Depression in developing countries: lessons from Zimbabwe.
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Depressive Disorder↗
Biomedical subjects
C Todd
Publications and source records attributed to C Todd.
Raising concerns about family history of breast cancer in primary care consultations: prospective, population based study. Women's Concerns Study Group.
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Breast Neoplasms↗
Prevalent vertebral deformity predicts incident hip though not distal forearm fracture: results from the European Prospective Osteoporosis Study.
The presence of a vertebral deformity increases the risk of subsequent spinal deformities. The aim of this analysis was to determine whether the presence of vertebral deformity predicts incident hip and other limb fractures. Six thousand three hundred and forty-four men and 6788 women aged 50 years and over were recruited from population registers in 31 European centers and followed prospectively for a median of 3 years. All subjects had radiographs performed at baseline and the presence of vertebral deformity was assessed using established morphometric methods. Incident limb fractures which occurred during the follow- up period were ascertained by annual postal questionnaire and confirmed by radiographs, review of medical records and personal interview. During a total of 40348 person-years of follow-up, 138 men and 391 women sustained a limb fracture. Amongst the women, after adjustment for age, prevalent vertebral deformity was a strong predictor of incident hip fracture, (rate ratio (RR) = 4.5; 95% CI 2.1-9.4) and a weak predictor of 'other' limb fractures (RR = 1.6; 95% CI 1.1-2.4), though not distal forearm fracture (RR = 1.0; 95% CI 0.6-1.6). The predictive risk increased with increasing number of prevalent deformities, particularly for subsequent hip fracture: for two or more deformities, RR = 7.2 (95% CI 3.0-17.3). Amongst men, vertebral deformity was not associated with an increased risk of incident limb fracture though there was a nonsignificant trend toward an increased risk of hip fracture with increasing number of deformities. In summary, prevalent radiographic vertebral deformities in women are a strong predictor of hip fracture, and to a lesser extent humerus and 'other' limb fractures; however, they do not predict distal forearm fractures.
Aged↗
Expression, candidate gene, and population studies of the melanocortin 5 receptor.
In mouse the melanocortin 5 receptor is known to regulate sebaceous gland function. To clarify its role in man, we have studied melanocortin 5 receptor expression in skin, and allelic variation at the melanocortin 5 receptor locus in diverse human populations and candidate disease groups. Melanocortin 5 receptor protein and mRNA expression were studied by immunohistochemistry and reverse transcriptase polymerase chain reaction. Melanocortin 5 receptor mRNA was detected in normal skin and cultured keratinocytes but not in cultured fibroblasts or melanocytes. Immunohistochemistry revealed melanocortin 5 receptor immunoreactivity in the epithelium and appendages, including the sebaceous gland, eccrine glands, and apocrine glands, as well as low level expression in the interfollciular epidermis. In order to screen for genetic diversity in the melanocortin 5 receptor that might be useful for allelic association studies we sequenced the entire melanocortin 5 receptor coding region in a range of human populations. One nonsynonymous change (Phe209Leu) and four synonymous changes (Ala81Ala, Asp108Asp, Ser125Ser, and Thr248Thr) were identified. Similar results were found in each of the populations except for the Inuit in which only the Asp108Asp variant was seen. The apparent "global distribution" of melanocortin 5 receptor variants may indicate that they are old in evolutionary terms. Variation of melanocortin 5 receptor was examined in patients with acne (n = 21), hidradenitis supprativa (n = 4), and sebaceous gland lesions comprising sebaceous nevi, adenomas, and hyperplasia (n = 13). No additional mutations were found. In order to determine the functional status of the Phe209Leu change, increase in cAMP in response to stimulation with alpha-melanocyte-stimulating hormone was measured in HEK-293 cells transfected with either wild-type or the Phe209Leu variant. The variant melanocortin 5 receptor was shown to act in a concentration-dependent manner, which did not differ from that of wild type. We have therefore found no evidence of a causative role for melanocortin 5 receptor in sebaceous gland dysfunction, and in the absence of any association between variation at the locus and disease group, the pathophysiologic role of the melanocortin 5 receptor in man requires further study.
Acne Vulgaris↗
Experiences and expectations of the new genetics in relation to familial risk of breast cancer: a comparison of the views of GPs and practice nurses.
BACKGROUND: Advances in genetics may change the practice of medicine in many ways. Ascertaining practitioners' perceptions about managing the risk of familial breast cancer can give an insight into the current and expected impact on general practice to inform relevant education. Little is known about the practice nurses' (PNs) views of the new genetics in comparison with those of the GP. OBJECTIVES: Our aim was to describe and compare the views of GPs and PNs on their experiences and expectations of the new genetics in relation to managing familial risk of breast cancer. METHOD: A questionnaire, assessing views on the current and future impact of genetic advances in general and on the management of women with a familial risk of breast cancer, was sent to all GPs and PNs in the 66 practices of the Cambridge and Huntingdon Health Authority. RESULTS: There was a 69% response rate. The words 'cautious', 'mixed feelings', 'hopeful' and 'optimistic' were used most frequently in response to views on genetic advances, but PNs chose more positive words than GPs (P < 0.001). PNs were also more optimistic than GPs in relation to the future positive impact of genetics on practice (P < 0.0001). Sixty-one per cent of GPs and 45% of PNs agreed that genetic advances in relation to breast cancer were already affecting their work. A minority of practitioners had attended recent educational events in risk assessment for breast cancer, and only 8% of GPs reported a practice policy on familial breast cancer risk management. CONCLUSIONS: GPs and PNs show a cautious optimism in relation to advances in genetics, with PNs most optimistic. Many perceive that genetic advances in relation to breast cancer are already affecting their workloads, yet educational attendance and practice policies are lacking. Given PN involvement, multi-professional education may be appropriate. Education about risk management, including family history and genetics, might be better integrated into more general teaching on the prevention and management of breast cancer, than taught alone.
Breast Neoplasms↗
HIV/AIDS epidemiology.
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Acquired Immunodeficiency Syndrome↗
Pleiotropic effects of the melanocortin 1 receptor (MC1R) gene on human pigmentation.
Variants of the melanocortin 1 receptor (MC1R) gene are common in individuals with red hair and fair skin, but the relative contribution to these pigmentary traits in heterozygotes, homozygotes and compound heterozygotes for variants at this locus from the multiple alleles present in Caucasian populations is unclear. We have investigated 174 individuals from 11 large kindreds with a preponderance of red hair and an additional 99 unrelated redheads, for MC1R variants and have confirmed that red hair is usually inherited as a recessive characteristic with the R151C, R160W, D294H, R142H, 86insA and 537insC alleles at this locus. The V60L variant, which is common in the population may act as a partially penetrant recessive allele. These individuals plus 167 randomly ascertained Caucasians demonstrate that heterozygotes for two alleles, R151C and 537insC, have a significantly elevated risk of red hair. The shade of red hair frequently differs in heterozygotes from that in homozygotes/compound heterozygotes and there is also evidence for a heterozygote effect on beard hair colour, skin type and freckling. The data provide evidence for a dosage effect of MC1R variants on hair as well as skin colour.
Alleles↗
Melanocortin-1-receptor gene and sun sensitivity in individuals without red hair.
Susceptibility to sunburn, photoageing, and skin cancer is inversely related to an individual's ability to tan after sun exposure. We examined variants in the melanocortin-1-receptor (MC1R) gene in individuals from Ireland and the UK. We found evidence of an association between the degree of tanning after repeated sun exposure, and the number of variant alleles present. Heterozygotes were intermediate between wild-type individuals and those with two variant alleles. We suggest that MC1R gene status therefore determines sun sensitivity in people without red hair.
Adult↗
Evidence for variable selective pressures at MC1R.
It is widely assumed that genes that influence variation in skin and hair pigmentation are under selection. To date, the melanocortin 1 receptor (MC1R) is the only gene identified that explains substantial phenotypic variance in human pigmentation. Here we investigate MC1R polymorphism in several populations, for evidence of selection. We conclude that MC1R is under strong functional constraint in Africa, where any diversion from eumelanin production (black pigmentation) appears to be evolutionarily deleterious. Although many of the MC1R amino acid variants observed in non-African populations do affect MC1R function and contribute to high levels of MC1R diversity in Europeans, we found no evidence, in either the magnitude or the patterns of diversity, for its enhancement by selection; rather, our analyses show that levels of MC1R polymorphism simply reflect neutral expectations under relaxation of strong functional constraint outside Africa.
Africa↗
Depression and the response of residential homes to physical health needs.
OBJECTIVE: To investigate the response of residential homes to four specific health problems of residents and the relationship between the quality of this response and the prevalence of depression. DESIGN AND SAMPLE: Post hoc analysis of data collected for a cross-sectional survey of homes chosen to represent "excellent" and "standard" care; resident sample sufficient to detect difference between 20% and 40% depression prevalence between two groups of homes (90% power, 5% significance). Three hundred and nine residents were assessed. SETTING: Seventeen residential homes in different areas of England. METHODS: Data were collected about aspects of the care provided, including quality rating of care plans. Standard instruments were used to collect resident data by direct and informant interviews, including assessments of dementia, depression, dependency, medication and specific health problems. RESULTS: Seventy-nine per cent of the sample were suffering from dementia; 40% of 194 residents who could be assessed for depression were depressed. Of residents assessed by research nurses, 72% had problems with mobility, 67% with stability, 40% with hearing and 46% with vision. Quality of response to these problems was variable. In a combined assessment of care plan quality and key worker awareness, 7% of homes' responses to these four problems in residents were rated as good. Seventeen per cent of depressed residents were so identified by their key workers. Good interventions by key workers were associated with less depression in residents. DISCUSSION: The response of home staff and community health professionals to physical health needs in residential homes is variable and should be improved. This study suggests that improving this aspect of care provision might reduce depression and thus improve quality of life.
Aged↗
Continuity of care in maternity services: women's views of one team midwifery scheme.
OBJECTIVE: To describe the views of women using one team midwifery scheme and compare them with women using more traditional models of midwifery care. DESIGN: Postal and interview survey of 1482 consecutive women delivering over a six-month period. SETTING: Hospital and community in the South-East of England. SAMPLES: Three groups of women were surveyed: (1) the Study Group consisted of women who delivered either at Hospital A or at home, and who received their antenatal, intrapartum and postnatal care from one of seven midwifery teams; (2) Comparison Group A consisted of women who received their antenatal and postnatal care from traditionally organised community midwives who were delivered by hospital midwives at Hospital A; and (3) Comparison Group B consisted of women who received their antenatal and postnatal care from traditionally organised community midwives who were delivered by hospital midwives at Hospital B. METHODS: Postal questionnaires and interviews, and an audit of midwife contacts. MAIN OUTCOME MEASURES: Process of care and satisfaction with care. FINDINGS: 88% of women responded. Women cared for under the team scheme exhibited no overall advantages in terms of satisfaction with various aspects of their care. Women cared for under the traditional model of care were the most satisfied with antenatal care. They had reported the highest percentage of named midwives, the highest continuity of carer antenatally and were the most likely to say that they had formed a relationship with their midwives. The majority of women who had met their delivering midwives previously did report that it made them feel more at ease, however, the majority of those who had not met their delivering midwives previously reported that it did not affect them one way or the other. CONCLUSION: In the team scheme, attempts to increase continuity of carer throughout pregnancy, labour and the postnatal period appear to have occurred at the expense of continuity in the ante- and postnatal periods. From the women's perspective the findings of this study support the view that the smaller the size of midwifery teams the better. The current focus on continuity throughout pregnancy and childbirth and the postnatal period may be misguided, if it is provided at the expense of continuity of carer in pregnancy and the postnatal period.
Adolescent↗
Five facts and five concepts for rehabilitation of mechanical low back pain.
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Humans↗
Communication of doubt and certainty in radiological reports.
We have investigated the reliability of communication of uncertainty in radiological reports. The 18 most commonly used verbal expressions of probability were identified from a series of radiological reports. 11 clinicians (three radiologists, three rheumatologists and five orthopaedic surgeons) recorded the probability that they ascribed to each of the 18 expressions using visual analogue scales. Each subject was re-tested on four occasions at least 1 week apart. The results were analysed to assess reproducibility within and between individuals. We found considerable variation in the probabilities assigned to many commonly used expressions between subjects, and between repeated testing of the same subject. Some expressions were rated much more consistently than others. "Absent", "excludes", "unlikely", "probable", "certain" and "definite" were the most consistently rated expressions. We have identified a potential source of misunderstanding in radiological reports owing to differences in interpretation of expressions used by radiologists and referring clinicians.
Diagnostic Services↗
General practitioners' views of working with team midwifery.
This report presents the results of a survey of general practitioners (GPs) working alongside a midwifery team in south-east England. Sixty-nine per cent of the GPs thought team midwifery was a good idea in theory. However, just 37% thought it was working well locally and 56% reported that they would like to go back to working in the way they did before. Of greatest concern was the decline in interprofessional communications and the loss of continuity for patients. Therefore, team midwifery, as implemented in this locality, may not attain the goals aimed at by the organisation of care in this way.
Attitude of Health Personnel↗
Genetic studies of the human melanocortin-1 receptor.
Genetic approaches have suggested a critical role for the melanocortin-1 receptor in the control of pigmentation. We showed that this gene is unusually polymorphic in European populations and that, of the many variants, three in particular appear to be associated with red hair or fair skin. Family studies suggest these are inherited as an autosomal recessive trait (or at least approximate to this in many families). To date all individuals with two of these three changes (homozygote or compound heterozygote) have red hair. Early functional studies are in keeping with defective signalling through MC1R. An interested and perhaps unexpected question relates to the evolutionary factors that have given rise to such variants. Two models can be proposed, that are based on multiple alleles with minor changes in function or genetic hitch-hicking.
Animals↗
Quality of life in patients with vertebral fractures: validation of the Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO). Working Party for Quality of Life of the European Foundation for Osteoporosis.
Vertebral fractures may be minor or lead to pain, decreased physical function, immobility, social isolation and depression, which together contribute to quality of life. A Working Party of the European Foundation for Osteoporosis has developed a specific questionnaire for patients with vertebral fractures. This questionnaire, QUALEFFO, includes questions in the domains pain, physical function, social function, general health perception and mental function. QUALEFFO was validated in a multicenter study in seven countries. The study was done in 159 patients aged 55-80 years with clinical osteoporosis, i.e., back pain and other complaints with at least one vertebral fracture and lumbar bone mineral density T-score <-1. Patients with a recent vertebral fracture were excluded because of unstable disease. Controls were age- and sex-matched, and did not have chronic back pain or vertebral fractures. Subjects with conditions exerting a major influence on quality of life were excluded. The QUALEFFO was administered twice within 4 weeks and compared with a generic questionnaire, the Short Form 36 of the Medical Outcomes Study (SF-36). Standard spinal radiographs were made for assessment of vertebral height. Seven questions were removed from the analysis because of low response rate, linguistic ambiguities or redundancy. The 41 remaining questions were analyzed for repeatability, internal consistency and the capacity to discriminate between patients with vertebral fractures and controls. Comparison with the SF-36 was performed within similar domains by conditional logistic regression and by receiver operating characteristic (ROC) curves. The repeatability of QUALEFFO was good (kappa statistics 0.54-0.90) and 26 of 41 questions had a kappa score >/=0.70. The internal consistency of the five domains was adequate, with Crohnbach alpha around 0.80. All except five questions discriminated significantly between patients and controls. The median scores of QUALEFFO were significantly higher in patients with vertebral fractures than in controls in all five domain (p<0. 001), which is consistent with decreased quality of life in patients with osteoporosis. Spinal radiographs were assessed using the McCloskey-Kanis algorithm. According to this, 124 patients (78%) had vertebral fractures of >/=3 SD severity, in contrast with 7 controls (4%). Significant correlations existed between scores of similar domains of QUALEFFO and the SF-36, especially for pain, physical function and mental function. All five domains within each questionnaire discriminated significantly between fracture cases and controls. The odds ratios for pain and social function were greater for QUALEFFO, while general health perception was more discriminating using the SF-36. The ROC curve analysis of QUALEFFO indicated that all five domains were significantly predictive of vertebral fractures. When comparing similar domains of the two questionnaires, QUALEFFO domains demonstrated significantly better performance for pain, physical function and social function. The QUALEFFO total score and SF-36 physical composite score showed similar performance. In conclusion, QUALEFFO is repeatable, coherent and discriminates well between patients with vertebral fractures and control subjects. The results of this study confirm the decreased quality of life in patients with vertebral fractures.
Aged↗
Women, poverty and common mental disorders in four restructuring societies.
BACKGROUND: Poverty and female gender have been found to be associated with depression and anxiety in developed countries. The rationale behind this paper was to bring together five epidemiological data sets from four low to middle income countries to examine whether key economic and development indicators such as income and poor education, and female gender, were associated with common mental disorders. METHOD: The paper is based on five datasets: three based on primary care attenders in Goa, India; Harare, Zimbabwe and Santiago, Chile; and two based on community samples in Pelotas, Brazil and Olinda, Brazil. All five studies estimated prevalence of common mental disorders along with variables to measure economic deprivation and education. FINDINGS: In all five studies, female gender, low education and poverty were strongly associated with common mental disorders. When income was divided into tertiles, with the lowest tertile as a reference value, there was a significant trend for reduced morbidity for the lower two tertiles. DISCUSSION: These findings have considerable implications since the rapid economic changes in all four societies have been associated with rising income disparity and economic inequality. Examples of population based prevention strategies based on increasing the proportion of those who complete schooling and on high-risk strategies such as providing loan facilities to the impoverished are potential outcomes of these findings. Development agencies who focus on women as a priority group have failed to recognize their unique vulnerability to common mental disorders and need to reorient their priorities accordingly.
Adult↗
The onset of common mental disorders in primary care attenders in Harare, Zimbabwe.
BACKGROUND: This study aimed to investigate the onset and predictors of common mental disorders (CMD) in primary-care attenders in Harare, Zimbabwe. METHOD: Two (T1) and 12-month (T2) follow-up of a cohort of primary-care attenders without a common mental disorder (N = 197) as defined by the Shona Symposium Questionnaire (SSQ), recruited from primary health care clinics, traditional medical practitioner clinics and general practitioner surgeries. Outcome measure was caseness as determined by scores on the SSQ at follow-up. RESULTS: Follow-up rate was 86% at 2 months and 75% at 12 months. Onset of CMD was recorded in 16% at T1 and T2. Higher psychological morbidity scores at recruitment, death of a first-degree relative and disability predicted the presence of a CMD at both follow-up points. While female gender and economic difficulties predicted onset only in the short-term, belief in supernatural causation was strongly predictive of CMD at T2. Caseness at both follow-up points was associated with economic problems and disability at those follow-up points. CONCLUSIONS: Policy initiatives to reduce economic deprivation and targeting interventions to primary-care attenders who are subclinical cases and those who have been bereaved or who are disabled may reduce the onset of new cases of CMD. Closer collaboration between biomedical and traditional medical practitioners may provide avenues for developing methods of intervention for persons with supernatural illness models.
Adolescent↗