Status and after-care of young adults with congenital heart defects

INTRODUCTION: We studied patients with congenital heart defects born in 1975 and followed by our institution. We were interested in the outcome of these patients at the age of 20 years with regard to professional status, physical activity and psychosocial aspects. Furthermore, we investigated the handover from the paediatric to the adult cardiologist as well as the information level concerning antibiotic prophylaxis against bacterial endocarditis. METHODS: From a previous follow-up study to the age of 16 years, we knew 224 patients with congenital heart disease born in 1975, 119 were considered to need further cardiological follow-up. In 112 (94%) we have a complete follow-up to the age of 20 years with a structured interview by phone. RESULTS: Mortality and medical care during the period between 16 and 20 years of age were at a lower level than in the previous periods. Except in patients suffering from complex or surgically treated cyanotic heart disease, the results, compared to the standard population at the age of 20 years, are better with regard to professional status, and equal for physical activity and psychosocial integration. Only 60% of the patients were followed by an adult cardiologist and only 45% of the patients needing antibiotic prophylaxis against bacterial endocarditis are aware of this. CONCLUSION: Except in patients with complex congenital or surgically treated cyanotic heart diseases, the outcome at the age of 20 years with regard to professional status, physical activity and psychosocial integration is very good compared with the standard population at the age of 20 years. The handover to the adult cardiologist is inadequate and knowledge and awareness of antibiotic prophylaxis against bacterial endocarditis is also insufficient-both aspects need improvement.     

Relationship between self-rated functional status and psychosocial stress in patients suffering from rheumatoid arthritis

BACKGROUND: To assess relationship between psychosocial factors and self-rated functioning in rheumatoid arthritis (RA). METHODS: In 66 RA patients (mean age +/- SD = 50.8 +/- 12.6 years, women 49 (74%), illness duration mean +/- SD = 13.4 +/- 10.5 years) aspects of developmental psychosocial stress thought to influence human behavior were assessed in an in depth interview using structured biographical history. Furthermore evaluation included Trait anxiety, global functional status according to the ACR criteria, radiological staging of illness and patients' self-ratings of functioning obtained by the Health Assessment Questionnaire (HAQ). Bivariate correlations were performed using psychosocial and somatic factors and self-rated functional status. RESULTS: Scores of developmental psychosocial stress significantly correlated with interviewers scoring of nurture (r = -0.722, p < 0.001) indicating good internal consistency of interview data. Significant correlations were found between patients' scoring of functional status (HAQ) and (i) ACR criteria (r = 0.490, p < 0.0001) and (ii) score of Trait anxiety (r = 0.367, p < 0.003). There was no significant correlation between developmental psychosocial stress and HAQ score. CONCLUSION: Developmental psychosocial stress does not significantly contribute as to how RA patients perceive their functional ability. In a proportion of RA patients self-rated functional status may depend on the patients disposition (e.g. neuroticism) probably promoting impaired illness behavior (e.g. regressive tendencies) which should be considered in assessing treatment procedures.     

A nursing rehabilitation program for women with breast cancer receiving adjuvant chemotherapy

PURPOSE/OBJECTIVES: To examine the effects of a comprehensive rehabilitation program on facilitating physical and psychosocial adaptation of women with breast cancer who are receiving adjuvant chemotherapy. DESIGN: Experimental. SETTING: Breast evaluation clinics of two New England medical centers with comprehensive cancer treatment programs. SAMPLE: 14 women (mean age = 44 years) receiving adjuvant chemotherapy for breast cancer (86% stage II) following surgical treatment. METHODS: Subjects were assigned randomly to the experimental group or the usual care group. Experimental group members began a structured exercise program of walking and attended support group meetings. All subjects were tested before beginning chemotherapy, during the course of chemotherapy, and one month following chemotherapy completion. MAIN RESEARCH VARIABLES: Performance status, physical functioning, psychosocial adjustment, self-concept and body image, and 12 symptoms (e.g., fatigue, nausea, anxiety). FINDINGS: Measures of physical performance, psychosocial adjustment, and symptom intensity revealed improved adaptation in subjects who completed the walking/support group program. CONCLUSIONS: Physical and psychosocial benefits from a modest walking exercise program and a support group are possible for patients receiving adjuvant chemotherapy. IMPLICATIONS FOR NURSING PRACTICE: Although more detailed research is necessary to answer some of the questions raised by this study, implementing the walking program and forming a support group are achievable in an outpatient setting.     

Psychological adjustment to survival from Hodgkin's disease.

Compared the psychological adjustment of 60 male Hodgkin's disease survivors, aged 20–47 yrs, with an age-matched sample of 20 physically healthy men. Assessment included objective self-report, projective testing, observer rating, and interview. Measures included the Global Assessment Scale, Rosenberg Self-Esteem Scale, and Thematic Apperception Test (TAT). All Ss had received no treatment and had shown no evidence of disease for the previous 6–240 mo (median 2 yrs). On most measures, no differences were found between cancer survivors and healthy controls. However, the hypothesis of greater psychosocial dysfunction in the cancer sample overall was partially confirmed by significantly lowered intimacy motivation, increased avoidant thinking about illness, prolonged difficulty in returning to premorbid work status, and illness-related concerns. Conversely, patients were significantly more appreciative of life than nonpatients. Within the patient group, late stage (aggressively treated) Ss were at highest risk for psychological distress and psychosocial disruption during the 1st 2 yrs off treatment. (52 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Spectroscopic and thermodynamic evidence for a complex denaturation mechanism of bovine beta-lactoglobulin A

PURPOSE/OBJECTIVES: To investigate the patterns of functioning and psychosocial adjustment of midlife and older women following surgery for breast cancer. Differences between those who received follow-up adjuvant therapy and those who did not also were compared. DESIGN: 2 x 3 mixed design with one between-groups factor (type of treatment) and one within-subjects factor (time). SETTING: Four midwestern hospitals. SAMPLE: 46 patients with breast cancer who are age 55 or older. METHODS: Baseline data about presurgical functional status and other variables were obtained during the first week after surgery. Follow-up data were obtained at six weeks, three months, and six months postsurgery. Data were collected via telephone interviews and mailed questionnaires. MAIN RESEARCH VARIABLES: Functional status, patient symptomatology, quality of life (QOL), demands of illness, and type of treatment (surgery only versus surgery plus adjuvant therapy). FINDINGS: No differences existed between the two treatment groups at baseline, with the exception of lower functional status reported by the surgery-only group. In the surgery-only group, functional status improved significantly from six weeks to three months postsurgery. The most frequently reported symptoms of both groups included fatigue and pain. CONCLUSIONS: These results suggest that both groups did equally well, regardless of whether they received adjuvant therapy (radiation or chemotherapy). Neither QOL nor demands of illness differed between the two groups, nor did these scores change significantly over time following surgery. IMPLICATIONS FOR NURSING PRACTICE: These findings suggest that women undergoing surgery for breast cancer, whether they receive adjuvant therapy or not, may have functional and psychosocial needs that could be effectively addressed by nursing interventions pre- and postsurgery.     

Breast cancer risk assessment: use of complete pedigree information and the effect of misspecified ages at diagnosis of affected relatives

OBJECTIVES: To assess if there is relationship between: (i) preoperative psychological defensive strategies, mood and type of lower urinary tract reconstruction, and (ii) psychosocial adaptation after radical cystectomy for bladder cancer. PATIENTS AND METHODS: Fifty-seven consecutive patients (44 men and 13 women, mean age 62 years, range 34-81) undergoing radical cystectomy (ileal conduit urinary diversion in 17, continent cutaneous diversion in 22 and orthotopic bladder replacement in 18) were assessed preoperatively using the meta-contrast technique (MCT), a projective test to reveal individual defensive strategies. From the results the patients were classified as hypothetical 'at risk' or 'no risk' patients for postoperative psychosocial complications. An 'at risk' patient was designated as one who showed neurotic defensive strategies in coping with threats, i.e. primitive, immature or regressive strategies or even lack of defence in connection with pronounced anxiety. All patients completed a questionnaire and were interviewed; 10 questions dealt with mood, five reflecting anxiety and five the depressive states. The questionnaire and the interview were repeated 3 and 12 months, and 5 years after surgery. RESULTS: The remembered difficulties during the first month after discharge from hospital differed between the 'risk' and 'no risk' groups after 1 and 5 years. On a visual analogue scale (VAS) the 'risk' patients had very low scores (less difficulty) or very high, while the 'no risk' patients had intermediate scores. VAS score were also higher, although not significantly so, in patients using primitive defence strategies. The psychosocial situation did not differ between the groups in the first year, but at 5 years there were differences in self-esteem and interpersonal contact-seeking. High depression scores before surgery were associated with high VAS scores at 3 months when recalling the first month after discharge, but the anxiety score was not predictive. Men with orthotopic bladder replacement adapted less well throughout the 5 year follow-up. Elderly patients with stereotypy (the commonest defensive strategy at these ages) adapted relatively well to ileal conduit diversion. About 20% of patients had difficulty in accepting the postoperative situation, regardless of urinary diversion modes. CONCLUSION: The combination of defensive strategies assessed using the MCT and selected on hypothetical grounds was less discriminatory than expected for those at risk of postoperative psychosocial problems. However, those with primitive strategies apparently had a long-term risk of poor adaptation. The search for an optimal instrument for the identification of patients at risk is warranted. In this study, patients with a 'wet' stoma did not seem to fare less well than those with a continent reconstruction.     

Predictors of long-term change in functional status after coronary artery bypass graft surgery in women

A cohort of 164 women who had undergone coronary artery bypass graft surgery (CABG) was followed for one year to examine changes in functional status and determine the relative influence of clinical, psychosocial and sociodemographic factors on change in functional status outcomes between 6 and 12 months after surgery. Clinical, psychosocial, sociodemographic and preoperative functional status data were collected by written questionnaire and personal interview at the time of surgery and again at 6 and 12 months after CABG. Functional status scores improved significantly from before to 6 months after CABG. Between 6 and 12 months post-CABG 65% sustained or continued to experience improvement in physical functioning, 83% in social and leisure activities, and 54% in psychological functioning. Predictors of sustained improvement in physical functioning were being married, younger age, low 6-month functioning, having an ejection fraction of 50% or greater, and being white. The significant predictors of sustained improvement in social and leisure activities and psychological functioning were being married and low 6-month psychological functioning, respectively. These data suggest that interventions to improve long-term outcomes in women undergoing CABG should take into account not only their age, functional capacity and level of functioning at 6 months post-CABG, but also their race and marital status as potential risk factors for long-term functional status disability.     

The effects of preoperative therapy with angiotensin-converting enzyme inhibitors on clinical outcome after cardiovascular surgery

PURPOSE: Quality of life of breast cancer survivors 8 years after diagnosis was compared with that among similarly aged women who had never confronted cancer (controls). METHODS: Survivors of a consecutive series of 227 breast cancer patients first treated in 1984 were approached for this study. Random-digit dialing was used to identify controls with the same age and residential distribution as the survivors. Quality of life was assessed in terms of physical health, functional status, psychologic distress, and social functioning. RESULTS: Participation was obtained from 96% (n = 124) of 129 eligible survivors and 61% (n = 262) of 427 potentially eligible controls. Consistently smaller proportions of survivors reported positive quality-of-life outcomes compared with controls, but these differences were generally small and nonsignificant statistically. When limited to women who remained free of disease over the entire follow-up period (n = 98), survivors' quality of life was similar to that among controls, with the exception of arm problems and sexual satisfaction for those women who lived with a partner. In contrast, survivors who developed recurrence or new primary breast cancer (n = 26) experienced a worse quality of life in all domains except social functioning. CONCLUSION: In most domains and for women without further disease events after diagnosis, quality of life does not seem to be permanently and globally impaired by breast cancer. Consequently, breast cancer survivors who remain free of disease probably do not need organized late psychosocial follow-up to improve quality of life. However, arm problems and sexuality are two areas in which additional effort may be still needed to improve quality of life of long-term survivors.     

Is there a relationship between psychological well-being and patient-carers consensus? A clinical pilot study

Does communication with terminal cancer patients about their disease influence their psychological well-being? The degree of patient-carer consensus about the disease was compared to psychological well-being related to acceptance of the disease, emotional state, and hope. These were evaluated and scored from 6 (good) to 0 (poor) through a semi-structured interview of 10 open-ended questions. Nineteen palliative care patients were studied, 18 of whom were suffering from advanced cancer. Overall, 57 interviews were conducted with the patients, staff nurses, and medical doctors. The answers of the carers (staff nurses and doctors) were compared to the patients' answers to determine the degree of consensus in terms of communication about disease, aim of treatment, and ultimate objective of hospitalization. The consensus between patients and carers was scored from 6 (satisfactory) to 0 (unsatisfactory). A significant positive correlation between the scores of consensus and those of psychological well-being (r = 0.90, p < 0.001) was found. These results suggest that good and truthful communication may improve patients' psychological well-being.     

Evaluation of problem solving and communication skills of persons with schizophrenia

This study examined gender differences in 162 female and 65 male patients with cancer referred to home care. Data were collected before hospital discharge using the Multidimensional Functional Assessment Questionnaire, the Karnofsky Performance Status, and the Quality of Life-Cancer Scale. Controlling for age and stage of disease, the results showed that men reported significantly more cancer-related impairments, more limitations in activity of daily living, and poorer social resources than women. No gender differences were found in quality of life, perceived emotional health, perceived physical health, performance status, and comorbidity. Significant predictors of self-care activities were: for women perceived physical health, Karnofsky Performance Status, and stage of disease (58% variance explained); for men Karnofsky Performance Status and medication taken (67% variance explained). Gender differences should be considered in discharge planning to provide appropriate home care services for male and female patients with cancer.     

Psychosocial effects of level of information and severity of disease on head-and-neck cancer patients

This study examined the psychosocial effects of levels of information available to patients and compared them with those of disease severity. A questionnaire with multiple-choice and open-ended questions assessing quality of life in various domains (e.g., fears and worries, functioning in the family) and scales assessing anxiety, anger, and depression were administered to patients and their partners or closest relatives. The subjects were 55 head-and-neck cancer patients (40 men and 15 women) in disease stages I to IV, grades of tumors G1 to G3-4, with disease durations ranging from three months to 21 years. They were divided into three groups on the basis of the amounts of information they had about their disease and prognosis, and again on the basis of disease severity, based on stages and patients' evaluations. The numbers of psychosocial variables differentiating significantly between the groups deviated significantly from chance in both groupings. The results showed more effects for information than for disease severity. The highly informed were better adjusted in interpersonal relations and had more intimacy with family, but had more fears, anxiety, changes in their lives, worries about health, and concern with physical symptoms. The reports of partners were fewer and lent some support to those of patients. Disease severity affected mostly fears, anxiety, and worries about health.     

Rehabilitation outcomes of long-term survivors treated for head and neck cancer

BACKGROUND: Little is known about the rehabilitation outcomes of long-term survivors following treatment for head and neck cancer. There are, for example, no studies on physical and psychosocial rehabilitation outcomes of T1 glottic larynx carcinoma, despite the fact that these form the majority of head and neck cancer sites. Thus, this investigation afforded a unique opportunity for examining similarities and differences among T1 glottic larynx patients, laryngectomy patients, and those who had surgery for cancer of the oral cavity and/or oropharynx along a variety of physical and psychosocial dimensions. METHODS: To describe the impact of these three types of head and neck cancer and their treatment on the physical and psychosocial functioning of long-term survivors, a self-report questionnaire was completed by 110 patients treated between 2 and 6 years previously in a major cancer center. RESULTS: Data indicate that a higher percentage of patients treated with laryngectomy or commando procedures still experience severe psychosocial distress between 2 and 6 years after their last treatment than do patients treated with radiotherapy for a T1 carcinoma of the glottic larynx. Psychosocial and physical complaints are still reported by many laryngectomy patients, apparently the result of problems in effective communication with others. Many commando procedure patients experience problems with respect to food intake, and with disfigurement and its consequences. T1 larynx patients mainly experience a considerable number of physical complaints. The greater the time that had elapsed since treatment, the fewer the psychosocial problems associated with head and neck tumors. Open discussion of the illness in the family, social support, and perceptions of adequate information from the specialist are the most important predictors of positive rehabilitation outcomes. CONCLUSIONS: This study indicates that T1 larynx patients report many physical complaints even though several years had elapsed since treatment. Also, laryngectomy patients may need psychosocial guidance for a longer posttreatment period and that health care personnel must involve the partner as much as possible in all communications. Commando procedure patients in particular feel hindered by their disfigurement and its consequences. Future research with respect to validation of the specific head and neck modules is needed.     

The impact of cancer on daily living: A comparison with cardiac patients and healthy controls.

Examined the psychosocial and physical problems of 32 Ss with cancer by comparing them to Ss with cardiac disease with a similar functional performance status and to Ss without any illnesses. All Ss completed a cancer inventory of problem situations. Ss with cancer were found to have a larger number of problems and more severe problems than Ss with cardiac disease. Some of the problem subscales that were particularly notable for cancer patients were Functional Health Status, Body Image, Weight Maintenance, Worry, Sexual Dysfunction, Problems Associated with Treatment, and Job-Related. Ss with cancer and cardiac disease did not differ greatly from one another or from the healthy controls in subscales associated with the medical setting. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mismatches in Social Support and Psychosocial Adjustment to Breast Cancer.

Emotional support is known to provide psychosocial benefits for women with breast cancer, but women can experience a mismatch between support that is wanted and support that is received from their personal supporter. The role of wanted and unwanted support in psychosocial adjustment was examined in 79 women recovering from breast cancer. Four distinct patterns of desired support actions were found using cluster analysis. Patterns of wanted support were not related to better or worse psychosocial adjustment. However, a misalignment of support between the provider and the receiver significantly influenced psychosocial adjustment, and unwanted but received support (support commission) was uniquely associated with poor psychosocial adjustment. Clinical interventions using the support instrument could help match support providers' actions to receivers' preferences. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluation of tryptamine in an impinger and on XAD-2 for the determination of hexamethylene-based isocyanates in spray-painting operations

We have investigated the relationship between immunohistochemically determined p53 status and outcome in 277 women with node-positive primary breast cancer who, following tumour excision and axillary clearance, were randomised to receive either 6 cycles of cyclophosphamide/methotrexate/S-fluorouracil (CMF) (n = 130) or no such post-operative treatment (n = 147). Follow-up data (median = 9 years) were available on all patients. A significant association was found between p53 status and survival. Patients with p53-positive tumours had a less favourable outcome than those with p53-negative disease. Women receiving adjuvant CMF chemotherapy had a significantly more favourable outcome compared to those who did not. The effect was seen both in women with p53-positive and p53-negative tumours; multivariate analysis showed relative risks for overall survival attributable to chemotherapy of 2.3 (95% CI 1.2-4.3) for women with p53-positive tumours and of 2.1 (95% CI 1.4-3.0) for those with p53-negative tumours. Thus, adjuvant chemotherapy with CMF is associated with a survival benefit in women with node-positive breast cancer irrespective of immunohistochemically determined p53 status.     

The Juvenile Arthritis Quality of Life Questionnaire--development of a new responsive index for juvenile rheumatoid arthritis and juvenile spondyloarthritides

OBJECTIVE: To develop a disease specific measure of quality of life for application in children with juvenile rheumatoid arthritis and juvenile spondyloarthritides-the Juvenile Arthritis Quality of Life Questionnaire (JAQQ). METHODS: Patients and their parents were interviewed by a trained interviewer using a questionnaire focusing on physical function, psychosocial function, and general symptoms to determine the most appropriate items to include in the JAQQ. Respondents volunteered items and scored them for frequency of occurrence and importance. Items so generated were scored by a panel of experts for potential responsiveness and categorized into dimensions. Item number was reduced using this scoring system. The product was then pretested to confirm its construct validity and responsiveness. Thereafter, it was distributed to clinical experts to establish face and content validity. RESULTS: 91 patients, mean age 10.35 years (range 1.25-18.0), mean disease duration 3.99 years, and their parents were included in the interview process. 220 items generated were ultimately reduced to 85. Pretesting this version of the instrument in a further 30 patients showed it to have construct validity and responsiveness and led to a further reduction in items to 74, distributed in 4 dimensions: gross motor function (17 items), fine motor function (16 items), psychosocial function (22 items), and general symptoms (19 items). Face and content validity were established in 20 clinicians. Scaling was by 7 point Likert scale to enhance responsiveness. English and French versions were developed. CONCLUSION: The JAQQ measures physical and psychosocial function and an array of general symptoms. Preliminary data suggest it is valid and responsive and thus might have potential in clinical trials.     

Raised plasma endothelin-1 concentrations in patients with primary hypercholesterolemia without evidence of atherosclerosis

This study investigated the Psychosocial adjustment in 40 patients who received orthotopic liver transplantation (OLT) for several endstage liver diseases. Twenty patients were grafted because they suffered from liver Cancer as well as cirrhosis. Particular attention was paid to evaluating whether cancer could affect recipients' coping with transplant. Each patient underwent a semi-structured interview to obtain information on their psychosocial life, relationship with the donor, organ acceptance and life expectancy. Interview was performed I year after transplantation. A psychodiagnostic evaluation was also performed using a Minnesota Multiphasic Personality Inventory (MMPI) and a Human Figure Test. Psychosocial adaptation in everyday life following liver transplantation seemed good in most of the patients, whatever the indication for transplantation might be. It can he seen that by replacing the diseased organ a high percentage of oncological patients overcame their fear of cancer.     

Primary vitrectomy for bullous rhegmatogenous retinal detachments due to complex breaks

Sixty-five patients who underwent modified radical mastectomy were compared with 55 breast conservation patients, all of whom were in stage I, II or III of breast cancer and were under treatment at an oncology clinic in northern Israel. The main findings indicate no differences between the groups in physical, psychosocial, marital or medical interaction, according to the CARE scale. These findings reflect the results of similar comparative studies conducted during the 1980s and 1990s as documented in the literature. Sexual interaction showed statistical differences favoring the women who had undergone mastectomies.     

Consumers and evaluation of interactive health communication applications. The Science Panel on Interactive Communication and Health

During the early phase following stroke, patients with aphasia and their families are totally involved in the rehabilitation programme, but later, in the chronic phase, after discharge, the family generally has no support and many problems may arise or become more acute and provoke disturbances in this system. The patients with aphasia and their spouses may feel the situation differently according to their own characteristics, including gender. The present study includes 55 spouses of patients with chronic aphasia and 37 controls (spouses of subjects without physical or cognitive impairments) who filled out a questionnaire concerning their respective spouses (European Brain Injury Questionnaire--EBIQ) and some aspects about themselves. It was concluded, from the opinions expressed by the spouses of patients with chronic aphasia that they have problems in several domains not only related to communication or physical impairments. The opinions of husbands and wives of patients with aphasia, but not of the controls, were different, with more references to behaviour changes in women with aphasia. Spouses' responses also show important changes in their own lives. These results stress the importance of adequate attention to the long-term psychosocial problems of patients and relatives.