Does family history of depression predict major depression in midlife women? Study of Women’s Health Across the Nation Mental Health Study (SWAN MHS)

This study aims to determine whether family history of depression predicts major depression in midlife women independent of psychosocial and health profiles at midlife. Participants were 303 African American and Caucasian women (42–52 years at baseline) recruited into the Study of Women’s Health Across the Nation (SWAN) and the Women’s Mental Health Study (MHS) in Pittsburgh. Major depression was assessed annually with the Structured Clinical Interview for DSM-IV. Family mental health history was collected at the ninth or tenth follow-up. Multivariable logistic regression was used to determine whether family history of depression predicted major depression in midlife, adjusting for covariates. The odds of experiencing major depression during the study were three times greater for those with a family history than for those without a family history (OR?=?3.22, 95 % CI?=?1.95–5.31). Family history predicted depression (OR?=?2.67, 95 % CI?=?1.50–4.78) after adjusting for lifetime history of depression, age, trait anxiety, chronic medical conditions, and stressful life events. In analyses stratified by lifetime history of depression, family history significantly predicted depression only among women with a lifetime history of depression. Family history of depression predicts major depression in midlife women generally, but particularly in those with a lifetime history of depression prior to midlife.     

Paediatric critical incident analysis: lessons learnt on analysis,recommendations and implementation

The objectives of this study were to identify causal and contributing factors of serious patient safety incidents in a paediatric university hospital, to report on ensuing recommendations and to assess the extent of implementation of the recommendations. The possible causal and contributing factors identified in 17 incidents were classified by a system devised by Vincent et al. Proposed recommendations were classified by the same system, and degrees of implementation were established. A median of 5 causal and contributing factors per incident were identified. Twenty-two percent of all factors were related to teamwork and 22 % to task factors. A median of 5 recommendations per analysis were formulated. Most recommendations were related to task factors (36 %). The time load of each analysis was a mean of 27 h. One third of the recommendations have been acted upon, mostly those related to task and team factors. Conclusion: Incident analysis is time-consuming but yields indispensable information on causal and contributing factors, presenting numerous opportunities for quality improvement. The value of these analyses could be improved by appointing responsibilities and setting up time frames for implementation. A bottom-up approach with managerial support appears to be a key to turning incident analysis and quality improvement into an ongoing process.     

Doxycycline disrupts chondrocyte differentiation and inhibits cartilage matrix degradation

Objective. The effects of doxycycline were tested in an in vitro system in which the cartilages of embryonic avian tibias are completely degraded. Methods. Tibias were cultured with 5, 20, or 40 μg/ml doxycycline. Control tibias were cultured without doxycycline. Conditioned media and tissue sections were examined for enzyme activity and matrix loss. Results. Cartilages were not resorbed in the presence of doxycycline, whereas control cartilages were completely degraded. Collagen degradation was reduced in association with treatment with doxycycline at all doses studied. Higher concentrations of doxycycline reduced collagenase and gelatinase activity and prevented proteoglycan loss, cell death, and deposition of type X collagen in the cartilage matrix; in addition, treatment with doxycycline at higher concentrations caused increases in the length of the hypertrophic region. Conclusion. The effects of doxycycline extend beyond inhibition of the proteolytic enzymes by stimulating cartilage growth and disrupting the terminal differentiation of chondrocytes.     

Impact of a Dyadic Intervention on Family Supporter Involvement in Helping Adults Manage Type 2 Diabetes

BackgroundFamily support for adults’ diabetes care is associated with improved self-management and outcomes, but healthcare providers lack structured ways to engage those supporters.ObjectiveAssess the impact of a patient-supporter diabetes management intervention on supporters’ engagement in patients’ diabetes care, support techniques, and caregiving experience.DesignMultivariate regression models examined between-group differences in support-related measures observed as part of a larger trial randomizing participants to a dyadic intervention versus usual care.ParticipantsA total of 239 adults with type 2 diabetes and either A1c >8% or systolic blood pressure >160mmHg enrolled with a family supporter.InterventionHealth coaches provided training on positive support techniques and facilitated self-management information sharing and goal-setting.Main MeasuresPatient and supporter reports at baseline and 12 months of supporter roles in diabetes care and caregiving experience.ResultsAt 12 months, intervention-assigned patients had higher odds of reporting increased supporter involvement in remembering medical appointments (AOR 2.74, 95% CI 1.44, 5.21), performing home testing (AOR 2.40, 95% CI 1.29, 4.46), accessing online portals (AOR 2.34, 95% CI 1.29, 4.30), deciding when to contact healthcare providers (AOR 2.12, 95% CI 1.15, 3.91), and refilling medications (AOR 2.10, 95% CI 1.14, 3.89), but not with attending medical appointments or with healthy eating and exercise. Intervention-assigned patients reported increased supporter use of autonomy supportive communication (+0.27 points on a 7-point scale, p=0.02) and goal-setting techniques (+0.30 points on a 5-point scale, p=0.01). There were no differences at 12 months in change scores measuring supporter distress about patients’ diabetes or caregiving burden. Intervention-assigned supporters had significantly larger increases in satisfaction with health system support for their role (+0.88 points on a 10-point scale, p=0.01).ConclusionsA dyadic patient-supporter intervention led to increased family supporter involvement in diabetes self-management and increased use of positive support techniques, without increasing caregiver stress.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-021-06946-8.KEY WORDS: diabetes, social support, self-management, caregiving     

Development of a biochemical marker to detect current breast milk intake

The WHO recommends exclusive breastfeeding for 6 months, but despite interventions, breastfeeding rates remain stubbornly low. Financial voucher incentives have shown promise but require a biomarker for validation of intake. This study aimed to develop a simple biochemical assay of infant urine that would tell if an infant was receiving any breast milk to validate maternal report. Urine samples were collected and snap frozen from 34 infants attending with minor illness or feeding problems, of whom 12 infants were exclusively breastfed, nine exclusively formula fed, and 11 mixed breast/formula fed. High‐performance anion exchange chromatography was used to identify discriminating patterns of monosaccharide composition of unconjugated glycans in a sequence of three experiments. The absolute concentration of all human milk oligosaccharides measured blind could detect “any breastfeeding” only with a sensitivity of 48% and specificity of 78%. Unblinded examination of N‐acetylglucosamine (GlcNAc) measured as GlcNH₂ after hydrolysis of GlcNAc improved sensitivity to 75% at the expense of a specificity of 28%. Estimation of the relative abundance of GlcNH2 (GlcNH2[%]) or the ratio of GlcNH2 to endogenous mannose (Man) improved accuracy. In a further blind experiment, the GlcNH2/Man ratio with a cut‐off of 1.5 correctly identified all those receiving “any breast milk,” while excluding exclusively formula fed infants. The GlcNH2/Man ratio in infant urine is a promising test to provide biochemical confirmation of any breastfeeding for trials of breastfeeding promotion.     

Sexuality Among Middle-Aged and Older Adults With Diagnosed and Undiagnosed Diabetes: A national, population-based study

OBJECTIVE

To describe sexual activity, behavior, and problems among middle-age and older adults by diabetes status.

RESEARCH DESIGN AND METHODS

This was a substudy of 1,993 community-residing adults, aged 57–85 years, from a cross-sectional, nationally representative sample (N = 3,005). In-home interviews, observed medications, and A1C were used to stratify by diagnosed diabetes, undiagnosed diabetes, or no diabetes. Logistic regression was used to model associations between diabetes conditions and sexual characteristics, separately by gender.

RESULTS

The survey response rate was 75.5%. More than 60% of partnered individuals with diagnosed diabetes were sexually active. Women with diagnosed diabetes were less likely than men with diagnosed diabetes (adjusted odds ratio 0.28 [95% CI 0.16–0.49]) and other women (0.63 [0.45–0.87]) to be sexually active. Partnered sexual behaviors did not differ by gender or diabetes status. The prevalence of orgasm problems was similarly elevated among men with diagnosed and undiagnosed diabetes compared with that for other men, but erectile difficulties were elevated only among men with diagnosed diabetes (2.51 [1.53 to 4.14]). Women with undiagnosed diabetes were less likely to have discussed sex with a physician (11%) than women with diagnosed diabetes (19%) and men with undiagnosed (28%) or diagnosed (47%) diabetes.

CONCLUSIONS

Many middle-age and older adults with diabetes are sexually active and engage in sexual behaviors similarly to individuals without diabetes. Women with diabetes were more likely than men to cease all sexual activity. Older women with diabetes are as likely to have sexual problems but are significantly less likely than men to discuss them.Advances in treatment for diabetes have prolonged and improved quality of life for many of the ∼12 million affected individuals aged ≥60 years in the U.S. Clinical guidelines for diabetes care include assessment and treatment of erectile problems in men (1). Sexual problems may be a warning sign of diabetes or a consequence that can lead to depression, lack of adherence to treatment, and strained intimate relationships. In contrast, older women''s sexual issues have been largely overlooked in screening for and treating diabetes (1,2). Failure to recognize and address sexual issues among middle-aged and older adults with diabetes may impair quality of life and adaptation to the disease.Some adults with diabetes maintain sexual relationships throughout their lives (3). Prior studies have focused on the pathophysiological effects of diabetes on male sexual function, primarily erection and sexual desire. The effects of diabetes on women''s sexual functioning are poorly understood and probably multifactorial (2). Sexual problems in adults with diabetes have been associated with age, disease duration, and comorbidity (1). The effects of chronic hyperglycemia, degree of diabetes control, or use of glucose-lowering drugs are less clear (4), in part because individuals with undiagnosed or preclinical diabetes are typically aggregated with control subjects in other studies (1). Psychosocial correlates of sexual problems in individuals with diagnosed diabetes have been found in younger adults. Studies including older adults find associations with depression (1), vulnerability, lifestyle restrictions due to disease management (5), and marital conflict (6).Prior data on sexuality in individuals with diabetes were derived primarily from studies that are small, have not included very old individuals or aggregated individuals ≥65 years, lacked a comparison group, and relied on convenience or other nongeneralizable samples (1,2). Comprehensive, population-based data are needed to further physicians'' understanding of the sexual norms and problems of older adults with diagnosed and undiagnosed diabetes. Virtually nothing is known about sexual function among individuals with undiagnosed diabetes; this information could be relevant for diagnosis, motivation to engage in treatment, and prevention of sexual and nonsexual diabetes-related complications. The National Social Life, Health and Aging Project (NSHAP) provides disease-specific data on the sexual activity, behaviors, and problems of middle-aged and older adults affected by diabetes.     

Elective paratracheal neck dissection for lateral metastases from papillary carcinoma of the thyroid: Is it indicated?

BACKGROUND: Therapeutic paratracheal neck dissection for patients with papillary carcinoma of the thyroid is standard treatment. Its use as an elective procedure is controversial. METHODS: Thirty-seven patients with papillary carcinoma of the thyroid and evidence of positive adenopathy at levels II-V underwent selective neck dissection and elective/therapeutic paratracheal neck dissection. Results of preoperative ultrasonography of the neck were compared with the dissection specimens. RESULTS: Morbidity of the surgical procedure was minimal (1 permanent hypocalcemia). All specimens showed metastases from papillary thyroid carcinoma: 100% (37/37) in the jugular chain of lymphatics and 83.7% (31/37) in the paratracheal region. The rate of occult (negative physical examination and ultrasonography) metastases in the paratracheal region in the presence of metastases in the ipsilateral jugular chain was 83.3% (20/24). CONCLUSION: The high rate of occult metastases in the paratracheal region and the low rate of surgical morbidity speak in favor of elective paratracheal neck dissection in patients with metastatic papillary carcinoma of the thyroid.     

Characterization of Ribosomal Binding and Antibacterial Activities Using Two Orthogonal High-Throughput Screens

We report here the affinity and antibacterial activity of a structurally similar class of neomycin dimers. The affinity of the dimer library for rRNA was established by using a screen that measures the displacement of fluorescein-neomycin (F-neo) probe from RNA. A rapid growth inhibition assay using a single drug concentration was used to examine the antibacterial activity. The structure-activity relationship data were then rapidly analyzed using a two-dimensional ribosomal binding-bacterial inhibition plot analysis.