Underlying factors in the association between depressed mood and mobility limitation in older people

BACKGROUND: Depressed mood may either precede mobility limitation or follow from mobility limitation. OBJECTIVE: To compare mood status among people with manifest mobility limitation, those with preclinical mobility limitation and those without mobility limitation and investigate factors explaining the association between depressed mood and mobility limitation. DESIGN: Cross-sectional. Subjects: 645 community-living 75- to 81-year-old people. METHODS: Depressed mood was assessed using the Centre for Epidemiologic Studies Depression Scale (CES-D, cut-off score 16); difficulty walking 500 m was assessed by self-report. Those reporting difficulty were categorised as having manifest mobility limitation. Those with no difficulty but reporting task modifications, such as reduced frequency of walking, were categorised as having preclinical mobility limitation. The association between depressed mood and mobility limitation was analysed using logistic regression analysis with gender, age, economic situation, the availability of a confidant, chronic conditions, and widespread pain as covariates. RESULTS: Depressed mood was found in 34% of subjects with manifest mobility limitation, in 26% of those with preclinical mobility limitation, and in 13% of those without mobility limitation. The unadjusted odds ratio for depressed mood was 3.43 (95% CI 2.04-5.76) among subjects with manifest mobility limitation and 2.38 (95% CI 1.52-3.73) among those with preclinical mobility limitation, compared to those without mobility limitation.Adjustment for covariates reduced the risks to 2.10 (95% CI 1.15-3.82) and 1.99 (95% CI 1.24-3.20), respectively. Widespread pain explained 28% of the increased risk of depressed mood among those with manifest mobility limitation. CONCLUSION: The dose-response relationship between depressed mood and mobility limitation suggests that both conditions may progress simultaneously and may share aetiology, at least in part. Pain may be an underlying factor in both depressed mood and mobility limitation.     

EssenCES, a short questionnaire for assessing the social climate of forensic psychiatric wards

BACKGROUND: A supportive ward atmosphere is considered by many to be a precondition for successful treatment in forensic psychiatry, but there is a clear need for a valid and economic climate evaluation instrument. AIMS: To validate a short questionnaire, designed for assessing forensic psychiatric wards. Climate dimensions measured with the 'Essen Climate Evaluation Schema' (EssenCES) are 'Therapeutic Hold', 'Patients' Cohesion and Mutual Support' and 'Safety' (versus threat of aggression and violence). METHOD: In 17 forensic mental hospitals in Germany, patients and staff completed the EssenCES and other questionnaires. Problematic events were recorded over a period of 3 weeks on each ward. RESULTS: The anticipated three factor structure of the instrument was confirmed. The pattern of correlations also provided support for the validity of the subscales. CONCLUSIONS: The climate questionnaire is an economic and valid instrument for assessing the ward atmosphere in forensic psychiatry. Findings from a pilot study in England give confidence to the structural validity of the English version too.     

Body mass index does not improve the ability to predict biochemical recurrence after radical prostatectomy

PurposeTo test whether body mass index (BMI) improves pre- or post-operative biochemical recurrence (BCR) predictions after radical prostatectomy.Materials and methodsPre- and post-operative data were available in 2416 and 2499 men, respectively. Cox regression models addressed the association between BMI and the rate of BCR after adjusting for pre- and post-operative predictors. Predictive accuracy was quantified using Harrell’s concordance index, with and without BMI and subjected to 200 bootstraps to reduce overfit bias. Differences in predictive accuracy were compared using the Mantel–Haenszel test.ResultsAfter adjusting for either pre- or post-operative variables, increasing BMI was a statistically independent risk factor of BCR in both models (both p ⩽ 0.003). Its addition to pre- and post-operative variables respectively increased predictive accuracy measures from 69.6 to 70.2% (+0.6%, p = 0.7) and from 78.1 to 78.4% (+0.3%, p = 0.8).ConclusionOur data emphasise that despite its significance, inclusion of BMI into models, to predict BCR, does not improve their accuracy.     

Effect of Physical Activity Counseling on Disability in Older People: A 2‐Year Randomized Controlled Trial

OBJECTIVES: To study the effect of a physical activity counseling intervention on instrumental activity of daily living (IADL) disability. DESIGN: Primary care–based, single‐blind, randomized controlled trial. SETTING: City of Jyväskylä, central Finland. PARTICIPANTS: Six hundred thirty‐two people aged 75 to 81 who were able to walk 500 meters without assistance, were at most moderately physically active, had a Mini‐Mental State Examination score greater than 21, had no medical contraindications for physical activity, and gave informed consent for participation. INTERVENTION: A single individualized physical activity counseling session with supportive phone calls from a physiotherapist every 4 months for 2 years and annual lectures on physical activity. Control group received no intervention. MEASUREMENTS: The outcome was IADL disability defined as having difficulties in or inability to perform IADL tasks. Analyses were carried out according to baseline IADL disability, mobility limitation, and cognitive status. RESULTS: At the end of the follow‐up, IADL disability had increased in both groups (P<.001) and was lower in the intervention group, but the group‐by‐time interaction effect did not reach statistical significance. Subgroup analyses revealed that the intervention prevented incident disability in subjects without disability at baseline (risk ratio=0.68, 95% confidence interval=0.47–0.97) but had no effect on recovery from disability. CONCLUSION: The physical activity counseling intervention had no effect on older sedentary community‐dwelling persons with a wide range of IADL disability, although it prevented incident IADL disability. The results warrant further investigation to explore the benefits of a primary care–based physical activity counseling program on decreasing and postponing IADL disability.     

Surgical treatment concepts for patients with pancreatic cancer in Germany—results from a national survey conducted among members of the “Chirurgische Arbeitsgemeinschaft Onkologie” (CAO) and the “Arbeitsgemeinschaft Internistische Onkologie” (AIO) of the Germany Cancer Society (DKG)

Background  

To date, only limited data are available regarding the routine surgical management of patients with exocrine pancreatic cancer (PC) in German community and university hospitals.     

Speech segmentation in aphasia

Background: Speech segmentation is one of the initial and mandatory phases of language learning. Although some people with aphasia have shown a preserved ability to learn novel words, their speech segmentation abilities have not been explored.

Aims: We examined the ability of individuals with chronic aphasia to segment words from running speech via statistical learning. We also explored the relationships between speech segmentation and aphasia severity, and short-term memory capacity. We further examined the role of lesion location in speech segmentation and short-term memory performance.

Methods & Procedures: The experimental task was first validated with a group of young adults (n = 120). Participants with chronic aphasia (n = 14) were exposed to an artificial language and were evaluated in their ability to segment words using a speech segmentation test. Their performance was contrasted against chance level and compared to that of a group of elderly matched controls (n = 14) using group and case-by-case analyses.

Outcomes & Results: As a group, participants with aphasia were significantly above chance level in their ability to segment words from the novel language and did not significantly differ from the group of elderly controls. Speech segmentation ability in the aphasic participants was not associated with aphasia severity although it significantly correlated with word pointing span, a measure of verbal short-term memory. Case-by-case analyses identified four individuals with aphasia who performed above chance level on the speech segmentation task, all with predominantly posterior lesions and mild fluent aphasia. Their short-term memory capacity was also better preserved than in the rest of the group.

Conclusions: Our findings indicate that speech segmentation via statistical learning can remain functional in people with chronic aphasia and suggest that this initial language learning mechanism is associated with the functionality of the verbal short-term memory system and the integrity of the left inferior frontal region.     

Late psychiatric morbidity in survivors of cancer at a young age: A nationwide registry‐based study

Childhood cancer survivors have been shown to be prone to psychosocial adverse outcomes. Data on young adults and their psychiatric late effects are still scarce. In a nationwide, registry‐based study, we explored the risk (HR) of new psychiatric diagnoses in 5‐year survivors of childhood and young adulthood (YA) cancer (n = 13,860) compared with a sibling cohort (n = 43,392). Hazard ratios (HRs) were calculated using Cox regression models. Patients and siblings were identified from the Finnish Cancer Registry and Central Population Registry, respectively. Outcome diagnoses were retrieved from the national hospital discharge register. The risk of organic memory/brain disorders was significantly increased in both childhood (HR 4.9; 95%CI 2.7–8.9) and YA (HR 2.1; 95%CI 1.4–3.1) cancer survivors compared with siblings. Mood disorders were also more common in childhood (HR 1.3; 95%CI 1.1–1.7) and YA survivors (1.3; 95%CI 1.1–1.5) than in siblings. Radiotherapy did not explain the differences. Female childhood cancer survivors had significantly increased HRs for mood disorders, psychotic disorders, neurotic/anxiety disorders, somatization/eating disorders and personality disorders. In survivors of YA cancers, females had significantly increased HR for neurotic/anxiety disorders, and the difference between female survivors and siblings was significantly (p < 0.05) higher than that between male survivors and male siblings. The effect of treatment era was also analyzed, and the risk of organic memory and brain disorders in childhood cancer survivors did not diminish over time. Despite the trend of decreased use of cranial irradiation in children, the risk of organic memory/brain disorders was elevated, even during the most recent era. Thus, additional research on chemotherapy‐only protocols and their impact on mental health, is warranted.     

Respiratory sinus arrhythmia as a predictor of sudden cardiac death after myocardial infarction

Background. Measurement of high-frequency (HF) spectral power of heart rate (HR) variability has not been able to identify the patients at risk of sudden cardiac death (SCD) despite the experimental evidence of protective role of vagal activity for fatal arrhythmias.

Aim. We developed a novel respiratory sinus arrhythmia (RSA) analysis method and tested its ability to predict SCD after an acute myocardial infarction.

Method. The RSA analysis method was developed in 13 subjects from simultaneous recordings of respiration and R-R intervals. An adaptive threshold was computed based on the zero-phase forward and reverse digital filtering in the analysis of RSA. With this method, only respiration-related R-R interval fluctuations are included. The prognostic power of RSA, analyzed from 24-hour electrocardiographic recordings, was subsequently assessed in a large postinfarction population including 1631 patients with mean follow-up of 40±17 months.

Results. Depressed RSA was a strong predictor of SCD (hazard ratio 7.4; 95% CI 3.6–15.1; P <0.0001) but only a weak predictor of non-SCD. The RSA index remained an independent predictor of SCD after adjustments for ejection fraction and other clinical risk variables (RR 4.7; 95% CI 2.28–9.85).

Conclusions. Reduced respiratory-related HR dynamics, detected by RSA index, are a specific marker of an increased risk of SCD among postinfarction patients.