Depression and its associated factors among patients with diabetes: A cross-sectional survey at Mnazi Mmoja Referral Hospital in Zanzibar, Tanzania.

BACKGROUND: Depression is one of the mental illnesses that cause disability worldwide, and is a significant contributor to the global burden of diseases. Although depression is reported among patients with diabetes in high-income countries, it remains undetected or undiagnosed in low and middle-income countries. This article describes the prevalence of depression and its associated factors among patients with diabetes in Zanzibar, United Republic of Tanzania. MATERIALS AND METHODS: A cross-sectional study design was conducted at Mnazi Mmoja Referral Hospital (MMRH). A simple random sampling method was used to select the potential participants. Depressive symptoms were assessed using Patient Health Questionnaire-9(PHQ-9). Data were coded and analyzed using SPSS 23.0. A Chi-square test was performed to obtain the association between depression and socio-demographic, medical and psychological factors. A P-value of <0.05 with a 95% confidence interval was used to determine the significant associations between the variables. Also, multiple logistic regression was performed with the factors with P-value <0.2 to ascertain the confounding factors. RESULTS: A total of 267 patients with diabetes responded to the questionnaire of which 142 (53.2%) were males. The mean age of participants was 50 years and a standard deviation of ±14. The overall prevalence of depression in this study was 73%. The specific type of depression among diabetic patients varied from severe (8%) to mild depression (30%). Respondents who had difficulties in adhering to the treatment regimen (AOR = 5.7: 95% CI, 2.11-15.18, p = 0.001), feeling angry or stressed (AOR = 4.4: 95% CI, 2.44-8.10, p<0.001), and had diabetic retinopathy (AOR = 2.8: 95% CI, 1.45-5.28, p = 0.002) had symptoms of depression. Furthermore, respondents who had diabetic foot ulcers (AOR = 0.1: 95% CI, 0.04-0.49, p = 0.003) and impotence for male patients (AOR = 0.4: 95% CI, 0.20-0.68, p = 0.002) were 0.1 and 0.4 times less likely to have depression respectively. CONCLUSION: The majority of patients with diabetes have symptoms of depression. Adherence to the treatment regimen, diabetic retinopathy, feeling angry or stressed, impotence and diabetic foot ulcer were associated with depression. Thus, early screening of depression among patients with diabetes is crucial to enhance self-management and good health outcomes.

Observation of ϒ(4S)→η

We report the first observation of the hadronic transition ϒ(4S)→η^{'}ϒ(1S), using 496 fb^{-1} data collected at the ϒ(4S) resonance with the Belle detector at the KEKB asymmetric-energy e^{+}e^{-} collider. We reconstruct the η^{'} meson through its decays to ρ^{0}γ and to π^{+}π^{-}η, with η→γγ. We measure B(ϒ(4S)→η^{'}ϒ(1S))=[3.43±0.88(stat)±0.21(syst)]×10^{-5}, with a significance of 5.7σ.

Laparoscopic Versus Open Cholecystectomy: A Cost-Effectiveness Analysis at Rwanda Military Hospital.

BACKGROUND: Laparoscopic cholecystectomy is first-line treatment for uncomplicated gallstone disease in high-income countries due to benefits such as shorter hospital stays, reduced morbidity, more rapid return to work, and lower mortality as well-being considered cost-effective. However, there persists a lack of uptake in low- and middle-income countries. Thus, there is a need to evaluate laparoscopic cholecystectomy in comparison with an open approach in these settings. METHODS: A cost-effectiveness analysis was performed to evaluate laparoscopic and open cholecystectomies at Rwanda Military Hospital (RMH), a tertiary care referral hospital in Rwanda. Sensitivity and threshold analyses were performed to determine the robustness of the results. RESULTS: The laparoscopic and open cholecystectomy costs and effectiveness values were $2664.47 with 0.87 quality-adjusted life years (QALYs) and $2058.72 with 0.75 QALYs, respectively. The incremental cost-effectiveness ratio for laparoscopic over open cholecystectomy was $4946.18. Results are sensitive to the initial laparoscopic equipment investment and number of cases performed annually but robust to other parameters. The laparoscopic intervention is more cost-effective with investment costs less than $91,979, greater than 65 cases annually, or at willingness-to-pay (WTP) thresholds greater than $3975/QALY. CONCLUSIONS: At RMH, while laparoscopic cholecystectomy may be a more effective approach, it is also more expensive given the low caseload and high investment costs. At commonly accepted WTP thresholds, it is not cost-effective. However, as investment costs decrease and/or case volume increases, the laparoscopic approach may become favorable. Countries and hospitals should aspire to develop innovative, low-cost options in high volume to combat these barriers and provide laparoscopic surgery.

First Observation of the Hadronic Transition ϒ(4S)→ηh(b)(1P) and New Measurement of the h(b)(1P) and η(b)(1S) Parameters.

Using a sample of 771.6×10(6) ϒϒ(4S) decays collected by the Belle experiment at the KEKB e(+)e(-) collider, we observe, for the first time, the transition ϒ(4S)→ηh(b)(1P) with the branching fraction B[ϒ(4S)→ηh(b)(1P)]=(2.18±0.11±0.18)×10(-3) and we measure the h(b)(1P) mass M(h(b)(1P))=(9899.3±0.4±1.0) MeV/c(2), corresponding to the hyperfine (HF) splitting ΔM(HF)(1P)=(0.6±0.4±1.0) MeV/c(2). Using the transition h(b)(1P)→γη(b)(1S), we measure the η(b)(1S) mass M(η(b)(1S))=(9400.7±1.7±1.6) MeV/c(2), corresponding to ΔM(HF)(1S)=(59.6±1.7±1.6) MeV/c(2), the η(b)(1S) width Γ(η(b)(1S))=(8(-5)(+6)±5) MeV/c(2) and the branching fraction B[h(b)(1P)→γη(b)(1S)]=(56±8±4)%.

Interference study of the chi c0(13P0) in the reaction -pp-->pi0pi0.

Fermilab experiment E835 has observed (-)pp annihilation production of the charmonium state chi(c0) and its subsequent decay into pi(0)pi(0). Although the resonant amplitude is an order of magnitude smaller than that of the nonresonant continuum production of pi(0)pi(0), an enhanced interference signal is evident. A partial wave expansion is used to extract physics parameters. The amplitudes J=0 and 2, of comparable strength, dominate the expansion. Both are accessed by L=1 in the entrance (-)pp channel. The product of the input and output branching fractions is determined to be B((-)pp-->chi(c0))xB(chi(c0)-->pi(0)pi(0))=(5.09+/-0.81+/-0.25)x10(-7).

The use of colored elastomeric "O"s as a motivational instrument for patients with anodontia: report of case.

Complete and/or removable partial dentures are the most commonly selected treatment for the prosthodontic management of young patients who present with oligodontia or anodontia such as in the case of patients with ectodermal dysplasia. Bakri, Belanger and Nowak have reported on the different ways that these prostheses can be modified to ease the child's burden of growing up with missing teeth and having to wear prostheses that make them different from their peers. Some of their suggestions include the placement of diastemas, the use of artificial "baby" teeth and their subsequent replacement with permanent teeth to simulate the primary and mixed dentition stages. They have also recommended deleting primary teeth to mimic the normal exfoliation pattern. The purpose of this article is to report the attitude change and improvement in self-esteem experienced by two young girls from the simple addition of colored elastomeric molded "O"s to the orthodontic appliances placed on their prostheses.

Condylar cartilage response to continuous passive motion in adult guinea pigs: A pilot study.

This article reports on the development and testing of a continuous passive motion device suitable for experimental animals and on the effect of 1 week of continuous passive motion on the thickness of the condylar cartilage in adult guinea pigs. Continuous passive motion is currently used for postsurgical joint therapy and consists of moving a synovial joint passively and constantly through its normal range of motion. In this study continuous passive motion was applied to the temporomandibular joints of two experimental animals for 7 hours per day for 5 days. Two animals were restrained for the same amount of time that the experimental animals were on the continuous passive motion machines (control group 1), and two animals were allowed normal cage activity (control group 2). Six weeks later all animals were sacrificed. Each mandibular condyle was sectioned sagitally, and routine histologic sections were prepared with hematoxylin-eosin stain. Microscopic examination of the mandibular condylar cartilage of the animals placed on continuous passive motion showed a marked increase in thickness compared with the condylar cartilage found on the control animals. The condylar cartilage of the animals placed on continuous passive motion averaged 345 microm, and the controls averaged 232 microm. These findings demonstrate the application of continuous passive motion in an experimental model and provide interesting information regarding the response of the mandibular condyle to increased motion. More studies are necessary to further investigate the effect of continuous passive motion on the condylar cartilage.

Adult orthodontic treatment: a challenging case report.

The case of a 61-year-old woman with a primary diagnosis of spondyloepiphyseal dysplasia and severe maxillary and mandibular spacing as well as anterior and posterior crossbites is presented. Clinical findings led to a diagnosis of macroglossia which required partial glossectomy in addition to comprehensive orthodontic treatment to correct malocclusion.

Evaluation of an alternative traffic light change anticipation system.

A driving simulator was used to study the efficacy of an alternative signal phasing program. The new Traffic Light Change Anticipation System (TLCAS) utilizes a flashing amber in conjunction with a solid green indication to warn drivers of the impending onset of the solid amber indication. This new program was expected to provide drivers with additional information with which to make safe stopping or crossing decisions, and reduce behaviour associated with increased accident rates at signalized intersections. Additionally, a new measure of first response variability was introduced to evaluate the effect of the new program on driver behavior. The results indicated that the new system has the ability to reduce the number of red light violations. Of the 1148 target intersections, 43 violations were recorded for the regular program compared to 9 for the TLCAS program. The severity of decelerations was also impacted. The regular program displayed average maximum decelerations of 3.1 m/sec2 compared to 2.5 m/sec2 for the TLCAS program. However, the TLCAS program showed an increased variability in first response five times larger than the regular program. This finding, in conjunction with traditional measures, indicates that the new system performs comparably to an increased amber duration by increasing the potential for conflicting decisions between successive drivers approaching an intersection. Altogether, the results suggest that this alternative signal phasing program would not improve intersection safety. The findings also suggest that further study of the longitudinal behavior after the introduction of a TLCAS program may be warranted. Specifically, future studies should examine whether subjects engage in appropriate adaptive changes when confronted with a solid amber period warning after becoming familiar with the TLCAS.