Psychological Morbidity In Patients Research Articles

Impact of Quality and Type of Anticoagulant Treatment, and Inflammatory Biomarkers on Quality of Life and Psychological Morbidity in Patients with Atrial Fibrillation: An Exploratory Study

Background: Owing to increasing worldwide life expectancy, the step rise in the prevalence of atrial fibrillation (AF) represents an urgent public health issue. Indeed, AF can severely affect a patient's quality of life (QoL) since it is associated with serious outcomes, such as stroke, cardiac failure, and cognitive impairment/dementia, resulting in increased morbidity and mortality and a burden for health-care systems. Anticoagulation therapy prevents stroke in individuals with AF, whether with vitamin K antagonists (VKA) or direct oral anticoagulants (DOACs). So far, effective AF management is missing since its etiology is unraveled. Within the research project [Cognitive Decline Risk Profiles and Quality of Life in Atrial Fibrillation: A Longitudinal Study- 2022.072(057-DEFI/058-CE)] a pilot study was conducted to assess a dynamic cohort of AF outpatients who attended the anticoagulation clinic at Santo António University Hospital Center, a Portuguese university public hospital. In this study, QoL, distress and cognitive impairment in patients with AF was assessed considering quality and type of anticoagulant treatment. Methods: With a cross-sectional design, quality of anticoagulation therapy was measured calculating Time in Therapeutic Range (TTR) using Rosendaal method for patients under VKA (TTR>70% as good control); for those patients under DOAC, the presence of plasma therapeutic levels of this drug, taking into account the time of blood sampling, meant an anticoagulant treatment of quality. QoL and distress were assessed by the Atrial Fibrillation Effect on Quality-of-life Questionnaire (AFEQT) and the Depression, Anxiety and Stress Scale (DASS-21), respectively. Cognitive impairment was assessed by the Montreal Cognitive Assessment (MoCA) scale. Data on sociodemographic, clinic [medical history including quality and type of anticoagulation therapy, stroke(CHA2DS2-VASc) and bleeding(HAS-BLED) risk scores, duration of illness) and inflammatory biomarkers were also collected. Results: A total of 62 AF patients were included (mean age 74.4±10.2 years, 59.7% women) with a mean CHA2DS2-VASc of 4.3±1.6 and HAS-BLED of 2.6±1.2. Fifty patients (80.6%) were on VKA and twelve (19.4%) on DOACs (all in apixaban). Those individuals under VKA showed a mean TTR score of 77.1 ± 14.7% (67.4% with a good control) and 11 patients in apixaban presented DOAC therapeutic plasma level. Participants had an illness duration average of 16.02 years±10.62. The mean scores of AFEQT was 2.65 ± .93 showing a good QoL and for MoCA was 21.66 ± 3.90 indicating mild cognitive impairment. Regarding anxiety, depression, and stress (DASS-21) the mean scores were 4.27 ± 4.08, 6.52 ± 4.92 and 7.37 ± 5.37, respectively showing non-clinical psychological morbidity. Patients with higher plasmatic levels of C Reactive Protein (CRP) reported more depression (r= .482; p= .005) and those with a longer illness duration presented a higher level of cognitive impairment, (r= -.398; p= .001). No other associations were found between inflammatory biomarkers and psychological variables. There were significant differences according to sex, age, and illness duration, with women reporting lower QoL (p = .002), higher depression (p = .004), higher stress (p = .005) and older patients (p = .017) as well as patients under VKA and longer disease duration reporting better TTR. (p = .007). No differences were found on patients' QoL (p = .342), anxiety (p = .370), depression (p = .167) and stress (p = .117), cognitive impairment, (p = .084) between good and non-good quality of anticoagulant treatment and between VKA versus DOAC therapy (p = .444). Conclusion: The majority of the patients showed good quality of anticoagulation and QoL, but they revealed mild cognitive impairment. Patients' QoL, distress and cognitive impairment were independent of quality and type of anticoagulation treatment. Older AF patients, particularly those with longer diagnosis, should be assessed for cognitive function on a regular basis, preventing dementia and economic burden. The association of depression with higher levels of CRP in AF patients underlines the nature of these two inflammatory conditions that coexisting associate to worse outcomes. Future studies should assess cognitive function over time to unravel the pathophysiology of cognitive decline and the effect of AF treatments on cognition to optimize and personalize AF therapy.

Psychological morbidity in patients with pemphigus and its clinicodemographic risk factor: A comparative study.

Due to the long disease duration, impact on appearance, social stigmatization, and numerous side effects of treatment, pemphigus, an autoimmune bullous disease, often has a significant psychological impact on patients. On the other hand, mood disorders may exacerbate the disease by affecting the patient's self-management, forming a vicious circle. To investigate anxiety and depressive disorders in patients with pemphigus, a total of 140 patients with pemphigus were recruited for this cross-sectional retrospective study between March 2020 and January 2022. A control group of 118 patients with psoriasis, a commonly known psychosomatic dermatosis, was established. Patients were evaluated at the visiting day with the Beck Anxiety Inventory and Beck Depression Inventory second edition for mood disorders, the Dermatology Life Quality Index and the EuroQol Five Dimensions Questionnaire for disease-related life quality, and the Visual Analogue Scale for pain and itching symptoms. In our cohort, 30.7% of patients with pemphigus suffered from either anxiety disorder (25%) or depressive disorders (14.3%). Propensity score matching was implemented to create a comparable cohort of pemphigus and psoriasis groups considering the baseline discrepancy. Thirty-four comparable pairs of pemphigus and psoriasis patients were extracted. The prevalence and severity of depressive disorder in pemphigus patients were significantly higher than in psoriasis patients, while anxiety disorder levels appeared to be similar in two groups. Multivariate logistic regression analysis further revealed that disease-related hospitalization history, active mucosal damage, and concomitant thyroid disease are independent risk factors for mood disorders in pemphigus patients. Our results showed that pemphigus patients had a high prevalence and severity of mood disorders. Relevant clinicodemographic indicators may be valuable for prediction and early identification of mood disorders in pemphigus. Better disease education from physicians may be important for these patients to achieve overall disease management.

Asian Americans suffer within-community discrimination related to COVID-19

Asian Americans suffer within-community discrimination related to COVID-19

A clinical study on psychological morbidity in patients with major abdominal surgeries

Background: This study focuses on common psychiatric problems that generally surface during post operative period of patients who have undergone major abdominal surgeries and reviews psychiatric issues specific to specialized surgical settings and patients. Aims: To assess the prevalence of psychiatric morbidity among post operative patients who have undergone abdominal surgeries. Study design: Longitudinal prospective study was made on patients who underwent major abdominal surgeries from April 2021 to November 2021. Details of Socio demographic profile were assessed by a semi structured questionnaire A detailed Clinical examination and Mental Status Examination was carried out in the post operative period. Brief Psychiatric Rating Scale (BPRS) by Overall was administered to screen for Psychiatric problems. ICD 10 Classificatory System was used to diagnose Psychiatric disorders Prevalence of Psychiatric morbidity in Post Operative state was calculated. Socio demographic variables were measured. Statistical analyses were done, data interpretation was done and study results were obtained. Results: 131 patients who were qualified for the study during the period between April 2021 and December 2021 were observed for Psychiatric morbidity during their post operative period of their abdominal surgeries. The interview was carried out on the fifth day of their postoperative periods. Conclusion: The service of the Consultation Liasion Psychiatry in General Hospital setting is invaluable and especially in surgical wards, it increases the Quality of care. Identification of factors precipitating Psychiatric morbidity would result in effective formulation of Intervention strategies.

Quality of Life, Social Support, Coping Strategies, and Psychiatric Morbidity in Patients with Rheumatoid Arthritis.

Background and Objectives Patients with rheumatoid arthritis (RA) have greater psychological morbidity, despite that research in this area is scarce from developing countries. This study was aimed to assess the association of quality of life, social support, coping strategies, and psychological morbidity in patients with RA. Materials and Methods In this cross-sectional study, 40 patients with RA, who were not receiving steroids or disease modifying antirheumatic drugs, were recruited through purposive sampling. Social support questionnaire, coping strategy check list, and World Health Organization quality of life-BREF (WHOQOL-BREF) were administered to assess social support, coping, and quality of life, respectively. Results More than half of the patients had psychiatric disorders (60%), with depression being the commonest disorder (52.5%). Internalization coping and disease severity indicators like tender joints counts, swollen joints counts, pain, and disease activity were found as significant predictors for psychiatric disorders, while externalization coping, quality of life (all domains), and physical functions were found to protect against psychiatric morbidity. Conclusions Coping, quality of life, disease severity, and physical functions predicted the psychiatric disorders in RA. Multipronged interventions to enhance quality of life with promoting adaptive coping and timely treatment may further improve their mental health and overall disease course.

Psychological Morbidity in patients with Idiopathic Hirsutism presenting for Laser Treatment at a Tertiary Care Hospital

Objective: The objective of our study was to determine the frequency of depression, anxiety, and stress in females presenting for laser treatment of hirsutism at a dermatology clinic.
 Materials and Methods: This was a cross-sectional descriptive study. 152 female participants of all ages presenting for laser treatment of hirsutism to the dermatology department –removed for blind review--from June 2019 to Dec 2019, were included using a consecutive convenient sampling technique. Patients having an FG (Ferriman and Gallwey) score of 8 or more, were included whereas those having any underlying cause (as assessed by history and examination and laboratory investigations where required) for both hirsutism and psychological disorder were excluded. The participants were given an Urdu version of the DASS 21 (depression, anxiety, and stress scale) to complete.
 Results: The participants had a mean age of 30.22 (SD = 9.17). The prevalence of depression, anxiety, and stress in the sample was found to be 13.2%, 23.7%, and 17.8%, respectively. Mean depression, anxiety, and stress scores on DASS 21 were 4.43(SD=4.87, Cut-off= 10), 4.34(SD=5.12, Cut-off= 8), and 8.21(SD=6.26, Cut-off=15), respectively, indicating that the scores were within the normal range. Anxiety was the most common illness in the sample and both depression and stress showed a decline with advancing age up till 45years of age. No statistically significant association was found between the severity of hirsutism and depression, stress, and anxiety scores.
 Conclusion: Psychological morbidity was found to be lower in patients of idiopathic hirsutism presenting for laser treatment. The long-term efficacy of laser treatment needs further evaluation in future research.

Fatigue, perceived stigma, self-reported cognitive deficits and psychological morbidity in patients recovered from COVID-19 infection.

BackgroundFew studies have highlighted multiple psychosocial and physical outcomes in patients with COVID-19 infection after recovery. However, the data from developing countries is limited.AimTo evaluate psychological morbidity, post-traumatic stress disorder (PTSD), fatigue, and perceived stigma among patients with COVID-19 after recovery from the acute phase of COVID-19 infection.MethodsIn a cross-sectional online survey, 206 adult patients (age>18 years), recovered from COVID-19 infection completed the Patient Health Questionnaire-4 (PHQ-4), the Impact of Events Scale-Revised (IES-R), Fatigue Severity Scale (FSS), 4 items self-designed questionnaire evaluating cognitive deficits and self-designed questionnaire to evaluate perceived stigma. Additionally, they completed the information about demographic and clinical information.ResultsThe prevalence of anxiety, depressive symptoms, and PTSD in the study sample was 24.8 %, 23.8 %, and 30 % respectively. About three-fifths of the participants (61.2 %) had at least one fatigue symptom as per the FSS with the mean FSS score being 32.10 ± 15.28. About one-fourth of the participants (23.7 %) reported “feeling confused and always feeling mentally foggy”, and 38 % of patients reported experiencing at least one cognitive problem. The level of felt stigma related to self was seen in 31.1 %, 20 % reported stigma related to family, and 50 % reported stigma in relation to neighbors and society. Those reporting higher PTSD scores had higher anxiety and depressive scores, reported more fatigue and stigma, and had a higher level of cognitive deficits. A higher fatigue score was also associated with higher anxiety, depression, and cognitive deficits.ConclusionsOur study reveals that a significant proportion of patients after recovery from COVID-19 experience psychological morbidities, fatigue, cognitive problems, and stigma. Efforts should be made to take care of these issues in routine post-COVID follow-up care.

Neuroinflammation, epilepsy and psychological morbidity in patients undergoing surgery for intracranial meningioma

Neuroinflammation, epilepsy and psychological morbidity in patients undergoing surgery for intracranial meningioma

Validation of the Distress Thermometer in patients with advanced cancer receiving specialist palliative care in a hospice setting

Background: Ongoing assessment of psychological reaction to illness in palliative and end of life care settings is recommended, yet validated tools are not routinely used in clinical practice. The Distress Thermometer is a short screening tool developed for use in oncology, to detect individuals who would benefit from further psychological assessment. However the optimal cut-off to detect indicative psychological morbidity in patients with advanced cancer receiving specialist palliative care is unclear. Aim: To provide the first validation of the Distress Thermometer in an advanced cancer population receiving specialist palliative care in a UK hospice setting. Design: Receiver Operating Characteristics analysis was used to compare the sensitivity and specificity of cut-offs indicative of psychological morbidity on the Distress Thermometer in comparison to the Hospital Anxiety and Depression Scale. Setting/Participants: Data were derived from 202 patients with advanced cancer who were approached on admission to inpatient or day hospice care, with 139 patients providing complete data on both measures. Results: The area under the curve was optimal using a Distress Thermometer cut-off score of ⩾6 for total distress and for anxiety, and a cut-off score of ⩾4 optimal when screening for depression. Conclusions: The Distress Thermometer is a valid, accurate screening tool to be used in advanced cancer but with caution in relation to the lack of specificity. With little variation between the area under the curve scores, arguably a Distress Thermometer cut-off score of ⩾5 is most appropriate in screening for all types of psychological morbidity if sensitivity is to be prioritised.

Psychological morbidity among children with transfusion dependent β-thalassaemia and their parents in Sri Lanka.

Thalassaemia is a chronic disease which requires lifelong treatment in a majority. Despite recent advances in the medical care, minimal attempts are made to improve psychological health in these patients. In this study, we aim to describe the psychological morbidity in patients with transfusion dependent β-thalassaemia and their mothers in Sri Lanka. This case control study was conducted in the three largest thalassaemia centres of Sri Lanka. All patients with transfusion dependent β-thalassaemia aged 4-18 years were recruited as cases whilst a randomly selected group of children without chronic diseases were recruited as controls. Psychological morbidity of children was assessed using the Strengths and Difficulties Questionnaire and depressive symptoms of mothers was assessed by the Centre for Epidemiological Studies Depression Scale. 288 transfusion dependent β-thalassaemia patients and equal number of controls were recruited. Abnormal emotional, conduct, hyperactivity and peer relationship symptom scores were reported by 18%, 17%, 9% and 14% of patients with thalassaemia respectively. Prevalences of abnormal psychological symptom scores in all domains were significantly higher among patients compared to controls. Abnormal conduct symptoms were significantly more prevalent among patients with HbE β-thalassaemia and those with suboptimal pretransfusion haemoglobin levels, lower transfusion volumes, hypothyroidism and undernutrition. Short stature was associated with abnormal emotional and hyperactivity scores. Depressive symptoms were significantly higher among mothers of patients with thalassaemia. Higher depressive symptom scores in mothers were significantly associated with abnormal emotional, conduct and peer relationship symptom scores in children. A higher proportion of patients with transfusion dependent β-thalassaemia had abnormal psychological symptom scores. Abnormal conduct symptoms were more prevalent among patients with HbE β-thalassaemia, those who were inadequately transfused and having hypothyroidism and undernutrition. Mothers of the children with transfusion dependent β-thalassaemia had significantly higher depressive symptoms which were significantly associated with psychological symptoms among children.

Defining the Supportive Care Needs and Psychological Morbidity of Patients With Functioning Versus Nonfunctioning Neuroendocrine Tumors: Protocol for a Phase 1 Trial of a Nurse-Led Online and Phone-Based Intervention.

BackgroundOnline information resources and support have been demonstrated to positively influence the well-being of people diagnosed with cancer. This has been explored in past literature for more common cancers; however, for rare cancers, such as neuroendocrine tumors (NETs), there are little to no support or resources available. Despite relatively good prognoses, the quality of life (QoL) of patients with NETs is significantly lower compared with samples of mixed cancer patients and the general population. Patients with NETs also typically report unclear and difficult pathways of disease management and treatment, given the heterogeneity of the diagnosis. There is a vital need to improve the availability of disease-specific information for this patient group and provide supportive care that is tailored to the unique needs of the NET patient population.ObjectiveThis study described the protocol of a study aimed to better understand the outcomes and experiences of patients diagnosed with NETs and to develop and pilot test a nurse-led online and phone-based intervention that will provide tailored supportive care targeted to NET subgroups (functioning vs nonfunctioning).MethodsThis is a multisite cohort with 3 phases, incorporating both quantitative and qualitative data collection. Phase 1 is a mixed methods prospective cohort study of NET patients identifying differences in patient experiences and priority of needs between NET subgroups. Phase 2 utilizes results from phase 1 to develop an online and nurse-led phone-based intervention. Phase 3 is to pilot test and evaluate the intervention’s acceptability, appropriateness, and feasibility.ResultsCurrently, the project is progressing through phase 1 and has completed recruitment. A total of 138 participants have been recruited to the study. To date, patient-reported outcome data from 123 participants at baseline and 87 participants at 6-month follow-up have been collected. Of these, qualitative data from semistructured interviews from 35 participants have also been obtained. Phase 2 and phase 3 of the project are yet to be completed.ConclusionsLimited research for patients with NETs suggests that QoL and patient experiences are significantly impaired compared with the general population. Furthermore, past research has failed to delineate how the clinical variability between those with functioning and nonfunctioning NETs impacts patient supportive care needs. This study will improve on the availability of disease-specific information as well as informing the design of a nurse-led online and phone-based supportive care intervention tailored for the unique needs of the NET patient population.International Registered Report Identifier (IRRID)DERR1-10.2196/14361

Quality of life and psychological morbidity in patients with superficial cutaneous dermatophytosis.

We are facing an onslaught of chronic and recurrent dermatophytosis in epidemic proportions never encountered previously. There is a dearth of studies assessing the quality of life (QoL) and psychological morbidity in patients with superficial dermatophytosis. Our aim was to assess QoL and psychological morbidity in a sample of Indian patients suffering from dermatophytosis by using Dermatology Life Quality Index (DLQI) questionnaire and General Health Questionnaire (GHQ), respectively. This was a single-centre, cross-sectional study where consecutive patients of first episode, chronic or recurrent dermatophytosis were invited to participate. In addition to DLQI and GHQ12, patients' demographic data, duration and symptoms of dermatophyte infection, were also documented and recorded in the case record form. We recruited 196 patients who satisfied the inclusion criteria. The mean total DLQI score was 13.41±7.56 (range 0-30). The main items in the questionnaire influenced by the disease were "symptoms and feelings," followed by "daily activities," "leisure" and "personal relationships." Age of the patient and body surface area involved had a significant impact on the QoL in our study (P≤0.05). The mean GHQ-12 score was 16.98; 84.9% of patients had a score higher than or equal to 12 indicating significant psychological distress. GHQ-12 was found to have significant correlation with the DLQI score. Quality of life issues and psychosocial aspect should be considered while managing dermatophytosis as education about the disease, its management and prognosis may go a long way in improving the adherence to treatment and overall outcome in these patients.

Medical and Psychological Morbidity of Patients with Urogenital Fistula

Aim: This study aimed to determine the frequency of medical and psychological morbidity of patients with urogenital fi stulae.
 Methods: It was a descriptive study carried out at Liaquat University Hospital and Isra University Hospital, Hyderabad, Pakistan from 01/06/2007 to 30/06/2018, where 520 patients with urogenital fi stulae were managed. A pre-designed proforma was used to record the details about medical and psycho-social consequences. Data was analyzed, and results were described as frequency and percentages.
 Results: Among 16759 gynecological admissions, 520 (3.1%) were confi rmed cases of urinary fi stulae. Average age of patients was 31±2.8 years and average parity was 3±2.4. Regarding health consequences, all patients had major degree depression. Majority (88%) of the patients were malnourished. Severe excoriation of vulva and inner thighs was seen in 338 (65%) patients. Vaginal stenosis, vaginal and vesical calculi were other medical problems. Almost all (n= 511, 98%) patients were found to be socially isolated. 62% patients kept themselves restricted to home, with avoidance of family gatherings and travelling. Marital breakdown seen in 81% (n=241). 90% of patients quit their job. Majority of them suff ered social, verbal or physical abuse.
 Conclusions: Patients with urogenital fi stulae not only havesurgical morbidity, they also do suff er from signifi cant medical and psychosocial morbidity. There is a defi nite need to address these under-looked miseriesby a devoted fi stulae team working in collaboration with social workers, religious leaders and healthcare providers.

The medical and psychological morbidity of patients with urogenital fistulae

Aims: To analyze the frequency of medical and psychological morbidity of patients with urogenital fistulae. There are many complications related to childbirth and gynaecological surgeries. Urogenital fistula is one of the worst complications. The women suffer from significant medical and psychological morbidity. These issues need to be addressed at every forum.
 Methods: A descriptive study was carried out at Liaquat University Hospital and Isra University Hospital Hyderabad Pakistan from 01/06/2007 to 30/06/2018. 520 patients with urogenital fistulae were managed. A pre-designed performa was used to record the details about medical and psycho-social consequences. Data was analyzed, results were described as frequency and percentage.
 Results: During the study period 520 confirmed cases of urinary fistulae were managed. Regarding psychological health all (100%) patients had major degree depression. 511 (98%) patients were found socially isolated. 458 (88%) patients were malnourished. 338 (65%) had severe excoriation of vulva, bladder and vaginal calculi were present 25 (4.8%) patients. Majority of the patients were suffered social, verbal and physical abuse.
 Conclusions: Patients with urogenital fistulae are not only having the surgical morbidity but they do suffer significant medical and social morbidity. There is a definite need to address these under looked miseries by a devoted fistulae team work in collaboration with social workers, religious leaders and healthcare providers to bring life back to these patients.

Causal Attributions, Social Support and Psychological Morbidity in Patients Undergoing Thyroid Surgery

Causal Attributions, Social Support and Psychological Morbidity in Patients Undergoing Thyroid Surgery

Altered neural processing of emotional faces in remitted Cushing's disease

Patients with long-term remission of Cushing's disease (CD) demonstrate residual psychological complaints. At present, it is not known how previous exposure to hypercortisolism affects psychological functioning in the long-term. Earlier magnetic resonance imaging (MRI) studies demonstrated abnormalities of brain structure and resting-state connectivity in patients with long-term remission of CD, but no data are available on functional alterations in the brain during the performance of emotional or cognitive tasks in these patients. We performed a cross-sectional functional MRI study, investigating brain activation during emotion processing in patients with long-term remission of CD. Processing of emotional faces versus a non-emotional control condition was examined in 21 patients and 21 matched healthy controls. Analyses focused on activation and connectivity of two a priori determined regions of interest: the amygdala and the medial prefrontal-orbitofrontal cortex (mPFC-OFC). We also assessed psychological functioning, cognitive failure, and clinical disease severity. Patients showed less mPFC activation during processing of emotional faces compared to controls, whereas no differences were found in amygdala activation. An exploratory psychophysiological interaction analysis demonstrated decreased functional coupling between the ventromedial PFC and posterior cingulate cortex (a region structurally connected to the PFC) in CD-patients. The present study is the first to show alterations in brain function and task-related functional coupling in patients with long-term remission of CD relative to matched healthy controls. These alterations may, together with abnormalities in brain structure, be related to the persisting psychological morbidity in patients with CD after long-term remission.

Does the degree of ptosis predict the degree of psychological morbidity in bariatric patients undergoing reconstruction?

There is proven therapeutic benefit in bariatric surgery for obese patients. Successful bariatric surgery will result in massive weight loss and ptotic skin, which can cause significant functional and psychological problems. As the incidence of bariatric surgery increases, so will the demand for plastic surgery. Currently, there is no evidence-based indication for massive weight loss body contouring, and therefore there is no standardized provision. A prospective, multicenter, observational study of outcomes in 75 patients undergoing bariatric and plastic surgery procedures at two clinical sites was performed to determine whether the degree of ptosis can be determined by the type (malabsorptive or restrictive) of bariatric surgery and if the extent of disfigurement has an impact on psychological morbidity. Massive weight loss body contouring is not purely aesthetic surgery, but it leads to functional and psychosocial benefits. This study has given preliminary data on which anthropometric measurements and their thresholds lead to the greatest benefit from massive weight loss body contouring. From this study, the fourth quartiles of the anthropometric measurements xiphisternum to pubic symphysis (≥91 cm), umbilicus to pubic symphysis (≥38 cm), and hip circumference (≥143 cm) were statistically significant in crossing the psychometric tolerances from within the normal range to pathological psychology. This study demonstrates that there is a statistically significant, quantifiable correlation among type of bariatric surgery, degree of ptosis, and psychological morbidity in patients who have undergone bariatric surgery. This pilot study could provide the basis for evidence-based guidelines for plastic surgery referral.

This issue of ACTA, printed and electronic

The illustration on the cover shows virtual reality cataract surgery, which is discussed by Selvander and Åsman in this issue of ACTA. Prokofyeva et al. in Germany and Belgium review the potential prevention of cataracts in Europe. Risk factors for cataract include smoking, diabetes, asthma and cardiovascular disease. Heijl et al. in Sweden, Germany and the UK find visual field progression in patients with glaucoma to be variable and frequently rapid enough to influence quality of life. Andersson et al. in Sweden tested an artificial neural network and found this to equal physicians in the assessment of visual fields in glaucoma. Kok et al. in the Netherlands show that cataracts influence the estimation of retinal nerve fibre layer thickness with OCT. Martinez-de-la-Casa et al. in Spain recommend tissue glue to close conjunctiva after trabeculectomy. Rii et al. in Japan discuss childhood-onset optic disc pit maculopathy following blunt ocular trauma. Hamoudi et al. in Denmark report a small change in refraction following pars plana vitrectomy. Burstedt et al. in Sweden describe genotype–phenotype in Bothnia-type retinitis pigmentosa. Gustavsson et al. in Sweden found signs of intraocular inflammation in proliferative diabetic retinopathy, but less so in patients with no or nonproliferative retinopathy. Immonen et al. in Finland conclude that telomere length is not associated with exudative AMD or high-risk drusen. Matsuba et al. in Japan used 3D-CT to localize intraocular foreign body. Molvær et al. in Denmark use computer models to localize stem cells in the corneal limbal region. Koranyi et al. in Sweden recommend cut and paste method for surgery of pterygium. Selvander and Åsman in Sweden recommend a virtual reality training system for cataract surgery. Cornut et al. in France found that initial visual acuity predicts outcome in post-traumatic endophthalmitis. Nangia et al. in India and Germany found undercorrected refractive errors to be a major cause of visual impairment in India. Sveinn Hakon Hardarsson in Iceland presents his PhD thesis on retinal oximetry, which is published as an electronic supplement to the journal. The following publications are published in the electronic portion of ACTA and are available on www.actaophtalmologica.com, as are all publications in ACTA Ophthalmologica. Scanlon et al. in the UK demonstrate that the risk of progression of diabetic retinopathy is significantly higher for patients with diabetic retinopathy in both eyes compared with those who have retinopathy in one or neither eye. Bezatis et al. in Germany found that Ozurdex improves vision and reduces macular oedema in retinal vein occlusion. Pemp et al. in Romania and Austria found increased vessel diameters in the retina of patients with type 1 diabetes and no or mild retinopathy. Nishi et al. in Japan suggest that contrast and functional visual acuity may detect early visual disturbance in patients with epiretinal membranes. Yang et al. in China and Germany report choroidal vascular engorgement in patients with central serous chorioretinopathy. Linke et al. in Germany report similar results in both eyes in 12500 patients undergoing refractive surgery. Ling et al. in China found that doxycycline reduced angiogenesis and inflammation in alkali-burned mouse corneas. Mansouri et al. in USA found only modest intragrader reproducibility in evaluating parapapillary atrophy. Häntzschel et al. in Germany examined the correlation between structural damage to optic nerve and visual field and found this to be less prominent in normal tension than high tension glaucoma. Mastropasqua et al. in Italy found increased density of conjunctival goblet cells in patients treated with preservative-free tafluprost. Kim et al. from Korea found the I-care tonometer to be reliable and give slightly higher IOP readings than Goldman tonometry. Dimitrova et al. in Macedonia and Japan comment on the paper by Stalmans et al. on blood flow and body posture. Rencová et al. in Czech Republic report that rheohemapheresis reduces drusenoid retinal pigment epithelium detachment. Comez et al. in Turkey recommend evisceration with cornea preservation. Yoshikawa et al. in Japan suggest that blocking vascular adhesion protein suppresses neovascularization. Mattila et al. in Finland used corneal cross-linking to treat pseudomonas keratitis. de Geus et al. in the Netherlands found little help in changing from bevacizumab to ranibizumab in unresponsive patients. Bailie et al. in the UK report significant visual and psychological morbidity in patients with optic atrophy. I wish you all a warm and happy summer.

The mediator role of psychological morbidity in patients with chronic low back pain in differentiated treatments

This study analyzed the mediating role of psychological morbidity and the variables that discriminated low versus high disability, in patients receiving physiotherapy and acupuncture. A total of 203 patients answered measures of illness and medication representations, coping, depression, anxiety, quality of life, and functional disability. Morbidity was a mediator between functional disability and quality of life. Treatment consequences and quality of life, in the acupuncture group, and emotional representations, quality of life, depression, anxiety, and active strategies for pain relief, in the physiotherapy group, discriminated patients with low versus high disability. These results have important implications for identifying high-risk patients.

Waiting for thyroid surgery: A study of psychological morbidity and determinants of health associated with long wait times for thyroid surgery

Patients with thyroid pathology tend have longer surgical wait times. Uncertainty during this wait can have negative psychologically impact. This study aims to determine the degree of psychological morbidity in patients waiting for thyroid surgery. Prospectively assessing patients pre- and postoperative psychological morbidity (level 2c). Patients waiting for thyroidectomy were mailed a sociodemographic and four psychological morbidity questionnaires: Impact of Events Scale-Revised (IES-R), Illness Intrusiveness Ratings Scale (IIRS), Perceived Stress Scale (PSS) and Hospital Anxiety and Depression Scale (HADS). We assessed whether anxiety was related to length of wait and a number of clinical/sociodemographic factors. We achieved a 53% response rate over a 3-year period, with 176 patients providing complete preoperative data; and 74 (42%) completed postoperative data. The average age was 53 (± 12) years; 82% were female. Respondents with a suspicious or known malignancy waited an average of 107 days while those with benign neoplastic biopsies waited an average of 218 days for thyroidectomy. Respondents reported substantial psychological morbidity with high IES-R, IIRS, PSS, and HADS scores. There was no significant association between psychological morbidity and wait times, clinical or sociodemographic factors. Postoperative anxiety decreased significantly in all psychological morbidity measures except for the IIRS. Patients waiting for thyroid surgery have mild to moderate psychological morbidity and long wait times for surgery. These appear not to be related. Psychological morbidity decreases after surgery. Reducing wait time can potentially reduce the time that patients have to live with unnecessary stress and anxiety.