Stress Management in Women with Hashimoto’s thyroiditis: A Randomized Controlled Trial

Aim: Stress has been implicated in the pathogenesis of Hashimoto's thyroiditis (HT), nevertheless evidence is scarce regarding the effect of stress management on individuals suffering from HT. The purpose of this study was to evaluate the impact of an 8-week stress management intervention on the anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-TG) antibodies as well as thyroid-stimulating hormone (TSH) levels of women with HT. Secondary endpoints included the effect on the patients’ lifestyle, body mass index (BMI), depression, anxiety and stress. Methods: This was a two-arm parallel group (stress management intervention vs. standard care groups) randomized controlled study. Adult women with Hashimoto's thyroiditis, completed questionnaires on stress, anxiety, depression and lifestyle, at the beginning of the programme and 8 weeks later. Laboratory thyroid function tests (anti-TPO, anti-TG antibodies and TSH) were also measured at baseline and at the end of the study. Results: A total of 60 women with HT, aged 25-76 years, participated in the study (30 patients in each group). After eight weeks, patients in the intervention group demonstrated statistically significant beneficial decrements in the rate change of anti-TG titers and the levels of stress, depression and anxiety as well as better lifestyle scores, compared to the control group.   

Impact of anti-hypertensive medication on quality of life and mental health in essential hypertension

Background: Patients with chronic conditions like hypertension may experience many negative emotions which increase their risk for poor quality of life as well as the development of anxiety and depression symptomatology. However our knowledge about the potential effects of factors such as psychological characteristics, clinical characteristics and medication that associated with this phenomenon is still elusive and debatable.Aims: This study aims to investigate the possible link among dimensions of depressive symptoms, psychopathology and quality of life in essential hypertension. We examine also whether anti-hypertensive medication impacts on depressive symptoms, psychopathology and quality of life in a sample of hypertensive patients.Methods: A hybrid of both cross-sectional and prospective design was performed. A sample of 197 patients (89 men - 108 women, mean age 53 years, SD = 12 ranged 25-78) with a newly diagnosis of essential hypertension was recruited from an outpatient hypertension clinic of a university hospital in Greece. The questionnaires included at baseline (T1): a) question for the recording of social-demographic characteristics and clinical features, b) The Short Form 36 (SF-36) General Health Survey questionnaire, c) the Beck Depression Inventory –II (BDI-II), d) The Symptom Checklist-90-Revised (SCL-90-R) e) The Eyesenck Personality Questionnaire (EPQ) andf) The Cardiac Anxiety Questionnaire (CAQ-10GR). Οne hundred twenty four participants completed the SF-36, BDI-II, SCL-90-R and EPQ again one year later (T2).Results: Lower levels of quality of life and higher levels of depression, psychopathology and cardiac anxiety (cardiophobia) were observed. Linear regression models found that for psychical health component cardiophobia (Beta=-.36), dyslipidaemia (Beta=.32), somatization (Beta=.3), paranoid ideation (Beta=.3), duration of disease (Beta=-.25), avoidance activities (Beta=-.16), CRP (Beta=.14) and depression(Beta=.13) were associated on levels of quality of life in hypertensive patients after controlling for age and other socio-demographic variables and clinical characteristics For mental component summary cardiophobia (Beta=-.56), somatization (Beta=.54), depression (Beta=-.44), dyslipidaemia (Beta=-.38), duration of disease (Beta=-.37), obsessive-compulsive (Beta=-.32), paranoid ideation (Beta=.29), introversion (Beta=.21), and CRP (Beta=.16) had also impact on mental health in hypertensive patients. Paired t tests showed that there were not significant differences on the psychological measures from baseline to one-year follow-up with exception on phobic anxiety (p=.05).Conclusions: Quality of life is associated with depression and anxiety symptoms in the case of hypertension. Heart focused anxiety symptoms - as avoidance activities and/or attention and monitoring cardiac activity, as well as dyslipidaemia and CRP may be mechanisms linking hypertensive patients’ present deteriorated depressive symptoms and levels of quality of life. The biological effect of clinical features is outlined. Finally, our findings do not support that anti-hypertensive medication has any impact on depression, general psychopathology and quality of life scores. The adoption of the perception of illness may contribute to higher levels of phobic anxiety after one year follow up.Εισαγωγή: Ασθενείς με χρόνιες καταστάσεις όπως η ιδιοπαθής υπέρταση βιώνουν αρνητικά συναισθήματα τα οποία τελικά επιβαρύνουν την συνολική ποιότητα ζωής αυτών των ασθενών και επιπλέον ενισχύουν την ανάπτυξη άγχους και καταθλιπτικής συμπτωματολογίας. Παρόλα αυτά η υπάρχουσα γνώση για το ρόλο των ψυχολογικών παραγόντων και της φαρμακευτικής αγωγής σε συνδυασμό με τα κλινικά χαρακτηριστικά της νόσου, είναι ακόμα ελλιπής και υπό συζήτηση.Σκοπός: Η παρούσα μελέτη αποσκοπεί στη διερεύνηση της πιθανής διασύνδεσης ανάμεσα στα καταθλιπτικά συμπτώματα, την ψυχοπαθολογία και την ποιότητα ζωής στην ιδιοπαθή υπέρταση. Επιπλέον εξετάζει εάν η αντιυπερτασική αγωγή επιδρά στην στους παραπάνω ψυχο-κοινωνικούς παράγοντες στο δείγμα των ασθενών της μελέτης, Methods: Χρησιμοποιήθηκε ένα υβριδικό συγχρονικό-προοπτικό ερευνητικό μοντέλο. Το δείγμα της μελέτης αποτέλεσαν 197 ασθενείς (89 άνδρες - 108 γυναίκες, μέση ηλικία 53 χρόνια, τυπική απόκλιση = 12 με εύρος 25-78) με νεοδιαγνωσμένη ιδιοπαθή υπέρταση, που συγκεντρώθηκαν από το εξωτερικό ανιτυπερτασικό ιατρείο ενός πανεπιστημιακού νοσοκομείου των Αθηνών. Τα παρακάτω ερωτηματολόγια χρησιμοποιήθηκαν για την αρχική μέτρηση (T1): α) ερωτηματολόγιο κοινωνικο-δημογραφικών κα κλινικών χαρακτηριστικών, β) η Επισκόπηση Υγείας SF-36, γ) η Κλίμακα Κατάθλιψης του Beck (BDI-II), δ) η Κλίμακα Ψυχοπαθολογίας SCL-90-R ε) Ερωτηματολόγιο Προσωπικότητας Ενηλίκων (EPQ) και στ) την Κλίμακα Μέτρησης Άγχους για την Καρδιακή Λειτουργία (CAQ-10GR). Εκατόν είκοσι τέσσερις συμμετέχοντες συμπλήρωσαν τα ερωτηματολόγια SF-36, BDI-II, SCL-90-R και EPQ μετά από ένα χρόνο θεραπείας. (T2).Αποτελέσματα: Παρατηρήθηκαν χαμηλά επίπεδα στην ποιότητα ζωής και υψηλά επίπεδα στην ψυχοπαθολογία μεταξύ των υπερτασικών ασθενών. Τα μοντέλα της ανάλυσης παλινδρόμησης έδειξαν πως για την φυσική διάσταση της ποιότητας ζωής η καρδιοφοβία (Beta=-0,36), η δυσλιπιδαιμία (Beta=0,32), η σωματοποίηση (Beta=0,3), ο παρανοειδής ιδεασμός (Beta=0,3), η διάρκεια νόσου (Beta=-0, 25), η αποφυγή δραστηριοτήτων (Beta=-0,16), ο δείκτης φλεγμονής CRP (Beta=0,14) και η κατάθλιψη (Beta=0,13) συσχετίστηκαν στατιστικά σημαντικά με αυτή τη διάσταση της ποιότητας ζωής μετά από τον έλεγχο για την ηλικία και άλλους κοινωνικό-δημογραφικούς παράγοντες. Αναφορικά με την ψυχική διάσταση της ποιότητας ζωής τα αποτελέσματα έδειξαν πως η καρδιοφοβία (Beta=-0,56), η σωματοποίηση (Beta=0,54), η κατάθλιψη (Beta=-0,44), η δυσλιπιδαιμία (Beta=-0,38), η διάρκεια της νόσου (Beta= -0,37), ο ιδεοψυχαναγκασμός (Beta=-0,32), ο παρανοειδής ιδεασμός (Beta=0,29), η εσωστρέφεια (Beta=0,21), και ο δείκτης φλεγμονής CRP (Beta=0,16) έχουν στατιστικά σημαντική επίδραση στην ψυχική υγεία στους υπερτασικούς ασθενείς. Δεν ανιχνεύτηκαν στατιστικά σημαντικές διαφορές στις διαστάσεις της ποιότητας ζωής και της ψυχικής υγείας μεταξύ της αρχικής μέτρησης και ένα χρόνο μετά τη ρύθμιση της φαρμακευτικής αγωγής, πλην του φοβικού άγχους (p=0,05).Συμπεράσματα: Η ποιότητα ζωής συνδέεται με την κατάθλιψη και νευρωτική συμπτωματολογία στην περίπτωση των ασθενών με υπέρταση. Το άγχος με επικέντρωση στη λειτουργία της καρδιάς, η αποφυγή δραστηριοτήτων καθώς και βιολογικοί δείκτες όπως η δυσλιπιδαιμία και ο δείκτης φλεγμονής ίσως αποτελούν ένα μηχανισμό που συνδέεται με την επιβαρυμένη ποιότητα ζωής των ασθενών με υψηλή αρτηριακή πίεση.Το βιολογικό φορτίο της νόσου αναλύεται. Τέλος, τα αποτελέσματα μας δεν στηρίζουν την υπόθεση ότι η αντιυπερτασική αγωγή επηρεάζει την ποιότητα ζωής και την ψυχική υγεία των ασθενών αυτών. Προφανώς η υιοθέτηση του ρόλου του ασθενούς συμβάλει στα υψηλά επίπεδα φοβικού άγχους ένα χρόνο μετά τη ρύθμιση της αρτηριακής πίεσης

Impact of the COVID-19 pandemic on the mental health of hospital staff : An umbrella review of 44 meta-analyses

Background: Hospital staff is at high risk of developing mental health issues during the coronavirus (COVID-19) pandemic. However, the literature lacks an overall and inclusive picture of mental health problemswith comprehensive analysis among hospital staff during the COVID-19 pandemic. Objectives: To ascertain the prevalence of anxiety, depression and other mental health outcomes as reported in original articles among hospital staff during the COVID-19 pandemic. Design: A PRISMA 2020 and MOOSE 2000 compliant umbrella review of published meta-analyses of observational studies evaluating the prevalence of mental health problems in hospital staff during the pandemic. Review methods: Systematic searcheswere conducted in PubMed/Medline, CINAHL, EMBASE, and PsycINFO from December 1st, 2019, until August 13th 2021. The randomeffects model was used for the meta-analysis, and the I-2 indexwas employed to assess between-study heterogeneity. Publication bias using Egger test and LFK indexwas examined. Data was analyzed using STATA 17.0 software. AMSTAR-2 was applied for the quality assessment of systematic reviews, while we used GRADE to rate the quality of evidence. Results: Forty-four meta-analyses from1298 individual studieswere included in the final analysis, encompassing the prevalence of 16 mental health symptoms. One-third of hospital workers reported anxiety (Prevalence: 29.9%, 95% CI:27.1% to 32.7%) and depression (Prevalence: 28.4%, 95% CI:25.5% to 31.3%) symptomatology, while about 40% (95% CI: 36.9% to 42.0%) suffered from sleeping disorders. Fear-related symptoms, reduced well-being, poor quality of life, and acute stress symptoms had the highest prevalence among hospital staff. However, the quality of evidence in these areas varied from low to very low. Nurses suffered more often from sleep problems and symptoms of anxiety and depression than doctors, whereas doctors reported a higher prevalence of acute stress and post-traumatic disorders. The burden of anxiety, depression, and sleep disorders was higher among female employees than their male counterparts. Remarkably, acute stress and insomnia affected more than half of first-line medical staff. Conclusions: The prevalence of mental health problems among hospital staff during the COVID-19 pandemic is generally high, with anxiety, depression and insomnia symptoms representing the most robust evidence based on a large dataset of prevalence meta-analyses. However, there is no strong confidence in the body of evidence for each outcome assessed. (C) 2022 The Author(s). Published by Elsevier Ltd

The Contemporary Role of Speckle Tracking Echocardiography in Cirrhotic Cardiomyopathy

Cirrhotic cardiomyopathy (CCM) is characterized by elevated cardiac output at rest, an inability to further increase contractility under stress, and diastolic dysfunction. The diagnosis of CCM is crucial as it can lead to complications during liver transplantation. However, its recognition poses challenges with conventional echocardiography techniques. Speckle tracking echocardiography (STE), particularly global longitudinal strain (GLS), is a novel index that enhances the diagnostic efficacy of echocardiography for both ischemic and non-ischemic cardiomyopathies. GLS proves more sensitive in identifying early systolic dysfunction and is also influenced by advanced diastolic dysfunction. Consequently, there is an expanding scope for GLS utilization in cirrhotic cases, with newly updated diagnostic criteria for CCM incorporating GLS. Specifically, systolic dysfunction is now defined as either a left ventricular ejection fraction below 50% or an absolute GLS below 18%. However, conflicting data on GLS alterations in liver cirrhosis patients persist, as many individuals with advanced disease and a poor prognosis exhibit a hyperdynamic state with preserved or increased GLS. Consequently, the presence of CCM, according to the updated criteria, does not exhibit a significant association—in the majority of studies—with the severity of liver disease and prognosis. Furthermore, information on other indices measured with STE, such as left atrial and right ventricular strain, is promising but currently limited. This review aims to offer a critical assessment of the existing evidence concerning the application of STE in patients with liver cirrhosis

Personality Traits, Burnout, and Psychopathology in Healthcare Professionals in Intensive Care Units—A Moderated Analysis

This study explored the associations between personality dimensions, burnout, and psychopathology in healthcare professionals in intensive care units (ICUs). This study further aimed to discern the differences in these relationships when considering the variables of critical care experience (less than 5 years, 5–10 years, and more than 10 years), profession (nurses versus intensivists), and the urban size of the city where the ICU is located (metropolitan cities versus smaller urban cities). This cross-sectional investigation’s outcomes are based on data from 503 ICU personnel, including 155 intensivists and 348 nurses, in 31 ICU departments in Greece. Participants underwent a comprehensive assessment involving a sociodemographic questionnaire, the Eysenck Personality Questionnaire (EPQ), the Maslach Burnout Inventory (MBI), and the Symptom Checklist-90 (SCL-90). To analyze the interplay among critical care experience, burnout status, and psychopathology, a moderation analysis was conducted with personality dimensions (i.e., psychoticism, extraversion, and neuroticism) serving as the mediator variable. Profession and the urban size of the ICU location were considered as moderators influencing these relationships. Male healthcare professionals showed higher psychoticism levels than females, aligning with prior research. Experienced nurses reported lower personal achievement, hinting at potential motivation challenges for professional growth. Psychoticism predicted high depersonalization and low personal achievement. Neuroticism and psychoticism negatively impacted ICU personnel’s mental well-being, reflected in elevated psychopathology scores and burnout status. Psychoticism appears to be the primary factor influencing burnout among the three personality dimensions, particularly affecting intensivists. In contrast, nurses are more influenced by their critical care experience on their mental health status

Agreement between Family Members and the Physicians View in the ICU Environment: Personal Experience as a Factor Influencing Attitudes towards Corresponding Hypothetical Situations

Background: It is not known whether intensive care unit (ICU) patients family members realistically assess patients health status. Objectives: The aim was to investigate the agreement between family and intensivists assessment concerning changes in patient health, focusing on family members resilience and their perceptions of decision making. Methods: For each ICU patient, withdrawal criteria were assessed by intensivists while family members assessed the patients health development and completed the Connor-Davidson Resilience Scale and the Self-Compassion Scale. Six months after ICU discharge, follow-up contact was established, and family members gave their responses to two hypothetical scenarios. Results: 162 ICU patients and 189 family members were recruited. Intensivists decisions about whether a patient met the withdrawal criteria had 75,9% accuracy for prediction of survival. Families assessments were statistically independent of intensivists opinions, and resilience had a significant positive effect on the probability of agreement with intensivists. Six months after discharge, family members whose relatives were still alive were significantly more likely to consider that the family or patient themselves should be involved in decision-making. Conclusions: Resilience is related to an enhanced probability of agreement of the family with intensivists perceptions of patients health progression. Family attitudes in hypothetical scenarios were found to be significantly affected by the patients actual health progression

Risk and Protective Factors for Sudden Cardiac Death: An Umbrella Review of Meta-Analyses

Background: Sudden cardiac death (SCD) is a global public health issue, accounting for 10-20% of deaths in industrialized countries. Identification of modifiable risk factors may reduce SCD incidence. Methods: This umbrella review systematically evaluates published meta-analyses of observational and randomized controlled trials (RCT) for the association of modifiable risk and protective factors of SCD. Results: Fifty-five meta-analyses were included in the final analysis, of which 31 analyzed observational studies and 24 analyzed RCTs. Five associations of meta-analyses of observational studies presented convincing evidence, including three risk factors [diabetes mellitus (DM), smoking, and early repolarization pattern (ERP)] and two protective factors [implanted cardiac defibrillator (ICD) and physical activity]. Meta-analyses of RCTs identified five protective factors with a high level of evidence: ICDs, mineralocorticoid receptor antagonist (MRA), beta-blockers, and sodium-glucose cotransporter-2 (SGLT-2) inhibitors in patients with HF. On the contrary, other established, significant protective agents [i.e., amiodarone and statins along with angiotensin-converting enzyme (ACE) inhibitors in heart failure (HF)], did not show credibility. Likewise, risk factors as left ventricular ejection fraction in HF, and left ventricular hypertrophy, non-sustain ventricular tachycardia, history of syncope or aborted SCD in pediatric patients with hypertrophic cardiomyopathy, presented weak or no evidence. Conclusions: Lifestyle risk factors (physical activity, smoking), comorbidities like DM, and electrocardiographic features like ERP constitute modifiable risk factors of SCD. Alternatively, the use of MRA, beta-blockers, SGLT-2 inhibitors, and ICD in patients with HF are credible protective factors. Further investigation targeted in specific populations will be important for reducing the burden of SCD

Comparing efficacy and safety in catheter ablation strategies for atrial fibrillation: protocol of a network meta-analysis of randomised controlled trials

Introduction Atrial fibrillation (AF) is the most common sustained arrhythmia. Catheter ablation (CA) of AF is an increasingly offered therapeutic approach, primary to relieve AF-related symptoms. Despite the development of new ablation approaches, there is no consensus regarding the most efficient ablation strategy. The objective of this network meta-analysis (NMA) is to compare the efficacy and safety of all different CA approaches for the treatment of patients with paroxysmal (PAF) and non-PAF (non-PAF). Methods and analysis We will perform a systematic search to identify randomised controlled trials of different CA approaches for the treatment of PAF and non-PAF, through the final search date of 1 March 2020. Information sources will include major bibliographic databases (MEDLINE, Web of Science and CENTRAL) and clinical trial registries. Our primary outcomes will be the efficacy (recurrence-free survival) and safety of different CA approaches for the treatment of AF. Secondary outcomes will be all-cause mortality and procedural time. An NMA will be performed to determine the relative effects of different catheter ablation approaches (such as pulmonary vein isolation alone or in combination with ablation lines, ablation of complex fractionated atrial electrograms, etc). In PAF, a separate analysis will be performed including different energy sources (such as radiofrequency, cryogenic and laser energy). Risk of bias assessment and sensitivity analyses will be conducted to assess the robustness of the findings to potential bias. Ethics and dissemination No ethical approval will be needed because data are collected from previous studies. The results will be presented through peer-review journals and conference presentation. PROSPERO registration number CRD42020169494

Risk and protective factors for atrial fibrillation after cardiac surgery and valvular interventions : an umbrella review of meta-analyses

Objective Postoperative atrial fibrillation (POAF) is a common complication affecting approximately one-third of patients after cardiac surgery and valvular interventions. This umbrella review systematically appraises the epidemiological credibility of published meta-analyses of both observational and randomised controlled trials (RCT) to assess the risk and protective factors of POAF. Methods Three databases were searched up to June 2021. According to established criteria, evidence of association was rated as convincing, highly suggestive, suggestive, weak or not significant concerning observational studies and as high, moderate, low or very low regarding RCTs. Results We identified 47 studies (reporting 61 associations), 13 referring to observational studies and 34 to RCTs. Only the transfemoral transcatheter aortic valve replacement (TAVR) approach was associated with the prevention of POAF and was supported by convincing evidence from meta-analyses of observational data. Two other associations provided highly suggestive evidence, including preoperative hypertension and neutrophil/lymphocyte ratio. Three associations between protective factors and POAF presented a high level of evidence in meta-analyses, including RCTs. These associations included atrial and biatrial pacing and performing a posterior pericardiotomy. Nineteen associations were supported by moderate evidence, including use of drugs such as amiodarone, b-blockers, glucocorticoids and statins and the performance of TAVR compared with surgical aortic valve replacement. Conclusions Our study provides evidence confirming the protective role of amiodarone, b-blockers, atrial pacing and posterior pericardiotomy against POAF as well as highlights the risk of untreated hypertension. Further research is needed to assess the potential role of statins, glucocorticoids and colchicine in the prevention of POAF.Funding Agencies|ALF grants (County Council of Ostergotland) [RO818141]</p