The effect of weight compared to BMI on patient reported outcomes at long term follow up of primary total hip arthroplasty.

Introduction: Obesity has been linked to the development of osteoarthritis meaning that a large portion of arthroplasty patients are overweight or obese. Whilst the short-term complications associated with obesity are well described there is a paucity of evidence on the effect of weight compared to BMI for long term functional outcomes of total hip replacements (THR). The aim of this study was to investigate the influence of BMI and weight on long-term patient reported outcome measures following primary THR. Methods: 846 patients who underwent primary THR at the Royal Adelaide Hospital between 2000 and 2009 had a pre-operative height and weight recorded. Patient reported outcome measures (PROMs) were completed at 1, 5 and greater than 10 years follow-up. Categorical comparison of PROMs was performed for patients in weight categories of 0-65 kg, 65-80 kg, 80-95 kg, 95-110 kg and >110 kg; and BMI categories as per the WHO Classifications. Results: There was no difference in absolute or change in PROMs for any weight category. BMI did not have an effect on the change in (HHS), however there was a statistically significant decrease in absolute (HHS) values at 1 and 5 years with increasing obesity. 65 patients underwent revision within the first ten years. Conclusion: The results from this study confirm for the first time that there was no impact of weight or BMI on the change in long-term PROMs of THR. There remains a need for larger registry studies to investigate the effect of weight and BMI on long-term patient outcomes and revision rate.

Twenty years of melanoma in Victoria, Queensland, and South Australia (1997 - 2016).

BACKGROUND: Given the high incidence of melanoma in Australia alongside high mortality with later stage disease, we investigated the populations and locations most at risk, to optimise public health activities in areas where intervention is most needed. This study examines trends and identifies significant prognostic factors and potential disparities in incidence, mortality and survival between population groups in Victoria, Queensland and South Australia. METHODS: The analysis includes data from the population-based cancer registries of the three states over a twenty-year period (1997-2016). Age-standardized and age-specific incidence rates were calculated, and long-term trends analysed using Joinpoint Regression. Five-year relative survival estimates for the study population were calculated using the cohort method and multivariable flexible parametric survival models were applied for each jurisdiction to calculate adjusted excess mortality hazard ratios for the key characteristics. RESULTS: There were more males with melanoma than females in all the three states. Over 60% of the cases occurred in the 40-74 years age group. Most melanomas had a Breslow thickness less than or equal to 1.0 mm. For males, Victoria and Queensland had a statistically significant increasing trend whereas in South Australia there was a decreasing trend. For females, the incidence rate trend was stable in Victoria but significantly decreasing in South Australia. In Queensland there was an increasing and statistically significant trend from 2006 to 2016. Across all three states there was a reducing incidence rate in the youngest cohort, stabilizing incidence in the 40-59-year-old age group, and increasing in the oldest cohorts. Five-year relative survival decreased with increasing age and with Breslow thickness across all three jurisdictions. Males had between 43%- 46% excess mortality compared to females in all the three states. There was higher risk with increasing age and Breslow thickness, with the largest risk among the 75 + age group and those with a Breslow thickness of > 4 mm. CONCLUSION: It is the first time that data from these three registries has been analysed together in a uniform way, covering more than half of the Australian population. This study compares the epidemiology of melanoma across three states and provides a better understanding of trends and factors affecting outcome for Australians with melanoma. While there has been some improvement in aspects of incidence and mortality, this has not been evenly achieved across Australia.

Association between grass, tree and weed pollen and asthma health outcomes in Adelaide, South Australia: a time series regression analysis.

OBJECTIVES: We aim to establish daily risk estimates of the relationships between grass, tree and weed pollen and asthma health outcomes. DESIGN: Time series regression analysis of exposure and health outcomes using interaction by month to determine risk estimates all year round. SETTING: Metropolitan Adelaide, South Australia. PARTICIPANTS: Health outcomes for asthma are based on 15 years of hospital admissions, 13 years emergency presentations and ambulance callouts. In adults (≥18 years), there were 10 381 hospitalisations, 26 098 emergency department (ED) presentations and 11 799 ambulance callouts and in children (0-17 years), 22 114, 39 813 and 3774, respectively. OUTCOME MEASURES: The cumulative effect of 7 day lags was calculated as the sum of the coefficients and reported as incidence rate ratio (IRR) related to an increase in 10 grains of pollen/m3. RESULTS: In relation to grass pollen, children and adults were disparate in their timing of health effects. Asthma outcomes in children were positively related to grass pollen in May, and for adults in October. Positive associations with weed pollen in children was seen from February to May across all health outcomes. For adults, weed pollen-related health outcomes were restricted to February. Adults were not affected by tree pollen, while children's asthma morbidity was associated with tree pollen in August and September. In children, IRRs ranged from 1.14 (95% CI 1.06 to 1.21) for ED presentations for tree pollen in August to 1.98 (95% CI 1.06 to 3.72) for weed pollen in February. In adults, IRRs ranged from 1.28 (95% CI 1.01 to 1.62) for weed pollen in February to 1.31 (95% CI 1.08 to 1.57) for grass pollen in October. CONCLUSION: Monthly risk assessment indicated that most pollen-related asthma health outcomes in children occur in the colder part of the year, while adults are affected in the warm season. The findings indicate a need for year-round pollen monitoring and related health campaigns to provide effective public health prevention.

Pollen Exposure and Cardiopulmonary Health Impacts in Adelaide, South Australia.

(1) Background: Limited research has suggested that cardiopulmonary health outcomes should be considered in relation to pollen exposure. This study sets out to test the relationship between pollen types (grasses, trees, weeds) and cardiovascular, lower respiratory and COPD health outcomes using 15 years (2003-2017) of data gathered in Adelaide, South Australia; (2) Methods: A time-series analysis by months was conducted using cardiopulmonary data from hospital admissions, emergency presentations and ambulance callouts in relation to daily pollen concentrations in children (0-17) for lower respiratory outcomes and for adults (18+). Incidence rate ratios (IRR) were calculated over lags from 0 to 7 days; (3) Results: IRR increases in cardiovascular outcomes in March, May, and October were related to grass pollen, while increases in July, November, and December were related to tree pollen. IRRs ranged from IRR 1.05 (95% confidence interval (CI) 1.00-1.10) to 1.25 (95% CI 1.12-1.40). COPD increases related to grass pollen occurred only in May. Pollen-related increases were observed for lower respiratory outcomes in adults and in children; (4) Conclusion: Notable increases in pollen-related associations with cardiopulmonary outcomes were not restricted to any one season. Prevention measures for pollen-related health effects should be widened to consider cardiopulmonary outcomes.

Holistic approach supporting mental wellbeing of people in enforced quarantine in South Australia during the COVID-19 pandemic.

OBJECTIVES: To report the experience of quarantine for international arrivals to South Australia requiring quarantine in a medi-hotel setting during the COVID-19 pandemic and to describe the range of evidence-based support services to mitigate the mental health impacts of quarantine. METHODS: A range of services targeted at physical and mental wellbeing were provided. Data from 533 adult respondents out of 721 passengers were included. The Kessler 10 was used to measure psychological distress at two time points. RESULTS: About 7.1% of respondents reported psychological distress at time one, reduced to 2.4% at time two. There was no significant difference in psychological distress by gender at either time point. The mean K10 score at time one was 13.6 (standard deviation=5.2) and the mean score at time two was 11.5 (standard deviation=3.1), with a significant reduction in mean scores (p<0.001) between the two time points. CONCLUSIONS: The level of psychological stress in repatriated Australians was low at arrival and improved further at the time of release from quarantine. Implications for public health: A collaborative multi-sector approach to provide support services for individuals in quarantine can mitigate risks to mental wellbeing.

Do Children With Spinal Deformity Who Have Metal Implants and Frequent Exposure to X-Rays Increase Their Risk of Cancer?

STUDY DESIGN: Spinal surgery cohort. OBJECTIVE: The authors assess the risk of cancer in children who have undergone frequent radiographs and have metal implants for the treatment of spinal deformity. SUMMARY OF BACKGROUND DATA: Concerns have been raised regarding the cancer risk to children exposed to repeated radiological examinations as part of routine surveillance to monitor progression of spinal deformity. Additionally, there are reports of increased cancer risk in adults having joint replacement with metal implants causing raised metal ion levels in the blood. METHODS: A large number of consecutive children undergoing instrumented spinal surgery since 1979 were examined for their development of malignancy. High quality data on all invasive cancers from the South Australian Cancer Registry and deaths were linked to the spinal surgery cohort with the calculation of standardized incidence ratios (SIRs) using the Quinquinquennium method. RESULTS: The study cohort was formed by 865 children. The average follow-up time from date of surgery to either death or censoring date was 18 years with a maximum of 36 years. A total of 15,921 person years were examined. There was no increased rate of cancer in these patients. For the total cohort, the SIR was 1.00 (95% confidence interval [CI] 0.50-1.79). For females the SIR was 0.83 (95% CI 0.33-1.70) and for males the SIR was 1.33 (95% CI 0.36-3.40). The male SIR reflected an expected cancer incidence of three cases, when four cases were observed, and was not statistically significant. CONCLUSION: This study has found that radiation exposure and possible exposure to circulating metal ions as a result of routine instrumented spine surgery in children since 1979 is not associated with an increased risk of cancer in up to 36 years of follow up. LEVEL OF EVIDENCE: 2.

Cancer staging at diagnosis data comparisons in South Australia.

Cancer stage at diagnosis is an important gap for Australian population based cancer registries. The study aims to understand the quality and completeness of three different collections of cancer staging data. The South Australian Cancer Registry data collection for breast and colorectal cancer (CRC) cases diagnosed in 2011, was linked to Registry Derived Stage (RDS) data, pathology plus hospital metastasis codes (pathology stage), and the South Australian Clinical Cancer Registry Stage (SACCR stage). The agreement between staging systems was examined using kappa statistics. Kaplan-Meier curves and Cox regression were used to examine the difference in survival by staging methods. Among 2,530 breast and CRC cases 98.8% were stageable (n = 2,500) according to histology. Among stageable cases, 84.6% had RDS, 51.2% had pathology stage and 29.5% had SACCR stage. The kappa statistic for RDS and pathology stage was 0.930 for breast cancer and 0.973 for CRC, and 0.574 for RDS and SACCR stage for breast cancer and 0.632 for CRC. The agreement between pathology stage and SACCR stage was 0.430 for breast cancer and 0.528 for CRC. The distribution of stage was similar across staging methods, although more stage four cancers by pathology stage, and survival patterns were similar but not the same. The agreement was high between different staging systems. Pathology stage had a higher than expected stage 4 proportion. This study highlights an opportunity to collect stage information in a cost-effective manner, while collecting data that usefully represent stage at diagnosis across the population, for population based epidemiological analyses.

The Spectrum of Adverse Pregnancy Outcomes Based on Kidney Disease Diagnoses: A 20-Year Population Study.

BACKGROUND AND OBJECTIVES: Kidney disorders in pregnancy may be under-recognized and have variable impact on outcomes depending on diagnosis. Population-level data are limited, particularly for Australia, and comparison of impact of different kidney disorders on pregnancy has rarely been assessed. This study examined the prevalence and outcomes of varied kidney disorders using population-level perinatal data from a large cohort. METHODS: Women with singleton pregnancies > 20 weeks' gestation from the South Australian Pregnancy Outcomes Unit (1990-2012). Women with a kidney disorders diagnostic code were grouped into categories (immunological, cystic/genetic, urological, vesicoureteral reflux (VUR), pyelonephritis and "other"). Key pregnancy outcomes were assessed, with adjustment for demographic variables. RESULTS: Kidney disorders were reported in 1,392 (0.3%) of 407,580 births. These pregnancies had increased risk of pregnancy-induced hypertension (OR 2.16, 95% CI 1.82-2.56), induction of labor (RRR vs. spontaneous birth 2.10, 95% CI 1.87-2.36), all Caesarean section (OR 1.31, 95% CI 1.17-1.47) as well as Caesarean section without labor (RRR 1.82, 95% CI 1.57-2.10), preterm birth (< 37 weeks; 2.76, 95% CI 2.40-3.18), low birth weight (< 2,500 g) infants (OR 2.43, 95% CI 2.07-2.84), and neonatal intensive care admission (OR 2.64, 95% CI 2.12-3.29). Diagnostic subgroups demonstrated differing patterns of adverse outcomes, enabling the development of a matrix of risk. Women with immunological renal conditions and VUR had greatest risk overall, and only women with immunological diseases had increased risk of small-for-gestational age < 10th centile (OR 2.36, 95% CI 1.26-4.42). Women with nonchronic urological conditions and pyelonephritis had increased risk of preterm birth, but not other adverse events. VUR conferred particularly increased risk of Caesarean section and induced labor. CONCLUSIONS: In a cohort of > 1,300 women with varied kidney disorders, increased adverse obstetric and perinatal events were observed, and the nature and magnitude of risk differed according to diagnosis. In particular, vesicoureteric reflux is not a benign condition in pregnancy. Women with nonchronic conditions still had increased risk of preterm birth. We confirm that women with kidney disorders warrant vigilant and tailored prepregnancy care and clinical care in pregnancy.

Where Patients With Cancer Die: A Population-Based Study, 1990 to 2012.

AIMS: To describe changes in the place of death of patients with cancer from 1990 to 2012, and to identify issues for their end-of-life care. MATERIALS AND METHODS: Population-based descriptive study, with analyses of place of death patterns, using the South Australian Cancer Registry records of 86 257 patients with cancer who died from 1990 to 2012. RESULTS: From 1990 to 2012, the proportion of cancer deaths in hospital decreased from 63.4% to 50.9%, and in nursing homes increased from 8.2% to 22.5%. After the year 2000, the proportions in hospices and at home were both below 15%. Multivariate analyses showed that young patients with cancer were more likely to die in a hospice or at home, compared to elderly patients with cancer who were more likely to die in a nursing home; the likelihood of dying in a hospice increased with socioeconomic status; patients with a short survival time or a hematological malignancy were more likely to die in a metropolitan hospital. CONCLUSIONS: Compared to most other countries, the proportion of cancer deaths at home was low, and many patients would not have died at their preferred place. The trend for more cancer deaths to occur in nursing homes is likely to continue, but nursing homes generally lack the resources and skilled staff to provide quality palliative care. Models of palliative care delivery should take account of patient preferences, the growth of terminal cancer care in nursing homes, and apparent inequities.

Regional morbidity and mortality during heatwaves in South Australia.

Heatwaves can be a common occurrence in Australia, and the public health impacts can be severe. Heat warnings and interventions are being adopted widely to reduce the preventable health impacts. This study examines the effects of heatwaves on morbidity and mortality in different climatic regions in the state of South Australia, to inform the targeting of heat warnings according to regional needs. Heatwaves were defined using the excess heat factor (EHF), an index based on mean daily temperature indices that quantifies heatwave severity relative to the local climate. In all regions, there were increases in morbidity (daily rates of ambulance call-outs and heat-related emergency presentations and hospital admissions) on heatwave days compared to non-heatwave days, which increased with heatwave severity. This study demonstrates that a consistent measure for heatwave severity, based on EHF, can be used to underpin public health warnings for climatically diverse areas.

Long-term Trends in Singleton Preterm Birth in South Australia From 1986 to 2014.

OBJECTIVE: To describe long-term trends in the prevalence of preterm birth and rates of preterm birth in singleton pregnancies complicated by hypertensive disorders of pregnancy, small for gestational age (SGA), and preterm prelabor rupture of membranes (PROM) in South Australia. METHODS: We conducted a retrospective population study including all singleton live births in the state of South Australia from 1986 to 2014. Long-term trends for preterm birth, hypertensive disorders of pregnancy, SGA, preterm PROM as well as stillbirth were assessed using joinpoint regression analyses. Trends in maternal age, body mass index (BMI), ethnic diversity, parity, and smoking over time were also assessed. RESULTS: From 1986 to 2014, with a total of 539,234 singleton births, the overall preterm birth rates increased from 5.1% to 7.1% (P<.001) and for iatrogenic preterm birth increased from 1.6% to 3.2% (P<.001). The incidence of hypertensive disorders of pregnancy decreased from 8.7% to 7.2%. Among pregnancies complicated by hypertensive disorders of pregnancy, the proportion of preterm birth increased (10.4-17.5%, P<.001). The incidence of SGA decreased from 11.1% to 8.0%. Among pregnancies complicated by SGA, the proportion of preterm birth increased (2.9-5.4%, P<.001). The incidence of preterm PROM increased from 1.4% to 2.2%. Among pregnancies complicated by preterm PROM, the proportion of preterm birth remained stable. Preterm stillbirth rates declined (4.23-2.32%, P<.001). Maternal age, BMI, and ethnic diversity have all increased since 1986, whereas maternal smoking has decreased. CONCLUSION: In South Australia, the preterm birth rate among singletons increased from 1986 to 2014 by 40%, with iatrogenic preterm birth being responsible for 80% of this increase. Incidence of hypertensive disorders of pregnancy and SGA declined. Among pregnancies complicated by hypertensive disorders of pregnancy and SGA, the proportions of preterm birth increased, indicating earlier interventions in these women. The diagnosis of preterm PROM increased from 1% to 2%, and greater than 80% of preterm PROM was associated with preterm birth after 1990. Increasing iatrogenic delivery may be attributable, in part, to changing maternal phenotype and to altered clinicians' behavior. However, improvements in fetal surveillance, particularly ultrasonography, and advanced neonatal care may underpin perinatal clinical decision-making and the likelihood of iatrogenic birth.

Impact of irritability: a 2-year observational study of outpatients with bipolar I or schizoaffective disorder.

OBJECTIVES: Many people experience irritability when manic, hypomanic, or depressed, yet its impact on illness severity and quality of life in bipolar and schizoaffective disorders is poorly understood. This study aimed to examine the relationship between irritability and symptom burden, functioning, quality of life, social support, suicidality, and overall illness severity in a naturalistic cohort of people with bipolar I or schizoaffective disorder. METHODS: We used data from 239 adult outpatients with bipolar I or schizoaffective disorder in the Bipolar Comprehensive Outcomes Study (BCOS) - a non-interventional observational study with a 2-year follow-up period. Baseline demographic and clinical characteristics of participants with and without irritability were compared. A mixed-model repeated measures analysis was conducted to examine the longitudinal effect of irritability on clinical and quality-of-life variables over follow-up using significant baseline variables. RESULTS: At baseline, 54% of participants were irritable. Baseline irritability was associated with illness severity, mania, depression, psychotic symptoms, suicidality, poor functioning, and quality of life, but not diagnosis (schizoaffective/bipolar disorder). Participants with irritability were less likely to have a partner and perceived less adequate social support. On average, over follow-up, those with irritability reported more symptoms, functional impairment, and suicidality. Furthermore, the effects of irritability could not be fully explained by illness severity. CONCLUSIONS: Irritability was associated with more negative symptomatic, functional, and quality-of-life outcomes and suicidality. The identification, monitoring, and targeted treatment of irritability may be worth considering, to enhance health and wellbeing outcomes for adults with bipolar and schizoaffective disorders.

Statin and Aspirin Use and the Risk of Mood Disorders among Men.

BACKGROUND: There is a growing understanding that depression is associated with systemic inflammation. Statins and aspirin have anti-inflammatory properties. Given these agents have been shown to reduce the risk of a number of diseases characterized by inflammation, we aimed to determine whether a similar relationship exists for mood disorders (MD). METHODS: This study examined data collected from 961 men (24-98 years) participating in the Geelong Osteoporosis Study. MD were identified using a semistructured clinical interview (SCID-I/NP). Anthropometry was measured and information on medication use and lifestyle factors was obtained via questionnaire. Two study designs were utilized: a nested case-control and a retrospective cohort study. RESULTS: In the nested case-control study, exposure to statin and aspirin was documented for 9 of 142 (6.3%) cases and 234 of 795 (29.4%) controls (P < .001); after adjustment for age, exposure to these anti-inflammatory agents was associated with reduced likelihood of MD (OR 0.2, 95%CI 0.1-0.5). No effect modifiers or other confounders were identified. In the retrospective cohort study of 836 men, among the 210 exposed to statins or aspirin, 6 (2.9%) developed de novo MD during 1000 person-years of observation, whereas among 626 nonexposed, 34 (5.4%) developed de novo MD during 3071 person-years of observation. The hazard ratio for de novo MD associated with exposure to anti-inflammatory agents was 0.55 (95%CI 0.23-1.32). CONCLUSIONS: This study provides both cross-sectional and longitudinal evidence consistent with the hypothesis that statin and aspirin use is associated with a reduced risk of MD.

Prevalence of cardiovascular and metabolic events in patients prescribed clozapine: a retrospective observational, clinical cohort study.

BACKGROUND: The efficacy of clozapine for the treatment of schizophrenia has been demonstrated. However, a range of adverse events have been associated with its use. To date, there remains a paucity of data regarding the prevalence of clozapine-induced cardiovascular (CV) and parameters associated with the development of metabolic syndrome, alongside associated risk factors for their development. METHODS: An observational, clinical cohort study design of 355 clozapine patients who were enrolled in the Barwon Health Clozapine Program at Geelong Hospital, Victoria, Australia, between 2008-12. Medical records were accessed retrospectively. Multivariate logistic regression was used to determine associations with adverse event(s). RESULTS: Older age of commencement with clozapine was consistently associated with increased risk of CV abnormalities, with the exception of tachycardia where older age was protective (Odds Ratio [OR]: 0.97; 95% Confidence Intervals [CI]: 0.95, 0.99). Males had significantly greater odds of most metabolic disturbances with the exception of being obese (BMI: ≥30 OR: 0.45; 95% CIs: 0.24, 0.85). Older age of commencement was a significantly associated variable with High- Density Lipoprotein-cholesterol (OR: 1.03; 95% CIs: 1.01, 1.07) and fasting glucose (OR:1.04; 95% CIs: 1.02, 1.07). An increase in BMI was consistently and significantly associated with all metabolic events. CONCLUSION: Male patients who are obese at any point during treatment and older at treatment commencement may be the most vulnerable to adverse CV and metabolic events. While future studies using a matched case-control design may be required to verify these findings, we recommend that treating clinicians consider these risks when assessing patient suitability to clozapine therapy.

The relationships between insomnia, sleep apnoea and depression: findings from the American National Health and Nutrition Examination Survey, 2005-2008.

OBJECTIVE: To determine the association between insomnia, obstructive sleep apnoea (OSA), and comorbid insomnia-OSA and depression, while controlling for relevant lifestyle and health factors, among a large population-based sample of US adults. METHOD: We examined a sample of 11,329 adults (≥18 years) who participated in the National Health and Nutrition Examination Survey (NHANES) during the years 2005-2008. Insomnia was classified via a combination of self-reported positive physician diagnosis and high-frequency 'trouble falling asleep', 'waking during the night', 'waking too early', and 'feeling unrested during the day'. OSA was classified as a combination of a positive response to a physician-diagnosed condition, in addition to a high frequency of self-reported nocturnal 'snoring', 'snorting/stopping breathing' and 'feeling overly sleepy during the day'. Comorbid insomnia-OSA was further assessed by combining a positive response to either insomnia (all), or sleep apnoea (all), as classified above. Depressive symptomology was assessed by the Patient Health Questionnaire-9 (PHQ-9), with scores of >9 used to indicate depression. Odds ratios (ORs) and 95% confidence intervals (CIs) for sleep disorders and depression were attained from logistic regression modelling adjusted for sex, age, poverty level, smoking status and body mass index (BMI). RESULTS: Those who reported insomnia, OSA or comorbid insomnia-OSA symptoms reported higher rates of depression (33.6%, 22.2%, 27.1%, respectively), and consistently reported poorer physical health outcomes than those who did not report sleep disorders. After adjusting for sex, age, poverty level, smoking status and BMI (kg/m(2)), insomnia (OR 6.57, 95% CI 3.89-11.11), OSA (OR 5.14, 95% CI 3.14-8.41) and comorbid insomnia-OSA (OR 6.67, 95% CI 4.44-10.00) were associated with an increased likelihood of reporting depression. CONCLUSIONS: Insomnia, OSA and comorbid insomnia-OSA are associated with significant depressive symptomology among this large population-based sample of adults.

Long-term efficacy of a tele-health intervention for acute coronary syndrome patients with depression: 12-month results of the MoodCare randomized controlled trial.

BACKGROUND: Depression is common after a cardiac event; however it often remains untreated. Previously, we reported the efficacy and feasibility of a 6-month tele-health programme (MoodCare), which integrates depression management into a cardiovascular disease (CVD) risk reduction programme for Acute Coronary Syndrome (ACS) patients with low mood. Here, we evaluate the long-term efficacy of the programme at 12-month follow-up. DESIGN: A two-arm, parallel, randomized design to compare the long-term effects of 'MoodCare' (n = 61) to usual care (UC) (n = 60) at 12 months. METHOD: 121 ACS patients recruited from six hospitals in Victoria and Brisbane, Australia were randomized to a telephone-delivered cognitive behavioural therapy and risk-reduction programme or usual medical care. Mixed-model repeated measurements (MMRM) analysis was applied with results expressed as estimated marginal mean changes in depression and health-related quality of life (HRQOL) outcomes by group. RESULTS: After 12 months, treatment effects were observed for those with major depressive disorder (MDD) for PHQ-9 depression (MoodCare: mean score: 6.5; 95% CI: 4.9-8.0 versus UC: 9.3; 95% CI: 7.7-10.9, p = 0.012)) and SF-12 mental health scores (MoodCare: 42.5; 95% CI: 39.8-45.2 versus UC: 36.8; 95% CI: 34.1-39.6, p = 0.005). No beneficial treatment effects were observed in those with no MDD at baseline. CONCLUSION: After 12 months, MoodCare was superior to UC for improving mental health outcomes for those with a clinical diagnosis of major depression. Our findings support the implementation of depression-based interventions for cardiac patients with a clinical diagnosis of depression and provide evidence of longer term efficacy to one year.

Towards stage specific treatments: effects of duration of illness on therapeutic response to adjunctive treatment with N-acetyl cysteine in schizophrenia.

Schizophrenia is a chronic and often debilitating disorder in which stage of illness appears to influence course, outcome, prognosis and treatment response. Current evidence suggests roles for oxidative, neuroinflammatory, neurotrophic, apoptotic, mitochondrial and glutamatergic systems in the disorder; all targets of N-acetyl cysteine (NAC). A double blind, placebo controlled trial suggested NAC to be beneficial to those diagnosed with schizophrenia. The current manuscript aims to investigate duration of the illness as a key factor that may be modulating the response to NAC in the participants who took part in the study. A sample of 121 participants were randomised in a double fashion to 24 weeks (placebo=62; NAC=59). Clinical and functional variables were collected over the treatment period. Duration of the illness at baseline was grouped into <10 years, 10-<20 years and >20 years. Mixed Model Repeated Measures Analysis was used to explore the effect of illness duration on response to treatment with NAC. A significant interaction between duration of the illness and response to treatment with NAC was consistently found for positive symptoms and functional variables, but not for negative or general symptoms or for side effect related outcomes. The pattern of changes suggests that this mediator effect of duration of illness in response to treatment is more evident in those participants with 20 years or more of illness duration. Our results suggest a potential advantage of adjunctive NAC over placebo on functioning and positive symptoms reduction in those patients with chronic schizophrenia. This has potential for suggesting stage specific treatments.

The association between poor dental health and depression: findings from a large-scale, population-based study (the NHANES study).

OBJECTIVE: To examine the relationship of poor dental health and depression, controlling for markers of inflammation (C-reactive protein; CRP) and adiposity (body mass index; BMI). METHOD: Data from two National Health and Nutrition Examination Surveys (2005-2008) were utilized (n=10214). Dental health was assessed using the Oral Health Questionnaire (OHQ). Depression was measured using the Patient Health Questionnaire-9 (PHQ-9), where cases were identified using a cut off score of 10 or above. Logistic regression was applied to measure magnitude of associations, controlling for a range of covariates including CRP and BMI. RESULTS: After adjustment for covariates, a significant dose-response relationship between number of oral health conditions and likelihood of PHQ-9 defined depression was observed. Compared with individuals without an oral health condition, adjusted odds ratio (95% confidence interval) for depression in those with two, four and six conditions were 1.60 (1.08-2.38), 2.13 (1.46-3.11) and 3.94 (2.72-5.72), respectively. Level of CRP and being underweight or obese were associated with being depressed. CONCLUSIONS: A positive association exists between poor dental health and depression that is independent of CRP and BMI.

Castelli risk indexes 1 and 2 are higher in major depression but other characteristics of the metabolic syndrome are not specific to mood disorders.

AIMS: This study examined whether Castelli risk indexes 1 (total/high-density lipoprotein (HDL) cholesterol) and 2 (low density lipoprotein (LDL)/HDL cholesterol) and other shared metabolic disorders might underpin the pathophysiology of the metabolic syndrome, major depression or bipolar disorder. MAIN METHODS: This cross-sectional study examined 92 major depressed, 49 bipolar depressed and 201 normal controls in whom the Castelli risk indexes 1 and 2 and key characteristics of the metabolic syndrome, i.e. waist/hip circumference, body mass index (BMI), systolic/diastolic blood pressure, total cholesterol, low-density lipoprotein (LDL) and HDL cholesterol, triglycerides, insulin, glucose, hemoglobin A1c (HbA1c) and homocysteine were assessed. KEY FINDINGS: Castelli risk indexes 1 and 2 were significantly higher in major depressed patients than in bipolar disorder patients and controls. There were no significant differences in waist or hip circumference, total and LDL cholesterol, triglycerides, plasma glucose, insulin, homocysteine and HbA1c between depression and bipolar patients and controls. Bipolar patients had a significantly higher BMI than major depressed patients and normal controls. SIGNIFICANCE: Major depression is accompanied by increased Castelli risk indexes 1 and 2, which may be risk factors for cardiovascular disease. Other key characteristics of the metabolic syndrome, either metabolic biomarkers or central obesity, are not necessarily specific to major depression or bipolar disorder.