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Current Problems in Cardiology Mar 2024Post-stroke depression (PSD) is a prevalent neuropsychiatric sequelae following stroke, often associated with diminished functional recovery and heightened mortality... (Meta-Analysis)
Meta-Analysis Review
Association between baseline high-sensitive C-reactive protein, homocysteine levels, and post-stroke depression among stroke patients: a systematic review, meta-analysis, and meta-regression.
BACKGROUND
Post-stroke depression (PSD) is a prevalent neuropsychiatric sequelae following stroke, often associated with diminished functional recovery and heightened mortality risk. Emerging evidence suggests neuroinflammation, triggered in response to stroke events, may be instrumental in precipitating PSD.
AIM
This study aims to assess the significance of high-sensitivity C-reactive protein (Hs-CRP) and homocysteine (Hcy) in post-stroke individuals with PSD.
METHODS
We systematically searched all electronic databases from inception until May 30, 2023. Outcomes were reported as standard mean difference (SMD), and their corresponding 95% confidence interval (95% CI).
RESULTS
A total of 12 studies with 3,230 patients were included in this study. The mean age of the overall cohort was 65.7 years, and patients with PSD were observed to be older than patients without PSD (68.3 years versus 63.1 years). We observed a higher female prevalence in the PSD group (44.4% versus 40.7%). PSD patients were more likely to be widowed (19.4% versus 8.4%) and more likely to have a family history of psychiatric disorder (11.3% versus 4.9%) compared to non-PSD patients. We also observed that patients with PSD had higher levels of baseline Hs-CRP [SMD 0.16, (95% CI 0.08 to 0.25), p<0.001], and Hcy [SMD 0.14, (95% CI 0.05 to 0.22), p<0.001] than patients without PSD. Meta-regression analysis did not reveal any effect modifier for higher Hs-CRP in the study group, however, history of widowhood was a significant effect modifier when assessing Hcy levels between the two groups (coefficient 1.998, p=0.038).
CONCLUSION
Baseline levels of Hs-CRP and Hcy were significantly higher in patients with PSD, highlighting the role of recognizing demographic and biochemical markers in understanding the complexities of post-stroke depression.
Topics: Humans; Female; Aged; C-Reactive Protein; Depression; Stroke; Biomarkers; Disease Progression
PubMed: 38103817
DOI: 10.1016/j.cpcardiol.2023.102338 -
Cureus Dec 2021Patients with acute myocardial infarction (AMI) or ischaemic heart disease are at risk of developing anxiety and depression. This systematic review aims to identify the... (Review)
Review
Patients with acute myocardial infarction (AMI) or ischaemic heart disease are at risk of developing anxiety and depression. This systematic review aims to identify the various risk factors and the role of cardiac rehabilitation in reducing the risk of depression in patients after AMI. In this review, we included data on the prevalence of depression in patients post-AMI for the years 2016-2017 from a cardiac rehabilitation unit at Morriston Hospital, Swansea, a primary coronary angioplasty centre. Results from our meta-analysis were compared with the findings of previous studies. Our data showed the prevalence of depression to be 14% pre-cardiac rehabilitation and 3% post-cardiac rehabilitation. A meta-analysis of seven studies showed the prevalence to be approximately 20-35% depending on the type of questionnaire or screening method used. Gender, marital status, age, and sedentary lifestyle were found to be risk factors for depression post-acute coronary syndrome (ACS). Females, patients aged >65 years, and those who were single, lived alone, or widowed were at a higher risk of depression, and patients with sedentary lifestyles were more likely to have post-ACS depression. Depression in patients post-myocardial infarction was also associated with increased mortality and morbidity risk as well as higher hospital re-admission and future cardiac events. The meta-analysis showed significant publication bias, studies with negative results were less likely to be published, and the study data were heterogeneous. The pooled estimate for depression estimated using the random-effects model was 1.78 (95% confidence interval = 1.58-2.01).
PubMed: 35141096
DOI: 10.7759/cureus.20851 -
Death Studies 2021The loss of a loved one is often associated with "death from a broken heart" for the survivor, and there is evidence that shows that widowers and widows are at risk for...
The loss of a loved one is often associated with "death from a broken heart" for the survivor, and there is evidence that shows that widowers and widows are at risk for higher morbidity and mortality than the general population. This systematic review will summarize the physical and physiological health outcomes of spousal bereavement. A systematic database search was conducted, and 38 studies were analyzed. The majority of studies found a statistically significant and positive association between spousal bereavement and adverse physical and physiological health outcomes such as inflammation, cardiovascular risk, chronic pain, and mortality.
Topics: Bereavement; Grief; Humans; Outcome Assessment, Health Care
PubMed: 31535594
DOI: 10.1080/07481187.2019.1661884 -
European Journal of Oncology Nursing :... Oct 2014To systematically review the literature on the severity and risk factors for loneliness in adult cancer patients. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To systematically review the literature on the severity and risk factors for loneliness in adult cancer patients.
METHODS
We systematically reviewed quantitative studies addressing loneliness in cancer patients. Exclusion criteria were absence of a validated loneliness questionnaire, and studies that focused on loneliness determined by specific circumstances, and not cancer in general (e.g. appearance concerns, cultural and language barriers, requiring palliative care). We searched PsycINFO, CINAHL, Embase, Cochrane Library, and Pubmed in compliance with the predefined in- and exclusion criteria. The search, quality appraisal, and data extraction were performed by two independent reviewers. Weighted mean scores were calculated by using random effects adjusted inverse variance weighting.
RESULTS
We included 15 studies. In 13 studies the UCLA loneliness scale was used (range 20-80; higher scores indicate higher loneliness). The weighted mean loneliness score was 38.26 (95% CI: 35.51-41.00), which corresponds to moderate loneliness. Time since diagnosis was positively associated with degree of loneliness. Other cancer-related factors, such as cancer site, treatment type, or stage of disease were not associated with loneliness. The non-cancer related determinants of loneliness in cancer patients that emerged from our review were being unmarried (people who have never been married, are widowed or divorced), and lack of psychological or social support.
CONCLUSION
Our findings suggest that the level of loneliness rises with increasing time after cancer diagnosis. Furthermore, social functioning emerged as a consistent theme, for which it was shown that lack of social support was associated with increasing levels of loneliness.
Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Loneliness; Male; Mental Disorders; Middle Aged; Neoplasms; Ontario; Quality of Life; Risk Factors; Social Support; Surveys and Questionnaires
PubMed: 24993076
DOI: 10.1016/j.ejon.2014.05.002 -
West African Journal of Medicine Sep 2021Suicidal behaviour is a global public health issue affecting all ages, gender, and regions of the world. This systematic review sought to synthesize the available...
BACKGROUND/PURPOSE
Suicidal behaviour is a global public health issue affecting all ages, gender, and regions of the world. This systematic review sought to synthesize the available evidence on the prevalence and risk factors for suicide and suicidal behaviour across the lifespan in Nigeria.
DATA SOURCE
The databases of PubMed, Embase, Medline, PsychInfo, Google Scholar and African Journals OnLine (AJOL).
STUDY SELECTION
Literature on suicidal behaviour and suicide from Nigeria published between 2000 and 2019.
DATA EXTRACTION
Data were extracted independently by two authors using a fixed template.
RESULTS
The search identified 431 articles; 23 were eligible for inclusion. The 12-month prevalence of suicide ideation among adolescents was between 6.1-22.9% and 3-12.5% for attempts; identified risk factors were sexual abuse, family dysfunction and food insecurity. For the adult population, lifetime rates of suicidal ideation, plan and attempt were 3.2%, 1.0% and 0.7% respectively; risk factors included age (peak in the third decade of life), childhood adverse experiences and the presence of mood disorders. In the elderly the rates were 4.0% for ideation, 0.7% for plan and 0.2% for attempt. Risk factors identified in the elderly were being single (separation or widowhood) and rural residence. Suicides accounted for 0.3- 1.6% of autopsies performed by the coroners and constituted the least common cause of death. Suicides were more common in males and peaked in the third decade of life.
CONCLUSION
Suicide and suicidal behaviour in the Nigerian population seem to peak in young adult life suggesting that suicide prevention initiatives should target late adolescence.
Topics: Adolescent; Aged; Child; Humans; Longevity; Male; Nigeria; Risk Factors; Suicidal Ideation; Suicide, Attempted; Young Adult
PubMed: 34672509
DOI: No ID Found -
Journal of Palliative Medicine Jun 2015It has been more than two decades since the passage of the Patient Self-Determination Act (PSDA) of 1991, an act that requires many medical points of care, including... (Review)
Review
BACKGROUND
It has been more than two decades since the passage of the Patient Self-Determination Act (PSDA) of 1991, an act that requires many medical points of care, including emergency departments (EDs), to provide information to patients about advance directives (ADs).
OBJECTIVE
The study objective was to determine the prevalence of ADs among ED patients with a focus on older adults and factors associated with rates of completion.
METHODS
We searched PubMed, Embase, PsycINFO, CINAHL, Web of Science, Medline, and the Cochrane Library. Articles were selected according to the following criteria: (1) population: adult ED patients; (2) outcome measures: quantitative prevalence data pertaining to ADs and factors associated with completion of an AD; (3) location: EDs in the United States; and (4) date: published 1991 or later.
RESULTS
Of the 258 references retrieved as a result of our search, six studies met inclusion criteria. Rates of patient-reported AD completion ranged from 21% to 53%, while ADs were available to ED personnel for 1% to 44% of patients. Patients aged ≥65 years had ADs 21% to 46% of the time. Sociodemographics (e.g., older age, specific religion, white or African American race, being widowed, or having children) and health status related variables (e.g., poor health, institutionalization, and having a primary care provider) were associated with greater likelihood of having an AD.
CONCLUSIONS
Published rates of AD completion vary widely among patients presenting to U.S. EDs. Patient sociodemographic and health status factors are associated with increased rates of AD completion, though rates are low for all populations.
Topics: Advance Directives; Aged; Aged, 80 and over; Emergency Service, Hospital; Humans; United States
PubMed: 25763860
DOI: 10.1089/jpm.2014.0368 -
Family Process Sep 2021The death of a family member affects not only individual family members but also their relationships and interactions. Grief has been studied mostly as an intrapersonal...
The death of a family member affects not only individual family members but also their relationships and interactions. Grief has been studied mostly as an intrapersonal experience. Adopting the family perspective, this systematic scoping review focused on parent-child relationships in widowed families so as to identify what is already known on this topic and the research gaps for future study. The review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Four databases (Web of Science, Psycinfo, PubMed, and CINAHL Plus) were searched. Search terms were combinations of two concepts: (1) loss of a parent (20 terms) and (2) parent-child (eight terms). 5,419 studies were identified during the search, of which 36 studies were included in the review following two rounds of screening. Four research themes emerged, and the aggregated findings were identified: (a) The surviving parent and children are likely to become closer following the loss of a parent, while other relevant factors need to be taken into account; (b) Better parent-child relationships play a protective role in children's adjustment to loss; (c) The surviving parent and children's adjustment to loss are interdependent; (d) Through parenting, communication style, coping strategy, and other attributes, the surviving parent can influence their children's adjustment. Gender and age differences were identified in parent-child relationships. The findings further justify the importance of a family perspective when conducting research and practice on bereavement. Several research gaps were identified. Existing studies paid insufficient attention to children's agency and bidirectional relationships, and the interaction process and its role underlying parent-child bidirectional causality. A conceptual framework of parent-child relationships in widowed families is proposed based on these findings.
Topics: Bereavement; Female; Humans; Parent-Child Relations; Parenting; Parents; Widowhood
PubMed: 33118179
DOI: 10.1111/famp.12610 -
Health Science Reports Feb 2024Multimorbidity among older adults is a growing concern in India. Multimorbidity is defined as the coexistence of two or more chronic health conditions in an individual....
BACKGROUND
Multimorbidity among older adults is a growing concern in India. Multimorbidity is defined as the coexistence of two or more chronic health conditions in an individual. Primary studies have been conducted on risk factors of multimorbidity in India, but no systematic review has been conducted on this topic. This systematic review aimed to synthesize the existing evidence on risk factors of multimorbidity among older adults in India.
METHODS
The JBI and Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed. Several databases were searched for published and unpublished studies until August 03, 2022. The screening of titles and abstracts and full texts, data extraction, and quality assessment were conducted by two independent reviewers. Any disagreements were resolved through discussion or by involving a third reviewer. Data synthesis was conducted using narrative synthesis and random effects meta-analysis, where appropriate.
RESULTS
Out of 8781 records identified from the literature search, 16 and 15 studies were included in the systematic review and meta-analysis, respectively. All included studies were cross-sectional, and 10 met a critical appraisal score of more than 70%. Broadly, sociodemographic, lifestyle, and health conditions-related factors were explored in these studies. The pooled odds of multimorbidity were higher in people aged ≥70 years compared to 60-69 years (odds ratio (OR) 1.51; 95% confidence interval (CI) 1.20-1.91), females compared to males (1.38; 1.09-1.75), single, divorced, separated, and widowed compared to married (1.29; 1.11-1.49), economically dependent compared to economically independent (1.54; 1.21-1.97), and smokers compared to non-smokers (1.33; 1.16-1.52) and were lower in working compared to not working (0.51; 0.36-0.72).
CONCLUSION
This systematic review and meta-analysis provided a comprehensive picture of the problem by synthesizing the existing evidence on risk factors of multimorbidity among older adults in India. These synthesized sociodemographic and lifestyle factors should be taken into consideration when developing health interventions for addressing multimorbidity among older adults in India.
PubMed: 38420204
DOI: 10.1002/hsr2.1915 -
Social Psychiatry and Psychiatric... Jul 2019To conduct a systematic review and meta-analysis examining the association of the prevalence of depression and time since spousal loss in widowed people. (Meta-Analysis)
Meta-Analysis
PURPOSE
To conduct a systematic review and meta-analysis examining the association of the prevalence of depression and time since spousal loss in widowed people.
METHODS
The databases MEDLINE, Embase and PsycInfo were searched (May 2017) for papers reporting on time since spousal loss in widowed people and the prevalence of common mental disorders. A systematic review was conducted according to MOOSE guidelines. Random effects meta-analyses of the prevalence of depression were conducted by intervals of time since spousal loss.
RESULTS
The literature search identified 12,982 studies of which 22 were eligible for inclusion in the systematic review. Of these, 14 were furthermore eligible for inclusion in the meta-analysis. The summary estimates found in the meta-analysis for the prevalence of depression in the intervals of time since spousal loss were: ≤ 1 month: 38.2% (21.9-55.8%); > 1 month to 3 months: 25.0% (17.3-33.5%); > 3 months to 6 months: 23.1% (18.0-28.7%); > 6 months to 12 months: 19.4% (15.2-24.0%); > 12 months to 18 months: 11.1% (5.3-18.7%); > 18 months to 24 months: 15.2% (12.3-18.2%); > 24 months to 60 months: 10.5% (4.3-18.5%).
CONCLUSION
Widowhood is associated with a high prevalence of depression and the study identifies a population group needing special attention in daily clinical practice. The prevalence is highest in the first month of widowhood, however, continues to be high at least 5 years into widowhood.
Topics: Depression; Female; Humans; Prevalence; Time Factors; Widowhood
PubMed: 30887075
DOI: 10.1007/s00127-019-01680-3 -
The Cochrane Database of Systematic... Feb 2018Available evidence has been inconclusive on whether pulmonary artery perfusion during cardiopulmonary bypass (CPB) is associated with decreased or increased mortality,... (Review)
Review
BACKGROUND
Available evidence has been inconclusive on whether pulmonary artery perfusion during cardiopulmonary bypass (CPB) is associated with decreased or increased mortality, pulmonary events, and serious adverse events (SAEs) after open heart surgery. To our knowledge, no previous systematic reviews have included meta-analyses of these interventions.
OBJECTIVES
To assess the benefits and harms of single-shot or continuous pulmonary artery perfusion with blood (oxygenated or deoxygenated) or a preservation solution compared with no perfusion during cardiopulmonary bypass (CPB) in terms of mortality, pulmonary events, serious adverse events (SAEs), and increased inflammatory markers for adult surgical patients.
SEARCH METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Science Citation Index Expanded, and advanced Google for relevant studies. We handsearched retrieved study reports and scanned citations of included studies and relevant reviews to ensure that no relevant trials were missed. We searched for ongoing trials and unpublished trials in the World Health Organization International Clinical Trials Registry Platform (ICTRP) and at clinicaltrials.gov (4 July 2017). We contacted medicinal firms producing preservation solutions to retrieve additional studies conducted to examine relevant interventions.
SELECTION CRITERIA
We included randomized controlled trials (RCTs) that compared pulmonary artery perfusion versus no perfusion during CPB in adult patients (≧ 18 years).
DATA COLLECTION AND ANALYSIS
Two independent review authors extracted data, conducted fixed-effect and random-effects meta-analyses, and calculated risk ratios (RRs) or odds ratios (ORs) for dichotomous outcomes. For continuous data, we have presented mean differences (MDs) and 95% confidence intervals (CIs) as estimates of the intervention effect. To minimize the risk of systematic error, we assessed risk of bias of included trials. To reduce the risk of random errors caused by sparse data and repetitive updating of cumulative meta-analyses, we applied Trial Sequential Analyses (TSAs). We used GRADE principles to assess the quality of evidence.
MAIN RESULTS
We included in this review four RCTs (210 participants) reporting relevant outcomes. Investigators randomly assigned participants to pulmonary artery perfusion with blood versus no perfusion during CPB. Only one trial included the pulmonary artery perfusion intervention with a preservation solution; therefore we did not perform meta-analysis. Likewise, only one trial reported patient-specific data for the outcome "pulmonary events"; therefore we have provided no results from meta-analysis. Instead, review authors added two explorative secondary outcomes for this version of the review: the ratio of partial pressure of oxygen in arterial blood (PaO) to fraction of inspired oxygen (FiO); and intubation time. Last, review authors found no comparable data for the secondary outcome inflammatory markers.The effect of pulmonary artery perfusion on all-cause mortality was uncertain (Peto OR 1.78, 95% CI 0.43 to 7.40; TSA adjusted CI 0.01 to 493; 4 studies, 210 participants; GRADE: very low quality). Sensitivity analysis of one trial with overall low risk of bias (except for blinding of personnel during the surgical procedure) yielded no evidence of a difference for mortality (Peto OR 1.65, 95% CI 0.27 to 10.15; 1 study, 60 participants). The TSA calculated required information size was not reached and the futility boundaries did not cross; thus this analysis cannot refute a 100% increase in mortality.The effect of pulmonary artery perfusion with blood on SAEs was likewise uncertain (RR 1.12, 95% CI 0.66 to 1.89; 3 studies, 180 participants; GRADE: very low quality). Data show an association between pulmonary artery perfusion with blood during CPB and a higher postoperative PaO/FiO ratio (MD 27.80, 95% CI 5.67 to 49.93; 3 studies, 119 participants; TSA adjusted CI 5.67 to 49.93; GRADE: very low quality), although TSA could not confirm or refute a 10% increase in the PaO/FiO ratio, as the required information size was not reached.
AUTHORS' CONCLUSIONS
The effects of pulmonary artery perfusion with blood during cardiopulmonary bypass (CPB) are uncertain owing to the small numbers of participants included in meta-analyses. Risks of death and serious adverse events may be higher with pulmonary artery perfusion with blood during CPB, and robust evidence for any beneficial effects is lacking. Future randomized controlled trials (RCTs) should provide long-term follow-up and patient stratification by preoperative lung function and other documented risk factors for mortality. One study that is awaiting classification (epub abstract with preliminary results) may change the results of this review when full study details have been published.
Topics: Adult; Cardiac Surgical Procedures; Cardiopulmonary Bypass; Cause of Death; Humans; Lung; Lung Diseases; Organ Preservation Solutions; Oxygen Consumption; Perfusion; Postoperative Complications; Pulmonary Artery; Pulmonary Circulation; Randomized Controlled Trials as Topic
PubMed: 29419895
DOI: 10.1002/14651858.CD011098.pub2