Bidirectionality of smoking and depression in adolescents: a systematic review

Abstract Introduction Recently, evidence has been accumulating that both smoking and mental health disorders are continuously increasing among adolescents. This systematic review elucidates the research into evidence of the direction of the association and risk factors influencing the relationship between smoking and depression. We also highlight recent studies on the effects of electronic cigarettes and developments on the association between depression and smoking. Methods A literature search was conducted on databases including PubMed, Ovid Medline, EMBASE, and PsycINFO and in relevant neurology and psychiatry journals. Terms used for electronic searches included smoking, tobacco, cigarettes; depression; adolescent, youth; direction. Relevant information was then utilized to synthesize findings on the association between smoking and depression among adolescent population. Results The initial database searches yielded 2,738 related articles. After screening and cross-referencing, duplicate articles, articles published in languages other than English, and studies on animals, social and lifestyle factors, mood disorders, and substance use were excluded. Of these, a total of 122 publications only focusing on smoking and depression in the adolescent population were selected for synthesis in this qualitative systemic review. These include 110 original research articles, eight meta-analyses and reviews, and four reports and websites. Conclusion The relationship between smoking and depression in the literature does not reflect the cause-effect relationship. The lack of evidence on the direction of the association may reflect futile study designs, confounding factors and/or use of indirect measures of depression and quantification of smoking. Future prospective randomized studies should target elucidation of the causal association.

Comparison of Mammography, Sonography, Fine-Needle Aspiration Cytology, and Excision Biopsy for the Diagnosis of Breast Lesions

Background and Objective: Problem of invasive tests in breast lesion diagnosis can be addressed by comparing noninvasive tests with final Histopathological diagnosis obtained a?er excision biopsy. Present study was carried out to study diagnos?c u?lity of mammography, sonography, FNAC compared to excision biopsy for diagnosis of breast lesions Methods: Prospec?ve Observa?onal study was carried out among 81 women with Breast related symptoms. Digital Mammography Machine, ACUSON S3000TM Ultrasound System; FNAC and surgery for excision Biopsy were used. Sensi?vity, Specificity, Accuracy, Posi?ve and Nega?ve Predic?ve values were measured and p<0.05 was considered as sta?s?cally significant. Results: Sonography and FNAC composite have sensi?vity, specificity, accuracy, posi?ve and nega?ve predic?ve values 100.00%, 81.40%, 90.12%, 82.61% and 100.00% respec?vely. Mammography+FNAC (97.3%) is not as sensi?ve as Sonography+FNAC (100%), Sonography combined with FNAC is equally sensi?ve to excision biopsy (100%) and therefore can be used for screening purpose. Conclusion: Contrary to present guidelines which consider Mammography as most important screening tool for Breast Cancer, combina?on of Sonography and FNAC can be considered equally reliable.

Impact of Real-time Assessment on the Training of Trainers for the Introduction of Rotavirus Vaccine in India

Background and aim: The introduction of rotavirus vaccine (RVV) in the universal immunization program of India is a big feat as it became the first nation in the World Health Organization (WHO) Southeast Asia region to do so. The involvement of huge numbers of frontline workers in introducing new vaccines in India and the underlined deficits in skills and knowledge require efficient capacity building programs. In view of this, limited research is available on the effectiveness of capacity-building interventions for healthcare workers. There is a dearth of studies from India measuring the “on-spot” impact of immunization trainings on healthcare workers. This study aims to assess the effectiveness of training in RVV introduction in enhancing the knowledge of the participants. Methods: The study was conducted among the participants attending two training workshops for the introduction of RVV: a state workshop in Pune and a regional workshop in Guwahati. The participants who attended the workshops and participated in both the pre- and post-test were included in the study. Real-time data was collected via Google forms pre- and post-training sessions. Results: In both workshops, a comparison of pre- and post-test scores of all questions taken together showed a significant increase in the knowledge level of the participants (p < 0.05). In Guwahati, the knowledge of the participants regarding doses of RVV, inadequate dosing, vaccine vial monitor (VVM), open vial policy, operationalization of RVV and monetary incentive increased significantly. In Pune, the knowledge of the participants regarding doses of RVV, bundling approach, schedule and dose, storage temperature for RVV, VVM, open vial policy, vaccine delivery and operationalization of RVV increased significantly after the training. Conclusion: A pre-planned and well-designed knowledge assessment tool can be used to understand the impact of training workshops in enhancing the knowledge and practical skills of the participants prior to the introduction of a new vaccine.

Posttraumatic stress disorder: a serious post-earthquake complication / Transtorno do estresse pós-traumático: complicação séria pós-terremoto

Abstract Objectives Earthquakes are unpredictable and devastating natural disasters. They can cause massive destruction and loss of life and survivors may suffer psychological symptoms of severe intensity. Our goal in this article is to review studies published in the last 20 years to compile what is known about posttraumatic stress disorder (PTSD) occurring after earthquakes. The review also describes other psychiatric complications that can be associated with earthquakes, to provide readers with better overall understanding, and discusses several sociodemographic factors that can be associated with post-earthquake PTSD Method A search for literature was conducted on major databases such as MEDLINE, PubMed, EMBASE, and PsycINFO and in neurology and psychiatry journals, and many other medical journals. Terms used for electronic searches included, but were not limited to, posttraumatic stress disorder (PTSD), posttraumatic symptoms, anxiety, depression, major depressive disorder, earthquake, and natural disaster. The relevant information was then utilized to determine the relationships between earthquakes and posttraumatic stress symptoms. Results It was found that PTSD is the most commonly occurring mental health condition among earthquake survivors. Major depressive disorder, generalized anxiety disorder, obsessive compulsive disorder, social phobia, and specific phobias were also listed. Conclusion The PTSD prevalence rate varied widely. It was dependent on multiple risk factors in target populations and also on the interval of time that had elapsed between the exposure to the deadly incident and measurement. Females seemed to be the most widely-affected group, while elderly people and young children exhibit considerable psychosocial impact.

Resumo Objetivos Terremotos são desastres naturais imprevisíveis e devastadores. Eles podem causar destruição em massa e morte, e os sobreviventes podem apresentar sintomas psicológicos severos. O objetivo deste estudo foi revisar estudos publicados nos últimos 20 anos pra compilar o conhecimento disponível acerca da ocorrência de transtorno do estresse pós-traumático (TEPT) após terremotos. A revisão também descreve outras complicações psiquiátricas que podem estar associadas a terremotos, oferecendo aos leitores um melhor entendimento geral sobre o assunto, e discute vários fatores sociodemográficos que podem estar associados com TEPT pós-terremoto. Métodos Foi realizada uma busca de literatura nas principais bases de dados, como MEDLINE, PubMed, EMBASE e PsycINFO, e também em revistas de neurologia e psiquiatria, e vários outros periódicos médicos. Os termos usados nas buscas eletrônicas incluíram, mas não se limitaram a, posttraumatic stress disorder (PTSD), posttraumatic symptoms, anxiety, depression, major depressive disorder, earthquake e natural disaster. As informações relevantes foram então utilizadas para determinar as relações entre terremotos e sintomas de estresse pós-traumático. Resultados A revisão revelou que o TEPT é a condição de saúde mental mais comum em sobreviventes de terremoto. Depressão maior, transtorno de ansiedade generalizada, transtorno obsessivo-compulsivo, fobia social e fobias específicas foram outras condições encontrados. Conclusão A prevalência de TEPT variou bastante. O transtorno foi dependente de múltiplos fatores de risco em populações-alvo e também do intervalo de tempo decorrido entre a exposição ao incidente fatal e a avaliação. As mulheres pareceram ser o grupo mais amplamente afetado, ao passo que idosos e crianças demonstração considerável impacto psicossocial.

QT dispersion and early arrhythmic risk in acute myocardial infarction.

BACKGROUND: This study sought to find out QT dispersion in healthy individuals and patients of acute myocardial infarction and to find correlation, if any, between QT dispersion and the incidence of ventricular arrhythmias in acute myocardial infarction. METHODS AND RESULTS: QT dispersion was calculated from a 12-lead electrocardiogram in 100 patients of acute myocardial infarction admitted in intensive coronary care unit and 100 age- and sex-matched healthy individuals. In patients of acute myocardial infarction, QT dispersion was calculated on admission, 24 hours after admission and at the time of discharge from intensive coronary care unit. Average QT dispersion in acute myocardial infarction was found to be significantly higher on admission (76.4 +/- 18.3 ms), 24 hours after admission (62.88 +/- 17.52 ms) and at the time of discharge from intensive coronary care unit (51.79 +/- 16.79 ms) than in healthy individuals (29.76 +/- 6.06 ms; p<0.05). QT dispersion was found to be significantly increased in patients of acute myocardial infarction with ventricular arrhythmias (82.06 +/- 16.86 ms) than in those without (66.75 +/- 16.28 ms; p<0.01). Patients of acute myocardial infarction with ventricular tachycardia or ventricular fibrillation had significantly increased QT dispersion (96.25 +/- 15.97 ms) than those who had only ventricular premature beats (80 +/- 15.04 ms; p<0.01). QT dispersion was found to be significantly greater in patients with anterior wall acute myocardial infarction (79.80 +/- 18.19 ms) than in those with inferior wall acute myocardial infarction (71.9 +/- 17.48 ms; p<0.05). At the time of discharge from intensive coronary care unit no statistically significant difference was found in QT dispersion in those who received thrombolysis (51.58 +/- 16.05 ms) and those who did not (48.18 +/- 14.68 ms; p>0.05). QT dispersion was found to be significantly higher in those who died (88.66 +/- 15.97 ms) than in those who survived (74.23 +/- 17.91 ms; p<0.05). QT dispersion was significantly higher in ventricular arrhythmic deaths (97.14 +/- 17.04 ms) than those who had non-arrhythmiac deaths (81.25 +/- 11.25 ms; p<0.05). CONCLUSIONS: Interlead QT variation and its measure as QT dispersion challenges our current approach to the electrocardiographic assessment of arrhythmic risk. QT dispersion may provide a potentially simple, cheap, non-invasive method of measuring underlying dispersion of ventricular excitability.