Depression prevalence in Type 2 diabetes is not related to diabetes-depression symptom overlap but is related to symptom dimensions within patient self-report measures: a meta-analysis.

AIM: Depression is common in Type 2 diabetes, yet rates vary. Overlap between symptoms of depression and diabetes may account for this variability in depression prevalence rates. We examined to what extent depression prevalence was a function of the proportion of depression-diabetes symptom overlap (items within symptom dimensions) and sample characteristics. METHODS: Electronic and hand searching of published and unpublished works identified 147 eligible papers. Of 3656 screened, 147 studies (149 samples, N = 17-229 047, mean sample age 25.4-82.8 years, with 152 prevalence estimates), using 24 validated depression questionnaires were selected. Sample size, publication type, sample type, gender, age, BMI, HbA1c , depression questionnaire and prevalence rates were extracted. RESULTS: Prevalence rates ranged from 1.8% to 88% (mean = 28.30%) and were higher in younger samples, samples with higher mean HbA1c and clinic samples. Diabetes-depression symptom overlap did not affect prevalence. A higher proportion of anhedonia, cognition, cognitive, negative affect and sleep disturbance symptoms, and a lower proportion of somatic symptoms were consistently associated with higher depression prevalence. CONCLUSIONS: The lack of an overall effect of diabetes-depression symptom overlap might suggest that assessment of depression in Type 2 diabetes is generally not confounded by co-occuring symptoms. However, questionnaires with proportionally more or fewer items measuring other symptom categories were associated with higher estimates of depression prevalence. Depression measures that focus on the cardinal symptoms of depression (e.g. negative affect and cognition), limiting symptoms associated with increasing diabetes symptomatology (e.g. sleep disturbance, cognitive) may most accurately diagnose depression.

Healthy Families America: using research to enhance practice.

The Healthy Families America (HFA) initiative seeks to expand the availability of high-quality, intensive home visitation services and to create communitywide commitments to these services and others that promote a supportive atmosphere for all new parents. This article briefly describes HFA's theoretical framework, its history, and its current status. The HFA Research Network, a partnership among researchers who are engaged in evaluating HFA programs around the country, is also highlighted. Preliminary findings of the research partners suggest that HFA programs may have the most success at improving parent-child interactions, with more limited or mixed success in the areas of health care status and utilization, the prevention of child abuse and neglect, and improved maternal life course outcomes. HFA programs so far have not demonstrated significant improvements in children's development or maternal social support. The authors report variability in both outcomes and attrition rates across subgroups of families in these studies, but there are no consistent patterns to identify who is most likely to stay enrolled in an HFA program or who is most likely to benefit from that enrollment. The authors conclude that these and several other areas require additional research. They further recommend that researchers and practitioners move beyond a singular focus on individualized interventions and work to create a communitywide and national context in which support for all new parents is the norm.

The use of ketamine anaesthesia to milk two tropical rattlesnakes (Crotalus durissus terrificus).

A series of five experimental milkings using ketamine as anaesthetic are described. The drug produced effects which, depending upon the dose, ranged from tranquillisation to deep anaesthesia. No apparent side effects were observed. It is concluded that anaesthesia could play an important role in the safe milking of venomous snakes.