Integrating co-morbid depression and chronic physical disease management: identifying and resolving failures in self-regulation

Research suggests that treatments for depression among individuals with chronic physical disease do not improve disease outcomes significantly, and chronic disease management programs do not necessarily improve mood. For individuals experiencing co-morbid depression and chronic physical disease, demands on the self-regulation system are compounded, leading to a rapid depletion of self-regulatory resources. Because disease and depression management are not integrated, patients lack the understanding needed to prioritize self-regulatory goals in a way that makes disease and depression management synergistic. A framework in which the management of co-morbidity is considered alongside the management of either condition alone offers benefits to researchers and practitioners and may help improve clinical outcomes.     

A Preparedness Model for Mother–Baby Linked Longitudinal Surveillance for Emerging Threats

Introduction

Public health responses often lack the infrastructure to capture the impact of public health emergencies on pregnant women and infants, with limited mechanisms for linking pregnant women with their infants nationally to monitor long-term effects. In 2019, the Centers for Disease Control and Prevention (CDC), in close collaboration with state, local, and territorial health departments, began a 5-year initiative to establish population-based mother–baby linked longitudinal surveillance, the Surveillance for Emerging Threats to Mothers and Babies Network (SET-NET).

Objectives

The objective of this report is to describe an expanded surveillance approach that leverages and modernizes existing surveillance systems to address the impact of emerging health threats during pregnancy on pregnant women and their infants.

Methods

Mother–baby pairs are identified through prospective identification during pregnancy and/or identification of an infant with retrospective linking to maternal information. All data are obtained from existing data sources (e.g., electronic medical records, vital statistics, laboratory reports, and health department investigations and case reporting).

Results

Variables were selected for inclusion to address key surveillance questions proposed by CDC and health department subject matter experts. General variables include maternal demographics and health history, pregnancy and infant outcomes, maternal and infant laboratory results, and child health outcomes up to the second birthday. Exposure-specific modular variables are included for hepatitis C, syphilis, and Coronavirus Disease 2019 (COVID-19). The system is structured into four relational datasets (maternal, pregnancy outcomes and birth, infant/child follow-up, and laboratory testing).

Discussion

SET-NET provides a population-based mother–baby linked longitudinal surveillance approach and has already demonstrated rapid adaptation to COVID-19. This innovative approach leverages existing data sources and rapidly collects data and informs clinical guidance and practice. These data can help to reduce exposure risk and adverse outcomes among pregnant women and their infants, direct public health action, and strengthen public health systems.

     

A stochastic model for medium-term estimation of the prevalence of HIV infection in a South African heterosexual population.

This paper describes the development of a micro-simulation model to estimate the extent of HIV infection among black heterosexual South Africans and attempts to predict the number of newly acquired cases of HIV infection for the period 1985-2000. Owing to the lack of key data inputs, many assumptions are made. The inputs used are estimated demographic transition, HIV-positive immigrants, probability of being HIV-positive, probability of acquisition of infection upon at-risk contact by gender, time to AIDS distribution, average number of new sexual partners over time by age and gender, average number of sexual contacts per partner by gender and age group, and probability of sexual contact by age group between genders. Paediatric, homosexual and intravenous HIV cases are excluded from the model. The results indicate a fairly rapid increase in HIV infection from 1988 until the year 2000, when 5,664,487 adults, i.e. approximately 27% of the total adult (15-60 years) black population, could have become HIV-positive. This first phase of the model does not include the effect of a change in behaviour or the possible effect of effective drugs or vaccines and is therefore a worst-case scenario, maximum-potential estimate. The results are very similar to previously published South African actuarial and macro-simulation models.     

Considerations on the further expansion of the AIDS epidemic in South Africa--1990

An epidemiological composite of the human immunodeficiency virus (HIV) epidemic in South Africa was constructed from reported acquired immunodeficiency syndrome (AIDS) figures, blood donor seroprevalence data and a family of active surveillance studies in the Johannesburg area. Of great concern is the extensive and continuing silent spread of HIV in the urban black population, manifested by doubling times in male and female sexually transmitted disease (STD) clinic attenders of 10.67 and 9.78 months respectively, a doubling time in female family planning (FP) attenders of 6.55 months, and HIV infection rates of 1:56, 1:37 and 1:91, respectively. These data suggest a spread of infection far more extensive than the relatively lower AIDS figures. However, seroprevalence figures in municipal employees of mainly rural origin were considerably lower, only 1:1,250 in black men and none in women, but regular movements between urban and rural areas could well introduce and amplify infection in rural areas. A complete epidemiological picture of HIV can only be attained by employing both the above approach of the family of surveys complemented by a nationwide seroprevalence study to assess HIV penetration into the general 'background' population. Educational interventions should now be particularly targeted to the major risk groups in the urban black heterosexual community.     

Knowledge, beliefs and practices among black goldminers relating to the transmission of human immunodeficiency virus and other sexually transmitted diseases

The Chamber of Mines of South Africa employs approximately 750,000 miners from all over southern Africa. Sero-surveys in 1986 showed that, depending on geographical area of origin, between 0.02% and 3.76% of miners were positive for human immunodeficiency virus (HIV) antibodies. As a consequence, an intensive education campaign to stop the spread of HIV infection was launched. A study was undertaken to establish a valid baseline level of knowledge about black miners' beliefs, attitudes and practices related to HIV infection, acquired immunodeficiency syndrome (AIDS) and sexually transmitted diseases (STDs), and to recommend appropriate changes to the educational efforts of the Chamber of Mines. A structured, pre-tested questionnaire was used to interview in their home language 429 systematically sampled black miners from four different mines. The most relevant findings were that younger age, not being married and how general education predispose to contracting STDs, while a feeling of being at risk for contracting HIV infection is positively correlated with level of education. Close friends were the most important source of information on STDs, but the media and medical staff were the most important sources of information on AIDS/HIV infection. Condoms were used by 31% of respondents, while the main reasons for non-use were trust in the sexual partner and lack of availability. Promotion of a stable family life for miners may significantly impact on the transmission of HIV infection.     

The results of routine primary closure in carotid endarterectomy

PURPOSE OF STUDY: The aims of this study were to determine the incidence of restenosis following carotid endarterectomy with primary closure of the arteriotomy and to observe the natural history of disease progression in the 1st postoperative year. METHODS: The study group consisted of a consecutive series of 126 patients undergoing carotid endarterectomy. Duplex imaging was performed preoperatively and at 8 weeks, 6 months and 1 year postoperatively. RESULTS: Five patients (4%) had a residual stenosis. At 12 months, the overall restenosis rate was 15%: 8.5% for males and 28.9% for females. None of these restenoses were symptomatic. There was no significant difference in the diameter of the internal carotid artery between male and female patients (U = 896, P = 0.60) and no significant difference in the diameter of the arteries that had restenosed at 12 months and those that had remained patent (U = 391, P = 0.33). CONCLUSIONS: Carotid endarterectomy with primary closure is associated with a low incidence of restenosis in men, but not in women. Criteria for selective patching should consider both gender and vessel calibre.     

The effect of arterial filtration on reduction of gaseous microemboli in the middle cerebral artery during cardiopulmonary bypass

Noninvasive in vivo detection of gaseous microemboli in the middle cerebral artery, by transcranial Doppler ultrasound, was used to determine the effect of filtration in the arterial catheter using 25- and 40-microns filters and bubble oxygenators in patients undergoing cardiopulmonary bypass surgery. Eighteen patients undergoing coronary artery bypass surgery were studied using a closed cardiac (unvented heart) model. Group 1 patients (no filters) had the highest incidence of gaseous microemboli, as indicated by the ultrasound microemboli index, at both high and low oxygen flow rates. Group 2 patients (40-microns filters) had a significantly lower microemboli index, particularly at low oxygen flow rates (t = 4.9, p less than 0.001). The 25-microns group patients had the lowest values of all. No microemboli were detected at low oxygen flow rates, and microemboli were detected in only 0.1% of the samples at high oxygen flow rates. Additionally, observations on vented hearts in 3 patients undergoing cardiac valve surgery indicate that the origin of gaseous microemboli may be air trapped inside the heart.