Mental Health Status Scores Research Articles

Awake brain mapping by direct cortical stimulation; technical note to get higher resection rate and low morbidity in low-grade glioma patients.

Direct cortical stimulation has been used for brain mapping and localization of eloquent areas in awake patients. This simplified technique is to provide the positive areas, which can be preserved if the tumor or lesions are involved eloquent areas. The main objective of this study is to determine whether direct cortical stimulation in awake brain mapping for low-grade glioma patients increases the rate of resection or not. The authors present a retrospective study between 2020 to 2022 that includes 35 cases in a single center, to get higher resection rate, and their consequences in awake craniotomy in low-grade glioma patients. Here, two neurosurgeons were involved and the minimum follow-up was 12 months. The authors achieved 80% removal of tumors. To get higher resection rate we emphasized negative mapping with prior anatomical analysis to understand functional realignment. Stimulation-related complications will be thoroughly discussed with a potential future direction to minimize the issues. The authors used PROMIS score to measure patients physical and mental health status and kernofsky score to measure performance status before and after successful surgery. The authors found three cases of transient deficit in repetitive stimulation. Repeated stimulation to identify the eloquent areas with low voltage frequency is a good option. Numbness in the face related to stimulation may continue for 6 weeks. Functional realignment in shifted brain and edema can be seen while doing cortical and subcortical stimulation. Most of the stimulation from low to high for language mapping may vary from patient to patient. For safe removal of low-grade glioma a steep learning curve is needed to find out the negative areas, though the authors emphasize positive mapping of areas to secure the maximum eloquence.

Income in Relation to Psychosocial Factors Among Stroke Survivors using Smartwatches for Atrial Fibrillation Monitoring.

Timely detection of atrial fibrillation (AF) is critical for stroke prevention. Smartwatches are FDA-approved devices that can now aide in this detection. Investigate how socioeconomic status is associated with self-reported psychosocial outcomes, including anxiety, patient activation, and health-related quality of life in stroke survivors using smartwatch for AF detection. We analyzed data from the Pulsewatch study, a randomized controlled trial (NCT03761394). Participants in the intervention group wore a cardiac patch monitor in addition to a smartwatch for AF detection, whereas the control group wore only the cardiac patch monitor. Generalized anxiety disorder-7 scale, Consumer Health Activation Index and short-form health survey were completed to assess anxiety, patient activation, physical and mental health status at baseline, 14, and 44 days. We used a longitudinal linear regression model to examine changes in psychosocial outcomes in low (<$50K) vs. high (>$50K) income groups. A total of 95 participants (average age 64.9± 9.1 years; 57.9% male; 89.5% non-Hispanic white) were included. History of renal disease (p-value 0.029), statin use (p-value 0.034), depression (p-value 0.004), and anxiety (p-value <0.001), were different between the income groups. In the adjusted model, the low-income group was associated with increased anxiety (β 2.75, p-value 0.0003), and decreased physical health status (β -5.07, p-value 0.02). There was no change identified in self-reported patient engagement and mental health status score. Our findings demonstrate that low SES is associated with worse self-reporting of physical health status, and this may influence psychosocial outcomes in smartwatch users.

Sleep Quality and Mental Health in Students at a Jungle University in Peru: A Cross-sectional Study During COVID-19 Pandemic Confinement

ObjectiveThe objective was to evaluate the association between sleep quality and mental health in students at a jungle university in Peru. Materials and methodsAn analytical cross-sectional study was conducted on university students ≥18 years old during September and November 2020. Mental health status was measured with General Health Questionnaire (GHQ-12), and sleep quality with the Pittsburgh Sleep Quality Index (PSQI). The association was assessed using linear regression models, and crude (βc) and adjusted (βa) beta regression coefficients with their respective 95% confidence intervals (95%CI) were estimated. ResultsTwo hundred and seventy-nine students were evaluated, 35.1% were 20–21 years old and 56.6% were male. The mean PSQI was 7.9±3.2, and 75.3% presented sleep problems. The mean GHQ-12 was 14.0±6.6, and 57.7% showed suspected psychopathology. The total sleep quality score (βa=0.36; 95% CI: 0.11–0.61; p=0.005), as well as, higher component scores, subjective sleep quality (βa=1.57; 95% CI: 0.28–2.87; p=0.018), sleep duration (βa=1.25; 95% CI: 0.35–2.16; p=0.007), hypnotic medication use (βa=1.79; 95% CI: 0.43–3.15; p=0.010), and daytime dysfunction (βa=1.15; 95% CI: 0.10–2.19; p=0.032), were associated with worse mental health status score. ConclusionAfter 6 months of initiation of COVID-19 confinement, the frequency of sleep disturbance and mental health were elevated. Sleep quality disturbance was associated with worse mental health status.

Patterns and determinants of cannabis use in youth visiting an urban emergency department in France

Background Cannabis use frequently starts during adolescence and young adulthood and can induce psychosocial and health consequences. Young people constitute hard-to-reach populations. Emergency departments could constitute a key care setting to identify cannabis use and its consequences among young people. Objectives To estimate the rate of cannabis use in the 16- to 25-year-old population visiting the emergency department for any reason and to assess the psychosocial factors associated with cannabis use. Methods This was a cross-sectional study among young people who attended the emergency department, over 5-months. Data were sociodemographic characteristics, self-administered questionnaires for problematic substance use screening, and urine drug screening samples. They were classified in the cannabis use (CU) group if they had a positive urine screen or reported cannabis use in the previous month. Characteristics of individuals in the CU and non-CU groups were compared. Results A total of 460 participants were included, of whom 105 were in the CU group. Cannabis users were more likely to be male (aOR = 1.85; [1.18–2.90]), to be unemployed (aOR = 1.77; [1.03–3.04]), to have a lower mental health status score (aOR = 0. 82; [0.75–0.90]), to report a history of sexual abuse (aOR = 2.99; [1.70–5.25]), and to have a positive AUDIT screen (aOR = 4.23; [2.61–6.86]). Conclusions The emergency department is a primary care setting for young people, which is conducive to screening for substance use. Cannabis users can be assessed and referred to adapt their treatment, given their lack of adherence to the traditional addictology care system.

Effectiveness of Behavioral Activation in Treating Thai Older Adults with Subthreshold Depression Residing in the Community.

BackgroundIn recent years, behavioral activation (BA) has attracted increased interest as an effective depression treatment. However, empirical evidence supporting its effectiveness in non-Western countries is currently limited.ObjectiveTo examine the effectiveness of BA in reducing depressive symptoms, stress, and anxiety among Thai older adults with subthreshold depression.Methods and SubjectsA clustered randomized controlled trial was conducted in two health promoting hospitals (HPHs) in the Samut Songkhram province of Thailand. One hospital was used for the intervention (BA+usual care group) and the other for the control (usual care-only group). Each HPH randomly selected 41 eligible older adults residing in their jurisdictions to take part in the study. Mental health outcomes were assessed using the Thai Geriatric Depression Scale (TGDS) and Depression Anxiety Stress Scales (DASS). The BA effectiveness was evaluated using generalized estimating equations (GEE) at a group level and the reliable change index (RCI) at the individual level.ResultsOver 9 months, the adjusted mean change in depression (TGDS) scores [−2.47 (95% CI: −3.84, −1.00)], mental health status (DASS), specifically depression and stress score [−1.47 and −1.87 (95% CI: −2.43, −0.50 and −2.94, −0.79, respectively)], improved significantly in the BA+usual care group compared to the usual care-only group, whereas anxiety score improved significantly only at 6 months [−0.87 (95% CI: −1.52, −0.23)]. Additional RCI analysis showed that BA was directly associated with 14.63 to 24.39% points increase in the reliable improvement of depressive outcome compared to the usual care-only group.ConclusionThis study showed that the BA effectively improved depression, stress, and anxiety in older adults with subthreshold depression in a Thai community setting. Future research should evaluate the longer-term effectiveness of BA in diverse population groups.

Patients Place More of an Emphasis on Physical Recovery Than Return to Work or Financial Recovery.

Patients Place More of an Emphasis on Physical Recovery Than Return to Work or Financial Recovery.

Food insecurity and mental health outcomes among homeless adults: a scoping review.

This review summarises and synthesises the existing literature on the relationship between food insecurity (FS) and mental health conditions among adult individuals experiencing homelessness. Scoping review. Papers published between 1 January 2008 and 2 November 2018, searched in PubMed, Web of Science, Scopus, PsycINFO, Cochrane Library and CINAHL, using homelessness, food security and mental health keywords. Global evidence. Homeless adults aged 18 years or more. Nine articles (eight cross-sectional and one longitudinal) were included in the present review. FS was measured using the Household Food Insecurity Access Scale, the United States Department of Agriculture Household Food Security Survey Module, as well as single-item or constructed measures. Depression and depressive symptoms were the most common mental health conditions studied. Other mental health conditions assessed included alcohol and substance use, emotional disorders, mental health problems symptoms severity and psychiatric hospitalisations. Composite measures such as axis I and II categories and a cluster of severe mental conditions and mental health-related functioning status were also analysed. FS and mental health-related problems were considered as both exposure and outcome variables. The existing evidence suggests a potential association between FS and several mental health conditions, particularly depression, mental health symptoms severity and poor mental health status scores. This review suggests the potential association between some mental health conditions and FS among homeless adults. However, there is a need for more longitudinal- and interventional-based studies, in order to understand the nature and directionality of the links between FS and mental health in this population group.

General Mental Health Status Scores of Patients with Atypical Chest Pain, a Case-Control Study

General Mental Health Status Scores of Patients with Atypical Chest Pain, a Case-Control Study

Impact of pharmacist provided counseling on mental health status of postmenopausal Women

Menopause is described as the point of time when the last menstruation occurs in a woman. This is the period during which changes in the bleeding patterns due to alterations in the hormone levels were noticed. Due to alterations in these hormone levels, physical as well as mental health changes occur in women resulting in menopausal symptoms. Hence, this study was conducted to analyze the impact of counseling on MHS of postmenopausal women. This simple prospective interventional study was conducted in the Gynecology department of Tertiary Care Hospital for a period of 4 months in 200 patients divided into two groups. Mental health status (MHS) scores were calculated by using a validated questionnaire. Statistically significant difference in the score of baseline MHS was found between the two groups. Reduction in the score of MHS was seen in both the groups after counseling. Thus, this study revealed that providing counseling to postmenopausal women has positive impact on their mental health. Therefore, rendering effectual and repeated counseling to menopausal women depends on their need assist in leading a happy moreover healthy life.&#x0D; Keywords: Post menopause; Estrogen deficiency Mental health; Counseling

Examining gender-related differential item functioning of the Veterans Rand 12-item Health Survey.

Previous research suggests that gender differences in patient-reported outcome measures (PROMs) may reflect measurement bias rather than true differences in underlying health status. The aim of this study is to examine whether the Veterans Rand 12-item Health Survey (VR-12) allows for unbiased comparisons of physical and mental health scores across gender. The VR-12 is a generic PROM consisting of 12 items with 3-6 response options for the measurement of mental and physical health. Study data were from the 2015 Health Outcomes Survey pertaining to the Medicare beneficiaries. A total of 277,518 participants included 116,817 (42.1%) males and 160,701 (57.9%) females. Scale-level and item-level differential functioning methods were applied using multiple-group confirmatory factor analysis and ordinal logistic regression, respectively. The scale-level differential functioning showed support for strict invariance (RMSEA=0.045; CFI=0.995) across gender. Although we found statistically significant differential item functioning for several items, the magnitude was negligible (maximum ΔR 2=0.007). The VR-12 physical and mental health status scores are unbiased with respect to gender.

A comparison of the health status and psychological distress of partners of patients with a left ventricular assist device versus an implantable cardioverter defibrillator: A preliminary study

ObjectiveTo examine if the caregiving for patients with a left ventricular assist device (LVAD) is related to a poorer health status and more distress compared to patients with an implantable cardioverter defibrillator (ICD). BackgroundPartners distress may influence patient outcomes and is therefore an important aspect in the care of LVAD and ICD patients. MethodsMulti-center prospective observational study with 6 months follow-up of 33 LVAD partners (27% men; mean age = 54 ± 10 years) and 414 ICD partners (22% men; mean age = 60 ± 12 years). ResultsLVAD partners reported better physical (F = 10.71, p = .001) but poorer mental health status (F = 14.82, p < .001) and higher depression scores compared to ICD partners (F = 3.68, p = .05) at 6 months follow-up, also in adjusted analyses. There was no significant difference between groups on anxiety. ConclusionCaregivers of LVAD patients show higher distress levels compared to caregivers of ICD patients. LVAD partners may have a need for support beyond what is offered currently in clinical practice.

Evaluation of anal function and quality of life after transanal endoscopic microsurgery

To evaluate the impact of transanal endoscopic microsurgery (TEM) on postoperative anal function and quality of life in patients with benign rectal tumor and early rectal cancer. Clinical data of 50 patients with rectal adenoma and early rectal cancer undergoing transanal endoscopic microsurgery in our hospital from October 2008 to June 2013 were retrospectively analyzed. Anorectal manometry, endorectal ultrasonography (ERUS), the fecal incontinence severity index (FISI), and the physical and mental health status scores (SF-36) were used to evaluate preoperative and postoperative anorectal function and quality of life. Anorectal manometry indicated anal resting pressure (ARP), maximum squeeze pressure (MSP), rectal volume at sensory threshold(RVST), maximum tolerable volume(MTV) decreased significantly at the first month after surgery (P<0.05). MSP returned to preoperative level at the 3rd month (P>0.05). ARP and MTV returned to normal values at the 6th month (P>0.05). RVST returned to normal values at the 9th month (P>0.05). Recto-anal inhibitory reflex(RAIR) was absent in 1 (2%) patient preoperatively and in 30(60%), 18(36%), 7(14%), 2(4%) at the 1st, 3rd, 6th, 9th months after surgery respectively. ERUS showed similar width and thickness of internal sphincter at 1st and 6th month after surgery compared with preoperative measures (P>0.05). Six months after surgery, the mean FISI score decreased(preoperative vs postoperative:8.5 vs 5.8, P<0.05), suggesting an improvement in fecal continence. However, the overall quality of life did not danger significantly after surgery(P>0.05). TEM has little impact on anorectal anatomic structure. Anal function may be compromised in the short-term, however the vast majority of patients recover completely after 6-9 months. TEM is a safe, effective and minimally invasive surgery.

Symptoms, the Nature of Fibromyalgia, and Diagnostic and Statistical Manual 5 (DSM-5) Defined Mental Illness in Patients with Rheumatoid Arthritis and Fibromyalgia

PurposeTo describe and evaluate somatic symptoms in patients with rheumatoid arthritis (RA) and fibromyalgia, determine the relation between somatization syndromes and fibromyalgia, and evaluate symptom data in light of the Diagnostic and Statistical Manual-5 (DSM-5) criteria for somatic symptom disorder.MethodsWe administered the Patient Health Questionnaire-15 (PHQ-15), a measure of somatic symptom severity to 6,233 persons with fibromyalgia, RA, and osteoarthritis. PHQ-15 scores of 5, 10, and 15 represent low, medium, and high somatic symptom severity cut-points. A likely somatization syndrome was diagnosed when PHQ-15 score was ≥10. The intensity of fibromyalgia diagnostic symptoms was measured by the polysymptomatic distress (PSD) scale.Results26.4% of RA patients and 88.9% with fibromyalgia had PHQ-15 scores ≥10 compared with 9.3% in the general population. With each step-wise increase in PHQ-15 category, more abnormal mental and physical health status scores were observed. RA patients satisfying fibromyalgia criteria increased from 1.2% in the PHQ-15 low category to 88.9% in the high category. The sensitivity and specificity of PHQ-15≥10 for fibromyalgia diagnosis was 80.9% and 80.0% (correctly classified = 80.3%) compared with 84.3% and 93.7% (correctly classified = 91.7%) for the PSD scale. 51.4% of fibromyalgia patients and 14.8% with RA had fatigue, sleep or cognitive problems that were severe, continuous, and life-disturbing; and almost all fibromyalgia patients had severe impairments of function and quality of life.ConclusionsAll patients with fibromyalgia will satisfy the DSM-5 “A” criterion for distressing somatic symptoms, and most would seem to satisfy DSM-5 “B” criterion because symptom impact is life-disturbing or associated with substantial impairment of function and quality of life. But the “B” designation requires special knowledge that symptoms are “disproportionate” or “excessive,” something that is uncertain and controversial. The reliability and validity of DSM-5 criteria in this population is likely to be low.

Quality of life and other patient-reported outcomes following exenteration for pelvic malignancy

Pelvic exenteration is highly radical surgery offering the only potential cure for locally advanced pelvic cancer. This study compared quality of life and other relevant patient-reported outcomes over 12 months for patients who did and those who did not undergo pelvic exenteration. Consecutive patients referred for consideration of pelvic exenteration completed clinical and patient-reported outcome assessments at baseline, hospital discharge (exenteration patients only), and 1, 3, 6, 9 and 12 months. Outcomes included cancer-specific quality of life (Functional Assessment of Cancer Therapy - Colorectal; FACT-C), physical and mental health status (Short Form 36 version 2), psychological distress (Distress Thermometer), and pain (study-specific composite) scores. Linear mixed modelling compared trajectories between exenteration and no-exenteration groups. Among 182 patients, 148 (81.3 per cent) proceeded to exenteration. There were no baseline differences between the two groups. Among patients who had exenteration, the mean FACT-C score at baseline of 93.0 had reduced by 14·4 points at hospital discharge, but increased to 86·7 at 1 month after surgery and continued to improve, returning to baseline by 9 months. For patients in the no-exenteration group, FACT-C scores decreased between baseline and 1 month, increased slowly to 6 months and then began to decline at 9 months. There were few statistically or clinically significant differences in any patient-reported outcomes between the groups. Quality of life and related patient-reported outcomes improve rapidly after pelvic exenteration surgery. For 9 months after surgery, these outcomes are comparable with those of similar do patients who do not have surgery; thereafter, there is a decline in patients who do not have exenteration. Pelvic exenteration can be performed with acceptable quality of life and patient-reported outcomes.

Assessment of quality of life and functional outcome in patients sustaining moderate and major trauma: A multicentre, prospective cohort study

BackgroundTrauma care systems aim to reduce both death and disability, yet there is little data on post-trauma health status and functional outcome. ObjectivesTo evaluate baseline, discharge, six month and 12 month post-trauma quality of life, functional outcome and predictors of quality of life in Hong Kong. MethodsMulticentre, prospective cohort study using data from the trauma registries of three regional trauma centres in Hong Kong. Trauma patients with an ISS≥9 and aged≥18 years were included. The main outcome measures were the physical component summary (PCS) score and mental component summary (MCS) scores of the Short-Form 36 (SF36) for health status, and the extended Glasgow Outcome Scale (GOSE) for functional outcome. ResultsBetween 1 January 2010 and 31 September 2010, 400 patients (mean age 53.3 years; range 18–106; 69.5% male) were recruited to the study. There were no statistically significant differences in baseline characteristics between responders (N=177) and surviving non-responders (N=163). However, there were significant differences between these groups and the group of patients who died (N=60). Only 16/400 (4%) cases reported a GOSE≥7. 62/400 (15.5%) responders reached the HK population norm for PCS. 125/400 (31%) responders reached the HK population norm for MCS. If non-responders had similar outcomes to responders, then the percentages for GOSE≥7 would rise from 4% to 8%, for PCS from 15.5% to 30%, and for MCS from 31% to 60%. Univariate analysis showed that 12-month poor quality of life was significantly associated with age>65 years (OR 4.77), male gender (OR 0.44), pre-injury health problems (OR 2.30), admission to ICU (OR 2.15), ISS score 26–40 (OR 3.72), baseline PCS (OR 0.89), one-month PCS (OR 0.89), one-month MCS (OR 0.97), 6-month PCS (OR 0.76) and 6-month MCS (OR 0.97). ConclusionFor patients sustaining moderate or major trauma in Hong Kong at 12 months after injury<1 in 10 patients had an excellent recovery, ≤3 in 10 reached a physical health status score≥Hong Kong norm, although as many as 6 in 10 patients had a mental health status score which is≥Hong Kong norm.

Elevated Transferrin Saturation, Health-Related Quality Of Life and Telomere Length

ContextIncreased risk of heart disease, diabetes, dementia, cancer, and death has been found among individuals with elevated transferrin saturation (TS). Although TS has been linked to specific diseases, little research has focused on the relationship between elevated TS and current health status. PurposeThis study examined the relationship between elevated TS and measures of health status (telomere length and patient-reported health-related quality of life) to assess whether elevated TS is associated with negative patient outcomes beyond increased risk for morbidity and mortality. MethodsWe conducted an analysis of the Hemochromatosis and Iron Overload Screening (HEIRS) Study supplemented with assays for leukocyte telomere length in adults (>25 years old). The HEIRS Study identified individuals through a multiethnic, multicenter sample of 101,168 US and Canadian adults. Screening was done with serum biochemical tests of iron status and hemochromatosis (HFE) gene mutation testing. Our sample was comprised of HEIRS subjects with responses on health-related quality of life (general health (GH) and mental health (MH) subscales of the SF-36 Health Survey), and known leukocyte telomere length (n=669). Leukocyte telomere length was assessed through a quantitative PCR-based technique (qPCR). Unadjusted mean values of the general health status subscale, the mental health status subscale and telomere length were compared between groups with elevated TS (>45% for women and >50% for men) versus non-elevated TS (<45% for women and <50% for men) using t-tests. Comparisons also were made between mean values for the general and mental health status subscales and telomere length for the group with TS >60% versus with non-elevated TS (<45% for women and <50% for men). For each of the quantitative outcomes of GH, MH, and telomere length, separate general linear regression models were formed with TS elevation as a dichotomous predictor, controlled for demographic characteristics as well as health conditions associated with iron overload. ResultsAmong individuals with elevated TS (>45% for women and >50% for men), who also had a usual source of care, only 5.2% reported ever being told by a doctor that they had an elevated iron condition. Mean values for GH and MH, and telomere length were significantly lower in those with elevated TS (Table 1; p<0.01, p<0.001, and p<0.001, respectively), indicating worse general and mental health and shorter telomere length. In a fully adjusted model, elevated TS versus non-elevated TS was associated with worse general health status, mental health status and shorter telomere length. GH and MH status scores were progressively lower in individuals with increasing levels of TS (e.g., TS >60%) versus non-elevated TS. ConclusionsIncreased surveillance of elevated TS may be in order as elevated TS is associated with decreased health status and very few patients with elevated TS are aware of their condition. Disclosures:No relevant conflicts of interest to declare.

Food Access and Diet Quality Are Associated with Quality of Life Outcomes among HIV-Infected Individuals in Uganda

BackgroundFood insecurity is associated with poor nutritional and clinical outcomes among people living with HIV/AIDS. Few studies investigate the link between food insecurity, dietary diversity and health-related quality of life among people living with HIV/AIDS.ObjectiveWe investigated whether household food access and individual dietary diversity are associated with health-related quality of life among people living with HIV/AIDS in Uganda.MethodsWe surveyed 902 people living with HIV/AIDS and their households from two clinics in Northern Uganda. Health-related quality of life outcomes were assessed using the Medical Outcomes Study (MOS)-HIV Survey. We performed multivariate regressions to investigate the relationship between health-related quality of life, household food insecurity and individual dietary diversity.ResultsPeople living with HIV/AIDS from severe food insecurity households have mean mental health status scores that are 1.7 points lower (p<.001) and physical health status scores that are 1.5 points lower (p<.01). Individuals with high dietary diversity have mean mental health status scores that were 3.6 points higher (p<.001) and physical health status scores that were 2.8 points higher (p<.05).ConclusionsFood access and diet quality are associated with health-related quality of life and may be considered as part of comprehensive interventions designed to mitigate psychosocial consequences of HIV.

Unreadiness for Postpartum Discharge Following Healthy Term Pregnancy: Impact on Health Care Use and Outcomes

ObjectiveTo document the association between a lack of readiness, termed “unreadiness,” for postpartum discharge and the health of mothers and their term newborns. MethodsProspective observational cohort study of 4300 mother-infant dyads in a national, pediatric, practice-based research network. The association between unreadiness for discharge and health care use, health-related behaviors, and health outcomes was analyzed by the use of bivariate, multivariate linear, and logistic models. ResultsSixteen percent of mother-infant dyads were unready for discharge. Unreadiness was significantly associated with maternal and infant health care use and health outcomes but not independently associated with health-related behaviors. In multivariable analyses, after we controlled for important covariates and confounders, unready dyads had more calls to health care providers than ready dyads (13.3% increase for mothers, P = .01; 18.7% increase for infants, P < .01) during the first 2 weeks after discharge. In this same time frame, unready dyads also had more symptom days (8.5% increase for mothers, P < .01; 8.7% increase for infants, P < .01). Unready mothers had lower mean physical (5.0% decrease, P < .01) and mental (4.4% decrease, P < .01) health status scores at 4 weeks after discharge. ConclusionsUnreadiness at postpartum discharge was associated with increased health care use and poorer health outcomes in the first 2 to 4 weeks after discharge. Discharge plans should be individualized and jointly tailored to a family's needs rather than to a set timescale.

Abstract 250: Gender Differences in Health Status Amongst Patients with Peripheral Artery Disease

Aim: Unlike other cardiovascular disorders, few studies have examined gender differences in health outcomes in peripheral artery disease (PAD) patients. This study assessed whether gender was an independent determinant of health status at (a) initial diagnosis of PAD, (b) 12-month follow-up, or (c) the rate of change over a 12-month period, with the hypothesis that women's PAD health status will be comprised at both time points. Methods: From March'06 to November '10, 588 patients (381 men, 207 women) with newly diagnosed PAD (Rutherford stages I-III) were consecutively enrolled from two vascular clinics in the Netherlands. Clinical details were recorded and patients completed the Short Form 12 (SF-12) questionnaire at baseline and 12 months later. Physical (PCS) and mental component summary (MCS) scores were calculated and compared by gender at each time point and median values were used due to non-normally distributed data. Multivariable linear regression models adjusting for demographics, cardiovascular risk factors, co-morbidities and depression quantified the independent association of gender with health status. Results: Women had poorer PCS (36±10 vs. 40±10, P&lt;0.001) and MCS (46±12 vs. 49±11, P&lt;0.001) scores at diagnosis (baseline) as compared with men ( Figure 1 ). Independent correlates of poorer baseline PCS included age, body mass index, prior cardiovascular history, chronic obstructive pulmonary disease (COPD), and depression. For baseline MCS scores, indicators of poorer outcomes included female gender, age, COPD, and depression. Although PCS scores improved for both genders over 12 months (P&lt;0.001 for men; P&lt;.0.001 for women), 12-month MCS scores did not significantly change in men (P=0.14) or women (P=0.12) ( Figure 1 ). At 12 months, both PCS and MCS were worse in women, as compared with men (PCS [41+12 vs. 46+11, P=0.05], MCS [43+14 vs. 49+12, P=0.002]). Independent predictors in the rate of improvement in PCS scores included age, diabetes, and PCS-12 at baseline, but not gender, with no independent predictors for the MCS scores. Conclusion: Women with lower-extremity PAD have poorer physical and mental health status scores both at baseline and 12 months, however, improvement 12 months following diagnosis was independent of gender. Figure 1. Median PCS and MCS Scores at Baseline and 12-Month Follow-Up by Gender

Anorectal functional outcome after repeated transanal endoscopic microsurgery

To evaluate the status of anorectal function after repeated transanal endoscopic microsurgery (TEM). Twenty-one patients undergoing subtotal colectomy with ileorectal anastomosis were included. There were more than 5 large (> 1 cm) polyps in the remaining rectum (range: 6-20 cm from the anal edge). All patients, 19 with villous adenomas and 2 with low-grade adenocarcinomas, underwent TEM with submucosal endoscopic excision at least twice between 2005 and 2011. Anorectal manometry and a questionnaire about incontinence were carried out at week 1 before operation, and at weeks 2 and 3 and 6 mo after the last operation. Anal resting pressure, maximum squeeze pressure, maximum tolerable volume (MTV) and rectoanal inhibitory reflexes (RAIR) were recorded. The integrity and thickness of the internal anal sphincter (IAS) and external anal sphincter (EAS) were also evaluated by endoanal ultrasonography. We determined the physical and mental health status with SF-36 score to assess the effect of multiple TEM on patient quality of life (QoL). All patients answered the questionnaire. Apart from negative RAIR in 4 patients, all of the anorectal manometric values in the 21 patients were normal before operation. Mean anal resting pressure decreased from 38 ± 5 mmHg to 19 ± 3 mmHg (38 ± 5 mmHg vs 19 ± 3 mmHg, P = 0.000) and MTV from 165 ± 19 mL to 60 ± 11 mL (165 ± 19 mL vs 60 ± 11 mL, P = 0.000) at month 3 after surgery. Anal resting pressure and MTV were 37 ± 5 mmHg (38 ± 5 mmHg vs 37 ± 5 mmHg, P = 0.057) and 159 ± 19 mL (165 ± 19 mL vs 159 ± 19 mL, P = 0.071), respectively, at month 6 after TEM. Maximal squeeze pressure decreased from 171 ± 19 mmHg to 62 ± 12 mmHg (171 ± 19 mmHg vs 62 ± 12 mmHg, P = 0.000) at week 2 after operation, and returned to normal values by postoperative month 3 (171 ± 19 vs 166 ± 18, P = 0.051). RAIR were absent in 4 patients preoperatively and in 12 (χ(2) = 4.947, P = 0.026) patients at month 3 after surgery. RAIR was absent only in 5 patients at postoperative month 6 (χ(2) = 0.141, P = 0.707). Endosonography demonstrated that IAS disruption occurred in 8 patients, and 6 patients had temporary incontinence to flatus that was normalized by postoperative month 3. IAS thickness decreased from 1.9 ± 0.6 mm preoperatively to 1.3 ± 0.4 mm (1.9 ± 0.6 mm vs 1.3 ± 0.4 mm, P = 0.000) at postoperative month 3 and increased to 1.8 ± 0.5 mm (1.9 ± 0.6 mm vs 1.8 ± 0.5 mm, P = 0.239) at postoperative month 6. EAS thickness decreased from 3.7 ± 0.6 mm preoperatively to 3.5 ± 0.3 mm (3.7 ± 0.6 mm vs 3.5 ± 0.3 mm, P = 0.510) at month 3 and then increased to 3.6 ± 0.4 mm (3.7 ± 0.6 mm vs 3.6 ± 0.4 mm, P = 0.123) at month 6 after operation. Most patients had frequent stools per day and relatively high Wexner scores in a short time period. While actual fecal incontinence was exceptional, episodes of soiling were reported by 3 patients. With regard to the QoL, the physical and mental health status scores (SF-36) were 56.1 and 46.2 (50 in the general population), respectively. The anorectal function after repeated TEM is preserved. Multiple TEM procedures are useful for resection of multi-polyps in the remaining rectum.