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1.
Psychol Med ; 53(12): 5428-5441, 2023 09.
Artigo em Inglês | MEDLINE | ID: mdl-35879886

RESUMO

BACKGROUND: The impact of the coronavirus disease 2019 (COVID-19) pandemic on mental health is still being unravelled. It is important to identify which individuals are at greatest risk of worsening symptoms. This study aimed to examine changes in depression, anxiety and post-traumatic stress disorder (PTSD) symptoms using prospective and retrospective symptom change assessments, and to find and examine the effect of key risk factors. METHOD: Online questionnaires were administered to 34 465 individuals (aged 16 years or above) in April/May 2020 in the UK, recruited from existing cohorts or via social media. Around one-third (n = 12 718) of included participants had prior diagnoses of depression or anxiety and had completed pre-pandemic mental health assessments (between September 2018 and February 2020), allowing prospective investigation of symptom change. RESULTS: Prospective symptom analyses showed small decreases in depression (PHQ-9: -0.43 points) and anxiety [generalised anxiety disorder scale - 7 items (GAD)-7: -0.33 points] and increases in PTSD (PCL-6: 0.22 points). Conversely, retrospective symptom analyses demonstrated significant large increases (PHQ-9: 2.40; GAD-7 = 1.97), with 55% reported worsening mental health since the beginning of the pandemic on a global change rating. Across both prospective and retrospective measures of symptom change, worsening depression, anxiety and PTSD symptoms were associated with prior mental health diagnoses, female gender, young age and unemployed/student status. CONCLUSIONS: We highlight the effect of prior mental health diagnoses on worsening mental health during the pandemic and confirm previously reported sociodemographic risk factors. Discrepancies between prospective and retrospective measures of changes in mental health may be related to recall bias-related underestimation of prior symptom severity.


Assuntos
COVID-19 , Transtornos de Estresse Pós-Traumáticos , Feminino , Humanos , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/psicologia , COVID-19/epidemiologia , Pandemias , Depressão/psicologia , Estudos Retrospectivos , Estudos Prospectivos , SARS-CoV-2 , Ansiedade/psicologia , Reino Unido/epidemiologia
2.
Osteoporos Int ; 28(1): 119-125, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27543500

RESUMO

Calcium supplements appear to increase cardiovascular risk, but the mechanism is unknown. We investigated the acute effects of calcium supplements on blood pressure in postmenopausal women. The reduction in systolic blood pressure was smaller after calcium compared with the placebo in the hours following dosing. INTRODUCTION: Calcium supplements appear to be associated with increased cardiovascular risk; however, the mechanism of this is uncertain. We previously reported that blood pressure declined over a day in older women, and that this reduction was smaller following a calcium supplement. To confirm this finding, we investigated the acute effects of calcium supplements on blood pressure. METHODS: This was a randomised controlled crossover trial in 40 healthy postmenopausal women (mean age 71 years and BMI 27.2 kg/m2). Women attended on two occasions, with visits separated by ≥7 days. At each visit, they received either 1 g of calcium as citrate, or placebo. Blood pressure and serum calcium concentrations were measured immediately before, and 2, 4 and 6 h after each intervention. RESULTS: Ionised and total calcium concentrations increased after calcium (p < 0.0001 versus placebo). Systolic blood pressure decreased after both calcium and placebo, but significantly less so after calcium (p = 0.02). The reduction in systolic blood pressure from baseline was smaller after calcium compared with placebo by 6 mmHg at 4 h (p = 0.036) and by 9 mmHg at 6 h (p = 0.002). The reduction in diastolic blood pressure was similar after calcium and placebo. CONCLUSIONS: These findings are consistent with those of our previous trial and indicate that the use of calcium supplements in postmenopausal women attenuates the post-breakfast reduction in systolic blood pressure by around 6-9 mmHg. Whether these changes in blood pressure influence cardiovascular risk requires further study.


Assuntos
Pressão Sanguínea/efeitos dos fármacos , Conservadores da Densidade Óssea/farmacologia , Citrato de Cálcio/farmacologia , Suplementos Nutricionais , Pós-Menopausa/fisiologia , Idoso , Estudos Cross-Over , Método Duplo-Cego , Feminino , Humanos , Osteoporose Pós-Menopausa/prevenção & controle
3.
Osteoporos Int ; 27(3): 1209-1216, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26493812

RESUMO

SUMMARY: Calcium supplements have been associated with increased cardiovascular risk, but the mechanism is unknown. We investigated the effects of calcium supplements on the propensity of serum to calcify, based on the transition time of primary to secondary calciprotein particles (T50). Changes in serum calcium were related to changes in T50. INTRODUCTION: Calcium supplements have been associated with increased cardiovascular risk; however, it is unknown whether this is related to an increase in vascular calcification. METHODS: We investigated the acute and 3-month effects of calcium supplements on the propensity of serum to calcify, based on the transition time of primary to secondary calciprotein particles (T50), and on three possible regulators of calcification: fetuin-A, pyrophosphate and fibroblast growth factor-23 (FGF23). We randomized 41 postmenopausal women to 1 g/day of calcium as carbonate, or to a placebo containing no calcium. Measurements were performed at baseline and then 4 and 8 h after their first dose, and after 3 months of supplementation. Fetuin-A, pyrophosphate and FGF23 were measured in the first 10 participants allocated to calcium carbonate and placebo who completed the study. RESULTS: T50 declined in both groups, the changes tending to be greater in the calcium group. Pyrophosphate declined from baseline in the placebo group at 4 h and was different from the calcium group at this time point (p = 0.04). There were no other significant between-groups differences. The changes in serum total calcium from baseline were significantly related to changes in T50 at 4 h (r = -0.32, p = 0.05) and 8 h (r = -0.39, p = 0.01), to fetuin-A at 3 months (r = 0.57, p = 0.01) and to pyrophosphate at 4 h (r = 0.61, p = 0.02). CONCLUSIONS: These correlative findings suggest that serum calcium concentrations modulate the propensity of serum to calcify (T50), and possibly produce counter-regulatory changes in pyrophosphate and fetuin-A. This provides a possible mechanism by which calcium supplements might influence vascular calcification.


Assuntos
Conservadores da Densidade Óssea/efeitos adversos , Carbonato de Cálcio/efeitos adversos , Citrato de Cálcio/efeitos adversos , Suplementos Nutricionais/efeitos adversos , Calcificação Vascular/induzido quimicamente , Idoso , Biomarcadores/sangue , Conservadores da Densidade Óssea/administração & dosagem , Cálcio/sangue , Carbonato de Cálcio/administração & dosagem , Citrato de Cálcio/administração & dosagem , Difosfatos/sangue , Esquema de Medicação , Feminino , Fator de Crescimento de Fibroblastos 23 , Fatores de Crescimento de Fibroblastos/sangue , Humanos , Pessoa de Meia-Idade , Calcificação Vascular/sangue , alfa-2-Glicoproteína-HS/metabolismo
4.
J Intern Med ; 278(4): 354-68, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26174589

RESUMO

Calcium is an essential element in the diet, but there is continuing controversy regarding its optimal intake, and its role in the pathogenesis of osteoporosis. Most studies show little evidence of a relationship between calcium intake and bone density, or the rate of bone loss. Re-analysis of data from the placebo group from the Auckland Calcium Study demonstrates no relationship between dietary calcium intake and rate of bone loss over 5 years in healthy older women with intakes varying from <400 to >1500 mg day(-1) . Thus, supplements are not needed within this range of intakes to compensate for a demonstrable dietary deficiency, but might be acting as weak anti-resorptive agents via effects on parathyroid hormone and calcitonin. Consistent with this, supplements do acutely reduce bone resorption and produce small short-term effects on bone density, without evidence of a cumulative density benefit. As a result, anti-fracture efficacy remains unproven, with no evidence to support hip fracture prevention (other than in a cohort with severe vitamin D deficiency) and total fracture numbers are reduced by 0-10%, depending on which meta-analysis is considered. Five recent large studies have failed to demonstrate fracture prevention in their primary analyses. This must be balanced against an increase in gastrointestinal side effects (including a doubling of hospital admissions for these problems), a 17% increase in renal calculi and a 20-40% increase in risk of myocardial infarction. Each of these adverse events alone neutralizes any possible benefit in fracture prevention. Thus, calcium supplements appear to have a negative risk-benefit effect, and so should not be used routinely in the prevention or treatment of osteoporosis.


Assuntos
Cálcio/administração & dosagem , Adulto , Densidade Óssea/efeitos dos fármacos , Calcitonina/farmacologia , Cálcio/efeitos adversos , Cálculos/etiologia , Suplementos Nutricionais , Fraturas Ósseas/prevenção & controle , Trato Gastrointestinal/efeitos dos fármacos , Humanos , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Osteoporose/prevenção & controle , Hormônio Paratireóideo/farmacologia , Medição de Risco
5.
Eur J Clin Nutr ; 67(2): 214-7, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23232588

RESUMO

BACKGROUND/OBJECTIVES: Bioimpedance analysis (BIA) is a simple, convenient and widely used tool for the measurement of body composition in population surveys and surveillance. Prediction equations based on BIA applicable to preschool children are available but are based on total body water estimation and have not been developed across multiple ethnic groups. Our aim was to develop a BIA-based equation in a multi-ethnic sample of 2-year old using fat-free mass (FFM) from dual-energy X-ray absorptiometry (DXA) as criterion measure. SUBJECTS/METHODS: Single-frequency hand-to-foot BIA (model BIM4, Impedimed) and whole-body DXA measurements were carried out in 77 (35 boys, 42 girls; 27 European, 20 Polynesian, 30 Asian and other) healthy preschool children (age range 22-38 months). Body mass index s.d. scores were 0.41 ± 1.23 for boys and 0.61 ± 1.09 for girls. The performance of published equations applicable to this age group was assessed. The predicted residual sum of squares method was used to develop and cross-validate a multiple regression equation relating FFM to BIA measures. RESULTS: Published equations performed poorly for estimating FFM in this group of children. The prediction equation developed in all 77 children was: FFM (kg)=0.367 height(cm)(2)/resistance+0.188 weight (kg)+0.077 height (cm)+0.273 sex (male=1, female=0)-2.490, R(2)=0.89, standard error of estimate=0.50 kg. Ethnicity and age did not add significantly to the model. CONCLUSIONS: We have developed an equation that may have application for prediction of FFM in 2-3-year-old children, which does not require determination of hydration factors. Further work should be carried out using DXA scanning to extend the applicable age range.


Assuntos
Absorciometria de Fóton/métodos , Antropometria/métodos , Composição Corporal , Compartimentos de Líquidos Corporais , Estatura , Peso Corporal , Impedância Elétrica , Tecido Adiposo , Índice de Massa Corporal , Água Corporal , Pré-Escolar , Etnicidade , Feminino , Humanos , Masculino , Conceitos Matemáticos , Estado Nutricional , Reprodutibilidade dos Testes , Fatores Sexuais
6.
Artigo em Inglês | MEDLINE | ID: mdl-10897321

RESUMO

Assessment of a woman complaining of urinary incontinence includes full urological, gynaecological, medical, surgical and drug histories. General, neurological, abdominal and pelvic examinations are undertaken and with the history, enable a presumptive diagnosis to be formulated. Investigations for incontinence should be selected to suit the individual woman's need. Non-specialist investigations include urine testing, completion of a urinary diary and symptom score, pad testing, measurement of residual urine volume and biochemical tests. Specialist investigations include uroflowmetry, conventional and ambulatory cystometry, urethral pressure profilometry and measurement of urethral electrical conductance and leak point pressure. Imaging using ultrasound, X-ray, magnetic resonance or isotopes is sometimes indicated. While neurophysiological testing has little clinical application, cystourethroscopy is of value in various subgroups of women. Thorough assessment and appropriate investigation together result in an accurate diagnosis which in turn allows appropriate treatment for urinary incontinence to be initiated.


Assuntos
Incontinência Urinária/diagnóstico , Feminino , Humanos , Anamnese/métodos , Exame Físico/métodos , Incontinência Urinária/etiologia , Urodinâmica
8.
Artigo em Inglês | MEDLINE | ID: mdl-10895802

RESUMO

To ascertain the mode of action and benefits of transcutaneous electrical nerve stimulation (TENS) in detrusor overactivity, stress incontinence and interstitial cystitis, an English-language literature search using Medline (1984-1995) was undertaken with detrusor instability, incontinence, interstitial cystitis, neuromodulation, transcutaneous electrical nerve stimulation and urodynamics as keywords and the material so identified was reviewed. The mode of action of TENS and optimal stimulation parameters in bladder dysfunction remain unclear. Lack of strict selection criteria and deficient reporting of subjective and objective outcomes precluded full assessment of therapeutic efficacy. A beneficial effect was evident in some studies of detrusor overactivity and interstitial cystitis. A trial of TENS in detrusor overactivity and interstitial cystitis refractory to conventional therapy would seem justified. Continued experimental research and further clinical studies will lead to refinement of the treatment modality.


Assuntos
Estimulação Elétrica Nervosa Transcutânea , Doenças da Bexiga Urinária/terapia , Incontinência Urinária por Estresse/terapia , Cistite Intersticial/terapia , Feminino , Humanos , Masculino
10.
Nurs Times ; 72(23): 884-7, 1976 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-934904
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