Depression in primary care patients with coronary heart disease: baseline findings from the UPBEAT UK study

BACKGROUND: An association between depression and coronary heart disease is now accepted but there has been little primary care research on this topic. The UPBEAT-UK studies are centred on a cohort of primary patients with coronary heart disease assessed every six months for up to four years. The aim of this research was to determine the prevalence and associations of depression in this cohort at baseline. METHOD: Participants with coronary heart disease were recruited from general practice registers and assessed for cardiac symptoms, depression, quality of life and social problems. RESULTS: 803 people participated. 42% had a documented history of myocardial infarction, 54% a diagnosis of ischaemic heart disease or angina. 44% still experienced chest pain. 7% had an ICD-10 defined depressive disorder. Factors independently associated with this diagnosis were problems living alone (OR 5.49, 95% CI 2.11-13.30), problems carrying out usual activities (OR 3.71, 95% CI 1.93-7.14), experiencing chest pain (OR 3.27, 95% CI 1.58-6.76), other pains or discomfort (OR 3.39, 95% CI 1.42-8.10), younger age (OR 0.95 per year 95% CI 0.92-0.98). CONCLUSION: Problems living alone, chest pain and disability are important predictors of depression in this population

Depression and anxiety symptom trajectories in coronary heart disease: Associations with measures of disability and impact on 3-year health care costs

Background: As mortality from coronary heart disease (CHD) falls, years lived with disability increase. Depression and anxiety are known indicators of poor outcomes in CHD, but most research has measured distress symptoms at one time point, often following acute events. Here we consider the long-term trajectories of these symptoms in established CHD, and examine their association to distinct measures of disability and impact on costs. Methods and results: 803 patients with diagnosis of CHD were recruited from primary care, and completed detailed assessments every 6 months for 3 years. Latent class growth analysis (LCGA) was used to identify 5 distinct symptom trajectories based on the Hospital Anxiety and Depression Questionnaire (HADS): ‘stable low’, ‘chronic high’, ‘improving’, ‘worsening’, and ‘fluctuating’. The ‘chronic high’ group had highest association with reporting of chest pain (RRR 5.8, CI 2.9 to 11.7), smoking (2.9, 1.1 to 6.3), and poorer physical (0.88, 0.83–0.93) and mental (0.78, 0.73–0.84) quality of life. The ‘chronic high’ and ‘worsening’ trajectories had significantly higher health-care costs over the ‘stable low’ trajectory (107.2% and 95.5% increase, respectively). In addition, our trajectories were the only significant variable associated with increased health-care costs across the 3 years. Conclusions: Symptoms of depression and anxiety are highly prevalent in stable CHD patients, and their long-term trajectories are the single biggest driver of health care costs. Managing morbidity in these patients, in which depression and anxiety play a key role in, should become the primary focus of policy makers and future clinical trials

Up-beat UK: a programme of research into the relationship between coronary heart disease and depression in primary care patients.

Coronary heart disease and depression are both common health problems and by 2020 will be the two leading causes of disability worldwide. Depression has been found to be more common in patients with coronary heart disease but the nature of this relationship is uncertain. In the United Kingdom general practitioners are now being remunerated for case-finding for depression in patients with coronary heart disease, however it is unclear how general practitioners should manage these patients. We aim to explore the relationship between coronary heart disease and depression in a primary care population and to develop an intervention for patients with coronary heart disease and depression

Synthesis of kainoids via a highly stereoselective hydroformylation of kainic acid.

An efficient prepn. of a series of secondary amines, structurally related to the kainic acid scaffold, is described.  Naturally occurring (-)-α-kainic acid was hydroformylated with complete terminal selectivity and high stereoselectivity.  The stereochem. of the product was investigated through the ROESY and HETLOC spectra of the corresponding 2,4-dinitrophenylhydrazone, showing the presence of a single diastereoisomer with rotamers related to the presence of the Boc group.  The aldehyde was used as a platform to prep. amines by reductive amination in ionic liqs

Flavor and electroweak symmetry breaking at the TeV scale

We present a unified picture of flavor and electroweak symmetry breaking at the TeV scale. Flavor and Higgs bosons arise as pseudo-Goldstone modes in a nonlinear sigma model. Explicit collective symmetry breaking yields stable vacuum expectation values and masses protected at one loop by the little-Higgs mechanism. The coupling to the fermions through a Yukawa lagrangian with a U(1) global flavor symmetry generates well-definite mass textures that correctly reproduce the mass hierarchies and mixings of quarks and leptons. The model is more constrained than usual little- Higgs models because of bounds on weak and flavor physics. The main experimental signatures testable at the LHC are a rather large mass mh0 = 317+/-80 GeV for the (lightest) Higgs boson and a characteristic spectrum of new bosons and fermions with masses around the TeV scale

Beyond the Higgs boson at the Tevatron: detecting gluinos from Yukawa-unified SUSY

Simple SUSY GUT models based on the gauge group SO(10) require t-b-\tau Yukawa coupling unification, in addition to gauge coupling and matter unification. The Yukawa coupling unification places strong constraints on the expected superparticle mass spectrum, with scalar masses \sim 10 TeV while gluino masses are much lighter: in the 300--500 GeV range. The very heavy squarks suppress negative interference in the q\bar{q}\to\tg\tg cross section, leading to a large enhancement in production rates. The gluinos decay almost always via three-body modes into a pair of b-quarks, so we expect at least four b-jets per signal event. We investigate the capability of Fermilab Tevatron collider experiments to detect gluino pair production in Yukawa-unified SUSY. By requiring events with large missing E_T and \ge 2 or 3 tagged b-jets, we find a 5\sigma reach in excess of m_{\tg}\sim 400 GeV for 5 fb^{-1} of data. This range in m_{\tg} is much further than the conventional Tevatron SUSY reach, and should cut a significant swath through the most favored region of parameter space for Yukawa-unified SUSY models.Comment: 16 pages including 7 .eps figure

Characteristics of people with low health literacy on coronary heart disease GP registers in South London: A cross-sectional study

Objective To explore characteristics associated with, and prevalence of, low health literacy in patients recruited to investigate the role of depression in patients on General Practice (GP) Coronary Heart Disease (CHD) registers (the Up-Beat UK study). Design Cross-sectional cohort. The health literacy measure was the Rapid Estimate of Health Literacy in Medicine (REALM). Univariable analyses identified characteristics associated with low health literacy and compared health service use between health literacy statuses. Those variables where there was a statistically significant/borderline significant difference between health literacy statuses were entered into a multivariable model. Setting 16 General Practices in South London, UK. Participants Inclusion: patients >18 years, registered with a GP and on a GP CHD register. Exclusion: patients temporarily registered. Primary outcome measure REALM. Results Of the 803 Up-Beat cohort participants, 687 (85.55%) completed the REALM of whom 106 (15.43%) had low health literacy. Twenty-eight participants could not be included in the multivariable analysis due to missing predictor variable data, leaving a sample of 659. The variables remaining in the final model were age, gender, ethnicity, Indices of Multiple Deprivation score, years of education, employment; body mass index and alcohol intake, and anxiety scores (Hospital Anxiety and Depression Scale). Univariable analysis also showed that people with low health literacy may have more, and longer, practice nurse consultations than people with adequate health literacy. Conclusions There is a disadvantaged group of people on GP CHD registers with low health literacy. The multivariable model showed that patients with low health literacy have significantly higher anxiety levels than people with adequate health literacy. In addition, the univariable analyses show that such patients have more, and longer, consultations with practice nurses. We will collect 4-year longitudinal cohort data to explore the impact of health literacy in people on GP CHD registers and the impact of health literacy on health service use

The LOFAR long baseline snapshot calibrator survey

Aims. An efficient means of locating calibrator sources for international LOw Frequency ARray (LOFAR) is developed and used to determine the average density of usable calibrator sources on the sky for subarcsecond observations at 140 MHz. Methods. We used the multi-beaming capability of LOFAR to conduct a fast and computationally inexpensive survey with the full international LOFAR array. Sources were preselected on the basis of 325 MHz arcminute-scale flux density using existing catalogues. By observing 30 different sources in each of the 12 sets of pointings per hour, we were able to inspect 630 sources in two hours to determine if they possess a sufficiently bright compact component to be usable as LOFAR delay calibrators. Results. More than 40% of the observed sources are detected on multiple baselines between international stations and 86 are classified as satisfactory calibrators. We show that a flat low-frequency spectrum (from 74 to 325 MHz) is the best predictor of compactness at 140 MHz. We extrapolate from our sample to show that the sky density of calibrators that are sufficiently bright to calibrate dispersive and non-dispersive delays for the international LOFAR using existing methods is 1.0 per square degree. Conclusions. The observed density of satisfactory delay calibrator sources means that observations with international LOFAR should be possible at virtually any point in the sky provided that a fast and efficient search, using the methodology described here, is conducted prior to the observation to identify the best calibrator

An Outbreak of Rift Valley Fever in Northeastern Kenya, 1997-98

In December 1997, 170 hemorrhagic fever-associated deaths were reported in Carissa District, Kenya. Laboratory testing identified evidence of acute Rift Valley fever virus (RVFV). Of the 171 persons enrolled in a cross-sectional study, 31(18%) were anti-RVFV immunoglobulin (Ig) M positive. An age-adjusted IgM antibody prevalence of 14% was estimated for the district. We estimate approximately 27,500 infections occurred in Garissa District, making this the largest recorded outbreak of RVFV in East Africa. In multivariate analysis, contact with sheep body fluids and sheltering livestock in one’s home were significantly associated with infection. Direct contact with animals, particularly contact with sheep body fluids, was the most important modifiable risk factor for RVFV infection. Public education during epizootics may reduce human illness and deaths associated with future outbreaks