Gender-specific associations between activities of daily living disability and depressive symptoms among older adults in China: Evidence from the China Health and Retirement Longitudinal Study

PurposeTo evaluate the associations between BADL/IADL disability and depressive symptoms from the perspective of gender among older adults in China.MethodsThis cross-sectional study used the data from the second wave of the China Health and Retirement Longitudinal Study (CHARLS). The sample included 3463 older adults aged 60 years and older across China. Multivariable logistic regression models were conducted.ResultsAmong 3463 older adults, 1240 (35.8%) were classified as depressed, the prevalence of BADL and IADL disabilities were 756 (21.8%) and 1194 (34.5%), respectively. After controlling for covariates, BADL/IADL disability was significantly associated with an increased risk of depression prevalence both in men and women among older adults. Compared with IADL independent, IADL disability was about two times more likely to develop depressive symptoms in men (OR = 2.165, 95% CI = 1.661–2.822), which was much higher than that in women (OR = 1.748, 95% CI = 1.415–2.160). In contrast, the odds of being depressed for women with BADL disability (OR = 1.824, 95% CI = 1.447–2.299) were much higher than the odds for men with BADL disability (OR = 1.791, 95% CI = 1.348–2.379).ConclusionsOlder adults with BADL/IADL disability were more likely to have depressive symptoms both for men and women. However, the associations between depressive symptoms and BADL/IADL disability were different in gender. Our results suggest that differential institutional care service and appropriate strategies for improvement in mental health are required.     

Determinants of depressive symptoms in hospitalised men and women with heart failure

BACKGROUND: Depressive symptoms are prominent and related to an increased risk on cardiovascular disease outcomes and all cause mortality in HF patients. AIM: To intervene effectively, factors related to depressive symptoms in men and women should be identified. METHODS: Depressive symptoms of 921 hospitalised HF patients (61% male; age 71+/-11; LVEF 33%+/-14, NYHA II-IV) were assessed by the Center for Epidemiological Studies-Depression scale (CES-D). RESULTS: Overall 40% of the patients had depressive symptoms (CES-D >or=16), which were more common in women than in men (47% versus 36%, p<0.001). Multivariable analysis in men revealed that depressive symptoms were related to age (OR 0.84, 95% CI 0.71-0.98, p=0.03, per 10 years), physical health (OR 0.76, 95% CI 0.71-0.83, p<0.001, per 10 units) and HF symptoms. In women depressive symptoms were also related to NYHA II-III versus IV (OR 0.60, 95% CI 0.37-0.95, p<0.03) and COPD (OR 2.33, 95% CI 1.20-4.53, p<0.012). CONCLUSION: Depressive symptoms are more common in women than in men. In both men and women depressive symptoms are related to age and physical health. For clinical factors: In men only HF symptoms, but in women also NYHA and COPD were related to depressive symptoms.     

Awareness of hypertension and depressive symptoms: a cross-sectional study in a primary care population

Objective: To investigate the association of hypertension awareness and depressive symptoms, and to analyse factors predisposing aware hypertensives to depressive symptoms.

Design: Cross-sectional study in a primary care population.

Setting: Cardiovascular risk factor survey in two semi-rural towns in Finland.

Subjects: Two thousand six hundred seventy-six middle-aged risk persons without an established cardiovascular or renal disease or type 2 diabetes.

Main outcome measures: Depressive symptoms, previous and new diagnosis of hypertension.

Results: Hypertension was diagnosed in 47.9% of the subjects, of whom 34.5% (442/1 282) had previously undetected hypertension. Depressive symptoms were reported by 14% of the subjects previously aware of their hypertension, and by 9% of both unaware hypertensives and normotensive subjects. In the logistic regression analysis, both the normotensive (OR 0.62, 95% CI 0.45–0.86) (p?=?0.0038) and the unaware hypertensive subjects (OR 0.54, 95% CI 0.35–0.84) (p?=?0.0067) had lower risk for depressive symptoms than the previously diagnosed hypertensives. Among these aware hypertensives, female gender (OR 3.61, 95% CI 2.06–6.32), harmful alcohol use (OR 2.55, 95% CI 1.40–4.64) and obesity (OR 2.50, 95% CI 1.01–6.21) predicted depressive symptoms. Non-smoking (OR 0.57, 95% Cl 0.33–0.99) and moderate leisure-time physical activity compared to low (OR 0.53, 95% CI 0.33–0.84) seemed to buffer against depressive symptoms.

Conclusion: Depressive symptoms are common in hypertensive persons even without comorbidities, if the person is already aware of his/her hypertension. Many modifiable, lifestyle associated factors may contribute to the association of hypertension and depressive symptoms.

• Key Points

• Hypertension and depressive symptoms are known to form a toxic combination contributing even to all-cause mortality.

• Comorbidities or the labelling effect of the diagnosis of hypertension can confound their association.

• Our study shows that depressive symptoms are common in hypertensive persons even without comorbidities, if the person is already aware of his/her hypertension.

• Many modifiable, lifestyle-associated factors may contribute to the association of hypertension and depressive symptoms.

• When treating hypertensive patients, consideration of depressive symptoms is important in order to promote favorable lifestyle and control of hypertension.

     

Dietary intake of polyphenols and risk of colorectal cancer and adenoma–A case-control study from Iran

ObjectivesThe aim of this study is to examine the relationship between dietary polyphenols’ classes and individual polyphenol subclasses and also the risk of Colorectal cancer (CRC) and colorectal adenomas (CRA).DesignA hospital-based case-control study on the association between CRC and CRA and dietary polyphenols was conducted.SettingOverall, 129 colorectal cancers, 130 colorectal adenoma cases and 240 healthy controls were studied in three major general hospitals in Tehran province, Iran.ResultsIn a multivariate-adjusted model for potential confounders, higher consumption of stilbenes (OR 0.49 for the highest vs. the lowest quartile; 95% CI = 0.24−0.99; p for trend = 0.013) was associated with the decreased risk of CRA. Moreover, an inverse association between the risk of CRC and the intake of total polyphenols (OR 0.05 for the highest vs. the lowest quartile; 95% CI = 0.01−0.19; p for trend=<0.001), total flavonoids (OR 0.36 for the highest vs. the lowest quartile; 95% CI = 0.16−0.79; p for trend = 0.005), total phenolic acids (OR 0.24 for the highest vs. the lowest quartile; 95% CI = 0.10−0.56; p for trend = 0.002), anthocyanin (OR 0.21 for the highest vs. the lowest quartile; 95% CI = 0.08−0.55; p for trend = 0.001) and flavanols (OR 0.38 for the highest vs. the lowest quartile; 95% CI = 0.17−0.85; p for trend = 0.001) was observed.ConclusionThe present study showed that a higher intake of total polyphenols, total flavonoids, total phenolic acids anthocyanin and flavanols was related to the decreased risk of CRC. The higher consumption of stilbenes was also inversely associated with the risk of CRA.     

The association between exposure to second-hand smoke and major depressive disorder in perimenopausal women: results from apopulation-based study

Abstract

Purpose: The aim of this study was to test the hypothesis that exposure to second-hand smoke (SHS) would be positively associated with major depressive disorder (MDD) in perimenopausal women from a population-based perspective, after adjustment for all potential confounders.

Methods: This study used the National Health and Nutrition Examination Survey (NHANES) database, 2005–2012, to report on MDD in perimenopausal women.

Results: The odds ratio (OR) for MDD increased when there was a smoker was in the home, as compared to not having a smoker in the home (aOR?=?2.97, 95% confidence interval [CI]?=?1.15–7.67); however, in the non-poor group, the OR for MDD showed no difference between those who had or did not have a smoker in their home. For participants who self-rated their health condition as excellent, very good or good, the OR for MDD increased; it also increased if there were smokers in the home, as compared to those without smokers in the home (aOR?=?2.58, 95% CI?=?1.08–6.14).

Conclusions: The present study results augment our understanding of the clinical and public health significance of SHS, as well as the role of various socioeconomic and self-rated health conditions, in perimenopausal women.

• Key messages

• An increasing OR for MDD was demonstrated with regard to health status such as CVD, chronic respiratory tract disease, arthritis, thyroid problems, lower eGFR, fair or poor self-rated health condition, and elevated CRP level.

• Participants who self-rated their health condition as excellent, very good or good had an increased OR for MDD.

• The OR also increased if the women had smokers in their home versus women who did not have smokers in the home.

     

Influencing factors of depressive symptoms in patients with malignant tumour

ObjectiveTo assess the influencing factors of depressive symptoms in malignant tumour patients.MethodsParticipants were 2079 inpatients with malignant tumour (1291: depressive symptoms; 788 no depressive symptoms). Univariable and multivariable logistic regression were used to evaluate sociodemographic and clinical factors influencing depressive symptoms.ResultsRisk factors were family income ≤5000 yuan (odds ratio [OR]: 4.966, 95% confidence interval [CI]: 2.938–8.395) and 5001–10,000 yuan (OR: 3.111, 95% CI: 1.840–5.260); Karnofsky Performance Status of 70 (OR: 2.783, 95% CI: 1.281–6.042) and 80 (OR: 1.834, 95% CI: 1.139–2.953); disease course ≤1 year; palliative treatment (OR: 2.288, 95% CI: 1.292–4.055); progressive disease (OR: 1.876, 95% CI: 1.284–2.739); pain (OR: 1.973, 95% CI: 1.555–2.505); cancer type: lung (OR: 3.199, 95% CI: 1.938–5.279), oesophagus (OR: 3.288, 95% CI: 1.673–6.464), cervix (OR: 1.542, 95% CI: 1.056–2.253) and partial knowledge of disease condition (OR: 2.366, 95% CI: 1.653–3.385). Return to work (OR: 0.503, 95% CI: 0.348–0.727) and physical exercise (OR: 0.437, 95% CI: 0.347–0.551) were protective against depressive symptoms.ConclusionsSeveral factors affected depressive symptoms in malignant tumour patients, including income, disease type and course, palliative treatment, return to work and physical exercise.     

Risk Factors for Injuries From Physical Violence in African Women in the Gambia

BackgroundPhysical violence against women is a major public health problem in African countries; however, no studies have focused on factors associated with violent injuries to women in Africa.ObjectivesA matched case-control study was conducted to investigate risk factors for injuries from physical violence against African women in The Gambia.MethodsOver a 12-month study period, study participants were recruited from emergency departments of eight government-managed health care facilities. Cases were female patients aged ≥ 15 years who had been violently injured. Matched by the health facility, date of injury, sex, and age, a control patient for each case was selected from those injured due to nonviolent mechanisms.ResultsIn total, 194 case-control pairs were recruited. Results of a conditional logistic regression showed that being a Fula (odds ratio [OR] 2.45; 95% confidence interval [CI] 1.06–5.66), living in an extended family compound (OR 3.07; 95% CI 1.22–7.72), having six or more female siblings (OR 3.10; 95% CI 1.38–6.97), having been raised by grandparents (OR 3.34; 95% CI 1.06–10.51), and having been verbally (OR 3.04; 95% CI 1.56–5.96) or physically abused (OR 3.36; 95% CI 1.34–8.39) in the past 12 months were significantly associated with injury from physical violence.ConclusionMost risk factors identified for violent injury among African women are unique to the studied geography. Violence prevention programs, if designed based on these identified risk factors, may be more effective for this population.     

Quality of mental health care for youth with asthma and comorbid anxiety and depression

OBJECTIVES: Youth with asthma have a high rate of anxiety and depressive disorders, and these comorbid disorders are associated with increased asthma symptom burden and functional impairment. This study examined the rates and predictors of recognition of anxiety and depressive disorders among youth (ages 11 to 17) with asthma who are seen in primary care settings as well as the quality of mental health care provided to those with comorbid anxiety and depression over a 12-month period. METHODS: This study used automated utilization and pharmacy data from a health maintenance organization to describe the rate of recognition of Diagnostic and Statistical Manual of Mental Disorders, edition IV, anxiety and depressive disorders and the quality of mental health care provided for the 17% of youth with asthma and comorbid anxiety and/or depression during the 12-month period prior to diagnosis. Psychiatric diagnoses were based on a telephone version of the Computerized Diagnostic Interview Schedule for Children (Version 4.0). RESULTS: Approximately 35% of youth with 1 or more anxiety and depressive disorders and 43% of those with major depression were recognized by the medical system during a 12-month period. Greater functional impairment (odds ratio [OR] 3.32, 95% confidence interval [CI] 1.25-8.79), higher severity on parent-rated anxiety and depressive symptoms (OR 2.49, 95% CI 1.04-6.00), and a greater number of primary care visits (OR 1.26, 95% CI 1.10-1.44) were associated with significantly higher recognition rates while having Medicaid or Washington state medical insurance was associated with lower rates of recognition (OR 0.27, 95% CI 0.08-0.92). Only approximately 1 in 5 youths with comorbid major depression received an adequate dosage and duration of antidepressant medication, and only 1 in 6 received a minimally adequate number of psychotherapy sessions (> or =4 visits). CONCLUSION: Rates of recognition of comorbid anxiety and depressive disorders are low in youth with asthma and few youth with asthma and comorbid anxiety and depression receive guideline-level mental health treatment.     

Relationship between lifestyle factors and hyperhomocysteinemia in general Chinese population: a cross-sectional study

Objectives: Hyperhomocysteinemia (Hhcy) is a known cardiovascular disease (CVD) risk factor. Observational studies had supported the role of lifestyle factors such as physical activity, diet and alcohol consumption in CVD prevention. Our study aimed to determine the relationship between Hhcy and lifestyle factors in general Chinese population.

Methods: In this cross-sectional study, a total of 7135 adults (3320 men and 3815 women) aged 35 years or older were recruited from the rural Northeast China. Data on lifestyle factors, such as physical activities, sleep duration, current smoking and drinking status, dietary habits and familial factors were collected in interviews and laboratory examinations were performed by well-trained personnel.

Results: Plasma total homocysteine (tHcy) level was higher in men than in women, and greater in the elderly than in other age groups. Subjects with Hhcy were more likely to be current smokers (men: OR 1.328, 95% CI 1.143–1.543, p<0.001; women: OR 1.465, 95% CI 1.214–1.767, p<0.001). Separately, men with Hhcy were more likely to have an education of primary school or below (OR 1.251, 95% CI 1.068–1.465, p=0.006) and less likely to eat more vegetables (OR 0.927, 95% CI 0.863–0.996, p=0.037) than the normal-tHcy participants. In women, participants with Hhcy were more likely to have longer sleeping time (>9h/d) (OR 1.677, 95% CI 1.292–2.177, p<0.001), low physical activity (OR 1.721, 95% CI 1.197–2.475, p=0.044) and increased diet score (OR 1.126, 95% CI 1.007–1.259, p=0.037) and less likely to be current drinkers (OR 0.488, 95% CI 0.297–0.802, p=0.005) than the normal-tHcy participants.

Conclusion: Our study revealed that physical activity and current drinking status were not significantly associated with Hhcy in males, but inversely associated in females. In both genders, current smoking status and dietary habits were significantly associated with Hhcy. Our study supports existing recommendations for Chinese to maintain a physically active behaviors and healthy lifestyle habits.     

The influence of adverse reactions,subjective distress,and anxiety on retention of first‐time blood donors

BACKGROUND: This study investigated the effects of adverse events (i.e., needle reactions, fatigue, and vasovagal reactions) and feelings of distress and anxiety on retention of first‐time blood donors. All effects were explored separately for men and women. STUDY DESIGN AND METHODS: First‐time blood donors (n = 2438) received a questionnaire, asking them about their experience of adverse events, subjective distress, and anxiety at their first donation. Provision of a second donation was checked approximately 18 months later. After exclusion of nonresponders and donors who did not experience an adverse event, 1278 first‐time donors were included in the logistic regression analyses. RESULTS: Nine percent of donors who experienced an adverse event at their first donation did not return for a second donation. Vasovagal reactions decreased retention in both males and females (men—odds ratio [OR], 0.45; 95% CI, 0.23‐0.89; women—OR, 0.71; 95% CI, 0.51‐0.98). Fatigue decreased retention in males only (OR, 0.62; 95% CI, 0.42‐0.91), and subjective distress decreased retention in females only (OR, 0.77; 95% CI, 0.65‐0.92). CONCLUSION: In addition to decreasing vasovagal reactions, retention interventions could productively target coping with fatigue and reducing subjective distress after adverse reactions.     

Frailty Syndrome in Association with Depressive Symptoms and Functional Disability among Hospitalized Elderly

ABSTRACT

We sought to examine the frailty association with depression and functional disability in hospitalized older adults. In particular, we compared non-frail, pre-frail, and frail elderly hospitalized individuals. We performed a cross-sectional study with 255 hospitalized Brazilian elderly patients. We used a structured instrument to assess socio-economic data, the Fried frailty phenotype and used morbidity scales (Geriatric Depression; Katz; Lawton and Brody). The adjusted analysis revealed that frail elderly exhibit increased odds ratios (OR) for depressive symptoms (OR = 2.72, 95% CI: 1.12–6.62), disability related to basic activities (OR = 3.50, 95% CI: 1.26–9.60), and instrumental daily living (OR = 2.70, 95% CI: 1.12–6.44). Frailty in hospitalized older adults is associated with depressive symptomatology and functional disability.     

Factors associated with boarding and length of stay for pediatric mental health emergency visits

ObjectiveTo determine demographic and clinical risk factors associated with boarding (length of stay ≥24 h) for pediatric mental health emergency department (ED) visits.MethodsThis is a retrospective cross-sectional analysis of mental health visits identified by diagnosis codes for children 5–18 years old presenting to a tertiary pediatric ED in 2016. We performed multivariate logistic regression to identify demographic and clinical factors associated with boarding.ResultsThere were 1746 mental health visits and 386 (22%) visits had length of stay ≥24 h. In the multivariate logistic regression model, factors associated with boarding included: private insurance (OR 1.59, 95% CI 1.15, 2.19) and having both private and public insurance (OR 1.68, 95% CI 1.16, 2.43) relative to public insurance; presentation during a school month (OR 2.17, 95% CI 1.30, 3.63); physical or chemical restraint use (OR 4.80, 95% CI 2.61, 8.84); comorbid autism or developmental delay (OR 1.82, 95% CI 1.35, 2.46); prior psychiatric hospitalization (OR 2.55, 95% CI 1.93, 3.36); and reasons for presentation of agitation, aggression, or homicidal ideation (OR 2.76, 95% CI 1.40, 5.45), depression, self-injury, or suicidal ideation (OR 2.79, 95% CI 1.45, 5.40), and bipolar, mania, or psychosis (OR 5.78, 95% CI 2.36, 14.09) relative to anxiety.ConclusionsInsurance status, presentation month, restraint use, autism or developmental delay comorbidity, prior psychiatric hospitalization, and reason for presentation are associated with pediatric mental health ED boarding. Resources should be directed to improve the mental health care system for children with identified risk factors for boarding.     

Prevalence of abnormal serum liver enzymes in patients with type 2 diabetes mellitus: a cross-sectional study from China

Objectives: This cross-sectional study aimed to determine the prevalence of elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in Chinese type 2 diabetic patients and identify contributing risk factors.

Methods: This cross-sectional study was conducted in rural areas of China, and 1,198 type 2 diabetic patients with complete data were recruited. Elevated ALT and AST levels were defined as >40 U/L. Prevalence of abnormal liver enzymes was analyzed and multivariable analysis was used to identify independent risk factors.

Results: 10.3% and 6.1% diabetic patients had elevated ALT and elevated AST, respectively. The prevalence of elevated liver enzymes was gender-related; it was 13.8% in men and 7.5% in women for elevated ALT, and 7.4% in men and 3.1% in women for elevated AST. High triglyceride was positively associated with both elevated ALT (OR 1.80, 95% CI 1.08–3.01, p = 0.024) and elevated AST (OR 2.24, 95%CI 1.08–4.65, p = 0.031), while taking anti-diabetes medicine was inversely related to both elevated ALT (OR 0.48, 95% CI 0.29–0.80, p = 0.005) and elevated AST (OR 0.37, 95% CI 0.17–0.82, p = 0.014). The risk of elevated ALT in diabetic patients increased with the presence of obesity (OR 2.54, 95% CI 1.07–6.01, p = 0.034), and was lower in women (OR 0.37, 95% CI 0.19–0.72, p = 0.003). Hypertension (OR 4.33, 95% CI 1.41–13.30, p = 0.011), current drinking status (OR 2.90, 95% CI 1.21–6.96, p = 0.017) and national minority (OR 3.26, 95%CI 1.31–8.12, p = 0.011) were risk factors for elevated AST.

Conclusion: A relatively high prevalence of abnormal serum liver enzymes in diabetic patients was demonstrated in China, especially in males. More attention should be paid to preventing liver injuries in diabetic patients.     

The course of mental health problems in children presenting with abdominal pain in general practice

Abstract

Objective. To investigate the course of mental health problems in children presenting to general practice with abdominal pain and to evaluate the extent to which abdominal pain characteristics during follow-up predict the presence of mental health problems at 12 months’ follow-up. Design. A prospective cohort study with one-year follow-up. Setting. 53 general practices in the Netherlands, between May 2004 and March 2006. Subjects. 281 children aged 4–17 years. Main outcome measures. The presence of a depressive problem, an anxiety problem, and multiple non-specific somatic symptoms at follow-up and odds ratios of duration, frequency, and severity of abdominal pain with these mental health problems at follow-up. Results. A depressive problem persisted in 24/74 children (32.9%; 95% CI 22.3–44.9%), an anxiety problem in 13/43 (30.2%; 95% CI 17.2–46.1%) and the presence of multiple non-specific somatic symptoms in 75/170 children (44.1%; 95% CI 36.7–51.6%). None of the abdominal pain characteristics predicted a depressive or an anxiety problem at 12 months’ follow-up. More moments of moderate to severe abdominal pain predicted the presence of multiple non-specific somatic symptoms at follow-up. Conclusions. In one-third of the children presenting to general practice for abdominal pain, anxiety and depressive problems persist during one year of follow-up. Characteristics of the abdominal pain during the follow-up period do not predict anxiety or depressive problems after one-year follow-up. We recommend following over time children seen in primary care with abdominal pain.     

Can Yoga or Physical Therapy for Chronic Low Back Pain Improve Depression and Anxiety Among Adults From a Racially Diverse,Low-Income Community? A Secondary Analysis of a Randomized Controlled Trial

ObjectiveTo determine and compare the effect of yoga, physical therapy (PT), and education on depressive and anxious symptoms in patients with chronic low back pain (CLBP).DesignSecondary analysis of a randomized controlled trial.SettingAcademic safety net hospital and 7 community health centers.ParticipantsA total of 320 adults with CLBP.InterventionYoga classes, PT sessions, or an educational book.Outcome MeasureDepression and anxiety were measured using the Patient Health Questionnaire and Generalized Anxiety Disorder 7-item Scale, respectively, at baseline, 12, and 52 weeks. We identified baseline and midtreatment (6-wk) factors associated with clinically meaningful improvements in depressive (≥3 points) or anxious (≥2 points) symptoms at 12 weeks.ResultsParticipants (female=64%; mean age, 46.0±10.7 years) were predominantly non-White (82%), low-income (<$30,000/year, 59%), and had not received a college degree (71%). Most participants had mild or worse depressive (60%) and anxious (50%) symptoms. At 12 weeks, yoga and PT participants experienced modest within-group improvements in depressive symptoms (mean difference [MD]=?1.23 [95% CI, ?2.18 to ?0.28]; MD=?1.01 [95% CI, ?2.05 to ?0.03], respectively). Compared with the education group, 12-week differences were not statistically significant, although trends favored yoga (MD=?0.71 [95% CI, ?2.22 to 0.81]) and PT (MD= ?0.32 [95% CI, ?1.82 to 1.18]). At 12 weeks, improvements in anxious symptoms were only found in participants who had mild or moderate anxiety at baseline. Independent of treatment arm, participants who had 30% or greater improvement in pain or function midtreatment were more likely to have a clinically meaningful improvement in depressive symptoms (odds ratio [OR], 1.82 [95% CI, 1.03-3.22]; OR, 1.79 [95% CI, 1.06-3.04], respectively).ConclusionsIn our secondary analysis we found that depression and anxiety, common in this sample of underserved adults with CLBP, may improve modestly with PT and yoga. However, effects were not superior to education. Improvements in pain and function are associated with a decrease in depressive symptoms. More research is needed to optimize the integration of physical and psychological well-being in PT and yoga.     

Prevalence of verbal and physical workplace violence against nurses in psychiatric hospitals in China

ObjectiveWorkplace violence (WPV) is common in mental health services in China, but its multi-center prevalence measured using standardized rating scales has rarely been reported. This study aimed to explore the prevalence of verbal and physical violence against nurses working in psychiatric hospitals and examine its independent socio-demographic correlates in China.MethodsThis was a cross-sectional study conducted in 11 major psychiatric hospitals in China using a 9-item self-reported workplace violence scale.ResultsA total of 1906 psychiatric nurses were recruited to participate in this study. The one-year prevalence of verbal and/or physical workplace violence (WPV) was 84.2% (95% CI: 82.4–85.8). The prevalence rates of verbal abuse, threats and physical violence were 79.3% (95% CI: 77.4–81.1), 70.9% (95% CI: 68.8–73.0) and 57.9% (95% CI: 55.7–60.2), respectively. Multiple logistic regression analysis revealed that working in department of psychiatry (OR = 3.42, P < 0.001), having moderate (OR = 2.05, P = 0.009), severe (OR = 2.04, P = 0.015) or extremely severe (OR = 3.21, P < 0.001) anxiety level of WPV and working in hospitals with a WPV reporting system (OR = 1.88, P < 0.001) were significantly associated with WPV.ConclusionWPV against nurses is a serious occupational and public health concern in Chinese psychiatric hospitals. Appropriate preventive measures should be undertaken to reduce the risk of WPV in healthcare settings.     

Has the Prevalence of Invalidating Musculoskeletal Pain Changed Over the Last 15 Years (1993–2006)? A Spanish Population-Based Survey

The aim of the current study was to estimate the prevalence and time trend of invalidating musculoskeletal pain in the Spanish population and its association with socio-demographic factors, lifestyle habits, self-reported health status, and comorbidity with other diseases analyzing data from 1993–2006 Spanish National Health Surveys (SNHS). We analyzed individualized data taken from the SNHS conducted in 1993 (n = 20,707), 2001 (n = 21,058), 2003 (n = 21,650) and 2006 (n = 29,478). Invalidating musculoskeletal pain was defined as pain suffered from the preceding 2 weeks that decreased main working activity or free-time activity by at least half a day. We analyzed socio-demographic characteristics, self-perceived health status, lifestyle habits, and comorbid conditions using multivariate logistic regression models. Overall, the prevalence of invalidating musculoskeletal pain in Spanish adults was 6.1% (95% CI, 5.7–6.4) in 1993, 7.3% (95% CI, 6.9–7.7) in 2001, 5.5% (95% CI, 5.1–5.9) in 2003 and 6.4% (95% CI 6–6.8) in 2006. The prevalence of invalidating musculoskeletal pain among women was almost twice that of men in every year (P < .05). The multivariate analysis showed that occupational status (unemployed), sleep <8 hours/day and having any accident in the preceding year were significantly associated in both gender with a higher likelihood of suffering from invalidating musculoskeletal pain among Spanish adults. Within men, other predictors of invalidating musculoskeletal pain were to be married and lower educational level, whereas in women were age of 45–64 years old (OR 1.89, 95% CI 1.32–2.7), obesity (OR 1.23, 95% CI 1.06–1.42), a sedentary lifestyle (OR 1.23, 95% CI 1.06–1.42), and presence of comorbid chronic diseases (OR 1.32, 95% CI 1.14–1.53). Further, worse self-reported health status was also related to a greater prevalence of invalidating musculoskeletal pain (OR 6.88, 95% 5.62–8.40 men, OR 7.24, 95% 6.11–8.57 women). Finally, we found that the prevalence of invalidating musculoskeletal pain increased from 1993 to 2001 for both men (OR 1.31, 95% 1.08–1.58) and women (OR 1.19, 95% 1.03–1.39) with no significant increase from the remaining surveys. Our results suggest that invalidating musculoskeletal pain deserves an increased awareness among health professionals. More educational programs which address postural hygiene, physical exercise, and how to prevent obesity and sedentary lifestyle habits should be provided by Public Health Services.PerspectiveThis population-based study indicates that invalidating musculoskeletal pain that reduces main working activity is a public health problem in Spain. The prevalence of invalidating musculoskeletal pain was higher in women than in men and associated to lower income, poor sleeping, worse self-reported health status, and other comorbid conditions. Further, the prevalence of invalidating musculoskeletal pain increased from 1993 to 2001, but remained stable from the last years (2001 to 2006).     

Increased MMA concentration and body mass index are associated with spontaneous abortion in Brazilian women: A pilot study

BackgroundThe pathophysiology of spontaneous abortion is complex and may involve the interaction of genetic and environmental factors. We evaluated the predictors of spontaneous abortion in Brazilian pregnant women. The effects of age, gestational age, body mass index (BMI), cigarette smoking, alcohol ingestion, use of multivitamins and concentrations of vitamins (folate, cobalamin and vitamin B6) and vitamin-dependent metabolites were analyzed.MethodsStudy population included 100 healthy women that attended pre-natal care in 2 health centers of Sao Paulo, Brazil, and in whom pregnancy outcome was known. Folate and cobalamin status was measured in blood specimens collected between 4 and 16 weeks. The genotypes for 8 gene polymorphisms were evaluated by PCR-RFLP.ResultsEighty-eight women had normal pregnancy outcome (Group 1), while 12 experienced a miscarriage after blood collection (Group 2). Increased methylmalonic acid (MMA) concentrations were found in Group 2 (median [25th–75th percentile] = 274 [149–425] nmol/l) relative to Group 1 (138 [98–185]) (P < 0.01). No differences between the groups were observed for serum cobalamin, serum or red cell folate, and serum total homocysteine or allele frequencies for 8 polymorphisms. In a conditional logistic regression analysis including age, gestational age, serum creatinine, MMA, cystathionine, body mass index (BMI), cigarette smoking, alcohol ingestion and use of multivitamins the risk of abortion was significantly associated with MMA (OR [95% CI] = 3.80 [1.36, 10.62] per quartile increase in MMA), BMI (OR [95% CI] = 5.49 [1.29, 23.39] per quartile) and gestational age (OR [95% CI] = 0.10 [0.01, 0.77] per increase of interval in gestational age).ConclusionsIncreased serum MMA and BMI concentrations are associated with spontaneous abortion in Brazilian women.     

Association of Function,Symptoms, and Social Support Reported in Standardized Outpatient Clinic Questionnaires With Subsequent Hospital Discharge Disposition and 30-Day Readmissions

ObjectiveTo determine whether patient-reported information, routinely collected in an outpatient setting, is associated with readmission within 30 days of discharge and/or the need for post-acute care after a subsequent hospital admission.DesignRetrospective cohort study. Six domains of patient-reported information collected in the outpatient setting (psychological distress, respiratory symptoms, musculoskeletal pain, family support, mobility, and activities of daily living [ADLs]) were linked to electronic health record hospitalization data. Mixed effects logistic regression models with random intercepts were used to identify the association between the 6 domains and outcomes.SettingOutpatient clinics and hospitals in a Midwestern health system.Participants7671 patients who were hospitalized 11,445 times between May 2004 and May 2014 (N=7671).InterventionNone.Main Outcome Measures30-day hospital readmission and discharge home vs facility.ResultsDomains were significantly associated with 30-day readmission and placement in a facility. Specifically, mobility (odds ratio [OR]=1.30; 95% confidence interval [CI], 1.16, 1.46), ADLs (OR=1.27; 95% CI, 1.13, 1.42), respiratory symptoms (OR=1.26; 95% CI, 1.12, 1.41), and psychological distress (OR=1.20; 95% CI, 1.07, 1.35) had the strongest associations with 30-day readmission. The ADL (OR=2.52; 95% CI, 2.26, 2.81), mobility (OR=2.35; 95% CI, 2.10, 2.63), family support (OR=2.28; 95% CI, 1.98, 2.62), and psychological distress (OR=1.38; 95% CI, 1.25, 1.52) domains had the strongest associations with discharge to an institution.ConclusionsPatient-reported function, symptoms, and social support routinely collected in outpatient clinics are associated with future 30-day readmission and discharge to an institutional setting. Whether these data can be leveraged to guide interventions to address patient needs and improve outcomes requires further research.     

Openness Personality Trait Associated With Benefit From a Nonpharmacological Breathlessness Intervention in People With Intrathoracic Cancer: An Exploratory Analysis

ContextBreathlessness is common in people with lung cancer. Nonpharmacological breathlessness interventions reduce distress because of and increase mastery over breathlessness.ObjectivesIdentify patient characteristics associated with response to breathlessness interventions.MethodsExploratory secondary trial data analysis. Response defined as a one-point improvement in 0–10 Numerical Rating Scale of worst breathlessness/last 24 hours (response—worst) or a 0.5-point improvement in the Chronic Respiratory Questionnaire (CRQ) mastery (response—mastery) at four weeks. Univariable regression explored relationships with plausible demographic, clinical, and psychological variables followed by multivariable regression for associated (P < 0.05) variables.ResultsAbout 158 participants with intrathoracic cancer (mean age 69.4 [SD 9.35] years; 40% women) were randomized to one or three breathlessness training sessions. About 91 participants had evaluable data for response—worst and 107 for response—mastery. In the univariable analyses, the personality trait openness was associated with response—worst (odds ratio [OR] 1.99 [95% CI 1.08–3.67]; P = 0.028) and response—mastery (OR 1.84 [95% CI 1.04–3.23]; P = 0.035). Higher CRQ—fatigue (OR 0.61 [95% CI 0.41–0.91]; P = 0.015), CRQ—emotion (OR 0.68 [95% CI 0.47–0.96]; P = 0.030), and worse CRQ—mastery (OR 0.61 [95% CI 0.42–0.88]; P = 0.008), and the presence of metastases and fatigue were associated with reduced odds of response—mastery. In the adjusted response—mastery model, only openness remained (OR 1.73 [95% CI 0.95–3.15]; P = 0.072).ConclusionWorse baseline health, worse breathlessness mastery, but not severity, and openness were associated with a better odds of response. Breathlessness services must be easy to access, and patients should be encouraged and supported to attend.