Non-working Patients Research Articles

Role of Demographic Characteristics in predicting Psychological Burden and Marital Satisfaction among Diabetic Patients

The study was conducted to predict the relationship of psychological burden and marital satisfaction among patients of diabetic mellitus with role of demographic variables. Sample size was 150 diagnosed diabetic patients in which 75 married males and 75 were married females. Sample was approached through purposive sampling technique. All diabetic patients were selected from public hospitals and private clinics of Multan Division, Pakistan. The Nishter Hospital Multan, Combined Military Hospital Multan and City Hospital Multan and it was focused to their gender, age, education, type of disease, working status and socio-economic condition. Depression, Anxiety, Stress Scale (Lovibond, 1995) and Index of Marital Satisfaction (Hudson, 1981) were used as a research instrument to collect the data. Data were analyzed on SPSS. Findings of the study reveal that there is negative correlation between psychological burden and marital satisfaction. Moreover, depression, anxiety and stress are the significant negative predictors of marital satisfaction. Results suggest that level of psychological burden was reported higher among female patients than male. Mean score of marital satisfaction was greater among male as compared to female patients. Furthermore, there was significant mean score difference on PB between educated and uneducated patients. Patients with type 2 have greater level of psychological burden as compared to type 1 diabetes. Level of psychological burden was greater in those patients who have above than 3 children as compared to those who have 1-3 children. Difference is significant between working and non-working diabetic patients on psychological burden. Results suggest that there is no significant mean score difference of marital status with respect to education, type of diabetes, family size, and working status. There was no significant difference of PB and MS with respect to socio-economic status. Role of demographic characteristics of the participants is significant in predicting psychological burden among them.

Exploring Factors That Prolong the Diagnosis of Myasthenia Gravis.

Myasthenia gravis (MG) is a condition with significant phenotypic variability, posing a diagnostic challenge to many clinicians worldwide. Prolonged diagnosis can lead to reduced remission rates and morbidity. This study aimed to identify factors leading to a longer time to diagnosis in MG that could be addressed in future to optimize diagnosis time. One hundred and ten patients from 3 institutions in Melbourne, Australia, were included in this retrospective cohort study. Demographic and clinical data were collected for these patients over the first 5 years from diagnosis and at 10 years. Nonparametric statistical analysis was used to identify factors contributing to a longer diagnosis time. The median time for MG diagnosis was 102 (345) days. 90% of patients were diagnosed before 1 year. Female patients took longer than male patients to be diagnosed (p = 0.013). The time taken for first presentation after symptom onset contributed most to diagnosis time (median 17 [141] days), with female patients and not working as contributory factors. Neurology referral took longer if patients had diplopia (p = 0.022), respiratory (p = 0.026) symptoms, or saw an ophthalmologist first (p < 0.001). Outpatient management compared with inpatient was associated with a longer time to be seen by a neurologist from referral (p < 0.001), for the first diagnostic result to return (p = 0.001), and for the result to be reviewed (p < 0.001). Ocular MG had a median greater time to neurologist review than generalized MG (median 5 [25] days vs 1 [13] days, p = 0.035). Electrophysiology tests took longer for outpatients than inpatients (median 21 [35] days vs 2 [8] days, p < 0.001). Outpatients were also started on treatment later than inpatients (p < 0.001). There was no association of MG severity, ethnicity, age, medical and ocular comorbidities, and public or private health service on diagnosis time. There was also no impact of time to diagnosis on Myasthenia Gravis Foundation of America outcomes, number of follow-ups or hospitalizations, or prevalence of treatments used. This study is limited by low patient numbers and its retrospective nature. This study identified several factors that can contribute to a prolonged diagnosis time of MG. Patient and clinician education about MG and outpatient diagnostic efficiency needs emphasis. Further studies are also needed to explore the delayed presentation time of women and nonworking patients in MG.

Knowledge, Attitude, and Practice of Adult Diabetics Regarding Diabetic Foot Ulcers: A Cross-Sectional Study in Saudi Arabia.

Background Diabetic foot ulcers (DFUs) are one of the most common and fatal complications of diabetic patients with uncontrolled diabetes mellitus (DM) that may end with their feet amputation. These complications can be prevented through the adherence of diabetic patients to their diabetes management plan and by educating them about risk factors, complications of diabetic foot, and proper foot care. To develop effective health education programs to educate diabetic patients and caregivers regarding diabetic foot and its effective care, we should first identify gaps in patients' knowledge and perception of diabetic foot and evaluate their practice of foot care. Objectives This study aimed to evaluate knowledge and attitude toward DFUs and the practice of foot care among adult diabetic patients attending Al-Qunfudah Diabetes Center, Saudi Arabia, from October 2022 to March 2023. Methods A total of 403 adult diabetic patients were recruited in this cross-sectional study during their attendance at the diabetes center in Al-Qunfudah district, Saudi Arabia. The study researchers conducted a physical face-to-face interview with each diabetic patient using a validated questionnaire with closed-ended questions to collect their responses regarding their knowledge and attitude toward DFUs and their behavior toward foot care. The collected data were analyzed using IBM SPSS Statistics for Windows, version 23 (released 2015; IBM Corp., Armonk, New York, United States). Results Out of 403 diabetics, 50.4% (n = 203) had inadequate knowledge (knowledge score < 80%), 46.4% (n = 187) had negative attitudes (attitude score < 80%) toward DFUs, and the majority could not practice foot care well, with 77.7% (n = 313) giving a practice score less than 80%. Seventy patients (17.4%) self-reported a history of DFUs. Predictors of good knowledge about DFUs among diabetics include age between 30 and 59 years (odds ratio (OR) = 2.942, confidence interval (CI) 95% = 1.695-2.107, p < 0.001), marriage (OR = 3.101, CI 95% = 1.893-5.079, p < 0.001), working (OR = 5.325, CI 95% = 3.019-9.389, p < 0.001), diploma education (OR = 8.205, CI 95% = 3.332-20.203, p < 0.001), managing DM with oral drugs (OR = 2.219, CI 95% = 1.399-3.519, p < 0.001), and having no DFUs (OR = 2.712, CI 95% = 1.557-4.723, p < 0.001). Males were more likely to practice foot care well (OR = 1.925, CI 95% = 1.142-3.245, p = 0.013). Primary education (OR = 3.421, CI 95% = 1.655-7.073, p < 0.001) predicted appropriate foot care. Patients with DM for one to five years (OR = 1.995, CI 95% = 1.139-3.493, p = 0.016) and those on diet and metformin (OR = 2.133, CI 95% = 1.134-4.011, p = 0.019) were expected to have better foot care than other diabetics. Conclusion Diabetic patients in the Al-Qunfudah district of Saudi Arabia had inadequate knowledge and negative attitudes toward DFUs, and their foot care behaviors were inadequate. Furthermore, DFUs were self-reported in around 17% of diabetic patients. Specialized training programs are recommended to enhance knowledge regarding DFUs among diabetics and motivate and train them and caregivers on how to conduct proper foot care. These educational programs should target all diabetics, with an emphasis on those with DFUs, females, non-working patients, individuals who have had DM for a longer time, and illiterate diabetics. To understand the factors behind patients' negative attitudes toward diabetic foot, future qualitative research is required.

Risk of Macular Toxicity After Intra-Cameral 1mg/0.1 ml Cefuroxime for Endophthalmitis Prophylaxis in Phacoemulsification Cataract Surgery

The world's leading culprit of preventable blindness is cataracts. For numerous decades, postoperative endophthalmitis has instilled terror as a potential complication of cataract surgery. Objective: To determine the frequency of retinal toxicity in terms of transient macular edema following using per-operative intracameral cefuroxime 1mg/0.1ml for endophthalmitis prophylaxis. Methods: A Descriptive case series was done at LRBT Eye Hospital, Lahore, from 15th Dec 2020 to 14th Jun 2021. A total number of 118 senile cataract patients were included. After cataract surgery, an intracameral 1 mg injection of cefuroxime was given to each patient. The optimally corrected visual acuity and macular thickness at the center of the retina on OCT were assessed postoperatively at week 1. If they were found to be elevated, it was labeled as retinal toxicity. Data were collected on data collection proforma. Results: The average age of the participants was 59.68 ± 5.28 years. Mean visual acuity before and after surgery was 2.01 ± 0.74 and 1.92 ± 0.94, respectively. Mean central macular thickness before and after surgery was 241.08 ± 4.73 and 248.74 ± 5.86 µm, respectively. There were 71 (60.17%) male and 47 (39.83%) female patients. There were 42 (35.59%) farmers, 40 (33.90%) job holders, 05 (4.24%) business people, and 31 (26.27%) non-working patients. Retinal toxicity was found in 54 (45.76%) patients. Conclusions: Intracameral injection of cefuroxime sodium can result in transient macular edema and retinal toxicity. In this study, retinal toxicity occurred in 45.8% of patients undergoing phacoemulsification.

Longitudinal Analysis of Caregiver Burden in Head and Neck Cancer

Despite the critical role of caregivers in head and neck cancer (HNC), there is limited literature on caregiver burden (CGB) and its evolution over treatment. Research is needed to address evidence gaps that exist in understanding the causal pathways between caregiving and treatment outcomes. To evaluate the prevalence of and identify risk factors for CGB in HNC survivorship. This longitudinal prospective cohort study took place at the University of Pittsburgh Medical Center. Dyads of treatment-naive patients with HNC and their caregivers were recruited between October 2019 and December 2020. Eligible patient-caregiver dyads were 18 years or older and fluent in English. Patients undergoing definitive treatment identified a caregiver as the primary, nonprofessional, nonpaid person who provided the most assistance to them. Among 100 eligible dyadic participants, 2 caregivers declined participation, resulting in 96 enrolled participants. Data were analyzed from September 2021 through October 2022. Participants were surveyed at diagnosis, 3 months postdiagnosis, and 6 months postdiagnosis. Caregiver burden was evaluated with the 19-item Social Support Survey (scored 0-100, with higher scores indicating more support), Caregiver Reaction Assessment (CRA; scored 0-5, with higher scores on 4 subscales [disrupted schedule, financial problems, lack of family support, and health problems] indicating negative reactions, and higher scores on the fifth subscale [self-esteem] indicating favorable influence); and 3-item Loneliness Scale (scored 3-9, with higher scores indicating greater loneliness). Patient health-related quality of life was assessed using the University of Washington Quality of Life scale (UW-QOL; scored 0-100, with higher scores indicating better QOL). Of the 96 enrolled participants, half were women (48 [50%]), and a majority were White (92 [96%]), married or living with a partner (81 [84%]), and working (51 [53%]). Of these participants, 60 (63%) completed surveys at diagnosis and at least 1 follow-up. Of the 30 caregivers, most were women (24 [80%]), White (29 [97%]), married or living with a partner (28 [93%]), and working (22 [73%]). Caregivers of nonworking patients reported higher scores on the CRA subscale for health problems than caregivers of working patients (mean difference, 0.41; 95% CI, 0.18-0.64). Caregivers of patients with UW-QOL social/emotional (S/E) subscale scores of 62 or lower at diagnosis reported increased scores on the CRA subscale for health problems (UW-QOL-S/E score of 22: CRA score mean difference, 1.12; 95% CI, 0.48-1.77; UW-QOL-S/E score of 42: CRA score mean difference, 0.74; 95% CI, 0.34-1.15; and UW-QOL-S/E score of 62: CRA score mean difference, 0.36; 95% CI, 0.14-0.59). Woman caregivers had statistically significant worsening scores on the Social Support Survey (mean difference, -9.18; 95% CI, -17.14 to -1.22). The proportion of lonely caregivers increased over treatment. This cohort study highlights patient- and caregiver-specific factors that are associated with increased CGB. Results further demonstrate the potential implications for negative health outcomes for caregivers of patients who are not working and have lower health-related quality of life.

Assessment of anxiety and depression among tuberculosis patients of Ahmedabad, India

BackgroundIndia has high prevalence of Tuberculosis (TB). The long duration of treatment and chronic nature of illness predispose a person to anxiety as well as depression. Various addiction habits may affect treatment outcome and impact mental wellbeing in TB patients. This study was planned with the objectives of finding prevalence of anxiety and depression in tuberculosis patients at Ahmedabad district and to find association between anxiety, depression and different variables of TB patients as well as to assess the addiction profile of TB patients. MethodsA total of 600 TB patients above 18 years and having completed 3 months of anti TB treatment without any psychiatric illness were selected randomly from 3 types of health institutes where patients receive treatment namely Ahmedabad district TB center (Institute 1), one medical college attached hospital (Institute 2) and one private hospital (Institute 3).Hospital Anxiety and Depression Scale (HADS) was used to assess anxiety and depression. ResultsThe mean age of study patients was 41.57 ± 13.44 years and 66.3% (398) patients were males. The prevalence of anxiety and depression was found to be 37.5% and 41.2% respectively while in 18.66% patients both anxiety and depression coexisted simultaneously. Institute 1 reported highest prevalence of anxiety (45.4%) while institute 2 reported highest prevalence of depression (42.9%). The prevalence of anxiety among drug sensitive TB patients was 32.7% while among drug resistant TB patients was 80%.The prevalence of depression in drug sensitive TB patients was 37.03% while among drug resistant TB patients was 78.3%. Anxiety had a statistically significant association with gender, occupation, socioeconomic class, type of TB, site of TB and perceived social isolation (p < 0.05).Except gender, depression was significantly associated with all the variables (p < 0.05).Tobacco addiction was found in 37.5% patients, alcohol addiction in 8.3% while 4.5% patients had both types of addiction. There was a statistically significant association found between addiction and variables like gender, residence, occupation, type of TB and site of TB. ConclusionOne third of patients had anxiety and more than one third had depression in which the prevalence of depression was higher than anxiety. District TB Center had highest prevalence of anxiety while medical college attached hospital had highest prevalence of depression. Anxiety and depression were higher in drug resistant TB patients. Tobacco addiction was more common than alcohol. Addiction had a significant association with depression, nonworking rural males and patients who had drug resistant pulmonary TB.

Validity and reliability test for problem areas in Diabetes-Five item short form (PAID-5) Indonesia version.

Emotional distress experienced by patients with diabetes (PWD) can affect glycemic control and quality of life. However, limited tools are available in Indonesia to detect emotional distress in PWD in clinical setting or research. This study aimed to evaluate the validity and reliability of the Indonesia version of the Problem Areas in Diabetes (PAID-5) scale. After the cross-cultural adaptation method was conducted, psychometric tests were done from August to November 2019 at affiliated hospitals in Yogyakarta by involving 100 adult PWD. All PWD with no medical records of mental health problems or cognitive disorders were voluntarily included. Content and construct validity and internal consistency measurements were used to evaluate the psychometric properties. The mean age was 61.2 years of the men and women who equally participated in the study and mostly were non-working patients. The PAID-5 resulted in five question items to identify the emotional distress of PWD in the Indonesian language. Some minor modifications were done in items four and five after discussing them with the original authors and experts in Indonesia. The results showed item content validity index for item and scale were 0.6-0.8 and 0.72, respectively. The calculated r-values ranged from 0.751 to 0.888, which were higher than the r table (0.197). The Cronbach alpha of the Indonesia version of PAID-5 was 0.87 with inter-item and item-total correlations of 0.43-0.71 and 0.61-0.79, respectively. The results of the study indicate that PAID-5 is considered valid and reliable to assess emotional distress among PWD and can be useful in clinical setting or for research purposes. Continued assessment of emotional distress is applicable and helps patients to better deal with their emotional distress.

Depressive disorders and quality of live in patients with acute coronary syndrome in real clinical practice

Objective. To study the prevalence of depressive disorders using Zung Self-rating Depression Scale (SDS) in patients with acute coronary syndrome (ACS) in the daily work of the Regional Vascular Center in various gender and social subgroups and to compare their severity with the life quality level.Materials and Methods. The survey included 116 (57 female and 59 male) patients, admitted to Regional Vascular Center with ACS from March to November 2020 (Group 1), and 49 patients hospitalized with other cardiological pathology (Group 2), who made up a comparison group comparable in gender, age, presence of diabetes mellitus, heart attack and stroke in anamnesis.Results. In Group I the score on SDS was higher or equal to 50 (depression) in 18 % of cases: 15 % female and 3 % male patients (p &lt;0.05). The average score on SDS was notably higher in women than in men (p &lt;0.05). In Group 2 depression was detected in 27 % of cases, without gender differences. The average level of depression was higher in older age groups, both in men and women, in patients with ACS and without ACS. A negative correlation was established for the indicators of SDS and SF-36: in Group 1 r = –0.62, p &lt;0.05, in Group 2 r = –0.76, p &lt;0.05. In Group 1 indicators of health physical component (SF-36) among women were: physical functioning 50, role functioning 34, general health 51, in men: 80, 58 and 63 respectively (p &lt;0.05). In Group 2 these indicators significantly differed only in physical functioning: 60 female and 72 male. In Group 1 depression was observed in 2 % of working and in 30 % of non-working patients (p &lt;0.05); in Group 2: 0 and 34 % respectively. In Groups 1 and 2 depression was found in 10 and 5 % among married, in 31 and 43 % among unmarried patients (p &lt;0.05). In Group 1 depression was detected in 31 % among patients with diabetes, in 12 % – without diabetes (p &lt;0.05). The other analyzed diseases did not have a significant effect on the de pression score.Conclusions. The presence of ACS was associated with depressive disorders in women. At the same time, the severity of depressive disorders was inversely correlated with the quality of life. In women with ACS, the physical component and the psychological component of health on the quality of life scale are significantly lower in comparison with men. In addition, the absence of work and marriage negatively affected the prevalence of depressive disorders among all examined patients. And the presence of diabetes mellitus was associated with a higher level of depression among patients with ACS. It is necessary to develop and implement specialized rehabilitation programs for the following subgroups of patients with ACS and depression – unemployed and unmarried women, with a low level of quality of life, elderly patients, patients with diabetes mellitus.

Progression of liver fibrosis and associated factors among chronic hepatitis B patients at a general hospital in Northern Vietnam.

ABSTRACTEvaluation of liver fibrosis is necessary to make the therapeutic decision and assess the prognosis of CHB patients. The current study aimed to describe the progression and identify some influencing factors in patients with chronic hepatitis B at a General Hospital in Northern Vietnam. The longitudinal study included 55 eligible subjects diagnosed Hepatitis-B-virus. Dependent variable was the aspartate aminotransferase/platelet ratio index and we collected some demographic variables and disease related and behaviour variables. Bayesian Model Averaging was used to select variables into model. Mixed-effect linear models were used to evaluate the change of the aspartate aminotransferase/platelet ratio index over time and identify related factors. the aspartate aminotransferase/platelet ratio index differences between examinations, age of participants, working status were statistically significant. This pattern indicated that the average the aspartate aminotransferase/platelet ratio index of the population decreased by 0.005 (95% CI=-0.009; –0.001) after each patient’s visit, and increased by 0.013 if the patient’s age increased by 1 year (95% CI=0.005; 0.0219). For non-working patients, the aspartate aminotransferase/platelet ratio index was lower, coefficient was –0.054 (95% CI=-0.108; 0.001). Other variables such as gender, education level, time for disease detection, drinking tea, alcohol consumption, forgetting to take medicine and the aspartate aminotransferase/platelet ratio index were not significantly different. The study showed that the majority of study subjects had average the aspartate aminotransferase/platelet ratio index, and were relatively well controlled and treated during the study. Age and working status are factors that influence the the aspartate aminotransferase/platelet ratio index.

Return to work after cancer: Improved mental health in working cancer survivors.

Aim of the study was to compare working and non-working patients over a period of 12months regarding socio-demographic, cancer-specific and mental health parameters. This study was conducted as part of a Germany-wide longitudinal survey among 1398 patients in 13 national Comprehensive Cancer Centers. The sample used for analysis consisted of n=430 cancer patients younger than 65years (age M=52.4years, SD=8.1; 67.0% females). Socio-demographic, cancer-specific and mental health parameters (Depression: Patient Health Questionnaire, Anxiety: Generalized Anxiety Disorder Scale, Distress: Distress Thermometer) were assessed at baseline during hospitalization and at 12 months follow-up. 73.7% of all patients (n=317) have returned to work after one year. While working and non-working patients did not differ in socio-demographic parameters, there were significant differences in the presence of metastases, tumor and treatment status. Mixed analysis of variances revealed significant interactions between working status and time for depression (p=0.009), anxiety (p=0.003) and distress (p=0.007). Non-working patients reported higher levels of depression, anxiety and distress than working patients over time. A logistic regression showed significant associations between lower depression (p=0.019), lower distress (p=0.033) and the absence of a tumor (p=0.015) with working status. The majority of cancer survivors returned to work. Non-working patients had higher levels of depression, anxiety and distress than working patients. After controlling for cancer-specific factors, mental health parameters were still independently associated with working status. Return to work can thus be associated with an improved mental health in cancer survivors. In order to establish causality, further research is necessary.

Medical and social characteristics of patients of the first psychotic episode clinic

To study the medical and social characteristics of patients with the first episode of endogenous mental disorders and to compare them with the level of social functioning in the two-year follow-up. The study included 512 case histories of patients with ICD-10 diagnoses F20, F21, F23, F25, F31, F32. Patients were admitted to a 24-hour hospital in the period from 2018 to 2019. Clinical and psychometric methods were used. The level of social functioning was measured with the Personal and Social Performance Scale (PSP). At baseline, 23.8% (n=167) of patients met the criteria of the code F23 and 6.8% (n=35) of the code F25. Two years later the diagnoses were distributed as follows: F25 - 39.96% (n=205) and F21 - 17.4% (n=180). Affective disorders predominated in female patients (women - 23.6%; n=72; men - 18.7%, n=39), schizophrenia spectrum disorders were more frequent in men (81.3%; n=167) compared with women (75.5%, n=156). At the time of admission to the hospital, the number of non-working and non-student patients prevailed (52.4%, n=268). Most of them were female patients (31.5%, n=161). According to PSP, the majority of patients had moderate impairment of social functioning (82.0%) at the start of the study. After 2 years of follow-up, the majority of patients showed mild impairment of social functioning (92.0%). The results obtained indicate a rather favorable variant of the course of endogenous mental disorders over the period studied, which may be due to the volume of complex specialized care provided.

ОСОБЕННОСТИ РЕМИССИИ ПРИ БИПОЛЯРНОМ АФФЕКТИВНОМ РАССТРОЙСТВЕ, АССОЦИИРОВАННОМ С СИНДРОМОМ ЗАВИСИМОСТИ ОТ УПОТРЕБЛЕНИЯ РАСТИТЕЛЬНЫХ КАННАБИНОИДОВ (СРЕДИ ПАЦИЕНТОВ, НАЧАВШИХ УПОТРЕБЛЕНИЕ НА ФОНЕ БИПОЛЯРНОГО АФФЕКТИВНОГО РАССТРОЙСТВА, СТАЖ ЗАБОЛЕВАНИЯ БОЛЕЕ ПЯТИ ЛЕТ)

Bipolar disorder (BD) is a severe mental illness characterized by recurrent episodes of mania, depression, or mixed states. The lifetime prevalence of bipolar disorder across the spectrum is estimated at 2–4% in the general population and is the sixth leading cause of disability worldwide. Cannabis is the most commonly used substance after alcohol and tobacco. Its use increased from 4 to 9.5% between 2020 and 2022, and the prevalence of cannabis use disorders rose from 1.5 to 2.9% over the same period. Among patients with mental disorders, the most common reason for using cannabinoids is to try to alleviate their underlying illness, which is probably achieved in the initial stages of using this type of psychoactive substsance. However, its influence on the course and prognosis of the disease in the long term remains insufficiently studied, which requires a detailed investigation of this problem. For our study, in the period from 2020 to 2022, we selected 104 patients with a diagnosis of bipolar disorder (F31) with a plant cannabinoid addiction syndrome (F12) with a disease duration of more than five years, and the onset of cannabinoid use was noted already amid an established diagnosis of bipolar disorder. The average age in the group was 39 ± 3 years, the distribution by sex was 47% (p &lt; 0.005) — men, 53% (p &lt; 0.005) — women. The study showed that the beginning of the use of plant cannabinoids in a context of BD generally worsens the mental state of patients and, in terms of prognosis, is unfavorable for the course of the disease. This conclusion is confirmed by the complete absence of remission in 2% of patients with an interval of 6 months from the beginning of the study of these patients, the severity of the condition in general, rapid change in the phases of bipolar disorder, and the need to prescribe higher doses of a pharmacological drug. A change in the labor activity of patients was noted — in the primary study we did not register non-working patients; in the study spaced 6 months apart, there were 5% of them; the level of qualification of the work performed in the group as a whole also decreased (employed in highly skilled labor in the primary study — 31%, in the study of this group of patients, this figure decreased to 25%. The motive for using plant cannabinoids was an attempt to alleviate their mental state (73%), 20% of patients noted the motive as “an attempt to experience pleasure”, 7% of patients could not explain the reason for starting cannabinoid use.

Low adherence to treatment is a weak link in the problems of ulcerative colitis

To determine factors of adherence to treatment in patients with ulcerative colitis (UC). The study was performed in the department of treatment of inflammatory bowel diseases in Loginov Moscow Clinical Scientific Center from 2019 till 2021 years by surveying 1089 patients with UC. This analysis revealed patients with high adherence (HAP) and low adherence to treatment (LAP). In the survey analysis was determined, that there were more low-adherence patients, than high-adherence patients [596 (59.6%) and 404 (40.4%), respectively, (p0.001)]. In the group of HAP (100%) were 297 women (73.5%) and 107 (26.5%) men (p0.001). Also in this group prevailed patients with duration of disease more 5 years 305 (75.5%) and extraintestinal manifestations 261 (64.6%); p0.001. In the group of LAP (100%) were more patients younger 44 years, with bad habits and who did not follow diet (p0.001). The rate of UC reccurence more than 1 time per year was higher in LAP group 430 (72.1%), versus 137 (33.9%) patients in HAP (p0.001). The frequency of surgical procedures in UC patients was significantly higher in LAP 12 (2.0%) in comparison with 2 (0.5%) in HAP group (p0.001). In our study was determined, that among UC patients, examined in the department of inflammatory bowel diseases, 60% patients had low adherence to treatment. High adherence to the treatment is statistically significantly associated with female gender, family accommodation, non-working patients, extraintestinal manifestations, additional medical maintenance. Low adherence to the treatment is associated with steroids, male gender, age less than 44 year, bad habits (smoking, alcohol consumption), higher education, complicated UC and frequency of reccurences.

Work status and work ability of patients receiving kidney replacement therapy: results from a European survey.

ABSTRACTBackgroundEmployment is important for the quality of life and financial security of patients of working age receiving kidney replacement therapy (KRT). We aimed to examine self-reported work status and general, physical and mental work ability and to determine associations between demographic, disease-related, work-related and macroeconomic factors and employment. MethodsEuropeans from 37 countries, ages 19–65 years, treated with dialysis or kidney transplantation, filled out the web-based or paper-based cross-sectional EDITH kidney patient survey between November 2017 and January 2019. We performed descriptive analyses and multivariable generalized logistic mixed models.ResultsOf the 3544 patients, 36.5% were employed and working [25.8% of dialysis patients, 53.9% of kidney transplant recipients (KTRs)]. The mean general work ability was 5.5 out of 10 (dialysis: 4.8, KTRs: 6.5). Non-working patients (all: 4.1, dialysis: 3.9, KTRs: 4.7) scored lower than working patients (all: 7.7, dialysis 7.3, KTRs: 8.0). Working dialysis patients scored lower on physical and mental work ability (7.1 and 8.1) than working KTRs (8.0 and 8.4; P < 0.001). Impaired physical work ability (42.7%) was more prevalent than impaired mental work ability (26.7%). Male sex, age 40–49 years, higher education, home dialysis or kidney transplantation as current treatment, treatment history including kidney transplantation, absence of diabetes mellitus, better general work ability and higher country gross domestic product were positively associated with employment (P < 0.05).ConclusionsLow employment rates and impaired work ability were prevalent among European patients receiving KRT. Demographic, disease-related, work-related and macro-economic factors were associated with employment.

Depressive disorders and quality of life in patients with acute coronary syndrome in real clinical practice

Abstract Background The prevalence of depressive disorders has become more significant in recent years. Objective To study the prevalence of depressive disorders using Zung Anxiety Rating Scale (ZARS) in patients with acute coronary syndrome (ACS) in the daily work of the Regional Vascular Center (RVC) in various gender and social subgroups and to compare their severity with the life quality level. Materials and methods The survey included 116 (57 female and 59 male) patients, admitted to RVC with ACS from March to November 2020 (Group I), and 49 patients without ACS, comparable with demographic parameters (Group II). Patients were interviewed with the use of ZARS and the life quality assessment questionnaire (SF-36). Statistical data processing was carried out using Statistica v.13.3, Mann–Whitney U-test, Pearson's chi-squared test, Spearman's rank correlation coefficient. P values &amp;lt;0.05 were considered statistically significant. Results In Group I the score on ZARS was higher or equal to 50 (depression) in 18% of cases: 15% female and 3% male patients (p&amp;lt;0.05). The average score on ZARS was notably higher in women than in men (p&amp;lt;0.05). In Group II depression was detected in 27% of cases, without gender differences. A negative correlation was established for the indicators of ZARS and SF-36: in Group I r=−0.62, p&amp;lt;0.05, in Group II r=−0.76, p&amp;lt;0.05. In Group I indicators of health physical component (SF-36) among women were: physical functioning 50, role functioning 34, general health 51, in men: 80, 58 and 63 respectively (p&amp;lt;0.05). In Group II these indicators significantly differed only in physical functioning: 60 female and 72 male. In Group I depression was observed in 2% of working and in 30% of non-working patients (p&amp;lt;0.05); in Group II: 0% and 34% respectively. In Groups I and II depression was found in 10% and 5% among married, in 31% and 43% among unmarried patients (p&amp;lt;0.05). In Group I depression was detected in 31% among patients with diabetes, in 12% - without diabetes (p&amp;lt;0.05). The other analyzed diseases did not have a significant effect on the depression score. Conclusions The presence of ACS did not effect on the severity of depressive disorders in comparison with patients with other cardiac pathology, but among women with ACS their severity and prevalence was significantly higher. The severity of depressive disorders was inversely associated with life quality. Among patients with ACS, the health physical component according to SF-36 was significantly lower in women than in men; without ACS - no gender differences. Lack of work and marriage negatively affected on the prevalence of depression among all examined patients. Patients with ACS and diabetes had more elevated level of depression; the presence of depressive disorders was in close relationship with the health physical component among women (according to SF-36). It is necessary to develop and implement specialized rehabilitation programs for this subgroup of patients. Funding Acknowledgement Type of funding sources: None.

Non-psychotic depression and the social burden of illness

The burden of depression is increasing worldwide, caregivers are seen as a psychologically vulnerable group, and the social burden of non-psychotic depression remains unexplored.&#x0D; The aim of the study was to examine the clinical and functional characteristics of non-psychotic depression and the burden of family members of patients most involved in the interaction with patients. The study objectives included analysis of quality of life and co-occurring behavior of patients relatives as characteristics of their psychosocial adaptation.&#x0D; Methods. We used clinical and scales assessment of depression level, quality of life, subjective distress level, and coping behavior features.&#x0D; Results. Nonpsychotic depression was detected approximately half a year after the onset of symptoms, and in more than 40% of cases not by psychiatrists, self-treatment was typical. Impairments in social functioning in non-psychotic depression patients affected more in the areas of socially useful activities and social relationships, predominantly in non-working patients. 62.96% of patients rated relationships with loved ones as good, and 82.6% rated support from relatives in connection with the illness as adequate. In 60.87% of cases, there were psycho-traumatic microsocial factors. Spouses (45.5%) prevailed among supportive relatives, of whom 60% were employed, and limitation of labor activity due to the relatives illness was not characteristic, and material losses were insignificant. Supportive relatives more often than their sick relatives assessed the relationship with the sick as good (81.8%). In about 91% of cases, the attitude toward the mental illness of the relative was adequate, which exceeds the subjective assessment of patients with non-psychotic depression. The close relatives of the patients had decreased quality of life, which was mediated by severity of depression, higher than average level of distress related to mental disorder of the loved one (64,59,34 VAS scores). The structure of coping in supportive relatives is characterized on the whole by prevalence of constructive and relatively constructive coping-strategies, the most problematic being the emotional sphere of coping behavior.&#x0D; Conclusion. Even mild to moderate non-psychotic depression is associated with the presence of social burden of illness, covering not only the patients themselves, but also their family members, which necessitates psychologically corrective work with supportive relatives.

Cognitive functions, quality of life in patients with dyscirculatory (vascular) encephalopathy II stage in northerners from the position of ICF

Objective. The aim of the study was to analyze cognitive functions, emotional disorders, the quality of life with the application of the International Classification of Functioning (ICF) in patients with chronic cerebrovascular diseases, dyscirculatory (vascular) encephalopathy II stage in the Komi Republic. Design and methods. In the clinics of the Komi Republic, we examined 126 people (mean age — 65,8 ± 10,1 years; women comprised 76 participants, 60,3 %, p ≤ 0,05) with dyscirculatory (vascular) encephalopathy. Complaints and anamnesis were analyzed, somatic and neurological status, cognitive functions, emotional status, and sleep were assessed. Results. Out of 126 patients, 44,5 % patients are employed (56 people). Among non-working patients with an established group of disability, 35,7 % (in 14,3 % disability 2nd degree (10 people), in 21,4 % — disability 3rd degree (15 people), p ≤ 0,05). Among the workers, 3 people (5,3%) had disability 3rd degree. Hypertension (HTN) I stage was detected in 10,6 %, HTN II stage — in 44,4 %, HTN III stage — in 45 % (p ≤ 0,05); 27,8 % had history of ischemic heart disease, 7,2 % — myocardial infarction, 19,1% — cerebrovascular accident, 8,6% — heart rhythm disturbances, 15,8 % — significant stenosis of the brachiocephalic arteries. Based on memory function assessment by ICF, none demonstrated normal results. Mild cognitive impairment was usually found, and there was no case of dementia. Dysfunction in the domain of blood pressure function was found in all patients. The dysfunction of blood vessels was found in all patients with chronic cerebral ischemia II stage. Daily activities were reduced due to the physical dysfunction. According to the total assessment of health status by the SF-36 scale, the physical and mental components of health were similarly decreased. Conclusions. The SF-36 (questionnaire for assessing the quality of life) and ICF (International Classification of Functioning, Disabilities and Health) complement each other. Cognitive scales are the basic tools for examination of patients with chronic cerebral ischemia, making diagnosis according to ICF, and treating cognitive, physical and emotional disorders in dyscirculatory (vascular) encephalopathy.

P526 Social functioning, work-productivity and psychological assessment in a cohort of patients with inflammatory bowel disease: an observational study

Abstract Background Patients with inflammatory bowel disease (IBD), ulcerative colitis (UC) and Crohn’s disease, claims to suffer a significant hindrance in everyday life, because of the frequency of psychological complaints. The aim of this study was to identify and analyze social functioning, work productivity and psychological assessment in IBD patients and to correlate these parameters with history and activity of the disease. Methods An observational study was performed in 99 IBD patients. Psychosocial data were assessed through the administration of specific questionnaires: Social Functioning Questionnaire (QFS) for monitoring social functioning; Work Productivity and Activity Impairment questionnaire (WPAI) for work productivity; State-Trait Anxiety Inventory (STAI 1,2), for psychological assessment. IBD activity was measured by Partial Mayo score. Student’s t test or Wilcoxon rank sum test were used to compare continuous variables between subgroups and chi-square test to compare categorical variables. Univariate and multivariate linear regression were used, respectively, to assess the relationship between psychosocial and disease characteristics and to compare outcomes with determinant associated results in univariate regression. Results Univariate analysis showed a statistically significant correlation of the overall QFS score with both the level of education (0.6; 95% CI = 0.1–1.2; p = 0.028) and the unemployed status (- 4.5; 95% CI = -8.9- -0.1; p = 0.044). Moreover, the impairment of WPAI was greater in subjects with ulcerative colitis with severe endoscopic activity according with Partial Mayo score (15.5; 95% CI = 1.0–30.0; p = 0.038). Overall impairment in subjects with stable employment correlated with age (- 0.5; 95% CI = -0.9- -0.1; p = 0.010) and was greater in subjects who underwent at least one surgical operation (15.8; 95% CI = 3.0–28.6; p = 0.016). Psychological evaluation showed that state and trait anxiety correlated significantly with Partial Mayo score (respectively 1.8; 95% CI = 0.6–2.7; p = 0.004 and 1.3; 95% CI = 0.1–2.5; p = 0.042) and age (respectively - 0.2; 95% CI = -0.3- -0.1; p = 0.028 and - 0.3; 95% CI = -0.5 - -0.1; p = 0.037). State anxiety increased in case of long-standing illness (- 0.3; 95% CI = -0.5 - -0.1; p = 0.037), while the non-worker status correlated with trait anxiety when compared to paid employment (- 7.0; 95% CI = -0.9–13.1; p = 0.026). Conclusion Social functioning was correlated to the employment status and to the level of education. Work productivity was lower in UC patients with severe activity and who undergone at least one surgery related to IBD. The state of anxiety was related with age, duration and activity of illness, while the trait of anxiety was major in non-worker patients.

ОСОБЕННОСТИ МОТИВАЦИОННО-ПОТРЕБНОСТНОЙ СФЕРЫ БОЛЬНЫХ ЭПИЛЕПСИЕЙ: КЛИНИКО-ПСИХОЛОГИЧЕСКИЙ АСПЕКТ

Epilepsy is a common neuropsychiatric disease in which a number of personality characteristics change. Motivation takes one of the main places in the structure of the patient's personality. Motivation largely determines human behavior, is an important component, since it helps to understand the features and directions of human activity. A motive is an impulse to activity, which is associated with the goal of satisfying the arisen desires. Only by understanding how the patient's motivational-need sphere is arranged, it is possible to determine the patient's role, the degree of his participation in treatment-and-prophylactic measures, as well as influence the formation of motivation, motivate the sick person for educational activities, labor, production activities, etc. The study of the characteristics of the patient's motivational-need sphere is necessary in order to understand how the patient's motivation is formed in the treatment process, how important it is in his life and whether the patient will be able to effectively manage life, enjoy reality, successfully look and plan the future, precisely based on his own motive. That is why the problem of motivation is very relevant at the present time. This work analyzes the features of the motivational-need-related sphere of patients with epilepsy. The study included 317 patients aged 18 to 65 years with focal forms of epilepsy, whose structure was dominated by simple, complex partial seizures. Verification of the diagnosis in the examined patients was carried out on the basis of the results of clinical neurological, psychopathological, pathopsychological, electroencephalographic examination and computed tomography of the brain. The study used a methodology for assessing the level of claims: V. Gerbachevsky's questionnaire. Clinical and psychological research of patients with epilepsy made it possible to substantiate the choice of 2 clusters: the first cluster included able-bodied working patients – n=131 (41.3%), the second cluster - non-working patients – n=186 (58.7%). In the 1st cluster, indicators on the scales "Level of mobilization of efforts", "Regularity of results", "Cognitive motive" prevail, in the 2nd cluster indicators on the scale "Avoidance" prevail. Taking into account the motivational-need-oriented orientation of the patient is an important component in the construction of therapeutic programs aimed at improving the quality of medical care.

A mixed methods analysis of access barriers to dermatology care in a rural state.

To identify significant patient and system access barriers and facilitators to dermatology care in one rural health system with limited dermatology appointment availability. Mixed methods study using data from electronic medical records, patient surveys, stakeholder semi-structured interviews, and service area dermatologist demographics. Retrospective data were collected between 1 January 2017-1 March 2018, and interviews and surveys were conducted between June 1-August 31, 2018. Participants were recruited from two primary care practices in one rural Maine regional health system. Findings from thematic analyses, descriptive statistics, and statistical modelling were integrated using Chi-square tests for homogeneity to develop a unified understanding. Statistical modelling using odd-ratio logistic and linear regression were performed for each outcome variable of interest. Urgent referrals by primary care increased the likelihood of dermatology care overall (OR: 6.771; p=.007) and at nearby sites with limited availability (OR: 4.024; p=.024), but not at geographically further sites with higher capacities (p=.844). Referral under-diagnosis occurred in 20.8% of those biopsied. Older (p=.041) or non-working (p=.021) patients were more likely to remain unevaluated than seek more available but geographically further care. In rural areas with scarce appointment availability, primary care provider diagnostic accuracy may be an important barrier of dermatology care receipt and health outcomes, especially among at-risk populations. Although melanoma mortality rates are decreasing throughout the US, little is known about why rates in Maine continue to rise. This study applied a comprehensive approach to identify several patient and system access barriers to dermatology care in one underserved rural regional health system. While specific to this population and large service area, these findings will inform improvement efforts here and support broader future research efforts aimed at understanding and improving health outcomes in this rural state.