Robert H. Friis

Life events and changes in the course of depression in young adults

BACKGROUND Few community-based studies have examined the impact of life events, life conditions and life changes on the course of depression. This paper examines associations of life events on depressive symptom onset, improvement, and stability. METHODS Direct interview data from the Early Developmental Stages of Psychopathology Study (EDSP), a 4-5 year prospective-longitudinal design based on a representative community sample of adolescents and young adults, aged 14-24 years at baseline, are used. Life events were measured using the Munich Event-Questionnaire (MEL) consisting of 83 explicit items from various social role areas and subscales for the assessment of life event clusters categorized according to dimensions such as positive and negative and controllable and uncontrollable. Depressive disorders were assessed with the DSM-IV version of the Munich Composite Diagnostic Interview (M-CIDI). Multiple logistic regression analyses examined the effects of 22 predictors on the course of depression (onset, improvement, stability). RESULTS Younger age, low social class, negative and stressful life events linked to the family were associated with increased risk of new onset of depression. Anxiety was a significant independent predictor of new onset of depression. Absence of stressful school and family events was related to improvement in depression. The weighted total number of life events predicted stable depression. CONCLUSIONS The association between life events and the course of depression appears to vary according to the outcome being examined, with different clusters of life events differentially predicting onset, improvement, and stability.

Diabetes, depression and employment status

The relationship among diabetes, depression and employment status was assessed. It was hypothesized that: unemployment would be associated with diabetes; and employability problems would be associated with higher depression levels among diabetic persons than among non-diabetic persons. A case-control design was employed in which the cases (n = 56) were currently active diabetic patients and the controls (n = 56) were non-diabetic patients. Subjects were selected from a computerized data base at a primary care clinic located in Orange County, California, U.S.A. Depression was measured by the CES-D scale. The results were as follows: diabetes was associated with both depression and unemployment; being employed was the most significant predictor of depressive symptomatology followed by being diabetic; and education, type of diabetes, blood sugar level, medication type were not significant predictors of depressive symptomatology in a stepwise multiple regression analysis. Problems of employment among diabetic persons may warrant special employment and counseling programs.

Nosocomial Infection and Antibiotic Utilization in Geriatric Patients: A Pilot Prospective Surveillance Program in Skilled Nursing Facilities

Prospective surveillance of nosocomial infection was conducted at seven skilled proprietary nursing facilities in Orange County, Calif., USA. The average incidence of facility-acquired infection was 5.2 infections/1,000 patient days. The most common source of infection was urinary tract (47%), followed by respiratory tract (26%) and skin (14%). The four most common pathogens isolated were Proteus spp. (20%), Escherichia coli (17%), Staphylococcus aureus (13%) and Pseudomonas spp. (11%). Trimethoprim-sulfamethoxazole (20%) was the most frequently used antibiotic among all prescriptions, followed by ampicillin (16%) and ciprofloxacin (14%). Among all residents surveyed, 33% received at least one course of antibiotics during the study. Of special significance was the fact that 4 (22%) of the 18 strains of Pseudomonas were gentamicin resistant as were 12 of 80 (15%) of the strains of Enterobacteriaceae. Furthermore, 9 of 29 (31%) strains of Pseudomonas tested were found resistant to norfloxacin as were 15 of 129 (12%) strains of enterobacteriaceae. Susceptibility patterns of the isolated pathogens were similar to those of the acute care hospital. This study indicates that infection continues to be a major problem in the skilled nursing facility and that antibiotic-resistant pathogens will be a challenge for the future.

Adherence to Disease Modifying Drugs among Patients with Multiple Sclerosis in Germany: A Retrospective Cohort Study.

Background Long-term therapies such as disease modifying therapy for Multiple Sclerosis (MS) demand high levels of medication adherence in order to reach acceptable outcomes. The objective of this study was to describe adherence to four disease modifying drugs (DMDs) among statutorily insured patients within two years following treatment initiation. These drugs were interferon beta-1a i.m. (Avonex), interferon beta-1a s.c. (Rebif), interferon beta-1b s.c. (Betaferon) and glatiramer acetate s.c. (Copaxone). Methods This retrospective cohort study used pharmacy claims data from the data warehouse of the German Institute for Drug Use Evaluation (DAPI) from 2001 through 2009. New or renewed DMD prescriptions in the years 2002 to 2006 were identified and adherence was estimated during 730 days of follow-up by analyzing the medication possession ratio (MPR) as proxy for compliance and persistence defined as number of days from initiation of DMD therapy until discontinuation or interruption. Findings A total of 52,516 medication profiles or therapy cycles (11,891 Avonex, 14,060 Betaferon, 12,353 Copaxone and 14,212 Rebif) from 50,057 patients were included into the analysis. Among the 4 cohorts, no clinically relevant differences were found in available covariates. The Medication Possession Ratio (MPR) measured overall compliance, which was 39.9% with a threshold MPR≥0.8. There were small differences in the proportion of therapy cycles during which a patient was compliant for the following medications: Avonex (42.8%), Betaferon (40.6%), Rebif (39.2%), and Copaxone (37%). Overall persistence was 32.3% at the end of the 24 months observation period, i.e. during only one third of all included therapy cycles patients did not discontinue or interrupt DMD therapy. There were also small differences in the proportion of therapy cycles during which a patient was persistent as follows: Avonex (34.2%), Betaferon (33.4%), Rebif (31.7%) and Copaxone (29.8%). Conclusions Two years after initiating MS-modifying therapy, only 30–40% of patients were adherent to DMDs.

Introductory Biostatistics for the Health Sciences

Introductory Biostatistics for the Health Sciences , Introductory Biostatistics for the Health Sciences , کتابخانه دیجیتالی دانشگاه علوم پزشکی و خدمات درمانی شهید بهشتی

Initiation to methamphetamine use in a binational sample of women at the US-Mexico border.

This article examines comparative risk behaviors associated with methamphetamine use in a binational sample of women in the border cities of Tijuana, Mexico, and San Diego, California. Specifically, the study examined the differences and similarities in drug use and sexual risk behavior and the patterns of initiation to methamphetamine use. The binational pilot sample consisted of 70 adult women in Tijuana and 55 women in San Diego. Although there were important differences in the presentation of risk behavior and patterns of initiation between the two binational samples, women on both sides of the US–Mexico border also showed remarkable similarities in their risk profile. Results from this study suggest that despite significant cultural and socioeconomic differences between the study cities, certain specific substance abuse patterns (e.g., methamphetamine use) in border regions with an increasing demographic exchange and integration are emerging as an “equalizer” of risk, capable of dissolving context-based differentiating factors, and creating a more homogenous subpopulation of substance users.

A new test of peripheral insulin sensitivity invivo using artificial beta cell

A new in vivo test of insulin sensitivity is described. It utilizes closed-loop insulin delivery device (GCIIS, Biostator) capable of infusing glucose and insulin according to preselected algorithms. In euglycemic patients, insulin was infused by GCIIS to maintain euglycemia in the face of challenges with gradually increasing doses on intravenously administered glucose. Under the described experimental conditions, the endogenous insulin release was minimized as evidenced by serum C-peptide levels of less than 2 ng/ml, and thus the peripheral disposal of glucose should have depended entirely on the exogenous insulin. The amount of the insulin infused was considered to be a measure of peripheral insulin sensitivity. The test was applied to normal and non diabetic obese individuals, and to diabetics, both insulin dependent and independent. Significant insulin resistance was demonstrated in the obese and diabetic patients. In two obese females, the test was repeated after a prolonged period of starvation, and showed marked increase in insulin sensitivity. In two poorly controlled insulin dependent diabetics, marked increase in insulin sensitivity was also observed, here following a prolonged period of euglycemia (48 hours). It is concluded that the GCIIS controlled insulin sensitivity test is a simple, reliable test of peripheral insulin sensitivity, most convenient for clinical and experimental studies in vivo.

Type a Personalty: Hispanic and Anglo Diabetes and Cardiovascular Disease

Type A personality among Anglo and Hispanic diabetes and cardiovascular disease patients was assessed. The specific objectives were to relate differences in Type A personality to Anglo and Hispanic ethnicity and to diabetes and cardiovascular diseases — hypertension and heart disease. The subjects for this research were consecutive patients selected from the patient population of a primary care internal medicine clinic affiliated with the University of California, Irvine Medical Center. A total of 162 currently active diabetes and cardiovascular disease patients and a comparison group of 74 patients who did not have diabetes and cardiovascular disease were included. Type A personality was measured by the 10 item Framigham Type A Questionnaire.