Diabetes and psychiatric illness in the total population of Stockholm

Objective

Concomitant psychiatric disorders in people with diabetes affect morbidity and mortality. We aimed to study psychiatric morbidity in people with diabetes and the general population using administrative health care data in Stockholm County.

Methods

The study population included all living persons who resided in Stockholm County, Sweden, on January 1, 2011 (N = 2,058,408). Subjects with a diagnosis of diabetes were identified with data from all consultations in primary health care, specialist outpatient care and inpatient care during the time span 2009–2013. As outcome, information was obtained on all consultations due to any psychiatric diagnosis as well as, specifically, schizophrenia, bipolar disorders, depression, and anxiety disorders, in 2011–2013. Analyses were performed by age group and gender. Age-adjusted odds ratios (ORs) with 95% confidence intervals (95% CI) for women and men with diabetes, using individuals without diabetes as referents, were calculated.

Results

Age-adjusted OR for all psychiatric diagnoses among people with diabetes was 1.296 (95% CI 1.267–1.326) for women and 1.399 (95% CI 1.368–1.432) for men. The greatest excess risk was found for schizophrenia, with OR 3.439 (95% CI 3.057–3.868) in women and 2.787 (95% CI 2.514–3.089) in men, with ORs between 1.276 (95% CI 1.227–1.327) and 1.714 (95% CI 1.540–1.905) for the remaining diagnoses.

Conclusion

The prevalence of psychiatric disorders is elevated in people with diabetes, which calls for preventive action to be taken to minimize suffering and costs to society.     

Primary care practice characteristics associated with the quality of care received by patients with depression and comorbid chronic conditions

Objective

This study aimed to identify primary care practice characteristics associated with the quality of depression care in patients with comorbid chronic medical and/or psychiatric conditions.

Method

Using data from cross-sectional organizational and patient surveys conducted within 61 primary care clinics in Quebec, Canada, the relationships between primary care practice characteristics, comorbidity profile, and the recognition and minimally adequate treatment of depression were assessed using multilevel logistic regression analysis with 824 adults with past-year depression and comorbid chronic conditions.

Results

Likelihood of depression recognition was higher in clinics where accessibility of mental health professionals was not viewed to be a major barrier to depression care [odds ratio (OR)=1.61; 95% confidence interval (CI) 1.13–2.30]. Four practice characteristics were associated with minimal treatment adequacy: greater use of treatment algorithms for depression (OR=1.77; 95% CI=1.18–2.65), high value given to teamwork (OR=2.48; 95% CI=1.40–4.38), having at least one general practitioner at the clinic devote significant time in practice to mental health (OR=1.54; 95% CI=1.07–2.21) and low perceived barriers to depression care due to inadequate payment models (OR=2.12; 95% CI=1.30–3.46).

Conclusions

Several primary care practice characteristics significantly influence the quality of care provided to patients with depression and comorbid chronic conditions and should be targeted in quality improvement efforts.     

Peptic ulcer disease and mental illnesses

Objective

We evaluated the association between self-reported doctor-diagnosed peptic ulcer disease (PUD) and mental disorders in a representative cross-sectional study conducted in 2010 in Singapore.

Method

The sample comprised 6616 community-dwelling individuals. Participants were asked about a previous history of doctor-diagnosed PUD. Assessment of mental disorders was performed using the World Mental Health Composite International Diagnostic Interview version 3.0. Quality of life was assessed using the EuroQoL 5D.

Results

The weighted prevalence of PUD was 1.58% (95% CI=1.13–2.02). In adjusted analyses, PUD was more common among people with anxiety disorders [obsessive compulsive disorders (OR 4.22, 95% CI 1.59–11.21), Generalized Anxiety Disorders (OR 9.25, 95% CI 2.43-35.17), any anxiety disorders (OR 4.41, 95% CI 1.82-10.61)] and with any mood disorders (OR 2.66, 95% CI 1.08-6.53). PUD was associated with alcohol abuse and alcohol dependence, but not with smoking or nicotine dependence. Adjustment for nicotine and alcohol use attenuated the association of mood disorders with PUD, but not that of anxiety disorders. PUD was associated with reduced quality of life as measured on EuroQoL 5D, with further reduction in those with concomitant mental disorders.

Conclusion

PUD was associated with anxiety disorders, and this association is not attenuated with adjustment for nicotine dependence or alcohol use disorder.     

Parents’ traumatic brain injury increases their children’s risk for use of psychiatric care: the 1987 Finnish Birth Cohort study

Objective

Traumatic brain injury (TBI) of a parent causes significant changes in their family life and parent–children relationships. However, the number of children affected by parental TBI and the long-term consequences for these children remain unknown. We estimated the prevalence of children affected by parental TBI and investigated whether these children had greater use of psychiatric services than their peers.

Methods

This a retrospective population-based register study. All 60,069 children born in Finland in 1987 were followed up through national health and social registers from 1987 to 2008.

Results

During the 21-year follow-up, 1532 (2.6%) children had a parent with TBI. Overall, 22.5% of those having a parent with TBI were treated in specialized psychiatric care. Use of psychiatric care was significantly increased among those cohort members with a parent with mild [odds ratio (OR) 1.80, 95% confidence interval (CI) 1.37–2.38] or severe (OR 1.49, 95% CI 1.12–1.98) TBI compared to their peers.

Conclusions

Parental TBI is associated with increased use of specialized psychiatric services by children. Adult health care services must have appropriate systems in place to address the psychosocial needs and support the welfare and development of children of patients with TBI.     

Further evidence in support of the association between venous thrombosis and atherosclerosis: A case–control study

Introduction

Whether there is an association between venous thromboembolism (VTE) and atherosclerosis is still controversial.

Aims

In a case–control study conducted on subjects older than 50, we assessed the prevalence of symptomatic or subclinical atherosclerosis in a group of unselected patients with unprovoked VTE, and compared it with that of patients with secondary VTE and of matched control individuals free from VTE disorders.

Methods

Cases and controls were enquired about the presence of previous symptomatic manifestations of atherosclerosis. Those with a negative history underwent the ultrasound assessment of carotid arteries following a standardized procedure. An intima-media thickness higher than 0.9 mm or the detection of at least one carotid plaque was regarded as a subclinical manifestation of atherosclerosis. After adjusting for age, gender and risk factors for atherosclerosis, we calculated the odds ratio (OR) for symptomatic or subclinical atherosclerosis in patients with unprovoked VTE as compared to those with secondary VTE and controls.

Results

We recruited 100 patients with unprovoked VTE, 100 with secondary VTE and 100 control individuals. In patients with unprovoked VTE, the adjusted OR for symptomatic or subclinical atherosclerosis was 5.1 (95% CI, 2.0 to 13.1) in comparison to patients with secondary VTE, and 14.5 (95% CI, 5.8 to 36.3) in comparison to controls. The prevalence of atherosclerosis was higher in patients with secondary VTE than in controls (OR, 3.1; 95% CI, 1.6 to 6.1).

Conclusion

The results of this study confirm the presence of a strong association between venous thrombosis and atherosclerosis.     

Restoring professionalism: the physician fitness-for-duty evaluation

Objectives

We compare findings from 10 years of experience evaluating physicians referred for fitness-to-practice assessment to determine whether those referred for disruptive behavior are more or less likely to be declared fit for duty than those referred for mental health, substance abuse or sexual misconduct.

Method

Deidentified data from 381 physicians evaluated by the Vanderbilt Comprehensive Assessment Program (2001–2012) were analyzed and compared to general physician population data and also to previous reports of physician psychiatric diagnosis found by MEDLINE search.

Results

Compared to the physicians referred for disruptive behavior (37.5% of evaluations), each of the other groups was statistically significantly less likely to be assessed as fit for practice [substance use, %: odds ratio (OR)=0.22, 95% confidence interval (CI)=0.10–0.47, P< .001; mental health, %: OR=0.14, 95% CI=0.06–0.31, P< .001; sexual boundaries, %: OR=0.27, 95% CI=0.13–0.58, P= .001].

Conclusions

The number of referrals to evaluate physicians presenting with behavior alleged to be disruptive to clinical care increased following the 2008 Joint Commission guidelines that extended responsibility for professional conduct outside the profession itself to the institutions wherein physicians work. Better strategies to identify and manage disruptive physician behavior may allow those physicians to return to practice safely in the workplace.     

Correlates of depressive symptoms among at-risk youth presenting to the emergency department

Objective

The study's objective was to identify correlates of depressive symptoms among at-risk youth in an urban emergency department (ED).

Method

A systematic sample of adolescents (ages 14–18) in the ED were recruited as part of a larger study. Participants reporting past-year alcohol use and peer aggression self-administered a survey assessing: demographics, depressive symptoms and risk/protective factors. Logistic regression identified factors associated with depressive symptoms.

Results

Among 624 adolescents (88% response rate) meeting eligibility criteria, 22.8% (n=142) screened positive for depressive symptoms. In logistic regression, depressive symptoms were positively associated with female gender [odds ratio (OR): 2.84, 95% confidence interval (CI): 1.78–4.51], poor academic performance (OR: 1.57, 95% CI: 1.01–2.44), binge drinking (OR: 1.88, 95% CI: 1.21–2.91), community violence exposure (OR: 2.25, 95% CI: 1.59–3.18) and dating violence (OR: 2.14, 95% CI: 1.36–3.38) and were negatively associated with same-sex mentorship (OR: 0.52, 95% CI: 0.29–0.91) and older age (OR: 0.55, 95% CI 0.34–0.89). Including gender interaction terms did not significantly change findings.

Conclusions

Screening and intervention approaches for youth in the urban ED should address the co-occurrence of depressive symptoms with peer and dating violence, alcohol and nonmarijuana illicit drug use.     

Self-reported family history in estimating the risk of hormone,surgery and cast related VTE in women

Background

Combined hormonal contraceptives, menopause hormone treatment and surgery/cast in orthopedic patients are important risk factors for venous thromboembolism (VTE) in women.

Objectives

To evaluate whether self-reported family history can be used for risk assessment concerning hormone and surgery /cast related VTE in women.

Patients/methods

1288 women 18–64 years with a first event of VTE and 1327 age-matched controls were included in a nation-wide population-based case–control study in Sweden. Odds ratios were calculated by comparing occurrence of VTE in women with and without a positive family history in combination with hormones or surgery/cast.

Results

The risk of hormone-associated VTE was doubled in women with a family history of VTE as compared to women with hormones and negative family history. The risk was more than tripled in women with surgery/cast and a positive family history, as compared to surgery/cast patients with negative family history. Women with a positive family history and combined hormonal contraceptive or menopause hormone treatment had an OR of 15.3 (95% CI 6.1–38) and 5.9 (95% CI 3.3–11) respectively compared to women without hormones or family history. The corresponding OR in women with surgery/cast and a positive family history was 67 (95% CI 21–213) compared to women without surgery/cast treatment and a negative family history.

Conclusion

Self-reported family history is associated with increased odds of developing VTE on combined hormonal contraceptives, menopause hormone treatment and in connection with surgery or plaster. We believe that assessing family history of VTE can be helpful in identifying high risk patients.     

The presence of a depressive episode predicts lower return to work rate after myocardial infarction

Context

No studies have evaluated whether the presence of a depressive episode is associated with an increased risk of not returning to work following myocardial infarction (MI).

Objectives

To examine the prospective associations between depressive episode and anxiety disorders with return to work (RTW) after MI at 3 and 12 months based on International Classification of Diseases, 10th Revision.

Design

Prospective cohort study.

Setting

Four hospitals in the North of The Netherlands.

Participants

From a sample of patients hospitalized for MI (n= 487), we selected those who had a paid job at the time of the MI (N= 200).

Main exposure measures

Presence of a depressive episode and presence of any anxiety disorder during the first 3 months post-MI.

Main outcome measures

RTW at 12 months post-MI.

Results

Of the patients with work prior to MI, 75% had returned to work at 12 months. The presence of a depressive episode during the first 3 months (prevalence: 19.4%) was a significant predictor of no RTW at 12 months post-MI, also after controlling for confounders [odds ratio (OR) 3.48; 95% confidence interval (CI): 1.45–8.37]. The presence of an anxiety disorder (prevalence: 11.9%) had a borderline significant association with no RTW as well. This association remained after controlling for confounders (OR 2.90; 95% CI: 1.00–6.38) but diminished when controlling for depression.

Conclusions

The presence of a depressive episode was associated with an increased risk of no RTW in MI patients. The association between anxiety and risk of no RTW could in part be explained by the presence of depression. Further studies may address the possibility of countering the effect of depression by effective treatment.     

Prevalence,correlates and recognition of depression in Chinese inpatients with cancer

Objective

To determine the prevalence, correlates and recognition rates of depressive disorders (DDs) in Chinese inpatients with cancer.

Methods

Four hundred and sixty cancer inpatients were recruited from the oncology ward of a university hospital in Beijing, China. Patients were interviewed with a Chinese version of the Mini International Neuropsychiatric Interview 5.0 by eight trained psychiatrists. Case records of inpatients with DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) DDs were reviewed to determine whether treating oncologists made a diagnosis of depression, prescribed antidepressant medications and/or recommended psychiatric consultation/referral.

Results

The 1-month prevalence rates (95% confidence intervals) of DDs and major depressive disorder (MDD) were 25.9% (21.9%–29.9%) and 12.6% (9.6%–15.6%), respectively. In our multiple logistic regression analysis, being unmarried [odds ratio (OR)=1.41], cancer stage of metastasis (OR=2.35), time since cancer diagnosis ≤ 20 months (OR=2.05), frequent pain (OR=1.99~6.83) and being scored between two and four on the Eastern Cooperative Oncology Group Scale (OR=2.25~4.97) were independently associated with depression. Only 6.9% of patients with MDD were recognized by treating oncologists.

Conclusions

DDs are very common among Chinese inpatients with cancer. The high prevalence rate and low recognition rate of depression in cancer patients indicate a pressing need for routine screening, evaluation and treatment of depression in this patient population.     

Risk of prostate cancer in patients with schizophrenia

Objectives

To examine the rate of prostate cancer in a cohort of schizophrenia in-patients in the PSA-era as compared to expected rates. There is conflicting evidence on the relative risk of prostate cancer in men with schizophrenia.

Methods

the study sample was comprised of schizophrenia patients who had been admitted to a tertiary care mental health center between 1990 and 2011. The data for the sample was cross-referenced with the National Cancer Registry. Analyses of Standardized Incidence Rates (SIR) for prostate cancer and for lung cancer (representing an organ system not sensitive to sex hormones) were performed.

Results

Of 4,326 schizophrenia patients included in the present study, 181 (4.2%) were diagnosed with cancer at any site. Only 10 of these patients were diagnosed with prostate cancer. This reflects a reduced risk; SIR of 0.56 (95% CI 0.27–1.03). In the same cohort, 33 schizophrenia patients were diagnosed with lung cancer presenting a SIR of 1.43 (95% CI 0.98–2.01) in this sample.

Conclusions

The present study suggests a reduced rate of prostate cancer in patients admitted for schizophrenia. There are several possible explanations for this finding including chronic state of hyperprolactinemia induced by antipsychotic drugs.     

Association between obstructive sleep apnea and deep vein thrombosis / pulmonary embolism: A population-based retrospective cohort study

Background

Obstructive sleep apnea (OSA) is a major contributor to cardiovascular disease, and may cause severe morbidity and mortality. Recent studies have indicated that OSA patients exhibited elevated platelet activity, fibrinogen levels, and platelet aggregation.

Objectives

We investigated the risk of deep vein thrombosis (DVT) and pulmonary embolism (PE) in patients diagnosed with OSA compared with age- and sex-matched unaffected people.

Patients/Methods

This longitudinal, nationwide, population-based cohort study was conducted using data from Taiwan National Health Insurance Research Database (NHIRD) recorded between January 2000 and December 2011. The study consisted of 3511 patients with OSA and 35110 matched comparison individuals. A Cox proportional hazard regression was used to compute the risk of DVT and PE in patients with OSA compared with those without OSA.

Results

The DVT and PE risks were 3.50- and 3.97-fold higher (95% CI = 1.83–6.69 and 1.85–8.51) respectively, in the OSA cohort than in the reference cohort after we adjusted for age, sex, and comorbidities.

Conclusion

This nationwide population-based cohort study indicates that patients with OSA exhibit a higher risk of subsequent DVT and PE.     

Prevalence of liver disease in veterans with bipolar disorder or schizophrenia

Objective

To assess the prevalence of three liver diseases [hepatitis C virus (HCV), nonalcoholic fatty liver disease and alcohol-induced cirrhosis] in patients (veterans) with/without schizophrenia/schizoaffective disorder and bipolar disorder.

Methods

A retrospective electronic chart review of Veterans Integrated Services Network 20 facilities from January 1, 2001 to December 21, 2006 selected patients to one of two groups: schizophrenia/schizoaffective disorder or bipolar disorder. Patients in both groups were compared with veterans in an equal-sized random sample from the same data set of veterans without psychiatric diagnoses. Logistic regression models evaluated risk for overall liver diseases as well as HCV, nonalcoholic fatty liver disease and alcoholic-induced cirrhosis.

Results

Patients with schizophrenia (n=6521) had a higher prevalence of liver disease [22.4% versus 3.2%; odds ratio (OR)=8.73]; HCV (16.5% versus 1.9%; OR=10.21); and alcohol-related cirrhosis (1.6% versus 0.4%; OR=4.09) than matched controls. Patients with bipolar disorder (n=5319) had a higher prevalence of liver disease (21.5% versus 3.5%; OR=7.58); HCV (15.5% versus 2.1%; OR=8.60); and alcohol-related cirrhosis (1.6% versus 0.4%; OR=3.82) than matched controls. Risk factors for liver disease in patients with schizophrenia (versus matched controls) included diabetes (OR=1.29), hypertension (OR=1.27), HIV (OR=3.54), substance use disorder (SUD) (OR=2.28), alcohol use disorder (OR=3.05) and schizophrenia (OR=2.74). Risk factors for development of liver disease for patients with bipolar disorder: diabetes (OR=1.40), HIV (OR=3.66), SUD (OR=2.68), alcohol use disorder (OR=3.22) and bipolar disorder (OR=2.27).

Conclusions

This study in veterans shows that the presence of mental illness and its comorbidities represents a significant risk factor for the diagnosis of liver disease, including HCV and alcohol-related cirrhosis.     

The association between depressive disorders and health care utilization: results from the São Paulo Ageing and Health Study (SPAH)

Background

Although depressive disorders are associated with increased health care utilization in the elderly living in high-income countries, few studies have examined this relationship in Latin America.

Method

The present study is part of the São Paulo Ageing and Health Study, a population-based epidemiological study of mental disorders in 2072 low-income adults ≥ 65 years old living in São Paulo, Brazil. Depressive disorders defined as major depressive disorder (MDD) and clinically relevant depressive symptoms (CRDS) were assessed with the Geriatric Mental State and the Neuropsychiatric Inventory. We examined the association between depressive disorders/symptoms and health care utilization (outpatient visits, hospital admissions and medication use in the past 3 months) using count models.

Results

The prevalence of MDD and CRDS was 4.9% and 21.4%, respectively. In the fully adjusted model, older adults with MDD were 36% more likely to have one more outpatient visit (RM: 1.36, 95% CI: 1.11–1.67), while older adults with CRDS were 14% more likely to have one more outpatient visit (RM: 1.14, 95% CI: 1.02–1.28). Elderly individuals with MDD had a prevalence of hospital admissions in the previous 3 months that was twice that of those without depression (PR=2.02, 95% CI: 1.09–3.75). Significant differences were not found for medication use.

Conclusion

Among low-income older adults living in Brazil, those with MDD are more likely to have a recent hospital admission and outpatient service use than those without depression. Future studies are needed to examine the effectiveness of depression treatments for this population in order to both decrease the burden of illness as well as to minimize health care utilization related to depression.     

Schizophrenia and the risk of cardiovascular diseases: A meta-analysis of thirteen cohort studies

Background

Numerous studies have investigated the relationship between schizophrenia and the incidence of cardiovascular disease (CVD), but their results were not entirely consistent. Our study aimed to elucidate the association between schizophrenia and the risk of CVD by a meta-analysis of cohort studies.

Methods

PubMed, the Cochrane Library, and EMBASE databases were searched to identify relevant studies that met the prespecified inclusion criteria. We also reviewed reference lists from the retrieved articles. Relative risks (RRs) and 95% confidence intervals (CIs) were extracted and pooled using the fixed-effect or random-effects models.

Results

Thirteen studies involving 3,549,950 participants, with outcomes of CVD reported for 422,698, were included in the meta-analysis. The follow-up period ranged from 1.6 to 36.0 years. The meta-analysis found that the pooled RRs for schizophrenia compared with the reference group were 1.53 (95% CI: 1.27–1.86) for the incidence of CVD, 1.20 (95% CI: 0.93–1.53) for coronary heart disease (CHD), 1.71 (95% CI: 1.19–2.46) for stroke, and 1.81 (95% CI: 1.42–2.29) for congestive heart failure (CHF). Sensitivity analysis after the exclusion of a single cohort or using the unadjusted RRs yielded similar results to the primary overall estimations. No evidence of publication bias was observed.

Conclusions

Schizophrenia is associated with increased incidence of CVD, stroke and CHF, and might also increase the risk of CHD. Greater attention should be paid to schizophrenia patients to prevent the occurrence of CVD and to decrease the risk of cardiac morbidity.     

The association of psychosocial factors and obstetric history with depression in pregnant women: focus on the role of emotional support

Objective

Depression during pregnancy can negatively affect both maternal and fetal health. The benefits of early detection and treatment for antenatal depression have been emphasized. Therefore, we investigated risk factors for antenatal depression with a focus on emotional support.

Methods

We conducted a cross-sectional study of pregnant women (n= 1262) enrolled from the local division of a community mental health center. All subjects completed self-report questionnaires that assessed depressive mood, emotional support and other risk factors. Associations between antenatal depression and potential risk factors including emotional support were analyzed by logistic regression analysis.

Results

Antenatal depression was associated with various biopsychosocial correlates: unmarried state, low education, cigarette smoking, low income, familial history of depression, past history of depression, physical abuse history, sexual abuse history, premenstrual syndrome, primiparity and unplanned pregnancy. When the associations of emotional support with antenatal depression were specified by its resources, current emotional support from partner [odds ratio (OR)=2.26, 95% confidence interval (CI)=1.94–2.64] and mother (OR=1.43, 95% CI=1.26–1.62) and past experience for emotional support from mother (OR=1.52, 95% CI=1.32–1.74), but not from father significantly influenced depression during pregnancy.

Conclusions

The multidimensional biopsychosocial approach would be needed to identify and assess antenatal depression. Promoting emotional support from the partner, family member and, possibly, the health provider could be a protective effect against the development of antenatal depression.     

Sleep disturbances and reduced work functioning in depressive or anxiety disorders

Objectives

We aimed to examine the associations between sleep disturbances and work functioning in an epidemiologic cohort study in subjects with or without depressive or anxiety disorders.

Methods

There were 707 subjects included in our analyses with depressive or anxiety disorders and 728 subjects without current depressive or anxiety disorders. Insomnia was defined as a score ?9 using the Insomnia Rating Scale. Self-reported sleep duration was categorized in short, normal, and long (?6, 7–9, and ?10 h, respectively). Work absenteeism was defined as none, short (?2 weeks), or long (>2 weeks). Work performance was defined as not impaired, reduced, or impaired. Logistic regression analyses were performed to examine the associations of sleep disturbances with work functioning.

Results

In subjects with psychopathology, insomnia and short sleep duration were significantly associated with impaired work performance (odds ratio [OR] for insomnia, 2.20; [95% confidence interval {CI}, 1.50–3.22]; OR for short sleep, 2.54 [95% CI, 1.66–3.88] compared to normal sleep duration). Insomnia (OR, 2.48 [95% CI, 1.67–3.69]) and short sleep duration (OR, 1.85 [95% CI, 1.23–2.78]) also were associated with long-term absenteeism. These findings remained the same after considering clinical characteristics including medication use and symptom severity.In subjects without psychopathology, no significant associations were found between insomnia and short sleep duration on work functioning after considering subthreshold depression symptoms.

Conclusions

In subjects with psychopathology, sleep disturbances were negatively associated with work functioning, independent of disorder severity and use of psychotropic medication. Further research is needed to determine if treatment of sleep disturbances in subjects with psychopathology improves work functioning.     

Determinants of a hopeful attitude among family caregivers in a palliative care setting

Objective

This study investigated the determinants of a hopeful attitude among family caregivers involved with palliative care.

Method

We investigated a broad range of factors for the patient–family dyad in a palliative care setting using a cross-sectional design. The patients' sociodemographic, clinical and psychological factors were evaluated, as well as caregiver-related sociodemographic and psychological factors, including depressive symptoms, burden, coping style and religiosity. Caregivers were divided into two groups based on a hopeful or nonhopeful attitude and assessed using the abbreviated version of the seven-item Beck Hopelessness Scale (BHS-7).

Results

Of 304 analyzed dyads, 210 (69.1%) caregivers showed a hopeful attitude, with a BHS-7 score of 0. The adjusted logistic regression analyses showed that caregivers' hopeful attitude was determined by only their psychological status: less depressive symptoms [odds ratio (OR), 0.86; 95% confidence interval (CI), 0.83–0.90], active coping strategy (OR, 1.12; 95% CI, 1.07–1.18) and lower burden (OR, 0.93; 95% CI, 0.88–0.99). In a subpopulation analysis (n= 200), higher religiosity was a significantly associated factor.

Conclusion

Healthcare providers need to pay attention to the psychological vulnerability of caregivers to encourage a hopeful attitude. Additional studies of longitudinal design for hopeful attitude throughout the trajectory of palliative care are necessary.     

The role of inherited thrombophilia in patients with isolated pulmonary embolism: A systematic review and a meta-analysis of the literature

Introduction

Venous thromboembolism (VTE) is a common vascular disease that results in deep venous thrombosis (DVT) and pulmonary embolism (PE). Factor V Leiden mutation (FVL) and G20210A prothrombin mutation (PTM) are associated with an increased risk of VTE. Recent studies have reported a lower prevalence of FVL in patients with isolated PE than in patients with DVT with or without PE, suggesting the possibility that the prevalence of FVL in patients with isolated PE may be not significantly different from that of the general population. To address this issue, we performed a systematic review and a meta-analysis of published studies that assessed the prevalence of FVL and/or PTM in patients with isolated PE and in controls without VTE.

Methods

MEDLINE and EMBASE databases were searched up to October 2013. Pooled odds Ratios (OR) and 95% confidence intervals (CIs) were calculated using a random-effects model. Statistical heterogeneity was evaluated using the Cochran Q and I² statistics.

Results

Eighteen studies totalling more than 11,000 patients were included. FVL was found significantly more often in patients presenting isolated PE than in controls (OR 2.06; 95% CI 1.66, 2.56; p < 0.0001). The prevalence of PTM was also significantly different in patients presenting with isolated PE than in controls (OR 2.64, 95% CI 1.92, 3.63; p < 0.0001). Heterogeneity among studies was low.

Conclusion

FVL and PTM are both associated with isolated PE. However, the association magnitude between PE and FVL mutation appeared to be lower compared to that observed in the general population of VTE patients.