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Many women experience both vasomotor menopausal symptoms (VMS) and depressed mood at midlife, but little is known regarding the prospective bi-directional relationships between VMS and depressed mood and the role of sleep difficulties in both directions.
A pooled analysis was conducted using data from 21 312 women (median: 50 years, interquartile range 49−51) in eight studies from the InterLACE consortium. The degree of VMS, sleep difficulties, and depressed mood was self-reported and categorised as never, rarely, sometimes, and often (if reporting frequency) or never, mild, moderate, and severe (if reporting severity). Multivariable logistic regression models were used to examine the bi-directional associations adjusted for within-study correlation.
At baseline, the prevalence of VMS (40%, range 13–62%) and depressed mood (26%, 8–41%) varied substantially across studies, and a strong dose-dependent association between VMS and likelihood of depressed mood was found. Over 3 years of follow-up, women with often/severe VMS at baseline were more likely to have subsequent depressed mood compared with those without VMS (odds ratios (OR) 1.56, 1.27–1.92). Women with often/severe depressed mood at baseline were also more likely to have subsequent VMS than those without depressed mood (OR 1.89, 1.47–2.44). With further adjustment for the degree of sleep difficulties at baseline, the OR of having a subsequent depressed mood associated with often/severe VMS was attenuated and no longer significant (OR 1.13, 0.90–1.40). Conversely, often/severe depressed mood remained significantly associated with subsequent VMS (OR 1.80, 1.38–2.34).
Difficulty in sleeping largely explained the relationship between VMS and subsequent depressed mood, but it had little impact on the relationship between depressed mood and subsequent VMS.
There is limited evidence on the prevalence and identification of antenatal mental disorders.
To investigate the prevalence of mental disorders in early pregnancy and the diagnostic accuracy of depression-screening (Whooley) questions compared with the Edinburgh Postnatal Depression Scale (EPDS), against the Structured Clinical Interview DSM-IV-TR.
Cross-sectional survey of women responding to Whooley questions asked at their first antenatal appointment. Women responding positively and a random sample of women responding negatively were invited to participate.
Population prevalence was 27% (95% CI 22–32): 11% (95% CI 8–14) depression; 15% (95% CI 11–19) anxiety disorders; 2% (95% CI 1–4) obsessive–compulsive disorder; 0.8% (95% CI 0–1) post-traumatic stress disorder; 2% (95% CI 0.4–3) eating disorders; 0.3% (95% CI 0.1–1) bipolar disorder I, 0.3% (95% CI 0.1–1%) bipolar disorder II; 0.7% (95% CI 0–1) borderline personality disorder. For identification of depression, likelihood ratios were 8.2 (Whooley) and 9.8 (EPDS). Diagnostic accuracy was similar in identifying any disorder (likelihood ratios 5.8 and 6).
Endorsement of Whooley questions in pregnancy indicates the need for a clinical assessment of diagnosis and could be implemented when maternity professionals have been appropriately trained on how to ask the questions sensitively, in settings where a clear referral and care pathway is available.
Declaration of interest
L.M.H. chaired the National Institute for Health and Care Excellence CG192 guidelines development group on antenatal and postnatal mental health in 2012–2014.
Between May 2010 and September 2011, the University of Minnesota School of Public Health partnered with the Minnesota Department of Health (MDH) to assess the effect of exercises on team performance during public health emergency response.
Participants were divided into 3 research teams exposed to various levels of intervention. Groups consisted of a control group that was given standard MDH training exercises, a didactic group exposed to team dynamics and communication training, and a treatment group that received the didactic training in addition to a post-exercise facilitated debriefing. To assess differences in team performance, teams engaged in 15 functional exercises.
Differences in team performance across the 3 groups were identified, although there was no trend in team performance over time for any of the groups. Groups demonstrated fluctuation in team performance during the study period. Attitudinal surveys demonstrated an increase in workplace satisfaction and confidence in training among all groups throughout the study period.
Findings from this research support that a critical link exists between training type and team performance during public health emergency response. This research supports that intentional teamwork training for emergency response workers is essential for effective public health emergency response. (Disaster Med Public Health Preparedness. 2017;11:7–10)
Every year, there are over 1.6 million violent deaths worldwide, making violence one of the leading public health issues of our time. And with the 20th century just behind us, it's hard to forget that 191 million people lost their lives directly or indirectly through conflict. This collection of engaging case studies on violence and violent deaths reveals how violence is reconstructed from skeletal and contextual information. By sharing the complex methodologies for gleaning scientific data from human remains and the context they are found in, and complementary perspectives for examining violence from both past and contemporary societies, bioarchaeology and forensic anthropology prove to be fundamentally inseparable. This book provides a model for training forensic anthropologists and bioarchaeologists, not just in the fundamentals of excavation and skeletal analysis, but in all subfields of anthropology, to broaden their theoretical and practical approach to dealing with everyday violence.
Previous evidence indicates that changes in well-defined phases of dormancy in underground adventitious buds of leafy spurge in late summer and autumn are regulated by complex sensing and signaling pathways involving aboveground sugar signals. However, little information exists concerning seasonal photosynthesis and carbohydrate partitioning of leafy spurge, although such information would help to elucidate the involvement of sugar in controlling bud dormancy. An outdoor study was conducted over two growing seasons to determine and model seasonal patterns of photosynthesis and aboveground carbohydrate partitioning and their relationship to underground adventitious bud carbohydrate status. Photosynthesis and total nonstructural carbohydrate (TNC) content of aboveground tissues was greatest during vegetative growth. Photosynthesis gradually declined over the growing season, whereas TNC decreased sharply during flowering, followed by a gradual decline between midsummer and autumn. Leaf starch increased dramatically to midsummer before declining sharply throughout late summer and early autumn, whereas sucrose content responded inversely, indicating a mobilization of starch reserves and export of sugars to overwintering belowground sink tissues. Because newly formed underground adventitious buds showed a continuous increase in TNC from midsummer through autumn, export of sugars from aboveground tissues likely contributed to the increase in TNC. These results may facilitate new strategies for biological control of leafy spurge.
This study documents the findings of a qualitative investigation of the structure, process, and outcomes of an Intensive Case Management (ICM) program that was implemented in several government departments to improve the management of psychological injury and to reduce costs. The study demonstrated that the ICM model was effective in meeting its intended outcomes. Specifically, the model facilitated the delivery of timely and coordinated services to the workplace, and consequently, reduced the incidence of claim lodgment, assisted with accommodated return to work and minimised time away from work. Issues for future consideration included how the model could be integrated more firmly into the organisational culture and how to incorporate systematic follow-up and the capacity to address longer-term issues for injured workers.