Prevalence of major depressive disorder in the general population of South Korea

INTRODUCTION: Previous epidemiological studies have reported a high prevalence of major depressive disorder (MDD) in North America and Western Europe. However, little information exists on MDD in Asian countries. This study investigates the prevalence of MDD and its characteristics in the general population of South Korea. METHODS: A representative sample of the South Korean general population composed of 3719 non-institutionalized individuals aged 15 years or older was interviewed by telephone using the Sleep-EVAL system. The participation rate was 91.4%. The interviews covered sociodemographic characteristics, health care utilization, physical illnesses and Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) psychiatric disorders. RESULTS: A depressive mood, i.e., feeling sad, downcast, having the blues or having lost interest in things formerly pleasant was reported by 20.9% of the sample without significant difference between men and women and among age groups. DSM-IV MDD was found in 3.6% (95% CI: 3.0-4.2%) of the sample. The prevalence of MDD was comparable among age groups. Shift workers were more likely to have MDD than daytime workers. Factor significantly associated with MDD were: being a woman, being a light or heavy smoker, perceiving one's health as being average or poor, doing physical activities at least three times per week in the evening, having a BMI below 18.5 kg/m2 and perceiving one's life as being moderately or highly stressful. CONCLUSIONS: Prevalence of MDD in Korea is higher than what it was previously estimated to be two decades ago. The number of individuals seeking help for depression was very low, and only a small number of MDD subjects received appropriate treatment for their condition.     

Ethnicity and discordance in plasma HIV-1 RNA viral load and CD4+ lymphocyte count in a cohort of HIV-1-infected individuals.

BACKGROUND: Guidelines for commencing therapy for HIV infection have been based upon HIV-1 RNA and CD4 lymphocyte thresholds. The influence of confounding factors such as gender, ethnicity and co-infections is unproven. OBJECTIVES: To analyse ethnic discordance in plasma HIV-1 viral load (VL) and CD4+ count and its potential clinical significance in Black and Caucasian groups. STUDY DESIGN: Retrospective, cross-sectional, observational study of 537 antiretroviral nai;ve HIV-1-positive individuals attending two East London clinics. Baseline data were obtained from individuals who registered at the clinic from November 1996 to August 1999. An analysis was performed comparing ethnic differences in plasma HIV-1 VL, CD4+ count, CD8+ count, co-infections, CDC disease category, AIDS-defining illnesses and mode of transmission. RESULTS: Plasma HIV-1 VL was significantly lower in Blacks (4.5 copies/ml versus 4.7 copies/ml; P<0.05) despite lower baseline CD4+ counts and similar rates of disease progression to Caucasian groups. This association remained for patients with less advanced disease after stratification for CD4+ count (CD4+ 200-500, VL 4.5 copies/ml versus 4.7 copies/ml, P<0.01; CD4+ >500, VL 3.4 copies/ml versus 4.3 copies/ml, P<0.001) and disease category (non-AIDS, 4.4 copies/ml versus 4.7 copies/ml; P<0.005). On multivariate analysis, the association persisted following adjustment for gender, age, co-infections, CD4+ count and mode of transmission. CONCLUSIONS: These results suggest that plasma HIV-1 VL is discordantly low in Black compared with Caucasian groups stratified for CD4+ count, in this cohort of antiretroviral nai;ve HIV-1-positive individuals living in London. Although there are a number of possible explanations for this finding, it has considerable clinical relevance for the management of Black HIV-1-infected patients within UK, with significant implications for the decision about when to commence antiretroviral or immune-based therapies.     

Use and Views on Social Networking Sites of Pharmacy Students in the United Kingdom

Objective. To investigate students'' use and views on social networking sites and assess differences in attitudes between genders and years in the program.Methods. All pharmacy undergraduate students were invited via e-mail to complete an electronic questionnaire consisting of 21 questions relating to social networking.Results. Most (91.8%) of the 377 respondents reported using social networking Web sites, with 98.6% using Facebook and 33.7% using Twitter. Female students were more likely than male students to agree that they had been made sufficiently aware of the professional behavior expected of them when using social networking sites (76.6% vs 58.1% p=0.002) and to agree that students should have the same professional standards whether on placement or using social networking sites (76.3% vs 61.6%; p<0.001).Conclusions. A high level of social networking use and potentially inappropriate attitudes towards professionalism were found among pharmacy students. Further training may be useful to ensure pharmacy students are aware of how to apply codes of conduct when using social networking sites.     

The modified Stroop paradigm as a measure of selective attention towards pain-related stimuli among chronic pain patients: a meta-analysis.

Although the modified Stroop paradigm is considered to be a prominent paradigm for investigating selective attention in emotional disorders, relatively few studies have applied this paradigm to examine selective attention in chronic pain patients. Moreover, the results from these studies are not robust. The purpose of this article is to review the evidence for attentional bias in chronic pain patients, by means of a meta-analysis. Data from five studies were pooled and summarized into a mean difference (MD). Significant MD estimations (in milliseconds) were found for both sensory pain words (MD=26.7; 95% confidence interval (CI) 10.0-42.9) and affective pain words (MD=28.1; 95% CI 0.4-55.8). Meta-regression analysis indicated that methodological quality did not significantly affect the pooled MD estimation for both sensory pain words and affective pain words. Thus, the results from the present meta-analysis on studies applying the modified Stroop paradigm suggest that chronic pain patients selectively attend to both pain sensory and pain affective stimuli. Furthermore, the MD estimation did not depend on the methodological quality, tentatively indicating that even though studies differed in methodology, the results were rather consistent. Implications of the results are discussed.     

Diastolic filling abnormalities by color kinesis in newborns exposed to intrauterine cocaine.

Because cocaine crosses the placenta, we prospectively evaluated global and segmental systolic and diastolic cardiac function by color kinesis in clinically asymptomatic newborns who were exposed to cocaine in utero (group 1, n = 82). Their data were compared with normal controls (group 3, n = 87) and newborns exposed to drugs other than cocaine (group 2, n = 108). During left ventricular filling, newborns exposed to cocaine, compared with groups 2 and 3, had significantly (P <.05) higher global fractional area change (%) (76 +/- 10.3 vs 72 +/- 9.4 and 72 +/- 9.1, respectively), regional fractional area changes (%) for the anterior, septal, inferior, and lateral wall, and in the index of asynchrony (at 50% filling 13.2 +/- 5.8 vs 11.3 +/- 4.1 and 11.6 +/- 4.2, respectively). There were no significant differences in systolic function among the 3 groups. Prenatal cocaine exposure in asymptomatic infants leads to higher global and segmental fractional area changes and asynchrony during diastole. The significance and course of these alterations require further investigation.     

Value of Xpert MRSA/SA blood culture assay on the Gene Xpert Dx System for rapid detection of Staphylococcus aureus and coagulase-negative staphylococci in patients with staphylococcal bacteremia

The Xpert MRSA/SA BC assay was examined prospectively in patients with staphylococcal bacteremia including 6 patients with blood culture bottles inoculated with biological fluid (synovial fluid in 4 cases and peritoneal fluid in 2 cases). Among the 56 Staphylococci species isolated, 80.3% were coagulase-negative staphylococci (CoNS) and 19.7% were S. aureus. Methicillin susceptibility test results showed that 77.8% of isolates were methicillin-resistant CoNS (MRCoNS) and 22.2% of isolates were methicillin-susceptible CoNS (MSCoNS). Of 11 S. aureus isolates, 63.7% were methicillin-susceptible S. aureus (MSSA) and 36.3% were methicillin-resistant S. aureus (MRSA). Xpert MRSA/SA BC results showed that genotypic results were in concordance with phenotypic results in 94.6% of cases versus 5.4% of discordant cases. Of these 3 discordant cases, 1 S. aureus isolate had an MRSA phenotype and an SPA⁺mec⁺SCCmec⁻ genotype and another S. aureus isolate was phenotypically MSSA and genotypically SPA⁺mec⁺SCCmec⁻, and 1 S. epidermidis isolate was phenotypically MSCoNS and genotypically SPA⁻mec⁺SCCmec⁻.     

Improving Affordability Through Innovation in the Surgical Treatment of Mitral Valve Disease

ObjectiveTo determine whether technically innovative cardiac surgical platforms (ie, robotics) deployed in conjunction with surgical process improvement (systems innovation) influence total hospital costs to address the concern that expanding adoption might increase health care expenses.Patients and MethodsWe studied 185 propensity-matched patient pairs (370 patients) undergoing isolated conventional open vs robotic mitral valve repair with identical repair techniques and care teams between July 1, 2007, and January 31, 2011. Two time periods were considered, before the implementation of system innovations (pre-July 2009) and after implementation. Generalized linear mixed models were used to estimate the effect of the type of surgery on cost while adjusting for a time effect.ResultsBaseline characteristics of the study patients were similar, and all patients underwent successful mitral valve repair with no early deaths. Median length of stay (LOS) for patients undergoing open repair was unchanged at 5.3 days (P=.636) before and after systems innovation implementation, and was lower for robotic patients at 3.5 and 3.4 days, respectively (P=.003), throughout the study. The overall median costs associated with open and robotic repair were $31,838 and $32,144, respectively (P=.32). During the preimplementation period, the total cost was higher for robotic ($34,920) than for open ($32,650) repair (P<.001), but during the postimplementation period, the median cost of robotic repair ($30,606) became similar to that of open repair ($31,310) (P=.876). The largest decrease in robotic cost was associated with more rapid ventilator weaning and shortened median intensive care unit LOS, from 22.7 hours before July 2009 to 9.3 hours after implementation of systems innovations (P<.001).ConclusionFollowing the introduction of systems innovation, the total hospital cost associated with robotic mitral valve repair has become similar to that for a conventional open approach, while facilitating quicker patient recovery and diminished utilization of in-hospital resources. These data suggest that innovations in techniques (robotics) along with care systems (process improvement) can be cost-neutral, thereby improving the affordability of new technologies capable of improving early patient outcomes.