September 30, 2009 (EurekAlert) - Less than half of men and women in Ontario who may be suffering from depression see a doctor to treat their potentially debilitating condition, according to a new women's health study by researchers at St. Michael's Hospital and the Institute for Clinical Evaluative Sciences (ICES). What's more, many hospitalized for severe depression fail to see a doctor for follow-up care within 30 days of being discharged, and many head to hospital emergency departments for care. The findings suggest the need for a comprehensive care model involving a multidisciplinary team of health-care professionals, including family doctors and mental health specialists, to help women and men and better manage depression and improve their quality of life."As a leading cause of disease-related disability among women and men, depression puts a tremendous emotional and financial burden on people, their families and our health-care system," says Dr. Arlene Bierman, a physician at St. Michael's Hospital and principal investigator of the study Project for an Ontario Women's Health Evidence-Based Report (POWER). "Many Ontarians with depression are not treated for their condition and those who are often receive less than desired care. While there is a lot that is known about how to improve depression, we need to apply this to our work with patients if we want to improve the diagnosis and management of depression. "This involves better co-ordination among primary care and mental health-care professionals in both community and hospital settings," added Dr. Bierman, a researcher at ICES.

Nearly half a million Ontarians, aged 15 and older, suffer from depression. Worldwide, an estimated 154 million people are afflicted by the condition, which is responsible for lost productivity, increased disability claims and greater use of health-care services.

Key findings of the POWER study released today include:

• Less than 50% of men and women with depression visited a doctor for care for their condition
• 33% of men and women discharged from hospital for severe depression did not see a doctor for a follow-up visit within 30 days
• 17% visited a hospital emergency room within 30 days of discharge from hospital while about 8% were readmitted to hospital
• Many older adults started on antidepressant medication did not receive the recommended number of follow-up visits to manage their condition.

The lack of co-ordinated care for patients suggests the need for a collaborative care-model involving a team of health-care professionals, including mental health professionals and primary care providers.

"Research shows that patients cared for using a collaborative model are more likely to see improvement in symptoms, are able to better manage their depression and avoid multiple visits for emergency care," said Dr. Elizabeth Lin, lead author of the chapter and a research scientist at the Centre for Addiction and Mental Health (CAMH). A study by CAMH released earlier this year also found collaborative care to be a less costly and more effective way of providing mental health treatments for people on short-term disability leave for a psychiatric disorder.

September 29, 2009 (EurekAlert) - A study by Monash University researchers has shed new light on the microscopic antennas in the kidney that are involved in the organ's repair process.
The work may be a crucial step towards a cure for polycystic kidney disease, a potentially fatal disease that affects more than one in 1000 people.

The study, led by Dr James Deane a researcher at the Centre for Inflammatory Disease at the Monash Medical Centre, showed how kidney repair processes are controlled and helps explain the cause of polycystic kidney disease.

The findings have appeared in the latest edition of world's leading kidney research publication, the Journal of the American Society of Nephrology.

"We have shown for the first time that the hair-like structures on kidney cells, called cilia, change their length in response to injury in human patients, growing up to four times their original length in the later stages of kidney repair," Dr Deane said.

"These hair-like structures are antennas and the increases in their length amplify the signals they send to kidney cells at vital stages of repair. We think this is how they turn off the repair process when it is complete and allow the kidney to start working normally again"

Dr Deane said that if the switching on and off the repair process is not properly controlled, rapidly reproducing cells will distort the tubes of the kidney and prevent them from functioning properly, which is what appears to happen in people that have polycystic kidney disease, a condition which is currently untreatable.

"Our research helps put a logical framework behind what is happening in polycystic kidney disease, as the mutations that cause the disease can damage the hair-like structures of kidneys cells," Dr Deane said.

"We hope that this work will lead to new ways of treating both kidney injury and polycystic kidney disease."

The kidney is made up of about a million tiny living tubes that produce urine to rid the body of waste products. The cells that make up these tubes have hair-like structures, which are two thousandths of a millimetre long and respond to urine flow by sending reassuring signals back to the cells.

In an injured kidney there is a reduction in urine flow and reassuring signals from the hair-like structures are diminished. This causes kidney cells go into repair mode. Surviving kidney cells take on a new form that allows them to reproduce rapidly to replace cells that have died. When enough cells have been produced it is important that kidney cells stop reproducing and return to their normal form. This is where some extra input from the hair-like structures appears to be required.

August 4, 2009 (Newswise) - Feelings of depression could be one reason patients fail to follow their doctors' orders on exercising and eventually become less physically active, a new research review finds.Although past research shows that exercise improves chronic health conditions, such as heart disease and diabetes, it also shows that patients with these conditions often suffer from depression.

The new analysis evaluated 11 studies comprising some 20,000 patients. Eight studies reported that having symptoms of depression after a coronary event, such as heart attack, was a significant risk factor for developing a sedentary lifestyle or a poor adherence to an exercise regimen recommended by the patients' doctor.

The review appears in the July/August issue of the journal General Hospital Psychiatry.

One study, for example, investigated the role of depression and anxiety in 224 heart attack survivors, at three months and 12 months after their hospitalization. Of those with anxiety and depression during hospitalization, 59 percent had a significant decrease in exercise after three months, compared with 31 percent of those who were not depressed. A year later the gap widened, with 51 percent of depressed patients exercising less compared with 26 percent of non-depressed patients.

The studies used different methods to measure depression and physical activity and there was a great difference in how they compared factors such as the patients' health, physical activity and depression.

There are many suggested theories to explain why depression leads to a decline in activity. Babak Roshanaei-Moghaddam, M.D. of the department of psychiatry and behavioral sciences at University of Washington in Seattle and lead author of the study offered one theory.

"We have hypothesized that there are both behavioral habits associated with depression, such as smoking and obesity, which may then limit exercise motivation and enjoyment, as well as biologic factors that can cause obesity and decrease energy level, exercise tolerance and pain threshold," he said.

Evette Joy Ludman, Ph.D., of Seattle-based Group Health Cooperative, who had no affiliation with the study, agreed.

"Depression can indeed make people have less motivation and energy to exercise," Ludman said. "The sad part about this is that physical activity is not only important for preventing and managing many chronic conditions; it can be very helpful for improving mood and other symptoms of depression."

August 3, 2009 (Newswise) - Short sleep times, experienced by many individuals in Westernized societies, may contribute to the development of insulin resistance and reduced glucose tolerance, which in turn may increase the long-term risk of diabetes, according to a new study accepted for publication in The Endocrine Society's Journal of Clinical Endocrinology & Metabolism (JCEM).Sleep curtailment is an increasingly common aspect of the Western lifestyle, which is characterized by physical inactivity and overeating. Today, many Americans sleep fewer than six hours each night and individuals who report such short sleep times have in previous studies demonstrated an increased risk of developing diabetes. This new study examined whether reduced sleep duration itself may increase the risk of developing diabetes when combined with physical inactivity and overeating.

Researchers in this study subjected a group of healthy middle-aged men and women to two controlled 14-day periods of sedentary living with free access to food and 5.5 or 8.5 hour bedtimes. When the subjects had their bedtimes decreased from 8.5 hours to 5.5 hours they showed changes in their response to two common sugar tests, which were similar to those seen in people with an increased risk of developing diabetes.

"Our findings raise the possibility that when the unhealthy aspects of the Westernized lifestyle are combined with reduced sleep duration, this might contribute to the increased risk of many overweight and sedentary individuals developing diabetes," said Plamen Penev, MD, PhD, of the University of Chicago and a senior author of the study. "If confirmed by future larger studies, these results would indicate that a healthy lifestyle should include not only healthy eating habits and adequate amounts of physical activity, but also obtaining a sufficient amount of sleep."

Since the conclusions of this study are based on the detailed evaluation of a small group of subjects over a limited period of time under carefully controlled laboratory conditions, Dr. Penev emphasizes that additional intervention studies will be needed to examine the impact of habitual sleep curtailment on human glucose metabolism.

Other researchers working on the study include Arlet Nedeltcheva, Lynn Kessler and Jacqueline Imperial of the University of Chicago. The study was supported by NIH grants.

The article, "Exposure to recurrent sleep restriction in the setting of high caloric intake and physical inactivity results in increased insulin resistance and reduced glucose tolerance," will appear in the September 2009 issue of JCEM.

August 3, 2009 (Newswise) - Researchers at the Joslin Diabetes Center and several other institutions have for the first time linked high levels of glutamate - a neurotransmitter in the brain produced from glucose - in people with type 1 diabetes to symptoms of depression and lower levels of cognitive performance. The findings may lead to a better understanding of the underlying mechanisms of these conditions in people with diabetes. "These findings could lead to new ways to both understand and treat these conditions," said Alan Jacobson, M.D., Chief of Psychiatry at Joslin Diabetes Center, Professor of Psychiatry at Harvard Medical School and senior author of the paper published in the August issue of Archives of General Psychiatry, who noted that higher levels of both mild depression and lower scores on tests of cognitive function have been noticed for some time in patients with diabetes.

The study, which involved researchers at institutions in both the United States and Korea, documents increased levels of glutamate in the prefrontal area of the brains of people with type 1 diabetes, an area associated with both higher-level thinking and regulation of emotions. At the same time, the study shows a link between those high levels of glutamate to poorer glucose control, more symptoms of depression and lower scores on tests of cognitive function in those with diabetes.

"The importance of this paper lies in the linkage of a neurotransmitter that, in high levels, can cause damage to neurons, the degree of diabetic hyperglycemia (high blood glucose) and alterations in cognitive function and depression levels previously found in diabetes," said Jacobson.

The findings suggest that therapies to alter the transmission of glutamate may be of benefit in treating these conditions. While the study focused on people with type 1 diabetes, Dr. Jacobson suggests the findings could also be beneficial to individuals with type 2 diabetes as well.

Using proton magnetic resonance spectroscopy imaging, the researchers looked at brain glutamate levels in 123 people with type 1 diabetes with varying degrees of lifetime glycemic control and 38 subjects without diabetes.

According to the data, concentrations of glutamate were nine percent higher in the subjects with diabetes. At the same time, performances on tests of memory, executive function and psychomotor speed were lower in the diabetes group. An association with mild depression was also found. According to the paper, depression affects up to 25 percent of people with type 1 diabetes.

If confirmed, the findings could help further science's understanding of high blood sugar levels, said Jacobson, noting that the emphasis has until now been on the association between low blood sugar and brain damage.

Further, the findings on glutamate and its effects on the brain may lead to a new line of investigation into both types 1 and 2 diabetes in terms of interventions to improve the health of the brain, including possibly new medications for both diabetes and depression, he said.

March 4, 2009 (EurekAlert) - As with many developing nations, the shift in the occupied Palestinian territory (OPT) towards urbanization and Western-style diet, along with decreasing physical activity, has left heart disease, cerebrovascular disease, diabetes, and cancer as leading causes of death. The response of the Palestinian National Authority to the chronic-disease challenge has been limited, as has been interest from international donors on whom the authority has depended for funding such programmes. Military occupation and its consequences are major impediments to improving the OPT's fragmented healthcare system. These issues are discussed in the third paper in The Lancet Series on Health in the Occupied Palestinian Territory, written by Dr Abdullatif Husseini, Birzeit University, OPT, and colleagues.In 2005 (the latest year with data) heart disease caused 21% of all deaths in the OPT, followed by cerebrovascular disease (11%). Cancers were third with 10.3% of all deaths. Mortality from coronary heart disease was 2•8 times higher in Jerusalem Palestinian men than in Jewish men and 2•7 times higher for Palestinian women than for Jewish women. Although acute coronary care in the Israeli hospitals in which 84% of Palestinians from Jerusalem received their care was described as generally equally good, interventions were done less frequently on Palestinian patients than on Jewish patients.

Despite the absence of definitive evidence, diabetes mellitus and its complications are major health problems in the OPT according to all estimates. In 2000, the estimated prevalence rate of diabetes was 9•0% in adults aged 30 years and older. Reported age-adjusted cancer incidence for the occupied Palestinian territory for 1998 was lower than that in Jordan, Lebanon, and in Arabs living in Israel, probably because it was an underestimate since some patients use services outside the territory. In 2005, combined cancer mortality rate in the OPT was 27•8 per 100 000, which is not much different from that in 2000. Lung cancer, the most commonly diagnosed and most deadly cancer worldwide, is the most common type in Palestinian, Jordanian, Lebanese, and Palestinian Arab men living in Israel. Breast cancer is the most common type in Palestinian women. Smoking rates are high for men aged 10 years and older in the OPT (34.7%), but low for women in the same age group (2.1%). Obesity and being overweight is a big problem in the OPT and is particularly important in the adolescent population.

The authors say that primary prevention of chronic diseases should be urgently addressed by The Palestinian National Authority. The public health programmes required will need political will at the highest level. The Palestinian Ministry of Health's restricted budget encourages emphasis on primary prevention, while segregation and movement restriction encourages decentralisation. The authors encourage the use of community-based care and easily administered drugs to address the risk factors of chronic diseases. The OPT health-care system must become more integrated, and investment must be provided to train and develop the health-care workforce.

They conclude: "One of the major impediments to the improvement of the Palestinian health-care system is the continuing military occupation with all its consequences... Relevant to the challenge of chronic diseases is the effect of a state of perpetual limbo on the national economy, strategic planning, health-care policy formulation, and national priority setting. The geographic and administrative fragmentation of the occupied Palestinian territory, the military checkpoints and barriers to movement, and the separation wall and many other fences and barriers, all have detrimental effects on the ability to deliver good health care. The separation of Gaza Strip and the near impervious blockade of its population can only worsen health status and ability to deliver health care."

March 4, 2009 (Newswire) - Not only do teens with type 1 diabetes have the normal adolescent concerns of school, work and social activities, but they are responsible for taking insulin, monitoring blood glucose (blood sugar) levels and keeping doctor visits, too. Now, a new study suggests that feelings such as anger or sadness could interfere with teens' diabetes management."Adolescence is a difficult time to manage diabetes, for multiple reasons: some of them are physiological, like puberty; some are psychological, such as increasing autonomy. Also, there's a rise during adolescence of negative emotions," said Cynthia Berg, Ph.D., chairperson of the psychology department at the University of Utah in Salt Lake City.

Berg, a study co-author, and colleagues had 62 adolescents with type 1 diabetes complete daily diaries for two weeks, detailing their mood, average blood glucose levels, overall confidence in their ability to manage their diabetes and ability to manage daily diabetes tasks, such as eating healthy foods and taking insulin.

The findings appear in the latest issue of the Annals of Behavioral Medicine.

During the two-week study period, when teens reported more positive feelings, such as happiness or excitement, they tended to have lower - nearer normal - blood glucose levels. In contrast, when teens reported negative feelings, daily diary entries revealed a tendency toward higher blood glucose levels.

Researchers measured positive and negative emotions on a one- to five-point scale. "The important issue is that for every one-point change in emotion, there is a rather sizeable change in blood glucose," Berg said.

Ann Goebel-Fabbri, Ph.D., a psychologist at Joslin Diabetes Center in Boston, cautioned that the act of entering the blood glucose number in journals might cloud teens' moods. As a result, "they may feel negatively or positively charged from that result," she said.

"The take-home message for health care providers, parents and teens is that both emotions can potentially influence their confidence in blood sugar management," Goebel-Fabbri said. "At the same time, it can go in the opposite direction - the actual outcomes can also influence their emotions. It's a bidirectional relationship."

Fortenberry KT, et al. Perceived diabetes task competence mediates the relationship of both negative and positive affect with blood glucose in adolescents with type 1 diabetes. Annals of Behavioral Medicine 31(1), 2009.

February 24, 2009 (EurekAlert) - Researchers at the University of Vermont Cardiovascular Research Institute, Colchester, Vermont have found that increased expression in the heart of plasminogen activator inhibitor type-1 (PAI-1) is profibrotic. The results, which appear in the March 2009 issue of Experimental Biology and Medicine, implicate PAI-1 overexpression, known to accompany insulin resistance and type 2 diabetes, as a factor contributing to the high incidence of heart failure after myocardial infarction in people with diabetes. The research team, Dr. A.K.M. Tarikuz Zaman, a research associate, Mr. Christopher J. French, medical and graduate student, Dr. David J. Schneider, Professor of Medicine and Director of the Cardiology and Vascular Biology Units, and Dr. Burton E. Sobel, Professor of Medicine and Director of the Cardiovascular Research Institute, performed studies in 10 week old mice subjected to coronary occlusion. Controls and PAI-1 overexpressing mice congenic on a C57BL6 background had comparable PAI-1 content in left ventricular myocardium despite a marked elevation of PAI-1 in plasma in the latter. 6 weeks after coronary occlusion the PAI-1 overexpressing mice exhibited a 2-fold increase in left ventricular (LV) PAI-1 content. Histochemical analysis demonstrated 33% more LV fibrosis as well. The increased fibrosis associated with increased PAI-1 was accompanied by functional derangements including diminished LV wall thickness in both diastole and systole, increased end systolic LV dimensions, depressed fractional shortening, a greater impairment of LV segmental function, and greater transmitral E-wave amplitude.In summary, overexpression of PAI-1 in the heart altered the response of the left ventricle to myocardial infarction. It led to increased expression of PAI-1 late after coronary occlusion accompanied by increased fibrosis and functional derangements indicative of both systolic and diastolic dysfunction. Dr. Sobel said that "in concert with our previously reported findings demonstrating increased expression of PAI-1 in the heart in transgenic mice rendered insulin resistant, these results suggest that the markedly increased incidence and severity of heart failure following myocardial infarction in patients with insulin resistance and type 2 diabetes may reflect in part adverse consequences of increased PAI-1 expression in the heart predisposing to fibrosis and impairment performance of the left ventricle."

Dr. Steven R. Goodman, Editor-in-Chief of Experimental Biology and Medicine said "these elegant studies by Dr. Sobel and colleagues provide substantial insight into the mechanisms by which type 2 diabetes, with the resulting increase in PAI-1 in the heart, can lead to increased incidence and severity of heart failure following myocardial infarction. This is a major step forward in our understanding of the linkage between diabetes and cardiovascular disease".

February 24, 2009 (EurekAlert) - Postpartum depression is a serious-and often undiagnosed-condition affecting about 10 to 12 percent of new mothers. Some of the causes might include personal history of depression, stressful life events, and lack of social, financial or emotional support. Left untreated, it can have lasting negative effects not only on the mother but on her child's development.
In the first study of its kind, investigators at Harvard Medical School and the University of Minnesota School of Public Health report that low-income women with diabetes have a more than 50% increased risk of experiencing this serious illness.

"While previous studies have linked diabetes and depression in the general population, this is the first time, to our knowledge, that the relationship has been studied specifically in pregnant women and new mothers," says Katy Backes Kozhimannil, research fellow in the Department of Ambulatory Care and Prevention at Harvard Medical School and Harvard Pilgrim Health Care. "We believe these findings may help clinicians better identify and treat depression in new mothers."

These findings are published in the February 25 edition of JAMA, the Journal of the American Medical Association.

For over 25 years, clinicians have been aware that new mothers are at risk for postpartum depression. However, the condition is difficult to identify. Many symptoms are attributed to the every-day struggles of being a new mother. Others, such as irrational thoughts about harming the baby or, conversely, obsessing over the baby's health, are simply difficult for new mothers to admit.

To investigate the potential link between diabetes and postpartum depression, Kozhimannil and Bernard Harlow, professor in the University of Minnesota's School of Public Health, examined medical claims data from the New Jersey Medicaid program, looking at information from 11,024 new mothers who had given birth between July 2004 and September 2006. All women in the study were eligible for Medicaid 6 months prior to and one year after delivery and had incomes less than 115% of the federal poverty line ($24,000 for a family of four in 2006).

The researchers identified a woman as having depression if her records indicated a diagnosis, or if she had filled a prescription for an antidepressant medication during the study period. (Diabetes was also identified using both diagnosis and prescription information.)

Study data indicated that 9.6 percent of women with diabetes, who had no indication of depression during pregnancy, developed depression during the year following delivery, compared with 5.9 percent of women without diabetes. Put another way, pregnant women and new mothers with diabetes were approximately 55 to 60 percent more likely to experience postpartum depression. The increased risk of postpartam depression is similar for women who already had diabetes and those who developed it during pregnancy.

The researchers caution that these findings do not establish that diabetes causes postpartum depression, only that the two are related. Also, the medical claims data they used did not contain information on personal or family history of depression, weight or body mass index. Plus, it isn't yet clear the extent to which one can generalize findings from such a specific and localized population.

Still, according to Kozhimannil, "Health care facilities and clinicians that serve low-income and Medicaid populations may want to pay particular attention to managing the mental health concerns of women with diabetes during pregnancy and the postpartum period."

June 17, 2008 (EurekAlert) - Researchers have long known that type-2 diabetes and depression often go hand in hand. However, it's been unclear which condition develops first in patients who end up with both. Now, a new study led by Johns Hopkins doctors suggests that this chicken-and-egg problem has a dual answer: Patients with depression have an increased risk of developing type-2 diabetes, and patients with type-2 diabetes have an increased risk of developing depression.For the study, published in the June 18 Journal of the American Medical Association, diabetes expert Sherita Hill Golden, M.D., M.H.S., and her colleagues took advantage of data generated by the Multi-Ethnic Study of Atherosclerosis (MESA), which examined risk factors for atherosclerosis, or hardening of the arteries, in an ethnically diverse group of 6,814 men and women between ages 45 to 84. Participants in the MESA study identified themselves when they enrolled as white, black, Hispanic or Chinese.

During MESA, participants made three visits to clinics over the course of three years to be examined for various atherosclerosis risk factors, including type-2 diabetes and symptoms of depression, which could serve as a precursor for full-blown clinical depression.

The study also collected information on other atherosclerosis risk factors, such as participants' body-mass indices, blood pressure, diet and exercise patterns, and smoking habits, as well as information correlated with health in general, such as income and socioeconomic factors.

Mining the data for their own purposes, Golden and her colleagues excluded from their analysis all participants who had high fasting glucose, an indication of diabetes, at the initial clinic visit. They then looked to see whether participants who initially had elevated symptoms of depression, as indicated through a questionnaire, were more likely than those who didn't to develop high fasting glucose at the end of the three-year study period.

Results showed that those with elevated depressive symptoms were 42 percent more likely overall to develop diabetes by the end of the study than those without these symptoms. Moreover, the stronger the symptoms, the higher the risk of diabetes, a "dose response" that lends strength to the findings.

Even when the researchers accounted for such factors as overweight, lack of exercise, and smoking, the risk of developing diabetes was still 34 percent higher for patients with depressive symptoms.

To investigate whether diabetes could lead to depression, Golden and her colleagues used the same pool of MESA information and excluded those who had elevated depressive symptoms at the initial clinic visit. Then, they looked to see whether those who had high fasting glucose-with or without a formal diagnosis of diabetes-were more likely to develop depressive symptoms by the end of the study.

The researchers found that patients treated for diabetes, about 9 percent of the group, were about 54 percent more likely to develop elevated depressive symptoms than those without diabetes.

Surprisingly, those with prediabetes or untreated diabetes were about 25 percent less likely to develop elevated depressive symptoms than people with normal fasting glucose, a finding Golden's team cannot explain at this time.

Golden, an associate professor of medicine and epidemiology at the Johns Hopkins University School of Medicine, speculates that depression may lead patients to develop behaviors that trigger diabetes or make it worse, such as overeating, not exercising or smoking. Similarly, keeping up with the often extensive treatment regimens to care for their diabetes may make patients' depression worse. Understanding how one condition might lead to another could improve treatments for both problems, she says.

"Having both diabetes and depression can make it difficult for patients to get the good clinical outcomes that we like to see for each of these conditions," says Golden. "To make sure that patients with diabetes and depression receive the best care, we wanted to get to the bottom of the connection between these two conditions.

"It's important that doctors be attuned to look for both conditions in patients at risk for either diabetes or depression," Golden adds. "We may want to develop interventions for both treatments, instead of just one or the other."