Validation of the Social Appearance Anxiety Scale in Female Eating Disorder Patients

In the present study, we investigated the psychometric properties of the Social Appearance Anxiety Scale (SAAS) in a sample of 60 female eating disorder patients (M_age = 27.82, SD = 9.76). The SAAS was developed to assess anxiety about being negatively evaluated for one's appearance. All patients completed the SAAS, the Eating Disorder Inventory—2, the Physical Health Questionnaire—9 Depression and the Dimensional Assessment of Personality Psychopathology. The SAAS demonstrated a one‐factor structure and a high internal consistency. The SAAS was significantly positive in relation to body mass index, drive for thinness and body dissatisfaction. Concerning personality dimensions, the SAAS was positively related to emotional problems (e.g. depression, anxiety) and interpersonal problems (e.g. suspiciousness, submissiveness). Findings suggest that the SAAS is a psychometrically sound instrument to assess anxiety about being negatively evaluated about one's appearance in a sample of eating disorder patients. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association.     

Are Gender,Comorbidity, and Obesity Risk Factors for Postoperative Periprosthetic Fractures After Primary Total Hip Arthroplasty?

We studied the frequency and patient risk factors for postoperative periprosthetic fractures after primary total hip arthroplasty (THA). With a mean follow-up of 6.3 years, 305 postoperative periprosthetic fractures occurred in 14?065 primary THAs. In multivariable-adjusted Cox regression analyses, female gender (hazard ratio [HR], 1.48; 95% confidence interval [CI], 1.17-1.88), Deyo-Charlson comorbidity score of 2 (HR, 1.74 for score of 2; 95% CI, 1.25-2.43) or 3 or higher (HR, 1.71; 95% CI, 1.26-2.32), and American Society of Anesthesiologist class of 2 (HR, 1.84; 95% CI, 0.90-3.76) or 3 (HR, 2.45; 95% CI, 1.18-5.1) or 4 or higher (HR, 2.68; 95% CI, 0.70-10.28) were significantly associated with higher risk/hazard, and cemented implant, with lower hazard (HR, 0.68; 95% CI, 0.54-0.87) of postoperative periprosthetic fractures. Interventions targeted at optimizing comorbidity management may decrease postoperative fractures after THA.     

Anorexia,fatigue, and plasma interleukin-6 levels in chronic hemodialysis patients

This study aimed at evaluating the possible relationship between anorexia and fatigue in hemodialysis (HD) patients and at measuring the plasma levels of interleukin-6 (IL-6) and C-reactive protein (CRP) in HD patients with or without anorexia and/or fatigue. The first question of the Hemodialysis Study Appetite questionnaire was used to assess the appetite of the HD patients and the vitality scale of the SF-36 to assess fatigue. The Charlson Comorbidity Index was assessed in each patient. Seventy-six HD patients were studied. Forty-four were males and 32 females. Thirty-two were classified as not-anorexic and not-fatigued, 12 as not-anorexic but fatigued, 6 as anorexic and not-fatigued, and 26 as anorexic and fatigued. Plasma IL-6 levels (pg/mL) were significantly higher in anorexic and fatigued patients (10.9 ± 11.9) than in not-anorexic and not-fatigued (1.6 ± 0.6) (p < 0.001) and in anorexic but not-fatigued patients (1.8 ± 1.7) (p < 0.01). With respect to not-anorexic but fatigued patients (3.1 ± 1.5), the difference was not statistically significant (p = 0.058). The plasma CRP levels (mg/dL) also were significantly higher in anorexic and fatigued patients (9.2 ± 6.3) than in not-anorexic and not-fatigued patients (4.1 ± 4.5), in anorexic but not-fatigued patients (2.5 ± 1.6), and in not-anorexic but fatigued patients (4.1 ± 4.4) (p = 0.001). The presence of both anorexia and fatigue in chronic HD patients is associated with significantly higher levels of plasma IL-6 and CRP and a higher frequency of comorbidities.     

Factors Affecting Survival in Advanced Chronic Kidney Disease Patients Who Choose Not to Receive Dialysis

Introduction. Non-dialytic treatment (NDT) has become a recognized and important modality of treatment in end stage renal disease (ESRD) in certain groups of chronic kidney disease (CKD) patients. However, little is known about the prognosis of these NDT patients in terms of hospitalization rates and survival. We analyzed our experience in managing these NDT with a multidisciplinary team (MDT) approach over a three-year period. Patients and Methods. The Renal Unit at the Royal Liverpool University Hospital set up a dedicated MDT clinic to manage NDT patients in January 2003. Patients approaching end stage chronic kidney disease who chose not to dialyse were recruited from other nephrologists. The study group was classified according to age band (<70 years, 71–80 years, and >80 years), estimated glomerular filtration rate (eGFR) (<10 ml/min, 11–20 ml/min, and >20 ml/min) according to the Modified Diet In Renal Disease formula and Stoke comorbidity grade (SCG). The SCG is a validated scoring system for the survival of patients on renal replacement therapy. We also used the ERA-EDTA primary renal diagnosis codes. As there are no existing standards for NDT patients, we used the U.K. national set for haemodialysis patients as a reference and target for our NDT patients. Data was collected prospectively. Results. The median age was 79 years and the male: female ratio was approximately 1. The most common primary cause of kidney disease in the NDT study population was chronic renal failure of unknown cause n = 22 (31%), but the most common identifiable cause was diabetic nephropathy, n = 20 (28%). The most common comorbidity was ischaemic heart disease n = 25 (34%). Those achieving the standards for anaemia were 78% at referral. Only 30% of the NDT patients achieved the standard for blood pressure (<130/80 mmHg) at referral. Forty-three patients (60%) had no admissions at all. There were a total of 30 patients admitted on 58 occasions. Thirty-one (53%) of these were due to a non-renal cause. The median length of stay for the other NDT patients was 10 days. The median overall survival (life expectancy) was 1.95 years. The one-year overall survival was 65%. SCG was an independent prognostic factor in predicting survival in NDT patients studied (p = 0.005), the hazard ratio being 2.53, for each incremental increase in the SCG. At one year, the survival for comorbidity grade 0, 1 and 2 were 83%, 70% and 56% respectively. Of the 28 patients who died, 20 did so at home (71%). Discussion. The NDT of ESRD has become an important alternative modality in renal replacement therapy. With the emergence of epidemic proportions of CKD, more elderly patients with progressive renal disease will need to make informed decisions regarding renal replacement therapy. There is likely to be increasing number of elderly patients that will tolerate dialysis badly and who will be very dependent on others. We believe that there should be a multidisciplinary approach to assist the ESRD patients in choosing their modality of renal replacement therapy, and with an agreed care plan to support these patients in managing their chosen modality to achieve the best possible quality of life. There should be integrated services with primary care, community nurses, and palliative care teams to enable the majority of the patient's treatment to be carried out at home and to allow a dignified death. However. there was a statistically significant trend for shorter survival among those with greater comorbidities, as determined by the SCG. This is the first report of the potential importance of SCG as an independent prognostic factor in NDT patients. This will help us to counsel our patients in the future about their prognosis if they choose NDT as their modality of renal replacement therapy. Conclusion. Our prospective study is the first and currently the largest observational study of a multidisciplinary approach in the management of NDT patients. SCG was an independent prognostic factor in predicting survival. In those patients who chose not to dialyse, SCG provides a potentially useful indication of expected prognosis.     

Misophonia and comorbid psychiatric symptoms: a preliminary study of clinical findings

Abstract

Objective: Misophonia is a neurophysiological disorder, phenotypically characterized by heightened autonomic nervous system arousal which is accompanied by a high magnitude of emotional reactivity to repetitive and pattern-based auditory stimuli. This study identifies the prevalence of psychiatric symptoms in misophonia sufferers, the association between severity of misophonia and psychiatric symptoms, and the association between misophonia severity and gender.

Methods: Fifty-two misophonia sufferers, 30 females (mean age?=?40.93 ± 15.29) and 22 males (mean age?=?51.18 ± 15.91) were recruited in our study and they were diagnosed according the criteria proposed by Schröder et al. The participants were evaluated by the A-MISO-S for the severity of misophonia and the MINI to assess the presence of psychiatric symptoms.

Results: The most common comorbid symptoms reported by the misophonia patients were respectively PTSD (N?=?8, 15.38%), OCD (N?=?6, 11.53%), MDD (N?=?5, 9.61%), and anorexia (N?=?5, 9.61%). Misophonia severity was associated with the symptoms of MDD, OCD, and PTSD as well as anorexia. There was an indication of a significant difference between men and women in the severity of misophonic symptoms.

Conclusion: Our findings highlight the importance of recognizing psychiatric comorbidity among misophonia sufferers. The presence of these varying psychiatric disorders’ features in individuals with misophonia suggests that while misophonia has unique clinical characteristics with an underlying neurophysiological mechanism, may be associated with psychiatric symptoms. Therefore, when assessing individuals with misophonia symptoms, it is important to screen for psychiatric symptoms. This will assist researchers and clinicians to better understand the nature of the symptoms and how they may be interacting and ultimately allocating the most effective therapeutic strategies.     

Comorbidity burden is not associated with higher mortality after out-of-hospital cardiac arrest*

Abstract

Objectives. We investigated whether comorbidity burden of comatose survivors of out-of-hospital cardiac arrest (OHCA) affects outcome and if comorbidity modifies the effect of target temperature management (TTM) on final outcome. Design. The TTM trial randomized 939 patients to 24?h of TTM at either 33 or 36?°C with no difference regarding mortality and neurological outcome. This post-hoc study of the TTM-trial formed a modified comorbidity index (mCI), based on available comorbidities from the Charlson comorbidity index (CCI). Results. Bystander cardiopulmonary resuscitation (CPR) decreased with higher comorbidity group, p?=?0.01. Comorbidity groups were univariately associated with higher mortality compared to mCI0 (HR_mCI1: 1.55, CI: 1.25–1.93, p?<?0.001, HR_mCI2: 2.01, CI: 1.55–2.62, p?<?0.001, HR_mCI ≥ 3: 2.16, CI: 1.57–2.97, p?<?0.001). When adjusting for confounders there was a consistent, nonsignificant association between level of comorbidity and mortality (HRm_C11: 1.17, CI: 0.92–1.48, p?=?0.21, HR_mCI2: 1.28, CI: 0.96–1.71, p?=?0.10, HR_mCI ≥ 3: 1.37, CI: 0.97–1.95, p?=?0.08). There was no interaction between comorbidity burden and level of TTM on outcome, p?=?0.61. Conclusion. Comorbidity burden was associated with higher mortality following OHCA, but when adjusting for confounders, the influence was no longer significant. The association between mCI and mortality was not modified by TTM. Comorbidity burden is associated with lower rates of bystander cardiopulmonary resuscitation after OHCA.     

Application of KDQOL-SFTM 1.3 version in evaluating quality of life of maintenance hemodialysis patients in multiple centers

Objective To understand the quality of life (QOL) and its influencing factors in maintenance hemodialysis patients (hemodialysis maintenance, MHD), and to provide theoretical basis for improving QOL of patients. Methods A cross-sectional study was conducted in the blood purification centre in 8 hospitals of Hefei, and patients clinical data were collected. KDQOL-SF self-administered questionnaire was applied to assess the health related quality of life (HRQL) of patients and to analyze the factors influencing the QOL. Results The QOL of MHD patients in Hefei City was better compared with previous similar research results. Generally speaking, gender (male), education degree and household income were positive correlated with QOL scores (P＜0.05), and the scores of primary disease of patients with diabetic nephropathy or drugs were lower (P＜0.05) in physiological component summary (PCS), mental component summary (MCS), SF-36 and KDTA. Charlson comorbidity index (CCI) was negatively correlated with the MCS scores, PCS scores and SF scores (P＜0.05), and patients' occupational and medical insurance had impacts on MCS and KDTA score (P＜0.05). Conclusions The QOL of MHD patients are affected by many factors, and the CCI and cultural level are possible independent influencing factors. In addition, gender, household income per capita, primary disease, occupation, medical insurance also have certain influence.