Influence of socio-economic deprivation on the prevalence and outcome of depression in primary care: the Hampshire Depression Project

BACKGROUND

Health inequalities exist for many disorders, but the contribution of deprivation to the prevalence and outcome of depressive symptoms in primary care populations has been infrequently studied.

AIMS

To examine the influence of Jarman under-privileged area (UPA) scores on the prevalence and outcome of depressive symptoms in general practice patients.

METHOD

18 414 patients attending 55 representative practices completed the Hospital Anxiety and Depression Scale and a questionnaire for employment status. Outcome of those screening positive was assessed at 6 weeks and 6 months.

RESULTS

The UPA score accounted for 48.3% of the variance between practices in prevalence of depressive symptoms. Attending a high UPA score practice predicted persistence of depressive symptoms to 6 months.

CONCLUSIONS

The socio-economic deprivation of a practice locality is a powerful predictor of the prevalence and persistence of depressive symptoms.

Both pain and EEG response to cold pressor stimulation occurs faster in fibromyalgia patients than in control subjects

Pain-evoked brain potentials elicited by laser stimulation have been repeatedly shown to be abnormal in fibromyalgia syndrome. However, to our knowledge this is the first study assessing enduring (cold pressor) pain and correlated EEG changes in fibromyalgia. EEG power and subjective pain ratings during the cold pressor test were analyzed and contrasted with tasks not involving sensory stimulation (rest, mental arithmetic and pain imagery) in 20 patients with fibromyalgia and 21 healthy control subjects. Fibromyalgia patients both perceived pain and judged pain as intolerable earlier than control subjects, while pain intensity ratings and EEG power changes during subjective awareness of pain were similar in both groups. In patients and control subjects, pain was correlated with a rise in delta, theta and beta power. EEG power spectra during pain imagery and mental arithmetic were significantly different from those observed during the cold pressor test. In conclusion, fibromyalgia patients seem to process painful stimuli abnormally in a quantitative sense, thus producing both the sensation of pain, as well as the associated EEG patterns, much earlier than control subjects. However, the quality of the pain-associated EEG changes seems similar.

Left prefrontal activation predicts therapeutic effects of repetitive transcranial magnetic stimulation (rTMS) in major depression

There is evidence that repetitive transcranial magnetic stimulation (rTMS) applied to the prefrontal cortex has antidepressive properties. In the present study we evaluated the clinical status and the hemodynamic responses during mental work in the prefrontal cortex before therapeutic rTMS. Twelve patients diagnosed with major depression (DSM-IV) were randomized in a sham-controlled cross-over treatment protocol of 4 weeks' duration consisting of two periods of 5 days with rTMS separated by 9 days of no stimulation. rTMS (10 Hz) was applied to the left dorsolateral prefrontal cortex. Hemodynamic changes in the prefrontal cortex during mental work were evaluated by multi-site near-infrared spectroscopy (NIRS). Scores on the Hamilton Depression Rating Scale (HAMD) decreased significantly by -5.4 points after 5 days of active stimulation, whereas it did not change (+1.6 points) after sham stimulation. Absence of a task-related increase of total hemoglobin concentrations at the stimulation site (P<0.005), but not at other locations, before the first active rTMS significantly predicted the clinical response to active rTMS. Clinical benefits of rTMS are predicted by low local hemodynamic responses and support the idea of activation-dependent targeting of rTMS location.

Measurement of structure-dependent K+ --> &mgr;(+)nu(&mgr;)gamma decay

We report the first measurement of a structure-dependent component in the decay K+-->&mgr;(+)nu(&mgr;)gamma. Using the kinematic region where the muon kinetic energy is greater than 137 MeV and the photon energy is greater than 90 MeV, we find that the absolute value of the sum of the vector and axial-vector form factors is |F(V)+F(A)| = 0.165+/-0.007+/-0.011. This corresponds to a branching ratio of B(SD+) = (1.33+/-0.12+/-0.18)x10(-5). We also set the limit -0. 04<F(V)-F(A)<0.24 at 90% C.L.

A single nucleotide polymorphism in the first intron of the human IFN-gamma gene: absolute correlation with a polymorphic CA microsatellite marker of high IFN-gamma production

We have described previously a variable length CA repeat sequence in the first intron of the human IFN-gamma gene and showed that allele #2 is associated with high in vitro IFN-gamma production. In a consecutive study, allele #2 was found to be associated with allograft fibrosis in lung transplant patients, confirming its role as a marker of high IFN-gamma production, both in vivo and in vitro. In this study we have sequenced 50 PCR products that had been typed previously by PAGE for the identification of CA microsatellite alleles. We report on a novel single nucleotide polymorphism, T to A, at the 5' end of the CA repeat region in the first intron of the human IFN-gamma gene (+874*T/A). There is an absolute correlation between the presence of T allele and the presence of the high-producing microsatellite allele #2. This T to A polymorphism coincides with a putative NF-kappa B binding site which might have functional consequences for the transcription of the human IFN-gamma gene. Therefore, the T to A polymorphism could directly influence the level of IFN-gamma production associated with the CA microsatellite marker.

A systematic review of the effectiveness of environmental awareness interventions

PURPOSE

To evaluate and summarize evidence on the effectiveness of interventions available to public health staff regarding the protection of the public from environmental risks.

METHOD

This systematic review involved a comprehensive literature search, screening for relevance, quality assessment of relevant studies, data extraction and synthesis.

RESULTS

Fourteen of 65 relevant studies were of 'moderate' or 'strong' quality. Intervention types in these 14 studies included: mass campaign, counselling, school curriculum, educational sessions, and distribution of printed materials. Short-term improvements in awareness or knowledge were observed in 13 of the 14 studies. Eight of 13 studies that examined behavioural outcomes observed short-term improvements in self-reported behavioural outcomes.

CONCLUSIONS

Positive short-term changes in health-protective awareness, knowledge and self-reported behaviour appear to be associated with relatively intensive interventions that use multiple methods and settings, and/or are delivered over multiple sessions.

Comparison of once- and twice-daily dosing of fluticasone propionate 200 micrograms per day administered by diskus device in patients with asthma treated with or without inhaled corticosteroids

BACKGROUND

There are limited published data regarding the efficacy of once- versus twice-daily administration of flutica-sone propionate.

OBJECTIVE

Our purpose was to evaluate the effectiveness of fluticasone propionate powder 200 microg/d administered as a once- or twice-daily dosage regimen in patients who were currently being treated with bronchodilators only (BD patients) and in patients who required inhaled corticosteroids for maintenance treatment of asthma (ICS patients).

METHODS

Five hundred seventy patients were randomly assigned to receive one of the following inhaled treatments through the Diskus device (Glaxo Wellcome, Research Triangle Park, NC) for 12 weeks: fluticasone propionate 100 microg twice daily (FP100BID) or 200 microg once daily (FP200QD) or placebo.

RESULTS

BD patients treated with FP100BID, FP200QD, and placebo had mean increases in FEV(1) from baseline to end point of 0. 49 L, 0.37 L, and 0.21 L, respectively (P <.001, FP100BID vs placebo; P =.05, FP200QD vs placebo). ICS patients treated with FP100BID and FP200QD had mean increases in FEV(1) of 0.27 L and 0.11 L, respectively, compared with a decrease in FEV(1) of -0.08 L with placebo (P <.001, FP100BID vs placebo; P =.023, FP200QD vs placebo). BD patients treated with FP100BID and FP200QD had mean increases in morning peak expiratory flow from baseline to end point of 31 L/min and 27 L/min, respectively, compared with a 1 L/min increase in patients treated with placebo. ICS patients treated with FP100BID had a mean increase in morning peak expiratory flow (from baseline to end point) of 18 L/min compared with mean decreases of -3 L/min and -12 L/min in the FP200QD and placebo groups, respectively. More patients were withdrawn from placebo (26% and 48%, in BD and ICS patients, respectively) than from fluticasone propionate (7%-9% [BID-QD] and 18%-32% [BID-QD], in BD and ICS patients, respectively) because of failure to meet predetermined asthma stability criteria.

CONCLUSION

The efficacies of FP100BID and FP200QD were comparable with regard to improvement in pulmonary function and asthma stability in BD patients. In ICS patients, asthma control was maintained with FP200QD, whereas FP100BID provided greater improvements in pulmonary function and asthma stability.

[Is presentation of symptoms enough for detection of an illness? On the correlation between symptoms, findings, diagnosis and disability]

In 1999, the IV. civil division of the German Federal Supreme Court has issued a verdict which states that for some diseases the medical proof of a disease may be established solely on grounds of the individual complaints supporting the respective diagnosis. In the eyes of the psychiatrist, this statement is wrong and results from a confusion of diagnosis and disease. It also reveals a curious misconception of how psychiatric diagnoses, as instances of non-physical disorders, are established. Responsible for the confusion are the modern diagnostic manuals, which are misunderstood and thus misused as containing a list of diseases. However, the diagnostic manuals only intend to classify characteristic complexes of complaints and signs, without establishing them as diseases. The present paper explores the relationship between diagnosis and disease and explains how psychiatric diagnoses are made.

Saccharomyces cerevisiae RAI1 (YGL246c) is homologous to human DOM3Z and encodes a protein that binds the nuclear exoribonuclease Rat1p

The RAT1 gene of Saccharomyces cerevisiae encodes a 5'-->3' exoribonuclease which plays an essential role in yeast RNA degradation and/or processing in the nucleus. We have cloned a previously uncharacterized gene (YGL246c) that we refer to as RAI1 (Rat1p interacting protein 1). RAI1 is homologous to Caenorhabditis elegans DOM-3 and human DOM3Z. Deletion of RAI1 confers a growth defect which can be complemented by an additional copy of RAT1 on a centromeric vector or by directing Xrn1p, the cytoplasmic homolog of Rat1p, to the nucleus through the addition of a nuclear targeting sequence. Deletion of RAI1 is synthetically lethal with the rat1-1(ts) mutation and shows genetic interaction with a deletion of SKI2 but not XRN1. Polysome analysis of an rai1 deletion mutant indicated a defect in 60S biogenesis which was nearly fully reversed by high-copy RAT1. Northern blot analysis of rRNAs revealed that rai1 is required for normal 5.8S processing. In the absence of RAI1, 5.8S(L) was the predominant form of 5.8S and there was an accumulation of 3'-extended forms but not 5'-extended species of 5. 8S. In addition, a 27S pre-rRNA species accumulated in the rai1 mutant. Thus, deletion of RAI1 affects both 5' and 3' processing reactions of 5.8S rRNA. Consistent with the in vivo data suggesting that RAI1 enhances RAT1 function, purified Rai1p stabilized the in vitro exoribonuclease activity of Rat1p.

Neuroprotective effect of postischemic administration of progesterone in spontaneously hypertensive rats with focal cerebral ischemia

OBJECT

Exogenous progesterone has been shown to reduce brain edema and ischemia-induced cell damage and to improve physiological and neurological function during the early stage of focal cerebral ischemia. In the present study, the authors assessed the neuroprotective potential of progesterone during the late stage of ischemia in a transient middle cerebral artery (MCA) occlusion model in the rat.

METHODS

Forty-eight male spontaneously hypertensive rats were randomly assigned to six groups. Progesterone was dissolved in dimethyl sulfoxide (DMSO). In four groups of rats, the dissolved progesterone (4 mg/kg or 8 mg/kg) was administered for 2 or 7 days after ischemia. In two control groups DMSO was administered for 2 or 7 days after ischemia. Occlusion of the MCA was induced by insertion of an intraluminal suture, and reperfusion was accomplished by withdrawal of the suture. Treatment was initiated on reperfusion, which followed 2 hours of MCA occlusion, and continued once a day. Lesion volume, neurological deficit, and body weight loss were measured 2 or 7 days after ischemia, depending on the animal group. Treatment with a high dose of progesterone (8 mg/kg) resulted in reductions in lesion size, neurological deficits, and body weight, compared with control rats.

CONCLUSIONS

Administration of progesterone to male rats 2 hours after MCA occlusion reduces ischemic brain damage and improves neurological deficit even 7 days after ischemia.

A systematic review of the effectiveness of environmental awareness interventions

PURPOSE

To evaluate and summarize evidence on the effectiveness of interventions available to public health staff regarding the protection of the public from environmental risks.

METHOD

This systematic review involved a comprehensive literature search, screening for relevance, quality assessment of relevant studies, data extraction and synthesis.

RESULTS

Fourteen of 65 relevant studies were of 'moderate' or 'strong' quality. Intervention types in these 14 studies included: mass campaign, counselling, school curriculum, educational sessions, and distribution of printed materials. Short-term improvements in awareness or knowledge were observed in 13 of the 14 studies. Eight of 13 studies that examined behavioural outcomes observed short-term improvements in self-reported behavioural outcomes.

CONCLUSIONS

Positive short-term changes in health-protective awareness, knowledge and self-reported behaviour appear to be associated with relatively intensive interventions that use multiple methods and settings, and/or are delivered over multiple sessions.

Mode dynamics of interacting neural populations by bi-orthogonal spectral decomposition

A system of coupled bistable Hopf oscillators with an external periodic input source was used to model the ability of interacting neural populations to synchronize and desynchronize in response to variations of the input signal. We propose that, in biological systems, the settings of internal and external coupling strengths will affect the behaviour of the system to a greater degree than the input frequency. While input frequency and coupling strength were varied, the spatio-temporal dynamics of the network was examined by the bi-orthogonal decomposition technique. Within this method, effects of variation of input frequency and coupling strength were analyzed in terms of global, spatial and temporal mode entropy and energy, using the spatio-temporal data of the system. We observed a discontinuous evolution of spatio-temporal patterns depending sensitively on both the input frequency and the internal and external coupling strengths of the network.

Malignant melanoma occurring within a previously irradiated area

The commonest radiation-induced neoplasms are sarcomas. Ionizing radiation is not usually associated with the development of malignant melanoma. We report two patients with malignant melanoma occurring within a previously irradiated area. There is evidence to support radiation in the pathogenesis of melanoma but the family histories, especially in one patient, suggest that genetic mutations may also have played a role, particularly in relation to the short latent period.

Effects of a clinical-practice guideline and practice-based education on detection and outcome of depression in primary care: Hampshire Depression Project randomised controlled trial

BACKGROUND

Depression is a major individual and public-health burden throughout the world and is managed mainly in primary care. The most effective strategy to reduce this burden has been believed to be education of primary-care practitioners. We tested this assumption by assessing the effectiveness of an educational programme based on a clinical-practice guideline in improving the recognition and outcome of primary-care depression.

METHODS

We carried out a randomised controlled trial in a representative sample of 60 primary-care practices (26% of the total) in an English health district. Education was delivered to practice teams and quality tested by feedback from participants and expert raters. The primary endpoints were recognition of depression, defined by the hospital anxiety and depression (HAD) scale, and clinical improvement. Analysis was by intention to treat.

FINDINGS

The education was well received by participants, 80% of whom thought it would change their management of patients with depression. 21409 patients were screened, of whom 4192 were classified as depressed by the HAD scale. The sensitivity of physicians to depressive symptoms was 39% in the intervention group and 36% in the control group after education (odds ratio 1.2 [95% CI 0.88-1.61]). The outcome of depressed patients as a whole at 6 weeks or 6 months after the assessment did not significantly improve.

INTERPRETATION

Although well received, this in-practice programme, which was designed to convey the current consensus on best practice for the care of depression, did not deliver improvements in recognition of or recovery from depression.

The Toll-like receptor 2 is recruited to macrophage phagosomes and discriminates between pathogens

Macrophages orchestrate innate immunity by phagocytosing pathogens and coordinating inflammatory responses. Effective defence requires the host to discriminate between different pathogens. The specificity of innate immune recognition in Drosophila is mediated by the Toll family of receptors; Toll mediates anti-fungal responses, whereas 18-wheeler mediates anti-bacterial defence. A large number of Toll homologues have been identified in mammals, and Toll-like receptor 4 is critical in responses to Gram-negative bacteria. Here we show that Toll-like receptor 2 is recruited specifically to macrophage phagosomes containing yeast, and that a point mutation in the receptor abrogates inflammatory responses to yeast and Gram-positive bacteria, but not to Gram-negative bacteria. Thus, during the phagocytosis of pathogens, two classes of innate immune receptors cooperate to mediate host defence: phagocytic receptors, such as the mannose receptor, signal particle internalization, and the Toll-like receptors sample the contents of the vacuole and trigger an inflammatory response appropriate to defence against the specific organism.

Work practices and histopathological changes in the tenosynovium and flexor retinaculum in carpal tunnel syndrome in women

We studied 58 women of employable age with the carpal tunnel syndrome in order to determine whether the histological appearances of the carpal tunnel, tenosynovium and flexor retinaculum are influenced by work practices. Age, body mass index and the duration of symptoms did not correlate with the extent of oedema or fibrosis within the tenosynovium. The incidence of abnormality on histological examination of the tenosynovium was the same in employed and unemployed patients (p = 1.0), and was not influenced by the level of repetition (p = 0.89) or force (p = 0.29) of work. Myxoid degeneration within the flexor retinaculum was, however, more common in women undertaking ‘high-force’ work. Apart from this finding, the results suggest that work practices do not affect tenosynovial thickening, fibrosis or oedema in patients with carpal tunnel syndrome.