Depressogenic medication as an aetiological factor in major depression: an analysis in a clinical population of depressed elderly people.

OBJECTIVE: To study the role of depressogenic medication in the aetiology of major depression in the elderly. BACKGROUND: Depression can be caused, provoked or sustained by drugs prescribed for other reasons. The evidence for this statement is based on case-reports, not on investigations in relevant populations. METHOD: In the geriatric wards of three Dutch psychiatric hospitals, 195 patients with a DSM-III-R diagnosis of major depression (MDD) were studied. In the first week after admission the following data were recorded: age, gender, personal psychiatric history, family psychiatric history, Montgomery-Asberg Depression Rating Scale, Mini-Mental State Examination, history of stroke, use of medication and number of different medications used. Subjects using depressogenic medication were contrasted with subjects not using depressogenic medication on all variables. RESULTS: There was a significant negative relationship, adjusted for the other variables, between the use of depressogenic medication and a previous admission for depression. No other significant relationships between the use of depressogenic medication and aetiological variables were found. Patients with a first-time admission for MDD use depressogenic medication 2.44 times more often than patients with previous admissions for depression. CONCLUSION: The use of depressogenic medication is an independent and clinically relevant aetiological factor in MDD.     

Electroneurographic findings in workers exposed to mercury]

25 mercury-exposed workers as well as 27 age-matched controls were investigated in an electroneurographic study. The population of mercury-exposed workers was found to have --an increased latency of distal motor action potential at both median and peroneal nerves --an increased latency of distal sensory action potential at median nerve --a decrease of amplitudes of evoked muscle potentials at both median and peroneal nerves --a reduced motor nerve conduction velocity at both examined nerves --a reduced antidromic sensory nerve conduction velocity at median nerve. To detect early changes in nerval function we recommend regularly electroneurographic examinations of mercury-exposed people.     

Pulmonary aspergillosis: an unusual cytologic presentation.

Cytologic identification of Aspergillus is usually based on recognition of hyphal elements; conidia are rarely seen. We report a case of autopsy-proven pulmonary Aspergillosis which was studied antemortem by bronchoalveolar lavage. This mass arose in the clinical setting of chronic necrotizing pulmonary aspergillosis. The specimen contained numerous conidia, some of which exhibited germination. No hyphae were seen. This unusual cytologic expression of clinically significant fungal disease could be easily overlooked. Distinction of Aspergillus conidia from contaminating pollen is discussed.     

Evaluation of the Webler-Brown model for estimating tetrachloroethylene exposure from vinyl-lined asbestos-cement pipes

Background  

From May 1968 through March 1980, vinyl-lined asbestos-cement (VL/AC) water distribution pipes were installed in New England to avoid taste and odor problems associated with asbestos-cement pipes. The vinyl resin was applied to the inner pipe surface in a solution of tetrachloroethylene (perchloroethylene, PCE). Substantial amounts of PCE remained in the liner and subsequently leached into public drinking water supplies.     

Is apathy in late-life depressive illness related to age-at-onset, cognitive function or vascular risk?

BACKGROUND: Apathy has been shown to be an important feature of degenerative, vascular or traumatic brain disorder. Its presence is associated with high depression scores, higher age, low performance on frontal tasks, and more severe deep white matter hyperintensities. In late-life depression, lack of interest or motivation are often more prominent than depressed mood, especially in the late-onset type. It was hypothesized that in a heterogeneous sample of elderly depressed patients, apathy is associated with late-onset type of depression, cognitive dysfunction or vascular risk factors. METHOD: The Apathy Evaluation Scale (AES) was administered to twenty-nine elderly (> or = 60 years) inpatients with a DSM-IV major depression or dysthymic disorder. The severity of the depression was measured with the Montgomery-Asberg Depression Rating Scale (MADRS) and cognitive function with the Mini-mental State Examination (MMSE). The presence of vascular risk factors was traced in the patient's medical records. RESULTS: Apathy was found in 86% of the patients. The AES-score was correlated with the negative symptom score, but not with total MADRS or MMSE-score. No difference in AES-score between early-onset depressed (n = 16) and late-onset depressed (n = 13) patients was found, and between patients with or without vascular risk. CONCLUSION: Apathy is a main feature of moderate to severe depressive illness in elderly patients and related to the negative symptoms of the disorder. Further studies should include less severely depressed patients and investigate the relation between depression severity and apathy.     

Changing patterns of sun protection between the first and second summers for very young children

OBJECTIVES: To determine if an intensive intervention directed to mothers of newborns would increase levels of sun protection practice and lower rates of sunburning for their children; and to examine changes in sun protection practices and burning rates experienced between the first and second summers of life. DESIGN: Randomized study. SETTING AND PARTICIPANTS: Mothers of infants residing in the coastal town of Falmouth, Mass. INTERVENTION: Mothers were randomly selected to receive hospital education alone or hospital education plus tailored materials and telephone counseling. MAIN OUTCOME MEASURES: Child's sun protection practices and degree of skin damage at mean ages 6 and 18 months, as reported by the mother. RESULTS: Baseline surveys were completed by 108 mothers; 92 (85%) of the mothers completed posttests. There were few differences between intervention and control groups in use of sun protection for infants from the first summer (mean age, 6 months) to the second summer (mean age, 18 months). The child's routine use of hats, shirts, and shade dropped substantially from the first to the second summer. Conversely, sunscreen use rose from 34% to 93% (P<.001) for both groups during the same period. During the first summer, 22% of children received a sunburn or tan compared with 54% during the second summer (P<.001). CONCLUSIONS: Comprehensive sun protection begins to decline at a much earlier age than previously reported. Future studies should focus on parents' beliefs about the need for, and practice of, vigilant sun protection as their children grow from infancy to toddlerhood.     

Accuracy of the 15-item geriatric depression scale (GDS-15) in a community sample of the oldest old

BACKGROUND: Cognitive impairment is common in the oldest old. This might influence the sensitivity and specificity of the 15-item Geriatric Depression Scale (GDS-15). Few studies, however, have included subjects older than 85 years to evaluate the GDS-15 as a screening instrument for depression. OBJECTIVE: To assess the sensitivity and specificity of the GDS-15 in a community sample of the oldest old. METHODS: Seventy-nine subjects aged 85 and over were enrolled in the study. The GDS-15 and the Mini-Mental State Examination (MMSE) were administered by a trained interviewer. Within two days the Geriatric Mental State (GMS)/AGECAT, was administered to obtain a clinical diagnosis of depression. RESULTS: Eight subjects (10%) were diagnosed with clinical depression. At a cut-off point of 3/4 the sensitivity and specificity of the GDS-15 were 88% and 76% respectively. In the group with MMSE scores of 28 and higher sensitivity was unaffected at all cut-off points while specificity increased. In the group with MMSE scores below 28 sensitivity was also unaffected at all cut-off points while specificity decreased. CONCLUSION: The GDS-15 is a suitable instrument to diagnose depression in the general population of the oldest old. The optimal cut-off point depends on its intended use. In subjects with cognitive impairment the accuracy should be investigated further.     

Commercial discharge packs and breast-feeding counseling: effects on infant-feeding practices in a randomized trial

A randomized controlled trial was conducted to evaluate two interventions for prolonging the duration of breast-feeding in a multiethnic sample of 343 low-income urban women. One intervention compared research breast-feeding bedside counseling by a trained counselor, who also made eight telephone calls during the first 3 months of the infant's life, with the routine breast-feeding counseling provided in the hospital by nurses. The other intervention compared commercial discharge packs provided by formula companies with research discharge packs designed to be consistent with the WHO Code of Marketing of Breastmilk Substitutes. When infants were 4 months old, a telephone interviewer unaware of treatment status contacted 95% (324/343) of the women to determine the infants' feeding and health histories. Compared with routine counseling, research counseling delayed the first introduction of solid foods to the infant's diet (P = .03, one-tailed) but did not exert a statistically significant effect on breast-feeding by 4 months' postpartum. Women who received the research discharge pack, compared with those who received the commercial pack, were more likely to prolong exclusive breast-feeding (P = .004, one-tailed), to be partially breast-feeding at 4 months postpartum (P = .04, one-tailed), and to delay the daily use of solid foods in the infant's diet (P = .017, one-tailed). Among the women who received research counseling, the research discharge pack was associated with lower rates of rehospitalization of infants than was the commercial pack (1% v 14%; P = .014, two-tailed). We conclude that in high-risk maternity populations, commercial discharge materials for breast-feeding women should be replaced by materials consistent with the WHO Code.