Changes in gendered social position and the depression gap over time in the United States

Introduction: There is a large literature across disciplines aimed at understanding the causes of the depression gap, defined as an excess of depression among women compared with men. Based on the totality of evidence to date, social stress appears to be an important explanation for the depression gap. Social stress theory highlights women’s disadvantaged social position relative to men, positioning gender differences in socio-economic opportunities as social stressors, while also acknowledging how gender socialization teaches women to respond to stressors in depressogenic ways from an early age. This dissertation applied social stress theory to better understand the social causes of the depression gap with three related aims. Aim 1 summarized the evidence for variation or stability in the depression gap in recent decades, through a systematic review and meta-regression of depression gap studies over time and by age. Aim 2 examined the evidence for a changing depression gap across birth cohorts, and tested the extent to which any changes over time were mediated by changing gender differences in education, employment, and housework rates, three indicators of broader trends in gendered social position through the 21st Century. Aim 3 examined whether women in the workforce with competing domestic labor roles were at increased risk of depression, and whether pro-family workplace benefits buffered the effects of competing roles. Methods: In aim 1, depression gap estimates were extracted through a systematic review of published literature (from 1982-present). Analytic datasets were comprised of 76 diagnostic-based estimates and 68 symptom-based estimates. For each dataset, meta-regression models estimated time and age variation in the depression gap, as well as the interaction between time and age group, to estimate the variation in the gap over time by age. Data from the National Longitudinal Surveys were utilized for aims 2 and 3. Depression was measured with the Center for Epidemiologic Studies Depression Scale (CESD), and the depression gap was defined as differences in mean CESD scores for women vs. men. The aim 2 sample included 13,666 respondents interviewed from 1992-2014. Hierarchical mixed models estimated the magnitude of the gender depression gap over time, and its relationship with 10-year birth cohort (range: 1957-1994) and whether any variation was mediated by gender differences in: those with a college degree or more, those who were employed full-time, and the average number of hours spent doing housework per week. The sample in aim 3 was limited to employed women ages 17-57 (n=3993). Generalized estimating equations estimated the relationship between competing roles and depression, and the interaction between competing roles and pro-family employee benefits on depression. Interaction results were compared to models estimating the effect of non-family-related benefits on the relationship between competing roles and depression. Results: In aim 1, there was no evidence of change in the depression gap over time. Compared with the reference group (i.e., respondents ages 60+), the age effect was appreciable among the youngest age group (age 10-19) (RR=1.44; 95% CI=1.19, 1.74), but did not differ for any other age groups. The age by time interaction was elevated for youngest age group (RR=1.27; 95% CI=1.0, 1.61), suggesting that, compared to the oldest age group, the diagnostic depression gap had increased among the youngest ages from 1982 to 2017. There was no evidence of time changes among any other age group. Results were similar for symptom-based studies. In aim 2, there was a linear decrease in the depression gap by 0.18 points across birth cohort (95% CI= -0.26, -0.10). The results of the mediation analysis estimated that an increasing ratio of college degree attainment mediated 39% of the gender depression gap across cohorts (95% CI= 0.18, 0.78). There was no evidence of mediation due to changing employment or housework ratios. In aim 3, there was evidence that women in competing roles reported a 0.56-point higher CESD score (95% CI= 0.15, 0.97), compared with women not in competing roles. The interaction between pro-family benefits and competing roles was associated with CESD scores (B=-0.44, p=0.023). More specifically, among women without access to pro-family benefits, those in competing roles reported a 6.1 point higher CESD score (95% CI=1.14, 11.1), compared with those not in competing roles, however, among women with access to these benefits, there was no association between competing roles and CESD scores (difference=0.44; 95% CI=-0.2, 1.0). Results were similar for non-family-related benefits. Women in competing roles without non-family-related benefits reported a 3.59 point higher CESD score than those not in competing roles (95% CI=1.24, 5.95) while among women with access to these benefits, there was no association between competing roles and CESD symptoms. Conclusion: This dissertation provided evidence to partially support the hypothesis that the depression gap is changing over time and is meaningfully related to the social environment, through which gender roles, responsibilities, and opportunities available to women and men are defined and reinforced. The results of these studies suggest that the depression gap may be expanding and contracting over time for different age groups. Understanding the social causes of the depression gap is important to reduce the present and future burden of the depression gap, and to understand the fundamental processes through which depression disparities may be perpetuate or attenuated in adolescence and beyond

The Effect of Poststenotic Vessel Wall Compliance upon the Pulsus Tardus Phenomenon

Recent studies have investigated the detection of significant arterial stenoses through identification of the "pulsus tardus" phenomenon in Doppler waveforms obtained distal to the stenosis. The etiology of this phenomenon, however, has not yet been determined. Using an in vitro model based upon an electrical circuit analogy, the authors had as their objective to determine whether the compliance of the vessel wall immediately distal to a stenosis, in conjunction with the stenosis, is the cause of pulsus tardus. For a constant stenosis, it was found that the degree of pulsus tardus, as quantitated by the acceleration index, increased as the compliance of the poststenotic segment increased. It is concluded that pulsus tardus distal to an arterial stenosis is likely due to the compliance of the normally distensible artery, in conjunction with the stenosis. Pathological conditions that alter the compliance of the poststenotic segment may affect the degree of pulsus tardus, perhaps limiting its usefulness for upstream stenosis detection.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68136/2/10.1177_000331979404500703.pd

Associations between lifetime potentially traumatic events and chronic physical conditions in the South African Stress and Health Survey: a cross-sectional study

Background: This study examined the association between the type, and cumulative number of lifetime potentially traumatic events (PTEs), and chronic physical conditions, in a South African sample. PTE exposures have been associated with an increased risk for a wide range of chronic physical conditions, but it is unclear whether psychiatric disorders mediate this association. Given the established differences in trauma occurrence, and the epidemiology of posttraumatic stress disorder (PTSD) in South Africa relative to other countries, examining associations between PTEs and chronic physical conditions, particularly while accounting for psychiatric comorbidity is important. Methods: Data were drawn from the South African Stress and Health Study, a cross-sectional population-representative study of psychological and physical health of South African adults. Twenty-seven PTEs, based on the World Health Organization Composite International Diagnostic Interview Version 3.0, DSM-IV PTSD module were grouped into seven PTE types (war events, physical violence, sexual violence, accidents, unexpected death of a loved one, network events, and witnessing PTEs). Five clusters of physical conditions (cardiovascular, arthritis, respiratory, chronic pain, and other health conditions) were examined. Logistic regressions assessed the odds of reporting a physical condition in relation to type and cumulative number of PTEs. Cochran-Armitage test for trend was used to examine dose-response effect of cumulative PTEs on physical conditions. Results: After adjusting for sociodemographic variables and psychiatric disorders, respondents with any PTE had increased odds of all assessed physical conditions, ranging between 1.48 (95 % CI: 1.06–2.07) for arthritis and 2.07 (95 % CI: 1.57–2.73) for respiratory conditions, compared to those without PTE exposure. Sexual violence, physical violence, unexpected death of a loved one, and network PTEs significantly increased the odds of all or nearly all the physical conditions assessed. There was a dose-response relationship between number of PTEs and increased odds of all physical conditions. Conclusions: Results from this study, the first in an African general population, are consistent with other population-based studies; PTEs confer a broad-spectrum risk for chronic physical conditions, independent of psychiatric disorders. These risks increase with each cumulative PTE exposure. Clinically, comprehensive evaluations for risk of mental and physical health morbidities should be considered among PTE survivors

A Mouse Model of Zika Virus Pathogenesis

SummaryThe ongoing Zika virus (ZIKV) epidemic and unexpected clinical outcomes, including Guillain-Barré syndrome and birth defects, has brought an urgent need for animal models. We evaluated infection and pathogenesis with contemporary and historical ZIKV strains in immunocompetent mice and mice lacking components of the antiviral response. Four- to six-week-old Irf3−/− Irf5−/− Irf7−/− triple knockout mice, which produce little interferon α/β, and mice lacking the interferon receptor (Ifnar1−/−) developed neurological disease and succumbed to ZIKV infection, whereas single Irf3−/−, Irf5−/−, and Mavs−/− knockout mice exhibited no overt illness. Ifnar1−/− mice sustained high viral loads in the brain and spinal cord, consistent with evidence that ZIKV causes neurodevelopmental defects in human fetuses. The testes of Ifnar1−/− mice had the highest viral loads, which is relevant to sexual transmission of ZIKV. This model of ZIKV pathogenesis will be valuable for evaluating vaccines and therapeutics as well as understanding disease pathogenesis

Evaluation of a flipped classroom approach to learning introductory epidemiology

Background Although the flipped classroom model has been widely adopted in medical education, reports on its use in graduate-level public health programs are limited. This study describes the design, implementation, and evaluation of a flipped classroom redesign of an introductory epidemiology course and compares it to a traditional model. Methods One hundred fifty Masters-level students enrolled in an introductory epidemiology course with a traditional format (in-person lecture and discussion section, at-home assignment; 2015, N = 72) and a flipped classroom format (at-home lecture, in-person discussion section and assignment; 2016, N = 78). Using mixed methods, we compared student characteristics, examination scores, and end-of-course evaluations of the 2016 flipped classroom format and the 2015 traditional format. Data on the flipped classroom format, including pre- and post-course surveys, open-ended questions, self-reports of section leader teaching practices, and classroom observations, were evaluated. Results There were no statistically significant differences in examination scores or students’ assessment of the course between 2015 (traditional) and 2016 (flipped). In 2016, 57.1% (36) of respondents to the end-of-course evaluation found watching video lectures at home to have a positive impact on their time management. Open-ended survey responses indicated a number of strengths of the flipped classroom approach, including the freedom to watch pre-recorded lectures at any time and the ability of section leaders to clarify targeted concepts. Suggestions for improvement focused on ways to increase regular interaction with lecturers. Conclusions There was no significant difference in students’ performance on quantitative assessments comparing the traditional format to the flipped classroom format. The flipped format did allow for greater flexibility and applied learning opportunities at home and during discussion sections

Dilated renal collecting systems:Differentiating obstructive from nonobstructive dilation using duplex doppler ultrasound

Two patients with ileal loop urinary diversions, studied with real-time and Doppler sonogphy ("duplex sonography") of the kidneys, were shown to have dilated intrarenal collecting Resistive index measurements calculated from the Doppler signal correctly identified obstructive dilatation in 1 case and nonobstructive dilatation in the other.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/29467/1/0000553.pd

Combined anti-inflammatory and neuroprotective treatments have the potential to impact disease phenotypes in Cln3−/− mice

Batten disease, or juvenile NCL, is a fatal neurodegenerative disorder that occurs due to mutations in the CLN3 gene. Because the function of CLN3 remains unclear, experimental therapies for JNCL have largely concentrated upon the targeting of downstream pathomechanisms. Neuron loss is preceded by localized glial activation, and in this proof-of-concept study we have investigated whether targeting this innate immune response with ibuprofen in combination with the neuroprotective agent lamotrigine improves the previously documented beneficial effects of immunosuppressants alone. Drugs were administered daily to symptomatic Cln3 -/- mice over a 3 month period, starting at 6 months of age, and their impact was assessed using both behavioral and neuropathological outcome measures. During the treatment period, the combination of ibuprofen and lamotrigine significantly improved the performance of Cln3 -/- mice on the vertical pole test, slowing the disease-associated decline, but had less of an impact upon their rotarod performance. There were also moderate and regionally dependent effects upon astrocyte activation that were most pronounced for ibuprofen alone, but there was no overt effect upon microglial activation. Administering such treatments for longer periods will enable testing for any impact upon the neuron loss that occurs later in disease progression. Given the partial efficacy of these treatments, it will be important to test further drugs of this type in order to find more effective combinations

HSV-1 and Zika virus but not SARS-CoV-2 replicate in the human cornea and are restricted by corneal type III interferon

Here, we report our studies of immune-mediated regulation of Zika virus (ZIKV), herpes simplex virus 1 (HSV-1), and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the human cornea. We find that ZIKV can be transmitted via corneal transplantation in mice. However, in human corneal explants, we report that ZIKV does not replicate efficiently and that SARS-CoV-2 does not replicate at all. Additionally, we demonstrate that type III interferon (IFN-λ) and its receptor (IFNλR1) are expressed in the corneal epithelium. Treatment of human corneal explants with IFN-λ, and treatment of mice with IFN-λ eye drops, upregulates antiviral interferon-stimulated genes. In human corneal explants, blockade of IFNλR1 enhances replication of ZIKV and HSV-1 but not SARS-CoV-2. In addition to an antiviral role for IFNλR1 in the cornea, our results suggest that the human cornea does not support SARS-CoV-2 infection despite expression of ACE2, a SARS-CoV-2 receptor, in the human corneal epithelium

Cost Savings of Universal Decolonization to Prevent Intensive Care Unit Infection: Implications of the REDUCE MRSA Trial

ObjectiveTo estimate and compare the impact on healthcare costs of 3 alternative strategies for reducing bloodstream infections in the intensive care unit (ICU): methicillin-resistant Staphylococcus aureus (MRSA) nares screening and isolation, targeted decolonization (ie, screening, isolation, and decolonization of MRSA carriers or infections), and universal decolonization (ie, no screening and decolonization of all ICU patients).DesignCost analysis using decision modeling.MethodsWe developed a decision-analysis model to estimate the health care costs of targeted decolonization and universal decolonization strategies compared with a strategy of MRSA nares screening and isolation. Effectiveness estimates were derived from a recent randomized trial of the 3 strategies, and cost estimates were derived from the literature.ResultsIn the base case, universal decolonization was the dominant strategy and was estimated to have both lower intervention costs and lower total ICU costs than either screening and isolation or targeted decolonization. Compared with screening and isolation, universal decolonization was estimated to save $171,000 and prevent 9 additional bloodstream infections for every 1,000 ICU admissions. The dominance of universal decolonization persisted under a wide range of cost and effectiveness assumptions.ConclusionsA strategy of universal decolonization for patients admitted to the ICU would both reduce bloodstream infections and likely reduce healthcare costs compared with strategies of MRSA nares screening and isolation or screening and isolation coupled with targeted decolonization