Melancholia or Not; The Mysterious Differences in Depression : A Study of Pathophysiological Differences Between Depressive Subtypes – Findings from The Helsinki Birth Cohort Study

Depressive symptoms are behaviors and thought processes typical of depression. These symptoms can be classified into subtypes of depressive symptomatology based on established criteria. The depressive subtypes are known to differ in their presentation, but much is still unknown about their possible pathophysiologic differences. This study aimed to shed light on some of the pathophysiologic differences between melancholic and non-melancholic depressive symptoms. The study utilized the Helsinki Birth Cohort Study population. Depressive symptoms were determined based on subtyping developed from the criteria for melancholia in the Diagnostic and Statistical Manual of Mental Disorders. Advanced glycation end products, pulse wave velocity, body composition, and mortality were analyzed for each subtype and compared. Depressive symptoms were more common among women, were associated with less physical activity, lower likelihood of cohabitation, and lower likelihood of financial satisfaction. Comorbidities were also more common among those with depressive symptoms. Subtypes differed in regard to cholesterol, blood pressure, body mass index and fat mass. It was shown that melancholic depressive symptoms are more closely related to advanced glycation end products and mortality, whereas nonmelancholic depressive symptoms are more closely related to pulse wave velocity, body composition and impaired glucose regulation. In conclusion, the depressive subtypes seemed to show differing pathophysiology. This may suggest that the two subtypes represent differing disease processes that present with similar symptomatology.Depressiva symptom är beteenden och tankeprocesser som är typiska för depression. Dessa symptom kan bli klassificerade att tillhöra olika subtyper av depression baserat på etablerade kriterier. Dessa depressiva subtyper är kända för att variera i sin presentation, men mycket är ännu okänt när det kommer till patofysiologiska skillnader. Denna studie har försökt visa några patofysiologiska skillnader mellan melankoliska och icke-melankoliska depressiva symptom. Studien använde sig av Helsingfors Födelsekohort Studiens (HBCS) deltagare. Depressiva symptom var avgjorda på basen av subtyper som är fastslagna som del av kriterierna för melankoli i den psykiatriska handboken DSM (Diagnostic and Statistical Manual of Mental Disorders). Avancerade glykerade slutprodukter, pulsvågshastighet, kropssamansättning, och dödlighet analyserades för subtyperna och jämfördes. Depressiva symptom var vanligare hos kvinnor, var associerade med mindre fysisk aktivitet, var associerade med mindre sannolikhet för samboende samt mindre sannolikhet för finanssiell tillfredsställelse. Komorbiditeter var vanligare hos dem med depressiva symptom. Subtyperna skillde sig åt när det kom till kolesterol, blodtryck, index för kroppsmassa, och fet massa. Studien visade att melankoliska depressiva symptom är närmare relaterade till avancerade glykerade slutprodukter och dödlighet, medan icke-melankoliska depressiva symptom är närmare relaterade till pulsvågshastighet, kropssamansättning och nedsatt glukos reglering. De depressiva subtyperna yhar visat sig ha skillnader i patofysiologin. Detta tyder möjligen på att de två subtyperna representerar skilda sjukdomsprocesser som har liknande symptomatologi

Betydelsen av informationstransparens i hanteringen av risker i leveranskedjan

This master's thesis aims at enhancing the understanding of the role of visibility in managing supply chain risk. Global supply chains are increasingly important for modern societies. However, globalization and changing business trends have increased the vulnerability of these supply chains. At the same time, the increasing complexity has decreased the level of visibility in supply networks. The importance of visibility for supply chain management is widely acknowledged on a general level, but the link to risk management is a rather unexplored territory. The thesis takes a design science approach, using the CIMO logic to structure the problem. Visibility as an intervention (I) has been studied in the context (C) of supply chain risk, concentrating especially on late deliveries. For this setting, mechanisms (M) leading to specific outcomes (O) have been identified. A literature review has been conducted on supply chain risk management and supply chain visibility, highlighting the inter-linkage of these two concepts. Further, data has been collected in seven companies from the buying end of the supply chain using a questionnaire and in five companies using interviews. The main finding of the study is that the key role of visibility in managing supply chain risk lies in the identification phase of risk management. However, together with decision making, visibility also helps in mitigating and responding to risks. Further, visibility has an important role in improving customer relationships. The study also identifies that visibility and information sharing in the management of late deliveries are important especially between the buyer and the seller, while being less important between the buyer and logistics parties. The study meets the requirements of rigor for case research, but the findings should however be generalized with care outside the context of this study. The role of visibility in managing supply chain risk is an unexplored field and further research is needed to verify as well as to broaden and deepen the findings of this study

Higher pulse wave velocity in young adult offspring of mothers with type 1 diabetes : a case-control study

Background Offspring of mothers with type 1 diabetes have an increased risk for acquiring early onset cardiovascular disease (CVD). Arterial stiffness, measured as pulse wave velocity (PWV), is a non-invasive biomarker for CVD risk assessment. Our aim is to determine whether PWV is increased in young adult offspring of mothers with type 1 diabetes. Methods This is a case-control study carried out in the hospital district of Helsinki and Uusimaa, Finland. 75 offspring of mothers with type 1 diabetes (cases) and 84 offspring of mothers without diabetes (controls), aged 18-23 years, were enrolled in this study. All participants attended clinical assessments, including questionnaires and laboratory tests. Carotid-femoral PWV (cfPWV), carotid-radial PWV (crPWV), and PWV ratio were measured from each participant using the Complior Analyse mechanotransducer (Alam Medical, France). Student's t-test and chi-squared test were used to assess differences between the groups. Stata 17.0, StataCorp LP (College Station, TX, USA) statistical package was used for the analysis. Results We did not observe any differences in conventional CVD risk factors: systolic blood pressure, LDL, Hb(A1c), and smoking between cases and controls. We detected higher cfPWV in cases 6.5 (SD +/- 1.2) m/s than in controls 6.2 (SD +/- 0.7) m/s, p = 0.049, after adjustments for BMI, smoking, mean arterial pressure, height, and pulse rate was made. We did not observe any difference between cases and controls regarding crPWV or PWV ratio. Additionally, we detected no sex differences. Conclusions We report a novel finding of signs of increased arterial stiffness already in young adult offspring of mothers with type 1 diabetes compared to matched offspring of mothers without diabetes. Our finding suggests that exposure to an adverse intrauterine environment of type 1 diabetes mothers may affect the vascular health of offspring already in young adulthood. Additional research within this topic is warranted.Peer reviewe

Diminished levels of nasal S100A7 (psoriasin) in seasonal allergic rhinitis: an effect mediated by Th2 cytokines

<p>Abstract</p> <p>Background</p> <p>S100A7 is an antimicrobial peptide involved in several inflammatory diseases. The aim of the present study was to explore the expression and regulation of S100A7 in seasonal allergic rhinitis (SAR).</p> <p>Methods</p> <p>Nasal lavage (NAL) fluid was obtained from healthy controls before and after lipopolysaccharide (LPS) provocation, from SAR patients before and after allergen challenge, and from SAR patients having completed allergen-specific immunotherapy (ASIT). Nasal biopsies, nasal epithelial cells and blood were acquired from healthy donors. The airway epithelial cell line FaDu was used for <it>in vitro </it>experiments. Real-time RT-PCR and immunohistochemistry were used to determine S100A7 expression in nasal tissue and cells. Release of S100A7 in NAL and culture supernatants was measured by ELISA. The function of recombinant S100A7 was explored in epithelial cells, neutrophils and peripheral blood mononuclear cells (PBMC).</p> <p>Results</p> <p>Nasal administration of LPS induced S100A7 release in healthy non-allergic subjects. The level of S100A7 was lower in NAL from SAR patients than from healthy controls, and it was further reduced in the SAR group 6 h post allergen provocation. In contrast, ASIT patients displayed higher levels after completed treatment. S100A7 was expressed in the nasal epithelium and in glands, and it was secreted by cultured epithelial cells. Stimulation with IL-4 and histamine repressed the epithelial S100A7 release. Further, recombinant S100A7 induced activation of neutrophils and PBMC.</p> <p>Conclusions</p> <p>The present study shows an epithelial expression and excretion of S100A7 in the nose after microbial stimulation. The levels are diminished in rhinitis patients and in the presence of an allergic cytokine milieu, suggesting that the antimicrobial defense is compromised in patients with SAR.</p

Non-melancholic depressive symptoms are associated with above average fat mass index in the Helsinki birth cohort study

Publisher Copyright: © 2022, The Author(s).There is an existing link between two of the most common diseases, obesity and depression. These are both of great public health concern, but little is known about the relationships between the subtypes of these conditions. We hypothesized that non-melancholic depressive symptoms have a stronger relationship with both body composition (lean mass and fat mass) and dysfunctional glucose metabolism than melancholic depression. For this cross-sectional study 1510 participants from the Helsinki Birth Cohort Study had their body composition evaluated as lean mass and fat mass (Lean Mass Index [LMI, kg/m2] + Fat Mass Index [FMI kg/m2] = Body Mass Index). Participants were evaluated for depressive symptoms utilizing the Beck depression inventory, and had laboratory assessments including an oral glucose tolerance test. Higher than average FMI was associated with a higher percentage (mean [%], 95% CI) of participants scoring in the depressive range of the Beck depression inventory (20.2, 17.2–23.2) compared to those with low FMI (16.3, 13.8–18.9; p = 0.048) when adjusted for age, sex, education, and fasting plasma glucose concentration. Higher FMI was associated with a higher likelihood of having depressive symptoms (OR per 1-SD FMI = 1.37, 95% CI 1.13–1.65), whereas higher LMI was associated with a lower likelihood of having depressive symptoms (OR per 1-SD LMI = 0.76, 95% CI 0.64–0.91). Participants with an above average FMI more frequently (mean [%], 95% CI) had non-melancholic depressive symptoms (14.7, 11.8–17.7) as compared to those with low FMI (9.7, 7.6–11.9; p = 0.008) regardless of LMI levels. There was no difference between the body composition groups in the likelihood of having melancholic depressive symptoms. The non-melancholic group had higher (mean [kg/m2], SD) FMI (9.6, 4.1) than either of the other groups (BDI < 10: 7.7, 3.1; melancholic: 7.9, 3.6; p < 0.001), and a higher (mean [mmol/l], SD) 2-h glucose concentration (7.21, 1.65) than the non-depressed group (6.71, 1.70; p = 0.005). As hypothesized, non-melancholic depressive symptoms are most closely related to high fat mass index and dysfunctional glucose metabolism.Peer reviewe

Depressive symptoms and mortality-findings from Helsinki birth cohort study

Background Individuals with depression and depressive symptoms have a higher mortality rate than non-depressed individuals. The increased comorbidity and mortality associated with depression has remained largely unexplained. The underlying pathophysiological differences between depressive subtypes, melancholic and non-melancholic, may provide some explanation to this phenomenon. Methods One thousand nine hundred and ninety five participants (mean age 61 years) from the Helsinki Birth Cohort Study were recruited for this prospective study and followed up for a mean of 14.1 years. Information regarding medical history, lifestyle, and biochemical parameters were obtained. Depressive symptoms were assessed using the Beck Depression Inventory. Standardized mortality ratios were calculated. Results Participants were followed up for a total of 28,044 person-years. The melancholic depressive group had an increased adjusted risk of mortality [HR 1.49 (95% CI: 1.02-2.20)] when compared to the non-depressive group. Comparing mortality to the whole population of Finland using standardized mortality ratios (SMR) both the non-melancholic [1.11 (95% CI: 0.85-1.44)] and melancholic depressive [1.26 (95% CI: 0.87-1.81)] groups had higher mortality than the non-depressive group [0.82 (95% CI: 0.73-0.93)]. Conclusions Melancholic depressive symptoms are most strongly related to a higher mortality risk.Peer reviewe

Did we see it coming? An evaluation of the Swedish early awareness and alert system

Early awareness and alert (EAA) systems have been established in many countries but evidence on their ability to accurately prioritize new medicines (for early assessment) is limited. The purpose of this study is to assess whether the Swedish EAA System identified and prioritized (i.e. produced early assessment reports for) new medicines that would go on to have a substantial economic impact. Methods We adapted a study design commonly used in the assessment of diagnostic test accuracy. The prioritization made by the Swedish EAA System prior to marketing authorization comprised the index test and national drug sales data in the second year post-authorization served as the reference standard. All initial marketing authorization applications for medicinal products processed by the European Medicines Agency (EMA) between 2010 and 2015 (study population) were classified using the index test and the reference standard. Results Two hundred and fifty-three new medicinal products processed by EMA comprised the study population. Of these, 71 were prioritized by the Swedish EAA System and 21 were classified as having a substantial economic impact. The sensitivity and positive predictive value were 76.2% and 22.5%, respectively. Subgroup analyses showed that the accuracy of prioritization, in terms of sensitivity, was 100% for antineoplastic/immunomodulating agents. Conclusions The Swedish EAA System identified all new medicines that would go on to have a substantial economic impact and prioritized most of these medicines. Our findings provide reassurance to decision makers who rely on the outputs of the Swedish EAA System to keep informed about new medicines. Moreover, this study also provides valuable insights to stakeholders willing to establish and/or evaluate their own EAA activities and systems

Lastensuojelun, lastenpsykiatrian ja nuorisopsykiatrian yhteiset asiakkaat - yhteinen vastuu

Lasten, nuorten ja perheiden joustava ja oikea-aikainen avun saaminen edellyttää selkeitä yhteistyökäytäntöjä tuen, palvelujen ja hoidon järjestämisessä. Tutkimus on paikantanut hyviä käytäntöjä, mutta myös ongelmia, jotka liittyvät palvelujen johtamiseen, saatavuuteen, integrointiin, ammattilaisten yhteistyöhön sekä asiakkaiden osallisuuteen. Tarvittavien perus- ja erityispalvelujen järjestäminen lastensuojelun ja lasten- tai nuorisopsykiatrian yhteisasiakkaille edellyttää yhteistä ymmärrystä tuen ja hoidon tarpeesta sekä sopimusta yhteistyön sisällöstä. Hoidon ja yhteistyön kehittäminen onnistuu parhaiten yhteistyössä kaikkien asianosaisten asiakkaiden, potilaiden, heidän läheistensä sekä eri alojen ammattilaisten kanssa