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1.
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
2.
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 , Avaliação de Processos e Resultados (Cuidados de Saúde) , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/prevenção & controle , Técnicas Psicológicas , Sobreviventes/psicologia
3.
Life Sci ; 234: 116778, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31430454

RESUMO

AIMS: To clarify the role of the gut-brain axis in depression. MAIN METHODS: We used the iTRAQ technique to identify differential proteins in the intestine of the rat model of chronic unpredictable mild stress (CUMS)-induced depression. Significant differential proteins were subjected to Gene Ontology (GO) functional annotations and KEGG pathway enrichment analysis. Key proteins were validated at the mRNA and protein levels. The levels of cytokines in the intestine, serum and hypothalamus were examined by ELISA. HPLC-UV was used to detect the levels of amino acids. KEY FINDINGS: In the rat intestine, 349 differential proteins (209 downregulated, 140 upregulated) were identified. GO analysis indicated that "protein complex assembly" was the first-ranked biological process. SNARE complex components, including SNAP23, VAMP3 and VAMP8, were increased at the mRNA levels, while only VAMP3 and VAMP8 were also upregulated at the protein level. TNFα, IL6 and IL1ß were upregulated in the CUMS rat intestine, while TNFα was decreased in the serum and hypothalamus. IL1ß was decreased in the serum. "Protein digestion and absorption" was the most significantly enriched KEGG pathway, involving 5 differential proteins: SLC9A3, ANPEP, LAT1, ASCT2 and B0AT1. Glutamine, glycine and aspartic acid were perturbed in the CUMS rat intestine. SIGNIFICANCE: Our findings suggest that CUMS enhances the adaptive immune response in the intestine through ER-phagosome pathway mediated by SNARE complex and disturb absorption of amino acids. It advances our understanding of the role of gut-brain axis in depression and provides a potential therapeutic target for the disease.


Assuntos
Aminoácidos/análise , Citocinas/análise , Depressão/patologia , Mucosa Intestinal/metabolismo , Intestinos/patologia , Proteínas SNARE/análise , Aminoácidos/metabolismo , Animais , Citocinas/genética , Depressão/etiologia , Depressão/genética , Modelos Animais de Doenças , Regulação da Expressão Gênica , Absorção Intestinal , Masculino , Proteômica , Ratos , Ratos Sprague-Dawley , Proteínas SNARE/genética , Estresse Psicológico/complicações
4.
Medicine (Baltimore) ; 98(32): e16820, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31393414

RESUMO

BACKGROUND: Heart failure related depression is recently increased worldwide. Heart failure (HF) disease is identified as a critical cause of increasing morbidity, hospital readmission, and mortality. The most important purpose of treatment of HF disease is to relief disease problems, improve functional performance, and achieve better quality of life. OBJECTIVES: This study was proposed to evaluate the effects of low to moderate-intensity exercise program vs moderate-intensity continuous exercise program on the level of depressive disorder in heart failure patients. STUDY DESIGN: 12-week randomized controlled trial. METHODS: Sixty nine HF patients with mild to moderate level of depression and ejection fraction <40% were examined before and after 12-week intervention. Their age was ranged from 40 to 60 years. Patients were randomly classified into 3 groups. Group I (n = 23) received low to moderate intensity exercise program (LMIEP), group II (n = 23) received moderate-intensity exercise program (MICEP), and group III (n = 23) did not receive any exercise program (Non-exercised group). All patients were instructed to conduct home-based exercise with their pharmacological therapy. The level of depression was evaluated before and after 12 weeks of the intervention program. RESULTS: The 3 study groups were associated with significant decrease of depression level (P < .05). Significant differences were exhibited between the 3 groups in favor to both exercise programs (P < .05) with non-significant differences between the 2 exercise programs (P > .05). CONCLUSIONS: Both exercise programs had positive effects in reducing the severity of depression in HF patients. Low to moderate and moderate-intensity exercise programs should be proposed for depression illness specially patients with heart failure.


Assuntos
Depressão/etiologia , Depressão/terapia , Terapia por Exercício/métodos , Insuficiência Cardíaca/complicações , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Índice de Gravidade de Doença
5.
Medicine (Baltimore) ; 98(33): e16803, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415391

RESUMO

BACKGROUND: This proposed study will systematically assess the effect and safety of cognitive-behavioral therapy (CBT) for heart failure (HF). METHODS: We will search the following electronic databases for randomized controlled trials assessing the effect of CBT in patients with HF: PUBMED, EMBASE, Cochrane Library, Web of Science, Scopus, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, VIP Information, and Wanfang Data from their inceptions to present without any language limitations. Two authors will independently conduct the study selection, data extraction, and methodological quality assessment. The methodological quality will be evaluated by Cochrane risk of bias tool. RESULTS: This study will assess the efficacy and safety of CBT for patients with HF. The primary outcomes consist of depression and anxiety. The secondary outcomes comprise of all-cause mortality, change in body weight, urine output, change in serum sodium; and any adverse events. CONCLUSION: The results of this study will summarize the up-to-date evidence on the effect and safety of CBT for HF. PROSPERO REGISTRATION NUMBER: PROSPERO CRD42019135932.


Assuntos
Ansiedade/terapia , Terapia Cognitivo-Comportamental/métodos , Depressão/terapia , Insuficiência Cardíaca/psicologia , Adulto , Idoso , Ansiedade/etiologia , Depressão/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Revisão Sistemática como Assunto , Resultado do Tratamento
6.
Medicine (Baltimore) ; 98(30): e16477, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31348252

RESUMO

BACKGROUND: Traditional Chinese medicine (TCM) therapy is effective for post-stroke depression (PSD). TCM therapy encompasses various forms of practices. However, the comparative effectiveness of these therapies is still not clear. Here, we provide a network meta-analysis protocol to compare the effects of different types of TCM therapy on PSD, using both direct and indirect evidence. METHODS: Twelve databases investigation will be conducted through the keywords from their inception to June 1, 2019. At least 2 independent reviewers will identify eligible articles. EndNote X7 software is utilized to manage the literatures and RevMan V.5.3 (The Cochrane Collaboration) software is for data processing throughout the review. The package "netmeta" (version 0.5-0) in R (version 3.0.2, The R Foundation for Statistical Computing) will be used to perform network meta-analysis (NMA). In addition, the overall quality of evidence is evaluated by GRADEPro software, and Cochrane Collaboration Risk of Bias Tool is employed for the methodological quality. Generally speaking, this review protocol is reported according to the preferred reporting items for systematic review and meta-analysis protocols 2015 guidelines. RESULTS: According to this protocol, it will provide evidence in support of, or against, the hypothesis that TCM therapy for PSD is more effective than pharmacotherapy. The results of this study will also provide evidence on relative efficacy of different forms of TCM. Furthermore, this analysis will show which form(s) of TCM therapy is (are) the most effective. CONCLUSION: The results will help PSD doctors and patients choose the treatment regimen which is effective, time-saving and economical. PROSPERO REGISTRATION NUMBER: CRD42016041594.


Assuntos
Depressão/etiologia , Depressão/terapia , Medicina Tradicional Chinesa/métodos , Acidente Vascular Cerebral/complicações , Antidepressivos/uso terapêutico , Humanos , Meta-Análise em Rede , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa
7.
Bone Joint J ; 101-B(7): 800-807, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31256659

RESUMO

AIMS: Psychological factors play a critical role in patient presentation, satisfaction, and outcomes. Pain catastrophizing, anxiety, and depression are important to consider, as they are associated with poorer outcomes and are potentially modifiable. The aim of this study was to assess the level of pain catastrophizing, anxiety, and depression in patients with a range of hip pathology and to evaluate their relationship with patient-reported psychosocial and functional outcome measures. PATIENTS AND METHODS: Patients presenting to a tertiary-centre specialist hip clinic were prospectively evaluated for outcomes of pain catastrophizing, anxiety, and depression. Validated assessments were undertaken such as: the Pain Catastrophizing Scale (PCS), the Hospital Anxiety Depression Scale (HADS), and the 12-Item Short-Form Health Survey (SF-12). Patient characteristics and demographics were also recorded. Multiple linear regression modelling, with adaptive least absolute shrinkage and selection operator (LASSO) variable selection, was used for analysis. RESULTS: A total of 328 patients were identified for inclusion, with diagnoses of hip dysplasia (DDH; n = 50), femoroacetabular impingement (FAI; n = 55), lateral trochanteric pain syndrome (LTP; n = 23), hip osteoarthrosis (OA; n = 184), and avascular necrosis of the hip (AVN; n = 16) with a mean age of 31.0 years (14 to 65), 38.5 years (18 to 64), 63.7 years (20 to 78), 63.5 years (18 to 91), and 39.4 years (18 to 71), respectively. The percentage of patients with abnormal levels of pain catastrophizing, anxiety, or depression was: 22.0%, 16.0%, and 12.0% for DDH, respectively; 9.1%, 10.9%, and 7.3% for FAI, respectively; 13.0%, 4.3%, and 4.3% for LTP, respectively; 21.7%, 11.4%, and 14.1% for OA, respectively; and 25.0%, 43.8%, and 6.3% for AVN, respectively. HADS Anxiety (HADSA) and Hip Disability Osteoarthritis Outcome Score Activities of Daily Living subscale (HOOS ADL) predicted the PCS total (adjusted R2 = 0.4599). Age, HADS Depression (HADSD), and PCS total predicted HADSA (adjusted R2 = 0.4985). Age, HADSA, patient's percentage of perceived function, PCS total, and HOOS Quality of Life subscale (HOOS QOL) predicted HADSD (adjusted R2 = 0.5802). CONCLUSION: Patients with hip pathology may exhibit significant pain catastrophizing, anxiety, and depression. Identifying these factors and understanding the impact of psychosocial function could help improve patient treatment outcomes. Perioperative multidisciplinary assessment may be a beneficial part of comprehensive orthopaedic hip care. Cite this article: Bone Joint J 2019;101-B:800-807.


Assuntos
Ansiedade/etiologia , Catastrofização/etiologia , Depressão/etiologia , Impacto Femoroacetabular/psicologia , Necrose da Cabeça do Fêmur/psicologia , Luxação do Quadril/psicologia , Osteoartrite do Quadril/psicologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ansiedade/diagnóstico , Ansiedade/epidemiologia , Catastrofização/diagnóstico , Catastrofização/epidemiologia , Depressão/diagnóstico , Depressão/epidemiologia , Feminino , Indicadores Básicos de Saúde , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Dor/psicologia , Medidas de Resultados Relatados pelo Paciente , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Síndrome , Adulto Jovem
9.
AIDS Behav ; 23(Suppl 2): 153-161, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31317365

RESUMO

Despite widespread HIV screening and treatment programs across sub-Saharan Africa, many countries are not on course to meet the Joint United Nations Program on HIV/AIDS 90-90-90 targets. As mental health disorders such as depression are prevalent among people living with HIV, investment in understanding and addressing comorbid depression is increasing. This manuscript aims to assess depression and HIV management in sub-Saharan Africa using a 90-90-90 lens through a discussion of: depression and the HIV care continuum; the state of depression screening and treatment; and innovations such as task-shifting strategies for depression management. Due to the lack of mental health infrastructure and human resources, task-shifting approaches that integrate mental health management into existing primary and community health programs are increasingly being piloted and adopted across the region. Greater integration of such mental health care task-shifting into HIV programs will be critical to realizing the 90-90-90 goals and ending the HIV epidemic.


Assuntos
Antidepressivos/uso terapêutico , Serviços de Saúde Comunitária/organização & administração , Continuidade da Assistência ao Paciente , Prestação Integrada de Cuidados de Saúde/organização & administração , Depressão/diagnóstico , Depressão/tratamento farmacológico , Infecções por HIV/psicologia , Programas de Rastreamento/métodos , África ao Sul do Saara/epidemiologia , Depressão/etiologia , Depressão/psicologia , Transtorno Depressivo/epidemiologia , Metas , Infecções por HIV/complicações , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Humanos , Adesão à Medicação , Prevalência , Escalas de Graduação Psiquiátrica , Resultado do Tratamento , Nações Unidas
10.
Fortschr Neurol Psychiatr ; 87(9): 476-482, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31261412

RESUMO

BACKGROUND: Patients who suffer from amyotrophic lateral sclerosis sometimes show pathological changes in behaviour and cognition. Some even develop frontotemporal dementia. The family caregivers of the patients are faced with additional challenges. AIM: To describe the effect of changes in behaviour and cognition on the emotional state and the perceived stress and burdens of family caregivers. METHOD: Different search terms were used for searching in several databases. Ten trials were included in the study. Further examinations of this topic on the basis of additional literature are described in the discussion section. RESULTS: Changes in behaviour and cognition can lead to symptoms of anxiety and depression in family caregivers. The findings also show a correlation between apathy, disinhibition and executive dysfunction combined with an increase in caregiver burden. CONCLUSION: Changes in behaviour and cognition in patients with ALS have a negative impact on the emotional state of family caregivers and contribute to increased feelings of being burdened. Early and detailed information concerning possible disease-induced changes is necessary.


Assuntos
Esclerose Amiotrófica Lateral/terapia , Cuidadores/psicologia , Saúde da Família , Estresse Psicológico/etiologia , Esclerose Amiotrófica Lateral/complicações , Ansiedade/etiologia , Depressão/etiologia , Demência Frontotemporal/complicações , Humanos
11.
DNA Cell Biol ; 38(8): 808-813, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31335167

RESUMO

This study aims to investigate whether a relationship exists between the C3435T polymorphism of ABCB1 gene and poststroke depression (PSD). A total of 82 PSD patients and 115 nondepression patient (NPSD) controls were included in this study. All patients were evaluated using the Hamilton Rating Scale for Depression to determine the severity of depression and complete the packet. PSD patients were diagnosed in accordance with the DSM-V criteria. The C3435T polymorphism of ABCB1 was genotyped through fluorescence in situ hybridization and chromosome karyotype analysis system. The PSD (n = 82) and NPSD groups (n = 115) had a total prevalence rate of 41.6%. The prevalence of PSD in men was 58.5%, whereas that in women was 41.5%, and no statistically significant difference existed between the two groups (χ2 = 1.009; p = 0.315). The CC, CT, and TT frequencies of the PSD group were 26.8%, 47.6%, and 25.6%, respectively, whereas those of the NPSD group were 42.6%, 45.2%, and 12.2%, respectively. Based on the CC genotype, the relative risk of homozygous mutant TT was 3.341 (χ2 = 7.869; p = 0.005; OR = 3.341), and the T allele frequency in the PSD group was 49.4% higher than that in the NPSD group. The locus gene frequency was 34.8%, and the relative risk of allele T relative to allele C was 1.830 (χ2 = 8.381; p = 0.004; OR = 1.830). A certain correlation exists between the C3435T gene polymorphism and PSD in the Han population in South Anhui Province, China, and further studies are needed to confirm our findings.


Assuntos
Depressão/genética , Polimorfismo Genético , Acidente Vascular Cerebral/psicologia , Subfamília B de Transportador de Cassetes de Ligação de ATP/genética , Grupo com Ancestrais do Continente Asiático/genética , China , Depressão/etiologia , Feminino , Frequência do Gene , Predisposição Genética para Doença , Humanos , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/complicações
12.
Int J Equity Health ; 18(1): 87, 2019 06 13.
Artigo em Inglês | MEDLINE | ID: mdl-31196102

RESUMO

BACKGROUND: Inequalities in mental health are a notable and well documented policy concern in many countries, including South Africa. Individuals' perception of their position in the social hierarchy is strongly and negatively related to their mental health, whilst the global burden of poor mental health is greater amongst women. This paper offers a first glimpse of the factors that shape gender-based health inequalities across subjective social status. METHODS: This study employs the cross-sectional 2014 South African Social Attitudes Survey (SASAS). The prevalence of depressive symptoms is measured with the aid of the CES-D 8-item scale, with analyses disaggregated by gender. Concentration indices (CI) are used to measure inequalities in depressive symptoms related to subjective social status. The study applies the Wagstaff decomposition to determine the factors that contribute to these gender-based inequalities. RESULTS: More than 26% of the study sample had depressive symptoms (95% CI 24.92-28.07). The prevalence of depressive symptoms is significantly more pronounced in females (28.46% versus 24.38%; p = 0.011). The concentration index for depressive symptoms is - 0.276 (95% CI -0.341 - - 0.211), showing large inequalities across subjective social status. The observed SSS-related inequality in depressive symptoms however is higher for males (CI = -0.304) when compared to females (CI = -0.240) (p = 0.056). The most important contributor to SSS-related inequalities in depressive symptoms, at 61%, is subjective social status itself (contributing 82% in females versus 44% in males). Other variables that make large contributions to the inequalities in depressive symptoms at 11% each are race (contributing 2% in females versus 25% in males) and childhood conflict (contributing 17% in females versus 4% in males). CONCLUSION: Policy makers should target a reduction in the positive contribution of SSS to depression via the implementation of programmes that improve social welfare. Given the much greater contribution to inequalities among females, these policies should target women. Policies that protect children and especially the girl child from conflict can also be useful in reducing inequalities in depression related to subjective social status during adulthood. Overall, there is need for a multi-sectoral approach to address these inequalities.


Assuntos
Depressão/etiologia , Disparidades nos Níveis de Saúde , Saúde Mental , Sexismo , Classe Social , Determinantes Sociais da Saúde , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Estudos Transversais , Depressão/epidemiologia , Feminino , Identidade de Gênero , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores Sexuais , Fatores Socioeconômicos , África do Sul/epidemiologia , Adulto Jovem
13.
Anticancer Res ; 39(6): 3141-3146, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31177160

RESUMO

BACKGROUND/AIM: Breast cancer treatment represents a substantial amount of health-care costs and has a negative impact on womens' psychological health. Day-Surgery managment (DS) is a favorable alternative to a classic inpatient setting. In our prospective study we evaluated DS-treatment feasibility in terms of patient satisfaction, same-day-discharge rate, surgical-reintervention rate, psychological impact and costs. PATIENTS AND METHODS: We operated on 131 early breast cancer patients in DS. Surgical outcomes were evaluated. In 64 DS-treated breast cancer patients, psychological outcomes were analyzed using validated psychometric questionnaires and comparison was made with a corresponding group of women treated as inpatients. RESULTS: The same-day-discharge rate was 95.4%. No patient required readmission. The surgical-reintervention rate was 6.2%. DS-treatment significantly reduced anxiety (p=0.05) and depression (p=0.01) and afforded cost savings of 49%. CONCLUSION: DS-treatment of early breast cancer was feasible, with low reintervention rate, reduced anxiety and depression, high patients' satisfaction and substantial financial savings.


Assuntos
Procedimentos Cirúrgicos Ambulatórios , Neoplasias da Mama/cirurgia , Mastectomia , Saúde Mental , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Procedimentos Cirúrgicos Ambulatórios/economia , Procedimentos Cirúrgicos Ambulatórios/psicologia , Ansiedade/etiologia , Ansiedade/psicologia , Neoplasias da Mama/economia , Neoplasias da Mama/patologia , Neoplasias da Mama/psicologia , Redução de Custos , Análise Custo-Benefício , Depressão/etiologia , Depressão/psicologia , Estudos de Viabilidade , Feminino , Custos de Cuidados de Saúde , Humanos , Mastectomia/efeitos adversos , Mastectomia/economia , Mastectomia/psicologia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Satisfação do Paciente , Estudos Prospectivos , Reoperação , Fatores de Risco , Resultado do Tratamento
14.
BMC Public Health ; 19(1): 827, 2019 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-31242877

RESUMO

BACKGROUND: Depression, prevalent among people living with HIV (PLWH) in Malawi, is associated with negative HIV patient outcomes and likely affects HIV medical management. Despite the high prevalence of depression, its management has not been integrated into HIV care in Malawi or most low-income countries. METHODS: This study employs a pre-post design in two HIV clinics in Lilongwe, Malawi, to evaluate the effect of integrating depression management into routine HIV care on both mental health and HIV outcomes. Using a multiple baseline design, this study is examining mental health and HIV outcome data of adult (≥18 years) patients newly initiating ART who also have depression, comparing those entering care before and after the integration of depression screening and treatment into HIV care. The study is also collecting cost information to estimate the cost-effectiveness of the program in improving rates of depression remission and HIV treatment engagement and success. DISCUSSION: We anticipate that the study will generate evidence on the effect of depression management on HIV outcomes and the feasibility of integrating depression management into existing HIV care clinics. The results of the study will inform practice and policy decisions on integration of depression management in HIV care clinics in Malawi and related settings, and will help design a next-step strategy to scale-up integration to a larger scale. TRIAL REGISTRATION: ClinicalTrials.gov ID [ NCT03555669 ]. Retrospectively registered on 13 June 2018.


Assuntos
Depressão/terapia , Gerenciamento Clínico , Infecções por HIV/psicologia , Saúde Mental , Assistência ao Paciente , Adolescente , Adulto , Análise Custo-Benefício , Depressão/etiologia , Transtorno Depressivo/etiologia , Transtorno Depressivo/terapia , Feminino , HIV , Infecções por HIV/complicações , Infecções por HIV/terapia , Humanos , Malaui , Masculino , Programas de Rastreamento , Projetos de Pesquisa , Estudos Retrospectivos
15.
Pan Afr Med J ; 32: 95, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31223386

RESUMO

Creutzfeldt-jakob disease (CJD) is a very rare and fatal disease affecting the central nervous system. It is characterized by mental deterioration leading to progressive dementia, pyramidal and extrapyramidal symptoms as well as myoclonus. Early diagnosis is essential to prevent human-to-human transmission. We here report the case of a 62-year old patient in whom the diagnosis of sporadic CJD was retained based on his clinical status including dementia-related deterioration with myoclonus preceded by behavioral disorders, hallucinations and depression and on brain MRI data showing hyperintensities at the level of the striatum and the cortex on FLAIR and diffusion-weighted imaging sequences.


Assuntos
Encéfalo/diagnóstico por imagem , Síndrome de Creutzfeldt-Jakob/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Síndrome de Creutzfeldt-Jakob/fisiopatologia , Demência/etiologia , Depressão/etiologia , Alucinações/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Mioclonia/etiologia
17.
J Rehabil Med ; 51(7): 499-505, 2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31165172

RESUMO

BACKGROUND: Brain injury causes multiple symptoms. Among these, visual disturbances are common; 50-70% of patients experience some change in vision after injury/illness. Other very common and disabling symptoms are fatigue, anxiety and depression. This study examines whether levels of fatigue, anxiety and depression are increased if the patients also experience vision disorders. MATERIALS AND METHODS: A total of 123 patients enrolled in day care rehabilitation unit for medium-to-severe brain injury completed questionnaires about self-experienced fatigue, anxiety, depression and self-experienced level and type of visual disturbances. Symptoms of fatigue, anxiety and depression were compared with the occurrence of visual disturbances. Analyses were performed using binary logistic regression. RESULTS: An association was found between visual symptoms and fatigue, but not between visual symptoms and anxiety/depression. However, some visual symptoms, such as glare, blurred vision and reading difficulties, showed great differences between patients with or without anxiety/depression. CONCLUSION: Vision rehabilitation may be a tool for mitigating fatigue after acquired brain injury.


Assuntos
Ansiedade/etiologia , Lesões Encefálicas/complicações , Depressão/etiologia , Fadiga Mental/etiologia , Transtornos da Visão/etiologia , Adulto , Lesões Encefálicas/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
18.
BMC Neurol ; 19(1): 120, 2019 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-31185934

RESUMO

BACKGROUND: Clinical diagnosis of Parkinson's disease (PD) has always lagged behind clinical symptoms. The diagnostic latency might be influenced by many factors. The diagnostic latency of Chinese people with PD has been unknown. Here we designed this cross-sectional study with the purpose to identify the diagnostic latency and its determinants in Chinese people with PD. METHODS: One hundred and thirty-one newly diagnosed people with PD were recruited into this study. Demographic and clinical characteristics as well as a detailed clinical history were collected. Motor and non-motor symptoms (NMSs) severity were assessed with appropriate assessment scales. Medical professional types in the first medical consultations were also recorded. According to the initially presenting motor phenotypes, patients would be divided into the groups of rest tremor, limb rigidity, movement slowness and walking problems. The investigated variables would be compared among the four groups. RESULTS: The PD diagnostic latency in China was around 15 months. It closely correlated to the severity of motor symptoms, anxiety and depression as well as the number of NMSs. The diagnostic latency significantly varied among the groups of different motor phenotypes of onset. Finally, initially presenting with limb rigidity, having more NMSs, motor symptoms at a more serious degree and the initial medical consultations with physicians or specialists of non-neurology were considered as determinants of a longer diagnostic latency of PD. CONCLUSIONS: Patients presenting with minor motor symptoms and disturbing NMSs as well as physicians' unfamiliarity with PD symptomology were determinants of the diagnostic delay of PD. Health education in community and improvement of the referral system might be proper strategies to shorten the diagnostic latency of PD.


Assuntos
Diagnóstico Tardio , Doença de Parkinson/diagnóstico , Idoso , Ansiedade/etiologia , Grupo com Ancestrais do Continente Asiático , China , Estudos Transversais , Depressão/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/complicações , Tremor/etiologia
19.
BMC Neurol ; 19(1): 129, 2019 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-31200686

RESUMO

BACKGROUND: Multiple sclerosis (MS) is a neurological disease of the central nervous system and is associated with many psychosocial symptoms that are difficult to manage including low mood, anxiety, fatigue and pain, as well as low health-related quality of life. Internet-based psychosocial interventions that use mindfulness-based approaches are gathering much attention in recent literature, particularly in the treatment of chronic illnesses. However, no large randomized controlled trials have been done examining the efficacy of such interventions for people with MS (PwMS). METHODS/DESIGN: This study is a randomised controlled trial of an online mindfulness-based intervention (MBI) for PwMS. Participants will be randomised to receive either the MBI or offered the intervention after a waiting period. All participants will be assessed to determine whether they have a history of recurrent depressive disorder. The primary outcome will be severity of depression, according to the Centre of Epidemiology Depression Scale. Secondary outcomes will be anxiety severity, fatigue, pain and quality of life. Assessments will be conducted pre, post-treatment, at three and six-month follow-up. The online mindfulness-based program was developed in collaboration with end-users (n = 19 PwMS) who gave feedback about what would be feasible and acceptable, and the draft program was reviewed by both experts and patients. DISCUSSION: Multiple sclerosis is the most common acquired chronic neurological disease amongst young adults and is associated with a range of symptoms that can be difficult to cope with. In face-to-face interventions, a MBI demonstrated the largest effect in a recent meta-analysis of psychological treatments for PwMS, but MBIs for PwMS have not been delivered online. Hence, this trial will confirm whether MBIs can be efficacious when delivered online. A range of symptoms are assessed as outcomes so that the nature of benefits associated with the online MBI can be ascertained. TRIAL REGISTRATION: ACTRN12618001260213 . Date of Registration: 25/07/2018.


Assuntos
Depressão/prevenção & controle , Internet , Atenção Plena/métodos , Esclerose Múltipla/psicologia , Telemedicina/métodos , Depressão/etiologia , Humanos , Masculino , Qualidade de Vida , Projetos de Pesquisa
20.
J Surg Oncol ; 120(3): 389-396, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31209894

RESUMO

BACKGROUND AND OBJECTIVES: Etiologies, levels, and associated factors of psychological distress in cancer patients facing surgery are poorly defined. We conducted a prospective comparative study of perioperative anxiety and depression in patients undergoing abdominal surgery for either malignant or benign disease. METHODS: With Institutional Review Board approval, patients consenting for surgery at our institution were enrolled. Surveys were completed at a preoperative visit and within 2 weeks of a postoperative appointment. Participants listed their top three sources of anxiety, and completed the Patient Health Questionnaire-9 and the General Anxiety Disorder-7. RESULTS: A total of 79 patients completed the preoperative assessment and 44 (58.7%) finished the postoperative survey. Forty-one were male (51.9%), 12 (15.2%) had a psychiatric comorbidity (PSYHx), and 47 (59.5%) had cancer. Perioperative anxiety and depression did not differ by malignancy status. Patients were most concerned about surgery (22.5%) preoperatively and finances (27.9%) postoperatively. PSYHx, frailty, insurance status, and opioid use were all associated with perioperative psychological distress. CONCLUSIONS: Cancer patients did not have significantly higher levels of perioperative psychological distress compared with benign controls. Socioeconomic worries are prevalent throughout the perioperative period, and efforts to alleviate distress should focus on providing adequate counseling.


Assuntos
Ansiedade/etiologia , Depressão/etiologia , Doenças do Sistema Digestório/psicologia , Doenças do Sistema Digestório/cirurgia , Neoplasias do Sistema Digestório/psicologia , Neoplasias do Sistema Digestório/cirurgia , Abdome/cirurgia , Ansiedade/diagnóstico , Carcinoma Neuroendócrino/patologia , Carcinoma Neuroendócrino/psicologia , Carcinoma Neuroendócrino/cirurgia , Depressão/diagnóstico , Doenças do Sistema Digestório/patologia , Neoplasias do Sistema Digestório/patologia , Procedimentos Cirúrgicos do Sistema Digestório/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
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