Multi-sensor integration for an assessment of underwater radiated noise from common vessels in San Francisco Bay.

There is growing evidence that smaller vessels not required to broadcast data via the Automatic Identification System (AIS) contribute significant noise to urbanized coastal areas. The Marine Monitor (M2), a vessel tracking system that integrates AIS data with data collected via marine radar and high-definition camera, was employed to track all vessel types (regardless of AIS data availability) in a region of San Francisco Bay (SFB) where high-speed ferry, recreational, and commercial shipping traffic are common. Using a co-located hydrophone, source levels (SL) associated with 565 unique vessel passages were calculated and resultant cumulative daily sound exposure levels across the study area were modeled. Despite large ships primarily having the highest SLs, ferries and motorized recreational craft contributed noise to the largest area in two frequency bands of interest. The M2 provided data without the need for an on-site observer and enabled a systematic analysis of all relevant vessel types which showed that non-AIS vessels should not be excluded from consideration, especially in a highly urbanized estuary like SFB. This research provides an assessment of underwater radiated noise from all common vessel types in SFB suitable for informing habitat quality and threat evaluation for local cetacean species.

A Brief History of Awareness of the Link Between Alcohol and Fetal Alcohol Spectrum Disorder.

OBJECTIVE: Fetal alcohol spectrum disorder (FASD) is a medical term used to describe a range of mental and physical disabilities caused by maternal alcohol consumption. The role of alcohol as a teratogen and its effects on the cellular growth of the embryo and the fetus were not determined on scientific grounds until the late 1960s. However, the link between alcohol use during pregnancy and its harms to offspring might have been observed frequently over the many thousands of years during which alcohol has been available and used for social and other reasons. METHODS AND RESULTS: Using sources ranging from the biblical Book of Judges (pre-1700) up until the first public health bulletin (1977), we seek to provide an overview of the academic debate around early historical accounts ostensibly attributed to the awareness of alcohol as a prenatal teratogen as well as to describe the social and political influences that sculpted developments leading to the public recognition of FASD. CONCLUSIONS: Our analysis provides a brief overview of the discourse regarding historical awareness of the detrimental effects of prenatal alcohol exposure on fetal development leading to the formal recognition of FASD as a distinct clinical entity. Further research will be required to fully appreciate the scientific, medical, and societal ills associated with prenatal alcohol exposure.

The Standardization of Diagnostic Criteria for Fetal Alcohol Spectrum Disorder (FASD): Implications for Research, Clinical Practice and Population Health.

OBJECTIVE: Fetal Alcohol Spectrum Disorder (FASD) is a preventable disorder caused by maternal alcohol consumption and marked by a range of physical and mental disabilities. Although recognized by the scientific and medical community as a clinical disorder, no internationally standardized diagnostic tool yet exists for FASD. METHODS AND RESULTS: This review seeks to analyse the discrepancies in existing diagnostic tools for FASD, and the repercussions these differences have on research, public health, and government policy. CONCLUSIONS: Disagreement on the adoption of a standardised tool is reflective of existing gaps in research on the conditions and factors that influence fetal vulnerability to damage from exposure. This discordance has led to variability in research findings, inconsistencies in government messaging, and misdiagnoses or missed diagnoses. The objective measurement of the timing and level of prenatal alcohol exposure is key to bridging these gaps; however, there is conflicting or limited evidence to support the use of existing measures.

Gender similarities in somatic depression and in DSM depression secondary symptom profiles within the context of severity and bereavement.

BACKGROUND: Most population studies report higher rates of depression among women than men, and some researchers have observed gender differences in depression symptoms overall, or in sub-groupings (e.g. somatic depression). However, gender symptom differences have been inconsistent, prompting this investigation of gender differences in secondary DSM symptom profiles in the context of bereavement status, age, and depression severity. METHODS: Individuals with symptoms of core depression (flat affect or anhedonia) were selected from a large survey of adults in the Alberta, Canada workforce. Analyses involved the comparison of gender profiles across the seven DSM-IV secondary depressive symptoms plus a MANOVA of sex, bereavement, and age, with secondary symptoms comprising the dependent variable. RESULTS: Gender profiles were very similar, irrespective of depression severity or bereavement. Secondary symptoms were marginally more common among women and more frequent among bereaved young adults, but there was no evidence for a gender-related somatic factor. LIMITATIONS: First, data were gathered only for persons in the workforce and thus may not be generalizable to, for example, stay-at-home parents or those with employment issues. Second, the focus here is restricted to DSM symptoms, leaving risk factors, social roles, and brain functioning for separate investigation. Third, inferences were drawn from associations between groups of persons, rather than between individuals, requiring caution when speculating about individual attributes. CONCLUSIONS: Gender differences in depression represent a difference in amount, not kind, suggesting that the range of depressive experiences is similar for men and women. There was no gender difference ascribable to somatic depression.

Depression in primary care: current and future challenges.

OBJECTIVES: To describe the current state of knowledge about detection and treatment of major depressive disorder (MDD) by family physicians (FPs), and to identify gaps in practice and current and future challenges. METHODS: We reviewed the recent literature on MDD (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, or International Classification of Diseases, Revision 10) in primary care, with an emphasis on systematic reviews and meta-analyses addressing prevalence, the impact of an aging population and of chronic disease on MDD rates in primary care, detection and treatment rates by FPs, adequacy of treatment, and interventions that could improve recognition and treatment. RESULTS: About 10% of primary care patients are likely to meet criteria for MDD. The number of cases will increase as the baby boomer cohort ages and as the prevalence of chronic disease increases. The bidirectional relation between MDD and chronic disease is now firmly established. Detection and treatment rates in primary care remain low. Treatment quality is frequently inadequate in terms of follow-up and monitoring. Formal case management and collaborative care interventions are likely to provide some benefits. CONCLUSIONS: Low detection rates and low treatment rates need to be addressed. Planned reassessment may improve detection rates when the FP is uncertain whether MDD is present, but further research is needed to determine why FPs frequently do not initiate treatment, even when MDD is detected. A caring, attentive FP who monitors depressed patients is likely to have considerable placebo effect. Greater focus on integrated, concurrent treatment for MDD and chronic physical diseases in the middle-aged and elderly is also required.

Objectifs :Décrire l'état actuel des connaissances sur la détection et le traitement du trouble dépressif majeur (TDM) par les médecins de famille (MF), et identifier les écarts dans la pratique et les enjeux actuels et futurs. Méthodes : Nous avons revu la littérature récente sur le TDM (Manuel diagnostique et statistique des troubles mentaux, 4e édition, ou Classification internationale des maladies, 10e révision) dans les soins de première ligne, en mettant l'accent sur les revues systématiques et les méta-analyses traitant de la prévalence, de l'effet d'une population vieillissante et de la maladie chronique sur les taux de TDM dans les soins de première ligne, des taux de détection et de traitement par les MF, du caractère adéquat du traitement, et des interventions aptes à améliorer la reconnaissance et le traitement. Résultats : Environ 10 % des patients en soins de première ligne sont susceptibles de satisfaire aux critères du TDM. Le nombre de cas augmentera à mesure que vieillira la cohorte de la génération du baby-boom et que croîtra la prévalence des maladies chroniques. La relation bidirectionnelle entre le TDM et la maladie chronique est dorénavant fermement établie. Les taux de détection et de traitement dans les soins de première ligne demeurent faibles. La qualité des traitements est souvent inadéquate en ce qui a trait au suivi et à la surveillance. La prise en charge officielle de cas et les interventions de soins en collaboration sont susceptibles d'offrir certains avantages. Conclusions : Il faut remédier aux faibles taux de détection et de traitement. Une réévaluation planifiée peut améliorer les taux de détection lorsque le MF n'est pas certain de la présence d'un TDM, mais il faut plus de recherche pour déterminer pourquoi souvent, les MF ne commencent pas de traitement, même si le TDM est détecté. Un MF bienveillant et attentif qui surveille des patients déprimés est susceptible d'avoir un effet placebo considérable. Il faut également insister davantage sur le traitement intégré, concurrent du TDM et des maladies physiques chroniques chez les personnes d'âge moyen ou avancé.

The distribution of mental health service costs for depression in the Alberta population.

OBJECTIVES: In Canada, most mental health services are embedded in the public health care system. Little is known of the cost distribution within the mental health population. Our study aims to estimate the depression care costs of patients with a depression diagnosis, ranking them by the increasing total depression health care costs. METHODS: For fiscal year 2007/08, we extracted administrative health care records from across the continuum, including physicians, outpatient services, and hospitals. Using a unique patient identifier, all service costs were merged for each person. Costs were summed by service categories and then divided by the served population into 10 equal-size groups. Further, we divided costs in the top decile into 10 percentile groups. RESULTS: There were 208 167 people (5.9% of Albertans) who had at least 1 health care visit for depression. The total cost for depression treatment services was $114.5 million, an average $550 per treated person. In the first 9 deciles, most costs were for general practitioners. By the ninth decile, cost per person was about $400. Within the tenth decile, costs increased regularly, and in the top 1 percentile (1% of patients) there was an increase of cost per patient to $25 826 from $5792 in the previous percentile. CONCLUSION: Per person costs were highly skewed. Until the ninth decile, the cost increased slowly, consisting of mainly physician costs. In the last decile, costs increased substantially, mainly because of hospitalizations. Thus both primary care and specialist care play key roles.

Improving reliability of the assessment of the life course of schizophrenia.

OBJECTIVE: Life course studies of schizophrenia that have used a 3-phase model (onset, course, and outcome) have had their use restricted owing to differences in definition and methodology. The purpose of this investigation was to describe life course data in mathematical terms and to compare the results with the findings from other life course studies. METHOD: The study population was comprised of 128 of 137 people who were first admitted for schizophrenia to 1 of the 2 mental hospitals in Alberta in 1963 and followed until 1997 or death. Patient evaluations were based on retrospective and contemporaneous information collected from the patients and hospital files, treatment records, and family members. Mathematically derived ratings were formulated for course, outcome, and onset (pre-admission years). The distribution of the resulting 8 life course types was compared with profiles drawn from other such studies reported in the literature. RESULTS: The use of mathematical descriptions of onset, course, and outcome produced profiles that did not closely match the results of other investigations, largely owing to inconsistency across studies. Further, the present approach to outcome measurement produced results that were less favourable than those found in other studies. CONCLUSIONS: Studies on the life course of schizophrenia could be made more comparable by specifying mathematically expressed operational definitions of onset, course, and outcome. Nonetheless, the use of the term outcome can be questioned as it implies an assessment at a specific time rather than providing a summary statement of the quality of a life.

Frequency synchronization of blue whale calls near Pioneer Seamount.

Vocalizations of blue whales were recorded with a cabled hydrophone array at Pioneer Seamount, 50 miles off the California coast. Most calls occurred in repeated sequences of two-call pairs (A, then B). The B call is a frequency-modulated tone highly repeatable in form and pitch. A model of this sound is described which permits detecting very small frequency shifts. B calls are found to be aligned in frequency to about one part in 180. This requires very fine pitch discrimination and control over calling frequency, and suggests that synchronizing to a common frequency pattern carries some adaptive advantage. Some possibilities for acoustic sensing by whales requiring this fine frequency resolution are discussed.

A population-based family study of minor depression.

BACKGROUND: There is a paucity of research on whether minor depression is a familial disorder. METHODS: We conducted a population-based family study of minor depression in which subjects were interviewed using the Diagnostic Interview Schedule (DIS). Minor depression only (MDO) was diagnosed if there was a lifetime history of what the DIS refers to as a depressive "spell" and no lifetime history of either Diagnostic and Statistical Manual of Mental Disorders, Third Edition, major depression or dysthymia. There were 71 probands with a lifetime history of MDO; 577 controls with no lifetime history of MDO, major depression, or dysthymia; and 1,539 first-degree relatives (FDRs). Logistic regression was performed with the presence/absence of MDO in a proband/control as the "exposure" and MDO in an FDR as the "outcome". RESULTS: The odds ratio for the association between MDO in a proband and MDO in an FDR, after adjusting for age and sex of the FDR, was 1.55 (95% confidence interval: 0.93-2.58; P=.093). The study had 80% power to detect an odds ratio as small as 1.97, which is in the range of odds ratios seen for the familial aggregation of major depression. CONCLUSIONS: MDO does not appear to be a familial disorder, raising questions about the validity of "minor depression" as a distinct psychiatric syndrome.

Three-year physician treated prevalence rate of mental disorders in Alberta.

OBJECTIVE: To examine the rate at which adults seek services for mental disorders from different categories of physicians. METHOD: The study used billing data from all physicians during a 3-year period for the total adult population of the province of Alberta. RESULTS: During the 3-year period, 35% of adults consulted a physician and were given a mental disorder diagnosis. The highest rates of consultation were for anxiety disorders (21%), followed by mood disorders (depression) (16%). Among patients, 84% were seen by primary care physicians only, and 3% were seen solely by psychiatrists. The more serious the diagnosing (for example, psychosis) the more likely patients were to be seen by psychiatrists. CONCLUSIONS: These results show that the 3-year prevalence rate includes more than one-third of the entire adult population. These figures differ considerably from those derived from population surveys in showing markedly higher prevalence (and treatment) rates. The number of people treated in primary care far exceeds those treated in the specialist sector.

Expenditures on mental health and addictions for Canadian provinces in 2003 and 2004.

OBJECTIVE: To measure total public and private expenditures on mental health in each province. METHOD: Data for expenditures on mental health services were collected in the following categories: physician expenditures (general and psychiatrist fees for service and alternative funding), inpatient hospital (psychiatric and general), outpatient hospital, community mental health, pharmaceuticals, and substance abuse. Data for 2 years, 2003 and 2004, were collected from the Canadian Institute for Health Information (hospital inpatient and fees for service physicians), the individual provinces (pharmaceuticals, alternative physician payments, hospital outpatient, and community), and the Canadian Centre on Substance Abuse. Totals were expressed in terms of per capita and as a percentage of total provincial health spending. RESULTS: Total spending on mental health was $6.6 billion, of which $5.5 billion was from public sources. Nationally, the largest portion of expenditures was for hospitals, followed by community mental health expenses and pharmaceuticals. This varied by province. Public mental health spending was 6% of total public spending on health, while total mental health spending was 5% of total health spending. CONCLUSIONS: Canadian public mental health spending is lower than most developed countries, and a little below the minimum acceptable amount (5%) stated by the European Mental Health Economics Network.

Are lateral electronic portal images adequate for accurate on-line daily targeting of the prostate? Results of a prospective study.

The purpose of this report was to evaluate the magnitude of the error that would be introduced if only a lateral (LAT) portal image, as opposed to a pair of orthogonal images, was used to verify and correct daily setup errors and organ motion in external beam radiation therapy (EBRT) of prostate cancer. The 3-dimensional (3D) coordinates of gold markers from 12 consecutive prostate patients were reconstructed using a pair of orthogonal images. The data were re-analyzed using only the LAT images. Couch moves from the 2-dimensional (2D)-only data were compared with the complete 3D data set. The 2D-only data provided couch moves that differed on average from the 3D data by 2.3 +/- 3.0, 0.0 +/- 0.0, and 0.8 +/- 1.0 mm in the Lat, AP, and SI directions, respectively. Along AP and SI axes, the LAT image provided positional information similar to the orthogonal pair. The error along the LAT axis may be acceptable provided lateral margins are large enough. A LAT-only setup protocol reduces patient treatment times and increases patient throughput. In most circumstances, with exceptions such as morbidly obese patients, acquisition of only a LAT image for daily targeting of the prostate will provide adequate positional precision.

Case-control study of unemployment and parasuicide.

OBJECTIVE: The objective of the study was to estimate the odds ratio for the association between unemployment and parasuicide, controlling for potential confounding variables. METHODS: A case-control study was conducted involving 507 cases of parasuicide and 200 age- and sex-matched controls presenting to emergency departments in Edmonton, Canada. Subjects were interviewed using an extensive questionnaire developed for a World Health Organization study of parasuicide. The data were analyzed using conditional logistic regression. RESULTS: In a crude analysis, the odds ratio for the association between unemployment and parasuicide was 12.0 (95% confidence interval, 6.0-23.9). After controlling for sociodemographic factors, lifetime prevalence of several Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition, disorders, previous parasuicide, hopelessness, childhood experiences, and emotional support from family and friends, the odds ratio was 5.2 (95% confidence interval, 2.3-11.4). CONCLUSIONS: Those who are unemployed have an increased risk of parasuicide, and this association persists after accounting for a wide range of potential confounders.

Better practices in collaborative mental health care: an analysis of the evidence base.

OBJECTIVES: To conduct a systematic review of the experimental literature in order to identify better practices in collaborative mental health care in the primary care setting. METHODS: A review of Canadian and international literature using Medline, PsycInfo, Embase, the Cochrane Library, and other databases yielded over 900 related reports, of which, 38 studies met the inclusion criteria. A systematic review and descriptive analysis is presented, with key conclusions and best practices. RESULTS: Successful collaboration requires preparation, time, and supportive structures, building on preexisting clinical relationships. Collaborative practice is likely to be most developed when clinicians are colocated and most effective when the location is familiar and nonstigmatizing for patients. Degree of collaboration does not appear to predict clinical outcome. Enhanced collaboration paired with treatment guidelines or protocols offers important benefits over either intervention alone in major depression. Systematic follow-up was a powerful predictor of positive outcome in collaborative care for depression. A clear relation between collaborative efforts to increase medication adherence and clinical outcomes was not evident. Collaboration alone has not been shown to produce skill transfer in PCP knowledge or behaviours in the treatment of depression. Service restructuring designed to support changes in practice patterns of primary health care providers is also required. Enhanced patient education was part of many studies with good outcomes. Education was generally provided by someone other than the PCP. Collaborative interventions that are part of a research protocol may be difficult to sustain long-term without ongoing funding. Consumer choice about treatment modality may be important in treatment engagement in collaborative care (for example, having the option to choose psychotherapy vs medication). CONCLUSIONS: A body of experimental literature evaluating the impact of enhanced collaboration on patient outcomes-primarily in depressive disorders-now exists. Better practices in collaborative mental health care are beginning to emerge.

A population-based family study of DSM-III generalized anxiety disorder.

BACKGROUND: A recent meta-analysis provides evidence that generalized anxiety disorder (GAD) is familial. However, two of the key studies relied on subjects who were self-selected or recruited from the clinic setting, thereby limiting generalizability. METHOD: We conducted a family study of GAD in which probands and controls came from a community sample originally enrolled in a prevalence study in Edmonton, Canada. One hundred and sixty probands, 764 controls and 2386 first-degree relatives (FDRs) were interviewed using the Diagnostic Interview Schedule (DIS); lifetime diagnoses were made according to DSM-III criteria without exclusions. Logistic regression analysis was performed with GAD (in a proband) as the 'exposure', and GAD in an FDR as the 'outcome'. Several analytic strategies were used to control for potential confounding by major depressive disorder (MDD) and several anxiety disorders (panic disorder, phobic disorders, obsessive-compulsive disorder, and post-traumatic stress disorder). RESULTS: The odds ratios for the association between GAD in a proband and GAD in an FDR were in the range 1.4-1.8 when the entire FDR sample was analysed, and in the range 2.1-2.8 when we restricted to FDRs who were children of probands and controls. CONCLUSION: In the community setting, GAD exhibits mild to moderate familial aggregation.