoni was globally prevalent. Males were significantly more infected than females and older children were more infected than young children. The prevalence distribution among people could be explained by behaviour and occupations.     

The effectiveness of clinical pharmacist’s intervention in improving asthma care in children and adolescents: Randomized controlled study in Jordan

ObjectiveTo evaluate the effectiveness of clinical pharmacist’s intervention on achieving better asthma control, quality of life and other clinical parameters.MethodsA prospective randomized controlled study in north Jordan was conducted. Pediatric patients with asthma (aged 7–18 years old) were included and randomly allocated into two groups, intervention and control. Both groups were interviewed at the first visit and followed up twice by phone (at 3 and 6 months). Education was provided to patients and their caregivers in the intervention group only.ResultsOf 206 eligible patients recruited and randomized to our study, 178 patients completed the study (48.3% intervention versus 51.7% control). There were no significant differences in all baseline data between both groups. We identified significant differences in the improvement of asthma control (p < 0.001) and consequently pediatric and caregiver quality of life (p < 0.001) between both groups at the end of study. Significant differences were also detected in other clinical parameters (p < 0.05).ConclusionImplementation of clinical pharmacy service can positively influence asthma control, pediatric and caregiver’s quality of life, and other clinical parameters.Practice implicationsTo maintain a good asthma status, education of pediatric patients and their caregivers should be part of routine assessment during clinic visit.     

A comparison of cognitive and behavioral patterns in learning‐disabled children: Subtype and sex differences

A sample of 83 learning‐disabled (LD) females were individually matched to 83 LD males by age and Full Scale IQ and were compared on several cognitive and behavioral measures. Factor‐ and cluster‐analytic techniques were applied to the cognitive and behavioral data, and similar factor and profile structures were found for male and female LD children. The clusters and factors identified in the analyses demonstrated several significant relationships to performance on certain cognitive and behavioral measures, reading, and an attention‐impulsivity task for the combined male and female sample. Although statistically significant sex differences were found on measures suggesting that females were less impulsive and were better at reading comprehension than males, the study identified more similarities than differences among LD males and females.     

The halstead‐reitan neuropsychological test battery for older children: The effects of age versus clinical status on test performance

A meta‐analysis of reference group data for the Halstead‐Reitan Neuropsychological Test Battery for Older Children (HRB‐OC), 9 to 14 years of age, is presented, using the effect size statistic described by Glass (1978). The distance from a pooled normal mean is calculated for published reference data from two groups of normal 9‐year‐old children and six groups of children with compromised neuropsychological status. Results indicate that using age‐referenced normative data may significantly enhance interpretive accuracy with the HRB‐OC, especially for children at the ends of the HRB‐OC age spectrum. The ability of the HRB‐OC tests to separate children by age and by clinical status varies across tests and across samples.