The role of educational attainment and brain morphology in major depressive disorder: Findings from the ENIGMA major depressive disorder consortium

Brain structural abnormalities and low educational attainment are consistently associated with major depressive disorder (MDD), yet there has been little research investigating the complex interaction of these factors. Brain structural alterations may represent a vulnerability or differential susceptibility marker, and in the context of low educational attainment, predict MDD. We tested this moderation model in a large multisite sample of 1958 adults with MDD and 2921 controls (aged 18 to 86) from the ENIGMA MDD working group. Using generalized linear mixed models and within-sample split-half replication, we tested whether brain structure interacted with educational attainment to predict MDD status. Analyses revealed that cortical thickness in a number of occipital, parietal, and frontal regions significantly interacted with education to predict MDD. For the majority of regions, models suggested a differential susceptibility effect, whereby thicker cortex was more likely to predict MDD in individuals with low educational attainment, but less likely to predict MDD in individuals with high educational attainment. Findings suggest that greater thickness of brain regions subserving visuomotor and social-cognitive functions confers susceptibility to MDD, dependent on level of educational attainment. Longitudinal work, however, is ultimately needed to establish whether cortical thickness represents a preexisting susceptibility marker. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Urinary uric acid excretion as an indicator of severe hypoxia and mortality in patients with obstructive sleep apnea and chronic obstructive pulmonary disease

OBJECTIVE

Uric acid (UA) is the end product of adenosine triphosphate degradation, and could increase due to hypoxia. We investigated the association of UA metabolites with nocturnal hypoxemia, apnea-hypopnea index (AHI), noninvasive mechanical ventilation (NIMV) usage and five-year mortality.

MATERIALS/SUBJECTS AND METHODS

We obtained urinary specimen before and after the night polysomnography in order to measure UA excretion and overnight change in urinary UA/creatinine ratio (ΔUA/Cr) in 75 subjects (14 controls, 15 chronic obstructive pulmonary disease (COPD) without nocturnal hypoxemia (NH), 15 COPD with NH, 16 obstructive sleep apnea syndrome (OSAS) without NH, 15 OSAS with NH). Percentage of time spent below SaO2 of 90% (T90%) for >10% of sleep time was considered as nocturnal hypoxemia. Patients were contacted after 5 years with a questionnaire including information on the use of NIMV treatment (n: 58) and urinary specimen analysis (n: 35).

RESULTS

T90% was found to be significantly correlated with UA excretion (coefficient: 0.005, 95%CI: 0.003-0.007) and ΔUA/Cr (coefficient: 0.8, 95%CI: 0.3-1.2) after adjustments for age, gender, body mass index and apnea-hypopnea index. Median and IQR (interquartile range) of baseline UA excretion were 0.79 (0.51-0.89) and 0.41 (0.31-0.55) in 10 deceased and 58 surviving patients, respectively (p=0.001). UA excretion median and IQR of baseline and 5 years of NIMV treatment were 0.41 (0.36-0.57) and 0.29 (0.23-0.37), respectively (p=0.01).

CONCLUSION

UA excretion, as a marker of tissue hypoxia, may be useful in the management of OSA and COPD patients.

Are chronic urticaria, analgesic intolerance and seasonal rhinitis markers of different severities and phenotypes of the asthma they accompany?

BACKGROUND

Asthma is a heterogeneous disease that presents with different clinical phenotypes. We aimed to compare the patients with asthma diagnosis alone with the patients, who, in addition to their asthma had accompanying analgesic intolerance (AI), chronic urticaria (CU) or seasonal rhinitis (SR) if there are any distinctions and specific characteristics of these defined patient groups.

METHODS

Eighty-four asthma patients diagnosed with SR, 46 with CU, 75 with AI and 71 patients with asthma alone were enrolled to the study retrospectively. The reference group for the comparisons was the group with asthma diagnosis alone.

RESULTS

The mean age of all patients was 37.2±13 (15-80) and 70.7% of them were females. Asthma patients with SR had a significantly earlier onset of asthma (age: 27.4±10.8 and 34.5±15.9; respectively, p<0.01), significantly better pulmonary function tests and were significantly more atopic (92.9% and 28.8%; p<0.001). Moderate-to-severe asthma significantly correlated with older age at the time of diagnosis, older age of asthma onset, higher body mass index, less atopy and fewer pollen sensitivity. Asthma severity of patients with SR was significantly milder than the reference group (OR: 0.6, 95% CI 0.5-0.8). Asthma with AI tended to be more severe although the relation was insignificant (OR:1.6 95% CI:0.8-3.5).

CONCLUSIONS

Asthma patients with SR have significantly milder and earlier onset of asthma, better pulmonary function tests and are significantly more atopic while asthma with AI tends to be more severe. Asthma with CU does not show a specific phenotypic characteristic.

Allergy symptoms and IgE immune response to rose: an occupational and an environmental disease

BACKGROUND

Turkey is one of the four major producers of rose. Cultivation of rose is the main economic activity of many villagers in the Lakes region. Rose allergy has not been reported before. We investigated the prevalence of allergy symptoms and specific-IgE immune response due to rose in villagers who had been cultivating rose in Güneykent village in the Lakes region.

METHODS

A screening questionnaire including respiratory and allergic symptoms was administered to 290 villagers. The investigation team visited and studied 75 randomly selected villagers with an interviewer-administered questionnaire, pulmonary function testing, skin prick testing and serum total IgE. Specific IgE against Rosa rugosa was measured in 41 villagers.

RESULTS

Villagers reported asthma/allergy symptoms outside the rose season (17.6%), during the rose season (6.2%), and both during the rose season and outside the rose season (whole the year) (17.6%). Atopy and specific IgE against Rosa rugosa were detected in 12 (19%), and 8 (19.5%) of the villagers tested. Villagers who had symptoms whole the year reported wheeze more frequently than those who reported symptoms only outside the rose season (41.2% vs 11.1%).

CONCLUSIONS

IgE-mediated allergy could occur due to rose and/or its pollen. Symptoms mainly affect the upper airways. Further studies in the rose handlers, florists and workers of the rose industry would help elucidate the occurrence of rose allergy.

Asthma and allergy in Turkish university students: Two cross-sectional surveys 5 years apart

BACKGROUND

prevalence of asthma and allergic diseases is increasing worldwide. We investigated the first-year university students to a) determine prevalence of asthma, and allergic diseases, b) compare prevalence with a similar study conducted in 1994, and c) investigate determinants of asthma, current wheeze and seasonal rhinitis.

METHODS

an ECRHS based questionnaire was distributed to 5,406 students and completed by 4,639 (response: 85.3 %) in september 1999. Information from the students residing in Turkey was used in the analyses (1,800 boys, 2,712 girls).

RESULTS

prevalence % of asthma (symptom and/or medicine), current wheeze and seasonal rhinitis were 2.1, 6.9 and 12.7 in boys, and 2.5, 7.2 and 14.5 in girls. Current smoking, pet ownership and family atopy was reported more frecuently in 1999 than 1994. Cough and seasonal rhinitis increased almost twofold. Asthma diagnosis and attack rate was similar in 1999 and 1994. Family atopy, pet in childhood, smoking and passive smoking in childhood increased the risk of asthma, and current wheeze. Family atopy, passive smoking and current pet ownership increased the risk of seasonal rhinitis.

CONCLUSION

increased rate of smoking and pet ownership could contribute to the increased prevalence of asthma and allergic diseases in the last 5 years.

From analgesic intolerance to analgesic induced asthma: are there some determinants?

BACKGROUND

Analgesic intolerance (AI) sometimes appear alone and sometimes with bronchial asthma affecting about 10% of asthmatics and sometimes before and the other times after asthma.

OBJECTIVE

We investigated the possible clinical risk factors which might be affecting the transition from isolated AI to analgesic induced asthma (AIA).

METHODS

A total of 344 patients admitted to Hacettepe University Hospital Adult Allergy Unit between January 1991 and March 1999 and diagnosed with AI were enrolled in this survey. Patients having AIA (group I) (n = 191) were compared with the patients having AI without asthma (group II) (n = 153). The diagnosis of AI and AIA were made by history and oral provocation tests. A standard questionnaire was filled-in for all the patients.

RESULTS

The risk of AIA was increased with nasal polyp, and rhinosinusitis via OR's of 2.75 (95% CI: 1.09, 6.91), and 18.58 (95% CI: 9.86, 35.01), respectively. Having a pet, and ever smoking decreased the risk of AIA in the patients with AI via OR's of 0.53 (95% CI: 0.24, 1.17), and 0.37 (95% CI: 0.17, 0.80), respectively. The association of AIA and smoking was slightly modified by food intolerance (OR for ever smoked and food intolerance: 1.31, 95% CI: 0.40, 4.30).

CONCLUSION

There may be two different phenotypes of AI with different clinical features: one developing AIA (having nasal polyp and/or rhinosinusitis, and smoking if food allergy/intolerance is present), and the other AI without asthma (having pet, and could smoke). Findings of this study should be confirmed by further investigations.

Urban CO exposure and its health effects on traffic policemen in Ankara

Carbon monoxide (CO) is an important component of air pollution caused by traffic exhaust fumes. CO can cause chronic poisoning which shows its first symptoms as headaches, blurry vision, difficulty in concentration, and confusion. With the increasing number of vehicles in metropolitan areas of Turkey, the CO level has also increased in the city air as is the case in the capital city of Ankara, especially at certain locations. As far as the effects of CO on humans are concerned, traffic policemen are the population group under risk due to their inhalation of CO-rich air while on duty at the crowded cross-sections of the city. The traffic policemen on duty at these cross-sections are exposed to these high levels of CO for at least 6 h. This study was performed to investigate the traffic policemen (traffic organizers) who are exposed to high concentrations of CO at crowded cross-sections of Ankara City and to find out if chronic CO intoxication exits among this risk group. The CO levels in the ambient air at these cross-sections have also been compared to, and correlated with measurements of CO in the expired air of the target population. Additional factors like smoking, general health status, type of heating systems used at home, etc., have been taken into consideration by evaluating special questionnaires filled out by the policemen. A control group of clerk policemen, who were not engaged in street traffic activities was formed for comparative purposes.

Prevalence of asthma and allergic diseases in primary school children in Ankara, Turkey: two cross-sectional studies, five years apart

The prevalence of allergic diseases is reported to have increased worldwide. Two questionnaire surveys, five years apart, were conducted to evaluate the trend of prevalence rates and possible risk factors among primary school children in Ankara, Turkey. A previous survey in 1992 revealed the lifetime prevalences of asthma, wheezing, allergic rhinitis and atopic dermatitis were 17.4%, 23.3%, 28% and 6.1%, and the prevalences for the last 12 months were 8.3%, 11.9%, 15.4% and 4%, respectively. The survey was repeated with the same questionnaire in the same age group (6-13 years) of the same school in May 1997. The parents of 358 boys and 380 girls completed the questionnaire. The lifetime and last 12 months' prevalences of asthma, wheezing, rhinitis and atopic dermatitis were 16.8%, 22.5%, 18.7%, 6.5%, and 9.8%, 13.3%, 14.1%, 4.3%, respectively. There was a significant change only for the lifetime prevalence of rhinitis (p < 0.001). The rate of indoor smoking had declined from 73.9% to 64%, and pet ownership had risen from 7.9% to 22.9% (p < 0.001 for both). Atopic family history was the most prominent risk factor for all types of allergic disorders. Male gender was a significant risk factor for current asthma and wheezing [odds ratio (OR) = 1.80 and 1.59; 95% confidence intervals (CI) = 1.09-2.98 and 1.01-2.48, respectively], and passive smoking affected the occurrence of allergic rhinitis (OR = 1.84; CI = 1.13-3.00). The prevalence rates of allergic diseases among primary school children in Ankara stabilized during a 5-year period for all diseases other than allergic rhinitis. However, there are changing behavior patterns, i.e. indoor smoking and keeping pet animals, which that may have affected these rates.

Bee and wasp venom allergy in Turkey

BACKGROUND

Beekeeping has progressed recently to where bee sting exposure is an important public health problem in Turkey.

OBJECTIVE

To investigate the status of bee and wasp sting allergy in a region of Turkey.

METHODS

We conducted a questionnaire-based study of 786 subjects (cellulose paper factory personnel and family members older than 16 years of age) in Cay town of Afyon. Skin prick test with common aeroallergens and measurements of total IgE and specific IgE for bee and wasp venom were performed in 212 randomly selected subjects.

RESULTS

Cumulative lifetime sting rate was 94.5% (geometric mean: 6.1 times), and last year bee sting rate was 20.4% (geometric mean: 1.6 times). Subjects who had beehives had higher risk of bee sting (P < .05) in the last year, whereas there was no significant difference among the groups for the cumulative lifetime sting exposure. Severe and mild systemic reactions were noted in 2.2% and 5.3%, respectively. Emergency room visits were reported in 9.3%, and familial Hymenoptera allergy in 10.2%. Fatal potential of bee sting was known by 81%. There was no mortality related with Hymenoptera allergy in records of the last 5 years. In 24 subjects with multiple sting exposures, allergic reactions changed severity in the latter exposures, which became less severe in five and more severe in 19 subjects. Atopy rate detected by prick testing was 20.3%. Specific IgE levels were class 1 in 22, class 2 in 11, and class 3 in 2 subjects for bee; and class 1 in 24 and class 2 in 2 subjects for wasp. Nobody had received immunotherapy for venom allergy. None of the factors including atopy, sex, occupation, smoking and family history of bee sting was significantly related with severity of the systemic reaction (P > .05).

CONCLUSIONS

Bee and wasp stings are prevalent in Turkey. Severe systemic reactions complicating the sting are frequent (2.2%). Public awareness of potential fatality and treatment of the allergic reaction is not adequate.

Prevalence of asthma and allergic diseases in Turkish university students in Ankara

An epidemiological study was performed in the students of Hacettepe University from various parts of Turkey to find the prevalence of asthma and allergic diseases and search for geographical differences in Turkey. A questionnaire related with symptoms of asthma and allergic diseases was distributed to 4600 students and filled by 4331 students (1884 males, 43.5%-2447 females, 56.5%). Periodic prevalence of asthma or allergic disease during the last 12 months was 13.5%. The prevalence of awakening with chest tightness and/or feeling of retrosternal pressure in the last month was 2%. The current prevalences of the seasonal and perennial rhinoconjunctivitis, flexural eczema, food and drug intolerances, pollen and pet animal hypersensitivities were 6.4%, 1.6%, 0.8%, 4.5%, 3%, 5.2%, and 1% respectively. Drug, food, and pollen hypersensitivities were distinctively more common in the females, whereas wheezing was more common in males. Wheezing, wheezing associated shortness of breath, nocturnal asthma for the last 1 and 12 months were more common in the students from eastern region than those from western region. The highest asthmatic attack rate was reported in the eastern region. Seasonal rhinitis and pollen allergy were more prevalent in central region than northern region. No significant geographical difference was observed regarding the drug and pet hypersensitivities. Our study has shown the importance of asthma and allergic diseases as a public health problem. Explanation of the observed geographical differences aware for further studies.

An epidemiological study in an Anatolian village in Turkey environmentally exposed to tremolite asbestos

After several cases of malignant pleural mesothelioma (MPM) were detected in the village of Kureyşler in the Kütahya district of western Turkey, an epidemiological study was conducted. A questionnaire was completed by 124 villagers who were older than 20 years and standard posteroanterior chest X-rays were taken. The films were evaluated by three chest physicians. Samples of the white stucco that had been used by almost all villagers for indoor painting for many years were mineralogically examined. Chest X-rays showed that 23 (18%) had pleural plaques and calcifications compatible with asbestos exposure. Male sex and old age were associated with occurrence of pleural plaques. An analysis of white stucco samples revealed tremolite asbestos. In conclusion, tremolite fibers might be the cause of the high incidence of pleural plaques and MPM cases in the village of Kureyşler.

Environmental fibrous zeolite (erionite) exposure and malignant tumors other than mesothelioma

We studied the mortality in three villages in the Cappadocian region of Central Anatolia, Karain, Tuzköy, and Sarihidir, which were exposed to fibrous zeolite (erionite), a known carcinogen more potent than the amphibole asbestos. Between 1970 and 1994, there were 305 deaths in Karain, and 177 (58%) were cancer related, including 150 (49.2%) malignant pleural mesothelioma, seven (2.3%) malignant peritoneal mesothelioma, and six (1%) gastroesophageal carcinoma. Four deaths (1.3%) from lung cancer included two nonsmoking females. There were three cases (1%) of leukemia and six of other malignancies (1.9%). Between 1980 and 1994, there were 519 deaths in Tuzköy (T) and Sarihidir (S) (T = 432, S = 87). Of these, 257 were cancer related, and included 120 cases of malignant pleural mesothelioma and 64 cases of malignant peritoneal mesothelioma. Intraabdominal carcinoma was noted in 29 patients and 14 patients had lung cancer (four of whom were nonsmoking women). There were five cases of gastroesophageal cancer, five deaths due to leukemia, and 16 cases of various malignancies. These mortality figures support the hypothesis that erionite fibers cause cancer other than mesothelioma and lung cancer. Mineralogic analyses of the tissues should be performed to demonstrate this relationship.

Birch pollen related food hypersensitivity: as a para-occupational syndrome

Two patients presented with allergy to birch pollen and hypersensitivity to hazelnut and apple. Since both of these patients developed pollen sensitivity when they were abroad for occupational purpose, we want to mention this situation as "a para-occupational syndrome".