Effect of depression on mortality and cardiovascular morbidity in type 2 diabetes mellitus after 3 years follow up. The DIADEMA study protocol.

BACKGROUND: Type 2 diabetes mellitus and depression are highly prevalent diseases that are associated with an increased risk of cardiovascular disease and mortality. There is evidence about a bidirectional association between depressive symptoms and type 2 diabetes mellitus. However, prognostic implications of the joint effects of these two diseases on cardiovascular morbidity and mortality are not well-known. METHOD/DESIGN: A three-year, observational, prospective, cohort study, carried out in Primary Health Care Centres in Madrid (Spain). The project aims to analyze the effect of depression on cardiovascular events, all-cause and cardiovascular mortality in patients with type 2 diabetes mellitus, and to estimate a clinical predictive model of depression in these patients.The number of patients required is 3255, all them with type 2 diabetes mellitus, older than 18 years, who regularly visit their Primary Health Care Centres and agree to participate. They are chosen by simple random sampling from the list of patients with type 2 diabetes mellitus of each general practitioner.The main outcome measures are all-cause and cardiovascular mortality and cardiovascular morbidity; and exposure variable is the major depressive disorder.There will be a comparison between depressed and not depressed patients in all-cause mortality, cardiovascular mortality, coronary artery disease and stroke using the Chi-squared test. Logistic regression with random effects will be used to adjust for prognostic factors. Confounding factors that might alter the effect recorded will be taken into account in this analysis. To assess the effect of depression on the mortality, a survival analysis will be used comparing the two groups using the log-rank test. The control of potential confounding variables will be performed by the construction of a Cox regression model. DISCUSSION: Our study's main contribution is to evaluate the increase in the risk of cardiovascular morbidity and mortality, in depressed Spanish adults with type 2 diabetes mellitus attended in Primary Health Care Setting. It would also be useful to identify subgroups of patients for which the interventions could be more beneficial.

Language skills and nonverbal cognitive processes associated with reading comprehension in deaf children.

The main aim of this study was to examine the relationship between language skills (vocabulary knowledge and phonological awareness), nonverbal cognitive processes (attention, memory and executive functions) and reading comprehension in deaf children. Participants were thirty prelingually deaf children (10.7 ± 1.6 years old; 18 boys, 12 girls), who were classified as either good readers or poor readers by their scores on two reading comprehension tasks. The children were administered a rhyme judgment task and seven computerized neuropsychological tasks specifically designed and adapted for deaf children to evaluate vocabulary knowledge, attention, memory and executive functions in deaf children. A correlational approach was also used to assess the association between variables. Although the two groups did not show differences in phonological awareness, good readers showed better vocabulary and performed significantly better than poor readers on attention, memory and executive functions measures. Significant correlations were found between better scores in reading comprehension and better scores on tasks of vocabulary and non-verbal cognitive processes. The results suggest that in deaf children, vocabulary knowledge and nonverbal cognitive processes such as selective attention, visuo-spatial memory, abstract reasoning and sequential processing may be especially relevant for the development of reading comprehension.