Relationship Between Postnatal Depression of Mental Health Patients and the Psychological Health of Their Offspring

Postnatal depression is a major illness affecting maternal and family health. The rate of postnatal depression among mental health clients is postulated to be higher than in the community due to the added brain assault. Children of parents who are mental health clients are more likely to have psychological problems compared to children from other parents in the community. This study investigates the rate of postnatal depression among mental health clients and their offspring's psychological health. A total of 140 mental health clients were assessed using the Edinburgh Postnatal Depression Scale (EPDS). They subsequently completed the Strength and Difficulties Questionnaire (SDQ) regarding their children. The majority ethnicity was the Kadazan (40.7%). The mean age of mothers was 38.6 (7) years with most having a secondary education (53.6%) and a household income per month of < RM1000 per month (27.1%). The postnatal depression rate was 47.8%. Higher EPDS scores were associated with higher total SDQ scores in their offspring. Model 1 was unadjusted, giving an OR of 5.65 [95% CI (3.74, 7.55)], p < 0.001. After adjustment for confounders, Model 2 had an OR of 5.51 [95% CI (3.57, 7.46)], p < 0.001. More efforts need to be given to the early detection of maternal depression and its prompt treatment in mental health clients because of the relationship with the psychological health of the offspring.

Effect of Major Illness Insurance on Vulnerability to Poverty: Evidence From China

Disease is the primary cause of poverty in China. Health insurance is an essential mechanism for managing health risks and addressing the risk of financial loss. Using data from the China Family Panel Studies (CFPS) waves from 2010 to 2016, this study develops a random forest method to assess households' vulnerability to poverty and then examines the impact of major illness insurance on vulnerability to poverty by focusing on the rollout period of a major illness insurance scheme. The research also examines the impact of increased major illness insurance coverage on poverty reduction by focusing on the change from low- to high-coverage health insurance. The findings indicate that major illness insurance and improvements in the degree of coverage significantly reduce vulnerability to poverty. In addition, major illness insurance is found to alleviate the vicious cycle of poverty and disease through the mechanism of increasing household income, and its effect has strengthened over time. Compared to other poverty reduction policies, major illness insurance has a greater influence on poverty alleviation.

Different Involvement of Band 3 in Red Cell Deformability and Osmotic Fragility—A Comparative GP.Mur Erythrocyte Study

GP.Mur is a clinically important red blood cell (RBC) phenotype in Southeast Asia. The molecular entity of GP.Mur is glycophorin B-A-B hybrid protein that promotes band 3 expression and band 3–AQP1 interaction, and alters the organization of band 3 complexes with Rh/RhAG complexes. GP.Mur+ RBCs are more resistant to osmotic stress. To explore whether GP.Mur+ RBCs could be structurally more resilient, we compared deformability and osmotic fragility of fresh RBCs from 145 adults without major illness (47% GP.Mur). We also evaluated potential impacts of cellular and lipid factors on RBC deformability and osmotic resistivity. Contrary to our anticipation, these two physical properties were independent from each other based on multivariate regression analyses. GP.Mur+ RBCs were less deformable than non-GP.Mur RBCs. We also unexpectedly found 25% microcytosis in GP.Mur+ female subjects (10/40). Both microcytosis and membrane cholesterol reduced deformability, but the latter was only observed in non-GP.Mur and not GP.Mur+ normocytes. The osmotic fragility of erythrocytes was not affected by microcytosis; instead, larger mean corpuscular volume (MCV) increased the chances of hypotonic burst. From comparison with GP.Mur+ RBCs, higher band 3 expression strengthened the structure of RBC membrane and submembranous cytoskeletal networks and thereby reduced cell deformability; stronger band 3–AQP1 interaction additionally supported osmotic resistance. Thus, red cell deformability and osmotic resistivity involve distinct structural–functional roles of band 3.

1411 Amoebic Colitis: Inaccurate Diagnosis; Inappropriate Surgery

Global prevalence of symptomatic Amoebiasis (pathogen Entamoeba histolytica) is approximately 50 million cases per year, with an annual mortality of up to 100,000. Despite this, a diagnosis of amoebiasis is rarely considered in the UK. Transmission is via the faeco-oral route, person-to-person contact or oral-anal sexual contact. The majority of cases diagnosed in the UK are in international travellers or immigrants. Symptoms of amoebiasis can closely mirror those of Inflammatory Bowel Disease (IBD) resulting in diagnostic uncertainty. A misdiagnosis could result in treatment with corticosteroids, immunosuppressant or biological agents when standard treatment for amoebiasis is actually Metronidazole. In exceptional circumstances, a misdiagnosis of IBD may lead to a patient requiring colectomy and formation of end ileostomy due to an apparent failure of medical management. Emergency colonic surgery is associated with a risk of complications such as wound infections and collections, together with the psychological consequences of major illness and surgery. We report on two patients who have undergone emergency subtotal colectomy and end ileostomy in whom a diagnosis of amoebic colitis was made on histology. Both British Asian patients were under 55 years of age, had a travel history to India and presented with diarrhoea. The diagnosis of amoebiasis must be considered in the differential diagnosis for all returning travellers and immigrants who present with GI symptoms, consistent with IBD. A correct diagnosis allows appropriate, simple, curative treatment and avoids unnecessary surgery with its attendant morbidity. Polymerase chain reaction is the gold standard diagnostic test and is currently significantly under-utilised.

Topical Minoxidil Exposures and Toxicoses in Dogs and Cats: 211 Cases (2001–2019)

ABSTRACT Topical minoxidil is a medication for hair loss, initially available in the United States by prescription only and available since 1996 as an over-the-counter product. To determine the epidemiology of minoxidil exposures and toxicoses in dogs and cats, 211 dog and cat cases with topical minoxidil exposure were identified from the American Society for the Prevention of Cruelty to Animals Animal Poison Control Center database. In 87 cases with clinical signs of toxicosis (62 cats, 25 dogs), case narratives were reviewed and coded for exposure-related circumstances. Unintentional delivery, especially while pet owners applied minoxidil for his/her own hair loss (e.g., pet licked owner’s skin or pillowcase, pet was splashed during a medication spill), was the most common cat exposure circumstance. Exploratory behavior (e.g., searching through trash) was the most common dog exposure circumstance. Clinical signs occurred in dogs and cats even with low exposure amounts, such as drops or licks. In patients that developed clinical signs, most developed moderate or major illness (56.0% dogs, 59.7% cats). Death occurred in 8/62 (12.9%) cats that developed clinical signs after the pet owner’s minoxidil use. Pet owners should be educated on the risk of dog and cat toxicosis from accidental minoxidil exposure.

Helping Older People Breathe More Easily

One important type of clinically significant lung disease that is frequently encountered by pharmacists working in consultant roles is Chronic Obstructive Pulmonary Disease (COPD). Data recently published in the Journal of the American Medical Association suggests that about 6% of people from the United States aged 40 years or older report a COPD diagnosis, and a major illness affecting more than 1 in 20 of the nation's population is unequivocally an important public health priority. Moreover, in the same report, high rates of comorbidities such as dyslipidaemia, hypertension, heart disease, and cancer are noted, along with increasing emergency department presentations and increasing expenditure on drug therapy used for COPD management.

A Case of Atypical Bartonellosis in a 4-Year-Old Immunocompetent Child

In most cases, infection due to Bartonella henselae causes a mild disease presenting with a regional lymphadenopathy frequently associated with a low-grade fever, headache, poor appetite and exhaustion that spontaneously resolves itself in a few weeks. As the infection is generally transmitted by cats through scratching or biting, the disease is named cat scratch disease (CSD). However, in 5–20% of cases, mainly in immunocompromised patients, systemic involvement can occur and CSD may result in major illness. This report describes a case of systemic CSD diagnosed in an immunocompetent 4-year-old child that can be used as an example of the problems that pediatricians must solve to reach a diagnosis of atypical CSD. Despite the child’s lack of history suggesting any contact with cats and the absence of regional lymphadenopathy, the presence of a high fever, deterioration of their general condition, increased inflammatory biomarkers, hepatosplenic lesions (i.e., multiple abscesses), pericardial effusion with mild mitral valve regurgitation and a mild dilatation of the proximal and medial portion of the right coronary artery, seroconversion for B. henselae (IgG 1:256) supported the diagnosis of atypical CSD. Administration of oral azithromycin was initiated (10 mg/kg/die for 3 days) with a progressive normalization of clinical, laboratory and US hepatosplenic and cardiac findings. This case shows that the diagnosis of atypical CSD is challenging. The nonspecific, composite and variable clinical features of this disease require a careful evaluation in order to achieve a precise diagnosis and to avoid both a delayed diagnosis and therapy with a risk of negative evolution.

Discordance Between Patient and Caregiver on Ratings of Purpose in Life Following a Dementia Diagnostic Appointment

Purpose in life has been linked with better well-being and reduced risk for major illness. As such, work has focused on understanding what leads to changes in sense of purpose during adulthood, with a focus on major life events. Receiving a dementia diagnosis is a major life event that could affect purpose in life both for older adults with dementia and their potential caregivers. To examine this issue participants answered questions at two timepoints, before their diagnostic appointment at a specialized memory clinic, and between two days and two weeks after the appointment. Participants provided self-report ratings of sense of purpose and as well as open-ended answers regarding their purpose in life. Data is available from both caregivers and patients and qualitative coding was performed on participants’ open-ended responses. Our analysis revealed discordance between patients and caregivers, such that caregivers’ ratings of patients were lower in terms of purpose in life (t = -5.63, p < .001) and being in worse health (t = -3.41, p < .001) than patients’ ratings of themselves on the same measures. Discordance between caregiver and patient in the context of a dementia diagnostic appointment and outcomes associated with this discordance are discussed.

Trajectories of Purpose in Life Following a Dementia Diagnostic Appointment

Purpose in life has been linked with better well-being and reduced risk for major illness. As such, work has focused on understanding what leads to changes in sense of purpose during adulthood, with a focus on major life events. Receiving a dementia diagnosis is a major life event that could affect purpose in life both for older adults with dementia and their potential caregivers. To examine this issue participants answered questions at two timepoints, before their diagnostic appointment at a specialized memory clinic, and between two days and two weeks after the appointment. Participants provided self-report ratings of sense of purpose and as well as open-ended answers regarding their purpose in life. Data is available from both caregivers and patients and qualitative coding was performed on participants’ open-ended responses. While there was no significant, mean-level change in purpose in life for patients (t = -.14, p = .88) or caregivers (t = .73, p = .46), some participants exhibited reliable change in sense of purpose. Factors underlying individual increases and decreases in sense of purpose following a dementia diagnostic appointment are explored and discussed.

Role of Neurochemicals in Schizophrenia

Background: Schizophrenia is a complex, unpredictable and severe psychiatric disorder, which affects several domains of cognition, behavior and characterized by positive, negative, and cognitive symptoms. Etiology of schizophrenia represents the involvement of environmental factors, role of genes, social stressors, like discrimination or economic hardship, relationships, childhood difficulty, use of cannabis in adolescence, maternal stress, nutritional deficiencies, maternal infections, intrauterine growth retardation, and complications of pregnancy, while pathophysiology represents dysfunctional neurotransmission of dopamine, stress-associated signaling cascades (gabanergic, glutamatergic, cholinergic, serotonin, and adrenergic singling cascades) and enzymatic changes (acetylcholinesterase, catechol-o-methyl-transferase, monoamine oxidase, and phosphodiesterase). Objective: The objective of the current review is to determine the role of pathophysiological hypothesis impairments leading to positive, negative and cognitive symptoms of schizophrenia. Methods: Various pathophysiological hypotheses of schizophrenia were identified through searching relevant databases including PubMed, Scopus, and Web of Science up to the year 2019, using the keywords schizophrenia, role of dopamine, acetylcholine, oxidative stress, and inflammation in schizophrenia. Result: Alterations in the neurotransmission of dopamine, stress-associated signaling cascades (Gabanergic, glutamatergic, cholinergic, serotonin, and adrenergic singling cascades) and enzymatic changes (acetylcholinesterase, catechol-o-methyl-transferase, monoamine oxidase, and phosphodiesterase) were compiled in this review for easy learning of Schizophrenia. Conclusion: Schizophrenia is a major illness defined by delusions, hallucinations, disorganized behavior, and cognitive difficulties such as memory loss. This review aims to provide a brief overview of neurotransmitter role as well as other pathophysiological alterations in schizophrenia. A focus on more predictive animal models and specific biomarkers for positive, negative and cognitive symptoms will help to identify and develop novel therapeutic agents with fewer side effects.