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Item 9 of the Patient Health Questionnaire-9 (PHQ-9) queries about thoughts of death and self-harm, but not suicidality. Although it is sometimes used to assess suicide risk, most positive responses are not associated with suicidality. The PHQ-8, which omits Item 9, is thus increasingly used in research. We assessed equivalency of total score correlations and the diagnostic accuracy to detect major depression of the PHQ-8 and PHQ-9.
We conducted an individual patient data meta-analysis. We fit bivariate random-effects models to assess diagnostic accuracy.
16 742 participants (2097 major depression cases) from 54 studies were included. The correlation between PHQ-8 and PHQ-9 scores was 0.996 (95% confidence interval 0.996 to 0.996). The standard cutoff score of 10 for the PHQ-9 maximized sensitivity + specificity for the PHQ-8 among studies that used a semi-structured diagnostic interview reference standard (N = 27). At cutoff 10, the PHQ-8 was less sensitive by 0.02 (−0.06 to 0.00) and more specific by 0.01 (0.00 to 0.01) among those studies (N = 27), with similar results for studies that used other types of interviews (N = 27). For all 54 primary studies combined, across all cutoffs, the PHQ-8 was less sensitive than the PHQ-9 by 0.00 to 0.05 (0.03 at cutoff 10), and specificity was within 0.01 for all cutoffs (0.00 to 0.01).
PHQ-8 and PHQ-9 total scores were similar. Sensitivity may be minimally reduced with the PHQ-8, but specificity is similar.
Giardia duodenalis is the most common intestinal parasite of humans in the USA, but the risk factors for sporadic (non-outbreak) giardiasis are not well described. The Centers for Disease Control and Prevention and the Colorado and Minnesota public health departments conducted a case-control study to assess risk factors for sporadic giardiasis in the USA. Cases (N = 199) were patients with non-outbreak-associated laboratory-confirmed Giardia infection in Colorado and Minnesota, and controls (N = 381) were matched by age and site. Identified risk factors included international travel (aOR = 13.9; 95% CI 4.9–39.8), drinking water from a river, lake, stream, or spring (aOR = 6.5; 95% CI 2.0–20.6), swimming in a natural body of water (aOR = 3.3; 95% CI 1.5–7.0), male–male sexual behaviour (aOR = 45.7; 95% CI 5.8–362.0), having contact with children in diapers (aOR = 1.6; 95% CI 1.01–2.6), taking antibiotics (aOR = 2.5; 95% CI 1.2–5.0) and having a chronic gastrointestinal condition (aOR = 1.8; 95% CI 1.1–3.0). Eating raw produce was inversely associated with infection (aOR = 0.2; 95% CI 0.1–0.7). Our results highlight the diversity of risk factors for sporadic giardiasis and the importance of non-international-travel-associated risk factors, particularly those involving person-to-person transmission. Prevention measures should focus on reducing risks associated with diaper handling, sexual contact, swimming in untreated water, and drinking untreated water.
Different diagnostic interviews are used as reference standards for major depression classification in research. Semi-structured interviews involve clinical judgement, whereas fully structured interviews are completely scripted. The Mini International Neuropsychiatric Interview (MINI), a brief fully structured interview, is also sometimes used. It is not known whether interview method is associated with probability of major depression classification.
To evaluate the association between interview method and odds of major depression classification, controlling for depressive symptom scores and participant characteristics.
Data collected for an individual participant data meta-analysis of Patient Health Questionnaire-9 (PHQ-9) diagnostic accuracy were analysed and binomial generalised linear mixed models were fit.
A total of 17 158 participants (2287 with major depression) from 57 primary studies were analysed. Among fully structured interviews, odds of major depression were higher for the MINI compared with the Composite International Diagnostic Interview (CIDI) (odds ratio (OR) = 2.10; 95% CI = 1.15–3.87). Compared with semi-structured interviews, fully structured interviews (MINI excluded) were non-significantly more likely to classify participants with low-level depressive symptoms (PHQ-9 scores ≤6) as having major depression (OR = 3.13; 95% CI = 0.98–10.00), similarly likely for moderate-level symptoms (PHQ-9 scores 7–15) (OR = 0.96; 95% CI = 0.56–1.66) and significantly less likely for high-level symptoms (PHQ-9 scores ≥16) (OR = 0.50; 95% CI = 0.26–0.97).
The MINI may identify more people as depressed than the CIDI, and semi-structured and fully structured interviews may not be interchangeable methods, but these results should be replicated.
Declaration of interest
Drs Jetté and Patten declare that they received a grant, outside the submitted work, from the Hotchkiss Brain Institute, which was jointly funded by the Institute and Pfizer. Pfizer was the original sponsor of the development of the PHQ-9, which is now in the public domain. Dr Chan is a steering committee member or consultant of Astra Zeneca, Bayer, Lilly, MSD and Pfizer. She has received sponsorships and honorarium for giving lectures and providing consultancy and her affiliated institution has received research grants from these companies. Dr Hegerl declares that within the past 3 years, he was an advisory board member for Lundbeck, Servier and Otsuka Pharma; a consultant for Bayer Pharma; and a speaker for Medice Arzneimittel, Novartis, and Roche Pharma, all outside the submitted work. Dr Inagaki declares that he has received grants from Novartis Pharma, lecture fees from Pfizer, Mochida, Shionogi, Sumitomo Dainippon Pharma, Daiichi-Sankyo, Meiji Seika and Takeda, and royalties from Nippon Hyoron Sha, Nanzando, Seiwa Shoten, Igaku-shoin and Technomics, all outside of the submitted work. Dr Yamada reports personal fees from Meiji Seika Pharma Co., Ltd., MSD K.K., Asahi Kasei Pharma Corporation, Seishin Shobo, Seiwa Shoten Co., Ltd., Igaku-shoin Ltd., Chugai Igakusha and Sentan Igakusha, all outside the submitted work. All other authors declare no competing interests. No funder had any role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.
The History, Electrocardiogram (ECG), Age, Risk Factors, and Troponin (HEART) score is a decision aid designed to risk stratify emergency department (ED) patients with acute chest pain. It has been validated for ED use, but it has yet to be evaluated in a prehospital setting.
A prehospital modified HEART score can predict major adverse cardiac events (MACE) among undifferentiated chest pain patients transported to the ED.
A retrospective cohort study of patients with chest pain transported by two county-based Emergency Medical Service (EMS) agencies to a tertiary care center was conducted. Adults without ST-elevation myocardial infarction (STEMI) were included. Inter-facility transfers and those without a prehospital 12-lead ECG or an ED troponin measurement were excluded. Modified HEART scores were calculated by study investigators using a standardized data collection tool for each patient. All MACE (death, myocardial infarction [MI], or coronary revascularization) were determined by record review at 30 days. The sensitivity and negative predictive values (NPVs) for MACE at 30 days were calculated.
Over the study period, 794 patients met inclusion criteria. A MACE at 30 days was present in 10.7% (85/794) of patients with 12 deaths (1.5%), 66 MIs (8.3%), and 12 coronary revascularizations without MI (1.5%). The modified HEART score identified 33.2% (264/794) of patients as low risk. Among low-risk patients, 1.9% (5/264) had MACE (two MIs and three revascularizations without MI). The sensitivity and NPV for 30-day MACE was 94.1% (95% CI, 86.8-98.1) and 98.1% (95% CI, 95.6-99.4), respectively.
Prehospital modified HEART scores have a high NPV for MACE at 30 days. A study in which prehospital providers prospectively apply this decision aid is warranted.
Alcohol consumption around the time of conception is highly prevalent in Western countries. Exposure to ethanol levels during gestation has been associated with altered development of the mesolimbic reward pathway in rats and increased propensity to addiction, however the effect of exposure only around the time of conception is unknown. The current study investigated the effects of periconceptional alcohol exposure (PC:EtOH) on alcohol and palatable food preferences and gene expression in the ventral tegmental area (VTA) and the nucleus accumbens of the adult offspring. Rats were exposed to a liquid diet containing ethanol (EtOH) (12.5% vol/vol) or a control diet from 4 days before mating until 4 days after mating. PC:EtOH had no effect on alcohol preference in either sex. At 15 months of age, however, male PC:EtOH offspring consumed more high-fat food when compared with male control offspring, but this preference was not observed in females. Expression of the dopamine receptor type 1 (Drd1a) was lower in the VTA of male PC:EtOH offspring compared with their control counterparts. There was no effect of PC:EtOH on mRNA expression of the µ-opioid receptor, tyrosine hydroxylase (Th), dopamine receptor type 2 (Drd2) or dopamine active transporter (Slc6a3). These data support the hypothesis that periconceptional alcohol exposure can alter expression of key components of the mesolimbic reward pathway and heighten the preference of offspring for palatable foods and may therefore increase their propensity towards diet-induced obesity. These results highlight the importance of alcohol avoidance when planning a pregnancy.
The Square Kilometre Array will be an amazing instrument for pulsar astronomy. While the full SKA will be sensitive enough to detect all pulsars in the Galaxy visible from Earth, already with SKA1, pulsar searches will discover enough pulsars to increase the currently known population by a factor of four, no doubt including a range of amazing unknown sources. Real time processing is needed to deal with the 60 PB of pulsar search data collected per day, using a signal processing pipeline required to perform more than 10 POps. Here we present the suggested design of the pulsar search engine for the SKA and discuss challenges and solutions to the pulsar search venture.
Background: About 35% of patients with epilepsy may develop drug-resistant epilepsy (DRE). Identifying risk factors associated with DRE will allow us to identify earlier patients in the course of the disease. Methods: This is a case-control study nested within a cohort. Chart reviews of subjects who full fill inclusion criteria were completed. Inclusion criteria included age>18 years, focal epilepsy determined by clinical correlation and EEG. DRE was determined by ILAE criteria. Results: 149 subjects were included. Seventy had DRE (cases), and seventy-nine did not have DRE (controls). DRE group had a mean age of 41 years (SD+14.8) compared to the control group (49+17.5) (p=0.003). DRE group had a mean age at diagnosis of epilepsy of 19+15.3 compared to the control group with a mean of 33.6+21. (p=<0.001). The main risk factors identified in this study were; cortical dysplasia OR 8.67 (CI 1.04-72.3, p=0.026); mesial temporal sclerosis (MTS) (OR 2.69; CI 1.12-6.47; p=0.024); and presence of complex partial seizures (OR 2.04. Conclusions: Young age at diagnosis of focal epilepsy, diagnosis of cortical dysplasia, MTS, and presence of complex partial seizures are risk factors for DRE
Obesity in young adults is an increasing health problem in Australia and many other countries. Evidence-based information is needed to guide interventions that reduce the obesity-promoting elements in tertiary-education environments. In a food environmental audit survey, 252 outlets were audited across seven institutions: three universities and four technical and further education institutions campuses. A scoring instrument called the food environment-quality index was developed and used to assess all food outlets on these campuses. Information was collated on the availability, accessibility and promotion of foods and beverages and a composite score (maximum score=148; higher score indicates healthier outlets) was calculated. Each outlet and the overall campus were ranked into tertiles based on their ‘healthiness’. Differences in median scores for each outcome measure were compared between institutions and outlet types using one-way ANOVA with post hoc Scheffe’s testing, χ2 tests, Kruskal–Wallis H test and the Mann–Whitney U test. Binomial logistic regressions were used to compare the proportion of healthy v. unhealthy food categories across different types of outlets. Overall, the most frequently available items were sugar-sweetened beverages (20 % of all food/drink items) followed by chocolates (12 %), high-energy (>600 kJ/serve) foods (10 %), chips (10 %) and confectionery (10 %). Healthy food and beverages were observed to be less available, accessible and promoted than unhealthy options. The median score across all outlets was 72 (interquartile range=7). Tertiary-education food environments are dominated by high-energy, nutrient-poor foods and beverages. Interventions to decrease availability, accessibility and promotion of unhealthy foods are needed.
Aspiration pneumonia is an important cause of death in head and neck cancer patients. This study therefore aimed to evaluate the risk factors associated with aspiration pneumonia in head and neck cancer patients.
Hospital death records from 12 years (2000–2012) were reviewed to obtain the number of deaths. Treatment details and cause of death were analysed. Statistical analysis was performed to identify the risk factors for aspiration pneumonia.
The records revealed that aspiration pneumonia was the cause of death in 51 out of 85 patients. Primary tumour site (oropharynx and hypopharynx, odds ratio 3.3; 95 per cent confidence interval 1.17–9.4, p = 0.02) and advanced tumour stage (odds ratio 4.2, 95 per cent confidence interval 1.16–15.61, p = 0.02) had significant negative impacts on aspiration pneumonia related mortality.
Advanced pharyngeal cancer patients are at an increased risk of aspiration pneumonia related death. Investigations for the early detection of this condition are recommended in these high-risk patients.
First detected in North America in 2002, the emerald ash borer (EAB) (Agrilus planipennis Fairmaire; Coleoptera: Buprestidae), an invasive phloem-feeding beetle from Asia, has killed tens of millions of ash (Fraxinus Linnaeus; Oleaceae) trees. Although few parasitoids attack EAB in North America, three parasitoid species were found attacking EAB in China: the egg parasitoid Oobius agrili Zhang and Huang (Hymenoptera: Encyrtidae) and two larval parasitoids Tetrastichus planipennisi Yang (Hymenoptera: Eulophidae) and Spathius agrili Yang (Hymenoptera: Braconidae). In 2007, classical biological control of EAB began in the United States of America after release of these three species was approved. In 2013, release of the larval parasitoids was approved in Canada. Research continues at study sites in Michigan, United States of America where the establishment, prevalence, and spread of O. agrili and T. planipennisi have been monitored since 2008. However, establishment of S. agrili remains unconfirmed in northern areas, and its release is now restricted to regions below the 40th parallel. In 2015, approval for release of Spathius galinae Belokobylskij (Hymenoptera: Braconidae), an EAB larval parasitoid from the Russian Far East, may be granted in the United States of America. Researchers are guardedly optimistic that a complex of introduced and native natural enemies will regulate EAB densities below a tolerance threshold for survival of ash species or genotypes in forested ecosystems.
The goals of these experiments were to describe the morphology and synaptic
connections of amacrine cells in the baboon retina that contain immunoreactive
vesicular glutamate transporter 3 (vGluT3). These amacrine cells had the
morphology characteristic of knotty bistratified type 1 cells, and their
dendrites formed two plexuses on either side of the center of the inner
plexiform layer. The primary dendrites received large synapses from amacrine
cells, and the higher-order dendrites were both pre- and postsynaptic to other
amacrine cells. Based on light microscopic immunolabeling results, these include
AII cells and starburst cells, but not the polyaxonal amacrine cells
tracer-coupled to ON parasol ganglion cells. The vGluT3 cells received input
from ON bipolar cells at ribbon synapses and made synapses onto OFF bipolar
cells, including the diffuse DB3a type. Many synapses from vGluT3 cells onto
retinal ganglion cells were observed in both plexuses. At synapses where vGluT3
cells were presynaptic, two types of postsynaptic densities were observed; there
were relatively thin ones characteristic of inhibitory synapses and relatively
thick ones characteristic of excitatory synapses. In the light microscopic
experiments with Neurobiotin-injected ganglion cells, vGluT3 cells made contacts
with midget and parasol ganglion cells, including both ON and OFF types. Puncta
containing immunoreactive gephyrin, an inhibitory synapse marker, were found at
appositions between vGluT3 cells and each of the four types of labeled ganglion
cells. The vGluT3 cells did not have detectable levels of immunoreactive
γ-aminobutyric acid (GABA) or immunoreactive glycine transporter 1.
Thus, the vGluT3 cells would be expected to have ON responses to light and make
synapses onto neurons in both the ON and the OFF pathways. Taken with previous
results, these findings suggest that vGluT3 cells release glycine at some of
their output synapses and glutamate at others.
Since the publication of 47 key phytoplankton pigment data sheets in the volume by Jeffrey et al. (1997b), several new algal groups and pigments have been reported. To reflect this and the increased use of mass spectrometry for phytoplankton pigment characterisation we have compiled revised and expanded data sheets documenting 47 carotenoids and 21 chlorophylls. These new data sheets complement the ones produced for the 1997 volume. They are also available online, at www.cambridge.org/phytoplankton, for ease of consultation. We do not include data sheets for the many chlorophyll transformation products found particularly in sediments; for information on these pigments readers should refer to the comprehensive review by Keely (2006). Similarly, our coverage of pigments contained in phototrophic bacteria is limited mostly to cyanobacteria found in the water column of freshwater and marine environments (see Chapter 1, this volume), hence we exclude the newly discovered chlorophyll f in stromatolites (Chen et al., 2010). Readers interested in anoxygenic phototrophic bacteria should consult the reviews by Takaichi (1999) and Scheer (2006).
Background: The Consortium to Establish a Registry for Alzheimer's Disease Neuropsychological Assessment Battery (CERAD-NAB) offers information on the clinical diagnosis of Alzheimer's disease (AD) and gives a profile of cognitive functioning. This study explores the effects of age, education and gender on participants' performance on eight subtests in the Chinese-Cantonese version of the CERAD-NAB.
Methods: The original English version of the CERAD-NAB was translated and content-validated into a Chinese-Cantonese version to suit the Hong Kong Chinese population. The battery was administered to 187 healthy volunteers aged 60 to 94 years. Participants were excluded if they had neurological, medical or psychiatric disorders (including dementia). Stepwise multiple linear regression analyses were performed to assess the relative contribution of the demographic variables to the scores on each subtest.
Results: The Cantonese version of CERAD-NAB was shown to have good content validity and excellent inter-rater reliability. Stepwise multiple regression analyses revealed that performances on seven and four out of eight subtests in the CERAD-NAB were significantly influenced by education level and age, respectively. Age and education had significant effects on participants' performance on many tests. Gender also showed a significant effect on one subtest.
Conclusions: The preliminary data will serve as an initial phase for clinical interpretation of the CERAD-NAB for Cantonese-speaking Chinese elders.