Effects of vitamin supplementation on inflammatory markers and psychological wellbeing among distressed women: a randomized controlled trial.

BACKGROUND: Multivitamins are a popular supplement taken to promote physical and mental health. During periods of stress, they may have a protective role for health and wellbeing, although the current evidence of their efficacy is mixed. OBJECTIVE: To determine whether multivitamin supplementation impacts psychological and inflammatory markers of women who are experiencing psychological distress. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS: An 8-week randomized controlled trial was conducted to assess changes in both psychological state and pro-inflammatory markers of patients receiving multivitamins or placebo. The sample comprised women who reported elevated psychological distress in the previous 4 weeks. MAIN OUTCOME MEASURES: Psychological state was assessed using Spielberger's State-Trait Personality Inventory to assess anxiety, curiosity, depression and anger. Pro-inflammatory markers comprised interleukin (IL)-1ß, IL-5, IL-6, tumour necrosis factor (TNF)-α and TNF-ß. RESULTS: Improvements across time were observed for all psychological measures and cytokines, except IL-5, but were independent of the active intervention. Only TNF-ß demonstrated a significant differential change between groups over the course of the intervention, in favour of multivitamin supplementation (active group mean rank decreased from 11.1 to 7.1; placebo group mean rank decreased from 8.9 to 7.8). CONCLUSION: The results suggest that administration of multivitamins was not effective in improving psychological state. However, some evidence supported the positive impact of multivitamin supplementation on pro-inflammatory cytokine profiles of women currently experiencing stress.

The consumer-driven development and acceptability testing of a website designed to connect rural cancer patients and their families, carers and health professionals with appropriate information and psychosocial support.

Websites offer new opportunities to provide health-related information to rural communities. However, how acceptable they are to this population is unknown. This paper describes the consumer-led development of a website that provides rural-specific information on psychosocial care for rural South Australians affected by cancer, and examines its acceptability to users. The Country Cancer Support website was developed with people affected by cancer living in rural South Australia (N = 11), using a Participatory Action Research Framework and evidence-based behaviour change strategies. There were 32,389 visits in the first 3 years. An online survey (N = 111) revealed that users found the website easy to use, helpful and relevant. Most rural cancer patients and supporters (98.11%) believed it had been written by people who understood what they were going through. Patients and supporters for whom it was relevant, reported feeling more motivated and confident in accessing psychosocial support services in their rural area (66.67%) and/or capital city (67.65%) and/or in travelling for medical treatment (75.86%). Many also felt less isolated (73.33%) and/or distressed (53.57%). All health professionals reported gaining new knowledge. This study shows that carefully designed websites can successfully address rural populations' health information needs and increase intentions to access psychosocial support.

Panic disorder and incident coronary heart disease: a systematic review and meta-regression in 1131612 persons and 58111 cardiac events.

BACKGROUND: Substantial healthcare resources are devoted to panic disorder (PD) and coronary heart disease (CHD); however, the association between these conditions remains controversial. Our objective was to conduct a systematic review of studies assessing the association between PD, related syndromes, and incident CHD. METHOD: Relevant studies were retrieved from Medline, EMBASE, SCOPUS and PsycINFO without restrictions from inception to January 2015 supplemented with hand-searching. We included studies that reported hazard ratios (HR) or sufficient data to calculate the risk ratio and 95% confidence interval (CI) which were pooled using a random-effects model. Studies utilizing self-reported CHD were ineligible. Twelve studies were included comprising 1 131 612 persons and 58 111 incident CHD cases. RESULTS: PD was associated with the primary incident CHD endpoint [adjusted HR (aHR) 1.47, 95% CI 1.24-1.74, p < 0.00001] even after excluding angina (aHR 1.49, 95% CI 1.22-1.81, p < 0.00001). High to moderate quality evidence suggested an association with incident major adverse cardiac events (MACE; aHR 1.40, 95% CI 1.16-1.69, p = 0.0004) and myocardial infarction (aHR 1.36, 95% CI 1.12-1.66, p = 0.002). The risk for CHD was significant after excluding depression (aHR 1.64, 95% CI 1.45-1.85) and after depression adjustment (aHR 1.38, 95% CI 1.03-1.87). Age, sex, length of follow-up, socioeconomic status and diabetes were sources of heterogeneity in the primary endpoint. CONCLUSIONS: Meta-analysis showed that PD was independently associated with incident CHD, myocardial infarction and MACE; however, reverse causality cannot be ruled out and there was evidence of heterogeneity.

Overweight and obese women's perceptions about making healthy change during pregnancy: a mixed method study.

Overweight and obesity during pregnancy is associated with risk of a range of adverse health outcomes. While intervention studies aim to promote behavioral change, little is known about the underlying psychological mechanisms facilitating and hindering change. The aim of this study was to evaluate overweight and obese women's perceptions of making behavior change during pregnancy. We explored beliefs through self-administrated questionnaires (n = 464) and semi-structured face-to-face interviews (n = 26). Questions were designed according to the Health Belief Model. A triangulation protocol was followed to combine quantitative and qualitative data. A total of 269 women (58 %) indicated that high gestational weight gain is a concern, with 348 (75 %) indicating excessive weight gain is associated with complications during pregnancy or child birth. Women were aware of maternal complications associated with high gestational weight gain, but had more limited awareness of neonatal complications. While most women indicated in questionnaires that healthy eating and physical activity were associated with improved health during pregnancy, they were unable to identify specific benefits at interview. Barriers to making healthy behavior changes were highly individualized, the main barrier being lack of time. While the majority (91 %) of women indicated that they would make behavior changes if the change made them feel better, only half felt confident in their ability to do so. Interventions for overweight and obese pregnant women should incorporate education about neonatal health consequences and benefits of healthy behavior change in addition to incorporating strategies to enhance self-efficacy.

Adjustment to infertility: the role of intrapersonal and interpersonal resources/vulnerabilities.

BACKGROUND: Great variability exists in the degree of adjustment to infertility, which in turn is known to influence wellbeing. The main objective of this study is to identify intrapersonal [neuroticism, adult attachment style (AAS), perceived internal control, meaning of parenthood and intrinsic religiosity] and interpersonal (social support and marital adjustment) associates of adjustment to infertility. METHOD: A cross-sectional analysis of 85 consecutive heterosexual women, attending three infertility clinics in northern India during July 2005-March 2006, participated in the study. A range of scales were used to measure the intrapersonal and interpersonal attributes. The degree of adjustment to infertility was assessed using the Fertility Adjustment Scale. The data were analysed using multiple regression. RESULTS: The intrapersonal model (49.3%) explained a larger proportion of variance than did the interpersonal model (28.4%). Perception of children as necessary for marital completion, and the avoidance type of AAS was associated with poorer adjustment and constituted intrapersonal vulnerabilities. In contrast, intrinsic religiosity, sexual satisfaction and familial support were associated with better adjustment and were identified as helpful intrapersonal and interpersonal coping resources. CONCLUSIONS: The findings of the study highlight the merit of understanding intra- and interpersonal attributes for achieving better wellbeing outcomes. These findings would also prove valuable for researchers and practioners involved in designing and implementing psychosocial interventions.

The effect of functional gastrointestinal disorders on psychological comorbidity and quality of life in patients with inflammatory bowel disease.

BACKGROUND: Symptoms of functional gastrointestinal disorders (FGIDs) are common in patients with inflammatory bowel disease (IBD). Psychological comorbidities of anxiety and depression are also highly prevalent in IBD. AIM: To quantify the burden of FGIDs in a hospital-based cohort of patients with IBD and to determine whether there is any inter-relationship between the presence and number of FGIDs and patients' quality of life or psychological status. METHODS: A cross-sectional survey of 61 out-patients was performed. Data on psychological status, quality of life, disease activity and functional symptoms according to Rome III criteria were collected. RESULTS: Overall, 49 (80%) participants met Rome III criteria for a functional bowel disorder and 52% of participants met criteria for more than one FGID. Participants with no FGID had significantly better physical quality of life than those with more than two FGIDs (P = 0.025). However, there was no relationship among the number of FGIDs, mental quality of life, anxiety or depression. CONCLUSIONS: Functional gastrointestinal disorders are highly prevalent in out-patients with IBD. Somewhat unexpectedly, the presence of anxiety and/or depression did not appear to correlate with either the presence or the number of FGIDs.

Attitudes and experiences of restaurateurs regarding smoking bans in Adelaide, South Australia.

OBJECTIVES: To determine compliance with a voluntary code of practice (VCP) for restricting smoking in restaurants and to canvass the attitudes of restaurateurs towards tougher smoking restrictions. DESIGN: Cross-sectional survey conducted in 1996 using a telephone questionnaire. SETTING: Metropolitan restaurants and cafes in Adelaide, South Australia. PARTICIPANTS: 276 (86.8%) of a sample of randomly selected owners and managers. MAIN OUTCOME MEASURES: Restaurant non-smoking policies, reported and anticipated change in business, and restaurateurs' attitudes towards smoking restrictions. RESULTS: 26.8% of restaurants had a total smoking ban; 40.6% restricted smoking some other way; and 32.6% permitted unrestricted smoking. Only 15.1% of restaurants with a ban or restrictions had used the VCP to guide the development of their policy, and only half of these were complying with it. Although 78.4% of those with bans and 84.4% of those with restrictions reported that their non-smoking policy had been associated with either no change or a gain in business, only 33.3% of those allowing unrestricted smoking expected that this would be the case, if they were to limit smoking. A total of 50.4% of restaurateurs, including 45.3% of those with no restrictions, agreed that the government should ban smoking in all restaurants. CONCLUSIONS: The VCP made an insignificant contribution to adoption of non-smoking policies, and compliance with the code was poor. Despite concerns about loss of business, there was considerable support for legislation which would ban smoking in all dining establishments.

Women's role and satisfaction in the decision to have a caesarean section.

OBJECTIVE: To examine women's role in the decision to perform caesarean section (CS). DESIGN: Cross-sectional survey. Written questionnaires were completed seven weeks after giving birth by CS. SETTING: An obstetric tertiary referral hospital (Women's and Children's Hospital, Adelaide, South Australia), July to December 1996. PARTICIPANTS: A consecutive sample of women who underwent CS over a six-month period. To be eligible, women had to be at least 18 years old, able to complete a questionnaire in English and well enough to consent to study participation. MAIN OUTCOME MEASURES: Women's involvement in decision making, stated preference for CS, and satisfaction with obstetric care. RESULTS: 278 women (76.4%) returned questionnaires: 171 women (61.5%; 95% confidence interval [CI], 55.8%-67.2%) reported being involved in the decision to have a CS. Factors influencing their decision were physical duress and partner's reaction during labour (emergency CS), considerations about recovery, planning for the event and pain (elective CS), and information from the doctor (both groups). Half the women "strongly agreed" that they were satisfied with the decision to have a CS, but 40.9% only "agreed" and 4.7% were "not sure". About 20% reported they needed more information on other options, and only 28.8% "strongly agreed" that they had been given good information to prepare for the possibility of CS. 27.9% of women (95% CI, 22.5%-33.2%) "agreed" or "strongly agreed" that they had "insisted on a CS" and 21.3% (95% CI, 16.4%-26.2%) that they had told the staff they were "keen to have a CS". Given the option of a vaginal delivery, 37.8% of women (95% CI, 22.5%-55.2%) with a breech presentation, and 34% of women (95% CI, 21.2%-48.8%) who had had a previous CS, chose a CS. CONCLUSIONS: It is of concern that over a third of women felt they had not been involved in the decision to have a CS; others were very positive about CS, but an appreciable proportion may not have received sufficient information. A broad-based strategy of providing more information to women and their partners could be one way of ensuring appropriate CS rates and should be tested in a randomised controlled trial.

The impact of airport de-icing on a river: the case of the Ouseburn, Newcastle upon Tyne.

The damaging effects of airport de-icers to adjacent waterways have been suggested by a number of studies, but none have been able to demonstrate these effects in a field situation. The Ouseburn is a part-urban and partrural catchment of varied land-use and includes a tributary which drains the Newcastle International Airport. The tributary contributes only 3-5% of the river's average flow, yet it had a disproportionately adverse impact upon the river. This paper demonstrates how this was linked to the airport's winter application of urea salt de-icers. An integrated approach involving hydrological, chemical, bacteriological and macroinvertebrate sampling was used. During cold weather, higher levels of ammonia were recorded in the tributary and downstream, and concentrations peaked during runoff events. It is suggested that hydrolysis, facilitated by urea digesting bacteria, and surface runoff is the mechanism by which ammonia enters the stream. The airport tributary had a less diverse macroinvertebrate fauna than expected and had larger numbers of bacteria which were able to utilise urea. In-situ bioassay experiments found large deaths of Gammarus pulex (L.) and low biotic indices at a site downstream of the airport tributary confluence. Together with elevated ammonia levels this suggested that urea application adversely impacted on the main stream's water quality and ecology. The airport authorities have responded by changing to a less toxic de-icer.

Evaluation of the New South Wales Cancer Council Pap Test Reminder Service.

This study aimed to assess the effect of reminder letters on Pap test rates for women enrolled on the New South Wales Cancer Council Pap Test Reminder Service and to identify predictors of response to the letter. Ten weeks after they had received their reminder letter a questionnaire was sent to 3086 women. It was completed by 1525 (49 per cent) women, of whom 1393 (91 per cent) said they had received their reminder letter. Of these 1393, 48 per cent (95 per cent confidence interval 46 per cent to 51 per cent) reported having a Pap test within 10 weeks of the reminder letter arriving. The proportion of women having a Pap test in response to the reminder letter did not differ by age, region of residence or language spoken at home. Women were less likely to have had a Pap test if they did not know how they were enrolled, were of low socioeconomic status or had some tertiary education. Women on the reminder service have 15-month rescreening rates at least 9 per cent higher than other women in New South Wales; for women aged 50 to 69 in nonmetropolitan areas the increase is estimated at 19 per cent. Reminder services may be a cost-effective way to increase Pap test rescreening rates. Reminder services need accurate records and to follow up changes in address and date of next test.