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1.
Artículo en Inglés | MEDLINE | ID: mdl-32418192

RESUMEN

BACKGROUND: The variables for predicting blood transfusion perioperatively are not completely clear in coronary artery bypass grafting (CABG) patients. OBJECTIVES: To construct a comprehensive model to predict perioperative RBC transfusion in patients undergoing isolated CABG using adjusted preoperative variables. METHODS: Perioperative data of 1253 patients who underwent isolated CABG by the same surgical team were collected from April 2018 to March 2019. Logistic regression analyses were used to establish equations to construct two models for predicting intraoperative and postoperative RBC transfusions, respectively. All significant variables included in the two models were combined to form a comprehensive model to predict perioperative RBC transfusion. Area under the receiver operating characteristic (ROC) curve (AUC) was used to evaluate the discriminatory power of the models. RESULTS: The total RBC transfusion rate for CABG patients during hospitalization was 29.05%. The rate of intraoperative and postoperative RBC transfusions was 6.9% and 26.7%, respectively. Eight variables in a total of 30 risk factors constituted the intraoperative prediction model, 12 variables constituted the postoperative prediction model, and 13 variables for the combined model. The AUC of the three models were 0.87, 0.82, and 0.83, respectively, demonstrating moderate discriminatory power for RBC transfusion during the intraoperative, postoperative, and perioperative periods. CONCLUSION: The comprehensive model combined with all variables of predicting intraoperative and postoperative RBC transfusion is feasible for predicting perioperative RBC transfusion.

2.
Anesth Analg ; 2020 Mar 27.
Artículo en Inglés | MEDLINE | ID: mdl-32224720

RESUMEN

BACKGROUND: Postoperative delirium is a major debilitating complication for patients and is associated with poor outcomes. Previous studies have suggested that excessive general anesthesia may lead to postoperative delirium. Electroencephalography (EEG)-based monitors have been administered in clinical practice in an attempt to deliver appropriate anesthesia. The aim of this updated meta-analysis was to evaluate the current body of research concerning the effects of EEG-based monitor on postoperative delirium. METHODS: We conducted a meta-analysis of randomized controlled trials of the effect of processed EEG monitor on postoperative delirium as the primary outcome. The search was performed in CENTRAL, MEDLINE, and EMBASE, with no language restrictions from inception until June 23, 2019. Two independent reviewers screened records and full-text articles for inclusion. Data extraction and risk-of-bias assessment were conducted by 3 independent reviewers. Random-effects models were used to calculate combined-effect estimates. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the quality of evidence. RESULTS: Of 5904 records screened, 5 studies met our inclusion criteria, including 3612 patients. Meta-analysis revealed no significant effect of EEG-based monitors on postoperative delirium (risk ratio [RR], 0.79; 95% confidence interval [CI], 0.60-1.05; I = 73%). The results showed a statistically significant reduction in intensive care unit (ICU) length of stay (3 studies,weight mean difference [WMD] -0.29 days; 95% CI, -0.53 to -0.05) in patients with EEG monitored. EEG-guided anesthesia did not have a statistically significant difference in all-cause mortality (3 studies, RR, 0.63; 95% CI, 0.31-1.29) and hospital length of stay (4 studies, WMD -0.61 days; 95% CI, -1.34 to 0.11). Few studies investigated the effects of EEG-guided anesthesia on perioperative major nonneurological complications and did not come up with promising results. CONCLUSIONS: The current evidence is not sufficient to support the prevention effects of EEG monitor on postoperative delirium. More robustly designed and well-conducted studies with emphasis on this matter are warranted.

3.
BMJ Open ; 10(2): e032941, 2020 Feb 17.
Artículo en Inglés | MEDLINE | ID: mdl-32071177

RESUMEN

RATIONALE AND OBJECTIVE: Salt reduction remains a global challenge and different salt reduction strategies have been studied in China. This study is to systematically evaluate evidence from randomised controlled trials (RCT) in China and inform the effective salt reduction strategies. DESIGN: Systematic review and meta-analysis. DATA SOURCES: MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Wanfang Data and the China National Knowledge Infrastructure databases through October 2019. ELIGIBILITY CRITERIA: RCTs conducted in China with at least 4 weeks' duration of study and blood pressure (BP) reported. DATA EXTRACTION AND SYNTHESIS: Data were screened, extracted and appraised by two independent reviewers. The quality of study was assessed using a modified Cochrane Collaboration's risk of bias tool. The primary outcome was the difference in BP change from baseline to the end of study between interventions and control. The effects were pooled using a random effects model and associated factors were explored by a meta-regression. RESULTS: We identified 24 studies involving 10 448 participants, including 8 studies on health education (4583 participants), 2 studies on salt restriction diet (162 participants), 1 study on salt restriction spoon (50 participants) and 13 studies on salt substitute (5653 participants). Six studies on salt substitute and three studies on health education were identified with high quality. Pooled results from the six studies showed that salt substitutes significantly reduced systolic BP (-5.7 mm Hg; 95% CI -8.5 to -2.8) and diastolic BP (-2.0 mm Hg; 95% CI -3.5 to -0.4). The School-EduSalt study showed that the school-based health education significantly reduced systolic BP among parents (-2.3 mm Hg; 95% CI -4.5 to -0.04). CONCLUSIONS: Among four salt reduction strategies studied in China with RCT design, only salt substitute was proved effective in lowering BP by the pooled effect from multiple studies with high quality. More well-designed studies are warranted for other strategies.

4.
Medicine (Baltimore) ; 99(8): e19263, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32080135

RESUMEN

OBJECTIVES: To understand the possible effect of a novel salt substitute with very low sodium in reducing blood pressure, salt intake and use of anti-hypertensive medications among patients on regular medications, to inform the future randomized trials. DESIGN: Single-arm pilot trial. SETTING: A community health service center in Chongqing, China. PARTICIPANTS: A total of 43 patients with hypertension taking anti-hypertensive medications regularly. INTERVENTION: Patients received the salt substitute with 18% sodium chloride for 8 weeks. MAIN OUTCOME MEASURES: Patients were followed up weekly for the use of antihypertensive medications and measurements of blood pressure. We collected 24-h urine before and after the trial to measure sodium and potassium intake. RESULTS: Among 39 patients who completed the 8 weeks' intervention, 30.8% patients stopped or reduced anti-hypertensive medications during the trial. For patients that stopped or reduced medication, the mean SBP and DBP before intervention were 122.1 ±â€Š9.6 and 68.9 ±â€Š9.4 mm Hg and both did not increase after intervention (SBP change: 2.8 mm Hg (-5.1, 10.8), P = .48; DBP change: 1.8 mm Hg (-2.2, 5.7), P = .38). For the rest patients, the mean SBP and DBP before intervention were 141.6 ±â€Š16.9 and 74.6 ±â€Š6.6 mm Hg but reduced significantly after the intervention (SBP change: -16.0 mm Hg (-21.3, -10.6), P < .001; DBP change: -5.5 mm Hg (-8.1, -2.9), P < .001). The 24-h urine sodium decreased (P < .001) and potassium increased (P < .001) among all patients. No severe adverse events were reported. CONCLUSIONS: The novel salt substitute showed potential in reducing blood pressure and use of antihypertensive medications. Further randomized double-blind controlled trial is warranted to validate these findings.Clinical Trial Registration-URL:http://www.clinicaltrials.gov. Unique identifier: NCT03226327.


Asunto(s)
Dieta Hiposódica , Hipertensión/terapia , Sodio en la Dieta/administración & dosificación , Anciano , Antihipertensivos/uso terapéutico , Femenino , Humanos , Masculino , Proyectos Piloto , Potasio/orina , Sodio/orina , Cloruro de Sodio/administración & dosificación
5.
Sci Rep ; 9(1): 15859, 2019 Oct 30.
Artículo en Inglés | MEDLINE | ID: mdl-31666637

RESUMEN

To date, there have been very limited studies regarding the clinical epidemiology of attempted suicide in Chinese individuals with heroin-dependence. The objective of this study was to examine the prevalence and correlates of suicide attempt in Chinese individuals receiving methadone maintenance treatment for heroin dependence. Demographic, clinical, and psychosocial data of 603 methadone-maintained patients with heroin dependence were collected with a standardized self-administered questionnaire. The presence of suicide attempt and antisocial personality disorder was assessed by using a single question and the Mini-International Neuropsychiatric Interview 5.0. The one-month and lifetime prevalence rates of suicide attempt were 9.5% and 34.2%, respectively. In multivariable logistic regression, lifetime suicide attempt was significantly associated with female gender (OR = 2.81), being 20-39 years old (OR = 2.73), an education level of primary school or lower (OR = 2.07), poor economic status (OR = 3.06), injecting heroin before methadone maintenance treatment (OR = 2.92), depressive symptoms (OR = 3.46), anxiety symptoms (OR = 1.88), and antisocial personality disorder (OR = 2.85). Suicide attempt is very prevalent among Chinese individuals receiving methadone maintenance treatment for heroin dependence. Services for patients with heroin dependence in methadone maintenance treatment clinics in China should include psychosocial supports, periodic screening for suicide attempt and other suicidal behaviors and, when needed, psychiatric treatment and crisis intervention.

6.
BMJ Open ; 9(11): e031918, 2019 Nov 10.
Artículo en Inglés | MEDLINE | ID: mdl-31712344

RESUMEN

OBJECTIVES: To describe the prehospital and in-hospital delays to care and factors associated with the delays among patients with ST-segment elevation myocardial infarction (STEMI) in non-percutaneous coronary intervention (PCI) hospitals in China. DESIGN, SETTING AND PARTICIPANTS: We analysed data from a large registry-based quality of care improvement trial conducted from 2011 to 2014 among 101 non-PCI hospitals in China. A total of 7312 patients with STEMI were included. Prehospital delay was defined as time from symptom onset to hospital arrival >120 min, first ECG delay as time from arrival to first ECG >10 min, thrombolytic therapy delay as time from first ECG to thrombolytic therapy >10 min and in-hospital delay as time from arrival to thrombolytic therapy >30 min. Logistic regressions with generalised estimating equations were preformed to identify the factors associated with each delay. RESULTS: The rates of prehospital delay, first ECG delay, thrombolytic therapy delay and in-hospital delay were 67.1%, 31.4%, 85.8% and 67.8%, respectively. Patients who were female, older than 65 years old, illiterate, farmers, onset during late night and forenoon, had heart rate ≥100 beats/m at admission were more likely and patients who had history of myocardial infarction, hypertension or SBP <90 mm Hg at admission were less likely to have prehospital delay. First ECG delay was more likely to take place in patients arriving on regular hours. Thrombolytic therapy delay rate was lower in patients who had prehospital delay or first ECG delay but higher in those with heart rate ≥100 beats/m at admission. In-hospital delay rate was lower in patients with a history of dyslipidaemia and those who arrived during regular hours. CONCLUSION: Chinese patients with STEMI in low medical resource areas suffered severe prehospital and in-hospital delays to care. Future efforts should be made to improve the prehospital delay among vulnerable populations with low socioeconomic status. TRIAL REGISTRATION NUMBER: NCT01398228; Post-results.

7.
Artículo en Inglés | MEDLINE | ID: mdl-31722435

RESUMEN

OBJECTIVES: aCL and anti-ß2 glycoprotein I antibody (aß2GPI) are autoantibodies associated with thromboembolic diseases. Here we investigated whether they are correlated with ischaemic cardiovascular disease in a Chinese population. METHODS: Serum total aCL and aß2GPI isotypes (IgA, IgG or IgM, separately) were measured in 11 015 Chinese adults. Differences of antibody level between disease and non-disease groups were examined by t-test. The correlation between antibody and ischaemic cardiovascular disease was determined by logistic regression analysis. Performance of risk prediction models employed aCL or aß2GPI isotypes was evaluated by C statistic, net reclassification improvement index and integrated discrimination improvement. RESULTS: Total aCL and aß2GPI isotypes maintained low levels and increased with increasing age except total aCL and aß2GPI IgG in participants older than 70 years. When distinguishing ischaemic cardiovascular disease by coronary heart disease (CHD) and ischaemic stroke, the stroke group had higher levels of aCL and aß2GPI isotypes than the non-stroke group, while the CHD group only had a slightly higher aß2GPI IgG than non-CHD groups. aCL and aß2GPI were positively correlated with stroke but not with CHD, and improved the performance of conventional risk factors for stroke risk prediction, with C statistic from 0.769 (95% CI 0.744, 0.793) to 0.777 (95% CI 0.754, 0.800) (aß2GPI IgG, P = 0.0091), and 0.778 (95% CI 0.754, 0.801) (aß2GPI IgA, P = 0.0793). Stroke risk could be better reclassified by aCL and aß2GPI, in association with both net reclassification improvement and integrated discrimination improvement statistics (P < 0.05). CONCLUSION: aCL and aß2GPI are associated with ischaemic stroke and have added value for stroke risk prediction.

8.
J Geriatr Psychiatry Neurol ; 32(6): 312-318, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31480989

RESUMEN

OBJECTIVE: To estimate the prevalence of depressive symptoms (depression thereafter) and to identify the sociodemographic and clinical correlates of depression in a sample of elderly patients treated in the primary care setting in Wuhan, China. BACKGROUND: Primary care is an opportune setting for the management of late-life depression in China, but there have been no representative studies on the clinical epidemiology of depression in elderly Chinese primary care patients. METHODS: In total, 752 elderly patients (≥ 65 years) were consecutively recruited from 13 primary care centers in Wuhan, China, and interviewed with a standardized questionnaire. Depression was assessed with the 15-item Geriatric Depression Scale (GDS-15). RESULTS: Of the elderly Chinese primary care patients, 30.6% had depression (GDS-15 ≥ 5). Correlates of depression were an education level of primary school or less (odds ratio [OR]: 1.94, 95% confidence interval [CI]: 1.36-2.77, P < .001), poor financial status (OR: 2.19, 95% CI: 1.16-4.15, P = .016), lack of an exercise habit (OR: 1.40, 95% CI: 1.06-1.74, P = .023), 2 or more chronic medical conditions (OR: 1.90, 95% CI: 1.34-2.69, P < .001), and loneliness (OR: 3.53, 95% CI: 2.46-5.08, P < .001). CONCLUSIONS: Depression is prevalent among elderly Chinese primary care patients, indicating that elderly patients treated in primary care have a high level of need for mental health services in China. There is an urgent need to integrate mental health services into primary health care.

9.
Int J Clin Pract ; 73(11): e13400, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31390128

RESUMEN

AIMS: Carotid femoral pulse wave velocity (CF-PWV) is associated with vascular-related diseases. However, this association has rarely been compared in the same study population, which would improve our understanding of the role of these diseases in developing arteriosclerosis. This study was designed to assess arterial function in different vascular-related diseases and the potential interrelationships between these diseases and arteriosclerosis. METHODS: There were 13 798 participants with or without established vascular-related diseases, including hypertension, diabetes, coronary artery disease (CAD), stroke and peripheral artery disease (PAD), enrolled into the study from 2010 to 2016, comprising 6648 males and 7150 females. The odds ratio (OR) of arteriosclerosis (defined as CF-PWV >12 m/s) in associations with the vascular-related diseases was modelled using multivariable logistic regression analyses to adjust for possible confounders. RESULTS: Compared with participants without vascular-related diseases, those presenting the diseases showed a significantly higher prevalence and age- and sex-adjusted OR of arteriosclerosis (all P < .001). After further adjustment for hypertension, the ORs became much smaller and not significant for CAD or stroke. Compared with apparently healthy participants, participants with each of the diseases showed a significantly higher adjusted OR (range: 2.46-3.30, all P < .001); participants with each vascular-related disease only showed much smaller and non-significant ORs, except for hypertension (OR = 2.73, 95% CI: 2.46, 3.04). After further adjustment for hypertension, these ORs became non-significant (range: 0.81-1.36, all P > .05). CONCLUSIONS AND CLINICAL IMPLICATIONS: The associations between arteriosclerosis and diseases other than hypertension were largely explained by the association with hypertension, indicating that hypertension could be the single most important factor that leads to arteriosclerosis. TRIAL REGISTRATION: ClinicalTrials.gov NCT02569268.


Asunto(s)
Enfermedades Cardiovasculares/embriología , Flujo Pulsátil/fisiología , Análisis de la Onda del Pulso/estadística & datos numéricos , Adulto , Anciano , Beijing , Enfermedades Cardiovasculares/enzimología , Enfermedades Cardiovasculares/fisiopatología , Enfermedad Coronaria , Femenino , Humanos , Hipertensión/epidemiología , Masculino , Persona de Mediana Edad
10.
Neuropsychiatr Dis Treat ; 15: 2063-2072, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31410010

RESUMEN

Purpose: Nightmares are associated with many negative health outcomes; however, little is known about the characteristics of nightmares in heroin-dependent patients (HDPs). This study examined the prevalence and correlates of frequent nightmares (FNs) and their association with functional impairment in Chinese patients undergoing methadone maintenance therapy (MMT). Patients and methods: In total, 603 Chinese HDPs from three MMT clinics in Wuhan, China, completed this survey. FNs were defined as reporting nightmares at least once a week. The Sheehan Disability Scale (ShDS) was used to assess the severity of functional impairment of patients. A standardized questionnaire was used to collect data on socio-demographics, drug use characteristics, physical health, mental health, and insomnia. Results: The prevalence of FNs in Chinese HDPs receiving MMT was 25.9%. Factors significantly associated with nightmares among MMT HDPs included an educational attainment of senior high school and above (OR=2.73, P<0.001), unemployment (OR=3.16, P<0.001), a history of re-education through forced labor (OR=3.14, P<0.001), injecting heroin before MMT (OR=3.62, P=0.002), a high dose of methadone (>70 mg/day) (OR=2.03, P=0.006), use of hypnotics (OR=1.91, P=0.044), the presence of hepatitis B virus core antibody (OR=4.63, P<0.001), pain (OR=3.20, P<0.001), anxiety (OR=2.06, P=0.039), and insomnia (OR=5.75, P<0.001). After controlling for potential confounders, nightmares were still significantly associated with a higher ShDS score (ß=2.718, P=0.006). Conclusion: FNs are prevalent among Chinese HDPs receiving MMT and significantly associated with functional impairment. Nightmares are a clinically relevant phenomenon in Chinese MMT clinics, which deserves more clinical and research attention.

11.
Lancet Planet Health ; 3(6): e270-e279, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31229002

RESUMEN

BACKGROUND: Air pollution in Beijing has been improving through implementation of the Air Pollution Prevention and Control Action Plan (2013-17), but its implications for respiratory morbidity have not been directly investigated. We aimed to assess the potential effects of air-quality improvements on respiratory health by investigating the number of cases of acute exacerbations of chronic obstructive pulmonary disease (COPD) advanced by air pollution each year. METHODS: Daily city-wide concentrations of PM10, PM2·5, PMcoarse (particulate matter >2·5-10 µm diameter), nitrogen dioxide (NO2), sulphur dioxide (SO2), carbon monoxide (CO), and ozone (O3) in 2013-17 were averaged from 35 monitoring stations across Beijing. A generalised additive Poisson time-series model was applied to estimate the relative risks (RRs) and 95% CIs for hospitalisation for acute exacerbation of COPD associated with pollutant concentrations. FINDINGS: From Jan 18, 2013, to Dec 31, 2017, 161 613 hospitalisations for acute exacerbation of COPD were recorded. Mean ambient concentrations of SO2 decreased by 68% and PM2·5 decreased by 33% over this 5-year period. For each IQR increase in pollutant concentration, RRs for same-day hospitalisation for acute exacerbation of COPD were 1·029 (95% CI 1·023-1·035) for PM10, 1·028 (1·021-1·034) for PM2·5, 1·018 (1·013-1·022) for PMcoarse, 1·036 (1·028-1·044) for NO2, 1·019 (1·013-1·024) for SO2, 1·024 (1·018-1·029) for CO, and 1·027 (1·010-1·044) for O3 in the warm season (May to October). Women and patients aged 65 years or older were more susceptible to the effects of these pollutants on hospitalisation risk than were men and patients younger than 65 years. In 2013, there were 12 679 acute exacerbations of COPD cases that were advanced by PM2·5 pollution above the expected number of cases if daily PM2·5 concentrations had not exceeded the WHO target (25 µg/m3), whereas the respective figure in 2017 was 7377 cases. INTERPRETATION: Despite improvement in overall air quality, increased acute air pollution episodes were significantly associated with increased hospitalisations for acute exacerbations of COPD in Beijing. Stringent air pollution control policies are important and effective for reducing COPD morbidity, and long-term multidimensional policies to safeguard public health are indicated. FUNDING: UK Medical Research Council.

12.
J Am Coll Cardiol ; 73(24): 3041-3050, 2019 Jun 25.
Artículo en Inglés | MEDLINE | ID: mdl-31221251

RESUMEN

BACKGROUND: Previous studies have suggested that coronary heart disease (CHD) may be associated with accelerated cognitive decline. However, the temporal pattern of cognitive decline before and after incident CHD remains largely unknown. OBJECTIVES: The purpose of this study was to determine the cognitive trajectory before and after incident CHD diagnosis in a national representative cohort age ≥50 years. METHODS: This study included 7,888 participants (mean age 62.1 ± 10.2 years) with no history of stroke or incident stroke during follow-up from the English Longitudinal Study of Ageing. Participants underwent a cognitive assessment at baseline (wave 1, 2002 to 2003), and at least 1 other time point (from wave 2 [2004 to 2005] to wave 8 [2016 to 2017]). Incident CHD was identified as a diagnosis of myocardial infarction and/or angina during follow-up. RESULTS: Incident CHD was associated with accelerated cognitive decline during a median follow-up of 12 years. The annual rate of cognitive decline before CHD diagnosis among individuals who experienced incident CHD was similar to that of participants who remained CHD-free throughout follow-up. No short-term cognitive decline was observed in participants with CHD diagnosis after the event. In the years following CHD diagnosis, global cognition, verbal memory, and temporal orientation scores declined significantly faster than they did before the event, after multivariable adjustment. Sensitivity analyses yielded similar results. CONCLUSIONS: Incident CHD is associated with accelerated cognitive decline after, but not before, the event. Attention should be drawn to the long-term cognitive deterioration related to CHD. Careful monitoring of cognitive function is warranted in CHD patients in the years following the event.

13.
BMJ Open ; 9(6): e028126, 2019 06 14.
Artículo en Inglés | MEDLINE | ID: mdl-31203245

RESUMEN

OBJECTIVES: Healthy behaviour changes, such as reducing salt intake, are important to prevent lifestyle-related diseases. Social environment is a major challenge to achieve such behaviours, but the explicit mechanisms remain largely unknown. We investigated whether social networks of children were associated with their behaviours to reduce salt intake. DESIGN: An ancillary study of a school-based cluster randomised controlled trial to reduce salt intake in children and their families (School-EduSalt), in which salt intake of children was significantly reduced by 25%. SETTING: 14 primary schools in urban Changzhi, northern China. PARTICIPANTS: 603 children aged 10-12 years in the intervention arm. PRIMARY AND SECONDARY OUTCOME MEASURES: We developed a score assessing salt-reduction behaviours (SRB score) of children based on self-administered questionnaires. The SRB score was validated by the changes in salt intake measured by 24-hour urine collection in a random sample of 135 children. A 1-unit increase in SRB score was associated with a 0.31 g/day greater reduction in salt intake during the trial (95% CI 0.06 to 0.57, p=0.016). RESULTS: Children from families with more family members not supporting salt reduction had significantly lower SRB scores (p<0.0001). Children from a class with a smaller size and from a class with more friendship connections, as well as children having more friends within the class all showed higher SRB scores (all p<0.05). Children whose school teachers attended the intervention programme more frequently also had higher SRB scores (p=0.043). CONCLUSION: Social networks were associated with the behaviours to reduce salt intake in children. Future salt-reduction programmes may benefit from strategies that actively engage families and teachers, and strategies that enhance interconnectivity among peers. TRIAL REGISTRATION NUMBER: NCT01821144; post-results.

14.
Front Psychiatry ; 10: 306, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31178762

RESUMEN

Background: Cigarette smoking is associated with sexual dysfunction in the general population. Both smoking and sexual dysfunction are common in heroin-dependent patients (HDPs) receiving methadone maintenance treatment (MMT), but their association in MMT HDPs is rarely studied. This study examined the association between smoking and sexual dissatisfaction in Chinese HDPs receiving MMT. Methods: In total, 480 Chinese HDPs, who had sex with their regular or irregular sex partners within one month prior to the study, were included from three MMT clinics in Wuhan, China. Sexual dissatisfaction was assessed with one single question. Socio-demographic and clinical data and smoking characteristics were collected with a standardized questionnaire. Multiple binary logistic regression was used to analyze the association between smoking and sexual dissatisfaction, as well as the associations between levels of smoking and nicotine dependence and sexual dissatisfaction. Results: The prevalence of current smoking was 95.6% in HDPs receiving MMT. Rates of sexual dissatisfaction were higher in current smokers than non-smokers (32.9% vs. 14.3%) with a borderline significant P value of 0.074. After adjusting potential socio-demographic and clinical confounders, current smoking was significantly linked to sexual dissatisfaction (OR = 1.95, P = 0.026), and heavy smoking and severe nicotine dependence were significantly linked to sexual dissatisfaction (OR = 1.80, P = 0.025; OR = 3.27, P < 0.001). Conclusion: Smoking is significantly associated with sexual dysfunction in HDPs receiving MMT. It deserves further investigation as to whether quitting smoking can improve the sexual function of methadone-maintained patients.

15.
Neurology ; 93(1): e20-e28, 2019 07 02.
Artículo en Inglés | MEDLINE | ID: mdl-31127071

RESUMEN

OBJECTIVE: To determine the trajectory of cognitive decline before and after incident stroke. METHODS: By using data from the English Longitudinal Study of Ageing, we studied 9,278 participants without dementia with no history of stroke who underwent cognitive assessment at baseline (wave 1) and at least 1 other time point (waves 2-7). We used linear mixed models to analyze repeated measures and longitudinal data. RESULTS: Among the 9,278 participants (56.8% women, mean age 63.1 ± 10.3 years), 471 (5.1%) incident stroke events were identified. Compared with stroke-free participants, multivariable-adjusted rates of prestroke cognitive decline in global cognition, memory, semantic fluency, and temporal orientation of participants who later experienced an incident stroke were increased by -0.029 , -0.016, -0.022, and -0.024 SD/y, respectively. Among the 471 stroke survivors, the multivariable-adjusted acute changes in the 4 cognitive domains were -0.257, -0.150, -0.121, and -0.272 SD, respectively. In the years after stroke, global cognition declined over time and was steeper than its prestroke slope, that is, by -0.064 SD/y after multivariable adjustment. The rates of memory, semantic fluency, and temporal orientation decline were -0.046, -0.033, and -0.037 SD/y, respectively. CONCLUSIONS: Accelerated prestroke cognitive decline and poststroke cognitive decline were associated with incident stroke over a follow-up period of 12 years. Attention should be paid to the long-term cognitive problems of stroke survivors, and intervention and management of major vascular risk factors should start from early life or midlife to reduce the risk of cerebrovascular disease and the associated cognitive impairment.


Asunto(s)
Disfunción Cognitiva/complicaciones , Disfunción Cognitiva/epidemiología , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/epidemiología , Anciano , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Accidente Cerebrovascular/psicología
16.
PeerJ ; 7: e6860, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31106067

RESUMEN

Background: Quality of life (QOL) is an important primary care outcome, but the QOL of older adults treated in primary care is understudied in China. This study examined QOL and its associated factors in older adults treated in Chinese primary care. Methods: A total of 752 older patients (65+ years) were consecutively recruited from 13 primary care centers in Wuhan, China, and interviewed with a standardized questionnaire, concerning socio-demographics, major medical conditions, loneliness, and depression. QOL and depression were measured with the Chinese six-item QOL questionnaire and the shortened Geriatric Depression Scale, respectively. Multiple linear regression was used to identify factors associated with poor QOL. Results: The average QOL score of primary care older adults was (20.7 ± 2.5), significantly lower than that of the Chinese general population. Factors significantly associated with poor QOL of Chinese primary care older adults included engaging in manual labor before older adulthood (unstandardized coefficient [ß]: -0.702, P < 0.001), no living adult children (ß: -1.720, P = 0.001), physical inactivity (ß: -0.696, P < 0.001), having ≥ four major medical conditions (ß: -1.813, P < 0.001), hearing problem (ß: -1.004, P = 0.017), depression (ß: -1.153, P < 0.001), and loneliness (ß: -1.396, P < 0.001). Conclusions: Older adults treated in Chinese primary care have poorer QOL than the general population. Addressing psychosocial problems at Chinese primary care settings could be helpful in improving QOL in Chinese older adults.

17.
J Addict Med ; 13(4): 314-321, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30633047

RESUMEN

OBJECTIVES: Unhealthy alcohol use is associated with negative health outcomes in clients attending methadone maintenance therapy (MMT) programs. However, debates exist regarding the methadone dose of drinkers, and little is known about the health outcomes of drinkers with other types of alcohol use. This study examined the drinking pattern and its association with methadone dose, and depressive and anxiety symptoms in Chinese clients undergoing MMT. METHODS: A secondary data analysis was conducted with data from a large-scale cross-sectional survey of 549 clients of 3 MMT clinics in Wuhan, China. Depression, anxiety, and alcohol dependence were measured with Zung Self-rating Depression Scale, Zung Self-rating Anxiety Scale, and Alcohol Dependence Scale, respectively. Drinking pattern was assessed using 3 indicators: weekly amount of alcohol consumed, weekly frequency of alcohol consumed, and severity of alcohol dependence. RESULTS: The prevalence of current drinking, hazardous drinking, regular drinking, and alcohol abuse/dependence was 29.0%, 10.4%, 14.2%, and 8.7%, respectively. In adjustment analyses, relative to nondrinkers, drinkers had significantly lower weight-based methadone dose (ß = -0.136, P = 0.008); hazardous drinkers, irregular drinkers, and drinkers without alcohol abuse/dependence had less severe depression (ß = -3.67, P = 0.004; ß = -2.37, P = 0.034; ß = -3.20, P = 0.001) and anxiety (ß = -4.90, P < 0.001; ß = -3.24, P = 0.006; ß = -4.52, P < 0.001), but drinkers with alcohol abuse/dependence had more severe depression (ß = 5.55, P < 0.001) and anxiety (ß = 4.31, P = 0.005). CONCLUSION: In Chinese MMT clinics, drinkers may use alcohol to compensate for inadequate MMT and self-medicate negative emotions. Compared with nondrinkers, the severities of depression and anxiety were lower among drinkers without alcohol abuse/dependence, but higher among those with alcohol abuse/dependence.

18.
J Affect Disord ; 245: 219-227, 2019 02 15.
Artículo en Inglés | MEDLINE | ID: mdl-30412774

RESUMEN

BACKGROUND: It is difficult to distinguish between bipolar disorder (BD) and unipolar disorder (UD) depression. Given the different pattern of cognitive impairments between BD and UD, P300 is potentially useful for the differential diagnosis. This meta-analysis was performed to estimate the extent of difference in P300 in patients with BD versus UD depression. METHODS: Studies comparing P300 between depressed BD and UD patients with or without healthy controls (HCs) were retrieved from major English and Chinese databases. Studies with BD and UD samples that were comparable in terms of age, gender, and depression severity, were rated as having high quality. Standardized mean differences (SMDs) of P300 latency and amplitude were calculated. RESULTS: In total, eight studies with a total of 397 depressed BD patients, 390 depressed UD patients, and 497 HCs, were included. Among included studies, six were rated as having good quality and three followed BD (n = 146) and UD (n = 144) patients during remission. BD patients had significantly longer P300 latency than UD patients during major depressive episode [SMD (95%CI): 0.580 (0.309, 0.850)] and remission [SMD (95%CI): 1.583 (1.322, 1.844)]. Compared to HCs, remitted BD patients still had significantly longer P300 latency [SMD (95%CI): 0.857 (0.059, 1.656)] but P300 latency of remitted UD patients had decreased to normal [SMD (95%CI): 0.536 (-0.272, 1.343)]. LIMITATIONS: Sample sizes of depressed and remitted patients with BD and UD of included studies are small. CONCLUSIONS: P300 latency can be used as an auxiliary diagnostic marker for differentiating BD from UD depression.


Asunto(s)
Trastorno Bipolar/diagnóstico , Trastorno Depresivo Mayor/diagnóstico , Potenciales Relacionados con Evento P300 , Adulto , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad
20.
Front Psychiatry ; 9: 325, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30072926

RESUMEN

Background: There is paucity of data regarding the prevalence and methods of deliberate self-harm (DSH) in patients with heroin dependence in international literature. In China, there have been a few studies investigating the prevalence of DSH in heroin-dependent patients (HDPs), but their rates varied widely. We thus conducted a meta-analysis of studies assessing the prevalence of DSH among Chinese HDPs. Methods: Relevant studies were retrieved from major Chinese databases (China National Knowledge Infrastructure, Wanfang data, and SinoMed) and western databases (PubMed, EMBASE, and PsycInfo). Two authors independently identified eligible studies and extracted data. Studies that included a representative sample of Chinese HDPs and ascertained DSH caseness in a reliable way were considered as high quality. Statistical analysis was performed using R software. Results: In total, 15 eligible studies with a total of 37,243 Chinese HDPs were included. All included studies were conducted in heroin detoxification settings. Only two studies were rated as high quality. The pooled prevalence of DSH in Chinese HDPs was 4.4% (95%CI: 2.9, 6.2%), but the heterogeneity of prevalence rates across studies was significant (I2 = 98%, P < 0.001). Studies rated as high quality had significantly higher prevalence of DSH than those rated as low quality (13.2 vs. 3.4%, P < 0.001). Swallowing foreign objects was the most common method of DSH, with a combined prevalence of 2.7% (95%CI: 1.6, 4.4%). Extreme DSH methods such as cutting off fingers and jumping from height were also not uncommon in this patient population. Conclusion: Due to methodological problems in available studies, we find a relatively low prevalence of DSH among Chinese HDPs receiving detoxification treatment. Nevertheless, the self-harmers of Chinese HDPs are more likely to harm themselves in a dangerous or life-threatening way. Restricting the availability of DSH methods may be an effective way to prevent or reduce DSH in China's detoxification treatment settings.

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