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Fattahi N, Nilsson O, Svensjö S, Roy J, Linné A, Hultgren R. Anxiety and disease awareness in individuals with heredity for abdominal aortic aneurysm. J Med Screen 2025; 32:67-75. [PMID: 39248023 DOI: 10.1177/09691413241278224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2024]
Abstract
ObjectiveThe psychological consequences of being aware of an increased risk of developing abdominal aortic aneurysm as a first-degree relative of a person with abdominal aortic aneurysm are hitherto unexplored. This study investigates the awareness of heritability and anxiety in male and female adult offspring of abdominal aortic aneurysm patients compared to controls. Health-related quality of life among participants with aortic pathology was compared to participants with normal aortic diameters.MethodsThis was a cross-sectional point prevalence study based on the participants examined in the Detecting Abdominal Aortic Aneurysm in First Degree Relatives Trial (DAAAD; 752 adult offspring, 756 matched controls), 2020-2022. Questionnaires about health-related quality of life and study-specific questions regarding awareness of heritability were collected prior to the aortic ultrasound.ResultsAttendance rate was higher among individuals with heredity compared to controls (67% vs. 52%, p < 0.001). Of 1508 adult offspring examined, 65% reported having a close relative with abdominal aortic aneurysm (6% in controls). Female adult offspring reported higher awareness of heritability than controls (38% vs. 12%, p < 0.001), as did males (32% vs. 8%, p < 0.001). A slight majority of participants with awareness reported anxiety (54% of female offspring; 51% of male). There were no measured differences in health-related quality of life between the groups when standard health-related quality of life instruments were used.ConclusionThe higher-than-expected proportion of adult offspring with awareness of heritability and anxiety about such risk indicates that we fail to communicate risk to this group appropriately via the current channels of information within the healthcare system. This calls for the development of dedicated strategies for improved communication of abdominal aortic aneurysm risk to patients and their next of kin.
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Affiliation(s)
- Nina Fattahi
- Department of Clinical Science and Education, Karolinska Institutet at Södersjukhuset, Stockholm, Sweden
- Section of Vascular Surgery, Department of Surgery, Södersjukhuset AB, Stockholm, Sweden
- Stockholm Aneurysm Research Group, STAR, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Olga Nilsson
- Stockholm Aneurysm Research Group, STAR, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Sverker Svensjö
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Department of Surgery, Centre for Clinical Research Dalarna, Falun, Sweden
| | - Joy Roy
- Stockholm Aneurysm Research Group, STAR, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Anneli Linné
- Department of Clinical Science and Education, Karolinska Institutet at Södersjukhuset, Stockholm, Sweden
- Section of Vascular Surgery, Department of Surgery, Södersjukhuset AB, Stockholm, Sweden
| | - Rebecka Hultgren
- Stockholm Aneurysm Research Group, STAR, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
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Sirois AC, Campbell KL, Sattar S, Rudolf M, Haase KR. Living with and beyond cancer: What older adults tell us about healthy aging. J Geriatr Oncol 2025; 16:102259. [PMID: 40381436 DOI: 10.1016/j.jgo.2025.102259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2025] [Revised: 04/10/2025] [Accepted: 05/08/2025] [Indexed: 05/20/2025]
Abstract
INTRODUCTION Healthy aging is a process that allows for optimal functional ability and wellbeing, but little is known about older adults' experiences living with and beyond cancer (also called survivorship). The purpose of this study was to explore the experiences and perceptions of healthy aging among older adults living with and beyond cancer. MATERIALS AND METHODS Community-dwelling older adults diagnosed with cancer at age ≥ 65 were recruited to participate in a series of in-depth semi-structured interviews. We used interpretive description and patient-oriented research methods. Data were thematically analyzed. RESULTS A total of 20 older adults living with and beyond cancer (mean age 74) in British Columbia, Canada, participated. Coping with cancer and age-related changes in older age was important for healthy aging and quality of life. Older adults coped by adapting to maintain their health and function, accepting and rejecting barriers, and defying ageist norms about cancer in older age. Participants reported discrepancies between their own priorities for healthy aging and their perceptions of healthcare providers' priorities for them. For example, older adults identified a lack of attention to quality of life and minimal integration of psychosocial supports in cancer treatment and survivorship care. Our findings also address the nuances of how cancer influences health behaviours in the context of pursuing healthy aging. DISCUSSION Understanding the experiences and perceptions of healthy aging among older adults living with and beyond cancer is critical to promoting health for this growing population. Our findings highlight the need for individualized care and the importance of quality of life for older adults living with and beyond cancer. This work can inform interventions to support healthy aging.
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Affiliation(s)
- Ailsa C Sirois
- School of Nursing, Faculty of Applied Science, University of British Columbia, Vancouver, Canada.
| | - Kristin L Campbell
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada; BC Cancer Research Institute, Vancouver, Canada
| | - Schroder Sattar
- College of Nursing, University of Saskatchewan, Saskatoon, Canada
| | - Margaret Rudolf
- School of Nursing, Faculty of Applied Science, University of British Columbia, Vancouver, Canada
| | - Kristen R Haase
- School of Nursing, Faculty of Applied Science, University of British Columbia, Vancouver, Canada; BC Cancer Research Institute, Vancouver, Canada
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Richer MJ, Grenier S, Plusquellec P. Exploring Interindividual Variability in Resilience to Stress: Social Support, Coping Styles, and Diurnal Cortisol in Older Adults. Behav Sci (Basel) 2025; 15:631. [PMID: 40426409 PMCID: PMC12109149 DOI: 10.3390/bs15050631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2025] [Revised: 04/30/2025] [Accepted: 05/02/2025] [Indexed: 05/29/2025] Open
Abstract
The psychobiological response to stress is known to be a key factor affecting health at any age, but especially in older adults. It involves the hypothalamic-pituitary-adrenal (HPA) axis, a hormonal circuit whose product is the activation of cortisol. We sought to explore the relationships leading to resilience to stress, as exemplified by the model of aging, stress, and resilience, in a sample of older adults at risk for mental health problems. Specifically, we examined the concurrent effects of individual age-related determinants, social support, and coping style on the cortisol awakening response (CAR), the cortisol area under the curve (AUC) with respect to ground, and the rate of change of cortisol from the awakening peak to bedtime. Our results showed an association between life impairment and health problems on the three indicators of HPA disturbance. An higher AUC was also observed in older age and in individuals reporting more major life events. Less use of avoidance coping was also associated with greater levels of CAR and AUC. Although significant, the measured determinant explained only a small part of the total interindividual variability in our three cortisol indices. Other factors, such as same-day stressors especially in older populations at risk for psychological distress, should be considered in future studies.
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Affiliation(s)
- Marie-Josée Richer
- School of Psychoeducation, Art and Sciences Faculty, University of Montreal, Montreal, QC H2V 2S9, Canada;
| | - Sébastien Grenier
- Department of Psychology, Art and Sciences Faculty, University of Montreal, Montreal, QC H2V 2S9, Canada;
- Research Center of the Institut Universitaire de Gériatrie de Montréal, Montreal, QC H3W 1W5, Canada
| | - Pierrich Plusquellec
- School of Psychoeducation, Art and Sciences Faculty, University of Montreal, Montreal, QC H2V 2S9, Canada;
- Research Center in Non-Verbal Communication Science, Research Center of the University Institute in Mental Health of Montreal, Montreal, QC H1N 3M5, Canada
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Türütgen N, Okur İ, Delibay AA, Demir ÇÖ, Dönmez S, Akkurt L, Annunziata MA. Cross-cultural adaptation, validity and reliability of the Turkish version of the Cognitive Functioning Self-Assessment Scale (CFSS). APPLIED NEUROPSYCHOLOGY. ADULT 2025:1-7. [PMID: 40202258 DOI: 10.1080/23279095.2025.2490846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/10/2025]
Abstract
The Cognitive Functioning Self-Assessment Scale (CFSS) is a scale that enables individuals to assess their subjective cognitive performance. The study aimed to cross-culturally adapt the CFSS to Turkish (CFSS-TR) and prove its psychometric properties. The study included 180 community-dwelling adults over 18 years of age with no psychological or neurological disorders. Participants were assessed using the CFSS-TR, Hospital Anxiety Depression Scale (HADS), and the Cognitive Failures Questionnaire (CFQ) via online survey. Two weeks later, the CFSS-TR was taken from the participants for the second time. The mean age of the individuals was 41.06 ± 13.34 years. The CFSS-TR had good test-retest reliability (ICC: 0.84, CI 95%: 0.78-0.88) and good internal consistency (α = 0.88). The standard error of measurement (SEM) and the 95% confidence interval minimal detectable change (MDC95) values for the total score were 0.11 and 0.30, respectively. CFSS-TR had a strong correlation with CFQ, moderate correlation with HADS depression subscore, and weak correlation with HADS anxiety subscore (respectively r = 0.71, r = 0.52, r = 0.39, p < 0.001). CFSS-TR is a reliable and valid questionnaire for self-assessment of cognitive function in Turkish-speaking community-dwelling adults.
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Affiliation(s)
- Nisa Türütgen
- Department of Physiotherapy and Rehabilitation, Faculty of Health Science, Kutahya Health Sciences University, Kutahya, Turkey
| | - İsmail Okur
- Department of Physiotherapy and Rehabilitation, Faculty of Health Science, Kutahya Health Sciences University, Kutahya, Turkey
| | - Aylin Aydoğdu Delibay
- Department of Physiotherapy and Rehabilitation, Faculty of Health Science, Kutahya Health Sciences University, Kutahya, Turkey
| | - Çimen Ölçay Demir
- Department of Physiotherapy and Rehabilitation, Faculty of Health Science, Kutahya Health Sciences University, Kutahya, Turkey
| | - Simge Dönmez
- Department of Physiotherapy and Rehabilitation, Faculty of Health Science, Kutahya Health Sciences University, Kutahya, Turkey
| | - Lütfiye Akkurt
- Department of Physiotherapy and Rehabilitation, Faculty of Health Science, Kutahya Health Sciences University, Kutahya, Turkey
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Basis N, Boker LK, Shochat T. Religiosity, Religious Orientation, and a Good Night's Sleep: The Role of Anxiety and Depression. J Sleep Res 2025:e70055. [PMID: 40177929 DOI: 10.1111/jsr.70055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Revised: 03/17/2025] [Accepted: 03/18/2025] [Indexed: 04/05/2025]
Abstract
Religious belief can be beneficial to mental health, particularly in relation to anxiety and depression, both of which are strongly linked to poor sleep. This study aimed to investigate the role of anxiety and depression as mediators in the relationship between religiosity/religious orientation and sleep health in the Druze community in Israel. The cross-sectional study included 93 religious and 140 non-religious Druze adults who completed a questionnaire and a 2-week sleep diary. We tested the effects of religiosity (yes/no) and religious orientation (religion as end, means and quest) on sleep quality and efficiency. Next, we examined anxiety and depression as mediators in these relationships. Eighty-three (35.6%) respondents had borderline or clinical anxiety, while 24(10.3%) had borderline or clinical depression. Thirty (12.9%) reported poor sleep quality. In mediation models, anxiety fully mediated the relationship between religiosity and sleep quality (β = 0.195, 95% CI [0.109-0.296]); religiosity and sleep efficiency (β = 0.619, 95% CI [0.193-1.137]); religion as end and sleep quality (β = 0.091, 95% CI [0.046-0.150]); religion as end and sleep efficiency (β = 0.304, 95% CI [0.094-0.577]); religion as quest and sleep efficiency (β = -0.325, 95% CI [-0.575-0.086]). Additionally, anxiety partially mediated the relationship between religion as quest and sleep quality (β = -0.096, 95% CI [-0.152-0.052]). In all models, non-religious status, lower levels of religion as end, and higher levels of religion as quest predicted higher anxiety, which in turn predicted lower sleep quality and efficiency. Other models were non-significant for anxiety or depression. Anxiety plays a crucial role in the relationship between religiosity, religious orientation and sleep health. Religious individuals experience less anxiety and report better sleep quality.
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Affiliation(s)
- Najwa Basis
- Cheryl Spencer Department of Nursing, The Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Lital Keinan Boker
- School of Public Health, the Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Tamar Shochat
- Cheryl Spencer Department of Nursing, The Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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Larsson K, Hjelm C, Strömberg A, Israelsson J, Bremer A, Agerström J, Carlsson N, Tsoukala D, Nordström EB, Årestedt K. Cardiac arrest survivors' self-reported cognitive function, and its association with self-reported health status, psychological distress, and life satisfaction-a Swedish nationwide registry study. Resuscitation 2025; 209:110550. [PMID: 39970976 DOI: 10.1016/j.resuscitation.2025.110550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2024] [Revised: 02/09/2025] [Accepted: 02/10/2025] [Indexed: 02/21/2025]
Abstract
AIM Self-reported cognitive function has been described as an important complement to performance-based measurements but has seldom been investigated in cardiac arrest (CA) survivors. Therefore, the aim was to describe self-reported cognitive function and its association with health status, psychological distress, and life satisfaction. METHODS This study utilised data from the Swedish Register of Cardiopulmonary Resuscitation (2018-2021), registered 3-6 months post-CA. Cognitive function was assessed by a single question: "How do you experience your memory, concentration, and/or planning abilities today compared to before the cardiac arrest?". Health status was measured using the EQ VAS, psychological distress with the Hospital Anxiety and Depression Scale, and overall life satisfaction with the Life Satisfaction checklist. Data were analysed using binary logistic regression. RESULTS Among 4026 identified survivors, 1254 fulfilled the inclusion criteria. The mean age was 65.9 years (SD = 13.4) and 31.7% were female. Self-reported cognitive function among survivors was reported as: 'Much worse' by 3.1%, 'Worse' by 23.8%, 'Unchanged' by 68.3%, 'Better' by 3.3%, and 'Much better' by 1.5%. Declined cognitive function was associated with lower health status (OR = 2.76, 95% CI = 2.09-3.64), symptoms of anxiety (OR = 3.84, 95% CI = 2.80-5.24) and depression (OR = 4.52, 95% CI = 3.22-6.32), and being dissatisfied with overall life (OR = 2.74, 95% CI = 2.11-3.54). These associations remained significant after age, sex, place of CA, aetiology, initial rhythm, initial witnessed status, and cerebral performance were controlled. CONCLUSIONS Survivors experiencing declined cognitive function post-CA are at a higher risk of poorer health status, increased psychological distress, and reduced life satisfaction, and these risks should be acknowledged by healthcare professionals.
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Affiliation(s)
- Karin Larsson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | - Carina Hjelm
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Anna Strömberg
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Department of Cardiology, Linköping University Hospital, Linköping, Sweden
| | - Johan Israelsson
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar/Växjö, Sweden; Department of Internal Medicine, Kalmar County Hospital, Region Kalmar County, Kalmar, Sweden
| | - Anders Bremer
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar/Växjö, Sweden
| | - Jens Agerström
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar/Växjö, Sweden
| | - Nina Carlsson
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar/Växjö, Sweden
| | - Dionysia Tsoukala
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar/Växjö, Sweden
| | - Erik Blennow Nordström
- Neurology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden; Department of Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden
| | - Kristofer Årestedt
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar/Växjö, Sweden; Department of Research, Region Kalmar County, Kalmar, Sweden
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Cui B, Luo H, He B, Liu X, Lv D, Zhang X, Su K, Zheng S, Lu J, Wang C, Yang Y, Zhao Z, Liu X, Wang X, Zhao Y, Nie X, Jiang Y, Zhang Z, Liu C, Chen X, Cai A, Lv Z, Liu Z, An F, Zhang Y, Yan Q, Kelley KW, Xu G, Xu L, Liu Q, Peng F. Gut dysbiosis conveys psychological stress to activate LRP5/β-catenin pathway promoting cancer stemness. Signal Transduct Target Ther 2025; 10:79. [PMID: 40038255 PMCID: PMC11880501 DOI: 10.1038/s41392-025-02159-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Revised: 01/02/2025] [Accepted: 01/23/2025] [Indexed: 03/06/2025] Open
Abstract
Psychological stress causes gut microbial dysbiosis and cancer progression, yet how gut microbiota determines psychological stress-induced tumor development remains unclear. Here we showed that psychological stress promotes breast tumor growth and cancer stemness, an outcome that depends on gut microbiota in germ-free and antibiotic-treated mice. Metagenomic and metabolomic analyses revealed that psychological stress markedly alters the composition and abundance of gut microbiota, especially Akkermansia muciniphila (A. muciniphila), and decreases short-chain fatty acid butyrate. Supplement of active A. muciniphila, butyrate or a butyrate-producing high fiber diet dramatically reversed the oncogenic property and anxiety-like behavior of psychological stress in a murine spontaneous tumor model or an orthotopic tumor model. Mechanistically, RNA sequencing analysis screened out that butyrate decreases LRP5 expression to block the activation of Wnt/β-catenin signaling pathway, dampening breast cancer stemness. Moreover, butyrate as a HDAC inhibitor elevated histone H3K9 acetylation level to transcriptionally activate ZFP36, which further accelerates LRP5 mRNA decay by binding adenine uridine-rich (AU-rich) elements of LRP5 transcript. Clinically, fecal A. muciniphila and serum butyrate were inversely correlated with tumoral LRP5/β-catenin expression, poor prognosis and negative mood in breast cancer patients. Altogether, our findings uncover a microbiota-dependent mechanism of psychological stress-triggered cancer stemness, and provide both clinical biomarkers and potential therapeutic avenues for cancer patients undergoing psychological stress.
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Affiliation(s)
- Bai Cui
- Institute of Cancer Stem Cell, Dalian Medical University, Dalian, China
| | - Huandong Luo
- Institute of Cancer Stem Cell, Dalian Medical University, Dalian, China
- State Key Laboratory of Oncology in South China, Cancer Center, Sun Yat-sen University, Guangzhou, China
| | - Bin He
- Institute of Cancer Stem Cell, Dalian Medical University, Dalian, China
| | - Xinyu Liu
- Key Laboratory of Separation Sciences for Analytical Chemistry, National Chromatographic R&A Center, Dalian Institute of Chemical Physics, Chinese Academy of Sciences (CAS), Dalian, China
| | - Dekang Lv
- Institute of Cancer Stem Cell, Dalian Medical University, Dalian, China
| | - Xiaoyu Zhang
- Institute of Cancer Stem Cell, Dalian Medical University, Dalian, China
| | - Keyu Su
- Institute of Cancer Stem Cell, Dalian Medical University, Dalian, China
| | - Sijia Zheng
- Key Laboratory of Separation Sciences for Analytical Chemistry, National Chromatographic R&A Center, Dalian Institute of Chemical Physics, Chinese Academy of Sciences (CAS), Dalian, China
| | - Jinxin Lu
- Institute of Cancer Stem Cell, Dalian Medical University, Dalian, China
| | - Cenxin Wang
- Institute of Cancer Stem Cell, Dalian Medical University, Dalian, China
| | - Yuqing Yang
- Institute of Cancer Stem Cell, Dalian Medical University, Dalian, China
| | - Zhuoran Zhao
- Institute of Cancer Stem Cell, Dalian Medical University, Dalian, China
| | - Xianxian Liu
- Institute of Cancer Stem Cell, Dalian Medical University, Dalian, China
| | - Xu Wang
- Institute of Cancer Stem Cell, Dalian Medical University, Dalian, China
| | - Yingrui Zhao
- Institute of Cancer Stem Cell, Dalian Medical University, Dalian, China
| | - Xiaoshan Nie
- Institute of Cancer Stem Cell, Dalian Medical University, Dalian, China
| | - Yuanyuan Jiang
- Institute of Cancer Stem Cell, Dalian Medical University, Dalian, China
| | - Ziyu Zhang
- Institute of Cancer Stem Cell, Dalian Medical University, Dalian, China
| | - Congcong Liu
- Institute of Cancer Stem Cell, Dalian Medical University, Dalian, China
| | - Xinyi Chen
- Institute of Cancer Stem Cell, Dalian Medical University, Dalian, China
| | - Anqi Cai
- Institute of Cancer Stem Cell, Dalian Medical University, Dalian, China
| | - Zhumeng Lv
- Institute of Cancer Stem Cell, Dalian Medical University, Dalian, China
| | - Zhihang Liu
- Institute of Cancer Stem Cell, Dalian Medical University, Dalian, China
| | - Fan An
- Institute of Cancer Stem Cell, Dalian Medical University, Dalian, China
| | - Yunkun Zhang
- Department of Pathology, The Second Hospital of Dalian Medical University, Dalian, China
| | - Qiulong Yan
- Department of Microbiology, College of Basic Medical Sciences, Dalian Medical University, Dalian, China
| | - Keith W Kelley
- Department of Pathology, College of Medicine and Department of Animal Sciences, College of ACES, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Guowang Xu
- Key Laboratory of Separation Sciences for Analytical Chemistry, National Chromatographic R&A Center, Dalian Institute of Chemical Physics, Chinese Academy of Sciences (CAS), Dalian, China
| | - Lingzhi Xu
- Department of Oncology, the Second Affiliated Hospital, Dalian Medical University, Dalian, China.
| | - Quentin Liu
- Institute of Cancer Stem Cell, Dalian Medical University, Dalian, China.
- State Key Laboratory of Oncology in South China, Cancer Center, Sun Yat-sen University, Guangzhou, China.
| | - Fei Peng
- Institute of Cancer Stem Cell, Dalian Medical University, Dalian, China.
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Tekdemir R, Tan Çamok Ö, Kandeğer A, Aydın M, Altınbaş K, Selvi Y. Adult separation anxiety and feelings of guilt as predictors of prolonged grief disorder. Int J Psychiatry Clin Pract 2025; 29:41-47. [PMID: 40089853 DOI: 10.1080/13651501.2025.2479696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2024] [Revised: 02/15/2025] [Accepted: 03/10/2025] [Indexed: 03/17/2025]
Abstract
INTRODUCTION This study aimed to evaluate the sociodemographic factors, loss-related factors, and adult separation anxiety associated with a diagnosis of Prolonged Grief Disorder (PGD), after controlling for anxiety, depression, and perceived social support during the COVID-19 pandemic in Türkiye. METHODS Participants (n=126) completed an online survey that included socio-demographic and loss-related information, as well as the Hospital Anxiety and Depression Scale, Prolonged Grief Disorder Scale-13, Multidimensional Scale of Perceived Social Support, and Adult Separation Anxiety Questionnaire-27. RESULTS Twelve participants were diagnosed with probable PGD (9.5%). In the linear regression analysis, it was found that when the deceased person was a first-degree relative and younger in age, the presence of guilt, increased separation anxiety, and higher depression scores significantly associated with the severity of PGD. CONCLUSION Even when the pandemic is under control, it remains crucial to offer mental health services those who have lost a loved one during the COVID-19 outbreak.
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Affiliation(s)
- Rukiye Tekdemir
- Department of Psychiatry, Selçuk University Medical Faculty, Konya, Turkey
| | - Özge Tan Çamok
- Department of Psychiatry, Selçuk University Medical Faculty, Konya, Turkey
| | - Ali Kandeğer
- Department of Psychiatry, Selçuk University Medical Faculty, Konya, Turkey
| | - Memduha Aydın
- Department of Psychiatry, Selçuk University Medical Faculty, Konya, Turkey
| | | | - Yavuz Selvi
- Department of Psychiatry, Selçuk University Medical Faculty, Konya, Turkey
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9
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Eide LSP, Sandvik RKN, Jorem GT, Boge RM, Beisland EG. Using the Hospital Anxiety and Depression Scale in Patients 80 Years-Old and Older: A Systematic Review. J Adv Nurs 2025. [PMID: 39953752 DOI: 10.1111/jan.16816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2024] [Revised: 01/20/2025] [Accepted: 01/28/2025] [Indexed: 02/17/2025]
Abstract
AIMS To identify and report results from studies of anxiety and depression, as measured by The Hospital Anxiety and Depression Scale (HADS) in patients ≥ 80 years admitted to hospital settings, and to inform nurses, researchers and educators in nursing about these findings. DESIGN Systematic review. DATA SOURCES MEDLINE, EMBASE, PsycINFO, CINAHL, Cochrane, Epistemonikos, Scopus and Web of Science Core Collection of studies published until October 2023. METHODS A search strategy was developed with a university librarian. Four independent reviewers screened titles and abstracts based on predefined inclusion criteria. Data were systematically extracted, descriptively analysed, and Critical Appraisal Skills Programme checklists were used to assess studies. RESULTS Out of 7076 identified studies, three met the eligibility criteria. Data from 420 participants aged ≥ 80 years were analysed, revealing anxiety prevalence rates between 6% and 18% and mean scores below 4. Depression prevalence rates ranged from 7% to 17%, with a mean score below 4. Most patients with depression were not previously recognised as being depressed. CONCLUSIONS Few publications reported on anxiety and/or depression in hospitalised patients aged ≥ 80 years using HADS. A gap in the knowledge base has been identified. IMPLICATIONS Anxiety and depression are mental health conditions that can lead to adverse events and strongly affect aging. Increased understanding of the role that these conditions have on hospitalised patients ≥ 80 years is important for nurses when in contact with this patient group. IMPACT There is a need for more studies to generate evidence regarding anxiety and depression in an increasingly common and challenging hospital population by building upon evidence that is based on validated instruments such as the Hospital Anxiety and Depression Scale. REPORTING METHOD The PRISMA guideline was followed, and the review registered in PROSPERO (Registration number CRD 42022380943). PATIENT CONTRIBUTION No patient or public contribution. TRIAL REGISTRATION CRD 42022380943.
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Affiliation(s)
- Leslie S P Eide
- Western Norway University of Applied Sciences, Bergen, Norway
| | | | | | - Ranveig M Boge
- Western Norway University of Applied Sciences, Bergen, Norway
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10
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Smits MJM, Bolman CAW, Mesters I, Lechner L. Blended Care Intervention for Cancer Aftercare in General Practice Centers: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2025; 14:e64662. [PMID: 39938086 PMCID: PMC11888081 DOI: 10.2196/64662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Revised: 12/04/2024] [Accepted: 12/05/2024] [Indexed: 02/14/2025] Open
Abstract
BACKGROUND Combining effective eHealth programs with face-to-face consultations in general practice may help general practitioners care for survivors of cancer. OBJECTIVE This study protocol describes a 2-armed randomized controlled trial to evaluate the cost-effectiveness of a blended intervention integrating the Cancer Aftercare Guide in general practice centers (GPCs). METHODS A parallel-group design will compare an intervention group with a waiting list control group. Participants will be nested within GPCs and randomization will occur at the GPC level. The participants in the intervention group will receive a blended care intervention. In contrast, the participants in the waiting list control group will receive care as usual for the duration of this study and will receive the online intervention afterward. All participants will be asked to complete an online questionnaire at baseline, 6 months, and 12 months after baseline, measuring self-reported adherence to lifestyle recommendations, psychosocial well-being, and quality of life. A process evaluation and cost evaluation are also included in this study. The effects will be evaluated based on differences in residual change scores between intervention and control group participants, using multilevel linear regression analyses. Moreover, effect analyses will be supplemented with Bayes factor analyses. Finally, an economic evaluation will be conducted from a societal perspective and will include medical costs, productivity costs, and costs of the blended care intervention. RESULTS This study was funded in July 2020. Data collection started in August 2022 and is likely to be completed by April 2025. As of December 2024, a total of 127 participants have been included in this study, recruited across 26 GPCs in the Netherlands. Data analysis will commence once data collection is completed. Data analysis is estimated to start in the spring of 2025. The results will likely be published in 2026. CONCLUSIONS The results will provide insight into the effectiveness of blended care and may be relevant to cancer aftercare, general practice, and the field of eHealth implementation in general. Potential challenges lie in recruitment due to the strain on the health care system since the COVID-19 pandemic. TRIAL REGISTRATION ISRCTN ISRCTN12451453; https://www.isrctn.com/ISRCTN12451453. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/64662.
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Affiliation(s)
- Michelle J M Smits
- Department of Health Psychology, Faculty of Psychology, Open University of the Netherlands, Heerlen, Netherlands
| | - Catherine A W Bolman
- Department of Health Psychology, Faculty of Psychology, Open University of the Netherlands, Heerlen, Netherlands
| | - Ilse Mesters
- Department of Epidemiology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Lilian Lechner
- Department of Health Psychology, Faculty of Psychology, Open University of the Netherlands, Heerlen, Netherlands
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11
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Salafia C, Bellizzi KM, Ligus K, Fritzson E, Park CL. Perceived negative consequences of cancer and psychological distress in survivors: the moderating role of social support. J Cancer Surviv 2025; 19:12-20. [PMID: 37606815 PMCID: PMC11018111 DOI: 10.1007/s11764-023-01444-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 08/01/2023] [Indexed: 08/23/2023]
Abstract
PURPOSE Many cancer survivors experience psychological distress at some point during their care. The degree to which individuals perceive negative consequences of cancer has been associated with psychological distress, including anxiety and depression. Identifying psychosocial factors that buffer the effects of illness perceptions on distress may provide a target for intervention to improve the psychological health of cancer survivors. As such, the present study aimed to examine whether social support moderates the relationship between perceived negative consequences of cancer and psychological distress. METHODS The current longitudinal study of 413 cancer survivors (64% female, 58% breast cancer, Mage = 59.68, SD = 11.41) examined social support as a potential moderator of the relationship, hypothesizing that greater overall perceived social support would buffer the relationship between perceived negative consequences of cancer and subsequent symptoms of anxiety and depression. RESULTS Perceived negative consequences of cancer predicted anxiety and depression over time (p < .05), but social support had a buffering effect on the perceived negative consequences of cancer-anxiety relationship (β = - .20, p < .001) as well as the perceived negative consequences of cancer-depression relationship (β = - .11, p < .05). CONCLUSION Results suggest that social support is a protective factor over time against the pathway of illness perceptions leading to psychological distress among cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS Interventions that improve social support in cancer survivors may attenuate psychological distress and help support these individuals in their survivorship journey.
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Affiliation(s)
- Caroline Salafia
- Department of Human Development and Family Sciences, University of Connecticut, 348 Mansfield Road, U-1058, Storrs, CT, 06269, USA.
| | - Keith M Bellizzi
- Department of Human Development and Family Sciences, University of Connecticut, 348 Mansfield Road, U-1058, Storrs, CT, 06269, USA
| | - Kaleigh Ligus
- Department of Human Development and Family Sciences, University of Connecticut, 348 Mansfield Road, U-1058, Storrs, CT, 06269, USA
| | - Emily Fritzson
- Department of Human Development and Family Sciences, University of Connecticut, 348 Mansfield Road, U-1058, Storrs, CT, 06269, USA
| | - Crystal L Park
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, U-1020, Storrs, CT, 06269, USA
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12
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Yue KC, Zhu YY, Sun JW, Wu XT, Liu WJ, Shi HF. Imaging characteristics of brain microstructure and cerebral perfusion in Crohn's disease patients with anxiety: A prospective comparative study. World J Gastroenterol 2025; 31:99014. [PMID: 39877713 PMCID: PMC11718645 DOI: 10.3748/wjg.v31.i4.99014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Revised: 11/13/2024] [Accepted: 12/09/2024] [Indexed: 12/30/2024] Open
Abstract
BACKGROUND Anxiety is a common comorbidity in patients with Crohn's disease (CD). Data on the imaging characteristics of brain microstructure and cerebral perfusion in CD with anxiety are limited. AIM To compare the imaging characteristics of brain microstructure and cerebral perfusion among CD patients with or without anxiety and healthy individuals. METHODS This prospective comparative study enrolled consecutive patients with active CD and healthy individuals who visited the study hospital between January 2022 and January 2023. Anxiety was measured using the Hospital Anxiety and Depression Scale-Anxiety. The imaging characteristics of brain microstructure and cerebral perfusion were measured by diffusion kurtosis imaging and intravoxel incoherent motion. RESULTS A total of 57 participants were enrolled. Among the patients with active CD, 16 had anxiety. Compared with healthy individuals, patients with active CD demonstrated significantly lower radial kurtosis values in the right cerebellar region 6, lower axial kurtosis (AK) values in the right insula, left superior temporal gyrus, and right thalamus, and higher slow and fast apparent diffusion coefficients (ADCslow and ADCfast) in the bilateral frontal lobe, bilateral temporal lobe, and bilateral insular lobe (all P < 0.05). Compared with patients with CD without anxiety, patients with CD and anxiety exhibited significantly higher ADCslow values in the left insular lobe and lower AK values in the right insula and right anterior cuneus (all P < 0.05). CONCLUSION There are variations in brain microstructure and perfusion among CD patients with/without anxiety and healthy individuals, suggesting potential use in assessing anxiety-related changes in active CD.
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Affiliation(s)
- Ke-Cen Yue
- Dalian Medical University, Dalian 116044, Liaoning Province, China
- Department of Radiology, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou Medical Center, Changzhou 213000, Jiangsu Province, China
| | - Ying-Yin Zhu
- Department of Radiology, Suzhou 100 Hospital, Suzhou 215000, Jiangsu Province, China
| | - Jing-Wen Sun
- Department of Radiology, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou Medical Center, Changzhou 213000, Jiangsu Province, China
| | - Xin-Tong Wu
- Dalian Medical University, Dalian 116044, Liaoning Province, China
- Department of Radiology, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou Medical Center, Changzhou 213000, Jiangsu Province, China
| | - Wen-Jia Liu
- Department of Gastroenterology, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou Medical Center, Changzhou 213000, Jiangsu Province, China
| | - Hai-Feng Shi
- Department of Radiology, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou Medical Center, Changzhou 213000, Jiangsu Province, China
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13
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Richer MJ, Grenier S, Lupien S, Plusquellec P. Increasing stress resilience in older adults through a 6-week prevention program: effects on coping strategies, anxiety symptoms, and cortisol levels. Front Psychol 2025; 15:1499609. [PMID: 39834757 PMCID: PMC11743716 DOI: 10.3389/fpsyg.2024.1499609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2024] [Accepted: 12/16/2024] [Indexed: 01/22/2025] Open
Abstract
Introduction As people age, chronic stress, resulting in prolonged or repeated activation of the hypothalamic-pituitary-adrenal (HPA) axis, has been associated with long-term adverse health outcomes. Coping strategies and social support have been recognized as contributing to resilience to stress in older adults. Few studies have evaluated stress management training (SMT) interventions based on psychoneuroendocrinology that were designed to be delivered to healthy older adults in community settings. Methods In this study, a total of 170 older adults (mean age = 76.07, SD = 7.67) participated in a cluster-randomized trial designed to compare the delivery of an SMT intervention with a waitlist condition. Results The effect of SMT on coping strategies, stress, anxiety, and depression was measured 3 weeks and 3 months after the intervention. In addition, we tested the effect on basal cortisol secretion over 2 days from saliva samples upon awakening and the total diurnal cortisol output [area under the curve with respect to ground (AUCg)]. Results from repeated measures analyses of variance showed that participants who received the intervention demonstrated a significant increase in problem-solving coping strategies and a decrease in anxiety scores 3 weeks after the intervention compared to the waitlist group. STM participants also demonstrated lower cortisol levels on the AUCg index. At the 3-month follow-up, gains were maintained only on the AUCg index. Discussion This type of brief preventive program could reduce basal cortisol levels in older adults, which may be an important protective factor against health outcomes associated with chronic HPA activation. Our results provide sufficient evidence to warrant further research to improve the effectiveness of O'stress in different settings.
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Affiliation(s)
| | - Sébastien Grenier
- Laboratoire d’étude sur l’anxiété et la dépression gériatrique, Centre de recherche de l’institut universitaire de gériatrie de Montréal, Montreal, QC, Canada
- Psychology department, University of Montreal, Montreal, QC, Canada
| | - Sonia Lupien
- Center for Studies on Human Stress, Centre de recherche de l’institut universitaire en santé mentale de Montréal, Montreal, QC, Canada
- Psychiatric Department, University of Montreal, Montreal, QC, Canada
| | - Pierrich Plusquellec
- Psychoeducation School, University of Montreal, Montreal, QC, Canada
- Center for Studies on Human Stress, Centre de recherche de l’institut universitaire en santé mentale de Montréal, Montreal, QC, Canada
- Centre d’études en sciences de la communication non verbale, Centre de recherche de l’institut universitaire en santé mentale de Montréal, Montreal, QC, Canada
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14
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Deng R, Cheng M, Yan S, Zhang C, Zhao Y, Tang Q, Yao J. Trajectories of psychological adaptation to Chinese older internal migrants: a latent transition model. Aging Ment Health 2025; 29:95-103. [PMID: 38902974 DOI: 10.1080/13607863.2024.2368630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 06/10/2024] [Indexed: 06/22/2024]
Abstract
OBJECTIVES Little is known about the heterogeneity and transitions between psychological adaptation patterns in Chinese older internal migrants. This study addressed two questions: (a) Do distinct patterns of psychological adaptation exist among Chinese older internal migrants? (b) If so, what factors predict different trajectories? METHOD The study drew on two waves of data and involved 405 older internal migrants into Nanjing, China. First, a latent transition analysis was performed to visualize the different patterns of psychological adaptation. Second, an ecological model of resilience was used to identify the factors explaining the differences between adaptation patterns. RESULTS Three main trajectories of psychological adaptation among Chinese older internal migrants over time were: recovery, stability and deterioration. Adaptation trajectories were associated with age, gender, length of stay, psychological resilience, self-esteem, family support, social participation, and living with a spouse. CONCLUSION Chinese older internal migrants undertake heterogeneous psychological adaptation trajectories, and their positive adaptation is closely associated with coping resources. Our data may provide references for the identification of vulnerable older internal migrants, as well as the making of targeted interventions.
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Affiliation(s)
- Ruyue Deng
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China
| | - Mingwen Cheng
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Shiyuan Yan
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China
| | - Chi Zhang
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China
| | - Yuefan Zhao
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China
| | - Qian Tang
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Jun Yao
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China
- Institute of Jiangsu Provincial Institute of Health, Nanjing Medical University, Nanjing, China
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15
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Giglberger M, Peter HL, Henze G, Bärtl C, Konzok J, Kirsch P, Kudielka BM, Kreuzpointner L, Wüst S. Associations Between the Neural Stress Response and Symptoms of Anxiety and Depression. J Neurosci Res 2025; 103:e70019. [PMID: 39817876 PMCID: PMC11737356 DOI: 10.1002/jnr.70019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 11/08/2024] [Accepted: 01/05/2025] [Indexed: 01/18/2025]
Abstract
Anxiety and depression disorders show high prevalence rates, and stress is a significant risk factor for both. However, studies investigating the interplay between anxiety, depression, and stress regulation in the brain are scarce. The present manuscript included 124 law students from the LawSTRESS project. Anxiety and depression symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS), and psychosocial stress was induced with the imaging stress paradigm ScanSTRESS. Anxiety, but not depression scores, were significantly related to neural stress responses in a striato-limbic cluster. Moreover, relative to women, men showed stronger associations between anxiety scores and activation in striatal and temporal clusters. A bifactor model of the HADS suggested a general factor characterized by tension, nervousness, and cheerlessness, which was associated with activation changes in a similar but more circumscribed cluster than anxiety. In the LawSTRESS project, the HADS was assessed at five sampling points (1 year, 3 months, 1 week prior exam, 1 week, and 1 month thereafter), and thus an exploratory trajectory analysis could be performed. It confirmed the relationship between anxiety scores and striatal stress responses at baseline but revealed no predictive value of the neural measure across the sampling points. Our results suggest that-in healthy young participants-neural acute psychosocial stress responses in striato-limbic structures are associated with anxiety, supporting the assumption that these regions are related to individual differences in vulnerability to stress-related disorders. A correlation with depression scores could not be found, and possible explanations are discussed.
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Affiliation(s)
| | - Hannah L. Peter
- Department of PsychologyUniversity of RegensburgRegensburgGermany
| | - Gina‐Isabelle Henze
- Department of PsychologyUniversity of RegensburgRegensburgGermany
- Research Division of Mind and Brain, Department of Psychiatry and Psychotherapy CCM, Charité‐Universitätsmedizin Berlin, Corporate Member of Freie Universität BerlinHumboldt‐Universität Zu Berlin, and Berlin Institute of HealthBerlinGermany
| | - Christoph Bärtl
- Department of PsychologyUniversity of RegensburgRegensburgGermany
| | - Julian Konzok
- Department of PsychologyUniversity of RegensburgRegensburgGermany
- Department of Epidemiology and Preventive MedicineUniversity of RegensburgRegensburgGermany
| | - Peter Kirsch
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty MannheimUniversity of HeidelbergHeidelbergGermany
| | | | | | - Stefan Wüst
- Department of PsychologyUniversity of RegensburgRegensburgGermany
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16
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Dutheil F, Palgen C, Brousse G, Cornet T, Mermillod M, Lakbar I, Vallet G, Baker JS, Schmidt J, Charbotel B, Pereira B, Delamarre L. Validation of visual analog scales of mood and anxiety at the workplace. PLoS One 2024; 19:e0316159. [PMID: 39739967 DOI: 10.1371/journal.pone.0316159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Accepted: 12/08/2024] [Indexed: 01/02/2025] Open
Abstract
The Hospital Anxiety and Depression Scale (HADS) is commonly used to detect depressive or anxious states, but its 14-item questionnaire is time-consuming. Visual analog scales (VAS) are easy to use and quick to implement. Although the VAS has been validated to assess pain and occupational stress, VAS scores for anxiety and mood have never been evaluated in the workplace. We aimed to validate the use of visual analog scales (VAS) for anxiety and mood compared to HADS in workers. A HADS self-reported questionnaire associated with VAS assessing perceived anxiety and mood on a horizontal line of 100 mm was administered to 182 workers, with a second test (retest) proposed one week later. Sociodemographic, characteristics of work, sleep, well-being, and stress were also assessed. VAS anxiety and mood correlated with the HADS sub-scores (0.70 and 0.65, respectively). The test-retest reliability was good. Optimal VAS cut-offs were ≥ 60/100 for anxiety and ≤ 60/100 for mood, to define at-risk patients. The VAS is quick to perform, easy to use, and reliable for screening depression and anxiety in occupational medicine. We recommend validated questionnaires for at-risk patients. TRIAL REGISTRATION CLINICALTRIALS gov: NCT02596737. Available at: https://www. CLINICALTRIALS gov/ct2/show/NCT02596737.
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Affiliation(s)
- Frédéric Dutheil
- University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Preventive and Occupational Medicine, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Clara Palgen
- University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Preventive and Occupational Medicine, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Georges Brousse
- NPSY-SYDO, University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Psychiatry, Université Clermont Auvergne, Clermont-Ferrand, France
| | | | - Martial Mermillod
- CNRS, LPNC, Univ. Grenoble Alpes, Grenoble, France
- Institut Universitaire de France, Paris, France
| | - Ines Lakbar
- Intensive Care Unit, Anesthesia and Critical Care Department (DAR-B), Saint-Eloi Teaching Hospital, University of Montpellier, Montpellier, France
| | - Guillaume Vallet
- CNRS, LaPSCo, Physiological and Psychosocial Stress, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Julien S Baker
- Centre for Health and Exercise Science Research, Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon Tong, Hong Kong
| | - Jeannot Schmidt
- CNRS, LaPSCo, Physiological and Psychosocial Stress, University Hospital of Clermont-Ferrand (CHU), Emergency Department, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Barbara Charbotel
- Univ Lyon 1, IFSTTAR, UMRESTTE, UMR_T9405, University of Lyon, Lyon, France
| | - Bruno Pereira
- University Hospital of Clermont Ferrand, CHU Clermont-Ferrand, Clinical Research and Innovation Direction, Clermont-Ferrand, France
| | - Louis Delamarre
- CNRS, LaPSCo, Physiological and Psychosocial Stress, Université Clermont Auvergne, Clermont-Ferrand, France
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17
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Nilsson O, Stenman M, Letterstål A, Hultgren R. One-year results of an eHealth intervention on anxiety in patients undergoing abdominal aortic aneurysm surgery: randomized clinical trial. BJS Open 2024; 9:zrae144. [PMID: 39812416 PMCID: PMC11733888 DOI: 10.1093/bjsopen/zrae144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 09/18/2024] [Accepted: 10/25/2024] [Indexed: 01/16/2025] Open
Abstract
BACKGROUND The longitudinal effects of educational interventions in people with abdominal aortic aneurysm are largely unexplored. This prospective study investigated whether the anxiety-lowering effect of an eHealth intervention observed at the 1-month follow-up is maintained 1 year after abdominal aortic aneurysm surgery. METHODS Those scheduled for surgical repair of abdominal aortic aneurysm were recruited in a single-centre randomized clinical trial. The control group received care and follow-up per the institution's standard. The intervention group received an eHealth tool along with psychosocial support. The 1-month results have been reported. The primary outcome measure was the anxiety mean score (HADS-A). RESULTS Of 120 included participants, 96 completed the 1-year follow-up (48 in each treatment group). The mean age was 73 years, a majority (86%) were male and 73% were current or previous smokers. Anxiety symptoms measured with the HADS-A decreased over time in both the intervention group (-0.33) and the control group (-0.35, P = 0.868). The improvements in anxiety symptoms seen in the short-term follow-up were not sustained at the 1-year follow-up. No significant mean score differences were found in the intention-to-treat or per-protocol analyses. CONCLUSION In this randomized clinical trial, an eHealth intervention did not result in a sustained reduction in anxiety symptoms compared with standard care in the same cohort. The study provides an insight into the limited acceptability of an eHealth tool in people with abdominal aortic aneurysm and valuable data on the recovery trajectory following open and endovascular abdominal aortic aneurysm surgery. Further research is warranted to evaluate the relevance and long-term effectiveness of eHealth interventions in abdominal aortic aneurysm care. REGISTRATION NUMBER NCT03157973 (http://www.clinicaltrials.gov).
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Affiliation(s)
- Olga Nilsson
- Department of Molecular Medicine and Surgery, Stockholm Aortic Research Group, STAR, Karolinska Institutet, Stockholm, Sweden
- Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Malin Stenman
- Department of Molecular Medicine and Surgery, Stockholm Aortic Research Group, STAR, Karolinska Institutet, Stockholm, Sweden
- Perioperative Medicine and Intensive Care Function, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Letterstål
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Rebecka Hultgren
- Department of Molecular Medicine and Surgery, Stockholm Aortic Research Group, STAR, Karolinska Institutet, Stockholm, Sweden
- Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
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18
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Vanmaele A, Branidis P, Karamanidou M, Bouwens E, Hoeks SE, de Bruin JL, ten Raa S, Akkerhuis KM, van Lier F, Budde RPJ, Fioole B, Verhagen HJM, Boersma E, Kardys I. Evolution of quality of life, anxiety, and depression over time in patients with an abdominal aortic aneurysm approaching the surgical threshold. BJS Open 2024; 9:zrae150. [PMID: 39792053 PMCID: PMC11720167 DOI: 10.1093/bjsopen/zrae150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2024] [Accepted: 11/06/2024] [Indexed: 01/12/2025] Open
Abstract
BACKGROUND Contrary to the impact of screening, the effect of long-term surveillance on the quality of life of patients with an abdominal aortic aneurysm is not well known. Therefore, the aim of this study was to describe patient-reported outcomes of patients with an abdominal aortic aneurysm approaching the surgical threshold. METHODS This multicentre, observational cohort study included patients with an abdominal aortic aneurysm with a maximum aneurysm diameter of greater than or equal to 40 mm. The EuroQol five-dimension five-level questionnaire (range -0.446 to 1, minimal clinically important difference 0.071), the Hospital Anxiety and Depression Scale questionnaire (0-21 points/subscale, minimal clinically important difference 1.7 points), and the short version of the Patient Health Questionnaire (0-6 points) were mailed to patients with an abdominal aortic aneurysm at baseline and after 1 and 2 years or until abdominal aortic aneurysm surgery/death. Linear mixed-effects models were used to describe the evolution of patient-reported outcomes over time and investigate changes attributable to clinical characteristics. RESULTS In total, 291 to 294 responses to each questionnaire were available from 124 patients with an abdominal aortic aneurysm, of whom 34 underwent surgery during follow-up. The mean health-related quality of life and anxiety and depression scores over time were 0.781 (95% c.i. 0.749 to 0.814), 4.4 points (95% c.i. 3.9 to 4.9), and 4.6 points (95% c.i. 4.0 to 5.2) respectively. Anxiety and depression scores decreased in patients who underwent surgery with a mean of 2.8 (95% c.i. 1.1 to 4.6) and 2.0 (95% c.i. 0.4 to 3.6) points/year respectively, compared with patients who had not had surgery. Considering the minimal clinically important difference, patients with a primary education alone, compared with a secondary education, had higher or increasing anxiety and depression scores. Patients with a first-degree relative with an abdominal aortic aneurysm had a higher risk of clinical anxiety. CONCLUSION Although health-related quality of life, anxiety, and depression remain stable over time on average, anxiety and depression decrease in patients approaching surgery. Patients with a family history of abdominal aortic aneurysm or a primary education alone experience more anxiety and/or depression and thus might benefit from a tailored approach during surveillance.
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Affiliation(s)
- Alexander Vanmaele
- Department of Cardiology, Thorax Centre, Cardiovascular Institute, Erasmus MC, Rotterdam, The Netherlands
- Department of Vascular Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Petros Branidis
- Department of Cardiology, Thorax Centre, Cardiovascular Institute, Erasmus MC, Rotterdam, The Netherlands
- Department of Vascular Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Maria Karamanidou
- Department of Cardiology, Thorax Centre, Cardiovascular Institute, Erasmus MC, Rotterdam, The Netherlands
- Department of Vascular Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Elke Bouwens
- Department of Cardiology, Thorax Centre, Cardiovascular Institute, Erasmus MC, Rotterdam, The Netherlands
- Department of Vascular Surgery, Erasmus MC, Rotterdam, The Netherlands
- Department of Anaesthesiology, Erasmus MC, Rotterdam, The Netherlands
| | - Sanne E Hoeks
- Department of Anaesthesiology, Erasmus MC, Rotterdam, The Netherlands
| | - Jorg L de Bruin
- Department of Vascular Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Sander ten Raa
- Department of Vascular Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - K Martijn Akkerhuis
- Department of Cardiology, Thorax Centre, Cardiovascular Institute, Erasmus MC, Rotterdam, The Netherlands
| | - Felix van Lier
- Department of Anaesthesiology, Erasmus MC, Rotterdam, The Netherlands
| | - Ricardo P J Budde
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Bram Fioole
- Department of Vascular Surgery, Maasstad Hospital, Rotterdam, The Netherlands
| | | | - Eric Boersma
- Department of Cardiology, Thorax Centre, Cardiovascular Institute, Erasmus MC, Rotterdam, The Netherlands
| | - Isabella Kardys
- Department of Cardiology, Thorax Centre, Cardiovascular Institute, Erasmus MC, Rotterdam, The Netherlands
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Elhamid YAA, Elazkalany GS, Niazy MH, Afifi AY. Anxiety and depression in primary knee osteoarthritis patients: are they related to clinical features and radiographic changes? Reumatologia 2024; 62:421-429. [PMID: 39866307 PMCID: PMC11758106 DOI: 10.5114/reum/195120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 10/23/2024] [Indexed: 01/28/2025] Open
Abstract
Introduction Osteoarthritis (OA) is a worldwide, disabling condition, more prevalent in older people. Although anxiety and depression disorders are common in OA and may affect compliance with treatment, both disorders are still underrecognized and undertreated. The present study aimed to screen for anxiety and depression among patients with primary knee OA, and to study the relationship between Hospital Anxiety and Depression Scale (HADS) score and different disease parameters. Material and methods Fifty patients fulfilling primary knee OA classification criteria were recruited for the study, and 50 age- and sex-matched healthy individuals served as a control group. Medical history was taken, clinical examination was done, and pain intensity was assessed using the Visual Analogue Scale. The 6-minute walk test was used for functional status assessment, and plain X-ray knees were scored according to the Kellgren and Lawrence classification system. Participants completed the HADS questionnaire. Results Twenty-nine patients were female (58%) and 21 were male (42%). The mean HADS score was significantly higher in OA patients than controls (p = 0.001). The mean HADS-A (Anxiety) score was statistically significantly higher in OA patients than controls (p < 0.001). Anxiety was more frequent in patients (44%) than in controls (10%) (p < 0.001). In regression analysis, female sex could be considered as a predictor for each of HADS-A and HADS-D (Depression) (β: 0.4, 0.3; t: 3.28, 2.2; p = 0.002, 0.03; CI: 1.3-5.6, 0.2-4.4), respectively, while knee giving way was considered as a predictor for HADS-A (β: 0.34, t: 2.8, p = 0.007, CI: 0.96-5.87). Conclusions The results of the present study showed that anxiety level rather than depression was significantly higher in patients with primary knee OA than in controls. Female sex could be considered as a predictor for each of HADS-A and HADS-D, while knee giving way was considered as a predictor for HADS-A.
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Affiliation(s)
- Yasmin A Abd Elhamid
- Department of Rheumatology and Rehabilitation, Faculty of Medicine, Cairo University, Kasr Alainy Hospital, Cairo, Egypt
| | - Ghada S Elazkalany
- Department of Rheumatology and Rehabilitation, Faculty of Medicine, Cairo University, Kasr Alainy Hospital, Cairo, Egypt
| | - Marwa H Niazy
- Department of Rheumatology and Rehabilitation, Faculty of Medicine, Cairo University, Kasr Alainy Hospital, Cairo, Egypt
| | - Angie Y Afifi
- Department of Rheumatology and Rehabilitation, Faculty of Medicine, Cairo University, Kasr Alainy Hospital, Cairo, Egypt
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Oker A, Laraki Y, Anders R, Fongaro E, Capdevielle D, Raffard S. Validation of the French COVID-Related Thoughts and Behavioral Symptoms Questionnaire (Cov-Tabs): A self-report assessment. L'ENCEPHALE 2024; 50:610-615. [PMID: 38311477 DOI: 10.1016/j.encep.2023.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 11/11/2023] [Accepted: 11/14/2023] [Indexed: 02/06/2024]
Abstract
OBJECTIVES The COVID-Related Thoughts and Behavioral Symptoms (Cov-Tabs) is a self-reported questionnaire developed to identify the presence of psychological distress and anxiety-related behavior associated with COVID-19. This scale has been used since the first episodes of mass contamination of COVID-19 disease in the USA without psychometric validation analysis. The objective of this paper is to validate the French version of the Cov-TaBS. METHOD In this study, we assessed a French translation of Cov-Tabs in 300 subjects from the general population. Moreover, we assessed convergent and discriminant validities using an anxiety and depression scale and a paranoid ideation scale. Statistical analyses consisted of evaluating internal consistency, test-retest reliability, and construct validity as well. RESULTS The French translation of the Cov-Tabs demonstrated high internal consistency and reliability, as well as good temporal stability over a period of less than 2 weeks. It also showed strong convergent validity with anxiety and depression traits and divergent validity with paranoid ideation. CONCLUSION Our study indicates that the French version of the Cov-Tabs has robust psychometric properties and is a valid tool for evaluating behavioral symptomatology and thoughts related to COVID-19 disease. Therefore, the French version of the Cov-Tabs is a valid tool that can be used in French-speaking individuals.
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Affiliation(s)
- Ali Oker
- Université de Reims Champagne-Ardenne, C2S, Reims, France.
| | - Yasmine Laraki
- CHU de Montpellier, Montpellier, France; Laboratoire EPSYLON (EA 4556), Université Paul-Valéry Montpellier 3, Université de Montpellier, Montpellier, France
| | - Royce Anders
- Laboratoire EPSYLON (EA 4556), Université Paul-Valéry Montpellier 3, Université de Montpellier, Montpellier, France
| | | | - Delphine Capdevielle
- CHU de Montpellier, Montpellier, France; Laboratoire EPSYLON (EA 4556), Université Paul-Valéry Montpellier 3, Université de Montpellier, Montpellier, France; IGF, Université de Montpellier, CNRS, INSERM, Montpellier, France
| | - Stéphane Raffard
- CHU de Montpellier, Montpellier, France; Laboratoire EPSYLON (EA 4556), Université Paul-Valéry Montpellier 3, Université de Montpellier, Montpellier, France
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21
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Domingue BW, Kanopka K, Trejo S, Rhemtulla M, Tucker-Drob EM. Ubiquitous bias and false discovery due to model misspecification in analysis of statistical interactions: The role of the outcome's distribution and metric properties. Psychol Methods 2024; 29:1164-1179. [PMID: 36201820 PMCID: PMC10369499 DOI: 10.1037/met0000532] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Studies of interaction effects are of great interest because they identify crucial interplay between predictors in explaining outcomes. Previous work has considered several potential sources of statistical bias and substantive misinterpretation in the study of interactions, but less attention has been devoted to the role of the outcome variable in such research. Here, we consider bias and false discovery associated with estimates of interaction parameters as a function of the distributional and metric properties of the outcome variable. We begin by illustrating that, for a variety of noncontinuously distributed outcomes (i.e., binary and count outcomes), attempts to use the linear model for recovery leads to catastrophic levels of bias and false discovery. Next, focusing on transformations of normally distributed variables (i.e., censoring and noninterval scaling), we show that linear models again produce spurious interaction effects. We provide explanations offering geometric and algebraic intuition as to why interactions are a challenge for these incorrectly specified models. In light of these findings, we make two specific recommendations. First, a careful consideration of the outcome's distributional properties should be a standard component of interaction studies. Second, researchers should approach research focusing on interactions with heightened levels of scrutiny. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Benjamin W. Domingue
- Graduate School of Education, Stanford University & Center for Population Health Sciences, Stanford Medicine
| | | | - Sam Trejo
- Department of Sociology & Office of Population Research, Princeton University
| | | | - Elliot M. Tucker-Drob
- Department of Psychology & Population Research Center, University of Texas at Austin
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22
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Safaei F, Shahrokh S, Naderi N, Rastegar R, Shamsi A. Unveiling the efficacy of paroxetine and gabapentin in ulcerative colitis patients in remission with co-existing IBS-like symptoms: a single-blinded randomized clinical trial. Front Med (Lausanne) 2024; 11:1468885. [PMID: 39635600 PMCID: PMC11614664 DOI: 10.3389/fmed.2024.1468885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Accepted: 11/07/2024] [Indexed: 12/07/2024] Open
Abstract
Introduction This clinical trial is designed to explore the efficacy of paroxetine and gabapentin in alleviating functional gastrointestinal symptoms, anxiety, depression, and quality of life in patients with ulcerative colitis during the remission stage. Methods The study enrolled 97 patients with ulcerative colitis in remission who had reported functional gastrointestinal symptoms. Patients were measured in terms of quality of life, anxiety, depression, and IBS severity. One group received paroxetine at a dosage of 20 mg/day, and the other group received gabapentin at a dosage of 100 mg/day in the first month and 300 mg/day in the second and third months. The patients were followed up for 3 months. Results Anxiety (p < 0.001), depression (p = 0.012), and severity score levels (p = 0.045) among patients in the paroxetine group were significantly lower compared to the gabapentin group following the intervention. Paired evaluation in each treatment group revealed a significant reduction in the paroxetine group, while changes in the gabapentin group were not significant. Quality-of-life scores among patients in the paroxetine group were significantly higher compared to the gabapentin group following the intervention (p < 0.001). Conclusion The rate of improvement in gastrointestinal functional symptoms, anxiety, depression, and quality of life is significantly superior with paroxetine compared to gabapentin. Clinical trial registration https://irct.behdasht.gov.ir/trial/69397, identifier RCT20220417054557N1.
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Affiliation(s)
- Farahnaz Safaei
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shabnam Shahrokh
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nosratollah Naderi
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reyhaneh Rastegar
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Shamsi
- Department of Psychiatry, Taleghani Hospital, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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23
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Faronbi JO, Ojewale MO, Faronbi GO, Oladapo OM. Influence of physical activity on loneliness and depression among the older adults in Nigeria. Sci Rep 2024; 14:26781. [PMID: 39500948 PMCID: PMC11538448 DOI: 10.1038/s41598-024-77263-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Accepted: 10/21/2024] [Indexed: 11/08/2024] Open
Abstract
This study aims to determine the predictive influence of physical activities (PA) and evaluate the interactive effect of PA and loneliness on depression among older adults in Nigeria. Data was collected from 369 randomly selected older adults and analysed using descriptive statistics, chi-square test and logistic regression models. The result showed that that the predictors of depression were loneliness (OR = 4.59; p < 0.001), PA High (OR = 2.51; p = 0.008), Age 80-89(OR = 9.63; p < 0.001), education: Secondary (OR = 2.04; 0.049), religion (OR = 0.30; p 0 < 0.001) and living arrangement: Family (OR = 1.87; p = 0.037. The study further showed that there is an interactive effect of PA to reduce the odds of loneliness on depression (OR reduced from 4.59 to 3.40). The study concluded that the predictors of depression in this population are loneliness, physical activity, age, education, and religion while depression and the living arrangements are the predictors of loneliness among older adults.
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Affiliation(s)
- Joel O Faronbi
- Academy of Nursing, Department of Health and Care Profession, University of Exeter, Exeter, UK.
| | - Mariam O Ojewale
- Department of Nursing Science, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Grace O Faronbi
- Department of Nursing Education, University of the Witwatersrand, Johannesburg, South Africa
| | - Olagbegi M Oladapo
- Division of Physiotherapy, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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24
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Lyckegård Finn E, Parinder A, Nyman E, Dahlin LB. Complex Regional Pain Syndrome: a cross-sectional study of physical symptoms, disability, and psychological health in long term. Pain Rep 2024; 9:e1180. [PMID: 39315115 PMCID: PMC11419548 DOI: 10.1097/pr9.0000000000001180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 05/23/2024] [Accepted: 06/20/2024] [Indexed: 09/25/2024] Open
Abstract
Introduction Knowledge about long-time residual symptoms, disabilities, and psychological health in complex regional pain syndrome (CRPS) is limited. Objectives The aim was to evaluate outcome, focusing on physical symptoms, disability, and psychological health, in individuals with CRPS through a cross-sectional survey study. Methods Individuals with a confirmed diagnosis of CRPS were identified through medical charts and sent validated survey forms (Disabilities of the Arm, Shoulder and Hand-Quick version, Specific Hand Surgery Questionnaire-8 questions, EuroQol 5 Dimensions 3 levels, Life Satisfaction Questionnaire-11, Hospital Anxiety and Depression Scale, Pain Catastrophizing Scale, and Sense of Coherence-29) and complementary questions. Results Responders (response rate: 99/238, 42%; CRPS type 1: 72%; CRPS type 2: 28%; time since diagnosis median: 59 [34-94] months) reported remaining symptoms and disability (Disabilities of the Arm, Shoulder and Hand-Quick version score: 45 [20-70]) and more improvement in type 1 than in type 2. Only 9% of individuals with CRPS reported no residual pain or discomfort. Approximately 60% had problems in daily activities, 49% had sleeping problems, and 90% experienced moderate-extreme pain with 23% still on sick leave. The Hospital Anxiety and Depression Scale survey revealed significantly higher scores than a Swedish reference population. Individuals with a low Sense of Coherence and high pain catastrophizing had worse disability and were less satisfied with their lives and physical and psychological health. A lower level of education and more anxiety were associated with worsened disability over time. Conclusion Individuals with CRPS suffer in the long term from pain, sleeping problems, and limitations in daily activities with occurrence of anxiety and depression, resulting in dissatisfaction with many aspects of their lives. A low Sense of Coherence and high pain catastrophizing are associated with a worse outcome. Biopsychosocial aspects should be addressed in clinical practice.
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Affiliation(s)
- Ellen Lyckegård Finn
- Department of Translational Medicine—Hand Surgery, Lund University, Malmö, Sweden
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
| | - Astrid Parinder
- Department of Translational Medicine—Hand Surgery, Lund University, Malmö, Sweden
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
| | - Erika Nyman
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Hand Surgery, Plastic Surgery and Burns, Linköping University Hospital, Linköping, Sweden
| | - Lars. B. Dahlin
- Department of Translational Medicine—Hand Surgery, Lund University, Malmö, Sweden
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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25
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Albatineh AN, Al-Taiar A, Al-Sabah R, Zogheib B. Psychometric properties of the Arabic version of the hospital anxiety and depression scale in hemodialysis patients. PSYCHOL HEALTH MED 2024; 29:1664-1679. [PMID: 34758693 DOI: 10.1080/13548506.2021.2002922] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 11/01/2021] [Indexed: 10/19/2022]
Abstract
The literature lacks a rigorous psychometric evaluation of the Arabic version of Hospital Anxiety and Depression Scale (HADS) in hemodialysis (HD) patients. This study aims to evaluate reliability, determine the underlying factor structure of the Arabic version of HADS and assess its suitability as screening tool for depression and anxiety among Arabic HD patients.A sample of 370 HD patients were recruited from all health districts in Kuwait. Reliability for HADS (all items) and its subscales HADS-A (anxiety) and HADS-D (depression) were estimated using Cronbach's alpha and item analysis was conducted. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted to extract and test the factor structure for the Arabic version of HADS. Eight models were tested using CFA to determine goodness-of-fit.The Cronbach α for the Arabic HADS (all items), HADS-A and HADS-D were 0.884, 0.852 and 0.764, respectively. Pearson correlation coefficient between HADS-A and HADS-D subscales indicated significant correlation (r = +0.69, PV < 0.001). EFA indicated two factors with eigenvalues >1, which accounted for 48.5% of the total variance. CFA revealed the one-factor model had the poorest fit, the two-factor models with acceptable fit, and three-factor models showed good fit.The Arabic HADS has good reliability and internal consistency, which warrants its use in screening for anxiety and depression among Arabic HD patients. Furthermore, the three-factor structure has shown a better fit which warrants further exploration in HD patients with the advancement in theory of psychological models for anxiety and depression.
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Affiliation(s)
- Ahmed N Albatineh
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait
| | - Abdullah Al-Taiar
- School of Community & Environmental Health, College of Health Sciences, Old Dominion University, Norfolk, VA, USA
| | - Reem Al-Sabah
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait
| | - Bashar Zogheib
- Department of Mathematics and Natural Sciences, American University of Kuwait, Kuwait
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26
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Holmlund L, Hörnsten C, Hörnsten Å, Olsson K, Valham F, Hellström Ängerud K. More positive patient-reported outcomes in patients newly diagnosed with atrial fibrillation: a comparative longitudinal study. Eur J Cardiovasc Nurs 2024; 23:618-626. [PMID: 38170563 DOI: 10.1093/eurjcn/zvad139] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/29/2023] [Accepted: 12/23/2023] [Indexed: 01/05/2024]
Abstract
AIMS To compare patient-reported outcomes (PROs) in patients newly (<6 months) diagnosed with atrial fibrillation (AF) with those who have had a longer diagnosis (≥6 months) and to investigate whether or not these outcomes change over a 6-month period. METHODS AND RESULTS In this longitudinal survey study, 129 patients with AF completed the Revised Illness Perception Questionnaire, the Arrhythmia-Specific questionnaire in Tachycardia and Arrhythmia, and the Hospital Anxiety and Depression Scale at baseline and after 6 months. At baseline, patients newly diagnosed with AF (n = 53), compared with patients with a previous diagnosis (n = 76), reported AF as more temporary (P = 0.003) and had a higher belief in personal and treatment control (P = 0.004 and P = 0.041, respectively). At a 6-month follow-up, patients newly diagnosed reported a lower symptom burden (P = 0.004), better health-related quality of life (HRQoL); (P = 0.015), and a higher personal control (P < 0.001) than patients previously diagnosed. Over time, in patients newly diagnosed, symptom burden and the anxiety symptom score decreased (P = 0.001 and P = 0.014, respectively) and HRQoL improved (P = 0.002). CONCLUSION Patients newly diagnosed with AF reported more positive PROs both at baseline and at a 6-month follow-up than patients with a previous diagnosis of AF. Therefore, it is important to quickly capture patients newly diagnosed to support their belief in their own abilities. Such support may, alongside medical treatments, help patients manage the disease, which may lead to reduced symptom burden and better HRQoL over time.
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Affiliation(s)
- Lena Holmlund
- Department of Nursing, Umeå University, Linnaeus väg 9, 907 36 Umeå, Sweden
| | - Carl Hörnsten
- Department of Clinical Sciences, Psychiatry, Umeå University, Umeå, Sweden
| | - Åsa Hörnsten
- Department of Nursing, Umeå University, Linnaeus väg 9, 907 36 Umeå, Sweden
| | - Karin Olsson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Fredrik Valham
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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27
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De Nys L, Oyebola EF, Connelly J, Ryde GC, Whittaker AC. Digital music and movement intervention to improve health and wellbeing in older adults in care homes: a pilot mixed methods study. BMC Geriatr 2024; 24:733. [PMID: 39232667 PMCID: PMC11373285 DOI: 10.1186/s12877-024-05324-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 08/23/2024] [Indexed: 09/06/2024] Open
Abstract
BACKGROUND Low physical activity among older adults is related to adverse health outcomes such as depression and loneliness, poor physical function and increased risk of falls. This study was designed to increase physical activity through a digital, group-based, physical activity and music intervention and to examine its effectiveness on social, mental and physical health outcomes. METHODS Participants were 34 older adults (65 years +) recruited across four care homes in Scotland to a pilot study. Surveys were administered at baseline and post-intervention, comprising measures of fear of falling, depression and anxiety, loneliness, sleep satisfaction and quality of life. A battery of physical function tests and saliva sampling for cortisol and dehydroepiandrosterone hormone analysis were also conducted at each time point. Additionally, process evaluation measures (recruitment, intervention fidelity, attendance, retention rates and safety) were monitored. The intervention comprised 12 weeks of three prescribed digital sessions per week: movement and music (n = 2) and music-only (n = 1), delivered by an activity coordinator in the care home. Post-intervention interviews with staff and participants were conducted to gain qualitative data on the acceptability of the intervention. RESULTS An average of 88% of prescribed sessions were delivered. Pre- to post-intervention intention-to-treat analysis across all participants revealed significant improvements in anxiety, salivary DHEA, fear of falling and loneliness. There were no significant improvements in health-related quality of life, perceived stress, sleep satisfaction or physical function tests, including handgrip strength. Qualitative analysis highlighted benefits of and barriers to the programme. CONCLUSIONS The digital movement and music intervention was deemed acceptable and delivered with moderate fidelity, justifying progression to a full-scale trial. Although a proper control group would have yielded more confident causal relationships, preliminary psychosocial and biological effects were evident from this trial. To show significant improvements in physical function, it is likely that a bigger sample size providing sufficient power to detect significant changes, greater adherence, longer intervention and/or higher exercise volume may be necessary. TRIAL REGISTRATION The trial is registered at ClinicalTrials.gov, number NCT05601102 on 01/11/2022.
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Affiliation(s)
- Len De Nys
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, Scotland, UK
| | - Esther F Oyebola
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, Scotland, UK
| | - Jenni Connelly
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, Scotland, UK
| | - Gemma C Ryde
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, UK
| | - Anna C Whittaker
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, Scotland, UK.
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Valtierra Oba ER, Anguiano Morán AC, Calderón Cortes E, Valtierra Oba MI, Lemus Loeza BM, Rodríguez-Orozco AR. Irritable Bowel Syndrome in the Elderly Population: A Comprehensive Review. Cureus 2024; 16:e68156. [PMID: 39347183 PMCID: PMC11439088 DOI: 10.7759/cureus.68156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2024] [Indexed: 10/01/2024] Open
Abstract
Irritable bowel syndrome (IBS) is a fairly common functional digestive disorder; it occurs at any age but it is more common in adults and older adults. Patients experience a series of symptoms in which abdominal pain and changes in bowel movements stand out; some studies have revealed a possible association between IBS and psychological problems, such as anxiety and depression. Recent findings point to disorders of gut-brain interaction, disruption and alteration of gut microbiota and dysbiosis as key factors in the etiopathogenesis of IBS; aging is also one the factors involved. Most patients diagnosed with IBS required pharmacotherapy, greater caution needs to be considered when treating older patients because of the risk-benefit profile in the elderly. In this scenario, probiotics and non-pharmacological treatments appear as safe and accessible options. Clinicians must take into consideration the unique biopsychosocial factors in older adults when treating IBS. We aim to review critically recent literature on the topic of IBS as there is a need for consolidated guidelines.
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29
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Bonafede M, d'Errico A, Rugarli S, Mensi C, Miligi L, Calisti R, della Gatta R, Piro S, Melis P, Vasselli D, Binazzi A. The psychological impact of diagnosis of sinonasal, nasopharyngeal, and laryngeal cancers: a systematic review. Front Psychol 2024; 15:1355186. [PMID: 39077217 PMCID: PMC11285066 DOI: 10.3389/fpsyg.2024.1355186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 06/19/2024] [Indexed: 07/31/2024] Open
Abstract
Objective High risk of degraded quality of life and psychological distress is observed in patients diagnosed with sinonasal, nasopharyngeal, and laryngeal cancers, which could be caused by exposure to carcinogens in workplaces. This review aimed to investigate the psychological impact of diagnosis associated with the possible occupational etiology of such neoplasms and to explore the instruments that evaluate the quality of life (QoL), anxiety, and depression in these patients. Methods Studies were considered for the review only if they described aspects of the psychological impact of the diagnosis of sinonasal, nasopharyngeal, and laryngeal cancers and reported results distinguished by the tumor site. The psychological impact was assessed in terms of health-related QoL, anxiety, and depression using reliable psychometric questionnaires administered at the time of diagnosis and 1 year later. Results In more than 5,900 records identified, 442 studies fulfilled the eligibility criteria and 436 were excluded after full-text screening, resulting in six studies to be finally included in the review. The EORTC Core Quality of Life questionnaire (EORTC QLQ-C30), EORTC QLQ-H&N35, and Functional Assessment of Cancer Therapy (FACT) were used to evaluate the QoL, whereas the Hospital Anxiety and Depression Scale (HADS) and Center for Epidemiologic Studies Depression Scale (CES-D) questionnaires were employed to assess anxiety and depression. QoL scores were similar to those of the general population at the time of diagnosis and remained unchanged or slightly improved at 1 year since diagnosis. In contrast, a higher prevalence of anxiety and depression was observed compared with the general population, although the results were inconsistent across the very few studies identified. No study investigating the association between the potential occupational etiology and QoL or distress was found. Conclusion Exploring the existing scientific literature on emotional distress in sinonasal, nasopharyngeal, and laryngeal cancer patients was prompted by concerns over the disfiguring nature of treatment and the additional emotional burden resulting from their occupational etiology. Unfortunately, neither a crucial element nor other risk factors (lifestyle, smoking, drinking, etc.) were examined in any study. Patients' employment history should be considered in order to assess the possible impact of believing they are affected by an occupational exposure disease in the evaluation of their psychological distress. This history would support evidence-based recommendations about dedicated psychological interventions.
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Affiliation(s)
- Michela Bonafede
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers' Compensation Authority (INAIL), Roma, Italy
| | - Angelo d'Errico
- Epidemiology, Local Health Unit ASL TO3, Piedmont Region, Grugliasco, Italy
| | - Sabrina Rugarli
- Occupational Health Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Carolina Mensi
- Occupational Health Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Lucia Miligi
- Sinonasal Cancer Registry of Tuscany, Occupational and Environmental Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Firenze, Italy
| | - Roberto Calisti
- Sinonasal Cancer Registry of Marche, Department of Prevention, Unit of Workplace Prevention and Safety and of Occupational Epidemiology (SPreSAL Epi Occ), Macerata Health Authority, Civitanova Marche, Italy
| | - Rosa della Gatta
- Sinonasal Cancer Registry of Marche, Department of Prevention, Unit of Workplace Prevention and Safety and of Occupational Epidemiology (SPreSAL Epi Occ), Macerata Health Authority, Civitanova Marche, Italy
| | - Sara Piro
- Sinonasal Cancer Registry of Tuscany, Occupational and Environmental Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Firenze, Italy
| | - Paola Melis
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers' Compensation Authority (INAIL), Roma, Italy
| | - Donatella Vasselli
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers' Compensation Authority (INAIL), Roma, Italy
| | - Alessandra Binazzi
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers' Compensation Authority (INAIL), Roma, Italy
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Sıvrıkaya EC, Yılmaz O, Tuzuner T, Korkmaz YT, Alver A, Arıkan SM, Kocak N, Sahın E. Is serum BDNF level relıable parameter ın detectıng of dental anxıety before ımpacted thırd molar surgery? Med Oral Patol Oral Cir Bucal 2024; 29:e584-e590. [PMID: 38907644 PMCID: PMC11249369 DOI: 10.4317/medoral.26558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 06/03/2024] [Indexed: 06/24/2024] Open
Abstract
BACKGROUND Brain-derived neurotrophic factor (BDNF) is a factor that implicate in the pathophysiology and treatment of depression and anxiety. The aim of this study was to determine the relationship between dental anxiety and BDNF serum level through impacted third molar surgery. MATERIAL AND METHODS In this randomized, double-blind, cross-sectional study, the sample included patients who had been admitted for the impacted third molar extraction under local anesthesia between January to November 2020. The primary predictor variable was serum BDNF level and the second predictor variable was dental anxiety scores before and after operation in patients. The primary outcome variable was the correlation between anxiety scores (APAIS, MDAS, STAI, VAS) and serum BDNF level. The sample included 55 patients (22 Male, 33 Female) aged 18 to 42 (24,2+5,55). RESULTS Comparison of pre-operative scores (APAIS, MDAS, STAI, VAS and BDNF) and post-operative scores were statistically significant (P < .05). Post-operatively, MDAS and VAS scores decreased, while BDNF levels and STAI scores increased compared to the preoperative scores. BDNF was not correlated with APAIS, MDAS, STAI, and VAS preoperatively and postoperatively. CONCLUSIONS There may be a relationship between serum BDNF level and dental anxiety scale, but, no correlation was found between them.
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Affiliation(s)
- E-C Sıvrıkaya
- Department of Oral Maxillofacial Surgery, Faculty of Dentistry, Karadeniz Technical University Ktu loj 33/8 Ortahisar, Trabzon, Turkey
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Long SO, Hope SV. What patient-reported outcome measures may be suitable for research involving older adults with frailty? A scoping review. Eur Geriatr Med 2024; 15:629-644. [PMID: 38532081 PMCID: PMC11329537 DOI: 10.1007/s41999-024-00964-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 02/14/2024] [Indexed: 03/28/2024]
Abstract
INTRODUCTION The need to develop and evaluate frailty-related interventions is increasingly important, and inclusion of patient-reported outcomes is vital. Patient-reported outcomes can be defined as measures of health, quality of life or functional status reported directly by patients with no clinician interpretation. Numerous validated questionnaires can thus be considered patient-reported outcome measures (PROMs). This review aimed to identify existing PROMs currently used in quantitative research that may be suitable for older people with frailty. METHOD PubMed and Cochrane were searched up to 24/11/22. Inclusion criteria were quantitative studies, use of a PROM, and either measurement of frailty or inclusion of older adult participants. Criteria were created to distinguish PROMs from questionnaire-based clinical assessments. 197 papers were screened. PROMs were categorized according to the domain assessed, as derived from a published consensus 'Standard Set of Health Outcome Measures for Older People'. RESULTS 88 studies were included. 112 unique PROMs were used 289 times, most frequently the SF-36 (n = 21), EQ-5D (n = 21) and Barthel Index (n = 14). The most frequently assessed outcome domains included Mood and Emotional Health and Activities of Daily Living, with fewer assessments of Participation in Decision-Making and Carer Burden. CONCLUSIONS PROM usage in frailty research is highly heterogeneous. Frequently used PROMs omit important outcomes identified by older adults. Further research should evaluate the importance of specific outcomes and identify PROMs relevant to people at different stages of frailty. Consistent and appropriate PROM use in frailty research would facilitate more effective comparisons and meaningful evaluation of frailty interventions.
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Affiliation(s)
- S O Long
- University of Exeter, Exeter, UK
| | - S V Hope
- University of Exeter, Exeter, UK.
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK.
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Bramness JG, Hjellvik V, Høye A, Tesli M, Haram M, Nystad W, Krokstad S. The epidemiology of major depression among adults in Norway: an observational study on the concurrence between population surveys and registry data - a NCDNOR project. BMC Public Health 2024; 24:1330. [PMID: 38755615 PMCID: PMC11100182 DOI: 10.1186/s12889-024-18754-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 05/02/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Mental health problems, and major depression in particular, are important public health issues. Following trends in the prevalence of major depression is difficult because of the costs and complications of diagnostic interviews and general population self-report health surveys. Scandinavian countries, however, have several central, population-based health registries. We aimed to investigate how well these registries capture the epidemiology of major depression in the population. METHODS In two Norwegian regional surveys of general population health, each repeated after 10 years, responders were asked to report depressive symptoms using the Hopkins Symptom Checklist (HSCL) or the Hospital Anxiety and Depression Scale (HADS). Data were linked to three central health registries capturing contact with primary care, specialist care and prescriptions for antidepressants, to investigate how well these registries reflected self-reported depressive symptoms. RESULTS Most responders scored low on Hopkins Symptom Checklist (HSCL) and the Hospital Anxiety and Depression Scale (HADS), but 10% and 13%, respectively, scored above cut-off, with only minor changes between the two survey times. Females scored higher than males. Older people scored lower than younger, and a social gradient was visible. Around 12% of those who scored above the cut-off on either scale were recorded in the central health registries during the following year. This correlation was highest in primary care data, followed by prescription data and lowest in specialist care. Females were more often recorded in registries (p < 0.001), as were younger people (p < 0.001). CONCLUSIONS There was a strong association between scores on screening for major depression in the general population surveys and being recorded in central health registries. There was a low sensitivity of these registries. and there was some variation in how sensitive the central health registries were in picking up depression, especially for males and older people. However, the stability of the measures over time suggests we may get an impression of the prevalence of major depression in the general population by using data from the central health registries. A combination of primary care data, prescription data and specialist care data have a higher sensitivity.
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Affiliation(s)
- Jørgen G Bramness
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, P.O.Box 222, Oslo, 0213, Norway.
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway.
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
- Section for Clinical Addiction Research, Oslo University Hospital, Oslo, Norway.
| | - Vidar Hjellvik
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Anne Høye
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Center for Clinical Documentation and Evaluation (SKDE), Tromsø, Norway
- Division of Mental Health and Substance Abuse, University Hospital of North Norway, Tromsø, Norway
| | - Martin Tesli
- Department of Mental Health and Suicide, Norwegian Institute of Public Health, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Marit Haram
- Department of Mental Health and Suicide, Norwegian Institute of Public Health, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Wenche Nystad
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Steinar Krokstad
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, HUNT Research Centre, NTNU, Levanger, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
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Shih LC, Stevenson MT, Bellows S, Fasano A, Kuo SH, Lyons KE, Moore H, Shill HA, Shukla AW, Singer C, Elble RJ. Validation of a New Patient-Reported Outcome Measure of the Functional Impact of Essential Tremor on Activities of Daily Living. Tremor Other Hyperkinet Mov (N Y) 2024; 14:26. [PMID: 38765931 PMCID: PMC11100532 DOI: 10.5334/tohm.886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 04/30/2024] [Indexed: 05/22/2024] Open
Abstract
Background The Essential Tremor Rating Assessment Scale (TETRAS) is a popular scale for essential tremor (ET), but its activities of daily living (ADL) and performance (P) subscales are based on a structured interview and physical exam. No patient-reported outcome (PRO) scale for ET has been developed according to US regulatory guidelines. Objective Develop and validate a TETRAS PRO subscale. Methods Fourteen items, rated 0-4, were derived from TETRAS ADL and structured cognitive interviews of 18 ET patients. Convergent validity analyses of TETRAS PRO versus TETRAS ADL, TETRAS-P, and the Quality of Life in Essential Tremor Questionnaire (QUEST) were computed for 67 adults with ET or ET plus. Test-retest reliability was computed at intervals of 1 and 30 days. The influence of mood (Hospital Anxiety and Depression Scale, HADS) and coping behaviors (Essen Coping Questionnaire, ECQ) was examined with multiple linear regression. Results TETRAS PRO was strongly correlated (r > 0.7) with TETRAS ADL, TETRAS-P, and QUEST and exhibited good to excellent reliability (Cronbach alpha 95%CI = 0.853-0.926; 30-day test-retest intraclass correlation 95%CI = 0.814-0.921). The 30-day estimate of minimum detectable change (MDC) was 6.6 (95%CI 5.2-8.0). TETRAS-P (rsemipartial = 0.607), HADS depression (rsemipartial = 0.384), and the coping strategy of information seeking and exchange of experiences (rsemipartial = 0.176) contributed statistically to TETRAS PRO in a multiple linear regression (R2 = 0.67). Conclusions TETRAS PRO is a valid and reliable scale that is influenced strongly by tremor severity, moderately by mood (depression), and minimally by coping skills. The MDC for TETRAS PRO is probably sufficient to detect clinically important change.
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Affiliation(s)
- Ludy C. Shih
- Beth Israel Deaconess Medical Center, Department of Neurology, Boston, MA 02215, US
- Harvard Medical School, Boston, MA 02215, US
| | | | - Steven Bellows
- Baylor College of Medicine, Department of Neurology, Houston, TX, US
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson’s Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada
- Krembil Brain Institute, Toronto, Ontario, Canada
| | - Sheng-Han Kuo
- Columbia University, Department of Neurology, New York, NY, US
| | - Kelly E. Lyons
- University of Kansas Medical Center, Department of Neurology, US
| | - Henry Moore
- University of Miami School of Medicine, Department of Neurology, Miami, FL, US
| | | | - Aparna Wagle Shukla
- Fixel Institute for Neurological Diseases, University of Florida, Department of Neurology, Gainesville, FL, US
| | - Carlos Singer
- University of Miami School of Medicine, Department of Neurology, Miami, FL, US
| | - Rodger J. Elble
- Southern Illinois University School of Medicine, Department of Neurology, Springfield, IL, US
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Kim TS, Lee WH, Heo Y. Prevalence and Contributing Factors of Anxiety and Depression in Patients with Vestibular Migraine. EAR, NOSE & THROAT JOURNAL 2024; 103:305-312. [PMID: 37329273 DOI: 10.1177/01455613231181219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/19/2023] Open
Abstract
Objective: Anxiety and depression are psychiatric comorbidities potentially associated with dizziness and migraine, which can influence disease state, prognosis, and clinical outcomes. Vestibular migraine (VM) is a disease that causes repeated vestibular symptoms in people with a history of migraines. We investigated the prevalence and contributing factors of anxiety and depression in patients with VM. Methods: A total of 74 patients with VM were enrolled in this study. All patients underwent pure-tone audiometry, the examination of spontaneous nystagmus, Dix-Hallpike maneuver or supine-roll test, video head impulse test, and caloric testing on the day of the visit. We used the Hospital Anxiety and Depression Scale (HADS) to assess the symptoms of anxiety and depression. Dizziness Handicap Inventory was used to measure the intensity of vestibular symptoms. The participants were divided into normal and abnormal groups based on their HADS anxiety and depression scores, and demographic and clinical factors were analyzed. To identify factors associated with anxiety and depression, multivariate logistic regression analyses were performed. Results: A total of 36 (48.6%) patients demonstrated clinically relevant anxiety levels, and 24 (32.4%) demonstrated depression. Twenty-five (33.8%) patients were diagnosed with peripheral vestibular dysfunction. In the multivariable analyses, peripheral vestibular dysfunction and severe intensity vestibular symptoms were significantly associated with anxiety and depression. None of migraine features were significantly associated with anxiety and depression. Conclusion: The prevalence of anxiety in patients with VM is considerably higher than in the depression. VM patients with peripheral vestibular dysfunction are particularly susceptible to anxiety and depression. Therefore, timely screening for vestibular function and psychiatric disorders in VM patients should be considered.
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Affiliation(s)
- Tae Su Kim
- Department of Otolaryngology, School of Medicine, Kangwon National University, Chuncheon, Republic of Korea
| | - Woo Hyun Lee
- Department of Otolaryngology, School of Medicine, Kangwon National University, Chuncheon, Republic of Korea
| | - Yoon Heo
- Department of Otolaryngology, Kangwon National University Hospital, Chuncheon, Republic of Korea
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Giombi F, Canali L, Zuppardo J, Pace GM, Pirola F, Ferreli F, Mercante G, Spriano G, Cerasuolo M, Malvezzi L. Psychiatric Burden in Chronic Sinonasal Diseases: A Single-Center Cross-Sectional Observational Study. Cureus 2024; 16:e57471. [PMID: 38699136 PMCID: PMC11065418 DOI: 10.7759/cureus.57471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Chronic rhinosinusitis (CRS) and nasal septum deviation (SD) are two widely diffused clinical conditions in otorhinolaryngology clinical practice. Albeit nasal symptoms are the most commonly referred by patients affected by both conditions, recent evidence has explored the impairment of nasal function beyond its local implication. Indeed, the prevalence of psychiatric disorders, specifically anxiety and depression, was found higher in patients suffering from SD or CRS than in the general population. The aim of this study was to evaluate the psychiatric burden of these conditions in terms of anxiety and depression and to assess its relationship with clinical phenotype and age. METHODS Monocentric cross-sectional observational study. Consecutive patients affected by CRS with or without nasal polyps or by SD were considered eligible. At referral, each patient underwent nasal endoscopy for clinical diagnosis and had to fill in the Hospital Anxiety and Depression Scale (HADS), the Sinonasal Outcome Test-22 (SNOT-22), and the Visual Analogue Scale (VAS) for global nasal symptoms. The population was grouped according to disease and age. RESULTS One hundred fifty patients were enrolled. We observed a statistically significant difference in mean HADS score between patients affected by CRS with nasal polyps and those suffering from CRS without nasal polyps or SD both in the overall population and by age groups. Nevertheless, there was no significant difference in the HADS score between younger patients affected by CRS and SD. The mean HADS score was significantly higher in younger patients affected by SD compared to older. Furthermore, we observed an inverse correlation between age and HADS score in each disease group, statistically significant for SD. On the contrary, in the overall population, HADS score and patient-related outcomes (PROs) were directly correlated. Conclusions: In the era of personalized medicine, our work remarks on the critical impact of anxiety and depression on the quality of life (QoL) of patients affected by sinonasal conditions. According to our results, age affects patient-reported outcomes (PROs) and should, therefore, be enhanced in the therapeutic decision process.
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Affiliation(s)
- Francesco Giombi
- Department of Biomedical Sciences, Humanitas University, Milan, ITA
- Otorhinolaryngology Unit, Humanitas Research Hospital, Milan, ITA
| | - Luca Canali
- Department of Biomedical Sciences, Humanitas University, Milan, ITA
- Otorhinolaryngology Unit, Humanitas Research Hospital, Milan, ITA
| | - Jessica Zuppardo
- Department of Biomedical Sciences, Humanitas University, Milan, ITA
- Otorhinolaryngology Unit, Humanitas Research Hospital, Milan, ITA
| | - Gian Marco Pace
- Department of Biomedical Sciences, Humanitas University, Milan, ITA
- Otorhinolaryngology Unit, Humanitas Research Hospital, Milan, ITA
| | - Francesca Pirola
- Department of Biomedical Sciences, Humanitas University, Milan, ITA
- Otorhinolaryngology Unit, Humanitas Research Hospital, Milan, ITA
| | - Fabio Ferreli
- Department of Biomedical Sciences, Humanitas University, Milan, ITA
- Otorhinolaryngology Unit, Humanitas Research Hospital, Milan, ITA
| | - Giuseppe Mercante
- Department of Biomedical Sciences, Humanitas University, Milan, ITA
- Otorhinolaryngology Unit, Humanitas Research Hospital, Milan, ITA
| | - Giuseppe Spriano
- Department of Biomedical Sciences, Humanitas University, Milan, ITA
- Otorhinolaryngology Unit, Humanitas Research Hospital, Milan, ITA
| | - Michele Cerasuolo
- Department of Biomedical Sciences, Humanitas University, Milan, ITA
- Otorhinolaryngology Unit, Humanitas Research Hospital, Milan, ITA
- Otorhinolaryngology Head and Neck Surgery Unit, Casa di Cura Humanitas San Pio X, Milan, ITA
| | - Luca Malvezzi
- Department of Biomedical Sciences, Humanitas University, Milan, ITA
- Otorhinolaryngology Unit, Humanitas Research Hospital, Milan, ITA
- Otorhinolaryngology Head and Neck Surgery Unit, Casa di Cura Humanitas San Pio X, Milan, ITA
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Hermus JPS, Stam P, van Kuijk SMJ, Witlox MA, van Rhijn LW, Arts JJC, Poeze M. Does anxiety influence outcome measurements in ankle replacement patients? Foot Ankle Surg 2024; 30:231-238. [PMID: 37996295 DOI: 10.1016/j.fas.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 11/13/2023] [Accepted: 11/15/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Total ankle arthroplasty (TAA) is increasingly used to treat end-stage ankle arthritis to restore ankle functional outcomes and alleviate pain. This treatment outcome may be influenced by pre-morbid patient anxiety. METHODS Twenty-five Infinity TAA implants were prospectively followed post-operatively with a mean follow-up time of 34.18 months. Demographic, clinical, and functional outcomes were assessed. Analysis was performed on the effect of anxiety, reported by the HADS, on patient-perceived postoperative pain, functioning, and quality of life. RESULTS Postoperative the PROMs and Range of Motion (ROM) improved significantly. Linear regression analysis and Pearson correlation showed a significant negative effect of anxiety on the postoperative patient-reported outcome measurements (EQ-5D-5L, VAS, and MOxFQ) at the end of follow-up. CONCLUSION Good functional, clinical, and radiographic results were observed in this prospective cohort study. Anxiety had a negative influence on the outcome of the patient-reported outcome measurements (EQ-5D-5L and MOxFQ) postoperatively. LEVEL OF EVIDENCE Level III, prospective cohort study.
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Affiliation(s)
- J P S Hermus
- Department of Orthopaedic Surgery, Research school CAPHRI, Maastricht University Medical Center+, Maastricht, the Netherlands.
| | - P Stam
- Department of Orthopaedic Surgery, Research school CAPHRI, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - S M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - M A Witlox
- Department of Orthopaedic Surgery, Research school CAPHRI, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - L W van Rhijn
- Department of Orthopaedic Surgery, Research school CAPHRI, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - J J C Arts
- Department of Orthopaedic Surgery, Research school CAPHRI, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - M Poeze
- Department of Traumasurgery, Maastricht University Medical Center+, Maastricht, the Netherlands
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Sinclair C, Yeoh L, Karusoo‐Musumeci A, Auret KA, Clayton JM, Hilgeman M, Halcomb E, Sinclair R, Martini A, Meller A, Walton R, Wei L, Dao‐Tran T, Kurrle S, Comans T. Validating care and treatment scenarios for measuring decisional conflict regarding future care preferences among older adults. Health Expect 2024; 27:e14010. [PMID: 38450803 PMCID: PMC10918722 DOI: 10.1111/hex.14010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 02/14/2024] [Accepted: 02/24/2024] [Indexed: 03/08/2024] Open
Abstract
OBJECTIVE Decisional conflict is used increasingly as an outcome measure in advance care planning (ACP) studies. When the Decisional Conflict Scale (DCS) is used in anticipatory decision-making contexts, the scale is typically tethered to hypothetical scenarios. This study reports preliminary validation data for hypothetical scenarios relating to life-sustaining treatments and care utilisation to inform their broader use in ACP studies. METHODS Three hypothetical scenarios were developed by a panel of multidisciplinary researchers, clinicians and community representatives. A convenience sample of 262 older adults were surveyed. Analyses investigated comprehensibility, missing data properties, sample norms, structural, convergent and discriminant validity. RESULTS Response characteristics suggested that two of the scenarios had adequate comprehensibility and response spread. Missing response rates were unrelated to demographic characteristics. Predicted associations between DCS scores and anxiety (r's = .31-.37, p < .001), and ACP engagement (r's = -.41 to -.37, p < .001) indicated convergent validity. CONCLUSION A substantial proportion of older adults reported clinically significant levels of decisional conflict when responding to a range of hypothetical scenarios about care or treatment. Two scenarios showed acceptable comprehensibility and response characteristics. A third scenario may be suitable following further refinement. PATIENT OR PUBLIC CONTRIBUTION The scenarios tested here were designed in collaboration with a community representative and were further piloted with two groups of community members with relevant lived experiences; four people with life-limiting conditions and five current or former care partners.
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Affiliation(s)
- Craig Sinclair
- School of PsychologyUniversity of New South WalesSydneyNew South WalesAustralia
- Neuroscience Research Australia (NeuRA)SydneyNew South WalesAustralia
| | - Ling Yeoh
- School of PsychologyUniversity of New South WalesSydneyNew South WalesAustralia
| | | | - Kirsten A. Auret
- Rural Clinical School of Western AustraliaUniversity of Western AustraliaAlbanyWestern AustraliaAustralia
| | - Josephine M. Clayton
- The Palliative Centre, HammondCareSydneyNew South WalesAustralia
- Northern Clinical SchoolUniversity of SydneySydneyNew South WalesAustralia
| | - Michelle Hilgeman
- Tuscaloosa Veterans Affairs Medical CenterTuscaloosaAlabamaUSA
- Department of PsychologyThe University of AlabamaTuscaloosaAlabamaUSA
| | - Elizabeth Halcomb
- School of NursingUniversity of WollongongWollongongNew South WalesAustralia
| | - Ron Sinclair
- University of AdelaideAdelaideSouth AustraliaAustralia
| | - Angelita Martini
- Brightwater GroupPerthWestern AustraliaAustralia
- University of Western AustraliaPerthWestern AustraliaAustralia
| | - Anne Meller
- Prince of Wales Hospital, South Eastern Sydney Local Health DistrictSydneyNew South WalesAustralia
| | | | - Li Wei
- College of Science, Health, Engineering and EducationMurdoch UniversityPerthWestern AustraliaAustralia
| | - Tiet‐Hanh Dao‐Tran
- Centre for Health Services ResearchUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Susan Kurrle
- Northern Clinical SchoolUniversity of SydneySydneyNew South WalesAustralia
| | - Tracy Comans
- Centre for Health Services ResearchUniversity of QueenslandBrisbaneQueenslandAustralia
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Gharipour M, Dianatkhah M, Jahanfar S, Rodrigues APDS, Eftekhari A, Mohammadifard N, Sarrafzadegan N, de Oliveira C, Silveira EA. How Do Genetic and Environmental Factors Influence Cardiometabolic Risk Factors? Findings from the Isfahan Twins Study. J Res Health Sci 2024; 24:e00604. [PMID: 39072540 PMCID: PMC10999106 DOI: 10.34172/jrhs.2024.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/15/2024] [Accepted: 02/17/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND Disease-discordant twins are excellent subjects for matched case-control studies as they allow for the control of confounding factors such as age, gender, genetic background, and intrauterine and early environment factors. Study design: A cross-sectional study. METHODS Past medical history documentation and physical examination were conducted for all participants. Fasting venous blood samples were taken to measure fasting blood glucose (FBG) and lipid levels. The ACE model, a structural equation model, was used to assess heritability. RESULTS This study included 710 twin pairs (210 monozygotic and 500 dizygotic) ranging in age from 2 to 52 years (mean age: 11.67±10.71 years). The study was conducted using participants from the Isfahan Twin Registry (ITR) in 2017. Results showed that in early childhood (2-6 years), height, weight, and body mass index (BMI) were influenced by shared environmental factors (76%, 75%, and 73%, respectively). In late childhood (7-12 years), hip circumference, waist circumference (WC), and low-density lipoprotein (LDL) cholesterol were found to be highly heritable (90%, 76%, and 64%, respectively). In adolescents, height (94%), neck circumference (85%), LDL-cholesterol (81%), WC (70%), triglycerides (69%), weight (68%), and BMI (65%) were all found to be highly or moderately heritable. In adult twins, arm circumference (97%), weight (86%), BMI (82%), and neck circumference (81%) were highly heritable. CONCLUSION This study demonstrates that both genetic and environmental factors play a role in influencing individuals at different stages of their lives. Notably, while certain traits such as obesity have a high heritability during childhood, their heritability tends to decrease as individuals transition into adulthood.
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Affiliation(s)
- Mojgan Gharipour
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
- School of Medicine, Faculty of Health at Deakin University, Melbourne, Australia
| | - Minoo Dianatkhah
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shayesteh Jahanfar
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, USA
| | | | - Ava Eftekhari
- Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Noushin Mohammadifard
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
- Faculty of Medicine, School of Population and Public Health, The University of British Columbia, Vancouver, Canada
| | - Cesar de Oliveira
- Department of Epidemiology and Public Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Erika Aparecida Silveira
- Graduate Program in Health Sciences, Faculty of Medicine, Federal University of Goiás, Goiânia, Brazil
- Department of Epidemiology and Public Health, Institute of Epidemiology and Health Care, University College London, London, UK
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Scarff S, Gullo HL, Nalder EJ, Fleming J. Further investigations into performance variance on the Multiple Errands Test. Aust Occup Ther J 2024; 71:102-112. [PMID: 37953706 DOI: 10.1111/1440-1630.12914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 09/27/2023] [Accepted: 10/14/2023] [Indexed: 11/14/2023]
Abstract
INTRODUCTION The Multiple Errands Test (MET) is a complex, performance-based assessment that is useful for characterising the impact of impairments of executive function on everyday activities. However, performance variance amongst those without neurological pathology, and the impact of non-cognitive factors on this, requires further investigation. METHODS This was a cross-sectional analytic study, conducted with a convenience sample of 40 neurologically intact community-dwelling Australian adults. Participants completed a hospital or shopping centre version of the MET, where their Performance Efficiency, Task Completions and Rule Breaks were recorded. Non-cognitive factors of interest were demographic (age, sex and education), psychological (measured with the Hospital Anxiety and Depression Scale and self-ratings of test anxiety) and assessment-related (assessment site, self-reported site familiarity and observed strategy use). MET performance was analysed using descriptive statistics. A series of standard multiple and binary logistic regression analyses examined the relationships between MET performance and non-cognitive factors. RESULTS Most participants (n = 35, 87.5%) completed at least 10 of the 12 prescribed tasks and broke an average of four rules (SD = 2.36). They achieved an average performance efficiency rating of 0.75/1 (SD = 0.15), suggesting variability in the extent to which participants made non-essential location stops and/or failed to complete tasks whilst at an essential location. The assessment site and participant site familiarity had a statistically significant (p < 0.05) impact on Performance Efficiency and Task Completion scores, and psychological factors had a statistically significant (p < 0.05) relationship with Rule Breaks. CONCLUSION Findings suggest that the impact of factors other than cognition should be considered when interpreting MET performance. The assessment site and participant site familiarity may contribute to significant variability in Performance Efficiency scores. Clinicians should also be aware of the potential impact of these assessment-related factors on Task Completions and psychological distress on Rule Breaks.
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Affiliation(s)
- Shannon Scarff
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
- Surgical, Treatment and Rehabilitation Service, Herston, Australia
| | - Hannah L Gullo
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
- The Prince Charles Hospital, Chermside, Australia
| | - Emily J Nalder
- Department of Occupational Science and Occupational Therapy & Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Jennifer Fleming
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
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Fong W, Woon TH, Kwan YH, Braun J, van der Heijde D, Boonen A, Kiltz U. Comparison of the ASAS Health Index in patients classified as radiographic axial spondyloarthritis (axSpA) or non-radiographic axSpA in the ASAS Health Index international validation study. RMD Open 2024; 10:e003794. [PMID: 38296803 PMCID: PMC10831435 DOI: 10.1136/rmdopen-2023-003794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/21/2023] [Indexed: 02/02/2024] Open
Abstract
OBJECTIVES To determine if there were differences in the Assessment of SpondyloArthritis international Society Health Index (ASAS HI) scores between patients classified as radiographic axial spondyloarthritis (r-axSpA) and non-radiographic axSpA (nr-axSpA), and to identify factors associated with higher ASAS HI scores in both disease phenotypes. METHODS This study was an ancillary analysis of the ASAS HI international validation project performed in 23 countries. Patients were included if they were ≥18 years of age and diagnosed with axSpA. Univariable and multivariable analysis were performed to determine if ASAS HI scores differed between the axSpA phenotypes, and to identify other variables associated with ASAS HI scores. We also tested for potential interactions between the axSpA phenotype and significant variables identified through the multivariable regression. RESULTS A total of 976 patients were included, with 703 having r-axSpA and 273 nr-axSpA. Patients with r-axSpA reported higher (worse) ASAS HI scores compared with those with nr-axSpA (6.8 (4.4) vs 6.0 (4.0), p=0.02), but the axSpA phenotype was not associated with ASAS HI scores in the multivariable regression (β: -0.19, 95% CI: -0.56 to 0.19). Female gender, having worse physical function (Bath Ankylosing Spondylitis Functional Index), disease activity (Ankylosing Spondylitis Disease Activity Score) and anxiety and depressive symptoms (Hospital Anxiety and Depression Scale) were associated with higher ASAS HI scores. No interactions were found to be significant. CONCLUSION Overall health and functioning are similarly affected in patients with r-axSpA and nr-axSpA. Female patients, having worse physical function, disease activity, anxiety and depressive symptoms were independently associated with higher ASAS HI scores.
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Affiliation(s)
- Warren Fong
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ting Hui Woon
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
| | - Yu Heng Kwan
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
- Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore
| | | | | | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, and the Caphri Research Institute Maastricht University, Maastricht, The Netherlands
| | - Uta Kiltz
- Ruhr University Bochum, Bochum, Germany
- Rheumazentrum Ruhrgebiet, Herne, Germany
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Kehrer-Dunlap A, Bollinger R, Chen SW, Keleman A, Thompson R, Fagan A, Ances B, Stark S. Higher amyloid is associated with greater loneliness among cognitively normal older adults during the COVID-19 pandemic. F1000Res 2024; 11:1134. [PMID: 39434871 PMCID: PMC11491702 DOI: 10.12688/f1000research.124891.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 10/23/2024] Open
Abstract
Background Loneliness has been associated with several consequences, including increased risk of developing Alzheimer disease (AD). Loneliness may arise during the preclinical phase of AD, but little is known about the relationship between loneliness and amyloid accumulation consistent with preclinical AD. Therefore, the purpose of this study was to examine the relationship between amyloid accumulation and subjective experiences of loneliness among cognitively normal older adults during the COVID-19 pandemic. Methods A global Clinical Dementia Rating ® Scale score of 0 was required for enrollment. Cortical amyloid burden was measured using [11C] Pittsburgh compound B or [18F]-Florbetapir PET tracers. Centiloids were used to synchronize measures. Demographic characteristics and measures of loneliness, anxiety, and depression were collected via self-report. Multiple linear regression was used to examine the relationship between loneliness and amyloid accumulation. Results The 108 participants had a mean age of 75.0 and an average amyloid accumulation of 22.2 ± 31.9. Mean UCLA Loneliness Scale scores were 31.6 ± 10.8. A significant positive association was detected between loneliness and amyloid accumulation (β = 0.064, SE = 0.027, 95% CI = [0.011, 0.118], p = 0.018). Conclusions These findings highlight the relationship between higher amyloid accumulation and greater loneliness during the COVID-19 pandemic. Healthcare professionals should include routine assessments for characteristics of loneliness in routine clinical evaluations and integrate loneliness reduction and prevention treatments among older adults experiencing loneliness. Additional research is needed with a larger, more diverse sample to examine the relationship between loneliness and amyloid accumulation.
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Affiliation(s)
- Abigail Kehrer-Dunlap
- Program in Occupational Therapy, Washington University in St. Louis School of Medicine, St. Louis, Missouri, 63108, USA
| | - Rebecca Bollinger
- Program in Occupational Therapy, Washington University in St. Louis School of Medicine, St. Louis, Missouri, 63108, USA
| | - Szu-Wei Chen
- Program in Occupational Therapy, Washington University in St. Louis School of Medicine, St. Louis, Missouri, 63108, USA
| | - Audrey Keleman
- Program in Occupational Therapy, Washington University in St. Louis School of Medicine, St. Louis, Missouri, 63108, USA
| | - Regina Thompson
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, Missouri, 63108, USA
| | - Anne Fagan
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, Missouri, 63108, USA
- Knight Alzheimer Disease Research Center, Washington University in St. Louis School of Medicine, St. Louis, Missouri, 63108, USA
| | - Beau Ances
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, Missouri, 63108, USA
- Knight Alzheimer Disease Research Center, Washington University in St. Louis School of Medicine, St. Louis, Missouri, 63108, USA
| | - Susan Stark
- Program in Occupational Therapy, Washington University in St. Louis School of Medicine, St. Louis, Missouri, 63108, USA
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Bedawi EO, Stavroulias D, Hedley E, Blyth KG, Kirk A, De Fonseka D, Edwards JG, Internullo E, Corcoran JP, Marchbank A, Panchal R, Caruana E, Kadwani O, Okiror L, Saba T, Purohit M, Mercer RM, Taberham R, Kanellakis N, Condliffe AM, Lewis LG, Addala DN, Asciak R, Banka R, George V, Hassan M, McCracken D, Sundaralingam A, Wrightson JM, Dobson M, West A, Barnes G, Harvey J, Slade M, Chester-Jones M, Dutton S, Miller RF, Maskell NA, Belcher E, Rahman NM. Early Video-assisted Thoracoscopic Surgery or Intrapleural Enzyme Therapy in Pleural Infection: A Feasibility Randomized Controlled Trial. The Third Multicenter Intrapleural Sepsis Trial-MIST-3. Am J Respir Crit Care Med 2023; 208:1305-1315. [PMID: 37820359 PMCID: PMC10765402 DOI: 10.1164/rccm.202305-0854oc] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 10/11/2023] [Indexed: 10/13/2023] Open
Abstract
Rationale: Assessing the early use of video-assisted thoracoscopic surgery (VATS) or intrapleural enzyme therapy (IET) in pleural infection requires a phase III randomized controlled trial (RCT). Objectives: To establish the feasibility of randomization in a surgery-versus-nonsurgery trial as well as the key outcome measures that are important to identify relevant patient-centered outcomes in a subsequent RCT. Methods: The MIST-3 (third Multicenter Intrapleural Sepsis Trial) was a prospective multicenter RCT involving eight U.K. centers combining on-site and off-site surgical services. The study enrolled all patients with a confirmed diagnosis of pleural infection and randomized those with ongoing pleural sepsis after an initial period (as long as 24 h) of standard care to one of three treatment arms: continued standard care, early IET, or a surgical opinion with regard to early VATS. The primary outcome was feasibility based on >50% of eligible patients being successfully randomized, >95% of randomized participants retained to discharge, and >80% of randomized participants retained to 2 weeks of follow-up. The analysis was performed per intention to treat. Measurements and Main Results: Of 97 eligible patients, 60 (62%) were randomized, with 100% retained to discharge and 84% retained to 2 weeks. Baseline demographic, clinical, and microbiological characteristics of the patients were similar across groups. Median times to intervention were 1.0 and 3.5 days in the IET and surgery groups, respectively (P = 0.02). Despite the difference in time to intervention, length of stay (from randomization to discharge) was similar in both intervention arms (7 d) compared with standard care (10 d) (P = 0.70). There were no significant intergroup differences in 2-month readmission and further intervention, although the study was not adequately powered for this outcome. Compared with VATS, IET demonstrated a larger improvement in mean EuroQol five-dimension health utility index (five-level edition) from baseline (0.35) to 2 months (0.83) (P = 0.023). One serious adverse event was reported in the VATS arm. Conclusions: This is the first multicenter RCT of early IET versus early surgery in pleural infection. Despite the logistical challenges posed by the coronavirus disease (COVID-19) pandemic, the study met its predefined feasibility criteria, demonstrated potential shortening of length of stay with early surgery, and signals toward earlier resolution of pain and a shortened recovery with IET. The study findings suggest that a definitive phase III study is feasible but highlights important considerations and significant modifications to the design that would be required to adequately assess optimal initial management in pleural infection.The trial was registered on ISRCTN (number 18,192,121).
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Affiliation(s)
- Eihab O. Bedawi
- Oxford Respiratory Trials Unit, Nuffield Department of Medicine
- National Institute for Health and Care Research Oxford Biomedical Research Centre
- Oxford Centre for Respiratory Medicine and
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
- Academic Directorate of Respiratory Medicine
| | - Dionisios Stavroulias
- Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford University Hospitals National Health Service (NHS) Foundation Trust, Oxford, United Kingdom
| | - Emma Hedley
- Oxford Respiratory Trials Unit, Nuffield Department of Medicine
| | - Kevin G. Blyth
- School of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
- Department of Respiratory Medicine, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Alan Kirk
- Department of Thoracic Surgery, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | | | - John G. Edwards
- Department of Thoracic Surgery, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Eveline Internullo
- Department of Thoracic Surgery, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | | | - Adrian Marchbank
- Department of Cardiothoracic Surgery, Derriford Hospital, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | - Rakesh Panchal
- Department of Respiratory Medicine, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Edward Caruana
- Department of Thoracic Surgery, Glenfield Hospitals, University Hospitals of Leicester, Leicester, United Kingdom
| | | | - Lawrence Okiror
- Department of Thoracic Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | | | - Manoj Purohit
- Department of Cardiothoracic Surgery, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, United Kingdom
| | - Rachel M. Mercer
- Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Portsmouth, United Kingdom
| | - Rhona Taberham
- Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford University Hospitals National Health Service (NHS) Foundation Trust, Oxford, United Kingdom
| | - Nikolaos Kanellakis
- Oxford Respiratory Trials Unit, Nuffield Department of Medicine
- National Institute for Health and Care Research Oxford Biomedical Research Centre
- Laboratory of Pleural and Lung Cancer Translational Research
- Chinese Academy of Medical Sciences Oxford Institute, Nuffield Department of Medicine, and
| | - Alison M. Condliffe
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
- Academic Directorate of Respiratory Medicine
| | | | - Dinesh N. Addala
- Oxford Respiratory Trials Unit, Nuffield Department of Medicine
- National Institute for Health and Care Research Oxford Biomedical Research Centre
- Oxford Centre for Respiratory Medicine and
| | - Rachelle Asciak
- Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Portsmouth, United Kingdom
| | - Radhika Banka
- Department of Respiratory Medicine, PD Hinduja National Hospital, Mumbai, India
| | - Vineeth George
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Maged Hassan
- Chest Diseases Department, Alexandria University, Alexandria, Egypt
| | - David McCracken
- Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, Northern Ireland
| | - Anand Sundaralingam
- Oxford Respiratory Trials Unit, Nuffield Department of Medicine
- Oxford Centre for Respiratory Medicine and
| | - John M. Wrightson
- Oxford Respiratory Trials Unit, Nuffield Department of Medicine
- Oxford Centre for Respiratory Medicine and
| | - Melissa Dobson
- Oxford Respiratory Trials Unit, Nuffield Department of Medicine
- National Institute for Health and Care Research Oxford Biomedical Research Centre
| | - Alex West
- Department of Respiratory Medicine and
| | | | - John Harvey
- Department of Respiratory Medicine, North Bristol NHS Trust, Bristol, United Kingdom
- Academic Respiratory Unit, University of Bristol, Bristol, United Kingdom
| | - Mark Slade
- Department of Respiratory Medicine, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, United Kingdom; and
| | - Mae Chester-Jones
- Oxford Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | - Susan Dutton
- Oxford Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | - Robert F. Miller
- Institute for Global Health, University College London, London, United Kingdom
| | - Nick A. Maskell
- Department of Respiratory Medicine, North Bristol NHS Trust, Bristol, United Kingdom
- Academic Respiratory Unit, University of Bristol, Bristol, United Kingdom
| | - Elizabeth Belcher
- Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford University Hospitals National Health Service (NHS) Foundation Trust, Oxford, United Kingdom
| | - Najib M. Rahman
- Oxford Respiratory Trials Unit, Nuffield Department of Medicine
- National Institute for Health and Care Research Oxford Biomedical Research Centre
- Laboratory of Pleural and Lung Cancer Translational Research
- Chinese Academy of Medical Sciences Oxford Institute, Nuffield Department of Medicine, and
- Oxford Centre for Respiratory Medicine and
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Cowlishaw S, Gibson K, Alexander S, Howard A, Agathos J, Strauven S, Chisholm K, Fredrickson J, Pham L, Lau W, O’Donnell ML. Improving mental health following multiple disasters in Australia: a randomized controlled trial of the Skills for Life Adjustment and Resilience (SOLAR) programme. Eur J Psychotraumatol 2023; 14:2284032. [PMID: 38073550 PMCID: PMC10993813 DOI: 10.1080/20008066.2023.2284032] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/20/2023] [Indexed: 12/18/2023] Open
Abstract
Background: The mental health impacts of climate change-related disasters are significant. However, access to mental health services is often limited by the availability of trained clinicians. Although building local community capability for the mental health response is often prioritised in policy settings, the lack of evidence-based programs is problematic. The aim of this study was to test the efficacy of the Skills for Life Adjustment and Resilience programme (SOLAR) delivered by trained local community members following compound disasters (drought, wildfires, pandemic-related lockdowns) in Australia.Method: Thirty-six community members were trained to deliver the SOLAR programme, a skills-based, trauma informed, psychosocial programme. Sixty-six people with anxiety, depression and/or posttraumatic stress symptoms, and impairment were randomised into the SOLAR programme or a Self-Help condition. They were assessed pre, post and two months following the interventions. The SOLAR programme was delivered across five 1-hourly sessions (either face to face or virtually). Those in the Self-Help condition received weekly emails with self-help information including links to online educational videos.Results: Multigroup analyses indicated that participants in the SOLAR condition experienced significantly lower levels of anxiety and depression, and PTSD symptom severity between pre - and post-intervention (T1 to T2), relative to the Self-Help condition, while controlling for scores at intake. These differences were not statistically different at follow-up. The SOLAR programme was associated with large effect size improvements in posttraumatic stress symptoms over time.Conclusion: The SOLAR programme was effective in improving anxiety, depression and posttraumatic stress symptoms over time. However, by follow-up the size of the effect was similar to an active self-help condition. Given the ongoing stressors in the community associated with compounding disasters it may be that booster sessions would have been useful to sustain programme impact.Trial registration: Australian New Zealand Clinical Trials Registry identifier: ACTRN12621000283875..
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Affiliation(s)
- S. Cowlishaw
- Phoenix Australia - Centre for Posttraumatic Mental Health, Carlton, Australia
- Department of Psychiatry, The University of Melbourne, Parkville, Australia
| | - K. Gibson
- Phoenix Australia - Centre for Posttraumatic Mental Health, Carlton, Australia
- Department of Psychiatry, The University of Melbourne, Parkville, Australia
| | - S. Alexander
- Phoenix Australia - Centre for Posttraumatic Mental Health, Carlton, Australia
- Department of Psychiatry, The University of Melbourne, Parkville, Australia
| | - A. Howard
- Phoenix Australia - Centre for Posttraumatic Mental Health, Carlton, Australia
- Department of Psychiatry, The University of Melbourne, Parkville, Australia
| | - J. Agathos
- Phoenix Australia - Centre for Posttraumatic Mental Health, Carlton, Australia
- Department of Psychiatry, The University of Melbourne, Parkville, Australia
| | - S. Strauven
- Phoenix Australia - Centre for Posttraumatic Mental Health, Carlton, Australia
- Department of Psychiatry, The University of Melbourne, Parkville, Australia
| | - K. Chisholm
- Phoenix Australia - Centre for Posttraumatic Mental Health, Carlton, Australia
- Department of Psychiatry, The University of Melbourne, Parkville, Australia
| | - J. Fredrickson
- Phoenix Australia - Centre for Posttraumatic Mental Health, Carlton, Australia
- Department of Psychiatry, The University of Melbourne, Parkville, Australia
| | - L. Pham
- Phoenix Australia - Centre for Posttraumatic Mental Health, Carlton, Australia
- Department of Psychiatry, The University of Melbourne, Parkville, Australia
| | - W. Lau
- Phoenix Australia - Centre for Posttraumatic Mental Health, Carlton, Australia
- Department of Psychiatry, The University of Melbourne, Parkville, Australia
| | - M. L. O’Donnell
- Phoenix Australia - Centre for Posttraumatic Mental Health, Carlton, Australia
- Department of Psychiatry, The University of Melbourne, Parkville, Australia
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Sivertsen HE, Helvik AS, Gjøra L, Haugan G. Psychometric validation of the Hospital Anxiety and Depression Scale (HADS) in community-dwelling older adults. BMC Psychiatry 2023; 23:903. [PMID: 38053095 PMCID: PMC10696870 DOI: 10.1186/s12888-023-05407-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 11/26/2023] [Indexed: 12/07/2023] Open
Abstract
OBJECTIVES The Hospital Anxiety and Depression Scale (HADS) is commonly used to measure anxiety and depression, but the number of studies validating psychometric properties in older adults are limited. To our knowledge, no previous studies have utilized confirmative factor analyses in community-dwelling older adults, regardless of health conditions. Thus, this study aimed to examine the psychometric properties of HADS in older adults 70 + living at home in a large Norwegian city. METHODS In total, 1190 inhabitants ≥ 70 (range 70 - 96) years completed the HADS inventory in the population-based Trøndelag Health Study (HUNT), termed "HUNT4 70 + " in Trondheim, Norway. Confirmatory factor analyses were performed to test the dimensionality, reliability, and construct validity. RESULTS The original two-factor-solution (Model-1) revealed only partly a good fit to the present data; however, including a cross-loading for item 6D ("I feel cheerful") along with a correlated error term between item 2D ("I still enjoy the things I used to enjoy") and 12D ("I look forward with enjoyment to things") improved the fit substantially. Good to acceptable measurement reliability was demonstrated, and the construct validity was acceptable. CONCLUSIONS The HADS involves some items that are not reliable and valid indicators for the depression construct in this population, especially item 6 is problematic. To improve the reliability and validity of the Norwegian version of HADS, we recommend that essential aspects of depression in older adults should be included.
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Affiliation(s)
- Heidi Emly Sivertsen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | - Anne-Sofie Helvik
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Linda Gjøra
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Psychiatry, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Gørill Haugan
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
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Srifuengfung M, Abraham J, Avidan MS, Lenze EJ. Perioperative Anxiety and Depression in Older Adults: Epidemiology and Treatment. Am J Geriatr Psychiatry 2023; 31:996-1008. [PMID: 37482501 PMCID: PMC10592367 DOI: 10.1016/j.jagp.2023.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/20/2023] [Accepted: 07/03/2023] [Indexed: 07/25/2023]
Abstract
The intervals before and after major surgery is a high-risk period for older adults; in this setting, anxiety and depression are common and serious problems. We comprehensively reviewed current evidence on perioperative anxiety and depression in older adults, focusing on epidemiology, impact, correlates, medication risks, and treatment. Principles of perioperative mental healthcare are proposed based on the findings. Prevalence estimates of clinically significant anxiety and depression range from 5% to 45% for anxiety and 6% to 52% for depression, depending on surgical populations and measurement tools. Anxiety and depression may increase risk for surgical complications and reduce patient participation during rehabilitation. Medical comorbidities, pain, insomnia, cognitive impairment, and delirium are common co-occurring problems. Concomitant uses of central nervous system acting medications (benzodiazepines, anticholinergics, and opioids) amplify the risks of delirium and falls. Based on these findings, we propose that anxiety and depression care should be part of perioperative management in older adults; components include education, psychological support, opioid-sparing pain management, sleep management, deprescribing central nervous system active medications, and continuation and optimization of existing antidepressants. More research is needed to test and improve these care strategies.
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Affiliation(s)
- Maytinee Srifuengfung
- Department of Psychiatry (MS, EJL), Washington University School of Medicine, St. Louis, MO; Department of Psychiatry (MS), Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Joanna Abraham
- Department of Anesthesiology (JA, MSA), Washington University School of Medicine, St. Louis, MO; Institute for Informatics (JA), Washington University School of Medicine, St. Louis, MO
| | - Michael S Avidan
- Department of Anesthesiology (JA, MSA), Washington University School of Medicine, St. Louis, MO
| | - Eric J Lenze
- Department of Psychiatry (MS, EJL), Washington University School of Medicine, St. Louis, MO
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Duport A, Bédard S, Raynauld C, Bordeleau M, Neblett R, Balg F, Devanne H, Léonard G. Cross-cultural translation and psychometric validation of the French version of the Fear-Avoidance Components Scale (FACS). PLoS One 2023; 18:e0288899. [PMID: 37824567 PMCID: PMC10569597 DOI: 10.1371/journal.pone.0288899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/20/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND The Fear-Avoidance Components Scale (FACS) is a reliable and valid instrument widely used to assess fear-avoidance beliefs related to pain and disability. However, there is a scarcity of validated translations of the FACS in different cultural and linguistic contexts, including the French population. This study aimed to translate and validate the French version of the FACS (FACS-Fr/CF), examining its psychometric properties among French-speaking individuals. METHODS A cross-cultural translation process-including forward translation, backward translation, expert committee review, and pre-testing-was conducted to develop the FACS-Fr/CF. The translated version was administered to a sample of French-speaking adults (n = 55) with chronic musculoskeletal pain. Internal consistency (including confirmatory analyses of the 2 factors identified in the Serbian version), test-retest reliability and convergent validity were then assessed. RESULTS The FACS-Fr/CF demonstrated high global internal consistency (α = 0.94, 95% CI: 0.91-0.96) as well as high internal consistency of the 2 factors identified in the Serbian version (α = 0.90, 95% CI: 0.86-0.94 and α = 0.90, 95% CI: 0.85-0.94, respectively). Test-retest analysis revealed a moderate (close to high) reliability (ICC = 0.89; 95% CI: 0.82-0.94 and r = 0.89; p<0.005). Convergent validity was supported by significant correlations between the FACS-Fr/CF scores and the Tampa Scale for Kinesiophobia (r = 0.82; p < 0.005), the Pain Catastrophizing Scale (r = 0.72; p < 0.005) and the Hospital Anxiety and Depression Scale (r = 0.66; p < 0.005). CONCLUSION The present study provides evidence for the cross-cultural translation and psychometric validation of the FACS-Fr/CF. The FACS-Fr/CF exhibits a high internal consistency, a moderate (close to high) test-retest reliability, and good construct validity, suggesting its utility in assessing fear-avoidance beliefs in the French-speaking population. This validated tool can enhance the assessment and understanding of fear-avoidance behaviors and facilitate cross-cultural research in pain-related studies.
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Affiliation(s)
- Arnaud Duport
- URePSSS—Unité de Recherche Pluridisciplinaire Sport Santé Société, ULR 7369, Université du Littoral Côte d’Opale, Université d’Artois, Université de Lille, Calais, France
- Research Center on Aging, CIUSSS de l’Estrie-CHUS, Sherbrooke, Québec, Canada
| | - Sonia Bédard
- Centre de recherche du CHUS, CIUSSS de l’Estrie-CHUS, Sherbrooke, Québec, Canada
- Surgery Department, Orthopedic Service, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Catherine Raynauld
- Centre de recherche du CHUS, CIUSSS de l’Estrie-CHUS, Sherbrooke, Québec, Canada
- Surgery Department, Orthopedic Service, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Martine Bordeleau
- Research Center on Aging, CIUSSS de l’Estrie-CHUS, Sherbrooke, Québec, Canada
| | - Randy Neblett
- PRIDE Research Foundation, Dallas, TX, United States of America
| | - Frédéric Balg
- Centre de recherche du CHUS, CIUSSS de l’Estrie-CHUS, Sherbrooke, Québec, Canada
- Surgery Department, Orthopedic Service, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Hervé Devanne
- URePSSS—Unité de Recherche Pluridisciplinaire Sport Santé Société, ULR 7369, Université du Littoral Côte d’Opale, Université d’Artois, Université de Lille, Calais, France
| | - Guillaume Léonard
- Research Center on Aging, CIUSSS de l’Estrie-CHUS, Sherbrooke, Québec, Canada
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
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Wei X, Wang T, Zhang Y, Jiang N, Wang Q, Cao H, Shi X, Wang J. The effect of anxiety, depression, and structural social capital on life satisfaction among people with hearing disabilities: a cross-sectional study in Shanghai, China. Front Psychiatry 2023; 14:1164324. [PMID: 37867770 PMCID: PMC10585097 DOI: 10.3389/fpsyt.2023.1164324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 08/02/2023] [Indexed: 10/24/2023] Open
Abstract
Background Life satisfaction (LS) serves as a crucial indicator of social wellbeing and plays a significant role in formulating strategies aimed at enhancing health outcomes among the hearing-disabled population. This study aimed to examine the effect of anxiety, depression, and structural social capital on life satisfaction among people with hearing disabilities in Shanghai, China. Methods A cross-sectional study was conducted in Shanghai, China. As of March 2022, 337 people with hearing disabilities were recruited from the Shanghai Disabled Persons' Federation. An online survey was conducted using a four-part questionnaire to collect data including demographic characteristics, the Hospital Anxiety and Depression Scale (HADS), the Social Capital Scale (SCS), and a single-item question to measure life satisfaction. One-sample t-tests, Pearson's correlation analysis, and hierarchical multiple regression analysis were performed. Results Anxiety (β = - 0.153) and depression (β = - 0.242) were significant factors influencing life satisfaction among people with hearing disabilities. Structural social capital also played an influential role in life satisfaction, and people with hearing disabilities who lack social networks (β = 0.125) and social support (β = 0.121) reported significantly lower levels of life satisfaction. However, no significant relationship was found in this study between LS and other components of structural social capital, such as social participation. Conclusion This study shows that paying attention to mental health is critical for people with hearing disabilities to achieve social wellbeing and promote LS improvement. At the same time, the government and society also need to focus on the structural social capital, provide various social service programs, enhance social support, and expand social networks, improving LS for people with hearing disabilities.
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Affiliation(s)
- Xiaomin Wei
- Shanghai Municipal Center for Health Promotion, Shanghai, China
| | - Ting Wang
- Key Lab of Health Technology Assessment of Ministry of Health, School of Public Health, Fudan University, Shanghai, China
| | - Yuxin Zhang
- Key Lab of Health Technology Assessment of Ministry of Health, School of Public Health, Fudan University, Shanghai, China
| | - Nan Jiang
- Key Lab of Health Technology Assessment of Ministry of Health, School of Public Health, Fudan University, Shanghai, China
| | - Quqing Wang
- Key Lab of Health Technology Assessment of Ministry of Health, School of Public Health, Fudan University, Shanghai, China
| | - He Cao
- Key Lab of Health Technology Assessment of Ministry of Health, School of Public Health, Fudan University, Shanghai, China
| | - Xinrui Shi
- Key Lab of Health Technology Assessment of Ministry of Health, School of Public Health, Fudan University, Shanghai, China
| | - Jiwei Wang
- Key Lab of Health Technology Assessment of Ministry of Health, School of Public Health, Fudan University, Shanghai, China
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Motolese F, Stelitano D, Lanzone J, Albergo G, Cruciani A, Masciulli C, Musumeci G, Pilato F, Rossi M, Ribolsi M, Di Lazzaro V, Capone F. Feasibility and efficacy of an at-home, smart-device aided mindfulness program in people with Multiple Sclerosis. Mult Scler Relat Disord 2023; 78:104931. [PMID: 37603929 DOI: 10.1016/j.msard.2023.104931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 07/16/2023] [Accepted: 08/04/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Multiple Sclerosis (MS) is a chronic disease with a high prevalence of neuropsychiatric symptoms. Mindfulness is a practice that encourages individuals to cultivate a present-focused, acceptance-based approach for managing psychological distress. Its positive effect on MS has been demonstrated, but learning such technique is expensive and time-consuming. In this study, we investigated the feasibility and efficacy of an 8-week, at-home, smart-device aided mindfulness program in a cohort of MS patients. Specifically, we explored the role of a brain-sensing headband providing real-time auditory feedback as supportive tool for meditation exercises. METHODS The study included two visits, one at baseline and another after the mindfulness program. We measured adherence to the proposed mindfulness treatment and its effect on questionnaires investigating different psychological domains, cognition, fatigue, quality of life and quantitative EEG parameters. All participants received a smart biofeedback device to be used during the therapeutic program consisting of daily meditative exercises. RESULTS Twenty-nine patients were recruited for the present study. Among them, 27 (93%) completed the entire program and 17 (63%) completed more than 80% of the scheduled sessions. We observed a statistically significant reduction of the Ruminative Response Scale score and a significant increase of the Digit Span Backward. Regarding neurophysiological data, we found a significant reduction of the whole-scalp beta and parieto-occipital theta power post intervention. CONCLUSION Our results show that an at-home, smart-device aided mindfulness program is feasible for people with MS. The efficacy in terms of reappraisals of stress, cognitive and emotional coping responses is also supported by our neurophysiological data. Further studies are warranted to better explore the role of such approaches in managing the psychological impact of MS diagnosis.
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Affiliation(s)
- Francesco Motolese
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Roma, Italy
| | - Domenica Stelitano
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy
| | - Jacopo Lanzone
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Unit of Milan Institute, Italy
| | - Giuliano Albergo
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Roma, Italy
| | - Alessandro Cruciani
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Roma, Italy
| | | | - Gabriella Musumeci
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Roma, Italy
| | - Fabio Pilato
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Roma, Italy
| | - Mariagrazia Rossi
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Roma, Italy
| | - Michele Ribolsi
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Roma, Italy
| | - Vincenzo Di Lazzaro
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Roma, Italy
| | - Fioravante Capone
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Roma, Italy.
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Sasaki T, Shitara H, Tajika T, Ichinose T, Hamano N, Kamiyama M, Yamamoto A, Kobayashi T, Takagishi K, Chikuda H. Relationship between Nontraumatic Shoulder Disorders and Neuropathic Pain: Retrospective Observational Analyses of Clinical Features and Background Factors. Anesthesiol Res Pract 2023; 2023:6046746. [PMID: 37808338 PMCID: PMC10558267 DOI: 10.1155/2023/6046746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 08/31/2023] [Accepted: 09/13/2023] [Indexed: 10/10/2023] Open
Abstract
Background Accurate identification of neuropathic pain is necessary for appropriate treatment; however, the relationship between nontraumatic shoulder disorders and neuropathic pain remains unknown. Therefore, this retrospective observational study aimed to investigate the relationship, features, background factors, and prevalence of neuropathic pain among patients with nontraumatic shoulder disorders. Methods We evaluated 198 patients who visited our outpatient clinic, which specializes in shoulder disorders, from April 2015 to March 2016. The patients' age, sex, affected side, diagnosis, and pain duration were recorded, and the results of physical examination, including passive range of motion, impingement sign, and muscular strength assessments, were analyzed. The presence of neuropathic pain was assessed using the painDETECT questionnaire. Participants were divided into two groups according to the presence of neuropathic pain. Pain intensity was assessed using a visual analog scale, and the patient's mental status was assessed using the short-form McGill Pain Questionnaire and Hospital Anxiety and Depression Scale. The scores were compared between the groups. Results Neuropathic pain was observed in 7.6% of patients. The visual analog scale score for pain, short-form McGill Pain Questionnaire score, and Hospital Anxiety and Depression Scale score were significantly associated with the presence of neuropathic pain in the univariate analysis. Patient background factors and physical function were not associated with the presence of neuropathic pain. The prevalence of neuropathic pain in patients with frozen shoulder was 33.3%, which was significantly higher than that in patients with other shoulder disorders. Conclusion The occurrence of neuropathic pain may aggravate pain in patients with nontraumatic shoulder disorders. Neuropathic pain was not a rare condition in patients with nontraumatic shoulder disorders, particularly in those with frozen shoulder. The coexistence of neuropathic pain cannot be determined from background factors or physical function. Accurate diagnosis of neuropathic pain is essential in patients with nontraumatic shoulder disorders.
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Affiliation(s)
- Tsuyoshi Sasaki
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Hitoshi Shitara
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Tsuyoshi Tajika
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Tsuyoshi Ichinose
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Noritaka Hamano
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Masataka Kamiyama
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Atsushi Yamamoto
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Tsutomu Kobayashi
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Kenji Takagishi
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
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Pacheco RI, Cristo MI, Anjo SI, Silva AF, Sousa MI, Tavares RS, Sousa AP, Almeida Santos T, Moura-Ramos M, Caramelo F, Manadas B, Ramalho-Santos J, Amaral SG. New Insights on Sperm Function in Male Infertility of Unknown Origin: A Multimodal Approach. Biomolecules 2023; 13:1462. [PMID: 37892144 PMCID: PMC10605211 DOI: 10.3390/biom13101462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/21/2023] [Accepted: 09/23/2023] [Indexed: 10/29/2023] Open
Abstract
The global trend of rising (male) infertility is concerning, and the unidentifiable causes in half of the cases, the so-called unknown origin male infertility (UOMI), demands a better understanding and assessment of both external/internal factors and mechanisms potentially involved. In this work, it was our aim to obtain new insight on UOMI, specifically on idiopathic (ID) and Unexplained male infertility (UMI), relying on a detailed evaluation of the male gamete, including functional, metabolic and proteomic aspects. For this purpose, 1114 semen samples, from males in couples seeking infertility treatment, were collected at the Reproductive Medicine Unit from the Centro Hospitalar e Universitário de Coimbra (CHUC), from July 2018-July 2022. Based on the couples' clinical data, seminal/hormonal analysis, and strict eligibility criteria, samples were categorized in 3 groups, control (CTRL), ID and UMI. Lifestyle factors and anxiety/depression symptoms were assessed via survey. Sperm samples were evaluated functionally, mitochondrially and using proteomics. The results of Assisted Reproduction Techniques were assessed whenever available. According to our results, ID patients presented the worst sperm functional profile, while UMI patients were similar to controls. The proteomic analysis revealed 145 differentially expressed proteins, 8 of which were specifically altered in ID and UMI samples. Acrosin (ACRO) and sperm acrosome membrane-associated protein 4 (SACA4) were downregulated in ID patients while laminin subunit beta-2 (LAMB2), mannose 6-phosphate isomerase (MPI), ATP-dependent 6-phosphofructokinase liver type (PFKAL), STAR domain-containing protein 10 (STA10), serotransferrin (TRFE) and exportin-2 (XPO2) were downregulated in UMI patients. Using random forest analysis, SACA4 and LAMB2 were identified as the sperm proteins with a higher chance of distinguishing ID and UMI patients, and their function and expression variation were in accordance with the functional results. No alterations were observed in terms of lifestyle and psychological factors among the 3 groups. These findings obtained in an experimental setting based on 3 well-defined groups of subjects, might help to validate new biomarkers for unknown origin male infertility (ID and UMI) that, in the future, can be used to improve diagnostics and treatments.
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Affiliation(s)
- Rita I. Pacheco
- CNC—Center for Neuroscience and Cell Biology, University of Coimbra, 3004-504 Coimbra, Portugal
| | - Maria I. Cristo
- CNC—Center for Neuroscience and Cell Biology, University of Coimbra, 3004-504 Coimbra, Portugal
- IIIUC—Institute for Interdisciplinary Research, University of Coimbra, 3030-789 Coimbra, Portugal
| | - Sandra I. Anjo
- CNC—Center for Neuroscience and Cell Biology, University of Coimbra, 3004-504 Coimbra, Portugal
- IIIUC—Institute for Interdisciplinary Research, University of Coimbra, 3030-789 Coimbra, Portugal
| | - Andreia F. Silva
- CNC—Center for Neuroscience and Cell Biology, University of Coimbra, 3004-504 Coimbra, Portugal
- IIIUC—Institute for Interdisciplinary Research, University of Coimbra, 3030-789 Coimbra, Portugal
| | - Maria Inês Sousa
- CNC—Center for Neuroscience and Cell Biology, University of Coimbra, 3004-504 Coimbra, Portugal
- Department of Life Sciences, Faculty of Sciences and Technology, University of Coimbra, 3000-456 Coimbra, Portugal
| | - Renata S. Tavares
- CNC—Center for Neuroscience and Cell Biology, University of Coimbra, 3004-504 Coimbra, Portugal
- Department of Life Sciences, Faculty of Sciences and Technology, University of Coimbra, 3000-456 Coimbra, Portugal
| | - Ana Paula Sousa
- CNC—Center for Neuroscience and Cell Biology, University of Coimbra, 3004-504 Coimbra, Portugal
- Reproductive Medicine Unit, Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, Portugal
- Eugin Coimbra, Rua Filipe Hodart 12, 3000-185 Coimbra, Portugal
| | - Teresa Almeida Santos
- CNC—Center for Neuroscience and Cell Biology, University of Coimbra, 3004-504 Coimbra, Portugal
- Reproductive Medicine Unit, Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, Portugal
- Eugin Coimbra, Rua Filipe Hodart 12, 3000-185 Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
| | - Mariana Moura-Ramos
- Reproductive Medicine Unit, Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, Portugal
- Eugin Coimbra, Rua Filipe Hodart 12, 3000-185 Coimbra, Portugal
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, 3000-115 Coimbra, Portugal
- Clinical Psychology Unit, Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, Portugal
| | | | - Bruno Manadas
- CNC—Center for Neuroscience and Cell Biology, University of Coimbra, 3004-504 Coimbra, Portugal
- IIIUC—Institute for Interdisciplinary Research, University of Coimbra, 3030-789 Coimbra, Portugal
| | - João Ramalho-Santos
- CNC—Center for Neuroscience and Cell Biology, University of Coimbra, 3004-504 Coimbra, Portugal
- Department of Life Sciences, Faculty of Sciences and Technology, University of Coimbra, 3000-456 Coimbra, Portugal
| | - Sandra Gomes Amaral
- CNC—Center for Neuroscience and Cell Biology, University of Coimbra, 3004-504 Coimbra, Portugal
- IIIUC—Institute for Interdisciplinary Research, University of Coimbra, 3030-789 Coimbra, Portugal
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