The long-term follow-up of women treated for postnatal depression at a specialist day hospital compared to routine primary care

BACKGROUND: Postnatal depression affects approximately 13% of childbearing women. There are very few specialist treatment centres, despite emerging evidence that these units are superior to routine primary care in the short term. We investigated the long-term benefits of treatment for postnatal depression at a specialist day unit, compared to routine primary care. METHODS: Women who took part in an earlier study of postnatal depression were invited to participate in this follow-up. Self-report questionnaires (the Work, Leisure and Family Life Questionnaire - Modified (WLFQ-M) and the Dyadic Adjustment Scale (DAS)) were administered, together with the revised Clinical Interview Schedule (CIS-R). Information was also obtained regarding subsequent children and depressive episodes since the initial study. RESULTS: Of the original cohort of 60 women, 23 agreed to participate in the follow-up. There were no significant differences between DAS and WLFLQ-M scores or ICD-10 diagnoses of depressive episode between the women who had previously received specialist care. However, the numbers were small and make conclusions difficult. Qualitative analysis suggests that treatment at a specialist unit is beneficial in the long term. CONCLUSION: Further, larger studies of the long-term benefits of specialist treatment need to be carried out. (Int J Psych Clin Pract 2002; 6: 199-203 )     

22例伪膜性结肠炎临床特征分析

背景:我国不合理使用抗生素的现象严重,抗生素相关性腹泻如伪膜性结肠炎(PMC)的发病率呈上升趋势。目的:综合分析PMC的临床特征以提高其诊治水平。方法:收集2007年6月～2012年2月于湖南省人民医院住院治疗,经结肠镜检查确诊的PMC患者,对其病史资料进行回顾性分析。结果:共22例PMC患者纳入研究,其中70岁以上者18例(81.8%),18例患者存在基础疾病。所有患者均于使用抗生素过程中出现腹泻,并可伴有不同程度的腹痛、发热、血便等其他症状。使用头孢菌素类抗生素者最多见(14例),20例患者联合使用两种或两种以上抗生素。21例接受结肠镜检查者均可见典型伪膜样病灶,内镜分型轻度9例,中度7例,重度5例。经停用原有抗生素以及使用甲硝唑、万古霉素、益生菌制剂等治疗后,21例患者好转出院。结论:PMC多发生于有基础疾病的老年人,病程早期缺乏特异性临床表现。结肠镜检查是诊断PMC的重要手段之一,确诊后应尽早停用原有抗生素,使用足量、足疗程的甲硝唑和万古霉素以及益生菌制剂。     

First-admission schizophrenic patients northern Norway, 1980-95: Sex differences in diagnostic in practice

The aim of this project was to approach subjects who committed parasuicide but did not primarily receive or accept a recommendation for care through the regular routines after referral to a general hospital. Three hundred and twenty-nine consecutive parasuicides in 10- to 89-year-olds (162 men and 167 women) were studied. One hundred were subsequently hospitalized in the departments of psychiatry, 130 were followed up at outpatient facilities, and 96 left without any follow-up. A psychiatric liaison consultation was made in 57% of the total sample. The 96 subjects without follow-up were compared with the subjects who received follow-up. The sample was somewhat younger and included slightly more men. They were single in 54% and unemployed in 43% of the cases. According to the DSM-IV, 27% had a concurrent depression. According to the CAGE questions, 57% had indication of substance addiction. Fifty-four per cent had currently low global functioning, less than 50 points on the GAF. They had not been in contact with psychiatric care previously to the same extent as the others. About 34% of these who did not receive or rejected follow-up initially after a second approach agreed to follow-up when contacted by the project team, referring them to appropriate authorities such as social welfare offices, family counselling, or psychosocial staff within psychiatry or primary care. This may imply that the group delineated is at risk for eventual suicide and that the acceptance of follow-up should be interpreted as an indication that a substantial number needs help and can be successfully encountered by means of a case manager approach.     

Female reproductive factors and risk of all-cause and cause-specific mortality among women: The Japan Public Health Center–based Prospective Study (JPHC study)

Purpose

We investigated the association between reproductive history and mortality from all and major causes among Japanese women.

妊娠梅毒219例随访分析

目的：分析广州市番禺区妊娠梅毒筛查、诊治、随访情况,为妊娠梅毒管理工作提供改进依据。方法采用回顾调查分析法,对番禺区2011年10月至2013年9月筛查103665例孕妇新发现的219例妊娠梅毒患者随访情况进行统计。结果103665例孕妇中确诊妊娠梅毒219例,妊娠梅毒筛查阳性发生率为0.21％,均为潜伏梅毒;176例患者在孕期进行了1个疗程的治疗,其中33例积极接受2个疗程规范治疗;40例未治疗;3例因电话空号、关机或拒绝无法随访;先天梅毒共14例,发生率为6．4％。结论妊娠梅毒是一种严重母婴传播疾病,经过规范治疗、密切随访、加强宣传教育,提高患者依从性可降低先天梅毒的发生。     

Association of HTR2A-1438G/A Genetic Polymorphism With Smoking and Chronic Obstructive Pulmonary Disease

Introduction

Cigarette smoking is a major risk factor in the development of chronic obstructive pulmonary disease (COPD). Serotonin levels have been associated with COPD and smoking has been as a significant modulator. Elevated levels of serotonin are responsible for bronchoconstriction and pulmonary vasoconstriction and also nicotine dependence, thus serotonin response could be affected by genetic polymorphisms in transporters and receptors of serotonin.

Quality of life for parents of children with autism spectrum disorders

This project describes health-related quality of life (HRQoL) of parents of children with autism spectrum disorders (ASDs) using mixed methods. Parents of children with ASDs (N = 224) reported on their HRQoL, depression, and caregiving burden using quantitative tools. HRQoL scores were slightly worse than from those in normative populations especially related to stress and mental health. For example, parents reported average HRQoL scores from SF-6D of 0.74, which was clinically significant lower than an average normative U.S. population. 40% of parents reported having clinical depression symptoms. Married parents reported lower depression symptoms than parents who were not. In addition, families with three or more children with special health care needs (CSHCN) reported lower HRQL and higher caregiving burden than families with less CSHCN. In the qualitative study, we conducted five focus groups to gain insight as to the reasons a child's ASD might influence a parent's HRQoL. Qualitative data further supports the notion that parental HRQoL was negatively influenced by their child's ASDs. Studies that seek to quantify the influence of ASDs and to assess the effect of interventions for children with ASDs may consider measuring the effects on family members as well.     

Sex Differences in Platelet Reactivity and Cardiovascular and Psychological Response to Mental Stress in Patients With Stable Ischemic Heart Disease: Insights From the REMIT Study

BackgroundAlthough emotional stress is associated with ischemic heart disease (IHD) and related clinical events, sex-specific differences in the psychobiological response to mental stress have not been clearly identified.ObjectivesWe aimed to study the differential psychological and cardiovascular responses to mental stress between male and female patients with stable IHD.MethodsPatients with stable IHD enrolled in the REMIT (Responses of Mental Stress–Induced Myocardial Ischemia to Escitalopram) study underwent psychometric assessments, transthoracic echocardiography, and platelet aggregation studies at baseline and after 3 mental stress tasks. Mental stress–induced myocardial ischemia (MSIMI) was defined as the development or worsening of regional wall motion abnormality, reduction of left ventricular ejection fraction (LVEF) ≥8% by transthoracic echocardiography, and/or ischemic ST-segment change on electrocardiogram during 1 or more of the 3 mental stress tasks.ResultsIn the 310 participants with known IHD (18% women, 82% men), most baseline characteristics were similar between women and men (including heart rate, blood pressure, and LVEF), although women were more likely to be nonwhite, living alone (p < 0.001), and unmarried (p < 0.001); they also had higher baseline depression and anxiety (p < 0.05). At rest, women had heightened platelet aggregation responses to serotonin (p = 0.007) and epinephrine (p = 0.004) compared with men. Following mental stress, women had more MSIMI (57% vs. 41%; p < 0.04), expressed more negative (p = 0.02) and less positive emotion (p < 0.001), and demonstrated higher collagen-stimulated platelet aggregation responses (p = 0.04) than men. Men were more likely than women to show changes in traditional physiological measures, such as blood pressure (p < 0.05) and double product.ConclusionsIn this exploratory analysis, we identified clear, measurable, and differential responses to mental stress in women and men. Further studies should test the association of sex differences in cardiovascular and platelet reactivity in response to mental stress and long-term outcomes. (Responses of Myocardial Ischemia to Escitalopram Treatment [REMIT]; NCT00574847)