Emotional health and quality of life after aneurysmal subarachnoid hemorrhage

Background

Emotional disorders and decrease in health-related quality of life (HRQoL) are well-documented sequelae of aneurysmal subarachnoid hemorrhage (SAH). The aim of this study was to analyze the impact of emotional disorders on HRQoL in survivors of SAH.

Methods

This was a retrospective study enrolling 114 SAH-survivors at 1–10 years (mean 4,5 years) after the disease. Emotional State Questionnaire (EST-Q) was used to measure emotional health and the Short Form Health Survey (SF-36) was used to assess HRQoL of the patients.

Results

Most of the patients reported good recovery, but EST-Q results revealed high prevalence of emotional disorders after SAH. Almost half of the patients had higher than cut-off values indicating fatigue (47 %) and insomnia (46 %). About one third of SAH-patients had higher than cut-off scores demonstrating depression (30 %) and anxiety (31 %). The patients scored significantly lower in all scales of SF-36 as compared to age-matched general population. All EST-Q subscale results were significantly and negatively correlated with SF-36 scores. Fatigue was independently related to all SF-36 subscales and depression to most of the mental health component scores. Emotional symptoms alone were demonstrated to explain 23–47 % of the SF-36 subscale values, and more than half of the variance of mental health component score values were found to be explained by emotional disorders (53 %).

Conclusions

Emotional disorders are frequent after SAH and significantly associated with impairment of HRQOL. Proper and timely screening tests are important to reveal development of emotional problems and improve QoL for the SAH-patients.     

N-[4-(N,N,N-Trimethylammonium)Benzyl]Chitosan Chloride as a Gene Carrier: The Influence of Polyplex Composition and Cell Type

Polyplex-based gene delivery systems are promising substitutes for viral vectors because of their high versatility and lack of disadvantages commonly encountered with viruses. In this work, we studied the DNA polyplexes with N-[4-(N,N,N-trimethylammonium)benzyl]chitosan chloride (TMAB-CS) of various compositions in different cell types. Investigations of the interaction of TMAB-CS with DNA by different physical methods revealed that the molecular weight and the degree of substitution do not dramatically influence the hydrodynamic properties of polyplexes. Highly substituted TMAB-CS samples had a high affinity for DNA. The transfection protocol was optimized in HEK293T cells and achieved the highest efficiency of 30–35%. TMAB-CS was dramatically less effective in nonadherent K562 cells (around 1% transfected cells), but it was more effective and less toxic than polyarginine.     

Efficacy of a self‐study programme to teach spiritual care

Aim and objectives. This study investigated the efficacy of a self study programme designed to teach nurses about how to talk with patients about spirituality, and to identify factors predicting this learning. Furthermore, the study investigated whether there were differences in learning between students and practicing clinicians, and between those in a religious or non‐religious institution. Background. Although USA and UK accrediting bodies mandate nurses learn how to assess and support patient spiritual health, there is a paucity of evidence to guide educators regarding how to teach spiritual care to nurses. Indeed, it is unknown if aspects of spiritual care can be taught using formal approaches. Design. A pretest‐posttest pre‐experimental design was used to study how attitude toward spiritual care, ability to create empathic verbal responses to expressed spiritual pain, personal spiritual experience, and knowledge about communication for spiritual caregiving changed from before to after programme completion. Methods. Study participants, 201 nursing students and RNs, independently completed the mailed self‐study programme (i.e. workbook with supplemental DVD) and self‐report study instruments (i.e. Daily Spiritual Experience Scale, Spiritual Care Perspective Scale‐Revised, Response Empathy Scale, Communicating for Spiritual Care Test, and Information about You form). Results. Significant differences were seen between the before and after scores measuring attitude, ability, spiritual experience, and knowledge. An interaction effect of time between students and registered nurses for both spiritual care attitude and personal spiritual experience was observed. Conclusions. Findings suggest learning occurred for both students and RNs, regardless of whether they were at a religious institution or not. Relevance to clinical practice. These data indicate that this self‐study programme was an effective approach to teach nurses about how to converse with patients about spirituality.     

Why the transformation of the risk message is a healthy sign: a model of the reception of warning messages

In this article, we examine the communication of health risks caused by technological and natural disasters to the public. Contrary to the commonly accepted view, we argue that in the context of the risk society, the transformation and multiplication of risk messages among the public is a healthy sign. We aim to show how the recipients of risk communication can overcome the confusion that emanates from the inevitable contradictions of warning messages. We used Luhmann’s communication theory to develop a model of the analysis of personal interpretations of warning messages and examined how this explained the variations in the personal sense of risk that shaped the reception of a warning message. Our model developed Luhmann’s concepts of first- and second-order observations: direct and reflective approaches to risk messages. Using data derived from seven focus groups conducted in four Estonian cities in 2009–2010, we examined how the choice between direct and reflective approaches to risk messages was dependent on recipient’s reflection of social relations in the messages and the channels of their delivery. We found that the first response to the warning message depended on whether the information could be dealt with by first-order observation. When members of the focus group realised they needed to use a second-order observation strategy, they tended to use emotions to respond to risk messages. Our data show that defining risks and legitimising solutions in a collective discussion tended to be more important for an individual than accessing the one-dimensional official constructions of risks.     

Variations in quality of frozen-thawed semen from Swedish Red and White AI sires at 1 and 4 years of age

The predictability of semen quality of mature sires from measurements at an early age is not well established. The aim of the present study was to determine age-dependent changes in the quality of bull semen for artificial insemination (AI). Semen was collected and frozen from each of six Swedish Red and White (SRB) dairy AI bulls when they were 1 and 4 years old. Three batches were randomly selected from each bull and age group. From each batch, semen was analysed immediately after thawing [post-thaw (PT), control] as well as after washing/resuspension (W) and after a swim-up procedure (SU). The analyses comprised subjective and computerized (computer-aided sperm analysis, CASA) measurements of motility as well as sperm concentration, morphology and membrane integrity. When semen was analysed, PT, overall sperm motility (CASA), concentration of motile spermatozoa and membrane integrity improved when sires were older. After SU, there was a similar improvement in membrane integrity and concentration of motile spermatozoa, but linear motility decreased. No significant differences between ages were recorded after W-treatment. The above findings indicate that SU is not only superior to W-treatment in differentiating semen quality among bulls but also reveals age-dependent changes. Improved motility and membrane integrity suggest increased viability of spermatozoa at 4 years of age in the SRB sires examined here.     

Social inequalities in the use of health care services after 8 years of health care reforms – a comparative study of the Baltic countries

Objective:  In nineties, Estonia, Latvia and Lithuania have implemented a wide range of changes to health systems. The objective of this paper was to assess social inequalities in utilisation of, and access to, health care services in the late nineties. Methods:  The comparative NORBALT Survey conducted in 1999 is used. Direct standardization and logistic regression was applied to analyse primary, out-patient and hospital care utilisation, and self reported financial barriers, by socio-demographic and geographical variables. Results:  In all three countries social inequalities in utilization were large for out-patient specialist care, smaller or absent with regards to primary care or to hospitalisations. Inequalities were large and consistent in relationship to household income, less so in relationship to educational level. Inequalities in utilization of care were larger in Latvia as well in the self reported barriers to health care in absolute and relative terms were larger. Conclusions:  After 8 years of reforms, important pro-rich inequalities in the use of health services existed. In Latvia, these inequalities were largest, possibly due to higher ratio of cost sharing as compared to Estonia and Lithuania. Submitted: 15 February 2008; revised: 16 July 2008, 04 October 2008; accepted: 08 October 2008     

Life expectancy of patients with malignant pleural effusion treated with video-assisted thoracoscopic talc pleurodesis

The aim of the current study was to analyse postoperative complications and survival after video-assisted thoracoscopic (VATS) talc pleurodesis for malignant pleural effusion. All patients with morphologically proven malignant pleural effusion who underwent VATS talc pleurodesis from November 1995 to November 2002 were included in retrospective analysis. VATS was performed in general anaesthesia and 5 g of asbestos-free talc was insufflated into the pleural cavity. Postoperative pleural drainage was used until fluid output was less than 100 ml/24 h. Ninety-eight patients (28 male and 70 female) with mean age 59.6 (range 18-82) years were included. Thirteen patients had a bilateral pleural effusion. The most common primary cancer sites were lung (30 cases), breast (25) and ovarium (11). Average duration of the operation was 46 (range 10-120) min. Median duration of postoperative drainage was 3 (range 1-20) days and postoperative hospitalisation 7 (range 3-70) days. Twenty-eight patients had postoperative complications (fever in 17 cases). In seven cases pleurodesis was ineffective. Median survival was 8.4 months. Six-, 12- and 24-month survival was 58% (95% CI [0.47-0.67]), 39% [0.29-0.49] and 20% [0.12-0.29], respectively. Survival data after VATS talc pleurodesis advocate use of this invasive treatment method despite the advanced stage of cancer.     

Seasonal recovery of Eimeria oocysts from soil on naturally contaminated pastures

Though Eimeria is an important parasite of cattle, research is lacking on how the parasite persist in the pasture soils. In this study, feces samples were collected from three pastures in June and October 2010 and soil samples in April 2011. Coordinates of sampling locations were recorded with Global Positioning System together with information about grass cover, shade, and elevation. All soil samples were collected from the same locations as the fecal samples and used in model evaluating the possible factors influencing the concentration of oocysts in the soil. Feces and soil samples were investigated using a quantitative flotation technique. Eimeria oocysts were found in 95.6 % of fecal samples collected in summer and 84.5 % of samples in fall. In contrast, the same locations soil samples were positive for Eimeria oocysts in 37.3 % (summer) and 44.3 % (fall). Despite larger numbers of oocysts in fecal samples shed during summer compared to fall, there was no difference in the concentration of oocysts in soil samples the following spring. The odds of higher numbers of oocysts in soil samples in spring were higher if fecal samples collected in summer were in shade or if containing Eimeria alabamensis during the fall. Factors other than the concentrations of oocysts shed in feces appear to affect whether oocysts persist between grazing seasons.     

Interleukin 10 family gene polymorphisms are not associated with major depressive disorder and panic disorder phenotypes

Genetic regulation of immune system and inflammatory response may be related to the pathogenesis and manifestations of mood and anxiety disorders. In the present study we examined a range of single-nucleotide polymorphisms (SNP) in chromosomal region 1q32, the locus of interleukin 10 (IL10) gene, in patients with major depressive disorder (n = 312) and panic disorder (n = 210), and matched healthy controls (n = 356). We found no significant associations of the SNPs in IL10 family genes with either diagnostic group. Haplotype analysis revealed seven haplotype blocks, but their frequencies did not differ between patients and controls. Significant associations were detected for SNP rs1539243 in IKBKE (inhibitor of kappa light polypeptide gene enhancer in B-cells, kinase epsilon) gene showing different allelic and genotypic distributions in the total as well as in separate diagnostic groups as compared to controls. IKBKE emerged as a candidate for further studies of genetic factors associated with panic disorder and major depressive disorder.