[Significance of immunological markers in patients with obstructive sleep apnea and comorbid pathology]. / Znachimost' immunologicheskikh markerov u patsientov s obstruktivnym apnoe sna i komorbidnoi patologiei.

OBJECTIVE: To determine the significance of immunological markers in patients with obstructive sleep apnea (OSA) and comorbid pathology. MATERIAL AND METHODS: Sixty-five patients were examined. Two groups of patients were distinguished: the main group with moderate and severe OSA and the control group without OSA. The subjects underwent anthropometry, polysomnography, assessment of cognitive and emotional disorders. Glial fibrillar acidic protein (GFAP), antibodies against NR1-NR2 subunits of NMDA receptors (AT to GRIN2A) and the acetylcholine receptor (AT to AChR), and brain-derived neurotrophic factor (BDNF) were studied by enzyme immunoassay. RESULTS: In patients with OSA, indicators of markers: GFAP (p=0.017), BDNF (p=0.006), antibodies to AChR (p=0.002), as well as chronic cerebral ischemia (p=0.000), depression on the HADS (p=0.004) and the Beck scale (p=0.000), drowsiness on the Epworth scale (p=0.001), asthenia on the visual analogue scale (p=0.000) and the MFI 20 (p=0.013) were higher than in the control group. A relationship was established in the main group between the identified subjective disorders on the Mini-Mental State Examination scale (MMSE) and BDNF (r=0.302, p=0.014) and the average score on the MMSE and BDNF (r=-0.266, p=0.032). CONCLUSION: The results demonstrate the relationship of neurospecific proteins with cognitive impairment in patients with OSA. The neuromarker GFAP in patients with sleep apnea has shown itself to be a predictor of decreased neurogenesis, and BDNF as a representative marker of neuroplasticity. Large values of AT to AChR in patients with OSA may indicate possible neuromuscular transmission disorders. Along with drowsiness and asthenia, patients with OSA have changes in the emotional background, mainly due to depression. The severity of depression and the severity of asthenia increase with increasing severity of apnea and are probably associated with low levels of saturation, which in turn leads to dysregulation of the prefrontal cortex, hippocampus and amygdala.

Exploring perceptions and expectations of COPD patients: A grounded theory approach for personalized therapeutic interventions.

Objectives: This study aimed to investigate the dynamic patterns of perception and expectations among COPD patients. Methods: Conducted at the Heart-Respiratory Rehabilitation Unit, IRCCS Fondazione Don Carlo Gnocchi, in Milan, Italy, the research involved 28 participants (16 males; mean age 72.8 ± 9.9) in face-to-face interviews. Utilizing a Grounded Theory approach, complemented by clinical data, recorded, and transcribed interviews underwent enhancement through the integration of two pictorial tools. Results: The central theme that emerged was a profound sense of responsibility toward their condition, perceived as a significant threat to life. Key symptoms, such as shortness of breath, coupled with negative expectations about their condition, contributed to depressive mood and avoidance behaviors. A notable proportion (N = 17; 60.71%) of participants struggled to envision a positive future, expressing a pervasive sense of hopelessness, which significantly influenced their health behaviors and adherence to medical recommendations. Conversely, individuals who felt supported and optimistic about treatment efficacy exhibited more positive expectations and adopted proactive coping strategies. Discussion: Recognizing the dynamic nature of patients' perceptions and negative illness expectations is essential to create personalized therapeutic interventions and meet the specific needs of COPD patients, ultimately improving the overall effectiveness of their care journey.

Evaluation of Quality of Life, Anxiety, and Depression in Patients with Primary Axillary Hyperhidrosis Undergoing Treatment with a Microwave Device: One-year Follow-up.

Hyperhidrosis is associated with social and emotional stress, affecting quality of life. Microwave energy technology treats primary axillary hyperhidrosis by thermolysis of sweat glands. The successful reduction of sweating in patients with primary axillary hyperhidrosis after microwave treatment has been studied, but there is limited evidence on the psychological and long-term effects. This study examined patient- reported outcome measures including depression and anxiety in patients with primary axillary hyperhidrosis and the effect of microwave therapy on these parameters. Patients received 1 or 2 microwave-based treatments, within 3-month intervals. All patients were finally examined at approximately 1 year after the first treatment using the Hyperhidrosis Disease Severity Scale, Hyperhidrosis Quality of Life©, Dermatology Life Quality Index, and Hospital Anxiety and Depression Scale©. A total of 103 individuals with primary axillary hyperhidrosis were included in the study, with a Hyperhidrosis Disease Severity Scale score of 3 or 4. Statistically significant improvement in quality of life, anxiety, and depression scores were observed at 1-year follow-up. The primary endpoint, Hyperhidrosis Disease Severity Scale of 2 or less 1 year after the first treatment, was achieved by 88.2% of patients. No serious adverse side effects were observed.

[Effects of childhood abuse experience, recent life events and coping styles on depressive symptoms of medical students].

OBJECTIVE: To analyze the influence of childhood abuse experience, recent life events and coping styles on depression symptoms of medical students based on the model of "vulnerability-stress-coping". METHODS: A longitudinal study design was adopted to select freshmen from Hefei City and Anqing City in Anhui province by cluster sampling. A total of 4211 questionnaires were collected at baseline from November to December 2019. Follow-up surveys were conducted in November to December 2020, and a total of 3662 medical students were finally included in this study. The childhood trauma questionnaire, adolescent self-rating life events checklist, coping style questionnaire and self-rating depression scale were used to evaluate childhood abuse experience, recent life events, coping styles and depression symptoms of medical students. The PROCESS software model 1(double interaction analysis) and model 3(triple interaction analysis) were used to investigate the independent and interactive effects of childhood abuse experience, recent life events, and different coping styles on depressive symptoms of medical students during follow-up. RESULTS: Among the 3662 medical students, 976 were male and 2686 were female, with an average age of(19.2±1.0) years. Spearman correlation analysis showed that childhood abuse experience, recent life events, self-blame, fantasy, problem avoidance, and rationalization coping style were positively related to depressive symptoms(P<0.05). The coping style of problem solving and seeking help was negatively related to depressive symptoms(P<0.05). In model 1, both childhood abuse experience(ß=0.097, 95%CI 0.065-0.129) and recent life events(ß=0.102, 95%CI 0.073-0.132) had a positive predictive effect on depressive symptoms, and they also had positive interaction on depressive symptoms(ß=0.030, 95%CI 0.025-0.004). In model 3, there was a negative interaction between childhood abuse, recent life events and seeking help(ß=-0.034, 95%CI-0.061--0.007) or fantasy(ß=-0.039, 95%CI-0.065--0.013) coping styles on depressive symptoms. CONCLUSION: Childhood abuse experience and recent life events are the predisposition factors for depressive symptoms of medical students, and they can mutually promote depression, while seeking help and fantasy coping styles could weaken the promoting effects of both.

[Relationship between academic procrastination and depression in myopia junior middle school students in a district of Chongqing in 2022].

OBJECTIVE: To understand the relationship between academic delay and depression in myopic junior high school students. METHODS: Medical visual acuity examination(including far-vision examination and dioptometry) and questionnaire survey(including Middle School students' Academic Procrastination Questionnaire and Childhood Depression Scale) were conducted among 1752 junior middle school students in a district of Chongqing in June 2022. Difference analysis, correlation analysis and binary Logistic regression analysis were performed on the data obtained from myopic students. RESULTS: 1116(63.69%) students with myopia were detected, 405 students with academic delay and 1289 students with depression. Among them, 266(65.68%) and 835(64.78%) were nearsighted due to academic procrastination and depression. There were significant differences in academic procrastination and depression between myopic and non-myopic students(P<0.01). Moreover, myopic junior high school students have a greater risk of academic procrastination and depression(OR=4.94, 95%CI 3.04-8.01). CONCLUSION: Myopic junior high school students are more likely to have academic delay and depression.

Cognitive behavioral therapy approaches to the improvement of mental health in Parkinson's disease patients: a systematic review and meta-analysis.

BACKGROUND: Non-motor symptoms (NMS) such as impaired cognition, anxiety, and depression can have a strong adverse effect on the quality of life (QoL) of Parkinson's disease (PD) patients. The clinical application of cognitive behavioral therapy (CBT) offers an opportunity to improve cognitive function, mental health, and overall QoL for these patients. OBJECTIVE: CBT is frequently applied as a treatment option aimed at benefiting the mental health of PD patients, but the relative utility of CBT in this patient population has yet to be rigorously assessed. The present review was thus conducted with the goal of examining the relative safety and efficacy of CBT as a treatment option for PD patients suffering from cognitive impairment, anxiety, and depression, with a particular focus on the impact of CBT on PD patient QoL. METHODS: The PubMed, Embase, Medline, and Cochrane Library databases were searched for all studies published from their inception to present using keywords including "cognitive behavioral therapy" and "Parkinson's disease". Two reviewers independently screened these published studies and extracted relevant data from studies that met with defined inclusion/exclusion criteria, in addition to assessing the risk of bias. Those randomized controlled trials (RCTs) assessing the impact of CBT on older PD patients were eligible for study inclusion. In total, 22 articles incorporating 1,053 patients were included in this meta-analysis. Study quality was examined as per the Cochrane risk of bias framework. Heterogeneity and associated outcomes were assessed based on mean difference (MD), I2, and 95% confidence interval (95%CI) values. RESULTS: In total, 22 RCTs were ultimately found to be eligible for inclusion in the present meta-analysis. The results of this meta-analysis indicated that CBT significantly impacted cognition as compared to other treatment options (including placebo treatment, clinical monitoring, clinic-based treatment, psychoeducation, physical activity training, health enhancement) (I2 = 49%, MD = 0.23, 95%CI: 0.03-0.44, P = 0.03). CBT was also associated with significant improvements in PD patient QoL (I2 = 0%, MD = 3.45, 95%CI: 1.13-5.57, P = 0.04), anxiety symptoms (I2 = 57%, MD = -2.01, 95%CI: -4.01-0.01, P = 0.05), and depression symptoms (I2 = 74%, MD = -3.94, 95%CI: -6.47 to -1.42, P = 0.04). CONCLUSIONS: These results reveal that CBT can have beneficial effects on PD patient cognitive status and QoL. Notably, CBT represents an effective option for treating NMS such as anxiety and depression in PD patients. These results offer strong evidence in favor of applying CBT as a means of enhancing the mental health, cognition, and QoL of individuals with PD. However, additional high-quality large-scale studies will be essential to confirm and expand upon these results.

CADA-PRO: A Patient Questionnaire Measuring Key Cognitive, Motor, Emotional, and Behavioral Outcomes in CADASIL.

BACKGROUND: Cerebral small vessel disease (cSVD) of ischemic type, either sporadic or genetic, as cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), can impact the quality of daily life on various cognitive, motor, emotional, or behavioral aspects. No instrument has been developed to measure these outcomes from the patient's perspective. We thus aimed to develop and validate a patient-reported questionnaire. METHODS: In a development study, 79 items were generated by consensus between patients, family representatives, and cSVD experts. A first sample of patients allowed assessing the feasibility (missing data, floor and ceiling effect, and acceptability), internal consistency, and dimensionality of a first set of items. Thereafter, in a validation study, we tested a reduced version of the item set in a larger sample to assess the feasibility, internal consistency, dimensionality, test-retest reliability, concurrent validity, and sensitivity to change. RESULTS: The scale was developed in 44 patients with cSVD and validated in a second sample of 89 individuals (including 43 patients with CADASIL and 46 with another cSVD). The final CADASIL Patient-Reported Outcome scale comprised 18 items covering 4 categories of consequences (depression/anxiety, attention/executive functions, motor, and daily activities) of the disease. The proportion of missing data was low, and no item displayed a major floor or ceiling effect. Both the internal consistency and test-retest reliability were good (Cronbach alpha=0.95, intraclass correlation coefficient=0.88). In patients with CADASIL, CADASIL Patient-Reported Outcome scores correlated with the modified Rankin Scale, Starkstein Apathy Scale, Hospital Anxiety and Depression scale, Working Memory Index, and trail making test times. In patients with other cSVDs, CADASIL Patient-Reported Outcome correlated only with Hospital Anxiety and Depression scale and Starkstein Apathy Scale. CONCLUSIONS: The CADASIL Patient-Reported Outcome may be an innovative instrument for measuring patient-reported outcomes in future cSVD trials. Full validation was obtained for its use in patients with CADASIL, but further improvement is needed for its application in other cSVDs.

Analysis of related factors influencing the sleep quality in patients with rotator cuff tear after arthroscopic surgery.

Recent studies have reported a prevalence of sleep disturbance in patients undergoing arthroscopic rotator cuff repair. The purpose of our study was to explore patient-reported factors correlated with sleep disturbance in patients with arthroscopic rotator cuff repair. We retrospectively evaluated 133 patients who underwent arthroscopic rotator cuff repair for 6 months. We obtained the Pittsburgh Sleep Quality Index (PSQI) scores, the visual analog scale (VAS) pain score, the University of California-Los Angeles Shoulder Rating Scale score (UCLA score), the Hospital Anxiety and Depression Scale (HADS), and patient demographics. According to the PSQI scores, participants were divided into a sleep disorder group (A group, PSQI ≥5) and a normal sleep group (B group, PSQI <5). Statistical analyses included Student t test, Mann-Whitney U test, chi-square test, and binary logistic regression analysis to determine which patient-reported factors were associated with sleep disturbance. The mean VAS, UCLA score, UCLA Flexion, HADS-Anxiety (HADS-A), and HADS-Depression (HADS-D) scores in group A were 3.54, 26.36, 3.25, 5.43, and 5.93, respectively; in group B, the mean scores were 1.49, 30.72, 4.50, 2.11, and 1.79, respectively. There were statistically significant differences in the VAS, UCLA, UCLA Flexion, HADS-A, HADS-D scores between the 2 groups (P < .05). In the categories of sex, age, body mass index, and tear size, there was no statistical significant difference between the 2 groups. (P > .05). HADS-D and UCLA Flexion were independent factors affecting sleep disturbance after arthroscopic rotator cuff repair at 6 months (P < .05). Our study demonstrated that patients with sleep disturbances after arthroscopic shoulder surgery had a close relationship with the HADS-D, UCLA Flexion scores and had more pain, more dysfunction, and more pronounced psychological abnormalities. Therefore, more emphasis on psychotherapy and rehabilitation is required for patients with sleep disturbance.

Women Suffered More Than Men Both During and After the COVID-19 Pandemic-A Cross-Sectional Study Among 29,079 Patients With Type 2 Diabetes.

OBJECTIVE: To investigate the gender differences and the disparities between infected and noninfected patients with type 2 diabetes (T2D) regarding patient-reported experiences during the COVID-19 pandemic in Norway. METHOD: Register study using questionnaires sent electronically to patients with T2D, June 2022. The questionnaire included 82 questions covering COVID-19 disease, symptoms, medications, comorbidities, hospital care, possibility of working from home and information received from health authorities. Clinical and demographic data were collected from the Norwegian diabetes registry for adults. RESULTS: A total of 29,079 T2D patients participated, of whom 38.1% were women. Patients infected with COVID-19 were younger, had shorter diabetes duration and less comorbidities than noninfected (p < 0.01). Women reported significantly more anxiety, depression and fear of not getting their diabetes medication than men did. Most patients were vaccinated against COVID-19 (98.3%), whereas approximately 60% had received seasonal flu vaccine, and only 27.2% the pneumococcal vaccine. Women described more vaccine adverse effects and long Covid symptoms. Overall, 14% experienced vaccine complications and 27.3% of infected individuals reported long Covid symptoms. 2.4% of the infected patients needed hospital admission. Patients were satisfied with the follow-up of their diabetes, and with information from the government during the pandemic. CONCLUSION: Female patients were more likely to experience a prolonged Covid course, and higher degree of adverse effects from the COVID-19 vaccine than male patients. Also, long Covid symptoms were significantly more often reported among female patients, while men were more prone to be hospitalised when infected. Hospitalised patients, both men and women, had significantly higher HbA1C than those who were not hospitalised. T2D patients had a surprisingly low pneumococcal vaccination coverage, despite recommendations in national guidelines.

[Exploring the characteristics changes of cardiopulmonary exercise testing in patients with acute coronary syndrome after PCI before and during the COVID-19 pandemic].

Objective: To investigate the changes in cardiopulmonary exercise testing (CPET) characteristics before and after the outbreak of COVID-19 in patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI). Methods: This is a cross-sectional study that included ACS patients who underwent PCI at the General Hospital of the Northern Theater Command from July 2018 to February 2023. Based on the timeline of the COVID-19 pandemic, patients were divided into two groups: the pre-pandemic group and the during-pandemic group, with January 2020 as the dividing line. Clinical data were collected from both groups, and a comparative analysis was performed on their postoperative CPET outcomes, including peak oxygen uptake (peak VO2), peak metabolic equivalents (peak MET), and other indicators. Weber's classification was used to assess cardiac function. In addition, the 7-tiem generalized anxiety disorder scale (GAD-7) and the patient health questionnaire-9 (PHQ-9) were used to assess the patients' psychological anxiety and depression states, respectively. Multivariate logistic regression was used to analyze the influencing factors of CPET after PCI. Results: A total of 4 310 post-PCI ACS patients were included, with an average age of (58.7±9.1) years, and 3 464 (80.37%) were male. There were 1 698 patients in the pre-pandemic group and 2 612 patients in the during-pandemic group. The main indicator of the CPET, peak VO2 (15.04±3.93) ml·min-1·kg-1 in the during-pandemic group, was lower than that in the pre-pandemic group (15.52±3.68) ml·min-1·kg-1, and the difference was statistically significant (P<0.001). Multivariate logistic regression analysis showed that advanced age, female gender, high body mass index, elevated high-sensitivity C-reactive protein, reduced high-density lipoprotein cholesterol, smoking history, history of myocardial infarction, more severe ACS classification, and mild to moderate degree of depression were related to poor cardiopulmonary outcomes (P<0.05). Conclusion: The COVID-19 pandemic had a negative impact on the cardiopulmonary outcomes of ACS patients after PCI. Reduced physical activity, and increased psychological stress should be given consideration and attention regarding their impact on patients' cardiopulmonary function.

The Impact of COVID-19 Fear on Mental Health of Community Behavioral Health Providers.

OBJECTIVE: The COVID-19 pandemic has impacted communities worldwide. Behavioral health providers are at the forefront providing services and are thus vulnerable to psychological sequalae. This study hypothesizes that the fear of COVID-19 predicts depression and anxiety among these providers. METHODS: A questionnaire was delivered to community behavioral health providers to assess fear of COVID-19 using the Fear of COVID-19 Scale (FCV-19S). Anxiety and depression were assessed using Generalized Anxiety Disorder (GAD-2) scale and Patient Health Questionnaire (PHQ-2). Demographic data were analyzed using descriptive statistics, and the relationship between explanatory variables and outcomes was assessed using univariate generalized linear models and 1-way analysis of variance (ANOVA). RESULTS: FCV-19S scores were significantly higher among persons who smoked (z = 2.4, P < 0.05) or had a predisposing health condition. The multivariate models showed significant association with fear of COVID-19 and having a predisposing health condition, belonging to an ethnic minority group, not been diagnosed positive, and having a high total anxiety score. CONCLUSIONS: The study indicated that 50% of the behavioral health providers screened had poor mental health owing to multiple factors identified. Hence, it is essential to strengthen their support to better mitigate situations contributing to fear.

Anxiety and depression as risk factors for postoperative complications and pain in lumbar spine surgery: A national database study.

Objective: To investigate the potential association between anxiety and depression and surgical outcomes in patients undergoing LSS. By analyzing data from the Nationwide Inpatient Sample (NIS) database, we aim to identify whether anxiety and depression serve as predictors for postoperative complications and pain-related symptoms. Methods: A retrospective analysis was conducted via the NIS database. Those undergoing LSS from 2010 to 2019 were divided into four groups: those with a diagnosis of anxiety, depression, both depression and anxiety, and neither depression nor anxiety. The chi-squared test, rank sum test, the Student-Newman-Keuls, least significant difference, and Bonferroni tests were used to identify differences between these groups. Logistic regression analysis was utilized to determine if anxiety and depression were predictors for postoperative complications and pain-related symptoms. Results: From 2010 to 2019, 832,099 patients undergoing LSS were identified. Patients with either anxiety or depression were associated with heavier economic burdens ($85,375, $76,840, $88,542 in the anxiety, depression, and comorbid group, respectively, p < 0.001) and prolonged hospital stay (p < 0.001). They were identified to experience higher risks of various complications especially thrombophilia (OR = 1.82, and 1.55 in the anxiety and the depression group, respectively, p < 0.01). Multiple pain-related symptoms, but face reduced risks of inpatient mortality (OR = 0.71, 0.75, and 0.63 in the anxiety, depression, and comorbid group, respectively, p < 0.01). Conclusions: The overall morbidities of depression and anxiety were relatively high. Psychiatric comorbidities were closely correlated with the negative outcomes after LSS. The psychological health of patients receiving LSS requires necessary attention to ensure pain control and prevent complications postoperatively.

Cardiovascular training versus resistance training for fatigue in people with cancer.

BACKGROUND: With prevalence estimates between 50% and 90% of people with cancer, cancer-related fatigue is one of the most common morbidities related to cancer and its treatment. Exercise is beneficial for the treatment of cancer-related fatigue. However, the efficacy of different types of exercise (i.e. cardiovascular training and resistance training) have not yet been investigated systematically and compared directly in a meta-analysis. OBJECTIVES: To compare the benefits and harms of cardiovascular training versus resistance training for treatment or prevention of cancer-related fatigue in people with cancer. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, and five other databases in January 2023. We searched ClinicalTrials.gov and the International Clinical Trials Registry Platform for ongoing trials. We integrated results from update searches of previously published Cochrane reviews. In total, our searches included trials from inception to October 2023. SELECTION CRITERIA: We included randomised controlled trials investigating cardiovascular training compared with resistance training, with exercise as the main component. We included studies on adults with cancer (aged 18 years and older), with or without a diagnosis of cancer-related fatigue, for any type of cancer and any type of cancer treatment, with the intervention starting before, during, or after treatment. We included trials evaluating at least one of our primary outcomes (cancer-related fatigue or quality of life). We excluded combined cardiovascular and resistance interventions, yoga, and mindfulness-based interventions. Our primary outcomes were cancer-related fatigue and quality of life. Our secondary outcomes were adverse events, anxiety, and depression. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methodology. For analyses, we pooled results within the same period of outcome assessment (i.e. short term (up to and including 12 weeks' follow-up), medium term (more than 12 weeks' to less than six months' follow-up), and long term (six months' follow-up or longer)). We assessed risk of bias using the Cochrane RoB 1 tool, and certainty of the evidence using GRADE. MAIN RESULTS: We included six studies with 447 participants with prostate, breast, or lung cancer who received radiotherapy or chemotherapy, had surgery, or a combination of these. All studies had a high risk of bias due to lack of blinding. Three studies had an additional high risk of bias domain; one study for attrition bias, and two studies for selection bias. Interventions in the cardiovascular training groups included training on a cycle ergometer, treadmill, an elliptical trainer, or indoor bike. Interventions in the resistance training group included a varying number of exercises using bodyweight, weights, or resistance bands. Interventions varied in frequency, intensity, and duration. None of the included studies reported including participants with a confirmed cancer-related fatigue diagnosis. The interventions in four studies started during cancer treatment and in two studies after cancer treatment. Before treatment No studies reported interventions starting before cancer treatment. During treatment The evidence was very uncertain about the effect of cardiovascular training compared with resistance training for short-term cancer-related fatigue (mean difference (MD) -0.29, 95% confidence interval (CI) -2.52 to 1.84; 4 studies, 311 participants; Functional Assessment of Chronic Illness Therapy - Fatigue (FACIT-Fatigue) scale where higher values indicate better outcome; very low-certainty evidence) and long-term cancer-related fatigue (MD 1.30, 95% CI -2.17 to 4.77; 1 study, 141 participants; FACIT-Fatigue scale; very low-certainty evidence). The evidence was very uncertain about the effect of cardiovascular training compared with resistance training for short-term quality of life (MD 1.47, 95% CI -1.47 to 4.42; 4 studies, 319 participants; Functional Assessment of Cancer Therapy - General scale where higher values indicate better outcome; very low-certainty evidence) and for long-term quality of life (MD 3.40, 95% CI -4.85 to 11.65; 1 study, 141 participants; Functional Assessment of Cancer Therapy - Anemia scale where higher values indicate better outcome; very low-certainty evidence). The evidence is very uncertain about the effect of cardiovascular training compared with resistance training on the occurrence of adverse events at any follow-up (risk ratio (RR) 2.00, 95% CI 0.19 to 21.18; 2 studies, 128 participants; very low-certainty evidence). No studies reported medium-term cancer-related fatigue or quality of life. After treatment The evidence was very uncertain about the effect of cardiovascular training compared with resistance training for short-term cancer-related fatigue (MD 1.47, 95% CI -0.09 to 3.03; 1 study, 95 participants; Multidimensional Fatigue Inventory-20 General Fatigue subscale where higher values indicate worse outcome; very low-certainty evidence). Resistance training may improve short-term quality of life compared to cardiovascular training, but the evidence is very uncertain (MD -10.96, 95% CI -17.77 to -4.15; 1 study, 95 participants; European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30 Global Health subscale where higher values indicate better outcome; very low-certainty evidence). No studies reported outcomes at medium-term or long-term follow-up. AUTHORS' CONCLUSIONS: The evidence is very uncertain about the effects of cardiovascular training compared with resistance training on treatment of cancer-related fatigue in people with cancer. Larger, well-conducted studies including people with different cancer types receiving different treatments are needed to increase the certainty in the evidence and to better understand who may benefit most from cardiovascular or resistance training. Moreover, studies comparing the effects of cardiovascular and resistance training initiated before as well as after cancer treatment are needed to understand the prophylactic and rehabilitative effects of these exercise types on cancer-related fatigue.

Association between apathy and caregiver burden in patients with amyotrophic lateral sclerosis: a cross-sectional study.

OBJECTIVES: To investigate the relationship among patients' apathy, cognitive impairment, depression, anxiety, and caregiver burden in amyotrophic lateral sclerosis (ALS). DESIGN: A cross-sectional study design was used. SETTING: The study was conducted at a tertiary hospital in Wuhan, Hubei, China. PARTICIPANTS: A total of 109 patients with ALS and their caregivers were included. OUTCOME MEASURES: Patients with ALS were screened using the Edinburgh Cognitive and Behavioural Screen, Beck Depression Inventory-II, Generalised Anxiety Disorder-7 and Apathy Scale to assess their cognition, depression, anxiety and apathy, respectively. The primary caregivers completed the Zarit Burden Interview. The association between apathy, cognitive impairment, depression, anxiety and caregiver burden was analysed using logistic regression. Mediation models were employed to investigate the mediating effect of patients' apathy on the relationship between depression/anxiety and caregiver burden. RESULTS: Patients in the high caregiver burden group exhibited significantly higher levels of depression, anxiety and apathy compared with those in the low caregiver burden group (p<0.05). There was a positive association observed between caregiver burden and disease course (rs=0.198, p<0.05), depression (rs=0.189, p<0.05), anxiety (rs=0.257, p<0.05) and apathy (rs=0.388, p<0.05). There was a negative association between caregiver burden and the Revised ALS Functional Rating Scale (rs=-0.275, p<0.05). Apathy was an independent risk factor for higher caregiver burden (OR 1.121, 95% CI 1.041 to 1.206, p<0.05). Apathy fully mediated the relationship between depression and caregiver burden (ß=0.35, 95% CI 0.16 to 0.54, p<0.05) while partially mediating the relationship between anxiety and caregiver burden (ß=0.34, 95% CI 0.16 to 0.52, p<0.05). CONCLUSIONS: Apathy, depression and anxiety exerted a detrimental impact on caregiver burden in individuals with ALS. Apathy played a mediating role in the relationship between depression and caregiver burden and between anxiety and caregiver burden. These findings underscore the importance of identifying apathy and developing interventions for its management within the context of ALS.

Increased risk of depression and associated symptoms in poststroke aphasia.

Poststroke aphasia hinders patients' emotional processing and social adaptation. This study estimated the risks of depression and related symptoms in patients developing or not developing aphasia after various types of stroke. Using data from the US Collaborative Network within the TriNetX Diamond Network, we conducted a retrospective cohort study of adults experiencing their first stroke between 2013 and 2022. Diagnoses were confirmed using corresponding International Classification of Diseases, Tenth Revision, Clinical Modification codes. Patients were stratified by poststroke aphasia status and stroke type, with propensity score matching performed to control for confounders. The primary outcome was depression within one year post-stroke; secondary outcomes included anxiety, fatigue, agitation, emotional impact, and insomnia. Each matched group comprised 12,333 patients. The risk of depression was significantly higher in patients with poststroke aphasia (hazard ratio: 1.728; 95% CI 1.464-2.038; p < 0.001), especially those with post-hemorrhagic-stroke aphasia (hazard ratio: 2.321; 95% CI 1.814-2.970; p < 0.001). Patients with poststroke aphasia also had higher risks of fatigue, agitation, and emotional impact. Anxiety and insomnia risks were higher in those with post-hemorrhagic-stroke aphasia. Poststroke aphasia, particularly post-hemorrhagic-stroke aphasia, may increase the risks of depression and associated symptoms, indicating the need for comprehensive psychiatric assessments.

Effect of Music Therapy on Negative Psychology, Sleep, and Quality of Life in Elderly Patients Recovering from Cerebral Infarction with Depression and Anxiety: A Retrospective Analysis.

OBJECTIVE: To observe the effects of music therapy on negative psychology, sleep, and quality of life in elderly patients recovering from cerebral infarction accompanied by depression and anxiety. METHODS: We performed a retrospective analysis of 160 patients with convalescent cerebral infarction diagnosed between December 2022 and December 2023 in the Affiliated Brain Hospital of Nanjing Medical University. Cases from the control group (n = 76) were treated with conventional rehabilitation training. Meanwhile, the music therapy group (n = 84) cases were managed with standard and music therapy. Various measures, including polysomnography, the general quality of life questionnaire-74 (GQOL-74), the self-rating anxiety scale (SAS), and the self-rating depression scale (SDS) were collected at baseline (admission) and 4 weeks post-admission. RESULTS: After 4 weeks, the music therapy group exhibited higher GQOL-74 scores, lower SAS scores, and lower SDS scores (P < 0.001). Furthermore, compared with the control group, the music therapy group had shorter sleep latency, longer sleep duration, higher sleep efficiency, lower wake time, fewer wake times, shorter S1 stage, longer S3 + S4 stage, and longer REM period (P < 0.001). CONCLUSIONS: Music therapy appears to be effective in improving negative psychology, sleep quality, and quality of life in elderly patients with comorbid depression and anxiety during recovery from cerebral infarction.

Acupuncture for the treatment of anxiety and depression in patients with spinal cord injury: A study protocol for systematic review and meta analysis.

BACKGROUND: Spinal cord injury patients frequently suffer from anxiety and depression, which can seriously affect their quality of life and recovery. Acupuncture, as a traditional Chinese therapy, has been used to treat anxiety and depression for more than 2000 years. The aim is to evaluate the clinical efficacy of acupuncture in the treatment of anxiety and depression in spinal cord injury patients. METHODS: The literature on acupuncture treating anxiety and depression in patients with spinal cord injury in PubMed, Embase, Cochrane Library, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Chinese Scientific Journal Data, and Wanfang data were searched through computers from the establishment of the database to May 2024. In the study, the Cochrane tool for assessing the risk of bias was used and the meta-analyses were carried out using the software package Review Manager 5.4. RESULTS: Ten trials were included in this systematic review, with 361 cases in the experimental group and 355 cases in the control group. Meta-analysis showed that compared with conventional treatment, acupuncture combined with conventional treatment was beneficial in improving the total clinical efficacy (odds ratio = 3.55 [95% confidence interval {CI}: 1.34-9.37], P < .001). We found acupuncture-assisted therapy could be beneficial in improving the Modified Barthel Index (MD = 10.48 [95% CI: 4.78-16.19], P < .001) and reducing anxiety or depression scores (such as the Self-Rating Anxiety Scale [MD = -6.08 {95% CI: -6.85 to -5.30}, P < .001]; reducing the Self-Rating Depression Scale [MD = -6.01 {95% CI: -6.95 to -5.07}, P < .001]). In addition, the study showed that the application of acupuncture treatment could improve 5-hydroxytryptamine compared to control group (MD = 44.99 [95% CI: 40.04-49.95], P < .001) and reduce TNF-α compared to control group (MD = -7.78 [95% CI: -8.73 to -6.83], P < .001). CONCLUSION: Acupuncture could be used as a complementary therapy to reduce anxiety and depression in spinal cord injury patients. Further original and high-quality research is needed to verify the conclusions of this study.

Anxiety and Depression in Advanced and Metastatic Lung Cancer Patients-Correlations with Performance Status and Type of Treatment.

Background and Objectives: The treatment of advanced and metastatic lung cancer is multimodal, and it is coordinated by a multidisciplinary team. Anxiety and depression occur frequently in patients with lung cancer, creating considerable discomfort in therapeutic management. At the same time, these psychoemotional symptoms affect the patients' quality of life. Objective: This research seeks to identify correlations both between anxiety and depression and the patients' performance statuses, as well as between anxiety and depression and the type of treatment: radiotherapy, chemotherapy, tyrosine kinase inhibitors (TKI), immunotherapy and palliative care. Materials and Methods: The study evaluated 105 patients with lung cancer from two oncologic centers. Patients were assessed for anxiety and depression using the questionnaire Hospital Anxiety and Depression Scale (HADS). The HADS is a self-report rating scale of 14 items. It measures anxiety and depression, and has two subscales. There are seven items for each subscale. There are 4-point Likert scale ranging from 0 to 3. For each subscale, the score is the sum of the seven items, ranging from 0 to 21. Results: The most powerful correlation with statistical significance was observed between the IT type of treatment (immunotherapy) and the normal level of anxiety, PC = 0.82 (p < 0.001) as well as the normal level of depression. Palliative treatment was correlated with anxiety and depression, both borderline and abnormal. For ECOG 3-4 performance status and abnormal anxiety, respectively, abnormal depression was significantly associated. Also, continuous hospitalization was associated with abnormal anxiety and depression. Conclusions: Early assessments of anxiety and depression are necessary in patients with advanced and metastatic lung cancer, with unfavorable performance status, who have been admitted to continuous hospitalization, and who require palliative care.

Impact research of pain nursing combined with hospice care on quality of life for patients with advanced lung cancer.

This study aims to evaluate the impact of integrating pain nursing with hospice care on the quality of life among patients with advanced lung cancer. This study involving 60 advanced lung cancer patients admitted from January 2022 to January 2023. Participants were randomly assigned to 2 groups: the observation group received a combination of pain nursing and hospice care, while the control group received standard nursing care. The study assessed changes in the numeric rating scale for pain, self-rating anxiety scale (SAS), self-rating depression scale (SDS), cancer fatigue scale (CFS), death attitude, and various quality of life dimensions as measured by the Quality of Life Questionnaire-Core 30. Post-intervention, both groups exhibited reductions in numeric rating scale, SAS, SDS, and CFS scores compared to baseline, with more significant improvements observed in the observation group (P < .05). Additionally, post-intervention scores for death attitude and Quality of Life Questionnaire-Core 30 domains (physical, cognitive, social, role, and emotional functioning, as well as overall health) increased in both groups, with the observation group showing greater improvements than the control group (P < .05). The combination of pain nursing and hospice care significantly reduces pain, anxiety, and depression, decreases cancer-related fatigue, and improves the quality of life and death attitudes in patients with advanced lung cancer, highlighting the benefits of this integrative approach in palliative care settings.

Biopsychosocial Associates of Psychological Distress and Post-Traumatic Growth among Canadian Cancer Patients during the COVID-19 Pandemic.

OBJECTIVE: Understanding both the positive and negative psychological outcomes among cancer patients during the pandemic is critical for planning post-pandemic cancer care. This study (1) examined levels of psychological distress and post-traumatic growth (PTG) among Canadian cancer patients during the COVID-19 pandemic and (2) explored variables that were associated with psychological distress and PTG during the pandemic using a biopsychosocial framework. METHOD: A cross-section survey was undertaken of patients receiving ongoing care at a regional cancer centre in Ontario, Canada, between February and December 2021. Self-reported questionnaires assessing sociodemographic information, social difficulties, psychological distress (depression, anxiety fear of recurrence, and emotional distress), PTG, illness perceptions, and behavioural responses to the pandemic were administered. Disease-related information was extracted from patient health records. RESULTS: Prevalences of moderate to severe levels of depression, anxiety, fear of recurrence and emotional distress were reported by 26.0%, 21.2%, 44.2%, and 50.0% of the sample (N = 104), respectively. Approximately 43% of the sample reported experiencing high PTG, and these positive experiences were not associated with levels of distress. Social factors, including social difficulties, being female, lower education, and unemployment status were prominent associative factors of patient distress. Perceptions of the pandemic as threatening, adopting more health safety behaviours, and not being on active treatment also increased patient likelihood to experience severe psychological distress. Younger age and adopting more health safety behaviours increased the likelihood of experiencing high PTG. The discriminatory power of the predictive models was strong, with a C-statistic > 0.80. CONCLUSIONS: Examining both the positive and negative psychological patient outcomes during the pandemic has highlighted the complex range of coping responses. Interventions that adopt a multi-pronged approach to screen and address social distress, as well as to leverage health safety behaviours, may improve the adjustments in the pandemic aftermath.