Risk Factors for Early Revision After Primary TKA in Medicare Patients.

Risk Factors for Early Revision After Primary TKA in Medicare Patients.

Clin Orthop Relat Res. 2013 May 10;
Bozic KJ, Lau E, Ong K, Chan V, Kurtz S, Vail TP, Rubash HE, Berry DJ

BACKGROUND: Patient, surgeon, health system, and device factors are all known to influence outcomes in total knee arthroplasty (TKA). However, patient-related factors associated with an increased risk of early failure are not well understood, particularly in elderly patients. QUESTIONS/PURPOSES: The purpose of this study was to identify specific comorbid conditions associated with increased risk of early revision in Medicare patients undergoing TKA. METHODS: A total of 117,903 Medicare patients who underwent primary TKA between 1998 and 2010 were identified from the Medicare 5% national sample administrative database and used to determine the relative risk of revision within 12 months after primary TKA as a function of baseline medical comorbidities. Cox regression was used to evaluate the impact of 29 comorbid conditions on risk of early failure controlling for age, sex, race, census region, socioeconomic status, and all other baseline comorbidities. RESULTS: The most significant independent risk factors for revision TKA within 12 months were chronic pulmonary disease, depression, alcohol abuse, drug abuse, renal disease, hemiplegia or paraplegia, and obesity. CONCLUSIONS: This information could be valuable to patients and their surgeons when making shared medical decisions regarding elective TKA and for risk-stratifying publicly reported outcomes in Medicare patients undergoing TKA. LEVEL OF EVIDENCE: Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence. HubMed – depression

Humor, Laughter, and the Cerebellum: Insights from Patients with Acute Cerebellar Stroke.

Cerebellum. 2013 May 11;
Frank B, Andrzejewski K, Göricke S, Wondzinski E, Siebler M, Wild B, Timmann D

Extent of cerebellar involvement in cognition and emotion is still a topic of ongoing research. In particular, the cerebellar role in humor processing and control of laughter is not well known. A hypermetric dysregulation of affective behavior has been assumed in cerebellar damage. Thus, we aimed at investigating humor comprehension and appreciation as well as the expression of laughter in 21 patients in the acute or subacute state after stroke restricted to the cerebellum, and in the same number of matched healthy control subjects. Patients with acute and subacute cerebellar damage showed preserved comprehension and appreciation of humor using a validated humor test evaluating comprehension, funniness and aversiveness of cartoons (“3WD Humor Test”). Additionally, there was no difference when compared to healthy controls in the number and intensity of facial reactions and laughter while observing jokes, humorous cartoons, or video sketches measured by the Facial Action Coding System. However, as depression scores were significantly increased in patients with cerebellar stroke, a concealing effect of accompanying depression cannot be excluded. Current findings add to descriptions in the literature that cognitive or affective disorders in patients with lesions restricted to the cerebellum, even in the acute state after damage, are frequently mild and might only be present in more sensitive or specific tests. HubMed – depression

How are Depression and Type D Personality Associated with Outcomes in Chronic Heart Failure Patients?

Curr Heart Fail Rep. 2013 May 10;
Widdershoven J, Kessing D, Schiffer A, Denollet J, Kupper N

This review aims to summarize the current evidence for the association of depression and Type D personality with clinical and patient-centred outcomes and self-care in chronic heart failure (CHF) patients. Emotional distress is highly prevalent in CHF patients. In contrast to results in coronary artery disease, there is inconsistent evidence for the adverse effects of depression and Type D on prognosis. Type D and depression are important predictors of impaired health status in CHF, and patients characterised by depression or Type D report reduced self-care. Pathophysiological processes associated with depression and Type D are discussed, as they may contribute to disease progression. Future research may benefit from taking inconsistencies in and problems with assessment of depression and Type D into account, as well as focusing on the network of psychophysiological and behavioural factors to elucidate their precise role in CHF patients with depression or Type D. Furthermore, it is advised that clinicians address the observed differences in self-care behaviours to improve health in CHF patients with depression or Type D personality. HubMed – depression

Parents’ education and the risk of major depression in early adulthood.

Soc Psychiatry Psychiatr Epidemiol. 2013 May 10;
Park AL, Fuhrer R, Quesnel-Vallée A

BACKGROUND: Early-life low socioeconomic position (SEP) increases the risk of adult major depression; however, associations vary according to the measure of SEP and adults’ life stage. Although maternal education often predicts offspring health better than other SEP indicators, including paternal education, it is unclear how maternal and paternal education differentially influence early-adult depression, and how early-life and adult risk factors may mediate the association. METHODS: Longitudinal data come from the Canadian National Population Health Survey from 1994/1995 to 2006/2007, restricted to a sample (N = 1,267) that was aged 12-24 years in 1994/1995. Past-year major depressive episode (MDE) was assessed in 2004/2005 and 2006/2007 using the Composite International Diagnostic Interview Short Form for Major Depression. Logistic regression models were used to estimate odds ratios (OR) and 95 % confidence intervals (CI) for the association between both maternal and paternal education and MDE, adjusting for respondent’s demographics, early-life adversities, adult SEP, psychosocial factors, and physical health. RESULTS: Offsprings of mothers with less than secondary school education had higher odds of MDE (adjusted OR 2.04, 95 % CI 1.25-3.32) relative to those whose mothers had more education. Paternal education was not associated with MDE. Although adult income, student status, psychosocial stress, and several early-life adversities remained associated with MDE in the fully adjusted model, the estimate for maternal education was not reduced. CONCLUSIONS: Maternal education was associated with MDE in early adulthood, independent of paternal education and other early-life and early-adult risk factors. HubMed – depression