Depressive severity associated with cesarean section in young depressed individuals.
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ABSTRACT:
SUBMITTER: Yang XT
PROVIDER: S-EPMC6759114 | biostudies-literature | 2019 Aug
REPOSITORIES: biostudies-literature
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Depressive severity associated with cesarean section in young depressed individuals.
Yang Xiao-Tong XT Zhang Wen-Rui WR Tian Zi-Chen ZC Wang Kun K Ding Wei-Jun WJ Liu Yuan Y Wang Chun-Xiu CX Leng Hai-Xia HX Peng Mao M Zhao Wen-Feng WF Li Jia-Yi JY Yang Lei L Zhang Xing-Yue XY Wu Lei L Wang Jun-Hui JH Fernandez Alejandro A Si Tian-Mei TM Fu Liu-Hui LH Ghia Jean-Eric JE Dong Hui-Qing HQ Wang Yu-Ping YP Wang Hong-Xing HX
Chinese medical journal 20190801 15
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Project description:BackgroundJenny dystocia occurs very rarely and is associated mainly with postural defects due to long fetal extremities. However, the management of dystocia in equines is relatively difficult compared with that in other large animals. Owing to the absence of well-described published papers on cesarean section in donkeys, this condition remain life-threatening after unsuccessful surgical intervention.Patient presentationA 4-year-old Jenny with a difficult birth due to a previous car accident presented for 3 consecutive years at different stages of labor onset. Upon early presentation, there was straining and frequent aggressive rolling. Further examination also revealed a fully dilated cervix and narrow pelvic cavity due to the downward bending of the iliac wing. Surgical sites (lower flank, ventral midline, and paramedian) were used for each cesarean section. General anesthesia was used in all three procedures. Additionally, local infiltration of 2% lidocaine along with light general anesthesia was used when the patient presented with a live fetus. In all approaches, surgical sites were prepared for cesarean section, and dead fetuses were removed at the first and third parity due to delayed presentation. However, in the second parity, a live female foal was delivered. In all the approaches, the first layer of uterine closure was made by using a simple continuous suture pattern (biting all the layers of the uterine wall). The sutures were then oversewed with a Cushing suture pattern using # 0 polyglycolic acid. The skin was closed in different suture patterns during each technique using nonabsorbable suture material # 1 silk. Postoperative subcutaneous swelling was observed and regressed gradually in all surgical approaches. The duration of skin suture removal was determined based on the extent of wound healing and the site of the incision.ConclusionThis is the first ever report describing 3 consecutive cesarean sections in the same donkey with pelvic deformity. Thus, this study was able to indicate different approaches for cesarean section in equines. Moreover, owing to the bleeding nature of the equine uterus, simple continuous suturing was the pattern of choice for 1st layer uterine closure. It was also concluded that subcutaneous edema is unavoidable in donkeys.
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Project description:Mild depressive symptoms (MDS) reflect vulnerability to major depression that does not meet the criteria for a major depressive disorder (MDD). Previous research indicates that it is difficult to identify MDS in young adults, and they exhibit diverse aspects of depressive symptoms caused by clinical depression, which can lead to poor academic performance, relationship difficulties, and even suicide. Additionally, many young adults remain unaware of their depressive symptoms during the early stages of MDD. Thus, the present study investigated clinical, neurocognitive, and physiological characteristics of young adults with various symptoms of depression and explored sex-specific differences. A total of 113 students aged 18-35 (MDD: n = 32; MDS: n =37; control [CON]: n = 44) participated in the study. Self-report clinical measures, short-term cardiac activity measured by finger sensors, and neurocognitive data were collected. Pearson's correlations, two-way analysis of variance (ANOVA), principal component analysis, and exploratory structural equation modeling were conducted for the statistical analyses. Furthermore, the measurement invariance of the latent factor model was tested, and fit indices were compared according to sex. The results revealed that male students showed greater sympatho-vagal activity than female students. Additionally, male MDS students tended to exhibit decreased performance levels in neurocognitive function tasks compared with MDD and CON males, whereas female MDS students showed distinct characteristics compared to MDD and CON females on self-report measures of anxiety. Correlation analyses identified a positive association between the level of anger perception and latency in the executive function test among both males and females. Additionally, the use of a structured model revealed significant sex-specific differences in factor estimates. The present results suggest that recognizing the early signs of MDS that account for sex-specific differences in both subjective and objective measures may improve the diagnosis and monitoring of young adults with MDS.
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Project description:AimsThe objective of this study is to investigate whether type of depressive symptoms (i.e. cognitive-affective or somatic) is related to a patient-perceived need for professional psychological care in individuals with diabetes.MethodsIn total 2266 participants were recruited as part of the screening procedure for a multi-center randomized controlled trial on the treatment of depressive symptoms among individuals with diabetes. Individuals were invited to complete Beck Depression Inventory-II (BDI-II). Patients with elevated depressive symptoms (BDI-II ≥14) were interviewed about their psychological care need. Based on their care needs patients were categorized into: unmet need, no need, met need and unclear need. These groups were compared on type of depressive symptoms, as categorized into cognitive-affective symptoms and somatic symptoms.Results568 eligible individuals had elevated depressive symptoms, of whom 519 were reached. Among these depressed individuals, 19.7% (102 of 519) had an unmet need for psychological care. Participants with an unmet need were younger (p<0.001) and had higher total depression scores compared to the group with no need (p<0.001). They also scored higher on cognitive-affective symptoms (p<0.001), whereas somatic symptoms did not significantly differ (p = 0.232). Logistic regression revealed that cognitive-affective symptoms predicted an unmet need (p = 0.001). However, overall predictive capacity of type of depressive symptoms on care needs was weak.ConclusionsCognitive-affective symptoms of depression-but not somatic symptoms-were associated with an unmet need for psychological care among depressed individuals with diabetes. Future research is needed to reveal better predictors explaining the discrepancy between distress and low care needs in order to optimize screening procedures.
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Project description:BackgroundThe risk factors associated with niche on the cesarean scar have been reported, however, the degree of these factors associated with large niche and the accumulation effects of these risk factors on the development of large niche are unclear.MethodsLarge niche was evaluated by transvaginal sonography during mid-follicular phase. Logistic regression model was used to assess 32 risk factors by univariate analysis. Then, a scoring model based on the screened risk factors was generated. The performance of this model was evaluated by area under curve (AUC). Finally, the scoring model was applied in 123 women to assess the external validation.Result(s)In the training cohort study, 163 women were diagnosed with large niche. The final scoring model involves eight risk factors with the rating scores including age at delivery (30-34 years: 1 point; ≥ 35 years: 4.5 points), retroflexed uterus (8.5 points), meconium-stained amniotic fluid (4.5 points), twice CSs (4.0 points), postpartum endometritis (4.5 points), premature rupture of membranes (2.5 points), intrahepatic cholestasis of pregnancy (mild to moderate: 3 points; severe: 6.5 points), and cervical dilatation (1-3 cm: 2.0 points; 4-10 cm: 4.5 points). The accumulation effect with a cut-off value of 8.0 in the scoring was associated with the large niche after CS.Conclusion(s)This is the first scoring model to objectively quantify the risk of a large niche after CS. Optimal risk factors control by avoiding high score factors and multiple factors accumulation may eliminate the risk of large niche development.
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Project description:Prior epidemiological studies investigating the association between delivery mode (i.e., vaginal birth and cesarean section [C-section]) and autism spectrum disorder (ASD) and intellectual disability (ID) risk have reported mixed findings. This study examined ASD and ID risks associated with primary and repeat C-section within diverse US regions. During even years 2000-2016, 8-years-olds were identified with ASD and/or ID and matched to birth records [ASD only (N = 8566, 83.6% male), ASD + ID (N = 3445, 79.5% male), ID only (N = 6158, 60.8% male)] using the Centers for Disease Control and Prevention's Autism and Developmental Disabilities Monitoring Network methodology. The comparison birth cohort (N = 1,456,914, 51.1% male) comprised all births recorded in the National Center for Health Statistics corresponding to birth years and counties in which surveillance occurred. C-section rates in the birth cohort demonstrated significant regional variation with lowest rates in the West. Overall models demonstrate increased odds of disability associated with primary and repeat C-section. Adjusted models, stratified by region, identified significant variability in disability likelihood associated with repeat C-section: increased odds occurred for all case groups in the Southeast, for ASD only and ID only in the Mid-Atlantic, and no case groups in the West. Regional variability in disability risk associated with repeat C-section coincides with differences in birth cohorts' C-section rates. This suggests increased likelihood of disability is not incurred by the procedure itself, but rather C-section serves as a proxy for exposures with regional variability that influence fetal development and C-section rates.
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Project description:BackgroundRising cesarean section (CS) rates are a major public health concern and cause worldwide debates. To propose and implement effective measures to reduce or increase CS rates where necessary requires an appropriate classification. Despite several existing CS classifications, there has not yet been a systematic review of these. This study aimed to 1) identify the main CS classifications used worldwide, 2) analyze advantages and deficiencies of each system.Methods and findingsThree electronic databases were searched for classifications published 1968-2008. Two reviewers independently assessed classifications using a form created based on items rated as important by international experts. Seven domains (ease, clarity, mutually exclusive categories, totally inclusive classification, prospective identification of categories, reproducibility, implementability) were assessed and graded. Classifications were tested in 12 hypothetical clinical case-scenarios. From a total of 2948 citations, 60 were selected for full-text evaluation and 27 classifications identified. Indications classifications present important limitations and their overall score ranged from 2-9 (maximum grade =14). Degree of urgency classifications also had several drawbacks (overall scores 6-9). Woman-based classifications performed best (scores 5-14). Other types of classifications require data not routinely collected and may not be relevant in all settings (scores 3-8).ConclusionsThis review and critical appraisal of CS classifications is a methodologically sound contribution to establish the basis for the appropriate monitoring and rational use of CS. Results suggest that women-based classifications in general, and Robson's classification, in particular, would be in the best position to fulfill current international and local needs and that efforts to develop an internationally applicable CS classification would be most appropriately placed in building upon this classification. The use of a single CS classification will facilitate auditing, analyzing and comparing CS rates across different settings and help to create and implement effective strategies specifically targeted to optimize CS rates where necessary.
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Project description:ObjectiveTo investigate the association of genetic polymorphisms of SIRT with postpartum depressive symptoms and analyze the risk factors for postpartum depressive symptoms in women following cesarean section.MethodsA total of 368 Chinese woman undergoing cesarean section were enrolled in this study. A cutoff of ≥10 for the Edinburgh Postnatal Depression Scale identified postpartum depressive symptoms. Genotypes of SIRT1, SIRT 2, and SIRT 6 were determined using Sequenom MassArray single-nucleotide polymorphism (SNP) analysis. We analyzed the contribution of genetic factors (SNPs, linkage disequilibrium, and haplotype) to postpartum depressive symptoms and performed logistic regression analysis to identify all potential risk factors for postpartum depressive symptoms and define interactions between genetic and environmental factors.ResultsThe incidence of postpartum depressive symptoms was 18.7% in this cohort. Univariate analysis suggested that SIRT2 polymorphism at rs2873703 (TT genotype) and rs4801933 ((TT genotype) and SIRT6 polymorphism at rs350846 (CC genotype) and rs107251 (TT genotype) were significantly correlated with the occurrence of postpartum depressive symptoms (p<0.05). Linkage disequilibrium was identified between SIRT6 polymorphisms rs350846 and rs107251. Incidence of postpartum depressive symptoms in cesarean-section parturients with SIRT2 haplotype CCC was decreased (OR 0.407, 95% CI 0.191-0.867; p=0.016). SIRT2 polymorphisms rs2873703 and rs4801933 were multiply collinear. Logistic regression analysis showed that SIRT2 polymorphism at rs2873703 (TT genotype) and rs4801933 (TT genotype), domestic violence, stress during pregnancy, and depressive prenatal mood were risk factors for postpartum depressive symptoms (p<0.05).ConclusionPregnant women with SIRT2 genotypes rs2873703 TT and rs4801933 TT and experiencing domestic violence, stress during pregnancy, and prenatal depression are more likely to suffer from postpartum depressive symptoms.
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Project description:Introduction and importanceUterine arteriovenous malformations are a rare but potentially life-threatening condition. They may be congenital or acquired and should be suspected in cases of severe or persistent uterine hemorrhage.Case presentationWe present the clinical case of a 32-year-old woman who suffered from bleeding after a spontaneous miscarriage. Uterine arteriovenous malformation with trophoblastic retention was suspected on ultrasound and Doppler examination. Magnetic resonance imaging confirmed the diagnosis, leading to embolization of both uterine arteries, followed by operative hysteroscopy to remove the retained tissue, with a favorable outcome.Clinical discussionUterine arteriovenous malformation is rare, with fewer than 100 cases reported in the literature (1). It is a potentially fatal condition due to the heavy bleeding that patients may experience. Color Doppler ultrasound (US) is a non-invasive method for initially diagnosing this rare condition, which can be confirmed by diagnostic angiography. A conservative approach or embolization is the preferred treatment to avoid hysterectomy in patients of childbearing age.ConclusionsThis case report emphasizes the use of ultrasound and MRI to diagnose a uterine AVM in a patient of childbearing age who presented with post-partum retention of products. It also showcases our experience with embolization in this patient, which allowed her to preserve her fertility.
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Project description:Cesarean section rates remain high in Georgia. As a cesarean section in the first pregnancy generally lead to a cesarean section in subsequent pregnancies, primiparous women should be targeted for prevention strategies. The aim of the study was to assess factors associated with cesarean section among primiparous women. The study comprised 17,065 primiparous women with singleton, cephalic deliveries at 37-43 weeks of gestation registered in the Georgian Birth Registry in 2017. The main outcome was cesarean section. Descriptive statistics and logistic regression analysis were used to identify factors associated with cesarean section. The proportion of cesarean section was 37.1% with regional variations from 14.2% to 57.4%. Increased maternal age, obesity and having a baby weighing ≥4000 g were all associated with higher odds of cesarean section. Of serious concern for newborn well-being is the high proportion of cesarean section at 37-38 weeks of gestation. Further research should focus on organizational and economical aspects of maternity care to uncover the underlying causes of the high cesarean section rate in Georgia.
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