The relationship of the perceived impact of the current Greek recession with increased suicide risk is moderated by mental illness in patients with long-term conditions

Objective: Adverse life events may contribute to the emergence of suicidality. We aimed to test the relationship between the impact of the Greek recession and suicidal risk in people with long-term conditions (LTCs) and to determine whether this relationship is moderated by the presence of a mental disorder. Methods: Suicidal risk (RASS) and crisis parameters were assessed in a cross-sectional survey including 376 patients with LTCs (type-II diabetes mellitus, rheumatological disorders and chronic obstructive pulmonary disease) attending the Emergency Department or specialty clinics. A diagnosis of mental disorder was confirmed by the Mini International Neuropsychiatric Interview (MINI) interview. Hierarchical regression models were used to quantify moderator effects. Results: Suicidal risk was significantly associated with the perceived impact of the recession (p = 0.028). However, moderation analysis showed that this relationship was significant only in those diagnosed with either major depressive disorder or generalized anxiety disorder. Conclusions: These findings suggest that the perceived impact of the current Greek recession is not correlated with suicidal risk per se, but the recession may act as precipitator in combination with other risk factors, such as the presence of a mental illness, thus supporting the importance of early diagnosis and treatment of mental disorders in vulnerable groups

Pre-validation of the WHO organ dysfunction based criteria for identification of maternal near miss

<p>Abstract</p> <p>Background</p> <p>To evaluate the performance of the WHO criteria for defining maternal near miss and identifying deaths among cases of severe maternal morbidity (SMM) admitted for intensive care.</p> <p>Method</p> <p>Between October 2002 and September 2007, 673 women with SMM were admitted, and among them 18 died. Variables used for the definition of maternal near miss according to WHO criteria and for the SOFA score were retrospectively evaluated. The identification of at least one of the WHO criteria in women who did not die defined the case as a near miss. Organ failure was evaluated through the maximum SOFA score above 2 for each one of the six components of the score, being considered the gold standard for the diagnosis of maternal near miss. The aggregated score (Total Maximum SOFA score) was calculated using the worst result of the maximum SOFA score. Sensitivity, specificity, positive and negative predictive values of these WHO criteria for predicting maternal death and also for identifying cases of organ failure were estimated.</p> <p>Results</p> <p>The WHO criteria identified 194 cases of maternal near miss and all the 18 deaths. The most prevalent criteria among cases of maternal deaths were the use of vasoactive drug and the use of mechanical ventilation (≥1 h). For the prediction of maternal deaths, sensitivity was 100% and specificity 70.4%. These criteria identified 119 of the 120 cases of organ failure by the maximum SOFA score (Sensitivity 99.2%) among 194 case of maternal near miss (61.34%). There was disagreement in 76 cases, one organ failure without any WHO criteria and 75 cases with no failure but with WHO criteria. The Total Maximum SOFA score had a good performance (area under the curve of 0.897) for prediction of cases of maternal near miss according to the WHO criteria.</p> <p>Conclusions</p> <p>The WHO criteria for maternal near miss showed to be able to identify all cases of death and almost all cases of organ failure. Therefore they allow evaluation of the severity of the complication and consequently enable clinicians to build a plan of care or to provide an early transfer for appropriate reference centers.</p

Multiple sea-ice states and abrupt MOC transitions in a general circulation ocean model

Sea ice has been suggested, based on simple models, to play an important role in past glacial–interglacial oscillations via the so-called “sea-ice switch” mechanism. An important requirement for this mechanism is that multiple sea-ice extents exist under the same land ice configuration. This hypothesis of multiple sea-ice extents is tested with a state-of-the-art ocean general circulation model coupled to an atmospheric energy–moisture-balance model. The model includes a dynamic-thermodynamic sea-ice module, has a realistic ocean configuration and bathymetry, and is forced by annual mean forcing. Several runs with two different land ice distributions represent present-day and cold-climate conditions. In each case the ocean model is initiated with both ice-free and fully ice-covered states. We find that the present-day runs converge approximately to the same sea-ice state for the northern hemisphere while for the southern hemisphere a difference in sea-ice extent of about three degrees in latitude between the different runs is observed. The cold climate runs lead to meridional sea-ice extents that are different by up to four degrees in latitude in both hemispheres. While approaching the final states, the model exhibits abrupt transitions from extended sea-ice states and weak meridional overturning circulation, to less extended sea ice and stronger meridional overturning circulation, and vice versa. These transitions are linked to temperature changes in the North Atlantic high-latitude deep water. Such abrupt changes may be associated with Dansgaard–Oeschger events, as proposed by previous studies. Although multiple sea ice states have been observed, the difference between these states is not large enough to provide a strong support for the sea-ice-switch mechanism