Depressive symptoms during rehabilitation period predict poor outcome of lumbar spinal stenosis surgery: A two-year perspective

<p>Abstract</p> <p>Background</p> <p>Previous research has shown an association between preoperative depressive symptoms and a poorer surgery outcome in lumbar spinal stenosis (LSS). It is not known whether depressive symptoms throughout the recovery period are relevant to the outcome of surgery in LSS. In this prospective clinical study the predictive value of preoperative and postoperative depressive symptoms with respect to the surgery outcome is reported.</p> <p>Methods</p> <p>96 patients (mean age 62 years) with symptomatic lumbar spinal stenosis underwent decompressive surgery. They completed the same set of questionnaires preoperatively and 3 months, 6 months, 1 year and 2 years postoperatively. Depressive symptoms were assessed with the 21-item Beck Depression Inventory. Physical functioning and pain were assessed with the Oswestry Disability Index, the Stucki Questionnaire, self-reported walking ability and VAS rating. Logistic regression analyses were used to examine the predictive value of preoperative and postoperative depressive symptoms regarding the surgery outcome. A "good" outcome was defined in two ways: first, by gaining a 30% improvement in relation to the preoperative disability and pain, and second, by having a score at or below the median value for disability and pain on 2-year follow-up.</p> <p>Results</p> <p>Having elevated depressive symptoms particularly on 3-month follow-up was predictive of a poorer surgery outcome regarding pain and disability: when the outcome was defined as less than 30% improvement from the baseline, the OR's (with 95% confidence intervals) were 2.94 (1.06-8.12), <0.05 for Oswestry and 3.33 (1.13-9.79), <0.05 for VAS. In median split approach the OR was 4.11 (1.27-13.32), <0.05 for Oswestry. Predictive associations also emerged between having depressive symptoms on 6-month and 1-year follow-ups and a poorer outcome regarding disability. The predictive value of elevated depressive symptoms particularly with respect to 2-yeard disability was evident whether the outcome was defined as a 30% improvement compared to the preoperative status or as belonging to the better scoring half of the study population on 2-year follow-up.</p> <p>Conclusions</p> <p>Preoperative and postoperative depressive symptoms may indicate those patients at greater risk of a poorer postoperative functional ability. For these patients, further clinical evaluation should be carried out, especially during postoperative stages.</p

Anticholinergic drug burden tools/scales and adverse outcomes in different clinical settings: a systematic review of reviews

Background: Cumulative anticholinergic exposure (anticholinergic burden) has been linked to a number of adverse outcomes. To conduct research in this area, an agreed approach to describing anticholinergic burden is needed. Objective: This review set out to identify anticholinergic burden scales, to describe their rationale, the settings in which they have been used and the outcomes associated with them. Methods: A search was performed using the Healthcare Databases Advanced Search of MEDLINE, EMBASE, Cochrane, CINAHL and PsycINFO from inception to October 2016 to identify systematic reviews describing anticholinergic burden scales or tools. Abstracts and titles were reviewed to determine eligibility for review with eligible articles read in full. The final selection of reviews was critically appraised using the ROBIS tool and pre-defined data were extracted; the primary data of interest were the anticholinergic burden scales or tools used. Results: Five reviews were identified for analysis containing a total of 62 original articles. Eighteen anticholinergic burden scales or tools were identified with variation in their derivation, content and how they quantified the anticholinergic activity of medications. The Drug Burden Index was the most commonly used scale or tool in community and database studies, while the Anticholinergic Risk Scale was used more frequently in care homes and hospital settings. The association between anticholinergic burden and clinical outcomes varied by index and study. Falls and hospitalisation were consistently found to be associated with anticholinergic burden. Mortality, delirium, physical function and cognition were not consistently associated. Conclusions: Anticholinergic burden scales vary in their rationale, use and association with outcomes. This review showed that the concept of anticholinergic burden has been variably defined and inconsistently described using a number of indices with different content and scoring. The association between adverse outcomes and anticholinergic burden varies between scores and has not been conclusively established

Desmídias filamentosas (Conjugatophyceae) de um lago de inundação de águas pretas na Amazônia Central

Com base em 109 amostras coletadas em diferentes fases do ciclo hidrológico nos anos de 2002 a 2004 no lago Cutiuaú, um ambiente de águas pretas localizado no Parque Nacional do Jaú na bacia do rio Negro, foi realizado um levantamento taxonômico das espécies de desmídias filamentosas. Foram identificadas 15 espécies distribuídas em sete gêneros, sendo Desmidium C. Agardh ex Ralfs, com sete espécies, o gênero que apresentou a maior riqueza específica, incluindo D. quadratum citado pela primeira vez para o estado do Amazonas. O gênero Groenbladia Teiling apresentou três espécies, enquanto os gêneros Bambusina Kützing ex Kützing, Hyalotheca Ehrenberg ex Ralfs, Phymatodocis Nordstedt, Spondylosium Brébisson ex Kützing e Teilingia Bourrelly, apresentaram uma única espécie. Em relação aos períodos do ciclo hidrológico, três táxons foram registrados no período de águas baixas, seis no de vazante, oito no de águas altas e 15, ou seja, todos foram observados no período de enchente.A taxonomic survey regarding the filamentous desmids species was carried out made based on 109 samples collected in different phases of the hydrological cycle between the years of 2002 and 2004 in Cutiuaú lake, an black water system located in Jau National Park in the Negro river basin. A total of 15 filamentous desmids species distributed in seven genera were identified. Desmidium C. Agardh ex Ralfs, with seven species, was the genera with more species richness, being D. quadratum mentioned for first time in Amazonas State. Three Groenbladia Teiling species and one of Bambusina Kützing ex Kützing, Hyalotheca Ehrenberg ex Ralfs, Phymatodocis Nordstedt, Spondylosium Brébisson ex Kützing and Teilingia Bourrelly were registered. In relation to hydrological cycle, three taxa were registered in the low water period, six in the decreasing water period, eight in the high water period and 15, all of identified taxa, in the increasing water period

Levantamento taxonômico de desmídias (Chlorophyta) do lago Novo (Amapá, Brasil): gêneros Staurastrum, Staurodesmus e Xanthidium

Neste estudo são descritas e ilustradas as espécies de três gêneros de desmídias (Staurastrum, Staurodesmus e Xanthidium) do lago Novo, um ambiente localizado na região dos lagos, na planície costeira do Estado do Amapá. Um total de 35 táxons foi registrado, sendo 23 do gênero Staurastrum, sete do gênero Staurodesmus e cinco do gênero Xanthidium. Todos os táxons apresentados neste trabalho constituem primeira citação para o estado do Amapá.This study describes and sketches the species of three desmids genus (Staurastrum, Staurodesmus and Xanthidium) from Lake Novo, located in the coastal plain lake region of Amapá State. In total, 35 taxa were registered, being 23 of Staurastrum, seven of Staurodesmus and five of Xanthidium genus. These results are the first documented taxa registered in the Amapá State

The Pain Disability Questionnaire: a reliability and validity study

The goal of this study was to translate and adapt The Pain Disability Questionnaire (PDQ) to Brazilian Portuguese, as well as to assess its psychometric properties and practicability. The following methodological steps were followed: translation, synthesis, back-translation, expert committee assessment and pre-test. The psychometric properties were assessed through the application of a questionnaire to 119 patients with chronic musculoskeletal disorders. The results indicated the reliability of the instrument, with a Cronbach's alpha coefficient of 0.86, and high stability in the test-retest. A moderate correlation was found between the PDQ scores and the numerical pain scale. Negative correlations were found between the Spitzer Quality of Life Index and the functional condition, psychosocial component and total PDQ score. Construct validity demonstrated significant difference in PDQ scores between symptomatic and asymptomatic individuals. The PDQ revealed fast application and easy understanding. The results indicated a successful cultural adaptation and reliable psychometric properties.El objetivo de este estudio fue traducir y adaptar el Cuestionario The Pain Disability Questionnaire (PDQ) para el portugués de Brasil, evaluando sus propiedades psicométricas y la usabilidad. Fueron seguidos los siguientes pasos metodológicos: traducción, síntesis, retrotraducción, evaluación por un comité de expertos y realización de una prueba piloto. Las propiedades psicométricas fueron evaluadas por la aplicación del cuestionario en 119 pacientes con lesiones musculares. Los resultados indican la confiabilidad del instrumento con el coeficiente alfa de Cronbach de 0,86, y alta estabilidad en la prueba piloto. Una correlación moderada se encontró entre las puntuaciones de la PDQ y la escala numérica del dolor. Correlaciones negativas fueron observadas entre el Spitzer Quality of Life Index y la condición funcional, el componente psicosocial, y la puntuación total de la PDQ. La validez del constructo demostró una diferencia significativa en las puntuaciones del PDQ entre sujetos sintomáticos y asintomáticos. El PDQ demostró ser rápido y comprensible. Los resultados indicaron una exitosa adaptación cultural y propiedades psicométricas confiables.O objetivo deste estudo foi traduzir e adaptar The Pain Disability Questionnaire (PDQ) para o português do Brasil, avaliar suas propriedades psicométricas e praticabilidade. Os seguintes passos metodológicos foram seguidos: tradução, síntese, retrotradução, avaliação por comitê de especialistas e pré-teste. As propriedades psicométricas foram avaliadas pela aplicação do questionário a 119 pacientes com lesões musculoesqueléticas crônicas. Os resultados indicaram a confiabilidade do instrumento com o coeficiente alfa de Cronbach de 0,86, e alta estabilidade na aplicação do teste-reteste. Uma correlação moderada foi encontrada entre os escores do PDQ e a escala numérica de dor. Correlações negativas foram encontradas entre o Spitzer Quality of Life Index e a condição funcional, componente psicossocial e escore total do PDQ. A validade de construto demonstrou diferença significativa nos escores do PDQ entre indivíduos sintomáticos e assintomáticos. O PDQ mostrou aplicação rápida e fácil entendimento. Os resultados indicaram sucesso na adaptação cultural e propriedades psicométricas confiáveis