The Impact of Motor Disability and the Level of Fatigue on Adherence to Therapeutic Recommendations in Patients with Multiple Sclerosis Treated with Immunomodulation

Aim: The aim of the study was to clarify whether the motor disability and the fatigue-related syndrome affect the level of compliance with therapeutic recommendations.Methods: Prospective studies were conducted among 165 patients treated under the drug program - Treatment of Multiple Sclerosis (MS) at the Department of Neurology and Clinical Neuroimmunology of the Regional Specialist Hospital in Grudziadz (Poland). The research was carried out by the method of diagnostic survey, questionnaire technique with the use of standardized research tools. The Adherence in Chronic Diseases Scale (ACDS) was used to assess the level of compliance with therapeutic recommendations. The Expanded Disability Status Scale (EDSS) was used to assess the degree of disability, and the Modified Fatigue Impact Scale (MFIS) was used to assess the degree of disability. The Chi-square test, Shapiro-Wilk test and Kruskal-Wallis were used.Results: The statistical analysis showed that there is a relationship (p=0.0055) between the patient''s motor disability assessed in the EDSS scale and the level of compliance with therapeutic recommendations assessed in the ACDS scale. The higher the patient''s disability level (EDSS 4.5-6.5), the lower the treatment adherence rate. The conducted research shows that the average score in the MFIS scale for individual levels of compliance with therapeutic recommendations expressed in the ACDS scale is, respectively: for the low level - 38.3 MFIS points, for the medium level - 34.4 MFIS points and for the high level- 33.2 MFIS points. The obtained results were not statistically significant (p=0.6098).Conclusion: It was found that the level of adherence to therapeutic recommendations in patients with relapsing-remitting multiple sclerosis treated with immunomodulation in the study group remained high. There is a relationship between the patient''s disability and the level of adherence to therapeutic recommendations.     

乳腺癌化疗患者癌性疲乏、应对方式与生活质量的相关性

目的:探讨乳腺癌化疗患者癌性疲乏、应对方式与生活质量之间的相关性.方法:本研究是横断面研究,采用方便抽样法选择乳腺癌改良根治术后行药物化疗的女性患者120例,用癌性疲乏自评量表 (the Revised Piper Fatigue Scale,PFS)、Jalowiec的应对量表 (Jalowiec Coping Scale,JCS)和欧洲癌症研究与治疗组织开发的癌症患者生命质量测定系列量表的核心问卷[Quality of Life Questionnaire-Core 30,QLQ-C30(V3.0)]和针对乳腺癌人群的特异性问卷 (Quality of Life Questionnaire-Breast 23,QLQ-BR23),分别测评患者的癌性疲乏水平、应对方式和生活质量状况.采用Spearman相关分析患者癌性疲乏状况、应对方式以及生活质量三者之间的相关性.结果:乳腺癌化疗患者的癌性疲乏总分与QLQ-C30的功能和总体健康状况呈负相关(r＝-0.24,-0.39;均P<0.01);积极的应对方式如勇敢面对、乐观与PFS的感知维度呈负相关(r＝-0.25,-0.18;均P<0.05),与QLQ-BR23的功能维度呈正相关(r＝0.35,0.21;均P<0.05);消极应对方式如情感、听天由命与PFS的认知维度呈正相关(r＝0.33,0.18;均P<0.05),与QLQ-BR23的功能维度呈负相关(r＝-0.40,-0.32;均P<0.05),与QLQ-BR23症状维度呈正相关(r＝0.40,0.28;均P<0.05).结论:乳腺癌化疗患者所经历的癌性疲乏状况、采取的应对方式及其生活质量三者间存在一定程度的关联,此发现对临床护理有指导意义.     

Substance Use: Impact on Adherence and HIV Medical Treatment

Substance use is highly prevalent among people living with HIV/AIDS, is often comorbid with other mental health problems, related to poor HIV medical outcomes, and, is associated with poor medication and treatment adherence. The current review reports on the recent state of the literature in terms of substance use and its relation to HIV medication and treatment adherence, and offers recommendations for advancing treatment and secondary HIV prevention efforts. Identifying substance users within HIV primary care and developing, evaluating, and refining integrative substance use-mental health-adherence interventions may be clinically important targets for effective disease management and may contribute to secondary HIV prevention efforts.     

Stress and Coping Styles are Associated with Severe Fatigue in Medical Students

Fatigue is a common complaint among medical students and researchers consider it to be related to poor academic outcomes. The authors' goal in the present study was to determine whether stress and coping strategies were associated with fatigue in medical students. The study group consisted of 73 second-year healthy students attending the Osaka City University Graduate School of Medicine. Participants completed a questionnaire about fatigue (Japanese version of Chalder Fatigue Scale), stress, stress coping (Japanese version of the Coping Inventory for Stressful Situations), overwork, and nocturnal sleeping hours. On univariate and multivariate logistic regression analyses adjusted for age and gender, stress was positively associated with fatigue. In addition, after adjustment for age, gender, and emotion- and task-oriented stress coping activities, avoidance-oriented stress coping activity was associated with fatigue. The results suggest that stress and the coping style are correlated with fatigue in medical students.     

Quality of Life of Autistic Parents and Coping Style

目的 探讨孤独症儿童父母的生活质量和应对方式.方法 采用生活质量综合评定问卷-74 (GQOLI- 74)和特质应对方式问卷( TCSQ)对46例孤独症儿童的父母及46例健康儿童的父母进行对照研究.结果 ①孤独症儿童父母的GQOLI—74维度评分均明显低于对照组,其中以物质生活状态(t=1.98,P＜0.05)和心理健康(t=2.56,P＜0.01)尤为显著,具有统计学意叉;②孤独症儿童父母的积极应对得分低于对照组(t=1.91,P＜0.05),消极应对得分高于对照组(t=-2.59,P＜0.01),消极应对表现突出,差异均具有统计学意义.结论 孤独症儿童父母的生活质量较健康对照者差,他们应对生活应激事件时易采用消极的应对方式.     

孤独症儿童父母生活质量和应对方式的调查研究

目的探讨孤独症儿童父母的生活质量和应对方式。方法采用生活质量综合评定问卷-74(GQOLI-74)和特质应对方式问卷(TCSQ)对46例孤独症儿童的父母及46例健康儿童的父母进行对照研究。结果①孤独症儿童父母的GQOLI-74维度评分均明显低于对照组,其中以物质生活状态(t=1.98,P<0.05)和心理健康(t=2.56,P<0.01)尤为显著,具有统计学意义;②孤独症儿童父母的积极应对得分低于对照组(t=1.91,P<0.05),消极应对得分高于对照组(t=-2.59,P<0.01),消极应对表现突出,差异均具有统计学意义。结论孤独症儿童父母的生活质量较健康对照者差,他们应对生活应激事件时易采用消极的应对方式。     

The Impact of Public Hospital Closure on Medical and Residency Education: Implications and Recommendations

Background:Challenges around safety-net hospital closure have impacted medical student and resident exposure to urban public healthcare sites that may influence their future practice choices.Objective:To assess the impact of the closure of a public safety-net teaching hospital for the clinical medical education of Charles Drew University medical students and residents.Method:Retrospective cohort study of medical students’ and residents’ and clinical placement into safety-net experiences after the closure of the primary teaching hospital.Results:The hospital closure impacted both medical student and residency training experiences. Only 71% (17/24) of medical student rotations and 13% (23/180) of residents were maintained at public safety-net clinical sittings. The closure of the public safety-net hospital resulted in the loss of 36% of residency training spots sponsored by historically black medical schools in the United States and an even larger negative impact on the number of physicians training in underserved urban areas of Los Angeles County.Conclusion:While the medical educational program changes undertaken in the wake of hospital closure have negatively affected the immediate clinical educational experiences of medical students and residents, it remains to be seen whether the training site location changes will alter their long-term preferences in specialty choice and practice location.     

医务人员压力反应与社会支持、生活事件、应对方式的相关研究

目的：研究生活事件、应对方式、社会支持等应激有关因素对医务人员应激反应的影响。探讨在应激系统中各应激有关因素的作用途径。方法：使用领悟社会支持量表、生活事件量表、特质应对方式问卷和自编压力反应问卷对556名医务人员进行调查。结果：单因素相关分析显示：压力反应与生活事件、应对方式、社会支持之间相关均有显著性意义。多因素回归分析和路径分析表明生活事件、应对方式、社会支持对压力反应均有预测性。其中消极应对方式是影响医务人员压力反应的最主要因素；积极应对方式通过影响消极应对方式间接影响压力反应；生活事件可以直接导致压力反应，也可通过应对方式间接影响压力反应；社会支持对压力反应没有直接影响，而是通过生活事件和应对方式来影响压力反应。结论：心理压力是多因素相互作用的系统。     

Prevalence of Fatigue Among Cancer Patients Receiving Various Anticancer Therapies and its Impact on Quality of Life: A Cross-Sectional Study

Background:

Fatigue is disabling and continuous phenomenon in cancer patients during and after various anticancer treatments which can continue for many years after treatment and definitely it has profound effect on Quality of Life (QOL). However, determining its severity is still underestimated among the cancer patients and also very few studies in the literature exist reporting on Cancer-Related Fatigue (CRF) among Indian population.

Aims:

To find out the prevalence of rate of fatigue in cancer patient receiving various anti cancer therapies. To find out the relative impact of fatigue on QOL.

Materials and Methods:

This cross-sectional observational study included a total 121 cancer patients receiving radiotherapy, chemotherapy, and concurrent chemo-radiation with the age group of above 15 years who fulfilled the inclusion and exclusion criteria. All the patients were assessed for severity of fatigue using Brief Fatigue Inventory (BFI) and for QOL using FACT-G scale while they were receiving the anticancer therapies as an in-patient in the regional cancer centers in Madhya Pradesh, India.

Results:

The severe fatigue was more prevalent in chemotherapy [58/59 (98.30%)], and concurrent chemo-radiation (33/42 (78.57%)) as compared to radiotherapy (Moderate-9/20 (45%) and Severe-9/20 (45%)). Moderate correlations were exhibited between fatigue due to radiotherapy and QOL (r = -0.71, P < 0.01), whereas weak correlation was found between fatigue due to chemotherapy and concurrent chemo-radiation (r = -0.361, P < 0.01 and r = -0.453, P < 0.01, respectively).

Conclusion:

Severity of fatigue was found more after chemotherapy and concurrent chemo-radiation therapy while impact on QOL was more after the radiotherapy.     

Emergent Life Events During Youth Evidence-Based Treatment: Impact on Future Provider Adherence and Clinical Progress

Emergent life events (ELEs)—unexpected stressors disclosed in psychotherapy that have a significant negative impact on the client—commonly occur in community populations of youth and are associated with decreased provider adherence to evidence-based treatment (EBT) in session. The present study extends previous research by examining longer term associations of ELEs with (a) provider adherence to planned EBT practices in subsequent sessions and (b) clinical progress. Data were drawn from the modular EBT condition (MATCH) of the Child STEPs California trial conducted with primarily Latino youth, ages 5–15, who were 54% male (Chorpita et al., 2017). Study 1 utilized data from 57 MATCH participants who reported at least one ELE during treatment. Provider adherence was measured by identifying whether planned practices were covered in either the session in which the ELE was reported or the following session using the MATCH Consultation Record. In Study 2, clinical progress for 78 MATCH participants was assessed using weekly youth- and caregiver-ratings of symptomatology (Brief Problem Checklist) and functioning (Top Problems Assessment). Study 1 revealed that ELEs were associated with reduced adherence to planned practices for at least two sessions. Study 2 demonstrated that each disruptive ELE (i.e., an ELE for which no EBT content was covered) was associated with a 14%–20% slower rate of clinical improvement, with greater declines for functioning and externalizing symptoms. Findings suggest that ELEs can be a major barrier to the effectiveness of an EBT and require further research in order to be addressed effectively.     

Association of Coping Styles with Quality of Life in Cancer Patients

Methods:The study was performed on 150 cancer patients (71 females and 79 males) admitted to the hospitals affiliated with Kermanshah University of Medical Sciences. Endler and Parker Coping Inventory for Stressful Situations, and World Health Organization''s Quality of Life Questionnaire were used to evaluate their coping style and QOL, respectively.Results:The Present study showed in cancer patients being male, single, having higher salary and education, and lower age are related to higher QOL. Furthermore, in general, QOL of cancer patients was positively correlated with avoidant coping style (P < 0.05, r : 0.170) and negatively associated with emotion-focused coping styles (P < 0.01, r : −0.378).Conclusion:The results suggested that focusing on a patient''s coping style, predominantly on an emotion-focused coping style, is essential to improve patient''s QOL, and that patients possibly to employ a more emotion-oriented coping style should receive enough notice, particularly before discharge.     

应对策略和社会支持对哮喘患者生活质量的影响

目的研究应对策略和社会支持对哮喘患者生活质量的影响。方法对769例哮喘患者应用哮喘生活质量评估表、医学应对问卷和社会支持评定量表进行调查,对收集到的数据运用SPSS 10.0进行相关分析和多元逐步回归分析。结果①哮喘患者的整体生活质量偏差;②哮喘患者的生活质量与社会支持总分、客观支持和支持利用度呈显著正相关,与屈服和回避应对呈显著负相关;③屈服和回避应对进入生活质量的回归方程。结论应对方式和社会支持是影响哮喘患者生活质量的重要因素。     

医护人员睡眠质量与职业倦怠和应对方式

目的了解医护人员睡眠质量的状况,探讨应对方式和职业倦怠与睡眠质量的关系。方法采用匹兹堡睡眠质量指数量表(PSQI)、职业倦怠问卷(MBI-GS)、简易应对方式问卷(SCSQ)对155名医院医护人员进行问卷调查。结果①医护人员睡眠质量总分与国内常模比较无显著性差异;医生与护士睡眠质量比较也未见显著性差异;②医生和护士的职业倦怠总分存在差异(t=2.49,P<0.01),医生总体职业倦怠水平高于护士。医生的情绪衰竭和去个性化两个因子均高于护士,差异有统计学意义(t=3.36,P<0.01;t=2.01,P<0.05);③医生积极应对因子低于护士,消极应对因子高于护士,差异有显著性(t=3.30,P<0.01;t=2.45,P<0.05);④医护人员的睡眠质量总分与职业倦怠总分存在显著的正相关(r=0.343,P<0.01);主观睡眠质量因子、睡眠时间因子、睡眠障碍因子和日间功能障碍因子与情绪衰竭因子存在显著正相关(r=0.260,0.218,0.568;P<0.01)。而睡眠质量总分及各因子分与积极应对因子和消极应对因子相关性不显著。结论医护人员睡眠质量的总体状况较好,医生的职业倦怠比护士更严重。与护士相比,医生更多的采取消极应对方式。并且医护人员的睡眠质量与职业倦怠存在一定程度的正相关,与应对方式相关性不明显。     

慢性乙型肝炎患者心身症状和应对方式对生活质量的影响

目的 :研究慢性乙型肝炎患者的心身症状水平和应对方式对生活质量的影响。方法 :对 15 2名住院慢性乙肝病人用慢性肝病问卷 (CLDQ)、症状自评量表 (SCL - 90 )、医学应对问卷 (MCMQ)进行调查。结果 :慢性乙肝患者SCL - 90得分与常模和对照组有显著差异 ,各因子与CLDQ各维度呈负相关 ,以SCL - 90总均分 0 .4 4为划界分将病人分成阳性组和阴性组 ,阳性组CLDQ各维度得分均低于阴性组。患者面对应对低于常模 ,回避和屈服应对高于常模 ,阳性组比阴性组患者更倾向于采用回避和屈服应对 ,这两种消极的应对方式与生活质量呈负相关。结论 :慢性乙肝患者的心身症状及不良的应对方式对患者的生活质量有较大影响 ,要想通过心理干预减轻患者心身症状 ,提高患者的生活质量 ,重点应该放在改变不良应对方式上     

神经类型、生活事件、心理健康状况与睡眠质量

目的 :了解医科大学生的睡眠质量与神经类型、生活事件及心理健康状况等因素的相关关系。方法 :采用《睡眠质量调查表》、《症状自评量表》、《80 8神经类型测试表》和《生活事件量表》对 2 90名不同年级的医科大学生进行了测试及分析。结果 :医科大学生的睡眠质量随着年级的增加逐渐提高 ,女生的睡眠质量好于男生 ,一年级男生睡眠质量最差 ;睡眠质量的各主要因子与SCL -90的大部分因子呈正相关 ,其中焦虑因子是影响睡眠质量的主要因素 ;不同神经类型的学生的睡眠质量存在差异 ;工作学习中的负性事件与睡眠质量的各主要因子呈正相关。结论 :睡眠质量受多种因素影响     

脑卒中患者的生活质量与应对方式以及社会支持的相关性研究

目的：探讨脑卒中患者的生活质量、应对方式及其社会支持状况。方法：采用生活质量综合评定问卷（GQOLI）、医学应对问卷（MCMQ）及社会支持评定量表（SSAS）对60例脑卒中患者（观察组）及60名健康自愿者（对照组）进行测评。结果：①观察组生活质量总分及躯体功能、心理功能、社会功能3个维度评分均显著低于对照组（P〈0．01）；②观察组面对分量表评分显著低于对照组，而屈服分量表评分则显著高于对照组（P〈0．01）；③观察组社会支持总分及客观支持、主观支持、支持利用度评分均显著低于对照组（P〈0．01）；④脑卒中患者的生活质量总分及躯体功能、心理功能、社会功能3个维度评分与面对分量表评分及社会支持总分、客观支持、主观支持、支持利用度3个维度评分均呈显著性正相关，而与屈服分量表评分则呈显著性负相关（P〈0．05或P〈0．01）。结论：脑卒中患者的生活质量偏低，与应对方式及社会支持有关。     

精神分裂症患者生活质量与应对方式的关系

目的探讨精神分裂症患者生活质量与应对方式的关系。方法选取符合美国精神疾病诊断与统计手册第4版(DSM-IV)中精神分裂症诊断标准的医院门诊和住院患者共175例。采用世界卫生组织生存质量测定量表简表(WHOQOL-BREF)和应对方式问卷(CSQ)对患者进行评估。结果生活质量的生理、心理、社会关系、环境4个因子及总分与应对方式中的问题解决呈显著正相关(r=0.41,0.51,0.37,0.34,0.49;P<0.001),与自责呈显著负相关(r=-0.36,-0.44,-0.32,-0.21,-0.38;P<0.01),与回避呈显著负相关(r=-0.16,-0.19,-0.18,-0.16,-0.20;P<0.05);问题解决和自责两种应对方式能够很好地预测精神分裂症患者的生活质量(F=39.68,P=0.00)。结论精神分裂症患者的生活质量与应对方式关系密切,且问题解决和自责两种应对方式可作为生活质量的预测指标。