The contribution of major depression to the global burden of ischemic heart disease: a comparative risk assessment

Background

Cardiovascular disease and mental health both hold enormous public health importance, both ranking highly in results of the recent Global Burden of Disease Study 2010 (GBD 2010). For the first time, the GBD 2010 has systematically and quantitatively assessed major depression as an independent risk factor for the development of ischemic heart disease (IHD) using comparative risk assessment methodology.

Methods

A pooled relative risk (RR) was calculated from studies identified through a systematic review with strict inclusion criteria designed to provide evidence of independent risk factor status. Accepted case definitions of depression include diagnosis by a clinician or by non-clinician raters adhering to Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases (ICD) classifications. We therefore refer to the exposure in this paper as major depression as opposed to the DSM-IV category of major depressive disorder (MDD). The population attributable fraction (PAF) was calculated using the pooled RR estimate. Attributable burden was calculated by multiplying the PAF by the underlying burden of IHD estimated as part of GBD 2010.

Results

The pooled relative risk of developing IHD in those with major depression was 1.56 (95% CI 1.30 to 1.87). Globally there were almost 4 million estimated IHD disability-adjusted life years (DALYs), which can be attributed to major depression in 2010; 3.5 million years of life lost and 250,000 years of life lived with a disability. These findings highlight a previously underestimated mortality component of the burden of major depression. As a proportion of overall IHD burden, 2.95% (95% CI 1.48 to 4.46%) of IHD DALYs were estimated to be attributable to MDD in 2010. Eastern Europe and North Africa/Middle East demonstrate the highest proportion with Asia Pacific, high income representing the lowest.

Conclusions

The present work comprises the most robust systematic review of its kind to date. The key finding that major depression may be responsible for approximately 3% of global IHD DALYs warrants assessment for depression in patients at high risk of developing IHD or at risk of a repeat IHD event.

     

Sweets consumption of preschool children—extent, context, and consumption patterns

Objectives

Sweets consumption is one of the risk factors of caries, especially among children. The aim of our study was to explore the extent and context of preschoolers’ sweets consumption and to identify high-risk groups.

Materials and methods

The baseline cross-sectional data used originated from a nutritional intervention study encompassing 879 parental surveys, which were obtained in 52 kindergartens in Baden-Württemberg—the third largest federal state in Germany—between September and March 2009. Our outcome variable “sweets consumption” was operationalized using food-frequency items and analyzed by testing the influence of sociodemographic, educational, cultural, and family context covariates.

Results

Most preschoolers consumed sweets every day—on average 9.7?±?6.2 times per week. Most popular were cookies, gummy bears, and chocolate. Sweets consumption did not correlate significantly with sociodemographic factors like age and sex but rather was associated with cultural and contextual factors such as immigrant background, parental education, specific nutritional knowledge levels, and access arrangements in the home.

Conclusions

The consumption patterns identified are a result of high availability and parental influence (factors such as parents’ knowledge levels, interest in, and habits regarding their child’s nutrition).

Clinical relevance

Dental practitioners should place more emphasis on gathering information from young patients regarding excessive and frequent consumption of sweets and consequently on trying to educate the children and their parents on oral health risks associated with such consumption. Particular attention is to be paid to children of Turkish and Arabic decent, as they have been shown to consume above-average amounts of sweets.     

Adolescent HIV-1 Transgenic Rats: Evidence for Dopaminergic Alterations in Behavior and Neurochemistry Revealed by Methamphetamine Challenge

Since the introduction of combination antiretroviral therapy (cART) in the mid-90s, the most severe forms of HIV-1-associated neurocognitive disorders (HAND) have diminished. However, milder forms of HAND remain prevalent. Basic and clinical studies implicate alterations in the dopaminergic (DAergic) system in HIV-1 infection. We used the Fischer 344 HIV-1 transgenic (HIV-1 Tg) rat, which expresses 7 of the 9 HIV-1 genes, to examine potential DAergic alterations. Animals were studied beginning at 35 days of age to assess early-onset DAergic alterations, well before any documented neurological symptoms or clinical signs of "wasting". At 48 hr intervals, animals were administered a single dose of methamphetamine (METH) (0, 0.5, 1, 2.5 and 5 mg/kg/ml s.c.) and tested for the auditory startle response (ASR) and prepulse inhibition (PPI), using an auditory prepulse [85dB(A) broad-band noise stimulus] and an auditory startle stimulus [100 dB(A) broad-band noise stimulus] in a sound-attenuating chamber with a continuous 70dB(A) white noise background. The protocol used a 5-min acclimation period, 6 startle trials, and 36 PPI trials [ISIs of 0, 8, 40, 80, 120, and 4000 ms, 6-trial blocks, Latin square design]. As the dose of METH increased, PPI of the startle response decreased. The HIV-1 Tg rats displayed a greater dose-dependency to the METH-induced disruption of PPI compared to non-transgenic controls. Western blot analysis of midbrain extracts revealed lower tyrosine hydroxylase (TH) protein levels and higher monoamine oxidase A (MAO-A) protein levels in HIV-1 Tg rats treated with METH compared to non-transgenic controls. Early-detected cognitive alterations in the preattentive process of sensorimotor gating may have significant predictive utility regarding the progression of DAergic alterations in HIV-1 infection.     

Operability and early outcome in 48 Irish patients with peritoneal malignancy treated by surgery and intraperitoneal chemotherapy in a specialized centre

BackgroundIn selected cases of peritoneal malignancy a novel approach of complete macroscopic tumour removal by extensive surgical cytoreduction, combined with intraperitoneal chemotherapy, provides a possibility of cure. The experience with 48 consecutive Irish cases undergoing laparotomy in a specialized centre is reported.Patients and methodsA subset of 48 Irish patients out of a total of 120 cases with peritoneal malignancy underwent surgery between September 1999 and March 2011 in an English National referral centre. Overall 37/48 (77%) had appendiceal mucinous tumours with pseudomyxoma peritonei type syndrome. The treatment strategy involved macroscopic complete tumour removal (complete cytoreduction) combined with intra-operative, intraperitoneal chemotherapy.ResultsOverall 30/48 (62.5%) had complete cytoreduction, 15/48 (31.3%) had major debulking and 3 (4.2%) had laparotomy and biopsy only. The median (range) operating time in hours was 9.8 (4.8–16) in the 30 who had complete cytoreduction compared with 6.3 (4.5–11) in the 15 who had debulking (p = 0.019). There was no post-operative mortality.Overall five year survival for the complete tumour removal group was 66% compared with 12% for those only amenable to major debulking.ConclusionThis novel strategy of cytoreduction combined with intraperitoneal chemotherapy is effective in selected patients with peritoneal malignancy. The complex surgery is particularly effective for appendiceal tumours and provides the only possibility of cure in this challenging disease.     

Adenoid Cystic Carcinoma of the Nasal Cavity and Paranasal Sinuses: A Meta-Analysis

Objectives To identify independent predictors of outcome in patients with adenoid cystic carcinoma (ACC) of the paranasal sinuses and skull base.Design Meta-analysis of the literature and data from the International ACC Study Group.Setting University-affiliated medical center.Participants The study group consisted of 520 patients, 99 of them from the international cohort. The median follow-up period was 60 months (range, 32 to 100 months).Main Outcome Measures Overall survival (OS) and disease-specific survival (DSS).Results The 5-year OS and DSS of the entire cohort were 62% and 67%, respectively. The local recurrence rate was 36.6%, and the regional recurrence rate was 7%. Distant metastasis, most commonly present in the lung, was recorded in 106 patients (29.1%). In the international cohort, positive margins and ACC of the sphenoid or ethmoidal sinuses were significant predictors of outcome (p < 0.001). Perineural invasion and adjuvant treatment (radiotherapy or chemoradiation) were not associated with prognosis.Conclusion Tumor margin status and tumor site are associated with prognosis in ACC of the paranasal sinuses, whereas perineural invasion is not. Adjuvant treatment apparently has no impact on outcome.     

Scaffolding rehabilitation behaviour using a voice-mediated assistive technology for cognition

A variety of cognitive deficits can lead to difficulties performing complex behavioural sequences and thus, disability in the performance of routine and rehabilitation behaviours. Interventions to date involve increasing support or providing behavioural training. Assistive technologies for cognition have the potential to augment cognitive capacity thus enabling the performance of behavioural sequences. Guide is an assistive technology for cognition that scaffolds task performance by providing verbal prompts and responding to verbal feedback. Guide was used to provide verbal support and guidance for eight amputees (mean age 64), with cognitive impairment of vascular origin, putting on their prosthetic limbs. Participants were referred to the research due to problems learning the correct behavioural sequence. The research used repeated trials with random assignment to intervention and baseline conditions. The voice-mediated assistive technology for cognition resulted in a significant reduction of safety critical errors and omitted steps. Discussion focuses upon the relation between voice-mediated cognitive support for memory and executive function, and suggestions are made for future research.     

How actual motor competence and perceived motor competence influence motor‐skill engagement of a novel cycling task

In early childhood, factors that contribute to motor‐skill engagement (MSE) are unknown. Our aim was to explore the relationships between actual and perceived motor competence and their influences on MSE on a balance bike (bike with no pedals). A secondary aim was to investigate whether MSE had an effect on ability on a balance bike. This study comprised of 45 children (29% female) aged 4.5 ± 0.5 years. MSE was assessed using distance travelled on a balance bike over an 8‐week period. Actual motor competence was assessed using the Movement Assessment Battery for Children, second edition. Perceived motor competence was assessed using the Pictorial Scale of Perceived Movement Skill Competence. Ability on a balance bike was measured using timed trials on a specifically designed track. Pearson product‐moment correlations were used to assess relationships between actual and perceived motor competence and ability on a balance bike. Linear regressions were used to examine whether actual or perceived motor competence or ability on a balance bike predicted MSE. Repeated measures ANOVA was used to examine whether there was a difference in ability on a balance bike between three MSE groups over 8 weeks. No relationships were found, and none of the variables predicted MSE. There was a significant difference between the MSE groups on ability on a balance bike over time (P = 0.019). Investigating the contributors to MSE on a novel cycling task during early childhood provides knowledge to ensure children are given the best opportunities for practice and acquisition of skills.