Prevalence and factors associated with depression and depression-related healthcare access in mothers of 9-month old infants in the Republic of Ireland

Aims.Untreated maternal depression during the postpartum period can have a profound impact on the short- and long-term psychological and physical well-being of children. There is, therefore, an imperative for increased understanding of the determinants of depression and depression-related healthcare access during this period.Methods.Respondents were 11 089 mothers of 9-month-old infants recruited to the Growing Up in Ireland study. Of this sample, 10 827 had complete data on all relevant variables. Respondents provided sociodemographic, socioeconomic and household information, and completed the Center for Epidemiologic Studies Depression Scale (CESD).Results.11.1% of mothers scored above the CESD threshold for depression. 10.0% of depressed mothers and 25.4% of depressed fathers had depressed partners. Among depressed mothers, 73.1% had not attended a healthcare professional for a mental health problem since the birth of the cohort infant. In the adjusted model, the likelihood of depression was highest in mothers who: had lower educational levels (odds ratio (OR) 1.26; 95% confidence intervals (CIs) 1.08, 1.46); were unemployed (OR 1.27; 95% CIs 1.10, 1.47); reported previous mental health problems (OR 6.55; 95% CIs 5.68, 7.56); reported that the cohort child was the result of an unintended pregnancy (OR 1.43; 95% CIs 1.22, 1.68), was preterm (OR 1.35; 95% CIs 1.07, 1.70), or had health/developmental problems (OR 1.20; 95% CIs 1.04, 1.39); had no partner in the household (OR 1.33; 95% CIs 1.04, 1.70) or were living with a depressed partner (OR 2.66; 95% CIs 1.97, 3.60); reported no family living nearby (OR 1.33; 95% CIs 1.16, 1.54); were in the lowest income group (OR 1.60; 95% CIs 1.21, 2.12). The primary determinant of not seeking treatment for depression was being of non-white ethnicity (OR 2.21; 95% CIs 1.18, 4.13).Conclusions.Results highlight the prevalence of maternal depression in the later postpartum period, particularly for lower socioeconomic groups, those with previous mental health problems, and those with limited social support. The large proportion of unmet need in depressed mothers, particularly among ethnic minority groups, emphasises the need for a greater awareness of postpartum mental health problems and increased efforts by healthcare professionals to ensure that mothers can access the required services.</jats:sec

Antidepressant use in 27 European countries: associations with sociodemographic, cultural and economic factors

Background Prescribing of antidepressants varies widely between European countries despite no evidence of difference in the prevalence of affective disorders. Aims To investigate associations between the use of antidepressants, country-level spending on healthcare and country-level attitudes towards mental health problems. Method We used Eurobarometer 2010, a large general population survey from 27 European countries, to measure antidepressant use and regularity of use. We then analysed the associations with country-level spending on healthcare and country-level attitudes towards mental health problems. Results Higher country spending on healthcare was strongly associated with regular use of antidepressants. Beliefs that mentally ill people are ‘dangerous’ were associated with higher use, and beliefs that they ‘never recover’ or ‘have themselves to blame’ were associated with lower and less regular use of antidepressants. Conclusions Contextual factors, such as healthcare spending and public attitudes towards mental illness, may partly explain variations in antidepressant use and regular use of these medications

Probing the causes of thermal hysteresis using tunable N-agg micelles with linear and brush-like thermoresponsive coronas

Self-assembled thermoresponsive polymers in aqueous solution have great potential as smart, switchable materials for use in biomedical applications. In recent years, attention has turned to the reversibility of these polymers’ thermal transitions, which has led to debate over what factors influence discrepancies in the transition temperature when heating the system compared to the temperature obtained when cooling the system, known as the thermal hysteresis. Herein, we synthesize micelles with tunable aggregation numbers (Nagg) whose cores contain poly(n-butyl acrylate-co-N,N-dimethylacrylamide) (p(nBA-co-DMA)) and four different thermoresponsive corona blocks, namely poly(N-isopropylacrylamide) (pNIPAM), poly(N,N-diethylacrylamide) (pDEAm), poly(diethylene glycol monomethyl ether methacrylate) (pDEGMA) and poly(oligo(ethylene glycol) monomethyl ether methacrylate) (pOEGMA). By studying their thermoresponsive behavior, we elucidate the effects of changing numerous important characteristics both in the thermoresponsive chain chemistry and architecture, and in the structure of their self-assemblies. Our findings demonstrate large deviations in the reversibility between the self-assemblies and the corresponding thermoresponsive homopolymers; specifically we find that micelles whose corona consist of polymers with a brush-like architecture (pDEGMA and pOEGMA) exhibit irreversible phase transitions at a critical chain density. These results lead to a deeper understanding of stimuli-responsive self-assemblies and demonstrate the potential of tunable Nagg micelles for uncovering structure–property relationships in responsive polymer systems

Service delivery interventions to increase uptake of voluntary medical male circumcision for HIV prevention: A systematic review.

BackgroundVoluntary medical male circumcision (VMMC) remains an essential component of combination HIV prevention services, particularly in priority countries in sub-Saharan Africa. As VMMC programs seek to maximize impact and efficiency, and to support World Health Organization guidance, specific uptake-enhancing strategies are critical to identify.MethodsWe systematically reviewed the literature to evaluate the impact of service delivery interventions (e.g., facility layout, service co-location, mobile outreach) on VMMC uptake among adolescent and adult men. For the main effectiveness review, we searched for publications or conference abstracts that measured VMMC uptake or uptake of HIV testing or risk reduction counselling within VMMC services. We synthesized data by coding categories and outcomes. We also reviewed studies assessing acceptability, values/preferences, costs, and feasibility.ResultsFour randomized controlled trials and five observational studies were included in the effectiveness review. Studies took place in South Africa, Tanzania, Uganda, Zambia, and Zimbabwe. They assessed a range of service delivery innovations, including community-, school-, and facility-based interventions. Overall, interventions increased VMMC uptake; some successfully improved uptake among age-specific subpopulations, but urban-rural stratification showed no clear trends. Interventions that increased adult men's uptake included mobile services (compared to static facilities), home-based testing with active referral follow-up, and facility-based HIV testing with enhanced comprehensive sexual education. Six acceptability studies suggested interventions were generally perceived to help men choose to get circumcised. Eleven cost studies suggested interventions create economies-of-scale and efficiencies. Three studies suggested such interventions were feasible, improving facility preparedness, service quality and quantity, and efficiencies.ConclusionsInnovative changes in male-centered VMMC services can improve adult men's and adolescent boys' VMMC uptake. Limited evidence on interventions that enhance access and acceptability show promising results, but evidence gaps persist due to inconsistent intervention definition and delivery, due in part to contextual relevance and limited age disaggregation

Economic compensation interventions to increase uptake of voluntary medical male circumcision for HIV prevention: A systematic review and meta-analysis.

BackgroundEconomic compensation interventions may help support higher voluntary medical male circumcision (VMMC) coverage in priority sub-Saharan African countries. To inform World Health Organization guidelines, we conducted a systematic review of economic compensation interventions to increase VMMC uptake.MethodsEconomic compensation interventions were defined as providing money or in-kind compensation, reimbursement for associated costs (e.g. travel, lost wages), or lottery entry. We searched five electronic databases and four scientific conferences for studies examining the impact of such interventions on VMMC uptake, HIV testing and safer-sex/risk-reduction counseling uptake within VMMC, community expectations about compensation, and potential coercion. We screened citations, extracted data, and assessed risk of bias in duplicate. We conducted random-effects meta-analysis. We also reviewed studies examining acceptability, values/preferences, costs, and feasibility.ResultsOf 2484 citations identified, five randomized controlled trials (RCTs) and three non-randomized controlled trials met our eligibility criteria. Studies took place in Kenya, Malawi, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe. Meta-analysis of four RCTs showed significant impact of any economic compensation on VMMC uptake (relative risk: 5.23, 95% CI: 3.13 to 8.76). RCTs of food/transport vouchers and conditional cash transfers generally showed increases in VMMC uptake, but lotteries, subsidized VMMC, and receiving a gift appeared somewhat less effective. Three non-randomized trials showed mixed impact. Six additional studies suggested economic compensation interventions were generally acceptable, valued for addressing key barriers, and motivating to men. However, some participants felt they were insufficiently motivating or necessary; one study suggested they might raise community suspicions. One study from South Africa found a program cost of US$91 per additional circumcision and US$450-$1350 per HIV infection averted.ConclusionsEconomic compensation interventions, particularly transport/food vouchers, positively impacted VMMC uptake among adult men and were generally acceptable to potential clients. Carefully selected economic interventions may be a useful targeted strategy to enhance VMMC coverage

Precise calibration of LIGO test mass actuators using photon radiation pressure

Precise calibration of kilometer-scale interferometric gravitational wave detectors is crucial for source localization and waveform reconstruction. A technique that uses the radiation pressure of a power-modulated auxiliary laser to induce calibrated displacements of one of the ~10 kg arm cavity mirrors, a so-called photon calibrator, has been demonstrated previously and has recently been implemented on the LIGO detectors. In this article, we discuss the inherent precision and accuracy of the LIGO photon calibrators and several improvements that have been developed to reduce the estimated voice coil actuator calibration uncertainties to less than 2 percent (1-sigma). These improvements include accounting for rotation-induced apparent length variations caused by interferometer and photon calibrator beam centering offsets, absolute laser power measurement using temperature-controlled InGaAs photodetectors mounted on integrating spheres and calibrated by NIST, minimizing errors induced by localized elastic deformation of the mirror surface by using a two-beam configuration with the photon calibrator beams symmetrically displaced about the center of the optic, and simultaneously actuating the test mass with voice coil actuators and the photon calibrator to minimize fluctuations caused by the changing interferometer response. The photon calibrator is able to operate in the most sensitive interferometer configuration, and is expected to become a primary calibration method for future gravitational wave searches.Comment: 13 pages, 6 figures, accepted by Classical and Quantum Gravit

Precise calibration of LIGO test mass actuators using photon radiation pressure

Precise calibration of kilometer-scale interferometric gravitational wave detectors is crucial for source localization and waveform reconstruction. A technique that uses the radiation pressure of a power-modulated auxiliary laser to induce calibrated displacements of one of the ~10 kg arm cavity mirrors, a so-called photon calibrator, has been demonstrated previously and has recently been implemented on the LIGO detectors. In this article, we discuss the inherent precision and accuracy of the LIGO photon calibrators and several improvements that have been developed to reduce the estimated voice coil actuator calibration uncertainties to less than 2 percent (1-sigma). These improvements include accounting for rotation-induced apparent length variations caused by interferometer and photon calibrator beam centering offsets, absolute laser power measurement using temperature-controlled InGaAs photodetectors mounted on integrating spheres and calibrated by NIST, minimizing errors induced by localized elastic deformation of the mirror surface by using a two-beam configuration with the photon calibrator beams symmetrically displaced about the center of the optic, and simultaneously actuating the test mass with voice coil actuators and the photon calibrator to minimize fluctuations caused by the changing interferometer response. The photon calibrator is able to operate in the most sensitive interferometer configuration, and is expected to become a primary calibration method for future gravitational wave searches.Comment: 13 pages, 6 figures, accepted by Classical and Quantum Gravit

Weekly epirubicin for breast cancer with liver metastases and abnormal liver biochemistry.

Thirty-six consecutive patients with breast cancer and liver metastases with abnormal liver biochemistry were treated with epirubicin 25 mg m-2 i.v. weekly. No dose modification was made for abnormal liver biochemistry, but dose intensity was adjusted by delaying treatment according to myelosuppression. The UICC overall response rate according to UICC criteria was 11/36 (30%) and median response duration was 27 weeks. Liver biochemistry improved in a further seven patients. Treatment was well tolerated. Epirubicin given in this way is effective in patients with breast cancer and liver metastases. An initial deterioration in liver biochemistry may occur before there is a response to epirubicin