Association Between Smoking and Heart Rate Variability Among Individuals with Depression

Background

Both depression and smoking have been independently associated with lower heart rate variability (HRV), suggesting dysregulation of cardiac autonomic function. However, no studies have systematically explored the effects of smoking on HRV among depressed patients.

Purpose

This study examined differences in HRV based on smoking status among depressed individuals.

Methods

Electrophysiological data were examined among 77 adult outpatients without a history of myocardial infarction, who met criteria for major depressive disorder or dysthymia. Frequency domain [low frequency (LF), high frequency (HF), LF/HF ratio, respiratory sinus arrhythmia (RSA)] parameters of HRV, and heart rate and inter-beat interval (IBI) data were compared between depressed smokers (n?=?34) and depressed nonsmokers (n?=?44).

Results

After controlling for covariates, depressed smokers, compared to depressed nonsmokers, displayed significantly lower LF, HF, and RSA.

Conclusions

Among depressed patients, smoking is associated with significantly lower HRV, indicating dysregulated autonomic modulation of the heart.     

Uranium and other natural radionuclides in drinking water and risk of leukemia: a case-cohort study in Finland

Objective: We assessed the effect of natural uranium and other radionuclides in drinking water on risk of leukemia. Methods: The subjects (n = 144,627) in the base cohort had lived outside the municipal tapwater system during 1967–1980. A subcohort was formed as a stratified random sample of the base cohort and subjects using drinking water from drilled wells prior to 1981 were identified. A case–cohort design was used comparing exposure among cases with leukemia (n = 35) with a stratified random sample (n = 274) from the subcohort. Activity concentrations of uranium, radium-226, and radon in the drinking water were analyzed using radiochemical and alpha-spectrometric methods. Results: The median activity concentration of uranium in well water was 0.08 Bq/L for the leukemia cases and 0.06 Bq/L for the reference group, radon concentrations 80 and 130 Bq/L, respectively, and radium-226 concentrations 0.01 Bq/L for both groups. The hazard ratio of leukemia for uranium was 0.91 (95% confidence interval 0.73–1.13) per Bq/L, for radon 0.79 per Bq/L (95% CI 0.27–2.29), and for radium-226 0.80 (95% CI 0.46–1.39) per Bq/L. Conclusions: Our results do not indicate an increased risk of leukemia from ingestion of natural uranium or other radionuclides through drinking water at these exposure levels.     

A randomized trial of the Fischer cone biopsy excisor and loop electrosurgical excision procedure

OBJECTIVE: To compare specimens obtained with the Fischer cone biopsy excisor or loop electrosurgical excision procedure (LEEP) with respect to number of specimens obtained, margin interpretability, adequacy of excision, and ease of use. METHODS: One hundred eligible patients aged 13 years and older were randomly assigned to treatment with the Fischer cone biopsy excisor or LEEP. Eligibility criteria included: (1) cervical intraepithelial neoplasia (CIN) 2 or 3, (2) persistent CIN 1, or (3) cytologic/histologic discrepancy. Following excision, providers ranked ease of use on a scale of 1 to 10. A pathologist blinded to procedure type analyzed specimens for margin interpretability and adequacy of excision. Before study initiation we calculated that a total of 100 patients would be required to demonstrate a significant difference in the interpretable margin rate of 80% for LEEP and 99% for cone biopsy excisor (power 80%, alpha =.05). RESULTS: After adjustment for ease of use, lesion size, and degree of neoplasia, the cone biopsy excisor was no more likely to result in a single specimen than LEEP (74% versus 63%, relative risk [RR] 0.93, 95% confidence interval [CI] 0.79 -1.11), to result in a specimen with interpretable margins (65% versus 73%, RR 0.97, 95% CI 0.78-1.22), or to result in a fully excised cervical lesion (72% versus 62% for LEEPs, RR 1.08, 95% CI 0.77-1.52). Providers found their experiences with both Fischer cone biopsy excisor and LEEP cone biopsies to be similar, even after adjustment for year of training and previous experience (RR 0.95, 95% CI 0.72-1.24). CONCLUSION: The Fischer cone biopsy excisor and LEEP performed similarly with respect to the number of final specimens, margin interpretability, and ease of use. LEVEL OF EVIDENCE: I     

Primary health care for Korean immigrants: sustaining a culturally sensitive model

This report describes a 4-year long bilingual interdisciplinary primary health care project that was designed to make culturally sensitive services available to underserved Korean immigrants in Chicago. It also describes some of the particular needs of this population and the strategies that the project staff adopted to identify and address the population's mental health needs. The project reflected the successful collaborative efforts of four participating principals: the Korean community, the University of Illinois at Chicago College of Nursing, the Chicago Department of Public Health, and the W. K. Kellogg Foundation. The model of service demonstrated in the project paired a bilingual advanced practice nurse, a certified family nurse practitioner, with a bilingual community advocate to conduct a program emphasizing community outreach and health promotion and prevention. A bilingual physician provided consultation for the nurse and attended to patients in need of medical care. Patients were referred to bilingual community social service agencies for assistance with a variety of other problems. A central goal of the project was for the services developed during its course to be assimilated into the regular programming of the Chicago Department of Public Health, a goal that was achieved. Finally, some of the challenges of introducing role change into an organization are discussed.