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1.
Adv Exp Med Biol ; 1191: 141-153, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32002927

RESUMO

Substantial evidence from various studies suggests a preeminent role for early adverse experiences in the development of psychopathology. The most recent studies reviewed here suggest that early life stressors are associated with an increased risk for anxiety disorders in adulthood. Early life stress predisposes individuals to develop a number of psychiatric syndromes, particularly affective disorders, including anxiety disorders, and is therefore a significant health problem.This review examines the emerging literature on the relationship between stress, hypothalamic-pituitary-adrenal (HPA) axis function, and generalized anxiety disorder (GAD), panic disorder, and phobias and the role of early life stress as an important risk factor for HPA axis dysfunction.The most consistent findings in the literature show increased activity of the HPA axis in depression associated with hypercortisolemia and reduced inhibitory feedback. In addition to melancholic depression, a spectrum of other conditions may be associated with increased and prolonged activation of the HPA axis, including panic, GAD, phobias and anxiety. Moreover, HPA axis changes appear to be state-dependent, tending to improve upon resolution of the anxiety syndrome. Interestingly, persistent HPA hyperactivity has been associated with higher rates of relapse. These studies suggest that an evaluation of the HPA axis during treatment may help identify patients who are at a higher risk for relapse. These findings suggest that this dysfunction of the HPA axis is partially attributable to an imbalance between glucocorticoid and mineralocorticoid receptors. Evidence has consistently demonstrated that glucocorticoid receptor function is impaired in anxiety disorders. Moreover, normal basal cortisol levels and hyper-responsiveness of the adrenal cortex during a psychosocial stressor are observed in social phobics. Finally, abnormal HPA axis activity has also been observed in generalized anxiety disordered patients. Early stressful life events may provoke alterations of the stress response and thus of the HPA axis that can endure during adulthood, predisposing individuals to develop psychopathology.


Assuntos
Experiências Adversas da Infância , Transtornos de Ansiedade/etiologia , Transtornos de Ansiedade/fisiopatologia , Ansiedade/etiologia , Ansiedade/fisiopatologia , Sistema Hipotálamo-Hipofisário/fisiopatologia , Sistema Hipófise-Suprarrenal/fisiopatologia , Estresse Psicológico/complicações , Ansiedade/psicologia , Transtornos de Ansiedade/psicologia , Humanos , Estresse Psicológico/psicologia
2.
Epidemiol Psychiatr Sci ; 29: e86, 2020 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31915100

RESUMO

With cancer incidence increasing over time worldwide, attention to the burden of psychiatric and psychosocial consequences of the disease is now mandatory for both cancer and mental health care professionals. Psychiatric disorders have been shown to affect at least 30-35% of cancer patients during all phases of the disease trajectory, and differ in nature according to stage and type of cancer. Other clinically relevant distressing psychosocial and existential conditions (e.g. demoralisation, health anxiety, loss of meaning and existential distress) not included as 'disorders' in the usual diagnostic and nosological systems (i.e. meta-diagnostic conditions) have also been shown to be present in another 15-20% of cancer patients. In this editorial, we will present a summary of the extensive literature regarding the epidemiology of the several psychosocial disorders affecting cancer patients as a cause of distress and burden to be taken into consideration and addressed in cancer care through evidence-based intervention.


Assuntos
Transtornos Mentais/complicações , Saúde Mental , Neoplasias/psicologia , Estresse Psicológico/psicologia , Ansiedade/etiologia , Disfunção Cognitiva/etiologia , Efeitos Psicossociais da Doença , Depressão/etiologia , Humanos , Transtornos Mentais/psicologia , Neoplasias/complicações , Neoplasias/diagnóstico , Psico-Oncologia , Qualidade de Vida , Estresse Psicológico/diagnóstico , Estresse Psicológico/etiologia
3.
Heart Fail Clin ; 16(1): 131-138, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31735311

RESUMO

The occurrence of depression, anxiety, and insomnia is strikingly high in patients with heart failure and is linked to increased morbidity and mortality. However, symptoms are frequently unrecognized and the integration of mental health into cardiology care plans is not routine. This article describes the prevalence, identification, and treatment of common comorbid psychological disorders.


Assuntos
Ansiedade/etiologia , Depressão/etiologia , Insuficiência Cardíaca/complicações , Ansiedade/epidemiologia , Ansiedade/psicologia , Depressão/epidemiologia , Depressão/psicologia , Saúde Global , Insuficiência Cardíaca/psicologia , Humanos , Incidência , Prevalência
4.
Medicine (Baltimore) ; 98(50): e18196, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852076

RESUMO

This study aimed at investigating the prevalence of anxiety and depression, and their risk factors as well as their correlation with prognosis in refractory or relapsed (R/R) acute myeloid leukemia (AML) patients.A total of 180 R/R AML patients were enrolled and their anxiety and depression were assessed by Hospital Anxiety and Depression Scale (HADS) before treatment. Besides, HADS was also evaluated in 180 de novo AML patients prior treatment and 180 healthy controls (HCs), respectively.Both the HADS-Anxiety and HADS-Depression scores were increased in R/R AML patients compared with de novo AML patients and HCs (all P < .001). Meanwhile, the prevalence of anxiety and depression was 53.9% and 45.6% in R/R AML patients, which were also greatly higher compared with de novo AML patients and HCs (all P < .01). Regarding risk factors, higher Eastern Cooperative Oncology Group score and lines of salvage therapy were correlated with anxiety and depression in R/R AML patients (all P < .05). Furthermore, anxiety and depression were associated with shorter overall survival (OS) in R/R AML patients (all P < .05), while no association of different degrees of anxiety and depression with OS was observed (all P > .05).Anxiety and depression are highly prevalent and implicated in the management and prognosis of R/R AML.


Assuntos
Ansiedade/etiologia , Depressão/epidemiologia , Leucemia Mieloide Aguda/complicações , Indução de Remissão/métodos , Medição de Risco/métodos , Ansiedade/epidemiologia , China/epidemiologia , Terapia Combinada , Depressão/etiologia , Feminino , Seguimentos , Humanos , Incidência , Leucemia Mieloide Aguda/terapia , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Estudos Retrospectivos , Fatores de Risco
5.
Medicine (Baltimore) ; 98(50): e18331, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852127

RESUMO

This study assessed sex differences in cardiac and motor functions, quality of life (QoL), and mental status in Chinese chronic heart failure (CHF) patients after metoprolol treatment.This single-center prospective study, conducted from February 2013 to April 2016, included CHF patients (men and women) with resting heart rate (HR) >80 beats/min using metoprolol continuous release tablets. Metoprolol-induced changes in cardiac and motor functions, QoL, and mental status at 1, 3, 6, 9, and 12 months from baseline, within and between the sexes, were analyzed. Descriptive data were represented as counts, percentages, and mean ± standard deviation. Differences at various follow-up periods were compared using repeated measures one-way analysis of variance, followed by post hoc Dunnett's multiple comparison test. Statistical significance was considered at P < .05.Compared with men, women reported significantly higher systolic blood pressure (SBP) (122.28 ±â€Š6.76 vs 125.47 ±â€Š6.67 mm Hg, P < .05) and Veterans Specific Activity Questionnaire score (8.16 ±â€Š0.98 vs 8.47 ±â€Š0.89, P = .05) at 12 months. Men reported higher Hospital Anxiety and Depression Scale scores for depression than women at 1 month (10.27 vs 8.83, P < .05) and for anxiety at 12 months (8.4 vs 7.72, P < .05). Metoprolol significantly decreased HR and Minnesota Living with Heart Failure Questionnaire score in men (64.5 ±â€Š3.13 and 53.7 ±â€Š8.00) and women (65.38 ±â€Š3.32 and 53.85 ±â€Š8.42, respectively). Ejection fraction (%, men: 50.00 ±â€Š4.45, women: 50.72 ±â€Š4.09), cardiac index (L/min/m, men: 2.70 ±â€Š0.25, women: 2.78 ±â€Š0.23), 6-minute walk test distance (m, men: 414.41 ±â€Š20.84, women: 420.34 ±â€Š20.35), and short form-8 questionnaire scores (men: 52.05 ±â€Š1.94, women: 52.19 ±â€Š2.58) increased significantly in both the sexes (P < .001 for all) at 12 months. Copenhagen Burnout Inventory score significantly increased in men (mean score 62.43, P < .05).Metoprolol treatment improves cardiac and motor functions, QoL, and anxiety scores but causes greater depression and burnout in men and women. Sex was seen to affect mental status of CHF patients the most.


Assuntos
Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/psicologia , Metoprolol/uso terapêutico , Qualidade de Vida , Fatores Sexuais , Adulto , Idoso , Ansiedade/tratamento farmacológico , Ansiedade/etiologia , Grupo com Ancestrais do Continente Asiático/psicologia , China , Doença Crônica , Depressão/tratamento farmacológico , Depressão/etiologia , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Atividade Motora/efeitos dos fármacos , Estudos Prospectivos , Inquéritos e Questionários , Resultado do Tratamento
6.
BMC Neurol ; 19(1): 277, 2019 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-31706292

RESUMO

BACKGROUND AND PURPOSE: Early supported discharge (ESD) has been shown to be efficient and safe as part of the stroke care pathway. The best results have been seen with a multidisciplinary team and after mild to moderate stroke. However, how very early supported discharge (VESD) works has not been studied. The aim of this study was to investigate whether VESD for stroke patients in need of ongoing individualized rehabilitation affects the level of anxiety and overall disability for the patient compared with ordinary discharge routine. METHODS: A randomized controlled trial was performed with intention to treat analyses comparing VESD and ordinary discharge from hospital. All patients admitted at the stroke care unit at Sahlgrenska University Hospital of Gothenburg between August 2011 and April 2016 were screened. Inclusion occurred on day 4 using a block randomization of 20 and with a blinded assessor. Assessments were made 5 days post-stroke and 3 and 12 months post-stroke. Patients in the VESD group underwent continued rehabilitation in their homes with a multidisciplinary team from the stroke care unit for a maximum of 1 month. The patients in the control group had support as usual after discharge when needed such as home care service and outpatient rehabilitation. The primary outcome was anxiety as assessed by the Hospital Anxiety and Depression Scale-Anxiety subscale (HADS-A). The secondary outcome was the patients' degree of overall disability, measured by the modified Rankin Scale (mRS). RESULTS: No significant differences were found between the groups regarding anxiety at three or 12 months post-stroke (p = 0.811). The overall disability was significantly lower in the VESD group 3 months post-stroke (p = 0.004), compared to the control group. However, there was no significant difference between the groups 1 year post-stroke. CONCLUSIONS: The VESD does not affects the level of anxiety compared to ordinary rehabilitation. The VESD leads to a faster improvement of overall disability compared to ordinary rehabilitation. We suggest considering coordinated VESD for patients with mild to moderate stroke in addition to ordinary rehabilitation as part of the service from a stroke unit. TRIAL REGISTRATION: Clinical Trials.gov: NCT01622205. Registered 19 June 2012 (retrospectively registered).


Assuntos
Ansiedade/etiologia , Serviços de Assistência Domiciliar , Recuperação de Função Fisiológica , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/psicologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Alta do Paciente
7.
BMC Public Health ; 19(1): 1508, 2019 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-31718590

RESUMO

BACKGROUND: Noise exposure is considered a stressor that may potentially exert negative health effects among the exposed individuals. On a population basis, the most prevalent and immediate response to noise is annoyance, which is an individually experienced phenomenon that may activate physiological stress-responses and result in both physical and mental symptoms. Health implications of traffic noise have been investigated thoroughly, but not of neighbour noise. The aim of the present study was to examine the associations between neighbour noise annoyance and eight different physical and mental health symptoms. METHODS: Cross-sectional data from the Danish Health and Morbidity Survey 2017 were used. The present study included a random sample of 3893 adults living in multi-storey housing. Information on neighbour noise annoyance and various health symptoms (e.g. pain in various body parts, headache, sleeping problems, depression, and anxiety) during the past two weeks was obtained by self-administered questionnaires. The question on neighbour noise annoyance and health symptoms, respectively, had three possible response options: 'Yes, very annoyed/bothered', 'Yes, slightly annoyed/bothered', 'No'. The associations between neighbour noise annoyance and very bothering physical and mental health symptoms were investigated using multiple logistic regression models. RESULTS: Being very annoyed by neighbour noise was significantly associated with higher odds of being very bothered by all eight health symptoms (adjusted OR = 1.73-3.32, all p-values < 0.05) compared to individuals not annoyed by noise from neighbours. Statistically significant interactions were observed between sex and two of the eight health symptoms. Among women, a strong association was observed between neighbour noise annoyance and being very bothered by pain or discomfort in the shoulder or neck, and in the arms, hands, legs, knees, hips or joints. Among men, no associations were observed. CONCLUSIONS: Based on the findings from this study, neighbour noise annoyance is strongly associated with eight different physical and mental health symptoms. Future studies are encouraged to 1) determine the direction of causality using a longitudinal design, 2) explore the biological mechanisms explaining the sex-specific impact of neighbour noise annoyance on symptoms of musculoskeletal pain or discomfort and the other outcomes as well.


Assuntos
Exposição Ambiental , Habitação , Ruído/efeitos adversos , Características de Residência , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ansiedade/etiologia , Estudos Transversais , Dinamarca , Depressão/etiologia , Feminino , Cefaleia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Ruído dos Transportes/efeitos adversos , Razão de Chances , Dor/etiologia , Fatores Sexuais , Transtornos do Sono-Vigília/etiologia , Inquéritos e Questionários , Adulto Jovem
8.
Harefuah ; 158(11): 711-715, 2019 Nov.
Artigo em Hebraico | MEDLINE | ID: mdl-31721512

RESUMO

INTRODUCTION: Burns are one of the most common and painful injuries among babies and children. The pain endured during and in between treatment can be minimized with sedation. These sedations, however, are not without side effects and risks. Given the potential complications, we devised a Burn Analgesic Treatment Protocol that incorporates safe analgesia during burn treatment and throughout the day, thus minimizing the necessity for sedations. AIMS: Assessment of the effectiveness of the analgesic protocol by quantification of overall number of sedations needed for burn treatment and by assessment of the overall experience of the treating medical team exposed to burn care before and after implementation of the protocol. METHODS: A retrospective analysis of analgesic treatment regimens among admitted pediatric burn patients both before and after the implementation of our analgesic protocol was performed. Furthermore, questionnaires were given to the nurses of the treating medical team in order to better assess overall experience with the new analgesic protocol. RESULTS: A total of 87 patients were treated with the new analgesic protocol and 46 patients served as the control group. A significantly lower number of sedations were performed in the group treated with the new protocol compared to the control group (18% vs 30%, p=0.057). The questionnaires filled out by the treating nurses revealed an average score of 4.5 (between 1 - 5), indicating high satisfaction with the protocol. CONCLUSIONS: Our new analgesic protocol allows for highly effective treatment of burn wounds while minimizing the necessity for sedations, thus increasing overall patient safety and reducing potential complications.


Assuntos
Analgésicos , Ansiedade , Queimaduras , Dor , Analgésicos/uso terapêutico , Ansiedade/tratamento farmacológico , Ansiedade/etiologia , Queimaduras/complicações , Criança , Humanos , Dor/tratamento farmacológico , Dor/etiologia , Pacientes , Estudos Retrospectivos
9.
Medicine (Baltimore) ; 98(46): e17980, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31725664

RESUMO

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) which is characterized by developmentally inappropriate levels of attention, hyperactivity and impulsivity, is considered as the most common neurodevelopmental disorder in childhood. Physical exercise has shown to have several benefits in the improvement of children with ADHD. In this meta-analysis, we aimed to systematically show, with evidence, the impact of physical exercise on children with ADHD. METHODS: Web of Science, MEDLINE, EMBASE, Google Scholar, Cochrane Central and http://www.ClinicalTrials.gov were the searched sources for studies which were based on the impact of physical exercise on children with ADHD. Relevant endpoints were assessed. This evidence based meta-analysis was carried out by the most relevant RevMan 5.3 software. Due to the involvement of continuous data (mean and standard deviation), weight mean difference (WMD) with 95% confidence intervals (CI) were used to represent the final analysis. A significant level of P ≤ .05 was set and a fixed statistical effect model was used throughout the analysis. RESULTS: Fourteen studies with a total number of 574 participants with ADHD were included in this evidenced based meta-analysis. Two hundred and seventy six (276) participants were assigned to the physical activity group whereas 298 participants were assigned to the control group. Results of this analysis showed that anxiety and depression were significantly improved with physical activity in these children with ADHD (WMD: -1.84; 95% CI: [-2.65 - (-1.03)], P = .00001). Hyperactive/impulsive symptoms (WMD: -0.01; 95% CI: [-0.32 - 0.29], P = .93) and inattention symptoms (WMD: -0.22; 95% CI: [-0.51 - 0.08], P = .15) were also improved with physical exercise but the results were not statistically significant. This evidence based analysis showed thought problems (WMD: -3.49; 95% CI: [-5.51 - (-1.47)], P = .0007), social problems (WMD: -5.08; 95% CI: [-7.34 - (-2.82)], P = .0001), and aggressive behaviors (WMD: -3.90; 95% CI: [-7.10 - (-0.70)], P = .02) to have significantly been improved in participants with ADHD who were assigned to physical activity group. CONCLUSIONS: This current meta-analysis showed with evidence, that physical exercise has a major contribution owing to significant improvement in anxiety and depression, aggressive behaviors, thought and social problems among children suffering from ADHD. Therefore, physical exercise should be incorporated in the daily life of children with ADHD. Further future research should be able to confirm this hypothesis.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/terapia , Exercício/fisiologia , Agressão/fisiologia , Ansiedade/etiologia , Ansiedade/terapia , Atenção/fisiologia , Transtorno do Deficit de Atenção com Hiperatividade/complicações , Transtorno do Deficit de Atenção com Hiperatividade/fisiopatologia , Criança , Depressão/etiologia , Depressão/terapia , Humanos , Relações Interpessoais , Saúde Mental
10.
Medicine (Baltimore) ; 98(48): e18130, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770245

RESUMO

BACKGROUND: Almost 40% of individuals with chronic whiplash-associated disorders (WAD) report headache after 5 years, making it one of the most common persistent symptoms besides neck pain, but randomized treatment studies are lacking. This study aimed to evaluate the effect of 3 different exercise approaches on headache in chronic WAD grades 2 and 3, and to identify potential factors associated with such headache, and whether they differ depending on 3 different aspects of such headache (current headache, maximum headache, or headache bothersomeness). METHODS: This was an analysis of a randomized clinical trial of people with chronic WAD and headache (n = 188), who were randomized to either 12 weeks of neck-specific exercise without (NSE) or with a behavioral approach (NSEB) or physical activity prescription (PPA). Data were collected at baseline and at 3, 6, and 12 months. Physical and psychosocial factors were tested for association with headache. Multivariate regression models and linear mixed models were used. RESULTS: The NSE/NSEB groups reported reduced headache both over time and compared to PPA. Up to 51% (NSE) and 61% (NSEB) reported at least 50% reduction in their headache at 12 months. The PPA group was not improved over time. Neck pain and dizziness were associated with headache regardless of aspect of headache. The only associated psychosocial factor was anxiety, which was associated with headache bothersomeness. Other factors were mainly physical, and up to 51% of the variance was explained. CONCLUSION: Headache in chronic WAD, may be reduced with neck-specific exercise with or without a behavioral approach. Chronic headache was associated with neck pain and dizziness regardless of aspect tested. Other factors associated with headache in chronic WAD were mainly physical rather than psychosocial. TRIAL REGISTRATION NUMBER: Clinical Trials.gov, no: NCT015285.


Assuntos
Terapia Comportamental/métodos , Terapia por Exercício/métodos , Cefaleia/terapia , Cervicalgia/terapia , Traumatismos em Chicotada/terapia , Adulto , Ansiedade/etiologia , Ansiedade/terapia , Doença Crônica , Terapia Combinada , Tontura/etiologia , Tontura/terapia , Exercício , Feminino , Cefaleia/etiologia , Cefaleia/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Cervicalgia/etiologia , Cervicalgia/psicologia , Análise de Regressão , Resultado do Tratamento , Traumatismos em Chicotada/complicações , Traumatismos em Chicotada/psicologia
11.
Medicine (Baltimore) ; 98(48): e18132, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770247

RESUMO

BACKGROUND: This study will explore the effects of high-quality nursing care (HQNC) for patients with lung cancer (LC) during the perioperative period (PPP). METHODS: A literature search will be performed at Cochrane Library, MEDLINE, EMBASE, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure since its inception until October 1, 2019. All electronic databases will be searched with no restrictions of language and publication status. Two authors will perform study selection, data collection, and study quality assessment, respectively. We will use RevMan 5.3 software for statistical analysis. RESULTS: This study will summarize the latest evidence on assessing the depression, anxiety, quality of life, and adverse events of HQNC in patients with LC during PPP. CONCLUSION: The results of this study may provide helpful evidence of HQNC on psychological effects in patients with LC during PPP. PROSPERO REGISTRATION NUMBER: PROSPERO CRD42019155982.


Assuntos
Neoplasias Pulmonares/enfermagem , Cuidados de Enfermagem/normas , Assistência Perioperatória/enfermagem , Assistência Perioperatória/psicologia , Qualidade da Assistência à Saúde , Ansiedade/etiologia , Depressão/etiologia , Humanos , Neoplasias Pulmonares/psicologia , Neoplasias Pulmonares/cirurgia , Cuidados de Enfermagem/métodos , Cuidados de Enfermagem/psicologia , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Revisão Sistemática como Assunto
12.
BMC Health Serv Res ; 19(1): 748, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31651309

RESUMO

BACKGROUND: Despite the growing evidence base supporting intensive lifestyle and medical treatments for severe obesity, patient engagement in specialist obesity services is difficult to achieve and poorly understood. To address this knowledge gap, we aimed to develop a model for predicting non-completion of a specialist multidisciplinary service for clinically severe obesity, termed the Metabolic Rehabilitation Programme (MRP). METHOD: Using a case-control study design in a public hospital setting, we extracted data from medical records for all eligible patients with a body mass index (BMI) of ≥35 kg/m2 with either type 2 diabetes or fatty liver disease referred to the MRP from 2010 through 2015. Non-completion status (case definition) was coded for patients whom started but dropped-out of the MRP within 12 months. Using multivariable logistic regression, we tested the following baseline predictors hypothesised in previous research: age, gender, BMI, waist circumference, residential distance from the clinic, blood pressure, obstructive sleep apnoea (OSA), current continuous positive airway pressure (CPAP) therapy, current depression/anxiety, diabetes status, and medications. We used receiver operating characteristics and area under the curve to test the performance of models. RESULTS: Out of the 219 eligible patient records, 78 (35.6%) non-completion cases were identified. Significant differences between non-completers versus completers were: age (47.1 versus 54.5 years, p < 0.001); residential distance from the clinic (21.8 versus 17.1 km, p = 0.018); obstructive sleep apnoea (OSA) (42.9% versus 56.7%, p = 0.050) and CPAP therapy (11.7% versus 28.4%, p = 0.005). The probability of non-completion could be independently associated with age, residential distance, and either OSA or CPAP. There was no statistically significant difference in performance between the alternate models (69.5% versus 66.4%, p = 0.57). CONCLUSIONS: Non-completion of intensive specialist obesity management services is most common among younger patients, with fewer complex care needs, and those living further away from the clinic. Clinicians should be aware of these potential risk factors for dropping out early when managing outpatients with severe obesity, whereas policy makers might consider strategies for increasing access to specialist obesity management services.


Assuntos
Manejo da Obesidade/estatística & dados numéricos , Obesidade Mórbida/terapia , Cooperação do Paciente/estatística & dados numéricos , Ansiedade/etiologia , Pressão Sanguínea/fisiologia , Índice de Massa Corporal , Estudos de Casos e Controles , Pressão Positiva Contínua nas Vias Aéreas , Depressão/etiologia , Diabetes Mellitus Tipo 2/complicações , Feminino , Hospitalização/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/complicações , Obesidade Mórbida/psicologia , Fatores de Risco , Apneia Obstrutiva do Sono/complicações
13.
Medicine (Baltimore) ; 98(43): e17314, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31651837

RESUMO

This study aimed to investigate the prevalence/severity of anxiety and depression, and also their correlations with clinical characteristics and survival profiles in acute myeloid leukemia (AML) patients.In all, 208 AML patients and 200 age and sex-matched healthy controls (HCs) were recruited in this study. Anxiety and depression were assessed by the Hospital Anxiety and Depression Scale (HADS) in AML patients before initiating therapy and in HCs after being enrolled. Treatment response was assessed, and event-free survival (EFS), and also the overall survival (OS) were calculated.The HADS-anxiety score (P < .001), anxiety prevalence (P < .001), and anxiety severity (P < .001) were increased in AML patients than those in HCs. The HADS-depression score (P < .001), depression prevalence (P < .001), and also depression severity (P < .001) were higher in AML patients compared with HCs. No correlation of anxiety or depression with clinical characteristics was found in AML patients (all P > .05). Moreover, the anxiety (P = .178) and depression (P = .512) rates were similar between complete remission (CR) patients and non-CR patients. Additionally, the EFS was worse in anxiety patients compared with nonanxiety patients (P = .013). The OS was shorter in anxiety patients compared with nonanxiety patients (P = .015) and was also worse in depression patients compared with nondepression patients (P = .007).Anxiety and depression are much more frequent and severe in AML patients compared to HCs, and both of them predict unfavorable survival profiles in AML patients.


Assuntos
Ansiedade/mortalidade , Depressão/mortalidade , Leucemia Mieloide Aguda/mortalidade , Adulto , Antineoplásicos/uso terapêutico , Ansiedade/etiologia , Estudos de Casos e Controles , Depressão/etiologia , Intervalo Livre de Doença , Feminino , Humanos , Leucemia Mieloide Aguda/tratamento farmacológico , Leucemia Mieloide Aguda/psicologia , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Índice de Gravidade de Doença
14.
Medicine (Baltimore) ; 98(39): e17307, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574859

RESUMO

To investigate the cognitive and psychological outcomes of pediatric allogeneic HSCT survivors in China.A total of 135 3 to 18 years old children and adolescents who underwent allo-HSCT and survived at least 3 months post-HSCT were recruited and completed the assessments. Cognitive and psychological functions were assessed via age-appropriate standardized measures. Clinical information was extracted from the medical records.Forty one 3 to 6 years old children completed Psychological Questionnaires for 3 to 6 years Children. The scores of 21(51.2%) children in cognitive development dimension, 18(43.9%) in motor development dimension, 16(39.0%) in language development and social development dimension, 15(36.6%) in emotion and will dimension and 14(34.1%) in living habits dimension were less than the standard. Fifty six 8 to 16 years old children and adolescents completed the Depression Self-rating Scale for Children and 9 (16.1%) of these met the criteria of depression. Sixty nine 7 to 16 years old children and adolescents completed the screening for Child Anxiety Related Disorders and 7 (10.1%) of these met the criteria of anxiety, especially social phobia and school phobia. Eighty nine 6 to 18 years old children and adolescents completed the Symptom Checklist-90 and 43.8% to 77.5% of these experienced mild symptoms like obsession-compulsion (77.5%), hostility (64%), and interpersonal sensitivity (60.7%). Children treated with total body irradiation (TBI) showed more cognitive impairments like motor deficits than those without TBI. Also older children and adolescents had more symptoms like psychoticism.These findings demonstrated cognitive and psychological late effects of pediatric allo-HSCT survivors in a single center in China and highlighted that the survivors conditioned with TBI had more cognitive impairments and older children and adolescents had more symptoms. Early intervention in these children and adolescents might minimize the cognitive losses and psychological effects.


Assuntos
Ansiedade , Disfunção Cognitiva , Depressão , Transplante de Células-Tronco Hematopoéticas , Complicações Pós-Operatórias , Qualidade de Vida , Adolescente , Ansiedade/diagnóstico , Ansiedade/etiologia , Ansiedade/prevenção & controle , Criança , Pré-Escolar , China/epidemiologia , Cognição , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/prevenção & controle , Depressão/diagnóstico , Depressão/etiologia , Depressão/prevenção & controle , Intervenção Médica Precoce/métodos , Feminino , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Transplante de Células-Tronco Hematopoéticas/métodos , Humanos , Masculino , Destreza Motora , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/prevenção & controle , Técnicas Psicológicas , Sobreviventes/psicologia
15.
J Rehabil Med ; 51(10): 755-760, 2019 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-31565752

RESUMO

OBJECTIVES: To explore mechanisms affecting mental health in patients with stroke. The aims were to investigate the association between pre-stroke physical activity and symptoms of anxiety and depression 3 months after stroke, and to investigate how self-reported physical activity changed from before to 3 months after the stroke. DESIGN: Secondary analyses of a prospective observational multicentre study. PATIENTS: Stroke patients from 11 Norwegian stroke units. METHODS: Symptoms of anxiety and depression were measured using the Hospital Anxiety and Depression Scale, and physical activity was assessed by self-report. Negative binomial regression was used to analyse associations. RESULTS: The analysed sample consisted of 205 patients; mean age was 74 years (standard deviation (SD) 11.5); 46% were women. Higher activity levels before stroke were associated with fewer symptoms of depression in multivariable analyses with regression coefficient of 0.84 (95% confidence interval 0.73-0.97), p = 0.015. Eighty-five (41.5%) patients reported similar activity levels before and after stroke. CONCLUSION: In this group of patients with mild symptoms of emotional distress, it seems that pre-stroke physical activity might be protective against post-stroke depression, but not anxiety. Many patients with mild-to-moderate stroke report being equally active before and after the stroke.


Assuntos
Ansiedade , Depressão , Exercício/fisiologia , Acidente Vascular Cerebral , Idoso , Ansiedade/epidemiologia , Ansiedade/etiologia , Depressão/epidemiologia , Depressão/etiologia , Feminino , Humanos , Masculino , Noruega , Autorrelato , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/epidemiologia
16.
Medicine (Baltimore) ; 98(38): e17184, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567960

RESUMO

Although both multiple sclerosis (MS) and neuromyelitis optica (NMO) are demyelinating diseases, their psychiatric disturbances may differ given differences in the neurological manifestations. We used subjective and objective measurements to compare the psychiatric disturbances in patients with MS and NMO.Psychiatric disturbances were assessed in 24 MS and 35 NMO patients using the Beck Hopelessness Scale, Symptom Checklist-95 and the brief version of World Health Organization Quality of Life. Personality was assessed using the Big Five Inventory-10. Disease-related function was assessed using the Fatigue Severity Scale, Short-Form McGill Pain Questionnaire, and the Global Assessment of Function. Positivity offset (PO) and negativity bias (NB) and heart rate variability (HRV) were measured using a modified implicit affect test and photoplethysmograph, respectively. Data were analyzed using analysis of covariance with age and sex as covariates.MS patients had higher levels of depression, anxiety, panic attacks, obsessive-compulsiveness, aggression, paranoia, interpersonal sensitivity, self-regulation problems, stress vulnerability, and lower psychological quality of life (QOL) compared with NMO patients. The PO and NB and HRV values were not significantly different between groups. However, NMO patients had lower QOL, and higher levels of hopelessness, suicidality, and fatigue than the normal range. Disease duration was associated with hopelessness in NMO patients and with several psychiatric disturbances, but not hopelessness, in MS patients.Subjective psychiatric disturbances were more severe in patients with MS than in those with NMO, whereas PO and NB and HRV in patients with NMO were comparable with those of MS patients. Our findings highlight the need for different clinical approaches to assess and treat psychiatric disturbances in patients with MS and NMO.


Assuntos
Transtornos Mentais/etiologia , Esclerose Múltipla/psicologia , Neuromielite Óptica/psicologia , Adulto , Ansiedade/etiologia , Depressão/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/complicações , Neuromielite Óptica/complicações , Transtorno Obsessivo-Compulsivo/etiologia , Transtorno de Pânico/etiologia , Transtornos Paranoides/etiologia , Escalas de Graduação Psiquiátrica , Qualidade de Vida/psicologia , Estresse Psicológico/etiologia
17.
PLoS Negl Trop Dis ; 13(9): e0007768, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31568478

RESUMO

BACKGROUND: Zika virus (ZIKV) infection in pregnancy can cause microcephaly and a wide spectrum of severe adverse outcomes, collectively called "Congenital Zika Syndrome" (CZS). Parenting a child with disabilities can have adverse mental health impacts, but these associations have not been fully explored in the context of CZS in Brazil. METHODOLOGY/PRINCIPAL FINDINGS: A cross-sectional study was undertaken in Recife and Rio de Janeiro, including 163 caregivers of a child with CZS (cases) and 324 caregivers with an unaffected child (comparison subjects), identified from existing studies. The primary caregiver, almost always the mother, was interviewed using a structured questionnaire to collect information on: depression, anxiety, and stress (Depression, Anxiety, and Stress Scale-DASS-21), social support (Medical Outcomes Study Social Support Scale-MOS-SSS), and socio-demographic data. Data was collected May 2017-January 2018. Ethical standards were adhered to throughout the research. A high proportion of mothers reported experiencing severe or extremely severe levels of depression (18%), anxiety (27%) and stress (36%). Mothers of children with CZS were more likely to experience symptoms of depression, anxiety andstress, compared to mothers of comparison children. These associations were more apparent among mothers living in Rio de Janeiro. These differences were reduced after adjustment for socio-economic status and social support. Among mothers of children with CZS, low social support was linked to higher levels of depression, anxiety and stress, but there was no association with socio-economic status. CONCLUSIONS/SIGNIFICANCE: Depression, anxiety and stress were very common among mothers of young children in Brazil, regardless of whether they were parenting a child with disabilities. Mothers of children with CZS may be particularly vulnerable to poor mental health, and this association may be buffered through better social support.


Assuntos
Ansiedade/epidemiologia , Mães/psicologia , Estresse Psicológico/epidemiologia , Infecção por Zika virus/congênito , Adulto , Ansiedade/etiologia , Brasil , Cuidadores/psicologia , Estudos de Casos e Controles , Estudos Transversais , Depressão/epidemiologia , Depressão/etiologia , Feminino , Humanos , Lactente , Masculino , Microcefalia , Classe Social , Apoio Social , Estresse Psicológico/etiologia , Inquéritos e Questionários
19.
Braz J Med Biol Res ; 52(9): e8533, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31483000

RESUMO

This study aimed to evaluate the effect of a newly designed intensive caregiver education program (ICEP) on reducing cognitive impairment, anxiety, and depression in acute ischemic stroke (AIS) patients. One hundred and ninety-six AIS patients were divided into ICEP group and Control group in a 1:1 ratio using blocked randomization method. In the ICEP group, the caregivers received ICEP, while in the Control group caregivers received usual education and guidance. All patients received conventional rehabilitation treatment. Cognitive impairment (assessed by Mini Mental State Examination (MMSE) score and Montreal Cognitive Assessment (MoCA) score), anxiety (assessed by Hospital Anxiety and Depression Scale (HADS)-A score and Self-rating Anxiety Scale (SAS) score), and depression (assessed by HADS-D score and Self-rating Depression Scale (SDS) score) were assessed at baseline (M0), 3 months (M3), 6 months (M6), and 12 months (M12). Cognitive impairment score at M12 and cognitive impairment score change (M12-M0) were increased, while cognitive impairment rate at M12 was reduced in the ICEP group compared with the Control group. Anxiety score change (M12-M0), anxiety score at M12, and anxiety rate at M12 were decreased in the ICEP group compared with the Control group. Depression score change (M12-M0), depression score at M12, and depression rate at M12 were lower in the ICEP group compared with the Control group. Further subgroup analysis based on baseline features also provided similar results. In conclusion, ICEP effectively reduced cognitive impairment, anxiety, and depression in AIS patients.


Assuntos
Transtornos de Ansiedade/prevenção & controle , Ansiedade/prevenção & controle , Cuidadores , Disfunção Cognitiva/prevenção & controle , Transtorno Depressivo/prevenção & controle , Educação em Saúde/métodos , Acidente Vascular Cerebral/enfermagem , Adulto , Ansiedade/etiologia , Transtornos de Ansiedade/etiologia , Estudos de Casos e Controles , Disfunção Cognitiva/etiologia , Transtorno Depressivo/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/psicologia , Reabilitação do Acidente Vascular Cerebral
20.
Rhinology ; 57(6): 469-476, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31502597

RESUMO

BACKGROUND: Empty nose syndrome (ENS) is a debilitating disorder characterised by paradoxical nasal obstruction after excessive surgical excision of nasal tissues. ENS negatively impacts the quality of life (QOL) and psychological status of patients. This study aimed to determine the associations among disease-specific QOL impairments and the severity of anxiety and depression before and after surgery in ENS patients. METHODS: A total of 68 ENS patients were prospectively recruited and underwent submucosal Medpor implantation. QOL impairments and the severity of anxiety and depression were evaluated using the Sinonasal Outcome Test-25 (SNOT-25), Beck Depression Inventory-II (BDI-II), and Beck Anxiety Inventory (BAI) 1 day before and 6 months after surgery. RESULTS: The BDI-II and BAI scores were significantly associated with the total score and ear/facial symptoms, psychological dysfunction, sleep dysfunction, and empty nose symptoms domains of the SNOT-25. Surgery improved disease-specific and psychological symptoms. Post-operative changes in the BDI-II score were correlated with changes in the total score and sleep dysfunction and empty nose symptoms domains of the SNOT-25. A SNOT-25 total score of greater than 60, sleep dysfunction domain score of greater than 18, and empty nose symptoms domain score of greater than 14 were good predictors of moderate-to-severe depression. CONCLUSIONS: ENS symptoms are associated with psychological burden and could be good predictors of moderate-to-severe depression. Targeted symptom improvement could reduce the psychological burden.


Assuntos
Depressão/diagnóstico , Obstrução Nasal/diagnóstico , Obstrução Nasal/psicologia , Procedimentos Cirúrgicos Nasais/efeitos adversos , Ansiedade/diagnóstico , Ansiedade/etiologia , Depressão/etiologia , Humanos , Obstrução Nasal/etiologia , Doenças Nasais/etiologia , Doenças Nasais/cirurgia , Qualidade de Vida , Síndrome
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