294 research outputs found
Inflammatory markers and physical performance in older persons: The InCHIANTI study
No full textBackground. Some studies have proposed chronic inflammation as an underlying biological mechanism responsible for physical function decline in elderly people. The aim of this study is to evaluate the relationship between several inflammatory markers and physical performance in an older population. Methods. This study is part of the "Invecchiare in Chianti" (InCHIANTI) study, a prospective population-based study of older people, aimed at identifying risk factors for late-life disability. The study sample consisted of 1020 participants aged 65 years and older living in the Chianti area of Italy. Physical performance was assessed using walking speed, the chair-stand test, and the standing balance test. Hand-grip strength was assessed using a hand-held dynamometer. Serum levels of C-reactive protein (CRP), interleukin (IL)-6, tumor necrosis factor-alpha (TNF-alpha), IL-10, IL-1beta, IL-6sR, and IL- RA were determined. Linear regression analyses were used to assess the multivariate relationship of inflammatory marker levels with physical performance, scored as a continuous variable from 0 to 3, and hand-grip strength after adjustment for demographics, chronic conditions, medication use, and other biological variables. Results. CRP, IL-6. and IL I RA were significantly correlated with physical performance (r = -0. 162, r = -0.251, and r = -0. 127, respectively). Significant correlations with hand-grip strength were found for CRP and IL-6 (r = -0.081 and r = -0.089, respectively). After adjustment for covariates, high levels of IL-6 and IL-IRA continued to be strongly associated with worse physical performance (p 0.60 mg/dl group (p for trend -.004), and from 2.25 in the lowest IL-6 quartile to 2.08 in the highest IL-6 quartile (p for trend 0.60 mg/dl group (p for trend =.001), and from 27.4 kg for the lowest IL-6 quartile to 25.1 kg for the highest IL-6 quartile (p for trend =.001). Conclusions. Inflammation. measured as high levels of IL-6, CRP, and IL- IRA, is significantly associated with poor physical performance and muscle strength in older persons. These data also support the biological face validity of physical performance measures. The assessment of inflammatory markers may represent a useful screening test and perhaps a potential target of intervention
Hemoglobin levels and skeletal muscle: Results from the InCHIANTI study
No full textBackground. Anemia is associated with reduced physical performance and muscle strength. The aim of the study was to explore whether anemia and hemoglobin levels are associated with differences in quantitative and qualitative measures of muscle and fat. Methods. The study sample consisted of 909 participants 65 years and older enrolled in the "Invecchiare in Chianti" (InCHIANTI) study, a prospective population-based study of older people aimed at identifying risk factors for late-life disability. All the analyses were performed considering continuous hemoglobin levels as well as the dichotomous anemia variable (defined according to World Health Organization criteria as hemoglobin < 12 g/dL in women and < 13 g/dL in men). A peripheral quantitative computed tomography (pQCT) scan was performed in all participants to evaluate total, muscular. and fat cross-sectional areas of the calf and relative muscle density. Ankle extension strength was measured using a hand-held dynamometer. Linear regression analyses were used to assess the multivariate relationship of pQCT and skeletal muscle strength measures with hemoglobin levels and anemia after adjustment for demographics, chronic conditions. medication use, and other biological variables. Results. Participants were aged 74.8 +/- 6.8 years. In our sample, 94 participants (10.3%) were anemic. Hemoglobin levels were significantly associated with muscle density (P = 0.225 [SE, standard error 0.098], p =.02), muscle area/total area ratio (beta = 0.778 [SE 0.262] p =.003), fat area/total area ratio (beta = -0.869 [SE 0.225]; p <.001). Skeletal muscle strength and muscle density were highly associated with anemia (P = -3.266 [SE 1.173], p =.005 and P = -0.816 [SE 0.374] p =.03, respectively). Results did not change when analyses were rerun in a restricted sample of participants not affected by major medical conditions. Conclusion. The present study shows that hemoglobin levels are associated with the parameters of body composition obtained by pQCT, and that decreases in muscular strength measures occur in the presence of anemia
Outcomes for depression and anxiety in primary care and details of treatment: a naturalistic longitudinal study
No full textAbstract Background There is little evidence as to whether or not guideline concordant care in general practice results in better clinical outcomes for people with anxiety and depression. This study aims to determine possible associations between guideline concordant care and clinical outcomes in general practice patients with depression and anxiety, and identify patient and treatment characteristics associated with clinical improvement. Methods This study forms part of the Netherlands Study of Depression and Anxiety (NESDA). Adult patients, recruited in general practice (67 GPs), were interviewed to assess DSM-IV diagnoses during baseline assessment of NESDA, and also completed questionnaires measuring symptom severity, received care, socio-demographic variables and social support both at baseline and 12 months later. The definition of guideline adherence was based on an algorithm on care received. Information on guideline adherence was obtained from GP medical records. Results 721 patients with a current (6-month recency) anxiety or depressive disorder participated. While patients who received guideline concordant care (N = 281) suffered from more severe symptoms than patients who received non-guideline concordant care (N = 440), both groups showed equal improvement in their depressive or anxiety symptoms after 12 months. Patients who (still) had moderate or severe symptoms at follow-up, were more often unemployed, had smaller personal networks and more severe depressive symptoms at baseline than patients with mild symptoms at follow-up. The particular type of treatment followed made no difference to clinical outcomes. Conclusion The added value of guideline concordant care could not be demonstrated in this study. Symptom severity, employment status, social support and comorbidity of anxiety and depression all play a role in poor clinical outcomes.</p
On the threshold of disorder : definition and course of subthreshold depression and subthreshold anxiety
No full textPas wanneer mensen lijden aan ernstige angst en depressie, wordt dit in de psychiatrie als een ziekte beschouwd. Er wordt dan ook wel gesproken van ‘klinische angst en depressie’. Maar ook wanneer de klachten milder zijn, oftewel subklinisch, kunnen ze de kwaliteit van leven verminderen en invloed hebben op het functioneren op het werk en het sociale leven.
UMCG-promovendus Julie Karsten onderzocht hoe subklinische, maar wel belemmerende angst en depressie, in kaart kunnen worden gebracht. Ze stelt vast dat zogeheten ‘ernstvragenlijsten’ hiertoe geschikter zijn dan de diagnostische interviews die bij het beoordelen van ernstigere, klinische stoornissen worden gebruikt. Verder blijkt dat wie aan subklinische depressie en angst lijdt een groter risico loopt om binnen twee jaar een klinische depressie of angststoornis te ontwikkelen. Ook functioneren deze mensen in de nabije toekomst minder goed dan mensen zonder subklinische depressie of angstklachten.
Om klinische angst en depressie tegen te gaan, helpt het om al bij subklinische depressie en angst in te grijpen, stelt Karsten. Toch betekent dit niet dat iedereen met subklinische klachten een behandeling nodig heeft. Veel klachten nemen in de loop van de tijd vanzelf af. Wel zijn subklinische depressie en angst alarmsignalen die er op wijzen dat de omstandigheden en behoeften van de persoon in kwestie onder de loep moeten worden genomen.
Wanneer een behandeling wel nodig lijkt, kan met name voor subklinische klachten een ‘stepped care’ model geschikt zijn. Dat wil zeggen: startend met relatief weinig ingrijpende en goedkope interventies, die intensiever worden wanneer klachten niet verbeteren of zelfs erger worden. Dit kan uiteenlopen van eenvoudig ‘in de gaten houden’ door de huisarts tot gespecialiseerde psychologische behandeling
Subthreshold depression and subthreshold anxiety are common and associated with increased impairment, subjective suffering, and economic costs. Furthermore, individuals with subthreshold depression or subthreshold anxiety are at elevated risk for developing full-syndromal psychiatric disorders. However, no empirically based operationalization for these subthreshold disorders is available, leading to different outcomes in the literature regarding symptom features, correlates, and course. In this study, we empirically operationalized subthreshold, yet clinically significant depression and anxiety leading to functional impairment, on the criterion that mental problems must be impairing to be regarded as clinically significant (the so called “clinical significance criterion of mental disorder”). We then assessed their course over two years in terms of (1) occurrence of full-syndromal depressive and anxiety disorder and (2) extent of functional impairment. We found that clinically significant subthreshold depression and subthreshold anxiety were better defined by cut-off scores on symptom severity scales, respectively the IDS-SR30 and the BAI, than a symptom cut-off in a diagnostic interview, the CIDI. Based on these cut-off scores, subthreshold depression and subthreshold anxiety were strong predictors of full-syndromal depressive and anxiety disorders within two years, in addition to a depressive or anxiety disorder in the past. Individuals with subthreshold depression or subthreshold anxiety were still more impaired than individuals below the subthreshold cut-off two years later. Worse functioning was associated with a history of anxiety disorder, high neuroticism, low conscientiousness, a high number of traumatic events in childhood, and a high number of somatic conditions. Considerations for treatment of subthreshold disorder and prevention of full-syndromal disorders are discussed.
Anemia is associated with depression in older adults: results from the InCHIANTI study
No full textBACKGROUND: Depression is a common disorder among older adults, and it has been associated with adverse outcomes, including increased risk of morbidity and mortality as well as incomplete or delayed recovery from illness and disability. The objective of this study was to examine whether depressive symptoms and anemia are associated among older adults living in the community. METHODS: We used data from the "Invecchiare in Chianti" (Aging in the Chianti area, InCHIANTI) study, a prospective population-based study of older people living in the community. Anemia was defined by the World Health Organization (WHO) criteria: hemoglobin concentration below 12 g/dl in women and below 13 g/dl in men. Depressive symptoms were measured by using the Center for Epidemiological Studies Depression Scale (CES-D). Participants with a CES-D score > or = 16 were considered to be depressed. RESULTS: Mean age of the 986 participants was 75 years, and 56% were female; 313 (32%) study participants were depressed. Anemia was recorded in 48 of the 313 (15%) participants with depression and in 53 of the 673 (8%) participants without depression (p 26), respectively (p for linear trend =.01). CONCLUSIONS: Depressive symptoms are associated with anemia in a general population of older persons living in the communit
Psychological distress, physical illness, and risk of coronary heart disease
No full textStudy objective: The aims of this study are to confirm the association between psychological distress and coronary heart disease (CHD) using an epidemiological community study with hospital admissions data and to examine if any association is explained by existing illness.
Design: Prospective cohort study modelling the association between psychological distress, measured using the 30 item general health questionnaire (GHQ), and hospital admissions data for CHD (ICD 410–414), using proportional hazards modelling adjusted for sociodemographic, CHD risk factors, and angina, bronchitis, diabetes, ischaemia, and stroke.
Setting: Two suburbs of Glasgow, Renfrew and Paisley, in Scotland.
Participants: 6575 men and women aged 45–64 years from Paisley.
Main: results: Five year CHD risk in distressed men compared with non-distressed men was 1.78 (95% confidence intervals (CI), 1.15 to 2.75) in age adjusted analysis, 1.78 (95% CI, 1.14 to 2.79) with sociodemographic and CHD risk factor adjustment, and 1.61 (95% CI 1.02 to 2.55) with additional adjustment for existing illness. Psychological distress was unrelated to five year CHD risk in women. In further analysis, compared with healthy, non-distressed men, distressed physically ill men had a greater risk of CHD than non-distressed physically ill men, a relative risk of 4.01 (95% CI 2.42 to 6.66) compared with 2.12 (95% CI 1.35 to 3.32).
Conclusion: The association of psychological distress with an increased risk of five year CHD risk in men could be a function of baseline physical illness but an effect independent of physical illness cannot be ruled out. Its presence among physically ill men greatly increases CHD risk
Gender-specific changes in quality of life following cardiovascular disease: a prospective study
No full textGender-specific changes in Quality of Life (QoL) following cardiovascular disease (CVD) were studied in 208 patients to determine whether gender-related differences in postmorbid QoL result from differences in disease severity, premorbid QoL, or different CVD-related recovery. Premorbid data were available from a community-based survey. Follow-ups were done at 6 weeks, 6 months, and 12 months after diagnosis. Results showed that females had worse QoL at all three postmorbid assessments compared to males. However, multivariate analyses adjusting for premorbid gender differences and disease severity showed no significant gender-related differences for physical and psychologic, functioning. Therefore, gender differences in QoL following CVD mainly result from premorbid differences in QoL, age, comorbidity, and disease severity at the time of diagnosis, and do not appear to be the consequence of gender-specific recovery. However, in clinical practice it is important to acknowledge the poorer QoL of females following CVD. (C) 2002 Elsevier Science. All rights reserve
Operating characteristics of depression and anxiety disorder phenotype dimensions and trait neuroticism: A theoretical examination of the fear and distress disorders from the Netherlands study of depression and anxiety
No full textOperating characteristics of depression and anxiety disorder phenotype dimensions and trait neuroticism: A theoretical examination of the fear and distress disorders from the Netherlands study of depression and anxiet
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