Unipolar depression in adolescence is common worldwide but often unrecognized

Unipolar depressive disorder in adolescence is common worldwide but often unrecognised. The incidence, notably in girls, rises sharply after puberty and, by the end of adolescence, the 1 year prevalence rate exceeds 4%.

The burden of depression is highest in low-income and middle-income countries. Depression is associated with morbidity, and heightens suicide risk.

The strongest risk factors for depression in adolescents are:

- family history of depression
- exposure to psychosocial stress

Factors that interact to increase risk through hormonal and perturbed neural pathways include:

- inherited risks
- developmental factors
- sex hormones
- psychosocial adversity

References:

Depression in adolescence. Prof Anita Thapar et al. The Lancet, Volume 379, Issue 9820, Pages 1056 - 1067, 17 March 2012.

Image source: OpenClipArt.org

Common rashes - 2-minute video overview by a dermatologist for About.com

The whole playlist is here: Does it Itch? | Common Rashes & Skin Conditions - YouTube http://bit.ly/12k3vFB

Here are some helpful resources:

Rash diagnosis algorithm - NCEMI eTools http://bit.ly/WvZ5IU

Academic Life in Emergency Medicine: Paucis Verbis: Approach to rashes http://bit.ly/WvZ3B1

Related:

Acne Treatments | Skin Care - YouTube http://bit.ly/12k3zVP

Myopia, the most common refractive error, has a prevalence of 10-30% in Western countries, but as high as 80% in Asia

Myopia (nearsightedness), the most common form of refractive error, has a prevalence of about 10-30% in most Western countries, but this figure is as high as 80% in parts of Asia. Furthermore, myopic refractive error is likely to progress during school years, and maintaining appropriate spectacle correction requires regular services for children in these age groups.

A study of self correction of refractive error among young people in rural China showed that although visual acuity was slightly worse with self refraction than automated or subjective refraction, acuity was excellent in nearly all these young people with inadequately corrected refractive error at baseline. Inaccurate power was less common with self refraction than automated refraction.

Self refraction could decrease the requirement for scarce trained personnel, expensive devices, and cycloplegia in children’s vision programs in rural China.

References:

Self correction of refractive error among young people in rural China: results of cross sectional investigation. BMJ 2011; 343 doi: 10.1136/bmj.d4767 (Published 9 August 2011).

Nearsightedness (myopia) becoming more frequent, affects 42% of Americans

Correcting refractive error in low income countries. BMJ 2011; 343 doi: 10.1136/bmj.d4793 (Published 9 August 2011).

20-20-20 rule: For every 20 minutes of reading a screen take a 20-second eye break, look at something beyond 20 feet. NYTimes, 2012.

Nearsighted kids may get worse in winter http://trib.in/VcvmC1 -- Myopia progression seem to decrease in periods with longer days and to increase in periods with shorter days. Children should be encouraged to spend more time outside during daytime to prevent myopia (study) http://buff.ly/X1cFSm

Image source: OpenClipArt.org.

SHAKE may be common in hospitals: Supplement-associated Hyperammonemia After Cachectic Episode

High-protein dietary supplements were started for 2 patients, who had a period of anorexia before hospital admission but no history of liver disease. Subsequent altered mental status with ataxia developed in both patients.

Hyperammonemia was noted, while liver function test results remained normal.

Removal of the high-protein dietary supplements led to reversal of symptoms and normalization of the ammonia level.

With the ubiquity of nutrition supplement use, SHAKE (supplement-associated hyperammonemia after c[k]achetic episode) syndrome may be common in modern hospitals.

References:
Iatrogenic Hyperammonemia After Anorexia. Emily Welsh, BA; Jan Kucera, MD; Michael D. Perloff, MD, PhD. Arch Intern Med. 2010;170(5):486-488.
Image source: sxc.hu.

Effect of deployment on mental health of soldiers: common disorders and alcohol misuse more frequent than PTSD

This Lancet study examined the consequences of deployment to Iraq and Afghanistan on the mental health of UK armed forces from 2003 to 2009.

9990 (56%) participants completed the study questionnaire (roughly 8000 regulars, 1700 reservists).

The prevalence was:

- 19·7% for symptoms of common mental disorders

- 13% for alcohol misuse

- 4% for post-traumatic stress disorder (PTSD)

Deployment to Iraq or Afghanistan was significantly associated with alcohol misuse for regulars (odds ratio 1·22) and with post-traumatic stress disorder (PTSD) for reservists (2·83)

Symptoms of common mental disorders and alcohol misuse remain the most frequently reported mental disorders in UK armed forces personnel, whereas the prevalence of post-traumatic stress disorder (PTSD) was low.

References:

What are the consequences of deployment to Iraq and Afghanistan on the mental health of the UK armed forces? A cohort study. The Lancet, Volume 375, Issue 9728, Pages 1783 - 1797, 22 May 2010.

What Happened to the Marlboro Marine?

Image source: The Los Angeles Times.