Cognitive function in unipolar major depression: a comparison of currently depressed, previously depressed, and never depressed individuals

There is a lack of consensus upon a conclusive cognitive profile characterizing unipolar major depression. Currently depressed (n?=?37), recovered previously depressed (n?=?81), and never depressed controls (n?=?50) underwent assessment of executive functions, working memory, attention, and psychomotor speed. Currently depressed yielded significantly lower test scores than previously and never depressed subjects on a measure of working memory. Both currently depressed and previously depressed scored significantly lower than never depressed subjects on measures of processing speed. Recurrent depressed performed similarly to subjects with a single depressive episode. These findings indicate a mild and limited cognitive impairment during the course of a mild to moderate major depressive disorder among relatively young adults. Impaired processing speed should be considered in further studies as a potential irreversible marker for recurrent depression.     

Is a midwife's continuous presence during childbirth a matter of course? Midwives' experiences and thoughts about factors that may influence their continuous support of women during labour

Objective

to gain an understanding about midwives' experiences of providing a continuous supportive presence in the delivery room during childbirth, and to learn about factors that may affect this continuous support.

Design/setting

qualitative study at a maternity unit in Norway, where about 4000 births take place each year. In-depth interviews were conducted with ten midwives working in two different maternity wards. The qualitative data were analysed using systematic text condensation.

Findings

the analysis generated three main themes: relational competence, the midwife's ideology, the culture and philosophy of the maternity unit. The midwives identified being mentally present and actively developing mutual trust with the woman in labour as two very important factors for building a relationship with her. They suggested that the midwife's first encounter with the woman is a key opportunity for establishing rapport during labour. Successfully providing a continuous presence during labour fostered the midwives' perception of themselves as a ‘good midwife’; this was considered a feature of holistic care and health promotion. The workload in the unit sometimes made it difficult for them to provide a continuous presence in the delivery room. The midwives experienced feelings of inadequacy when they felt that they had too little time available for the woman in labour.

Key conclusions

midwives' skill in building a relationship with the woman in labour combined with their values and understanding of the midwifery profession are important factors influencing their decision to provide a continuous presence during childbirth. If it is policy that maternity units should provide continuous support to women in labour, managers should ensure that it is actually provided.     

Induction of invasion in an organotypic oral cancer model by CoCl2, a hypoxia mimetic

Brusevold IJ, Husvik C, Schreurs O, Schenck K, Bryne M, Søland TM. Induction of invasion in an organotypic oral cancer model by CoCl ₂ , a hypoxia mimetic. Eur J Oral Sci 2010; 118: 168–176. © 2010 The Authors. Journal compilation © 2010 Eur J Oral Sci Invasion is a hallmark of malignancy. The aim of this study was to develop an in vitro model that can be used for experimental studies of cancer cell invasion. The organotypic oral cancer model was constructed by growing oral squamous cell carcinoma (OSCC) cells on a collagen matrix in which normal human fibroblasts were incorporated. Immunohistochemical staining of the model showed that the expression of invasion‐related molecules such as phosphorylated extracellular signal‐regulated kinases 1 and 2 (p‐ERK1/2), cyclooxygenase‐2 (COX‐2), p75^NTR, and hepatocyte growth factor receptor (Met) was similar to that seen in OSCC. Treatment of the model with cobalt chloride (CoCl₂) to mimic hypoxic conditions increased cancer cell invasion, defined as the appearance of cancer cell islands protruding into the matrix. Models treated with CoCl₂ showed increased expression of p75^NTR and laminin‐5 in the cancer cells, and a more pronounced fragmentation of collagen IV in the basal membrane area, in contrast to models that were left untreated. The results indicate that the present model is well suited for studies on cancer cell invasion in the matrix and that the addition of CoCl₂ on day 3 of the experiment is indicated because it markedly increases the invasion and improves the model.     

Encouraging adolescents to contact their GP: a community-based trial

Background

Adolescents, especially males, often fail to see their GP.

Aim

To determine whether an informative letter could enhance the accessibility and utilisation of healthcare facilities and services.

Design and setting

A community-based trial in one town in Oslo, using a retrospective control group.

Method

GPs in one town in Oslo sent a personal, informative letter at the beginning of 2008 and 2009 to individuals in their practice population who were turning 16 years of age that year. The pooled data for the same year for each surgery were collected. Retrospective data from 1990 and 1991 served as controls for the intervention groups of data collected in 2006 and 2007 respectively. An International Classification of Primary Care-2 diagnosis was given for each contact.

Results

The proportion of adolescents in contact with a GP increased from 59% in the control group to 69% in the intervention group (P<0.001). For the males, the increase was from 54% to 72% (P<0.001). This reduced sex differences in healthcare seeking. For diagnoses mentioned in the informative letter the incidence rose from 38% in the control group to 55% in the intervention group (P<0.001). For the females, there was a non-significant increase in the proportion in contact with the GP, from 63% to 66% in control and intervention groups, respectively. The most frequent contact reasons were respiratory disorders, followed by general and unspecified complaints, skin disorders, musculoskeletal disorders, and psychological disorders. This pattern did not change because of the intervention.

Conclusion

An information letter about health problems and health rights (such as the protection of the adolescent’s privacy) seems to enhance the accessibility and utilisation of GPs, as measured by contact rate, particularly for males.     

Optimizing medication adherence with home-monitoring – A feasibility study using capillary microsampling and mHealth in solid organ-transplanted adolescents

Background

Reliable methods to detect and reduce medication nonadherence in solid organ-transplanted (SOT) adolescents are warranted. We aimed to evaluate the feasibility of combining a medication-manager application (TusenTac®-app) with home-sampling of tacrolimus (Tac) in young SOT recipients.

Methods

Kidney and combined SOT recipients between 14 and 25 years were included. During an 8-week intervention period, the participants were instructed to use the transplant-specific, age-adapted TusenTac®-app daily and to perform weekly at-home Tac trough finger-prick microsampling. Microsample Tac concentrations were controlled against timed venous samples twice. Medication implementation and persistence adherence were measured with BAASIS© questionnaires, TusenTac®-registrations, Tac trough concentration coefficient of variation (CV%) and self-reporting by interview. For comparison, venous Tac trough CV% were obtained from the year before and after the short-term intervention.

Results

Twenty-two recipients were included, two withdrawals, leaving 20; median age 17.9 (14.5–24.8) years, 12 females (60%). The participants registered their dosage intake 88% (1502/1703) of the expected times, and 90% (106/118) of the microsamples were obtained correctly. At inclusion, 11 recipients (55%) were nonadherent assessed with BAASIS© questionnaire, four of these (36%) turned adherent during the intervention period. At the end, 70% reported improved timing-adherence at the interview. There was no significant change in TacCV% from the year before to the year after the short-term intervention. Home-sampling was reliable and measured Tac concentrations accurately.

Conclusions

Home-monitoring, combining Tac finger-prick microsampling and a medication-manager app, is feasible in adolescent SOT recipients with 70% perceived improvement in medication timing-adherence. There were no significant long-term changes in TacCV% confirming the need for continuous use and individualized interventions.