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)-1β, IL-5, IL-6, tumour necrosis factor (TNF)-α and TNF-β.

RESULTS

Improvements across time were observed for all psychological measures and cytokines, except IL-5, but were independent of the active intervention. Only TNF-β 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.

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.

Site-Selective Photoluminescence Excitation and Photoluminescence Spectroscopy of Er-Implanted Wurtzite GaN

Site-selective photoluminescence (PL) and photoluminescence excitation (PLE) spectroscopy have been carried out at 6K on the ∼1540 nm 4I15/2 → 4I15/2 emissions of Er3+ in Er-implanted GaN. The PLE spectra exhibit several broad, below-gap, defect- or impurity-related absorption bands which excite three distinct site-selective Er + PL spectra. The near-band edge spectral position and lineshape of the PLE spectrum of one of the site-selective PL bands suggest that this Er site forms a trap level within the band gap and an exciton bound at this trap is involved in the excitation mechanism. In addition, high resolution PLE spectra obtained with a tunable laser in the 810 nm spectral range reveal a set of sharp PLE peaks due to the 4I15/2 → 4I9/2 internal Er+ ƒ-band absorption superimposed on the broad defect PLE band. The site-selective PL spectrum excited by the sharp line ∼810 nm Er+ intra-ƒ shell PLE bands is characteristic of a fourth distinct Er+ site. The simple structure of the site-selective PL and PLE spectra associated with direct intra-ƒ shell absorption suggests that the optically active Er site responsible for these spectra is of high symmetry in wurtzite GaN and that it could be attributed to a single Er atom on a Ga site.

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.

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.

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.

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.