Epidemiologic studies on bone mineral density and fractures

Osteoporosis is currently defined as a systemic skeletal disease characterized by low bone mass and microarchitectnral deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture. The burden of fractures is substantial, both in terms of individual and public health. The most serious fracture, i.e. hip fracture, is associated with a high mortality rate of approximately 25 % within one year and a considerable decline of physical and social functions. Hip fracture is not a rare event. On average, the lifetime risk of a hip fracture for a 50 year old woman is approximately 16 % 4. The total number of incident hip fractures in the Netherlands was 10360 in 1987 and it is expected that, partly as a consequence of aging of the population, this number will have exceeded 20000 by the year of 2010. The general aim of the thesis is to study determinants of bone density and consequences of vertebral fractures or deformities

Explaining the Efficacy of an Internet-Based Behavioral Activation Intervention for Major Depression:A Mechanistic Study of a Randomized-Controlled Trial

Background: Behavioral activation is an effective treatment for depression that is theorized to facilitate structured increases in enjoyable activities that increase opportunities for contact with positive reinforcement; to date, however, only few mechanistic studies focused on a standalone intervention. Method: Interventions using internet-based behavioral activation or psychoeducation were compared based on data from a randomized-controlled trial of 313 patients with major depressive disorder. Activation level and depression were measured fortnightly (baseline, Weeks 2, 4, 6, 8, 10), using the Patient Health Questionnaire-9 and the Behavioral Activation for Depression Scale-Short Form, respectively. Analysis was performed to determine if a change in activation level mediated treatment efficacy. Results: Latent growth modeling showed that internet-based behavioral activation treatment significantly reduced depressive symptoms from baseline to the end of treatment (standardized coefficient = −.13, p = .017) by increasing the rate of growth in the activation level (mediated effect)

Psychological interventions for depression in Chinese university students:A systematic review and meta-analysis

Background: University students in China are vulnerable to depression with a high estimated prevalence. It is currently unknown which types of psychological interventions are being delivered to treat depression in this population and whether they are effective. Therefore, a systematic review was conducted to address this issue. Methods: We searched records in English and Chinese databases up to January 2019. Results: From 2,739 records, we identified 39 randomized controlled trails (RCTs) and 54 non-RCTs. A range of psychological interventions were identified including cognitive behaviour therapy, interpersonal therapy, and local interventions. Hedge's g pooled effect size of 23 comparisons from 21 RCTs (N =858) compared to a control group (N = 802) was 1.08 (95% CI: 0.72 to 1.45). Heterogeneity was moderate with I2 = 47 (95%CI: 14 to 68). Type of control group was significantly associated with the effect size (p =0.039). Comparisons between the intervention condition and the ‘no intervention’ condition yielded a higher effect size (Hedges’ g =1.38, 95% CI: 0.89 to 1.87) than comparisons between the intervention condition and the ‘usual care/control’ condition (Hedges’ g = 0.56, 95% CI 0.08 to 1.05). No other significant differences based on the study characteristics were observed. Limitations: Publication bias and quality of inclusions. Conclusions: Collectively, there is evidence that psychological interventions for depression in Chinese university students are effective as compared to control groups, although the effects merit further examination by research of higher quality. Innovations in treatment delivery could facilitate wider dissemination of evidence-based interventions

Non-steroidal anti-inflammatory drugs and the risk of psychosis

The objective of the current research was to examine the relation between nonsteroidal anti-inflammatory drugs (NSAID) use and risk of psychosis. To this end we performed a longitudinal case-control study using prescription data from a Dutch health insurance company. Men aged 25 years or over and women aged 30 years or over were excluded to prevent inclusion of non-incident cases. This resulted in eighty-two cases and 359 randomly selected controls from the same population. The overall relative risk of incident antipsychotic use for NSAID users, adjusted for age and prescription frequency, was 0.80 (95% CI: 0.48-1.33). After stratification for gender the risk of psychosis was significantly lower (59%) in male NSAID users only. The relative risks for male and female subjects were 0.41 (95% CI: 0.17-0.97) and 1.31 (95% CI: 0.65-2.64), respectively. These results suggest that in men NSAIDs may lower the risk of psychosis. (c) 2006 Elsevier B.V. and ECNP. All rights reserved

Low socioeconomic status increases effects of negative life events on antenatal anxiety and depression

Problem: Low socioeconomic status and prior negative life events are documented risk factors for antenatal anxiety and depression, preterm birth and birth weight. We aimed to asses whether the adverse effects of prior negative life events increase with lower socioeconomic status and which aspects of socioeconomic status are most relevant. Methods: We performed a population-based cohort study in the Netherlands including 5398 women in their first trimester of pregnancy. We assessed the number of negative life events prior to pregnancy, aspects of paternal and maternal socio-economic position and symptoms of anxiety and depression. Associations of the number of prior negative life events with anxiety, depression, low birth weight and gestational age were quantified. Findings: The number of prior negative life events, particularly when they had occurred in the two years before pregnancy and maternal aspects of low socioeconomic status (educational level, unemployment and income) were associated with antenatal anxiety and depression. Furthermore, low socioeconomic status increased the adverse effects of prior negative life events. Obstetric outcomes showed similar trends, although mostly not statistically significant. Discussion: Low socioeconomic status and prior negative life events both have an adverse effect on antenatal anxiety and depression. Furthermore, low socioeconomic status increases the adverse impact of prior negative life events on anxiety and depressive symptoms in pregnancy. Conclusion: Interventions for anxiety and depression during pregnancy should be targeted particularly to unemployed, less-educated or low-income women who recently experienced negative life events

Correction factors for oxygen and flow-rate effects on neonatal Fleisch and Lilly pneumotachometers

Objective: To assess the effects of different oxygen concentrations and flow rates on the measurement errors of neonatal pneumotachometers in heated and unheated situations and to develop correction factors to correct for these effects. Design: Prospective laboratory study. Setting: Outpatient clinic with equipment in a standardized setting. Subjects: Neonatal pneumotachometers. Interventions: In standardized conditions, the tested pneumotachometer was calibrated at a flow rate of 3 L/min with 60% oxygen and was set in series with a closed spirometer system being used as a reference. Different air-flow levels (1-9 L/min) and oxygen concentrations (21-100%) were infused into the closed system with the pneumotachometer and spirometer. Measurements and Main Results: The pneumotachometers were significantly affected by changing oxygen concentrations (p < .01) and increasing flow rates (p < .01), increasing the actually measured flow rate. Correction factors, developed by multiple regression analysis, significantly reduced the overall maximum errors of the pneumotachometers from -1.1 to 0.6 L/min to -0.5 to 0.4 L/min. Conclusions: The effects of changes in oxygen concentrations and flow rates on neonatal pneumotachometers could be considerably decreased by the use of correction factors such as were calculated in this study. This will preclude frequent calibration procedures with actual flow and oxygen levels during changes in experimental settings. Copyrigh

J-shaped relation between change in diastolic blood pressure and progression of aortic atherosclerosis

The J-shaped relation between diastolic blood pressure and mortality from coronary heart disease continues to provoke controversy. We examined the association between diastolic blood pressure and progression of aortic atherosclerosis in a population-based cohort of 855 women, aged 45-64 years at baseline. The women were examined radiographically for calcified deposits in the abdominal aorta, which have been shown to reflect intimal atherosclerosis. After 9 years of follow-up, slight progression of atherosclerosis was noted in 19% of women and substantial progression in 16%. The age-adjusted relative risk of substantial atherosclerotic progression in women with a decrease in diastolic pressure of 10 mm Hg or more was 2·5 (95% CI 1·3-5·6), compared with the reference group of women who had a smaller decrease or no change. The excess risk in this group was confined to women whose increase in pulse pressure was above the median (3·9 [1·5-9·9] vs 1·1 [0 3-4·2] in women with an increase in pulse pressure below the median). The relative risks for women with rises in diastolic pressure of 1-9 mm Hg and 10 mm Hg or more were 2·2 (1 1-4 3) and 3·5 (1 6-8 0), respectively. These findings suggest that a decline in diastolic blood pressure indicates vessel wall stiffening associated with atherosclerotic progression. They support the hypothesis that in low-risk subjects progression of atherosclerosis may be accompanied by a decrease in diastolic blood pressure rather than the opposing idea that low diastolic blood pressure precipitates the occurrence of atherosclerotic events

Vertebral deformities and functional impairment in men and women

Abstract The objective of this study was to assess the prevalence and health effects of vertebral deformities i

Altered emotional experiences attributed to antipsychotic medications - A potential link with estimated dopamine D-2 receptor occupancy

Altered emotional experiences in response to antipsychotics may increase the burden of disease in patients with schizophrenia. In a large cross-sectional study, patients with schizophrenia completed the Subjects Reaction to Antipsychotics questionnaire (SRA) to assess whether they attributed altered emotional experiences (flattened affect or depressive symptoms) to their antipsychotics. Association with antipsychotic D-2 receptor affinity and occupancy was examined using logistic regression. We compared antipsychotic-attributed emotional experiences between patients using antipsychotic monotherapy and combination therapy. Of the 1298 included patients, 23% attributed flattened affect to their anti psychotics and 16% attributed depressive symptoms to their antipsychotics, based on the SRA. No differences were observed between antipsychotics in patients on monotherapy. We discuss that within these patients' relatively low dose range, altered emotional experiences did not appear to relate to the level of D-2 receptor affinity of antipsychotic monotherapy. Patients using antipsychotic combination therapy (22%) were more likely to attribute depressive symptoms to their antipsychotics than patients using antipsychotic monotherapy (OR [95%CI]=1.443 [1.033-2.015]); possibly due to higher D-2 receptor occupancies as estimated by dose equivalents. (C) 2016 Published by Elsevier Ireland Ltd

Tapering Antidepressants While Receiving Digital Preventive Cognitive Therapy During Pregnancy:An Experience Sampling Methodology Trial

Background: Previous studies indicated that affect fluctuations, the use of antidepressant medication (ADM), as well as depression during pregnancy might have adverse effects on offspring outcomes. The aim of the current proof-of-principle study is to explore the effect of tapering ADM while receiving online preventive cognitive therapy (PCT) on pregnant women and the offspring as compared to pregnant women continuing ADM. Objectives: We sought to compare positive and negative affect fluctuations in pregnant women receiving online PCT while tapering ADM vs. pregnant women continuing ADM, and to investigate if affect fluctuations in early pregnancy were related to offspring birth weight. Method: An experience sampling methodology (ESM)-trial ran alongside a Dutch randomized controlled trial (RCT) and prospective observational cohort of women using ADM at the start of pregnancy. In the ESM-trial fluctuations of positive and negative affect were assessed in the first 8 weeks after inclusion. Recurrences of depression were assessed up to 12 weeks post-partum, and birth records were used to assess offspring birth weight. The RCT has been registered at the Netherlands Trial Register (NTR4694, ). Results: In total, 19 pregnant women using ADM at start of their pregnancy participated in the ESM-trial. There were no significant differences in positive and negative affect fluctuations, nor recurrence rates between women receiving PCT while tapering ADM vs. women continuing ADM. We found no association between affect fluctuations, pre-natal depressive symptoms, and birth weight (all p > 0.05). Conclusion: This explorative study showed that tapering ADM while receiving online PCT may protect pregnant women against recurrences of depression and affect fluctuations, without affecting birth weight. There is a high need for more controlled studies focusing on tapering ADM with (online) psychological interventions during pregnancy