Comparative analysis of acoustic therapies for tinnitus treatment based on auditory event-related potentials.

Introduction: So far, Auditory Event-Related Potential (AERP) features have been used to characterize neural activity of patients with tinnitus. However, these EEG patterns could be used to evaluate tinnitus evolution as well. The aim of the present study is to propose a methodology based on AERPs to evaluate the effectiveness of four acoustic therapies for tinnitus treatment. Methods: The acoustic therapies were: (1) Tinnitus Retraining Therapy (TRT), (2) Auditory Discrimination Therapy (ADT), (3) Therapy for Enriched Acoustic Environment (TEAE), and (4) Binaural Beats Therapy (BBT). In addition, relaxing music was included as a placebo for both: tinnitus sufferers and healthy individuals. To meet this aim, 103 participants were recruited, 53% were females and 47% were males. All the participants were treated for 8 weeks with one of these five sounds, which were moreover tuned in accordance with the acoustic features of their tinnitus (if applied) and hearing loss. They were electroencephalographically monitored before and after their acoustic therapy, and wherefrom AERPs were estimated. The sound effect of acoustic therapies was evaluated by examining the area under the curve of those AERPs. Two parameters were obtained: (1) amplitude and (2) topographical distribution. Results: The findings of the investigation showed that after an 8-week treatment, TRT and ADT, respectively achieved significant neurophysiological changes over somatosensory and occipital regions. On one hand, TRT increased the tinnitus perception. On the other hand, ADT redirected the tinnitus attention, what in turn diminished the tinnitus perception. Tinnitus handicapped inventory outcomes verified these neurophysiological findings, revealing that 31% of patients in each group reported that TRT increased tinnitus perception, but ADT diminished it. Discussion: Tinnitus has been identified as a multifactorial condition highly associated with hearing loss, age, sex, marital status, education, and even, employment. However, no conclusive evidence has been found yet. In this study, a significant (but low) correlation was found between tinnitus intensity and right ear hearing loss, left ear hearing loss, heart rate, area under the curve of AERPs, and acoustic therapy. This study raises the possibility to assign acoustic therapies by neurophysiological response of patient.

Fat mass to fat-free mass ratio and its associations with clinical characteristics in asthma.

BACKGROUND: Fat mass to fat-free mass ratio (FM/FFM) assesses the combined effect of the balance between fat mass and fat-free mass. AIMS: to evaluate the associations beetween FM/FFM and clinical outcomes in asthma and to compare clinical characteristics between individuals with higher and lower FM/FFM. METHODS: 128 participants with asthma underwent anthropometric, spirometry and bioelectrical impedance assessments. Physical activity in daily life (PADL) was assessed by the Actigraph for 7 days. Daily dose of inhaled medication, steps of pharmacological treatment, Asthma Control Questionnaire, Asthma Quality of Life Questionnaire and Hospital Anxiety and Depression Scale were also assessed. Participants were classified into two groups according to the 50th percentile of reference values for FM/FFM. RESULTS: Individuals with higher FM/FFM (n=75) used higher daily doses of inhaled corticosteroids, had worse lung function and fewer steps/day when compared to those with lower FM/FFM (n=53) (P≤0.021). Associations were found between absolute values of FM/FFM with lung function (FEV1 and FVC [liters]): R2=0.207 and 0.364;P<0.0001), and between the categories of lower or higher FM/FFM with steps of medication treatment (Cramer's V=0.218;P=0.016) and level of PADL (Cramer's V=0.236;P=0.009). The highest FM/FFM was a determining factor of physical inactivity (OR: 3.21;95%CI:1.17-8.78) and highest steps of pharmacological treatment (OR: 8.89;95%CI:1.23-64.08). CONCLUSION: Higher FM/FFM is significantly associated with worse clinical characteristics in individuals with asthma, such as higher doses of inhaled corticosteroids, worse lung function and fewer steps/day. Moreover, higher FM/FFM is a determining factor of physical inactivity and the highest steps of pharmacological treatment for asthma.

Prevalence of depression and anxiety in the different clinical forms of multiple sclerosis and associations with disability: A systematic review and meta-analysis.

Multiple sclerosis (MS) is a chronic neurodegenerative and autoimmune disease. Motor, sensory and cognitive deficits in MS are commonly accompanied by psychiatric disorders. Depression and anxiety affect the quality of life of MS patients, and the treatment is still not well-established. Prevalence rates in MS patients for depression and anxiety vary widely between studies. However, the prevalence of these psychiatric disorders in the subgroups of MS patients and their association with a disability has not been studied yet. Therefore, this systematic review and meta-analysis proposes to estimate the prevalence of depression and anxiety in MS and to perform subgroup analyses (study type, Extended Disability Status Scale/EDSS, duration of MS, region, type of MS) on observational studies. The protocol was registered in PROSPERO (4202125033). A computerized search on PubMed, EMBASE and Scopus for studies on depression and anxiety in MS was performed from 2015 to 2021, and 12 articles were included. Most of the studies in the meta-analysis had a low risk of bias. The prevalence of depression was 27.01% (MS), 15.78% (relapsing-remitting multiple sclerosis/RRMS), and 19.13% (progressive multiple sclerosis/PMS). For anxiety the prevalence was 35.19% (MS), 21.40% (RRMS), and 24.07% (PMS). The prevalence of depression/anxiety for patients with EDSS <3 was 26.69/45.56% and for EDSS >3 was 22.96/26.70%. Using HADS-A (8) the prevalence was 38.5% and for depression was 22.4%. Then, our study brought together current data regarding psychiatric disorders in MS patients, which are comorbidities that affect the quality of life of these patients.

Presencia de ansiedad y depresión en pacientes de consulta externa de gastroenterología en Lima Metropolitana

Los objetivos fueron identificar la presencia de ansiedad y depresión en pacientes que acuden a consultorio externo de gastroenterología en la ciudad de Lima y describir los antecedentes gastroenterológicos y síntomas más relacionados a estos trastornos. La muestra estuvo conformada por 200 pacientes adultos pertenecientes a 32 distritos de Lima Metropolitana, atendidos por la especialidad de Gastroenterología en la modalidad de consultorio externo durante marzo a octubre del 2021, a quienes se les aplicó la Escala de Ansiedad y Depresión Hospitalaria (HADS) adaptada por Vilela. El estudio fue descriptivo-correlacional y la muestra prospectiva. Alrededor de 1 de cada 2 pacientes (49%, n=98) presentó ansiedad, 1 de cada 5 (19%, n=38) depresión y 16,5% (n=33) concomitantemente ambos trastornos. Los antecedentes gastroenterológicos de Dispepsia (v=0,216) y Síndrome de Intestino Irritable (v=0,188) mostraron asociación estadística para ambas variables. Diarrea (v=0,214) y dolor torácico (v=0,215) fueron síntomas asociados a ansiedad, así como dolor torácico, con depresión. Los trastornos de ansiedad y depresión tienen alta prevalencia en la población que acude a consulta externa, sugerimos explorar dichas variables y ofrecer un abordaje multidisciplinario a los pacientes atendidos por esta modalidad.

The objectives were to identify anxiety and depression in patients attending a gastroenterology outpatient clinic in the city of Lima, and to describe the gastroenterological history and symptoms most related to these disorders. 200 adult patients belonging to 32 districts of Metropolitan Lima attended from March to October 2021 were enrolled; the Hospital Anxiety and Depression Scale (HADS) adapted by Vilela was applied. The study was descriptive-correlational and prospective sample. 49% (n=98) reported anxiety, 19% (n=38) depression and 16.5% (n=33) both disorders concomitantly. Dyspepsia (v=0.216) and Irritable Bowel Syndrome (v=0.188) showed a statistical association for both variables. Diarrhea (v=0.214) and chest pain (v=0.215) were symptoms associated with anxiety, as well as chest pain with depression. Anxiety and depression are highly prevalent among patients that come to outpatient office visits, we suggest exploring these variables and offering a multidisciplinary approach to patients treated by this modality.

Validation of the COVID-19 Fear Scale modified for application during the perinatal period.

PURPOSE: The COVID-19 Fear Scale (FCV-19S) allows screening in general population; however, there is no specific instrument in our population for screening in the perinatal period that considers fear related with COVID-19 and offspring well-being. We aimed to validate the FCV-19S modified for application during the perinatal period. MATERIALS AND METHODS: Analytical, cross-sectional design. After signing consent, women 18-45 years were included. Internal consistency was calculated with Cronbach's alpha, external validity using the Hospital Anxiety and Depression Scale (HADS), factorial analysis and intraclass correlation coefficient for re-test. RESULTS: The sample included 178 women, mean age 31.04 ± 5.9. We obtained internal consistency with Cronbach's alpha = 0.873 (95%CI, 0.842-0.899). Spearman's Rho coefficient was 0.207 (p= .013). All the elements were statistically significant for the polychoric correlation (p<.001). Reliability test-retest with intraclass correlation was 0.873. CONCLUSIONS: The version of FCV-19S modified with eight items is a valid measurement instrument for application during the perinatal period, showing adequate internal consistency and external validity with HADS as measure of concurrence to identify anxiety related with COVID-19 during the perinatal period.

Validity of the Hospital Anxiety and Depression Scale (HADS) in primary care patients in Colombia.

OBJECTIVE: To assess the validity of the Hospital Anxiety and Depression Scale (HADS) for depression and anxiety screening in primary care patients in Colombia. METHODS: A criterion validity study was conducted with 243 adults that had completed the HADS and were later assessed using the MINI as a gold standard. Cronbach's alpha, McDonald's omega and factor structure were applied through confirmatory factor analysis (CFA). ROC curve analysis and Youden's statistic were used to determine the cut-off point. RESULTS: Cronbach's α was reported to be 0.85 and 0.82 for McDonalds' ω. CFA supported a two-factor solution demonstrating satisfactory fit. Root mean square error of approximation = 0.04, Comparative Fix Index (CFI) and Tucker-Lewis Index (TLI) = 0.97. For HADS-A, the cut-off point was determined as 6 associated with a sensitivity of 0.76, a specificity of 0.72 and Youden's index of 0.50. The ABC was 0.81. For HADS-D, the cut-off point was determined as 4 associated with a sensitivity of 0.78, a specificity of 0.74 and Youden's index of 0.53. The ABC was 0.82. CONCLUSION: The HADS is a valid and reliable instrument for anxiety and depression screening in adult patients of primary healthcare services in Colombia.

Sintomatologia depressiva e suas repercussões na representação social da depressão: um estudo com adolescentes

A depressão tem sido retratada como o mal do século, tornando-se um problema de saúde pública que tem afetado milhões de pessoas no mundo. Este estudo objetivou compreender como os adolescentes representam a depressão. Participaram 168 estudantes do ensino médio, com idades de 14 a 18 anos, de escolas públicas e privadas de João Pessoa-Paraíba, Brasil. Utilizou-se a Técnica de Associação Livre de Palavras (TALP), Questionário sociodemográfico e a Escala de Ansiedade e Depressão Hospitalar (HADS). Observou-se a representação social da depressão ancorada em vivências subjetivas enfatizando os aspectos individuais desse fenômeno como tristeza, solidão, angústia, sofrimento e suicídio. Os adolescentes apresentaram sintomatologia depressiva em 21,4 %, sendo estes percentuais acentuados quando comparados com outros estudos na área. Espera-se que este estudo possa promover ações de prevenção no contexto escolar e reflexões sobre meios de conscientização da depressão como um transtorno de causas múltiplas.

La depresión ha sido retratada como el mal del siglo, convirtiéndose en un problema de salud pública que ha afectado a millones de personas en todo el mundo. Este estudio tuvo como objetivo comprender cómo los adolescentes representan la depresión. Participaron 168 estudiantes de secundaria, de 14 a 18 años, de escuelas públicas y privadas en João Pessoa-Paraíba, Brasil. Se utilizó la técnica de asociación de palabras libres (TALP), Cuestionario sociodemográfico y la Escala de ansiedad y depresión hospitalaria (HADS). Se observó la representación social de la depresión anclada en experiencias subjetivas que enfatizan los aspectos individuales de este fenómeno como la tristeza, la soledad, la angustia, el sufrimiento y el suicidio. Los adolescentes presentaron síntomas depresivos en 21.4 %, estos porcentajes se acentuaron en comparación con otros estudios en el área. Se espera que este estudio pueda promover acciones preventivas en el contexto escolar y reflexiones sobre formas de crear conciencia sobre la depresión como un trastorno de múltiples causas.

Depression has been portrayed as the evil of the century, becoming a public health problem that has affected millions of people worldwide. This study aimed to understand how adolescents represent depression. One hundred and sixty-eight high school students aged 14 to 18 years participated, from public and private schools in João Pessoa-Paraíba, Brazil. We used the Free Association of Words Technique (TALP), a sociodemographic questionnaire, and the Hospital Anxiety and Depression Scale (HADS). The social representation of depression anchored in subjective experiences was observed, emphasizing the individual aspects of this phenomenon, such as sadness, loneliness, anguish, suffering and suicide. The adolescents presented depressive symptoms in 21.4 % of the cases, and these percentages are higher when compared to other studies in the area. It is hoped that this study can promote preventive actions in the school context and reflect on ways to raise awareness of depression as a disorder with multiple causes.

Impacto en la calidad de vida por la comprensión del tinnitus / The Quality of Life impaction by Tinnitus Comprehension

El tinnitus es la sensación de sonido en ausencia de cualquier fuente externa. Nuestro objetivo fue evaluar la repercusión del tinnitus en la calidad de vida. Se inscribieron 25 pacientes con tinnitus con una amplia gama de umbrales de pérdida auditiva (HLT) y estado de gravedad de tinnitus. La gravedad, la ansiedad y la depresión del tinnitus se evaluaron mediante el inventario de discapacidades por tinnitus (THI), el índice funcional de tinnitus (TFI) y la escala de ansiedad y depresión hospitalaria (HADS), respectivamente. Se realizó una audiometría de conducción aérea de tono puro. El impacto de la percepción del tinnitus en la calidad de vida se encontró más alto en el grupo de sufrimiento. La escala de ansiedad y depresión figuraba en 40% y 60%, respectivamente. El uso de la mano fue de 20 diestros y 5 zurdos. El tinnitus bilateral se está experimentando en el 76%. El LH se presentó en 17 (68%) de los pacientes con tinnitus. La descripción del sonido del tinnitus como silbido (40%), siseo (24%), pulsante (16%), timbre (8%) y ruidos de tono alto (12%). Con respecto al cuestionario THI, los sujetos con tinnitus se dividen en 60% (leve), 30% (moderado) y 10% (grave). Mientras que el cuestionario TFI, el 50% mostró un (leve), el 25% (moderado) y el 25% mostró (severo). Postulamos una fuerte asociación positiva significativa entre HADS y la gravedad del tinnitus: THI (P = 0,000) y TFI (P = 0,001). Esos datos revelaron que la percepción del tinnitus tiene impactos negativos en la calidad de vida mientras que la gravedad puede verse alterada por la lateralidad

Tinnitus is the sensation of sound in the absence of any external source, and the aim is to assess the impaction of tinnitus on QoL. 25-tinnitus sufferers were enrolled with a wide range of hearing loss thresholds (HLT) and tinnitus severity status. Tinnitus severity, anxiety and depression were assessed using tinnitus handicap inventory (THI), tinnitus functional index (TFI), and the hospital anxiety and depression scale (HADS), respectively. Pure tone air conduction audiometry was performed. The impaction of tinnitus perception on QoL was found higher in suffering group. The anxiety and depression scale figured in 40%, and 60%, respectively. The handed use was 20 rights handed and 5 left-handed. Bilateral tinnitus is experiencing in 76%. The HL occurred in 17(68%) of tinnitus patients. The description of tinnitus sound as whistling (40%), hissing (24%), pulsating (16%), ringing (8%), and high pitch noises (12%). Regarding THI questionnaire, tinnitus subjects are divided to 60% (mild), 30% (moderate), and 10% (severe). While TFI questionnaire, 50% showed a (mild), 25% (moderate), and 25% showed (severe). We postulated a strong significant positive association between HADS and tinnitus severity: THI (P=0.000) and TFI (P= 0.001). Those data revealed that tinnitus perception has negative impacts on QoL, and the severity may be altered by laterality.

Association between hospital anxiety and depression scale and problem-related distress in patients with cancer in a Brazilian private institution.

OBJECTIVE: Emotional symptoms are frequently reported among patients with cancer. We evaluated the association between emotional symptoms and problem-related distress in a sample of patients with cancer about to initiate chemotherapy within a private hospital in Brazil. METHODS: Patients were assessed before initiating chemotherapy, treatment mid-point, and on the last day of treatment for anxiety and depression (Hospital Anxiety and Depression Scale [HADS]) and for problem-related distress (Distress Thermometer Problem List). Problem-related distress variable was computed as the sum of practical, physical, spiritual and familial problems. Mixed-model analysis was applied to determine the association between HADS and problem-related distress, adjusting for age and gender. RESULTS: A total of 655 consecutive patients were enrolled. There was a significant main effect of time (F = 8.99, p = 0.0001), showing that emotional symptoms improve over time. A significant main effect was observed for problem-related distress (F = 371.56, p < 0.0001) revealing that patients with elevated problem-related distress at baseline tend to have higher HADS across the three time points, compared to patients with lower problem-related distress. There was an interaction effect between problem-related distress and time (F = 85.22, p < 0.0001), suggesting that HADS scores decreased differently over time, depending on patients' initial level of problem-related distress. CONCLUSION: Overall, emotional symptoms, while decreasing over time, remained associated with problem-related distress after chemotherapy in Brazil. The potential benefit of implementing a psychosocial intervention remains high throughout cancer treatment.

Comparing the hospital anxiety and depression scale to the Brief Edinburgh Depression Scale for identifying cases of major depressive disorder in advanced cancer palliative patients.

OBJECTIVE: This study sought to compare the Hospital Anxiety and Depression Subscale (HADS-D) and Brief Edinburgh Depression Scale (BEDS) as case-finding tools of major depressive disorder in patients with advanced cancer in a palliative care service. METHODS: An observational study was performed which included patients with advanced cancer who attended the palliative care service at the National Institute of Cancer in Mexico. Patients were asked to fill out the Hospital Anxiety and Depression Scale (HADS) and BEDS and were then assessed by a psychiatrist to evaluate major depressive disorder (MDD) as per the DSM-5 criteria. The case-finding capability of each scale was determined using receiver operating characteristic curves, assessing the area under the curve (AUC) in comparison to the clinical diagnosis. RESULTS: Eighty-nine patients were included; median age was 57 years, and 71% were female. Among these, 19 patients were diagnosed with MDD during the interview. When comparing the self-reported scales, BEDS had a better performance compared with HADS-D (AUC 0.8541 vs. 0.7665). Limitations include a heterogeneous population and a limited sample size. SIGNIFICANCE OF RESULTS: The BEDS outperformed the HADS-D tool in discriminating patients with and without depression. A BEDS cutoff value of ≥5 is suggested as a case-finding score for depression in this population.

Cosmetic camouflage improves health-related quality of life in women with systemic lupus erythematosus and permanent skin damage: A controlled intervention study.

OBJECTIVE: To investigate the effect of cosmetic camouflage in health-related quality of life (HRQoL) in women with systemic lupus erythematosus (SLE) and permanent facial skin damage. METHODS: This is a randomized controlled clinical trial (Universal Trial Number: U1111-1210-2554e) with SLE women from outpatients using ACR/1997 and/or SLICC/2012 criteria, aged over 18 years old, with modified SLEDAI 2k < 4 and permanent facial skin damage, recruited in two tertiary centers to use cosmetic camouflage (n = 36) or no intervention (n = 20). Endpoints were score variations in SLE Quality of Life (SLEQoL) (total and each domain), Dermatology Life Quality Index (DLQI), Rosenberg self-esteem scale and Hospital Anxiety and Depression Scale (HADS), after daily use of cosmetic camouflage for 12 +/-2 weeks (Phase I), "as needed" use of cosmetic camouflage for another 12 +/-2 weeks (Phase II), and during total follow up (24 +/-2 weeks). Univariate and multivariate linear regressions were conducted by protocol analysis. RESULTS: Both groups were similar at baseline regarding age, disease duration, socio-demographic, clinical, laboratory and treatment characteristics. The comparison of score variations between intervention and control groups showed an independent HRQoL improvement in total SLEQoL score after using cosmetic camouflage in Phase I [ß -27.56 (CI 95% -47.86 to -7.27) p = 0.009] and total follow up [ß -28.04 (CI 95% -48.65 to -7.44) p = 0.09], specifically in mood, self-image and physical functioning domains. Also, there was an improvement in DLQI scores during Phase I [ß -7.65 (CI 95% -12.31 to -3.00) p = 0.002] and total follow up [ß -8.97(CI95% -12.99 to -4.94) p < 0.001). Scores for depression [ß -1.92 (CI 95% -3.67 to -0.16) p = 0.033], anxiety [ß -2.87 (CI 95% -5.67 to -0.07] p = 0.045] and self-esteem [ß 2.79 (CI 95% 0.13 to 5.46) p = 0.041] improved considering the total follow up. No significant changes occurred in the control group scores. CONCLUSION: The use of cosmetic camouflage improved the HRQoL in female SLE patients with permanent facial skin damage.

Screening for symptoms of anxiety and depression in patients admitted to a university hospital with acute coronary syndrome / Rastreio de sintomas ansiosos e depressivos em pacientes com síndrome coronariana aguda internados em um hospital universitário

Abstract Objective: To investigate the prevalence of anxiety and depression in patients admitted for acute coronary syndrome to a university hospital and to examine associations with use of psychotropic drugs. Methods: Ninety-one patients who had had an acute coronary event were enrolled on this cross-sectional prevalence study. Characteristics of the study population and the prevalence rates of depression and anxiety in the sample were assessed using the Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) psychiatric consultation protocol, which includes clinical and sociodemographic data, and the Hospital Anxiety and Depression Scale (HADS). Results: The prevalence of symptoms of anxiety was 48.4% (44 patients) and the prevalence of depressive symptoms was 26.4% (24 patients). Of these, 19 patients (20.9% of the whole sample) had scores indicative of both types of symptoms concomitantly. Considering the whole sample, just 17 patients (18.7%) were receiving treatment for anxiety or depression with benzodiazepines and/or antidepressants. Conclusions: Anxiety and depression are disorders that are more prevalent among patients with acute coronary syndrome than in the general population, but they are generally under-diagnosed and under-treated. Patients with anxiety and depression simultaneously had higher scores on the HADS for anxiety and depression and therefore require more intensive care.

Resumo Objetivo: Investigar a prevalência de ansiedade e depressão em pacientes com síndrome coronariana aguda internados em um hospital universitário e examinar sua associação com o uso de drogas psicotrópicas. Métodos: Noventa e um pacientes que sofreram evento coronariano agudo foram incluídos nesse estudo transversal de prevalência. O protocolo de interconsulta psiquiátrica do Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), com os dados clínicos e sociodemográficos, e a Escala Hospitalar de Ansiedade e Depressão (HADS) foram utilizados para avaliar as características da população estudada e a prevalência de depressão e ansiedade nessa amostra. Resultados: A prevalência de sintomas ansiosos foi de 48,4% (44 pacientes), e a de sintomas depressivos, de 26,4% (24 pacientes). Desses, 19 (20,9% do total da amostra) pontuaram para os dois sintomas concomitantemente. Considerando a amostra como um todo, apenas 17 pacientes (18,7%) estavam recebendo tratamento para ansiedade ou depressão com benzodiazepínicos e/ou antidepressivos. Conclusão: Ansiedade e depressão são transtornos mais prevalentes em pacientes com síndrome coronariana aguda do que na população geral, mas geralmente são subdiagnosticados e subtratados. Os pacientes com presença simultânea de ansiedade e depressão apresentam escores mais altos na escala HADS para ansiedade e depressão e necessitam, portanto, de um controle mais intensivo.

Prevalencia de Ansiedad y Depresión en Pacientes Hospitalizados

La ansiedad como la depresión conllevan una serie de respuestas emocionales en los pacientes, que alteran el funcionamiento general, la morbimortalidad y los costos de atención en salud, al prolongar la estancia del paciente en el hospital. Es importante detectar oportunamente los estados de ánimo depresivos y ansiosos en pacientes hospitalizados, esto con el fin de mejorar la recuperación del paciente, disminuir la vulnerabilidad a diversas enfermedades y evitar prolongar la estancia hospitalaria. El propósito del presente fue evaluar a pacientes hospitalizados en los servicios de medicina interna y hematología del Hospital Juárez de México, para: 1) determinar niveles de ansiedad y depresión, y 2) determinar relaciones entre depresión, ansiedad y tiempo con la enfermedad. Participaron 111 pacientes hospitalizados a los cuales se les aplicó la Escala de ansiedad y depresión hospitalaria (Hospital Anxiety and Depression Scale, HADS).Se identificó mayor presencia de ansiedad y depresión a mayor tiempo de enfermedad.

Anxiety and depression lead to a series of emotional responses in patients which alter general functioning, morbidity-mortality, and health care costs, by prolonging the patient's stay in the hospital. It is important to timely detect depressive and anxious moods in hospitalized patients in order to improve patient ́s recovery and to avoid a longer hospital stay. The propose of this paper was to assess hospitalized patients in intern and hematological medicine services areas in the Juarez ́s hospital in Mexico to 1) determine anxiety and depression levels, and 2) determine the relationship between depression, anxiety and period with an illness. A total of 111 hospitalized patients participated, whom which the Hospital Anxiety and Depression Scale (HADS) was applied. It was identified as a major presence of anxiety and depression when the period with an illness variable was high.

Economic value of treating lumbar disc herniation in Brazil.

OBJECT: Lumbar discectomy is one of the most common surgical spine procedures. In order to understand the value of this surgical care, it is important to understand the costs to the health care system and patient for good results. The objective of this study was to evaluate for the first time the cost-effectiveness of spine surgery in Latin America for lumbar discectomy in terms of cost per quality-adjusted life year (QALY) gained for patients in Brazil. METHODS: The authors performed a prospective cohort study involving 143 consecutive patients who underwent open discectomy for lumbar disc herniation (LDH). Patient-reported outcomes were assessed utilizing the SF-6D, which is derived from a 12-month variation of the SF-36. Direct medical costs included medical reimbursement, costs of hospital care, and overall resource consumption. Disability losses were considered indirect costs. A 4-year horizon with 3% discounting was applied to health-utilities estimates. Sensitivity analysis was performed by varying utility gain by 20%. The costs were expressed in Reais (R$) and US dollars ($), applying an exchange rate of 2.4:1 (the rate at the time of manuscript preparation). RESULTS: The direct and indirect costs of open lumbar discectomy were estimated at an average of R$3426.72 ($1427.80) and R$2027.67 ($844.86), respectively. The mean total cost of treatment was estimated at R$5454.40 ($2272.66) (SD R$2709.17 [$1128.82]). The SF-6D utility gain was 0.044 (95% CI 0.03197-0.05923, p = 0.017) at 12 months. The 4-year discounted QALY gain was 0.176928. The estimated cost-utility ratio was R$30,828.35 ($12,845.14) per QALY gained. The sensitivity analysis showed a range of R$25,690.29 ($10,714.28) to R$38,535.44 ($16,056.43) per QALY gained. CONCLUSIONS: The use of open lumbar discectomy to treat LDH is associated with a significant improvement in patient outcomes as measured by the SF-6D. Open lumbar discectomy performed in the Brazilian supplementary health care system provides a cost-utility ratio of R$30,828.35 ($12,845.14) per QALY. The value of acceptable cost-effectiveness will vary by country and region.

O Perfil Sociodemográfico, histórico do uso de substâncias e de tratamento, e a indicação de ansiedade e depressão dos pacientes em tratamento no grupo álcool e drogas do ambulatório médico de especialidades psiquiátricas Dra. Jandira Masur / The Sociodemographic Profile, history of substance use and treatment, and the indication of anxiety and depression of the patients being treated in the alcohol and drugs group of the psychiatric specialty clinic Dr. Jandira Masur

Objetivo: Conhecer o perfil sociodemográfico, o histórico do uso de substâncias e de tratamento e se há indicação de ansiedade e depressão dos pacientes em tratamento no grupo de Álcool e Drogas do AME Psiquiatria Dra Jandira Masur...

La Escala de Ansiedad y Depresión Hospitalaria (HAD) en fibromialgia: análisis de sensibilidad y especificidad / Hospital Anxiety and Depression Scale (HADS) in fibromyalgia: sensitivity and specificity analysis

La sociedad española de Reumatología (SER) (rivera et al., 2006) recomienda la escala de ansiedad y Depresión Hospitalaria (Hospital anxiety and Depression Scale - HADS, Zigmond y Snaith, 1983) para la evaluación clínica de ansiedad y depresión en Fibromialgia (FM). sin embargo, no constan índices de sensibilidad/especificidad ni puntos de corte en FM. Con el objetivo de comprobar aplicabilidad, propiedades psicométricas y sensibilidad/especificidad del HAD en FM, se evaluó a 131 pacientes ambulatorios del Hospital de san Vicente (alicante, España), utilizando como criterios externos BDI y STAI-E. se analizaron ítems, consistencia interna y estructura factorial mediante análisis confirmatorio y puntos de corte con curvas ROC. Se replicó la estructura de dos factores. La fiabilidad es adecuada (HADA=.80, HADD=.85). Se muestran diferentes puntos de corte con sensibilidad/especificidad superior al 70 por ciento para cada subescala. El Had presenta propiedades psicométricas óptimas en población FM, mostrándose útil como instrumento de "screening" de sintomatología ansioso-depresiva en esta población.

Spanish Society of Rheumatology (SER) (Rivera et al., 2006) suggests the Hospital Anxiety and Depression Scale (HADS, Zigmond y Snaith, 1983) for clinical assessment of anxiety and depression in fibromyalgia (FM). However, there is no HAD-FM cut-off yet. Aiming to assess applicability, psychometric properties and sensitivity/specificity of HADS in FM, 131 outpatients were assessed at San Vicente Hospital (Fibromyalgia service, Alicante, Spain), using like external criteria BDI and STAI-E. Item analysis was performed, calculating the internal consistency and factor structure study by confirmatory factor analysis (CFA). The cut-off points were found by ROC curves. Two-factor structure was replicated. Reliability is adequate (HADA=.80, HADD=.85). Several cut-off points are showed with sensitivity and specificity levels >70 percent for both subscales. HADS has optimal psychometric properties in FM and its useful as a screening tool to assess anxious-depressive symptoms in FM patients.

Análise Fatorial Confirmatória e Normatização da Hospital Anxiety and Depression Scale (HADS) / Confirmatory Factor Analysis and Standardization of the Hospital Anxiety and Depression Scale (HADS)

RESUMOOs principais objetivos deste estudo foram realizar a análise fatorial confirmatória da Hospital Anxiety and Depression Scale (HADS) e conduzir análises de curvas ROC para a normatização de seus pontos de corte, em uma amostra não-clínica. Os resultados exibiram evidências de validade estrutural da HADS e foram propostas mudanças para os parâmetros diagnósticos da ansiedade (≥7 pontos) e depressão (≥6 pontos). Ao final, destaca-se a necessidade de cautela na interpretação dos escores e decisão diagnóstica, principalmente na mensuração da depressão.

ABSTRACTThe main objectives of this study were to perform a confirmatory factor analysis of the Hospital Anxiety and Depression Scale (HADS) and to conduct ROC curves for standardization of cut-off points, in a nonclinical sample. The results showed evidences of the structural validity of HADS and changes were proposed to the diagnostic parameters of anxiety (≥7 points) and depression (≥6 points). Finally, we highlight that caution is needed for the interpretation of the scores and diagnostic decision, especially for the depression measure.

Development and validation of the distress thermometer for parents of a chronically ill child.

OBJECTIVE: To develop and validate a Distress Thermometer for Parents (DT-P) for chronically ill children and to determine a cutoff score for clinical distress. STUDY DESIGN: Parents of a chronically ill child (0-18 years) were recruited via announcements or were actively approached at the outpatient clinics of the Emma Children's Hospital/Academic Medical Center and Vrije Universiteit Medical Center. We modeled the development of the DT-P on the Distress Thermometer used in oncology medical care. The DT-P consists of a thermometer score from 0 (no distress) to 10 (extreme distress) and a problem list (practical, social, emotional, physical, cognitive, and parenting domains). The DT-P was validated with the Hospital Anxiety and Depression Scale (HADS) and the Parenting Stress Index. RESULTS: The mean thermometer score of the 706 participating parents was 3.7 (SD 3.0). The thermometer score and the scores in the practical, emotional, physical, and cognitive problem domains were strongly related to anxiety, depression, and the total score of the HADS (0.55 ≤ r ≤ 0.72). The thermometer score and all problem domain scores were moderately-to-strongly related to the Parenting Stress Index (0.38 ≤ r ≤ 0.63). A cutoff-score of 4 correctly identified 86% of "clinical HADS cases" (sensitivity) and 67% of "nonclinical HADS cases" (specificity). CONCLUSIONS: We developed the DT-P and examined its diagnostic utility in a large sample. The DT-P appeared to be a valid and useful short screening-tool for identifying parental distress.