Psychosocial stressors and depression at a Swedish primary health care centre. A gender perspective study

<p>Abstract</p> <p>Background</p> <p>Psychosocial stress may account for the higher prevalence of depression in women and in individuals with a low educational background. The aim of this study was to analyse the association between depression and socio-demographic data, psychosocial stressors and lifestyle circumstances from a gender perspective in a relatively affluent primary care setting.</p> <p>Methods</p> <p>Patients, aged 18- 75 years, visiting a drop-in clinic at a primary care health centre were screened with Beck's Depression Inventory (BDI). The physicians used also targeted screening with BDI. A questionnaire on socio-demographic data, psychosocial stressors and use of alcohol and tobacco was distributed. Among patients, who scored BDI ≥10, DSM-IV-criteria were used to diagnose depression. Of the 404 participants, 48 men and 76 women were diagnosed with depression. The reference group consisted of patients with BDI score <10, 187 men and 93 women. Age-adjusted odds ratios (ORs) with 95% confidence intervals (CI) as being depressed were calculated for the psychosocial stressors and lifestyle circumstances, separately for men and women. Multiple logistic regression analyses were used to determine the age-adjusted main effect models for men and women.</p> <p>Results</p> <p>The same three psychosocial stressors: feeling very stressed, perceived poor physical health and being dissatisfied with one's family situation were associated with depression equally in men and women. The negative predictive values of the main effect models in men and women were 90.7% and 76.5%, respectively. Being dissatisfied with one's work situation had high ORs in both men and women. Unemployment and smoking were associated with depression in men only.</p> <p>Conclusions</p> <p>Three questions, frequently asked by physicians, which involve patient's family and working situation as well as perceived stress and physical health, could be used as depression indicators in early detection of depression in men and women in primary health care.</p

The course of untreated anxiety and depression, and determinants of poor one-year outcome: a one-year cohort study

<p>Abstract</p> <p>Background</p> <p>Little is known about the course and outcome of untreated anxiety and depression in patients with and without a self-perceived need for care. The aim of the present study was to examine the one-year course of untreated anxiety and depression, and to determine predictors of a poor outcome.</p> <p>Method</p> <p>Baseline and one-year follow-up data were used of 594 primary care patients with current anxiety or depressive disorders at baseline (established by the Composite Interview Diagnostic Instrument (CIDI)), from the Netherlands Study of Depression and Anxiety (NESDA). Receipt of and need for care were assessed by the Perceived Need for Care Questionnaire (PNCQ).</p> <p>Results</p> <p>In depression, treated and untreated patients with a perceived treatment need showed more rapid symptom decline but greater symptom severity at follow-up than untreated patients without a self-perceived mental problem or treatment need. A lower education level, lower income, unemployment, loneliness, less social support, perceived need for care, number of somatic disorders, a comorbid anxiety and depressive disorder and symptom severity at baseline predicted a poorer outcome in both anxiety and depression. When all variables were considered at the same time, only baseline symptom severity appeared to predict a poorer outcome in anxiety. In depression, a poorer outcome was also predicted by more loneliness and a comorbid anxiety and depressive disorder.</p> <p>Conclusion</p> <p>In clinical practice, special attention should be paid to exploring the need for care among possible risk groups (e.g. low social economic status, low social support), and support them in making an informed decision on whether or not to seek treatment.</p

Cost-effectiveness of a domestic violence and abuse training and support programme in primary care in the real world: updated modelling based on an MRC phase IV observational pragmatic implementation study

OBJECTIVES: To evaluate the cost-effectiveness of the implementation of the Identification and Referral to Improve Safety (IRIS) programme using up-to-date real-world information on costs and effectiveness from routine clinical practice. A Markov model was constructed to estimate mean costs and quality-adjusted life-years (QALYs) of IRIS versus usual care per woman registered at a general practice from a societal and health service perspective with a 10-year time horizon. DESIGN AND SETTING: Cost-utility analysis in UK general practices, including data from six sites which have been running IRIS for at least 2 years across England. PARTICIPANTS: Based on the Markov model, which uses health states to represent possible outcomes of the intervention, we stipulated a hypothetical cohort of 10 000 women aged 16 years or older. INTERVENTIONS: The IRIS trial was a randomised controlled trial that tested the effectiveness of a primary care training and support intervention to improve the response to women experiencing domestic violence and abuse, and found it to be cost-effective. As a result, the IRIS programme has been implemented across the UK, generating data on costs and effectiveness outside a trial context. RESULTS: The IRIS programme saved £14 per woman aged 16 years or older registered in general practice (95% uncertainty interval -£151 to £37) and produced QALY gains of 0.001 per woman (95% uncertainty interval -0.005 to 0.006). The incremental net monetary benefit was positive both from a societal and National Health Service perspective (£42 and £22, respectively) and the IRIS programme was cost-effective in 61% of simulations using real-life data when the cost-effectiveness threshold was £20 000 per QALY gained as advised by National Institute for Health and Care Excellence. CONCLUSION: The IRIS programme is likely to be cost-effective and cost-saving from a societal perspective in the UK and cost-effective from a health service perspective, although there is considerable uncertainty surrounding these results, reflected in the large uncertainty intervals

Outcomes for depression and anxiety in primary care and details of treatment: a naturalistic longitudinal study

<p>Abstract</p> <p>Background</p> <p>There is little evidence as to whether or not guideline concordant care in general practice results in better clinical outcomes for people with anxiety and depression. This study aims to determine possible associations between guideline concordant care and clinical outcomes in general practice patients with depression and anxiety, and identify patient and treatment characteristics associated with clinical improvement.</p> <p>Methods</p> <p>This study forms part of the Netherlands Study of Depression and Anxiety (NESDA).</p> <p>Adult patients, recruited in general practice (67 GPs), were interviewed to assess DSM-IV diagnoses during baseline assessment of NESDA, and also completed questionnaires measuring symptom severity, received care, socio-demographic variables and social support both at baseline and 12 months later. The definition of guideline adherence was based on an algorithm on care received. Information on guideline adherence was obtained from GP medical records.</p> <p>Results</p> <p>721 patients with a current (6-month recency) anxiety or depressive disorder participated. While patients who received guideline concordant care (N = 281) suffered from more severe symptoms than patients who received non-guideline concordant care (N = 440), both groups showed equal improvement in their depressive or anxiety symptoms after 12 months. Patients who (still) had moderate or severe symptoms at follow-up, were more often unemployed, had smaller personal networks and more severe depressive symptoms at baseline than patients with mild symptoms at follow-up. The particular type of treatment followed made no difference to clinical outcomes.</p> <p>Conclusion</p> <p>The added value of guideline concordant care could not be demonstrated in this study. Symptom severity, employment status, social support and comorbidity of anxiety and depression all play a role in poor clinical outcomes.</p

Observational studies of depression in primary care: what do we know?

<p>Abstract</p> <p>Background</p> <p>We undertook a systematic review of observational studies of depression in primary care to determine 1) the nature and scope of the published studies 2) the methodological quality of the studies; 3) the identified recovery and risk factors for persistent depression and 3) the treatment and health service use patterns among patients.</p> <p>Methods</p> <p>Searches were conducted in MEDLINE, CINAHL and PsycINFO using combinations of topic and keywords, and Medical Subject Headings in MEDLINE, Headings in CINAHL and descriptors in PsycINFO. Searches were limited to adult populations and articles published in English during 1985–2006.</p> <p>Results</p> <p>40 articles from 17 observational cohort studies were identified, most were undertaken in the US or Europe. Studies varied widely in aims and methods making it difficult to meaningfully compare the results. Methodological limitations were common including: selection bias of patients and physicians; small sample sizes (range 35–108 patients at baseline and 20–59 patients at follow-up); and short follow-up times limiting the extent to which these studies can be used to inform our understanding of recovery and relapse among primary care patients with depression. Risk factors for the persistence of depression identified in this review were: severity and chronicity of the depressive episode, the presence of suicidal thoughts, antidepressant use, poorer self-reported quality of life, lower self-reported social support, experiencing key life events, lower education level and unemployment.</p> <p>Conclusion</p> <p>Despite the growing interest in depression being managed as a chronic illness, this review identified only 17 observational studies of depression in primary care, most of which have included small sample sizes and been relatively short-term. Future research should be large enough to investigate risk factors for chronicity and relapse, and should be conducted over a longer time frame.</p

Breast-feeding influences on later life--cardiovascular disease.

Current evidence, almost exclusively from observational studies, provides a rather mixed picture. From the few studies that have been able to look at fatal or non-fatal cardiovascular events, there is little indication that breast-feeding is associated with either an increased or decreased risk. With respect to blood pressure, the meta-analyses suggest a small but statistically significant lowering of around 1 mmHg SBP associated with having been breast-fed in infancy. However, there is a strong indication from the meta-analyses that even this small effect may partly be accounted for by publication bias. The strongest evidence for an effect of breast-feeding reviewed in this chapter is for serum lipids, where there is good evidence that being breast-fed is associated with an increase in serum total cholesterol in infancy. In childhood there appears to be no association, while in adults there is some indication of breast-feeding being associated with a small decline in total cholesterol levels. As already outlined at the start of the chapter, this whole area of research is made particularly difficult by the fact that breast-feeding can be defined in many different ways. Some studies use definitions that are equivalent to exclusive breast-feeding prior to weaning, while others define it as having ever been breast-fed. This problem of classification is likely to dilute any real associations that may exist. The other major problem is one of interpretation. A result implying that breast-feeding is a "good thing" for cardiovascular health could equally be construed as evidence for a "bad" effect of bottle-feeding. From these data alone, we cannot convincingly determine which conclusion is correct. This is not simply a philosophical debating point. As discussed above in relation to the interpretation of results from the randomised trial of infant feeding, the issue has implications for all research on this topic. Some progress in this area will be made if studies are conducted which define breast-feeding in a more precise and comparable way, and take account of the composition of alternative infant feeds. This will be most easily done by following up more recent study populations that were originally recruited to look at shorter-term effects of infant feeding on outcomes such as growth. With respect to randomised trial evidence, looking at the cardiovascular disease risk profiles of children (and later adults) who were part of the PROBIT trial in Belarus (see Chapters 5 and 10) is likely to prove fruitful

Apparent pulp and paper consumption tendency in the last 40 years in Venezuela

CONTENIDO Editorial. Reflexiones sobre la política ambiental venezolana. Reflections on Venezuelan environmental politics. Lozada, José Rafael Artículo Tendencia del consumo aparente de pulpa y papel en los últimos 40 años en Venezuela. Apparent pulp and paper consumption tendency in the last 40 years in Venezuela. González, Ronalds W. y Carrero G., Omar E. Posibilidades de uso de los extractos tánicos de corteza de pino caribe en colas para madera. Possibilities of Caribbean Pine bark tannic extracts for wood adhesives. Encinas, Osvaldo; Paredes, Gerardo de Jesús y Tiburzi, Luciano Evaluación de las propiedades de los combustibles vegetales como indicadores de áreas críticas de incendios forestales en Santiago del Estero (Argentina). Properties assesment of plant fuels as indicators of forest fires critical areas in Santiago del Estero (Argentine). Barrionuevo, Selva Azucena y López, José Antonio Estudio florístico de las lianas con fines de manejo del bosque, en un área del Lote Boscoso El Dorado Tumeremo, estado Bolívar, Venezuela. Floristic study of lianas for forest management in an area from El Dorado Tumeremo forest lot, Bolívar state, Venezuela. Hernández, Javier A.; Hernández P., Clemente de J. y Noguera L., Oscar E. Anatomía xilemática de 26 especies de la familia Annonaceae en Venezuela. Wood anatomy of 26 species of annonaceae family in Venezuela. León Hernández, Williams J. Clave de identificación macroscópica para 22 especies maderables de Bolivia. Macroscopic identification key for 22 commercial species from Bolivia. Moya Roque, Róger; Gómez Cortés, Marcia y Rivero Moreno, Jaime Situación actual y perspectivas del manejo de recursos forestales en Venezuela. Current situation and perspectives of forest resources management in Venezuela. Lozada, José Rafael Estimación de la pedregosidad volumétrica del suelo, con base en el área de fragmentos de roca expuestos, en un inceptisol de Los Andes venezolanos. Estimation of soil volumetric stoniness, based on the exposed area of rock fragments, in an inceptisol of the Venezuelan Andes. Andrades, Jesús; Delgado E., Fernando A. y López, Roberto A. Determinación de los esfuerzos de diseño de vigas laminadas encoladas de teca (Tectona grandis) y adhesivo MDI. Determination of stress parameters of glue-laminated beams of teak (Tectona grandis) and adhesive (MDI). Contreras Miranda, Wilver; Valero, Styles W.; Thomson, Edward; Owen de Contreras, Mary E.; Barrios, Eric y Betancourt, Rolando Nota Técnica Análisis cualitativo de los principales impactos ambientales en el ciclo de vida de la madera laminada encolada de pino caribe del sur de los estados Anzoátegui y Monagas. Qualitative analysis of the main environmental impacts on the life cycle of Caribbean pine Glue-laminated timber from Anzoátegui and Monagas states. Barrios, Eric; Contreras Miranda, Wilver; Sosa, Milena y Owen de Contreras, Mary E. Tesis Impacto de la extracción selectiva de maderas sobre el almacenamiento de carbono en un bosque de la Guayana venezolana. Impact of selective wood extraction over carbon storage in a forest of the venezuelan Guayana. Vilanova T., Emilio J. Evaluación de dos sistemas silvopastoriles a través de indicadores de calidad de suelo (físicos y químicos) en la operadora agrícola universitaria judibana, estado Mérida. Asessment of two silvopastoral systems through soil quality indicators (physical and chemical) in the opeadora agrícola universitaria judibana, Mérida state. Dávila P., Mario E. Efectos de las xilanas en la refinabilidad y propiedades físico-mecánicas de la pulpa Kraft de Eucalyptus spp. Effects of xylans on the refinability, physical and mechanical properties of Eucalyptus spp. Kraft pulps. Albarrán M., Eyra [email protected]@ula.veNivel analíticosemestra

The ratio of second to fourth digit lengths: a marker of impaired fetal growth?

Background: epidemiological studies showing that impaired fetal growth has long-term adverse health consequences have depended on crude measures of fetal growth such as overall weight or length. For future studies, there is a need to develop improved morphological markers of fetal growth which persist into adult life. Recent studies have suggested that the ratio of the length of the second finger relative to the length of the fourth finger (2D:4D ratio) is determined during fetal life and may be such a marker. Aims: to determine whether the 2D:4D ratio is associated with size at birth. Design: Cohort study. Subjects: 139 men and women born in Preston, Lancashire between 1935 and 1943. Outcome measures: Measurements of the 2D:4D ratio in palm prints. Results: men who had an above average placental weight and a shorter neonatal crown-heel length had higher 2D:4D ratios in adult life. Conclusions: these preliminary findings lend support to the hypothesis that the 2D:4D ratio is determined during fetal life