健康教育对习惯性流产患者社会支持和抑郁的影响

目的:探讨健康教育对于习惯性流产患者社会支持和抑郁的影响.方法:选择2010年6月～ 2011年6月习惯性流产患者140例,随机分为实验组(健康教育组)70例和对照组70例,对照组实施常规护理,而实验组在对照组的基础上进行健康教育的干预,用社会支持量表(SSQ)和汉密尔顿抑郁量表对两组患者在干预前后进行测量,比较评分结果.结果:实验组社会支持总分与对照组相比明显提高,抑郁总分较对照组明显下降.结论:在临床护理中应注重与患者建立良好的护患关系;对患者进行健康教育对习惯性流产患者抑郁的缓解及社会支持水平的提高是有效的.     

Screening and Quantification of Depression in Mild-to-Moderate Dementia Through the GDS Short Forms

Abstract

We evaluated the validity of the 1-, 4- and 15-item versions of the GDS in 51 patients affected by mild to moderate dementia, using the long form as standard. The following sensitivity and specificity values were obtained: 66% and 91% for GDS-1, 93% and 87% for GDS-4, 79% and 100% for GDS-15. GDS-15 also showed good agreement with GDS-30 in defining the severity of depression. These findings support the use of GDS-4 for the screening of depression and of GDS-15 for its severity assessment.     

The effect of the Mediterranean diet on plasma brain-derived neurotrophic factor (BDNF) levels: The PREDIMED-NAVARRA randomized trial

Abstract

Objectives

There are no human studies assessing the effect of nutritional interventions on plasma brain-derived neurotrophic factor (BDNF) concentrations. The aim of this study was to assess the role of a nutritional intervention based on a Mediterranean diet (MeDiet) on plasma BDNF levels.

Methods

PREvención con Dieta MEDiterránea (PREDIMED) is a randomized clinical trial designed to assess the effect of a Mediterranean diet (MeDiet) on the primary prevention of cardiovascular disease. For this analysis, 243 participants from the Navarra centre were randomly selected. Participants were assigned to one of three dietary interventions: control (low-fat) diet, MeDiet supplemented with virgin olive oil (MeDiet + VOO), or MeDiet supplemented with nuts (MeDiet + Nuts). Plasma BDNF levels were measured after 3 years of intervention. Multivariate-adjusted means of BDNF for each intervention were compared using generalized linear models. Logistic regression models were fit to assess the association between the dietary intervention and the likelihood to have low plasma BDNF values (<13 µg/ml, 10th percentile). Analyses were repeated after stratifying the sample according to baseline prevalence of different diseases.

Results

Higher but non-significant plasma BDNF levels were observed for participants assigned to both MeDiets. Participants assigned to MeDiet + Nuts showed a significant lower risk (odds ratios (OR) = 0.22; 95% confidence intervals (CI) = 0.05–0.90) of low plasma BDNF values (<13 µg/ml) as compared to the control group. Among participants with prevalent depression at baseline, significantly higher BDNF levels were found for those assigned to the MeDiet + Nuts.

Discussion

Adherence to a MeDiet was associated to an improvement in plasma BDNF concentrations in individuals with depression.     

Inositol and Ginkgo biloba as Adjuncts in Chronic Depression: Case Report

The treatment of resistant depression has involved the use of various adjuncts in addition to the antidepressant, such as lithium or liothyronine (T₃). This case report describes a woman with a history of chronic depression (dysthymic disorder), unresponsive to a number of traditional antidepressants, who was treated with the antidepressant bupropion and the nutritional and herbal supplements inositol and ginkgo. Her bupropion was able to be reduced, and she appeared to respond well to the added supplements, reducing her Ham-D score from 17 to 11. In this case, it was hypothesized that the inositol was the probable active adjunct with regard to the antidepressant effect, with the ginkgo helping with cognition. The inositol theory is reviewed with reference to mania and depression.     

Mental Illness,Not Obesity Status,is Associated with Food Insecurity Among the Elderly in the Health and Retirement Study

Abstract

Objectives: Food insecurity, limited or uncertain access to adequate nutrition, is an increasingly recognized determinant of health outcomes and is often associated with having obesity. It is unclear, however, if this association persists in elderly populations.

Methods: We conducted a cross-sectional study of 2868 participants’ aged 65+ years from the Health and Retirement Study. Multivariate logistic regression was used to assess associations between food insecurity and body mass index, demographic characteristics, psychiatric history, and medical history.

Results: Participants with overweight/obesity had a higher prevalence of food insecurity than leaner counterparts, however, weight status was not a significant predictor of food insecurity after multivariate adjustment. Instead, mental illness, current smoking status, and non-White race were all independently associated with food insecurity.

Discussion: Beyond financial status, health care providers are encouraged to use these characteristics to identify elderly patients that may be at risk of food insecurity.     

天麻素注射液联合盐酸氟西丁治疗卒中后抑郁的临床效果观察

目的 探讨天麻素注射液联合盐酸氟西丁治疗卒中后抑郁的临床效果及安全性.方法 对符合条件的102例卒中后抑郁患者随机分为两组,每组51例,天麻素注射液(600 mg,1次/d,静脉滴注,疗程14 d)联合盐酸氟西丁(20 mg,1次/d,口服,30 d)组为治疗组.单用盐酸氟西丁(20 mg,1次/d,口服,30 d)为对照组.观察两组患者的症状及体征变化以及汉密尔顿抑郁量表评分,评价疗效.结果 治疗组痊愈9.8％ (5/51),显著进步52.9％ (27/51),进步27.5％(14/51),无效9.8％ (5/51),总有效率90.2％ (46/51).对照组痊愈2.0％(1/51),显著进步11.7％ (6/51),进步66.7％ (34/51),无效19.6％(10/51),总有效率80.4％ (41/51).治疗组的疗效优于对照组,二者比较差异有统计学意义(x2=13.03,P＜0.05).治疗组不良反应发生率为3.92％ (2/51),对照组为25.5％(13/51),两组比较差异有统计学意义(x2=9.64,P＜0.01).结论 天麻素注射液联合盐酸氟西丁是治疗卒中后抑郁的一种疗效确切且副反应少的治疗方法.     

Chemotherapy‐Induced Neuropathic Pain and Its Relation to Cluster Symptoms in Breast Cancer Patients Treated with Paclitaxel

Abstract The majority of patients with breast cancer receiving chemotherapy report multiple symptoms. Compelling evidence has shown that subgroups of patients can be clustered by the severity of symptoms. Recent studies demonstrate that chemotherapy with such substances as paclitaxel can cause neuropathic pain (CINP) and consequently neural damage. Objectives: the present study examined the relationship between symptom clusters and CINP among 40 patients with breast cancer. The study was based on 2 sessions conducted before and during paclitaxel treatment. In each session, neuropathic pain was assessed by the DN4 Questionnaire. In the second session, the Lee Fatigue Scale, the General Sleep Disturbance Scale, and the Center for Epidemiological Studies–Depression Scale were also administered, and the worst pain intensity was assessed. Using cluster analysis, 2 symptom clusters were identified on the basis of the severity of the 4 symptoms scores. Patients in the High Cluster (37%) experienced a high level of all symptoms, whereas patients in the Low Cluster (63%) experienced a low level of all symptoms. Twenty patients (50%) were diagnosed with CINP. A subgroup of patients (23%) from the High Cluster was identified as having CINP; 35% were in the Low Cluster and free of CINP. In conclusion, there appears to be a specific subgroup of patients with hypersensitive cancer who need greater attention to symptom management. Early detection of symptoms, together with careful dose selection and assessment of early stages in the development of neuropathic pain, are essential for preventing the simultaneous occurrence of severe multiple symptoms and CINP.     

Expert Knowledge in Palliative Care on the World Wide Web: Palliativedrugs.Org

ABSTRACT.?

In my last Internet-related article, I speculated that social networking would be the coming wave in the effort to share knowledge among experts in various disciplines. At the time I did not know that a palliative care site on the World Wide Web (WWW), palliativedrugs.com, already provided the infrastructure for sharing expert knowledge in the field. The Web site is an excellent traditional formulary but it is primarily devoted to “unlicensed” (“off-label”) use of medications in palliative care, something we in the specialty often do with little to support our interventions except shared knowledge and experience. There is nothing fancy about this Web site. In a good way, its format is a throwback to Web sites of the 1990s. In only the loosest sense can one describe it as “multimedia.” Yet, it provides the perfect forum for expert knowledge and is a “must see” resource. Its existing content is voluminous and reliable, filtered and reviewed by renowned clinicians and educators in the field. Although its origin and structure were not specifically designed for social or professional networking, the Web site's format makes it a natural way for practitioners around the world to contribute to an ever-growing body of expertise in palliative care.