Synnytyksen jälkeisen masennuksen tunnistaminen, systemoitu kirjallisuuskatsaus

Tämä opinnäytetyö on osa HYKS-Naistentautien ja synnytysten toimialan, sekä Laurea-ammattikorkeakoulun yhteistä laadunkehittämishanketta 2007-2012. Se liittyy päihdeongelmaisten ja masentuneiden äitien perheiden hoitotyön kehittämiseen. Projektiraportin aiheena on synnytyksen jälkeisen masennuksen tunnistaminen. Raportin tavoitteena on vastata kliinisessä hoitotyössä masentuneiden äitien perheiden hoitotyön kehittämiseen esittelemällä uusinta tutkittua tietoa aiheesta. Lisäksi raportin tavoitteena on toimia hoitotyön apuvälineenä ja herättää keskustelua aiheesta. Opinnäytetyöprojekti on toteutettu systemoituna kirjallisuuskatsauksena Turun yliopiston, Axelin ym. mallin mukaan. Systemaattinen tiedonhaku tehtiin Laurus, Medic, Aleksi ja Ovid Fulltext tietokannoista. Hakutermit määritettiin Finn Mesh ja YSA asiasanakirjojen mukaan. Hakuja tehtiin perushaulla, sanoja yhdistelemällä ja katkaisemalla. Tiedonhakua täydennettiin manuaalisella tiedonhaulla. Projektiraporttiin valittiin 32 artikkelia, joista kahdeksan ulkolaista, viisi väitöskirjaa ja neljä pro-gradua. Tutkimustulosten mukaan äidiksi tulo saattaa olla haastava ja vaativa tehtävä ja näin altistaa synnytyksen jälkeiselle masennukselle. Se on yksi tunnetuimpia elämäntilanteisiin liittyviä sairauksia. Synnytyksen jälkeisen masennuksen sairastavuus vaihtelee 10-15% välillä, riippuen arviointimenetelmästä. Äidin masennuksella voi olla voimakkaat vaikutukset lapsen kehitykseen ja perheen hyvinvointiin, sekä se voi lisätä terveydenhuollon kustannuksia. Synnytyksen jälkeisen masennuksen oireet ovat moninaisia. Perusoireet ovat yleensä mielialan lasku, elämänilon ja mielihyvän kokemusten väheneminen. Lisäksi havaitaan paljon muita tavallisen masennuksen oireita ja spesifejä oireita, kuten liiallinen huolehtiminen vauvasta. Synnytyksen jälkeiselle masennukselle altistavia tekijöitä on paljon. Tässä projektiraportissa riskitekijät on jaettu persoonallisiin, sosiaalisiin, fyysisiin, vauvaan liittyviin, ympäristöön liittyviin ja muihin yksittäisiin riskitekijöihin. Tutkimusten tulokset masennukselle altistavista tekijöistä ovat osin ristiriitaisia. Todennäköisiksi riskitekijöiksi voidaan laskea sosiaalisen tuen puute ja parisuhteen epätyydyttävyys. Iso osa synnytyksen jälkeisistä masennuksista jää diagnosoimatta. Sairaalassa masennuksen tunnistaminen on haastavaa lyhyen sairaalajakson ja tavallisten lapsivuodeoireiden vuoksi. Pohjan havaitsemiseen luo vuorovaikutteinen haastattelu ja elämäntiladiagnoosi. Tärkeintä synnytyksen jälkeen olisi seuloa masennuksen riskejä ja jakaa tietoa mahdollisesta masennuksesta. Sairaalan ja neuvolan yhteistyö on tärkeää synnytyksen jälkeisen masennuksen havaitsemisen edistämiseksi.Diagnosing Postpartum Depression, Systemized Literature Assessment This scholarly thesis is part of the quality improvement program 2007-2011, executed in the HUCH Department of Obstetrics and Gynaecology and Laurea University of Applied Sciences. It concerns the improvement of the nursing of the families of depressed and substance abusing mothers. The subject of this project report is the diagnosis of postpartum depression(PPD). The aim of this report is to respond to the need of improvement in the nursing of the depressed mothers' families by representing the latest information about the subject. The scholarly thesis was executed as a systemized literature assessment according to the model of University of Turku, Axel, etc. The systemized information retrieval was done in follow-ing data banks: Laurus, Medic, Aleksi and Ovid Fulltext. The search terms were determined by Finn Mesh and YSA. The searches were done by basic search, combining words and cutting words. The information retrieval was supplemented by manual research. There were 32 arti-cles chosen into the project report, eight of which were foreign, five dissertations and four master's theses. According to the research results, becoming a mother may be a challenging situation and therefore predispose to postpartum depression. PPD is one of the bestknown diseases connected to the life situation of the patient. The number of mothers suffering from PPD vary from 10 to 15 percent, depending on the evaluation method. Mother's depression may have strong impact on child's development and family's wellbeing, and it may increase the expenses of the public health care. The basic symptoms of PPD are usually depressed mood and diminished pleasure. In addition, many of the symptoms of depression can occur as well as some more specific symptoms like excessive nursing. There is a number of factors predisposing to postpartum depression. In this project report the risk factors have been categorised into personal, social, physical, baby related, environment related and other individual risk factors. The research results concerning the risk factors are partly contradictory. However, the lack of social support and unsatisfying relationship can be considered as probable risk factors. Many PPD cases go undiagnosed. Diagnosing the condition in hospital is demanding due to the short period the mother spends in the hospital and the normal symptoms of puerperium disorder. The basis for recognising PPD is formed trough interactive interview and life condition diagnosis. The most important thing postpartum would be screening the risk factors and dealing information about the possibility of postpartum depression. The collaboration between the hospital and the maternity clinic is an important factor in improving the diagnosing of postpartum depression

COVID-19 infectivity profile correction

The infectivity profile of an individual with COVID-19 is attributed to the paper Temporal dynamics in viral shedding and transmissibility of COVID-19 by He et al., published in Nature Medicine in April 2020. However, the analysis within this paper contains a mistake such that the published infectivity profile is incorrect and the conclusion that infectiousness begins 2.3 days before symptom onset is no longer supported. In this document we discuss the error and compute the correct infectivity profile. We also establish confidence intervals on this profile, quantify the difference between the published and the corrected profiles, and discuss an issue of normalisation when fitting serial interval data. This infectivity profile plays a central role in policy and decision making, thus it is crucial that this issue is corrected with the utmost urgency to prevent the propagation of this error into further studies and policies. We hope that this preprint will reach all researchers and policy makers who are using the incorrect infectivity profile to inform their work.Comment: 5 pages, 2 figure

Horizontal gene transfer rate is not the primary determinant of observed antibiotic resistance frequencies in Streptococcus pneumoniae

The extent to which evolution is constrained by the rate at which horizontal gene transfer (HGT) allows DNA to move between genetic lineages is an open question, which we address in the context of antibiotic resistance in Streptococcus pneumoniae. We analyze microbiological, genomic, and epidemiological data from the largest-to-date sequenced pneumococcal carriage study in 955 infants from a refugee camp on the Thailand-Myanmar border. Using a unified framework, we simultaneously test prior hypotheses on rates of HGT and a key evolutionary covariate (duration of carriage) as determinants of resistance frequencies. We conclude that in this setting, there is little evidence of HGT playing a major role in determining resistance frequencies. Instead, observed resistance frequencies are best explained as the outcome of selection acting on a pool of variants, irrespective of the rate at which resistance determinants move between genetic lineages.ISSN:2375-254

CATH: comprehensive structural and functional annotations for genome sequences.

The latest version of the CATH-Gene3D protein structure classification database (4.0, http://www.cathdb.info) provides annotations for over 235,000 protein domain structures and includes 25 million domain predictions. This article provides an update on the major developments in the 2 years since the last publication in this journal including: significant improvements to the predictive power of our functional families (FunFams); the release of our 'current' putative domain assignments (CATH-B); a new, strictly non-redundant data set of CATH domains suitable for homology benchmarking experiments (CATH-40) and a number of improvements to the web pages

Mathematical modelling for antibiotic resistance control policy: do we know enough?

Background: Antibiotics remain the cornerstone of modern medicine. Yet there exists an inherent dilemma in their use: we are able to prevent harm by administering antibiotic treatment as necessary to both humans and animals, but we must be mindful of limiting the spread of resistance and safeguarding the efficacy of antibiotics for current and future generations. Policies that strike the right balance must be informed by a transparent rationale that relies on a robust evidence base. Main text: One way to generate the evidence base needed to inform policies for managing antibiotic resistance is by using mathematical models. These models can distil the key drivers of the dynamics of resistance transmission from complex infection and evolutionary processes, as well as predict likely responses to policy change in silico. Here, we ask whether we know enough about antibiotic resistance for mathematical modelling to robustly and effectively inform policy. We consider in turn the challenges associated with capturing antibiotic resistance evolution using mathematical models, and with translating mathematical modelling evidence into policy. Conclusions: We suggest that in spite of promising advances, we lack a complete understanding of key principles. From this we advocate for priority areas of future empirical and theoretical research

Psychosocial correlates with depressive symptoms six years after a first episode of psychosis as compared with findings from a general population sample

BACKGROUND: Depression is frequently occurring during and after psychosis. The aim of this study was to analyze if the psychosocial characteristics associated with depression/depressive symptoms in the late phase of a first episode psychosis (FEP) population were different compared to persons from the general population. METHODS: A questionnaire was sent out to all individuals six years after their FEP and to a general population sample. Depressive symptoms were recorded using a self-rating scale, the Major Depression Inventory. RESULTS: Formerly FEP persons had a higher representation of depressive symptoms/depression, unemployment, financial problems and insufficient social network. Depressive symptoms/depression were found to be associated with psychosocial problems. An age and gender effect was found in the general population, but not in the FEP sample. When the psychosocial characteristics were taken into account there were no association between having had FEP and depressive symptoms. CONCLUSIONS: The association between having been a FEP patient and depressive symptoms/depression disappeared when negative social aspects were taken into account

High baseline Tie1 level predicts poor survival in metastatic breast cancer

BackgroundAngiopoietin growth factors (Angs) regulate angiogenesis and lymphangiogenesis by binding to the endothelial Tie2 receptor. Ang2 expression is elevated in tissue hypoxia and inflammation, which also induce cleavage of the extracellular domain of the orphan Tie1 receptor. Here we have examined if the concentrations of Ang2 and the soluble extracellular domain of Tie1 in patient plasma are associated with the prognosis of patients with metastatic breast cancer.MethodsPlasma Tie1 and Ang2 levels were measured in metastatic breast cancer patients treated in a phase II trial with a taxane-bevacizumab combination chemotherapy in the first-line treatment setting. They were analyzed before treatment, after 6weeks and 6months of treatment, and at the final study visit. Using the median concentrations as cutoffs, Tie1 and Ang2 data were dichotomized into low and high concentration groups. Additionally, we analyzed Tie1 concentrations in plasma from 10 healthy women participating in a breast cancer primary prevention study.ResultsPlasma samples were available from 58 (89%) of the 65 patients treated in the trial. The baseline Tie1 levels of the healthy controls were significantly lower than those of the metastatic patients (p<0.001). The overall survival of the patients with a high baseline Tie1 level was significantly shorter (multivariate HR 3.07, 95% CI 1.39-6.79, p=0.005). Additionally, the progression-free survival was shorter for patients with a high baseline Tie1 level (multivariate HR 3.78, 95% CI 1.57-9.09, p=0.003). In contrast, the baseline Ang2 levels had no prognostic impact in a multivariate Cox proportional hazard regression analysis. The combined analysis of baseline Tie1 and Ang2 levels revealed that patients with both high Tie1 and high Ang2 baseline levels had a significantly shorter overall survival than the patients with low baseline levels of both markers (multivariate HR for overall survival 4.32, 95% CI 1.44-12.94, p=0.009).ConclusionsThis is the first study to demonstrate the prognostic value of baseline Tie1 plasma concentration in patients with metastatic breast cancer. Combined with the results of the Ang2 analyses, the patients with both high Tie1 and Ang2 levels before treatment had the poorest survival.Trial registrationClinicaltrials.gov: NCT00979641, registration date 19-DEC-2008. The regional Ethics Committee: R08142M, registration date 18-NOV-2008

High baseline Tie1 level predicts poor survival in metastatic breast cancer

BackgroundAngiopoietin growth factors (Angs) regulate angiogenesis and lymphangiogenesis by binding to the endothelial Tie2 receptor. Ang2 expression is elevated in tissue hypoxia and inflammation, which also induce cleavage of the extracellular domain of the orphan Tie1 receptor. Here we have examined if the concentrations of Ang2 and the soluble extracellular domain of Tie1 in patient plasma are associated with the prognosis of patients with metastatic breast cancer.MethodsPlasma Tie1 and Ang2 levels were measured in metastatic breast cancer patients treated in a phase II trial with a taxane-bevacizumab combination chemotherapy in the first-line treatment setting. They were analyzed before treatment, after 6weeks and 6months of treatment, and at the final study visit. Using the median concentrations as cutoffs, Tie1 and Ang2 data were dichotomized into low and high concentration groups. Additionally, we analyzed Tie1 concentrations in plasma from 10 healthy women participating in a breast cancer primary prevention study.ResultsPlasma samples were available from 58 (89%) of the 65 patients treated in the trial. The baseline Tie1 levels of the healthy controls were significantly lower than those of the metastatic patients (pPeer reviewe