Clinical features and genetic biomarkers associated with different phenotypes of systemic lupus erythematosus in Paraguayan patients.

Systemic lupus erythematosus (SLE) is a complex autoimmune disease characterized by a heterogeneous clinical picture that makes the diagnosis and follow-up of these patients difficult. This study aimed to identify correlations between clinical, immunological, and genetic biomarkers and clinical manifestations in SLE. A retrospective study of data from medical records and immunological and genetic studies of SLE patients in Paraguay was carried out. A descriptive analysis was performed based on the type of variable. Human leukocyte antigen (HLA) allele frequencies (DPA1, DPB1, DQA1, DQB1, and DRB1) were calculated, and univariate logistic regression analyses were performed between each of the explanatory variables and the presence or absence of each phenotype. Odds ratios, 95% confidence intervals, and p values were recorded. Associations with p<0.05 were considered statistically significant. 104 SLE patients were included: 86% were female, with a mean age of 32.80±10.36 years. An association was identified between anti-double stranded DNA (anti-dsDNA) and the presence of the renal phenotype and between anti-dsDNA and the absence of the joint and hematological phenotypes. Immunoglobulin M isotype rheumatoid factor was associated with the absence of a renal phenotype. HLA-DQB1*02:02 and HLA-DRB1*07:01 were associated with the cutaneous phenotype. An association was identified between age at disease onset over 30 years and the presence of the joint phenotype. No other associations were identified. Potential clinical, immunological, and genetic biomarkers of phenotypes have been identified in SLE Paraguayan patients.

Systemic lupus erythematosus dysregulates the expression of long noncoding RNAs in placentas.

BACKGROUND: Systemic lupus erythematosus (SLE) can cause placental dysfunctions, which may result in pregnancy complications. Long noncoding RNAs (lncRNAs) are actively involved in the regulation of immune responses during pregnancy. The present study aimed to determine the lncRNA expression profiles in placentas from women with SLE to gain new insights into the underlying molecular mechanisms in SLE pregnancies. METHODS: RNA sequencing (RNA-seq) analysis was performed to identify SLE-dysregulated lncRNAs and mRNAs in placentas from women with SLE and normal full-term (NT) pregnancies. Bioinformatics analysis was conducted to predict the biological functions of these SLE-dysregulated lncRNAs and mRNAs. RESULTS: RNA-seq analysis identified 52 dysregulated lncRNAs in SLE placentas, including 37 that were upregulated and 15 downregulated. Additional 130 SLE-dysregulated mRNAs were discovered, including 122 upregulated and 8 downregulated. Bioinformatics analysis revealed that SLE-dysregulated genes were associated with biological functions and gene networks, such as regulation of type I interferon-mediated signaling pathway, response to hypoxia, regulation of MAPK (mitogen-activated protein kinase) cascade, response to steroid hormone, complement and coagulation cascades, and Th1 and Th2 cell differentiation. CONCLUSIONS: This is the first report of the lncRNA profiles in placentas from SLE pregnancies. These results suggest that the aberrant expression and the potential regulatory function of lncRNAs in placentas may play comprehensive roles in the pathogenesis of SLE pregnancies. SLE-dysregulated lncRNAs may potentially serve as biomarkers for SLE.

Sexual Dimorphisms of Protein-Coding Gene Profiles in Placentas From Women With Systemic Lupus Erythematosus.

Background: Systemic lupus erythematosus (SLE) may cause pathogenic changes in the placentas during human pregnancy, such as decreased placental weight, intraplacental hematoma, ischemic hypoxic change, placental infarction, and decidual vasculopathy, which contribute to high maternal and fetal mortality and morbidity. Sex-specific adaptations of the fetus are associated with SLE pregnancies. The present study aimed to determine the transcriptomic profiles of female and male placentas from women with SLE. Methods: RNA sequencing (RNA-seq) was performed to identify differentially expressed protein-coding genes (DEGs) in placentas from women with SLE vs. normal term (NT) pregnancies with female and male fetuses (n = 3-5/sex/group). Real-time-quantitative PCR was performed (n = 4 /sex/group) to validate the RNA-seq results. Bioinformatics functional analysis was performed to predict the biological functions and pathways of SLE-dysregulated protein-coding genes. Results: Compared with NT-female (NT-F) placentas, 119 DEGs were identified in SLE-female (SLE-F) placentas. Among these 119 DEGs, five and zero are located on X- and Y-chromosomes, respectively, and four are located on the mitochondrial genome. Compared with NT-male (NT-M) placentas, 458 DEGs were identified in SLE-male (SLE-M) placentas, among which 16 are located on the X-chromosome and zero on the Y-chromosome and mitochondrial genome. Twenty-four DEGs were commonly dysregulated in SLE-F and -M placentas. Functional analysis showed that SLE-dysregulated protein-coding genes were associated with diverse biological functions and pathways, including angiogenesis, cellular response to growth factor stimulus, heparin-binding, HIF (hypoxia-inducible factor)-1 signaling pathway, and Interleukin-17 (IL-17) signaling pathway in both SLE-F and -M placentas. Biological regulations were differentially enriched between SLE-F and -M placentas. Regulation of blood circulation, response to glucocorticoid, and rhythmic process were all enriched in SLE-F, but not SLE-M placentas. In contrast, tumor necrosis factor production, Th17 cell differentiation, and MDA (melanoma differentiation-associated gene)-5 signaling pathway were enriched in SLE-M but not SLE-F placentas. Conclusion: This report investigated the protein-coding gene profiles of placenta tissues from SLE patients using RNA-seq. The results suggest that the SLE-dysregulated protein-coding genes in placentas may contribute to the pathophysiological progress of SLE pregnancies in a fetal sex-specific manner, leading to adverse pregnancy outcomes.

Adolescents' knowledge of a peer's non-suicidal self-injury and own non-suicidal self-injury and suicidality.

OBJECTIVE: Some research suggests that suicidal ideation and attempt among adolescents may be contagious - that is adolescents who are exposed to peers' suicidal behaviour are more likely to experience suicidal ideation or attempt suicide themselves. Less is known about the potential contagion effect of non-suicidal self-injury (NSSI). Our objective was to determine whether knowledge of a friend's NSSI is associated with adolescent's own non-suicidal self-injury and suicidal behaviours. METHODS: Data from 1483 youth ages 14-17 years were obtained from the 2014 Ontario Child Health Study, a cross-sectional population-based survey of children and adolescents in Ontario, Canada. Logistic regression models were used to examine associations between knowledge of a friend's NSSI and adolescents' own self-reported self-injurious and suicidal behaviours. Interactions with gender, age group and presence of a mental disorder were investigated. RESULTS: Knowledge of a friend's non-suicidal self-injury was significantly associated with the adolescent's own non-suicidal self-injury (OR = 2.03, 95% CI 1.05-3.90), suicidal ideation (OR = 3.08, 95% CI 1.50-6.30) and suicide attempt (OR = 2.87, 95% CI 1.20-6.87). CONCLUSION: These findings suggest an apparent contagion effect for non-suicidal self-injury. Awareness of a friend's self-injurious behaviours is associated with an adolescent's own self-injury and suicidality. Interventions aimed at preventing NSSI and suicidality should consider prevention of possible contagion at the school and/or community level.

Adherence to 24-hour movement guidelines and academic performance in adolescents.

OBJECTIVE: The aim of the study was to examine the association between meeting combinations of the Canadian 24-h movement guidelines and academic performance in adolescents. STUDY DESIGN: This cross-sectional study used the 2017 Ontario Student Drug Use and Health Survey, a survey representative of Ontario students in grades 7-12 attending publicly funded schools. A total of 10,160 students were included in the analysis. METHODS: Moderate to vigorous physical activity (MVPA), screen time, sleep duration, and academic performance were self-reported. A multiple linear regression model was used to examine differences in academic performance between adolescents meeting and those not meeting the combinations of movement guidelines (≥60 min/day of MVPA; ≤2 h/day of screen time; 9-11 h/night of sleep for ages 11-13 years, 8-10 h/night for ages 14-17 years, and 7-9 h/night for ages 18 years or older). Covariates included age, sex, ethnicity, subjective socio-economic status, body mass index z-score, and substance use. RESULTS: We found that 5.1% of students met all three movement guidelines, whereas 39.0% did not meet any. Middle school students who met all three guidelines or either the screen time or sleep guideline displayed better academic performance than those who met none of the guidelines. High school students who met the screen time and sleep guidelines displayed better academic performance than those who did not meet any guidelines. CONCLUSIONS: Adhering to screen time and sleep duration recommendations is associated with better academic performance among adolescents.

Incidence of major depression diagnoses in the Canadian Armed Forces: longitudinal analysis of clinical and health administrative data.

PURPOSE: Major depression is a leading cause of morbidity in military populations. However, due to a lack of longitudinal data, little is known about the rate at which military personnel experience the onset of new episodes of major depression. We used a new source of clinical and administrative data to estimate the incidence of major depression diagnoses in Canadian Armed Forces (CAF) personnel, and to compare incidence rates between demographic and occupational factors. METHODS: We extracted all data recorded in the electronic medical records of CAF Regular Force personnel, at every primary care and mental health clinical encounter since 2016. Using a 12-month lookback period, we linked data over time, and identified all patients with incident diagnoses of major depression. We then linked clinical data to CAF administrative records, and estimated incidence rates. We used multivariate Poisson regression to compare adjusted incidence rates between demographic and occupational factors. RESULTS: From January to December 2017, CAF Regular Force personnel were diagnosed with major depression at a rate of 29.2 new cases per 1000 person-years at risk. Female sex, age 30 years and older, and non-officer ranks were associated with significantly higher incidence rates. CONCLUSIONS: We completed the largest study to date on diagnoses of major depression in the Canadian military, and have provided the first estimates of incidence rates in CAF personnel. Our results can inform future mental health resource allocation, and ongoing major depression prevention efforts within the Canadian Armed Forces and other military organizations.

Lifetime experience of multiple common mental disorders and 19-year mortality: results from a Canadian population-based cohort.

AIMS: To examine the impact of multiple psychiatric disorders over the lifetime on risk of mortality in the general population. METHODS: Data came from a random community-based sample of 1397 adults in Atlantic Canada, recruited in 1992. Major depression, dysthymia, panic disorder, generalised anxiety disorder and alcohol use disorders were assessed using the Diagnostic Interview Schedule (DIS). Vital status of participants through 2011 was determined using probabilistic linkages to the Canadian Mortality Database. Cox proportional hazard models with age at study entry as the time scale were used to investigate the relationship between DIS diagnoses and mortality, adjusted for participant education, smoking and obesity at baseline. RESULTS: Results suggested that mood and anxiety disorders rarely presented in isolation - the majority of participants experienced multiple psychiatric disorders over the lifetime. Elevated risk of death was found among men with both major depression and dysthymia (HR 2.56; 95% CI 1.12-5.89), depression and alcohol use disorders (HR 2.45; 95% CI 1.18-5.10) and among men and women who experienced both panic disorder and alcohol use disorders (HR 3.80; 95% CI 1.19-12.16). CONCLUSION: The experience of multiple mental disorders over the lifetime is extremely common, and associated with increased risk of mortality, most notably among men. Clinicians should be aware of the importance of considering contemporaneous symptoms of multiple psychiatric conditions.

Cyberbullying victimisation and internalising and externalising problems among adolescents: the moderating role of parent-child relationship and child's sex.

AIMS: Previous research has found links between cyberbullying victimisation and internalising and externalising problems among adolescents. However, little is known about the factors that might moderate these relationships. Thus, the present study examined the relationships between cyberbullying victimisation and psychological distress, suicidality, self-rated poor mental health and substance use among adolescents, and tested whether parent-child relationship and child's sex would moderate these relationships. METHODS: Self-report data on experiences of cyberbullying victimisation, self-rated poor mental health, psychological distress, suicidality and substance use were derived from the 2013 Ontario Student Drug Use and Health Survey, a province-wide school-based survey of students in grades 7 through 12 aged 11-20 years (N = 5478). Logistic regression models adjusted for age, sex, ethnicity, subjective socioeconomic status and involvement in physical fighting, bullying victimisation and perpetration at school. RESULTS: Cyberbullying victimisation was associated with self-rated poor mental health (adjusted odds ratio (OR) 2.15; 95% confidence interval (CI) 1.64-2.81), psychological distress (OR 2.41; 95% CI 1.90-3.06), suicidal ideation (OR 2.38; 95% CI 1.83-3.08) and attempts (OR 2.07; 95% CI 1.27-3.38), smoking tobacco cigarette (OR 1.96; 95% CI 1.45-2.65), cannabis use (OR 1.82; 95% CI 1.32-2.51), and binge drinking (OR 1.44; 95% CI 1.03-2.02). The association between cyberbullying victimisation and psychological distress was modified by parent-child relationship and child's sex (three-way interaction term p < 0.05). The association between cyberbullying victimisation and psychological distress was much stronger among boys who have a negative relationship with their parents. CONCLUSIONS: Findings suggest that cyberbullying victimisation is strongly associated with psychological distress in most adolescents with the exception of males who get along well with their parents. Further research using a longitudinal design is necessary to disentangle the interrelationship among child's sex, parent-child relationship, cyberbullying victimisation and mental health outcomes among adolescents in order to improve ongoing mental health prevention efforts.

Food insecurity and mental illness: disproportionate impacts in the context of perceived stress and social isolation.

OBJECTIVES: Food insecurity is associated with elevated risk of mental illness. This risk may be further compounded by stressful life events and by social isolation. This study investigated whether the risk of mental illness is higher among individuals experiencing food insecurity along with greater stress and social isolation. STUDY DESIGN: Cross-sectional self-report survey data from the 2009-10 Canadian Community Health Survey (N = 100,401). METHODS: We estimated prevalence differences of the risk of self-reported mental illness associated with food insecurity alone and in combination with stressful life events and social isolation. Sensitivity analyses were conducted on a sub-sample who completed a structured diagnostic interview. RESULTS: Overall, the prevalence of mental illness was 18.4% [95% CI 16.7-20.1] higher for women and 13.5% higher [95% CI 11.9, 15.2] for men in severely food insecure households compared to those reporting food security. The increased risk of mental illness associated with food insecurity was more pronounced among females and those reporting higher stress and social isolation. CONCLUSIONS: Individuals reporting food insecurity are at increased risk of mental illness. This increased risk is further exacerbated in high stress and socially isolated environments. Policies, clinical and public health interventions must address broader constellations of risks that exist when food insecurity is present.

Consistency in adult reporting of adverse childhood experiences.

BACKGROUND: Many studies have used retrospective reports to assess the long-term consequences of early life stress. However, current individual characteristics and experiences may bias the recall of these reports. In particular, depressed mood may increase the likelihood of recall of negative experiences. The aim of the study was to assess whether specific factors are associated with consistency in the reporting of childhood adverse experiences. METHOD: The sample comprised 7466 adults from Canada's National Population Health Survey who had reported on seven childhood adverse experiences in 1994/1995 and 2006/2007. Logistic regression was used to explore differences between those who consistently reported adverse experiences and those whose reports were inconsistent. RESULTS: Among those retrospectively reporting on childhood traumatic experiences in 1994/1995 and 2006/2007, 39% were inconsistent in their reports of these experiences. The development of depression, increasing levels of psychological distress, as well as increasing work and chronic stress were associated with an increasing likelihood of reporting a childhood adverse experience in 2006/2007 that had not been previously reported. Increases in mastery were associated with reduced likelihood of new reporting of a childhood adverse experience in 2006/2007. The development of depression and increases in chronic stress and psychological distress were also associated with reduced likelihood of 'forgetting' a previously reported event. CONCLUSIONS: Concurrent mental health factors may influence the reporting of traumatic childhood experiences. Studies that use retrospective reporting to estimate associations between childhood adversity and adult outcomes associated with mental health may be biased.

A genome-wide association study identifies a new locus associated with the response to anti-TNF therapy in rheumatoid arthritis.

Anti-Tumor Necrosis Factor (anti-TNF) drugs are biologic agents commonly used to treat rheumatoid arthritis (RA). However, anti-TNFs are not effective in approximately one out of four treated patients. We conducted a Genome-Wide Association Study (GWAS) to identify the genetic variation associated with the response to anti-TNF therapy in RA. In the discovery stage, 372 RA patients treated with an anti-TNF agent (infliximab, adalimumab or etanercept) were analyzed and treatment response was defined at 12 weeks of therapy. We found a genome-wide significant association in the MED15 gene with the response to etanercept (P<1.5e-8). Using an independent cohort of 245 RA patients, we performed a replication study of the most significant GWAS associations. We replicated the association at the MED15 locus and found suggestive evidence of association in the previously associated MAFB locus. The results of this study suggest novel mechanisms associated with the response to anti-TNF therapies.

Childhood adversity and subsequent mental health status in adulthood: screening for associations using two linked surveys.

AIMS: Accumulating evidence links childhood adversity to negative health outcomes in adulthood. However, most of the available evidence is retrospective and subject to recall bias. Published reports have sometimes focused on specific childhood exposures (e.g. abuse) and/or specific outcomes (e.g. major depression). Other studies have linked childhood adversity to a large and diverse number of adult risk factors and health outcomes such as cardiovascular disease. To advance this literature, we undertook a broad examination of data from two linked surveys. The goal was to avoid retrospective distortion and to provide a descriptive overview of patterns of association. METHODS: A baseline interview for the Canadian National Longitudinal Study of Children and Youth collected information about childhood adversities affecting children aged 0-11 in 1994. The sampling procedures employed in a subsequent study called the National Population Health Survey (NPHS) made it possible to link n = 1977 of these respondents to follow-up data collected later when respondents were between the ages of 14 and 27. Outcomes included major depressive episodes (MDE), some risk factors and educational attainment. Cross-tabulations were used to examine these associations and adjusted estimates were made using the regression models. As the NPHS was a longitudinal study with multiple interviews, for most analyses generalized estimating equations (GEE) were used. As there were multiple exposures and outcomes, a statistical procedure to control the false discovery rate (Benjamini-Hochberg) was employed. RESULTS: Childhood adversities were consistently associated with a cluster of potentially related outcomes: MDE, psychotropic medication use and smoking. These outcomes may be related to one another since psychotropic medications are used in the treatment of major depression, and smoking is strongly associated with major depression. However, no consistent associations were observed for other outcomes examined: physical inactivity, excessive alcohol consumption, binge drinking or educational attainment. CONCLUSIONS: The conditions found to be the most strongly associated with childhood adversities were a cluster of outcomes that potentially share pathophysiological connections. Although prior literature has suggested that a very large number of adult outcomes, including physical inactivity and alcohol-related outcomes follow childhood adversity, this analysis suggests a degree of specificity with outcomes potentially related to depression. Some of the other reported adverse outcomes (e.g. those related to alcohol use, physical inactivity or more distal outcomes such as obesity and cardiovascular disease) may emerge later in life and in some cases may be secondary to depression, psychotropic medication use and smoking.

Trajectories of childhood neighbourhood cohesion and adolescent mental health: evidence from a national Canadian cohort.

BACKGROUND: The objective of this study was to examine associations between trajectories of childhood neighbourhood social cohesion and adolescent mental health and behaviour. METHOD: This study used data from the National Longitudinal Survey of Children and Youth, a nationally representative sample of Canadian children. The sample included 5577 children aged 0-3 years in 1994-1995, prospectively followed until age 12-15 years. Parental perceived neighbourhood cohesion was assessed every 2 years. Latent growth class modelling was used to identify trajectories of neighbourhood cohesion. Mental health and behavioural outcomes were self-reported at age 12-15 years. Logistic regression was used to examine associations between neighbourhood cohesion trajectories and outcomes, adjusting for potential confounders. RESULTS: Five distinct trajectories were identified: 'stable low' (4.2%); 'moderate increasing' (9.1%); 'stable moderate' (68.5%); 'high falling' (8.9%); and 'stable high' (9.3%). Relative to those living in stable moderately cohesive neighbourhoods, those in stable low cohesive neighbourhoods were more likely to experience symptoms of anxiety/depression [odds ratio (OR) = 1.73, 95% confidence interval (CI) 1.04-2.90] and engage in indirect aggression (OR = 1.62, 95% CI 1.07-2.45). Those with improvements in neighbourhood cohesion had significantly lower odds of hyperactivity (OR = 0.67, 95% CI 0.46-0.98) and indirect aggression (OR = 0.69, 95% CI 0.49-0.96). In contrast, those with a decline in neighbourhood cohesion had increased odds of hyperactivity (OR = 1.67, 95% CI 1.21-2.29). Those in highly cohesive neighbourhoods in early childhood were more likely to engage in prosocial behaviour ('high falling': OR = 1.93, 95% CI 1.38-2.69; 'stable high': OR = 1.89, 95% CI 1.35-2.63). CONCLUSIONS: These results suggest that neighbourhood cohesion in childhood may have time-sensitive effects on several domains of adolescent mental health and behaviour.

Retrospective and prospectively assessed childhood adversity in association with major depression, alcohol consumption and painful conditions.

BACKGROUND: Considerable evidence now links childhood adversity to a variety of adult health problems. Unfortunately, almost all of these studies have relied upon retrospective assessment of childhood events, creating a vulnerability to bias. In this study, we sought to examine three associations using data sources that allowed for both prospective and retrospective assessment of childhood events. METHODS: A 1994 national survey of children between the ages of 0 and 11 collected data from a 'person most knowledgeable' (usually the mother) about a child. It was possible to link data for n = 1977 of these respondents to data collected from the same people in a subsequent adult study. The latter survey included retrospective reports of childhood adversity. We examined three adult health outcomes in relation to prospectively and retrospectively assessed childhood adversity: major depressive episodes, excessive alcohol consumption and painful conditions. RESULTS: A strong association between childhood adversities (as assessed by both retrospective and prospective methods) and major depression was identified although the association with retrospective assessment was stronger. Weaker associations were found for painful conditions, but these did not depend on the method of assessment. Associations were not found for excessive alcohol consumption irrespective of the method of assessment. CONCLUSIONS: These findings help to allay concerns that associations between childhood adversities and health outcomes during adulthood are merely artefacts of recall bias. In this study, retrospective and prospective assessment strategies produced similar results.

Early development, stress and depression across the life course: pathways to depression in a national British birth cohort.

BACKGROUND: The aetiology of depression is multifactorial, with biological, cognitive and environmental factors across the life course influencing risk of a depressive episode. There is inconsistent evidence linking early life development and later depression. The aim of this study was to investigate relationships between low birthweight (LBW), infant neurodevelopment, and acute and chronic stress as components in pathways to depression in adulthood. METHOD: The sample included 4627 members of the National Survey of Health and Development (NSHD; the 1946 British birth cohort). Weight at birth, age of developmental milestones, economic deprivation in early childhood, acute stressors in childhood and adulthood, and socio-economic status (SES) in adulthood were assessed for their direct and indirect effects on adolescent (ages 13 and 15 years) and adult (ages 36, 43 and 53 years) measures of depressive symptoms in a structural equation modelling (SEM) framework. A structural equation model developed to incorporate all variables exhibited excellent model fit according to several indices. RESULTS: The path of prediction from birthweight to age of developmental milestones to adolescent depression/anxiety to adult depression/anxiety was significant (p < 0.001). Notably, direct paths from birthweight (p = 0.25) and age of developmental milestones (p = 0.23) to adult depression were not significant. Childhood deprivation and stressors had important direct and indirect effects on depression. Stressors in adulthood were strongly associated with adult depression. CONCLUSIONS: Depression in adulthood is influenced by an accumulation of stressors across the life course, including many that originate in the first years of life. Effects of early-life development on mental health appear by adolescence.

Childhood cognitive ability and its relationship with anxiety and depression in adolescence.

BACKGROUND: Childhood cognitive ability may have protective effects against internalizing symptoms in adolescence, although this may depend on the time of symptom assessment and child gender. Also, the effects of childhood stressors on adolescent internalizing symptoms may be moderated by childhood cognitive ability. METHODS: The sample included 4405 individuals from the Canadian National Longitudinal Study of Children and Youth (NLSCY). Between ages 4-5 and 10-11, children completed a test of verbal ability and scholastic aptitude and a series of mathematics computation tests. Internalizing symptoms were assessed via self-reports at ages 12-13 and 14-15. RESULTS: Greater cognitive ability was generally associated with decreased odds of internalizing symptoms at age 12-13. However, greater cognitive ability generally increased, or had no effect on, the odds of internalizing symptoms at age 14-15. Some of the effects of childhood cognitive ability varied with child gender. Also, childhood cognitive ability attenuated the effects of family dysfunction and chronic illness throughout childhood on subsequent internalizing symptoms. LIMITATIONS: These data are largely subject to some degree of reporting bias, the tests of cognitive ability are limited and may not represent overall cognitive ability, and there may be intermediary variables that account for the relationship between childhood cognitive ability and adolescent internalizing symptoms. CONCLUSION: Results suggest that programs attempting to increase early cognitive skills may be particularly beneficial for girls. Also, an increased focus on cognitive skills may attenuate the negative effects of some stressors on subsequent anxious and depressive symptoms, regardless of child gender.

Déficit de vitamina D en pacientes post-menopáusicas y su relación con el metabolismo fosfocálcico y la osteoporosis / Vitamin D deficiency in post-menopausal patients and its relation with the mineral metabolism and the osteoporosis

La influencia de la hipovitaminosis D en la mujer post-menopáusica constituye un tema de gran importancia por las implicancias en el metabolismo fosfo-cálcico y su posible asociación en el desarrollo de otros tipos de patologías. Es por eso que el presente estudio tiene por objetivo conocer la prevalencia de la hipovitaminosis D en una población de mujeres post-menopáusicas y su asociación con los cambios en el metabolismo fosfocálcico y con el desarrollo de la osteoporosis. Se incluyó 67 mujeres post-menopáusicas procedentes de una consulta ambulatoria de reumatología. Se consideraron las siguientes variables clínicas (i.e. edad, peso), laboratorio (i.e. concentraciones de calcio, fosforo y PTH) y la presencia o ausencia de osteopenia u osteoporosis. El valor de la media de la edad de las pacientes fue de 66 ± 11,29 años y las concentraciones de vitamina D inferior a 30 ng/ml se observó en 50 (74,6%) pacientes. La osteopenia u osteoporosis se observó en una parte importante de nuestros pacientes. No se observó una correlación significativa entre las concentraciones de vitamina D y las concentraciones de calcio y fósforo. Se observó una correlación negativa en relación a las concentraciones de PTH (P= 0,049). Las pacientes con osteoporosis u osteopenia presentan con frecuencia hipovitaminosis D. Es por eso que existe la necesidad de realizar una detección y tratamiento temprano a fin de evitar las graves complicaciones que podrían acompañar a la pérdida de densidad ósea en este grupo de pacientes.

Foetal origins of depression? A systematic review and meta-analysis of low birth weight and later depression.

BACKGROUND: The foetal origins hypothesis suggests an association between low birth weight and later depression, yet evidence supporting this association has been inconsistent. METHOD: We systematically reviewed evidence for an association between low birth weight and adult depression or psychological distress in the general population by meta-analysis. We searched EMBASE, Medline, PsycINFO and ISI Web of Science for studies reporting observational data with low birth weight as the exposure and self- or clinician-rated depression or psychological distress measures as an outcome. Selective studies of exposures such as famine or outcomes such as severe illness only were excluded. Altogether,1454 studies were screened for relevance, 26 were included in the qualitative synthesis, 18 were included in the meta-analysis. A random effects meta-analysis method was used to obtain a pooled estimate of effect size. RESULTS: The odds of depression or psychological distress was greater for those of low birth weight (<2500 g) compared to those of normal birth weight (>2500 g) or greater [odds ratio (OR) 1.15, 95% confidence intervals (CI) 1.00-1.32]. However, this association became non-significant after trim-and-fill correction for publication bias (OR 1.08, 95% CI 0.92-1.27). Using meta-regression, no differences in effect size were observed by gender, outcome measure of depression or psychological distress, or whether the effect size was adjusted for possible confounders. CONCLUSIONS: We found evidence to support a weak association between low birth weight and later depression or psychological distress, which may be due to publication bias. It remains possible that the association may vary according to severity of symptoms or other factors.

Symptoms of depression and anxiety, and change in body mass index from adolescence to adulthood: results from a British birth cohort.

BACKGROUND: Depression and anxiety have been shown to be associated with obesity and underweight, but little is known about how the relationship varies across the life course, from adolescence through adulthood. We aimed to investigate the association between adolescent- and adult-onset affective symptoms and body mass index (BMI) change from age 15 to 53 years. METHOD: We used data from a British birth cohort born in 1946 and followed up ever since. The relationship between affective symptom profiles, distinguishing adolescent-onset and adult-onset symptoms, and BMI change from adolescence to age 53 years was investigated using multilevel models. RESULTS: Women with adolescent-onset symptoms had lower mean BMI at age 15 years, faster rates of increase across adulthood, and higher BMI at age 53 years than those with no symptoms. Men with adolescent-onset symptoms had lower BMI at all ages from 15 to 53 years. The BMI trajectories of men and women with adult-onset symptoms did not differ from those with absence of symptoms at all ages. CONCLUSIONS: The relationship between affective symptoms and change in BMI varies by sex and age at onset of symptoms. Adolescence may be an important period for the development of the association between affective symptoms and weight gain in girls. Intervention to prevent increases in BMI across adult life in women with adolescent-onset symptoms, even if they are not overweight at this age, should be considered.

Maternal distress in early life predicts the waist-to-hip ratio in schoolchildren.

We report on life course stress determinants of overweight in children, using data from the longitudinal follow-up of the nested case-control arm of the SAGE (study of asthma genes and the environment) birth cohort in Manitoba, Canada. Waist and hip measurements were obtained during a clinic visit at age 9-11 years. Multiple linear regression was conducted to determine the relationship between the waist-to-hip ratio and maternal smoking during pregnancy, postpartum maternal distress and stress reactivity in children (cortisol, cortisol-DHEA [dihydroepiandrostrenone] ratio quartiles) following a clinic stressor at age 8-10 years. We found waist-to-hip risk at age 9-11 years to be elevated among boys and girls whose mothers had experienced distress in the postnatal period. This association varied by gender and asthma status. In healthy girls, postpartum distress increased waist-to-hip ratio by a factor of 0.034 (P < 0.01), independent of the child's stage of puberty and adrenarche, cortisol-DHEA ratio and duration of exclusive breastfeeding. Among girls with asthma, maternal smoking during pregnancy was associated with an increased waist-to-hip ratio, if the mother also experienced distress in the postpartum period (0.072, P = 0.038). Among asthmatic boys, an association between maternal distress and waist-to-hip ratio was evident at the highest cortisol-DHEA ratios. Stress-induced changes to leptin and infant over-eating pathways were proposed to explain the postnatal maternal distress effects. Drawing on the theories of evolutionary biology, our findings underscore the significance of postnatal stress in disrupting hypothalamic-pituitary-adrenal axis function in infants and increasing risk for child overweight.