Cross-national variations in reported discrimination among people treated for major depression worldwide: The ASPEN/INDIGO international study

Background: No study has so far explored differences in discrimination reported by people with major depressive disorder (MDD) across countries and cultures. Aims: To (a) compare reported discrimination across different countries, and (b) explore the relative weight of individual and contextual factors in explaining levels of reported discrimination in people with MDD. Method: Cross-sectional multisite international survey (34 countries worldwide) of 1082 people with MDD. Experienced and anticipated discrimination were assessed by the Discrimination and Stigma Scale (DISC). Countries were classified according to their rating on the Human Development Index (HDI). Multilevel negative binomial and Poisson models were used. Results: People living in 'very high HDI' countries reported higher discrimination than those in 'medium/low HDI' countries. Variation in reported discrimination across countries was only partially explained by individual-level variables. The contribution of country-level variables was significant for anticipated discrimination only. Conclusions: Contextual factors play an important role in anticipated discrimination. Country-specific interventions should be implemented to prevent discrimination towards people with MDD

Vacuum assisted wound closure in patients with lower extremity arterial disease

Aim. The purpose of this investigation was to analyze predictors for wound healing, amputation and mortality after vacuum assisted closure (VAC (R)) therapy of wounds in the lower limb in patients with arterial disease. Methods. One hundred and twenty one wounds were treated and followed for 12 months at two vascular centres in Uppsala and Malmo, Sweden. VAC (R) therapy was applied in the wound at a topical negative pressure of 125 mmHg. Results. Median age of the patients was 74 years and critical lower limb ischemia was present in 87% of the patients at admission. Intestinal flora was cultivated in 74% of the wounds. VAC (R) associated bleeding occurred in four patients. Complete wound healing was achieved in 66%. Deep groin infections were associated with synthetic graft infection (P<0.001), treatment outside hospital (P<0.001), faster healing (P<0.01) and lower amputation rate (P<0.005). Diabetes mellitus (OR 2.7; [95% CI 1.2-6.2]) and foot wound (OR 3.0; (95% CI 1.2-7.4]) were independent predictors for amputation. The absence of complete wound healing was the strongest factor for both amputation (P<0.001) and death (P<0.001). Conclusion. VAC (R) therapy of complex wounds in the lower limbs in patients with vascular disease was associated with high healing rates. Non-healed wounds after VAC (R) therapy were predictors for amputation and death. [Int Angiol 2009;28:26-3 1

Promoting mental well-being among older people: an evidence review of technology-based interventions

Given a changing demographic landscape, the promotion of older adults’ wellbeing and independence is a public health issue. In recent years, the potential of technology-based resources for the promotion of wellbeing in later life has been highlighted. This systematic review analysed the effectiveness of technology-based interventions for the promotion of mental wellbeing among adults aged 65 and over without extensive health or social care needs. The data originates from an evidence review project commissioned by the National Institute for Health and Care Excellence (NICE) in the UK on the effectiveness of different actions to promote the mental wellbeing of older people. Systematic searches were performed in 8 bibliographic databases. Publications from the period 2003 onwards were considered. From the original review data material, 25 intervention studies were selected for this review, covering technology use for educational purposes, computer/internet exposure or training, telephone/internet communication, or computer gaming. The number of studies employing an RCT design and looking at comparable outcomes was low, resulting in the strength of the evidence being moderate and somewhat inconsistent. When considering the six studies with higher quality ratings, four of them - all focused on computer/internet training - reported significant favorable effects on one or several outcomes among intervention recipients (e.g. increased life satisfaction, experienced social support). While the review results highlight a lack of methodologically rigorous studies evaluating the effects of technology-based interventions for optimal ageing, they also present promising examples of effective interventions that can serve as best practice examples in this emerging field

Promoting mental wellbeing among older people: technology-based interventions

This systematic review explored the effectiveness of technology-based interventions in promoting the mental health and wellbeing of people aged 65 and over. Data were collected as part of a wider review commissioned by the National Institute for Health and Care Excellence (NICE) in England on the effectiveness of different actions to promote the mental wellbeing and independence of older people. All studies identified through this review were subject to a detailed critical appraisal of quality, looking at internal and external validity. Twenty-one papers covering evaluations of technological interventions were identified. They examined the psychosocial effects of technologies for education, exposure to, and/or training to use, computers and the internet, telephone/internet communication and computer gaming. Few studies took the form of randomized controlled trials, with little comparability in outcome measures, resulting in an inconsistent evidence base with moderate strength and quality. However, three out of six studies with high or moderate quality ratings (all focused on computer/internet training) reported statistically significant positive effects on psychosocial outcomes, including increased life satisfaction and experienced social support, as well as reduced depression levels among intervention recipients. The review results highlight the need for more methodologically rigorous studies evaluating the effects of technology-based interventions on mental wellbeing. Well-performed technology-based interventions to promote various aspects of mental wellbeing, as identified in this review, can serve as best practice examples in this emerging field

Sources, transport and sinks of beryllium in a coastal landscape affected by acidic soils

Beryllium (Be) sources, transport and sinks were studied in a coastal landscape where acidic soils (acid sulfate soils) have developed after drainage of fine-grained sulfide-bearing sediments. The study included the determination of total abundance and speciation of Be in a variety of solid and aqueous materials in both the terrestrial and estuarine parts of the landscape. A major feature was that despite normal (background) Be concentration in the sulfide-bearing sediments, the Be leaching from these sediments after O2-exposure and acid sulfate soil development were extensive, with concentrations up to 76 μg L_1 in soil water, 39 μg L_1 in runoff and 12 μg L_1 in low-order streams. These high Be concentrations were mainly in the solution form (i.e., passing a 1 kilodalton filter) and modelled to be dominated by free Be2+. The extensive Be release within, and leaching from the acid sulfate soils was controlled by pH, with a critical value of 4.0 below which the Be concentrations increased strongly. Although plagioclase and mica were most likely the main carriers of Be within these soils, it is suggested that other minerals such as Be hydroxides, Al hydroxides carrying Be, and Be sulfides are the main contributors of the abundance of dissolved Be in the acidic waters. When the acidic and Be-rich creek water was neutralized in the estuary of relatively low salinity, the dominating solution form of Be was removed by transformation to particles, reflected in the suspended particulate matter that had hydroxylamine hydrochloride extractable Be up to 17 mg kg_1 and ammonium acetate EDTA extractable Be up to 4 mg kg _1. In corresponding pristine materials (parent material of the acid sulfate soils) in the catchment, the median Be extractability with these reagents were only 0.3 and 0.05 mg kg_1, respectively. As the Be-rich suspended particulate matter ultimately became benthic sediment, the Be was preserved in terms of total concentrations but underwent to some extent changes in speciation, including release from hydroxides and concomitant scavenging by organic matter and particle surfaces