HADS Scores Research Articles

Lipopolysaccharide, VE-cadherin, HMGB1, and HIF-1α levels are elevated in the systemic circulation in chronic migraine patients with medication overuse headache: evidence of leaky gut and inflammation

ObjectiveMedication overuse headache (MOH) was recently shown to be associated with leaky gut in rodents. We aimed to investigate whether chronic migraine (CM) patients with MOH have elevated lipopolysaccharide levels and inflammatory molecules in blood circulation.Materials and methodsThe study included women participants (40 CM patients with NSAID overuse headache, 35 episodic migraine (EM) patients, and 20 healthy non-headache sufferers). Migraine duration, monthly migraine headache days, MigSCog, HADS-D, HADS-A, and HIT-6 scores were recorded. Serum samples were collected to measure circulating LPS, LPS binding protein (LBP), tight junction protein occludin, adherens junction protein vascular endothelial cadherin (VE-cadherin), CGRP, HMGB1, HIF-1α, IL-6, and IL-17 levels.ResultsSerum LPS, VE-Cadherin, CGRP, HIF-1α, and IL-6 levels were significantly higher in the CM + MOH group compared to the EM group and healthy controls while serum LBP and HMGB1 were higher in the CM + MOH group compared to healthy controls. IL-17 and occludin levels were comparable between the three groups. Serum HMGB1 levels in EM patients were higher compared to the control group. Mig-SCog and HIT-6 scores were higher in the CM + MOH group compared to EM patients. HADS-A and HADS-D scores were significantly higher in the CM + MOH group compared to EM patients and healthy controls, and they were also higher in EM patients compared to healthy subjects. LPS levels were correlated with VE-cadherin and occludin levels. The number of monthly migraine headache days was positively correlated with serum LPS, HIF-1α, VE-cadherin, and IL-6 levels, HADS-A, HADS-D, HIT-6, and MigSCog scores.ConclusionWe have evidence for the first time that CM + MOH is associated with elevated serum LPS and LBP levels suggestive of LPS leak into the systemic circulation. Higher levels of nociceptive and/or pro-inflammatory molecules such as HMGB1, HIF-1α, IL-6, and CGRP may play a role in trigeminal sensitization and neurobiology of MOH. Intestinal hyperpermeability and consequent inflammatory response should be considered as a potential contributory factor in patients with MOH.Graphical

Assessment of anxiety and depression among professional healthcare workers during the COVID-19 pandemic – observational cross-sectional study

Aim: Evaluate the prevalence of depression among professional healthcare workers (PHCW) during the COVID-19 pandemic. Methods: A cross-sectional study was conducted during the fourth wave of COVID-19 infection in Iraq. A semi-structured questionnaire in English was used to obtain information about the study variables. Results: The study included 314 participants, with a mean age of 34.3 years, slightly higher male to female sex (55.1 to 44.9%), doctors represent (26.1%), pharmacist represent (26.4%) while 36.9% includes other PHCW (nurse, laboratory technician, doctor assistance, and paramedics). There was a high prevalence of depression in the current study (98.4%). There was no significant association between total HADS with sex, specialty, and duration of working in COVID-19 isolation wards. Meanwhile, age above 50 years appears to be associated with higher HADS scores compared to younger PHCW. Conclusion: Healthcare practitioners faced a heightened susceptibility to experiencing depression throughout the COVID-19 pandemic.

Depression, anxiety, lower sleep quality and social support in square cabin hospitals during Shanghai's COVID-19 lockdown, China.

To investigate and compare the associated factors of depression, anxiety, and other psychological differences between patients with Corona Virus Disease 2019 quarantined in square cabin hospitals (SCH) and isolation wards (IW) in China. Cluster sampling method was performed during Shanghai's Two-Month Lockdown in 2022. Hospital Anxiety and Depression Scale Depression subscale (HADS-D), 7-tiem Generalized Anxiety Disorder Scale (GAD-7), Pittsburgh sleep quality index (PSQI), and Perceived Social Support Scale (PSSS) were used to investigate psychological differences. The HADS-D and GAD-7 scores of SCH patients were significantly higher than those in IW (p < 0.001; p = 0.0295). Sleep latency (SCH-IW = -3.76, p < 0.001), sleep duration (SCH-IW = -2.22, p < 0.05), habitual sleep efficiency (SCH-IW = -4.11, p < 0.001), sleep disturbance (SCH-IW = -3.59, p < 0.001) and use of sleep medication (SCH-IW = -5.18, p < 0.001) of SCH patients were significantly worse. Depression was the main emotional problem of quarantined patients. Patients in SCH had lower social support. Sleep disorders and the lowest oxygen saturation ≤ 93% were risk factors for depression, while social support and child status were protective factors. Myalgia and constipation were risk factors for anxiety, while marital status was the protective factor. Patients quarantined in SCH had higher risks of depression and anxiety, lower sleep quality and social support. Somatic discomfort and sleep disorders exacerbated depression and anxiety, which could be ameliorated by social support and taken into consideration in future SCH construction.

Evaluation of alexithymia, anger and anxiety depression levels in smokers

ABSTRACT Objective Smokingis a major mental health concern due to its addictive nature and its status asthe leading preventable cause of premature death worldwide. This study aimed toexamine the levels of alexithymia, anger, anxiety, and depression in smokerscompared to nonsmokers. Materials and Methods Thiscase-control study involved 176 smokers from a Smoking Cessation Clinic and 175age- and gender-matched nonsmokers. Participants completed assessments usingthe Toronto Alexithymia Scale (TAS-20), State-Trait Anger Expression Inventory(STAXI), and Hospital Anxiety and Depression Scale (HADS). Nicotine dependencein smokers was measured using the Fagerström Nicotine Dependency Test.Statistical analysis was performed using SPSS 22.0. Findings Significantdifferences were observed between smokers and nonsmokers in TAS, TAS-1, TAS-2,HADS-A, and HADS-D scores. Smokers exhibited higher levels of alexithymia, anger expression, and anxiety, while nonsmokers demonstrated better angercontrol. Additionally, addiction levels in smokers were associated withvariations in TAS, TAS-1, TAS-2, TAS-3, STAXI scores (SA, AC, AI, AO), andHADS-A, highlighting a complex interplay between addiction, psychologicalfactors, and smoking habits. Result This study establishes a link between smoking status, addictionlevels, and elevated alexithymia, anger, anxiety, and depression. The findingsunderscore the psychological impact of smoking, contributing valuable insightsfor mental health interventions in individuals with smoking habits.

Association between dysphagia and symptoms of depression and anxiety after ischemic stroke.

Dysphagia is associated with poor outcome, higher mortality, reduced quality of life, and social isolation. We investigate the relationship between swallowing impairment and symptoms of anxiety and depression after ischemic stroke. Consecutive patients with ischemic stroke participating in the prospective STROKE-CARD Registry study from 2020 to 2022 were assessed for dysphagia on hospital admission (clinical swallowing assessment) and for persistence until discharge and 3-month follow-up (SINGER Independency Index). Anxiety and depression symptoms were recorded using Beck Depression Inventory (BDI) and Hospital Anxiety and Depression Scale (HADS) at 3-month follow-up. Of 648 patients, 19.3% had dysphagia on admission, persisting in 14.8% at discharge and 6.8% at 3-month follow-up. With the presence or duration of dysphagia (no dysphagia, dysphagia at baseline, at discharge, at 3 months), score (mean ± SD) increased on the BDI (7.9 ± 6.7, 12.5 ± 8.7, 13.5 ± 9.0, 16.5 ± 10.2), HADS-D (4.4 ± 3.7, 7.1 ± 4.2, 7.7 ± 4.4, 9.8 ± 4.3), and HADS-A (4.4 ± 3.5, 5.4 ± 3.6, 6.0 ± 3.6, 7.0 ± 3.6). In linear regression analysis adjusting for age, sex, diabetes, dementia, and either functional disability or stroke severity, BDI and HADS-D scores were significantly higher in patients with dysphagia across all points in time (admission, discharge, 3-month follow-up). An independent association with HADS-A scores was only evident in patients with persisting dysphagia after 3 months. Patients with dysphagia were more likely to receive antidepressants, antipsychotics, or benzodiazepines at discharge and 3-month follow-up. Dysphagia after stroke is common and severely affects psychosocial functioning of individuals. Our results highlight swallowing impairment as an independent predictor for poststroke depressive and, to a lesser extent, anxiety symptoms.

A pro-inflammatory diet is associated with long-term depression and anxiety levels but not fatigue in people with multiple sclerosis

BackgroundMultiple sclerosis is characterised by acute and chronic inflammation in the CNS. Diet may influence inflammation, and therefore MS outcomes. ObjectiveTo determine whether the Dietary Inflammatory Index (DII®)) is associated with depression, anxiety, and fatigue in a prospective cohort of people with MS. MethodsPeople with a first clinical diagnosis of demyelination were followed over 10 years (n=223). DII and energy-adjusted DII (E-DIITM) scores were calculated from the dietary intake in the preceding 12 months measured by food frequency questionnaire. Depression and anxiety were assessed by the Hospital Anxiety and Depression Scale (HADS-A and HADS-D, respectively), and fatigue by the Fatigue Severity Scale. ResultsA higher E-DII score was associated with higher levels of depression and anxiety five years later (e.g., highest vs lowest E-DII quartile, HADS-D score: β=2.23, 95%CI=0.98,3.48, p<0.001; HADS-A score: β=1.90, 95%CI=0.59,3.21, p<0.001). A cumulative E-DII score was associated with depression (p<0.01) and anxiety (p=0.05) at the 10-year review. No associations were seen for fatigue. ConclusionOur findings suggest that, in people with MS, a more pro-inflammatory diet may long-term adverse impact on depression and anxiety, but not fatigue.

The comparison of functional status and health-related parameters in ovarian cancer survivors with healthy controls

PurposeThe primary purpose of this study was to evaluate functional status and health-related parameters in ovarian cancer (OC) survivors and to compare these parameters with healthy controls. The secondary purpose of this study was to compare these parameters in early and advanced OC survivors.MethodsThirty-two OC survivors (n = 15 early stage; n = 17 advanced stage) with no evidence/suspicion of cancer recurrence after completing adjuvant local and systemic treatments for at least 12 months and 32 healthy controls were recruited for functional- and health-related assessments. Participants were assessed using the following methods of measuring the following: 6-min walk test (6MWT) for functional exercise capacity, 30-s chair stand test (30 s-CST) for functional fitness and muscle endurance, a handheld dynamometer for peripheral muscle strength, and a handheld dynamometer for lower extremity strength, Medical Micro RPM for respiratory muscle strength, International Physical Activity Questionnaire-Short Form (IPAQ-SF) for physical activity level, and Eastern Cooperative Oncology Group Performance Scale (ECOG-PS) for performance status, Checklist Individual Strength (CIS) for fatigue, Treatment/Gynecological Oncology-Neurotoxicity (FACT/GOG-NTX) for neuropathy, the Hospital Anxiety and Depression Scale (HADS) for anxiety and depression level, and the World Health Organization-Five Well-Being Index (WHO-5) for generic quality of life.ResultsAll OC survivors underwent surgery and chemotherapy, and only 9.4% received radiotherapy in addition to chemotherapy. The median recurrence-free period post-completion of adjuvant treatments was 24.00 (12.00–75.00) months. OC survivors had lower 6MWT (m) (p < 0.001, r = 1.50), peripheral muscle strength (p = 0.005, r = 0.72), knee extension (p < 0.001, r = 1.54), and respiratory muscle strength (maximal inspiratory pressure) (p < 0.001, r = 1.90) (maximal expiratory pressure) (p < 0.001, r = 1.68) compared to healthy controls. HADS-A (p = 0.005, r = 0.75) and CIS scores (p = 0.025, r = 0.59) were also higher in the OC survivors. Early-stage OC survivors had better 6MWT (m) than advanced-stage OC survivors (p = 0.005, r = 1.83). Peripheral muscle strength was lower in advanced-stage OC survivors (p = 0.013, r = 0.92). FACT/GOG-NTX scores were higher in early-stage OC survivors (p < 0.001, r = 1.42). No significant differences were observed between early- and advanced-stage OC survivors in other measures (p < 0.05).ConclusionThe findings suggest functional status, and health-related parameters are negatively affected in OC survivors. Additionally, higher levels of fatigue, neuropathy anxiety, and depression were reported in advanced OC survivors.

Frequency and characteristics of refractory dyspnea in idiopathic fibrosing interstitial pneumonia

Patients with idiopathic fibrosing interstitial pneumonias (f-IIPs) mainly suffer from dyspnea. Refractory dyspnea, defined as persistent dyspnea despite optimal treatment, could be the signal to prescribe dyspnea relievers. We aimed to examine the prevalence and characteristics of refractory dyspnea in consecutive patients with f-IIPs.Refractory dyspnea was defined by an mMRC≥3 and also by a VAS dyspnea score≥2 at rest. The sensory and affective characteristics of refractory dyspnea (mMRC≥3) and associated quality of life (QoL) anxiety and depression were compared with non-refractory dyspnea (mMRC1-2) using the Multidimensional Dyspnea Profile (MDP), King's Brief Interstitial Lung Disease (KBILD) and Hospital Anxiety and Depression scale (HADs).We included 40 patients (24 men), aged 72 [68–79], FVC of 71 % [59–86] and DLCO 47 % [40–49]. Refractory dyspnea, was found in 38 % (95%CI:23–54) when defined by mMRC≥3 and in 67 % (95%CI:50–81) using a resting VAS dyspnea score ≥2. The agreement between the two definitions was low. Patients with refractory dyspnea (mMRC≥3) were more often women (60 % vs.28 %, p = 0.046), had a lower DLCO (24 % [22–43] vs.47 % [43–51], p = 0.014) and more frequently used oxygen (60 % vs.12 %, p = 0.003); they experience more intense air hunger (5/10 [3-6] vs.2/10 [0–5], p = 0.018)). No significant differences were observed in VAS, MDP, KBILD, or HADs scores between refractory and non-refractory dyspnea patients.Our results indicate a significant frequency of refractory dyspnea in patients with f-IIPs and an association with air hunger but no impact on the affective dimension of dyspnea, anxiety, depression and QoL, suggesting that the mMRC score might not accurately identify patients distressed by their breathlessness.

To study the effectiveness and impact on the quality of life of patients with subclinical and clinically pronounced anxiety disorder of a mobile application in combination with Adaptol therapy

To study the effectiveness and the quality of life impact of the mobile application Zdorovye.ru in people with subclinical and clinical anxiety disorder (AD). 200 patients with more than 7 points on the Hospital Anxiety and Depression Scale (HADS) were included. Participants were randomized into two groups: experimental one (EG, n=133) - to receive standard treatment with temgicoluril (Adaptol), 500 mg (Olainfarm JSC, Latvia) and the Zdorovye.ru application; control group (CG, n=52) - standard treatment with temgicoluril (Adaptol). There were a significant decrease in the HADS-A score, PSS-10 score and an increase in the visual analog scale EQ-5D score in both groups after 3 months of treatment (p<0.001). Clinical improvement was noticeable after 1.5 months in EG group: a decrease in HADS-A scores (p=0.001) and in tension and stress on PSS-10 subscales (p<0.001) were noted. This effect was not observed in the CG. After 3 months, all participants noted an improvement in quality of life (p<0.001), without a statistically significant difference between groups (p=0.233). The application left a positive impression on users and doctors - most respondents rated it as useful and clear. Taking temgicoluril (Adaptol) for 3 months led to symptoms decrease and the quality of life and well-being improvement in patients with AD. Using the mobile application Zdorovye.ru in conjunction with drug therapy made it possible to achieve a clinical effect earlier, in 1.5 months.

Application of Noise Reduction Earplugs in Patients undergoing Total Knee Arthroplasty: A Retrospective Study.

Patients undergoing total knee arthroplasty (TKA) need to tolerate the effects of noise. This study retrospectively analyzed the clinical data of 167 TKA patients at The Affiliated Hospital of Southwest Medical University from April 2019 to April 2021. A total of 154 patients who met inclusion criteria were divided into the conventional noise reduction management group (CMG) and the noise reduction earplug group (EPG), following different management schemes. The CMG received routine noise reduction management after surgery, while the EPG used noise reduction earplugs based on the CMG. The clinical indexes of the two groups were compared. In this study, 79 patients were included in the CMG, and 75 patients were included in the EPG. The results showed that the Pittsburgh Sleep Quality Index (PSQI) scores of both groups 2 weeks after surgery were significantly lower than those before management (ZEPG = 5.995, ZCMG = 4.109, all P < 0.001), and the EPG exhibited a significantly lower PSQI score than the CMG (Z = -2.442, P < 0.05). Two weeks after surgery, the EPG had significantly lower levels of systolic blood pressure (ZSBP = -4.303) and diastolic blood pressure (ZDBP = -3.115), as well as lower scores on the Hospital Anxiety and Depression Scale-Anxiety (HADS-A; ZHADS-A = -7.140) and Hospital Anxiety and Depression Scale-Depression (HADS-D; ZHADS-D = -4.545) compared to the CMG (all P < 0.05). In addition, no significant correlation existed between the duration of wearing earplugs and the HADS-A and HADS-D scores (r = -0.201, r = -0.002, P > 0.05). Noise reduction earplugs can improve sleep quality and regulate negative emotions of patients undergoing TKA treatment through a complex mechanism involving noise, which is beneficial to the prognosis of the disease.

Mental state as a predictor of outcome in spinal stenosis surgery: Four quadrants model integrating patient satisfaction and functional outcome

IntroductionMental status, characterised by anxiety and depression, significantly influences physical well-being, particularly in patients with spinal stenosis symptoms. Research questionThe prevalence of depression and anxiety in our cohort. The correlation between psychological distress and physical outcome after surgery, including postoperative recovery and satisfaction. Materials and methodsQuestionnaires evaluating anxiety and depression (HADS), functionality (ODI), quality of life (EQ-5D), and perceived recovery (Likert-scale) were sent to a randomly selected cohort of 450 lumbar spinal stenosis patients, with or without spondylolisthesis, who underwent surgery between 2007 and 2013. Results are presented, dichotomised by HADS score (score ≥8 indicating psychologically impaired) and in a Four Quadrants Model integrating functional outcomes and perceived recovery separately for psychologically impaired and non-impaired cases. ResultsAmong the 147 included patients, 32 (22%) exhibited anxiety and/or depression (impaired cases). Satisfactory outcome (perceived recovery) was reported in 29.0% of the impaired cases and 78.3% of the non-impaired cases (p < 0.001). The mean postoperative functionality score of the impaired cases was 42.46 ± 16.24, in contrast to 18.48 ± 18.25 for the non-impaired cases (p < 0.001). In the impaired group, only 12.5% achieved both a good functional outcome (ODI ≤24) and satisfactory perceived recovery, compared with 58.4% in the non-impaired group. Discussion and conclusionPatients reporting anxiety and/or depression demonstrate an inferior long-term outcome after spinal stenosis surgery compared to non-impaired patients. This clinically relevant difference underscores the importance of addressing depression and anxiety in preoperative counselling to optimize patient satisfaction and functional outcomes.

Forecasting tobacco smoking recurrence in lung TB patients

Aim of study: Identify tobacco smoking (TS) recurrence predictors in lung TB patients. Маterials and Methods: In all, the results of over the phone consulting on to-bacco smoking cessation with 335 smoking TB pa-tients (age from 18 to 70). Inclusion criteria: tobacco smoking in the course of 3 years and longer. Exclusion criteria: psychic diseases and disorders, аlcohol or narcotic drugs’ addiction. Number of cigarettes per day, duration of TS, nicotine dependence (ND) degree based on Fagerstrom test, motivation for smoking cessation, and anxiety and depression markers by HADS score were defined in all the patients. The smoking patients were offered over the phone consulting throughout the first month of smoking cessation in case they cease (time for consulting sessions coordinated with patients). Effectiveness of cessation was evaluated after 6 months. The patients were aggregated into the following groups: those who successfully ceased smoking and have not smoked for 6 months and longer (Group 1), and those who resumed TS after treatment (Group 2). Data was statistically processed with the help of SPSS programme

Specific probiotics and prebiotics to improve the quality of life of patients with chronic irritable bowel syndrome.

Irritable bowel syndrome (IBS) is a chronic disorder with an important impact on patients' quality of life. Although several data indicate that psychological symptoms are frequently reported by patients with IBS, few therapies have been evaluated regarding these issues. A retrospective observational study was conducted to evaluate the effectiveness of a probiotic-based dietary supplement (Colicron®) in a group of patients with diarrhea-predominant IBS (IBS-D). We included patients treated with Colicron® (1 cps/day for 8 weeks). Primary endpoint was the gastrointestinal symptoms' remission evaluated by Visual Analogue Scale (VAS); secondary endpoint was the impact of the treatment on physical and mental health evaluated by Hospital Anxiety and Depression Score (HADS) and Short Form Health Survey 36 (SF-36). VAS was assessed at week 4 (T4), week 8 (T8) and week 12 (T12), whereas HADS and SF-36 were performed even at the start of the Colicron® treatment (T0). An improvement of VAS Score was observed at T8 (P<0.001) and T12 (P<0.05) compared to T4. Lower HADS-A (anxiety subdomain) score was obtained at each time point versus T0 (P<0.01), and higher scores of all SF-36 domains were observed during the treatment (0.05<P<0.001) compared to baseline. Moreover, HADS-D (depression subdomain) score, correlated positively, at T0 (P<0.05) and T4 (P<0.05) with the age, as well as a positive correlation was detected between disease duration (P<0.05) and age of patients (P<0.001). Colicron® could be useful in improving both gastrointestinal and psychological symptoms in IBS-D patients. Further prospective clinical trials are needed to confirm these preliminary data.

Risk factors and prognosis of depression in Takayasu arteritis patients

Background: Takayasu arteritis (TA) is associated with an increased risk of developing complicated comorbidities, which can bring both psychological and physical burdens to the patients. Objective: TA is found to carry a high risk of developing depression. This research aimed to investigate the risk factors and prognosis of depression in TA patients. Design: A longitudinal observation cohort was conducted on TA patients with or without depression to explore the clinical characteristics. Methods: In this cohort study, 90 TA patients were split into two groups with or without depression. Depression was evaluated by the Hospital Anxiety and Depression Scale (HADS) in TA patients. TA patients with depression were followed up for at least 3 months. We used multivariate logistic regression analysis to find the risk factors and Kaplan–Meier curve analysis to determine the prognosis. Results: We concluded 90 TA patients in this research, 29 of whom were in depression. Indian Takayasu’s Arteritis Activity Score (ITAS2010) ⩾2 (odds ratio (OR) (95% confidence interval, CI) 26.664 (2.004–354.741), p = 0.013), interleukin-6 (IL-6) (OR (95% CI) 1.070 (1.022–1.121), p = 0.004), prednisone equivalents (OR (95% CI) 1.101 (1.030–1.177), p = 0.005), and carotidynia (OR (95% CI) 5.829 (1.142–29.751), p = 0.034) have been shown independent risk factors for depression in TA patients. We also identified the association between disease remission with the improvement of HADS-D score (Log-rank p = 0.005, hazard ratio (HR) 0.25) and depression (Log-rank p = 0.043, HR 0.28). Conclusion: Aggressive treatment to achieve remission can promote improvement of depression in patients with TA. Screening for depression should also be performed in patients with elevated disease activity, IL-6, glucocorticoid use, and carotidynia.

Circulating mitochondrial long non-coding 7S RNA in primary health care patients with depression/anxiety

BackgroundThe significant role of long non-coding 7S RNA in controlling mitochondrial transcription highlights its importance in mitochondrial function. Considering the suggested connection between mitochondrial dysfunction and the onset of mental disorders, this study aimed to explore the potential involvement of 7S RNA in the context of depression/anxiety. ResultsA total of 181 patients in primary health care (age 20–64 years) with depression/anxiety and 59 healthy controls were included in the study. 7S RNA was measured using quantitative real-time PCR in plasma samples collected before (baseline) and after 8 weeks of treatment (mindfulness or cognitive-based behavioral therapy). Upon adjustment for age and sex, the baseline plasma levels of 7S RNA were significantly higher in patients than in healthy controls (p < 0.001). Notably, post-treatment, there was a significant reduction in 7S RNA levels (p = 0.03). These changes in 7S RNA were related to the treatment response, as indicated by HADS-D (Hospital Anxiety and Depression Scale) scores (ß = −0.04, p = 0.04), even after accounting for baseline scores and other cofounders. ConclusionThe findings of this study indicate an association between plasma 7S RNA levels and depression/anxiety, as well as treatment response. While further confirmatory analyses are necessary, plasma 7S RNA holds promise as a potential predictive biomarker for both depression/anxiety and the treatment response within these disorders.

Understanding Predictors of Fatigue Over Time in Persons With Inflammatory Bowel Disease: The Importance of Depressive and Anxiety Symptoms.

Fatigue is a complex and frequent symptom in persons with inflammatory bowel disease (IBD), with detrimental impact. We aimed to determine predictors of fatigue over time. Two hundred forty-seven adults with IBD participated in a prospective study conducted in Manitoba, Canada, providing data at baseline and annually for 3 years. Participants reported fatigue impact (Daily Fatigue Impact Scale [DFIS]), depression and anxiety symptoms (Hospital Anxiety and Depression Scale [HADS]), and pain (Pain Effects Scale [PES]). Physician-diagnosed comorbidities, IBD characteristics, and physical and cognitive functioning were also assessed. We tested factors associated with fatigue using multivariable generalized linear models that estimated within-person and between-person effects. Most participants were women (63.2%), White (85.4%), and had Crohn's disease (62%). At baseline, 27.9% reported moderate-severe fatigue impact, 16.7% had clinically elevated anxiety (HADS-A ≥11), and 6.5% had clinically elevated depression (HADS-D ≥11). Overall fatigue burden was stable over time, although approximately half the participants showed improved or worsening fatigue impact between annual visits during the study. On multivariable analysis, participants with a one-point higher HADS-D score had, on average, a 0.63-point higher DFIS score, whereas participants with a one-point higher PES score had a 0.78-point higher DFIS score. Within individuals, a one-point increase in HADS-D scores was associated with 0.61-point higher DFIS scores, in HADS-A scores with 0.23-point higher DFIS scores, and in PES scores with 0.38-point higher DFIS scores. No other variables predicted fatigue. Anxiety, depression, and pain predicted fatigue impact over time in IBD, suggesting that targeting psychological factors and pain for intervention may lessen fatigue burden.

Assessment of post-COVID-19 fatigue among female survivors 2 years after hospital discharge: a nested case–control study

BackgroundFatigue is a common symptom of long COVID syndrome. Compared to male survivors, females have a higher incidence of post-COVID fatigue. Therefore, long-term follow-up is necessary to understand which groups of females are more vulnerable to post-COVID fatigue.MethodsThis is a nested case–control study of female COVID-19 survivors who were discharged from two designated hospitals in Wuhan, China in 2020, and received 2-year follow-up from March 1 to April 6, 2022. All patients completed the Checklist Individual Strength-subscale subjective fatigue (CIS-fatigue), a chronic obstructive pulmonary disease (COPD) assessment test (CAT), and the Hospital Anxiety and Depression Scale (HADS; including the HADS-Anxiety [HADS-A] and the HADS-Depression [HADS-D]). Individuals with CIS-fatigue scores of 27 or higher were classified as cases. The risk factors for fatigue was analysed with multivariable logistic regression analysis.ResultsA total of 899 female COVID-19 survivors were enrolled for analysis, including 47 cases and 852 controls. Compared with controls, cases had higher CAT, HADS-A and HADS-D scores, and showed a higher prevalence of symptoms, including anxiety (cases vs. controls, 44.7% vs. 4.0%, p < 0.001), chest tightness (21.2% vs. 2.3%, p < 0.001), dyspnoea (19.1% vs. 0.8%, p < 0.001) and so on. In multivariable logistic regression analysis, age (OR, 1.03; 95% CI, 1.01–1.06; p = 0.02) and cerebrovascular disease (OR, 11.32; 95% CI, 2.87–43.00; p < 0.001) were risk factors for fatigue. Fatigue had a statistically significant moderate correlation with depression (r = 0.44, p < 0.001), but not with CAT ≥ 10.ConclusionFemale COVID-19 patients who had cerebrovascular disease and older age have higher risk of fatigue. Patients with fatigue have higher CAT scores, and are more likely to have concurrent depression.

Predictors of disease burden in patients with untreated transthyretin amyloid cardiomyopathy: post hoc analysis of an international survey study

Abstract Background Transthyretin amyloid cardiomyopathy (ATTR-CM) is a progressive condition that can cause debilitating symptoms.[1] The burden of untreated ATTR-CM was recently evaluated in an international, multicentre, real-world survey study.[2] Identifying predictors of ATTR-CM burden can help improve patients’ therapeutic journey. Purpose To identify predictors of disease burden on patients with ATTR-CM treated with symptomatic but not disease-modifying therapy using data from the recent international real-world survey study. Methods The original study surveyed 208 patients with untreated ATTR-CM recruited from international amyloidosis centres of excellence in 7 countries between July 2021 and August 2022. This post hoc analysis used univariate and multivariate models to evaluate selected survey variables as predictors of patient burden. Variables and outcomes included in the models are described in the figure. Univariate associations were confirmed with a t-test and Pearson correlation coefficient. The full multivariate models included all variables and were then optimised using forward selection and CV Press criteria with 8-fold cross-validation to identify the best predictors. Results The patient population in the original study were generally male (86%) and elderly (median 81 [range: 46 – 90] years), with wild-type ATTR-CM (91% of 155 with genetic testing; median time since diagnosis: 6 months). Of the 199 patients with a recorded NYHA classification, 60% were class II, 22% were class III, 18% were class I, and none were class IV. The investigator reported each neurologic symptom variable (Figure) as a current symptom in 25–41 patients, and gastrointestinal or urinary problems in 36 patients. Out-of-pocket expenses in the prior 3 months were reported by 78 patients. Respective median (IQR) KCCQ-OS, -CS and -TS scores were 67.7 (46.4–84.4; n = 183), 69.0 (49.5–87.5; n = 202), and 75.0 (52.1–91.7; n = 208); HADS-A and HADS-D scores were 5.0 (3.0–8.0; n = 205), and 6.0 (3.0–10.0; n = 204); SF-12 PCS and MCS scores were 36.3 (27.5–43.5; n = 206) and 46.8 (39.4–54.4; n = 206); and PROMIS Fatigue T-score was 50.8 (45.8–57.8; n = 203). In the unadjusted univariate models, NYHA class and the neurologic symptom variable of weakness, especially in the legs, were independently associated with all outcome measures of burden. Closely reflecting the statistically significant predictors in the full multivariate models, older age (continuous or age over 80 years), symptomatic heart failure (NYHA class II or III), female sex, and having weakness, especially in the legs, were among the best predictors of a higher burden in several optimized models (Table). Conclusions In this study of patients with ATTR-CM receiving symptomatic but not disease-modifying therapy, our analysis suggests that older age, female sex, and cardiac or neurologic symptoms are often predictors of higher disease burden.Figure:Variables and outcome measuresTable:Optimised models

Fagerstrom score predicts smoking status six months after hospitalization for acute myocardial infraction:a prospective study

Abstract Backround Cardiovascular patients who quit smoking reduce their risk for future disease and mortality by 1/3 after 2 years. Despite this, more than half of all cardiac patients continue to smoke after being discharged from the hospital. Fagerstrom score is a validated marker of nicotine addiction in smokers. Purpose The aim of this study is to investigate the predictive value of the Fargestrom score (F.Sc) as a smoking cessation tool in patients with acute myocardial infarction (AMI) at 3 and 6 months after discharge. Methods We investigated a) the predictive value of F.Sc for the smoking status in patients early after AMI and b) the effectiveness of medically assisted smoking cessation programs in the prevention of relapsing to smoking post discharge. In 103 smokers (58±12 years,79.6% males) we assessed F.Sc during hospitalization for AMI. Patients filled a questionnaire during a face-to-face interview were followed-up at 3 and 6 months. The questionnaire was divided into the following sections: demographics, habits related to smoking, knowledge of smoking risks to health and methods to quit smoking. We recorded the type of MI, number and type of diseased coronary vessels, peak cardiac enzymes levels, left ventricular ejection fraction by echocardiography, intervention during hospitalization, previous medical history. The hospital anxiety and depression scale (HADS) were used to assess the patient’s mental health condition. For the evaluation of nicotine addiction, we use F.Sc. Results 59 people were hospitalized for STEMI and 44 for NSTEMI. The peak levels of high-sensitivity (hs)-troponin T during hospitalization were 3843.2 [991.3–9338.8] ng/mL. 100 AMI patients underwent PCI and 3 received thrombolysis. All patients were smoking conventional cigarettes before admission for AMI. 29 (28.2%) οf participants had a previous diagnosis of CAD, 55 (53.4%) had hypertension, 49 (47.6%) had hyperlipidemia. The mean HADS-D value was 7.4 ± 1.6, and only 20/103 (19.41%) participants had HADS-D score equal or greater than 10. 28 patients (27.2%) did not quit smoking throughout the 6 months of follow-up (F.Sc: 8.1±1.6), 39 patients (37.8%) ceased smoking at 3 months but relapsed to smoking at 6 months (score:6.8±2.1) and only 34 (33%) had ceased smoking for 6 consecutive months (F.Sc:5.2±2 P&amp;lt;0.05 for all comparisons between subgroups). Out of 73 patients that abstained from smoking the first 3 months post-AMI, those who participated in a smoking cessation program displayed lower rate of relapsing to smoking compared with those who opted to cease smoking without any support(33.3% vs 61.8% p=0.012). Conclusion Fagerstrom score was found to be a valid quantitative predictor of smoking cessation in the period of 6-months follow-up AMI. Patients who participated in a smoking cessation program displayed lower relapse rates suggesting the effectiveness of these programs for smoking cessation in AMI patients.F.Sc and different smoking behaviorsAssociation of F.Sc with smoking status

Improvement in health‐related quality of life and symptoms of anxiety and depression in patients with alopecia areata randomized to baricitinib or placebo: Results from two international randomized controlled trials

AbstractBackgroundAlopecia areata (AA) is an autoimmune hair loss disorder associated with high rates of emotional and psychosocial distress. Baricitinib, an oral selective Janus kinase (JAK) 1 and JAK 2 inhibitor, was superior to placebo with respect to hair regrowth in two phase 3 trials involving 1200 adults with severe AA (≥50% of scalp hair loss).ObjectivesThis analysis investigated the evolution of health‐related quality of life (HRQoL) and symptoms of anxiety and depression after treatment with baricitinib in severe AA.MethodsPatients were randomized to placebo, baricitinib 2‐mg, or baricitinib 4‐mg. Improvements in HRQoL and psychological burden were measured using Skindex‐16 AA and Hospital Anxiety and Depression Scales (HADS‐A and HADS‐D), respectively. Changes from baseline through Week 36 were analyzed using analysis of covariance with modified last observation carried forward for missing data. Proportion of patients with baseline HADS score ≥8 that shifted to &lt;8 (normal) was analyzed at Week 36 using logistic regression with nonresponder imputation.ResultsAt Week 36, patients receiving baricitinib 2‐mg and 4‐mg reported significant improvements versus placebo in Skindex‐16 AA symptoms (2‐mg: −2.80 and 4‐mg: −2.53), functioning (2‐mg: −14.02 and 4‐mg: −17.14), and emotions (2‐mg: −20.42 and 4‐mg: −24.11) domain scores. In comparison to placebo, patients receiving baricitinib 2‐mg and 4‐mg experienced significant reductions in HADS‐A (2‐mg:‐0.96 and 4‐mg:‐1.04) and HADS‐D (2‐mg: −0.30 and 4‐mg: −0.33) scores after 36 weeks. More patients on baricitinib shifted from a score ≥8 to &lt;8 for anxiety (2‐mg: 33% and 4‐mg: 39%) and depression (2‐mg: 34% and 4‐mg: 45%) but results were generally not significant.ConclusionsIn two large trials, greater improvements in HRQoL and symptoms of anxiety and depression were observed after treatment with baricitinib 2‐mg and 4‐mg compared to placebo. These results support that hair regrowth has a positive impact on HRQoL and psychological burden in severe AA.