Non-binary gender, vulnerable populations and mental health during the COVID-19 pandemic: Data from the COVID-19 MEntal health inTernational for the general population (COMET-G) study.

BACKGROUND: The COVID-19 pandemic has brought significant mental health challenges, particularly for vulnerable populations, including non-binary gender individuals. The COMET international study aimed to investigate specific risk factors for clinical depression or distress during the pandemic, also in these special populations. METHODS: Chi-square tests were used for initial screening to select only those variables which would show an initial significance. Risk Ratios (RR) were calculated, and a Multiple Backward Stepwise Linear Regression Analysis (MBSLRA) was followed with those variables given significant results at screening and with the presence of distress or depression or the lack of both of them. RESULTS: The most important risk factors for depression were female (RR = 1.59-5.49) and non-binary gender (RR = 1.56-7.41), unemployment (RR = 1.41-6.57), not working during lockdowns (RR = 1.43-5.79), bad general health (RR = 2.74-9.98), chronic somatic disorder (RR = 1.22-5.57), history of mental disorders (depression RR = 2.31-9.47; suicide attempt RR = 2.33-9.75; psychosis RR = 2.14-10.08; Bipolar disorder RR = 2.75-12.86), smoking status (RR = 1.15-5.31) and substance use (RR = 1.77-8.01). The risk factors for distress or depression that survived MBSLRA were younger age, being widowed, living alone, bad general health, being a carer, chronic somatic disorder, not working during lockdowns, being single, self-reported history of depression, bipolar disorder, self-harm, suicide attempts and of other mental disorders, smoking, alcohol, and substance use. CONCLUSIONS: Targeted preventive interventions are crucial to safeguard the mental health of vulnerable groups, emphasizing the importance of diverse samples in future research. LIMITATIONS: Online data collection may have resulted in the underrepresentation of certain population groups.

Somatic multicomorbidity and disability in patients with psychiatric disorders in comparison to the general population: a quasi-epidemiological investigation in 54,826 subjects from 40 countries (COMET-G study).

BACKGROUND: The prevalence of medical illnesses is high among patients with psychiatric disorders. The current study aimed to investigate multi-comorbidity in patients with psychiatric disorders in comparison to the general population. Secondary aims were to investigate factors associated with metabolic syndrome and treatment appropriateness of mental disorders. METHODS: The sample included 54,826 subjects (64.73% females; 34.15% males; 1.11% nonbinary gender) from 40 countries (COMET-G study). The analysis was based on the registration of previous history that could serve as a fair approximation for the lifetime prevalence of various medical conditions. RESULTS: About 24.5% reported a history of somatic and 26.14% of mental disorders. Mental disorders were by far the most prevalent group of medical conditions. Comorbidity of any somatic with any mental disorder was reported by 8.21%. One-third to almost two-thirds of somatic patients were also suffering from a mental disorder depending on the severity and multicomorbidity. Bipolar and psychotic patients and to a lesser extent depressives, manifested an earlier (15-20 years) manifestation of somatic multicomorbidity, severe disability, and probably earlier death. The overwhelming majority of patients with mental disorders were not receiving treatment or were being treated in a way that was not recommended. Antipsychotics and antidepressants were not related to the development of metabolic syndrome. CONCLUSIONS: The finding that one-third to almost two-thirds of somatic patients also suffered from a mental disorder strongly suggests that psychiatry is the field with the most trans-specialty and interdisciplinary value and application points to the importance of teaching psychiatry and mental health in medical schools and also to the need for more technocratically oriented training of psychiatric residents.

The Paradoxical Clinical Course of Persons with Gambling Disorder and Comorbid Attention-Deficit/Hyperactivity Disorder (ADHD).

The co-occurrence of gambling disorder (GD) and attention-deficit/hyperactivity disorder (ADHD) has been widely reported. In this study, we aimed to investigate the social background, clinical characteristics, and clinical course of initial-visit GD patients with and without ADHD in a Japanese psychiatric hospital. We recruited 40 initial-visit GD patients and collected comprehensive information by self-report questionnaires, direct interviews, and medical records. 27.5% of the GD patients had comorbid ADHD. Compared to the GD patients without ADHD, those with ADHD had significantly higher comorbidity rates of autism spectrum disorder (ASD), lower rates of marriage, slightly less years of education and marginally lower employment rates. On the other hand, the GD patients with ADHD showed higher treatment retention rates and participation rates in the mutual support group. Despite presenting with disadvantageous characteristics, GD patients with ADHD exhibited a more favourable clinical course. Therefore, clinicians should be mindful of the possibility of ADHD comorbidity and the potential for better clinical outcomes among GD patients with ADHD.

Results of the COVID-19 mental health international for the health professionals (COMET-HP) study: depression, suicidal tendencies and conspiracism.

INTRODUCTION: The current study aimed to investigate the rates of anxiety, clinical depression, and suicidality and their changes in health professionals during the COVID-19 outbreak. MATERIALS AND METHODS: The data came from the larger COMET-G study. The study sample includes 12,792 health professionals from 40 countries (62.40% women aged 39.76 ± 11.70; 36.81% men aged 35.91 ± 11.00 and 0.78% non-binary gender aged 35.15 ± 13.03). Distress and clinical depression were identified with the use of a previously developed cut-off and algorithm, respectively. STATISTICAL ANALYSIS: Descriptive statistics were calculated. Chi-square tests, multiple forward stepwise linear regression analyses, and Factorial Analysis of Variance (ANOVA) tested relations among variables. RESULTS: Clinical depression was detected in 13.16% with male doctors and 'non-binary genders' having the lowest rates (7.89 and 5.88% respectively) and 'non-binary gender' nurses and administrative staff had the highest (37.50%); distress was present in 15.19%. A significant percentage reported a deterioration in mental state, family dynamics, and everyday lifestyle. Persons with a history of mental disorders had higher rates of current depression (24.64% vs. 9.62%; p < 0.0001). Suicidal tendencies were at least doubled in terms of RASS scores. Approximately one-third of participants were accepting (at least to a moderate degree) a non-bizarre conspiracy. The highest Relative Risk (RR) to develop clinical depression was associated with a history of Bipolar disorder (RR = 4.23). CONCLUSIONS: The current study reported findings in health care professionals similar in magnitude and quality to those reported earlier in the general population although rates of clinical depression, suicidal tendencies, and adherence to conspiracy theories were much lower. However, the general model of factors interplay seems to be the same and this could be of practical utility since many of these factors are modifiable.

The effect of different degrees of lockdown and self-identified gender on anxiety, depression and suicidality during the COVID-19 pandemic: Data from the international COMET-G study.

INTRODUCTION: During the COVID-19 pandemic various degrees of lockdown were applied by countries around the world. It is considered that such measures have an adverse effect on mental health but the relationship of measure intensity with the mental health effect has not been thoroughly studied. Here we report data from the larger COMET-G study pertaining to this question. MATERIAL AND METHODS: During the COVID-19 pandemic, data were gathered with an online questionnaire from 55,589 participants from 40 countries (64.85% females aged 35.80 ± 13.61; 34.05% males aged 34.90±13.29 and 1.10% other aged 31.64±13.15). Anxiety was measured with the STAI, depression with the CES-D and suicidality with the RASS. Distress and probable depression were identified with the use of a previously developed cut-off and algorithm respectively. STATISTICAL ANALYSIS: It included the calculation of Relative Risk (RR), Factorial ANOVA and Multiple backwards stepwise linear regression analysis RESULTS: Approximately two-thirds were currently living under significant restrictions due to lockdown. For both males and females the risk to develop clinical depression correlated significantly with each and every level of increasing lockdown degree (RR 1.72 and 1.90 respectively). The combined lockdown and psychiatric history increased RR to 6.88 The overall relationship of lockdown with severity of depression, though significant was small. CONCLUSIONS: The current study is the first which reports an almost linear relationship between lockdown degree and effect in mental health. Our findings, support previous suggestions concerning the need for a proactive targeted intervention to protect mental health more specifically in vulnerable groups.

Results of the COVID-19 mental health international for the general population (COMET-G) study.

INTRODUCTION: There are few published empirical data on the effects of COVID-19 on mental health, and until now, there is no large international study. MATERIAL AND METHODS: During the COVID-19 pandemic, an online questionnaire gathered data from 55,589 participants from 40 countries (64.85% females aged 35.80 ± 13.61; 34.05% males aged 34.90±13.29 and 1.10% other aged 31.64±13.15). Distress and probable depression were identified with the use of a previously developed cut-off and algorithm respectively. STATISTICAL ANALYSIS: Descriptive statistics were calculated. Chi-square tests, multiple forward stepwise linear regression analyses and Factorial Analysis of Variance (ANOVA) tested relations among variables. RESULTS: Probable depression was detected in 17.80% and distress in 16.71%. A significant percentage reported a deterioration in mental state, family dynamics and everyday lifestyle. Persons with a history of mental disorders had higher rates of current depression (31.82% vs. 13.07%). At least half of participants were accepting (at least to a moderate degree) a non-bizarre conspiracy. The highest Relative Risk (RR) to develop depression was associated with history of Bipolar disorder and self-harm/attempts (RR = 5.88). Suicidality was not increased in persons without a history of any mental disorder. Based on these results a model was developed. CONCLUSIONS: The final model revealed multiple vulnerabilities and an interplay leading from simple anxiety to probable depression and suicidality through distress. This could be of practical utility since many of these factors are modifiable. Future research and interventions should specifically focus on them.

The effect of aging on the antioxidative activity of astaxanthin in human aqueous humor.

We previously evaluated the antioxidative effects of astaxanthin intake in the aqueous humor by measuring reactive oxygen species-related parameters, including O2 •- scavenging activity, H2O2 level, and total hydroperoxides level. In this study, we analyzed the antioxidative effects of astaxanthin in relation to age in 16 males and 19 females (average age 71.3 and 70.6, respectively) who underwent bilateral cataract surgery on one side before and the other side after astaxanthin intake (6 mg/day for 2 weeks). None of the parameters correlated with age before astaxanthin intake, but only total hydroperoxides level was significantly correlated after the astaxanthin intake (r = 0.4, p<0.05). Total hydroperoxides levels were similar in younger and older patients (<70 vs ≥70 years) before astaxanthin, but decreased significantly more in younger patients (-0.21 ± 0.18 vs -0.05 ± 0.31, p<0.05) after the intake, resulting in significantly different levels (p<0.05). The previously observed decrease in mean total hydroperoxides levels following astaxanthin intake was therefore considered likely to be attributable to a greater response in younger subjects. Given that total hydroperoxides levels reflect general antioxidative status, astaxanthin intake may exert a greater antioxidative effect in younger patients. Further comparative studies involving younger subjects and different astaxanthin doses are needed.

Effects of astaxanthin on VEGF level and antioxidation in human aqueous humor: difference by sex.

In our previous report, we showed the effect of astaxanthin intake on VEGF level in the aqueous humor and the relationship between VEGF level and reactive oxygen species-related parameters and other relevant factors. VEGF level is associated with total hydroperoxide level, and a multivariate analysis identified sex as a secondary factor affecting these relationships. Here, we analyzed the effects of astaxanthin on the relationship between VEGF level and reactive oxygen species-related parameters by sex. Patients (16 males and 19 females, aged 71.3 and 70.6, respectively) underwent bilateral cataract surgery on one side before and the other side after astaxanthin treatment (6 mg/day for 2 weeks). Levels of VEGF, hydrogen peroxide, and total hydroperoxide, and O2 •- scavenging activity, were measured in the aqueous humor. In females only, VEGF level was negatively correlated with O2 •- scavenging activity before the astaxanthin intake (r = -0.6, p<0.01) and positively correlated with total hydroperoxide level before and after the astaxanthin intake (r = 0.7 and 0.8, respectively, p<0.01). In conclusion, astaxanthin appears to affect O2 •- scavenging activity in the aqueous humor in females, and is likely to be involved in the control of VEGF levels in the anterior eye.

Gender differences in mRNA expression of aquaporin 8 and glutathione peroxidase in cataractous lens following intake of an antioxidant supplement.

Antioxidants can decrease oxidative damage and prevent age-related ocular disease. Our previous investigation on human aqueous humor following intake of a lutein-containing antioxidant supplement reported an increase in the scavenging activity of superoxide in both genders and an increase in the amount of hydrogen peroxide (H2O2) in females. Aquaporin 8 (AQP8) is a diffusion facilitator of H2O2 and glutathione peroxidase (Gpx) is a H2O2 scavenging enzyme. The correlation between AQP8 and Gpx may be the key to determining how oxidative stress in the aqueous humor affects the lens after intake of antioxidant supplements. In this study, 24 patients with the same grade of binocular cataract were included. Anterior capsule samples, including lens epithelial cells (LECs), were collected during cataract surgery before (as pre-intake samples) and after 6 weeks of oral intake of Ocuvite Lutein ® (as post-intake samples). The mRNA expression of APQ8 and Gpx was measured using real-time polymerase chain reaction. Among males, AQP8 expression decreased significantly after the supplementation (P = .03), while there was no statistical change among females. AQP8 expression was significantly correlated to that of Gpx in post-intake samples among females (R = 0.69, P = .02), while no correlation was evident among males. The results suggest antioxidant supplementation may work by different mechanisms on LECs between genders. After supplementation, a decrease in AQP8 in LECs may inhibit the influx of H2O2 from the aqueous humor in males. In females however, the correlation between AQP8 and Gpx in LECs may indicate an increase in Gpx activity following the influx of H2O2 from the aqueous humor and further scavenging of H2O2.

Evaluating the Biostability of Yellow and Clear Intraocular Lenses with a System Simulating Natural Intraocular Environment.

PURPOSE: Blue light-filtering intraocular lenses (IOLs) are thought to protect the retina from blue light damage after cataract surgery, and the implantation of yellow-tinted IOLs has been commonly used in cataract surgery. To our knowledge, this is the first investigation measuring the long-term biostability of yellow-tinted IOLs using an in vitro system simulating natural intraocular environment. METHODS: Six hydrophobic acrylic IOLs, three clear IOLs, and three yellow-tinted IOLs were included in the study. Each yellow-tinted IOL was a matching counterpart of a clear IOL, with the only difference being the lens color. The IOLs were kept in conditions replicating the intraocular environment using a perfusion culture system for 7 months. Resolution, light transmittance rate, and the modulation transfer function (MTF) were measured before and after culturing. Surface roughness of the anterior and posterior surfaces was also measured. RESULTS: After culturing for 7 months, there were no changes in the resolution, the light transmittance rate, and MTF. The surface roughness of the anterior and posterior surfaces increased after culturing; however, this increase was clinically insignificant. There were no differences in surface roughness between the clear and yellow-tinted IOLs, either before or after culturing. CONCLUSIONS: A novel in vitro system replicating intraocular environment was used to investigate the biostability of yellow-tinted IOLs. The surface roughness showed no clinically significant increase after culturing for 7 months. TRANSLATIONAL RELEVANCE: This system is useful for evaluating the biostability of IOLs.

The effect of astaxanthin on vascular endothelial growth factor (VEGF) levels and peroxidation reactions in the aqueous humor.

We explored the effect of astaxanthin on vascular endothelial growth factor in the aqueous humor, by measuring vascular endothelial growth factor levels and oxidation-related parameters, including O2 (•-) scavenging activity, H2O2 level, and total hydroperoxide level in the aqueous humor, obtained from 35 patients before and after astaxanthin administration. We evaluated the relationship between vascular endothelial growth factor and the oxidation-related parameters as well as the patient's diabetic status, age, and sex. Vascular endothelial growth factor levels did not change significantly but O2 (•-) scavenging activity and total hydroperoxide level significantly (p<0.05) increased and decreased, respectively. Both pre- and post- astaxanthin intake, vascular endothelial growth factor and total hydroperoxide levels were positively correlated (Pearson: r = 0.42, p<0.05; r = 0.55, p<0.01, respectively). Analysis of vascular endothelial growth factor levels and O2 (•-) scavenging activities gave a negative correlation but only pre-astaxanthin intake (r = -0.37, p<0.05). Differences in levels pre- and post-astaxanthin only showed association between vascular endothelial growth factor and total hydroperoxide (r = 0.49, p<0.01) analyzed by multiple linear regression. Using multivariate analysis, pre-astaxanthin vascular endothelial growth factor level was associated with two factors of total hydroperoxide and O2 (•-) scavenging activity (r = 0.49, p<0.05), and post-astaxanthin vascular endothelial growth factor level with two factors of total hydroperoxide and sex (r = 0.60, p<0.01). Astaxanthin intake may have affected vascular endothelial growth factor level through its antioxidant effects by increasing O2 (•-) scavenging activity and suppressing peroxide production.

A study of factors contributing to the aggravation of gambling disorder.

While many Japanese nationals are considered to have problems with pachinko and pachisuro (Japanese slot machines), the factors contributing to the process by which gambling disorder-is aggravated remain unclear. Therefore, the aim of this study was to establish baseline data for measures to prevent the further escalation of this gambling disorder; To elucidate the contributing factors, a self-administered questionnaire was distributed to pathological gamblers. The survey items were composed of the following basic attributes; scores on the South Oaks Gambling Screen (SOGS); gambling motivation; matters arising, after gambling behavior; remedies for excessive gambling; the Kessler 6 (K6); the CAGE (Cut down, Annoyed, Guilty, Eye opener) questionnaire; and the 8-item Family Adaptability and Cohesion Evaluation Scale at Kwansei Gakuin IV (FACESKGIV-8). The results of hierarchical multiple regression analysis using SOGS scores as the dependent variable indicated that the variables determined to contribute to the aggravation of gambling addiction were age, sex, past employment experience in the service sector, obtaining money as a motivation for gambling, and seeing limits as a remedy for excessive gambling. Because gamblers tend to fixate on money and experience increasing difficulty devoting attention to other matters as gambling problems grow more serious, the results of this study suggest the need to provide environments that will enable affected individuals to reflect on their own style of gambling at the stage at which their gambling behavior begins to exceed the scope of their own revenue.

[Malnutrition and social isolation among elderly residents of city public housing].

OBJECTIVES: The aim of this study was to examine relations between malnutrition and social isolation among elderly residents of a city public housing facility. METHODS: The present participants were 442 residents aged 65 and older of a public housing facility in Nagoya city. An anonymous self-administered questionnaire survey was conducted regarding demographics, nutritional status, and social isolation. Nutritional status was evaluated using the Mini Nutritional Assessment(®)-Short Form (MNA(®)). Combining "at risk for malnutrition" and "malnutrition," the status was classified into two groups: "normal nutrition" and "at risk for malnutrition." Social isolation was examined using the Japanese version of the abbreviated Lubben Social Network Scale (LSNS-6), which was divided into isolation (less than 12 points) and non-isolation (more than 12 points). Multivariate logistic regression analyses were conducted to assess association between malnutrition and isolation by adjusting for the following possible confounders: age, sex, living alone, self-rated economic conditions, housebound, loneliness, eligible for Long-Term Care Insurance, and the Tokyo Metropolitan Institute of Gerontology (TMIG) Index of Competence. RESULTS: Among 343 respondents (77.6%), the number of valid responses was 288 (65.2%)-121 men and 167 women. The average age was 74.7±6.1 years old (mean±standard deviation), ranging from 65 to 98. Based on the LSNS-6, social isolation was encountered in 44.1%. According to the MNA(®) classification, 171 (59.4%) were classified as "normal nutritional status," 108 (37.5%) as "at risk for malnutrition," and 9 (3.1%) as "malnutrition." "At risk for malnutrition" and "malnutrition" were found in 40.6% in this study. Multivariate logistic analyses showed that risk factors for malnutrition were social isolation (OR=2.52, 95% CI; 1.44-4.41) and poor economic conditions (OR=1.98, 95% CI; 1.15-3.41). Significant interaction between age and living alone suggested that elderly individuals over 75 years of age who live alone were also at risk for malnutrition. CONCLUSION: This study revealed that malnutrition of elderly individuals was associated with social isolation and poor economic conditions as well as age over 75 and living alone. Malnutrition and social isolation can be prevalent in elderly residents of city public housing facilities. Measures of social isolation as well as nutritional support are necessary for health promotion and preventive care of the elderly.

[Study of free radicals in aqueous humor in glaucoma and cataracts: differences in presence or absence of diabetes mellitus and neovascular glaucoma].

PURPOSE: This study was conducted for the purpose of comparing differences in the types of free radicals in the aqueous humor of glaucoma and cataract patients. SUBJECTS AND METHODS: Free radicals in the aqueous humor of 44 glaucoma eyes and 15 cataract eyes were measured by electron spin resonance (ESR), followed by comparing the detection rates. In addition, subgroup analyses were also conducted for the presence or absence of complications of diabetes mellitus (DM) and neovascular glaucoma (NVG) in the patients. RESULTS: Three types of free radicals were measured, ascorbate-free radical (AFR), AFR containing a trace amount of superoxide (SO) (AFR +), and SO containing a trace amount of AFR (SO +). Significant differences were observed in the detection rates of each type between the glaucoma group (maximum SO +) and the cataract group (maximum AFR), between the DM group (maximum SO +) and the non-DM group (maximum AFR) in the glaucoma, and between the DM group (maximum AFR +) and the non-DM group (maximum AFR) in the cataract. SO + was detected in all cases of NVG regardless of whether they were DM or non-DM. CONCLUSION: Glaucoma cases are more susceptible to the generation of SO in the aqueous humor than cataracts, and they are more liable to occur in DM than in non-DM in both glaucoma and cataract cases. This study suggest an evidence for a strong correlation with SO and vascularization in NVG.

The gender-differentiated antioxidant effects of a lutein-containing supplement in the aqueous humor of patients with senile cataracts.

Antioxidant supplements are expected to decrease oxidative damage and prevent ocular diseases. In this study, changes in the anti-oxidative ability and oxidative status in the aqueous humor before and after intake of a lutein-containing supplement were measured. Forty patients who all had identical grades of cataracts in both eyes were included. The aqueous humor was collected as pre-intake samples during cataract surgery. Ocuvite + Lutein(Ⓡ), an antioxidant supplement, was administered orally beginning the day after surgery. Six weeks later, the aqueous humor was collected as a post-intake sample during cataract surgery of the opposite eye. To determine the anti-oxidative ability, the levels of superoxide (O2(*-)) scavenging activity were measured. To determine the oxidative status, the levels of hydrogen peroxide (H2O2) and total amount of hydroperoxides (TH, including H2O2 and peroxides of lipids, proteins, and nucleic acids) were measured. In post-intake samples, the O2(*-) scavenging activities were significantly higher in both genders (p < 0.05). The levels of H2O2 were significantly higher (p < 0.01) while the levels of TH were significantly lower (p < 0.01) only in females. The level of H2O2 was significantly negatively correlated to the TH in the post-intake samples of both genders (r = -0.50 and p < 0.05 for males; r = -0.59 and p < 0.01 for females) while the level of H2O2 was significantly positively correlated to the O2(*-) scavenging activity in both pre- and post-intake aqueous humor in females only (r = 0.66 and p < 0.01 for pre-intake samples, r = 0.71 and p < 0.01 for post-intake samples). After the introduction of the antioxidant supplement, O2(*-) scavenging activity increased while H2O2 levels remained the same in males, suggesting that scavenging rates are proportional. In postmenopausal females, the superoxide scavenging activity also increased, however unlike in males, the H2O2 levels also increased meaning H2O2 was not completely scavenged. H2O2 is a non-free radical and can be excreted from the aqueous humor to prevent further oxidation of lipids, proteins, and nucleic acids, which was confirmed by the low levels of TH in post-intake samples. Antioxidant supplements are suggested to be effective in reducing oxidation in the aqueous humor by different mechanisms in both genders.

Awareness of pre-alcoholic status and changes in such awareness: analysis of narratives by male Japanese patients and their families.

In this study, we investigated the extent of awareness on the part of alcoholic people with regard to their alcoholism and changes in such awareness over time. We conducted qualitative, descriptive analysis of data obtained during semistructured interviews of alcoholic people and family members with whom they lived during the pre-alcoholic stage. The awareness of pre-alcoholic people was found to involve seven elements and to undergo changes at three stages of alcohol consumption (when enjoying the effects of alcohol, when escaping from a reality difficult to face directly, and when alcohol began to cause health problems). The results suggest that professional support for pre-alcoholic people should be tailored to the stage of alcohol use of each individual case and should include advice on appropriate alcohol consumption. In addition, identification and follow-up of problematic drinkers and short-term intervention are required.

[Awareness of pre-alcoholics and changes process in their awareness--analysis of narratives by patients and their families].

This study aimed to compare the process of changes in the recognition of pre-alcoholism between alcoholic patients and their family members, and examine the timing and methods of intervention for patients and their families. We conducted semi-structured interviews with 15 patient-family pairs, consisting of inpatients on the alcoholism ward and their family members in the same household. Our analysis of interview data showed that the process of changes in the patients' drinking behavior, i.e., from healthy drinking to alcohol dependence, had the following 4 stages: "look to benefits of alcohol consumption", "escape reality that they found hard to bear", "manifest health-related impairment", and "have increasing difficulties in restraining themselves from drinking". Drinking problems became more serious when the patients went through several stages at one time, or when they moved back and forth between the stages. There was a time gap between patients and their families in recognizing drinking problems, which leads to the worsening of the problems. Behind this lied communication and emotional problems between patients and their family members. The findings suggest the need to take account of the pre-alcoholic stages, and adequately respond to and care for both patients and families from an early stage onward.

Effects of astaxanthin on antioxidation in human aqueous humor.

We evaluated the antioxidative effects of astaxanthin through the changes in superoxide scavenging activity, levels of hydrogen peroxide and total hydroperoxides in human aqueous humor. The study subjects were 35 patients who underwent bilateral cataract surgery on one side before and the other side after intake of astaxanthin (6 mg/day for 2 weeks). Their aqueous humor was taken during the surgery and subjected to measurements of the three parameters. After astaxanthin intake, the superoxide scavenging activity was significantly (p<0.05) elevated, while the level of total hydroperoxides was significantly (p<0.05) lowered. There was a significant negative correlation between the superoxide scavenging activity and the level of total hydroperoxides (r = -0.485, p<0.01), but no correlations between the hydrogen peroxide level and the other two parameters. Astaxanthin intake clearly enhanced the superoxide scavenging activity and suppressed the total hydroperoxides production in human aqueous humor, indicating the possibility that astaxanthin has suppressive effects on various oxidative stress-related diseases.

Effects of antioxidant supplementation on mRNA expression of glucose-6-phosphate dehydrogenase, ß-actin and 18S rRNA in the anterior capsule of the lens in cataract patients.

This was a preliminary study of the effects of antioxidant supplementation on the peroxidation status of the lens by investigating mRNA expression of anti-oxidative enzymes in the lens. The mRNA expression levels of glucose-6-phosphate dehydrogenase (G6PDH), ß-actin (ß-ACT) and 18S rRNA (18S) were measured in this study because they are common reference genes for measuring mRNA levels by means of a real-time reverse transcription polymerase chain reaction (RT-PCR) in various tissues. Thirteen patients with binocular cataracts of the same grade were included in the study after giving informed consent. A piece of the anterior capsule, along with a sample of lenticular epithelial cells (LECs), was collected as a pre-intake sample during cataract surgery. Ocuvite + Lutein(®), an antioxidant supplement, was administered orally beginning the day after surgery. Six weeks later, a piece of the anterior capsule along with a sample of LECs, was collected as a post-intake sample during cataract surgery of the opposite eye. RNA was purified from the homogenized samples, and cDNA was reverse transcribed to measure mRNA levels. The expression levels of G6PDH, 18S and ß-ACT were measured using RT-PCR. The expression levels of G6PDH and 18S were significantly higher in the post-intake samples than they were in the pre-intake samples. Significant positive correlations between the expression levels of G6PDH and 18S were observed in both the pre- and post-intake samples. Following gender-specific analyses, the expression levels of G6PDH and 18S in the post-intake samples were found to be significantly higher among the female patients. A significant positive correlation between the expression levels of G6PDH and 18S was observed in the post-intake samples from the male patients. There were no significant changes in the gene expression levels of ß-ACT after supplementation among male or female patients. ß-ACT has been verified for use as a reference gene for measuring the effects of antioxidant supplementation in the lens by RT-PCR. Antioxidant supplementation was noted to increase G6PDH in the pentose phosphate cycle and 18S rRNA in the ribosome.

Relationship between Pentosidine and Pyridinoline Levels in Human Diabetic Cataract Lenses.

The relationship between the levels of two different crosslink compounds, pentosidine and pyridinoline, in human diabetic cataract lenses was investigated to elucidate the pathogenic mechanism of diabetic cataract. Subjects were classified into diabetes mellitus (DM) group and non-DM group according to the presence or absence of DM. The levels of the crosslink compounds were determined using high-performance liquid chromatography and spectrofluorometry after acid hydrolysis. In the non-DM group the pentosidine level was significantly and positively correlated with the pyridinoline level and age. In the DM group the pentosidine level was not significantly correlated with either pyridinoline level or age. Pyridinoline levels and age were not significantly correlated in either group. The increase in crosslink compounds due to glycation and the relationship between the compounds are changed in DM lenses.