Persistent depression affects adherence to secondary prevention behaviors after acute coronary syndromes

Background: The persistence of depressive symptoms after hospitalization is a strong risk factor for mortality after acute coronary syndromes (ACS). Poor adherence to secondary prevention behaviors may be a mediator of the relationship between depression and increased mortality. Objective: To determine whether rates of adherence to risk reducing behaviors were affected by depressive status during hospitalization and 3 months later. Design: Prospective observational cohort study. Setting: Three university hospitals. Participants: Five hundred and sixty patients were enrolled within 7 days after ACS. Of these, 492 (88%) patients completed 3-month follow-up. Measurements: We used the Beck Depression Inventory (BDI) to assess depressive symptoms in the hospital and 3 months after discharge. We assessed adherence to 5 risk-reducing behaviors by patient self-report at 3 months. We used χ2 analysis to compare differences in adherence among 3 groups: persistently nondepressed (BDI<10 at hospitalization and 3 months); remittent depressed (BDI ≥10 at hospitalization; <10 at 3 months); and persistently depressed patients (BDI ≥10 at hospitalization and 3 months). Results: Compared with persistently nondepressed, persistently depressed patients reported lower rates of adherence to quitting smoking (adjusted odds ratio [OR] 0.23, 95% confidence interval [95% CI] 0.05 to 0.97), taking medications (adjusted OR 0.50, 95% CI 0.27 to 0.95), exercising (adjusted OR 0.57, 95% CI 0.34 to 0.95), and attending cardiac rehabilitation (adjusted OR 0.5, 95% CI 0.27 to 0.91). There were no significant differences between remittent depressed and persistently nondepressed patients. Conclusions: Persistently depressed patients were less likely to adhere to behaviors that reduce the risk of recurrent ACS. Differences in adherence to these behaviors may explain in part why depression predicts mortality after ACS. Key Words: cardiovascular diseases, depression, medication adherence, prevention, self car

EULAR recommendations for cardiovascular risk management in Rheumatic and Musculoskeletal Diseases, including Systemic Lupus Erythematosus and Antiphospholipid Syndrome

Acknowledgements: The committee wishes to acknowledge the support of the EULAR Standing Committee on Clinical Affairs and the EULAR Secretariat. Funding: This study was funded by European Alliance of Associations for Rheumatology, EULAR. Project number: CLI112Peer reviewedPostprin

EULAR recommendations for cardiovascular risk management in rheumatic and musculoskeletal diseases, including systemic lupus erythematosus and antiphospholipid syndrome

Objective To develop recommendations for cardiovascular risk (CVR) management in gout, vasculitis, systemic sclerosis (SSc), myositis, mixed connective tissue disease (MCTD), Sjogren's syndrome (SS), systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS). Methods Following European League against Rheumatism (EULAR) standardised procedures, a multidisciplinary task force formulated recommendations for CVR prediction and management based on systematic literature reviews and expert opinion. Results Four overarching principles emphasising the need of regular screening and management of modifiable CVR factors and patient education were endorsed. Nineteen recommendations (eleven for gout, vasculitis, SSc, MCTD, myositis, SS; eight for SLE, APS) were developed covering three topics: (1) CVR prediction tools; (2) interventions on traditional CVR factors and (3) interventions on disease-related CVR factors. Several statements relied on expert opinion because high-quality evidence was lacking. Use of generic CVR prediction tools is recommended due to lack of validated rheumatic diseases-specific tools. Diuretics should be avoided in gout and beta-blockers in SSc, and a blood pressure targe

Experimental approach and initial forest response to a simulated ice storm experiment in a northern hardwood forest.

Ice storms are a type of extreme winter weather event common to north temperate and boreal forests worldwide. Recent climate modelling studies suggest that these storms may become more frequent and severe under a changing climate. Compared to other types of storm events, relatively little is known about the direct and indirect impacts of these storms on forests, as naturally occurring ice storms are inherently difficult to study. Here we describe a novel experimental approach used to create a suite of ice storms in a mature hardwood forest in New Hampshire, USA. The experiment included five ice storm intensities (0, 6.4, 12.7 and 19.1 mm radial ice accretion) applied in a single year, and one ice storm intensity (12.7 mm) applied in two consecutive years. Results demonstrate the feasibility of this approach for creating experimental ice storms, quantify the increase in fine and coarse woody debris mass and nutrients transferred from the forest canopy to the soil under the different icing conditions, and show an increase in the damage to the forest canopy with increasing icing that evolves over time. In this forest, little damage occurred below 6.4 mm radial ice accretion, moderate damage occurred with up to 12.7 mm of accretion, and significant branch breakage and canopy damage occurred with 19.1 mm of ice. The icing in consecutive years demonstrated an interactive effect of ice storm frequency and severity such that some branches damaged in the first year of icing appeared to remain in the canopy and then fall to the ground in the second year of icing. These results have implications for National Weather Service ice storm warning levels, as they provide a quantitative assessment of ice-load related inputs of forest debris that will be useful to municipalities creating response plans for current and future ice storms

Downsizing a long-term precipitation network: Using a quantitative approach to inform difficult decisions

<div><p>The design of a precipitation monitoring network must balance the demand for accurate estimates with the resources needed to build and maintain the network. If there are changes in the objectives of the monitoring or the availability of resources, network designs should be adjusted. At the Hubbard Brook Experimental Forest in New Hampshire, USA, precipitation has been monitored with a network established in 1955 that has grown to 23 gauges distributed across nine small catchments. This high sampling intensity allowed us to simulate reduced sampling schemes and thereby evaluate the effect of decommissioning gauges on the quality of precipitation estimates. We considered all possible scenarios of sampling intensity for the catchments on the south-facing slope (2047 combinations) and the north-facing slope (4095 combinations), from the current scenario with 11 or 12 gauges to only 1 gauge remaining. Gauge scenarios differed by as much as 6.0% from the best estimate (based on all the gauges), depending on the catchment, but 95% of the scenarios gave estimates within 2% of the long-term average annual precipitation. The insensitivity of precipitation estimates and the catchment fluxes that depend on them under many reduced monitoring scenarios allowed us to base our reduction decision on other factors such as technician safety, the time required for monitoring, and co-location with other hydrometeorological measurements (snow, air temperature). At Hubbard Brook, precipitation gauges could be reduced from 23 to 10 with a change of <2% in the long-term precipitation estimates. The decision-making approach illustrated in this case study is applicable to the redesign of monitoring networks when reduction of effort seems warranted.</p></div

Boxplots of monthly precipitation (mm day^-1) for the 1998 to 2014 period.

<p>Boxes extend from the 1^st to the 3^rd quartile and the line shows the median. The whisker extends up to 1.5 times the and interquarile range (IQR) from the box or to the most extreme value. Open circles indicate values more than 1.5 times the IQR from the box. Vertical dashed lines separate the north and south facing gauges. Colored boxes highlight gauges discussed in the text, with colors corresponding to <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0195966#pone.0195966.g006" target="_blank">Fig 6</a>.</p