Physical comorbidities of older age bipolar disorder (OABD) patients: A global replication analysis of prevalence and sex differences.

OBJECTIVES: To compare the prevalence of physical morbidities between older aged patients with bipolar disorder (OABD) and non-psychiatric comparisons (NC), and to analyze sex differences in prevalence. METHODS: OABD was defined as bipolar disorder among adults aged ≥50 years. Outcomes analyzed were the prevalence of diseases affecting the cardiovascular, respiratory, gastrointestinal, genitourinary, renal, musculoskeletal, and endocrine systems. The analysis used cross-sectional data of OABD participants (n = 878; mean age 60.9 ± 8.0 years, n = 496 (56%) women) from the collaborative Global Aging & Geriatric Experiments in Bipolar Disorder (GAGE-BD) dataset and NC participants recruited at the same sites (n = 355; mean age 64.4 ± 9.7 years, n = 215 (61%) women). RESULTS: After controlling for sex, age, education, and smoking history, the OABD group had more cardiovascular (odds ratio [95% confidence interval]: 2.12 [1.38-3.30]), renal (5.97 [1.31-43.16]), musculoskeletal (2.09 [1.30-3.43]) and endocrine (1.90 [1.20-3.05]) diseases than NC. Women with OABD had more gastrointestinal (1.56 [0.99-2.49]), genitourinary (1.72 [1.02-2.92]), musculoskeletal (2.64 [1.66-4.37]) and endocrine (1.71 [1.08-2.73]) comorbidities than men with OABD, when age, education, smoking history, and study site were controlled. CONCLUSIONS: This replication GAGE-BD study confirms previous findings indicating that OABD present more physical morbidities than matched comparison participants, and that this health burden is significantly greater among women.

Detection of contraband drugs in forensic-correctional mental health services using TeknoScan-a gas chromatography tool.

Substance misuse is a major problem among individuals involved in forensic-correctional mental health services. Urine drug screening detects substance use and deters the entry of contraband into forensic-correctional units, albeit with limitations. For example, a point-of-care urine sample may not be possible and patients can alter or substitute samples to avoid detection, highlighting the role of ancillary tools to detect contraband substances. This study describes the pattern and types of substances detected from environmental samples using a gas chromatographic analyzer (TeknoScan TSI3000) in forensic-correctional populations to model the benefits of similar tools in similar settings. Samples collected over 18 months (January 2020 to June 2021) by trained staff members using the machine were reviewed. During this period, 217 environmental samples were recorded, and 66 (30%) samples were positive for contraband substances, including tetrahydrocannabinol (25%), methamphetamines (19%), and cocaine (16%). Other substances detected include methylene-dioxymethamphetamine, heroin, morphine, lysergic acid diethylamide, tramadol, and methyl-benzoate. Fewer positive samples were detected, especially during the time corresponding with the COVID-19 restriction on the forensic units. TeknoScan was beneficial as an ancillary tool to detect and deter contraband substances. It also provided evidence for risk management. Adequate training is needed for the successful implementation of the tool.

Health trends in Canada 1990-2019: An analysis for the Global Burden of Disease Study.

OBJECTIVE: Monitoring trends in key population health indicators is important for informing health policies. The aim of this study was to examine population health trends in Canada over the past 30 years in relation to other countries. METHODS: We used data on disability-adjusted life years (DALYs), years of life lost (YLL), years lived with disability, life expectancy (LE), and child mortality for Canada and other countries between 1990 and 2019 provided by the Global Burden of Disease Study. RESULTS: Life expectancy, age-standardized YLL, and age-standardized DALYs all improved in Canada between 1990 and 2019, although the rate of improvement has leveled off since 2011. The top five causes of all-age DALYs in Canada in 2019 were neoplasms, cardiovascular diseases, musculoskeletal disorders, neurological disorders, and mental disorders. The greatest increases in all-age DALYs since 1990 were observed for substance use, diabetes and chronic kidney disease, and sense organ disorders. Age-standardized DALYs declined for most conditions, except for substance use, diabetes and chronic kidney disease, and musculoskeletal disorders, which increased by 94.6%, 14.6%, and 7.3% respectively since 1990. Canada's world ranking for age-standardized DALYs declined from 9th place in 1990 to 24th in 2019. CONCLUSION: Canadians are healthier today than in 1990, but progress has slowed in Canada in recent years in comparison with other high-income countries. The growing burden of substance abuse, diabetes/chronic kidney disease, and musculoskeletal diseases will require continued action to improve population health.

RéSUMé: OBJECTIF: La surveillance des tendances des indicateurs clés de la santé de la population est importante pour éclairer les politiques de santé. Dans cette étude, nous avons examiné les tendances de la santé de la population au Canada au cours des 30 dernières années par rapport à d'autres pays. MéTHODES: Nous avons utilisé des données sur les années de vie ajustées en fonction de l'incapacité (DALY), les années de vie perdues (YLL), les années vécues avec un handicap, l'espérance de vie (LE) et la mortalité infantile pour le Canada et d'autres pays entre 1990 et 2019, fournies par l'Étude mondiale sur le fardeau de la maladie. RéSULTATS: L'espérance de vie, les YLL ajustées selon l'âge et les DALY ajustées selon l'âge ont tous connu une amélioration au Canada entre 1990 et 2019, bien que le taux d'amélioration se soit stabilisé depuis 2011. Les cinq principales causes des DALY pour tous les âges au Canada en 2019 étaient les néoplasmes, les maladies cardiovasculaires, les affections musculosquelettiques, les affections neurologiques et les troubles mentaux. Les plus fortes augmentations des DALY pour tous les âges depuis 1990 ont été observées pour l'usage de substances, le diabète et les maladies rénales chroniques, ainsi que les troubles des organes sensoriels. Les DALY ajustées selon l'âge ont diminué pour la plupart des conditions, à l'exception de l'usage de substances, du diabète et des maladies rénales chroniques, ainsi que des troubles musculosquelettiques, qui ont augmenté de 94,6 %, 14,6 % et 7,3 % respectivement depuis 1990. Le classement mondial du Canada pour les DALY ajustées selon l'âge est diminué de la 9ième place en 1990 à la 24ième place en 2019. CONCLUSION: Les Canadiens sont en meilleure santé aujourd'hui qu'en 1990, mais les progrès se sont ralentis ces dernières années par rapport à d'autres pays à revenu élevé. La croissance du fardeau lié à l'abus de substances, au diabète/maladies rénales chroniques et aux affections musculosquelettiques exigera des actions continues pour améliorer la santé de la population.

Substance Use Disorders and Antisocial Personality Disorder among a Sample of Incarcerated Individuals with Inadequate Health Care: Implications for Correctional Mental-Behavioural Health and Addiction Services.

Epidemiological estimates of substance use disorders (SUD) are critical for the planning of evidence-informed intervention and services. In this study, 250 incarcerated individuals in Nigeria were interviewed with the Mini International Neuropsychiatric Inventory (MINI) to diagnose SUD and antisocial personality disorder (ASPD). Most of the participants were males (97.6%), and the mean age was 35.4 (SD=13.5) years. Substance use disorder and ASPD were prevalent in 57.6% and 11.2% of the participants, respectively. Of those diagnosed with SUD, 35.2% and 22.4% had poly-SUD and mono-SUD respectively. Psychotic and dependence syndromes involving cannabis misuse were the most prevalent poly-SUD, and mono-SUD was characterized by alcohol, nicotine, and opioid dependence syndromes. Substance use disorder was more likely in participants charged with robbery and convicted, while ASPD was associated with prior and long-term imprisonment. There is a need for effective integration of treatment for ASPD/SUD into correctional mental health services in settings with inadequate health care using an appropriate model and a viable strategy.

Canadian Burden of Skin Disease From 1990 to 2017: Results From the Global Burden of Disease 2017 Study [Formula: see text].

BACKGROUND: Skin diseases can have high morbidity that can be costly to society and individuals. To date, there has been no comprehensive assessment of the burden of skin disease in Canada. OBJECTIVES: To evaluate the burden of 18 skin and subcutaneous diseases from 1990 to 2017 in Canada using the Global Burden of Disease (GBD) data. METHODS: The 2017 GBD study measures health loss from 359 diseases and injuries in 195 countries; we evaluated trends in population health in Canada from 1990 to 2017 using incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs). Data are presented as rates (per 100 000), counts, or percent change with the uncertainty interval in brackets. RESULTS: From 1990 to 2017 for all skin diseases, DALY rates increased by 8% to 971 per 100 000 (674-1319), YLD rates increased by 8% to 897 per 100 000 (616-1235), YLL rates increased by 4% to 74 per 100 000 (53-89), and death rates increased by 18% to 5 per 100 000 (3-6). DALY rates for melanoma increased by 2% to 54 per 100 000 (39-68), for keratinocyte carcinoma by 14% to 17 per 100 000 (16-19), and for skin and subcutaneous disease by 8% to 900 per 100 000 (619-1233). The observed over expected ratios were higher for skin and subcutaneous disease (1.37) and keratinocyte carcinoma (1.17) and were lower for melanoma (0.73). CONCLUSIONS: The burden of skin disease has increased in Canada since 1990. These results can be used to guide health policy regarding skin disease in Canada.

A longitudinal cohort study of symptoms and other concerns among Nigerian people with stages 3-5 chronic kidney diseases: study protocol.

BACKGROUND: The burden of symptoms and other concerns in chronic kidney disease (CKD) is known to be high, adversely affecting the quality of life of the growing number of those with this condition in developing countries. In this paper, we describe the protocol of a longitudinal observational study among people living with CKD. The study is developed to assess the bio-psychosocial factors associated with palliative care symptoms and concerns, and pattern of health services usage among Nigerians with stages 3-5 CKD. The overall objective is to establish the evidence-base for advocacy and policy formulation, treatment guidelines, care and services, and future clinical trial studies. METHODS: This is a multi-center study to investigate the longitudinal course of symptoms and other concerns among patients with stages 3-5 CKD in Nigeria. Interviewer administered and self-report measures at baseline (T0) and 3-month (T1) address socio-demographic characteristics, clinical-illness related information, palliative care-related symptoms and other concerns, pattern of formal or informal service usage, and bio psychosocial measures including estimated glomerular filtration rate (eGFR), anxiety, depression, quality of life, functioning, social support and spiritual wellbeing. DISCUSSION: This study represents the first longitudinal investigation of palliative care symptoms and concerns among people with CKD in Nigeria. It includes early stages of CKD in compliance with best practices, and a comprehensive range of bio-psychosocial outcomes to understand how these factors are associated with symptoms. This study will provide evidence for how best to integrate palliative care into management of CKD to improve care and quality of life of people with CKD. The study team welcomes collaborations with both national and international researchers.

Does ceasing exercise induce depressive symptoms? A systematic review of experimental trials including immunological and neurogenic markers.

BACKGROUND: Regular exercise in adults improves depressive symptoms (DS) and major depressive disorder (MDD), however the clinical effects of ceasing exercise are largely unknown. METHODS: Seven databases were searched from inception to December 2017. Eligibility criteria included English language studies investigating the effects of ceasing exercise on DS or MDD in regularly active adults with or without prior DS or MDD. Blood based markers related to exercise cessation (EC) were assessed, if recorded. Studies investigating exercise follow-up periods were excluded. RESULTS: No studies investigated EC in MDD. Six studies including two RCTS and three studies investigating neurogenic and immune biological markers associated with DS met inclusion criteria (152 healthy adults, females n = 50/32.89%). Compared to baseline, EC increased DS after three days, one week, and two weeks. Female participants had significantly more DS than male participants. Following EC, no changes in brain derived neurotrophic factor (BDNF) or tumour necrosis factor alpha (TNF) were evident, however C-reactive protein (CRP) at week one and interleukin 6 (IL6) at week two were reduced. LIMITATIONS: Quality concerns including risks of attrition and reporting bias limit our confidence in these results. CONCLUSIONS: Ceasing regular exercise increases DS in healthy adults, with greater DS in females than males. Contrary to the cytokine/inflammatory hypothesis of depression, DS were associated with reduced CRP and IL6 and without increased TNF. High quality trials are needed to extend this field of research in both healthy and MDD populations.

Anxiety disorders in breast cancer: Prevalence, types, and determinants.

The coexistence of anxiety disorders among women with breast cancer has been linked with delay in diagnosis, treatment abandonment, and poor quality of life. This study investigated anxiety disorders with their determinants among 200 participants with histological diagnosis of breast cancer. A questionnaire was designed to elicit sociodemographic and clinical factors, while the schedule for clinical assessment in neuropsychiatry (SCAN) was used to ascertain the presence of anxiety disorders. The mean age of participants was 49.6 years (SD = 11.2) and more than half (54%) presented with advanced cancers (stages 3 and 4). Anxiety disorder was observed in 38 (19%) of the participants. Low income, absence of previous history of breast cancer, and early stage of breast cancer were the significant determinants of anxiety disorders (p < 0.05). However, only absence of previous history of breast cancer (odds ratio [OR] = 3.460, 95% confidence interval [CI] = 1.200-6.960) and early stage of breast cancer (OR = 1.560, 95% CI = 1.120-2.174) were the determinants of anxiety disorders following logistic regression. We advocate for public awareness to promote early screening. Similarly, there is need to improve access to care and integrate culturally appropriate psychosocial intervention into breast cancer care using the available knowledge on vulnerability factors. Further study on anxiety disorders in breast cancer is indicated.

Impact of emotional distress on caregivers burden among Nigerian children with Obstructive Adenotonsillar hypertrophy.

BACKGROUND: Despite the significance of the role of caregivers among children with Obstructive Adenotonsillar hypertrophy (OAT), their caregiving experience and emotional well-being are given poor attention in research, policy and service design. This study represents a novel effort sought to investigate the burden experienced by caregivers of children with OAT and the impact of emotional distress on their caregiving burden. METHODOLOGY: A total of one hundred consecutive caregivers of children with OAT were interviewed with designed socio-demographic questionnaire. This was subsequently followed by administration of General Health Questionnaire-12 (GHQ-12) to ascertain emotional distress using cut-off score ≥ 3 and Zarit Caregivers Burden of care scale was used to characterize the pattern of burden experienced by these caregivers. RESULTS: In this study, the mean ages of children with OAT and their caregivers were 36.7(± 21.8) months and 34.4(± 5.4) years, respectively. The affected children were mainly males (68%), while their caregivers were predominantly females (84%). Fifty-seven percent of children with OAT were schooling but 13% of them had academic delay. Majority of the caregivers (66%) had a tertiary level of education. Of the total participants, up to 43% reported various degrees of burden of care, with majority (34%) of them reporting mild to moderate burden of care. In the same vein, 48% were emotionally distressed. Following regression analyses, emotional distress was independently associated with burden of care among participants (Odds ratio [OR]=0.108; 95% Confidence Interval [95% CI]=0.043-0.272; p < 0.001). CONCLUSION: Caregivers of children with OAT reported the experience of various degrees of burden, and worse among caregivers with emotional distress. Overall, the level of distress and burden observed in this study were many-fold what has been reported among caregivers of other populations of children. The results of this study support the proposal of proactive measures to address the psychosocial needs of caregivers as integral to the care of children with OAT. Further research on the well-being of caregivers is also justified.

Screening for depression with Centre for Epidemiological Studies Depression Scale Revised and its implication for consultation-liaison psychiatry practice among cancer subjects: a perspective from a developing country.

OBJECTIVE: Co-morbidity of depressive symptomatology is a common indication for use of mental health services in oncology. In this regard, screening instruments are useful for prompt identification of mental disorders in cancer. This study is set to evaluate the diagnostic validity of Centre for Epidemiological Studies Depression Scale Revised (CES-DR) for depression screening in cancer. METHODS: The CES-DR and the Schedule for Clinical Assessment in Neuropsychiatry (SCAN) were administered by the researchers on 200 attendees of a Nigerian hospital with histological diagnoses of cancer. Subsequently, the diagnostic validity of CES-DR was compared with SCAN. RESULTS: Ninety-eight (49.0%) participants had significant depressive symptomatology (CES-DR scores of ≥ 16) as against the diagnosis of depression in 55 (27.5%) participants following SCAN interview. Furthermore, of these 55 (27.5%) depressed participants, two (3.6%) participants had CES-DR scores <16 (non-cases). The Cronbach's alpha reliability of CES-DR was 0.86, and sensitivity and specificity of CES-DR were 96.4% and 68.7%, respectively, whereas positive and negative predictive values of CES-DR were found to be 0.54 and 0.98, respectively, in this study. The average administration time of CES-DR was 6 (± 2) min, and an inter-rater reliability of 93.7% was observed. CONCLUSIONS: The CES-DR was found in this study to be a useful tool for screening for depression in cancer but with diagnostic limitation when compared with SCAN. The development as well as popularization of screening instrument(s) with improved diagnostic and administration property for prompt identification of mental disorders to improve consultation-liaison psychiatry services in cancer care is recommended. Furthermore, replication of similar research is warranted.

A controlled study of depression among attendees of an oncology clinic in West Africa.

OBJECTIVE: Depression is commonly encountered among cancer patients and has been linked with grave consequences if not promptly treated. This study was set to determine the prevalence of depression in cancer patients. METHOD: The samples were recruited using systematic random sampling and made up of 200 cancer patients and 200 age and sex matched controls that consented and met the inclusion criteria. The instruments used included: Socio-demographic and clinical profile questionnaire, Centre for Epidemiological Studies Depression Scale Revised (CES-DR), and the Schedule for Clinical Assessment in Neuropsychiatry (SCAN). The instruments were administered by the researchers on the subjects and controls, and data obtained were analyzed using SPSS-15. RESULTS: A larger proportion of cancer patients compared to controls had depressive symptomatology (CES-DR score of 16 and above) made up of 98 (49.0%) cancer patients compared to 40 (20.0%) controls, and the difference was statistically significant, p = < 0.001. Seventy-four (18.5%) subjects from the two groups had depressive disorder using SCAN. The prevalence of depression in cancer subjects was 27.5% with 9.5% in controls and the difference was statistically significant with p = < 0.001. A substantial proportion of cancer patients with depression, 36 (65.5%, n = 55), had moderate depression, 15 (27.3%, n = 55) were mildly depressed, and 7.2% (n = 55) had severe depression. CONCLUSION: A significant proportion of cancer patients had depression compared with the controls with acute medical conditions. Prompt identification and treatment of cancer, mental disorders like depression should be integrated into cancer care in this part of the world.