Perceived friend support buffers against symptoms of depression in peer victimized adolescents: Evidence from a population-based cohort in South Korea.

BACKGROUND: Peer victimization is associated with an increased risk for depression, but there is less evidence on how certain factors such as friend support can buffer this association. This study investigated the associations between friend support and depressive symptoms among victimized and non-victimized adolescent girls and boys from South Korea. METHODS: Participants includes 2258 students from the Korean Children and Youth Panel Survey, a nationally representative sample of middle school students in South Korea. Self-reported perceived friend support, depressive symptoms and peer victimization were measured using validated scales during middle school year 3 (mean age= 15.7 years). RESULTS: The association between peer victimization and depressive symptoms varied by sex (p for sex by peer victimization interaction<0.05). Peer victimization was more strongly associated with same year depressive symptoms in girls (ß=0.55) than boys (ß=0.24). After controlling for key confounders, including prior year mental health symptoms, higher levels of friend support were found to attenuate the association between peer victimization and depressive symptoms (p for friend support by peer victimization interaction <0.05). Peer victimization was associated with more depressive symptoms for adolescents with low and moderate friend support, but not those with high friend support. LIMITATIONS: Peer victimization, depressive symptoms, and friend support, were self-reported and measured the same year. CONCLUSIONS: Friend support protects victimized South Korean adolescents from the negative effect of peer victimization on depressive symptoms, hence contributes to closing the gap in depression between victimized and non-victimized adolescents.

Trajectories of poverty and economic hardship among American families supporting a child with a neurodisability.

BACKGROUND: Caring for a child with a neurodisability (ND) impacts the financial decisions, relationships and well-being of family members, but evidence on the economic trajectories of families throughout the life course is missing. METHODS: Using data from the Panel Study of Income Dynamics, we tracked the families of 3317 children starting 5 years before childbirth until the child reached 20 years of age. We used regression and latent growth curve modelling to estimate trajectories of poverty and economic hardship over time. RESULTS: Families with a child with an ND had higher rates of poverty and economic hardship prior to childbirth and persistently over time. Analysis uncovered five latent trajectories for each indicator. After controlling for family and caregiver characteristics that preceded the birth of the child, raising a child with an ND was not associated with a unique trajectory of poverty. Families raising a child with an ND were however more likely to experience persistent economic hardship. CONCLUSIONS: The study establishes descriptive evidence for how having a child with an ND relates to changes in family economic conditions. The social and economic conditions that precede the child's birth seem to be driving the economic inequalities observed later throughout the life course.

The longitudinal effects of neighbourhood social and material deprivation change on psychological distress in urban, community-dwelling Canadian adults.

OBJECTIVE: The purpose of this study was to assess how longitudinal changes in neighbourhood material and social deprivation affect distress outcomes in adult Canadians. STUDY DESIGN: This study used a prospective cohort approach. METHODS: We paired data from 2745 urban participants of Canada's National Population Health Survey-who completed the Kessler 6-Item psychological distress screening tool at baseline and follow-up-with neighbourhood social and material deprivation data from the census-based Pampalon Deprivation Index. Data were paired using participants' postal code. We conducted multiple linear regression models, which were stratified by baseline deprivation level and controlled for key confounders. RESULTS: Most participants lived in neighbourhoods that did not change drastically in social or material deprivation level during the six years between baseline and follow-up. We found that a worsening of material settings was significantly associated with worsening distress scores at follow-up. This finding is discussed in the context of existing literature, and made relevant for urban health research and policy.

Place and health in diabetes: the neighbourhood environment and risk of depression in adults with type 2 diabetes.

BACKGROUND: Depression is a common co-illness in people with diabetes. Evidence suggests that the neighbourhood environment impacts the risk of depression, but few studies have investigated this effect in those with diabetes. We examined the effect of a range of neighbourhood characteristics on depression in people with Type 2 diabetes. METHODS: This cohort study used five waves of data from 1298 participants with Type 2 diabetes from the Diabetes Health Study (2008-2013). We assessed depression using the Patient Health Questionnaire. We measured neighbourhood deprivation using census data; density of services using geospatial data; level of greenness using satellite imagery; and perceived neighbourhood characteristics using survey data. The effect of neighbourhood factors on risk of depression was estimated using survival analysis, adjusting for sociodemographic variables. We tested effect modification by age, sex and socio-economic characteristics using interaction terms. RESULTS: More physical activity facilities, cultural services and a greater level of greenness in the neighbourhood were associated with a lower risk of depression in our sample, even after adjusting for confounders. Material deprivation was associated with increased risk of depression, particularly in participants who were older or retired. CONCLUSIONS: Characteristics of neighbourhoods were associated with the risk of depression in people with Type 2 diabetes and there were vulnerable subgroups within this association. Clinicians are encouraged to consider the neighbourhood environment of their patients when assessing the risk of depression. Future intervention research is need for health policy recommendations.

Self-reported use of diabetes healthcare services in a Quebec community-based sample: impact of depression status.

OBJECTIVES: To ascertain the impact of minor and major depression on self-reported use of and access to diabetes healthcare services, and the care components received in a community-based Quebec sample with type 2 diabetes. STUDY DESIGN: Adults with type 2 diabetes who took part in baseline and 1-year follow-up telephone interviews for the Diabetes Health Study were assessed (n = 1175). METHODS: Information was collected regarding depression status (i.e. minor or major depression), use of and access to diabetes healthcare services, sociodemographic and diabetes characteristics, treatment, diabetes complications, disability, body mass index, residential area and depression. RESULTS: People with major depression were more likely to be high users or non-users of diabetes healthcare services. The high users reported more diabetes complications. People with major depression also reported more problems with accessing diabetes healthcare services, specifically having to wait too long between making their appointment and their visit, specialist care not being available in their area, general health deterioration, being unable to leave their house due to their health and problems with transportation. People with major depression were less likely to report having their feet checked by their doctor, and were more likely to report problems with getting advice from their doctor. CONCLUSIONS: People with diabetes need to use healthcare services in order to receive recommended care components. People with major depression and no complications are less likely to report using healthcare services; conversely, people with major depression and complications are more likely to be high users of healthcare services. People with major depression perceive more problems with the health care they receive.

Indicators of self-rated health in the Canadian population with diabetes.

AIMS: Self-rated health is a widely used measure of general health assessing risk factors and poor health outcomes in health surveys and clinical settings. The characteristics of self-rated health may be different in populations with specific chronic conditions, such as populations with diabetes. This study investigates the characteristics of self-rated health in a Canadian community sample of people with diabetes. METHODS: Self-rated health was obtained from 1837 adults with Type 2 diabetes participating in the Montreal Diabetes Health and Well-Being Study. Global disability and depression were assessed using the World Health Organization Disability Assessment Schedule II and the Patient Health Questionnaire, respectively. Logistic regressions studied the association between self-rated health and depression, disability, diabetes-related characteristics, socio-demographic factors, social support and lifestyle-related behaviours in both men and women. RESULTS: Participants' answers were dichotomized into excellent/very good/ good (78%) and fair/poor (22%) self-rated health. Both depression (men: odds ratio 1.9, 95% CI 1.4-2.6; women: odds ratio 1.5, 95% CI 1.2-1.9) and disability (men: odds ratio 1.7, 95% CI 1.4-1.9; women: odds ratio 1.7, 95% CI 1.5-1.9) were associated with fair/poor self-rated health. The associations remained unchanged even after controlling for diabetes characteristics. After controlling for confounding variables, chronic conditions were associated with fair/poor self-rated health in both men and women. Obesity was associated with fair/poor self-rated health in women only, while lifestyle behaviours such as being physically active and alcohol consumption were associated with good/very good/excellent self-rated health in men. CONCLUSIONS: In men and women, depression and disability are important factors that are associated with self-rated health in a large sample of individuals with Type 2 diabetes.

Types of smokers in a community sample of individuals with Type 2 diabetes: a latent class analysis.

AIMS: Despite the detrimental effects of smoking on their health, a high number of adults with Type 2 diabetes continue to smoke. Identifying distinct types of smokers within this population could help tailor and target intervention programmes. This study examined whether smokers with Type 2 diabetes could be classified into different profiles based on smoking habits, socio-economic characteristics and lifestyle factors. METHODS: A sample of adults with self-reported diabetes was selected from random-digit dialing. Analyses included 383 participants with Type 2 diabetes who were current smokers. Information related to smoking, socio-economic status, health and lifestyle was collected by phone interview at baseline and 1 year later. Latent class analysis was used to identify subgroups of smokers. RESULTS: We uncovered three meaningful classes of smokers: class 1, long-time smokers with long-standing diabetes (n = 105); class 2, heavy smokers with deprived socio-economic status, poor health and unhealthy lifestyle characteristics (n = 105); class 3, working and active smokers who were more recently diagnosed with diabetes (n = 173). Members of class 2 were significantly more likely to be disabled and depressed at baseline and 1 year later compared with other classes. CONCLUSIONS: Different profiles of smokers exist among adults with Type 2 diabetes, each suggesting different cessation treatment needs. Distinguishing between these types of smokers may enable clinicians to tailor their approach to smoking cessation.

Analysis of variables associated with surgery versus observation in patients with pancreatic cystic lesions referred for endoscopic ultrasound.

BACKGROUND AND STUDY AIM: Endoscopic ultrasound (EUS) with fine-needle aspiration (FNA) for cyst fluid analysis (CFA) is often requested for pancreatic cystic lesions, to determine whether to operate or to observe. If this decision is not influenced by the EUS findings, the procedure may be unjustifiable. We aimed to determine whether EUS-CFA results predict surgery or observation in patients with pancreatic cysts referred for EUS. PATIENTS AND METHODS: Consecutive patients referred to a quaternary pancreaticobiliary center for EUS evaluation of pancreatic cysts were eligible. Clinical data, computed tomography (CT) results, EUS findings, and CFA results were reviewed retrospectively. Statistical analysis was performed to determine variables associated with surgery versus observation. RESULTS: Over 33 months, data on 194 consecutive patients referred for EUS for evaluation of pancreatic cysts were analyzed. Of these, 136 (70 %) patients had EUS-FNA. After the initial workup (including EUS with/without CFA), 35 (18 %) underwent surgery. Predictors of surgery were: younger age (< 65 years) (P = 0.0027), malignant appearance at EUS (P = 0.02), and history of EUS-FNA (P = 0.012). Cyst fluid appearance, and carcinoembryonic antigen (CEA), carbohydrate antigen 19­9 (CA 19­9), and amylase levels were not significant determinants of surgery. In 14/50 (28 %) of cases where EUS-CFA clearly suggested benign serous lesions, surgery was still performed and in 9/11 (82 %) of cases with malignant EUS-CFA findings, surgery was not done. CONCLUSIONS: In patients with pancreatic cysts referred for EUS, age and EUS appearance independently predict surgery. The "perceived need for EUS-CFA" also predicts surgery, but not the EUS-CFA results. The clinical value of EUS-CFA requires further study.

A prospective comparison of endoscopic ultrasound-guided fine needle aspiration results obtained in the same lesion, with and without the needle stylet.

BACKGROUND AND STUDY AIMS: The effectiveness of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) with (S+) and without (S-) a stylet has never been compared. We prospectively compared the yield for malignancy and sample quality of S+ and S- EUS-FNA. PATIENTS AND METHODS: S+ or S- EUS-FNA was performed on consecutive solid lesions, with a 22-gauge needle, with systematic assignment of S+ or S- passes in a 1 : 2 ratio. Slides were read by a single, blinded cytologist and were rated for bloodiness, adequacy, and presence of malignancy. The yield for malignancy was compared only in lesions in which equal numbers of S+ and S- passes were performed. RESULTS: A total of 309 passes (mean 2.3 passes/lesion, range 1-6, 82% adequate, 38% S+, 62% S-) were performed on 135 lesions (63% malignant, 42% nodes, 58% masses [79% pancreatic]) in 111 patients (mean age 62.9 years, range 30-86). In 46 lesions where an equal number (53 S+ and 53 S-) of passes was performed, there was no difference in the proportion of cases in which S+ FNA was "equal to or better than" S- FNA ([S+] 89% vs. [S-] 87%; P>0.05). The results of the two methods agreed in 80% cases (kappa 0.60). The sensitivities for malignancy were: S+ 87% vs. S- 83%, P>0.05. Specificities were 100%. Sample adequacy was significantly lower in S+ passes (75% vs. 87%, P=0.013), and sample bloodiness was significantly higher (75% vs. 52%, P<0.0001). CONCLUSIONS: Use of the stylet with EUS-FNA does not increase the yield for malignancy and is associated with poorer sample quality. The value of the stylet for EUS-FNA is questionable and requires further investigation.

The association between obesity and anxiety disorders in the population: a systematic review and meta-analysis.

Anxiety disorders are the most prevalent mental disorders in developed countries. Obesity is hypothesized to be a risk factor for anxiety disorders but evidence supporting an association between these two conditions is not clear. The objectives of this paper were to systematically review the literature for a link between obesity and anxiety disorders in the general population, and to present a pooled estimate of association. We performed a systematic search for epidemiological articles reporting on obesity (explanatory variable) and anxiety disorders (outcome variable) in seven bibliographical databases. Two independent reviewers abstracted the data and assessed study quality. We found 16 studies (2 prospective and 14 cross-sectional) that met the selection criteria. Measures of effect from prospective data were mixed but cross-sectional evidence suggested a positive association between obesity and anxiety. The pooled odds ratio from cross-sectional studies was 1.4 (confidence interval: 1.2-1.6). Subgroup analyses revealed a positive association in men and women. Overall, a moderate level of evidence exists for a positive association between obesity and anxiety disorders. Questions remain regarding the role of obesity severity and subtypes of anxiety disorders. The causal relationship from obesity to anxiety disorders could not be inferred from current data; future etiologic studies are recommended.

Bioethics for clinicians: 18. Aboriginal cultures.

Although philosophies and practices analogous to bioethics exist in Aboriginal cultures, the terms and categorical distinctions of "ethics" and "bioethics" do not generally exist. In this article we address ethical values appropriate to Aboriginal patients, rather than a preconceived "Aboriginal bioethic." Aboriginal beliefs are rooted in the context of oral history and culture. For Aboriginal people, decision-making is best understood as a process and not as the correct interpretation of a unified code. Aboriginal cultures differ from religious and cultural groups that draw on Scripture and textual foundations for their ethical beliefs and practices. Aboriginal ethical values generally emphasize holism, pluralism, autonomy, community- or family-based decision-making, and the maintenance of quality of life rather than the exclusive pursuit of a cure. Most Aboriginal belief systems also emphasize achieving balance and wellness within the domains of human life (mental, physical, emotional and spiritual). Although these bioethical tenets are important to understand and apply, examining specific applications in detail is not as useful as developing a more generalized understanding of how to approach ethical decision-making with Aboriginal people. Aboriginal ethical decisions are often situational and highly dependent on the values of the individual within the context of his or her family and community.

Time trends in systemic adjuvant treatment for node-negative breast cancer.

PURPOSE: We conducted a population-based study in Quebec, Canada, to assess longitudinal changes in systemic adjuvant therapy for node-negative breast cancer. MATERIALS AND METHODS: A stratified random sample was selected among women with newly diagnosed node-negative breast cancer in 1988, 1991, and 1993. Information on the patient, her tumor, source of care, and treatment was abstracted from medical charts. Patients were classified as being at minimal, moderate, or high risk of recurrence on the basis of criteria proposed at the 4th International Conference on Adjuvant Therapy of Primary Breast Cancer (St. Gallen, Switzerland, 1992), and systemic adjuvant treatment received was dichotomized as being consistent or not consistent with consensus recommendations. RESULTS: Overall, 1,578 cases of invasive breast carcinoma were reviewed. The proportion of patients who were given hormonal or cytotoxic treatment increased from 51.7% to 73.1% from 1988 to 1993. Virtually all women at minimal risk were treated in 1991 and 1993 according to the consensus statement. The proportions of women so treated were 75.0% and 65.4% in the moderate- and high-risk categories, respectively, in 1991. In 1993, these proportions were 71.4% and 67.0%, respectively. Omission of chemotherapy, especially in high-risk women with estrogen receptor-negative tumors who were 50 to 69 years of age, was the most frequent inconsistency with guidelines. CONCLUSION: Systemic adjuvant therapy for node-negative breast cancer has gained acceptance. Better understanding of the decision-making process, of the perception of the risks and benefits involved, and of the impact of alternative strategies for the dissemination of consensus recommendations are needed to promote the use of chemotherapy in specific categories of women who are at high risk of recurrence.

mdr1 mRNA expression by RT-PCR in patients with primary breast cancer submitted to neoadjuvant therapy.

mdr1 expression by reverse transcription and polymerase chain reaction (RT-PCR) has been compared to P-glycoprotein (Pgp) expression by immunohistochemistry (IHC) and correlated with clinical response to neoadjuvant therapy. RNA has been recovered from glass slide smears of fine-needle aspiration from 57 untreated primary breast cancers prior to neoadjuvant chemotherapy (33 cases), hormone therapy (23 cases), or both (1 case). Furthermore, mdr1 mRNA has been analyzed in 6 cases after 2 months of treatment. The neoadjuvant therapy consisted of 4 cycles of adriamycin and cyclophosphamide or tamoxifen. Of 57 tumor specimens, an interpretable result was obtained in 52 cases, indicating the feasibility of the analysis by RT-PCR with very small tumor specimens. The presence of mdr1 mRNA has been documented in 44/52 (84%) tumor samples with a spectrum of expression levels. The expression of mdr1 mRNA was compared with P-glycoprotein (Pgp) expression by IHC using JSB-1, 4E3, and C494 monoclonal antibodies in 48 of the 52 interpretable tumor samples. 12/48 (25%) expressed Pgp by IHC. All tumors expressing Pgp by IHC were also positive by RT-PCR. The results confirm the higher prevalence of mdr1 mRNA compared to the protein expression. However, mdr1 mRNA expression was found to correlate significantly with resistance to neoadjuvant hormone therapy only while Pgp expression detected by JSB-1 immunostaining only correlated with chemoresistance. The lack of convincing correlation with chemoresistance suggests that mRNA and Pgp may not be directly or solely responsible for clinical response to drugs. Further studies should focus on the post-translational modulation of P-glycoprotein and other mechanisms of drug resistance.

[Diagnosis of differentiated thyroid cancers]. / Diagnostic des cancers thyroïdiens différenciés.

Thyroid nodule is a frequent clinical problem. Since the majority of these are benign, it is important to identify the cancers among them and at the same time avoid surgery in most. Fine needle aspiration biopsy is a direct method, reliable and without risk. Today this technique constitute the first step in evaluation of a thyroid nodule. If done properly, it will have a false negative rate of 1 to 2%. In few cases the diagnosis will remain uncertain even after the needle biopsy. In these cases thyroid scan and clinical criteria will be helpful to reach a therapeutic decision.

[Thoracic "staging" by videothoracoscopy: a new technique]. / "Staging" thoracique par vidéothoracoscopie: nouvelle technique.

We are describing a technique of pre resectional staging of thoracic neoplasm by video assisted thoracic surgical (VATS) techniques. This method was applied on 27 patients, when the lymph nodes II, III, IV, VII, VIII and IX were biopsied or excised. In two cases (2) we were forced to proceed to open thoracotomy for staging because of extensive adhesion. In the other 25 patients, the surgical staging was the same as the VATS staging in 92% of the cases. This technic has obvious advantages for lower mediastinal nodes (100%). VATS should be considered among other staging procedure for thoracic neoplasms.

Retinoblastoma and p53 gene product expression in breast carcinoma: immunohistochemical analysis and clinicopathologic correlation.

We examined 100 breast cancers for retinoblastoma (Rb) and p53 protein expression by immunohistochemistry using the PMG3.245 and PAb 1801 antibodies. We assessed percentages of reactive cells and their intensity, as well as staining patterns. The results were correlated with neu protein reactivity and a panel of variables, including age, tumor size and type, nuclear grade, estrogen receptor/progesterone receptor content, and lymph node status. Retinoblastoma protein negativity, either partial or complete, was noted in 47% of cases. Surprisingly, a relatively stronger Rb reaction was seen in some high nuclear grade tumors. p53 positivity was found in 23% of cases and was a significant predictor of Rb loss. p53 also was correlated with poorly differentiated (nuclear grade III) neoplasms and neu expression but not with negative ER status. Tissue distribution profiles for Rb-negative and p53-positive cells were variable in this series, with both uniform and heterogeneous patterns observed. This suggests that Rb and p53 alterations may represent early or late events in transformation. Our findings further implicate Rb and p53 derangements in mammary oncogenesis.

Acute polyarthritis associated with birefringent lipid microspherules occurring in a patient with longstanding rheumatoid arthritis.

We describe a 52-year-old patient with longstanding rheumatoid arthritis (RA) who developed an acute polyarthritis of her hands and wrists. Synovial fluid analysis revealed the presence of intra and extracellular lipid microspherules with the typical appearance of Maltese crosses under polarized light microscopy. No other specific cause could be identified. This is the first description of an acute polyarthritis associated with lipid microspherules in RA.