Psychosocial Influences on Parental Decision-Making Regarding Vaccination Against Seasonal Influenza for Young Children in Hong Kong: a Longitudinal Study, 2012–2013

Purpose

Vaccination uptake remained low, although annual subsidies are provided to encourage 6–72-month-old Hong Kong children to be vaccinated against seasonal influenza. This study was aimed to investigate the psychosocial influences on parental decision-making regarding young children’s seasonal influenza vaccination.

Methods

One-thousand two-hundred twenty-six parents of eligible children were recruited using random digit dialing in August–October 2012 to assess baseline perceptions and re-contacted in March 2013 to record children’s vaccination uptake. Structural equation modeling (SEM) was performed to examine factors associated with parental decision about children’s vaccination based on the complete data of 1222 respondents.

Results

Of the 1226 respondents who completed the follow-up survey, 34.3 % reported that their child was vaccinated during the follow-up period. Child’s past influenza vaccination history (β?=?0.48), belief in vaccination safety (β?=?0.35), and social norms (β?=?0.25) were strongly associated with parental intention to vaccinate their child which directly predicted child vaccination uptake (β?=?0.57). Belief in vaccination safety (β?=?0.42) and social norms (β?=?0.36) were strongly associated with vaccination intention of parents whose children never received influenza vaccine.

Conclusion

Interventions that address concerns on vaccination safety and utilize social norms may be effective to initiate Chinese parents to vaccinate their children.

     

Interleukin 18 Promoter Variants (−137G>C and −607C>A) in Patients with Chronic Hepatitis C: Association with Treatment Response

Background

Recently, two functional IL18 promoter variants, ?607C>A (rs1946518) and ?137G>C (rs187238), were associated with viral clearance in patients with hepatitis C. The present study focused on their relevance for treatment response.

Methods

Seven hundred fifty-seven chronically infected European patients and 791 controls were enrolled in the study. IL18 genotyping was performed by allele-specific PCR. Liver histology was available in 67.9%.

Results

Genotype and allele frequencies were equally distributed in patients and controls. No significant association with various disease characteristics was observed. However, when comparing patients with sustained virological response (SR) and non-SR, statistically significant associations were found for both variants (p?=?0.0416 and p?=?0.0274, respectively). In viral genotype 1, the ?607A allele was positively associated with treatment response (p?=?0.0190; OR 1.537; 95% CI, 1.072–2.205) and the ?137G allele with a higher rate of nonresponse (p?=?0.0302; OR 1.524; 95% CI, 1.040–2.233).

Conclusions

The association of IL18 variants with treatment response in genotype 1 hepatitis C patients implies a predictive and modifying role of these genetic variants.

     

Socioeconomic Differences in Parenting Strategies to Prevent Adolescent Smoking: A Case Study from the Netherlands

Purpose

This study aimed to identify possible socioeconomic differences in the use of anti-smoking parenting strategies.

Methods

In 2012, survey data of adolescents (N?=?225) aged 13 to 17 years and their mothers (N?=?122) and fathers (N?=?105) were collected in Haarlem, the Netherlands. Questions on smoking behaviour and eleven anti-smoking parenting strategies were answered by adolescents, mothers and fathers. School tracks of adolescents and educational level of parents were measured as indicators of socioeconomic position. Linear multilevel regression analyses were applied to study the association between socioeconomic position (SEP) and standardised scores of anti-smoking strategies. Analyses were controlled for age, sex and smoking by parents and adolescents.

Results

We found no consistent socioeconomic differences in the use of anti-smoking parenting strategies. There were no statistically significant differences in relation to parental educational level or when using adolescent reports on parenting practices. However, when using parental reports, a few strategies varied significantly according to adolescent educational track. Adolescents in higher educational tracks were more likely to have no-smoking rules in the home (standardised regression coefficient (β)?=?0.20, 95 % confidence interval (CI): 0.03; 0.37, p?=?0.022) and more likely to have a no-smoking agreement (β?=?0.17, 95 % CI: 0.00; 0.34, p?=?0.048). However, they were less likely to frequently communicate about smoking with their parents (β?=??0.25, 95 % CI: ?0.41; ?0.08, p?=?0.004).

Conclusion

In this specific population, there was no consistent support for the hypothesis that anti-smoking parenting strategies contribute to socioeconomic inequalities in adolescent smoking. Parental factors that are more likely to contribute to these inequalities include parental smoking and parenting styles.

     

Cognitive-Behavioural Therapy for Inflammatory Bowel Disease: 24-Month Data from a Randomised Controlled Trial

Purpose

There is ongoing controversy on the effectiveness of psychotherapy in inflammatory bowel disease (IBD). In the few small studies, cognitive-behavioural therapy (CBT) has been shown to alleviate symptoms of anxiety or depression. However, there is little research on the impact of CBT on physical outcomes in IBD and no studies on long-term effectiveness of CBT.

Methods

The present two-arm pragmatic randomised controlled trial aimed to establish the impact of CBT on disease course after 24 months of observation. The study compared standard care plus CBT (+CBT) with standard care alone (SC). CBT was delivered over 10 weeks, face-to-face (F2F) or online (cCBT). The data were analysed using linear mixed-effects models.

Results

CBT did not significantly influence disease activity as measured by disease activity indices at 24 months (Crohn’s Disease Activity Index (CDAI), p?=?0.92; Simple Clinical Colitis Activity Index (SCCAI), p?=?0.88) or blood parameters (C-reactive protein (CRP), p?<?0.62; haemoglobin (Hb), p?=?0.77; platelet, p?=?0.64; white cell count (WCC), p?=?0.59) nor did CBT significantly affect mental health, coping or quality of life (all p?>?0.05).

Conclusions

Therefore, we conclude that CBT does not influence the course of IBD over 24 months. Given the high rate of attrition, particularly in the CBT group, future trials should consider a personalised approach to psychotherapy, perhaps combining online and one-to-one therapist time.

     

The Role of Mindfulness in the Insomnia Severity of Female Chronic Hypnotic Users

Purpose

To investigate dispositional mindfulness, psychiatric symptoms, and their relationship with insomnia severity among female chronic hypnotic users.

Methods

Observational, cross-sectional study, including 76 women with chronic hypnotic use. Participants completed several self-report questionnaires: sociodemographic characteristics, depressive symptoms (CES-D), anxiety levels (STAI-T), dispositional mindfulness (FFMQ), and insomnia severity (ISI). Exploratory linear regression models were used to identify factors related to insomnia severity.

Results

Multiple linear regression models showed that, for the total sample (N?=?76), age (B?=???0.14, p?=?0.003), depressive symptoms (B?=?0.16, p =?0.005), and the mindfulness facets “observe” (B?=?0.21. p?=?0.013) and “act with awareness—auto pilot” (B?=???0.48, p =?0.017) were correlated to insomnia severity.

Conclusion

Results confirm a relationship between mindfulness and insomnia among female chronic hypnotic users, specifically regarding the ability to observe and act with awareness. A higher score on the “observe” facet was positively correlated with insomnia. This may be because the skill of observing itself, isolated from other mindfulness precepts, does not provide sufficient strategies to cope with the observed discomfort. Increased “acting with awareness—autopilot” was negatively correlated with insomnia severity, arguably because it stimulates breaking automatic patterns of thoughts and behaviors that contribute to the perpetuation of the insomnia cycle.

     

Asthma and Hypogammaglobulinemia: an Asthma Phenotype with Low Type 2 Inflammation

Purpose

Little is known about hypogammaglobulinemia (HGG) in asthma patients. No data are available on the characteristics of adult patients with asthma and HGG.

Methods

We conducted a retrospective monocentric study between January 2006 and December 2012. Asthma patients with a serum immunoglobulin (Ig) quantitative analysis were included and classified into two groups depending on their serum IgG concentration: presence or absence of HGG. Clinical, biological, functional, and radiologic characteristics were compared in univariate and multivariate analysis, using a logistic regression model.

Results

In univariate analysis, asthma patients with HGG (n?=?25) were older (58 years old?±?18 vs 49?±?18, p?=?0.04) and more frequently active or former smokers as compared to patients with normoglobulinemia (n?=?80) (56.0 vs 35.0 %, p?=?0.01). Total IgE?<?30 kUI/L was more frequently observed in patients with HGG (53.0 vs 18.3 %, p?=?0.01). HGG asthma patients had lower fraction of exhaled nitric oxide (p?=?0.02), blood eosinophilia (p?=?0.0009), and presented with more severe composite score for bronchiectasis (p?=?0.01). In multivariate analysis, asthma patients with HGG had increased risk of being smokers [OR?=?6.11 (IC 95 %?=?1.16–32.04)], having total IgE concentration?<?30 kUI/L [OR?=?12.87 (IC 95 %?=?2.30–72.15)], and a more severe composite score of bronchiectasis [OR?=?20.65 (IC 95 %?=?2.13–199.74)].

Conclusion

Asthma patients with HGG are older and more often tobacco smoker than asthma patients without HGG. These patients have low type-2 inflammation markers.

     

Body Esteem Among Women with Multiple Sclerosis and its Relationship with Demographic,Clinical and Socio-Psychological Factors

Purpose

The principal aim of this study was to verify if specific socio-demographic, clinical, and socio-psychological factors are correlates of body esteem in women with multiple sclerosis (MS).

Methods

The study included 185 women with MS who completed the Body Esteem Scale (BES), Rosenberg Self-Esteem Scale (RSES), Multiple Sclerosis Impact Scale (MSIS-29), Brief Illness Perception Questionnaire (B-IPQ), Actually Received Support Scale (a part of the Berlin Social Support Scale), and Expanded Disability Status Scale (EDSS). The patients were recruited as a result of cooperation with the Multiple Sclerosis Rehabilitation Centre in Borne Sulinowo and Polish Society of Multiple Sclerosis. The demographic characteristics of the participants and their illness-related problems were determined with a self-report survey.

Results

A hierarchical multiple regression revealed that four factors, psychological condition (R ²?=?0.23, p?≤?0.001), received support (R ²?=?0.28, p?≤?0.001), personal control (R ²?=?0.30, p?≤?0.001), and physical condition (R ²?=?0.31, p?≤?0.001), were significant correlates of the general body esteem in our study group of women with MS. The model explained 31 % of variance in body esteem.

Conclusion

Positive body esteem, an important component of self-esteem in women with MS, is associated with better social support, overcoming negative illness-related appraisals and improvement of psychological well-being. Subjective perception of a negative impact of MS on one’s physical condition may be helpful in the identification of women with MS being at increased risk of decreased body esteem.

     

Context Matters: Examining Perceived Health and Fitness Outcomes of Physical Activity Participation Among South Korean Adults and Youth

Purpose

To examine associations between physical activity contexts and health and fitness perceptions among Korean adults and youth.

Method

Data were from the Korean Survey on Citizens’ Sports Participation in 2015. Korean youth (N?=?832; M_age?=?14.7) and adults (N?=?6719; M_age?=?41.3) were included in the hierarchical logistic and linear regressions. Youth physical activity was examined in school-based (i.e., school-based and after-school/Saturday school sports) and out of school (i.e., organized sports) settings. Adults who met the World Health Organization (WHO) physical activity guidelines or not, and participated in structured (e.g., sport) and unstructured (e.g., walking) physical activity were compared. The outcome variables were self-reported health and fitness. Gender interactions between physical activity and all outcomes were examined for the adult sample only.

Results

No associations existed between physical activity and perceived health or fitness among youth. Adults who met the WHO guidelines, or participated in structured physical activity showed higher odds of reporting good health. Unstructured physical activity was associated with lower odds of reporting good health. Positive perceptions of fitness were more likely to be reported by males who met physical activity guidelines compared to females.

Conclusions

For youth, the potential benefit of physical activity, regardless of contexts, may be more apparent for psychological health than perceived physical health, and school should be used as a venue to promote physical activity. For adults, structured physical activity and achieving the WHO physical activity guidelines may be suggested for perceptions of overall health.

     

Infertility Centrality in the Woman’s Identity and Goal Adjustment Predict Psychological Adjustment Among Women in Ongoing Fertility Treatments

Purpose

Some of the women that go through repeated fertility treatments will not adjust well to the treatments and will experience increased distress. The present study examined how centrality of the fertility problem in the woman’s identity and dispositional goal adjustment (disengagement and reengagement) are associated with the woman’s psychological adjustment. These issues are examined in a context of a pro-natal society (Israel) where parenthood is a major life goal.

Methods

One hundred ninety-three women in ongoing fertility treatments filled out questionnaires, and follow-up on their psychological well-being was carried out after 3 months (N?=?130).

Results

Women who perceived their fertility problem as more central to their identity experienced greater distress (β?=?0.34, p?<?0.01) and less well-being (β?=???0.31, p?<?0.01). Concurrently, high ability for goal disengagement was a resource that protected women from these feelings. Women high on goal disengagement who were low on goal reengagement experienced greater distress (β of interaction?=???0.24, p?<?0.01), probably because they remained with feelings of emptiness and lack of purpose. These findings were found in both cross-sectional and longitudinal analyses. Finally, the models predicting well-being and distress at T2 using centrality, goal adjustment, and T1 well-being/distress explained 42 and 47.5% of the variance, respectively.

Conclusions

Much research and therapeutic attention has been invested in coping with fertility treatments, while the options of reducing investment in treatments and finding alternative goals did not receive adequate attention. This study discusses these issues and their possible clinical implications especially in a pro-natal context.

     

Allow natural death versus do-not-resuscitate: titles,information contents,outcomes, and the considerations related to do-not-resuscitate decision

Background

As the “do not resuscitate” (DNR) discussion involves communication, this study explored (1) the effects of a title that included “allow natural death”, and of information contents and outcomes of the decision; and (2) the information needs and consideration of the DNR decision, and benefits and barriers of the DNR discussion.

Methods

Healthy adults (n?=?524) were presented with a scenario with different titles, information contents, and outcomes, and they rated the probability of a DNR decision. A questionnaire including information needs, consideration of the decision, and benefits and barriers of DNR discussion was also used.

Results

There was a significantly higher probability of signing the DNR order when the title included “allow natural death” (t?=???4.51, p?<?0.001), when comprehensive information was provided (F?=?60.64, p?<?0.001), and when there were worse outcomes (F?=?292.16, p?<?0.001). Common information needs included remaining life period and the prognosis. Common barriers were the families’ worries and uncertainty about future physical changes.

Conclusion

The title, information contents, and outcomes may influence the DNR decisions. Health-care providers should address the concept of natural death, provide comprehensive information, and help patients and families to overcome the barriers.

     

Abstracts 2016

Background

Musculoskeletal pain is associated with comorbidity, extensive use of health services, long-term disability and reduced quality of life. The scientific literature on effects of treatment for musculoskeletal pain is inconclusive.

Purpose

The purpose of this study is to compare a multidisciplinary intervention (MI), including use of the novel Interdisciplinary Structured Interview with a Visual Educational Tool (ISIVET), with a brief intervention (BI), on effects on mental and physical symptoms, functioning ability, use of health services and coping in patients sick-listed due to musculoskeletal pain.

Method

Two hundred eighty-four adults aged 18–60, referred to a specialist clinic in physical rehabilitation, were randomized to MI or BI. Patients received a medical examination at baseline and completed a comprehensive questionnaire at baseline, 3 months and 12 months.

Results

Both groups reported improvements in mental and physical symptoms, including pain, and improved functioning ability at 3 and 12 months, but the MI group improved faster than the BI group except from reports of pain, which had a similar course. Significant interactions between group and time were found on mental symptoms (anxiety (p?<?0.05), depression (p?<?0.01), somatization (p?<?0.01)) and functioning ability (p?<?0.01) due to stronger effects in the MI group at 3 months. At 3 and 12 months, the MI group reported significantly less use of health services (general practitioner (p?<?0.05)). At 12 months, the MI group reported better self-evaluated capability of coping with complaints (p?<?0.001) and they took better care of their own health (p?<?0.001), compared to the BI group.

Conclusion

The results indicate that the MI may represent an important supplement in the treatment of musculoskeletal pain.

     

Palliative enteral feeding for patients with malignant esophageal obstruction: a retrospective study

Background

Malignant esophageal obstruction leads to dysphagia, deterioration in quality of life, and malnutrition. Traditional bedside nasogastric (NG) tube placement is very difficult under these circumstances. However, endoscopically assisted NG tube placement under fluoroscopic guidance could be an alternative option for establishing palliative enteral nutrition. This study aimed to compare the clinical outcomes of enteral tube feeding and esophageal stenting for patients with malignant esophageal obstruction and a short life expectancy.

Methods

Thirty-one patients were divided into 3 groups according to their treatment modality: NG tube (n?=?12), esophageal stent group (n?=?10), and supportive care with nil per os (NPO) (n?=?9). Enteral nutrition, clinical outcomes, length of hospital stay, and median survival were evaluated.

Results

There were no significant baseline differences among the groups, except in age. The tube and stent groups had significantly higher enteral calorie intake (p?=?0.01), higher serum albumin (p?<?0.01), shorter hospital stay (p?=?0.01), and longer median survival (p?<?0.01) than the NPO group. The incidence of dislodgement in the tube group was significantly higher than in the stent group (58 % vs. 20 %, respectively; p?=?0.01). However, stenting costs more than NG tube placement.

Conclusions

Palliative enteral feeding by NG tube is safe, inexpensive, and has a low complication rate. Endoscopically assisted NG tube placement under fluoroscopic guidance could be a feasible palliative option for malignant esophageal obstruction for patients who have a short life expectancy.

     

Perceived Social Support Mediates the Longitudinal Relations between Ambivalence over Emotional Expression and Quality of Life among Chinese American Breast Cancer Survivors

Purpose

The present study examined perceived social support as a mediator of the longitudinal link between ambivalence over emotional expression (AEE) and quality of life among a sample of Chinese breast cancer survivors.

Methods

Ninety-six Chinese breast cancer survivors recruited from Southern California completed four surveys in total: (1) a baseline survey (T1), 1-month follow-up (T2), 3-month follow-up (T3), and 6-month follow-up (T4). Participants filled out a paper-pen questionnaire containing the Ambivalence over Emotional Expression Questionnaire (AEQ), the Functional Assessment of Cancer Therapy-General (FACT-G), and the Medical Outcomes Study Social Support Scale (MOS-SSS).

Results

Higher T1 AEE was associated with lower T1 social support (B?=??0.01, SE?=?0.004, p?<?0.01) which in turn was associated with lower quality of life at T2 (B?=?2.98, SE?=?0.64, p?<?0.01), T3 (B?=?2.14, SE?=?0.54, p?<?0.01), and T4 (B?=?2.08, SE?=?0.68, p?<?0.01).

Conclusions

These results suggest that the harmful effect of AEE on quality of life is explained by reduced social support. Given the detrimental effects of AEE on social support and quality of life, future research on interventions that facilitate emotional disclosure is needed. Implications for the effects of Chinese culture on AEE are discussed.

     

Psychosocial and Physiological Predictors of Mortality in Patients of Heart Failure: Independent Effects of Marital Status and C-Reactive Protein

Purpose

Few studies have examined the interplay between psychosocial and physiological variables in prediction of mortality in heart failure (HF) patients. This study investigated the prospective influence of marital status, social support, depression, and C-reactive protein (CRP) on the mortality of patients with chronic HF. In addition, it examined whether there was a mediating relationship between social support and marital status and whether depression and inflammation influenced one another to predict mortality of HF patients.

Methods

The participants were 220 HF patients, among whom 48 were deceased over an average of 4.60 years. A number of psychosocial and biomedical variables were examined for their associations with mortality and their relationships between each other in hierarchical logistic regression analyses.

Results

After adjusting for New York Heart Association (NYHA) class, age, and gender, being unmarried predicted mortality (OR?=?2.80, p?=?0.004), whereas perceived social support did not. Higher CRP was not associated with depression, and it independently predicted mortality (OR?=?1.92, p?=?0.030). Depression predicted mortality only in the univariate analysis (OR?=?1.02, p?=?0.030), but the association was no longer significant either after removing somatic items or after adjusting for covariates. In the combined multivariate model, marital status (OR?=?2.20, p?=?0.047), CRP (OR?=?1.91, p?=?0.035), and NYHA class (OR?=?2.41, p?=?0.001) independently predicted mortality.

Conclusions

Monitoring chronic HF patients who are unmarried, with elevated inflammation, or in higher NYHA class may help identify those at greater mortality risk to implement targeted intervention.

     

Effects of a Multi-Component Workplace Intervention Program with Environmental Changes on Physical Activity among Japanese White-Collar Employees: a Cluster-Randomized Controlled Trial

Purpose

This study aimed to investigate effects of a flexible multi-component workplace intervention program for improving physical activity among Japanese white-collar employees in a cluster randomized controlled trial design.

Methods

A total of 208 worksites and nested employees were approached. Any worksite interested in a 3-month physical activity promotion intervention and white-collar workers aged 18 years or older were eligible. The worksites were randomly assigned to an intervention or a control, stratified by worksite size. The intervention worksites were offered an intervention program that allows these worksites to select intervention components from a set of options, including environmental changes. The control worksites were offered feedback and basic occupational health services. Physical activity level was measured using a self-reported questionnaire at baseline and at 3 and 6 months of follow-up.

Results

Three worksites (92 employees) were allocated to the intervention and five worksites (98 employees) to the control worksites. The overall physical activity level in the intervention worksites significantly increased compared with the control worksites (Coeff?=?0.45, SE?=?0.19, p?=?0.018). For subgroup analyses, the intervention effect on the overall physical activity level was significant among medium- and large-sized worksites but not among small-sized worksites.

Conclusion

This trial showed a significant and positive effect of the intervention program on physical activity. The program is unique because of its flexibility and feasibility. However, small worksites might receive less benefit from the program, indicating a need for further support and/or new technologies.

Trial Registration

UMIN Clinical Trials Registry (ID=UMIN000024069).

     

Association of MICA-TM and MICB C1_2_A Microsatellite Polymorphisms with Tumor Progression in Patients with Colorectal Cancer

Purpose

The major histocompatibility complex class I related A (MICA) and MICB molecules are ligands of NKG2D receptors on natural killer cells, gamma/delta T cells, and CD8aß T cells that mediate host antitumor immune response. The role of MICA-TM and MICB C1_2_A alleles in patients with colorectal cancer has not yet been investigated.

Methods

We have analyzed the MICA-TM and MICB C1_2_A polymorphisms in colorectal cancer patients (n?=?79) by polymerase chain reaction amplification, subsequent electrophoresis, and sequencing in comparison to a previously analyzed cohort of healthy controls (n?=?306). Allele frequencies obtained for MICA-TM and MICB C1_2_A were compared to histopathological data regarding tumor invasion, disease progression, microsatellite instability, and the presence of KRAS mutations (codon 12) and analyzed for possible impact on tumor-related survival (n?=?61).

Results

Allele frequencies of MICA-TM and MICB C1_2_A polymorphisms were not different in patients with colorectal cancer in comparison to normal controls. In colorectal cancer patients, MICA-TM A4 allele was directly and MICA-TM A5 allele was inversely associated with lymph node involvement and advanced UICC stages. Tumor-related survival in colorectal cancer patients was significantly reduced in the presence of the MICA-TM A4 allele (p?=?0.015). In patients with microsatellite stable tumors, survival was reduced in association with the MICA-TM A4 allele (p?=?0.006) and MICA-TM A9 allele (p?=?0.034), but increased in patients showing the MICA-TM A5 allele (p?=?0.042).

Conclusions

Specific MICA-TM alleles seem to influence tumor progression and midterm survival of patients with colorectal cancer, indicating an important role of host innate immune predisposition involving NKG2D mediated antitumor response.

     

Negative Stress Beliefs Predict Somatic Symptoms in Students Under Academic Stress

Purpose

Medically unexplained symptoms are abundantly present in the general population. Stress may lead to increased symptom reporting because of widespread beliefs that it is dangerous for one’s health. This study aimed at clarifying the role of stress beliefs in somatic symptom reporting using a quasi-experimental study design.

Methods

Two hundred sixteen German university students (60 % of an initial sample of 363) were examined at the beginning of the term (less stressful period) and at the end of the term (stressful period due to exams). Negative beliefs about stress at baseline were expected to predict somatic symptoms at follow-up.

Results

Negative beliefs about stress at baseline significantly predicted somatic symptoms at follow-up (β?=?0.16, p?=?.012), even when controlling for general strain, physical and mental health status, neuroticism, optimism, and somatosensory amplification.

Conclusions

Being convinced that “stress is bad for you” was prospectively associated with somatic symptoms during a stressful period. Further research in patients with medically unexplained conditions is warranted to corroborate these findings.

     

Self-esteem and Body Mass Index from Adolescence to Mid-adulthood. A 26-year Follow-up

Purpose

This study examined the developmental trajectories of self-esteem and body mass index (BMI) from adolescence to mid-adulthood and the way the association between self-esteem and BMI changed during a 26-year follow-up.

Methods

Participants of a Finnish cohort study in 1983 at 16 years (N?=?2194) were followed up at ages 22 (N?=?1656), 32 (N?=?1471), and 42 (N?=?1334) using postal questionnaires. Measures at each time point covered self-esteem and self-reported weight and height. Analyses were done using latent growth curve models (LGM) and difference scores.

Results

In LGM analyses among females both the initial levels (r?=??0.13) and slopes (r?=?-0.26) of the self-esteem and BMI trajectories correlated negatively. Among males, there were no significant correlations between self-esteem and BMI growth factors. The association between increasing BMI and decreasing self-esteem among females was strongest between ages 22 and 32 (r?=??0.16), while among males, increases in BMI and self-esteem correlated positively (r?=?0.11) during that period. Among females, cross-sectional correlations between self-esteem and BMI showed an increasing trend (p?<?0.001) from age 16 (r?=??0.07) to age 42 (r?=??0.17), whereas among males negative correlation (r?=??0.08) emerged only in mid-adulthood at age 42.

Conclusion

Among females, higher and increasing BMI is associated with lower and more slowly increasing self-esteem. This association is not restricted to adolescent years but persists and gets stronger in mid-adulthood. Among males, associations are weaker but indicate more age-related differences. The results highlight the need for interventions that tackle weight-related stigma and discrimination, especially among women with higher body weight and size.

     

Inhalative sedation with small tidal volumes under venovenous ECMO

Background

Inhalative sedation is an emerging method for long-term sedation in intensive care therapy. There is evidence that it is easy to control and may be beneficial compared to intravenous sedation. Yet little is known about the use in patients with compromised lung function. In this retrospective analysis, we searched files of patients receiving inhalative sedation under venovenous extracorporeal membrane oxygenator (vv-ECMO) support due to lung failure.

Methods

After ethical approval, we performed a retrospective analysis of patients receiving vv-ECMO support and inhalative sedation in the surgical ICU in 2015. Isoflurane was administered via the AnaConDa®-system. Sedation was tested using Richmond Agitation and Sedation scale (RASS).

Results

7 patients were identified. Median age was 50 years (26/70 years). All were male. Median ECMO runtime was 129 h (37/1008 h) and the survival rate was 57.9%. Dose of isoflurane was 1.7 ml/h (0.8 / 4.0 ml/h) resulting in expiratory concentrations of 0.8 Vol% (0.3/1.8 Vol%), inspiratory of 0.6 Vol% (0.1/1.4 Vol%). Higher concentrations of isoflurane were associated with increased depth of sedation (expiratory p?=?0.016; inspiratory p?=?0.027; averaged p?=?0.015). With tidal volume below 350 ml, association was still present for expiratory and averaged concentrations of isoflurane (expiratory p?=?0.031; inspiratory p?=?0.082; average p?=?0.039).

Conclusions

This is the first study that shows that inhalative concentrations of isoflurane are associated with depth of sedation in patients with lung failure. We were able to show that even with major impacts in lung mechanics and function targeted sedation with volatile anaesthetics is feasible and dose–response relationship appears to exist.