Health behaviours of patients with affective disorders: a cross-sectional study.

BACKGROUND: Severe mental disorders, including affective disorders (AD), are associated with high rates of physical illnesses that lead to premature patient death. Excess somatic comorbidity may be partially explained by lifestyle factors. This study aimed to investigate the health behaviours (HBs) of patients with AD in comparison to the HBs of patients with type 2 diabetes (T2D) and healthy controls (HCs) and to examine associations among HBs and sociodemographic and clinical factors, subjective quality of life and health status, and health locus of control. METHODS: The sample consisted of 108 patients with AD, including 60 with bipolar disorder (BP) and 48 with unipolar disorder (UAD). Analyses included comparisons with a subgroup of AD individuals, patients with T2D and HCs matched in age and sex. The Health Behaviour Inventory was used to evaluate the overall levels of HBs and 4 HB categories. To identify independent determinants of health behaviours, a multivariate linear regression analysis was performed with factors identified as significant in bivariate analyses. RESULTS: Most AD patients had a low level of HBs (40%), followed by moderate (35%) and high levels (25%), and there were no significant differences in HBs between the BP and UAD groups. Compared with the T2D and HC groups, the AD group had a significantly lower level of overall HBs and lower levels of HBs in one of the categories. Independent predictors of overall HBs were quality of life (ß = 0.28, p < 0.001), age (ß = 0.27, p = 0.002), and depressive symptoms (ß = 0.23, p = 0.008). A total of 30% of the variance in HBs was explained. CONCLUSIONS: These findings emphasise the need for a systematic assessment of single and multiple health behaviours to provide better care for patients with AD and reduce the potential adverse effects of an unhealthy lifestyle.

Are yoga and physical activity determinants of quality of life in Polish adults? a cross-sectional study.

OBJECTIVES: Yoga is an ancient form of physical activity (PA) that encompasses meditation, stretching and breathing techniques. Although the benefits of PA and associated lifestyle interventions are clear, we here addressed the paucity of evidence regarding the specific relationship between yoga and quality of life (QOL) in adults in Poland. We hypothesised that participation in PA and yoga could result in a positive impact on QOL. DESIGN: Cross-sectional, self-administered questionnaire-based survey. Both the quantitative and qualitative variables were statistically compared. Multivariate analyses were performed using linear regression. Results were determined based on age, sex and education level; a p<0.05 was considered significant. SETTING: Questionnaires were delivered to participants online, at high schools and universities, and in elderly communities in Poland. PARTICIPANTS: 714 polish citizens aged over 18 participated in the study; there are no specific entry and exclusion criteria besides age. RESULTS: Statistically significant differences (p<0.05) were observed between the QOL of the physically active group (PAG) and non-PAG (N-PAG). Meanwhile, yoga practice was revealed to have a significant effect on QOL; QOL was found to be statistically higher (p<0.001) in the PAG with yoga (PAG-Y) (4.29±0.66) than in the N-PAG (3.83±0.92) and PAG without yoga (4.07±0.68). CONCLUSIONS: The study shows that both regular PA and yoga practices could improve QOL; however, PAG-Y produced higher QOL scores than PA of other types. This outcome may be explained by the impact of physiological and psychological aspects within yoga practice. These results suggest that this unique combination impacts health more positively than other kinds of PA alone.

Development and Psychometric Properties of the Caregiver Burden Scale in Polish Caregivers of Stroke Patients.

Purpose: Most stroke patients require long-term care of their family members. Excessive care burden entails several negative consequences; therefore, the severity of the burden should be periodically assessed. For this purpose, valid multidimensional measures are needed. Our study, which is a part of a larger research project, aims to translate and evaluate the psychometric properties of the Polish Caregiver Burden Scale (CBS) in relation to construct validity and internal consistency in caregivers of the patients after stroke. Patients and Methods: The sample of this cross-sectional observational study consisted of 366 informal caregivers to consecutive first-ever stroke survivors. The five-factor Polish CBS and the Hospital Anxiety and Depression Scale (HADS) were administered during the home visits at three to six months after patients' hospitalisation. Exploratory (EFA), confirmatory (CFA) factor analyses and a net analysis were performed to investigate the internal structure and a factorial construct validity of the CBS. Correlation analyses between the CBS and the HADS were carried out to examine convergent validity. Cronbach's alpha and item-total correlation were applied to assess internal consistency. Results: Three out of five factors identified by EFA were similar to the original indices of the CBS, while the remaining two deviated from the original structure of the CBS. The CFA five-factor model represented an acceptable fit (confirmatory fit index, CFI = 0.96, root mean square error, RMSEA = 0.04) but only after a modification. All subscale scores of the CBS were positively correlated with the HADS, supporting the convergent validity. Cronbach's alpha coefficients for the overall scale (0.92) and all subscales (0.72-0.87) except one (0.69) and item-total correlation results indicated good internal consistency. Conclusion: The Polish version of the CBS showed acceptable internal consistency and good convergent validity. Factorial validity and structural integrity were partially supported. The interrelationships between the CBS subdomains, their partial mutual contamination, and the scale's non-orthogonal structure should be considered when interpreting the results of further studies using this version of the scale.

Effect of Face Masks on Blood Saturation, Heart Rate, and Well-Being Indicators in Health Care Providers Working in Specialized COVID-19 Center.

This study aims to investigate whether wearing face masks (filtering facepieces, FFP class 2) with personal protective equipment (FPP2/PPE), while working a 12-h shift in a COVID-19 referral center, affects the blood saturation, heart rate (HR), and well-being of health care providers (HCPs). The study included a group of 37 HCPs. To perform continuous recordings of the SpO2 and heart rate (HR) in real time, we used a Nellcor PM10N (Covidien, Mansfield, MA, USA) portable monitoring system. SpO2, HR, and HCP well-being scales were measured during two 3-h shifts, while HCPs worked during a 12-h period. Additionally, each subject completed a questionnaire concerning their well-being. The difference in the SpO2 level between the 1st and 2nd working shifts while wearing an FFP2/PPE was small, with a median decrease in SpO2 of -1%. The scales of the well-being indicators increased within the shift. They were mainly fatigue and thirst with median scores of 2 out of 6 (range 0-4). We assume that during a 12-h period, a work scheme that consists of a 3-h shift in FFP2/PPE and a 3-h rest period (working without FPP2/PPE) is a reliable and safe solution for HCPs working in specialized COVID-19 referral hospitals.

Neuropsychological exponents for the driving ability in remitted bipolar patients.

BACKGROUND: Bipolar disorder (BD) is associated with cognitive deficits regardless of the phase of the disease. Medications used in treatment are an additional factor that may affect cognitive performance. Poor cognitive performance can significantly affect a patient's ability to drive. AIM OF THE STUDY: This study aims to explore cognitive functions relevant for safe driving in the group of remitted bipolar patients. METHOD: Patients with BD in remission (n = 33) and healthy volunteers (n = 32) were included. Selected psychometric tests for drivers were carried out using computer software: called Specialistic Diagnostic Platform (SPD): The Cross-over Test (COT) version with free tempo (COT-F) and tempo of 50 tasks per minute (COT-50) and the Signal Test (ST). Moreover, the following neuropsychological tests were used: Rey Auditory Verbal Learning Test (RAVLT), Stroop Color-Word Test (SCWT) part A and B, and Trail Making Test (TMT) version A and B. RESULTS: In comparison with healthy controls bipolar patients in remission had poorer outcomes for some cognitive parameters and longer reaction times in both tests for drivers and neuropsychological tests. Additionally, we found a significant correlation between the time of performance of neuropsychological tests and the time of psychometric tests for drivers. CONCLUSION: Patients with BD performed worse in several cognitive domains assessed by tests for drivers and neuropsychological tasks. These deficits can affect the speed of the patient's motor reactions while driving.

The impact of FFP3 respirators on the blood saturation.

This study aims to investigate whether wearing a filtering facepiece class 3 respirators with personal protective equipment (FPP3/PPE) during work in the intensive care unit (ICU) affects the blood saturation (SpO2), the heart rate (HR), and the well-being of health care workers (HCWs). This preliminary study included a group of 21 volunteers (including 16 females (76%), with a median age of 23 years). Each worker served as his own control and performed the test two times: they wore the FFP3/PPE and did not wear it for a three-hour shift in the ICU. The working with an FFP3/PPE compared to not working with an FFP3/PPE caused a significant, but within normal ranges, influence on the level of SpO2 with a mean decrease of - 1.43%. The highest reduction in the SpO2 was - 2.29% and occurred after 150 min of work. All of the score scales of the well-being markers increased consecutively but moderately during the shift while wearing the FFP3/PPE. We assume that a 3-h shift rhythm is a safe and reliable solution, i.e., three hours of working in the FFP3/PPE in the ICU, followed by rest or working without an FFP3/PPE.

Needs of older persons living in long-term care institutions: on the usefulness of cluster approach.

BACKGROUND: Long-term care units' residents do not constitute a homogeneous population. Providing effective care, tailored to individual needs, is crucial in this context. It can be facilitated by suitable tools and methods, which include needs assessment along with the physical, psychological and social aspects of care. We thus applied a cluster approach to identify their putative groupings to enable the provision of tailored care. METHODS: The needs of 242 residents of care homes in four Polish cities (Poznan, Wroclaw, Bialystok and Lublin), aged 75-102 years (184 females), with the Mini-Mental State Examination (MMSE) score ≥ 15 points, were assessed with the CANE (Camberwell Assessment of Need for the Elderly) questionnaire. Their independence in activities of daily living was evaluated by the Barthel Index (BI), and symptoms of depression by the Geriatric Depression Scale (GDS). The results of MMSE, BI and GDS were selected as variables for K-means cluster analysis. RESULTS: Cluster 1 (C1), n = 83, included subjects without dementia according to MMSE (23.7 ± 4.4), with no dependency (BI = 85.8 ± 14.4) and no symptoms of depression (GDS = 3.3 ± 2.0). All subjects of cluster 2 (C2), n = 87, had symptoms of depression (GDS = 8.9 ± 2.1), and their MMSE (21.0 ± 4.0) and BI (79.8 ± 15.1) were lower than those in C1 (p = 0.006 and p = 0.046, respectively). Subjects of cluster 3 (C3), n = 72, had the lowest MMSE (18.3 ± 3.1) and BI (30.6 ± 18,8, p < 0.001 vs. C1 & C2). Their GDS (7.6 ± 2.3) were higher than C1 (p < 0.001) but lower than C2 (p < 0.001). The number of met needs was higher in C2 than in C1 (10.0 ± 3.2 vs 8.2 ± 2.7, p < 0.001), and in C3 (12.1 ± 3.1) than in both C1 and C2 (p < 0.001). The number of unmet needs was higher in C3 than in C1 (1.2 ± 1.5 vs 0.7 ± 1.0, p = 0.015). There were also differences in the patterns of needs between the clusters. CONCLUSIONS: Clustering seems to be a promising approach for use in long-term care, allowing for more appropriate and optimized care delivery. External validation studies are necessary for generalized recommendations regarding care optimization in various regional perspectives.

Polish version of the Brief Negative Symptom Scale (BNSS). / Polska wersja Krótkiej Skali Objawów Negatywnych (Brief Negative Symptom Scale ­ BNSS).

OBJECTIVES: To create a Polish adaptation of the Brief Negative Symptom Scale (BNSS), to assess the internal consistency of the Polish version of the BNSS, and to make correlations between the BNSS scores and the Positive and Negative Syndrome Scale (PANSS) in the group of patients with schizophrenia. METHODS: The procedure of Polish adaptation of the assessment form (Scoresheet) of the BNSS, comprising 13 items organized in 6 subscales (anhedonia, lack of proper distress, asociality, avolition, blunted affect, and alogia), as well as the Manual and the Workbook of the scale was carried out. Psychometric tests were performed in 40 patients with paranoid schizophrenia (20 men and 20 women), aged 44±13 years, with illness duration of 17±10 years, and severity of symptoms on the PANSS 56±16 points, receiving unchanged pharmacological treatment in the last three months. RESULTS: The Polish version was accepted by the authors of the scale. The reliability analysis showed high values of the Cronbach's alpha coefficient both for the whole scale (0.97) and for individual subscales (0.74-0.93). The BNSS and its subscales showed a high significant correlation with the total PANSS score and with the PANSS negative symptom subscale, both original and modified. CONCLUSIONS: The obtained results indicate good psychometric properties of the Polish version of the BNSS and its possible usefulness in the study of negative symptoms of schizophrenia conducted in Poland.

Polish version of the Self-evaluation of Negative Symptoms (SNS). / Polska wersja Skali Samooceny Objawów Negatywnych (Self-evaluation of Negative Symptoms ­ SNS).

OBJECTIVES: The aim of the study was to create a Polish version of the Self-evaluation of NegativeSymptoms (SNS) scale, to assess its internal consistency, and to make correlations between the SNS scores and the Brief Negative Symptom Scale (BNSS) scores in the group of patients with schizophrenia. MATERIAL AND METHODS: The procedure of Polish adaptation of the French-language version of the SNS scale, comprising 20 items organized in 5 subscales: asociality, blunted affect, alogia, avolition and anhedonia, was carried out. Psychometric tests were performed in 40 patients with paranoid schizophrenia (20 men and 20 women) with severity of symptoms on the Positive and Negative Syndrome Scale (PANSS) 56±16 points, receiving unchanged pharmacological treatment in the last 3 months. RESULTS: The Polish version of the SNS scale was accepted by the author of the scale, Professor Sonia Dollfus. The reliability analysis showed high values of the Cronbach's alpha coefficient for the whole scale (0.91) and for the subscales (0.61-0.85). The SNS and its subscales showed significant correlations with the total BNSS score and with the scores of the BNSS subscales, which confirms the validity of the scale. CONCLUSIONS: A statistically significant level of consistency of the whole scale and its individual domains with the results of the clinical assessment with the BNSS, speaks for the adequacy of the self - assessment of negative symptoms by a patient with schizophrenia. Good psychometric properties of the Polish version of the SNS obtained in the study can indicate its usefulness in the research on negative symptoms conducted in Poland.

The pattern of pharmacological treatment of bipolar patients discharged from psychiatric units in Poland.

BACKGROUND: The concomitant use of two or more mood stabilisers (MS), second-generation antipsychotics (SGA), lamotrigine as well as antidepressants, is frequently reported in the treatment of bipolar patients The aim of this study was to investigate the pattern of pharmacological treatment with special regard to polypharmacy defined as two or more psychiatric drugs taken at the same time in the same patients with bipolar disorder discharged from psychiatric units in Poland. METHOD: Pharmacotherapy of 127 consecutive patients (57 females and 70 males) with an ICD-10 diagnosis of bipolar disorder (BP) at the point of discharge from five psychiatric regional hospitals/units in Poland, was evaluated in 2015/2016 on the basis of medical files. The effect of treatment on mental status at discharge was examined using the Clinical Global Impression-Improvement scale (CGI-I). RESULTS: When only MS, SGA and lamotrigine, were taken into account, 78 (61%) of patients were prescribed two, 27 (21.3%) three and one patient four medications. The combination of MS and SGA was most commonly used (n=61, 48%). Medications preferred by Polish psychiatrists at patients' discharge were valproates (n=69, 54%), olanzapine (n=48, 37%), quetiapine (n=47, 37%) and lamotrigine (n=33, 25.9%). Thirty patients (23.6%) were prescribed lithium. No relationships were found between polypharmacy and patients' age, duration of illness and the rate of CGI-I. However, polypharmacy was significantly associated with types of bipolar disorder, particularly with the bipolar I disorder. CONCLUSION: The prevalence of polypharmacy especially with MS and SGA in the treatment of bipolar patients discharged from psychiatric units in Poland is high. The most significant factor predisposing to polypharmacy is a diagnosis of bipolar - I disorder. In general, our study confirms trends observed in other countries.

Depressive symptoms in stroke patients treated and non-treated with intravenous thrombolytic therapy: a 1-year follow-up study.

INTRODUCTION: This is a prospective study, first to compare the frequency of depressive symptoms in stroke survivors treated, and non-treated, with intravenous thrombolysis and second, to explore relationships between post-stroke depression (PSD) and stroke treatment modalities, taking into account other possible determinants of PSD, including post-traumatic stress symptoms. METHODS: Groups of 73 thrombolysed and 73 non-thrombolysed patients matched for age and gender were examined at 3 and 12 months after discharge. PSD was assessed using the Beck Depression Inventory. Post-traumatic stress symptoms (PTSS), disability and social support were assessed with the Impact of Event Scale-Revised, the Barthel Index and the Berlin Social Support Scale. RESULTS: At 3 months, PSD was present in 23.3% of the thrombolysed and 31.5% in the non-thrombolysed groups (p = 0.265). At 12 months, the frequencies were 29.2 and 20.6% (p = 0.229). Logistic regression of the combined group of thrombolysed and non-thrombolysed patients indicated that at 3 months, the adjusted predictors of PSD were disability (OR 24.35), presence of PTSS (OR 9.32), low social support (OR 3.68) and non-thrombolytic treatment (OR 3.19). At 12 months, the predictors were disability (OR 15.78) and low education (OR 3.61). LIMITATIONS: The use of a questionnaire for the detection of depression, the relatively small sample size and a significant drop-out rate could limit the interpretation of these results. CONCLUSIONS: (1) Thrombolysed and non-thrombolysed stroke survivors had similar frequency of depressive symptoms although the thrombolysed patients had more severe neurological deficits in the acute phase. It can be assumed that if thrombolysis had not been used, depressive symptoms would have been more frequent. (2) Lack of the rt-PA treatment was associated with three-time greater odds of screening for PSD at 3 months post-stroke, after adjustment for other PSD correlates. (3) Therefore, thrombolytic therapy seems to have a positive, but indirect, effect on patients' mood, especially in the first months after stroke. (4) All stroke patients, irrespective of the method of treatment, should be monitored for the presence of depression.

Validity of the EASYCare Standard 2010 assessment instrument for self-assessment of health, independence, and well-being of older people living at home in Poland.

EASYCare Standard 2010 is a brief instrument identifying concerns in health, functional independence, and well-being, from older persons' perspective. It has not previously been validated for self-assessment. Our aim was to determine whether self-assessment (EC1) can give comparable results to an evaluation performed by professionals (EC2), for older people living at home. The study included community-dwelling individuals (aged at least 60 years, n = 100; 67 females) without dementia (abbreviated mental test score [AMTS] above 6). It comprised two assessments (self and professional), including summarising indexes: Independence score [IS], Risk of breakdown in care [RBC], Risk of falls [RF], performed within a period between 1 and 2 weeks. Additionally, during EC1, reference tests of physical and mental function (Barthel Index: 96.3 ± 6.5, Lawton scale: 6.7 ± 2.0, geriatric depression scale: 3.0 ± 2.7, AMTS: 10.2 ± 1.0) were applied to test for concurrent validity. Cohen's kappa values (self-assessment vs. professional assessment) across all EASYCare domains were high (0.89-0.95). Results of all summarising indexes derived from self-assessment correlated strongly with reference tests. No differences were found in IS and RBC between EC1 and EC2 (8.6 ± 12.0 vs. 9.0 ± 12.7 and 1.0 ± 1.1 vs. 1.2 ± 1.4). Results of RF were higher in EC2 (1.0 ± 1.1 vs. 1.1 ± 1.4; p = 0.005), due to a different response to the item "Do you feel safe outside your home?" We conclude that self-assessment with EASYCare Standard in older people without severe functional impairment living at home can deliver valid results, similar to those obtained through professional assessment, thus providing an efficient system for assessment of relatively independent individuals.

Is Venlafaxine More Effective than Escitalopram and Nortriptyline in the Management of Painful Symptoms in Patients with Major Depression?

BACKGROUND: Conflicting data regarding the efficacy of antidepressants of different mechanism of action on unexplained painful physical symptoms (UPPS) in depression have been published so far. OBJECTIVE: The aim of this study was to compare the impact of escitalopram (ESC), nortriptyline (NOR), and venlafaxine (VEN) on UPPS in patients with major depression. MATERIALS AND METHODS: Sixty patients, participants in the GENDEP study, with a diagnosis of depression according to the ICD-10 criteria were randomly assigned to treatment with ESC (10-30 mg, mean dose 15.2, standard deviation [SD]±9.2) or NOR (50-150 mg, mean dose 106.2, SD±8.2). Additionally, 30 patients who were treated with VEN (75-225 mg, mean dose 181.3, SD±8.8) were included. Before inclusion (day 0) and throughout the study (days 14, 28, 42, 56), the severity of pain was monitored using the visual analog scale. RESULTS: The patients treated with ESC, NOR, and VEN did not differ in the intensity of pain at days 0, 14, 28, 42, and 56. CONCLUSION: Our results do not support the hypothesis suggesting the superiority of VEN over ESC and NOR in the management of UPPS in major depression.

Clinical recovery and health-related quality of life in ischaemic stroke survivors receiving thrombolytic treatment: a 1-year follow-up study.

The aims of this study were to examine prospectively the course of neurological and functional recovery and health related quality of life (HRQoL) in ischaemic stroke patients after intravenous thrombolysis, to assess the 1-year outcome and to determine the early predictors. A group of 53 consecutive patients were assessed at admission to the acute stroke unit (T0), before their discharge (T1), and at 3 (T2) and 12 (T3) months after hospital discharge. The National Institutes of Health Stroke Scale (NIHSS), the Barthel Index (BI) and the Stroke Specific Quality of Life Scale (SSQoL) were used to evaluate stroke severity, functional disability and health related quality of life (HRQoL). A good outcome was defined as simultaneous improvement in all three scales. At T0, 83 % of the patients had severe or moderate neurological impairment. Additionally, 77 % demonstrated very severe or severe disability when assessed by the BI. 74 and 79 % of the patients reported an acceptable HRQoL at 3 and 12 months following discharge, respectively. Neurological and functional status improved significantly over time with most changes occurring during hospitalization and the subsequent 3 months. At T3, 75.5 % of the patients had the good outcome which had been independently predicted by the level of stroke related disability at T0. A majority of the stroke survivors treated with thrombolysis achieved a good outcome. The measurement of stroke specific HRQoL, as a tool for gathering information from the patient, should be incorporated in the assessment of post-stroke recovery and outcome.

Evaluation of the quality of life of postmenopausal osteoporotic and osteopenic women with or without fractures.

INTRODUCTION: Most studies concerned with the quality of life (QoL) of women with reduced bone mineral density (BMD) focus on patients with vertebral and non-vertebral fractures. Our objective was to evaluate QoL among patients with reduced BMD regardless of their fracture history compared to women with normal BMD. MATERIAL AND METHODS: Eighty-five patients in the study group were classified as osteoporotic, with BMD results measured by densitometry and expressed by T-score ≤ -2.5 SD, 122 women were osteopenic, with -2.5 < T-score ≤ -1.0 SD, and 97 subjects were assessed as normal, with T-score > -1.0 SD. Mean ages of women according to groups were 59.90, 57.67 and 55.68, respectively. Assessment of life quality was conducted using the Polish version of the QUALEFFO-41 scale. RESULTS: The ratings in the assessment (QUALEFFO-41) of QoL were lower for osteoporotic and osteopenic women than for the normal BMD group with regard to pain (p = 0.006), social function (p = 0.001), health perception (p = 0.001), and mental function (p = 0.001). For total QUALEFFO-41 the associated factors were: secondary and higher education (OR = 0.49; 95% CI: 0.29-0.82), self-perceived deformity of the back (OR = 4.09; 95% CI: 1.88-8.93), previous fractures (OR = 2.52; 95% CI: 1.09-5.82), reduced height (OR = 2.48; 95% CI: 1.13-5.39) and anxiety (OR = 1.42; 95% CI: 1.21-1.66). CONCLUSIONS: It seems necessary to evaluate QoL of women with reduced BMD before fractures occur, to aid development of health education aiming to reduce the incidence of osteoporosis and prevent fractures.

Unexplained Painful Physical Symptoms in Patients with Major Depressive Disorder: Prevalence, Pathophysiology and Management.

Patients with major depression often report pain. In this article, we review the current literature regarding the prevalence and consequences, as well as the pathophysiology, of unexplained painful physical symptoms (UPPS) in patients with major depressive disorder (MDD). UPPS are experienced by approximately two-thirds of depressed patients. The presence of UPPS makes a correct diagnosis of depression more difficult. Moreover, UPPS are a predictor of a poor response to treatment and a more chronic course of depression. Pain, in the course of depression, also has a negative impact on functioning and quality of life. Frequent comorbidity of depression and UPPS has inspired the formulation of an hypothesis regarding a shared neurobiological mechanism of both conditions. Evidence from neuroimaging studies has shown that frontal-limbic dysfunction in depression may explain abnormal pain processing, leading to the presence of UPPS. Increased levels of proinflamatory cytokines and substance P in patients with MDD may also clarify the pathophysiology of UPPS. Finally, dysfunction of the descending serotonergic and noradrenergic pathways that normally suppress ascending sensations has been proposed as a core mechanism of UPPS. Psychological factors such as catastrophizing also play a role in both depression and chronic pain. Therefore, pharmacological treatment and/or cognitive therapy are recommended in the treatment of depression with UPPS. Some data suggest that serotonin and noradrenaline reuptake inhibitors (SNRIs) are more effective than selective serotonin reuptake inhibitors (SSRIs) in the alleviation of depression and UPPS. However, the pooled analysis of eight randomised clinical trials showed similar efficacy of duloxetine (an SNRI) and paroxetine (an SSRI) in reducing UPPS in depression. Further integrative studies examining genetic factors (e.g. polymorphisms of genes for interleukins, serotonin transporter and receptors), molecular factors (e.g. cytokines, substance P) and neuroimaging findings (e.g. functional studies during painful stimulation) might provide further explanation of the pathophysiology of UPPS in MDD and therefore facilitate the development of more effective methods of treatment.

The Camberwell Assessment of Need for the Elderly questionnaire as a tool for the assessment of needs in elderly individuals living in long-term care institutions.

OBJECTIVES: The aim of the study was to evaluate the Camberwell Assessment of Need for the Elderly questionnaire (CANE) in assessing the needs of elderly individuals living in long-term care institutions (LTCI) in Poland. SETTING AND PARTICIPANTS: The needs of 173 residents were assessed. The inclusion criteria were age (at least 75 years of age) and the lack of severe cognitive impairment (Mini Mental Scale Examination score of at least 15 points). MEASUREMENTS: In all participants, met and unmet needs were assessed by themselves and by the nursing staff involved in care activities. RESULTS: The number of met needs assessed by the staff was higher than in the users' opinions (p<0.0001), whereas the number of unmet needs was lower (p<0.001). However, the average percentage of the agreement between the user and the staff was as high as 86.2%. The areas characterized by the lowest agreement were Company (65.3%), Memory (75.7%), Eyesight/hearing/communication (70.5%) and Psychological distress (70.5%). CONCLUSIONS: Despite a high percentage of agreement reached between the staff and user assessments of needs in our study, we were able to identify the areas of discrepancies between these two perceptions of needs. These can be treated as signals pointing to those aspects of care that should be addressed.

Burden in caregivers of long-term stroke survivors: Prevalence and determinants at 6 months and 5 years after stroke.

OBJECTIVES: To assess the prevalence of considerable burden among caregivers of stroke survivors at 6 months (Time 1) and 5 years after stroke (Time 2), to analyse changes in burden severity over time and to identify factors associated with the burden. METHODS: Eighty eight patient/caregiver pairs were assessed. Caregiver burden was measured with the Caregiver Burden Scale. Socio-demographic, stroke-related and psychological characteristics were analysed as potential determinants of the burden. Exact multiple logistic regression was used to identify the predictive factors. RESULTS: Considerable burden was reported by 44% of the caregivers at Time 1 and 30% at Time 2. The burden was independently associated with caregivers' sense of coherence and amount of time spent caregiving at Time 1, and with caregivers' anxiety at Time 2. CONCLUSIONS: A significant proportion of the caregivers experienced considerable burden in the post-acute and chronic phases of stroke, although this proportion declined over time. Several characteristics were associated with the increased burden at different time points. All the independent predictors related to aspects of the carers. PRACTICE IMPLICATIONS: Programmes including education about coping strategies and time management, as well as respite care provision, could be beneficial and might help to reduce the burden of caregiving.