Depression Treatment: High-Inspired Oxygen Concentration Further Impairs Opioid-Induced Respiratory Depression.

High-inspired oxygen concentration further impairs opioid-induced respiratory depression.

Filed under: Depression Treatment

Br J Anaesth. 2013 Jan 4;
Niesters M, Mahajan RP, Aarts L, Dahan A

BACKGROUND: /st>Hyperoxaemia depresses the output of peripheral and central chemoreceptors. Patients treated with opioids often receive supplemental oxygen to avert possible decreases in oxygen saturation (). We examined the effect of a single dose of remifentanil in healthy volunteers inhaling room air vs air enriched with 50% oxygen. METHODS: /st>Twenty healthy volunteers received i.v. 50 ?g remifentanil (infused over 60 s) at anormoxic (N) or hyperoxic ( 0.5, H) background on separate occasions. Minute ventilation (Vi), respiratory rate (RR), end-tidal Pco(2), and were collected on a breath-to-breath basis. The occurrence of apnoea was recorded. RESULTS: /st>During normoxia, remifentanil decreased Vi from 7.4 (1.3) [mean (sd)] to 2.2 (1.2) litre min(-1) (P<0.01), and during hyperoxia from 7.9 (1.0) to 1.2 (1.2) litre min(-1) (P<0.01; H vs N: P<0.001). RR decreased from 13.1 (2.9) to 6.1 (2.8) bpm during N (P<0.01) and from 13.2 (3.0) to 3.6 (4.0) bpm during H (P<0.01; H vs N: P<0.01). During normoxia, decreased from 98.4 (1.5) to 88.6 (6.7)% (P<0.01), while during hyperoxia, changed from 99.7 (0.7) to 98.7 (1.0)% (P<0.001). Apnoea developed in two subjects during normoxia and 10 during hyperoxia. CONCLUSIONS: /st>Respiratory depression from remifentanil is more pronounced in hyperoxia than normoxia as determined from minute ventilation, end-tidal Pco(2), and RR. During hyperoxia, respiratory depression may be masked when measuring as pulse oximetry remains in normal values during the first minutes of respiratory depression.
HubMed – depression


[Health indicators in the time of crisis in Italy].

Filed under: Depression Treatment

Epidemiol Prev. 2012 Nov; 36(6): 337-66
Costa G, Marra M, Salmaso S,

to estimate for the first time in Italy the consequences of the national current economic crisis on health and on social determinants of health, assessing its impact on a set of distal determinants (development and economic wellbeing, labour and environment) and of prossimal ones (material, psychosocial, professional, environmental and behavioural risk factors) on health care performance and on health outcomes normally related to economic trends, as self-perceived health, depression, number of suicides attempts, road traffic incidents and work injuries. The analysis is therefore aimed at identifying the most promising entry points in order to plan and implement either health care and other policies to tackle the negative effects of crisis on health.using the main international and national references on the measure of wellbeing and on the role of social determinants, this paper draws a conceptual framework of all the connections between recession and health. For each mechanism identified, it examines the value of the main available indicators before and during the crisis in order to measure its impact, adjusting if possible for the trend observed in the previous years. Indicators have been selected according to their availability in the main Italian national informative sources and, when not possible, circumscribing the analysis to the regional or local level.regarding the short term impact, results have shown an association between the recession and the raise of mental health related problems (measured in terms of number of suicides, depression and substance misuse), especially on the most disadvantaged groups because of their higher job and financial insecurity. A first ex-ante impact assessment on long term effects allows to attribute almost two hundred deaths a year due to the increase of unemployment rate. Regarding the budget cuts on public expenditure of the health care sector, significant reductions have been shown in specialist care and in drug prescriptions, associated with the increase of co-payment and with a stronger effect on the most vulnerable socioeconomic groups. Nevertheless the crisis does not seem to be associated with a reduction of indicators of quality, continuity and outcomes of the health care, at least in the considered clinical pathways (diabetes and maternal and child health). At the same time the crisis seems to be associated with the reduction in the rate of injuries in the workplace (although it has been observed an increase of the serious ones) and car crashes, probably explained by the reduction of industrial production and of household consumptions.the conceptual framework seems to be the appropriate tool to set an Italian surveillance system for assessing the short and medium term impact of crisis on health, in particular the health of the most disadvantaged groups, mainly focusing on unemployed which are the most vulnerable target.
HubMed – depression


Characteristics of people with low health literacy on coronary heart disease GP registers in South London: a cross-sectional study.

Filed under: Depression Treatment

BMJ Open. 2013; 3(1):
Rowlands GP, Mehay A, Hampshire S, Phillips R, Williams P, Mann A, Steptoe A, Walters P, Tylee AT

To explore characteristics associated with, and prevalence of, low health literacy in patients recruited to investigate the role of depression in patients on General Practice (GP) Coronary Heart Disease (CHD) registers (the Up-Beat UK study).Cross-sectional cohort. The health literacy measure was the Rapid Estimate of Health Literacy in Medicine (REALM). Univariable analyses identified characteristics associated with low health literacy and compared health service use between health literacy statuses. Those variables where there was a statistically significant/borderline significant difference between health literacy statuses were entered into a multivariable model.16 General Practices in South London, UK.Inclusion: patients >18 years, registered with a GP and on a GP CHD register. Exclusion: patients temporarily registered.REALM.Of the 803 Up-Beat cohort participants, 687 (85.55%) completed the REALM of whom 106 (15.43%) had low health literacy. Twenty-eight participants could not be included in the multivariable analysis due to missing predictor variable data, leaving a sample of 659. The variables remaining in the final model were age, gender, ethnicity, Indices of Multiple Deprivation score, years of education, employment; body mass index and alcohol intake, and anxiety scores (Hospital Anxiety and Depression Scale). Univariable analysis also showed that people with low health literacy may have more, and longer, practice nurse consultations than people with adequate health literacy.There is a disadvantaged group of people on GP CHD registers with low health literacy. The multivariable model showed that patients with low health literacy have significantly higher anxiety levels than people with adequate health literacy. In addition, the univariable analyses show that such patients have more, and longer, consultations with practice nurses. We will collect 4-year longitudinal cohort data to explore the impact of health literacy in people on GP CHD registers and the impact of health literacy on health service use.
HubMed – depression


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