Age of onset and course of major depressive disorder: associations with psychosocial functioning outcomes in adulthood

BACKGROUND

Major depressive disorder (MDD) that onsets by adolescence is associated with various deficits in psychosocial functioning. However, adolescent-onset MDD often follows a recurrent course that may drive its associated impairment.

METHOD

To tease apart these two clinical features, we examined the relative associations of age of onset (adolescent versus adult) and course (recurrent versus single episodes) of MDD with a broad range of psychosocial functioning outcomes assessed in early adulthood. Participants comprised a large, population-based sample of male and female twins from the Minnesota Twin Family Study (MTFS; n = 1252) assessed prospectively from ages 17 to 29 years.

RESULTS

A recurrent course of MDD predicted impairment in several psychosocial domains in adulthood, regardless of whether the onset was in adolescence or adulthood. By contrast, adolescent-onset MDD showed less evidence of impairment in adulthood after accounting for recurrence. Individuals with both an adolescent onset and recurrent episodes of MDD represented a particularly severe group with pervasive psychosocial impairment in adulthood.

CONCLUSIONS

The negative implications of adolescent-onset MDD for psychosocial functioning in adulthood seem to be due primarily to its frequently recurrent course, rather than its early onset, per se. The results highlight the importance of considering both age of onset and course for understanding MDD and its implications for functioning, and also in guiding targeted intervention efforts.

Publish or perish: strategies to help rural early career researchers increase publication output

INTRODUCTION

Researchers are challenged to publish or perish. A range of barriers to writing can result in sub-optimal productivity, particularly for early career researchers. Researchers in rural areas may face additional challenges of distance and limited access to colleagues. Implementing strategies to address some of these obstacles was identified as a priority for a group of early career, rural researchers.

METHODS

In late 2010, the Wiljo-Piri Writing Group was established, embarking on fortnightly lunch-time meetings for support, networking and the public setting of writing goals; and arranging pairing of 'writing buddies' committed to writing daily, with contact before and/or after each writing session to provide motivation and accountability. Key measures for improvement were publication output (publications per person per year (PPY)) and perceptions of effectiveness of strategies.

RESULTS

Publication output varied between individuals and over time; overall PPY rates improved from 0.5 to 1.25. 'Buddy writing' helped facilitate adherence to routine writing sessions and was associated with perceptions of increased creativity, efficiency, confidence and ability to focus.

CONCLUSIONS

Structured peer support can be a powerful tool to create and maintain regular writing practices and increase publication output. 'Buddy writing' is applicable to any research or academic setting, and helps maintain commitment to daily writing sessions. Furthermore, such interventions can provide peer support for those working in rural settings, helping to address issues such as geographical and professional isolation. Suggested key steps in establishing structured peer support are provided.

Prevalence of Trichomonas vaginalis, Mycoplasma genitalium and Ureaplasma urealyticum in men with urethritis attending an urban sexual health clinic

We conducted a study to determine the prevalence of Trichomonas vaginalis (TV), Mycoplasma genitalium (MG) and Ureaplasma urealyticum (UU) in men with urethritis, attending an urban sexual health clinic, in order to inform screening and treatment policies. Men attending an urban sexual health clinic between June 2011 and January 2012 were evaluated. Urine samples were collected from men with urethritis and tested for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (GC) and TV using transcription-mediated amplification and for MG and UU using polymerase chain reaction. Eighty-three samples were analysed. The prevalence of CT was 33.7% (28/83), GC was 16.8% (14/83), TV was 3.6% (3/83), MG was 12.0% (10/83) and UU was 4.8% (4/83). Fifteen men had recurrent urethritis. Of these, three were found to have had TV, five to have had MG and none to have had UU, at initial presentation. Given the prevalence of MG in this study, there is an urgent need for further larger studies looking at optimal treatment regimens and screening strategies in urethritis.

Fetal effects of combined spinal-epidural vs epidural labour analgesia: a prospective, randomised double-blind study

We have compared fetal heart rate patterns, Apgar scores and umbilical cord gas values following initiation of labour analgesia using either combined spinal-epidural or epidural. One hundred and fifteen healthy women requesting neuraxial analgesia in the first stage of labour were randomly assigned to receive either combined spinal-epidural (n = 62) or epidural analgesia (n = 53). Fetal heart rate traces, recorded for 30 min before and 60 min after neuraxial block, were categorised as normal, suspicious or pathological according to national guidelines. Sixty-one fetal heart rate tracings were analysed in the combined spinal-epidural group and 52 in the epidural group. No significant differences were found in fetal heart rate patterns, Apgar scores or umbilical artery and vein acid-base status between groups. However, in both combined spinal-epidural and epidural groups, there was a significant increase in the incidence of abnormal fetal heart rate patterns following neuraxial analgesia (p < 0.0001); two before compared with eight after analgesia in the combined spinal-epidural group and zero before compared with 11 after in the epidural group. These changes comprised increased decelerations (p = 0.0045) (combined spinal-epidural group nine before and 14 after analgesia, epidural group four before and 16 after), increased late decelerations (p < 0.0001) (combined spinal-epidural group zero before and seven after analgesia, epidural group zero before and eight after), and a reduction in acceleration rate (p = 0.034) (combined spinal-epidural group mean (SD) 12.2 (6.7) h(-1) before and 9.9 (6.1) h(-1) after analgesia, epidural group 11.0 (7.3) h(-1) before and 8.4 (5.9) h(-1) after). These fetal heart rate changes did not affect neonatal outcome in this healthy population.

Can a white nurse get it? 'Reflexive practice' and the non-Indigenous clinician/researcher working with Aboriginal people

CONTEXT

Reflexivity is crucial for non-Aboriginal researchers working with Aboriginal people. This article describes a process of 'reflexive practice' undertaken by a white clinician/researcher while working with Aboriginal people. The clinician/researcher elicited Aboriginal people's experience of being haemodialysis recipients in rural Australia and their perceptions of their disease and treatment. The aim of this article is to report the methods used during this qualitative project to guide the researcher in conducting culturally appropriate health research with Aboriginal people. The goal of this work was to improve health services, informed and guided by the Aboriginal recipients themselves. The article describes the theory and methods used to develop reflexive skills. It also reports how the clinician/researcher managed her closeness to the topic and participants (some being patients under her care) and the processes used to ensure her subjectivity did not interfere with the quality of research.

ISSUES

Three layers of reflexive practice are described: examining self within the research, examining interpersonal relationships with participants, and examining health systems. The alignment of the three 'lenses' used to describe the study is exposed. Complex insider/outsider roles are explored through multiple layers of reflexive practice. Regular journal writing was the primary tool used to undertake this reflexive practice. An Aboriginal advisory group and co-investigators collaborated and assisted the clinician/researcher to scrutinise and understand her positioning within the study. Researcher positioning, power and unequal relationships are discussed. Issues such as victim blaming and the disconnect between clinicians' views about treatment compliance and Aboriginal peoples' prioritisation of family obligations for before treatment are presented.

LESSONS LEARNED

Aboriginal patients must negotiate a health services system where racism and victim blaming are institutionalised, but the effect of these on the research relationship can be mitigated through reflexive practice. Using a framework for relational accountability that incorporates respect, responsibility and reciprocity can enable non-Aboriginal clinicians and/or researchers to work effectively with Aboriginal patients. These results may assist clinicians and policy makers develop strategies for improving quality of care.

A late IL-33 response after exposure to Schistosoma haematobium antigen is associated with an up-regulation of IL-13 in human eosinophils

IL-33, a proposed alarmin, stimulates innate immune cells and Th2 cells to produce IL-13 and is rapidly upregulated upon antigen exposure in murine helminth infection. The human IL-33 response to helminth antigen was analysed in Malians infected with Schistosoma haematobium by disrupting parasite integrity via chemotherapy. Plasma IL-33 was measured pretreatment, and 24 h and 9 weeks post-treatment. At 24 h post-treatment, IL-33 levels were low. Nine week post-treatment IL-33 levels were elevated and were associated with an increase in intracellular IL-13 in eosinophils. Up-regulation of intracellular IL-13 in eosinophils was also associated with eosinophil expression of ST2L, the IL-33 receptor. IL-33 may play an important downstream role in the human response to schistosome adult worm antigen exposure.

Prospective inter-relationships between late adolescent personality and major depressive disorder in early adulthood

BACKGROUND

A well-established body of literature demonstrates concurrent associations between personality traits and major depressive disorder (MDD), but there have been relatively few investigations of their dynamic interplay over time.

METHOD

Prospective inter-relationships between late-adolescent personality and MDD in early adulthood were examined in a community sample of male and female twins from the Minnesota Twin Family Study (MTFS; n = 1252). Participants were classified into naturally occurring MDD groups based on the timing (adolescent versus adult onset) and course (chronic/recurrent versus remitting) of MDD. MDD diagnoses were assessed at ages 17, 20, 24 and 29 years, and personality traits [negative emotionality (NEM), positive emotionality (PEM) and constraint (CON)] were assessed at ages 17, 24 and 29 years.

RESULTS

Multilevel modeling (MLM) analyses indicated that higher age-17 NEM was associated with the subsequent development of MDD, and any MDD, regardless of onset or course, was associated with higher NEM up to age 29. Moreover, the chronic/recurrent MDD groups failed to show the normative decrease in NEM from late adolescence to early adulthood. Lower age-17 PEM was also associated with the subsequent development of MDD but only among the chronic/recurrent MDD groups. Finally, the adolescent-onset MDD groups reported lower age-17 CON relative to the never-depressed and adult-onset MDD groups.

CONCLUSIONS

Taken together, the results speak to the role of personality traits for conferring risk for the onset of MDD in late adolescence and early adulthood, in addition to the pernicious implications of chronic/recurrent MDD, particularly when it onsets during adolescence, for adaptive personality development.

Docosahexaenoic acid (DHA) production by Thraustochytrium sp. ATCC 20892

Thraustochytrium sp. ATCC 20892 produced high yields of docosahexaenoic acid (DHA), more than four other strains of Thraustochytrium and Schizochytrium tested, but insignificant amounts of other polyunsaturated fatty acids. Glucose and sodium glutamate were the preferred carbon and nitrogen sources, respectively, and the optimum conditions for growth and DHA production were pH 7.0 at 25°C with 40 g glucose 1(-1) for 4 days. Temperature profiling under these optimum conditions further enhanced the yield and volumetric productivity of DHA.

A systematic review of interventions to promote social support and parenting skills in parents with an intellectual disability

The family support needs of parents with an intellectual disability (ID) are relatively unknown. This paper reviewed two types of intervention for parents with ID: those designed to strengthen social relationships and those teaching parenting skills. A literature search was conducted using electronic databases and a limited number of evaluative studies were found. The evidence for interventions aimed at strengthening social relationships was inconclusive; although positive changes were observed, there were limitations in study design which restricted the generalizability of the results. The evidence for parental skills teaching suggested that behavioural based interventions are more effective than less intensive forms such as lesson booklets and the provision of normal services, although these studies also had limitations. There is a need for further large scale controlled studies in this area to provide clearer evidence and to explore additional factors relating to child, parent and family which may impact on outcomes.

Abstract P6-06-04: Breast cancer in young women: Have the prognostic and predictive implications of breast cancer subtypes changed over time?

Background:

Breast cancer (BC) occurring in very young women has a worse prognosis compared to older women, and is the leading cause of cancer death in women aged &lt; 40 years. Over the last decade BC management has evolved to incorporate increased understanding of BC subtypes and new therapeutic agents such as taxanes and trastuzumab. Whether the previously observed poor prognosis associated with BC in young women persists in the context of modern adjuvant therapies and relative to the BC subtypes has not been widely investigated.

Methods:

We analyzed BC outcomes of young (40-49 years) and very young (&lt;40 years) patients (pts) according to subtype defined by immune histochemistry (IHC) and evaluated for any changes over time by comparing 2 cohorts representative of different time periods. Data from 1,101 women aged &lt; 50 diagnosed with invasive BC between 1986-1992, and 1,945 women diagnosed between 2004-2007 were abstracted from the British Columbia Cancer Agency's Breast Cancer Outcomes Database and analyzed according to two age categories (40 years and 40-49 years) and subtype (IHC was available on the earlier cohort from an established tumor repository for those years). Subtypes were defined as follows: Luminal: estrogen receptor (ER) and/or progesterone receptor (PR) positive, and HER2 negative, HER2: HER2 positive and any ER/PR, and Triple Negative (TN) (ie for ER,PR and HER2 negative). Survival analysis was performed using the Kaplan Meier method.

Results:

Median follow-up was 13.2 years and 6.2 years for the 1986-1992 and 2004-2007 cohorts respectively. Within both time cohorts, luminal subtype pts &lt;40 demonstrated worse survival compared with those 40-49. This difference remained after accounting for grade in the contemporary cohort alone (Hazard ratio 0.50 p = 0.0001). Inferior survival was observed for pts &lt;40 with HER2 BC in the 1986-1992 cohort, no impact of age was demonstrated in the HER2 2004-2007 cohort. No survival difference was seen between the age groups for TN BC in either time cohort. Across the HER2 and TN subtypes, and for luminal pts 40-49 a significant improvement was seen in 5-year RFS and OS between the 2 time cohorts. 5-year RFS but not OS improved over time for the luminal pts &lt;40.

5 year overall survival  1986-1992  2004-2007   5-yr OS (%)  5-yr OS (%) p value  (95% CI)  (95% CI)  Luminalage &lt; 4082 (76-89)  88 (84-93) 0.138 age 40-4990 (87-92)  95 (94-97) 0.001 p value0.055  &lt;0.001          HER2age &lt; 4049 (35-63)  89 (83-95) &lt;0.001 age 40-4966 (57-75)  89 (83-94) &lt;0.001 p value0.017  0.879          TNage &lt; 40 (101)67 (58-77)  82 (73-90) 0.011 age 40-49 (182)74 (67-80)  84 (79-89) &lt;0.001 p value0.909  0.759  

Conclusions:

We observed a significant improvement in survival over time for both HER2 and TN BC which may reflect improvements in adjuvant strategies based on subtype presentation. Inferior survival for pts &lt;40 with luminal BC persists in the modern era and this group should be targeted for research.

5 year relapse free survival  1986-1992  2004-2007    5-yr RFS (%)  5-yr RFS (%) p value  (95% CI)  (95% CI)  Luminalage&lt;4065(57-74)  79 (74-85) &lt;0.001 age 40-4977 (72-80)  92 (91-94) &lt;0.001 p value0.009  &lt;0.001          HER2age&lt;4039 (25-52)  81 (70-92) &lt;0.001 age 40-4958 (48-67)  84 (80-88) &lt;0.001 p value0.039  0.879          TNage&lt;4060 (51-70)  78 (69-87) 0.014 age 40-4963 (56-70)  77 (71-82) 0.001 p value0.868  0.933  

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-06-04.