Has Chlamydia trachomatis prevalence in young women in England, Scotland and Wales changed? Evidence from national probability surveys.

We evaluate the utility of the National Surveys of Attitudes and Sexual Lifestyles (Natsal) undertaken in 2000 and 2010, before and after the introduction of the National Chlamydia Screening Programme, as an evidence source for estimating the change in prevalence of Chlamydia trachomatis (CT) in England, Scotland and Wales. Both the 2000 and 2010 surveys tested urine samples for CT by Nucleic Acid Amplification Tests (NAATs). We examined the sources of uncertainty in estimates of CT prevalence change, including sample size and adjustments for test sensitivity and specificity, survey non-response and informative non-response. In 2000, the unadjusted CT prevalence was 4.22% in women aged 18-24 years; in 2010, CT prevalence was 3.92%, a non-significant absolute difference of 0.30 percentage points (95% credible interval -2.8 to 2.0). In addition to uncertainty due to small sample size, estimates were sensitive to specificity, survey non-response or informative non-response, such that plausible changes in any one of these would be enough to either reverse or double any likely change in prevalence. Alternative ways of monitoring changes in CT incidence and prevalence over time are discussed.

Proportion of Tubal Factor Infertility due to Chlamydia: Finite Mixture Modeling of Serum Antibody Titers.

In this study, we examined whether the proportion of tubal factor infertility (TFI) that is attributable to Chlamydia trachomatis, the population excess fraction (PEF), can be estimated from serological data using finite mixture modeling. Whole-cell inclusion immunofluorescence serum antibody titers were recorded among infertile women seen at St. Michael's Hospital in Bristol, United Kingdom, during the period 1985-1995. Women were classified as TFI cases or controls based on laparoscopic examination. Finite mixture models were used to identify the number of component titer distributions and the proportion of serum samples in each, from which estimates of PEF were derived. Four titer distributions were identified. The component at the highest titer was found only in samples from women with TFI, but there was also an excess of the second-highest titer component in TFI cases. Minimum and maximum estimates of the PEF were 28.0% (95% credible interval: 6.9, 50.0) and 46.8% (95% credible interval: 23.2, 64.1). Equivalent estimates based on the standard PEF formula from case-control studies were 0% and over 65%. Finite mixture modeling can be applied to serological data to obtain estimates of the proportion of reproductive damage attributable to C. trachomatis Further studies using modern assays in contemporary, representative populations should be undertaken.

Variation in the recall of socially rewarding information and depressive symptom severity: a prospective cohort study.

OBJECTIVE: To test the association between recall for socially rewarding (positive) and/or socially critical (negative) information and depressive symptoms. METHOD: Cohort study of people who had visited UK primary care in the past year reporting depressive symptoms (N = 558, 69% female). Positive and negative recall was assessed at three time-points, 2 weeks apart, using a computerised task. Depressive symptoms were assessed at four time-points using the Beck Depression Inventory (BDI). Analyses were conducted using multilevel models. RESULTS: Concurrently we found evidence that, for every increase in two positive words recalled, depressive symptoms reduced by 0.6 (95% CI -1.0 to -0.2) BDI points. This association was not affected by adjustment for confounders. There was no evidence of an association between negative recall and depressive symptoms (-0.1, 95% CI -0.5 to 0.3). Longitudinally, we found more evidence that positive recall was associated with reduced depressive symptoms than vice versa. CONCLUSION: People with more severe depressive symptoms recall less positive information, even if their recall of negative information is unaltered. Clinicians could put more emphasis on encouraging patients to recall positive, socially rewarding information, rather than trying to change negative interpretations of events that have already occurred.

Minimal clinically important difference on the Beck Depression Inventory--II according to the patient's perspective.

BACKGROUND: The Beck Depression Inventory, 2nd edition (BDI-II) is widely used in research on depression. However, the minimal clinically important difference (MCID) is unknown. MCID can be estimated in several ways. Here we take a patient-centred approach, anchoring the change on the BDI-II to the patient's global report of improvement. METHOD: We used data collected (n = 1039) from three randomized controlled trials for the management of depression. Improvement on a 'global rating of change' question was compared with changes in BDI-II scores using general linear modelling to explore baseline dependency, assessing whether MCID is best measured in absolute terms (i.e. difference) or as percent reduction in scores from baseline (i.e. ratio), and receiver operator characteristics (ROC) to estimate MCID according to the optimal threshold above which individuals report feeling 'better'. RESULTS: Improvement in BDI-II scores associated with reporting feeling 'better' depended on initial depression severity, and statistical modelling indicated that MCID is best measured on a ratio scale as a percentage reduction of score. We estimated a MCID of a 17.5% reduction in scores from baseline from ROC analyses. The corresponding estimate for individuals with longer duration depression who had not responded to antidepressants was higher at 32%. CONCLUSIONS: MCID on the BDI-II is dependent on baseline severity, is best measured on a ratio scale, and the MCID for treatment-resistant depression is larger than that for more typical depression. This has important implications for clinical trials and practice.

Common versus psychopathology-specific risk factors for psychotic experiences and depression during adolescence.

BACKGROUND: An argument often used to support the view that psychotic experiences (PEs) in general population samples are a valid phenotype for studying the aetiology of schizophrenia is that risk factors for schizophrenia show similar patterns of association with PEs. However, PEs often co-occur with depression, and no study has explicitly tested whether risk factors for schizophrenia are shared between PEs and depression, or are psychopathology specific, while jointly modelling both outcomes. METHOD: We used data from 7030 subjects from a birth cohort study. Depression and PEs at age 18 years were assessed using self-report questionnaires and semi-structured interviews. We compared the extent to which risk factors for schizophrenia across sociodemographic, familial, neurodevelopmental, stress-adversity, emotional-behavioural and substance use domains showed different associations with PEs and depression within bivariate models that allowed for their correlation. RESULTS: Most of the exposures examined were associated, to a similar degree, with an increased risk of both outcomes. However, whereas female sex and family history of depression showed some discrimination as potential risk factors for depression and PEs, with stronger associations in the former, markers of abnormal neurodevelopment showed stronger associations with PEs. CONCLUSIONS: The argument that PEs are valid markers for studying the aetiology of schizophrenia, made simply on the basis that they share risk factors in common, is not well supported. PEs seem to be a weak index of genetic and environmental risk for schizophrenia; however, studies disentangling aetiological pathways to PEs from those impacting upon co-morbid psychopathology might provide important insights into the aetiology of psychotic disorders.

Heart disease risk-factor status and dietary changes in the Cretan population over the past 30 y: the Seven Countries Study.

A follow-up study was conducted to identify the heart disease risk-factor status and dietary changes of surviving elderly subjects in Crete who took part in the Seven Countries Study in 1960. In 1991, data were obtained from 245 of the 686 original male participants (169 of the original 40-49-y age group and 76 men 50-59 y age group). In 1991, the men were 70-79 and 80-89 y old. There was a significant (11.5%) increase in serum total cholesterol concentrations between 1960 and 1991. Body mass index and systolic and diastolic blood pressures also increased significantly, and all age groups were characterized by central obesity. A representative subsample of 21 men took part in a 3-d weighed food record study. Dietary data indicated increases in the intake of saturated fat and decreases in monounsaturated fat over the 30-y period. Comparison with a 1962 representative Cretan sample indicated a significantly increased concentration of adipose palmitic acid (16:0) in our surviving sample. The observed changes occurred during a period when many developed countries were observing a decline in most heart disease risk factors.

Absence of atherosclerotic lesions in the thoracic aorta indicates absence of significant coronary artery disease.

Atherosclerotic lesions may be readily visualized in the thoracic aorta using transesophageal echocardiography. The absence of aortic plaque in the thoracic aorta rules out significant coronary artery obstruction whereas the existence of the former appears to be a sensitive and specific predictor of the latter.

Adipose tissue fatty acid composition, serum lipids, and serum alpha-tocopherol in continuous ambulatory peritoneal dialysis patients living on the island of Crete.

OBJECTIVE: A pilot study to explore diet-related atherogenic patterns in continuous ambulatory peritoneal dialysis (CAPD) patients on the island of Crete. Cretans are well known for their high olive consumption and low atherosclerotic heart disease mortality, in general. DESIGN: Case-control study. SETTING: This was a hospital-based study initiated in 1991. Catchment area was the island of Crete, Greece. PARTICIPANTS: Seventeen patients admitted for treatment to the General State Hospital of Rethimnon. Controls were selected from the general population of the island and consisted of a random sample of 27 subjects from a total of 168 healthy subjects who visited the Preventive Medicine Clinic of the University Hospital for routine check-up. The control group was age- and sex-matched with patients. Both CAPD patients and controls had been residents of Crete for at least the last 10 years. MAIN OUTCOME MEASURES: Adipose tissue was aspirated, and a 12-hour fasting blood sample was collected for determination of serum lipid parameters and serum alpha-tocopherol levels; dietary data from a 3-day recall were recorded. RESULTS: No significant differences between the two groups were observed with respect to the mean macronutrient intake. The mean levels of serum triglycerides (p = 0.016) and serum alpha-tocopherol (p = 0.001) were significantly higher in CAPD patients compared to controls. Mean levels of total serum cholesterol, high density lipoprotein (HDL) cholesterol, and low density lipoprotein (LDL) cholesterol were not significantly different. In CAPD patients the mean total percentage of monounsaturated fatty acids (MUFA) was significantly higher (p = 0.006) than in controls. The mean total percentage of saturated fatty acids (p = 0.004), along with the mean percentage of omega-6 (p = 0.002), the mean value of the ratio omega-6/omega-3 (p < 0.0001), and the percentage of linoleic acid (p = 0.001) were significantly lower in CAPD patients than in the controls. Among subjects with higher levels of MUFA in the adipose tissue, the CAPD patients were twice as likely to have high serum alpha-tocopherol (p < 0.001), and 2.6 times more likely to be in high risk of high total cholesterol (TC)/HDL (p = 0.08) compared to the controls. However, CAPD patients with high levels of MUFA in the adipose tissue (above the average of 65%) were unlikely [odds ratio (OR) = 0.001, p < 0.001] to be at risk of high TC/HDL (above the average of 4.1), and maybe unlikely (OR = 0.08, but p = 0.1) to have low serum alpha-tocopherol, when compared with the CAPD patients with low levels of MUFA. CAPD patients with high TC/HDL are 0.15 times less likely (p = 0.1) to have high levels of serum alpha-tocopherol compared to those with low TC/HDL. CONCLUSION: Cretan CAPD patients demonstrate an interesting profile consisting of unexpectedly positive aspects when atherogenesis-related factors such as those of adipose tissue fatty acid composition, serum lipids, and serum antioxidant alpha-tocopherol are considered.

Nutrition status of the elderly in Anogia, Crete, Greece.

General health and nutritional status of 167 free-living elderly Greek (aged 65-91 years) were assessed. The most prevalent diseases/symptoms encountered were related to respiratory, gastrointestinal, musculoskeletal and vascular systems (hypertension). Most subjects were socially active. Body mass index was < 20 and > 25 Kg/m2 in 7 and 57% of the subjects, respectively. Systolic blood pressure was significantly higher in women than in men, and as a group, 18 and 42%, respectively, had diastolic blood pressures > 90 and systolic blood pressures > 160 mmHg. Anemia and hypoalbuminemia were detected in < 5% of the population. Total fat intake was 40-45% of total energy intake and most of it came from monounsaturated fat. Hypercholesterolemia (> 6 mmol/L) was present in 32% of subjects. The percentages of men who smoked (66%) or drank (68%) were significantly higher than those of women (2 and 1%, respectively). Dietary intake data were compared with US recommended dietary allowances (RDA) for elderly. Daily energy and protein intakes were lower than the US RDA levels; calcium intake was > 50% of the US RDA, while magnesium and vitamin B6 levels were < 50% of the US RDA. Vitamin C intake was much higher than that of the US RDA. Mean thiamin, vitamin A, riboflavin and iron intakes were below the US RDA, while fiber intake was < 50% of the corresponding US estimate. Phosphorus was higher than the US RDA in men, while lower for women. Sodium intakes exceeded those recommended, while potassium levels were higher than those recommended in males, and lower in females.(ABSTRACT TRUNCATED AT 250 WORDS)

Autonomic nervous system activity during tilt testing in syncopal patients, estimated by power spectral analysis of heart rate variability.

Spectral analysis of heart rate variability (HRV) was used to assess changes in autonomic function before and during postural tilt in 28 syncopal patients: 14 (group A) with positive and 14 (group B) with negative tilting test, and 14 normal controls (group C). Frequency-domain measurements of the high (HF) and low (LF) frequency bands and the ratio LF/HF were derived from Holter recordings, computed by Fast Fourier analysis for 4-minute intervals immediately before tilt testing, immediately after tilting, and just before the end of the test. In group A, the mean values of LF and HF decreased slightly in response to tilting while the LF/HF ratio increased, though these changes were not statistically significant. All parameters showed a statistically significant increase just before the onset of syncope. In group B, there were no significant changes in the parameters measured throughout the test. In group C, there was an increase in the LF and LF/HF ratio and a decrease in the HF immediately after tilting. There were no further significant changes in any of the parameters during the test. Syncopal patients have a different pattern of response to the orthostatic stimulus, in that they do not show the increase in sympathetic tone observed in normal individuals immediately after tilting. In the patients with a positive tilt test, there is a shift in the balance of ANS activity towards the sympathetic system shortly before the onset of syncope.

Methotrexate in the treatment of rheumatoid arthritis. II. In vivo effects on bone mineral density.

OBJECTIVE: To determine the effect of methotrexate (MTX) on bone mineral density (BMD) in rheumatoid arthritis (RA). METHODS: One hundred and sixteen non-steroid-treated RA subjects (90 women) were studied in a prospective, longitudinal, non-randomized study. Subjects started MTX (n=36) or sulphasalazine (n=23) or continued long-term (>5 yr) treatment with MTX (n=28) or other disease-modifying anti-rheumatic drugs (n=29). BMD was estimated at entry and after 1 yr. Markers of bone turnover were measured at entry and at 1 yr, and additionally at 3 and 6 months in those starting treatment. Bone biopsies were taken before and after MTX treatment in four subjects. The primary outcome was change in BMD Z score and secondary outcomes were changes in bone turnover markers and bone formation by histomorphometry. RESULTS: Univariate analysis of covariance found that MTX at baseline was associated with reduced BMD at the femoral neck. However, femoral neck BMD was also associated with radiological damage score for the hand. Multivariate analysis and discriminant analysis of the subset of post-menopausal women showed that reduced bone density associated with MTX was due to confounders such as disease activity. There was no adverse effect of MTX on bone turnover markers or on measures of bone formation in biopsies. CONCLUSIONS: No adverse effect of low-dose MTX (mean 10 mg/week) on bone formation in RA was found.

Diagnosing coeliac disease by rectal gluten challenge: a prospective study based on immunopathology, computerized image analysis and logistic regression analysis.

The purpose of this study was to evaluate the use of rectal gluten challenge in the diagnosis of coeliac disease. A total of 103 patients with features suggestive of this diagnosis were prospectively enrolled into the study; a diagnosis of coeliac disease was based on strictly defined criteria used in judging the proximal jejunal biopsy. On that basis, 45 out of the 103 patients were deemed to have coeliac disease. A slurry of gluten powder in physiological saline was introduced into the rectum, and biopsies taken before and at 2 h or 4 h after the challenge were examined immunohistochemically by computerized image analysis. Cell counts were analysed by logistic regression, and the best equations were obtained for each challenge group. The 2 h challenge yielded diagnostic sensitivity and specificity of 69.6% and 78.6% respectively. The 4 h challenge provided sensitivity and specificity of 100% and 100% respectively. These results were compared with other clinical diagnostic predictors,including anti-endomysial antibodies, which yielded diagnostic sensitivity and specificity of 70% and 98% respectively. It is concluded that a 4 h rectal challenge is a highly sensitive means of identifying gluten-sensitized individuals, and would be of particular value in cases showing negative antibody screening or equivocal biopsy appearances.