Treatment for depression and its relationship to improvement in quality of life and psychological well-being in multiple sclerosis patients

Depression, a common problem in multiple sclerosis (MS), is generally associated with poorer quality of life (QOL). However, it is unclear whether treating depression also extends to better perceived QOL. Understanding QOL in MS has been limited by narrow definitions and exclusive focus on symptomology, with little emphasis on positive aspects of QOL. This study examined the impact of treating depression on QOL in 60 patients with a relapsing form of MS and moderate to severe depression, who were randomly assigned to one of three validated 16-week treatments for depression: individual cognitive-behavioral therapy, group psychotherapy, or sertraline. QOL was measured by the MSQOL-54, a version of the SF-36 adapted for MS, and Ryffs scales of psychological well-being, which measure positive attitudes and functioning. Depression and QOL were measured at baseline and immediately following treatment completion. Controlling for baseline neurological impairment and baseline QOL scores, regression analyses showed treating depression was significantly associated with improvements in the MSQOL-54 scales (R²s = 0.19–0.55, p < 0.001) and in four of the six scales of psychological well-being: environmental mastery (R² = 0.13, p < 0.001), positive relations (R² = 0.08, p < 0.001), purpose in life (R² = 0.16, p < 0.001), and self-acceptance (R² = 0.26, p < 0.001). Findings suggest treating depression influences both the negative and positive aspects of QOL and underscore the importance of examining QOL with two complementary approaches.     

Efficacy of vaccination against influenza in patients with multiple sclerosis: The role of concomitant therapies

Multiple sclerosis is a chronic progressive demyelinating disease affecting over 2.1 million patients worldwide. Patients affected by MS are exposed to an increased risk of infection from communicable diseases, which may lead to severe disease relapses.     

Factors associated with poor sleep quality in patients with multiple sclerosis differ by disease duration

BackgroundSleep disturbance is a common symptom of multiple sclerosis (MS) and knowledge about factors that contribute to poor sleep quality is scarce.ObjectiveThe aim was to explore the differences in the prevalence and determinants of poor sleep quality in a sample of patients with MS with disease duration ≤5 years and >5 years.MethodsWe collected data from 152 consecutive patients with MS; 66 patients (78% women, averaged 37.35 ± 10.1 years) were in the group with disease duration ≤5 years and 86 patients (73.3% women, averaged 42.10 ± 9.4 years) in the group with disease duration >5 years. Patients filled out the Pittsburgh Sleep Quality Index, the Hospital Anxiety and Depression Scale, the Multidimensional Fatigue Inventory, one item of the Incapacity Status Scale regarding bladder problems and one item of the Short Form-36 regarding pain. Multiple linear regression was used to analyze the relationship between the study variables.ResultsThe prevalence of poor sleep is significantly higher in patients with longer disease duration (34.8 vs. 51.2%). Anxiety, reduced motivation and mental fatigue (all p < 0.05) were associated with poor sleep quality in patients with disease duration ≤5 years, whereas pain (p < 0.01), depression and mental fatigue (both p < 0.05) were in patients with disease duration >5 years.ConclusionSleep problems are present in patients with MS with both short and long disease duration, but these problems are associated with different factors. These should be recognized and managed in addition to the treatment of sleep disorders.     

Coenzyme Q10 as a treatment for fatigue and depression in multiple sclerosis patients: A double blind randomized clinical trial

Objectives: Multiple sclerosis (MS) is the chronic inflammatory and demyelinating disorder of central nervous system which is accompanied with disability and negative life style changes such as fatigue and depression. The aim of this study is to investigate the effect of coenzyme Q10 (CoQ10) supplementation on fatigue and depression in patients with MS.

Methods: We performed a randomized, double-blinded, placebo-controlled trial to determine the effect of CoQ10 supplement (500?mg/day) vs. placebo for 12?weeks. Fatigue symptoms were quantified by means of fatigue severity scale (FSS) and the Beck depression inventory (BDI) was used to assess depressive symptoms.

Results: A significant decrease of FSS was observed in CoQ10 group during the intervention (P?=?0.001) and significant increase of FSS change was observed within placebo group (P?=?0.001). Repeated measure analysis of variance showed a significant time-by-treatment interaction for FSS (baseline 41.5?±?15.6 vs. endpoint 45?±?13.6; F_1,45?=?55.23, P?<?0.001, η²?=?0.56) and BDI (baseline 17.8?±?12.2 vs. endpoint 20.4?±?11.4; F_1,45?=?40.3, P?<?0.001, η²?=?0.48), indicating significant decrease of FSS and BDI in CoQ10 group compared to placebo group.

Conclusion: Our study suggests that CoQ10 supplementation (500?mg/day) can improve fatigue and depression in patients with multiple sclerosis.     

多发性硬化患者T淋巴细胞亚群与临床研究

目的研究T淋巴细胞亚群(CD4 ,CD8 )比值与多发性硬化患者发病的相关关系。方法采用间接免疫荧光染色及流式细胞仪检测28例多发性硬化(MS)活动期及缓解期外周血和脑脊液的CD4 、CD8 ,MS患者活动期应用糖皮质激素治疗。结果活动期MS的外周血CD4 、CD8 细胞较对照组减少,CD4 /CD8 比值较对照组升高(P<0.01)。脑脊液中CD4 、CD4 /CD8 比值较对照组升高,CD8 细胞降低(P<0.01),且脑脊液中T淋巴细胞亚群均高于自身外周血中相应细胞(P<0.01),而且缓解期与活动期比较外周血和脑脊液CD4 /CD8 比值及脑脊液中CD4 细胞明显降低,脑脊液中CD8 明显升高(P<0.01),但外周血和脑脊液CD8 细胞仍低于对照组。结论MS患者存在T淋巴细胞辅助免疫功能的明显增强,免疫抑制功能的明显减弱;糖皮质激素对活动期MS患者有效,随着病情的缓解T淋巴细胞亚群均有不同程度的改善;部分MS患者活动期与缓解期比较,外周血和脑脊液CD4 、CD8 及CD4 /CD8 比值变化不明显,常提示容易复发。     

孕妇心理状况及其与个性和应对方式的相关性

目的:探讨孕妇心理状况及其与个性和应对方式的相关性,为进一步的医学干预提供依据。方法:采用焦虑自评量表(SAS)、抑郁自评量表(SDS)、艾森克个性问卷(EPQ)及简易应对方式问卷(SCSQ)对113例孕中期孕妇的心理状况、个性与应对方式进行调查分析。结果:孕妇SAS及SDS总粗分显著高于全国常模(t=7.057,P=0.000;t=2.381,P=0.019),孕妇焦虑和抑郁的发生率分别为20.4%和27.8%。SAS和SDS总分均与EPQ的精神质(P)和神经质(N)维度呈显著正相关(χ2=0.307,P=0.001;χ2=0.496,P=0.000;χ2=0.416,P=0.000;χ2=0.321,P=0.001),与积极应付方式呈显著负相关(χ2=-0.208,P=0.030;χ2=-0.264,P=0.007)。结论:孕中期孕妇焦虑和抑郁的发生率较高。精神质、神经质的个性特点及应对方式的缺陷与孕妇产生焦虑抑郁情绪密切相关。临床上应在综合分析心理状态及其产生的中介机制的基础上,对伴有焦虑抑郁的孕妇进行有效的心理干预。     

Biographical disruption associated with multiple sclerosis: using propensity scoring to assess the impact

Chronic illness such as multiple sclerosis (MS) is often associated with 'biographical disruption', a concept that is derived from qualitative narrative analyses examining how people make sense of their illness in the context of their lives [Bury, M. (1982). Chronic illness as biographical disruption. Sociology of Health and Illness, 4, 167-182]. This paper attempts to operationalise the idea of disruption to one's life trajectory in quantitative analysis by examining the social, economic and emotional disruption associated with MS. A number of studies have suggested that it impacts negatively on employment, income and sexual relationships; however previous research has been based upon samples of people with MS (pwMS), with a dearth of studies comparing pwMS with the general population. This study reports a systematic comparison of MS and non-MS households to enable the impact of MS to be quantified in terms of household composition and marital status; household income; economic activity; and to determine whether biographical disruptions such as relationship breakdown or unemployment are more or less prevalent among those affected by MS compared to the general population. The MS sample came from randomly selected members of the UK MS Society (n=783) and those accessing the MS Society website (n=133). Data for the general population came from the 2001/02 British General Household Survey (GHS). Cases from the MS Society sample were matched using propensity scoring with cases from the GHS. The results of the matched analysis show that both men and women with MS are significantly less likely to be employed than those in the general population and are significantly more likely to have a 'below average' household income, despite the fact that they are in a higher social class and have higher educational levels than people in the general population. Differences between the MS and GHS samples in terms of marital status become non-significant when socio-demographic variables are controlled for using propensity scoring. This study provides robust evidence on how MS impacts on and disrupts the life of the person with MS and their household in terms of income and employment.     

Clinical efficacy of pneumococcal vaccination in multiple myeloma patients on novel agents: Results of a prospective clinical study

IntroductionAmong the high risk groups, patients with multiple myeloma (MM) have one of the highest incidence of invasive pneumococcal disease, mainly pneumonias. Recent changes in MM treatment have now led to an increase of survival, while the infection-related mortality remains high. The question of efficacy of pneumococcal vaccination in patients receiving novel target agents has not been clinically investigated before.Patients and methodsWe have introduced the 3-dose vaccination regimen by 13-valent pneumococcal conjugate (PCV13) vaccine between the treatment courses with novel target agents (bortezomib, lenalidomide, ixazomib) with a minimum of 1 month interval. The incidence of pneumonias during the one-year observation period was taken as a primary outcome in this registered clinical trial.ResultsFrom 2017 to 2020, we have prospectively included 18 adult patients who were vaccinated by PCV13 along with 18 patients of a control matched group. No adverse effects of vaccination were registered in the study. We have observed an independent effect of PCV13 vaccination on the incidence of pneumonias. The absolute risk reduction of pneumonias in patients received PCV13 vaccination was 33.3%. Number needed to treat for PCV13 vaccination in multiple myeloma patients receiving novel agents was 3.0; (95% CI 1.61–22.1; p = 0.0571).ConclusionTherefore, we have shown the clinical effectiveness of PCV13 vaccination schedule based on 3 doses given with a minimum 1 month interval between the courses of novel agents in multiple myeloma patients, despite the expected decrease in immunological response to vaccination during target and immunotherapy. ClinicalTrials.gov Identifier: NCT03619252.     

某区5岁及以下儿童家长手足口病认知和EV71疫苗接种意愿调查

目的 了解某区5岁及以下儿童家长对手足口病的认知情况和EV71疫苗接种意愿,为制定EV71疫苗免疫策略和健康促进提供科学依据。方法 采用整群随机抽样从北京市某区44家社区卫生服务中心抽取6家,对6家社区卫生服务中心接种门诊接种日当天带领儿童来进行预防接种的5岁及以下儿童家长进行面访并填写调查问卷。结果 该区5岁及以下儿童家长对手足口病防治知识知晓率为71%(95%CI=66%~76%),对预防措施的认知好于对传播途径的认知。儿童母亲(OR=2.77,95%CI=1.67~4.57)、本科/大专以上学历的儿童家长(OR=2.10,95% CI =1.24~3.56)、高年龄儿童的家长(OR=1.58,95%CI=1.10~2.26)知晓率更高。75%的被调查儿童家长表示会为孩子接种EV71疫苗,其中58%的家长更希望能够以“一类疫苗”和28%认为“一类疫苗或二类疫苗都行”的形式提供接种服务;知道我国正在研制EV71疫苗的家长接种意愿高于不知道者(OR=2.57,95%CI=1.17~5.65);25%的被调查儿童家长不会给孩子接种EV71疫苗,“担心疫苗不安全”(67%)和“担心疫苗效果不好”(34%)是最主要原因。结论 对低年龄儿童的家长、低学历家长更应加强手足口病知识宣传,以提高手足口病知识知晓程度。建议优先考虑将EV71疫苗作为一类疫苗进行接种,并通过多种途径向公众报告疫苗研究进展和EV71疫苗宣传,尤其提供预防接种服务的医务人员应积极向儿童家长宣传接种EV71疫苗,以提高儿童家长接种意愿。     

Young adults’ adjustment to a recent diagnosis of multiple sclerosis: The role of identity satisfaction and self-efficacy

Background

Although multiple sclerosis (MS) is often diagnosed during young adulthood (18–30 years), there is a lack of knowledge on the psychological adjustment to the illness among recently diagnosed young adult patients.

浅谈应用专家共识意见指导特殊健康状态儿童的疫苗接种

特殊健康状态儿童的疫苗接种已成为高免疫规划疫苗接种率省份或地区迫切需要解决的工作难点之一。国内陆续发布了不同专家团队编写的相关疫苗接种共识意见,对预防接种人员科学认识该人群的接种必要性及研判疫苗接种的安全性与有效性提供了重要依据。本文通过笔者参与特殊健康状态儿童预防接种系列共识的编写体会,浅谈如何客观认识专家共识的作用...     

野战部队军人焦虑、抑郁情绪状况及其影响因素研究

目的　研究野战部队军人焦虑、抑郁情绪的状况及其影响因素 ,为心理教育提供依据。方法　应用焦虑自评量表 (SAS)、抑郁自评量表 (SDS)、艾森克个性问卷 (EPQ)及自编相关因素调查表 ,对 83 3名男性军人进行心理测试。结果　①受测军人SAS、SDS评分显著高于中国常模 (P <0 0 0 1) ;83 3名军人中 641人 (76 9% )无焦虑情绪 ,168人 (2 0 2 % )有轻度焦虑 ,2 4人 (2 9% )有中重度焦虑 ;487人 (58 5% )无抑郁情绪 ,2 66人 (3 1 9% )有轻度抑郁 ,80人 (9 6% )有中重度抑郁。②受测军人SAS、SDS评分与EPQ的精神病质、神经质维度分呈显著正相关 (P <0 0 1) ,与效度量表分呈显著负相关 (P <0 0 1) ;与军人焦虑、抑郁情绪显著相关 (P <0 0 5或P <0 0 1)的因素有 :人际关系、休息情况、气候适应、文体活动、饮食、是否理解军训意义、兄弟个数及受表彰情况。③经多元逐步回归分析 ,焦虑情绪的直接影响因素是人际关系、神经质维度分、精神病质维度分、是否理解军训意义及文体活动 ,抑郁情绪的直接影响因素是人际关系、精神病质维度分、神经质维度分及受表彰情况。结论　驻南方野战部队军人中存在焦虑和抑郁者约占 2 3 %及 42 % ,情绪不稳定及病理性人格倾向、人际关系不良、文体活动单一等是造成负性情绪的主     

Systematic framework to evaluate the status of physical activity research for persons with multiple sclerosis

BackgroundExploring the current state of health behavior research for individuals with multiple sclerosis is essential to understanding the next steps required to reducing preventable disability. A way to link research to translational health promotion programs is by utilizing the Behavioral Epidemiological Framework, which describes a sequence of phases used to categorize health-related behavioral research.ObjectiveThis critical audit of the literature examines the current state of physical activity research for persons with multiple sclerosis by utilizing the proposed Behavioral Epidemiological Framework.MethodsAfter searching MEDLINE, PUBMED, PsycINFO, Google Scholar and several major areas within EBSCOHOST (2000 to present), retrieved articles were categorized according to the framework phases and coding rules.ResultsOf 139 articles, 49% were in phase 1 (establishing links between behavior and health), 18% phase 2 (developing methods for measuring behavior), 24% phase 3 (identifying factors influencing behavior and implications for theory), and 9% phase 4 and 5 (evaluating interventions to change behavior and translating research into practice).ConclusionsEmphasis on phase 1 research indicates the field is in its early stages of development. Providing those with multiple sclerosis with necessary tools through health promotion programs is needed to reduce secondary conditions and co-morbidities. Reassessment of the field of physical activity and multiple sclerosis in the future could provide insight into whether the field is evolving over time or remaining stagnant.     

A comparison of responsiveness indices in multiple sclerosis patients

Responsiveness was measured in a number of health-related quality of life (HRQoL) instruments among which two generic (SF-36 and COOP/WONCA Charts) and one disease-specific instrument, the Disability & Impact Profile (DIP). Subjects were 162 multiple sclerosis patients. The following responsiveness indices were used: effect size, standardised response mean and smallest real difference (SRD). The latter measure gives an indication of the magnitude of real change, i.e. change not attributable to noise or error and can thus be used for the interpretation of change scores in clinical practice whereby change scores larger than the SRD value indicate real change. It is assumed that low SRD values indicate high responsiveness. The results confirmed our expectation that the effect size and standardised response mean are probably less suitable for use in slowly progressive diseases, since they use the average change as the numerator. Therefore, the article focused on the SRD. Compared to scales, items measured on a visual analogue scale show high SRD values. The DIP scales generally show lower SRD values compared to scales of other questionnaires. The SRD seems to be a promising new measure to study responsiveness. More research into the interpretation of this measure is necessary.     

浙江省嘉善县儿童监护人肠道病毒71型疫苗接种意愿及影响因素的调查分析

目的 了解嘉善县5岁以下儿童监护人对肠道病毒71型(EV71)疫苗的接种意愿,分析其影响因素,为制定疫苗接种和疫情防控策略提供依据.方法 在嘉善县所有接种门诊接种现场随机选取5岁以下儿童监护人进行统一问卷调查.结果 共调查854名监护人,其中488名监护人(57.14％)愿意为孩子接种EV71疫苗,366名监护人(42.86％)不愿意为孩子接种EV71疫苗;调查儿童中有54名(6.32％)曾患过手足口病.监护人文化程度越高(x2趋势=7.59,P＜0.01)、年收入越高(x2趋势=13.31,P＜0.01)越愿意为孩子接种EV71疫苗.儿童监护人性别为男性(OR=1.38,95％CI:1.04～1.85)、听说过EV71疫苗(OR=1.51,95％CI:1.15～1.99)、孩子曾患过手足口病(OR =4.66,95％CI:2.17～9.99)是愿意为孩子接种EV71疫苗的保护因素.监护人不愿意接种的主要原因为担心疫苗安全性和不良反应(45.63％)、担心疫苗保护效果(26.78％)和疫苗价格太高(17.76％).结论 嘉善县儿童监护人对EV71疫苗的接种意愿不高,今后应加强EV71疫苗和手足口病相关知识的健康教育,提高家长对疾病的认识,消除在疫苗安全性与接种效果等方面的顾虑,提高疫苗接种率.     

徐州市预防接种医务人员二类疫苗推荐意愿及影响因素研究

目的了解徐州市预防接种医务人员对二类疫苗的推荐意愿及影响因素,为优化二类疫苗接种策略提供参考。方法采用一般情况调查表和二类疫苗推荐意愿调查表,结合典型抽样与整群抽样,抽取徐州市450例预防接种医务人员进行问卷调查。对数据进行探索性因子分析、单因素分析和多因素logistic回归分析。结果仅有150人表示愿意向儿童家长推荐二类疫苗,推荐意愿率为35.2%。多因素logistic回归分析显示,女性(OR=3.612,95%CI:1.936～6.739)、工龄高(OR_11～20年=12.369,95%CI:3.148～48.600;OR≥21年=17.838, 95%CI:3.662～86.888)、用工形式为正式编制(OR_临时合同=0.151,95%CI:0.068～0.335;OR_其他形式=0.070, 95%CI:0.026～0.186)的接种人员推荐意愿较高;疫苗负性事件对工作造成影响的接种人员推荐意愿较低(OR=0.428, 95%CI:0.238～0.770);疫苗接种条件(OR=6.963,95%CI:3.926...     

多学科合作健康教育对肾衰患者心理状况的影响

目的：探讨多学科合作式健康教育对改善肾衰患者焦虑抑郁心理状态的影响。方法：随机选择58例终末期肾脏病入院患者分为两组,对干预组除与对照组一样给予常规护理外,开展多学科合作式健康教育。使用焦虑自评量表(SAS)、抑郁自评量表(SDS)对两组患者进行评估,比较两组患者透析治疗前、透析治疗过程中的焦虑和抑郁状况。结果：多学科合作干预组患者的认知程度、治疗信心、合作程度明显提高,而焦虑、抑郁症状明显减轻。结论：多学科合作健康教育对改善透析患者的焦虑抑郁心理状况和提升患者依从性有显著作用。     

多发性硬化、视神经脊髓炎患者血清及脑脊液血管内皮生长因子水平及其临床意义

目的 探讨多发性硬化(MS)、视神经脊髓炎(NMO)患者血清及脑脊液血管内皮生长因子(VEGF)水平的差异及其与临床、影像学等指标的关系.方法 对53例MS、NMO发作期患者(患者组)及21例对照者(对照组)进行研究,MS分为传统型MS(CMS)与视神经脊髓型MS(OSMS).患者组发作期进行扩展残疾状态量表(EDSS)评分、MRI检查及寡克隆带测定,液相芯片分析技术检测血清及脑脊液中VEGF水平.结果 NMO、MS患者脑脊液VEGF水平(平均荧光强度分别为110.38±8.58、98.68±3.88)高于对照组(平均荧光强度为77.88±6.44),差异有统计学意义(P=0.006);NMO与MS、CMS与OSMS患者脑脊液VEGF水平比较差异无统计学意义(P>0.05).患者组血脑屏障(BBB)指数≥7及Tourtellotte合成率≥33.0ms/L者,血清VEGF水平分别高于BBB指数<7及Tourtellotte合成率<33.0ms/L者,差异有统计学意义(P=0.045、0.035).患者组血清及脑脊液VEGF水平与MRI病灶强化、MRI脊髓病灶长度、EDSS评分、BBB指数、Delpech指数及Tourtellotte合成率无明显相关性.结论 NMO、MS发作期患者脑脊液VEGF水平升高,但与临床分型无关.血清VEGF水平与NMO、MS病灶BBB破坏有关.NMO、MS患者血清及脑脊液VEGF水平与MRI表现、神经功能残疾及中枢神经系统内IgG合成的关系有待进一步证实.     

社区门诊冠心病患者的精神卫生状况以及心理干预的临床效果探讨

目的探讨心理干预协同药物在冠心病治疗中的作用。方法选取2009年1月—2012年6月接受治疗的冠心病患者126例,随机分为观察组和对照组各63例。对照组给予常规药物治疗,观察组在此基础上给予心理干预,比较两组治疗效果。计量资料用x±s表示,组间比较使用配对t检验,计数资料采用χ2检验,P<0.05为差异有统计学意义。结果治疗后对照组焦虑自评量表(celf-rating anxiety scale,SAS)和抑郁自评量表(self-ratingdepression scale,SDS)评分分别为(53.18±10.19)、(42.69±10.22)分,观察组分别为(35.13±8.05)、(39.84±8.91)分,两组比较差异均有统计学意义(均P<0.05)。观察组患者LVEF为(51.2±3.12)%、BNP为(164.2±56.7)ng/L均优于对照组的(42.16±2.66)%、(286.7±103.5)ng/L(均P<0.05)。结论对社区门诊冠心病患者采取心理干预协同药物治疗,可以提高临床疗效,改善患者抑郁、焦虑症状,值得在临床上应用和推广。     

Body composition differences between adults with multiple sclerosis and BMI-matched controls without MS

BackgroundPersons with multiple sclerosis (MS) have many health conditions related to overweight and obesity, but little is known about how body composition among those with MS compares to those without MS at the same weight.ObjectiveTo compare differences in whole body and regional body composition between persons with and without MS matched for sex and body mass index (BMI).MethodsPersons with MS (n = 51) and non-MS controls (n = 51) matched for sex and BMI. Total mass, lean mass, fat mass, and percent body fat (%BF) of total body and arm, leg, and trunk segments were assessed using dual-energy X-ray absorptiometry (DXA).ResultsMen with MS had significantly less whole body lean mass (mean difference: 9933.5 ± 3123.1 g, p < 0.01) and higher fat mass (mean difference: 6079.0 ± 2137.4 g, p = .01) and %BF (mean difference: 9.43 ± 2.04%, p < 0.01) than BMI-matched non-MS counterparts. Further, men with MS had significantly lower lean mass in the arm (p = 0.02) and leg (p < 0.01) and higher fat mass in the arm (p = 0.01), leg (p = 0.03) and trunk (p = 0.03) than men without MS. Men with MS had significantly higher %BF in all three regions (p < 0.01) than men without MS. There were no differences between women with and without MS.ConclusionsWe observed significant differences in whole body and regional body composition between BMI-matched men with and without MS. Additional research is needed to further explore differences in body composition, adipose distribution, and the impact of these differences on the health and function of men with MS.