Global variation in the prevalence and incidence of major depressive disorder: a systematic review of the epidemiological literature.

BACKGROUND: Summarizing the epidemiology of major depressive disorder (MDD) at a global level is complicated by significant heterogeneity in the data. The aim of this study is to present a global summary of the prevalence and incidence of MDD, accounting for sources of bias, and dealing with heterogeneity. Findings are informing MDD burden quantification in the Global Burden of Disease (GBD) 2010 Study. METHOD: A systematic review of prevalence and incidence of MDD was undertaken. Electronic databases Medline, PsycINFO and EMBASE were searched. Community-representative studies adhering to suitable diagnostic nomenclature were included. A meta-regression was conducted to explore sources of heterogeneity in prevalence and guide the stratification of data in a meta-analysis. RESULTS: The literature search identified 116 prevalence and four incidence studies. Prevalence period, sex, year of study, depression subtype, survey instrument, age and region were significant determinants of prevalence, explaining 57.7% of the variability between studies. The global point prevalence of MDD, adjusting for methodological differences, was 4.7% (4.4-5.0%). The pooled annual incidence was 3.0% (2.4-3.8%), clearly at odds with the pooled prevalence estimates and the previously reported average duration of 30 weeks for an episode of MDD. CONCLUSIONS: Our findings provide a comprehensive and up-to-date profile of the prevalence of MDD globally. Region and study methodology influenced the prevalence of MDD. This needs to be considered in the GBD 2010 study and in investigations into the ecological determinants of MDD. Good-quality estimates from low-/middle-income countries were sparse. More accurate data on incidence are also required.

Health-related quality of life in Swiss adolescents with asthma. Validation of the AAQOL-D and comparison with Australian adolescents.

PRINCIPLES: The Adolescent Asthma Quality of Life Questionnaire (AAQOL) is the only asthma-specific quality-of-life questionnaire to date for use specifically in adolescents. The aim of this study was translation of the AAQOL into German, revalidation of the German version (AAQOL-D) and comparison of health-related quality of life (HRQOL) in Swiss and Australian adolescents. METHODS: 60 adolescents with frequent episodic or persistent asthma aged 12-17 years were recruited. The standardised method consisted of (1) translation of the AAQOL; (2) additional item selection via semistructured interviews (n = 11); (3) item reduction and re-validation (n = 56). For item reduction the clinical impact method was applied. RESULTS: The same 32 items were identified as relevant for the AAQOL-D as in the original version (AAQOL). Internal consistency for the 6 dimensions and the total score was high (alpha = 0.76-0.87). Despite consideration of psychosocial aspects relevant to adolescents, high correlation with the Pediatric Asthma Quality of Life Questionnaire was confirmed for the AAQOL-D (rho = 0.85; p <0.0001). Correlation with a health status thermometer consisted in rho = 0.74 (p <0.0001). There was moderate correlation with clinical parameters of asthma severity (rho = 0.51-0.73; p < or = 0.0002), not however with frequency of medication (rho = 0.22; p = 0.13). Comparison of Swiss and Australian adolescents showed that Swiss adolescents were more bothered by cigarette smoke and the need to avoid places where cigarettes were smoked. CONCLUSIONS: The AAQOL-D is a valid multidimensional instrument in German for assessing HRQOL of adolescents with asthma. HRQOL of Swiss adolescents with asthma may be enhanced by implementing non-smoking policies promoting smoke-free environments.

Trehalose metabolism genes in Caenorhabditis elegans and filarial nematodes.

The sugar trehalose is claimed to be important in the physiology of nematodes where it may function in sugar transport, energy storage and protection against environmental stresses. In this study we investigated the role of trehalose metabolism in nematodes, using Caenorhabditis elegans as a model, and also identified complementary DNA clones putatively encoding genes involved in trehalose pathways in filarial nematodes. In C. elegans two putative trehalose-6-phosphate synthase (tps) genes encode the enzymes that catalyse trehalose synthesis and five putative trehalase (tre) genes encode enzymes catalysing hydrolysis of the sugar. We showed by RT-PCR or Northern analysis that each of these genes is expressed as mRNA at all stages of the C. elegans life cycle. Database searches and sequencing of expressed sequence tag clones revealed that at least one tps gene and two tre genes are expressed in the filarial nematode Brugia malayi, while one tps gene and at least one tre gene were identified for Onchocerca volvulus. We used the feeding method of RNA interference in C. elegans to knock down temporarily the expression of each of the tps and tre genes. Semiquantitative RT-PCR analysis confirmed that expression of each gene was silenced by RNA interference. We did not observe an obvious phenotype for any of the genes silenced individually but gas-chromatographic analysis showed >90% decline in trehalose levels when both tps genes were targeted simultaneously. This decline in trehalose content did not affect viability or development of the nematodes.

Differential validity of the Defense Mechanism Manual for the TAT between Asian Americans and Whites. Thematic Apperception Test.

Thematic Apperception Test (Murray, 1943) responses of 69 Asian American (hereafter, Asian) and 83 White students were coded for defenses according to the Defense Mechanism Manual (Cramer, 1991b) and studied for differential validity in predicting paper-and-pencil measures of relevant constructs. Three tests for differential validity were used: (a) differences between validity coefficients, (b) interactions between predictor and ethnicity in criterion prediction, and (c) differences between groups in mean prediction errors using a common regression equation. Modest differential validity was found. It was surprising that the DMM scales were slightly stronger predictors of their criteria among Asians than among Whites and when a common predictor was used, desirable criteria were overpredicted for Asians, whereas undesirable ones were overpredicted for Whites. The results were not affected by acculturation level or English vocabulary among the Asians.

Implications of vancomycin degradation products on therapeutic drug monitoring in patients with end-stage renal disease.

In renally impaired patients, vancomycin concentrations typically are maintained at body temperature for extended periods of time due to the drug's prolonged half-life. Both time and increased temperature potentiate production of vancomycin crystalline degradation products (CDP-1). Commercially available vancomycin assays, such as fluorescence polarization immunoassay (FPI) and radioimmunoassay, cross-react with CDP-1 isomers. Overestimation of vancomycin concentrations by 40-53% due to cross-reactivity of CDP-1 with active factor B vancomycin occurs with FPI. As FPI is the most common method of analyzing serum vancomycin, clinicians must be aware of its potential shortcomings and be prepared to alter vancomycin dosages in renally impaired patients. The possibility of adverse affects due to elevated concentrations of CDP-1 or therapeutic failures due to subtherapeutic levels of factor B vancomycin cannot be excluded.

A study of hepatic mitochondrial respiration and microsomal cytochrome P450 content in mice infected with the liver fluke Fasciola hepatica.

Previous studies of the effects of infection of Wistar rats with the common liver fluke, Fasciola hepatica, on liver bioenergetic and drug metabolism have demonstrated a loss of respiratory control in isolated mitochondria and reduced microsomal cytochrome P450 content, respectively, from 2 weeks post-infection throughout the acute phase of the infection. In the present study male Balb/c mice infected with F. hepatica showed a loss of respiratory control in isolated liver mitochondria only at 4 weeks post-infection. A similar time course was demonstrated for a reduction in hepatic microsomal cytochrome P450 content. Preparations from infected CBA mice showed similar changes to Balb/c mice but mitochondrial respiration in preparations from infected Swiss outbred mice was normal. A host difference between strains of mice and between mice and rats is therefore evident in the timing and extent of liver mitochondrial dysfunction and in the timing of the decrease in the cytochrome P450 content of hepatic microsomes. This difference between hosts may be related to the reported differences in cellular inflammatory responses to the migrating juvenile flukes in the livers of rats and mice.

Evaluation of two adaptive sodium nitroprusside control algorithms.

Computer control of sodium nitroprusside infusion may be safer and provide better control of arterial blood pressure than is achieved with manual control. In a series of test maneuvers in 20 mongrel dogs, the performance of two adaptive control algorithms (controllers) was compared and their safety tested. The controllers were set to infuse sodium nitroprusside to decrease mean arterial pressure and maintain it 20 to 30 mm Hg below the control pressure. Then, sequentially, the right atrium was paced to simulate a supraventricular tachydysrhythmia, the right ventricle was intermittently paced to simulate ventricular extrasystoles, large tidal volumes were given to simulate a respiratory-therapy maneuver, the catheter was clamped to simulate clotting, an air bubble was introduced, and the infused sodium nitroprusside concentrations were either doubled or halved. Next, 500 ml of blood was drawn. Then, in sequence, positive end-expiratory pressure was applied, the right atrium was paced, and large tidal volume breaths were given to cause the blood pressure to fluctuate. When the controllers were turned on, mean arterial pressure reached the set point and remained within 5 mm Hg of the target pressure after 8.6 +/- 0.9 minutes (mean +/- SEM). The controllers properly handled the differences in sodium nitroprusside sensitivity and the catastrophic challenges presented in the experiments. When the animals were not being disturbed, stability was maintained and the blood pressure was kept well within 5 mm Hg of the desired pressure. The controllers rejected all invalid pressure signals during testing.(ABSTRACT TRUNCATED AT 250 WORDS)

Planning services for the intellectually handicapped in North Canterbury.

The development of a wider range of service alternatives for the care of the intellectually handicapped (IH) has led to the establishment of multiple agencies in the field of service provision. A multi-agency, multi-disciplinary working party has undertaken a survey of all IH persons in the area, including an assessment of problems in service provision. There were a total of 2330 IH persons in the area. The prevalence rate for North Canterbury is 3.94 per 1000 which is substantially higher than the New Zealand figure of 3.29 of a previous survey. The working party has sponsored communication and mutual understanding and support through workshops, the formation of a parents committee and an information exchange system.

Abortion.

PIP: A survey of 886 adults over 16 was conducted regarding abortion in Papanui, New Zealand. Only 7.79% thought a person should never have an abortion under any circumstances, 16.70% thought the decision to have an abortion should be decided by a panel of two doctors, a social worker, and a statutory committee set up by the government. 44.4% thought the decision should be between a woman and the doctor of her choice. 20.54% thought the decision should be made solely by the woman concerned. The respondants had thought about the question. Other surveys in different electorates reflected similar views. It is hoped that people's opinions will influence legislators to enact more liberal abortion laws.^ieng

The selective action of beta-adrenoceptor blocking drugs and the nature of beta1 and beta2 adrenoceptors.

1 Purified membranes retaining a catecholamine responsive adenylate cyclase have prepared from rabbit heart, lung and (pseudo-pregnant) uterus. 2 These preparations have the characteristics of plasma membranes and both heart and lung respond to beta-adrenoceptor agonists in the order: (+/-)-isoprenaline greater than (-)-noradrenaline greater than (-)-adrenaline greater than (+)-isoprenaline greater than salbutamol. The sensitivity of the adenylate cyclase to beta-adrenoceptor stimulation is improved by pre-treatment of the animals with reserpine and syrosingopine. 3 Dose-ratios for several concentrations of propranolol (non-selective beta-adrenoceptor blocker), practolol and atenolol (cardio-selective beta-adrenoceptor blockers) have been measured on all three membrane preparations. Schild plots of log (dose ratio -1) vs. log dose were virtually coincident for heart and lung with a dissociation constant (Kb) for propranolol very close to the pharmacological value. The ratio of Kb values was 0.65 for practolol and 1.23 for atenolol compared with pharmacological cardio-selectivity ratios (measured on isolated atria and tracheal chain) of 67.6 and 110 respectively. The uterus/heart Kb ratio was 51.5 for atenolol. Inhibition of the uterus by practolol gave a Schild plot with slope significantly less than 1, indicating a different mechanism of action from the heart. 4 Kb values obtained by measuring adenylate cyclase stimulation in chopped tissue (including preparations of bronchial tree and alveolar tissue as well as whole lung) resembled the membrane values rather than those found in whole organs. 5 The results show that the pharmacological selectivity of practolol and atenolol is maintained at the receptor-adenylate cyclase level, at least as far as heart and uterus are concerned, though the smaller selectivity ratios in the biochemical system suggest that receptor differences is not the only factor and that phase distribution of the drug may also be important. Membranes prepared from whole lung show that phase distribution of the drug may also be important. Membranes prepared from whole lung show an overall beta1 response which may simply reflect the predominance of beta1 cell types containing beta1-adrenoceptors over bronchial smooth muscle.

Cardiotonic steroids: correlation of sodium-potassium adenosine triphosphate inhibition and ion transport in vitro with inotropic activity and toxicity in dogs.

1. A new series of cardiotonics based on five steroid nuclei has been evaluated for inhibition of Na-+/K-+-ATPase and Rb uptake by red blood cells, and for inotropic activity and toxicity in dogs. Structure-activity relationships are discussed. 2. The in vitro tests can be used satisfactorily to predict inotropic activity, but not toxicity or therapeutic ratio. 3. Although compounds with greatly improved therapeutic ratios relative to ouabain and tolusin have been obtained, they proved to be strongly emetic in the conscious dog.