Impact of multiple traumatic experiences on the persistence of depressive symptoms – a population-based study

The objective of this population-based study was to determine whether traumatic experiences in general, and multiple traumatic experiences in particular, are associated with persistent self-rated depressive symptoms in adult Finnish subjects over 2?years of follow-up. The study sample included 1405 subjects aged 25–64?years. Subjects (n=217) who were depressed both at baseline in 1999 and on follow-up 2?years later in 2001 (having persistent depressive symptoms) were compared with subjects (n=987) having no depressive symptoms either at baseline or on follow-up. All six categories of traumatic experiences (wartime experience, natural disaster, life-threatening accident, victim of violent crime, domestic violence and childhood sexual abuse) pertained to the respondents’ whole life span. Odds ratios, adjusted for significant covariates, were obtained from multiple logistic regression models that estimated the likelihood of persistent depressive symptoms in different trauma categories. Persistent depressive symptoms had a significant positive graded relationship with the number of traumatic experiences. The adjusted odds of persistent depression was 6.05 (95% CI 1.76–20.7) for men and 6.99 (95% CI 2.69–18.2) for women in those with three or more traumatic experiences compared with those with no such experiences at all. Multiple traumatic experiences substantially increase the likelihood of persistent depressive symptoms. Mental health intervention, as early as possible, may serve to prevent the chronicity of depressive reactions among victims of multiple traumas.     

High stromal versican expression predicts unfavourable outcome in oral squamous cell carcinoma

BACKGROUND: Versican, an extracellular matrix proteoglycan, has been noted to be expressed in several malignant tumours and has been suggested to play an important role in cancer development and tumour growth. AIMS: To investigate whether the versican expression level in the peritumoural stromal tissue of primary oral squamous cell carcinoma (OSCC) predicts relapse-free or disease-specific survival. Also, to study the associations between versican expression and several other clinicopathological variables, as well as tumour cell proliferation. METHODS: Immunohistochemistry was used to study the expression of versican and tumour cell proliferative activity in 139 OSCCs. All pertinent clinical data were collected retrospectively from the hospital records. RESULTS: In this cohort, versican expression did not correlate with the clinicopathological factors or tumour cell proliferation. In univariate analyses, higher risk for disease recurrence was associated with higher stromal versican expression score (p = 0.02), positive neck node status (p = 0.02), lower Karnofsky performance status (p = 0.03) and higher tumour cell proliferation index (p = 0.04). Increased disease-specific risk of death was associated with high stromal versican expression score (p = 0.005) higher T class (p = 0.002), positive neck node status (p<0.001), higher stage (p<0.001), poorer histological differentiation (p = 0.005), worse general condition of the patient (p = 0.049) and increased tumour cell proliferative index (p = 0.02). In multivariate disease-specific survival analysis, high stromal versican expression score (p = 0.048), poorer histological differentiation (p = 0.047) and higher stage (p = 0.002) independently predicted poorer disease outcome. CONCLUSIONS: In this cohort, increased stromal versican expression correlated with both increased risk for disease recurrence and shortened survival. High stromal versican expression may thus be considered an independent and adverse prognostic marker in OSCC.     

Local daily temperatures,thermal seasons,and suicide rates in Finland from 1974 to 2010

Objectives

Suicide peaks in late spring and October are still seen in Finland among many countries. Weather factors have been suggested as explanations for these peaks, although with inconsistent results. Since the exact timing of these peaks varies each year, the length of daylight and changes in it seem inadequate as an explanation. We hypothesized that ambient temperature and the timing of thermal seasons might associate with suicide rate.

Methods

Suicide rates from three areas across Finland (N = 10,802) were analyzed with Poisson regression in six different models against variables calculated from the local ambient daily temperature, diurnal temperature range, and the duration from the onset of thermal seasons. Separate models for men and women were constructed.

Results

The temperature change over 5 days associated with the suicide rate of men in Helsinki region, or in other words, the lower the suicide rate was, the higher the temperature decrease had been. For women, the results were more inconsistent.

Conclusions

Our study is in line with some earlier studies which imply that impairment of thermoregulation might exist among suicide victims.     

Visual field findings after a ruptured intracranial aneurysm

Background

Visual field defects (VFDs) negatively affect activities of daily living and rehabilitation following aneurysmal subarachnoid haemorrhage (aSAH). The aim here was to assess VFDs in patients with aSAH and their associations with age, gender, aSAH severity, and clinical outcome.

Methods

Patients admitted to Helsinki University Central Hospital and treated during 2011 were participants in this prospective study. Findings obtained with the Octopus 900 perimeter (Haag-Streit Inc, Koenic, Switzerland), the Goldmann perimeter (Haag-Streit Inc, Bern, Switzerland), or the confrontation visual field test on admission and 3 days, 14 days, 2 to 4 months, and 6 months postoperatively were assigned to 16 classes. Associations between post-chiasmal VFDs and relevant clinical, radiological, and demographic data were analysed with uni- and multivariate logistic regression.

Results

Of 105 survivors at 6 months, 20 (19 %) had VFDs occurring for aneurysm- or operation-related reasons; homonymous hemianopias or quadrantanopias were the most common finding, occurring in 16 patients (15 %). Posterior ischaemic optic neuropathy presented in two patients (2 %). Ten survivors (10 %) no longer fulfilled visual field requirements for driving licences. Significant associations emerged between VFDs at 6 months and the Hunt and Hess (H&H), World Federation of Neurosurgical Societies (WFNS), and Fisher grades on admission, presence of intracerebral haemorrhage (ICH), hydrocephalus, or postoperative infarction, and higher modified Rankin Scale scores at 6 months. Multivariate logistic regression showed the H&H grade and presence of ICH to independently predict VFDs.

Conclusions

Assessing VFDs is advisable, especially among patients with poor-grade aSAH (H&H grade IV or V) and ICH.     

Brown adipose tissue function is accompanied by cerebral activation in lean but not in obese humans

Brown adipose tissue (BAT) is able to generate heat and dissipate energy in response to cold exposure in mammals. It has recently been acknowledged that adult humans also have functional BAT, whose metabolic activity is reduced in obesity. In healthy humans, the cerebral mechanisms that putatively control BAT function are unclear. By using positron emission tomography (PET), we showed that cold-induced BAT activation is associated with glucose metabolism in the cerebellum, thalamus, and cingulate, temporoparietal, lateral frontal, and occipital cortices in lean participants, whereas no such associations were found under warm control conditions. The cold-induced increase in cerebral glucose metabolism was more robust in lean than obese participants. Cerebral glucose metabolism was not associated with skeletal muscle or white adipose tissue glucose uptake under warm or cold conditions. In conclusion, BAT metabolism was accompanied by the activation of specific cerebral regions, and this shows an uncharacterized role that the brain plays in the regulation of BAT function. In obese participants, the cold-induced response in cerebral activity was attenuated that provides a clue for obesity-induced impairment in BAT metabolism.     

Nursing students' motivation regulation strategies in blended learning: A qualitative study

Although there is a strong body of evidence showing that motivational factors are critical components of self‐regulated professional learning and commitment to work, little is known about nursing students' motivation regulation during their studies. The aim of this study was to gain a deeper understanding of nursing students' motivation regulation (MR) strategies and factors contributing to their reported use along their 3‐year study path in a blended learning environment. A purposeful sampling was used to select 12 undergraduate nursing students, who exhibited different MR profiles and had completed almost 3 years of study in a BL degree program. A qualitative, deductive, content analysis was used to depict students' experiences from their retrospective recollection in the interview situation. Seven motivation strategies were identified: environmental structuring, self‐consequating, goal‐oriented self‐talk, efficacy management, emotion regulation, regulation of value, and interest enhancement. Individual and situational factors were found to enhance and to sustain the use of appropriate MR strategies. The students exhibited versatility in their use of MR strategies, which were related to the study phase. These findings regarding nursing students' MR strategies should be considered in the development of nursing education programs and the implementation of improvements that contribute to professional and self‐regulated learning in BL programs.