Changes in the coping styles of spouses and the influence of these changes on their psychosocial functioning the first year after a patient's stroke

Objective

The objective of this study was to examine the changes in spouses' coping styles that occur in the first year after a patient's stroke and the influence of these changes on the spouses' psychosocial functioning.

Methods

A total of 211 spouses of patients with stroke were assessed at three different time points using self-reported questionnaires (at the time of the patient's admission to inpatient rehabilitation, 2 months after discharge and 1 year poststroke). We used linear mixed-model and multiple linear regression analyses to analyse the data.

Results

Spouses' use of an active coping style decreased significantly in the first year poststroke. There were no significant overall changes in the use of a passive coping style. The use of a passive coping style at admission and increases in passive coping style in the first year poststroke predicted worse psychosocial functioning 1 year poststroke. The models explained between 32% and 50% of the variance in quality of life, depressive symptoms and strain.

Conclusion

The present study indicates that spouses' passive coping style is maladaptive poststroke when used in the acute as well as in the chronic phase. Use of an active coping style decreases in the first year poststroke, but these decreases do not predict psychosocial outcomes.     

Question Mark Ear Deformity: A Combined Method for Correction

Question mark ear deformity or Cosman ear is a very uncommon congenital alteration. The deformity includes a cleft between the posterior helix and the lobule, an increase in anterior projection, an abnormal superior third that modifies the superior crura and the scaphoid fossa, partial or complete absence of the antihelix, transposition of the lobule and antihelix (severe cases), and postauricular tags. The authors present a case of moderate question mark ear deformity treated using Mustarde sutures and two cartilage grafts to correct the support and the contour defect. Adequate correction of the deformity and symmetry was achieved for both ears. The technique described in this report is suitable for minimal to moderate defects.     

Stage I hypertension is associated with impaired systolic function by strain imaging compared with prehypertension: A report from the prever study

High blood pressure (BP) is associated with higher rates of cardiovascular events, even in stage I hypertension (HTN) and prehypertension (preHTN). Lower left ventricular (LV) systolic function, assessed by global longitudinal strain (GLS), has been demonstrated in individuals with HTN compared to individuals with normal BP, but a comparison of individuals with preHTN and stage I HTN was not described to date. The PREVER study includes two randomized double‐blind controlled trials, performed in volunteers with preHTN (PREVER‐prevention trial) or stage I HTN (PREVER‐treatment trial), aged 30‐70 years. A subsample of patients of both trials had GLS measured from 2D echocardiograms performed at baseline and after 18 months of follow‐up. We compared baseline data from both studies and, among stage I HTN patients, clinical and echocardiographic correlates of GLS were determined. Participants with preHTN (n = 91;53% female; 55 ± 9 yo) and stage I HTN (n = 105; 44% female; 55 ± 8 yo) had similar clinical parameters beyond the expected differences in BP levels. Participants with stage I HTN had lower GLS (−17.5 ± 2.5% vs −18.2 ± 2.4%, P = .03) compared with those with preHTN. In stage I HTN, lower GLS was associated with lower e'' and lower LV ejection fraction. In conclusion, patients in Stage I HTN may already express changes in GLS compared with individuals with preHTN, suggesting that even mildly difference in BP can be impact in subclinical systolic function.     

Improvement of bone mineral density and markers of proximal renal tubular function in chronic hepatitis B patients switched from tenofovir disoproxil fumarate to tenofovir alafenamide

Tenofovir alafenamide (TAF) is a novel prodrug that reduces tenofovir plasma levels by 90% compared to tenofovir disoproxil fumarate (TDF), resulting in decreased bone mineral density (BMD) loss and renal toxicity. We aimed to study changes in BMD and markers of renal function of chronic hepatitis B (CHB) patients previously treated with TDF who were switched to TAF in as early as 12 weeks. This was a prospective single‐arm open‐label study of 75 CHB patients treated with TDF 300 mg daily who were switched to TAF 25 mg daily and followed for 24 weeks. All patients had been treated with TDF for at least 12 months and had HBV DNA <21 IU/mL at the time of switch. BMD and markers of renal function were taken on the day of switch and repeated after 12 and 24 weeks of TAF treatment. Hip and spine bone mineral density significantly increased from baseline to week 12 (+12.9% and +2.4%, respectively, P < 0.01). There were significant decreases in urinary beta‐2‐microglobulin to creatinine and retinol‐binding protein to creatinine ratios by week 12 (P < 0.01 for both). Mean estimated glomerular filtration rate (GFR) did not change. Tubular reabsorption of phosphate was decreased at week 24 (P < 0.05). In conclusion, CHB patients previously treated with TDF experienced significant improvement in bone density and some markers of renal tubular function and as early as 12 weeks after switching to TAF. Bone density changes associated with TDF may not be entirely related to renal handling of phosphate.     

Characteristics associated with anti-HCV serological markers in prisoners in the state of Paraná, Brazil: a case-control study

BackgroundThe prison system in Paraná, Brazil, is experiencing serious problems related to the increasing number of prisoners. Control of hepatitis C virus (HCV) has become more intense because the incarcerated population is considered a high-risk group for contagious diseases due to the favorable conditions found in prisons for the spread of these morbidities. The objective of this study was to identify features associated with hepatitis C infection among male prisoners in correctional institutions of Paraná state, Brazil.MethodsThis was a case-control study (27 cases and 54 controls) of men incarcerated in 11 penitentiaries in Paraná, Brazil. Information was obtained through a questionnaire in a cross-sectional epidemiological survey on HCV infection during the period from May 2015 to December 2016. Eligible men were recruited after testing positive for anti-HCV antibodies. Cases and controls were selected based on serological results of enzyme-linked immunosorbent assays and were matched by age, location of the penitentiary, and time in prison. Logistic regression analysis was used to identify risk factors for HCV seropositivity.ResultsThe main significant independent risk factor for the acquisition of HCV infection was the use of injectable drugs (OR = 4.00; 95%CI:1.41–11.35; p < 0.001).ConclusionsThis study provides evidence that HCV infection is associated with drug use by this population. This information is pivotal for tailoring prevention programs and guiding specific socioeducational measures that aim to reduce or prevent HCV transmission within the prison setting.