Disturbed eating attitudes, coping styles, and subjective quality of life in adolescents with Type 1 diabetes

OBJECTIVES: To evaluate coping styles and quality of life in youth with Type 1 diabetes with and without eating disorders and to identify relationships between these variables in each group. METHODS: Adolescents were evaluated for eating disorders with a two-stage diagnostic procedure. Adolescents with and without eating disorders then provided data on coping styles and on subjective well-being. RESULTS: Adolescents with Type 1 diabetes and disordered eating behavior reported more often blaming themselves and resorting to wishful thinking and poorer physical and psychosocial quality of life than do adolescents with Type 1 diabetes without disordered eating behavior. Specific coping strategies were also positively linked with quality of life and metabolic control. CONCLUSIONS: Eating disorders and disordered eating behavior in adolescents with Type 1 diabetes seem to be associated with certain negative and avoidant coping strategies and with impeded physical and bio-psychosocial well-being.     

Employer-Mandated Sleep Apnea Screening and Diagnosis in Commercial Drivers

INTRODUCTION:: Obstructive sleep apnea (OSA) is common among commercial drivers and associated with health/safety risks, leading several trucking firms to mandate OSA screening. METHODS:: A total of 19,371 commercial drivers were screened for OSA with an online questionnaire (Somni-Sage) through employer mandates. Questionnaire and polysomnography results were analyzed retrospectively. RESULTS:: Screening categorized 5908 drivers (30%) as higher risk. To date, employers have sent 2103 higher-risk drivers for polysomnography, demonstrating that 68% of high-risk drivers tested had an apnea-hypopnea index (AHI) greater than 10 and 80% had an AHI of 5 or more. A conservative prevalence estimate for OSA (AHI > 10) was 21% among the drivers studied. CONCLUSIONS:: Online screening followed by polysomnography for high-risk drivers demonstrates as many as 21% of commercial drivers may have OSA. Mandatory screening can have a high yield among commercial drivers.     

Cognitive deficits in vasculitis of the nervous system: a cross-sectional study

Objectives: To identify the cognitive and functional deficits in a well-characterized group of patients with vasculitis of the nervous system.

Methods: Sixty-seven patients diagnosed with Central Nervous System (CNS) or Peripheral nervous System (PNS) vasculitis over a 14-year period were retrospectively identified. Data on clinical presentation, laboratory, radiographic and tissue biopsy investigations, and treatment were collated. Cognitive, functional and quality of life evaluation assessments were performed in 31 patients who agreed to participate and included Addenbrooke’s Cognitive Examination-revised (ACE-R), Nottingham Extended Activities of Daily Living (NEADL) and EQ-5D-3L quality of life questionnaires.

Results: CNS vasculitis patients exhibited cognitive impairment, with a mean ACE-R score of 74/100 (standard deviation (SD) 16). NEADL and EQ-5D-3L scores were in the impaired range at 41/66 (SD 21) and 57/81 (SD 22), respectively. Patients with just PNS vasculitis exhibited fewer cognitive deficits with ACE-R and NEADL scores of 87 (SD 8) and 46 (SD 16) respectively. EQ-5D-3L score was in the impaired range of 65 (SD 22).

Conclusions: Vasculitis of the nervous system and, in particular, CNS vasculitis causes cognitive impairment and deficits in functional ability. Such patients should be targeted for cognitive rehabilitation.     

Quality of life after coronary artery bypass graft surgery in the elderly

Background

The aim of this study is to explore the quality of life of elderly patients after coronary artery bypass graft (CABG) surgery.

Methods

The present study employed a pre-post test design. Sixty three elderly patients (≥ 65 years), operated in one big general hospital in Athens, were interviewed before, 4 months and 12 months after CABG with the MacNew Heart disease health-related quality of life questionnaire.

Results

The majority of the sample were male (N = 48, 76.2%), married (N = 49, 77.8%) and pensioners (N = 54, 61.7%). After the operation and before discharge 42 (66.6%) patients presented complications. One year after the operation, 45 (80.4%) patients experienced improvement and only 11 (19.6%) deterioration in their reported quality of life. Despite this postoperative improvement in all domains, a high percentage of patients (> 60%) continued to report exacerbation in questions related to self confidence and dependence to others indicating an overprotective environment. Approximately one in two patients reported signs of cognitive dysfunction during the postoperative period. Elderly patients knew very little about their disease, especially before the operation (mean = 2.03, SD = 0.69, R = 1-5). Educational level, presence of complications in the immediate postoperative period and reported angina were related to a poorer QoL.

Conclusion

A high proportion of the patients experienced improvement while a substantial number had exacerbations related to self confidence and dependence to others. An important step to improve this situation might be through the institution of a structured multi-disciplinary rehabilitation program with focus on emotional support, information giving and education to elderly CABG patients and their significant others.     

Characteristics of self‐regulation in adolescent girls with Type 1 diabetes with and without eating disorders: A cross‐sectional study

Objectives. Pathology of the regulative mechanisms of self seems to be connected with eating disorders (EDs). The present study aimed to explore the hypothesis that there are differences in self‐regulation in adolescent girls with Type 1 diabetes with and without EDs. Design. A cross‐sectional design was employed comparing patterns of self‐regulation in adolescent girls with Type 1 diabetes with and without EDs in two eating status groups. Methods. For the presence of EDs, 76 adolescent girls with Type 1 diabetes were assessed. Of these, 23 were diagnosed with an ED. In addition, dimensions of self‐regulation as conceptualized in terms of Kohuts' psychodynamic theory of self were assessed. Results. Adolescent girls with Type 1 diabetes and an ED were higher in three aspects of self‐regulation – negative body self, object depreciation, and narcissistic gain from illness – in comparison with their peers without EDs. Conclusions. This study is the first to show evidence of deficits in self‐regulation in adolescent girls with Type 1 diabetes and EDs. The importance of evaluating parameters of self‐regulation for treatment planning for these youths is outlined.