Diabetes knowledge among persons with serious mental illness and type 2 diabetes

Type 2 diabetes is an important medical condition associated with serious mental illness. The authors studied the disease-specific knowledge about diabetes in a sample of 201 psychiatric outpatients with a diagnosis of schizophrenia or major mood disorders, all of whom had type 2 diabetes. In a multivariate analysis, disease-specific diabetes knowledge was associated with higher cognitive functioning, a higher level of education, and recent receipt of diabetes education. Disease-specific diabetes knowledge predicted lower levels of perceived barriers to diabetes care. Gaps in diabetes knowledge may be reduced by specialized interventions that take into account the cognitive deficits of persons with serious mental illness.     

Parameters affecting the efficiency of Agrobacterium tumefaciens-mediated transformation of Colletotrichum graminicola

We have developed an Agrobacterium tumefaciens-mediated transformation (ATMT) protocol for the plant pathogenic fungus Colletotrichum graminicola, the cause of anthracnose leaf blight and stalk rot of corn. The ATMT results in higher transformation efficiencies than previously available polyethylene glycol-mediated protocols, and falcate spores can be used instead of protoplasts for transformation. Various experimental parameters were tested for their effects on transformation efficiencies. The parameters with the greatest influence were the A. tumefaciens strain used and the Ti-plasmid it carried, the ratio of bacterium to fungus during cocultivation, and the length of cocultivation. Southern analysis demonstrated that most transformants (80%) contained tandem integrations of plasmid sequences, and at least 36% had integrations at multiple sites in the genome. In a majority of cases (70%), the whole Ti-plasmid, and not just the T-DNA, had integrated as a series of tandem repeats. Tandem integrations, especially of the whole plasmid, make it difficult to rescue DNA from both flanks of the integrations with standard PCR-based approaches. Thus, ATMT may be unsuitable for insertional mutagenesis of C. graminicola without further modification.     

Maternal crying and postpartum distress: the moderating role of partner support

Objective: This study aimed to investigate maternal crying as a signal of distress and request for support in the postpartum period. Background: The development of postpartum mental illness may be prevented if spouses can recognise their partner’s distress and respond supportively. Methods: A cross-sectional survey of primiparous mothers (N =137) was conducted to determine whether partner support moderates the association between maternal crying frequency and postpartum depression, anxiety and stress symptom severity. Results: Regression analyses indicated that, as hypothesised, women who reported more frequent crying and low partner support reported higher levels of depression. Conversely, women who reported frequent crying in the context of high partner support reported lower levels of depression symptoms. The expected moderation effect was not present in the analyses examining postpartum anxiety and stress symptoms as outcome variables. Conclusion: In keeping with the well-established finding that partner support is a protective factor for postpartum mood problems, the results indicated that the presence of a supportive partner moderates the association between crying and depression.     

The identification of severity ranges for the Edinburgh Postnatal Depression Scale

Objective: The present study established severity cut-off scores for the Edinburgh Postnatal Depression Scale (EPDS) based on a widely used depression symptom severity measure, the Beck Depression Inventory (BDI).

Background: The EPDS is a widely used screening tool to identify clinically significant levels of depression in postpartum women. Traditionally, an EPDS cut-off score is used to identify probable depression. This dichotomisation of postpartum women into depressed vs. non-depressed groups fails to account for valuable information regarding the variability in symptom severity among those in the depressed group. The identification of depression severity ranges (e.g. mild, moderate or severe) for the EPDS would provide incremental information regarding level of depression, which in turn, could inform treatment referrals.

Methods: A sample of 1516 postpartum women completed the EPDS and the BDI. Equipercentile linking was used to develop concordance between EPDS and BDI scores, and severity ranges were established by identifying EPDS scores that corresponded to established severity ranges on the BDI.

Results: The following severity ranges were established for the EPDS: none or minimal depression (0–6), mild depression (7–13), moderate depression (14–19), and severe depression (19–30).

Conclusion: Postpartum women experience a wide range of depression severity. The establishment of severity ranges for EPDS scores may guide treatment referrals. Although the study sample size was large, only a limited number of women scored in the severe range of depression symptoms. Replication in a larger sample of depressed women is an important direction for future research.     

NeOProM: Neonatal Oxygenation Prospective Meta-analysis Collaboration study protocol

Background

Most epidemiological studies on pediatric asthma rely on the report of "wheezing" in questionnaires. Our aim was to investigate the understanding of this term by parents and health professionals.

Methods

A cross-sectional survey was carried out in hospital and community settings within the south of Portugal. Parents or caregivers self-completed a written questionnaire with information on social characteristics and respiratory history. Multiple choice questions assessed their understanding of "wheezing". Health professionals (physicians, nurses and physiotherapists) were given an adapted version. We used bivariate analysis and multivariate models to study associations between definitions of "wheezing" and participants' characteristics.

Results

Questionnaires from 425 parents and 299 health professionals were included. The term "wheezing" was not recognized by 34% of parents, more frequently those who were younger (OR 0.4 per 10-year increment, 95% CI 0.3-0.7), had lower education (OR 3.3, 95% CI 1.5-7.4), and whose children had no history of respiratory disease (OR 4.6, 95% CI 2.5-8.7) (all ORs adjusted). 31% of parents familiar with "wheezing" either did not identify it as a sound, or did not locate it to the chest, while tactile (40%) and visual (34%) cues to identify "wheezing" were frequently used. Nurses reported using visual stimuli and overall assessments more often than physicians (p < 0.01). The geographical location was independently associated with how parents recognized and described "wheezing".

Conclusions

Different meanings for "wheezing" are recognized in Portuguese language and may be influenced by education, respiratory history and regional terminology. These findings are likely applicable to other non-English languages, and suggest the need for more accurate questionnaires and additional objective measurement instruments to study the epidemiology of wheezing disorders.     

Prominent coronary artery flow with normal coronary artery anatomy is a rare but ominous harbinger of poor outcome in the fetus

Objectives: “Heart sparing” refers to prominent antegrade fetal coronary artery (CA) blood flow readily visualized by color Doppler and is a harbinger of poor outcome in growth restricted fetus, but little is known of the features and presentation of heart sparing in normally grown fetuses. Our objective was to describe heart sparing effects in normally grown fetuses, and compare the presentation and outcome of heart sparing between fetuses with growth restriction and those who were normally grown.

Methods: In a series of fetuses with prominent antegrade CA flow, we assessed Doppler flow profiles in the aortic isthmus, ductus venosus (DV), umbilical vein (UV), umbilical artery (UA) and middle cerebral artery (MCA). We calculated MCA and UA systolic/diastolic ratios and the cerebral placental ratio, and measured fetal biometry. We evaluated cardiac function using the myocardial performance index (MPI) and the cardiovascular profile score (CVPS).

Results: Ten fetuses with heart sparing had normal DV flow at 24–36.6 (mean 30.9) weeks of gestation. Five had growth restriction (Group 1); 4/5 had normal MPI and CVPS, and one died. Five were normally grown (Group 2); 5/5 had elevated MPI and decreased CVPS, of these 2 died in utero and one died immediately after birth despite urgent delivery. Coronary arteries were normal after birth or autopsy.

Conclusions: Heart sparing confers a poor prognosis in fetal growth restriction and in normally grown fetuses with cardiac dysfunction. We suggest CA flow be assessed in all high-risk fetuses.     

Development of new postnatal diagnostic methods for chromosome disorders

Chromosome imbalances are the leading cause of intellectual and developmental disabilities in the population. This paper reviews the current methods used to diagnose chromosome abnormalities in children including karyotyping, fluorescence in situ hybridization and microarray technologies. Advances in molecular cytogenetics, especially with the use of microarrays, have substantially increased the detection of chromosome abnormalities in children with disabilities and congenital anomalies above that achievable with conventional cytogenetic banding and light microscopy.     

Health state preferences associated with weight status in children and adolescents

Background  

Childhood obesity is a substantial public health problem. The extent to which health state preferences (utilities) are related to a child's weight status has not been reported. The aims of this study were (1) to use a generic health state classification system to measure health related quality of life and calculate health utilities in a convenience sample of children and adolescents and (2) to determine the extent to which these measures are associated with weight status and body mass index (BMI).     

Influence of parity on fetal mortality in prolonged pregnancy

OBJECTIVE: In England an estimated 50,000 inductions of labour at or beyond 41 weeks' gestation are conducted each year. However, the published evidence on the effect of parity on stillbirth in prolonged pregnancy is limited, and has produced conflicting data. The aim of this study is to evaluate the influence of parity on fetal mortality in prolonged pregnancies. STUDY DESIGN: Retrospective analysis of 145,695 singleton births with known parity and no malformation noted at birth to residents in the former North-East Thames Region, UK. The parity and gestation specific stillbirth risks and relative risks per 1000 ongoing pregnancies were calculated in relation to parity between 37 and 45 weeks. RESULTS: Before 41 weeks the stillbirth risk rose gradually but did not differ by parity. By 41 weeks there was a substantial increase in the stillbirth risk in nulliparous women but not in parous women. The pattern of rise is such that the stillbirth risk is 2.9 times higher (95% CI 1.06-8.19) in nulliparous women at >42 weeks' gestation. CONCLUSION: Being parous appears to have a protective effect on fetal mortality in prolonged pregnancy. These findings question the need for routine induction of labour at 41 weeks in parous women.