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Cross-national epidemiology of DSM-IV major depressive episode

September 18, 2011 Comments off

Cross-national epidemiology of DSM-IV major depressive episode
Source: BMC Medicine

Background
Major depression is one of the leading causes of disability worldwide, yet epidemiologic data are not available for many countries, particularly low-middle income countries. This paper presents data on the prevalence, impairment, and demographic correlates of depression from 18 high and low-middle income countries in the World Mental Health Survey Initiative.

Methods
DSM-IV major depressive episodes (MDE) were evaluated in face-to-face interviews using the World Health Organization Composite International Diagnostic Interview (CIDI). Data from 18 countries were analyzed in this report (n = 89,037). All countries surveyed representative, population-based samples of adults.

Results
The average lifetime and 12-month prevalence estimates of DSM-IV MDE were 14.6% and 5.5% in the 10 high income and 11.1% and 5.9% in the 8 low-middle income countries. The average age of onset ascertained retrospectively was 25.7 in high and 24.0 in low-middle income countries. Functional impairment was associated with recency of MDE. The female:male ratio was about 2:1. In high income countries, younger age was associated with higher 12-month prevalence; in several low-middle income countries, in comparison, older age was associated with greater likelihood of MDE. The strongest demographic correlate in high income countries was being separated and in low-middle income countries was being divorced or widowed.

Conclusions
MDE is a significant public health problem across all regions of the world and is strongly linked to social conditions. Future research is needed to investigate the combination of demographic risk factors that are most strongly associated with MDE in the specific countries included in the WMH.

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Categories: BMC Medicine, business and economics, international, mental health and substance abuse, social and cultural issues

Divergence of gut permeability and mucosal immune gene expression in two gluten-associated conditions: celiac disease and gluten sensitivity

March 15, 2011 Comments off

Divergence of gut permeability and mucosal immune gene expression in two gluten-associated conditions: celiac disease and gluten sensitivity
Source: BMC Medicine

Background
Celiac disease (CD) is an autoimmune enteropathy triggered by the ingestion of gluten. Gluten-sensitive individuals (GS) cannot tolerate gluten and may develop gastrointestinal symptoms similar to those in CD, but the overall clinical picture is generally less severe and is not accompanied by the concurrence of tissue transglutaminase autoantibodies or autoimmune comorbidities. By studying and comparing mucosal expression of genes associated with intestinal barrier function, as well as innate and adaptive immunity in CD compared with GS, we sought to better understand the similarities and differences between these two gluten-associated disorders.

Methods
CD, GS and healthy, gluten-tolerant individuals were enrolled in this study. Intestinal permeability was evaluated using a lactulose and mannitol probe, and mucosal biopsy specimens were collected to study the expression of genes involved in barrier function and immunity.

Results
Unlike CD, GS is not associated with increased intestinal permeability. In fact, this was significantly reduced in GS compared with controls (P = 0.0308), paralleled by significantly increased expression of claudin (CLDN) 4 (P = 0.0286). Relative to controls, adaptive immunity markers interleukin (IL)-6 (P = 0.0124) and IL-21 (P = 0.0572) were expressed at higher levels in CD but not in GS, while expression of the innate immunity marker Toll-like receptor (TLR) 2 was increased in GS but not in CD (P = 0.0295). Finally, expression of the T-regulatory cell marker FOXP3 was significantly reduced in GS relative to controls (P = 0.0325) and CD patients (P = 0.0293).

Conclusions
This study shows that the two gluten-associated disorders, CD and GS, are different clinical entities, and it contributes to the characterization of GS as a condition associated with prevalent gluten-induced activation of innate, rather than adaptive, immune responses in the absence of detectable changes in mucosal barrier function.

+ Full Paper (PDF)

Categories: autoimmune disorders, BMC Medicine, documents in the news, gastrointenstinal diseases
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