Anxiety and depression in incident stroke survivors and their carers in rural Tanzania: A case-control follow-up study over five years

AimsTo quantify the extent and nature of anxiety and depression in a representative cohort of stroke survivors and their carers in rural Tanzania.DesignA cross-sectional design was used and stroke cases were followed up at 6–60 months post-stroke. Levels of anxiety and depression in stroke survivors, their carers (for physically dependent stroke survivors) and age- and sex-matched controls were assessed using the hospital anxiety and depression (HAD) scale. Other data collected included age, sex, time elapsed since stroke, quality of life, cognitive function, level of disability and socioeconomic status.ResultsLevels of depression seen in our cohort of stroke survivors (53.0%) are high compared to data from the developed and developing world. Anxiety levels (21.6%) are similar to published data. Stroke survivors (n = 58, full data set n = 51) and carers (n = 27) were significantly more anxious than controls (n = 58), whereas levels of depression were similar across all three groups. High stroke survivor HAD scores correlated with lower scores in physical health, psychological health and environment sections of the WHOQOL-Bref. Increased carer anxiety and depression were associated with reduced informant-reported levels of cognitive function in stroke survivors.ConclusionsTo our knowledge this is the first long term study of incident stroke cases in sub-Saharan Africa which has investigated the psychological health of stroke survivors and their carers. Our study highlights the growing need to develop community rehabilitation services in the developing world, which address both physical and psychological morbidity.     

Illness perception in patients with androgenetic alopecia and alopecia areata in China

ObjectiveThe aim of the present study was to provide more information on the role of illness perception in patients with androgenetic alopecia (AGA) and those with alopecia areata (AA), and to further investigate the relationship of illness perception with psychological disorders and dermatological QoL.MethodsThe study included 342 patients who were diagnosed with AGA (n = 212) or AA (n = 130) for the first time at our institution between October 2013 and December 2014. All patients were surveyed before clinical examination by several questionnaires including the Brief Illness Perception, Self-rating Depression Scale, Self-rating Anxiety Scale, and Dermatology Life Quality Index (DLQI).ResultsIn the AGA patients, the illness perception and QoL were low, whereas the prevalence of clinical depression and anxiety was higher compared to the AA patients. Illness perception was associated with psychological distress and low QoL in both groups, and some illness perception dimensions were found to be significant predictors of the DLQI scores.ConclusionIllness perception plays an important role in AGA and AA patients, and is associated with psychological distress and low QoL. The identification of critical components of illness perception in alopecia patients could help to understand alopecia specificities, to design consultations and interventions according to the perception, and to improve physical and mental outcomes as well as QoL in alopecia patients.     

Discrepant illness perceptions,affect and expressed emotion in people with psychosis and their carers

Background Illness perception, a measure of illness representations developed from physical medicine, has recently been applied to psychosis. We investigated how illness perceptions relate to affect and expressed emotion (EE) in carer-patient dyads, particularly if their perceptions differed. Method We interviewed 82 carer-patient dyads, after a relapse of psychosis. Carers were assessed for illness perceptions, distress, self-esteem and EE; patients for illness perceptions, depression, anxiety and self-esteem, in a cross sectional study. Results Carers were more pessimistic than patients about illness persistence and consequences, and carers with low mood were particularly pessimistic about persistence and controllability. Discrepant views about illness consequences were related to greater anxiety, depression, and lower self-esteem in patients, while discrepant views on controllability were associated with greater distress, depression, and lower self-esteem in carers. Illness perceptions did not relate directly to EE. Conclusions In this sample, meta-cognitive carer representations of illness in psychosis are related to negative affective reactions in carers, but not to EE. Resolving discrepant illness perceptions between carers and patients might provide a way of improving family reactions to the health threat of psychosis.     

The association between Type D personality and illness perceptions in colorectal cancer survivors: A study from the population-based PROFILES registry

ObjectiveTo examine the association between Type D personality and illness perceptions among colorectal cancer survivors 1–10 years post-diagnosis.MethodsData from two population-based surveys on colorectal cancer survivors was used. Patients diagnosed between 1998 and 2009, as registered in the Eindhoven Cancer Registry, received a questionnaire on Type D personality (DS14) and illness perceptions (B-IPQ); 81% (n = 3977) responded.Results750 (19%) patients had a Type D personality. They believe their illness has significantly more serious consequences, will last significantly longer, and experience significantly more symptoms that they attribute to their illness. Also, they are more concerned about their illness, and their disease more often influences them emotionally. Differences regarding ‘consequences’, ‘concern’ and ‘emotional response’ were also clinically relevant. The majority of patients stated that the cause of their disease was unknown (23.3%), hereditary (20.3%), lifestyle (15.1%), psychological distress (11.9%) or other (11.6%). Significant differences in perceptions on cause of disease between Type Ds and non-Type Ds were found for psychological distress (16.2 vs. 10.9%; p < 0.01), randomness (1.7 vs. 5.3%; p < 0.01) and unknown (18.8 vs. 24.4%; p < 0.01). Multivariate analyses showed that Type D was negatively associated with ‘coherence’ and positively with ‘consequences’, ‘timeline’, ‘identity’, ‘concern’, and ‘emotional representation’.ConclusionsThese results elucidate the associations between personality and illness perceptions, demonstrating their close interrelatedness. Our study may be helpful in further developing theoretical models regarding giving meaning to illness and the illness perceptions that the illness elicits. Future studies should investigate whether interventions can positively impact illness perceptions of Type D cancer patients.     

Outcomes of Thai patients with acute ischemic stroke after intravenous thrombolysis

The purpose of this study was to assess outcomes in Thai patients after treatment with intravenous recombinant tissue plasminogen activator (rtPA) and to determine the factors associated with good outcome and death.MethodsPatients with acute ischemic stroke who were treated with intravenous rtPA at Thammasat University Hospital between June 2007 and April 2010 were included. The measured outcome variables were good outcome (mRS 0,1) and death at 3 months. Stepwise multivariable analyses were performed by including the prespecified factors that were associated with the measured outcome variables in the univariate analysis.ResultsThe sample size was 197 patients. At 3 months, 93 patients (47%) had good outcomes while 23 patients (12%) died within the same period. Severe stroke (OR 0.19, 95% CI 0.08–0.44, p-value < 0.0001) and history of hypertension (OR 0.39, 95% CI 0.16–0.93, p-value = 0.033) were independently related to bad outcome at 3 months, while receiving intravenous nicardipine (OR 2.76, 95% CI 1.09–6.94, p-value = 0.032) was associated with good outcome. Severe stroke (OR 5.89, 95% CI 1.29–26.85, p-value = 0.022) and pretreatment high blood glucose levels (OR 8.06, 95% CI 1.21–53.62, p-value = 0.031) each were independently associated with patient death.ConclusionsStandard-dose intravenous rtPA in a cohort of Thai patients led to better clinical outcomes and comparable death rates when compared to other Asian cohorts receiving intravenous rtPA. Several factors were independently associated with patient outcomes at 3 months.     

Fatigue among stroke patients on long-term follow-up. The Bergen Stroke Study

BackgroundTo evaluate characteristics and mortality related to post-stroke fatigue (PSF).MethodsAll surviving stroke patients admitted to the Stroke Unit, Haukeland University Hospital, between February 2006 and November 2008 were sent a postal questionnaire including the Fatigue Severity Scale (FSS), the hospital anxiety and depression scale (HADSD), and the Barthel Index (BI) at least 6 months after stroke onset. Survival among patients returning the questionnaire was determined by November 2009. PSF was defined as FSS score ≥ 5.ResultsAmong 377 patients returning the questionnaire, 42.3% had PSF. Logistic regression showed that PSF was independently associated with pre-stroke depression, leucoaraiosis, myocardial infarction, diabetes mellitus, pain, and sleeping disturbances. Mean FSS score was lower among TIA patients than among patients with minor cerebral infarction (patients with BI = 100) (P = .002). Cox regression analysis showed mortality to be associated with PSF.ConclusionThere is a multifactorial basis for PSF suggesting different therapy options. Cerebral lesions may cause PSF in some patients. Post-stroke fatigue is associated with higher mortality.     

Does psychological distress vary between younger and older adults in health and disease?

ObjectiveThe effect of age on psychological distress remains controversial and it is unclear how a chronic medical illness influences this association. We aimed to compare the level of psychological distress between younger and older patients with chronic medical conditions attending hospital specialty clinics and to test whether a different pattern emerges when comparisons with individuals without long-term conditions are made.MethodsIn 519 individuals without chronic medical conditions and 949 patients with established severe chronic medical illnesses, we compared psychological distress (GHQ-28 and SCL-90R) between younger (< 65, N = 1040) and older (≥ 65, N = 428) participants after controlling for gender, marital status, education and primary diagnosis in multiple logistic regression models.ResultsAmong the healthy participants, a greater proportion of older individuals presented mild/moderate psychological distress (p = .026), predominantly depressive and somatization symptoms. Among the medical patients, both age groups presented elevated levels of psychological distress, but a greater proportion of younger patients had severe psychological distress (p = .016), predominantly depressive, anxiety and hostility symptoms. Younger patients reported similarly high levels of somatization symptoms compared to older patients. The odds of being assessed with severe psychological distress were significantly greater for younger individuals with physical illnesses, independently of gender, marital status, education and primary diagnosis.ConclusionsMedical patients from both age groups had significant psychological distress symptoms scores. Younger patients with chronic medical illnesses were more vulnerable to severe psychological distress, including symptoms of anxiety, depression, hostility and somatization. Therefore, clinicians should direct efforts to recognize these symptoms in order to prevent further functional impairment.     

Evidence for accelerated vascular aging in bipolar disorder

ObjectivesLittle is known about the effect of lifetime history of depression on ischemic stroke outcomes. This study compared a measure of current symptoms of depression at the time of the stroke and a measure of lifetime history of depression for their ability to predict quality of life and functioning at 3 and 12 months after stroke.MethodsA cohort of 460 ischemic stroke patients from the 2005 Greater Cincinnati/North Kentucky Stroke Study was assessed within 2 weeks of the stroke, including the 10-item Center for Epidemiological Studies Depression Scale (CESD) for current symptoms of depression. Lifetime history of depression was also assessed by a 2-question measure at 3 and 12 months after stroke. Two outcome measures, Stroke Specific Quality of Life (SSQOL) and the modified Rankin Scale (mRS) to assess functional status, were also collected at 3 and 12 months.ResultsOf the 322 survivors included in the analysis, 52.2% reported depression on at least one measure. Both current symptoms and lifetime history of depression predicted poor functional outcomes and poor quality of life at 3 and 12 months, after adjustment for age, race, sex, prior stroke, baseline functional status, and stroke severity. The combination of depression measures was a better predictor of poor outcomes than either measure alone.ConclusionDepression by either measure was a frequent, substantial, and independent predictor of poor outcomes at 3 and 12 months after stroke. Stroke outcomes studies should further examine the predictive value of assessing both depressive symptoms at the time of the stroke and lifetime history of depression.     

Evaluation of telephone assessment in stroke and TIA recurrence

IntroductionStroke recurrence is an important issue in stroke registries, but direct patient contact months after stroke is not always feasible. Telephone assessment is often used to evaluate long term stroke outcome, treatments and recurrences. Our aim is to evaluate telephone interview in a stroke registry.Material and methodsThree hundred and eighty patients with a stroke or TIA were prospectively registered, evaluating baseline characteristics and type of event. At 6 months, 248 patients were reviewed by structured telephone interview and 132 were reviewed by direct contact. We analysed stroke outcome and disability, treatments and stroke or TIA recurrences.ResultsThere were no differences in baseline characteristics and type or severity of the index event. At 6 months, treatments were similar between both groups and 10.5% (40 patients) had a recurrent event. There were no differences in recurrent ischaemic strokes (6.1% in direct contact vs 4.4% telephone, P = .49), but we detected a higher number of TIA in direct examination compared to phone interview (9.1% vs 4.0%, P = .04).ConclusionsTelephone assessment of stroke patients is reliable and facilitates stroke registries in detecting long-term treatments and stroke recurrences. However, it is probable that new transient events or TIA are under-estimated.     

The relationship between religious coping, psychological distress and quality of life in hemodialysis patients

ObjectiveNo studies have evaluated the relationship among religious coping, psychological distress and health-related quality of life (HRQoL) in patients with End stage renal disease (ESRD). This study assessed whether positive religious coping or religious struggle was independently associated with psychological distress and health-related quality of life (HRQoL) in hemodialysis patients.MethodsThis cross-sectional study recruited a random sample of 170 patients who had ESRD from three outpatient hemodialysis units. Socio-demographic and clinical data were collected. Patients completed the Brief RCOPE, the Hospital Anxiety and Depression Scale (HADS) and the World Health Organization Quality of Life instrument—Abbreviated version (WHOQOL-Bref).ResultsPositive or negative religious coping strategies were frequently adopted by hemodialysis patients to deal with ESRD. Religious struggle correlated with both depressive (r = 0.43; P < .0001) and anxiety (r = 0.32; P < .0001) symptoms. These associations remained significant following multivariate adjustment to clinical and socio-demographic data. Positive religious coping was associated with better overall, mental and social relations HRQoL and these associations were independent from psychological distress symptoms, socio-demographic and clinical variables. Religious struggle was an independent correlate of worse overall, physical, mental, social relations and environment HRQoL.ConclusionIn ESRD, religious struggle was independently associated with greater psychological distress and impaired HRQoL, while positive religious coping was associated with improved HRQoL. These data provide a rationale for the design of prospective and/or intervention studies targeting religious coping in hemodialysis populations.     

Serum GFAP levels in optic neuropathies

ObjectiveExperimental studies have indicated that adipocytokines are associated with vascular diseases with regard to the pathology of atherosclerotic plaque. We hypothesized that the strength of the associations between adipocytokines and stroke would differ between ischemic stroke subtypes.MethodsA total of 96 acute ischemic stroke patients (within 5 days from onset) and 48 non-stroke subjects were analyzed in this study. Stroke patients were comprised of 26 strokes due to large artery atherosclerosis (LAA) and 72 non-LAA strokes. Venous blood from all participants was drawn after an overnight fast, and serum levels of leptin, adiponectin and resistin were measured by multiple sandwich immunoassay techniques.ResultsCompared with non-LAA strokes, patients with LAA strokes had lower levels of serum adiponectin (6.4 ± 3.1 vs. 8.5 ± 3.9 μg/mL; P = 0.04), and a higher level of leptin-to-adiponectin ratio (L:A ratio; 1.6 ± 1.4 vs. 0.9 ± 0.9; P < 0.01). Multinomial logistic regression analyses showed that, although none of the adipocytokines was associated with non-LAA strokes, lower adiponectin (adjusted OR, 0.79 per 1-μg/mL increase; 95% CI, 0.64–0.98), higher leptin (aOR, 1.12 per 1-ng/mL increase; 95% CI, 1.004–1.25) and higher L:A ratio (aOR, 2.93 per 1-quartile increase; 95% CI, 1.39–6.15) showed significant associations with increased odds of having LAA stroke, compared to non-stroke subjects.ConclusionFrom our study, we documented that leptin and adiponectin had differential association patterns with ischemic stroke according to the stroke subtype. Careful consideration of the heterogeneity of stroke subtypes would be warranted in studying the utility of biomarkers including adipocytokines.     

Significance of seizure in cerebral venous sinus thrombosis

PurposeTo report the frequency and predictors of presenting seizures in cerebral venous sinus thrombosis (CVST) and their influence on seizure recurrence and outcome.MethodsThis retrospective study, between 1995 and 2011, included 90 consecutive patients with CVST diagnosed using magnetic resonance imaging (MRI) and magnetic resonance venography (MRV). Clinical parameters like frequency, type (presenting, early, and late), and duration of seizures, precipitating causes of CVST, and underlying prothrombotic conditions, were recorded. The location of infarction on MRI and the number of sinuses involved on MRV, were noted. The patients were prescribed anticoagulants, and those with seizures were prescribed antiepileptic drugs. The patients were followed up at 3, 6, and 12 months. The functional outcome at 6 months was categorized into death, poor, partial and complete recovery.ResultsA total of 42 patients with CVST presented with seizures (focal 11, focal with secondary generalized 19, and generalized tonic clonic 16), of whom 10 had status epilepticus. On univariate analysis, supratentorial lesion (P = 0.005), frontal (P = 0.02) or parietal lobe (P = 0.04) involvement and haemorrhagic lesion (P = 0.002) were associated with higher risk of presenting seizure. On multivariate analysis, only supratentorial parenchymal lesion on MRI (odds ratio [OR] = 4.67, 95% confidence interval [CI] 1.51–15.08, P = 0.005) was independently associated with higher risk of presenting seizure. Only 4 patients had early seizures and none had late seizures. At 6 months, 10 patients died and 73 patients had complete recovery. Seizures were not associated with death (P = 1.00) and 6-month functional outcome (P = 0.66).ConclusionAbout half the patients with CVST had presenting seizures which was independently related to supratentorial lesion. However, seizures were not related to death or 6-month outcome.     

Stigma and higher rates of psychiatric re-hospitalization: São Paulo public mental health system

ObjectiveThe aim of this study was to assess re-hospitalization rates of individuals with psychosis and bipolar disorder and to study determinants of readmission.MethodsProspective observational study, conducted in São Paulo, Brazil. One hundred-sixty-nine individuals with bipolar and psychotic disorder in need of hospitalization in the public mental health system were followed for 12 months after discharge. Their families were contacted by telephone and interviews were conducted at 1, 2, 6 and 12 months post-discharge to evaluate readmission rates and factors related.ResultsOne-year re-hospitalization rate was of 42.6%. Physical restraint during hospital stay was a risk factor (OR = 5.4–10.5) for readmission in most models. Not attending consultations after discharge was related to the 12-month point readmission (OR = 8.5, 95%CI 2.3–31.2) and to the survival model (OR = 3.2, 95%CI 1.5–7.2). Number of previous admissions was a risk factor for the survival model (OR = 6.6–11.9). Family's agreement with permanent hospitalization of individuals with mental illness was the predictor associated to readmission in all models (OR = 3.5–10.9) and resulted in shorter survival time to readmission; those readmitted were stereotyped as dangerous and unhealthy.ConclusionsFamily's stigma towards mental illness might contribute to the increase in readmission rates of their relatives with psychiatric disorders. More studies should be conducted to depict mechanisms by which stigma increases re-hospitalization rates.     

Effect of acupuncture treatment on spastic states of stroke patients

PurposesThe control of spasticity is often a significant problem in the management of patients with stroke. The aim of this study was to evaluate the effect of acupuncture treatment on the spastic states of stroke patients.SettingAn outpatient Acupuncture Department in the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine.ParticipantsOne hundred and thirty-one patients, mean (SD) age of 59 (12) years, with spastic hemiplegia were included at mean (SD) month of 17 (7) months after stroke.InterventionParticipants received two 30-day treatment regimens: combined stimulating surface projection zone of decussation of pyramid and traditional acupuncture treatment, and traditional acupuncture treatment only.Main outcome measuresDifferences in the modified Ashworth scale (MAS), Fugl–Meyer Assessment (FMA), Barthel Index (BI), and the electromyographic activity of the affected extremity between arms.ResultsThe average (±SD) upper extremity Ashworth score significantly decreased, from 3.08 ± 0.77 before treatment to 1.82 ± 0.65 after acupuncture intervention (wrist joint, P < 0.05), and from 2.72 ± 0.59 to 1.32 ± 0.71 (elbow joint, P < 0.05) for treatment group. There were significant differences noted between the treatment group and control group after administration. Lower extremity treatment responses were similar to upper extremity responses. However, both groups showed similar improvement in FMA (upper extremity) and FMA (lower extremity). However, the improvements of FMA (total), BI, and F/M ratio were better in treatment group than in control group.ConclusionsThese results suggested that acupuncturing surface projection zone of decussation of pyramid was effective in reducing spastically increased muscle tone and motor neuron excitability in spastic hemiplegia, and could improve spastic states of stroke patients, thus providing a safe and economical method for treating stroke patients.     

Hypertension and sleep apnea-hypopnea syndrome: changes in echocardiographic abnormalities depending on the presence of hypertension and treatment with CPAP

IntroductionSleep apnea–hypopnea syndrome (SAHS) is an emerging disease with high prevalence. There is controversy as to whether cardiac abnormalities are due to the disease itself or to the arterial hypertension frequently associated with this disease.ObjectivesTo analyze echocardiographic abnormalities in a population of SAHS patients depending on the presence or absence of hypertension at the time of diagnosis and after six months of treatment with continuous positive airway pressure (CPAP).MethodsWe studied 85 consecutive patients diagnosed with SAHS who required treatment with CPAP (Hypertensive: 43, nonhypertensive: 42). We performed a baseline echocardiogram after six months of treatment. We analyzed morphological (wall thickness, diameters, ejection fraction) and functional (peak E- and A-wave velocities, deceleration time, Tei index) parameters of the left and right ventricles.ResultsHypertensive patients were older and had higher blood pressure values, but there were no differences between groups in other clinical parameters. The hypertensive group had greater septal thickness (hypertensive: 12.1 ± 2.3; nonhypertensive: 10.8 ± 2.1 mm; p = 0.01). There were also differences in impairment of left (hypertensiveHT: 92.9%, nonhypertensive: 65%, p = 0.002) and right (hypertensive: 74.4%, nonhypertensive: 42.1%, p = 0.006) ventricular filling.After six months of treatment, an improvement of the myocardial performance index was noted in nonhypertensive patients (baseline Tei: 0.55 ± 0.1 vs. 6-month Tei: 0.49 ± 0.1; p = 0.01), whereas no significant change was observed in hypertensive patients.ConclusionsCardiac abnormalities in SAHS patients are increased in the presence of associated hypertension. Treatment with CPAP for six months improves cardiac abnormalities in nonhypertensive patients but not in hypertensive patients.     

Frequency and natural history of fatigue after stroke: a systematic review of longitudinal studies

BackgroundFatigue is a common and distressing symptom after stroke. Stroke survivors and health professionals need to know whether fatigue is likely to improve, or get worse over time; and whether there is a temporal association with depression or anxiety, which might provide a target for treatment,Aims and objectivesTo systematically review all longitudinal observational studies which have assessed fatigue on at least two separate time points after stroke onset to determine its frequency, natural history and temporal relationship with anxiety and/or depression.MethodWe systematically searched MEDLINE, EMBASE, CINAHL and PsychInfo using the keywords “fatigue” and “stroke” and their associated terms or synonyms. Data were extracted regarding time points after stroke where fatigue was assessed, frequency of fatigue at each time point and any reported associations with anxiety and/or depression.Results101 full texts were retrieved after scrutinising the titles and abstracts. Nine fulfilled our inclusion criteria. Fatigue was assessed at a variety of time points after stroke (from admission—to 36 months). The frequency of fatigue ranged from 35%–92% at the first time point. Frequency of fatigue declined across time points in seven of the studies (n = 764) and increased in two studies (n = 195). Three papers found significant associations between fatigue and mood at the same time point. The single study investigating temporal associations between fatigue and mood disorders reported that depression predicted subsequent fatigue.ConclusionsFatigue is present soon after stroke onset and remains common in the longer term. There is little evidence regarding the temporal relationship between fatigue and mood: this is an area where further research is needed.     

Stress management skills, neuroimmune processes and fatigue levels in persons with chronic fatigue syndrome

ObjectivesStressors and emotional distress responses impact chronic fatigue syndrome (CFS) symptoms, including fatigue. Having better stress management skills might mitigate fatigue by decreasing emotional distress. Because CFS patients comprise a heterogeneous population, we hypothesized that the role of stress management skills in decreasing fatigue may be most pronounced in the subgroup manifesting the greatest neuroimmune dysfunction.MethodsIn total, 117 individuals with CFS provided blood and saliva samples, and self-report measures of emotional distress, perceived stress management skills (PSMS), and fatigue. Plasma interleukin-1-beta (IL-1β, IL-2, IL-6, IL-10, and tumor necrosis factor-alpha (TNF-α), and diurnal salivary cortisol were analyzed. We examined relations among PSMS, emotional distress, and fatigue in CFS patients who did and did not evidence neuroimmune abnormalities.ResultsHaving greater PSMS related to less fatigue (p = .019) and emotional distress (p < .001), greater diurnal cortisol slope (p = .023) and lower IL-2 levels (p = .043). PSMS and emotional distress related to fatigue levels most strongly in CFS patients in the top tercile of IL-6, and emotional distress mediated the relationship between PSMS and fatigue most strongly in patients with the greatest circulating levels of IL-6 and a greater inflammatory (IL-6):anti-inflammatory (IL-10) cytokine ratio.DiscussionCFS patients having greater PSMS show less emotional distress and fatigue, and the influence of stress management skills on distress and fatigue appear greatest among patients who have elevated IL-6 levels. These findings support the need for research examining the impact of stress management interventions in subgroups of CFS patients showing neuroimmune dysfunction.     

Course and predictors of posttraumatic stress among male train drivers after the experience of 'person under the train' incidents

ObjectiveThe present prospective study aimed to identify the frequency and course of posttraumatic stress symptoms, anxiety, depression, and quality of life in train drivers after the experience of ‘person under the train’ incidents. Furthermore, associations between predictors of posttraumatic stress stratified by pre-, peri- and posttraumatic factors, psychological distress, quality of life (QoL), sense of coherence, lack of meaning in life, and post-trauma thoughts are analyzed.MethodsPatients (100% male, mean age 48 years) were assessed at the beginning (n = 73), at the end (n = 71) and six months (n = 49) after a four-week rehabilitation program and completed validated self-report questionnaires (e.g. Posttraumatic Diagnostic Scale, Hospital Anxiety and Depression Scale, Short-Form Health Survey).ResultsTrain drivers experienced averagely 1.8 ‘person under the train’ incidents (range 1–8); the majority (81%) was involved in a railway suicide. At the beginning of the rehabilitation, 44% of the patients were classified as having moderate to severe PTSD, and 14% as having severe PTSD. Posttraumatic stress decreased significantly over time (p = .003, η² = .17). We found no significant differences in the course of posttraumatic stress, anxiety, depression, distress and QoL between patients who experienced one or more than one railway related accident or suicide. Anxiety, sense of guilt and sense of alienation emerged as the most important factors in predicting posttraumatic stress six months after rehabilitation (R² = 0.55).ConclusionFindings emphasize the importance of rehabilitation programs for train drivers after railway-related incidents. However, research is needed to develop effective rehabilitation interventions particularly tailored to this patient group.     

Motor unit number index (MUNIX) versus motor unit number estimation (MUNE): a direct comparison in a longitudinal study of ALS patients

ObjectiveTo evaluate how the motor unit number index (MUNIX) is related to high-density motor unit number estimation (HD-MUNE) in healthy controls and patients with amyotrophic lateral sclerosis (ALS).MethodsBoth MUNIX and HD-MUNE were performed on the thenar muscles in 18 ALS patients and 24 healthy controls. Patients were measured at baseline, within 2 weeks, and after 4 and 8 months. Clinical evaluation included Medical Research Council (MRC) scale and the ALS functional rating scale (ALSFRS).ResultsThere was a significant positive correlation between MUNE and MUNIX values in ALS patients (r = 0.49 at baseline; r = 0.56 at 4 months; r = 0.56 at 8 months, all p < 0.05), but not in healthy controls. After 8 months, both MUNE and MUNIX values of the ALS patients decreased significantly more compared to MRC scale, ALS functional rating scale (ALSFRS) and compound muscle action potential (CMAP) (p < 0.05). There was no significant difference in relative decline of MUNIX and HD-MUNE values.ConclusionsIn ALS patients, MUNIX and HD-MUNE are significantly correlated. MUNIX has an almost equivalent potential in detecting motor neuron loss compared to HD-MUNE.SignificanceMUNIX could serve as a reliable and sensitive marker for monitoring disease progression in ALS.     

Short-term risk and predictors of stroke after transient ischemic attack

BackgroundTransient ischemic attack (TIA) is a marker of stroke, especially in the early phase following this event. The aims of this study are to determine the short-term risk of stroke and to evaluate the independent predictors of stroke in patients with TIA who are hospitalized within 48 hours after symptom onset.MethodsDuring a 36-month period (beginning in November 2007), 3554 patients (mean age: 70.5 ± 13 years; 49.9% female; mean NIHSS score: 1.4 ± 2.5) from 15 hospitals suffering from TIA were prospectively evaluated.ResultsOf the 3554 patients, 43 (1.2%) suffered from stroke during hospitalization (6.5 ± 4.3 days). We identified the following independent predictors for stroke after TIA: male sex (odds ratio [OR], 2.5; 95% confidence interval [CI], 1.3–5; P = 0.008), age ≥ 65 years (OR, 4.7; 95% CI, 1.4–15; P = 0.01), hyperlipidemia (OR, 2.4; 95% CI, 1.2–4.8; P = 0.015), and dysarthria (OR, 2; 95% CI, 1.1–5.0; P = 0.038).ConclusionPatient characteristics (male sex, age, and hyperlipidemia) and TIA symptom (dysarthria) may be useful in defining stroke after TIA in patients who were hospitalized with TIA.