Wang T, Li Q, Zhang S, et al. Urban-rural disparities in the association between social trust patterns and changes in depressive symptoms: longitudinal evidence from an elderly Chinese population. BMJ Open 2024;14:e086508. doi:10.1136/ bmjopen-2024-086508 This article has been corrected since it was published online. The funding of the paper has been updated from “Funding: This work was supported by the National Natural Science Foundation of China (Grant Number: 71774003) to Weiyan Jian. The funder had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.” to “Funding: This work was supported by the National Natural Science Foundation of China (Grant Number:72174007) to Weiyan Jian. The funder had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript;…
Risultati per: Gestione dei sintomi del tratto urinario inferiore femminili (LUTS - Lower Urinary Tract Symptoms)
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Individuals with Lynch syndrome have similar survival as the general population, but lower than family members without Lynch syndrome
Trial of alginates in throat symptoms: protocol for a pragmatic, multicentre, placebo controlled, double blind, parallel, randomised controlled trial of liquid alginate (Gaviscon Advance) for the treatment of persistent throat symptoms
Introduction
Persistent throat symptoms (PTS) are indicators for over 60 000 new patient referrals to NHS secondary care annually. PTS have been attributed to manifestation of gastro-oesophageal reflux disease (GORD) with the hypothesis that gastric refluxate damages and irritates the mucosa of the upper aerodigestive tract. Symptoms of PTS and GORD are commonly treated with proton pump inhibitors (PPIs) or alginates are often, incorrectly, advocated. The Trial of PPIs in Throat Symptoms trial definitively demonstrated that lansoprazole is no more effective than placebo in treating symptoms of PTS, indicating that empirical PPI treatment for PTS should be discouraged. The impact of this is an anticipated increase in prescriptions of alginates for PTS, however, there is a lack of evidence of the efficacy of alginates in treating this condition. Trial of alginates in throat symptoms aims to compare symptomatic response of the symptoms of PTS in liquid alginate (Gaviscon Advance) in comparison to a near matched placebo over an 8-week period to provide definitive evidence of the use of alginates in treating PTS.
Methods and analysis
This is a multicentre, pragmatic, double blind, parallel, randomised controlled trial. 250 adults with PTS will be recruited from NHS secondary care sites and randomised to either liquid alginate (Gaviscon Advance) or near matched placebo in a 1:1 ratio. The primary objective is to compare the symptomatic response in patients with PTS to liquid alginate (Gaviscon Advance) compared with placebo using the outcome measure of total Reflux Symptom Index questionnaire score at 8 weeks.
Ethics and dissemination
Favourable ethical opinion was received from the East Midlands—Leicester South Research Ethics Committee (reference: 22/EM/0205). All participants will provide informed consent prior to any trial specific activity taking place. Results will be disseminated in peer reviewed publications, at national and international conferences, in peer reviewed journals and to participants and the public (using lay language).
Trial registration number
ISRCTN13949559
Five-year trajectories of symptom severity, physical and mental functioning in patients with persistent somatic symptoms: the PROSPECTS cohort study
Objectives
Knowledge about the long-term course and prognosis of persistent somatic symptoms (PSS) is important to improve clinical decision-making and guidance for patients with PSS. Therefore, we aimed to: (1) identify distinct 5-year trajectories of symptom severity, physical and mental functioning in adult patients with PSS and (2) explore patient characteristics associated with these trajectories.
Design
We used longitudinal data (seven measurements over a 5-year period) of the PROSPECTS study: a prospective cohort of adult patients with PSS. We applied Latent Class Growth Mixture Modelling to identify distinct trajectories for the three outcomes.
Setting and participants
Patients were recruited in general practices and specialised treatment facilities for PSS throughout the Netherlands. The study population consisted of participants with three or more measurements available (n=297).
Primary outcome measures
Symptom severity (Patient Health Questionnaire 15), physical and mental functioning (RAND-36 Physical Component Summary and Mental Component Summary).
Results
For symptom severity, we identified two ‘stable’ trajectories: ‘severe symptoms, stable’ (15.8%) and ‘moderate symptoms, stable’ (84.2%). For physical functioning, we identified three trajectories: ‘poor physical functioning, marked improvement’ (8.5%); ‘poor physical functioning, stable’ (34.7%) and ‘moderate physical functioning, slight improvement’ (56.8%). For mental functioning, we identified three trajectories: ‘poor mental functioning, marked improvement’ (13.9%); ‘moderate mental functioning, deterioration’ (12.2%) and ‘moderate mental functioning, slight improvement’ (73.8%). Patients’ characteristics such as personal, social and environmental background, illness stressors, comorbid diseases, cognitive, emotional and behavioural responses varied for the distinct trajectories.
Conclusions
We identified distinct 5-year trajectories for the three outcomes. Our findings suggest a high prevalence of persistence of symptoms and limited improvement in physical and mental functioning in the majority of patients with PSS. In a small proportion of patients, we identified trajectories that showed considerable physical or mental improvement or deterioration. Patient characteristics differed for the identified trajectories and may guide early recognition, although predictive studies are warranted.
Paucity of viral infection symptoms in patients with immune-mediated inflammatory diseases
Objectives
Although patients with immune-mediated inflammatory diseases (IMID) are thought to be more susceptible to viral infections, it is unclear whether their presentation differs between patients with IMID and healthy controls. This study aimed to investigate the symptom pattern of common viral infections in patients with IMID and compare it with controls without IMIDs.
Design
A cross-sectional study conducted between 1 February and 30 April 2020, using a questionnaire.
Setting
Seven tertiary regional care centers in Germany, which specialised in the care of patients with IMID (namely, in gastroenterology, dermatology, rheumatology and immunology clinical care).
Participants
One thousand nine hundred nine participants completed the survey (757 patients with IMID; 1152 non-IMID controls).
Primary outcome measure
The occurrence of 11 common viral illness symptoms within the preceding 3 months in patients with IMID and non-IMID controls.
Results
Symptom data were clustered, based on number and co-occurrance, into 3 major clusters and 2 subclusters ranked by the average number of symptoms. Patients with inflammatory bowel disease and psoriasis were significantly overrepresented in the lower-frequency subcluster of the polysymptomatic cluster. Patients with rheumatoid arthritis were overrepresented in the lower-frequency subclusters of the intermediate and oligo-/asymptomatic clusters. Controls were over-represented only in the higher-frequency subclusters of each major cluster where none of the IMIDs were over-represented. Spondyloarthritis and other IMIDs were also overrepresented in the low-frequency subcluster, but the results were not significant. Overall, patients with rheumatoid arthritis patients reported fewer symptoms (rate ratio=0.68, 95% CI, 0.59 to 0.80) than non-IMID controls.
Conclusion
Patients with IMID are over-represented in low-frequency subclusters, even among individuals who have reported a broad range of viral infection symptoms. This pattern suggests that the manifestations of viral infections are different between patients with IMID and controls, thus challenging the accurate and early diagnosis of infections.
Relationship between social support and depressive symptoms among internal migrant workers and the mediating role of healthy lifestyle: a cross-sectional study in China
Objectives
To investigate the association between social support and depressive symptoms among internal migrant workers with a focus on the mediating role of a healthy lifestyle.
Design
Cross-sectional study.
Setting
The research was conducted among internal migrant workers in Henan Province, China, in August 2023.
Participants
Internal migrant workers are defined as individuals residing outside their registered household location (excluding mobility within the municipal district) and participating in various social and economic activities, including employment, entrepreneurship and social services.
Primary outcome measures and analyses
Social support was measured using the Chinese version of the social support rating scale. The severity of depression among the study participants was evaluated using the Patient Health Questionnaire-9. A healthy lifestyle was assessed based on the questionnaire we developed based on the American Medical Association Healthy Lifestyle Scale. Statistical analyses, including logistic regression, Spearman’s correlation and mediation analysis, were deployed to explore the associations between social support, healthy lifestyle and depressive symptoms.
Results
Among 19 326 participants, 21.45% exhibited depressive symptoms, with a higher prevalence observed among males. Social support levels among internal migrant workers were found to be lower than those in the general population, and higher social support was significantly associated with a decreased risk of depressive symptoms (OR=0.102, 95% CI: 0.086 to 0.121). Mediation analysis revealed that a healthy lifestyle partially mediated the relationship between social support and depressive symptoms among internal migrant workers, with a mediation effect of –0.063, accounting for 18.75% of the total effect.
Conclusion
This study provides insights into the complex interplay between social support, healthy lifestyle and depressive symptoms among internal migrant workers in China. Implementing interventions aimed at enhancing social support and promoting healthy lifestyle behaviours can significantly improve the mental health and overall well-being of internal migrant workers.
RAPID ONSET ASCITES THAT RAPIDLY RESOLVED WITH URINARY CATHETERIZATION
When Dysuria Is More Than Just a Urinary Tract Infection
This Teachable Moment describes a 66-year-old woman with mild dysuria, vulvar discomfort, and recurrent urinary tract infections.
Health-promoting lifestyles and influencing factors among pregnant women with urinary incontinence: a multicentre cross-sectional study
Objective
Lifestyle modification is an important part of non-surgical treatment for urinary incontinence (UI) and is strongly recommended. This study aims to explore the status and influencing factors of health-promoting lifestyle among pregnant women with UI.
Design
A multicentre cross-sectional study.
Setting
This study was conducted in obstetric clinics of three tertiary-level A hospitals in Zhejiang Province, mainland China.
Participants
A total of 519 pregnant women with UI were enrolled in this study from May 2023 to August 2023.
Outcome measures
Lifestyle Profile Scale for Gravidas with Urinary Incontinence (LPG-UI) was used to assess health-promoting lifestyle status. Multivariate stepwise linear regression analysis was performed to identify significant influence factors.
Results
Most participants reported mild-to-moderate UI, with over 60% experiencing UI starting from the first and second trimesters. The mean score of LPG-UI was 86.74 (SD=12.75) out of a score of 120. The results of multivariate stepwise linear regression analysis showed that those who had better environmental satisfaction (β=0.22, p
Linee guida sulla diagnosi e gestione dell’Alzheimer e disturbi collegati
Ridisegnare la gestione delle malattie croniche a partire dal rischio obesità
La disfunzionalità dell’adipe si riflette sui tessuti arteriosi, cardiaci e renali e queste interconnessioni rappresentano una sfida importante per il Ssn, ma anche un’opportunità per migliorare la presa in cura dei pazienti con patologie complesse
Riccardi, ok Cal a Linee guida gestione Sistema sanitario 2025
Rinviato a metà gennaio voto su piano revisione Rete oncologica
Urban-rural disparities in the association between social trust patterns and changes in depressive symptoms: longitudinal evidence from an elderly Chinese population
Objective
To examine the relationship between social trust and depressive symptoms among China’s elderly, placing special emphasis on the disparities between urban and rural settings.
Design
We employed latent profile analysis to categorise individual patterns of social trust. Subsequently, multiple linear regression analysis was employed to determine if there was an association between these identified social trust patterns and depressive symptoms. Additionally, we examined the potential interactive effects between urban-rural differences and patterns of social trust on depressive symptoms.
Setting
The China Family Panel Studies (CFPS) database.
Participants
The data was sourced from the CFPS for the years 2018 and 2020, encompassing a total of 5645 participants aged 60 and above.
Outcome measures
Depressive symptoms were evaluated employing an eight-item adaptation of the Centre for Epidemiologic Studies Depression Scale. The scores from these eight items were aggregated to create an index of depressive symptoms, which was used to quantify the severity of depressive symptoms.
Results
The findings demonstrate a significant link between patterns of social trust and depressive symptoms, with individuals manifesting high social trust (HST) showing a lower propensity for depressive symptoms (Beta=–2.26, 95% CI=–2.62, –1.92). Furthermore, a marked association is apparent between social trust patterns and the changes in depressive symptoms. Additionally, urban dwellers (Beta=–0.67, 95% CI=–1.23, –0.11) demonstrate a more pronounced correlation between patterns of social trust and depressive symptoms, particularly within the HST group.
Conclusion
Our findings highlight a strong link between social trust patterns and depressive symptoms, particularly regarding their changes. Urbanites, notably within the HST group, show a lower risk of experiencing depressive symptoms. There is an urgent requirement to establish social trust-specific interventions to decrease susceptibility to depressive symptoms among the rural populace.
Cost-effectiveness of metacognitive therapy for cardiac rehabilitation participants with symptoms of anxiety and/or depression: analysis of a randomised controlled trial
Objectives
The burden of cardiovascular disease (CVD) is increasing. Cardiac rehabilitation (CR) is a complex intervention offered to patients with CVD, following a heart event, diagnosis or intervention, and it aims to reduce mortality and morbidity. The objective of this within-trial economic evaluation was to compare the cost-effectiveness of metacognitive therapy (MCT) plus usual care (UC) to UC, from a health and social care perspective in the UK.
Methods
A multicentre, single-blind, randomised controlled trial (ISRCTN74643496) was conducted in the UK involving 332 patients with CR with elevated symptoms of anxiety and/or depression and compared group-based MCT with UC. The primary outcome of the cost-effectiveness analysis was quality-adjusted life-years (QALYs). The time horizon of the primary analysis was a 12-month follow-up. Missing data were imputed using multiple imputation. Uncertainty was explored by probabilistic bootstrapping. Sensitivity analyses tested the impact of the study design and assumptions on the incremental cost-effectiveness ratio.
Results
In the primary cost-effectiveness analysis, MCT intervention was dominant, with a cost-saving (net cost –£219; 95% CI –£1446, £1007) and QALY gains (net QALY 0.015; 95% CI –0.015, 0.045). However, there is a high level of uncertainty in the estimates. At a threshold of £30 000 per QALY, MCT intervention of around 76% was likely to be cost-effective.
Conclusions
Results suggest that intervention may be cost-saving and health-increasing; however, findings are uncertain and subject to limitations. Further research should aim to reduce the uncertainty in the findings (eg, with larger sample sizes) and explore potential longer-term economic benefits associated with MCT in this setting.
Linee guida sulla diagnosi e gestione della MRGE
Permissive Hypotension in Vasodilatory Shock: Is a Lower MAP Better?
A patient-level meta-analysis suggests benefit from lower mean arterial blood pressure goals.