Associations of Dietary Patterns with Incident Depression: The Maastricht Study

Our aim was to assess the association between a priori defined dietary patterns and incident depressive symptoms. We used data from The Maastricht Study, a population-based cohort study (n = 2646, mean (SD) age 59.9 (8.0) years, 49.5% women; 15,188 person-years of follow-up). Level of adherence to the Dutch Healthy Diet (DHD), Mediterranean Diet, and Dietary Approaches To Stop Hypertension (DASH) were derived from a validated Food Frequency Questionnaire. Depressive symptoms were assessed at baseline and annually over seven-year-follow-up (using the 9-item Patient Health Questionnaire). We used Cox proportional hazards regression analyses to assess the association between dietary patterns and depressive symptoms. One standard deviation (SD) higher adherence in the DHD and DASH was associated with a lower hazard ratio (HR) of depressive symptoms with HRs (95%CI) of 0.78 (0.69–0.89) and 0.87 (0.77–0.98), respectively, after adjustment for sociodemographic and cardiovascular risk factors. After further adjustment for lifestyle factors, the HR per one SD higher DHD was 0.83 (0.73–0.96), whereas adherence to Mediterranean and DASH diets was not associated with incident depressive symptoms. Higher adherence to the DHD lowered risk of incident depressive symptoms. Adherence to healthy diet could be an effective non-pharmacological preventive measure to reduce the incidence of depression.     

Characteristics and Risk Factors of Hospitalized and Nonhospitalized COVID-19 Patients,Atlanta, Georgia,USA, March–April 2020

We compared the characteristics of hospitalized and nonhospitalized patients who had coronavirus disease in Atlanta, Georgia, USA. We found that risk for hospitalization increased with a patient’s age and number of concurrent conditions. We also found a potential association between hospitalization and high hemoglobin A1c levels in persons with diabetes.     

The Protective Roles of Exercise and Maintenance of Daily Living Routines for Chinese Adolescents During the COVID-19 Quarantine Period

PurposeAdolescents are particularly vulnerable during the COVID-19 quarantine periods and may be at risk for developing psychological distress symptoms that extend beyond a crisis, including depression. This study examined adolescents’ postquarantine depressive symptoms associated with pandemic stressors. The primary aim was to identify potential protective factors that may buffer the association between the presence of COVID-19 cases in adolescents’ communities and their postquarantine depressive symptoms.MethodsAdolescents from public schools were recruited from Zhengzhou city, Henan, China (N = 1,487, M_age=13.14 years, 50% girls). Adolescents reported the presence of confirmed or suspected COVID-19 cases in their communities, their daily activities and routines during the 2-month quarantine period, and depressive symptoms after the quarantine period.ResultsThe presence of cases in adolescents’ communities during the quarantine contributed to more depressive symptoms in adolescents after the quarantine. This association was buffered by adolescents’ spending more time on physical activities and better maintenance of daily living routines during the quarantine period. The presence of community infection was also more strongly associated with depressive symptoms in older adolescents.ConclusionsThe presence of COVID-19 cases in communities contributed to adolescents’ poorer mental health, and the association was stronger for older adolescents. Spending time on physical activities and maintaining daily living routines during the quarantine appear to be practical strategies that can be used by adolescents to mitigate the association between pandemic stressors and their diminishing mental health.     

Symptom Diary–Based Analysis of Disease Course among Patients with Mild Coronavirus Disease,Germany, 2020

Limited information is available on the clinical course of outpatients with mild coronavirus disease (COVID-19). This information is critically important to inform public health prevention strategies and to provide anticipatory guidance to patients, primary care providers, and employers. We retrospectively assessed the daily prevalence of symptoms in 313 COVID-19 outpatients for the first 20 days of illness. Generalized estimating equations were used to assess the probability of symptom occurrence over time. Fatigue (91%), cough (85%), and headache (78%) were the most common symptoms and occurred a median of 1 day from symptom onset. Neurologic symptoms, such as loss of taste (66%) and anosmia (62%), and dyspnea (51%) occurred considerably later (median 3–4 days after symptom onset). Symptoms of COVID-19 are similar to those of other respiratory pathogens, so symptomatic patients should be tested more frequently for severe acute respiratory syndrome coronavirus 2 during influenza season to prevent further spread of COVID-19.     

Deficiency Citations on Inappropriate Psychotropics Use Related to Care for Behavioral Symptoms of Dementia

ObjectivesThe Centers for Medicare and Medicaid (CMS) initiated the National Partnership to Improve Dementia Care in Nursing Homes in 2012, which helped decrease antipsychotics use. However, inappropriate use of antipsychotics and other psychotropic medications to control behavioral symptoms associated with dementia persists. Nursing homes (NHs) can be flagged for inappropriate psychotropics use as a deficiency of care citation (F-758 tag). The purpose of this study was to comprehensively explore inappropriate psychotropic medication use deficiency, F-758 citations, in caring for NH residents with dementia.DesignA mixed-methods study was performed.Setting and ParticipantsDuring the first quarter of 2018 (January–March), 3526 NHs were surveyed, of which 642 received F-758 tags. Of the 642, the sample was confined to the 444 NHs that received the citation for the care of residents with dementia. Information on deficiencies was obtained from 2018 Certification and Survey Provider Enhanced Reporting data. Inspection reports for deficiencies were obtained from Centers for Medicare and Medicaid Nursing Home Compare and ProPublica.MethodsQuantitative analysis was used to examine the frequency of involved psychotropic medications, scope/severity of F-758 deficiency citations, and reasons for the citations. Reasons for F-758 citations by psychotropic medication categories and scope/severity of the citations were also examined using χ² tests. Qualitative data analysis was conducted using content analysis with an inductive coding approach to summarize the inspection reports.ResultsAntipsychotics were the most involved drug category for F-758 tag citations. The 3 most common reasons for F-758 citations included failure to identify and/or monitor behavioral symptoms (178 NHs), attempt gradual drug reduction (131 NHs), and maintain 14-day limitations on Pro Re Nata (PRN) psychotropic orders (121 NHs). Compared with those with no involvement of antipsychotic drugs, facilities with antipsychotics-related F-758 tags had higher rates of failure to identify/monitor behavioral symptoms (P < .001), attempt gradual drug reduction (P < .001), and provide adequate indications for psychotropics use (P < .001). NHs with F-758 tags related to inappropriate antianxiety medication use had a higher prevalence of failure to maintain 14-day limitation on PRN orders (P < .001) and provide nonpharmacologic interventions (P < .001).Conclusions and ImplicationsThis study suggests areas for improvement that could potentially reduce inappropriate psychotropics use. Supporting quality of dementia care workforce and improving cooperation within healthcare staff and professionals are recommended to ensure proper nonpharmacologic and pharmacologic interventions.     

乳酸及降钙素原对一氧化碳中毒后迟发性脑病的预测价值

目的探讨检测血乳酸、降钙素原和联合检测对急性一氧化碳中毒后迟发性脑病(DEACMP)的预测价值。 方法随机抽取我院在急诊科收住院的ACMP患者70例,随访3个月,以其中发生DEACMP患者10例为DEACMP组,其余60例为非DEACMP组,随机抽取同期笔者医院40例健康体检者为对照组。对患者立即行动脉血Lac和血清PCT检测,并计算Lac和PCT诊断DEACMP的灵敏度、特异度。 结果DEACMP组血Lac和PCT检测值均明显高于非DEACMP和对照组,差异有统计学意义(采用秩和检验,P<0.05);检测异常率亦明显高于非DEACMP组及对照组,差异有统计学意义(采用χ²检验,P<0.05)。Lac和PCT升高预测DEACMP的敏感度均为90.0% ,特异度分别为50.0%和65.0% ,准确性分别为55.7%和68.6%。联合检测时若其中1个指标为阳性时即预测DEACMP发病,则联合检测的敏感度为100.0%,特异度为41.7%,阳性预测值为21.7%,阴性预测值为100.0%,准确性为71.4%。 结论DEACMP患者早期动脉血Lac和PCT均明显升高,PCT诊断价值优于Lac,联合检测较单项指标检测对DEACMP发病预测价值更理想。     

非小细胞肺癌术后放疗的临床意义

目的　观察非小细胞肺癌 (NSCLC)术后放疗的价值。材料与方法　回顾性分析我院自 1985 - 0 1～1995 - 12经手术治疗的非小细胞肺癌 170例 ,分为单纯手术组 (单术组 ) 94例 ,手术加放疗组 (术放组 ) 76例 ,单术组Ⅰ、Ⅱ期病例略多。单术组术后未再接受其他治疗 ;术放组术后 2～ 4周进行放疗 ,6MV -X线常规分割外放疗DT5 0GY～ 60GY。分别统计 2组间 5年总生存率、5年无瘤生存率、局部复发率和远处转移率 ,为了排除 2组间病期早晚对顾后的影响 ,还单独分析了Ⅲ期病例 2组间各分析指标的差别 ,统计采用X2 检验。结果　单术组和术放组的 5年总生存率分别为 31 9% (30 / 94 ) ,31 6% (2 4 / 76) ,(P >0 0 5 )。 5年无瘤生存率分别为 2 5 5 % (2 4 / 94 ) ,2 8 9% (2 6/ 76) ,(P >0 0 5 )。 2组局部复发率分别为 31 9% (30 / 94 ) ,2 3 7% (18/ 76) ,(P>0 0 5 )。远转率分别为 4 8 9% (4 6/ 94 ) ,4 4 7% (34 / 76) (P >0 0 5 )。单纯分析Ⅲ期病例 ,单术组和术放组 5年无瘤生存率分别为 2 5 % (14 / 5 6) ,38 7% (2 4 / 62 ) (P >0 0 5 )。 2组局部复发率分别为 39 3% (2 2 / 5 6) ,2 4 2 % (15 / 62 ) ,(0 0 5

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西洛他唑治疗糖尿病合并下肢动脉闭塞症的功效及安全性观察

目的：观察西洛他唑治疗糖尿病合并下肢动脉闭塞症的效果及安全性。方法：选择糖尿病合并下肢动脉闭塞症患者33例,给予西洛他唑第一周50mg,2次／日。第二周始改为100mg,2次／日,观察并检测治疗前后症状体征,双下肢血管直径及峰值血流速度,肝肾功能,血尿常规,血脂及血液流变学等指标。结果：患者主观症状改善率在80％以上,双下肢血流峰值速度治疗后有显著性增加（P＜0．01）,血尿常规,肝肾功能等各项指标治疗前后无明显差异。结论：西洛他唑对糖尿病合并下肢动脉闭塞症是一种安全有效的药物。