The effectiveness of vitamin D supplementation in reducing depressive symptoms: a systematic review and meta-analysis of Randomized Controlled Trials (RCTs)

BACKGROUND: Depression is a widespread, global problem, increasingly linked with vitamin D deficiency in the literature. However, a knowledge gap persists regarding the relationship between depressive symptoms and vitamin D intake. OBJECTIVE: To determine the association between vitamin D supplementation and depressive symptoms in adults (aged 18+ years). METHODS: This study consists of a systematic review and meta-analysis of randomized controlled trials (RCTs), published before January 2019. Pooled summary estimates and between-study heterogeneity were examined. RESULTS: Ten RCTs (total participants = 3336; median duration = 12 months) were included. An association was found between high vitamin D supplementation (≥4000 IU) and reduced depressive symptoms, but not in the case of lower levels of vitamin D supplementation (<4000 IU). Neither baseline serum vitamin D before supplementation, nor the depression-scoring scales used affected this association. The overall quality of evidence was graded as ‘moderate’. CONCLUSIONS: Vitamin D supplementation at greater than 4000 IU was observed to have a positive effect on depressive symptoms. Future efforts could focus on obtaining higher-quality evidence with standardized RCT methodologies to confirm this association

Outcomes associated with community-based research projects in teaching undergraduate public health

BACKGROUND: Community based research projects have been widely used in teaching public health in many institutions. Nevertheless, there is a paucity of information on the learning outcomes of such a teaching strategy. We therefore attempted to evaluate our experience with such a project based teaching process. AIMS: The objective of this study was to evaluate the factors related to quality, impact and relevance of a 6-week student project for teaching public health in the faculty of medicine at Kuwait University. METHOD: Interactive sessions familiarized students with research methods. Concurrently, they designed and completed a participatory project with a Community Medicine mentor. Questionnaires were used to assess quality, impact and relevance of the project, and these were correlated with multiple demographic, statistical and research design factors. RESULTS: We evaluated a total of 104 projects that were completed during the period of September 2001 to June 2006. Three dimensions of outcome were assessed: quality; impact and relevance. The average (mean + SE; maximum of 5) scores across all projects were 2.6 + 0.05 (range 1.7-3.7) for quality, 2.8 + 0.06 (range 1.7-4.3) for impact and 3.3 + 0.08 (range 1.3-5) for relevance. The analysis of the relationship between various factors and the scores on each dimension of assessment revealed that various factors were associated with improved quality, impact or relevance to public health practice. CONCLUSIONS: We conclude that use of more objective measurement instruments with better a priori conceptualization along with appropriate use of statistics and a more developed study design were likely to result in more meaningful research outcomes. We also found that a biostatistics or epidemiology mentor improved the research outcome

Photodynamic therapy for subfoveal choroidal neovascularisation in Vogt‐Koyanagi‐Harada disease

AIM: To assess the effects of photodynamic therapy (PDT) with verteporfin in the treatment of subfoveal choroidal neovascularisation (CNV) secondary to Vogt‐Koyanagi‐Harada disease (VKH). METHODS: Six eyes of six patients with VKH who developed subfoveal CNV underwent standard PDT. Repeated treatments were performed at 3 month intervals for persistent leakage. Charts and angiographic data were analysed retrospectively. RESULTS: Age of patients ranged between 17 years and 27 years. Five CNV lesions were recent and classic (greatest lesion diameter was 1100–3100 μm). One CNV was chronic and partially scarred. Mean visual acuity (VA) at presentation was 20/200. Five patients had more than 1 year of follow up. In five eyes there was active inflammation and CNV. Of these eyes, the first three required one PDT each. The final CNV scar was smaller/stable with improvement of VA in two eyes. The third developed a larger CNV scar with loss of two lines of VA. Submacular fibrosis developed in all three. In the fourth eye, mild CNV leakage persisted after one PDT but hazy media precluded a second PDT. At 18 months the CNV scar and VA were stable. The fifth case, with mild inflammation, required three PDT. The CNV leakage became minimal, the lesion became smaller, and VA improved significantly. The sixth eye with CNV had no inflammation and needed two PDT sessions to halt the CNV leakage. The final lesion was smaller and vision was stable. There were no PDT related complications in our series. CONCLUSION: Photodynamic therapy with verteporfin appears to be a safe and viable treatment option for subfoveal CNV secondary to VKH. It offers a chance for stabilisation or even improvement of vision. Further study is warranted

Psychometric evaluation of the Dundee Ready Educational Environment Measure: Swedish version.

Background: The Dundee Ready Educational Environment Measure (DREEM) has been used in various studies to evaluate the educational environment. However, psychometric evaluations of the instrument seem sparse, for all known versions of the instrument. Aim: The aim was to psychometrically evaluate the Swedish version of the DREEM instrument. Method: A total of 503 students (undergraduate medicine), aged 19-46 years, in semesters 2, 6 and 10 were included in the study. Validity was evaluated through analysis of construct validity and reliability. Results: The instrument had in general both acceptable validity and reliability. Due to a rather poor model fit in the confirmatory factor analysis, an explorative factor analysis was also employed which suggested a new five-factor solution for the instrument. Conclusions: The Swedish version of the DREEM instrument is shown to be valid and reliable, except for the factor structure. The new five-factor solution found in this study is not proven to be a superior measurement model compared with the original, but could be seen as an alternative model to the original, where the strong and weak areas are somewhat more easily identified

A Study on Hemorrhage Detection Using Hybrid Method in Fundus Images

Image processing of a fundus image is performed for the early detection of diabetic retinopathy. Recently, several studies have proposed that the use of a morphological filter may help extract hemorrhages from the fundus image; however, extraction of hemorrhages using template matching with templates of various shapes has not been reported. In our study, we applied hue saturation value brightness correction and contrast-limited adaptive histogram equalization to fundus images. Then, using template matching with normalized cross-correlation, the candidate hemorrhages were extracted. Region growing thereafter reconstructed the shape of the hemorrhages which enabled us to calculate the size of the hemorrhages. To reduce the number of false positives, compactness and the ratio of bounding boxes were used. We also used the 5 × 5 kernel value of the hemorrhage and a foveal filter as other methods of false positive reduction in our study. In addition, we analyzed the cause of false positive (FP) and false negative in the detection of retinal hemorrhage. Combining template matching in various ways, our program achieved a sensitivity of 85% at 4.0 FPs per image. The result of our research may help the clinician in the diagnosis of diabetic retinopathy and might be a useful tool for early detection of diabetic retinopathy progression especially in the telemedicine