ContextChronic systemic inflammation in obesity originates from local immune responses in visceral adipose tissue. However, assessment of a broad range of inflammation-mediating cytokines and their relationship to physical activity and adipometrics has scarcely been reported to date.ObjectiveTo characterize the profile of a broad range of pro- and anti-inflammatory cytokines and the impact of physical activity and energy expenditure in individuals with general obesity, central obesity, and non-obese subjects.Design, Setting, and ParticipantsA cross-sectional study comprising 117 obese patients (body mass index (BMI) ≥ 30) and 83 non-obese community-based volunteers.Main Outcomes MeasuresSerum levels of interleukin (IL)-2, IL-4, IL-5, IL-10, IL-12, IL-13, granulocyte-macrophage colony-stimulating factor (GM-CSF), interferon (IFN)-γ and tumor necrosis factor (TNF)-α were measured. Physical activity and energy expenditure (MET) were assessed with actigraphy. Adipometrics comprised BMI, weight, abdominal-, waist- and hip-circumference, waist to hip ratio (WHR), and waist-to-height-ratio (WHtR).ResultsGeneral obesity was associated with significantly elevated levels of IL-5, IL-10, IL-12, IL-13, IFN-γ and TNF-α, central obesity with significantly elevated IL-5, IL-10, IL-12, IL-13 and IFN-γ-levels. In participants with general obesity, levels of IL-4, IL-10 and IL-13 were significantly elevated in participants with low physical activity, even when controlled for BMI which was negatively associated with physical acitivity. Cytokines significantly correlated with adipometrics, particularly in obese participants.ConclusionsResults confirm up-regulation of certain pro- and anti-inflammatory cytokines in obesity. In obese subjects, physical activity may lower levels and thus reduce pro-inflammatory effects of cytokines that may link obesity, insulin resistance and diabetes.

Depressive disorders are a major health problem in primary care, and at least half of these disorders remain undetected. 1 There are two recommended approaches to diagnosing depression in primary care: one is to perform routine screening, and the other is to evaluate patients only when the clinical presentation triggers the suspicion of depression. Our aim was to compare these two approaches, and to compare three different screening tools in order to evaluate which would be most appropriate for use in primary care. From among the many available screening tools, we selected three brief, self rating instruments: one disorder-specific (the depression module of the brief patient health questionnaire (B-PHQ, 9 items)), 2 one broad based (the general health questionnaire (GHQ-12, 12 items)), 3 and one that is less restricted to both issues (WHO-5 wellbeing index (WHO-5, 5 items)). 4 Methods and resultsEighteen primary care facilities participated in our prospective cohort study. The study protocol was approved by our local ethics committee. On one given day, all patients who presented in one of the practices were asked to complete the three screening questionnaires before seeing a doctor. The doctors who treated the patients remained blind to the questionnaire results until they had completed a brief "physician's encounter form" to indicate their clinical assessment of their patient's current diagnoses.Within a period not exceeding six days after they had completed the questionnaires, the patients were contacted by telephone for a fully structured, standardised psychiatric interview (composite international diagnostic interview (CIDI)) conducted by a trained psychologist blind to the screening results. We chose the composite international diagnostic interview as the reference standard because its reliability and validity have been established. 5 The interviewing psychologists met a high standard of inter-rater reliability.The main outcome measures were, firstly, the family doctors' performance in detecting depression without any tool to help guide diagnosis decisions and, secondly, the test accuracy of the screening questionnaires. We calculated sensitivity, specificity, and predictive values using two-by-two tables. We used two statistical tests to compare differences of characteristics of test accuracy (table). For 431 patients, all screening questionnaires, the composite international diagnostic interview, and the physician's encounter form were completed. Of these patients, 17% suffered from any depressive disorder and 83% did not. CommentThe sensitivity of the family doctors' unaided clinical diagnoses was 65%. With standard cut-off points, the briefest screening questionnaire (and therefore the most practical to use), the WHO-5, produced significantly greater sensitivity (93%) and a better negative predictive value (98%) than the other questionnaires (see table). However, the brief patient health questionnaire and unaided clinical diagnosis produced better specificity. The brief patient health questionnaire al...

BackgroundSuicide accounts for over 58,000 deaths in Europe per annum, where suicide attempts are estimated to be 20 times higher. Males have been found to have a disproportionately lower rate of suicide attempts and an excessively higher rate of suicides compared to females. The gender difference in suicide intent is postulated to contribute towards this gender imbalance. The aim of this study is to explore gender differences in suicide intent in a cross-national study of suicide attempts. The secondary aims are to investigate the gender differences in suicide attempt across age and country.MethodsData on suicide attempts (acquired from the EU-funded OSPI-Europe project) was obtained from eight regions in Germany, Hungary, Ireland and Portugal. Suicide intent data was categorized into ‘Non-habitual Deliberate Self-Harm’ (DSH), ‘Parasuicidal Pause’ (SP), ‘Parasuicidal Gesture’ (SG), and ‘Serious Suicide Attempt’ (SSA), applying the Feuerlein scale. Gender differences in intent were explored for significance by using χ2-tests, odds ratios, and regression analyses.ResultsSuicide intent data from 5212 participants was included in the analysis. A significant association between suicide intent and gender was found, where ‘Serious Suicide Attempts’ (SSA) were rated significantly more frequently in males than females (p < .001). There was a statistically significant gender difference in intent and age groups (p < .001) and between countries (p < .001). Furthermore, within the most utilised method, intentional drug overdose, ‘Serious Suicide Attempt’ (SSA) was rated significantly more often for males than females (p < .005).ConclusionsConsidering the differences in suicidal intent between males and females highlighted by the current study, gender targeted prevention and intervention strategies would be recommended.