Is Accurate Rate Response Programming Necessary?

Exercise capacity and general well-being are improved by appropriately programmed rate responsive pacemakers when compared to fixed rate units. Ten patients had activity sensing DDDR units implanted for combined AV block and sinus node incompetence. Ten patients had Sensolog activity sensing VVIR units implanted for complete heart block. The effects of over and under programming of rate response in both dual and single chamber activity sensor rate adaptive pacemakers has been assessed subjectively by visual analog scales and specific activity questionnaires and objectively by graded treadmill testing and the performance of standardized daily activities. Patients were randomly programmed to absent rate response (VVI in the Sensolog group), hyporesponsive (DDD in the dual chamber group), appropriate response (VVIR, DDDR according to Manufacturer's instructions) and over responsive (VVIR+, DDDR+) in a double-blind crossover design. Thirty percent of patients demanded early crossover from VVI, 30% from DDDR+ and 50% from VVIR+. Perception of Exercise Capability was similar to objective exercise treadmill times which were shorter in VVI than in VVIR or VVIR+ (P less than 0.05) or control subjects (P less than 0.001). There was no difference between any dual chamber mode or control subjects. General well-being was poorest in DDDR+ and VVIR+ modes despite objective improvement in exercise capacity. Symptoms were least in VVIR and DDDR and all but one patient chose appropriate programming as their overall preferred mode. Thus, even inaccurate rate response programming results in similar and improved exercise capacity compared to absent rate response but overprogramming is unacceptable to most patients, confirming that appropriate programming and sensor specificity is critical in rate responsive pacing.     

Experience and outcomes of stepping stones triple P for families of children with autism

This study investigated the experience and perceived outcomes of a behavioural family intervention, standard stepping stones triple P (SSTP), for parents of children with autism. An indepth, prospective, mixed-methods, multiple case-study design was employed. Parent participants and SSTP practitioners took part. Participation in SSTP was consistently associated with improved parental self-efficacy, and was also associated with improved parental psychological well-being and decreased perceived need for behavioural services for some families. Three key themes emerged from the qualitative interview data, reflecting changes attributed to participation in SSTP: (1) changes in the “attribution of cause” of misbehaviour, (2) “Who's the boss?” reflecting a change to parents feeling more in charge of their child's behaviour, daily routines and choices, and (3) “Rewarding is rewarding!” reflecting appreciation of a positive approach to behaviour management. Practitioners discussed their impressions of appropriate participants, timing, structure, and session preferences for SSTP, and implications related to the professional qualifications of practitioners delivering SSTP. Clinical implications for the use of SSTP with families of children with autism are discussed.     

Sexual functioning and sexual well-being in people with a limb amputation: a cross-sectional study in the Netherlands

Purpose: This study aimed to: (a) investigate whether, and if so which, sexual problems are present in people with a limb amputation; (b) analyze how they experience their sexuality; and (c) investigate whether sexuality was discussed with them during their rehabilitation process. Method: In total, 301 participants completed a survey consisting of a questionnaire on participant characteristics, the Hospital Anxiety and Depression Scale (HADS), the Maudsley Marital Questionnaire (MMQ), the Amputee Body Image Scale (ABIS), the Questionnaire about Sexual Counselling, the Questionnaire about Sexuality and the Short Sexual Functioning Scale (SSFS). Results: Overall, 20% of the participants experienced one or more sexual dysfunction(s). Participants who had at least one sexual dysfunction were more likely to be male, had an amputation more recently, and had a more negative body image. Moreover, sexuality was only scantly discussed by rehabilitation professionals. Conclusions: Sexual problems and sexual dysfunctions do occur in people with a limb amputation, but these problems are not discussed during the rehabilitation process. Justice for a person's “whole body” can only be served when sexuality is taken seriously in rehabilitation care in order to avoid cutting sexuality out of an amputee's life.

• Implications for Rehabilitation

• People with a limb amputation may be confronted with sexual problems and/or sexual dysfunctions.

• It is therefore important that sexuality is taken seriously as a part of standard rehabilitation care and that professionals bring up the issue of sexuality during the rehabilitation process.

     

浦东新区护士工作幸福感的现状及影响因素分析

目的 了解浦东新区护士工作幸福感的现状及影响因素,为支持性的护理工作环境提供参考.方法 2013年1~3月,对上海浦东新区7家医院的650名护士进行问卷调查. 结果 护士工作幸福感总分为(62. 15±25. 15)分,高于中间得分133分;不同医院级别、科室、职称、职务、月总收入的护士群体的心理幸福感水平存在差异. 结论 浦东新区不同规模医院的护士工作幸福感有待提高;提高护士心理幸福感和积极情绪体验,降低护士消极情绪体验,应为护士提供相应的管理方法,提供支持性的工作环境,以提高护士的身心健康,提高护士工作幸福感.     

Abide with me: religious group identification among older adults promotes health and well-being by maintaining multiple group memberships

Objectives: Aging is associated with deterioration in health and well-being, but previous research suggests that this can be attenuated by maintaining group memberships and the valued social identities associated with them. In this regard, religious identification may be especially beneficial in helping individuals withstand the challenges of aging, partly because religious identity serves as a basis for a wider social network of other group memberships. This paper aims to examine relationships between religion (identification and group membership) and well-being among older adults. The contribution of having and maintaining multiple group memberships in mediating these relationships is assessed, and also compared to patterns associated with other group memberships (social and exercise).

Method: Study 1 (N = 42) surveyed older adults living in residential care homes in Canada, who completed measures of religious identity, other group memberships, and depression. Study 2 (N = 7021) longitudinally assessed older adults in the UK on similar measures, but with the addition of perceived physical health.

Results: In Study 1, religious identification was associated with fewer depressive symptoms, and membership in multiple groups mediated that relationship. However, no relationships between social or exercise groups and mental health were evident. Study 2 replicated these patterns, but additionally, maintaining multiple group memberships over time partially mediated the relationship between religious group membership and physical health.

Conclusion: Together these findings suggest that religious social networks are an especially valuable source of social capital among older adults, supporting well-being directly and by promoting additional group memberships (including those that are non-religious).     

Correlates of subjective well-being in schizophrenic patients treated with atypical antipsychotics

Objective

A growing body of research indicates that a low subjective well-being (SW) may be predictive of non-adherence and less favourable outcome. This study examined baseline variables and variables in the course of treatment hypothesised to be associated with later SW.

Methods

Sixty-three inpatients with schizophreniform disorder or schizophrenia were randomly assigned to treatment with various atypical antipsychotics after a wash-out phase of 2 days. Subjects were evaluated with a protocol that examined psychopathology (Positive and Negative Symptom Scale, PANSS), side effects (Scandinavian Society of Pharmacology, UKU), and subjective well-being (Subjective Well-being under Neuroleptic treatment, SWN) at baseline and endpoint (mean duration of treatment 39.9 days). Two-thirds of subjects were multiple episode schizophrenic inpatients pre-treated with antipsychotics.

Results

Multiple regression analyses revealed that the PANSS negative score, neurological side effects, and SWN at baseline, as well as change of the PANSS positive score between baseline and endpoint, were associated independently with SW at endpoint (R²=0.55 after exclusion of two subjects).

Conclusions

Patients with low SW, severe negative symptoms, and neurological side effects, all at baseline, as well as those without improvement or deterioration of positive symptoms are at risk of low SW later in treatment and, most likely, of non-adherence.     

Enhancing positive perceptions of aging by savoring life lessons

Objectives: This study examined the effects of savoring valuable life lessons on perceptions of aging and on well-being among older adults.

Method: A total of 303 adults (mean age = 68.12 years) were randomly assigned to one of three experimental conditions: savoring life lessons (n = 95), reflecting on negative aspects of aging (n = 129), or untreated-control condition (n = 79). Participants in the savoring condition wrote about a valuable lesson they had learned in growing older, whereas participants in the negative-aging condition wrote about physical losses they had experienced in aging.

Results: After controlling for baseline happiness, health, gender, and age, participants who savored valuable life lessons reported greater positive perceptions of aging and life satisfaction, compared to participants in the negative-aging and untreated-control conditions. There were no differences across conditions in negative perceptions of aging or in anxiety.

Conclusion: These findings suggest that savoring valuable life lessons could be an effective addition to psychoeducational programs designed to improve perceptions of aging.     

More to Blue Zones than long life: positive psychological characteristics

Blue Zones are defined as regions of exceptional longevity. Emerging evidence also indicates the presence of several positive psychological characteristics amongst older inhabitants. No synthesis of this information is currently available. The current article focuses on psychological characteristics of successful ageing, including perceived well-being and cognitive health. Relevant findings concerning the Sardinian Blue Zone are reviewed along with an evidence suggesting links to the distinctive sociocultural environment of this region. People aged 65+ living in the Sardinian Blue Zone have substantially lower levels of depressive symptomatology, higher levels of self-perceived well-being and better subjective and objective cognitive health relative to matched control samples. These differences are robust, reliable and persist throughout late adulthood. Important determinants of the positive traits include increased active engagement in community religious and leisure activities. Sparse evidence for other Blue Zones exists but reduced levels of depression may be a shared attribute. Older Blue Zone Sardinians possess positive psychological characteristics, which are associated with successful ageing and are known to promote longevity. Blue Zone populations appear to be a valuable, but overlooked, resource for the study of positive aspects of ageing.     

Fog of War: Psychopharmaceutical “Side Effects” and the United States Military

ABSTRACT

The unprecedented reliance today on psychiatric drugs to maintain mission readiness in war and to treat veterans at home has been the subject of ethical debate in the United States. While acknowledging these debates, I advocate for an ethnography of how US soldiers and veterans of the Iraq and Afghanistan wars themselves articulate political and ethical tensions in their experiences of psychiatric drug treatment. Detailing one army veteran’s interpretations of drug effects as narrated through the lens of his current antiwar politics, I examine the radicalizing transformations of self and subjectivity that he attributes both to his witnessing drug use in Iraq and to the neurochemical effects of his own medications. Playing on the biomedical notion of “side effects,” I highlight surprising political and ethical openings that can surface when psychopharmaceuticals and war intersect. Psychotropic medication use offers a critical realm for furthering the ethnographic study of the lived tensions and contradictions of military medicine and medicalization as revealed in militarized embodied experience.     

Risk and protective factors for health-related quality of life among persons aging with HIV

For persons living with HIV, health-related quality of life (HRQOL) may be threatened by physical and mental conditions but may be protected by positive psychological traits. We performed an exploratory look at the risk and protective factors for HRQOL in older adults living with HIV. Cross-sectional analyses of baseline data from the Rush Center of Excellence on Disparities in HIV and Aging (CEDHA), a community-based cohort of persons ages ≥50 living with HIV (n?=?176) were performed. Analyses examined the relationship between risk/protective factors and two outcomes (i.e., self-reported health status [SRHS] and the healthy days index [HDI]). Having good/excellent health was associated with being a non-smoker (p?=?0.002), greater purpose in life (p?=?0.006), higher education (p?=?0.007), fewer depressive symptoms (p?=?0.004), fewer disabilities (p?=?0.000), and less loneliness (p?=?0.002) in bivariate analyses. Males (p?=?0.03) and African Americans/Blacks (p?=?0.03) reported higher HDI. Fewer depressive symptoms (p?=?0.000), disabilities (p?=?0.002), adverse life events (p?=?0.0103), and loneliness (p?=?0.000) were associated with higher HDI in bivariate analyses. In a logistic regression model, greater purpose in life, fewer disabilities, and being a non-smoker were associated with better SRHS after adjusting for covariates. For African Americans/Blacks, having fewer depressive symptoms and disabilities were associated with higher HDI after adjusting for covariates. Disabilities, depression, smoking status, race/ethnicity, and purpose in life were significantly associated with HRQOL. Findings support the need for research to examine the influence of cultural interpretations of life quality and focus on promoting physical function, smoking cessation, and psychological wellness in persons aging with HIV.