Prevalence of pre- and postpartum depression in Jamaican women.

BACKGROUND: Maternal depression during pregnancy has been studied less than depression in postpartum period. The aims of this study were to find out the prevalence of prepartum and postpartum depression and the risk factors associated in a cohort of Afro-Jamaican pregnant women in Jamaica. METHODS: The Zung self-rating depression scale instrument was administered to 73 healthy pregnant women at 28 weeks gestation and at 6 weeks postpartum for quantitative measurement of depression. Blood samples were collected at 8, 28, 35 weeks gestation and at day 1 and 6 weeks postpartum to study the thyroid status. RESULTS: Study demonstrated depression prevalence rates of 56% and 34% during prepartum and postpartum period, respectively. 94% women suffering depression in both periods were single. There were significant variations in both FT3 and TT4 concentrations which increased from week 8 to week 28 prepartum (p < 0.05) and then declined at the 35th week (p < 0.05 compared with week 28) and 1 day post delivery study (p < 0.05 compared with week 35). The mean values for TSH increased significantly from week 8 through week 35. The mean values at 1 day postpartum and 6 week postpartum were not significantly different from the 35 week values. For FT3, TT4 and TSH there were no significant between group differences in concentrations. The major determinants of postpartum depression were moderate and severe prepartum depression and change in TT4 hormone concentrations. CONCLUSION: High prevalence of depression was found during pre- and postpartum periods. Single mothers, prepartum depression and changes in TT4 were factors found to be significantly associated with postpartum depression.

Status of the thyroid gland in pregnancy and its relation to postpartum depression

OBJECTIVES: Adequate adjustments by the hypothalamic-pituitary-thyroid axis during pregnancy allow women to remain euthyroid with only slight changes in thyroid volume and other thyroid functions. In approximately 10 percent of women, the challenge of thyroid economy results in sub-clinical hypothyroidism. This study is to elucidate the association between such hypothyroidism and postpartum depression, if any. METHOD: Blood samples were collected from 73 healthy subjects attending the antenatal clinc of the University Hospital of the West Indies, at booking, 28 weeks, 36 weeks of gestation, and 1 day and 6 weeks postpartum. Serum level of total thyroxine, free tri-iodothyronine, and thyroid stimulating hormone (TSH) were determined by radioimmunoassays. The thyroid volume was estimated by ultrasonography in some subjects. A self-rating depression scale was administered at 28 weeks of gestation and at 6 weeks postpartum for quantitative measurement of depression. The preliminary results revealed that 22 subjects (30 percent) had postpartum depression, 12 (16 percent) had mild depressin and 10 (14 percent) had moderated to marked depression. Of these, only 2 subjects had total thyroxine values less than 5.5g/100 ml and TSH values greater than 2.5 IU/ml. There were no significant changes between postpartum and antepartum thyroid volumes. CONCLUSION: Although a significant number of women in this study had postpartum depression, no significant relationship between depression and the serum levels of thyroid hormones was established.(Au)

Effects of aqueous extract of neem (azadirachta indica a. juss) on streptozotocin induced diabetic rats

Neem (Azadirachta indica) products have been extensively used in Ayurvedic medicine in India for many centuries. To elucidate a common folkloric saying, "two leaves a day keeps diabetes away", thirty male Wistar rats weighing between 180 to 250 g were randomly assigned to three equal groups. To induce diabetes, rats in groups II and III received a single intraperitoneal dose of Streptozotocin (STZ) at a rate of 50 mg/Kg body weight. After 5 days of STZ treatment, diabetic rats in group III received 0.4 percent aqueous neem extract in drinking water for 188 days. Rats in group III received citrate buffer and served as drinking water for 188 days. Rats in group I received citrate buffer and served as control. All the rats were maintained under standard management conditions and received water/extract and dry pellet diet ad libitum. The animals were sacrificed after 290 days for histological examination of various tissues. The results of the study revealed that (1) the mean blood glucose levels showed a decreasing trend (p>0.05) during 48-77 days of neem treatment and also after 51 days of discontinuation of the neem treatment (2) the percent gain in body weight in neem treated diabetic rats was lower than in diabetic rats (20v/s 80 percent) (p value). In conclusion, the aqueous extract of neem showed significant improvements in the body weights and lessened mortality in STZ induced diabetic rats but could not normalise blood glucose levels.(AU)

Effect of Aqueous neem (azadirachta indica) extract on testosterone and other blood constituents in male rats: a pilot study

Effect of oral administration of crude aqueous neem extract on serum testosterone and other blood constituents was studied in the male Wistar rats for 10 weeks. The neem treatment resulted in significant decreases (p,0.01) in total testosterone, total bilirubin and K+ in serum. There were also increases (p<0.05) in packed cell volume, mean corpuscular haemoglobin concentration, red blood cell, white blood cell and lymphocyte counts without showing any cytotoxic effects in the body (AU)

Effect of aqueous Neem (azadirachta indica) extract on testosterone and other blood constituents in male rats: a pilot study

Effect of oral administration of crude aqueous neem extract on serum testosterone and other blood constituents was studied in the male Wistar rats for 10 weeks. The neem treatment resulted in significant decreases (p,0.01) in total testosterone, total bilirubin and K+ in serum. There were also increases (p<0.05) in packed cell volume, mean corpuscular haemoglobin concentration, red blood cell, white blood cell and lymphocyte counts without showing any cytotoxic effects in the body.

The mechanism of low testosterone levels in homozygous sickle-cell disease

Significantly lower testosterone levels are common in male patients with homozygous sickle-cell (SS) disease and have been attributed to either abnormalities of the hypothalamo-pituitary axis or primary testicular failure. The mechanism has now been investigated by observing the response to gonadrotropin-thytotropin releasing hormones (GnRH-TRH) in 10 male patients with SS disease and in 10 matched male sibling controls without sickle-cell disease. Mean basal levels of luteninizing hormone (LH) follicular stimulating hormone (FSH) and thyrotropin (TSH) were significantly elevated but prolactin (RL) levels were within the normal range in the SS group. All hormones increased following GnRH-TRH, and proportionate increases over baseline were similar for FSH and TSH in SS and AA subjects, but SS patients showed a lesser percentage increase in LH at 30 minutes, and a higher percentage increase in PRL at 60 minutes. These observations are more consistent with primary testicular failure than with adnormalities of the hypothalmic-pituitaty-testicular axis (AU)

The mechanism of low testosterone levels in homozygous sickle-cell disease

Significantly lower testosterone levels are common in male patients with homozygous sickle-cell (SS) disease and have been attributed to either abnormalities of the hypothalamo-pituitary axis or primary testicular failure. The mechanism has now been investigated by observing the response to gonadrotropinthytotropin releasing hormones (GnRH-TRH) in 10 male patients with SS disease and in 10 matched male sibling controls without sickle-cell disease. Mean basal levels of luteninizing hormone (LH) follicular stimulating hormone (FSH) and thyrotropin (TSH) were significantly elevated but prolactin (RL) levels were within the normal range in the SS group. All hormones increased following GnRH-TRH, and proportionate increases over baseline were similar for FSH and TSH in SS and AA subjects, but SS patients showed a lesser percentage increase in LH at 30 minutes, and a higher percentage increase in PRL at 60 minutes. These observations are more consistent with primary testicular failure than with adnormalities of the hypothalmic-pituitaty-testiculat axis.

Training of health professionals and community leaders in techniques to promote demand reduction for drugs

The problem of drug and its associated harmful effects on the individuals, their families and the nation has received a great deal of attention during the past decade. Media campaigns, traditional or affective educational programmes and other alternate activities, designed to help individuals achieve total abstinence, or modify their pattern of use were rarely successful at influencing behaviour change. It may be due to unsound methodology used to carry out these intervention programmes. A multidimensional intervention programme involving teaching and training of health professionals together with selected communities, is therefore, suggested. Under this programme, a problem based methodology will be used to resolve the issue of drug abuse through the process of active learning. The major component of this methodology will be to develop techniques for training of health professionals in drug prevention. The trained health professionals in turn will train community leaders who will increase the community's competence to deal with drug abuse. Community leaders together with the support of Neuroscience, Adolescent Development and Drug Research Programme (NADRAP), University of the West Indies, Mona and other such institutes, will be expected to influence the knowledge and behaviour of the individuals in promoting demand reduction for drugs in Jamaica.(AU)

Ethics and law in the medical curriculum: a University of the West Indies perspective

The Faculty of Medical Sciences (FMS), University of the West Indies, recognises that ethics and law are not currently given adequate importance in the training of health professionals. FMS also recognises the rapid advancement of technology, such as transplants, artificial organs, in vitro fertilization, life-sustaining equipment and euthanasia, as well as the ever-increasing prevalence of malpractice. Thus two conferences were held to consider the implementation of ethics and law in the medical curriculum. The conferences recommended an increased input into the curriculum of ethics and law, and that this programme be taught and examined in all the medical years. The article discusses implementation strategies (AU)

Thyroid-Gonad relationship in systemic lupus erythematosus

Thirty women with systemic lupus erythematosus (SLE) were examined to assess the thyroid-gonad relationship. Significant decreases in mean serum tri-iodo-thyronine and testerone levels and increases in mean serum estradiol and luteinizing hormone levels were observed in SLE patients as compared to control subjects. The serum levels of thyroxine, thyrotropin, tri-iodo-thyronine uptake, free thyroxine index and prolactin were, however, not significantly different in both groups. The interpretation of these findings is unclear but SLE could be regarded as one of the nonthyroidal systematic illness since low serum tri-iodo-thyrotropin levels were observed in our patients. Furthermore, high levels of estradiol and low levels of testosterone in our female patients may indicate involvement of sex steroids in the pathogenesis of SLE. (AU)

Thyroid-gonad relationship in chronic schizophrenia

The effects of the severity of psychiatric illnesses on thyroid function and their relationship to serum testosterone levels were studied in 38 men of African origin, suffering from chronic schizophrenia. Significantly lower levels of serum T4, T3, FT4I and testosterone in acutely psychotic patients indicated decreased thyroid-gonadal activity. Higher serum T4 and FT4I and lower serum TSH, testosterone and cortisol levels were observed in patients whose illnesses were in remission. Levels of both FT4I and testosterone in clinically stable patients, however, were not significantly different in comparison to controls, suggesting recovery from the illness. No significant differences either in thyroid or gonadal hormones were observed between patients exhibiting depression or elated affects; among disorganized, catatonic, paranoid and undifferentiated types; and among patients treated with different psychotropic drugs. The possible mechanisms involved in such thyroid-gonad relationship are discussed. (AU)

Impaired pituitary responsiveness to luteinizing hormone-thyrotropin releasing hormone: a possible sickle-cell disease - abstract

Homozygous sickle-cell(SS) disease is associated with delayed development and reduced fertility in both men and women. The results of an initial pilot study indicated significantly lower (p<0.01) serum levels of testosterone in male SS patients. This study is a further attempt to evaluate pituitary responsiveness to exogenous administration of luteinizing-thyrotropin releasing hormone (LHRH-TRH) in a group of 10 male SS patients, each matched with a brother without SS disease to determine whether a defect exists in the central regulation of pituitary secretions in these patients. The mean serum testosterone levels were significantly lower (p < 0.025), whereas basal levels of luteinizing hormone (LH) and thyrotropin (TSH) were significantly higher (p < 0.05) at 20 minutes in the SS patients. Mean LH responses were consistently higher in SS patients but the differences only reached significantly (p<0.05) at 120 minutes after LHRH-TRH administration. We concluded that subnormal levels of serum testosterone in SS disease are not solely attributable to primary testicular failure, but also result from defect(s) in LH-negative feed back operation (AU)

Abnormal thyroid hormone and thyrotropin levels in homozygous sickle cell disease

Male patients with SS disease had significantly lower T3 and higher TSH levels than a comparison group. Stimulation with TRH in 10 male sibling pairs showed highly significant increases in T3 and TSH in both patients and sibling controls although the increase in TSH was significantly greater in SS disease. The interpretation of these findings unclear although the thyroid indices indicate an abnormal pituitary-thyroid axis most consistent with a modest primary thyroid failure

Thyroid-gonad relationship in chronic schizophrenia - abstract

The effects of the severity of psychiatric illness on thyroid functions and their relationship to serum testosterone were studied in 38 men of African origin in Bellevue Hospital suffering from schizophrenia of 3-11 years' duration. Serum levels of thyroxin (T4), triiodothyronine (T3) uptake (T3U), thyrotropin (TSH), free thyroxin index (FT4I), testosterone, luteinizing hormone (LH), prolactin and cortisol were determined, using specific radio-immuno-assay kits. The results were compared with 22 age-matched healthy control subjects. Mean serum levels of T4, T3, FT4I and testosterone were significantly (p<0.01) lower than control subjects. This indicates decreased thyroid-gonadal activity in acutely psychotic patients. Serum T4 and FT4I were significantly (p<0.05) higher, whereas serum TSH, testosterone and cortisol were lower in patients who were in remission. This may indicate the existence of a 'rebound' phenomenon. Levels of both FT4I and testosterone in clinically stable patients, however, were not different from those in healthy control subjects, suggesting recovery from the illness. No significant differences either in serum thyroid or gonadal hormones were observed between patients exhibiting depression or elated affects; or amongst disorganized, catatonic, paranoid and undifferentiated types of schizophrenics or in patients treated with different neuroleptic drugs. Simultaneous decreases in both thyroidal and gonadal hormones, with normal levels of pituitary hormones (TSH, LH and prolactin), suggest dysfunction of the pituitary-thyroid-gonad axis in acutely psychotic patients. It is hypothesised that some common mechanism(s) which may involve hypothalamic TRH and/or dopamine is (are) responsible for such dysfunction during schizophrenic illness (AU)