Depressive and anxiety symptom prevalence in childhood-onset systemic lupus erythematosus: A systematic review.

BACKGROUND: Depressive and anxiety symptoms are common in children and youth and may impact outcomes for individuals with childhood-onset systemic lupus erythematosus. Research into the prevalence of depressive and anxiety symptoms and childhood-onset systemic lupus erythematosus comorbidity has reported conflicting results. OBJECTIVE: To synthesize current knowledge regarding the prevalence of depressive and anxiety symptoms in childhood-onset systemic lupus erythematosus. METHODS: Studies were identified through a comprehensive search of MEDLINE, EMBASE, PsychINFO, LILACS and Web of Science (from database inception to July 2018) using MESH headings and keywords for 'lupus erythematosus', and 'depression' or 'anxiety'. Included studies measured depressive and/or anxiety symptoms prospectively among children and youth aged 8 to 21 years with a diagnosis of childhood-onset systemic lupus erythematosus. Neuropsychiatric systemic lupus erythematosus was included. Studies without use of validated screening tools for major depressive disorder or anxiety disorders were excluded, as were studies where diagnosis was by retrospective analysis of patient charts. Data were extracted by two independent coders and where discrepancies occurred, agreement was reached by consensus. RESULTS: In total, 70 studies met the criteria for full text review and of these, 14 were included in the final analysis. The majority (70%) of studies were of cross-sectional design, with sample sizes ranging from 20 to 100 (mean = 48) participants. The mean age of participants was 15.9 years and participants were predominantly female. Prevalence rates for depressive symptoms ranged from 6.7% to 59%. Anxiety symptom prevalence was 34% to 37%. All studies employed self-report instruments to assess depressive and anxiety symptoms; none of the studies utilized a semi-structured diagnostic interview to make psychiatric diagnoses. Significant heterogeneity precluded meta-analysis of the data. CONCLUSIONS: Depressive and anxiety symptoms may be common comorbidities of childhood-onset systemic lupus erythematosus; however, current research is limited by a paucity of studies, small sample sizes and an inability to confirm psychiatric diagnoses. Future research addressing these limitations is needed.

[Specialized pain care in Germany]. / Spezialisierte Schmerzversorgung in Deutschland.

BACKGROUND: In order to characterize the pain care situation in Germany, a health technology assessment (HTA) was carried out on behalf of the German Institute for Medical Documentation and Information (DIMDI). METHODS: An up to date literature search was conducted using the database Pubmed. Reviews and studies which describe the pain care in Germany were included. The Physicians' Health Insurance Associations conducted an additional database survey. RESULTS: Overall 12 studies were included and the results of the analysis showed that there is a lack of some 2,500 curative pain care institutions in Germany. There is also clear under use of inpatient and outpatient institutions in palliative care. The results prove the benefits of the interdisciplinary approach in pain care. DISCUSSION: Further development should strive to increase the provision of pain and palliative care. There is a great need for pain care research in order to concrete the needs.

[Burnout. Can it be measured?]. / Burn-out. Kann man es messen?

Burnout is widely known as a work-related syndrome that is associated by serious individual and social consequences. The aim of the HTA report "Differential diagnostic of the burnout syndrome" published by DIMDI in 2010 was to determine how burnout can be diagnosed and distinguished from other disorders. Based on a systematic literature review of 36 databases, 852 studies published between 2004 and 2009 were identified. After considering inclusion and exclusion criteria, 25 medical and one ethical study remained. The study evidence is predominantly low. Self-assessment tools are mainly used. The analysis showed that no standardized, common valid procedure exists to obtain a burnout diagnosis. Overall the problem is to measure a phenomenon that is not exactly defined. It is primarily important to distinguish burnout from depression, alexithymia, feeling unwell, and the concept of prolonged exhaustion. Beside the need for a valid definition, further research is needed, particularly high-quality, long-term studies, to broaden the understanding of the syndrome. Furthermore, a standardized, internationally accepted and valid procedure for diagnosing burnout is necessary.

Type 1 diabetes mellitus and major depressive disorder: evidence for a biological link.

AIMS/HYPOTHESIS: A growing body of research suggests that the prevalence of major depressive disorder (MDD) in children and youth with type 1 diabetes mellitus is significantly higher than that of youth without type 1 diabetes and is associated with increased illness severity. The objective of this article is to review the current literature on the pathophysiology of these two common diseases with respect to potential areas of overlapping biological dysfunction. METHODS: A search of English language articles published between 1966 and 2010 was conducted and augmented with manual review of reference lists from the identified publications. RESULTS: The evidence suggests plausible mechanisms whereby a biological relationship between type 1 diabetes and MDD may exist. These include the effects of circulating cytokines associated with autoimmune diabetes, the direct impact of insulin deficiency on neurogenesis/neurotransmitter metabolism, the effects of the chronic hyperglycaemic state, occurrence of iatrogenic hypoglycaemia and the impact of basal hyperactivity of the hypothalamic-pituitary-adrenal axis. CONCLUSIONS/INTERPRETATION: Shared biological vulnerabilities may be implicated in the comorbidity of type 1 diabetes and MDD. Further research is warranted to determine the magnitude of associations and confirm their observation in clinical populations.

Effects of acute aerobic exercise on neural correlates of attention and inhibition in adolescents with bipolar disorder.

Executive dysfunction is common during and between mood episodes in bipolar disorder (BD), causing social and functional impairment. This study investigated the effect of acute exercise on adolescents with BD and healthy control subjects (HC) to test for positive or negative consequences on neural response during an executive task. Fifty adolescents (mean age 16.54±1.47 years, 56% female, 30 with BD) completed an attention and response inhibition task before and after 20 min of recumbent cycling at ~70% of age-predicted maximum heart rate. 3 T functional magnetic resonance imaging data were analyzed in a whole brain voxel-wise analysis and as regions of interest (ROI), examining Go and NoGo response events. In the whole brain analysis of Go trials, exercise had larger effect in BD vs HC throughout ventral prefrontal cortex, amygdala and hippocampus; the profile of these effects was of greater disengagement after exercise. Pre-exercise ROI analysis confirmed this 'deficit in deactivation' for BDs in rostral ACC and found an activation deficit on NoGo errors in accumbens. Pre-exercise accumbens NoGo error activity correlated with depression symptoms and Go activity with mania symptoms; no correlations were present after exercise. Performance was matched to controls and results survived a series of covariate analyses. This study provides evidence that acute aerobic exercise transiently changes neural response during an executive task among adolescents with BD, and that pre-exercise relationships between symptoms and neural response are absent after exercise. Acute aerobic exercise constitutes a biological probe that may provide insights regarding pathophysiology and treatment of BD.

Drug abuse trends among German youth.

Data of drug consumption in Baden-Würtemberg, Bavaria and West Germany are presented for the period 1967 to 1977. Two different indicators (representative surveys, and overdose deaths and apprehended illicit drugs) are compared. It can be stated that Germany is now in the third development stage of drug consumption characterized by a decentralizing drug scene and the concentration of a hard core of drug users. More than one-third of the hard core contact physicians three times and then move on. This relationship in particular should be analyzed more deeply in the future.

Psychosocial factors influencing alcohol problems in West German survey samples.

In order to distinguish between different types of people endangered by alcohol, five different indicators were used to classify the degree of alcohol affinity: KFA/Feuerlein, German version of part of the Manson Evaluation, alcohol-in-blood concentration, and frequency and amount of drinking. The degree of alcohol affinity potential is quite different depending on each indicator. All indicators together discriminate between nine independent types (each for men/women) of alcohol-endangered people. Further-more, five independent drinking motivations could be factor analyzed. The diversity in this field was completed by sixteen different therapies used by physicians for alcoholism treatment.

Ureteric stent in severe hydronephrosis of pregnancy.

Eleven women (12 pregnancies) were included in the study. A double-pigtail ureteric stent was passed under cytoscopic vision in 8 patients. The mean gestational age on insertion of the stents was 29 weeks (range, 25-35 weeks). Delivery took place at a mean of 39 weeks (range, 35-41 weeks). Stents remained in situ for a mean of 9 weeks (range, 6-14 weeks) before delivery and were removed 4-5 weeks postpartum. Double pigtail ureteric stents did not expose the women to infection. Renal function tests remained within the normal limits. Ureteric stent is an effective method for internal drainage of severe hydronephrosis during pregnancy.

[Verrucous carcinoma of the penis].

Malignant tumors of the penis are rare, and constitute only 1% of all tumors in males. The disease is more common in the black population of the USA due to genetic links and the rarity of circumcision. Penile carcinoma is extremely rare in Israel, only 10 cases having been reported during a period of 20 years. Verrucous carcinoma, often called giant condyloma acuminata, constitutes a subgroup of squamous cell carcinoma of the penis. The first description was by Buschke in 1925, and was followed by that of Loewenstein in 1939. The tumor is usually limited to the penile glans and does not invade lymph nodes. We present a 44-year-old Arab with verrucous carcinoma treated by partial amputation of the penis. He had been circumcised 11 years previously. During 18 months of follow-up there was no recurrence.

[Renal colic and renal calculus].

A positive diagnosis of urinary stone was made in 183 of 407 patients (44.9%) with renal colic seen in the emergency room. 182 (44.7%) had normal intravenous pyelograms, 26 (6.4%) had evidence of dilatation of the urinary system, possibly due to the passage of a stone, and 16 (3.9%) had other pathological urinary conditions, such as double collecting system or cysts. Stones were located in the upper urinary tract in 28.4%, in the midureter in 21.9%, and in the lower ureter in 49.7%. There was a statistically significant correlation between recurrent episodes of left-sided renal colic, erythrocytes in the urine and the presence of a stone in the urinary tract. No ethnic differences were found, nor was there a difference in the rates of stones found in those who were hospitalized and in those who were not.

[The psychological status of acne patients. Personality structure and physician-patient relations]. / Psychische Situation der Akne-Patienten. Persönlichkeitsstruktur und Arzt-Patienten-Beziehung.

The results of various studies dealing with the situation and psychological state of acne sufferers and their relationship to their doctors are presented. It was shown that out of approximately 2.7 to 3.5 million acne sufferers, only some 500,000 are presently undergoing medical treatment. Failure to seek medical treatment is closely associated with the fact that acne sufferers for the most part expect to be disappointed with the results. For a number of psychological reasons (self-consciousness, contact difficulties, low level of frustration tolerance) a substantial number of acne sufferers are particularly sensitive to actual or supposed lack of acceptance on the part of their doctors. Greater consideration of their psychological situation might improve the therapeutic outcome, increase compliance, and lead to a greater confidence in the doctor.

Endoscopic control during colposuspension procedure for the treatment of stress urinary incontinence.

Possible complications during colposuspension for urinary stress incontinence are inadvertent injury to the bladder or ureters. Surprisingly, endoscopic control during the procedure was never described. We suggest the routine use of cystoscopy during colposuspension for the early diagnosis of complications and immediate repair.

Giant obstructing calculus in the distal ureter secondary to obstruction by a ureterocele.

A 43-year-old man presented with bilateral simple ureteroceles complicated by calculi. A huge left ureteral calculus subsequently developed, causing nonfunctioning of the left kidney. This is apparently the largest calculus associated with an orthotopic ureterocele ever reported in the literature. Its cause, diagnosis, and treatment are discussed.