Depression, anxiety, and quality of life as predictors of rehospitalization in patients with chronic heart failure.

BACKGROUND: Chronic heart failure (CHF) is a severe condition, often co-occurring with depression and anxiety, that strongly affects the quality of life (QoL) in some patients. Conversely, depressive and anxiety symptoms are associated with a 2-3 fold increase in mortality risk and were shown to act independently of typical risk factors in CHF progression. The aim of this study was to examine the impact of depression, anxiety, and QoL on the occurrence of rehospitalization within one year after discharge in CHF patients. METHODS: 148 CHF patients were enrolled in a 10-center, prospective, observational study. All patients completed two questionnaires, the Hospital Anxiety and Depression Scale (HADS) and the Questionnaire Short Form Health Survey 36 (SF-36) at discharge timepoint. RESULTS: It was found that demographic and clinical characteristics are not associated with rehospitalization. Still, the levels of depression correlated with gender (p ≤ 0.027) and marital status (p ≤ 0.001), while the anxiety values ​​were dependent on the occurrence of chronic obstructive pulmonary disease (COPD). However, levels of depression (HADS-Depression) and anxiety (HADS-Anxiety) did not correlate with the risk of rehospitalization. Univariate logistic regression analysis results showed that rehospitalized patients had significantly lower levels of Bodily pain (BP, p = 0.014), Vitality (VT, p = 0.005), Social Functioning (SF, p = 0.007), and General Health (GH, p = 0.002). In the multivariate model, poor GH (OR 0.966, p = 0.005) remained a significant risk factor for rehospitalization, and poor General Health is singled out as the most reliable prognostic parameter for rehospitalization (AUC = 0.665, P = 0.002). CONCLUSION: Taken together, our results suggest that QoL assessment complements clinical prognostic markers to identify CHF patients at high risk for adverse events. CLINICAL TRIAL REGISTRATION: The study is registered under http://clinicaltrials.gov (NCT01501981, first posted on 30/12/2011), sponsored by Charité - Universitätsmedizin Berlin.

Export Competitiveness of Agri-Food Sector during the EU Integration Process: Evidence from the Western Balkans.

Trade agreements with the European Union (EU) and Central European Free Trade Agreement (CEFTA) significantly influenced the liberalisation of agri-food products in Western Balkan (WB) countries. In all Western Balkan countries, there has been an intensification of the trade of agri-food products and a partial change in the regional and commodity structures of trade. This paper aims to identify comparative advantages of agri-food sectors and consider its tendencies during the EU integration process. Additionally, this paper will discuss some opportunities for improvement of the export positions of agri-food products. In that context and based on the literature review, the indexes of revealed comparative advantages and its modified version will be used as a main method for analysis in this research. Results showed that all Western Balkan countries, except Albania, have comparative advantages in exporting agri-food products. It is evident that Serbia has the highest level of comparative advantages in this sector. Moreover, this paper suggests that all countries should aim to provide the best possible positions for their agri-food products during pre-accession negotiations for EU membership and take the necessary steps towards increasing the level of competitiveness in the common EU market.