The combined association of depression and socioeconomic status with length of post-operative hospital stay following coronary artery bypass graft surgery: Data from a prospective cohort study

Objective

To understand the association between pre-operative depression symptoms, including cognitive and somatic symptom subtypes, and length of post-operative stay in patients undergoing coronary artery bypass graft (CABG) surgery, and the role of socioeconomic status (SES).

Methods

We measured depression symptoms using the Beck Depression Inventory (BDI) and household income in the month prior to surgery in 310 participants undergoing elective, first-time, CABG. Participants were followed-up post-operatively to assess the length of their hospital stay.

Results

We showed that greater pre-operative depression symptoms on the BDI were associated with a longer hospital stay (hazard ratio = 0.978, 95% CI 0.957–0.999, p = .043) even after controlling for covariates, with the effect being observed for cognitive symptoms of depression but not somatic symptoms. Lower SES augmented the negative effect of depression on length of stay.

Conclusions

Depression symptoms interact with socioeconomic position to affect recovery following cardiac surgery and further work is needed in order to understand the pathways of this association.     

Predictors of Health-related Quality of Life and Adjustment to Prostate Cancer During Active Surveillance

Background

Active surveillance (AS) is emerging as an alternative approach to limit the risk of overtreatment and impairment of quality of life (QoL) in patients with low-risk localised prostate cancer. Although most patients report high levels of QoL, some men may be distressed by the idea of living with untreated cancer.

Objective

To identify factors associated with poor QoL during AS.

Design, setting, and participants

Between September 2007 and March 2012, 103 patients participated in the Prostate Cancer Research International Active Surveillance (PRIAS) QoL study. Mental health (Symptom Checklist-90), demographic, clinical, and decisional data were assessed at entrance in AS. Health-related QoL (HRQoL) Functional Assessment of Cancer Therapy-Prostate version and Mini-Mental Adjustment to Cancer outcomes were assessed after 10 mo of AS.

Outcome measurements and statistical analysis

Multivariate logistic regression models were used to identify predictors of low (<25th percentile) HRQoL, adjustment to cancer, and a global QoL index at 10 mo after enrolment.

Results and limitations

The mean age of the study patients was 67 yr (standard deviation: ±7 yr). Lack of partner (odds ratio [OR]: 0.08; p = 0.009) and impaired mental health (OR: 1.2, p = 0.1) were associated with low HRQoL (p = 0.006; area under the curve [AUC]: 0.72). The maladaptive adjustment to cancer (p = 0.047; AUC: 0.60) could be predicted by recent diagnosis (OR: 3.3; p = 0.072). Poor global QoL (overall p = 0.02; AUC: 0.85) was predicted by impaired mental health (OR: 1.16; p = 0.070) and time from diagnosis to enrolment in AS <5 mo (OR: 5.52; p = 0.009). Influence of different physicians on the choice of AS (OR: 0.17; p = 0.044), presence of a partner (OR: 0.22; p = 0.065), and diagnostic biopsy with >18 core specimens (OR: 0.89; p = 0.029) were predictors of better QoL. Limitations of this study were the small sample size and the lack of a control group.

Conclusions

Factors predicting poor QoL were lack of a partner, impaired mental health, recent diagnosis, influence of clinicians and lower number of core samples taken at diagnostic biopsy. Educational support from physicians and emotional/social support should be promoted in some cases to prevent poor QoL.     

Associations of psychological thriving with coping efficacy,expectations for future growth,and depressive symptoms over time in people with arthritis

Objective

Psychological thriving reflects a trajectory of growth over time as opposed to scaling back expectations. Whether thriving is a product, precursor, or process of coping with arthritis-related limitations is unclear. We examined associations between thriving, coping efficacy, and expectations for future growth in individuals with arthritis, and the relations of thriving to depressive symptoms and retrospective perceptions of personal growth over a six-month period.

Methods

A sample of 423 people with arthritis completed measures of thriving, coping efficacy, depressive symptoms, and expectations for future growth; 168 individuals completed a six-month follow-up survey. Structural equation modeling analyses compared three possible models of psychological thriving, controlling for disease-related variables. Hierarchical regression analyses of the cross-lagged associations of thriving with retrospective perceptions of positive personal change and depressive symptoms were also conducted.

Results

Structural equation analyses suggest that the process model in which thriving and coping efficacy jointly predicted expectations for future growth best fit the data. Baseline thriving was also associated with retrospective perceptions of personal growth at follow-up and fewer depressive symptoms at baseline and follow-up, after controlling for disease-related variables.

Conclusion

Overall, these findings suggest that psychological thriving is synergistically related to coping efficacy, and to expectations for future growth and less depression, in people with arthritis. Importantly, our findings support the notion that psychological thriving is more than scaling back expectations, and that thriving may be an important quality to cultivate to address the burden of depression in people with arthritis.     

The Adolescent Adjustment Profile (AAP) in comparisons of patients with obesity,phenylketonuria or neurobehavioural disorders

Psychosocial development in children with chronic disease is a key issue in paediatrics. This study investigated whether psychosocial adjustment could be reliably assessed with the 42-item Adolescent Adjustment Profile (AAP) instrument. The study mainly focused on adjustment-to-obesity measurement, although it compared three patient groups with chronic conditions. All phenylketonuria (PKU) patients in Sweden between ages 9 and 18 and their parents and teachers were invited to participate. Patients with neurobehavioural syndromes and obesity were age- and gender-matched with PKU patients. Healthy children constituted a reference group. Psychosocial adjustment was measured using the AAP, which is a multi-informant questionnaire that contains four domains. Information concerning parents’ socio-economic and civil status was requested separately. Respondents to the three questionnaires judged the PKU patients to be normal in all four domains. Patients with neurobehavioural syndromes demonstrated less competence and the most problems compared with the other three groups. According to the self-rating, the parent rating and the teacher rating questionnaires, obese patients had internalizing problems. The parent rating and the teacher rating questionnaire scored obese patients as having a lower work capacity than the reference group. Compared with the reference group, not only families with obese children but also families with children with neurobehavioural syndromes had significantly higher divorce rates. Obese patients were also investigated with the Strength and Difficulties Questionnaire (SDQ), another instrument that enables comparison between two measures of adjustment. The AAP had good psychometric properties; it was judged a useful instrument in research on adolescents with chronic diseases.     

Post-stroke emotional adjustment: A modified social cognitive transition model

Patients report a wide variety of emotional responses following stroke. Some individuals find the process of adjusting to their changed circumstances extremely difficult, while others cope well. Predicting and understanding patients' adjustment to stroke therefore poses challenges within rehabilitation settings. While research has revealed some of the variables associated with increased emotional distress (i.e., post-stroke depression) after stroke, a general model of post-stroke emotional adjustment has not yet been put forward. This article proposes that the Social Cognitive Transition model provides a sound theoretical basis upon which to build an understanding of post-stroke adjustment. The essential elements of a Social Cognitive Transition Model for Stroke are summarised, and clinical examples are used to discuss this model. The implications for psychological assessment, formulation and treatment are also discussed.     

埋藏式心脏转复除颤器患者的随访

目的报道7例埋藏式心脏转复除颤器(ICD)治疗恶性室性心律失常的情况。方法对6例单腔ICD及1例双腔ICD植入者进行随访,通过ICD程控仪调出储存的资料,了解ICD对恶性心律失常的治疗情况,并对其工作情况进行分析。结果随访5～44个月,平均23.7个月,ICD共检测到持续性室性心动过速(VT)2 129次,心室颤动(VF)6次。采用抗心动过速起搏(ATP)治疗VT的成功率为91.9%,ATP未能终止的VT经低能量转复(CV)治疗95.3%转为窦性心律,少数VT经治疗后加速为VF。高能量除颤(DF)终止VF的成功率为100%。4例12次误将室上性心动过速误判断为室性事件而启动治疗,其中2次心房颤动,10次窦性心动过速,经调整VT的识别参数及联合使用抗心律失常药物后未再发生类似情况。2例随访期间出现晕厥,ICD存储的信息显示发生了VF并复律成功。2例出现焦虑症,经心理治疗改善。结论术后严密随访,及时调整工作参数,同时关注患者的心理健康并给予针对性的心理支持和治疗,对提高ICD的治疗效果至关重要。     

老年人应对慢性病共病体验的Meta整合

目的 系统评价老年人应对慢性病共病的体验.方法 检索PubMed、Cochrane Library、Web of Science、Embase、中国知网、万方数据库、维普中文期刊全文数据库,检索时限为建库至2021年8月,检索老年人应对慢性病共病体验的质性研究文献,依据2016版澳大利亚乔安娜布里格斯研究所循证卫生保健...     

Beyond Liver and Culture: A Review of Theories and Research in Drinking among Chinese in North America

Low levels of alcohol consumption and drinking problems have been consistently found among the Chinese in North America and in other Chinese societies. Two theories of Chinese drinking have been popular in the literature. First, the physiological explanation attributes the light alcohol use among the Chinese to their high propensity to flush, which protects them from heavy drinking. Second, the cultural explanation suggests that Chinese cultural values emphasizing moderation and self-restraint discourage drinking to the point of drunkenness. A review of existing research shows that both explanations are not supported by adequate empirical research findings and are plagued with conceptual and methodological shortcomings. It is also noted that both theories cannot explain why some Chinese do become heavy or problem drinkers. It is suggested that we should look beyond physiological and cultural factors for a better understanding of contemporary Chinese drinking patterns.