The economic burden of depression in the United States: how did it change between 1990 and 2000?

BACKGROUND: The economic burden of depression was estimated to be 43.7 billion dollars in 1990. A subsequent study reported a cost burden of 52.9 billion dollars using revised prevalence data and a refined workplace cost estimation approach. The objective of the current report is to provide a 10-year update of these estimates using the same methodological framework. METHOD: Using a human capital approach, we developed prevalence-based estimates of 3 major cost categories: (1) direct costs, (2) mortality costs arising from depression-related suicides, and (3) costs associated with depression in the workplace. Cost-of-illness estimates from 1990 were updated to reflect the experience in 2000 using current epidemiologic data and publicly available population, wage, and cost information. RESULTS: Whereas the treatment rate of depression increased by over 50%, its economic burden rose by only 7%, going from 77.4 billion dollars in 1990 (inflation-adjusted dollars) to 83.1 billion dollars in 2000. Of the 2000 total, 26.1 billion dollars (31%) were direct medical costs, 5.4 billion dollars (7%) were suicide-related mortality costs, and 51.5 billion dollars (62%) were workplace costs. CONCLUSION: The economic burden of depression remained relatively stable between 1990 and 2000, despite a dramatic increase in the proportion of depression sufferers who received treatment. Future research will incorporate additional costs associated with depression sufferers, including the excess costs of their coexisting psychiatric and medical conditions and attention to the role of painful conditions as a driver of these costs.     

Extracorporeal lung support and endovascular stent in traumatic aortic rupture and severe lung failure

Blunt thoracic injury in association with aortic rupture represents a life-threatening situation. Surgical repair used to be the preferred method of treatment. Because most patients are multiple trauma patients including head injuries, bone fractures and respiratory failure, urgent surgical procedures portend excessively high morbidity and mortality rates. Delay in operative management bears the risk of exsanguinating hemorrhage, secondary complications, prolonged hospital stay with increased costs. We present here an alternative treatment protocol including pumpless extracorporal lung assist and endovascular aortic stent graft placement in a 20-year old traffic accident victim. This procedure may be an especially useful treatment option in managing patients with complex lung and aortic pathology primarily not suitable for transportation or surgery.     

Psychosocial correlates of physical activity and sedentary leisure habits in young adolescents: the Teens Eating for Energy and Nutrition at School study

BACKGROUND: Low levels of physical activity (PA) and highly sedentary leisure habits (SLH) in youth may establish behavioral patterns that will predispose youth to increased chronic disease risk in adulthood. The purpose of this paper was to examine associations of demographic and psychosocial factors with self-reported PA and SLH in young adolescents. METHODS: A general linear mixed model predicted self-reported PA and SLH in the spring from demographic and psychosocial variables measured the previous fall in 3798 seventh grade students. RESULTS: PA and SLH differed by race, with Caucasian students reporting among the highest PA and lowest SLH. Perceptions of higher academic rank or expectations predicted higher PA and lower SLH. Depressive symptomatology predicted higher SLH scores but not PA. Higher self-reported value of health, appearance, and achievement predicted higher PA and lower SLH in girls. Girls who reported that their mothers had an authoritative parenting style also reported higher PA and lower SLH. CONCLUSIONS: Determinants of PA and SLH appear to differ from each other, particularly in boys. Development of effective programs to increase PA and/or decrease SLH in young adolescents should be based on a clear understanding of the determinants of these behaviors.     

Gene expression profiling defines molecular subtypes of classical Hodgkin's disease

Although the prognosis of Hodgkin's disease is relatively good, around 20% of patients do not benefit from current therapies and succumb to their disease. A large-scale molecular characterization of disease might help improve HD management. Using cDNA arrays, we studied the mRNA expression levels of approximately 1000 selected genes in 34 benign and malignant lymphoid samples including 21 classical Hodgkin's disease (HD) tissue samples. Hierarchical clustering identified three main molecular groups of HD tumours relevant with respect to histology and clinical outcome (response to therapy and survival). Samples from all bad outcome HD (BOHD) patients clustered in one group whereas the two other groups contained most good outcome HD (GOHD) cases. The nodular sclerosis GOHD samples overexpressed genes involved in apoptotic induction and cell signalling, including cytokines, while the BOHD samples were characterized by the upregulation of genes involved in fibroblast activation, angiogenesis, extracellular matrix remodelling, cell proliferation, and the downregulation of tumour suppressor genes. Our results establish a molecular taxonomy of HD correlating with response to therapy and clinical outcome, thereby suggesting the possibility of improving the current prognostic classification.     

Carcinogenesis and translational controls: TACC1 is down-regulated in human cancers and associates with mRNA regulators

The three human TACC genes encode a family of proteins that are suspected to play a role in carcinogenesis. Their function is not precisely known; a Xenopus TACC protein called Maskin is involved in translational control, while the Drosophila D-TACC associates with microtubules and centrosomes. We have characterized the human TACC1 gene and its products. The TACC1 gene is located in region p12 of chromosome 8; its mRNA is ubiquitously expressed and encodes a protein with an apparent molecular mass of 125 kDa, which is cytoplasmic and mainly perinuclear. We show that TACC1 mRNA gene expression is down-regulated in various types of tumors. Using immunohistochemistry of tumor tissue-microarrays and sections, we confirm that the level of TACC1 protein is down-regulated in breast cancer. Finally, using the two-hybrid screen in yeast, GST pull-downs and co-immunoprecipitations, we identified two potential binding partners for TACC1, LSM7 and SmG. They constitute a conserved subfamily of Sm-like small proteins that associate with U6 snRNPs and play a role in several aspects of mRNA processing. We speculate that down-regulation of TACC1 may alter the control of mRNA homeostasis in polarized cells and participates in the oncogenic processes.     

Identification of a claims data "signature" and economic consequences for treatment-resistant depression

BACKGROUND: Major depressive disorder (MDD) is a debilitating condition with significant economic consequences. Conservative estimates indicate that between 10% and 20% of all individuals with MDD are treatment resistant. The objectives for this study were (1) to use current treatment strategies identified in the literature to evaluate the validity of studying treatment-resistant depression (TRD) using claims data and (2) to estimate cost differences between TRD-likely and TRD-unlikely patients identified by use of treatment patterns. METHOD: The data source consisted of medical, pharmaceutical, and disability claims from a Fortune 100 manufacturer for 1996 through 1998 (N = 125,242 continuously enrolled beneficiaries between the ages of 18 and 64 years). The sample included individuals with medical or disability claims for MDD (NMDD = 4186). A treatment pattern algorithm was applied to classify adult MDD patients into TRD-likely (NTRD = 487) and TRD-unlikely groups. Resource utilization and costs were compared among TRD-likely and TRD-unlikely patients and a random sample of average beneficiaries (i.e., 10% of all beneficiaries) for 1998. RESULTS: Consistent with the epidemiologic literature, the algorithm classified 12% of the MDD sample as TRD-likely. Mean annual costs were $10,954 for TRD-likely patients, $5025 for TRD-unlikely patients, and $3006 for average beneficiaries. TRD-likely patients used almost twice as many medical services as did TRD-unlikely patients and incurred significantly greater indirect costs (p < .0001). CONCLUSION: It is feasible to use an administrative dataset to develop a claim-based treatment algorithm to identify TRD-likely patients. Resource utilization by TRD-likely patients was substantial, not only for direct treatment of depression but also for treatment of comorbid medical conditions. Additionally, TRD imposed on employers substantial indirect costs resulting from high rates of depression-associated disability.     

Impact of a medically supervised safer injecting facility on drug dealing and other drug-related crime

North America's first medically supervised safer injecting facility (SIF) recently opened in Vancouver, Canada. One of the concerns prior to the SIF's opening was that the facility might lead to a migration of drug activity and an increase in drug-related crime. Therefore, we examined crime rates in the neighborhood where the SIF is located in the year before versus the year after the SIF opened. No increases were seen with respect to drug trafficking (124 vs. 116) or assaults/robbery (174 vs. 180), although a decline in vehicle break-ins/vehicle theft was observed (302 vs. 227). The SIF was not associated with increased drug trafficking or crimes commonly linked to drug use.     

HIV seroprevalence among participants at a Supervised Injection Facility in Vancouver, Canada: implications for prevention, care and treatment

North America's first government sanctioned medically supervised injection facility (SIF) was opened during September 2003 in Vancouver, Canada. This was in response to a large open public drug scene, high rates of HIV and hepatitis C transmission, fatal drug overdoses, and poor health outcomes among the city's injection drug users. Between December 2003 and April 2005, a representative sample of 1,035 SIF participants were enrolled in a prospective cohort that required completing an interviewer-administered questionnaire and providing a blood sample for HIV testing. HIV infection was detected in 170/1007 (17%) participants and was associated with Aboriginal ethnicity (adjusted Odds Ratio [aOR], 2.70, 95% Confidence Interval [95% CI], 1.84–3.97), a history of borrowing used needles/syringes (aOR, 2.0, 95% CI, 1.37–2.93), previous incarceration (aOR, 1.87, 95% CI, 1.11–3.14), and daily injection cocaine use (aOR, 1.42, 95% CI, 1.00–2.03). The SIF has attracted a large number of marginalized injection drug users and presents an excellent opportunity to enhance HIV prevention through education, the provision of sterile injecting equipment, and a supervised environment to self-inject. In addition, the SIF is an important point of contact for HIV positive individuals who may not be participating in HIV care and treatment.     

Association of APOE epsilon4 allele with survival in amyotrophic lateral sclerosis

APOE epsilon4 allele is associated with poorer outcome in degenerative neurological diseases. Its role in amyotrophic lateral sclerosis (ALS) is still unclear. The aim of the present study was to further analyze the association of APOE epsilon4 allele with progression and survival of ALS.One hundred consecutive ALS patients (53 males) and 133 controls were genotyped for the APOE epsilon4 allele. The association of this allele with survival to death or tracheostomy was analyzed by Kaplan-Meier survival analysis.The frequency of the APOE epsilon4 allele in ALS patients was slightly higher (15.1%) than in the control group (10.9%). Patients with or without an APOE epsilon4 allele had a similar age of onset and frequency of bulbar onset. There was a significant shortening of the 50% probability of survival (by 32 months) in patients carrying the APOE epsilon4 allele (p=0.03).In conclusion, carrying an APOE epsilon4 allele is a poor prognostic factor in ALS. This is compatible with a role of apolipoprotein on neuronal survival and repair.