Effect of Preoperative Modifiable Psychological and Behavioural Factors on Early Outcome Following Total Knee Arthroplasty in an Indian Population

BackgroundNon-surgical factors have been found to have significant impact on outcome following Total Knee Arthroplasty (TKA). The study was conducted to know the independent effect of each of the four interacting psychological factors: anxiety, depression, pain catastrophizing and kinesiophobia on early outcome following TKA in an Indian population.Materials and Methods104 consecutive patients undergoing TKA were included in the study and followed up at 6 weeks, 6 months and one year. Preoperatively, Hospital Anxiety and Depression Scale was used to diagnose and quantify anxiety and depression, pain catastrophizing and kinesiophobia were assessed using Pain Catastrophizing Scale and Tampa Scale for Kinesiophobia, respectively. Outcome was assessed on the basis of Knee Society Score and Knee Injury and Osteoarthritis Outcome Score. Regression analysis was done to know independent effect of each factor on outcome scores.ResultsNine (8.7%) patients were found to have undiagnosed psychopathology. The patients with psychopathologies were found to have significantly worse knee outcome scores on follow-up, although the rate of improvement in knee symptoms and function was not significantly different from those without psychopathology. The degree of Anxiety correlated with worse knee pain and stiffness up to 6 months while it correlated with poor knee function for a longer duration. The degree of depression and pain catastrophizing correlated with worse knee pain, stiffness and function at all visits while kinesiophobia didn’t show correlation independent other factors.ConclusionPsychopathology was found to be associated poor knee outcome scores with degree of preoperative depression and pain catastrophizing as significant independent predictors as poor outcome, whereas the effect of degree of anxiety on knee pain and stiffness was found to wane over time. Kinesiophobia didn’t show any independent correlation.Supplementary InformationThe online version of this article (10.1007/s43465-020-00325-x) contains supplementary material, which is available to authorized users.     

中药解郁胶囊治疗老年抑郁症的临床疗效观察

目的：观察中药解郁胶囊对老年抑郁症的临床疗效和安全性。方法：选取2020年11月至2021年12月甘肃中医药大学附属医院住院或门诊患者200例作为研究对象,按照纳入标准最终产生研究观察对象100例,健康对照组来自我院组织的年龄在60~80岁的健康体检的老年人100例。观察组中男37例,女63例,对照组中男43例,女57例。对照组采取常规治疗,观察组采取中医综合疗法治疗。对2组患者治疗前后减分情况、中医证候分析、服药及依从情况、不良反应及抑郁焦虑因子等无创性指标的影响。结果：对老年抑郁症的治疗效果主要从汉密尔顿抑郁量表减分情况及证候减分率体现,2组经过12个月中药和抗抑郁综合治疗,中医证候量表减分率（8.2±3.1）和（7.8±3.2）,比对照组的（8.8±3）与（8.4±3.6）,P值为0.001 6和0.001 3,治疗前后均有明显变化,差异有统计学意义（P<0.05）,中医证候量表减分率比较,差异有统计学意义（P<0.05）,从服药后出现的不良反应来看,中医综合观察组应明显低于对照观察组,差异有统计学意义（P<0.05）。从中医组治疗患者的依从性分析,差异有统计学意义（P<0.05）。结论：中药解郁胶囊与中医综合治疗患者治疗效果显著,依从性更佳。     

Relationship between depression,weight, and patient satisfaction 2 years after bariatric surgery

BackgroundFindings regarding longer term symptoms of depression and the impact of depression on outcomes such as weight loss and patient satisfaction, are mixed or lacking.ObjectivesThis study sought to understand the relationship between depression, weight loss, and patient satisfaction in the two years after bariatric surgery.SettingThis study used data from a multi-institutional, statewide quality improvement collaborative of 45 different bariatric surgery sites.MethodsParticipants included patients (N = 1991) who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) between 2015–2018. Participants self-reported symptoms of depression (Patient Health Questionnaire-8 [PHQ-8]), satisfaction with surgery, and weight presurgery and 1 year and 2 years postsurgery.ResultsCompared to presurgery, fewer patients’ PHQ-8 scores indicated clinically significant depression (PHQ-8≥10) at 1 year (P < .001; 14.3% versus 5.1%) and 2 years postsurgery (P < .0001; 8.7%). There was a significant increase in the prevalence of clinical depression from the first to second year postsurgery (P < .0001; 5.1% versus 8.7%). Higher PHQ-8 at baseline was related to less weight loss (%Total Weight Loss [%TWL] and %Excess Weight Loss [%EWL]) at 1 year postsurgery (P < .001), with a trend toward statistical significance at 2 years (P = .06). Postoperative depression was related to lower %TWL and %EWL, and less reduction in body mass index (BMI) at 1 year (P < .001) and 2 years (P < .0001). Baseline and postoperative depression were associated with lower patient satisfaction at both postoperative time points.ConclusionsThis study suggests improvements in depression up to 2 years postbariatric surgery, although it appears that the prevalence of depression increases after the first year. Depression, both pre- and postbariatric surgery, may impact weight loss and patient satisfaction.     

How are bariatric patients coping during the coronavirus disease 2019 (COVID-19) pandemic? Analysis of factors known to cause weight regain among postoperative bariatric patients

BackgroundThe global coronavirus disease 2019 (COVID-19) pandemic is wreaking havoc on society. Bariatric patients are more prone to severe infection due to their high body mass index (BMI) and are more vulnerable to the effects of isolation, such as depression or disruption of their health habits.ObjectivesTo quantify the impact of self-quarantine on bariatric patients and self-quarantine’s relationship with weight gain.SettingAcademic hospital, United States.MethodsA 30-item survey examining several known contributors to weight regain was distributed among the postoperative bariatric patients of our clinic. Changes in eating habits, exercise, depression, social support, loneliness, and anxiety were studied, among others.ResultsA total of 208 patients completed the survey (29.3% response rate). A large percentage of patients reported increases in their depression (44.2%), loneliness (36.2%), nervousness (54.7%), snacking (62.6%), loss of control when eating (48.2%), and binge eating (19.5%) and decreases in their social support (23.2%), healthy food eating (45.5%), and activity (55.2%). Difficulty in accessing vitamins was reported by 13%. Patients more than 18 months out of surgery regained more than 2 kg during an average of 47 days. Risk factors for weight regain were found to be loss of control when eating, increases in snacking and binge eating, reduced consumption of healthy food, and reduced physical activity.ConclusionBariatric patients are negatively affected by the COVID-19 pandemic and subsequent social isolation on many levels. This patient population is vulnerable to crisis situations; thus, additional intervention is needed to address behaviors that lead to weight regain.     

A prospective longitudinal study of chronic abdominal pain and symptoms after sleeve gastrectomy

BackgroundSleeve gastrectomy (SG) is widely applied. Few studies have evaluated patient-reported abdominal symptoms after SG.ObjectiveTo evaluate the prevalence of chronic abdominal pain (CAP) and symptom characteristics after SG.SettingOslo University Hospital and Voss Hospital.MethodsWe performed a longitudinal prospective cohort study of patients operated on with SG at two tertiary referral centers. For broad assessments of abdominal pain and symptoms, consultations were performed and questionnaires retrieved before and 2 years after SG. The definition of CAP or recurrent abdominal pain lasting for more than 3 months was sustained. Preoperative predictors of CAP were explored.ResultsOf 249 patients at baseline, 207 (83.1%) had follow-up consultations. Mean preoperative body mass index was 43.9 (6.0) kg/m², and 181 patients (72.7%) were female. Total weight loss was 31.9% (10.4%). CAP was reported in 32 of 223 patients (14.3%) before and in 50 of 186 patients (26.9%) after SG (P =.002). All mean gastrointestinal symptoms rating scale questionnaire scores increased after SG, and they were higher in patients with CAP. Symptoms of depression decreased but were more prevalent in patients with CAP at follow-up. Most quality-of-life scores increased after SG. However, patients with CAP had lower scores (except for physical functioning). Preoperative bothersome Gastrointestinal Symptom Rating Scale reflux symptoms, study center, and younger age seemed to predict CAP after SG.ConclusionThe prevalence of patient-reported CAP increased after SG. Patients reporting CAP had reduced quality-of-life scores.     

我国农村老年人抑郁倾向与认知功能变化轨迹关系研究

目的 探索我国农村老年人抑郁倾向与认知功能变化轨迹的关系。方法 基于中国老年健康影响因素跟踪调查（CLHLS）中2011-2018年农村≥65岁老年人的数据,分别构建无条件和条件潜变量增长曲线模型,分析我国农村老年人简易精神状态评价量表（MMSE）得分变化轨迹及与抑郁倾向的关系。结果 最终纳入了1 788名2011/2012年开始调查的农村老年人,其中有抑郁倾向者占19.1%;有、无抑郁倾向者基线MMSE得分别为26.62±3.54和27.59±3.17。无条件和条件潜变量增长曲线模型结果显示：MMSE得分下降率为0.52分（P<0.05）;纳入协变量前后,有抑郁倾向者MMSE初始得分比无抑郁倾向者分别低0.84分（P<0.05）和0.81分（P<0.05）,有抑郁倾向者MMSE得分下降速度比无抑郁倾向者分别慢0.33分（P<0.05）和0.40分（P<0.05）。结论 我国农村老年人抑郁倾向与认知功能变化轨迹有关,有抑郁倾向者处于更低水平轨迹,提示应积极关注我国农村老年人的心理健康并及时干预,以延缓或防止老年痴呆的发生发展。     

精准护理在新型冠状病毒肺炎流行期间肿瘤晚期患者中的应用

目的探讨精准护理在新型冠状病毒肺炎流行期间肿瘤晚期患者中的应用效果。方法选取2020年1—3月于医院肿瘤科住院的82例肿瘤晚期患者作为研究对象,所有患者住院后均实施精准护理,比较患者在入院和出院时的焦虑自评量表(SAS)及抑郁自评量表(SDS)评分。结果出院时,患者的SAS及SDS评分均低于入院时,差异有统计学意义(P<0.05)。结论精准护理可有效降低新型冠状病毒肺炎流行期间肿瘤晚期患者的焦虑及抑郁水平。     

健康生态学视角下我国中老年慢性病患者抑郁的影响因素分析

目的 基于健康生态学视角,探讨我国中老年慢性病患者抑郁的影响因素。 方法 数据来源于2018年中国健康与养老追踪调查,纳入年龄在45岁及以上中老年慢性病患者为研究对象,基于健康生态学模型,运用χ2检验和logistic回归分析中老年慢性病患者抑郁的影响因素。结果 共纳入研究对象5250名,抑郁发生率为40.84%,从个人特征看,女性、有肢体残疾、患多种慢性病、BADL受损、IADL受损是抑郁的危险因素;从行为方式看,晚间睡眠时长较长是抑郁的保护因素;从人际网络看,学历较高、对自身与子女关系满意、有社会参与是抑郁的保护因素,居住在农村、独居是抑郁的危险因素;从工作和生活条件看,从事农业工作是抑郁的危险因素,过去一年有收入、住房有洗澡设施是抑郁的保护因素。 结论 我国中老年慢性病患者抑郁发生率较高。抑郁影响因素是多层次、多维度的。应重视中老年慢性病患者心理状况,从个体到环境因素加强对慢性病患者抑郁的干预。     

社区老年人久坐行为、社会参与度与抑郁的关系研究

目的 调查社区老年人久坐行为、社会参与度与老年抑郁之间关系。方法 在2020年6月至8月间选择安徽省合肥市4个社区的632名60岁及以上的人群为调查对象,使用一般资料调查表、久坐行为自评问卷、社会活动参与频率问卷及病人健康问卷抑郁量表对目标人群进行问卷调查,使用Pearson相关分析和logistic回归分析探讨社区老年人久坐行为、社会参与度与抑郁的关系。结果 社区老年人每天久坐行为时间为（6.88±1.98）h,社会参与度得分为（15.53±3.79）分,抑郁的检出率为11.6%;社区老年人抑郁与久坐行为呈现正相关,与社会参与度呈现负相关（P<0.05）;logistic回归分析显示,在校正社会人口学等变量后,久坐行为是抑郁的危险性因素［OR=2.029,95%CI（1.689~2.439）;P<0.001］;社会参与度是社区老年人抑郁的保护性因素［OR=0.795,95%CI（0.721~0.877）;P<0.001］。结论 社区老年人久坐行为水平普遍较高,久坐行为及社会参与度是老年人抑郁患病风险的重要影响因素,社区卫生保健人员可通过干预老年人群的久坐时长,鼓励老年人群多参与社会交往频率从而减少抑郁的患病风险。