271 research outputs found

    Prospective associations between cardiovascular reactions to acute psychological stress and change in physical disability in a large community sample

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    Exaggerated haemodynamic reactions to acute psychological stress have been implicated in cardiovascular disease outcomes, while lower reactions have been considered benign. This study examined, in a large cohort, the prospective associations between stress reactivity and physical disability. Blood pressure and pulse rate were measured at rest and in response to a stress task. Physical disability was assessed using the OPCS survey of disability at baseline and five years later. Heart rate reactivity was negatively associated with change in physical disability over time, such that those with lower heart rate reactivity were more likely to deteriorate over the following five years. These effects remained significant following adjustment for a number of confounding variables. These data give further support to the recent argument that for some health outcomes, lower or blunted cardiovascular stress reactivity is not necessarily protective

    Blunted cardiac reactions to acute psychological stress predict symptoms of depression five years later: Evidence from a large community study

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    We recently reported a cross-sectional negative relationship between cardiovascular reactivity and depressive symptoms. The present analyses examined the prospective association between reactivity and symptoms of depression five years later. At the earlier time point depressive symptoms, using the Hospital Anxiety and Depression Scale (HADS), and cardiovascular reactions to a standard mental stress were measured in 1608 adults comprising three distinct age cohorts: 24-, 44-, and 63-year olds. Depression was re-assessed using the HADS five years later. Heart rate reactions to acute psychological stress were negatively associated with subsequent depressive symptoms; the lower the reactivity the higher the depression scores. This association withstood adjustment for symptom scores at the earlier time point, and for socio-demographic factors and medication status. The mechanisms underlying this prospective relationship remain to be determined

    Shrinking the Malaria Map: A Prospectus on Malaria Elimination

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    \ud Thirty-nine countries across the world are making progress toward malaria elimination. Some are committed to nationwide elimination, while others are pursuing spatially progressive elimination within their borders. Influential donor and multilateral organizations are supporting their goals of achieving malaria-free status. With elimination back on the global agenda, countries face a myriad of questions. Should they change their programs to eliminate rather than control malaria? What tools are available? What policies need to be put into place? How will they benefit from elimination? Unfortunately, answers to these questions, and resources for agencies and country program managers considering or pursuing elimination, are scarce. The 39 eliminating countries are all positioned along the endemic margins of the disease, yet they naturally experience a variety of country characteristics and epidemiologies that make their malaria situations different from one another. The Malaria Elimination Group (MEG) and this Prospectus recognize\ud that there is no single solution, strategy, or time line that will be appropriate for every country, and each is encouraged to initiate a comprehensive evaluation of its readiness and strategy for elimination. The Prospectus is designed to guide countries in conducting these assessments. The Prospectus provides detailed and informed discussion on the practical means of achieving and sustaining zero transmission. It is designed as a road map, providing direction and options from which to choose an appropriate path. As on all maps, the destination is clearly marked, but the possible routes to reach it are numerous. The Prospectus is divided into two sections: Section 1 Eliminating Malaria comprises four chapters covering the strategic components important to the periods before, during, and after an elimination program. Section 2 Tools for the Job, comprises six chapters that outline basic information about how interventions in an elimination program will be different from those in a control setting. Chapter 1, Making the Decision, evaluates the issues that a country should consider when deciding whether or not to eliminate malaria. The chapter begins with a discussion about the quantitative and qualitative benefits that a country could expect from eliminating malaria and then recommends a thorough feasibility assessment. The feasibility assessment is based on three major components: operational, technical, and financial feasibility. Cross-border and regional collaboration is a key subject in this chapter. Chapter 2, Getting to Zero, describes changes that programs must consider when moving from sustained control to an elimination goal. The key strategic issues that must be addressed are considered, including supply chains, surveillance systems, intersectoral collaboration, political will, and legislative framework. Cross-border collaboration is again a key component in Getting to Zero. Chapter 3, Holding the Line, provides recommendations on how to conduct an assessment of two key factors that will affect preventing the reemergence of malaria once transmission is interrupted: outbreak risk and importation risk. The chapter emphasizes the need for a strong surveillance system in order to prevent and, if necessary, respond to imported cases. Chapter 4, Financing Elimination, reviews the cost-effectiveness of elimination as compared with sustained control and then presents the costs of selected elimination programs as examples. It evaluates four innovative financing mechanisms that must support elimination, emphasizing the need for predictable and stable financing. Case studies from Swaziland and two provinces in China are provided. Chapter 5, Understanding Malaria, considers malaria from the point of view of elimination and provides a concise overview of the current burden of the disease, malaria transmission, and the available interventions that can be used in an elimination program. Chapter 6, Learning from History, extracts important lessons from the Global Malaria Eradication Program and analyzes some elimination efforts that were successful and some that were unsuccessful. The chapter also reviews how the malaria map has been shrinking since 1900. xiv A Prosp ectus on Mala ria Elimi natio n\ud Chapter 7, Measuring Malaria for Elimination, provides a precise language for discussing malaria and gives the elimination discussion a quantitative structure. The chapter also describes the role of epidemiological theory and mathematical modeling in defining and updating an elimination agenda for malaria. Chapter 8, Killing the Parasite, outlines the importance of case detection and management in an elimination setting. Options for diagnosis, the hidden challenge of Plasmodium vivax in an elimination setting, and the impact of immunity are all discussed. Chapter 9, Suppressing the Vector, explores vector control, a necessary element of any malaria program. It considers optimal methods available to interrupt transmission and discusses potential changes, such as insecticide resistance, that may affect elimination efforts. Chapter 10, Identifying the Gaps — What We Need to Know, reviews the gaps in our understanding of what is required for elimination. The chapter outlines a short-term research agenda with a focus on the operational needs that countries are facing today. The Prospectus reviews the operational, technical, and financial feasibility for those working on the front lines and considers whether, when, and how to eliminate malaria. A companion document, A Guide on Malaria Elimination for Policy Makers, is provided for those countries or agencies whose responsibility is primarily to make the policy decisions on whether to pursue or support a malaria elimination strategy. The Guide is available at www.malaria eliminationgroup.org

    Submerged macrophyte decline in shallow lakes: What have we learnt in the last forty years?

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    Over the last 40 years there has been substantial evidence that high biomasses of submerged aquaticplants and phytoplankton rarely occur together in shallow lakes, but it is clear that when present, plantshave a competitive advantage over algae. Aquatic plants provide habitat structure, which influences the fish community such that zooplanktonand other macroinvertebrates maintain a top-down control on algal growth, and this control is largelyindependent of the nutrient supply to the lake. Nonetheless it is clear that many, but not all, lakes losetheir vegetation as nutrient loading increases. However, in eutrophic lakes, the subsequent dominanceby phytoplankton is more likely to be a result of the loss of vegetation rather than the cause. At higher nutrient levels, grazing or mechanical damage can reduce plant cover allowing rapid devel-opment of algae. Changes to fish community structure or the influence of toxic chemicals can reduceinvertebrate algal grazers, overcoming the positive feedback loops that stabilise the plant dominance. The longer-term stability of macrophyte dominance is also reduced if there are few surviving plantspecies. Such loss of species richness is associated with increased nitrogen loading. Submerged plantsalso depend on a spring clear-water phase to become established, and local weather conditions duringwinter and spring may determine the relative success of phytoplankton and plant growth, leading to aprogressively longer period of algal dominance and fewer surviving plant species. The loss of submerged vegetation from lakes, although often perceived as a rapid change, is more likelyto be the final conclusion of a process in which the competitive advantage of a diverse plant communityis eroded by many pressures that are collectively interpreted as eutrophication. In attempts to manage our environment we hope to find simple, closed stable systems that will respondto measures designed to meet our perceptions of improved ecological quality. What we increasingly findare more complex open systems, which do not necessarily respond as expected. We look for simple andwidely applicable explanations where none are likely to exist

    Negative life events and symptoms of depression and anxiety: stress causation and/or stress generation

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    Background and Objectives: Stressful life events are known to contribute to development of depression; however, it is possible this link is bidirectional. The present study examined whether such stress generation effects are greater than the effects of stressful life events on depression, and whether stress generation is also evident with anxiety. Design: Participants were two large age cohorts (N = 732 aged 44 years; N = 705 aged 63 years) from the West of Scotland Twenty-07 study. Methods: Stressful life events, depression, and anxiety symptoms were measured twice five years apart. Cross-lagged panel analysis examined the mutual influences of stressful life events on depression and on anxiety over time. Results: Life events predicted later depressive symptomatology (p = .01), but the depression predicting life events relationship was less strong (p = .06), whereas earlier anxiety predicted life events five years later (p = .001). There was evidence of sex differences in the extent to which life events predicted later anxiety. Conclusions: This study provides evidence of stress causation for depression and weaker evidence for stress generation. In contrast, there was strong evidence of stress generation for anxiety but weaker evidence for stress causation, and that differed for men and women

    Haemodynamic reactions to acute psychological stress and smoking status in a large community sample

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    Exaggerated haemodynamic reactions to acute psychological stress have been implicated in a number of adverse health outcomes. This study examined, in a large community sample, the cross-sectional associations between haemodynamic reactivity and self-reported smoking status. Blood pressure and heart rate were measured at rest and in response to a 3-minute arithmetic stress task. Participants were classified as current, ex-, or non-smokers by their response to a simple prompt. Smokers had significantly smaller SBP and DBP reactions to acute stress than ex- and non-smokers; current and ex-smokers had lower HR reactivity. These effects remained significant following adjustment for a host of variables likely to be associated with reactivity and/or smoking. Although the act of smoking acutely increases haemodynamic activity, the present findings contribute to a growing body of literature showing that smokers have blunted reactivity to mental stress. They also support the hypothesis that blunted reactivity may be characteristic of a range of dependencies. The present results also suggest that smoking status needs to be considered in the design and analysis of stress reactivity studies. © 2009 Elsevier B.V. All rights reserved

    Salivary Immunoglobulin A Secretion Rate Is Negatively Associated with Cancer Mortality: The West of Scotland Twenty-07 Study

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    Immunoglobulins are essential for combating infectious disease although very high levels can indicate underlying pathology. The present study examined associations between secretory immunoglobulin A (sIgA) in saliva and mortality rates in the general population. Participants were 639 adults from the eldest cohort of the West of Scotland Twenty-07 Study aged 63 years at the time of saliva sampling in 1995. From unstimulated 2-minute saliva samples, saliva volume and S-IgA concentration were measured, and S-IgA secretion rate determined as their product. Mortality data were tracked for 19 years. Cox proportional hazard models were applied to compute hazard ratios (HR) for all-cause mortality from sIgA secretion rate. Associations were adjusted for gender, assay batch, household occupational group, smoking, medication usage, and self-reported health. There was a negative association between log sIgA secretion rate and all-cause mortality, HR = 0.81, 95%CI = 0.73–0.91, p < .001. Further analysis of specific causes of mortality revealed that the all-cause association was due to an underlying association with cancer mortality and in particular with cancers other than lung cancer. The HR for non-lung cancer was 0.68 (95%CI = 0.54 to 0.85) implying a 32% reduction in mortality risk per standard deviation rise in log sIgA secretion rate. Effects were stronger for men than women. For deaths from respiratory diseases, sIgA secretion had a non-linear relationship with mortality risk whereby only the very lowest levels of secretion were associated with elevated risk. SIgA concentration revealed a similar but weaker pattern of association. In the present study, higher secretion rates of sIgA were associated with a decreased risk of death from cancer, specifically non-lung cancer, as well as from respiratory disease. Thus, it appears that sIgA plays a protective role among older adults, and could serve as a marker of mortality risk, specifically cancer mortality

    Macrostructural analysis : unravelling polyphase glacitectonic histories

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    Many Pleistocene glacial profiles look extremely simple, comprising till, or glacitectonite, overlying older sediments or bedrock (Figure 4.1). In more complex sequences the till may itself be overlain by younger sediments laid down as the ice retreated or during a completely separate, later phase of advance. Macroscopically, subglacial traction tills (Evans et al., 2007) are typically massive, unstructured deposits suggesting that it should be relatively straightforward to unravel the glacitectonic deformation history recorded by the sequence. Many reconstructions do indeed look very simple, slabs of sediment have been tilted and stacked and then overridden by the glacier to cap the structure with till. Added to this is the use of vertical exaggeration which makes the whole structure look like alpine tectonics (for an example see fig. 5 in van Gijssel, 1987). Dropping the exaggeration led to the recognition that actually we were looking at much more horizontal structures, i.e. overriding nappes and not imbricated slabs (van der Wateren, 1987). Traditionally (van der Meer, 1987) glaciotectonics was thought to relate to large structures like big push moraines and not to smaller structures like drag structures underneath tills (Figure 4.2), let alone to the tills themselves. With the notion that deforming bed tills are tectonically and not sedimentologically structured and could be regarded as tectomicts (Menzies et al., 2006), comes the realisation that glacitectonics happens across a wide range of scales, from the microscopic to tens of kilometres. Only by realising the full range of glaciotectonic scales can we hope to understand the processes
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