Depression and quality of life of hemodialysis patients living in a poor region of Brazil Depressão e qualidade de vida entre pacientes em hemodiálise de uma região pobre do Brasil

OBJECTIVE: To determine the correlation between depression and quality of life (QOL) of patients in hemodialysis (HD). METHOD: One hundred and sixty six patients over 18 years of age who had been in HD for at least three months and had no history of transplant. QOL was assessed using the SF-36. To categorize depression, a score > 10 was used on the 10-item version of the Center for Epidemiologic Studies Depression Scale (CES-D). Comparisons between depressed and nondepressed patients were performed using the chi-square test, Student's t-test, and Mann-Whitney test. Multiple regression was performed to assess the predictive variables of patients' QOL. RESULTS: Symptoms of depression were found in 13 (7.8%) patients. The only variable that differed among depressed patients was QOL. Depressed patients presented lower scores in vitality (40.7 vs. 57.3; p = 0.010), role-emotional (25.6 vs. 62.5; p = 0.006), and mental health (50.1 vs. 65.4; p = 0.023). Regression analysis demonstrated that depression was a predictor of role-emotional (OR = 0.981, CI = 0.967-0.996; p = 0.010) and mental health (OR = 0.970, CI = 0.946-0.996; p = 0.022). CONCLUSION: Depressed patients experience a poor QOL because, in addition to their chronically affected physical aspects, they also feel limited in the mental dimensions, which usually have the highest score among non-depressed HD patients.<br>OBJETIVO: Determinar a correlação entre depressão e qualidade de vida (QV) de pacientes submetidos à hemodiálise (HD). MÉTODO: Foram estudados 166 pacientes com idade superior a 18 anos, em HD por pelo menos três meses e sem transplante prévio. O nível de QV foi medido pelo questionário SF-36. Para categorizar depressão foi utilizada a versão de 10 itens do Center for Epidemiologic Studies Depression Scale (CES-D; escore > 10). As comparações entre pacientes com e sem depressão foram realizadas pelos testes do qui-quadrado, t de Student e Mann-Whitney. Regressão múltipla foi realizada para testar variáveis preditivas de QV. RESULTADOS: Sintomas depressivos estavam presentes em 13 (7,8%) pacientes. A única variável que diferiu entre os pacientes com depressão foi QV. Pacientes depressivos apresentaram menor pontuação referente a vitalidade (40,7 vs. 57,3; p = 0,010), aspectos emocionais (25,6 vs. 62,5; p = 0,006) e saúde mental (50,1 vs. 65,4; p = 0,023). A análise de regressão demonstrou que depressão foi preditiva de aspectos emocionais (OR = 0,981, IC = 0,967-0,996; p = 0,010) e de saúde mental (OR = 0,970, CI = 0,946-0,996; p = 0,022). CONCLUSÃO: Pacientes com depressão vivenciam um nível baixo de QV porque, além dos aspectos físicos afetados cronicamente, esses pacientes são afetados nas dimensões mentais que costumam ser as dimensões com melhores pontuações entre os pacientes em HD sem depressão

ISSLS Prize in clinical science 2018: Longitudinal analysis of inflammatory, psychological, and sleep-related factors following an acute low back pain episode-the good, the bad, and the ugly

Prospective longitudinal study.To determine whether systemic cytokines and C-reactive protein (CRP) during an acute episode of low back pain (LBP) differ between individuals who did and did not recover by 6\ua0months and to identify sub-groups based on patterns of inflammatory, psychological, and sleep features associated with recovery/non-recovery. Systemic inflammation is observed in chronic LBP and may contribute to the transition from acute to persistent LBP. Longitudinal studies are required to determine whether changes present early or develop over time. Psychological and/or sleep-related factors may be related.Individuals within 2\ua0weeks of onset of acute LBP (N\ua0=\ua0109) and pain-free controls (N\ua0=\ua055) provided blood for assessment of CRP, tumor necrosis factor (TNF), interleukin-6 (IL-6) and interleukin-1β, and completed questionnaires related to pain, disability, sleep, and psychological status. LBP participants repeated measurements at 6 months. Biomarkers were compared between LBP and control participants at baseline, and in longitudinal (baseline/6 months) analysis, between unrecovered (≥pain and disability), partially recovered (reduced pain and/or disability) and recovered (no pain and disability) participants at 6 months. We assessed baseline patterns of inflammatory, psychological, sleep, and pain data using hierarchical clustering and related the clusters to recovery (% change in pain) at 6 months.CRP was higher in acute LBP than controls at baseline. In LBP, baseline CRP was higher in the recovered than non-recovered groups. Conversely, TNF was higher at both time-points in the non-recovered than recovered groups. Two sub-groups were identified that associated with more ("inflammatory/poor sleep") or less ("high TNF/depression") recovery.This is the first evidence of a relationship between an "acute-phase" systemic inflammatory response and recovery at 6 months. High inflammation (CRP/IL-6) was associated with good recovery, but specific elevation of TNF, along with depressive symptoms, was associated with bad recovery. Depression and TNF may have a two-way relationship. These slides can be retrieved under Electronic Supplementary Material