Decision-Making and Depressive Symptomatology

Difficulty making decisions is a core symptom of depressive illness, but the nature of these difficulties has not been well characterized. The two studies presented herein use the same hypothetical scenarios that call for a decision. In Study 1, participants were asked to make and explain their decisions in a free-response format, as well as to describe their prior experiences with similar situations. The results suggest that those with more depressive symptoms make decisions that are less likely to further their interests. We also identified several interesting associations between features of decision-making and the presence of depressive symptoms. In Study 2, participants were guided through their decisions with simple decision tools to investigate whether the association between depressive symptoms and poor decisions is better accounted for by failure to use of good decision-making strategies, or by other factors, such as differences in priorities or goals. With this minimal intervention the quality of decisions no longer declined significantly as a function of depressive symptom severity. Moreover, few associations between depressive symptom severity and decision-related goals and priorities were evident, suggesting that the previously-exposed difficulties of depressed individuals with decision-making were largely the result of their failure to use effective decision-making techniques.     

Lifestyle Changes and Coping Patterns Among Caregivers of Stroke Survivors

Abstract Although caregiving has been a major focus for research, little is known about the day-to-day changes in lifestyle faced by caregivers. Yet lifestyle, developed over time, manifests an individual's very identity. Using a multimethod approach, we assessed the perceptions of lifestyle changes and coping patterns of 20 caregivers of first-time stroke survivors in the early poststroke period. An outcome-oriented matrix was employed for qualitative analysis, and findings were expanded by additional quantitative analysis. Three themes emerged: pervasiveness of lifestyle change, cohort differences in the perception of lifestyle change and coping patterns, and primary issues of time and confinement. Findings suggest that strains relative to caregiving may not be confined to direct caregiving activities, but may be related to established patterns of daily life.     

Family Functioning Is Associated With Depressive Symptoms in Caregivers of Acute Stroke Survivors

Epstein-Lubow GP, Beevers CG, Bishop DS, Miller IW. Family functioning is associated with depressive symptoms in caregivers of acute stroke survivors.

Objective

To determine whether family functioning is uniquely associated with caregiver depressive symptoms in the immediate aftermath of stroke.

Design

Cross-sectional data from the baseline assessment of an intervention study for stroke survivors and their families.

Setting

Neurology inpatient service of a large urban hospital.

Participants

Stroke survivors (n=192), each with a primary caregiver. The mean age of stroke survivors was 66 years, and most, 57%, were men (n=110). The mean age of caregivers was 57 years, and 73% (n=140) of the caregivers were women. Eighty-five percent of caregivers were white.

Interventions

Not applicable.

Main Outcome Measures

Measures were chosen to assess caregivers' depressive symptoms (Centers for Epidemiologic Studies Depression Scale), family functioning (Family Assessment Device), and additional factors such as health status (Medical Outcomes Study 36-Item Short-Form Health Survey) and stroke survivors' cognitive abilities (modified Mini-Mental State Examination) and functional impairments (FIM and Frenchay Activities Index).

Results

Depressive symptoms were mild to moderate in 14% and severe in 27% of caregivers. Family functioning was assessed as unhealthy in 34% of caregiver-patient dyads. In statistical regression models, caregiver depression was associated with patients' sex, caregivers' general health, and family functioning.

Conclusions

Forty-one percent of caregivers experienced prominent depressive symptoms after their family member's stroke. Higher depression severity in caregivers was associated with caring for a man, and having worse health and poor family functioning. After stroke, the assessment of caregivers' health and family functioning may help determine which caregivers are most at risk for a depressive syndrome.     

Consistency Between Preference and Use of Long-Term Care Among Caregivers of Stroke Survivors

ABSTRACT Effective arguments have been made for the importance of expanded attention to understanding how family preferences influence decisions to choose long-term care. The effects of preference on the utilization of long-term care deserve further research, especially on a longitudinal basis. The family members of 582 first-time stroke patients from the neurology departments of four teaching hospitals in Taiwan were categorized into two groups based on their attitudes toward type of long-term care, i.e., a preference for nursing home care (n₁= 324) or a preference for home care (n₂= 258). The consistency rate between preference and utilization of the type of long-term care was estimated by the division of number of families preferring one type of long-term care by the number of families actually utilizing the services preferred. Results indicated that the consistency rate for those with nursing home preference was 8.3% while the consistency rate for those with home care preference was 94.2%. Accessibility of nursing home facilities near family residences was significantly associated with whether those preferring nursing home services actually utilized them, and the odds ratio was 20.8. The family manpower available for caregiving at home was tremendously associated with whether families utilized home care when home care was preferred; the odds ratio was 33.3. The preference for the type of long-term care was a strong predictor of the utilization when home care was preferred, yet not when a nursing home was preferred. The low consistency between preference and utilization for nursing homes preferred is due to the low accessibility of nursing home facilities in Taiwan. How to provide sufficient support to families for caregiving at home, and how to deal with the barrier of accessibility to nursing home services should be two major concerns for those who are planning and operating the long-term care system and for those trying to design institutional services and noninstitutional services as alternatives.     

Use of the Continuous Scale Physical Functional Performance Test in Stroke Survivors

Manns PJ, Tomczak CR, Jelani A, Cress ME, Haennel R. Use of the continuous scale physical functional performance test in stroke survivors.

Objective

To (1) determine the feasibility of the continuous scale physical functional performance 10-item test (CS-PFP10) for the measurement of physical function in stroke survivors, (2) characterize physical functional performance of stroke survivors and their matched controls, and (3) explore the associations among physical functional performance, ambulatory activity, and peak oxygen uptake (Vo₂peak).

Design

Case control.

Setting

University research setting.

Participants

Ten participants with stroke and 10 healthy controls matched for age, sex, and physical activity.

Interventions

Not applicable.

Main Outcome Measures

The CS-PFP10 test was used to measure functional ability. The test requires performance of 10 serial tasks that range from low to high difficulty. The step activity monitor was used to measure absolute ambulatory activity and was reported as the average number of steps a day over a 4-day period. Vo₂peak was determined using a metabolic cart and a recumbent cycle ergometer.

Results

Stroke survivors scored lower than healthy controls on all individual tasks, domains, and the total score on the CS-PFP10. Higher Vo₂peak was associated with higher total scores on the CS-PFP10 in both stroke survivors and controls. In stroke survivors, lower levels of impairment (as indicated by the Chedoke-McMaster stroke assessment) were associated with higher total CS-PFP10 scores.

Conclusions

The CS-PFP10 is a measure of physical performance that is feasible to use with ambulatory participants with stroke. Future investigations with people with stroke should explore the ability of the CS-PFP10 to provide meaningful information about change in CS-PFP10 subscales with interventions that target items on the subscales, such as balance or upper extremity strength.     

胃癌幸存者社会疏离现状及其影响因素分析

[摘要]目的：研究胃癌幸存者社会疏离现状和影响因素,为临床医护干预提供依据。方法： 采用便利抽样法选择2017年01月至2022年12月间我院治疗的胃癌幸存者,采用一般疏离量表调查患者其社会疏离现状,通过单因素分析和多重线性回归分析胃癌幸存者社会疏离影响因素。结果：胃癌幸存者社会疏离评分为45.39±6.55分,SDS评分为56.33±8.34分,社会支持评分为31.23±3.27分。抑郁自评量表（SDS）评分与社会疏离总分及其4个维度评分均呈正相关,社会支持与社会疏离总分及其4个维度评分均呈负相关,SDS与社会支持总分及其3个维度评分呈负相关（均P＜0.05）。单因素和多重线性回归分析显示：临床分期、治愈后时间、家庭人均月收入、放化疗情况、SDS评分、社会支持评分均为胃癌患者社会疏离独立影响因素（均P＜0.05）,性别不为其影响因素（P＞0.05）。其中临床分期Ⅲ~Ⅳ期、放疗或化疗或放疗+化疗、SDS评分均为胃癌幸存者社会疏离风险因素均P＜0.05）,治愈后时间≥3年、家庭人均月收入≥5000元、社会支持评分为患者社会疏离保护性因素（均P＜0.05）。结论：胃癌幸存者社会疏离水平较高,针对患者社会疏离影响因素,临床、患者、社会应该及时干预,提高患者融入家庭、回归社会的能力。     

Functional Status of Stroke Patients in Long-Term Care

Thirty persons who had remained in long-term care for one year or more post-stroke were assessed with respect to motor function, cognitive, perceptual, and communication ability and ADL capacity. Before the stroke they had lived an independent life, although 40% suffered from cardiovascular disease. At the follow-up, all patients had severe impairments due to the brain damage. None could walk or stand independently, ten could not call for help or attract attention in any way, and 13 could not take part in a conversation. Eleven patients had severe pain in spite of treatment with analgesics. Pain treatment and training methods that can reduce dependence and improve the quality of life for patients like these need to be developed. More appropriate assessment instruments for this patient group have to be constructed to make evaluation of training and care possible.     

Psychiatric Morbidity and Depressive Symptomatology in Patients with Permanent Pacemakers

Implantation of a permanent pacemaker requires a psychological effort on the patient's part for adaptation in the acute term, and chronically, it restricts activities of the patient and may cause some psychiatric disturbances. To investigate psychiatric morbidity and depressive symptomatology of the patients with permanent pacemakers, 84 pacemaker patients were diagnosed using the DSM-III-R criteria and depressive symptoms were determined by modified Hamilton Depression Rating Scale (mHDRS). Sixteen (19.1 %) patients had been given a psychiatric diagnosis. The most frequent diagnoses were adjustment disorder (5.9%) and major depressive episode (4.7%). Nine patients (10.7%) were diagnosed as having clinical depression (mHDRS ≥ 17). The mean score of mHDRS was 7.57 ± 7.46, and the severity of depression was significantly higher in females. The most frequent symptoms are difficulties in work and activities (53.6%), psychic anxiety (48.8%), loss of energy (42.9%), and hypochondriasis and insomnia (39.3%). Depressed mood, psychic anxiety, loss of energy, loss of interest, insomnia, and hypochondriasis were significantly more frequent in females. Uneducated patients had a more significant loss of energy than educated patients. Depressed mood, psychic anxiety, and somatic concerns and symptoms were more frequent in patients with permanent pacemakers than in the general population. These symptoms, resembling mixed anxiety-depression disorder, were related to fears of having a permanent pacemaker, since our series were composed of uneducated patients who did not have enough knowledge about the device.     

Risk Factors for Falls in Community Stroke Survivors: A Systematic Review and Meta-Analysis

Objective

To identify the risk factors for falls in community stroke survivors.

Development and Rasch Validation of an Observational Assessment Tool of Upper Limb Functional Impairment in Stroke Survivors: Functional Assessment Test for Upper Limb

ObjectiveTo develop and validate a quick observational clinical tool, the Functional ASsessment Test for Upper Limb (FAST-UL), for the evaluation of upper limb impairment in goal-directed functional-oriented motor tasks after stroke.DesignObservational, cross-sectional, psychometric study.SettingInpatient and outpatient rehabilitation clinic.ParticipantsA total of 188 post-stroke survivors (mean age 65.2±17.7 years, 61% men, 48% with ischemic stroke and 66% in the sub-acute phase; N=188).InterventionsNot applicable.Main Outcome MeasuresPrincipal component analysis and Rasch analysis through a Partial Credit Model were used to assess the structure and psychometric properties of the 5 items of the FAST-UL (Hand to Mouth [HtM], Reach to Target, Prono-Supination, Grasp and Release, and Pinch and Release [PaR]).ResultsThe Cronbach's α equal to 0.96 was indicative of an acceptable internal consistency; the reliability, as measured through the Person Separation Reliability equal to 0.87, was good. The FAST-UL tool was unidimensional. All the FAST-UL items were found to fit well the Rasch measurement model. The easiest to perform FAST-UL item was the HtM movement while the most difficult was the PaR movement.ConclusionsThe FAST-UL is a quick, easy-to-administer observational assessment tool of upper limb motor impairment in post-stroke survivors with good item-level psychometric properties.