Health-related quality of life in community-dwelling men with pneumoconiosis

BACKGROUND: There have been few data on the health-related quality of life (HRQOL) in patients with pneumoconiosis. HRQOL is an important aspect of daily living in patients with industrial diseases. Objectives: To investigate the HRQOL and factors that contribute to the impairment of HRQOL in patients with pneumoconiosis. METHODS: 297 patients with pneumoconiosis were recruited from a community-based case registry. The HRQOL was measured with the St. George's Respiratory Questionnaire (SGRQ). Pulmonary function, comorbidity and psychosocial variables were also assessed. Patients' mood state was evaluated with the Geriatric Depression Scale (GDS). RESULTS: The mean SGRQ symptom, activity, impact and total scores were 38.0 +/- 19.3, 44.5 +/- 21.9, 34.2 +/- 17.9 and 39.4 +/- 17.4, respectively. These figures were lower than those reported in patients with chronic obstructive pulmonary disease who attended chest clinics. The GDS score (r = 0.38), forced expiratory volume in 1 s predicted (FEV(1)% predicted;r = -0.33) and comorbidity (r = 0.21) were the most important predictors of the HRQOL. CONCLUSIONS: Besides lung functions, chest clinicians should consider the impact of mood symptoms and comorbidity on the HRQOL in the management of patients with pneumoconiosis.     

Selective serotonin-reuptake inhibitor antidepressants increase the risk of falls and hip fractures in elderly people by inhibiting cardiovascular ion channels

Surprising results from recently published retrospective studies show that the use of new selective serotonin-reuptake inhibitor antidepressants (SSRIs), similarly to the older tricyclic antidepressants (TCAs), increases the risk of falls and hip fractures among elderly people.The mechanism whereby antidepressants increase this risk is complex and may include orthostatic hypotension, arrhythmias, sedation and confusion. The increased risk of falls and hip fractures with the use of TCAs is not surprising considering their well-known cardiovascular, anticholinergic and antihistaminergic side-effects. But the increased risk of falls with SSRIs is highly unexpected since these drugs are believed to be free from the disadvantages of TCAs.We hypothesized that the new SSRI antidepressants may also have cardiovascular effects similarly to the older TCA compounds, which may be an explanation for the increased rate of falls and hip fractures. The experimental and clinical evidence in support of this hypothesis are discussed.     

The Prevalence of Insomnia, Its Sociodemographic and Clinical Correlates, and Treatment in Rural and Urban Regions of Beijing, China: A General Population-Based Survey

Study Objectives

To determine the prevalence of insomnia, its sociodemographic and clinical correlates, and treatment patterns in Chinese people.

Design

A total of 5,926 subjects were randomly selected in the urban and rural areas of Beijing and interviewed using standardized assessment tools. Basic sociodemographic and clinical data were also collected.

Setting

Urban and rural regions of Beijing municipality, China.

Patients or Participants

Adult residents older than 15 years. Interventions N/A.

Measurements and Results

The prevalence of at least one type of insomnia was 9.2%; the rates of difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), and early morning awakening (EMA) were 7.0%, 8.0%, and 4.9%, respectively. Increased age (age >44 and 24 years in the urban and rural samples, respectively), female sex, married, divorced, separated, or widowed marital status; having a major medical condition; and suffering from a psychiatric disorder were risk factors for all types of insomnia in both the urban and rural samples. A low level of education (primary school or illiteracy) was significantly associated with a higher likelihood of all types of insomnia in the urban sample. Current smokers and current drinkers were less likely to report any type of insomnia in the rural sample. Unemployment was associated with DMS in the urban sample, while it was associated with DIS and DMS in the rural sample. Only 5.4% of the participants with any type of insomnia reported their symptoms to medical practitioners. In contrast, nearly one-third of the subjects with insomnia reported taking benzodiazepines as sleep-enhancing drugs.

Conclusions

Nationwide epidemiologic surveys are needed to further explore the prevalence of insomnia in China. The low percentage of subjects treated for insomnia indicates a major public health problem that should be addressed. Strict controls on use of benzodiazepines are warranted.

Citation:

Xiang YT; Ma X; Cai ZJ; Li SR; Xiang YQ; Guo HL; Hou YZ; Li ZB; Li ZJ; Tao YF; Dang WM; Wu XM; Deng J; Lai KYC; Ungvari GS. The prevalence of insomnia, its sociodemographic and clinical correlates, and treatment in rural and urban regions of Beijing, China: a general population-based survey. SLEEP 2008;31(12):1655–1662.     

A comparison of immunomodulation therapies in mechanically ventilated patients with Guillain Barré syndrome

A comparison of the effectiveness of immunomodulatory therapies in patients with Guillain Barré syndrome (GBS) who require mechanical ventilation (MV) is important for patient treatment and cost. We aimed to compare the effectiveness of three modes of intervention on the outcome of patients with GBS receiving MV: intravenous immunoglobulin (IVIgG); small volume plasmapheresis (SVP) and large volume plasmapheresis (LVP). Patients with GBS satisfying National Institute of Neurological and Communicative Disorders and Stroke 1990 criteria and requiring MV between 1997 between 2007 were analyzed. The primary outcome parameters evaluated were mortality, duration of MV, hospital stay and Hughes scale at discharge from hospital. Of the 173 (Male: Female, 118:55) patients who required MV during the study, 106 patients received single modality treatment (IVIgG 31, LVP 45, SVP 30) based on availability, affordability and feasibility. Patients receiving IVIgG had a higher incidence of severe weakness and bulbar involvement. The mean duration of MV (p = 0.61), total hospital stay (p = 0.44) and Hughes scale at discharge (p = 0.31) did not differ among the three groups. Complications were similar in the three treatment groups except for hypoalbuminemia and anemia, which were more common in patients in the LVP group. In conclusion, the outcome of patients treated with these three immunomodulatory treatment modalities did not vary. The beneficial effects of SVP in our study warrant further randomized control trials especially in resource-constrained settings.     

Anxiety symptoms in patients with frontal lobe epilepsy versus generalized epilepsy

PurposeThe aim of this study was to compare the frequency of anxiety symptoms between patients with frontal lobe epilepsy (FLE) and generalized epilepsy (GE).MethodsForty and 78 patients with FLE and GE respectively were enrolled in the study. Anxiety symptoms were measured with the Hamilton anxiety rating scale (HARS) and the anxiety subscale of the hospital anxiety and depression scale (HADSA).ResultsCompared to the GE group, the FLE group had significantly higher HARS (10.9 ± 8.7 vs. 7.9 ± 6.8, p = 0.039) scores. Significant correlations were also found between anxiety symptoms and epilepsy-related variables, particularly with the seizure frequency and the number of currently taken anti-epileptic drugs.ConclusionAnxiety symptoms are more common in patients with FLE in comparison to those with GE. Further studies are warranted to clarify the relationship between anxiety symptoms and FLE.     

Microvascular contributions to age-related macular degeneration (AMD): from mechanisms of choriocapillaris aging to novel interventions

GeroScience - Aging of the microcirculatory network plays a central role in the pathogenesis of a wide range of age-related diseases, from heart failure to Alzheimer’s disease. In the eye,...     

Meta-analysis of adherence to highly active antiretroviral therapy in patients with HIV infection in China

With the widespread implementation of antiretroviral therapy in many countries, the HIV/AIDS epidemic has declined. However, little is known about the prevalence of adherence rate to Highly Active Antiretroviral Therapy (HAART) in patients with HIV infection in China. This is the first meta-analysis of cross-sectional studies of treatment adherence (≥ 95%) to HAART in Chinese patients. Both English (PubMed, PsycINFO, EMBASE, and Web of Science) and Chinese (WanFang, CNKI, and SinoMed) databases were systematically and independently searched by three investigators. Studies with adherence rate estimates of HAART were included. Adherence rate estimates of each eligible study were extracted and pooled using the random-effects model. A total of 40 studies conducted in China were eligible and analyzed. The mean rate of?≥?95% adherence to HAART was 81.1% (95%CI: 75.1%–88.0%, I²?=?97.3%) at one week, 80.9% (95%CI: 74.7%–85.9%, I²?=?96.6%) at one month, and 68.3% (95%CI: 46.1%–84.4%, I²?=?97.1%) at 3 months or longer. Subgroup analyses revealed that samples with no gender predominance, low education level, middle economic region, rural area, older age (42.3 years), and recent publication (2013 or later) were correlated to higher HAART adherence. The average rate of HAART adherence was relatively high in China, which indicates effective HIV/AIDS policy, prevention and control measures. However, the HAART adherence rate decreased over the study time period.