The role of personality dimensions, depressive symptoms and other psychosocial variables in predicting postpartum suicidal ideation: a cohort study.

Suicidability has been associated with neuroticism and psychoticism, but its role during perinatal period has not been analyzed. We explore the association between personality dimensions, depressive symptoms, and other psychosocial variables in postpartum suicidal ideation. A cohort of 1795 healthy Spanish women from the general population was assessed for suicidal ideation (EPDS-Item10) in early postpartum, 8 and 32 weeks postpartum. Sociodemographic, obstetric, and reproductive variables, psychiatric history, social support, stressful life-events during pregnancy, depressive symptoms (EPDS), and the Eysenck's personality dimensions (EPQ-RS) were also assessed at baseline. A major depressive episode (DSM-IV) was confirmed in women with EPDS>10 at follow-up assessments. Descriptive, bivariate, and multivariate analyses were conducted. Adjusted logistic regression analysis was reported as odds ratio (ORs) with 95% confidence intervals (CIs). Seven percent of mothers reported suicidal ideation during the first 8 months postpartum. Sixty-two percent of women with suicidal ideation had a major depressive episode at 8 weeks, and 70% at 32 weeks postpartum. Neuroticism and psychoticism predicted suicidal ideation throughout the first 2 weeks after delivery (OR, 1.03; 95%CI 1.01-1.06; and OR, 1.03; 95%CI 1.01-1.05 respectively). Early postpartum depressive symptoms (OR 1.2; 95%CI 1.11-1.26), personal psychiatric history (OR 2.1; 95%CI 1.33-3.27), and stressful life events during pregnancy (OR 1.88; 95%CI 1.12-3.16) also emerged as predictors of postpartum suicidal ideation. Analysis of women for postpartum suicidal ideation should include not only psychiatric symptoms but also psychosocial assessment (i.e., covering psychiatric history, stressful events, or long-standing personality vulnerabilities) in order to identify those in need of early psychosocial or psychiatric care.

Coping strategies and postpartum depressive symptoms: A structural equation modelling approach.

BACKGROUND: Variables such as the mother's personality, social support, coping strategies and stressful events have been described as risk factors for postpartum depression. Structural Equation Modelling (SEM) analysis was used to examine whether neuroticism, perceived social support, perceived life events, and coping strategies are associated with postpartum depressive symptoms at the 8th and 32nd weeks. METHODS: A total of 1626 pregnant women participated in a longitudinal study. Different evaluations were performed 8 and 32weeks after delivery. Several measures were used: the Edinburgh Postnatal Depression Scale (EPDS), the Diagnostic Interview for Genetic Studies (DIGS), the Eysenck Personality Questionnaire (EPQ-RS), the St. Paul Ramsey life events scale and the Duke-UNC Functional Social Support Questionnaire. The brief COPE scale was used to measure coping strategies. SEM analysis was conducted for all women and in those women with a clinical diagnosis of postpartum depression. RESULTS: Passive coping strategies were associated with postpartum depressive symptoms at both visits (8th and 32nd weeks). Neuroticism was associated with more passive coping strategies and less active coping strategies. Neuroticism and life stress were positively correlated, and social support was negatively correlated with life stress and neuroticism. CONCLUSIONS: Early identification of potential risk for symptomatology of depression postpartum should include assessment of neuroticism, life events, social support and coping strategies.

Mood changes after delivery: role of the serotonin transporter gene.

BACKGROUND: Polymorphic variations in the serotonin transporter gene (5-HTT) moderate the depressogenic effects of tryptophan depletion. After childbirth there is a sharp reduction in brain tryptophan availability, thus polymorphic variations in 5-HTT may play a similar role in the post-partum period. AIMS: To study the role of 5-HTT polymorphic variations in mood changes after delivery. METHOD: One thousand, eight hundred and four depression-free Spanish women were studied post-partum. We evaluated depressive symptoms at 2-3 days, 8 weeks and 32 weeks post-partum. We used diagnostic interview to confirm major depression for all probable cases. Based on two polymorphisms of 5-HTT (5-HTTLPR and STin2 VNTR), three genotype combinations were created to reflect different levels of 5-HTT expression. RESULTS: One hundred and seventy-three women (12.7%) experienced major depression during the 32-week post-partum period. Depressive symptoms were associated with the high-expression 5-HTT genotypes in a dose-response fashion at 8 weeks post-partum, but not at 32 weeks. CONCLUSIONS: High-expression 5-HTT genotypes may render women more vulnerable to depressive symptoms after childbirth.

[Increase in hospital services utilization by persons aged 55 years or older: population ageing and response of the health system]. / Incremento en la utilización de servicios hospitalarios por las personas mayores de 55 años: envejecimiento poblacional y respuesta del sistema de servicios de salud.

OBJECTIVES: To examine changes in hospital service utilization between 1985 and 1994 in Spain and Andalucía and to estimate the proportion of change due to population ageing. METHODS: The increase in hospitalization rates between 1985 and 1994 was calculated. Expected hospital discharges in 1994, were calculated by multiplying hospital discharge rates in 1985 by the population in 1994 for each age group. RESULTS: Between 1985 and 1994 hospitalization rates increased among persons aged 55 years old order. The increase ranged from 20.01% (55-64 years old) to 52% (more than 75 years old). The percentage of this increase due to population ageing was slight (range: 2.8 to 14.8%). CONCLUSIONS: The increase in hospitalization rates among persons aged 55 years old or older is only partially explained by population ageing, which can be attributed to supply and demand of services.

Incremento en la utilización de servicios hospitalarios por las personas mayores de 55 años: envejecimiento poblacional y respuesta del sistema de servicios de salud / Increase in hospital services utilization by persons aged 55 years or older: population ageing and response of the health system

Objetivo: Examinar los cambios en la tasa de hospitalización entre 1985 y 1994 en España y en Andalucía, y estimar la proporción atribuible al envejecimiento poblacional. Métodos: Se calcula el incremento de las tasas de hospitalización entre 1985 y 1994. Se estiman las altas esperadas en 1994 multiplicando las tasas de hospitalización de 1985 por la población en 1994 para cada grupo de edad. Resultados: Entre 1985 y 1994 se produjo un incremento en la tasa de hospitalización en los mayores de 55 años. El incremento oscila entre el 20,01% (de 55 a 64 años) y el 52% (> 75 años); y el porcentaje atribuible al envejecimiento poblacional es (..) (AU)

Objectives: To examine changes in hospital service utilization between 1985 and 1994 in Spain and Andalucía and to estimate the proportion of change due to population ageing. Methods: The increase in hospitalization rates between 1985 and 1994 was calculated. Expected hospital discharges in 1994, were calculated by multiplying hospital discharge rates in 1985 by the population in 1994 for each age group. Results: Between 1985 and 1994 hospitalization rates increased among persons aged 55 years old order. The increase ranged from (..) (AU)

Importance of estrogen receptors for the behavior of invasive micropapillary carcinoma of the breast. Review of 68 cases with follow-up of 54.

The aggressiveness of invasive micropapillary carcinomas of the breast (MPCa) is still controversially discussed. Therefore, we investigated a total of 68 cases and studied the evolution of 54. MPCa were frequently well-differentiated cancers with the following positivities for immunohistochemistry: 74.5% estrogen receptor (ER+), 46.3% progesterone receptor (PR+), 66% Bcl2+, and 36.4% C-erbB-2+. However, in 90.5% of the cases lymph nodes were involved at diagnosis, and 70.6% of T1 tumors showed wide metastatic spread. After a mean follow-up of 52.6 months, 55.6% of the patients were disease free (DF), 7.4% had disseminated disease and 37% had died. Univariate analysis showed significant differences. Thus, the DF group of patients included 90% of those having tumors with an associated colloid pattern, 73.3% of the ER positive tumors, none of the C-erbB-2 positive tumors, and 100% of the tumors with no axillary metastasis, 77.8% of those with metastasis to up to 3 nodes, and 47.2% of those metastasizing to 4 or more nodes. However, using Cox's regression model for survival analysis, ER was the only factor associated with duration of survival (p = 0.0175). In conclusion, although long-term survival in MPCa is determined by involvement of lymph nodes, as is the case in any other breast cancer type, their short-term evolution is influenced by other factors, mostly by estrogen receptors.

[The consistent use of condoms among intravenous drug users and their regular partners]. / Uso consistente del condón entre los usuarios de droga por vía intravenosa y sus parejas estables.

OBJECTIVE: To describe consistent condom use between drug injectors and their regular sexual partners and to identify factors associated to its use which may be amenable to intervention. METHODS: Information was collected by personal interviews of drug injectors in 13 sampling points of the city of Granada, Spain. A bivariate analysis of factors identified in the literature was carried out and a multivariate logistic regression was fitted to the data to test the hypothesized associations. RESULTS: The proportion of drug injectors who report consistent condom use with their regular partners was 26. 4%. Talking about condoms with other injectors and with their regular sexual partners, professional sources of information and counselling when receiving results of HIV testing are independently associated with the use of condoms. In terms of social indicators, those with the highest and lowest levels of social integration use condoms less than those who belong to the middle social group. Sociodemographic characteristics and history of drug injection are not associated with consistent condom use with the regular partner. CONCLUSION: The use of condoms between drug injectors and their regular sexual partners is associated with communication with other drug injectors, the sexual partner and hearth professionals, on this topic. Promoting consistent condom use with regular partners among intravenous drug users is best accomplished through peer groups and during HIV counseling.

Screening for impaired cognitive function among the elderly in Spain: reducing the number of items in the Short Portable Mental Status Questionnaire.

The objectives of this work are to assess the agreement in classifying the 10th percentile of the population with impaired cognitive function resulting from different combinations of items in the Short Portable Mental Status Questionnaire, to evaluate the effect of literacy status on the new reduced versions, and to propose items less biased by education. Three data sets of representative samples of non-institutionalized elderly (65-year-olds and older) living in urban and rural communities in Spain were analyzed. Cognitive function was assessed using either the original or a modified Spanish version of the Short Portable Mental Status Questionnaire (SPMSQ). Different combinations of items were excluded from the scale and for each resulting reduced scale the lower 10th percentile of the distribution assessed a cut-off score. Cohen's kappa was used to test the agreement between the whole scale and the reduced scales in identifying the lowest 10th percentile of people with cognitive impairment. To test the effect of literacy status, the three samples were combined. New distributions were obtained for reduced versions of the scale including the items with the highest correlation with cognitive impairment controlling for literacy status. All three samples follow a similar distribution of errors. Most kappa values obtained when excluding one or more items from the original scales were between 0.80 and 0.95, while proportion of agreement varied between 94.2% and 100%. Lack of agreement is highest when eliminating all items that represent one dimension. Shorter versions of the SPMSQ are as reliable as the complete 10-item version in identifying those at risk for cognitive dysfunction. Cut-off points differed by literacy status but remained stable regardless of the number of items included.