Prevalence of STIs, sexual practices and substance use among 2083 sexually active unmarried women in Lebanon.

Access to sexual and reproductive health in conservative communities and in the MENA region are particularly limited and, as such, increase women's vulnerability to unwanted pregnancies, unsafe abortions, and sexually transmitted infections (STIs). The aim was to assess the prevalence of STIs, sexual practices, recreational drug-use and their possible associations among cisgender unmarried women residing in Lebanon. Data on demographics, sexual practices and substance-use were collected from 2083 unmarried cisgender women who voluntarily attended a sexual health clinic in Lebanon between 2015 and 2019. They tested for HIV, Hepatitis B, Hepatitis C and Syphilis through rapid testing. Other infections (genital warts, Neisseria gonorrhea/Chlamydia trachomatis) were screened for. Regression models were computed between variables. There were two cases of HIV, one of Hepatitis B and syphilis, and no cases of Hepatitis C. Genital warts were present in 15% and symptoms indicative of Neisseria gonorrhea/Chlamydia trachomatis in 14%. Inconsistent condom-use (81%) was significantly associated with number of partners (adj. OR: 0.4). Inconsistent condom-use discussion with partners (33%) was significantly associated with unemployment (adj OR: 1.7), recreational drug-use (adj. OR: 1.4), and number of partners (adj. ORs 3.7-4.4). Unwanted pregnancies (11%) were significantly associated with age (adj. ORs 0.1-0.37), recreational drug-use (adj. OR: 2), using intrauterine device (adj. OR:2.9) and natural birth control methods (adj. OR: 2.4). Recreational drug-use (33%) was significantly associated with age (adj ORs 1.9-2.2), and smoking status (adj. OR: 0.6). The results indicate an urgent need for: (1) Accessible, non-stigmatizing, and inclusive sexual health services dedicated to women's sexual health; (2) Comprehensive and non-stigmatizing sexual health education for all, but especially women, in order to promote safer sexual practices and effective decision making with regards to contraception and condom-use.

Psychosocial Barriers and Enablers for Prostate Cancer Patients in Starting a Relationship.

Single prostate cancer (PCa) patients may face difficulties in starting a new relationship for various reasons. Here, we studied barriers and enablers to starting a relationship for PCa patients and characteristics of patients who were and were not in a relationship. PCa organizations distributed for us a 20-minute online survey, consisting of validated questionnaires (on treatment side effects, loneliness, social provision, and shyness) and questions on factors identified by patients as barriers and enablers to forming a new relationship. Participants were either single [n = 20] or had started a new relationship post-diagnosis [non-single, n = 15]. Three factors-confidence, sexual function, finding the right person-were perceived of as factors that can affect starting a relationship. Fourteen of twenty single patients were confident that they could find a partner and sixteen were comfortable in disclosing their cancer diagnosis to a potential partner. Non-single patients met their partners through various ways, including online dating and social events. They all revealed their cancer status prior to starting the relationship, and most partners reacted well to this disclosure. Single patients were lacking emotional support, more shy, and lonelier than non-single patients. Clinicians need to consider biopsychosocial factors when advising single patients who wish to start a new relationship.

A Retrospective Study to Identify Novel Factors Associated with Post-stroke Anxiety.

BACKGROUND AND PURPOSE: Post-stroke anxiety (PSA) is common and disabling. PSA should be considered as an important outcome in stroke. However, there is a lack of understanding of factors that may be linked to PSA. The purpose of this study was to determine the frequency of PSA and sociodemographic and clinical factors associated with PSA in a cohort of racially and ethnically diverse stroke patients. METHODS: We conducted a retrospective study of ischemic and hemorrhagic stroke patients seen in a stroke outpatient clinic from August 1, 2017 to June 30, 2018. Patients were eligible if a Generalized Anxiety Disorder 7-Item (GAD-7) instrument was available. GAD-7 scores greater than or equal to 10 indicated the presence of moderate to severe PSA. Multivariable logistic regression was used to identify independent sociodemographic and clinical factors associated with PSA. RESULTS: Records from 289 stroke patients with a GAD-7 instrument were analyzed. PSA was common (21%; GAD-7 ≥ 10). Fifty-seven percent of females had a GAD-7 greater than or equal to 10 compared to 41% of females who had a GAD-7 less than 10 (P = .03). Multivariable analysis found that self-reported nonmarried status (odds ratio, 3.27; 95% confidence interval, 1.44-7.44), excessive fatigue (odds ratio, 4.46; 95% confidence interval, 1.87-10.63), and depression (odds ratio, 1.24; 95% confidence interval, 1.16-1.33) were independently associated with PSA. CONCLUSIONS: PSA may occur more frequently in those who report non-married, excessive fatigue, or depression. Trials of PSA interventions should consider the potential impact of social support, depression, and comorbid conditions contributing to post-stroke fatigue, including sleep apnea.

Effects of electroacupuncture on anxiety and depression in unmarried patients with polycystic ovarian syndrome: secondary analysis of a pilot randomised controlled trial.

OBJECTIVE: To evaluate the efficacy of electroacupuncture (EA) for the treatment of anxiety and depression in unmarried patients with polycystic ovarian syndrome (PCOS) by secondary analysis of a randomised controlled trial. METHODS: A prospective pilot randomised controlled trial of unmarried women with PCOS was conducted from November 2012 to March 2016. Participants were assigned to the acupuncture group (receiving EA for 16 weeks) or the control group (receiving sham acupuncture for 16 weeks), with 27 patients in each group. The pre-specified primary outcomes and all secondary outcomes, with the exception of serum levels of neurotransmitters including norepinephrine (NE), epinephrine (AD), serotonin (5-HT) and γ-aminobutyric acid (GABA), will be reported separately. Additional outcome measures selected for this secondary analysis included anxiety and depression scale scores (Zung-SAS and Zung-SDS), 36-Item Short Form (SF-36) scale scores, PCOS Quality of Life (PCOSQOL) scale scores and Chinese Quality of Life (CHQOL) scale scores. RESULTS: After the16-week intervention, an increase in serum NE and reduction in 5-HT were observed in the acupuncture group (P=0.028 and P=0.023, respectively). The serum level of GABA decreased in both groups after the interventions (both P<0.001). However, there were no significant differences between the two groups in the levels of any neurotransmitters (p>0.05). After EA treatment, SAS and SDS scores were decreased in the acupuncture group (P=0.007 and P=0.027, respectively) and were lower than those of the control group (P=0.003 and P=0.004, respectively). The SF-36 domain scores for mental health, vitality, social functioning, general health and health transition, the total CHQOL scores, and the infertility problems and body hair domains of the PCOSQOL improved significantly after EA (P<0.05). CONCLUSION: EA appears to improve symptoms of anxiety/depression and quality of life in PCOS patients and may influence serum levels of NE and 5-HT. These findings should be interpreted with caution, given the secondary nature of the outcome measures reported herein. TRIAL REGISTRATION NUMBER: NCT01812161; ChiCTR-TRC-12002529.

The Influence of Marital Status on Contemporary Patterns of Postmastectomy Breast Reconstruction.

BACKGROUND: Marital status is known to influence quality of life, survival, and treatment decision-making after breast cancer diagnosis. We aimed to determine whether relationship status impacts contemporary patterns of immediate breast reconstruction. METHODS: Surveillance, Epidemiology, and End Results (SEER)-18 was used to identify females undergoing mastectomy for stage 0-III breast cancer from 1998 to 2014. Multivariate logistic regression was used to estimate the association of relationship status with the likelihood of postmastectomy reconstruction. Patients were grouped by diagnosis year to assess change in the reconstructed population with time. Among younger patients ≤45 years, a generalized logistic model was used to predict reconstruction subtype. RESULTS: Among 346,418 patients, reconstruction after mastectomy was more likely to occur in women with relationship support in the form of a marriage or partner [odds ratio (OR) 1.31; 95% confidence interval (CI), 1.28-1.34; p<0.001]. Women who were separated (OR 0.76), single (OR 0.73), or widowed (OR 0.56) were significantly less likely than married women to undergo reconstruction (all p<0.001). During the 17-year study period, change in reconstruction rates with time varied by relationship status (interaction p=0.02), with reconstruction rates among divorced patients increasing more slowly than those among married and partnered women. Among younger women, subtype patterns varied by relationship status (p=0.004), with divorced women less likely to receive autologous over implant reconstruction (OR 0.87; p = 0.03). CONCLUSION: Relationship status may influence decision-making regarding pursuit and type of postmastectomy reconstruction. Consideration of support networks of patients with breast cancer could facilitate tailored preoperative counseling by reconstructive surgeons.

Burnout syndrome in orthopaedic and trauma surgery residents in France: A nationwide survey.

BACKGROUND: Burnout syndrome is one of the manifestations of distress in healthcare workers and is characterised by emotional exhaustion (EE), depersonalisation (DP), and a sense of low personal accomplishment (PA). The surgical residency is a period of intense training that imposes major challenges on future surgeons, who may therefore be at high risk for burnout syndrome. Nevertheless, no data on burnout syndrome in orthopaedic and trauma surgery (OTS) residents in France is available. Therefore we performed a prospective survey to: (1) evaluate the prevalence of burnout syndrome among OTS residents in France, (2) and to look for factors associated with a higher or lower risk of burnout syndrome in the survey respondents. HYPOTHESIS: Burnout syndrome is at least as prevalent among OTS residents in France as among residents in other medical and surgical specialities. MATERIAL AND METHODS: A nationwide prospective survey was conducted in France between February and April 2017 via a digital questionnaire sent by email. Burnout syndrome was evaluated using the Maslach Burnout Inventory (MBI) and symptoms of depression using the General Health Questionnaire (GHQ-12). Demographic data and information on relationships with partners and working modalities were collected. RESULTS: Of 480 OTS residents, 107 (22%) completed the questionnaire. Mean age was 27 years and 65% (n=70) were male. High EE was reported by 26% (n=28), high DP by 63% (n=68), and low PA by 33% (n=36) of respondents. The scores on two or all three of the MBI sub-scales were abnormal, indicating severe burnout syndrome, in 40% (n=43) of respondents. The GHQ-12 scores indicated symptoms of depression in 40% (n=43) of respondents. Furthermore, 61% (n=66) of respondents stated that they would not recommend OTS or any other area of medicine to their children as a career and 10% (n=11) reported suicidal ideation during the past year. The statistical analysis identified three risk factors for burnout syndrome: medical errors (odds ratio [OR], 8.8; 95% confidence interval [95%CI], 1.7-58.7; p=0.0121), symptoms of depression (OR, 19.3; 95%CI, 2.9-196.0; p=0.0048), and living single (OR, 4.7; 95%CI, 1.4-18.9; p=0.0173). DISCUSSION: Despite the 22% response rate, this study provides useful information on the prevalence of burnout syndrome among OTS residents in France, with severe burnout in 40% and suicidal ideation in 10%. These prevalences may be overestimations, however, as residents who felt under stress may have been more likely to respond to the survey. In published studies, burnout syndrome was associated with higher risks of medical error and suicidal behaviour. These data emphasise the importance of detecting and managing burnout syndrome in healthcare staff. LEVEL OF EVIDENCE IV: Prospective descriptive cross-sectional survey with no control group.

Association between induced abortion and suicidal ideation among unmarried female migrant workers in three metropolitan cities in China: a cross-sectional study.

BACKGROUND: Despite reports of mental health issues, suicidality has not been closely examined among the migrant population. The association between induced abortion and suicidal ideation is unknown among unmarried female migrant workers of reproductive age in China. This study aims to examine induced abortion and suicidality among the Chinese migrant population. METHODS: We recruited 5115 unmarried female migrant workers during 2015 to 2016 from Shanghai, Beijing and Guangzhou, and collected demographic, psychosocial, reproductive and mental health information using structured questionnaires. We used logistic regression models to examine the association between lifetime induced abortion and suicidal ideation during the past year among the subjects. RESULTS: Overall, 8.2% of the subjects had suicidal ideation during the past year, and 15.5% of the subjects experienced induced abortion. Induced abortion was associated with nearly twice the odds of having past-year suicidal ideation (Odds ratio, OR = 1.89; 95% confidence interval, CI: 1.46, 2.44) after adjusting for age, education, years in the working place, tobacco use, alcohol consumption, daily internet use, attitude towards premarital pregnancy, multiple induced abortion, self-esteem, loneliness, depression, and anxiety disorders. The association was stronger in those aged > 25 (OR = 3.37, 95% CI = 2.16, 5.28), with > 5 years of stay in the working place (OR = 2.98, 95% CI = 2.02, 4.39), the non-anxiety group (OR = 2.28, 95% CI = 1.74, 3.00), and the non-depression group (OR = 2.94, 95% CI = 2.08, 4.15). CONCLUSIONS: Induced abortion was associated with increased odds for suicidal ideation among the unmarried female migrant workers in urban cities in China. More attention should be paid to the mental health of the population.

Do single people want to date a cancer survivor? A vignette study.

OBJECTIVE: Qualitative studies indicated that cancer survivors may be worried about finding a partner in the future, but whether this concern is warranted is unknown. We examined single people´s interest in dating a cancer survivor, how they perceive survivors' traits, and their preferences about the timing of disclosing a cancer history. METHODS: In three experimental vignette studies, dating website members (n = 324) and college students (n = 138 and n = 131) were randomly assigned to a vignette of a person with or without a history of cancer (experiment 1 & 2), or a cancer survivor beyond or during active follow-up (experiment 3). Respondents rated their interest in dating this fictive person, this person's traits, and indicated their preferences about the timing of disclosure. ANOVAs with main and interaction effects of condition, gender, and relationship history were conducted, partial eta squared and Cohen's d were used to estimate the magnitude of effects. Correlations were used to investigate relationships between interest in a date and assessment of traits. RESULTS: Cancer survivors' traits were assessed more positively, but interest to date them did not differ from healthy vignettes for both men and women. However, widowed respondents were much less interested in a date with a cancer survivor, and women showed less interest in a cancer survivor during active follow-up relative to survivors beyond follow-up. Most respondents wanted to hear about the cancer diagnosis after a few dates, hardly anyone wanted to hear about this before the first date (2% - 5%). CONCLUSION AND IMPLICATIONS FOR CANCER SURVIVORS: Cancer survivors do not have to expect any more problems in finding a date than people without a cancer history, and can wait a few dates before disclosing. Survivors dating widowed people and survivors in active follow-up could expect more hesitant reactions and should disclose earlier.

A qualitative metasynthesis exploring the impact of prostate cancer and its management on younger, unpartnered and gay men.

Prostate cancer (PCa) can negatively impact on men's sexual, urinary and emotional functioning, affecting quality of life. Most men with PCa are older (≥65 years), married and heterosexual and little is known about the impact on men who are younger, unpartnered or gay. We aimed to synthesise existing qualitative research on these three groups of men. A systematic metasynthesis was undertaken that included data on the unique impacts of PCa on younger (<65 years) (n = 7 papers), unpartnered (n = 17 papers) or gay or bisexual men (n = 11 papers) using a modified meta-ethnographic approach. The three overarching constructs illustrated the magnified disruption to men's biographies, that included: marginalisation, isolation and stigma-relating to men's sense of being "out of sync"; the burden of emotional and embodied vulnerabilities and the assault on identity-illustrating the multiple threats to men's work, sexual and social identities; shifting into different communities of practice-such as the shift from being part of a sexually active community to celibacy. These findings suggest that PCa can have a particular impact on the quality of life of younger, unpartnered and gay men. This has implications for the provision of tailored support and information to these potentially marginalised groups.

Factors contributing to poor satisfaction with sleep and healthcare seeking behavior in older adults.

OBJECTIVE: To identify factors influencing older adults' poor satisfaction with sleep and their current healthcare seeking behaviors. DESIGN: Cross-sectional study. SETTING: Pittsburgh Claude D. Pepper Older Americans Independence Center Community Registry. PARTICIPANTS: Individuals aged 60 or older enrolled in the registry that completed a cross-sectional mailed survey (N = 1026). MEASUREMENTS: Participant demographics (age, gender, marital status, race, education), overall health (self-rated health, pain, and comorbidities), and health behaviors (physical activity, smoking, drinking behaviors) were collected from the registry database. A mail survey was used to collect self-report on sleep problems and their current healthcare seeking behaviors. Simple and multiple logistic regression models were used to evaluate associations between variables. RESULTS: A total of 19.3% of participants reported being "dissatisfied" or "very dissatisfied" with their overall sleep quality. Participants who reported poor sleep satisfaction were more likely to be single and report poorer overall health compared to participants who were satisfied with their sleep quality. They were also more likely to report using over-the-counter (OTC) and prescription sleep medications, discuss sleep problems with a healthcare provider, and use strategies to improve their sleep (P < .05). A higher proportion of participants with trouble sleeping throughout the night reported they had discussions with a healthcare provider (47.2%), and used OTC (38.6%) or prescription (20.1%) sleep aids. CONCLUSIONS: These results underscore the possible linkage between poor satisfaction with sleep and older adults' current healthcare seeking behaviors and self-treatment methods, particularly using OTC medications to cope with sleep problems without consulting a healthcare provider.

The effect of living alone on the costs and benefits of surgery amongst older people.

Older people who live alone are a growing, high-cost group for health and social services. The literature on how living alone affects health and the costs and benefits of healthcare has focused on crude measures of health and utilisation and gives little consideration to other cost determinants and aspects of patient experience. We study the effect of living alone at each stage along an entire treatment pathway using a large dataset which provides information on pre-treatment experience, treatment benefits and costs of surgery for 105,843 patients receiving elective hip and knee replacements in England in 2009 and 2010. We find that patients who live alone are healthier prior to treatment and experience the same gains from treatment. However, living alone is associated with a 9.2% longer length of in-hospital stay and increased probabilities of readmission and discharge to expensive destinations. These increase the costs per patient by £179.88 (3.12%) and amount to an additional £4.9 million per annum. A lack of post-discharge support for those living alone is likely to be a key driver of these additional costs.

Older people living alone at home with terminal cancer.

This study describes the lived experiences of older people coping with terminal cancer and living alone, focusing on how they face challenges of the biographical life changes from their disease progression. Face-to-face semi-structured interviews were conducted in two phases with palliative care clients of a community-based service in Western Australia (2009-2011): Brief interviews with 43 cancer patients who live alone and then in-depth interviews with 8 of them. Using biographical disruption as the analytical framework for interpreting the qualitative data, four main themes emerged: Biographical disruption: adjusting to change; Biographical continuity: preserving normality; Biographical reconstruction: redefining normality; and Biographical closure: facing the end. Biographical disruption was a suitable framework for analysis, permitting identification of the biographical disruptions of the individual's world and the reframing that is undertaken by the individual to maintain autonomy and independence while acknowledging and accepting their closeness to death. Understanding the factors associated with the individual's need to maintain their own identity will enable nurses working with this population to tailor support plans that meet the individuals' needs while maintaining or restoring the person's sense of self. Interventions that directly address end-of-life suffering and bolster sense of dignity and personhood need to be considered.

Acting Independently While Living Alone: The Strategies and Struggles of Cancer Patients.

Cancer patients who live alone place specific importance on acting independently during treatment. We want to describe what it means to act independently and which strategies patients use to continue to act independently. We used a qualitative design, based on grounded theory. We interviewed 32 patients, 17 of them a second time. Patients who live alone defined acting independently in two different ways: It meant not only doing things alone but also using the help of others in a controlled way. These two meanings lead to two types of strategies. As treatment evolves, patients needed to change their preferred type of strategies to continue acting independently. Succeeding to change led to a feeling of mastery and success. However, failing to change led to struggling, whereby patients' needs became invisible. Health care providers should anticipate patients' inability to change strategies during cancer treatment, thereby preventing the patient's struggle from only becoming visible during crisis.

Presentación atípica del síndrome de Gorham-Stout: Caso clínico / Atypical presentation of Gorham-Stout syndrome: Case report

El síndrome de Gorham-Stout es una patología ósea extremadamente rara de etiología desconocida, caracterizada histopatológicamente por proliferación de los canales vasculares, que origina destrucción y resorción de la matriz ósea. Se presenta el caso de un paciente varón de nueve años de edad con un cuadro agudo caracterizado por fiebre, dolor torácico, dificultad respiratoria y disnea ante pequeños esfuerzos. Se realizaron estudios de imágenes y patología, en los que se encontraron lesiones liticas múltiples y presencia de un linfangioma mediastínico. Se diagnosticó síndrome de Gorham-Stout. Esta es una presentación atípica debido a la localización de la linfangiomatosis y al tamaño de la masa.

Gorham-Stout syndrome is an extremely rare pathology, of unknown etiology. It is characterized by proliferation of vascular channels that causes destruction and reabsorption of the bone matrix. We present a nine year-old male patient with an acute episode characterized by fever, chest pain, respiratory distress and dyspnea. The patient was submitted to computed tomography scan and a biopsy. The findings in the biopsy were multiple lytic lesions, osteolysis, and a mediastinal lymphangioma (lymphangiomatosis). The diagnosis was Gorham-Stout syndrome with atypical presentation.

Living With Cancer Alone? The Experiences of Singles Diagnosed With Colorectal Cancer.

This paper seeks to understand the experiences of single colorectal cancer patients. This study consisted of 12 semi-structured interviews that were digitally voice-recorded, transcribed, and analyzed. Six main themes emerged: (a) gradual shift in view of cancer diagnosis from fatalistic to normalized, (b) perception of cancer as a nadir experience, (c) concerns of singlehood, (d) factors influencing cancer experiences, (e) factors influencing coping with cancer, and (f) range of responses towards cancer diagnosis. Singles with colorectal cancer require short- to long-term individualized care plans, and psycho-emotional support. This may help enhance their individual coping and adjustment to the diagnosis.

Impact of singlehood during pregnancy on dietary intake and birth outcomes- a study in the Norwegian Mother and Child Cohort Study.

BACKGROUND: Little attention has been given to the impact of singlehood during pregnancy. The aim of this study was to examine the impact of marital status on diet during pregnancy and pregnancy outcome. METHODS: The study population comprised 62,773 women participating in the Norwegian Mother and Child Cohort Study. Marital status was categorised into singles living alone, singles living with parents and married/cohabiting (reference group). Participants answered a general health questionnaire in gestational week 15-17 and a food frequency questionnaire in gestational week 22. We used nonparametric tests to compare dietary intakes by marital status, and multiple logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI) for infants being small for gestational age (SGA), large for gestational age (LGA), and preterm delivery (defined as delivery before gestational week 37). RESULTS: Single women living with parents had lower intakes of fruits and vegetables, higher intake of total energy, higher proportion of energy from added sugar, and lower intake of fibre than the reference group. Singles living alone also had a higher intake of added sugar. In both of the single groups, daily smoking was more prevalent than in women living with a partner. In analyses adjusted for maternal age, pre-pregnancy BMI, energy intake, energy contributed by protein, education, income, parity and nausea, single women living alone had increased risk of SGA with OR = 1.27 (95% CI: 1.05, 1.55). When smoking was included among the confounding variables, the association was no longer significant. Likewise, singles living alone had increased risk of preterm delivery, with OR = 1.32 (95% CI: 1.01, 1.72) in a partly adjusted model, but the association did not remain significant in a model fully adjusted for confounding variables. CONCLUSIONS: Single mothers had lower dietary quality and included more smokers than women who lived with a partner. Single mothers living alone had higher prevalence of SGA and preterm delivery, but the associations with adverse pregnancy outcomes were confounded by other variables. This study shows that single mothers should be given special attention during antenatal care and counselling.

The stressors and vulnerabilities of young single childless women with breast cancer: a qualitative study.

PURPOSE OF THE RESEARCH: Marital or partnership status is seldom investigated as a primary contributing factor to women's wellbeing after a diagnosis of breast cancer. It has been suggested, however, that single childless women with breast cancer may face unique stressors. This paper explores the stressors and vulnerabilities of young single childless women with a first episode of breast cancer. METHODS AND SAMPLE: A qualitative descriptive method was used. As part of a larger study examining fertility concerns of young childless women with first episode of breast cancer, in-depth semi-structured interviews were conducted with 10 single women. Recorded interviews were analysed using the framework approach. KEY RESULTS: Findings cover three main themes: partnership worries; fertility concerns; and views about emotional and practical support received. Partnership worries included concerns about having to undergo treatment without a partner to support them; the fear of rejection by potential partners; and feelings about the precious time lost in diagnosis and treatment. Fertility concerns included dilemmas about having children and feelings about the options of pursuing Assisted Reproductive Techniques. Views about the emotional and practical support received included the overall support received as well as perceptions about the attitudes of health professionals towards fertility issues. CONCLUSIONS: Findings indicate that single childless women with breast cancer face additional vulnerabilities and may benefit from tailored support from health care professionals and interventions specifically targeted at them.

Living alone, obesity, and smoking increase risk for suicide independently of depressive mood findings from the population-based MONICA/KORA Augsburg cohort study.

BACKGROUND: Suicide is strongly associated with mental disorders, particularly with depression. There is insufficient knowledge to what extent sociodemographic and behavioral characteristics contribute to suicide risk. METHODS: A population-based cohort study on three independent cross-sectional MONICA/KORA Augsburg surveys with 12,888 subjects (6456 men, 6432 women) was followed up on average for 12.0 years. Information on sociodemographic characteristics, chronic disease conditions, smoking habits, alcohol consumption, depressive symptoms, personality type, and other psychodiagnostic parameters was assessed by standardized interviews. Cox proportional hazards regression analyses were used to compute hazard ratios (HRs) as estimates of relative risks for suicide mortality. Additionally, population-attributable risks were calculated. RESULTS: Within the follow-up period, a total of 1449 persons had died, 38 of them by suicide. Although several variables were associated with increased risk in the basic analyses, only obesity (HR=2.73), smoking (HR=2.23), and living alone (HR=2.19) remained significantly associated with suicide additionally to male sex (HR=3.57) and depressed mood (HR=2.01) in a multivariate analysis. LIMITATIONS: The generalization of our findings to countries with different social, economic or cultural conditions may be questioned. CONCLUSIONS: Our findings extend the knowledge about sociodemographic and behavioral risk factors for suicide in the general population: Suicide prevention measures should not consider only subjects with mental disorders but also address other adverse conditions.

Depression in women aged 75-89--predisposing factors and preventive measures.

BACKGROUND: There are analyses showing the relationship between low and irregular physical activity and the risk of more frequent occurrences of depression symptoms in the future. There are studies that do not prove the connection between those two dependencies. OBJECTIVES: The aim of this study was to find the relationship between physical activity before menopause and the occurrence of depression in senium. MATERIAL AND METHODS: The study was comprised of 200 randomly selected women, aged 75-89 years, who were treated in the local department of general surgery and oncology from January to June 2009. The study used a 15-point Geriatric Depression Scale which is an integral part of the EASY care (Polish version 1999-2002) questionnaire to assess emotional efficiency, and the Questionnaire Survey for Research on Physical Activity in Older People which contains 8 questions. The results were statistically analyzed using a Student's test and basic probabilities calculations. RESULTS: The probability of depression in women aged 75-89 is 0.8. Increased physical activity in pre-menopausal women neither affects the level of depression, nor prevents it (p < 0.1). Depression was more common in people living alone, in which case the probability is 0.85. Postmenopausal women enjoy a beneficial impact on physical activity in the following areas: previous activity (p < 0.001), family support (p < 0.0001), GP support (p < 0.001), and television education (p < 0.001). CONCLUSIONS: Depression among elderly women is very common. In this study, depression was found in 80% of senior women. There is a relationship between depression and physical activity. Increased physical activity in premenopausal women neither affects the level of depression, nor prevents it. There was no correlation between age, weight, education, place of residence and depression. Depression was more common in people living alone.

Do models of care designed for terminally ill 'home alone' people improve their end-of-life experience? A patient perspective.

Palliative care patients who live alone report greater psychological distress, and are less likely to die at home than those living with a family carer. However, there is a lack of research on the value of models of care that specifically address this disadvantage. This article describes the experiences of terminally ill 'home alone' people using one of two models of care aimed at maintaining participants' need for independent living, focusing on the effect of these two models of care on their physical, social and emotional needs. Twenty six palliative care patients of Silver Chain Hospice Care, in Western Australia, were randomly assigned to either having a personal alarm or additional care-aide hours in their home. An in-depth qualitative study was conducted in two phases in 2010 using face-to-face interviews. The care-aide model of care resulted in benefits such as easing the burden of everyday living; supporting well-being; enhancing quality of life and preserving a sense of dignity; and reducing loneliness and isolation. The personal alarm model of care imparted a sense of security; provided peace of mind; and helped to deal with feelings of isolation. Participants in both groups felt that they could remain at home longer. By providing a safer, more secure environment through the use of a personal alarm or additional care-aide hours, patients were able to continue their activities of daily living, could build a sense of 'normality' into their lives, and they could live independently through support and dignity.