Impact of psychiatric and medical comorbidity on cognitive function in depression

Aim:  The aim of the present study was to investigate the association between cognitive performance and psychiatric and medical comorbidity in major depression.
Methods:  The present study evaluated the cognitive performance of patients ( n  = 96) diagnosed with a major depressive episode in relation to the presence of medical and/or psychiatric comorbidity. Participants were assessed clinically and cognitively using the Mini International Neuropsychiatric Interview and Repeatable Battery for the Assessment of Neuropsychological Status. Four groups of comorbidity were categorized: (i) no comorbidity, (ii) medical comorbidity; (iii) psychiatric comorbidity; and (iv) both medical and psychiatric comorbidity, and subsequently analyzed for differences across six cognitive domains: immediate memory, visuospatial, language, attention, delayed memory, and total score.
Results:  Only 20.8% of the participants did not have a comorbidity of any kind, while psychiatric comorbidities (67.7%) were more frequent than medical comorbidities (39.6%). Education and severity of depressive symptoms negatively influenced cognitive performance. Psychiatric comorbidity alone significantly decreased cognitive performance in the visuospatial/constructional and the language domains and the total score. In addition, increasing numbers of psychiatric comorbidities were related to worse cognitive performance. In contrast, medical illnesses alone had no negative impact on any of the domains of cognitive performance. Evidence was found for additive effects of medical and psychiatric comorbidities in depression on visuospatial/constructional cognitive abilities.
Conclusion:  The strongest predictor of poor cognitive performance in depression was psychiatric comorbidity. The assessment and treatment of cognitive dysfunction in depression should consider the relative impact of psychiatric comorbidity.     

Psychiatric nursing for promotion of mental health and prevention of depression in the elderly: a case study

The aim of this case study was to describe and analyse the basic pre-conditions for an intervention programme focusing upon mental health promotion and prevention of depression in an elderly community group and to discuss the psychiatric nurse's community-oriented health promotion work. The intervention programme, which was led by a psychiatric nurse, was built on intersectorial co-operation between public and voluntary organizations, development of social networks to promote social support, and target group participation. The nurse's function in the community-oriented work was to act at the individual, group and society level, as well as to mobilize resources among individuals and organizations, in order to create a favourable interaction, resulting in health and empowerment for the individual. Pre-conditions for leading this work were: knowledge of health and mental all health among the elderly, investigation methodology, knowledge about the local society, as well as pedagogical, supervisory and social competence.     

Medication errors in chemotherapy: incidence,types and involvement of patients in prevention. A review of the literature

SCHWAPPACH D.L.B. & WERNLI M. (2010) European Journal of Cancer Care 19 , 285–292
Medication errors in chemotherapy: incidence, types and involvement of patients in prevention. A review of the literature Medication errors in chemotherapy occur frequently and have a high potential to cause considerable harm. The objective of this article is to review the literature of medication errors in chemotherapy, their incidences and characteristics, and to report on the growing evidence on involvement of patients in error prevention. Among all medication errors and adverse drug events, administration errors are common. Current developments in oncology, namely, increased outpatient treatment at ambulatory infusion units and the diffusion of oral chemotherapy to the outpatient setting, are likely to increase hazards since the process of preparing and administering the drug is often delegated to patients or their caregivers. While professional activities to error incidence reduction are effective and important, it has been increasingly acknowledged that patients often observe errors in the administration of drugs and can thus be a valuable resource in error prevention. However, patients need appropriate information, motivation and encouragement to act as ‘vigilant partners’. Examples of simple strategies to involve patients in their safety are presented. Evidence indicates that high self‐efficacy and perceived effectiveness of the specific preventive actions increase likelihood of participation in error prevention. Clinicians play a crucial role in supporting and enabling the chemotherapy patient in approaching errors.     

Associations between work schedule characteristics and occupational injury and illness

DE CASTRO A.B., FUJISHIRO K., RUE T., TAGALOG E.A., SAMACO‐PAQUIZ L.P.G. & GEE G.C. (2010) Associations between work schedule characteristics and occupational injury and illness. International Nursing Review 57 , 188–194 Background: Nurses often endure working irregular day, night and evening shifts as well as mandatory overtime (i.e. employer‐imposed work time in excess of one's assigned schedule). While these work characteristics are examined as potential risks for nurses' safety and health, it is not clear whether negative health impacts occur simply because of working long hours or in combination with other mechanisms. Aim: This study investigates how these work characteristics are associated with nurses' work‐related injury and illness over and above long work hours. Methods: In this cross‐sectional study, questionnaire data were collected from a sample of 655 registered nurses in the Philippines. Multiple logistic regression was used to assess associations of shift work and mandatory overtime with four work‐related health outcomes. Results: After weekly work hours, shift length and demographic variables were accounted for, non‐day shifts were associated with work‐related injury [odds ratio (OR) = 1.54; 95% confidence interval (CI): 1.07, 2.24] and work‐related illness (OR = 1.48; 95% CI: 1.02, 2.16). Also, frequency of working mandatory overtime was associated with work‐related injury (OR = 1.22; 95% CI: 1.06, 1.41), work‐related illness (OR = 1.19; 95% CI: 1.04, 1.37) and missing more than 2 days of work because of a work‐related injury or illness (OR = 1.25; 95% CI: 1.08, 1.44). Conclusions: These findings suggest that non‐day shifts and mandatory overtime may negatively impact nurses' health independent of working long hours. Mechanisms through which these work characteristics affect health, such as circadian rhythm disturbance, nurse‐to‐patient ratios and work–family conflict, should be examined in future studies.     

Health psychology and distress after haematopoietic stem cell transplantation

The purpose of this study of 23 adult haematopoietic stem cell transplantation (HSCT) recipients is to compare the presence of post-transplantation depression disorders by gender and to compare the outcomes among those with and without depressive disorders using a health psychology focus. This cross-sectional pilot study of mid-term survivors took place in hospital outpatient clinic. Main outcome measures are depression disorders, health status (Short Form-12) and health anxiety. Female survivors had a higher rate of depression disorders, but those with treated depressive disorders were similar to those without depression on health-related quality of life and health anxiety. Neither patient age nor time since HSCT was associated with depressive disorders. A health psychology approach may enhance management of HSCT survivorship.