Quality of life and physical activity associated to lower prevalence of depression in community-dwelling elderly subjects from Sao Paulo

Background

Studies investigating major depression and associated factors in older people from developing countries are scarce.

Methods

Cross-sectional study of a community-based sample of 1563 elderly subjects aged 60 years or older from Sao Paulo, Brazil. The frequency of major depression (MD) and the relationship with sociodemographic factors, cognitive and functional impairment (CFI), clinically significant depressive symptoms (CSDS) and clinical diseases were analyzed. A brief instrument for screening of depressive symptoms in elderly people, the Mini Mental State Examination, the Fuld Object Memory Evaluation, the Informant Questionnaire on Cognitive Decline in the Elderly, the Bayer Activities of Daily Living Scale, the Cambridge Mental Disorders of the Elderly Examination, and a sociodemographic and clinical questionnaire were applied to the subjects.

Results

Major depression was diagnosed in 60 patients (3.8%). A higher odds ratio of MD was associated with female gender, being widowed, previous depressive episode, hypertension, use of psychotropic medication, (CFI), and alcohol use. A lower odds ratio of depression diagnosis was associated with physical activity and going to cinema.

Limitations

The cross-sectional design of the study; our sample was restricted only to community residents, excluding persons in hospitals or nursing homes.

Conclusion

Our study shows significant association between depression and potentially modifiable factors, reinforcing the benefit of probable preventive measures, to incentive healthy lifestyle, leisure activities and the practice of physical exercise, as well as the diagnosis and treatment of CSDS, especially in primary care.     

帕罗西汀合并认知疗法治疗酒依赖伴发抑郁及对戒酒的影响

目的评价帕罗西汀合并认知疗法治疗酒依赖伴发抑郁的疗效及对戒酒的影响。方法将98例酒依赖伴发抑郁的患者随机分为研究组和对照组,分别用认知疗法合并帕罗西汀、单用帕罗西汀治疗4个月。用汉密顿抑郁量表(HAMD)评定疗效;用复饮率评定戒酒效果。结果治疗1个月后,研究组HAMD评分16.79±6.50与对照组相近17.88±6.59(P>0.05)。治疗4个月后HAMD评分10.76±5.32、明显低于对照组14.54±5.12(P<0.01);临床疗效(痊愈率44.44%、显效率22.22%、有效率33.34%)明显高于对照组(21.74%、21.74%、56.52%)(P<0.05);复饮率(24.44%)低于对照对照组(45.56%)(P<0.05)。结论认知疗法合并帕罗西汀治疗酒依赖伴发抑郁疗效较好,戒酒效果较好。     

慢性创伤后应激障碍教师群体的抑郁症状及其影响因素

目的了解慢性创伤后应激障碍(PTSD)教师的抑郁情绪及其影响因素。方法采用Beck抑郁问卷(BDI)、社会支持评定量表(SSRS)及家庭功能评定量表(FAD)作为调查工具对105例慢性创伤后应激障碍教师进行测查并收集数据。结果①所有慢性PTSD教师均存在重度抑郁;②抑郁与社会支持的各个维度及家庭功能除行为控制外的各个维度存在显著的负相关(r=-0.735～-0.319;P<0.01);③多元逐步回归分析后发现,支持总分及家庭功能的总的功能、沟通维度对抑郁的解释贡献率达74.2%。结论慢性PTSD教师均有较为明显的抑郁情绪。教师的抑郁情绪与社会支持、家庭功能有关,社会支持是影响抑郁的重要因素。     

The prognostic value of serological titres for clinical outcomes during treatment and follow-up of patients with chronic Q fever

ObjectivesWe assessed the prognostic value of phase I IgG titres during treatment and follow-up of chronic Q fever.MethodsWe performed a retrospective cohort study to analyse the course of phase I IgG titres in chronic Q fever. We used a multivariable time-varying Cox regression to assess our primary (first disease-related event) and secondary (therapy failure) outcomes. In a second analysis, we evaluated serological characteristics after 1 year of therapy (fourfold decrease in phase I IgG titre, absence of phase II IgM and reaching phase I IgG titre of ≤1:1024) with multivariable Cox regression.ResultsIn total, 337 patients that were treated for proven (n = 284, 84.3%) or probable (n = 53, 15.7%) chronic Q fever were included. Complications occurred in 190 (56.4%), disease-related mortality in 71 (21.1%) and therapy failure in 142 (42.1%) patients. The course of phase I IgG titres was not associated with first disease-related event (HR 1.00, 95% CI 0.86–1.15) or therapy failure (HR 1.02, 95% CI 0.91–1.15). Similar results were found for the serological characteristics for the primary (HR 0.97, 95% CI 0.62–1.51; HR 1.12, 95% CI 0.66–1.90; HR 0.99, 95% CI 0.57–1.69, respectively) and secondary outcomes (HR 0.86, 95% CI 0.57–1.29; HR 1.37, 95% CI 0.86–2.18; HR 0.80, 95% CI 0.48–1.34, respectively).DiscussionCoxiella burnetii serology does not reliably predict disease-related events or therapy failure during treatment and follow-up of chronic Q fever. Alternative markers for disease management are needed, but, for now, management should be based on clinical factors, PCR results, and imaging results.     

Self-management support in primary care is associated with improvement in patient activation

Objectives

To examine: 1) whether patient characteristics predict perceived self-management support (usefulness of information and collaborative care planning) by primary care providers after six months, and 2) the association between perceived self-management support and patient activation at 6 months

Growth rate of early-stage hepatocellular carcinoma in patients with chronic liver disease

Background/Aims

The goal of this study was to estimate the growth rate of hepatocellular carcinoma (HCC) and identify the host factors that significantly affect this rate.

Methods

Patients with early-stage HCC (n=175) who underwent two or more serial dynamic imaging studies without any anticancer treatment at two tertiary care hospitals in Korea were identified. For each patient, the tumor volume doubling time (TVDT) of HCC was calculated by comparing tumor volumes between serial imaging studies. Clinical and laboratory data were obtained from the medical records of the patients.

Results

The median TVDT was 85.7 days, with a range of 11 to 851.2 days. Multiple linear regression revealed that the initial tumor diameter (a tumor factor) and the etiology of chronic liver disease (a host factor) were significantly associated with the TVDT. The TVDT was shorter when the initial tumor diameter was smaller, and was shorter in HCC related to hepatitis B virus (HBV) infection than in HCC related to hepatitis C virus (HCV) infection (median, 76.8 days vs. 137.2 days; P=0.0234).

Conclusions

The etiology of chronic liver disease is a host factor that may significantly affect the growth rate of early-stage HCC, since HBV-associated HCC grows faster than HCV-associated HCC.     

Cognitive performance is impaired in euthymic Chinese patients with Bipolar 1 Disorder

Background

Data from euthymic patients with Bipolar Disorder (BD) has shown cognitive impairment and the notion that sufferers of BD achieve full recovery between illness episodes is questionable. These findings have not been replicated in a Chinese population. The present study examined the cognitive profile of euthymic Chinese patients with Bipolar 1 Disorder (BD-1) and matched healthy control participants.

Methods

Euthymic patients with BD-1 and matched controls (n=104 in total) completed serial measures to assess mood and also completed an IQ test and the Central Nervous System Vital Signs (CNSVS) computerized battery assessing memory (verbal and visual), executive functions, attention, psychomotor and processing speed.

Results

Patients with BD-1 performed worse than controls on all cognitive domains. When using 2 or more scores below the 5th percentile as a cutoff for neurocognitive impairment, 46.2% of the patients with BD-1 and none of the control sample scored in this range (p<.001). Correlational analysis among the illness variables in BD-1 revealed that cognitive performance was inversely correlated with the number of manic episodes and duration of illness.

Limitations

It was not possible to determine the causal relationship between associated illness and performance. The effect of medication on cognitive performance requires further study.

Conclusions

Euthymic Chinese patients with BD-1 demonstrate marked cognitive impairments and these correlated with illness parameters. Cognitive impairment in BD may be independent of language and culture.     

Angiogenesis in chronic hepatitis C is associated with inflammatory activity grade and fibrosis stage

Data regarding the assessment of angiogenesis in liver tissue in chronic hepatitis C (CHC) are rare. The study was performed to explain the association between the histopathological features and the number of new blood vessels in lobules and portal tracts in CHC. The second aim of the study was to define the localization of sprouting and pattern of formation of new vessels by estimating CD 34 antigen expression in the liver.The study involved 74 patients with CHC, infected with viral genotype 1b before antiviral therapy.The number of new-formatted blood vessels was positively associated with fibrosis stage and inflammatory activity grade in the liver biopsy from CHC patients. The relationship was evident in the portal tract, fibrous septa and periportal zones of lobules. The results suggest that inflammatory hepatocyte injury may promote neo-angiogenesis.     

Exploring the effectiveness of couples interventions for adults living with a chronic physical illness: A systematic review

ObjectivePartners have a significant role in a person’s ability to adjust to a chronic physical illness, which warrants their inclusion in couples interventions. However to deliver more specific, tailored support it is necessary to explore which types of couples interventions are most effective across certain chronic illness populations and outcomes.MethodsFive databases were searched using selected terms. Thirty-five articles met the eligibility criteria for inclusion.ResultsThe majority of studies were from the US, and most interventions targeted cancer populations. Couples interventions fell into two categories according to therapeutic approach; Cognitive Behavioural Skills Training (CBST) and Relationship Counselling (RC). When compared with a patient-only intervention or controls, CBST interventions effectively targeted behavioural, physical/somatic and cognitive outcomes, while RC more effectively targeted interpersonal outcomes.ConclusionCouples interventions can be more effective than patient-only interventions or controls across various patient and partner outcomes. Couples interventions tend to favour a skills-based or a relationship-based approach, which strongly influences the types outcomes effectively targeted.Practice implicationsOur findings suggest it could be therapeutically useful to integrate these two approaches to more holistically support couples living with chronic illness. We also identify the need to target understudied illness groups and ethnicities.     

Factors associated with healthcare-related frustrations among adults with chronic conditions

ObjectiveHealthcare-related frustrations (HRFs) are common occurrences in patient-provider interactions. Little is known about HRFs experienced by individuals with chronic conditions. The purposes of this study were to: 1) identify the frequency of six HRFs among adults with chronic conditions; 2) assess factors associated with these HRFs; and 3) examine factors associated with multiple HRFs.MethodsData were analyzed from 589 middle-aged and older adults with 1+ chronic conditions. A series of logistic regression models were fitted to identify factors associated with each frustration, and an ordinal regression model was fitted to identify factors associated with increasing frustrations.ResultsParticipants reported at least two of the six HRFs. The most commonly reported HRFs included feeling tired of describing the same condition (46%) and wishing their doctor had more time to speak with them during visits (44%). Having functional limitations (Beta = 0.58, P = 0.004), reporting more self-care barriers (Beta = 0.41, P < 0.001), visiting a physician more frequently (P < 0.05), and having less support (Beta = −0.64, P = 0.013) were associated with increasing HRFs.ConclusionReducing HRFs may improve patient-provider interactions, chronic disease management, and patients’ overall quality of life.Practice implicationsCare coordination, communication and cultural competency training, and a review of materials may help address these frustrations.     

Psychosocial factors associated with suicidal ideation in clinical patients with depression

Background

Depression is a major risk factor for suicide, but few studies have examined psychosocial risk factors for suicide in clinical patients with depression. The purpose of this study was to investigate psychosocial factors which could be associated with suicidal ideation in clinical patients with depression including: sick-leave, help-seeking behavior, and reluctance to admit mental health problems.

Methods

A multi-center cross-sectional survey using self-report questionnaire was conducted at 54 outpatient psychiatric clinics in Tokyo in 2012. Adult outpatients who were diagnosed by psychiatrists as mood disorders (F30–F39) in the International Classification of Diseases-10 (ICD-10) were included in the study. Those who met the criteria for current hypomanic or manic episode were excluded from the study.

Results

A total of 189 patients with depression participated in the survey. Multivariable logistic regression analysis showed that taking sick-leave and having sought help from family were associated with decreased odds of current suicidal ideation. Moderate or more severe depression was associated with increased odds of suicidal ideation, and reluctance to admit own mental health problem tended to increase odds of suicidal ideation.

Limitations

Living status and suicidal ideation before consultation with psychiatrist were not investigated. Severity of suicidal ideation and comorbid psychiatric disorders were not assessed.

Conclusions

Importance of treatment of more severe depression for suicide prevention was confirmed. Industrial health staffs should consider the possibility of positive effect of taking sick-leave when they see employees with depression. Promoting help-seeking for family and reducing stigma of mental illness may be effective for suicide prevention.     

Dopamine receptor D4 gene is not associated with major psychoses

We previously reported an association between dopamine receptor D4 (DRD4) gene exon 1 variants and delusional disorder. The aim of this investigation was to study the DRD4 gene exon 1 and 3 variants in schizophrenia, delusional, bipolar, and unipolar disorders. We studied 651 inpatients affected by schizophrenia (n = 229), delusional (n = 86), bipolar (n = 210), and unipolar (n = 126) disorders (DSM III-R) and 471 healthy controls; these were typed for DRD4 variants at the first and third exon using polymerase chain reaction techniques. DRD4 variants were not associated with schizophrenic and delusional subjects even when possible confounders like gender and onset were considered. A marginal association between DRD4 exon 3 variants with unipolar (excess of DRD4*2/4, p = 0.004) and bipolar (excess of DRD4*2/4, p = 0.001) disorders was observed, both associations drop to insignificance when corrected for multiple testing. Our results exclude that coding variants of the DRD4 exon 1 and 3 may play a major role in conferring susceptibility to major psychoses; moreover, we could not replicate the association of DRD4 exon 1 variant with delusional disorder. Am. J. Med. Genet. (Neuropsychiatr. Genet.) 88:486–491, 1999. © 1999 Wiley-Liss, Inc.     

C5aR在慢性移植物抗宿主病中的表达及其作用机制

目的:探讨补体5a(C5a)及其受体(C5aR)在慢性移植物抗宿主病(cGVHD)中的表达及其作用机制。方法:用流式细胞术检测20例cGVHD患者及9例健康供者外周血淋巴细胞中C5aR的表达及CD4~+CD25~+Foxp3~+调节性T细胞(Tregs)在CD4~+T细胞中的比例,并分析两者的相关性;将体外分离培养小鼠脾细胞分为对照组及重组小鼠C5a蛋白(rmC 5a)刺激组,用流式细胞术检测2组Tregs在CD4~+T细胞中的表达比例;另外,提取患者外周血单个核细胞进行体外培养,分为空白对照组及C5aR拮抗剂(C5aRA)组,用流式细胞术检测2组Tregs在CD4~+T细胞中的表达比例。结果:cGVHD患者外周血淋巴细胞表面C5aR的表达明显增多,而Tregs在CD4~+T细胞中的比例明显减少,两者呈显著负性相关(P0.05);体外培养小鼠脾细胞结果显示C5a下调Tregs在CD4~+T细胞中的比例;而体外培养患者外周血单个核细胞显示阻断C5aR可上调Tregs在CD4~+T细胞中的比例。结论:C5a/C5aR可能通过抑制Tregs的分化来介导cGVHD的发生发展。     

电针改善慢性脑低灌注大鼠空间学习记忆能力和海马IL-6/JAK2/STAT3的信号调节

目的:观察电针调节慢性脑低灌注(chronic cerebral hypoperfusion,CCH)对大鼠海马JAK2/STAT3通路和炎症反应的影响,探讨电针减轻CCH所致空间学习记忆能力障碍的作用机制。方法:将成年SD雄性大鼠随机分为假手术组、模型组和电针组(n=10),行改良永久性双侧颈总动脉结扎术造模,电针组采用2/15 Hz频率刺激(30 min/d,持续4周)大鼠百会和大椎穴,其余2组动物进行平衡处理。采用Morris水迷宫实验和激光多普勒血流仪评估及检测大鼠的空间学习记忆能力和局部脑血流量(regional cerebral blood flow,r CBF);采用ELISA、RTPCR与Western blot法分别检测大鼠海马组织中炎性因子白细胞介素6(IL-6)和IL-1β浓度,海马JAK2和STAT3的mRNA表达及其磷酸化蛋白含量;HE染色观察海马组织的病理变化。结果:电针组大鼠r CBF、各时点平均逃避潜伏期和原平台象限停留时间均较模型组动物有明显改善(P0.01或P0.05)。电针组大鼠海马组织中IL-1β与模型组相比显著降低(P0.05),而IL-6的含量有显著升高(P0.05),海马JAK2和STAT3的mRNA表达及pJAK2和p-STAT3蛋白含量也均比模型组明显升高(P0.05),海马CA1区神经细胞损伤减轻。结论:电针可通过调节IL-6/JAK2/STAT3信号通路抑制炎症反应,从而减轻海马神经细胞损伤和认知障碍。     

认知行为疗法在合并焦虑的慢性难愈合创面患者中的临床研究

目的探讨认知行为疗法对合并焦虑的慢性难愈合创面患者创面治疗效果的影响。 方法选取2018年2月至9月于临沂市中心医院烧伤整形科住院治疗的符合入选标准的40例合并焦虑的慢性难愈合创面患者,将所有患者随机编号,编号为奇数的设为干预组,编号为偶数的设为对照组,每组各20例。2组患者均接受常规慢性难愈合创面的治疗和护理,干预组患者在此基础上给予认知行为疗法干预,包括会谈治疗、音乐治疗及腹式呼吸放松治疗,共4周,对照组未予任何心理干预治疗。分别于入院时、治疗2周、治疗4周采用焦虑自评量表(SAS)、汉密尔顿焦虑量表(HAMA)对2组患者进行焦虑程度评分;应用毫米网格纸法测量患者入院时、治疗2周、治疗4周创面面积并计算创面愈合率。数据比较采用t检验。 结果入院时,干预组患者SAS评分(67.1±2.4) 分,对照组(65.9±2.2) 分,2组比较差异无统计学意义(t＝0.49, P＝0.65);认知行为疗法干预治疗2、4周后,干预组患者SAS评分分别为(55.6±1.9)、(49.3±2.6) 分,低于同期对照组(59.8±2.1)、(53.5±2.7) 分,差异均有统计学意义(t＝2.17、2.54,P＝0.04、0.02);入院时,干预组患者HAMA评分(23.8±3.3) 分,对照组(24.1±3.6) 分,2组比较差异无统计学意义(t＝0.96, P＝0.34);干预2、4周后,干预组患者HAMA评分分别为(17.2±2.7)、(11.9±2.1) 分,低于同期对照组(20.8±3.4)、(15.3±3.0) 分,差异均有统计学意义(t＝2.23、2.86,P＝0.03、0.01)。治疗2、4周后,干预组患者创面愈合率分别为(26.2±2.4)%、(80.5±4.2)%,均高于同期对照组(22.3±2.1)%、(59.2±3.9)%,2组比较差异均有统计学意义(t＝2.54、2.86,P＝0.02、0.01)。 结论认知行为疗法干预有助于缓解慢性难愈合创面患者的焦虑情绪,提高慢性难愈合创面的愈合速度。     

Single nucleotide polymorphism (SNP) rs3751143 in P2RX7 is associated with therapy failure in chronic Q fever while rs7125062 in MMP1 is associated with fewer complications

ObjectivesChronic Q fever is a persistent infection with the intracellular bacterium Coxiella burnetii. Development of chronic Q fever is associated with single nucleotide polymorphisms (SNPs) in genes encoding for pattern recognition receptors, for phagolysosomal pathway components and for matrix metalloproteinases (MMPs). We evaluated the association of SNPs in these innate-immunity and MMP genes with clinical outcomes.MethodsSNPs were selected from previous association studies and analysed in a cohort of patients with chronic Q fever. The primary outcome was all-cause mortality; secondary outcomes were therapy failure and chronic Q fever–related complications. Subdistribution hazard ratios (SHR) were calculated.ResultsNineteen SNPs were analysed in 134 patients with proven and 29 with probable chronic Q fever. In multivariable analysis, none of the selected SNPs was associated with all-cause mortality. However, SNP rs3751143 located in P2RX7 appeared to be associated with therapy failure (SHR 2.42; 95% confidence interval, 1.16–5.05; p 0.02), which is in line with other reports, showing that a loss of function of the P2X7 receptor leads to inefficient killing of intracellular organisms. In addition, SNP rs7125062 located in MMP1, involved in the cleavage of extracellular matrix, was associated with fewer chronic Q fever–related complications such as acute aneurysms (SHR 0.49; 95% confidence interval, 0.29–0.83; p 0.008).ConclusionsA polymorphism in P2RX7, known to lead to loss of function of the receptor and inefficient killing of intracellular organisms, and a polymorphism in MMP1 were respectively associated with more therapy failures and fewer complications such as acute aneurysms in patients with chronic Q fever.     

Decreased level of intracellular cholesterol in peripheral blood mononuclear cells is associated with chronic hepatitis C virus infection

Peripheral blood mononuclear cells (PBMCs) constitute the main extrahepatic place of, hepatitis C virus (HCV) replication. We aimed to determine the impact of CHC infection and microRNA-, 122 expression on cholesterol expression in PBMCs. HCV RNA strand, intracellular cholesterol, HMGCoA, reductase and miR-122 expression in PBMC were determined in 54 CHC patients. The study shows that significant decrease of intracellular cholesterol level in PBMC (p = 0.000000), accompanied by serum hypocholesterolemia is the characteristic feature of chronic hepatitis C infection. Although, microRNA-122 expression was detectable in PBMCs of CHC patients (52.5%), the alteration of intracellular cholesterol level was independent of miR-122 expression.     

Improving shared health decision making for children and adolescents with chronic illness: A narrative literature review

Objective

This review aims to increase understanding of health decision-making by children and adolescents with chronic illnesses and offer suggestions for improving shared decision-making with healthcare professionals.