1
|
Blanc JV, Burdairon JD, Malandain L, Ferreri F, Mouchabac S, Adrien V. Attachment and Mental Health of Men Having Sex with Men Engaging in Chemsex: Is Substance Abuse Only the Tip of the Iceberg? JOURNAL OF HOMOSEXUALITY 2024; 71:2875-2894. [PMID: 37815854 DOI: 10.1080/00918369.2023.2266086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
Gay and bisexual men and other men who have sex with men (GBMSM) with problematic chemsex (a specific sexualized drug use pattern) face several health issues. The aim of this monocentric observational study was to assess the mental health history and attachment style (AS) within 71 GBMSM seeking care for problematic chemsex. Attachment style (AS) was evaluated using the Relationship Scales Questionnaire. 82% of the cohort (58) had at least one mental health disorder (among depression, anxiety, alcohol use disorder or hypersexuality). 9.9% were admitted to intensive care due to chemsex use. Traumas were frequent, with 31% reporting childhood sex abuse and 24% declaring having attempted suicide. 62 (87%) had insecure AS: 38% preoccupied, 23% fearful and 24% dismissing. Users with a positive self model (N = 24) had fewer comorbidities (63% vs 92%, p = .003) and practiced more chemsex alone (75% vs 33%, p < .001) than users with negative self model (N = 47). Users with a positive other model (N = 35) practiced more slamsex (injections of substance in a sexual context) (80% vs 50%, p = .008) and had fewer comorbidities (71% vs 92%, p = .027) than users with a negative other model (N = 36). Attachment theory is a way to provide holistic and tailored and harm reduction.
Collapse
Affiliation(s)
- Jean-Victor Blanc
- Department of Psychiatry and Addiction Medicine, Hôpital Saint-Antoine, AP-HP, Sorbonne Université, Paris, France
| | - Jean-Del Burdairon
- Department of Psychiatry, Pôle Hospitalo-Universitaire Psychiatrie Paris 15e, GHU Paris Psychiatrie & Neurosciences, Paris, France
| | - Léo Malandain
- Department of Psychiatry and Addictive Disorders, University Hospital Cochin, University Paris Cité, Paris, France
| | - Florian Ferreri
- Department of Psychiatry and Addiction Medicine, Hôpital Saint-Antoine, AP-HP, Sorbonne Université, Paris, France
- Infrastructure for Clinical Research in Neurosciences (iCRIN) Psychiatry, Paris Brain Institute, Paris, France
| | - Stéphane Mouchabac
- Department of Psychiatry and Addiction Medicine, Hôpital Saint-Antoine, AP-HP, Sorbonne Université, Paris, France
- Infrastructure for Clinical Research in Neurosciences (iCRIN) Psychiatry, Paris Brain Institute, Paris, France
| | - Vladimir Adrien
- Department of Psychiatry and Addiction Medicine, Hôpital Saint-Antoine, AP-HP, Sorbonne Université, Paris, France
- Infrastructure for Clinical Research in Neurosciences (iCRIN) Psychiatry, Paris Brain Institute, Paris, France
| |
Collapse
|
2
|
Coca-Martinez M, Girsowicz E, Doonan RJ, Obrand DI, Bayne JP, Steinmetz OK, Mackenzie KS, Carli F, Martinez-Palli G, Gill HL. Multimodal Prehabilitation for Peripheral Arterial Disease Patients with Intermittent Claudication-A Pilot Randomized Controlled Trial. Ann Vasc Surg 2024; 107:2-12. [PMID: 37949167 DOI: 10.1016/j.avsg.2023.09.101] [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: 07/13/2023] [Revised: 09/10/2023] [Accepted: 09/25/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND To establish the feasibility and safety of multimodal prehabilitation (MP), and to obtain pilot data on the change in quality of life, functional walking capacity, and the need for surgery for a full-scale trial. METHODS Pilot randomized controlled trial that included patients older than 50 years old suffering from moderate to severe intermittent claudication and who were candidates for endovascular revascularization (ER). Participants were excluded if they presented with ischemic rest pain, gangrene or ulceration of the index leg, significant lesions in the iliac vessels, planned surgical bypass, comorbidities in which exercise was contraindicated or if they were unable to speak English or French. Participants were randomized in a 1:1 ratio to 12 weeks of MP or institutional standard of care (unsupervised walking advice). MP consisted of i)1 weekly supervised exercise session; ii) home-based exercise prescription; iii) nutritional counseling and supplementation; iv) smoking cessation therapy; and v) psychosocial support. Feasibility and safety were measured with recruitment and retention rates, as well as the occurrence of any adverse events. In addition, barriers to attend supervised sessions and compliance to each component were assessed. Change in functional walking capacity, health-related quality of life, and the rates of patients deciding not to undergo ER were collected and analyzed throughout the follow-up period of 12 months. RESULTS Of the 37 patients referred for eligibility, 27 (73%) accepted to participate in the trial and were randomized. Of the 27 patients included, 24 completed the 12-week program. Adherence to each prehabilitation component was 83% interquartile range [72,93] for supervised exercise, 90% [83,96] for home-based exercise and 69% [45,93] for nutritional sessions. Fifty percent of patients were referred for and underwent psychosocial intervention and 40% of the active smokers enrolled in the smoking cessation program. No adverse events were observed during the program. The 2 main barriers for not fully adhering to the intervention were excessive pain while performing the exercises and the difficulty to keep up with the prescribed exercises. A statistically significant mean change (standard deviation (SD)) was seen in the MP group versus standard of care for functional capacity, mean (SD) 6 Min Walk Test 60 (74) vs. -11 (40) meters P < 0.05, and quality of life mean (SD) VascuQol 1.15 (0.54) vs. -0.3 (1.09) points P < 0.05. There was no statistically significant difference between groups in the rates of patients deciding to undergo ER during the 1-year follow-up period. CONCLUSIONS The results of this pilot trial demonstrate that MP is safe and feasible. A 12-week MP program seems to improve quality of life and functional walking capacity to a greater extent than unsupervised walking advice. There is a need for a large-scale trial to investigate the effectiveness of MP at improving quality of life and assessing its impact on the rates of patients deciding not to undergo or delay ER. The long-term functional and quality of life outcomes of the patients deciding to undergo ER after prehabilitation also need to be assessed.
Collapse
Affiliation(s)
- Miquel Coca-Martinez
- Division of Vascular Surgery, Department of Surgery, McGill University, Montreal, Quebec, Canada; Department of Anesthesia and Intensive Care, Universitat de Barcelona, Barcelona, Spain; Department of Anesthesia, McGill University, Montreal, Quebec, Canada
| | - Elie Girsowicz
- Department of Vascular Surgery, Jewish General Hospital, Montreal, Quebec, Canada
| | - Robert J Doonan
- Department of Anesthesia, McGill University, Montreal, Quebec, Canada
| | - Daniel I Obrand
- Department of Vascular Surgery, Jewish General Hospital, Montreal, Quebec, Canada
| | - Jason P Bayne
- Department of Vascular Surgery, Jewish General Hospital, Montreal, Quebec, Canada
| | - Oren K Steinmetz
- Division of Vascular Surgery, Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Kent S Mackenzie
- Division of Vascular Surgery, Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Francesco Carli
- Department of Anesthesia, McGill University, Montreal, Quebec, Canada
| | | | - Heather L Gill
- Division of Vascular Surgery, Department of Surgery, McGill University, Montreal, Quebec, Canada.
| |
Collapse
|
3
|
Piraccini BM, Pampaloni F, Cedirian S, Quadrelli F, Bruni F, Rapparini L, Caro G, Acri MC, Ala L, Rossi A, Pellacani G, Lacarrubba F, Micali G, Dall'Oglio F, Vastarella M, Cantelli M, Nappa P, Diluvio L, Bianchi L, Gnesotto L, Sechi A, Naldi L, Tassone F, Peris K, Caldarola G, Pinto LM, Girolomoni G, Marangoni F, Bellinato F, Gisondi P, Scandagli I, Prignano F, Pimpinelli N, Tomasini C, Barruscotti S, De Simoni E, Simonetti O, Ambrogio F, Foti C, Boccaletti V, Fraghì A, Marzano AV, Mattioli MA, Rocca L, Barbareschi M, Ferrucci SM, Gallo G, Ribero S, Quaglino P, Balestri R, Ioris T, Caposiena Caro RD, Zalaudek I, Vagnozzi E, Fargnoli MC, Caponio C, Rubegni P, Cinotti E, Trovato E, Romanelli M, Dini V, Manzo Margiotta F, Feliciani C, de Felici Del Giudice MB, Atzori L, Sanna S, Lembo S, Raimondo A, Magnano M, Starace M. Real-life effectiveness and safety of baricitinib in patients with severe alopecia areata: A 24-week Italian study. J Eur Acad Dermatol Venereol 2024. [PMID: 39247945 DOI: 10.1111/jdv.20312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 08/05/2024] [Indexed: 09/10/2024]
Abstract
BACKGROUND Alopecia areata is an autoimmune condition characterized by rapid hair loss in the scalp, eyebrows and eyelashes, for which treatments are limited. Baricitinib, an oral inhibitor of Janus kinases 1 and 2, has been recently approved to treat alopecia areata. MATERIALS AND METHODS We conducted a retrospective study involving 23 medical centres across Italy, enrolling patients affected by severe alopecia areata (SALT >50), for more than 6 months. Clinical and trichoscopic assessment was performed at each visit and impact on quality of life, anxiety and depression were evaluated using the Skindex-16 and the Hospital Anxiety and Depression Scale (HADS), respectively. RESULTS A total of 118 patients were enrolled, with a mean age of 39 years and a mean SALT >95. The mean value of the SALT score decreased from an average of 96.6 (±8.23 sd) to 48 (±35.2 sd) after 24 weeks of treatment and 42.3% of patients achieved a SALT 30, 31.3% a SALT 20 and 20.3% a SALT 10 by Week 24. Trichoscopic signs showed fewer yellow dots and black dots significantly earlier than hair regrowth. Adverse events during the treatment period (mild laboratory test abnormalities) were reported in 12.7% patients. No drop-out were registered. CONCLUSION Data on the effectiveness and safety of baricitinib are promising and support the use of this drug in severe forms of AA, also in the early stages. We also suggest performing trichoscopy in order to reveal early response to therapy.
Collapse
Affiliation(s)
- B M Piraccini
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - F Pampaloni
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - S Cedirian
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - F Quadrelli
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - F Bruni
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - L Rapparini
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - G Caro
- Unit of Dermatology, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - M C Acri
- Unit of Dermatology, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - L Ala
- Unit of Dermatology, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - A Rossi
- Unit of Dermatology, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - G Pellacani
- Unit of Dermatology, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - F Lacarrubba
- Dermatology Clinic, University of Catania, Catania, Italy
| | - G Micali
- Dermatology Clinic, University of Catania, Catania, Italy
| | - F Dall'Oglio
- Dermatology Clinic, University of Catania, Catania, Italy
| | - M Vastarella
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - M Cantelli
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - P Nappa
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - L Diluvio
- Dermatology Unit, Fondazione Policlinico di Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - L Bianchi
- Dermatology Unit, Fondazione Policlinico di Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - L Gnesotto
- Dermatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - A Sechi
- Dermatology Unit, San Bortolo Hospital, Vicenza, Italy
| | - L Naldi
- Dermatology Unit, San Bortolo Hospital, Vicenza, Italy
| | - F Tassone
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - K Peris
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Caldarola
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - L M Pinto
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Girolomoni
- Dipartimento di Medicina, Sezione di Dermatologia, Università di Verona, Verona, Italy
| | - F Marangoni
- Dipartimento di Medicina, Sezione di Dermatologia, Università di Verona, Verona, Italy
| | - F Bellinato
- Dipartimento di Medicina, Sezione di Dermatologia, Università di Verona, Verona, Italy
| | - P Gisondi
- Dipartimento di Medicina, Sezione di Dermatologia, Università di Verona, Verona, Italy
| | - I Scandagli
- Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy
| | - F Prignano
- Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy
| | - N Pimpinelli
- Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy
| | - C Tomasini
- Dermatology Clinic, Fondazione IRCCS Policlinico san Matteo, Pavia, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - S Barruscotti
- Dermatology Clinic, Fondazione IRCCS Policlinico san Matteo, Pavia, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - E De Simoni
- Dermatology Clinic-Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy
| | - O Simonetti
- Dermatology Clinic-Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy
| | - F Ambrogio
- Section of Dermatology and Venereology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari "Aldo Moro", Bari, Italy
| | - C Foti
- Section of Dermatology and Venereology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari "Aldo Moro", Bari, Italy
| | - V Boccaletti
- Clinica Dermatologica, Università degli Studi di Brescia, Brescia, Italy
| | - A Fraghì
- Clinica Dermatologica, Università degli Studi di Brescia, Brescia, Italy
| | - A V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - M A Mattioli
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - L Rocca
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - M Barbareschi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - S M Ferrucci
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - G Gallo
- Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, Italy
| | - S Ribero
- Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, Italy
| | - P Quaglino
- Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, Italy
| | - R Balestri
- Division of Dermatology, "U.O. Multizonale APSS", Trento, Italy
| | - T Ioris
- Division of Dermatology, "U.O. Multizonale APSS", Trento, Italy
| | - R D Caposiena Caro
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - I Zalaudek
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - E Vagnozzi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
- Dermatology Unit, San Salvatore Hospital, ASL 1, Abruzzo, Italy
| | - M C Fargnoli
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
- Dermatology Unit, San Salvatore Hospital, ASL 1, Abruzzo, Italy
| | - C Caponio
- Dermatology Unit, San Salvatore Hospital, ASL 1, Abruzzo, Italy
| | - P Rubegni
- Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria Alle Scotte Hospital, Siena, Italy
| | - E Cinotti
- Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria Alle Scotte Hospital, Siena, Italy
| | - E Trovato
- Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria Alle Scotte Hospital, Siena, Italy
| | - M Romanelli
- Dermatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - V Dini
- Dermatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - F Manzo Margiotta
- Dermatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - C Feliciani
- Unit of Dermatology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - L Atzori
- Dermatology Unit, Department Medical Sciences and Public Health, University of Cagliari, Catania, Italy
| | - S Sanna
- Dermatology Unit, Department Medical Sciences and Public Health, University of Cagliari, Catania, Italy
| | - S Lembo
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Salerno, Italy
| | - A Raimondo
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Salerno, Italy
| | - M Magnano
- Unit of Dermatology, Versilia Hospital, Lido di Camaiore, Lucca, Italy
| | - M Starace
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| |
Collapse
|
4
|
Van Den Houte M, Guadagnoli L, Öhman L, Bergstedt A, Johansson B, Simrén M, Strid H, Van Oudenhove L, Svedlund J. Predictors of Symptoms Trajectories in Newly Diagnosed Ulcerative Colitis: A 3-Year Follow-up Cohort Study. J Crohns Colitis 2024; 18:1394-1405. [PMID: 38551078 DOI: 10.1093/ecco-jcc/jjae046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/01/2024] [Accepted: 03/28/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND AND AIMS Psychological symptoms are associated with poorer ulcerative colitis [UC]-related outcomes. However, the majority of research is cross-sectional. We aimed to identify subgroups based on the longitudinal evolution of GI symptom levels and health-related quality of life [HRQoL], and to disentangle the directionality of effects between GI symptom levels and psychological distress. METHODS Self-reported gastrointestinal [GI] symptom severity, HRQoL, inflammatory biomarkers, and psychological distress were assessed in 98 newly diagnosed UC patients at disease onset and yearly for 3 consecutive years. Latent class growth analysis was used to determine subgroups based on longitudinal trajectories of symptom severity and HRQoL, and baseline predictors of trajectory group membership were determined. Cross-lagged structural equation models were used to disentangle temporal relationships between psychological functioning and symptom severity. RESULTS Patients with higher initial psychological distress had increased probability of maintaining higher levels of diarrhoea and abdominal pain. Conversely, patients with lower initial levels of diarrhoea and abdominal pain had higher chances of maintaining lower levels of psychological distress. Higher levels of C-reactive protein at baseline predicted greater improvements in mental health after anti-inflammatory treatment. Reductions in diarrhoea and abdominal pain preceded reductions in psychological symptoms over time. CONCLUSIONS Baseline psychological distress is predictive of increased GI symptom severity and reduced mental HRQoL over time, suggesting early assessment of psychological symptoms may identify patients who may have worse disease trajectories. Abdominal pain predicted increased psychological distress, but not the other way around. Intervening on abdominal pain may help prevent or reduce future psychological distress.
Collapse
Affiliation(s)
- Maaike Van Den Houte
- Laboratory for Brain-Gut Axis Studies [LaBGAS], Translational Research in Gastrointestinal Disorders [TARGID], Department of Chronic Diseases and Metabolism [CHROMETA], KU Leuven, Leuven, Belgium
- Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Rehabilitation Research Center [REVAL], Hasselt University, Diepenbeek, Belgium
| | - Livia Guadagnoli
- Laboratory for Brain-Gut Axis Studies [LaBGAS], Translational Research in Gastrointestinal Disorders [TARGID], Department of Chronic Diseases and Metabolism [CHROMETA], KU Leuven, Leuven, Belgium
- Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Lena Öhman
- Department of Microbiology and Immunology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Anders Bergstedt
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy; University of Gothenburg, Gothenburg, Sweden
| | - Berndt Johansson
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy; University of Gothenburg, Gothenburg, Sweden
| | - Magnus Simrén
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hans Strid
- Department of Internal Medicine, Södra Älvsborgs Hospital, Borås, Sweden
| | - Lukas Van Oudenhove
- Laboratory for Brain-Gut Axis Studies [LaBGAS], Translational Research in Gastrointestinal Disorders [TARGID], Department of Chronic Diseases and Metabolism [CHROMETA], KU Leuven, Leuven, Belgium
- Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Cognitive & Affective Neuroscience Lab [CANLab], Department of Psychological and Brain Sciences, Dartmouth College; Hanover, New Hampshire, USA
| | - Jan Svedlund
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy; University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
5
|
D'Amours G, Clausen M, Luca S, Reble E, Kodida R, Assamad D, Bernier F, Chad L, Costain G, Dhalla I, Faghfoury H, Friedman JM, Hewson S, Jamieson T, Silver J, Shuman C, Osmond M, Carroll JC, Jobling R, Laberge AM, Aronson M, Liston E, Lerner-Ellis J, Marshall C, Brudno M, Pham Q, Rudzicz F, Cohn R, Mamdani M, Smith M, Shastri-Estrada S, Seto E, Thorpe K, Ungar W, Hayeems RZ, Bombard Y. Genetics Navigator: protocol for a mixed methods randomized controlled trial evaluating a digital platform to deliver genomic services in Canadian pediatric and adult populations. BMJ Open 2024; 14:e090084. [PMID: 39231549 DOI: 10.1136/bmjopen-2024-090084] [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] [Indexed: 09/06/2024] Open
Abstract
INTRODUCTION Genetic testing is used across medical disciplines leading to unprecedented demand for genetic services. This has resulted in excessive waitlists and unsustainable pressure on the standard model of genetic healthcare. Alternative models are needed; e-health tools represent scalable and evidence-based solution. We aim to evaluate the effectiveness of the Genetics Navigator, an interactive patient-centred digital platform that supports the collection of medical and family history, provision of pregenetic and postgenetic counselling and return of genetic testing results across paediatric and adult settings. METHODS AND ANALYSIS We will evaluate the effectiveness of the Genetics Navigator combined with usual care by a genetics clinician (physician or counsellor) to usual care alone in a randomised controlled trial. One hundred and thirty participants (adults patients or parents of paediatric patients) eligible for genetic testing through standard of care will be recruited across Ontario genetics clinics. Participants randomised into the intervention arm will use the Genetics Navigator for pretest and post-test genetic counselling and results disclosure in conjunction with their clinician. Participants randomised into the control arm will receive usual care, that is, clinician-delivered pretest and post-test genetic counselling, and results disclosure. The primary outcome is participant distress 2 weeks after test results disclosure. Secondary outcomes include knowledge, decisional conflict, anxiety, empowerment, quality of life, satisfaction, acceptability, digital health literacy and health resource use. Quantitative data will be analysed using statistical hypothesis tests and regression models. A subset of participants will be interviewed to explore user experience; data will be analysed using interpretive description. A cost-effectiveness analysis will examine the incremental cost of the Navigator compared with usual care per unit reduction in distress or unit improvement in quality of life from public payer and societal perspectives. ETHICS AND DISSEMINATION This study was approved by Clinical Trials Ontario. Results will be shared through stakeholder workshops, national and international conferences and peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT06455384.
Collapse
Affiliation(s)
- Guylaine D'Amours
- Genomics Health Services Research Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Marc Clausen
- Genomics Health Services Research Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Stephanie Luca
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Emma Reble
- Genomics Health Services Research Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Rita Kodida
- Genomics Health Services Research Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Daniel Assamad
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Francois Bernier
- Department of Medical Genetics, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Lauren Chad
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Gregory Costain
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Irfan Dhalla
- Care Experience Institute, Unity Health Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Hanna Faghfoury
- Fred A. Litwin Family Centre in Genetic Medicine, University Health Network, Toronto, Ontario, Canada
- Sinai Health, Toronto, Ontario, Canada
| | - Jan M Friedman
- Department of Medical Genetics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Stacy Hewson
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Trevor Jamieson
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Josh Silver
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
- Fred A. Litwin Family Centre in Genetic Medicine, University Health Network, Toronto, Ontario, Canada
| | - Cheryl Shuman
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Matthew Osmond
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - June C Carroll
- Department of Family Medicine, Sinai Health, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rebekah Jobling
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Anne-Marie Laberge
- Division of Medical Genetics, CHU Sainte-Justine, Montreal, Québec, Canada
- Department of Pediatrics, Université de Montréal, Montreal, Québec, Canada
| | - Melyssa Aronson
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
- Zane Cohen Centre for Digestive Diseases, Sinai Health, Toronto, Ontario, Canada
| | - Eriskay Liston
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Jordan Lerner-Ellis
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Christian Marshall
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Genome Diagnostics, Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Quynh Pham
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Centre for Digital Therapeutics, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Frank Rudzicz
- Faculty of Computer Science, Dalhousie University, Halifax, Nova Scotia, Canada
- Vector Institute for Artificial Intelligence, Toronto, Ontario, Canada
| | - Ronald Cohn
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Program in Genetics & Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Muhammad Mamdani
- Department of Data Science and Advanced Analytics, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Maureen Smith
- Patient Partner, Canadian Organization for Rare Disorders, Toronto, Ontario, Canada
| | - Serena Shastri-Estrada
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Genetics Navigator Advisory Board, Toronto, Ontario, Canada
| | - Emily Seto
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Centre for Digital Therapeutics, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Kevin Thorpe
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Wendy Ungar
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Robin Z Hayeems
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Yvonne Bombard
- Genomics Health Services Research Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
6
|
Fisher HM, Hyland KA, Miller SN, Amaden GH, Diachina A, Ulmer CS, Danforth M, LeBlanc TW, Somers TJ, Keefe FJ. Mindful Night-to-Day: A Pilot Feasibility Trial of a Mindfulness-Based Insomnia and Symptom Management Intervention for Patients with Hematologic Cancer. Behav Sleep Med 2024; 22:674-696. [PMID: 38597262 PMCID: PMC11365809 DOI: 10.1080/15402002.2024.2339819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
OBJECTIVES Patients with hematologic cancer experience severe symptoms (i.e. insomnia, fatigue, pain, distress). Few interventions addressing insomnia and other symptoms exist for this population. Mindfulness-Based Therapy for Insomnia (MBTI) may be appropriate but has only been tested in healthy outpatients. This study aimed to develop and test an adapted MBTI protocol for hematologic cancer patients. METHODS Patient (n = 3) and clinician (n = 1) focus groups, and user-testing (N = 5) informed adaptation of Mindful Night-to-Day (MBTI+). A single-arm pilot trial (N = 32) evaluated feasibility (accrual, attrition, adherence), acceptability (intervention satisfaction), and changes to insomnia symptom severity (Insomnia Severity Index; primary outcome) and secondary outcomes (fatigue, pain, distress, pre-sleep arousal, mindfulness, symptom management self-efficacy) at baseline, post-intervention, and 1-month post-intervention. Descriptive statistics and paired sample t-tests were conducted. RESULTS Qualitative feedback informed MBTI+ content, format, and delivery. Mindfulness was used to increase symptom awareness (sleepiness vs. fatigue). Meditations and behavioral skills were applied to inpatient treatment. MBTI+ met feasibility (N = 32/12 months; 8.1% attrition; 83.8% adherence) and acceptability (M = 3.52/4.00) benchmarks. Insomnia symptom severity decreased (d = 1.20) from baseline to post-intervention, as did most secondary outcomes. CONCLUSIONS MBTI+ was feasible, acceptable, and showed promise for benefits throughout inpatient and outpatient treatment. Findings warrant further evaluation in a randomized trial.
Collapse
Affiliation(s)
- Hannah M. Fisher
- Pain Prevention and Treatment Research Program, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Kelly A. Hyland
- Pain Prevention and Treatment Research Program, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Shannon N. Miller
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Grace H. Amaden
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Allison Diachina
- Pain Prevention and Treatment Research Program, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Christi S. Ulmer
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
- Durham Veterans Affairs (VA) Healthcare System, Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham, North Carolina
| | | | - Thomas W. LeBlanc
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Tamara J. Somers
- Pain Prevention and Treatment Research Program, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Francis J. Keefe
- Pain Prevention and Treatment Research Program, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| |
Collapse
|
7
|
Winsor AA, Richards C, Seri S, Liew A, Bagshaw AP. Quality of life in children with epilepsy: The role of parental mental health and sleep disruption. Epilepsy Behav 2024; 158:109941. [PMID: 39024683 DOI: 10.1016/j.yebeh.2024.109941] [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: 03/09/2024] [Revised: 06/14/2024] [Accepted: 07/04/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Parents of children with epilepsy (CWE) are at increased risk of mental health difficulties including anxiety and depression, as well as sleep difficulties. From both the child's and parent's perspectives, health-related quality of life has been shown to be strongly related to parental mental health. However, there is no literature on parental sleep as a predictor of child health-related quality of life. The role of parental variables has been assessed in relation to epilepsy-specific variables (e.g., seizure severity, anti-seizure medications) and how these relate to health-related quality of life, but prior studies have failed to consider the role of co-occurring conditions which are prevalent in CWE. The current study aims to assess how common anxiety symptoms, depression symptoms and sleep problems are in parents of CWE; and to determine the impact these parental variables as well as child co-occurring conditions have on health-related quality of life in CWE. METHODS 33 CWE aged 4-14 years old were recruited from two hospitals and parents were asked to complete a series of questionnaires assessing both child and parental variables. RESULTS It was found that 33.3 % and 12.0 % of parents of CWE experienced clinically significant anxiety and depression symptoms respectively. In addition 67.9 % of parents presented with significant sleep problems. In initial analysis, parental anxiety symptoms, depression symptoms and sleep problems were all significantly predictive of child health-related quality of life. However when co-occurring child sleep problems and neurodevelopmental characteristics were included, parental variables were no longer significantly predictive of child health-related quality of life. CONCLUSION These results suggest that child co-occurrences mediate the relationship between parental variables and child health-related quality of life. The current data highlight the need for a systemic approach to epilepsy management and suggest that support for co-occurrences could benefit health-related quality of life for children and their parents.
Collapse
Affiliation(s)
- Alice A Winsor
- Centre for Human Brain Health, University of Birmingham, UK; School of Psychology, University of Birmingham, UK; Maurice Wohl Clinical Neuroscience Institute, King's College London, UK.
| | | | - Stefano Seri
- Children's Epilepsy Surgery Programme, Birmingham Children's Hospital, UK; Aston Institute of Health and Neurodevelopment, Aston University, Birmingham, UK
| | - Ashley Liew
- Evelina London Children's Hospital, South London and Maudsley NHS Foundation Trust, UK; University of Warwick, UK
| | - Andrew P Bagshaw
- Centre for Human Brain Health, University of Birmingham, UK; School of Psychology, University of Birmingham, UK
| |
Collapse
|
8
|
Stapel B, Winter L, Heitland I, Löffler F, Bauersachs J, Westhoff-Bleck M, Kahl KG. Impact of congenital heart disease on personality disorders in adulthood. Eur J Prev Cardiol 2024; 31:1324-1332. [PMID: 38268119 DOI: 10.1093/eurjpc/zwae030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/09/2024] [Accepted: 01/13/2024] [Indexed: 01/26/2024]
Abstract
AIMS Adults with congenital heart disease (ACHD) constitute an ever-growing patient population characterized by high risks for cardiovascular- and mental disorders. Personality disorders (PDs) are associated with adverse physical and mental health. Studies assessing PD prevalence in ACHD are lacking. METHODS AND RESULTS Personality disorder point prevalence was assessed in 210 ACHD by Structured Clinical Interview for Axis-II Personality Disorders (SCID-II) and compared to meta-analytical data from the general population (GP). Depression and anxiety were measured by self-report (Hospital Anxiety and Depression Scale, HADS) and clinician rating (Montgomery-Åsberg depression rating scale, MADRS). Childhood maltreatment was assessed with the Childhood Trauma Questionnaire and quality-of-life (QOL) with the World Health Organization QOL Scale. PD prevalence was markedly higher in ACHD compared to GP (28.1 vs. 7.7%). Particularly borderline (4.8 vs. 0.9%) and cluster C (i.e. anxious or fearful; 17.1 vs. 3.0%) PDs were overrepresented. PD diagnosis was associated with a surgery age ≤12 years (χ²(1) = 7.861, ϕ = 0.195, P = 0.005) and higher childhood trauma levels (U = 2583.5, Z = -3.585, P < 0.001). ACHD with PD reported higher anxiety (HADS-A: U = 2116.0, Z = -5.723, P < 0.001) and depression (HADS-D: U = 2254.5, Z = -5.392, P < 0.001; MADRS: U = 2645.0, Z = -4.554, P < 0.001) levels and lower QOL (U = 2538.5, Z = -4.723, P < 0.001). CONCLUSION Personality disorders, particularly borderline- and cluster C, are significantly more frequent in ACHD compared to GP and associated with depression, anxiety, and decreased QOL. Data from the GP suggest an association with adverse cardiometabolic and mental health. To ensure guideline-based treatment, clinicians should be aware of the increased PD risk in ACHD.
Collapse
Affiliation(s)
- Britta Stapel
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Lotta Winter
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Ivo Heitland
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Friederike Löffler
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | | | - Kai G Kahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| |
Collapse
|
9
|
Shamsoddini A, Cheraghifard M, Hollisaz MT, Sobhani V. The Effects of Exergaming on Fear of Falling and the Balance Function in Anxious and Non-Anxious Older Adults: A Pilot Study. Clin Gerontol 2024:1-12. [PMID: 39152893 DOI: 10.1080/07317115.2024.2389238] [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] [Indexed: 08/19/2024]
Abstract
BACKGROUND Anxiety can exacerbate fear of falling and balance issues, potentially affecting intervention efficacy. This study examines exergaming's impact on fear of falling and balance in anxious and non-anxious older adults. MATERIALS AND METHODS Twenty older adults (10 anxious, 10 non-anxious) participated in six weeks of balance-oriented gaming. Fear of falling was assessed using the Falls Efficacy Scale and the Activities-specific Balance Confidence Scale. Balance was measured with the Berg Balance Scale and the Timed Up and Go Test before, after, and six weeks post-intervention. RESULTS Both groups showed significant improvements in balance and mobility, sustained during follow-up. However, only the non-anxious group exhibited significant reductions in fear of falling and increased balance confidence. Anxiety was linked to reduced enjoyment, lower efficacy perception, and heightened tension during the intervention. CONCLUSION Exergaming improves balance and reduces fear of falling in non-anxious older adults. Anxiety may diminish these benefits. CLINICAL IMPLICATIONS Assessing anxiety levels is crucial when prescribing exergaming interventions. Tailoring treatments to address anxiety could enhance outcomes.
Collapse
Affiliation(s)
- Alireza Shamsoddini
- Exercise Physiology of Research Center, LifeStyle Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Moslem Cheraghifard
- Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Taghi Hollisaz
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Vahid Sobhani
- Exercise Physiology of Research Center, LifeStyle Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| |
Collapse
|
10
|
Saarinen SL, Borregaard B, Ekholm O, Christensen AV, Thorup CB, Thomsen T, Thrysoee L, Mols RE, Juel K, Berg SK, Rasmussen TB. Self-reported mental and physical health is associated with not returning to work in patients with ischemic heart disease. Int J Cardiol 2024; 409:132180. [PMID: 38759797 DOI: 10.1016/j.ijcard.2024.132180] [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: 09/18/2023] [Revised: 05/09/2024] [Accepted: 05/13/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Ischemic Heart Disease (IHD) can lead to prolonged sick leave and loss of ability to work. This study aimed to describe non-return to work (non-RTW) across three IHD subgroups at 3 and at 12 months post discharge, and explore whether baseline characteristics, and patient-reported mental and physical health were associated with work detachment. METHODS Data from the national cohort study DenHeart were used, including the patient-reported outcomes (PROs) Short-Form 12, Hospital Anxiety and Depression Scale, Edmonton Symptom Assessment Scale and HeartQoL measured at discharge and register-based follow-up at 3 and at 12 months. A total of 3873 patients with IHD ≤ 63 years old and part of the workforce prior to hospitalisation, were included in the analyses and divided into three groups: chronic IHD/stable angina, non-STEMI (non-ST-Elevation Myocardial Infarction)/unstable angina and STEMI (ST-Elevation Myocardial Infarction). A composite outcome of 'prolonged sick leave' and/or 'left the workforce' was defined as non-return to work (non-RTW). Adjusted logistic regression models were performed. RESULTS Overall, the frequency of non-RTW was 37.7% and 38.0% at 3 and 12 months, respectively, thus not improving with time. The largest proportion of non-RTW was found in STEMI patients, followed by non-STEMI/unstable angina and IHD/stable angina patients. Several clinical and socio-demographic factors, as well as patient-reported mental and physical health were associated with non-RTW among the subgroups. CONCLUSION The findings demonstrate a need for identifying IHD patients at risk of non-RTW after discharge based on their mental and physical health and a need for initiatives to minimize unwanted non-RTW.
Collapse
Affiliation(s)
- Stine Lise Saarinen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Britt Borregaard
- Department of Cardiology, Odense University Hospital, Odense, Denmark; Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | | | - Charlotte Brun Thorup
- Department of Cardiology, Cardiothoracic surgery and Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | - Thordis Thomsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Acute, Critical and Emergency Care Science Unit, Department of Anaesthesiology, Herlev and Gentofte University Hospital, Herlev, Denmark
| | - Lars Thrysoee
- Department of Cardiology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Rikke Elmose Mols
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Knud Juel
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Selina Kikkenborg Berg
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Trine Bernholdt Rasmussen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, Herlev and Gentofte University Hospital, Hellerup, Denmark
| |
Collapse
|
11
|
Wang C, Yin L. Xiaoyaosan formula augments adjuvant therapy and enhances postoperative breast cancer care. Front Pharmacol 2024; 15:1388646. [PMID: 39185306 PMCID: PMC11344260 DOI: 10.3389/fphar.2024.1388646] [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: 02/27/2024] [Accepted: 07/12/2024] [Indexed: 08/27/2024] Open
Abstract
Introduction Xiaoyaosan (XYS), a traditional Chinese formula, not only has good antitumor effects but also attenuates distress, anorexia, and quality of life (QoL) by regulating neurology, the microbiota, immunology, and oxidative stress. This study aimed to assess the effect of XYS on QoL, psychological pressure, and spiritual well-being in breast cancer patients undergoing adjuvant chemotherapy. Methods This prospective cohort study enrolled 176 postoperative breast cancer patients who received adjuvant chemotherapy combined with (n = 81) or without (n = 95) XYS for comparison. The Quality-of-Life Questionnaire Core-30 (QLQ-C30), Hospital Anxiety and Depression Scale (HADS), University of California Los Angeles (UCLA-LS), and Functional Assessment of Chronic Illness Therapy-Spiritual Well-being (FACIT-Sp) scores were evaluated before adjuvant chemotherapy (T0) and after the first (T1), second (T2), third (T3), and fourth cycles (T4) of adjuvant chemotherapy. Results XYS improved the QLQ-C30 score at T2 (p = 0.043), T3 (p = 0.021), and T4 (p = 0.040) and the QLQ-C30 score at T4 (p = 0.027); moreover, XYS attenuated the QLQ-C30 score at T2 (p = 0.040), T3 (p = 0.023), and T4 (p = 0.027). Regarding distress, XYS reduced the HADS-anxiety score at T2 (p = 0.010), T3 (p = 0.025), and T4 (p = 0.019) and the HADS-defined anxiety score at T3 (p = 0.038). XYS also decreased the HADS-depression score at T2 (p = 0.016), T3 (p = 0.018), and T4 (p = 0.017) and the HADS-defined depression rate at T2 (p = 0.047), T3 (p = 0.012), and T4 (p = 0.013). In addition, XYS decreased the UCLA-LS at T2 (p = 0.023) but enhanced the FACIT-Sp at T2 (p = 0.029) and T4 (p = 0.026). Furthermore, after adjustment via propensity score matching, most of the significant findings remained. Discussion The addition of XYS to adjuvant chemotherapy improved QoL, psychological health, and spiritual well-being in breast cancer patients.
Collapse
Affiliation(s)
| | - Lianfang Yin
- Department of Chinese Medicine, The First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui, China
| |
Collapse
|
12
|
Gozzi N, Preatoni G, Ciotti F, Hubli M, Schweinhardt P, Curt A, Raspopovic S. Unraveling the physiological and psychosocial signatures of pain by machine learning. MED 2024:S2666-6340(24)00298-8. [PMID: 39116869 DOI: 10.1016/j.medj.2024.07.016] [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: 02/23/2024] [Revised: 04/12/2024] [Accepted: 07/15/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND Pain is a complex subjective experience, strongly impacting health and quality of life. Despite many attempts to find effective solutions, present treatments are generic, often unsuccessful, and present significant side effects. Designing individualized therapies requires understanding of multidimensional pain experience, considering physical and emotional aspects. Current clinical pain assessments, relying on subjective one-dimensional numeric self-reports, fail to capture this complexity. METHODS To this aim, we exploited machine learning to disentangle physiological and psychosocial components shaping the pain experience. Clinical, psychosocial, and physiological data were collected from 118 chronic pain and healthy participants undergoing 40 pain trials (4,697 trials). FINDINGS To understand the objective response to nociception, we classified pain from the physiological signals (accuracy >0.87), extracting the most important biomarkers. Then, using multilevel mixed-effects models, we predicted the reported pain, quantifying the mismatch between subjective level and measured physiological response. From these models, we introduced two metrics: TIP (subjective index of pain) and Φ (physiological index). These represent possible added value in the clinical process, capturing psychosocial and physiological pain dimensions, respectively. Patients with high TIP are characterized by frequent sick leave from work and increased clinical depression and anxiety, factors associated with long-term disability and poor recovery, and are indicated for alternative treatments, such as psychological ones. By contrast, patients with high Φ show strong nociceptive pain components and could benefit more from pharmacotherapy. CONCLUSIONS TIP and Φ, explaining the multidimensionality of pain, might provide a new tool potentially leading to targeted treatments, thereby reducing the costs of inefficient generic therapies. FUNDING RESC-PainSense, SNSF-MOVE-IT197271.
Collapse
Affiliation(s)
- Noemi Gozzi
- Laboratory for Neuroengineering, Department of Health Sciences and Technology, Institute for Robotics and Intelligent Systems, ETH Zürich, 8092 Zürich, Switzerland
| | - Greta Preatoni
- Laboratory for Neuroengineering, Department of Health Sciences and Technology, Institute for Robotics and Intelligent Systems, ETH Zürich, 8092 Zürich, Switzerland
| | - Federico Ciotti
- Laboratory for Neuroengineering, Department of Health Sciences and Technology, Institute for Robotics and Intelligent Systems, ETH Zürich, 8092 Zürich, Switzerland
| | - Michèle Hubli
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland
| | - Petra Schweinhardt
- Department of Chiropractic Medicine, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland
| | - Stanisa Raspopovic
- Laboratory for Neuroengineering, Department of Health Sciences and Technology, Institute for Robotics and Intelligent Systems, ETH Zürich, 8092 Zürich, Switzerland; Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, 1090 Vienna, Austria.
| |
Collapse
|
13
|
Lovette BC, Briskin EA, Grunberg VA, Vranceanu AM, Greenberg J. "I completely shut down": A mixed methods evaluation of the fear-avoidance model for young adults with a recent concussion and anxiety. Rehabil Psychol 2024; 69:206-216. [PMID: 38358710 PMCID: PMC11272430 DOI: 10.1037/rep0000549] [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] [Indexed: 02/16/2024]
Abstract
PURPOSE/OBJECTIVES The fear-avoidance model is a well-established framework for understanding the transition from acute to chronic pain. However, its applicability to concussions is not yet well understood. Here, we conduct the first mixed methods analysis of the fear-avoidance model in young adults with a recent concussion and co-occurring anxiety and assess the model's alignment with their lived experience. RESEARCH METHOD/DESIGN We conducted a mixed methods analysis using a cross-sectional parallel design. Seventeen participants completed questionnaires corresponding with the elements in the fear-avoidance model (e.g., pain catastrophizing, avoidance, disability, anxiety, depression, etc.) and participated in semistructured interviews probing their experiences following their concussion between March 2021 and February 2022. We calculated bivariate correlations for quantitative data and analyzed the qualitative data using hybrid inductive-deductive thematic analysis. RESULTS Quantitative results demonstrated strong and medium-sized correlations among theorized relationships within the fear-avoidance model (rs = .40-.85) with the majority being statistically significant. Qualitative results provided substantial convergent and complementary support (e.g., bi-directionality of some relationships, associations between nonadjacent model components, centrality of anxiety in symptom persistence) for the application of the fear-avoidance model to concussions. Findings highlighted additional factors (social factors and post-injury endurance patterns) relevant to this population. CONCLUSION/IMPLICATIONS The fear-avoidance model is a useful lens for understanding the lived experience of young adults with a recent concussion and co-occurring anxiety. Psychosocial treatment for this population would benefit from focusing on the interplay of concussion symptoms, anxiety, depression, disability, and pain-related fear, offering adaptive confrontation strategies, and addressing the interpersonal impact of concussion. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Collapse
Affiliation(s)
- Brenda C. Lovette
- Center for Health Outcomes and Interdisciplinary Research (CHOIR), Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- MGH Institute for Health Professions, Charlestown, MA, USA
| | - Ellie A. Briskin
- Center for Health Outcomes and Interdisciplinary Research (CHOIR), Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Victoria A. Grunberg
- Center for Health Outcomes and Interdisciplinary Research (CHOIR), Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Newborn Medicine, MassGeneral for Children, Boston, MA, USA
| | - Ana-Maria Vranceanu
- Center for Health Outcomes and Interdisciplinary Research (CHOIR), Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jonathan Greenberg
- Center for Health Outcomes and Interdisciplinary Research (CHOIR), Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| |
Collapse
|
14
|
Alekseeva TM, Topuzova MP, Kulikov VP, Kovzelev PD, Kosenko MG, Tregub PP. Hypercapnic hypoxia as a rehabilitation method for patients after ischemic stroke. Neurol Res 2024; 46:695-705. [PMID: 38643375 DOI: 10.1080/01616412.2024.2343510] [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: 01/24/2024] [Accepted: 04/03/2024] [Indexed: 04/22/2024]
Abstract
INTRODUCTION Experimental studies on animals have demonstrated a higher neuroprotective efficacy of hypercapnic hypoxia compared to normocapnic hypoxia. Respiratory training with hypercapnic hypoxia has shown a positive impact on the functional state of the nervous system in children with cerebral palsy (CP). It can be presumed that the combined effect of moderate hypercapnia and hypoxia will be promising for clinical application within the context of early rehabilitation after ischemic stroke. METHODS A randomized triple-blind placebo-controlled study was conducted on 102 patients with ischemic stroke, aged 63.07 ± 12.1 years. All patients were diagnosed with ischemic stroke based on neuroimaging criteria and/or clinical criteria within the 48-72 hour timeframe. The experimental group (n = 50) underwent daily respiratory training with hypercapnic hypoxia (FetCO2 5-6%, FetO2 15-16%) using the 'Carbonic' device for 7-11 sessions of 20 minutes each day during the treatment process. The control group (placebo, n = 52) underwent training on a similar device modified for breathing atmospheric air. Neurological examinations were conducted on all patients before the study and on the day after completing the training course. RESULTS The standard treatment demonstrated effectiveness in terms of neurological status scales in both groups. Intermittent exposure to hypercapnic hypoxia proved more effective in improving neurological function indicators in patients compared to the placebo group: NIHSS scale scores were 40% lower than in the placebo group (p < 0.001); mRS scale scores were 35% lower (p < 0.001); B-ADL-I and RMI indices were higher by 26% (p < 0.01) and 36% (p < 0.001), respectively; MoCA scale results were 13% higher (p < 0.05); HADS and BDI-II scale scores were lower by 35% (p < 0.05) and 25% (p < 0.05), respectively. The increase in MMSE scale scores in the intervention group was 54% higher (p < 0.001), and MoCA scale scores increased by 25% (p < 0.001). CONCLUSION Respiratory training with hypercapnic hypoxia improves the functional state of the nervous system in patients with ischemic stroke. After conducting further clarifying studies, hypercapnic hypoxia can be considered as an effective method of neurorehabilitation, which can be used as early as 48-72 hours after the onset of stroke.
Collapse
Affiliation(s)
- Tatiana M Alekseeva
- Department of Neurology with Clinic, V.A. Almazov National Medical Research Center, Saint-Petersburg, Russia
| | - Maria P Topuzova
- Department of Neurology with Clinic, V.A. Almazov National Medical Research Center, Saint-Petersburg, Russia
| | - Vladimir P Kulikov
- Department of Ultrasound and Functional Diagnostics, Altai State Medical University, Barnaul, Russia
| | - Pavel D Kovzelev
- Department of Neurology with Clinic, Smart Clinic ltd, Saint-Petersburg, Russia
| | - Mark G Kosenko
- Department of Pathophysiology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Pavel P Tregub
- Department of Pathophysiology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- Brain Science Institute, Research Center of Neurology, Moscow, Russia
- Scientific and Educational Resource Center "Innovative Technologies of Immunophenotyping, Digital Spatial Profiling and Ultrastructural Analysis", RUDN University, Moscow, Russia
| |
Collapse
|
15
|
Årestedt K, Rooth M, Bremer A, Koistinen L, Attin M, Israelsson J. Associations between initial heart rhythm and self-reported health among cardiac arrest survivors - A nationwide registry study. Resuscitation 2024; 201:110268. [PMID: 38871072 DOI: 10.1016/j.resuscitation.2024.110268] [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: 03/17/2024] [Revised: 05/20/2024] [Accepted: 06/04/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Non-shockable initial rhythm is a known risk factor for high mortality at cardiac arrest (CA). However, knowledge on its association with self-reported health in CA survivors is still incomplete. AIM To examine the associations between initial rhythm and self-reported health in CA survivors. METHODS This nationwide study used data from the Swedish Register for Cardiopulmonary Resuscitation 3-6 months post CA. Health status was measured using EQ-5D-5L and psychological distress by the Hospital Anxiety and Depression Scale (HADS). Kruskal-Wallis test was used to examine differences in self-reported health between groups of different initial rhythms. To control for potential confounders, age, sex, place of CA, aetiology, witnessed status, time to CPR, time to defibrillation, and neurological function were included as covariates in multiple regression analyses for continuous and categorical outcomes. RESULTS The study included 1783 adult CA survivors. Overall, the CA survivors reported good health status and symptoms of anxiety or depression were uncommon (13.7% and 13.9% respectively). Survivors with PEA and asystole reported significantly more problems in all dimensions of health status (p = 0.037 to p < 0.001), anxiety (p = 0.034), and depression (p = 0.017) compared to VT/VF. Overall, these differences did not remain in the adjusted regression analyses. CONCLUSIONS Initial rhythm is not associated with self-reported health when potential confounders are controlled. Initial rhythm seems to be an indicator of unfavourable factors causing the arrest, or factors related to characteristics and treatment. Therefore, initial rhythm may be used as a proxy for identifying patients at risk for poor outcomes such as worse health status and psychological distress.
Collapse
Affiliation(s)
- Kristofer Årestedt
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar/Växjö, Sweden; Department of Research, Region Kalmar County, Kalmar, Sweden.
| | - Martina Rooth
- Kalmar County Hospital, Region Kalmar County, Kalmar, Sweden
| | - Anders Bremer
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar/Växjö, Sweden
| | - Lauri Koistinen
- The Wellbeing Services County of Ostrobothnia, Department of Primary Care, Vaasa Health Care Center, Wasa, Finland
| | - Mina Attin
- School of Nursing, University of Nevada, Las Vegas, USA
| | - 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
| |
Collapse
|
16
|
Rahnea-Nita RA, Toma RV, Grigorean VT, Coman IS, Coman VE, Pleşea IE, Erchid A, Gorecki GP, Rahnea-Nita G. Reinitiating Chemotherapy beyond Progression after Maintenance Immunotherapy in Extensive-Stage Small-Cell Lung Cancer. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1225. [PMID: 39202506 PMCID: PMC11356350 DOI: 10.3390/medicina60081225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Revised: 07/25/2024] [Accepted: 07/26/2024] [Indexed: 09/03/2024]
Abstract
Introduction: Small-cell lung cancer (SCLC) is an aggressive form of cancer with a poor prognosis. The two-year survival rate is 8% of all cases. Case presentation: We present the case of a male patient who was 50 years old at the time of diagnosis in May 2022. He was diagnosed with extensive-stage small-cell lung cancer, treated with immunotherapy in combination with chemotherapy (Durvalumab in combination with Etoposide plus Carboplatin) as a first-line treatment, followed by maintenance immunotherapy. In December 2023, a PET-CT scan revealed progressive disease with multiple metastases. Chemotherapy was reinitiated with Etoposide plus Cisplatin in January 2024. After two cycles of chemotherapy, the patient developed post-chemotherapy anemia, for which treatment with Epoetinum alpha was initiated. Chemotherapy was continued for another five cycles, until May 2024, with the maintenance of hemoglobin at a level within 9.9 mg/dL-11 mg/dL. Upon assessment at the end of May 2024, the patient presented an ECOG = 2 performance status, with a moderate general state, moderate-intensity fatigue, no pain, no anxiety or depression and no dyspnea. Discussions, Literature Review and Conclusions: Reinitiating chemotherapy after the failure of maintenance immunotherapy may be an option in patients with SCLC. Epoetinum allows oncological treatment by preventing chemotherapy-induced anemia.
Collapse
Affiliation(s)
- Roxana-Andreea Rahnea-Nita
- 8th Clinical Department—Radiology, Oncology and Hematology, Faculty of Medicine, “Carol Davila” University of Medicine and Phamacy, 020021 Bucharest, Romania; (R.-A.R.-N.); (R.-V.T.)
- Department of Oncology-Palliative Care, “Sf. Luca” Chronic Diseases Hospital, 041915 Bucharest, Romania;
| | - Radu-Valeriu Toma
- 8th Clinical Department—Radiology, Oncology and Hematology, Faculty of Medicine, “Carol Davila” University of Medicine and Phamacy, 020021 Bucharest, Romania; (R.-A.R.-N.); (R.-V.T.)
- Department of Radiotherapy, “Prof. Dr. Alexandru Trestioreanu” Oncological Institute, 022328 Bucharest, Romania
| | - Valentin Titus Grigorean
- 10th Clinical Department—General Surgery, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (I.S.C.); (V.E.C.)
- Department of General Surgery, “Bagdasar-Arseni” Clinical Emergency Hospital, 041915 Bucharest, Romania;
| | - Ionuţ Simion Coman
- 10th Clinical Department—General Surgery, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (I.S.C.); (V.E.C.)
- Department of General Surgery, “Bagdasar-Arseni” Clinical Emergency Hospital, 041915 Bucharest, Romania;
| | - Violeta Elena Coman
- 10th Clinical Department—General Surgery, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (I.S.C.); (V.E.C.)
- Department of General Surgery, “Bagdasar-Arseni” Clinical Emergency Hospital, 041915 Bucharest, Romania;
| | - Iancu Emil Pleşea
- Department of Histopathology, “Bagdasar-Arseni Clinical Emergency Hospital”, 041915 Bucharest, Romania;
| | - Anwar Erchid
- Department of General Surgery, “Bagdasar-Arseni” Clinical Emergency Hospital, 041915 Bucharest, Romania;
| | - Gabriel-Petre Gorecki
- Department of Anesthesia and Intensive Care, Faculty of Medicine, “Titu Maiorescu” University, 031593 Bucharest, Romania;
- Department of Anesthesia and Intensive Care, CF2 Clinical Hospital, 011464 Bucharest, Romania
| | - Gabriela Rahnea-Nita
- Department of Oncology-Palliative Care, “Sf. Luca” Chronic Diseases Hospital, 041915 Bucharest, Romania;
- Specific Disciplines Department, Faculty of Nursing and Midwifery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| |
Collapse
|
17
|
Rahman NA, Ariaratnam S, Hashim NA, Azhar ZI. Prevalence and factors associated with generalized anxiety disorder among patients with chronic pain: A single center cross sectional study in Malaysia. PLoS One 2024; 19:e0307992. [PMID: 39058752 PMCID: PMC11280136 DOI: 10.1371/journal.pone.0307992] [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: 02/28/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Managing chronic pain was not only a major challenge but also a source of significant disability associated with mental illness. Studies on generalized anxiety disorder (GAD) in chronic pain population was rather limited. This study was aimed to determine the prevalence of GAD and its associated factors among patients attending a pain clinic at a general hospital. METHODS This cross-sectional study recruited 201 patients. The Hospital Anxiety Depression Scale (HADS) was used to determine anxiety level. Subsequently, patients who had scored 8 and above on the HADS were interviewed using Mini International Neuropsychiatric Interview (M.I.N.I) to ascertain the diagnosis of GAD. Whilst the Numerical Rating Scale (NRS) assessed pain severity. Multiple logistic regression analysis was used to determine factors associated with GAD. RESULTS Among those patients with chronic pain, the prevalence of GAD was 18.9%. Gender (AOR:7.94; 95% CI:2.34, 26.93), duration of the pain (AOR:1.30; 95% CI:1.03,1.63) and pain severity (AOR:18.75; CI:1.23,285.13) were significant factors associated with GAD. CONCLUSION GAD is a prevalent condition among chronic pain patients.
Collapse
Affiliation(s)
- Norlaila Abd Rahman
- Department of Psychiatry, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, Malaysia
| | - Suthahar Ariaratnam
- Department of Psychiatry, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, Malaysia
| | - Nurul Azreen Hashim
- Department of Psychiatry, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, Malaysia
| | - Zahir Izuan Azhar
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, Malaysia
| |
Collapse
|
18
|
Li S, Li H, Zhang R, Zhang F, Yin J, He L. Effect of modified opioid sparing anaesthesia on postoperative quality of recovery in patients undergoing laparoscopic bariatric surgery: protocol for a monocentre, double-blind randomised controlled trial - the MOSA study. BMJ Open 2024; 14:e086523. [PMID: 39059808 DOI: 10.1136/bmjopen-2024-086523] [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] [Indexed: 07/28/2024] Open
Abstract
INTRODUCTION Obesity patients undergoing laparoscopic bariatric surgery (LBS) are frequently encountered perioperative adverse events related to opioids-based anaesthesia (OBA) or opioids-free anaesthesia (OFA). While modified opioid-sparing anaesthesia (MOSA) has been shown to lower the occurrence of adverse events related to OBA and OFA. This study is to assess the efficacy of MOSA in enhancing the recovery quality among individuals undergoing LBS. METHODS AND ANALYSIS A single-centre, prospective, double-blind, randomised controlled trial is conducted at a tertiary hospital. A total of 74 eligible participants undergoing elective LBS will be recruited and randomly allocated. Patients in the MOSA group will receive a combination of low-dose opioids, minimal dexmedetomidine, esketamine and lidocaine, while in the OBA group will receive standard general anaesthesia with opioids. Patients in both groups will receive standard perioperative care. The primary outcome is the quality of recovery-15 score assessed at 24 hours after surgery. Secondary outcomes include pain levels, anxiety and depression assessments, gastrointestinal function recovery, perioperative complication rates, opioid consumption and length of hospital stay. ETHICS AND DISSEMINATION Ethical approval has been provided by the Ethical Committee of Yan'an Hospital of Kunming City (approval No. 2023-240-01). Eligible patients will provide written informed consent to the investigator. The outcomes of this trial will be disseminated in a peer-reviewed scholarly journal. TRIAL REGISTRATION NUMBER The study protocol is registered at https://www.chictr.org.cn/ on 19 December 2023. (identifier: ChiCTR2300078806). The trial was conducted using V.1.0.
Collapse
Affiliation(s)
- Shikuo Li
- Anesthesiology, Yan'an Hospital of Kunming City, Kunming, China
| | - Honghao Li
- Anesthesiology Operating Center, Yan'an Hospital of Kunming City, Kunming, China
| | - Ruqiang Zhang
- Anesthesiology, Yan'an Hospital of Kunming City, Kunming, China
| | - Furong Zhang
- Anesthesiology, Yan'an Hospital of Kunming City, Kunming, China
| | - Jianwei Yin
- Anesthesiology, Yan'an Hospital of Kunming City, Kunming, China
| | - Liang He
- Anesthesiology, Yan'an Hospital of Kunming City, Kunming, China
| |
Collapse
|
19
|
Click B, Cross RK, Regueiro M, Keefer L. The IBD Clinic of Tomorrow: Holistic, Patient-Centric, and Value-based Care. Clin Gastroenterol Hepatol 2024:S1542-3565(24)00634-7. [PMID: 39025251 DOI: 10.1016/j.cgh.2024.04.042] [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: 02/28/2024] [Revised: 04/17/2024] [Accepted: 04/23/2024] [Indexed: 07/20/2024]
Abstract
There is increasing recognition of the associated bi-directional impact of inflammatory bowel disease (IBD) on patient well-being and the potential benefit of multidisciplinary teams to address these unique needs. At certain IBD centers, there has been an evolution towards patient-centric, holistic care to enhance well-being and improve health-related outcomes. Multiple models, incorporating various disciplines, care modalities, digital tools and care delivery, and resource support have arisen in IBD. Although most IBD centers of excellence are now incorporating such multidisciplinary care models, many practices still practice IBD-limited specialty care, limiting evaluations and interventions to the IBD itself and its direct consequences (eg, extraintestinal manifestations). In this piece, we seek to review the evolution of IBD care towards a patient-centric, holistic model (termed 360 IBD Care) including the role and impact of digital health tools, monitoring, and delivery in IBD, and a shift towards value-based care models with discussion of payor priorities in IBD. We also suggest potential opportunities for IBD practitioners to incorporate elements of holistic care on a local scale. Together, we hope such care models will enhance not only IBD-specific health outcomes, but also improve the general well-being of our patients with IBD today and tomorrow.
Collapse
Affiliation(s)
- Benjamin Click
- Division of Gastroenterology and Hepatology, University of Colorado School of Medicine, Aurora, Colorado.
| | - Raymond K Cross
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Miguel Regueiro
- Digestive Diseases Institute, Cleveland Clinic, Cleveland, Ohio
| | - Laurie Keefer
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| |
Collapse
|
20
|
Zertal A, Alami Marrouni K, Arbour N, Jutras-Aswad D, Pomey MP, Rouleau I, Prat A, Larochelle C, Beaulieu P, Chamelian L, Sylvestre MP, Morin D, Ouellette JS, Fréjeau N, Duquette P. Efficacy of cannabinoids compared to the current standard treatments on symptom relief in persons with multiple sclerosis (CANSEP trial): study protocol for a randomized clinical trial. Front Neurol 2024; 15:1440678. [PMID: 39114536 PMCID: PMC11303178 DOI: 10.3389/fneur.2024.1440678] [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: 05/29/2024] [Accepted: 07/10/2024] [Indexed: 08/10/2024] Open
Abstract
Background Multiple sclerosis (MS) is an inflammatory and degenerative disease of the central nervous system. More than 90,000 Canadians are affected; a cure is yet to be found. Available treatments to manage the disease course are only partially effective. For many years, persons with MS (PwMS) have used cannabis to relax, to reduce pain and spasticity, or to improve sleep and daily functioning, despite the lack of scientific evidence on the efficacy of specific cannabinoids [i.e., tetrahydrocannabinol (THC) and cannabidiol (CBD)] on these MS symptoms. The purpose of this clinical trial is to assess the effectiveness of different doses of these cannabinoids, alone or combined, on spasticity relief, compared to placebo. Moreover, we aim to determine which treatment is best effective to address other key MS conditions. Methods A double-blinded, randomized, factorial, placebo-controlled trial will be performed. We intend to include up to 250 PwMS aged over 21 recruited from the Centre hospitalier de l'Université de Montréal MS Clinic. PwMS will be randomly assigned on a 1:1:1:1 ratio to one of the trial arms: THC alone, CBD alone, THC/CBD combination, or placebo, using stratified blocked randomization, with random blocks within each stratum. The primary outcome is a self-assessment of spasticity using the mean Numeric Rating Scale score over 7 days. The main outcome will be the difference in this score at 4 weeks compared to baseline. Secondary outcomes include assessments of spasticity as measured by a clinician, pain, fatigue, sleep, bowel, bladder, and sexual dysfunction, restless legs syndrome, mental health, quality of life, mobility, cognitive functioning, and adverse events. Treatment responders are eligible for a 12-week extension phase, using the same treatment allocation and assessments. Discussion Previous clinical studies examined the efficacy of cannabis-based medicines in PwMS, mostly using products with 1:1 THC/CBD ratio. The major barrier to effectively use cannabis in real-world clinical settings is the lack of evidence on benefits of specific cannabinoids and information on possible related risks. The CANSEP study will contribute to overcome these limitations and identify the risks and benefits of cannabis-based treatments in PwMS. Clinical trial registration ClinicalTrials.Gov, NCT05092191.
Collapse
Affiliation(s)
- Amel Zertal
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - Kanza Alami Marrouni
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Département de Neurosciences, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
| | - Nathalie Arbour
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Département de Neurosciences, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
| | - Didier Jutras-Aswad
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Département de Psychiatrie et d’addictologie, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
- Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC, Canada
| | - Marie-Pascale Pomey
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Département de Gestion, d’évaluation et de politique de santé, École de santé publique, Université de Montréal, Montreal, QC, Canada
- Centre d’Excellence sur le Partenariat avec les Patients et le Public, Université de Montréal, Montreal, QC, Canada
| | - Isabelle Rouleau
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Département de Psychologie, Faculté des Sciences Humaines, Université du Québec à Montréal, Montreal, QC, Canada
| | - Alexandre Prat
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Département de Neurosciences, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
- Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC, Canada
| | - Catherine Larochelle
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Département de Neurosciences, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
- Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC, Canada
| | - Pierre Beaulieu
- Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC, Canada
- Département d'anesthésiologie et de Médecine de la Douleur, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
- Département de Pharmacologie et Physiologie, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
| | - Laury Chamelian
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Département de Neurosciences, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
- Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC, Canada
| | - Marie-Pierre Sylvestre
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Département de Médecine Sociale et Préventive, École de Santé Publique, Université de Montréal, Montreal, QC, Canada
| | - Danielle Morin
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - Jean-Sylvain Ouellette
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- MS Canada, Toronto, ON, Canada
| | - Nathalie Fréjeau
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - Pierre Duquette
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Département de Neurosciences, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
- Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC, Canada
| |
Collapse
|
21
|
Rahnea-Nita RA, Rebegea LF, Toma RV, Nechifor A, Constantin GB, Rahnea-Nita G. Complete Favorable Response after Second-Line Immunotherapy in Stage IV Non-Small Lung Cancer with Visceral Metastases and Operated Brain Metastasis. J Pers Med 2024; 14:754. [PMID: 39064008 PMCID: PMC11278410 DOI: 10.3390/jpm14070754] [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: 05/30/2024] [Revised: 07/12/2024] [Accepted: 07/13/2024] [Indexed: 07/28/2024] Open
Abstract
INTRODUCTION Patients with non-small cell lung cancer (NSCLC) and brain metastatic disease have an unfavorable prognosis. The goal of the treatment in stage IV NSCLC is to increase the survival rate and to improve the quality of life. CASE REPORT We present the case of a young male patient (47 years old at the time of diagnosis in 2021) with NSCLC stage IV with the onset of the disease through neurological symptoms determined by brain metastasis. The immunohistochemical result raised problems of differential diagnosis. The complete favorable response was obtained 20 months after the initiation of second-line immunotherapy, maintaining this response 6 months later. DISCUSSION The therapeutic approach for the second-line treatment of patients with metastatic non-small cell lung cancer (NSCLC) without mutations has been revolutionized by the approval of immune-checkpoint inhibitors (ICIs). The combination of radiotherapy and immunotherapy can increase the abscopal phenomenon by the stimulation of an immune response against tumors at distant sites, outside the radiation field, as recent studies suggest. CONCLUSIONS Second-line immunotherapy is beneficial to the survival of patients with NSCLC with disease progression beyond initial chemotherapy. The combination of radiotherapy and immunotherapy has the potential to play an important role in metastatic NSCLC.
Collapse
Affiliation(s)
- Roxana-Andreea Rahnea-Nita
- Clinical Department, Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania; (R.-A.R.-N.); (R.-V.T.)
- Oncology-Palliative Care Department, “Sf. Luca” Chronic Diseases Hospital, 041915 Bucharest, Romania;
| | - Laura-Florentina Rebegea
- Clinical Department, Faculty of Medicine and Pharmacy, “Dunarea de Jos” University, 800008 Galati, Romania; (L.-F.R.); (A.N.)
- Radiotherapy Department, “Sf. Ap. Andrei” County Emergency Clinical Hospital, 800579 Galati, Romania
| | - Radu-Valeriu Toma
- Clinical Department, Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania; (R.-A.R.-N.); (R.-V.T.)
- The Radiotherapy Department, Oncological Institute “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
| | - Alexandru Nechifor
- Clinical Department, Faculty of Medicine and Pharmacy, “Dunarea de Jos” University, 800008 Galati, Romania; (L.-F.R.); (A.N.)
| | - Georgiana Bianca Constantin
- Morphological and Functional Sciences Department, Faculty of Medicine and Pharmacy, “Dunarea de Jos” University, 800008 Galati, Romania
| | - Gabriela Rahnea-Nita
- Oncology-Palliative Care Department, “Sf. Luca” Chronic Diseases Hospital, 041915 Bucharest, Romania;
- Clinical Department, Faculty of Midwifery and Nursing, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
| |
Collapse
|
22
|
Fillies B, Stapel B, Lemke LH, Löffler F, Bauersachs J, Kahl KG, Westhoff-Bleck M. Remission from depression is associated with improved quality of life and preserved exercise capacity in adults with congenital heart disease. Front Cardiovasc Med 2024; 11:1418342. [PMID: 39022619 PMCID: PMC11251921 DOI: 10.3389/fcvm.2024.1418342] [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: 04/16/2024] [Accepted: 06/17/2024] [Indexed: 07/20/2024] Open
Abstract
Aims Improved long-term survival has widened the treatment goals for adults with congenital heart disease (ACHD) by addressing parameters that impact mental well-being and exercise capacity. Depression, a frequent co-morbidity in ACHD, is linked to both. Whether successful treatment of depression also affects cardiac parameters is a matter of debate. Methods This prospective, cross-sectional, longitudinal study included N = 150 ACHD (mean age 35.2 ± 11.3 years, 57% male) at baseline (t0) and N = 114 at follow-up (mean follow-up: 4.8 ± 0.6 years; t1). Patients were interviewed using a structured clinical interview, and severity of depression was assessed using the Montgomery-Asperg Depression Scale (MADRS). Additional testing was performed using self-rating questionnaires concerning depression, anxiety and quality of life (QoL). Exercise capacity (VO2max) was assessed by symptom limited exercise testing. Results Of N = 33 patients diagnosed with depression at t0, N = 18 patients remitted and N = 15 were non-remitters. Remitters displayed significantly decreased anxiety (P = 0.013), improved global QoL (P = 0.002), and preserved VO2max (P = 0.958) at t1 compared to t0. This was associated with favourable health behaviour at t1 and stable body-mass-index. Contrarily, non-remitters reported further increased anxiety (P = 0.021) and no significant improvement in QoL (P = 0.405). VO2max declined significantly (P = 0.006) and body-mass-index increased (P = 0.004). Never-depressed patients showed no significant changes in anxiety (P = 0.415) or QoL (P = 0.211). VO2max decreased significantly (P < 0.001). Conclusion In ACHD, remission from depression is associated with better physical functioning, mental health, and QoL. The assessment and treatment of depression in ACHD emerges as an important clinical goal that should be included in a comprehensive multimodal treatment plan.
Collapse
Affiliation(s)
- Brit Fillies
- Department of Cardiology and Angiology, Hannover Medical School, Hanover, Germany
| | - Britta Stapel
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Lars H. Lemke
- Department of Cardiology and Angiology, Hannover Medical School, Hanover, Germany
| | - Friederike Löffler
- Department of Cardiology and Angiology, Hannover Medical School, Hanover, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hanover, Germany
| | - Kai G. Kahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | | |
Collapse
|
23
|
Atchison K, Wu P, Samii L, Walsh M, Ismail Z, Iaboni A, Goodarzi Z. Detection of anxiety symptoms and disorders in older adults: a diagnostic accuracy systematic review. Age Ageing 2024; 53:afae122. [PMID: 38954435 DOI: 10.1093/ageing/afae122] [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: 12/12/2023] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Anxiety symptoms and disorders are common in older adults and often go undetected. A systematic review was completed to identify tools that can be used to detect anxiety symptoms and disorders in community-dwelling older adults. METHODS MEDLINE, Embase and PsycINFO were searched using the search concepts anxiety, older adults and diagnostic accuracy in March 2023. Included articles assessed anxiety in community-dwelling older adults using an index anxiety tool and a gold standard form of anxiety assessment and reported resulting diagnostic accuracy outcomes. Estimates of pooled diagnostic accuracy outcomes were completed. RESULTS Twenty-three anxiety tools were identified from the 32 included articles. Pooled diagnostic accuracy outcomes were estimated for the Geriatric Anxiety Inventory (GAI)-20 [n = 3, sensitivity = 0.89, 95% confidence interval (CI) = 0.70-0.97, specificity = 0.80, 95% CI = 0.67-0.89] to detect generalized anxiety disorder (GAD) and for the GAI-20 (n = 3, cut off ≥ 9, sensitivity = 0.74, 95% CI = 0.62-0.83, specificity = 0.96, 95% CI = 0.74-1.00), Beck Anxiety Inventory (n = 3, sensitivity = 0.70, 95% CI = 0.58-0.79, specificity = 0.60, 95% CI = 0.51-0.68) and Hospital Anxiety and Depression Scale (HADS-A) (n = 3, sensitivity = 0.78, 95% CI = 0.60-0.89, specificity = 0.76, 95% CI = 0.60-0.87) to detect anxiety disorders in clinical samples. CONCLUSION The GAI-20 was the most studied tool and had adequate sensitivity while maintaining acceptable specificity when identifying GAD and anxiety disorders. The GAI-20, GAI-Short Form and HADS-A tools are supported for use in detecting anxiety in community-dwelling older adults. Brief, self-rated and easy-to-use tools may be the best options for anxiety detection in community-dwelling older adults given resource limitations. Clinicians may consider factors including patient comorbidities and anxiety prevalence when selecting a tool and cut off.
Collapse
Affiliation(s)
- Kayla Atchison
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Pauline Wu
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Leyla Samii
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Michael Walsh
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Zahinoor Ismail
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Andrea Iaboni
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Zahra Goodarzi
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
24
|
Zhao Q, Wang Z, Yang C, Chen H, Zhang Y, Zeb I, Wang P, Wu H, Xiao Q, Xu F, Bian Y, Xiang N, Qiu M. Anxiety symptoms without depression are associated with cognitive control network (CNN) dysfunction: An fNIRS study. Psychophysiology 2024; 61:e14564. [PMID: 38487932 DOI: 10.1111/psyp.14564] [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: 07/03/2023] [Revised: 11/21/2023] [Accepted: 01/20/2024] [Indexed: 06/06/2024]
Abstract
Anxiety is a common psychological disorder associated with other mental disorders, with depression being the most common comorbidity. Few studies have examined the neural mechanisms underlying anxiety after controlling for depression. This study aimed to explore whether there are differences in cortical activation in anxiety patients with different severities whose depression are normal. In the current study, depression levels were normal for 366 subjects-139 healthy subjects, 117 with mild anxiety, and 110 with major anxiety. Using the Hospital Anxiety and Depression Scale (HADS) and a verbal fluency task (VFT) to test subjects' anxiety and depression and cognitive function, respectively. A 53-channel guided near-infrared spectroscopic imaging technology (fNIRS) detected the concentration of oxyhemoglobin (oxy-Hb). Correlation analysis between anxiety severity and oxy-Hb concentration in the brain cortex was performed, as well as ANOVA analysis of oxy-Hb concentration among the three anxiety severity groups. The results showed that anxiety severity was significantly and negatively correlated with oxy-Hb concentrations in the left frontal eye field (lFEF) and in the right dorsolateral prefrontal area (rDLPFC). The oxy-Hb concentration in the lFEF and the rDLPFC were significantly lower in the major anxiety disorder group than that in the control group. This suggests that decreased cortical activity of the lFEF and rDLPFC may be neural markers of anxiety symptoms after controlling for depression. Anxiety symptoms without depression may be result from the dysfunction of the cognitive control network (CCN) which includes the lFEF and rDLPFC.
Collapse
Affiliation(s)
- Qinqin Zhao
- Dean's Office, MianYang Teachers' College, Mianyang, China
| | - Zheng Wang
- School of Education, Huazhong University of Science and Technology, Wuhan, China
| | - Caihong Yang
- School of Psychology, Central China Normal University, Wuhan, China
| | - Han Chen
- President Office, MianYang Teachers' College, Mianyang, China
| | - Yan Zhang
- School of Education, Huazhong University of Science and Technology, Wuhan, China
| | - Irum Zeb
- School of Education, Huazhong University of Science and Technology, Wuhan, China
| | - Pu Wang
- Department of Rehabilitation Medicine, The seventh Affiliated Hospital Sun Yat-sen University, Shenzhen, China
- Guangdong Engineering and Technology Research Center for Rehabilitation Medicine and Translation, Guangzhou, China
| | - Huifen Wu
- School of education, Hubei Engineering University, Xiaogan, Hubei, China
| | - Qiang Xiao
- Hospital of Huazhong University of Science and Technology, Wuhan, China
| | - Fang Xu
- Hospital of Huazhong University of Science and Technology, Wuhan, China
| | - Yueran Bian
- School of Education, Huazhong University of Science and Technology, Wuhan, China
| | - Nian Xiang
- Hospital of Huazhong University of Science and Technology, Wuhan, China
| | - Min Qiu
- Hospital of Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
25
|
Cassuriaga J, Feter N, da Silva LS, Feter J, Delpino FM, Rocha JQS, Vieira YP, Caputo EL, Reichert FF, da Silva MC, Rombaldi AJ. Exercise as medicine! Physical activity mitigated the impact of the COVID-19 pandemic on depressive symptoms in adults with depression. J Psychiatr Res 2024; 175:153-159. [PMID: 38735260 DOI: 10.1016/j.jpsychires.2024.05.031] [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: 04/12/2023] [Revised: 02/09/2024] [Accepted: 05/08/2024] [Indexed: 05/14/2024]
Abstract
We investigated the longitudinal association between physical activity (PA) and symptoms of depression and anxiety in people with depression during the COVID-19 pandemic. We used data from baseline (June 2020) to wave 3 (June 2021) of the PAMPA Cohort, an ambispective cohort with adults in south Brazil. The Hospital Anxiety and Depression Scale assessed depressive and anxiety symptoms in all waves. Participants reported frequency (minutes), type (aerobic, strength, combined), and place (out of home, at home) of physical activity at baseline. Generalized linear models were used to investigate the interaction between time and PA, adjusting for possible confounding variables. Subjective memory decline was assessed using multivariate Cox proportional hazard regression models to obtain adjusted hazard ratio (HR) and respective 95% confidence interval (CI). Participants (n = 424) with self-reported clinically diagnosed depression were included. We observed a non-linear increase trajectory of depression during the first year of the COVID-19 pandemic. PA was associated with a slower trajectory of depressive (slope: -1.89; 95%CI: -3.34, -0.43 points) but not anxiety (slope: -1.33; 95%CI: -2.93, 0.25 points) symptoms during the COVID-19 pandemic. Participants who continued physically active from pre-pandemic in wave 1 showed a lower risk of subjective memory decline during follow-up than those who persisted inactive in the same period (HR: 0.52; 95%CI: 0.30, 0.89). PA attenuated the impact of the COVID-19 pandemic on depressive symptoms in adults living with depression in south Brazil. Regularity of physical activity was associated with fewer depression and anxiety symptoms and a lower risk of subjective memory decline.
Collapse
Affiliation(s)
- Julia Cassuriaga
- Postgraduate Program Multicenter in Physiological Sciences, Universidade Federal de Pelotas, Brazil; Postgraduate Program in Physical Education, School of Physical Education, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Natan Feter
- Postgraduate Program in Epidemiology, School of Medicine, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil.
| | - Luísa Silveira da Silva
- Postgraduate Program in Epidemiology, School of Medicine, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Jayne Feter
- Postgraduate Program in Health Sciences, School of Medicine, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
| | | | - Juliana Quadros Santos Rocha
- Postgraduate Programme in Health Sciences, Federal University of Rio Grande, Rio Grande, Rio Grande do Sul, Brazil
| | - Yohana Pereira Vieira
- Postgraduate Programme in Health Sciences, Federal University of Rio Grande, Rio Grande, Rio Grande do Sul, Brazil
| | - Eduardo Lucia Caputo
- Postgraduate Programme in Health Sciences, Federal University of Rio Grande, Rio Grande, Rio Grande do Sul, Brazil
| | - Felipe Fossati Reichert
- Postgraduate Program in Physical Education, School of Physical Education, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Marcelo Cozzensa da Silva
- Postgraduate Program in Physical Education, School of Physical Education, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Airton José Rombaldi
- Postgraduate Program in Physical Education, School of Physical Education, Universidade Federal de Pelotas, Pelotas, Brazil
| |
Collapse
|
26
|
Wu Q, Daniels M, El-Jawahri A, Bakitas M, Li Z. Joint modeling in presence of informative censoring on the retrospective time scale with application to palliative care research. Biostatistics 2024; 25:754-768. [PMID: 37805939 PMCID: PMC11247190 DOI: 10.1093/biostatistics/kxad028] [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: 10/25/2022] [Revised: 07/02/2023] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
Joint modeling of longitudinal data such as quality of life data and survival data is important for palliative care researchers to draw efficient inferences because it can account for the associations between those two types of data. Modeling quality of life on a retrospective from death time scale is useful for investigators to interpret the analysis results of palliative care studies which have relatively short life expectancies. However, informative censoring remains a complex challenge for modeling quality of life on the retrospective time scale although it has been addressed for joint models on the prospective time scale. To fill this gap, we develop a novel joint modeling approach that can address the challenge by allowing informative censoring events to be dependent on patients' quality of life and survival through a random effect. There are two sub-models in our approach: a linear mixed effect model for the longitudinal quality of life and a competing-risk model for the death time and dropout time that share the same random effect as the longitudinal model. Our approach can provide unbiased estimates for parameters of interest by appropriately modeling the informative censoring time. Model performance is assessed with a simulation study and compared with existing approaches. A real-world study is presented to illustrate the application of the new approach.
Collapse
Affiliation(s)
- Quran Wu
- Department of Biostatistics, 2004 Mowry Rd, University of Florida, Gainesville, FL, 32610, USA
| | - Michael Daniels
- Department of Statistics, 102 Griffin-Floyd Hall, University of Florida, Gainesville, FL, 32611, USA
| | - Areej El-Jawahri
- Department of Oncology, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
| | - Marie Bakitas
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
| | - Zhigang Li
- Department of Biostatistics, 2004 Mowry Rd, University of Florida, Gainesville, FL, 32610, USA
| |
Collapse
|
27
|
Fjone KS, Stubberud J, Buanes EA, Hagen M, Laake JH, Hofsø K. Objective and subjective cognitive status after intensive care unit treatment for COVID-19. Brain Behav Immun Health 2024; 38:100786. [PMID: 38770194 PMCID: PMC11103414 DOI: 10.1016/j.bbih.2024.100786] [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: 01/12/2024] [Revised: 04/13/2024] [Accepted: 05/02/2024] [Indexed: 05/22/2024] Open
Abstract
Purpose Intensive care unit (ICU) survivors can experience wide-ranging and long-lasting symptoms after hospital discharge. Cognitive impairment has received increased attention in relation to the COVID-19 pandemic and can affect patients' long-term quality of life. This study aimed to investigate the prevalence of cognitive impairment using an objective neurocognitive test 6 and 12 months following ICU admission and possible predictive factors for scoring below the defined cut-off. We also explored the prevalence of subjective cognitive complaints at 12 months, including the associated factors. Methods This was a prospective observational study of a national cohort of COVID-19 ICU survivors during the three first pandemic waves in Norway. Data was collected by the Norwegian Intensive Care and Pandemic Registry and the study group. Results At the six-month follow-up, 23.1% (95% CI [18.2─28.5]) of the 273 respondents scored below the cut-off on the Mini-MoCA, indicating mild cognitive impairment. At the 12-month follow-up, the prevalence declined to 11.1% (95% CI [7.5─15.6]) in 253 respondents. Older age (OR 1.06, 95% CI [1.02─1.12]) and depression (OR 1.25, 95% CI [1.07─1.55]) were associated with cognitive impairment at six months. At 12 months, almost half of the patients reported subjective cognitive complaints. Symptoms of mental health problems and fatigue were associated with subjective cognitive complaints in our exploratory analyses. Conclusion Cognitive impairment declined significantly from 6 to 12 months in this cohort of COVID-19 ICU patients, while subjective cognitive complaints remained high at 12 months, perhaps attributed to a high total symptom burden.
Collapse
Affiliation(s)
- Kristina Struksnes Fjone
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Department of Public Health, Oslo Metropolitan University, Oslo, Norway
- Section for Physiotherapy, Department of Clinical Services, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
| | - Jan Stubberud
- Department of Psychology, University of Oslo, Oslo, Norway
- Department of Research, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Eirik Alnes Buanes
- Norwegian Intensive Care and Pandemic Registry, Haukeland University Hospital, Bergen, Norway
| | - Milada Hagen
- Department of Public Health, Oslo Metropolitan University, Oslo, Norway
| | - Jon Henrik Laake
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Department of Anaesthesia and Intensive Care Medicine, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Kristin Hofsø
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Department of Postoperative and Intensive Care Nursing, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Lovisenberg Diaconal University College, Oslo, Norway
| |
Collapse
|
28
|
Fuller LM, Whitford HM, Robinson R, Cristiano Y, Steward R, Poulsen M, Paul E, Snell G. What Happens to Frailty in the First Year After Lung Transplantation? Clin Transplant 2024; 38:e15393. [PMID: 39023090 DOI: 10.1111/ctr.15393] [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: 07/02/2023] [Revised: 05/23/2024] [Accepted: 06/13/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Frailty is prevalent in lung transplant (LTx) candidates, but the impact and subsequent frailty trajectory is unclear. This study aimed to investigate frailty over the first year after LTx. METHOD Post-LTx recipients completed a thrice weekly 12-week directly supervised exercise rehabilitation program. Edmonton Frail Scale (EFS) was used to assess frailty. Primary outcome was 6-Minute Walk Distance (6MWD) measured at pre-LTx, prerehabilitation, postrehabilitation, and 1 year post-LTx. RESULTS 106 of 139 recruited participants underwent LTx: mean age 58 years, 48% male, 52% with chronic obstructive pulmonary disease. Mean (± SD) frailty scores pre-LTx and 1 year post-LTx were 5.54 ± 2.4 and 3.28 ±1.5. Mean 6MWD improved significantly for all: prerehabilitation 326 m (SD 116), versus postrehabilitation 523 m (SD 101) (p < 0.001) versus 1 year 512 m (SD 120) (p < 0.001). There were significant differences between an EFS > 7 (frail) and EFS ≤ 7 (not frail) for 6MWD, grip strength (GS), anxiety, and depression. Postrehabilitation, there were no significant differences in 6MWD, GS, anxiety, or depression while comparing EFS > 7 versus ≤ 7. At 1 year, there was a significant difference in depression but not 6MWD, GS, or anxiety between those EFS ≤ 7 and > 7 (p = 0.017). CONCLUSION Participants in a structured post-LTx rehabilitation program improved in functional exercise capacity (6MWD), GS, depression, and anxiety. For frail participants exercise capacity, depression, anxiety, and GS were well managed in rehabilitation with no significant differences between those who were not frail. Pre-LTx frailty may be reversible post-LTx and should not be an absolute contraindication to LTx.
Collapse
Affiliation(s)
- Louise Mary Fuller
- Physiotherapy Department, The Alfred Hospital, Melbourne, Victoria, Australia
- Respiratory Department, Lung Transplant, The Alfred Hospital, Melbourne, Victoria, Australia
- Department of Physiotherapy, Swinburne University, Hawthorn, Victoria, Australia
| | - Helen M Whitford
- Respiratory Department, Lung Transplant, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Rebecca Robinson
- Physiotherapy Department, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Yvie Cristiano
- Respiratory Department, Lung Transplant, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Ranjana Steward
- Physiotherapy Department, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Megan Poulsen
- Physiotherapy Department, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Eldho Paul
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- The Alfred Hospital, Melbourne, Victoria, Australia
| | - Greg Snell
- Respiratory Department, Lung Transplant, The Alfred Hospital, Melbourne, Victoria, Australia
| |
Collapse
|
29
|
Steverson T, Marsden J, Blake J. The reliability, validity and clinical utility of the Clinical Outcomes in Routine Evaluation - ten-item version (CORE-10) in post-acute patients with stroke. Clin Rehabil 2024; 38:944-954. [PMID: 38439657 PMCID: PMC11118775 DOI: 10.1177/02692155241236602] [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: 08/16/2023] [Accepted: 02/14/2024] [Indexed: 03/06/2024]
Abstract
OBJECTIVE To explore the validity, reliability, and clinical utility of the Clinical Outcomes in Routine Evaluation - ten-item version (CORE-10: a ten-item questionnaire designed to measure psychological distress) in a stroke inpatient sample and calculate reliable and clinically significant change scores. SETTING A post-acute stroke rehabilitation ward in the East of England. PARTICIPANTS A total of 53 patients with stroke, capable of completing the CORE-10 as part of their routine clinical assessment. Exclusion criteria included moderate to severe aphasia and/or alexia. MAIN MEASURES Alongside the CORE-10, the Patient Health Questionnaire - 9, the Hospital Anxiety and Depression Scale, the Centre for Epidemiological Studies-Depression Scale, and the Beck Depression Inventory Second Edition were used as concurrent measures. RESULTS To assess reliability, the internal consistency and test-retest reliability of the CORE-10 were calculated. The average number of days between CORE-10 test-retest administrations was 2.84 (SD = 3.12, Mdn = 1). Concurrent validity was assessed by examining correlations between the CORE-10 and comparable measures, and clinical utility was assessed using the criteria of Burton and Tyson (2015). The internal consistency (Cronbach's alpha) for the CORE-10 was .80, and test-retest reliability interclass correlation coefficient was .81. Total score correlations between the CORE-10 and concurrent measures ranged from r = .49 to r = .89. The CORE-10 achieved the maximum score (i.e. 6/6) on criteria for clinical utility. Calculations demonstrated a reliable change index of nine points and a clinically significant change cut point of 12 on the CORE-10. Percentiles for CORE-10 total scores are reported. CONCLUSIONS This study provides preliminary support for the CORE-10 as a valid and reliable measure that has clinical utility for screening distress in inpatients with stroke.
Collapse
Affiliation(s)
| | | | - Joshua Blake
- University of East Anglia, UK
- Norfolk Community Health and Care NHS Trust, UK
| |
Collapse
|
30
|
Dotevall H, Tuomi L, Lindell E, Finizia C. Long-term effects on swallowing and laryngeal function after treatment for severe COVID-19 disease in intensive care. Eur Arch Otorhinolaryngol 2024; 281:3679-3691. [PMID: 38642087 PMCID: PMC11211183 DOI: 10.1007/s00405-024-08648-3] [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: 11/10/2023] [Accepted: 03/28/2024] [Indexed: 04/22/2024]
Abstract
PURPOSE This study aimed to assess swallowing and laryngeal function at long-term follow-up in patients treated for severe COVID-19 in the ICU. METHODS Thirty-six patients with severe COVID-19 were prospectively examined with fiberendoscopic evaluation of swallowing (FEES) about 6 and 12 months after ICU discharge. Comparison with initial FEES examinations during the time in hospital was performed in 17 patients. Analysis of swallowing function and laryngeal features was performed from video recordings. Twenty-five participants responded to Eating Assessment Tool, Voice Handicap Index, and the Hospital Anxiety and Depression Scale at follow-up. RESULTS Penetration to the laryngeal vestibule (PAS ≥ 3) was seen in 22% and silent aspiration (PAS = 8) in 11% of patients on at least one swallow at follow-up. Fourteen percent had obvious residue in the vallecula and/or pyriform sinuses after swallowing thick liquid or biscuits. Self-reported eating and swallowing difficulties were found in 40% of patients. Abnormal findings in the larynx were present in 53% at follow-up. Thirty-three percent had reduced or impaired vocal fold movement, of whom 22% had bilateral impaired abduction of the vocal folds. Possible anxiety and depression were found in 36% and 24% of responders, respectively. CONCLUSION Although a majority of patients appear to regain normal swallowing function by 1 year after treatment for severe COVID-19, our results indicate that dysphagia, abnormal laryngeal function, and anxiety/depression may remain in a substantial proportion of patients. This suggests that swallowing and laryngeal function, and emotional symptoms, should be followed up systematically over time in this patient group.
Collapse
Affiliation(s)
- Hans Dotevall
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Otorhinolaryngology, Head and Neck Surgery, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Lisa Tuomi
- Department of Otorhinolaryngology, Head and Neck Surgery, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden.
- Institute of Neuroscience and Physiology, Speech and Language Pathology Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Ellen Lindell
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Research, Education and Innovation, Södra Älvsborgs Hospital, Region Västra Götaland, Borås, Sweden
| | - Caterina Finizia
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Otorhinolaryngology, Head and Neck Surgery, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| |
Collapse
|
31
|
Daynes E, Baldwin MM, Annals M, Gardiner N, Chaplin E, Ward S, Greening NJ, Evans RA, Singh SJ. Changes in fatigue symptoms following an exercise-based rehabilitation programme for patients with long COVID. ERJ Open Res 2024; 10:00089-2024. [PMID: 39040593 PMCID: PMC11261384 DOI: 10.1183/23120541.00089-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 04/11/2024] [Indexed: 07/24/2024] Open
Abstract
Background There is evidence to support COVID-19 rehabilitation programmes improving persistent COVID-19 symptoms; however, there is concern that therapies that include an exercise component may increase fatigue and post-exertional symptom exacerbation (PESE). The objectives of the present study were to determine the effect of a 6-week COVID-19 rehabilitation programme on fatigue and PESE in individuals with ongoing COVID-19 symptoms. Methods After a routine medical assessment, individuals with persistent COVID-19 symptoms were enrolled on a 6-week COVID-19 specific rehabilitation programme. The programme included symptom-titrated exercise, education and self-management advice. Fatigue was assessed pre- and post-programme using the Functional Assessment Chronic Illness Therapy Fatigue questionnaire (FACIT). Exercise capacity (Incremental and Endurance Shuttle Walking Test (ISWT and ESWT)) and PESE (DePaul Symptom Questionnaire (DSQ)) were also assessed pre- and post-programme. Composite scores were calculated for the frequency and severity domains of the DSQ. Results 148 patients (median (IQR) age 59 (49-72) years, 82 (55%) female, 81 (54%) hospitalised) completed the COVID-19 rehabilitation programme. FACIT score was reduced pre- to post-programme by a mean (CI) change of -5 (-7- -4); p<0.01. Exercise capacity increased by 82 (65-99) m for the ISWT and 398 (333-462) s for the ESWT (n=148). PESE was assessed in 44 patients. The DSQ frequency and severity composite score improved by 20 (13-28) and 19 (13-26) points, respectively (p<0.01, n=44). Conclusion These data demonstrate the potential benefits of a COVID-19 rehabilitation programme in improving fatigue, exercise capacity and symptom exacerbation in those with persistent COVID-19 symptoms.
Collapse
Affiliation(s)
- Enya Daynes
- Centre for Exercise and Rehabilitation Sciences, NIHR Leicester Biomedical Research Centre Respiratory, Leicester, UK
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Molly M. Baldwin
- Centre for Exercise and Rehabilitation Sciences, NIHR Leicester Biomedical Research Centre Respiratory, Leicester, UK
| | - Matthew Annals
- Centre for Exercise and Rehabilitation Sciences, NIHR Leicester Biomedical Research Centre Respiratory, Leicester, UK
| | - Nikki Gardiner
- Centre for Exercise and Rehabilitation Sciences, NIHR Leicester Biomedical Research Centre Respiratory, Leicester, UK
| | - Emma Chaplin
- Centre for Exercise and Rehabilitation Sciences, NIHR Leicester Biomedical Research Centre Respiratory, Leicester, UK
| | - Sarah Ward
- Centre for Exercise and Rehabilitation Sciences, NIHR Leicester Biomedical Research Centre Respiratory, Leicester, UK
| | - Neil J. Greening
- Centre for Exercise and Rehabilitation Sciences, NIHR Leicester Biomedical Research Centre Respiratory, Leicester, UK
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Rachael A. Evans
- Centre for Exercise and Rehabilitation Sciences, NIHR Leicester Biomedical Research Centre Respiratory, Leicester, UK
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Sally J. Singh
- Centre for Exercise and Rehabilitation Sciences, NIHR Leicester Biomedical Research Centre Respiratory, Leicester, UK
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| |
Collapse
|
32
|
Recchia F, Yu AP, Ng TC, Fong DY, Chan DK, Cheng CP, Hui SS, Wang C, Siu PM. Study protocol for a comparative randomized controlled trial of Tai Chi and conventional exercise training on alleviating depression in older insomniacs. J Exerc Sci Fit 2024; 22:194-201. [PMID: 38559906 PMCID: PMC10979278 DOI: 10.1016/j.jesf.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 03/01/2024] [Accepted: 03/08/2024] [Indexed: 04/04/2024] Open
Abstract
Background Insomnia and depression are prevalent mental disorders that are often comorbid among older adults. Lifestyle intervention strategies incorporating Tai Chi or conventional exercise have been shown to alleviate symptoms of insomnia and depression. However, the comparative efficacy of these exercise modalities in individuals with both disorders has yet to be determined. Therefore, the aim of this study is to examine the efficacy of Tai Chi and conventional exercise for reducing depressive symptoms in older adults with chronic insomnia and depressive symptoms, when compared to a health education control. Methods This study is a prospective, assessor-blinded, three-arm, parallel group, randomized controlled trial. Older adults aged ≥60 years with a diagnosis of chronic insomnia and depressive symptoms will be randomly assigned to a Tai Chi, conventional exercise or health education control condition on a 1:1:1 basis. Interventions will last for 3 months, with a 6-month follow-up period. The primary outcome is depressive symptoms, assessed using the Hospital Anxiety and Depression Scale. Secondary outcomes include subjective sleep quality, 7-day actigraphy, 7-day sleep diary, anxiety symptoms, quality of life, medication usage and physical function. All measurements will be conducted at baseline, 3 months and 9 months by outcome assessors who are blinded to group allocation. Discussion This study will compare the efficacy of Tai Chi and conventional exercise in improving depression outcomes in older adults with chronic insomnia and depressive symptoms. Our results will shed light on the clinical potential of these interventions for combating insomnia and depression in older adults.
Collapse
Affiliation(s)
- Francesco Recchia
- Division of Kinesiology, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong China
| | - Angus P. Yu
- Division of Kinesiology, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong China
| | - Teryn C. Ng
- Division of Kinesiology, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong China
| | - Daniel Y. Fong
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong China
| | - Derwin K.C. Chan
- Department of Early Childhood Education, Faculty of Education and Human Development, The Education University of Hong Kong, Hong Kong China
| | - Calvin P. Cheng
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong China
| | - Stanley S.C. Hui
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong China
| | - Chenchen Wang
- Division of Rheumatology, Allergy & Immunology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
- Center for Complementary and Integrative Medicine, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Parco M. Siu
- Division of Kinesiology, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong China
| |
Collapse
|
33
|
Batalha MJ, Gabriel T, Valentim A, Soledade A, Gomes C, Alves B, Dos Santos ES, Passadouro R, Dias SS. Health literacy - study protocol for LiSa cohort study. BMC Public Health 2024; 24:1737. [PMID: 38951815 PMCID: PMC11218293 DOI: 10.1186/s12889-024-19148-8] [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: 02/07/2023] [Accepted: 06/14/2024] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND Health literacy is the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others, whether at home, at the workplace, in the community, marketplace, healthcare sector, or the political arena. The main aim of this project is to measure health literacy in the adult population living in the municipality of Leiria over the next 10 years. As secondary objectives it is intended to characterize anxiety and depression, metabolic risk and health behaviors in the same population and over the same period. METHODS This is a prospective cohort study that collects data on HL, anxiety and depression, health characteristics, health behavior and sociodemographic data. The study population will be composed by adults (≥ 18 years old) who are non-institutionalized and living in private households in Leiria. The random sample is stratified by gender and age groups. A face-to-face interview will be conducted with the Computer Assisted Personal Interview at baseline. Follow-up will be carried out every 2 years via telephone call. The association between independent variables and health literacy is examined by means of variance analysis with measurement repetition, and taking into consideration follow-up. DISCUSSION The LiSa project is a population-based study, derived from a random sampling technique that will allow the analysis of health outcomes in a representative sample of the population of the municipality of Leiria. The LiSa study will be a valuable resource for epidemiological research, as it will provide fundamental information to improve public health policies regarding health literacy in Portugal. TRIAL REGISTRATION Clinical trials: NCT05558631 (registered on 26/09/2022).
Collapse
Affiliation(s)
- Maria João Batalha
- ciTechCare - Center for Innovative Care and Health Technology, Polytechnic of Leiria, Leiria, Portugal
| | - Tiago Gabriel
- Unidade Local de Saúde da Região de Leiria, Leiria, Portugal
| | | | | | - Cátia Gomes
- Câmara Municipal de Leiria, Leiria, Portugal
| | | | | | - Rui Passadouro
- ciTechCare - Center for Innovative Care and Health Technology, Polytechnic of Leiria, Leiria, Portugal
- Unidade Local de Saúde da Região de Leiria, Leiria, Portugal
| | - Sara Simões Dias
- ciTechCare - Center for Innovative Care and Health Technology, Polytechnic of Leiria, Leiria, Portugal.
- School of Health Sciences, Polytechnic of Leiria, Leiria, Portugal.
| |
Collapse
|
34
|
Klasova J, Hussain N, Umer I, Al-Hindawi A, ElSaban M, Lahori S, D'Souza RS. Emotional and psychosocial function after dorsal column spinal cord stimulator implantation: a systematic review and meta-analysis. Reg Anesth Pain Med 2024:rapm-2024-105523. [PMID: 38942426 DOI: 10.1136/rapm-2024-105523] [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: 03/30/2024] [Accepted: 06/08/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND The efficacy of spinal cord stimulation (SCS) in chronic pain studies is traditionally assessed by pain scores, which do not reflect the multidimensional nature of pain perception. Despite the evidence of SCS's influence on emotional functioning comprehensive assessments of its effect remain lacking. OBJECTIVE To assess changes in emotional and psychosocial functioning in patients who underwent SCS implantation for chronic pain. EVIDENCE REVIEW Ovid MEDLINE, EMBASE, PsychINFO, Cochrane CENTRAL and Scopus databases were searched for original peer-reviewed publications reporting emotional functioning after SCS. The primary outcomes were a pooled mean difference (MD) in anxiety, depression, global functioning, mental well-being and pain catastrophizing at 12 months. The Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) was used to determine the quality of evidence. FINDINGS Thirty-two studies were included in the primary analysis. Statistically significant improvements were observed in anxiety (MD -2.16; 95% CI -2.84 to -1.49; p<0.001), depression (MD -4.66; 95% CI -6.26 to -3.06; p<0.001), global functioning (MD 20.30; 95% CI 14.69 to 25.90; p<0.001), mental well-being (MD 4.95; 95% CI 3.60 to 6.31; p<0.001), and pain catastrophizing (MD -12.09; 95% CI -14.94 to -9.23; p<0.001). Subgroup analyses revealed differences in Global Assessment of Functioning and mental well-being based on study design and in depression based on waveform paradigm. CONCLUSION The results highlight the statistically and clinically significant improvements in emotional and psychosocial outcomes in patients with chronic pain undergoing SCS therapy. However, these results need to be interpreted with caution due to the very low certainty of evidence per the GRADE criteria. PROSPERO REGISTRATION CRD42023446326.
Collapse
Affiliation(s)
- Johana Klasova
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Nasir Hussain
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Ibrahim Umer
- Department of Anesthesiology, St Joseph's University Medical Center, Paterson, New Jersey, USA
| | - Ahmed Al-Hindawi
- Royal College of Surgeons in Ireland Medical University of Bahrain, Al Muharraq, Bahrain
| | - Mariam ElSaban
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Simmy Lahori
- Department of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan S D'Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
35
|
Dove L, Baskozos G, Kelly T, Buchanan E, Schmid AB. Prevalence of weakness and factors mediating discrepancy between reported and observed leg weakness in people with sciatica. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024:10.1007/s00586-024-08330-6. [PMID: 38910169 DOI: 10.1007/s00586-024-08330-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 04/03/2024] [Accepted: 05/23/2024] [Indexed: 06/25/2024]
Abstract
PURPOSE To establish the prevalence and agreement between reported and observed leg weakness in people with sciatica. To establish which factors mediate any identified difference between reported and observed leg weakness in people with sciatica. METHODS 68 people with a clinical diagnosis of sciatica, records from spinal service, secondary care NHS Hospital, England, UK reviewed. Primary outcome measures were the sciatica bothersome index for reported leg weakness and the Medical Research Council scale for observed weakness. Agreement was established with Cohen's Kappa and intraclass correlation coefficient. Potential factors that may mediate a difference between reported and observed weakness included leg pain, sciatica bothersome index sensory subscale, age, hospital anxiety and depression subscale for anxiety. RESULTS 85% of patients reported weakness but only 34% had observed weakness. Cohen's Kappa (0.066, 95% CI - 0.53, 0.186; p = 0.317)] and ICC 0.213 (95% CI - 0.26, 0.428, p = 0.040) both showed poor agreement between reported and observed weakness. The difference between reported and observed measures of weakness was mediated by the severity of leg pain (b = 0.281, p = 0.024) and age (b = 0.253, p = 0.042). CONCLUSION There is a high prevalence of reported leg weakness in people with sciatica, which is not reflected in observed clinical measures of weakness. Differences between reported and observed weakness may be driven by the severity of leg pain and age. Further work needs to establish whether other objective measures can detect patient reported weakness.
Collapse
Affiliation(s)
- Lucy Dove
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, The University of Oxford, West Wing Level 6, Oxford, OX3 9DU, UK
- Oxford Spinal Surgery Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Georgios Baskozos
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, The University of Oxford, West Wing Level 6, Oxford, OX3 9DU, UK
| | - Thomas Kelly
- Integrated Pain and Spinal Service (IPASS), Berkshire Healthcare NHS Foundation Trust, Berkshire, UK
| | - Elaine Buchanan
- Oxford Spinal Surgery Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Annina B Schmid
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, The University of Oxford, West Wing Level 6, Oxford, OX3 9DU, UK.
| |
Collapse
|
36
|
Legrand A, Bernier MO, Bressand A, Buffet C, Mandin C, Menegaux F, Soret M, Broggio D, Bassinet C, Huet C, Leenhardt L, Lussey-Lepoutre C, Baudin C. Health-related quality of life and radioiodine therapy in thyroid cancer patients: a before-and-after study. Qual Life Res 2024:10.1007/s11136-024-03721-0. [PMID: 38907832 DOI: 10.1007/s11136-024-03721-0] [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: 06/17/2024] [Indexed: 06/24/2024]
Abstract
OBJECTIVE Thyroid cancers are on the rise, but the associated vital prognosis and long-term survival rates are very good. Therefore, treated patients' quality of life and psychological well-being are important considerations. The treatment usually involves surgery and radioactive iodine (radioiodine) ablation. This study aims to investigate potential effects of radioiodine ablation therapy on health-related quality of life, anxiety and depression symptoms, and nutritional status at 6 months post-therapy. METHODS This study included 136 patients diagnosed with thyroid cancer. Absorbed doses to the salivary glands were estimated from dosimeters worn by patients. Patient health-related quality of life, psychological status and nutritional status were assessed before and 6 months after therapy using standardized questionnaires (including SF-36, Hospital Anxiety and Depression (HAD) scale). Statistical analyses included random-effects logistic and linear regressions adjusted for potential confounders. RESULTS While no significant association was found between radioiodine exposure and anxiety or depression symptoms, or nutritional status, a significant increase in the SF-36 role physical sub- score was observed in relation with the salivary gland dose (β= 6.54, 95%CI 2.71;10.36 for a 1-Gy increase). CONCLUSIONS The findings suggest an improved physical health-related quality of life, namely reduced pain and functional impairment, 6 months after radioiodine therapy in thyroid cancer patients. No significant association was found between radioiodine exposure and mental health-related quality of life, anxiety or depression scores nor nutritional status. This study does not provide any evidence that radioiodine therapy has a potentially adverse effect on patient health-related quality of life.
Collapse
Affiliation(s)
- Alix Legrand
- Faculty of Medicine, School of Public Health, Sorbonne University, Paris, F-75013, France
- Ionizing Radiation Epidemiology Laboratory (LEPID), Institute for Radiological Protection and Nuclear Safety (IRSN), BP 17, Fontenay-aux-Roses, 92262, France
| | - Marie-Odile Bernier
- Ionizing Radiation Epidemiology Laboratory (LEPID), Institute for Radiological Protection and Nuclear Safety (IRSN), BP 17, Fontenay-aux-Roses, 92262, France
| | - Alice Bressand
- Ionizing Radiation Epidemiology Laboratory (LEPID), Institute for Radiological Protection and Nuclear Safety (IRSN), BP 17, Fontenay-aux-Roses, 92262, France
| | - Camille Buffet
- Thyroid disease and Endocrine Tumor Department, Sorbonne University, Pitié Salpêtrière Hospital AP-HP, Paris, F- 75013, France
- Sorbonne University, Groupe de recherche Clinique Tumeurs Thyroïdiennes n°16, Paris, F-75013, France
- Biomedical Imaging Laboratory, Sorbonne University, CNRS UMR 7371, INSERM U1146, LIB, Paris, F-75006, France
| | - Corinne Mandin
- Ionizing Radiation Epidemiology Laboratory (LEPID), Institute for Radiological Protection and Nuclear Safety (IRSN), BP 17, Fontenay-aux-Roses, 92262, France
| | - Fabrice Menegaux
- Department of General and Endocrine Surgery, Pitié Salpêtrière Hospital, Sorbonne University, AP-HP, Paris, F-75013, France
| | - Marine Soret
- Biomedical Imaging Laboratory, Sorbonne University, CNRS UMR 7371, INSERM U1146, LIB, Paris, F-75006, France
- Department of Nuclear Medicine, Pitié Salpêtrière Hospital, Sorbonne University, AP-HP, Paris, F-75013, France
| | - David Broggio
- Internal Dose Assessment Laboratory, Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France
| | - Céline Bassinet
- Ionizing Radiation Dosimetry Laboratory, Institut de Radioprotection et Sûreté Nucléaire, Fontenay-aux-Roses, France
| | - Christelle Huet
- Ionizing Radiation Dosimetry Laboratory, Institut de Radioprotection et Sûreté Nucléaire, Fontenay-aux-Roses, France
| | - Laurence Leenhardt
- Thyroid disease and Endocrine Tumor Department, Sorbonne University, Pitié Salpêtrière Hospital AP-HP, Paris, F- 75013, France
- Sorbonne University, Groupe de recherche Clinique Tumeurs Thyroïdiennes n°16, Paris, F-75013, France
| | - Charlotte Lussey-Lepoutre
- Sorbonne University, Groupe de recherche Clinique Tumeurs Thyroïdiennes n°16, Paris, F-75013, France
- Department of Nuclear Medicine, Pitié Salpêtrière Hospital, Sorbonne University, AP-HP, Paris, F-75013, France
- PARCC, INSERM, Equipe Labellisée par la Ligue contre le Cancer, Paris, F-75015, France
| | - Clémence Baudin
- Ionizing Radiation Epidemiology Laboratory (LEPID), Institute for Radiological Protection and Nuclear Safety (IRSN), BP 17, Fontenay-aux-Roses, 92262, France.
| |
Collapse
|
37
|
Grech J, Norman I, Azzopardi C, Grixti M, Sammut R. Assessing the feasibility and acceptability of a diabetes-specific nurse-led multicomponent smoking cessation intervention in diabetes education: study protocol for an open-label pragmatic randomised controlled trial. BMJ Open 2024; 14:e083235. [PMID: 38904126 PMCID: PMC11191808 DOI: 10.1136/bmjopen-2023-083235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 05/28/2024] [Indexed: 06/22/2024] Open
Abstract
INTRODUCTION Smoking cessation is an essential, but often overlooked aspect of diabetes management. Despite the need for tailored smoking cessation support for individuals with diabetes, evidence of effective interventions for this cohort is limited. Additionally, individuals with diabetes do not easily adopt such interventions, resulting in low uptake and abstinence rates. This protocol describes a study that aims to assess the feasibility and acceptability of a unique smoking cessation intervention, based on the best evidence, theory and the needs of individuals with diabetes, among patients and service providers, the diabetes nurse educators. METHODS AND ANALYSIS This is an open-label pragmatic randomised controlled trial. Between 80 and 100 individuals with type 1 or type 2 diabetes who smoke will be recruited from the diabetes outpatients at the main acute public hospital in Malta, starting in August 2023. Participants will be randomly assigned (1:1 ratio) to the intervention or control arm for 12 weeks. The experimental intervention will consist of three to four smoking cessation behavioural support sessions based on the 5As (Ask, Advise, Assess, Assist and Arrange) algorithm, and a 6-week supply of nicotine replacement therapy. The control intervention will consist of an active referral to the Maltese National Health Service's one-to-one smoking cessation support service, which is based on motivational interviewing. The primary feasibility and acceptability outcomes include the recruitment and participation rates, resources used, problems identified by the nurses, the nurses' perceived challenges and facilitators to implementation and the nurses' and patients' acceptability of the study intervention. Data analyses will be descriptive, with quantitative feasibility and acceptability outcomes reported with 95% confidence intervals. ETHICS AND DISSEMINATION Ethical clearance was obtained from the Faculty of Health Sciences Research Ethics Committee, University of Malta. The study results will be disseminated through conference presentations and a publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT05920096.
Collapse
Affiliation(s)
- Joseph Grech
- Department of Nursing, Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Ian Norman
- King's College London Florence Nightingale Faculty of Nursing Midwifery & Palliative Care, London, London, UK
| | | | - Moira Grixti
- Diabetes Education Unit, Mater Dei Hospital, Msida, Malta
| | - Roberta Sammut
- Department of Nursing, Faculty of Health Sciences, University of Malta, Msida, Malta
| |
Collapse
|
38
|
Radtke T, Künzi L, Kopp J, Rasi M, Braun J, Zens KD, Winter B, Anagnostopoulos A, Puhan MA, Fehr JS. Effects of Pycnogenol® in people with post-COVID-19 condition (PYCNOVID): study protocol for a single-center, placebo controlled, quadruple-blind, randomized trial. Trials 2024; 25:385. [PMID: 38879571 PMCID: PMC11179231 DOI: 10.1186/s13063-024-08187-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 05/17/2024] [Indexed: 06/19/2024] Open
Abstract
BACKGROUND A significant proportion of the global population has been infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at some point since the onset of the pandemic. Although most individuals who develop coronavirus disease 2019 (COVID-19) recover without complications, about 6% have persistent symptoms, referred to as post-COVID-19 condition (PCC). Intervention studies investigating treatments that potentially alleviate PCC-related symptoms and thus aim to mitigate the global public health burden and healthcare costs linked to PCC are desperately needed. The PYCNOVID trial investigates the effects of Pycnogenol®, a French maritime pine bark extract with anti-inflammatory and antioxidative properties, versus placebo on patient-reported health status in people with PCC. METHODS This is a single-center, placebo-controlled, quadruple blind, randomized trial. We aim to randomly assign 150 individuals with PCC (1:1 ratio) to receive either 200 mg Pycnogenol® or placebo daily for 12 weeks. Randomization is stratified for duration of PCC symptoms (≤ 6 months versus > 6 months) and presence of symptomatic chronic disease(s). The primary endpoint is perceived health status at 12 weeks (EuroQol-Visual Analogue Scale) adjusted for baseline values and stratification factors. Secondary endpoints include change in self-reported PCC symptoms, health-related quality of life, symptoms of depression and anxiety, cognitive function, functional exercise capacity, physical activity measured with accelerometry, and blood biomarkers for endothelial health, inflammation, coagulation, platelet function, and oxidative stress. Investigators, study participants, outcome assessors, and data analysts are blinded regarding the intervention assignment. Individuals with PCC were involved in the design of this study. DISCUSSION This is the first trial to investigate the effects of Pycnogenol® versus placebo on patient-reported health status in people with PCC. Should the trial proof clinical effectiveness, Pycnogenol® may serve as a therapeutic approach to mitigate symptoms associated with PCC. TRIAL REGISTRATION The study is registered at ClinicalTrials.gov. :NCT05890534, June 6, 2023.
Collapse
Affiliation(s)
- Thomas Radtke
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland.
| | - Lisa Künzi
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
| | - Julia Kopp
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
| | - Manuela Rasi
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
| | - Julia Braun
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
| | - Kyra D Zens
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
| | - Babette Winter
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
| | - Alexia Anagnostopoulos
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
| | - Milo A Puhan
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
| | - Jan S Fehr
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
| |
Collapse
|
39
|
Wang Y, Peng Y, Han M, Liu X, Niu H, Cheng J, Chang S, Liu T. GCTNet: a graph convolutional transformer network for major depressive disorder detection based on EEG signals. J Neural Eng 2024; 21:036042. [PMID: 38788706 DOI: 10.1088/1741-2552/ad5048] [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: 09/25/2023] [Accepted: 05/24/2024] [Indexed: 05/26/2024]
Abstract
Objective.Identifying major depressive disorder (MDD) using objective physiological signals has become a pressing challenge.Approach.Hence, this paper proposes a graph convolutional transformer network (GCTNet) for accurate and reliable MDD detection using electroencephalogram (EEG) signals. The developed framework integrates a residual graph convolutional network block to capture spatial information and a Transformer block to extract global temporal dynamics. Additionally, we introduce the contrastive cross-entropy (CCE) loss that combines contrastive learning to enhance the stability and discriminability of the extracted features, thereby improving classification performance.Main results. The effectiveness of the GCTNet model and CCE loss was assessed using EEG data from 41 MDD patients and 44 normal controls, in addition to a publicly available dataset. Utilizing a subject-independent data partitioning method and 10-fold cross-validation, the proposed method demonstrated significant performance, achieving an average Area Under the Curve of 0.7693 and 0.9755 across both datasets, respectively. Comparative analyses demonstrated the superiority of the GCTNet framework with CCE loss over state-of-the-art algorithms in MDD detection tasks.Significance. The proposed method offers an objective and effective approach to MDD detection, providing valuable support for clinical-assisted diagnosis.
Collapse
Affiliation(s)
- Yuwen Wang
- Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, People's Republic of China
| | - Yudan Peng
- Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, People's Republic of China
| | - Mingxiu Han
- Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, People's Republic of China
| | - Xinyi Liu
- Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, People's Republic of China
| | - Haijun Niu
- Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, People's Republic of China
| | - Jian Cheng
- School of Computer Science and Engineering, Beihang University, Beijing, People's Republic of China
| | - Suhua Chang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, People's Republic of China
| | - Tao Liu
- Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, People's Republic of China
| |
Collapse
|
40
|
Gamillscheg P, Mayer S, Pietrzak-Franger M, Hilmar C, Lange A, Simon J, Łaszewska A. Understanding the associations between information sources, sociodemographics, and views on public health measures: evidence from the COVID-19 pandemic in Austria. BMC Public Health 2024; 24:1576. [PMID: 38867264 PMCID: PMC11167807 DOI: 10.1186/s12889-024-19061-0] [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: 01/23/2024] [Accepted: 06/05/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Throughout the COVID-19 pandemic, it was a key priority for governments globally to ensure agreement with, and subsequently adherence to, imposed public health measures, specifically non-pharmaceutical interventions (NPIs). Prior research in this regard highlighted the role of COVID-19 information sources as well as sociodemographic and other personal characteristics, however, there is only limited evidence including both. To bridge this gap, this study investigated the associations of COVID-19 information sources such as social media and participant characteristics with agreement with and adherence to NPIs during the first lockdown in Austria. METHODS An online survey was conducted in May 2020 among adult Austrian residents asking about their experiences during the first lockdown. Collected data included sociodemographic characteristics, main COVID-19-related information sources, agreement with/adherence to three NPIs (no physical contact to family members not living in the same household, leisurely walks restricted to members of the same household, mandatory face masks) and information about perceived social support using the Multidimensional Scale of Perceived Social Support (MSPSS), anxiety/depression levels using the Hospital Anxiety and Depression Scale (HADS), whether participants felt well advised by the government, and whether participants perceived the pandemic to threaten their income. Ordered and multinomial logistic regression models were employed to achieve the research aims. RESULTS The cross-sectional sample consisted of 559 Austrian residents. Using social media as main COVID-19 information source was consistently associated with lower agreement with NPIs. A positive association with agreement with measures was found for higher educational backgrounds and higher anxiety levels. By contrast, higher levels of depression, not feeling well advised by the government, and perceiving the pandemic as an economic threat were negatively associated with agreement with measures. Moreover, the use of social media as main COVID-19 information source and not feeling well advised by the government were associated with lower adherence to NPIs. By contrast, higher levels of education were associated with higher adherence. CONCLUSIONS This comprehensive analysis emphasizes the associations of COVID-19 information sources as well as sociodemographic and other participant characteristics with agreement with and adherence to NPIs, bearing important implications for future public health crisis communication strategies.
Collapse
Affiliation(s)
- Peter Gamillscheg
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, Vienna, 1090, Austria
| | - Susanne Mayer
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, Vienna, 1090, Austria.
| | - Monika Pietrzak-Franger
- Department of English and American Studies, University of Vienna, Spitalgasse 2, Hof 8.3 (Campus), Vienna, 1090, Austria
| | - Carina Hilmar
- Department of English and American Studies, University of Vienna, Spitalgasse 2, Hof 8.3 (Campus), Vienna, 1090, Austria
| | - Alina Lange
- Department of English and American Studies, University of Vienna, Spitalgasse 2, Hof 8.3 (Campus), Vienna, 1090, Austria
| | - Judit Simon
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, Vienna, 1090, Austria
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
| | - Agata Łaszewska
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, Vienna, 1090, Austria
| |
Collapse
|
41
|
Huang X, Li A, Long P, Liu Y, Zhou Z, Pan Y. The Neutrophil-to-Albumin Ratio (NAR): A Novel Index in Relation to Clinical Symptoms, Quality of Life, and Psychological Status in Diarrhea-Predominant Irritable Bowel Syndrome (IBS-D). J Inflamm Res 2024; 17:3685-3695. [PMID: 38882187 PMCID: PMC11177865 DOI: 10.2147/jir.s458363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 06/05/2024] [Indexed: 06/18/2024] Open
Abstract
Introduction Irritable bowel syndrome (IBS) is a common gastrointestinal disorder characterized by chronic abdominal pain and alterations in bowel habits. Despite the importance of biomarkers in disease management, the quest for precise and non-invasive biomarkers for IBS continues. Methods This study focuses on investigating the clinical significance of the neutrophil-to-albumin ratio (NAR) as a potential biomarker in IBS. A cohort of 86 patients diagnosed with diarrhea-predominant IBS (IBS-D) and 106 healthy individuals were assessed for clinical symptoms, quality of life (QOL), psychological status, as well as serum and mucosal cytokine production. Results Our findings revealed that NAR levels were notably elevated in patients with IBS-D compared to healthy controls. Positive correlations were observed between NAR levels and IBS clinical symptoms, while negative correlations were noted with QOL. Additionally, NAR showed positive associations with anxiety and depression scores, along with significant relationships with cytokine production (serum IL-6, TNF-α, IL-1β, IL-17A, GM-CSF, IFN-γ, MCP-1; mucosal IL-6, TNF-α, IL-1β, IL-17A) in IBS-D. Interestingly, patients with lower baseline NAR levels demonstrated potentially better clinical outcomes. Conclusion The study underscores the potential utility of NAR as a novel biomarker in IBS, emphasizing its role in enhancing disease monitoring, understanding disease pathophysiology, and tailoring treatment strategies for patients with IBS-D.
Collapse
Affiliation(s)
- Xijing Huang
- Department of Gastroenterology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
- Clinical Immunology Translational Medicine Key Laboratory of Sichuan Province, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
| | - An Li
- Department of Gastroenterology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
- Clinical Immunology Translational Medicine Key Laboratory of Sichuan Province, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
| | - Ping Long
- Department of Gastroenterology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
- Clinical Immunology Translational Medicine Key Laboratory of Sichuan Province, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
| | - Ya Liu
- Department of Gastroenterology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
| | - Zhou Zhou
- Department of Gastroenterology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
| | - Yan Pan
- Department of Gastroenterology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
| |
Collapse
|
42
|
Bailey C, Agrawal N, Cope S, Proctor B, Mildon B, Butler M, Holt K, Edwards M, Poole N, Nicholson TR. Illness perceptions, experiences of stigma and engagement in functional neurological disorder (FND): exploring the role of multidisciplinary group education sessions. BMJ Neurol Open 2024; 6:e000633. [PMID: 38860228 PMCID: PMC11163674 DOI: 10.1136/bmjno-2024-000633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 04/21/2024] [Indexed: 06/12/2024] Open
Abstract
Background A critical first step in managing functional neurological disorder (FND) is a positive diagnosis and clear explanation using an understandable illness model. Multidisciplinary group education sessions are one way to achieve this, with some evidence they improve understanding, confidence in diagnosis and outcomes with further treatment. In many conditions, illness perceptions and stigma affect distress, functioning, quality of life and engagement. Exploring relationships between these factors could lead to deeper understanding of the impact of education. Methods Questionnaires assessing illness perceptions, quality of life, mood, anxiety, comorbidities, treatment engagement and stigma (both experienced and anticipated) were completed before, immediately and 1 month after a multidisciplinary online group education session for FND at a regional neurosciences centre. Free-text data on causal attributions and needs were also collected. Results 166 patients attended online education sessions from January 2022 to July 2023; 61 (37%) completed presession surveys, 42 (25%) completed postsession and 35 (21%) completed 1 month postsession surveys. Patients reported multiple comorbidities, poor quality of life, functioning and high levels of stigma. Illness perception scores indicated FND as threatening, mysterious and unpredictable, with low personal or treatment control over symptoms. Illness coherence/understanding (mean difference 2.27, p<0.01, 95% CI 1.22 to 4.23) and engagement (mean difference 2.42, p<0.01, 95% CI 0.46 to 4.36) increased after the session. There were no significant changes in stigma, distress, sense of control or anticipated discrimination. Free-text analysis revealed stress and trauma as the most common causal attributions, followed by physical illnesses. Patients requested personalised formulations, practical disability advice, help with explaining the condition to others (eg, employers), peer support and treatment. Conclusion Multidisciplinary group FND education sessions potentially improve patient understanding and engagement. Clinicians should consider the possible benefits of personalised formulations and linking to practical and peer support. Further work assessing illness perceptions is needed, such as adapting measures for FND.
Collapse
Affiliation(s)
- Cate Bailey
- Neuropsychiatry Research and Education Group, Institute of Psychiatry Psychology & Neuroscience, King's College London, London, UK
- East London NHS Foundation Trust, London, UK
| | - Niruj Agrawal
- Neuropsychiatry Service, South West London and St George's Mental Health NHS Trust, London, UK
- Atkinson Morley Regional Neurosciences Centre, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Sarah Cope
- Neuropsychiatry Service, South West London and St George's Mental Health NHS Trust, London, UK
| | - Barnaby Proctor
- Neuropsychiatry Service, South West London and St George's Mental Health NHS Trust, London, UK
| | | | - Matt Butler
- Neuropsychiatry Research and Education Group, Institute of Psychiatry Psychology & Neuroscience, King's College London, London, UK
| | - Kate Holt
- Atkinson Morley Regional Neurosciences Centre, St George's University Hospitals NHS Foundation Trust, London, UK
- Wolfson Neurorehabilitation Centre, Queen Mary's Hospital, London, UK
| | - Mark Edwards
- Neuropsychiatry Research and Education Group, Institute of Psychiatry Psychology & Neuroscience, King's College London, London, UK
| | - Norman Poole
- Neuropsychiatry Research and Education Group, Institute of Psychiatry Psychology & Neuroscience, King's College London, London, UK
- The Lishman Unit (Brain Injury and Functional Neurology), South London and Maudsley NHS Foundation Trust, London, UK
| | - Timothy R Nicholson
- Neuropsychiatry Research and Education Group, Institute of Psychiatry Psychology & Neuroscience, King's College London, London, UK
| |
Collapse
|
43
|
Arditte Hall KA, Price SN, Lucas AR, Park ER, Wagner LI, Mizrach HR, Werner MH, Juhel BC, Goldstein MR, Gorman MJ, Hall DL. An exploration into the relationship between insomnia and repetitive negative thinking among cancer survivors. J Psychosoc Oncol 2024:1-14. [PMID: 38831557 DOI: 10.1080/07347332.2024.2356193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
OBJECTIVE Insomnia and repetitive negative thinking (RNT) are both prevalent among cancer survivors, yet little work has investigated their interrelationship. To explore the hypothesis that RNT and insomnia are related, we conducted secondary analyses on data from a pilot clinical trial of cognitive behavioral therapy for insomnia (CBT-I) for cancer survivors. METHODS This study analyzed survey data from 40 cancer survivors with insomnia who participated in a pilot randomized trial of CBT-I. Correlations and linear regression models were used to determine associations between aspects of RNT and related constructs (fear of cancer recurrence [FCR], cancer-specific rumination, worry, and intolerance of uncertainty) and sleep (insomnia and sleep quality), while accounting for psychiatric symptoms such as anxiety and depression. Treatment-related change in RNT was examined using a series of linear mixed models. RESULTS Evidence for an association between RNT and insomnia among cancer survivors emerged. Higher levels of FCR and cancer-related rumination were correlated with more severe insomnia symptoms and worse sleep quality. Notably, FCR levels predicted insomnia, even after controlling for anxiety and depression. Results identified potential benefits and limitations of CBT-I in addressing RNT that should be examined more thoroughly in future research. CONCLUSIONS RNT is a potential target to consider in insomnia treatment for cancer survivors.
Collapse
Affiliation(s)
- Kimberly A Arditte Hall
- Department of Psychology and Philosophy, Framingham State University, Framingham, Massachusetts, USA
| | - Sarah N Price
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Alexander R Lucas
- Department of Health Behavior and Policy, School of Population Health, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Elyse R Park
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lynne I Wagner
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Helen R Mizrach
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Michael H Werner
- Department of Psychology and Philosophy, Framingham State University, Framingham, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Brooke C Juhel
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Michael R Goldstein
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Mark J Gorman
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Daniel L Hall
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| |
Collapse
|
44
|
Zeilinger EL, Zrnic‐Novakovic I, Oppenauer C, Fellinger M, Knefel M, Unseld M, Wagner T, Lubowitzki S, Bartsch R, Zöchbauer‐Müller S, Raderer M, Staber PB, Valent P, Gaiger A. Prevalence and biopsychosocial indicators of fatigue in cancer patients. Cancer Med 2024; 13:e7293. [PMID: 38819432 PMCID: PMC11141333 DOI: 10.1002/cam4.7293] [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: 01/08/2024] [Revised: 04/29/2024] [Accepted: 05/05/2024] [Indexed: 06/01/2024] Open
Abstract
INTRODUCTION Symptoms of cancer-related fatigue (CRF) can have a significant impact on patients' quality of life and treatment adherence. We aimed to investigate the relationship between CRF and multiple psychosocial and somatic indicators within a large mixed cancer sample. METHODS In this cross-sectional study, N = 1787 outpatients with cancer were assessed for CRF, pain, anxiety, and depression using validated screening instruments. We further obtained clinical parameters (Hb, CRP, creatinine, leukocytes, ASAT, and ALAT), sociodemographic data (age, gender, income, education level, marital status, parenthood, and living area), and lifestyle factors. Multivariate linear regression models were applied to estimate the impact of each indicator on CRF. RESULTS Overall, 90.6% of patients experienced some CRF, with 14.8% experiencing severe CRF. No gender difference was found in the prevalence of CRF. Patients with higher levels of pain, depressive symptoms, and lower Hb levels had significantly higher levels of CRF (ps <0.001). Lower levels of CRF were observed in patients who had children (p = 0.03), had less education (p < 0.001), and were physically active for more than 2 h per week before their oncological diagnosis (p = 0.014). The latter was only a significant indicator in the male subsample. CONCLUSION The present results demonstrate a high prevalence of CRF and highlight that not only somatic and psychosocial factors, but also lifestyle factors prior to diagnosis appear to be associated with the etiology and persistence of CRF. To effectively treat CRF, a biopsychosocial, personalized approach is recommended.
Collapse
Affiliation(s)
- Elisabeth L. Zeilinger
- Division of Hematology and Hemostaseology, Department of Medicine IMedical University of ViennaViennaAustria
- Department of Clinical Research SBGAcademy for Ageing Research, Haus der BarmherzigkeitViennaAustria
- Department of Clinical and Health Psychology, Faculty of PsychologyUniversity of ViennaViennaAustria
| | - Irina Zrnic‐Novakovic
- Department of Clinical and Health Psychology, Faculty of PsychologyUniversity of ViennaViennaAustria
| | - Claudia Oppenauer
- Division of Clinical Psychology, Department of Psychology and PsychodynamicsKarl Landsteiner University of Health SciencesKremsAustria
| | - Matthäus Fellinger
- Clinical Division of Social Psychiatry, Department of Psychiatry and PsychotherapyMedical University of ViennaViennaAustria
- Second Department of Psychiatry and PsychotherapyClinic Hietzing, Vienna Healthcare GroupViennaAustria
| | - Matthias Knefel
- Division of Hematology and Hemostaseology, Department of Medicine IMedical University of ViennaViennaAustria
- Department of Internal MedicineLandesklinikum Baden‐MödlingBadenAustria
| | - Matthias Unseld
- Department of Clinical Research SBGAcademy for Ageing Research, Haus der BarmherzigkeitViennaAustria
| | - Theresa Wagner
- Department of Clinical and Health Psychology, Faculty of PsychologyUniversity of ViennaViennaAustria
| | - Simone Lubowitzki
- Division of Hematology and Hemostaseology, Department of Medicine IMedical University of ViennaViennaAustria
| | - Rupert Bartsch
- Division of Oncology, Department of Internal Medicine IMedical University of ViennaViennaAustria
| | - Sabine Zöchbauer‐Müller
- Division of Oncology, Department of Internal Medicine IMedical University of ViennaViennaAustria
| | - Markus Raderer
- Division of Oncology, Department of Internal Medicine IMedical University of ViennaViennaAustria
| | - Philipp B. Staber
- Division of Hematology and Hemostaseology, Department of Medicine IMedical University of ViennaViennaAustria
| | - Peter Valent
- Division of Hematology and Hemostaseology, Department of Medicine IMedical University of ViennaViennaAustria
- Ludwig Boltzmann Institute for Hematology and OncologyMedical University of ViennaViennaAustria
| | - Alexander Gaiger
- Division of Hematology and Hemostaseology, Department of Medicine IMedical University of ViennaViennaAustria
- Ludwig Boltzmann Institute for Hematology and OncologyMedical University of ViennaViennaAustria
| |
Collapse
|
45
|
Lucchini A, Villa M, Giani M, Andreossi M, Alessandra V, Vigo V, Gatti S, Ferlicca D, Teggia Droghi M, Rezoagli E, Foti G, Pozzi M, Irccs San Gerardo Follow-Up Group. Long term outcome in patients treated with veno-venous extracorporeal membrane oxygenation: A prospective observational study. Intensive Crit Care Nurs 2024; 82:103631. [PMID: 38309144 DOI: 10.1016/j.iccn.2024.103631] [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: 06/25/2023] [Revised: 01/04/2024] [Accepted: 01/18/2024] [Indexed: 02/05/2024]
Abstract
INTRODUCTION Over the last few decades, the use of veno-venous extracorporeal membrane oxygenation (VV-ECMO) support for severe respiratory failure has increased. AIM This study aimed to assess the long-term outcomes of patients treated with VV-ECMO for respiratory failure. METHODS We performed a single-centre prospective evaluation of patients on VV-ECMO who were successfully discharged from the intensive care unit of an Italian University Hospital between January 2018 and May 2021. The enrolled patients underwent follow-up evaluations at 6 and 12 months after ICU discharge. The follow-up team performed psychological and functional assessments using the following instruments: Hospital Anxiety and Depression Scale (HADS), Post-traumatic Stress Disorder Symptom Severity Scale (PTSS-10), Euro Quality Five Domains Five Levels (EQ-5L-5D), and 6-minute walk test. RESULTS We enrolled 33 patients who were evaluated at a follow-up clinic. The median patient age was 51 years (range: 45-58 years). The median duration of VV-ECMO support was 12 (9-19) days and the length of ICU stay was 23 (18-42) days. A HADS score higher than 14 was reported in 8 (24 %) and 7 (21 %) patients at the six- and twelve-month visit, respectively. PTSS-10 total score ≥ 35 points was present in three (9 %) and two (6 %) patients at the six- and twelve-month examination. The median EQ-5L-5D-VAS was respectively 80 (80-90) and 87.5 (70-95). The PTSS-10 score significantly decreased from six to 12 months in COVID-19 survivors (p = 0.024). CONCLUSIONS In this cohort of patients treated with VV-ECMO, cognitive and psychological outcomes were good and comparable to those of patients with Adult Respiratory Distress Syndrome (ARDS) managed without ECMO. IMPLICATIONS FOR CLINICAL PRACTICE The findings of this study confirm the need for long-term follow-up and rehabilitation programs for every ICU survivor after discharge. COVID-19 survivors treated with VV-ECMO had outcomes comparable to those reported in non-COVID patients.
Collapse
Affiliation(s)
- Alberto Lucchini
- Direction of health and social professions - General Adult and Pediatric Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori - Monza; University of Milano-Bicocca, Via Pergolesi 33, Monza (MB), Italy.
| | - Marta Villa
- General Adult and Pediatric Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori - Monza.
| | - Marco Giani
- General Adult and Pediatric Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori - Monza; University of Milano-Bicocca, Via Pergolesi 33, Monza (MB), Italy.
| | - Mara Andreossi
- General Adult and Pediatric Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori - Monza.
| | - Valentino Alessandra
- General Adult and Pediatric Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori - Monza.
| | - Veronica Vigo
- General Adult and Pediatric Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori - Monza.
| | - Stefano Gatti
- General Adult and Pediatric Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori - Monza.
| | - Daniela Ferlicca
- General Adult and Pediatric Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori - Monza.
| | - Maddalena Teggia Droghi
- General Adult and Pediatric Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori - Monza.
| | - Emanuele Rezoagli
- General Adult and Pediatric Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori - Monza; University of Milano-Bicocca, Via Pergolesi 33, Monza (MB), Italy.
| | - Giuseppe Foti
- General Adult and Pediatric Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori - Monza; University of Milano-Bicocca, Via Pergolesi 33, Monza (MB), Italy.
| | - Matteo Pozzi
- University of Milano-Bicocca, Via Pergolesi 33, Monza (MB), Italy; Cardiosurgical ICU Fondazione IRCCS San Gerardo dei Tintori - Monza.
| | | |
Collapse
|
46
|
Tomaz A, Peron KA, Suzuki FADB, Monteiro SRG, Chandrasekhar SS, Penido NO. Standard and Extend High-Frequency Audiometry in Sudden Sensorineural Hearing Loss: Impacts on Tinnitus and Mental Health. Otol Neurotol 2024; 45:e366-e375. [PMID: 38511269 DOI: 10.1097/mao.0000000000004168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
OBJECTIVE To analyze the results of auditory assessment in standard (SA) and extended high-frequency (EHF) audiometry, associating the findings with sudden tinnitus and mental health of patients with unilateral sudden sensorineural hearing loss (SSNHL). STUDY DESIGN Prospective, cohort study. SETTING Outpatient otology clinic in a tertiary care hospital. SUBJECTS AND METHODS Patients experiencing unilateral SSNHL were evaluated with pure-tone audiometry performed at frequencies of 250 to16,000 Hz, tinnitus pitch and loudness matching tests, Tinnitus Handicap Inventory (THI), Analog and Visual Scale (AVS) for bothersome tinnitus, and the Hospital Anxiety and Depression Scale (HADS). RESULTS Eighteen patients with unilateral SSNHL were assessed. After starting treatment, there was a significant improvement in the SA (71.1 dB to 50 dB; p < 0.001*) and EHF audiometry (64.5 dB to 54.4 dB; p < 0.001*) thresholds at 15 days, and this persisted at 30 days of follow-up. Significant improvements were seen for tinnitus in loudness, VAS, and THI and for mental health in the realms of anxiety and depression by HADS. Despite improvements in SA, persistent EHF hearing loss was accompanied by persistent tinnitus, but it was of diminished loudness. CONCLUSION Despite improvement in pure-tone thresholds by SA, a subset of unilateral SSNHL patients did not experience hearing recovery in EHF thresholds and reported persistent tinnitus. We postulate that their diminished anxiety and better mental health may be related to both hearing improvement in standard audiometry and reduction in tinnitus loudness. This pilot prospective study investigates the utility of performing EHF audiometry to better understand outcomes in patients with SSNHL.
Collapse
Affiliation(s)
- Andreza Tomaz
- Department of Otolaryngology Head and Neck Surgery, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil
| | - Kelly Abdo Peron
- Department of Otolaryngology Head and Neck Surgery, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil
| | - Flavia Alencar de Barros Suzuki
- Department of Otolaryngology Head and Neck Surgery, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil
| | - Silvia Roberta Gesteira Monteiro
- Department of Otolaryngology Head and Neck Surgery, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil
| | | | - Norma Oliveira Penido
- Department of Otolaryngology Head and Neck Surgery, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil
| |
Collapse
|
47
|
Jheng YW, Chan YN, Wu CJ, Lin MW, Tseng LM, Wang YJ. Neuropathic Pain Affects Quality of Life in Breast Cancer Survivors with Chemotherapy-Induced Peripheral Neuropathy. Pain Manag Nurs 2024; 25:308-315. [PMID: 38278750 DOI: 10.1016/j.pmn.2023.12.013] [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: 03/25/2023] [Revised: 12/30/2023] [Accepted: 12/30/2023] [Indexed: 01/28/2024]
Abstract
BACKGROUND Despite the significant impact of chemotherapy-induced peripheral neuropathy on the quality of life for breast cancer survivors, there is a notable lack of comprehensive research. Therefore, a crucial need exists for further systematic investigation and inquiry into this matter. AIMS This study examined predictors of quality of life in breast cancer survivors with chemotherapy-induced peripheral neuropathy. DESIGN A cross-sectional, correlational design. SETTINGS This study was conducted at a medical center in northern Taiwan and a teaching hospital in northeastern Taiwan. PARTICIPANTS/SUBJECTS One hundred and thirty adult women with breast cancer, who have undergone chemotherapy and obtained a Total Neuropathy Scale-Clinical Version score>0, were enrolled. METHODS Neuropathic pain, sleep disturbances, depression, and quality of life were evaluated using multiple regression analysis to identify quality of life predictors. Clinical importance was established using the minimally important difference of Functional Assessment of Cancer Therapy-Breast. RESULTS The study indicated that improving depression (B = -10.87, p < .001) and neuropathic pain (B = -8.33, p = .004) may enhance the quality of life of breast cancer survivors with chemotherapy-induced peripheral neuropathy. Moreover, the individual's marital status and family history of breast cancer were identified as predictive factors. CONCLUSIONS This study illuminates quality of life determinants for breast cancer survivors with chemotherapy-induced peripheral neuropathy, advocating comprehensive care and addressing depression and neuropathic pain for better outcomes.
Collapse
Affiliation(s)
- You-Wun Jheng
- From the Department of Nursing, Taichung Veterans General Hospital Taichung, Taiwan
| | - Ya-Ning Chan
- Department of Population Health Sciences, Duke University, 215 Morris Street, Durham, NC 27701, USA.
| | - Chih-Jung Wu
- Department of Nursing, China Medical University, Taichung, Taiwan
| | - Ming-Wei Lin
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Ling-Ming Tseng
- Department of Surgery, Veterans General Hospital-Taipei, Taipei, Taiwan
| | - Ya-Jung Wang
- Department of Nursing, Da-Yeh University, Dacun, Changhua, Taiwan.
| |
Collapse
|
48
|
Rosmarin D, Soliman AM, Piercy J, Marwaha S, Anderson P, Camp HS. Health-Related Quality of Life Burden Among Adults with Vitiligo: Relationship to Disease Severity and Disease Location. Dermatol Ther (Heidelb) 2024; 14:1633-1647. [PMID: 38824482 PMCID: PMC11169145 DOI: 10.1007/s13555-024-01187-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 05/14/2024] [Indexed: 06/03/2024] Open
Abstract
INTRODUCTION Vitiligo was historically regarded as a cosmetic disorder; however, it is an autoimmune disease. As a visible condition, it affects patient well-being. We assessed the impact of disease severity, lesion location, and body surface area (BSA) affected on patient health-related quality of life (HRQoL). METHODS Retrospective data were from the Adelphi Real World Vitiligo Disease Specific Programme: a cross-sectional survey of physicians and their patients with vitiligo (10/2021-07/2022). Patient-reported outcomes were assessed by the Vitiligo-Specific Quality of Life Instrument (VitiQoL), Hospital Anxiety and Depression Scale (HADS), and EQ-5D-5L. The Work Productivity and Impairment Questionnaire (WPAI) questionnaire was used to assess disease-related impairment of daily activities. Data were stratified by physician-reported disease severity, presence/absence of vitiligo on the face, and BSA percentage affected. RESULTS In total, 1388 patients were included. Mean (SD) VitiQoL, HADS depression, and anxiety scores were higher for those with severe disease [40.5 (26.1), 5.2 (4.4), and 6.8 (4.7)] than those with mild [24.8 (18.8), 3.6 (3.8), 4.2 (3.8)] or moderate [27.1 (22.6), 3.8 (4.5), 4.3 (4.4)] disease. Patients with face affected reported higher VitiQoL [30.0 (22.3) versus 23.2 (19.3)], and HADS scores [depression, 4.3 (4.3) versus 3.2 (3.9); anxiety, 5.0 (4.3) versus 3.8 (3.9)] than those without. Patients with ≥ 5% BSA affected had higher VitiQoL, depression and anxiety scores [27.9 (21.8), 4.0 (4.4), and 4.5 (4.2)] than those with 0-5% [24.6 (19.7), 3.4 (3.7), and 4.3 (4.1)]. Patients with severe vitiligo, facial lesions, or ≥ 5% BSA reported higher activity impairment. Mean EQ-5D-5L-utility score was approximately 0.9 regardless of disease severity or total BSA affected. CONCLUSIONS These data demonstrate the impact disease severity can have on HRQoL and daily activities for patients with vitiligo. Lesions that are more severe, on the face, or covering a greater BSA are more often associated with poorer outcomes and activity impairment. These data also highlight the potential insensitivity of commonly used HRQoL measures and a need for more sensitive disease-specific measures.
Collapse
Affiliation(s)
- David Rosmarin
- Department of Dermatology, Indiana University School of Medicine, EH 139, DERM, IN, Indianapolis, IN, 46202, USA.
| | | | | | | | | | | |
Collapse
|
49
|
Yajima S, Masuda H. The significance of G8 and other geriatric assessments in urologic cancer management: A comprehensive review. Int J Urol 2024; 31:607-615. [PMID: 38402450 DOI: 10.1111/iju.15432] [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: 12/14/2023] [Accepted: 02/12/2024] [Indexed: 02/26/2024]
Abstract
In urologic oncology, which often involves older patients, it is important to consider how to manage their care appropriately. Geriatric assessment (GA) is a method that can address the specific needs of older cancer patients. The GA encompasses various assessment domains, but these domains exhibit variations across the literature. Some of the common items include functional ability, nutrition, comorbidities, cognitive ability, psychosocial disorders, polypharmacy, social and financial support, falls/imbalance, and vision/hearing. Despite the diversity of domains, there is limited consensus on reliable measurement methods. This review discusses the role of GA in managing urologic cancer in unique scenarios, such as those necessitating temporary or permanent urinary catheters or stomas due to urinary diversion. A comprehensive GA is time and human-resource-intensive in real-world clinical practice. Hence, simpler tools such as the Geriatric-8 (G8), capable of identifying high-risk patients requiring a detailed GA, are also under investigation in various contexts. Therefore, we conducted a systematic literature review on the G8. Our findings indicate that patients with low G8 scores encounter difficulties with stoma self-care after urinary diversion and have higher risks of urinary tract infections and ileus after radical cystectomy. The utilization of G8 as a screening tool for urologic cancer patients may facilitate the delivery of appropriate and personalized treatment and care.
Collapse
Affiliation(s)
- Shugo Yajima
- Department of Urology, National Cancer Center Hospital East, Chiba, Japan
| | - Hitoshi Masuda
- Department of Urology, National Cancer Center Hospital East, Chiba, Japan
| |
Collapse
|
50
|
Aggio D, Dixon C, Law EH, Randall R, Price T, Lloyd A. Estimation of health utility values for alopecia areata. Qual Life Res 2024; 33:1581-1592. [PMID: 38551802 PMCID: PMC11116246 DOI: 10.1007/s11136-024-03645-9] [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] [Accepted: 03/01/2024] [Indexed: 05/24/2024]
Abstract
PURPOSE Alopecia areata (AA) is an autoimmune-mediated inflammatory dermatological disease characterised by non-scarring hair loss affecting the scalp and sometimes other hair-bearing sites. This study aimed to elicit health state utility values (HSUVs) from the UK general population for AA using time trade off (TTO) interviews. METHODS Vignette descriptions of health states defined by the extent of hair loss were developed (as well as one describing caregiver burden). These were developed using data from standardised patient reported outcome (PRO) measures, a literature review and qualitative interviews. Health states were defined based on the severity of alopecia tool (SALT), which assesses extensiveness of scalp hair loss. HSUVs were then elicited for each health state in TTO interviews with the UK public. RESULTS One caregiver and five patient health states were developed based on the literature review findings, clinical trial PRO (Hospital Anxiety and Depression Scale and Alopecia Areata Patient Priority Outcomes Questionnaire) data and qualitative interviews with patients (N = 11), clinical experts (N = 4) and caregivers of adolescents with AA (N = 10). These data showed a more severe impact among patients with more extensive hair loss. One hundred and twenty participants evaluated the vignettes in TTO interviews. Patient HSUVs ranged from 0.502 for the most extensive hair loss health state (SALT 50-100 + eyebrow and eyelash loss) to 0.919 (SALT 0-10) for the mildest health state. The caregiver HSUV was 0.882. CONCLUSION Quantitative and qualitative data sources were used to develop and validate vignettes describing different AA health states. Patient and caregiver HSUVs demonstrate a large impact associated with AA, especially for states defined by more extensive hair loss.
Collapse
Affiliation(s)
- Daniel Aggio
- Acaster Lloyd Consulting Ltd, 8th Floor, Lacon House, 84 Theobalds Road, London, WC1X 8NL, UK.
| | - Caleb Dixon
- Acaster Lloyd Consulting Ltd, 8th Floor, Lacon House, 84 Theobalds Road, London, WC1X 8NL, UK
| | | | | | | | - Andrew Lloyd
- Acaster Lloyd Consulting Ltd, 8th Floor, Lacon House, 84 Theobalds Road, London, WC1X 8NL, UK
| |
Collapse
|