1,720,960 research outputs found
Clinical and Subclinical Distress, Quality of Life, and Psychological Well-Being after Cardiac Rehabilitation
Full text linkBackground
The literature has outlined positive effects of cardiac rehabilitation (CR) on clinical psychological distress (DSM depression and anxiety) and quality of life (QoL). In cardiac settings, subclinical distress (subthreshold depressive and anxious symptomatology) and psychological well-being also showed relevant clinical implications. This research explored these psychological variables, their changes over time and cardiac course of CR patients.
Methods
Clinical and subclinical distress, QoL, and psychological well-being were assessed in 108 consecutive patients undergoing CR, at baseline and up to 12 months after the program's completion.
Results
Of all patients, 25.9 per cent showed high distress with a DSM diagnosis, 31.5 per cent high distress without a DSM diagnosis, and 42.6 per cent low distress. Comparing these subgroups, worse QoL and psychological well-being were significantly linked not only to clinical but also to subclinical distress. After CR completion, a significant reduction in DSM diagnoses was observed, whereas there were no positive effects on subclinical distress, QoL, and well-being, or when they initially occurred, they were not long lasting. Moreover, only the subgroup with high distress without a DSM diagnosis was at greater risk for adverse cardiac outcomes, showing worse scores on items of contentment.
Conclusions
These findings confirm data on clinical distress reduction after CR completion. However, a large amount of relevant subclinical distress remains and predicts adverse cardiac events
Psychological correlates, allostatic overload and clinical course in patients with implantable cardioverter defibrillator (ICD)
No full textBackground Implantable cardioverter defibrillator (ICD) is a key treatment option for both primary and secondary prevention of sudden cardiac death. Despite this, there is a growing number of studies showing that ICD is often associated with post-implantation deleterious psychosocial effects, even in the absence of medical complications. Knowledge about the predictive role of pre-ICD psychological profile is scant. The present research aims to describe patients' pre-ICD psychological profile, focusing on acute and chronic distress, such as anxiety, depression, type D personality, psychosomatic syndromes and allostatic overload (AO), and to evaluate if these psychological variables could affect ICD outcomes and survival. Methods 117 consecutive patients (74.4% males; mean age = 63.1 ± 13.7 years) underwent psychological assessment prior to ICD implantation. Data on ICD-related complications and death were collected up to 26 months after the intervention. Results At baseline, 36.8% of the sample had anxiety and 17.9% depression. Among psychosomatic syndromes, psychological factors affecting medical conditions were the most frequent (37.6%). 12.8% presented with type D personality, whereas 16.2% showed moderate AO and 4.3% severe AO. 25.6% of the patients had post-ICD complications and 6% died. Severe AO was the only predictor of survival. Conclusion Our findings show that a reliable evaluation of stress and the inability to cope with it (allostatic overload) may help to identify patients at higher risk of post-ICD complications and death. Such sensitive index, more than traditional psychiatric diagnostic criteria, may help the physician to identify easily manifestations of distress and clinically relevant information, which could affect medical illness outcomes
Ill-being and well-being in patients with masked hypertension: a controlled study
Full text linkIntroduction. Among patients affected by masked hypertension (MH), psychological variables have been poorly investigated. This research aimed to fill the gap in the literature and to investigate ill-being and well-being in patients with MH, compared with patients with essential hypertension (EH) and normotensive subjects (NS).
Methods. 10 patients with MH, enrolled at the Division of Internal Medicine, Sant’Orsola Hospital (Bologna, Italy), were compared with 10 EH patients recruited at Bellaria Hospital (Bologna, Italy), and 10 NS, matched for age and sex. They were administered both observer- and self-rated measures. Results. 70% of MH patients showed ill-being (40% depression, 40% anxiety, 60% at least one psychosomatic syndrome). The most frequent causes of stress were loneliness (70%), work (60%), illness/bereavement (50%) and significant changes in life (50%). 40% of the patients developed allostatic overload (AO) as a consequence of stress. Compared with EH patients and NS, patients with MH reported a higher frequency of psychiatric diagnoses (p<0.05), in particular anxiety disorders. Further, they presented with higher levels of psychological distress (p<0.01), stress (p<0.5) and lower well-being (p<0.01) compared to both EH and NS groups.
Conclusion. Despite the small sample size, patients with MH showed high levels of ill-being and impaired well-being. Compared to EH, MH was found to be associated with higher levels of stress in particular for loneliness, psychological distress and psychiatric diagnoses and lower levels of well-being. These findings, if confirmed in further studies, could pave the way for considering psychosocial aspects as vulnerability factors in the course of MH
An innovative approach to the assessment of mood disturbances in patients with acute coronary syndrome
Full text linkBackground: The clinical value of the identification of mood disorders in patients with acutecoronary syndrome (ACS) is well established. However, assessment based on DSM criteriapresents some limitations. This study aimed to provide an innovative strategy for evaluating thespectrum of mood disturbances in ACS.
Methods: A total of 288 patients with a first episode of ACS underwent interviews based onDSM-IV-TR criteria (major depressive disorder, minor depression, and dysthymia), DiagnosticCriteria for Psychosomatic Research-DCPR (demoralization and type A behavior), and theClinical Interview for Depression-CID. Additional self-report inventories (psychological well-being and distress) were administered. A total of 100 consecutive patients who satisfied criteriafor DSM-IV-TR depression or DCPR demoralization were enrolled in a randomized controlledtrial on a sequential combination of cognitive-behavioral and well-being therapy (CBT/WBT) vsclinical management (CM) and reassessed up to 30-month post-intervention.
Results: A total of 29.9% of patients showed a DSM-IV-TR depressive syndrome. Inclusion ofdemoralization and type A identified psychological distress in 58% of the sample. According toCID, reactivity to social environment, fatigue, depressed mood, and somatic anxiety were themost common symptoms. Somatic symptoms were significantly associated with DSM-IV-TRdepression (fatigue and changes of appetite), whereas environmental reactivity with demoral-ization. Both depression and demoralization were associated with higher distress and lowerwell-being. Unlike CM, CBT/WBT was significantly associated with decrease of guilt, pessi-mism, fatigue, and early insomnia (CID).
Conclusions: The findings indicate that standard psychiatric approach identifies only a narrowpart of mood disturbances affecting ACS patients. A more articulated assessment unravelsspecific clinical configurations that may entail prognostic and therapeutic implications
Serial vs. parallel approach to screen sleep disorders: an exploratory study
No full textAiming to verify which is the most effective screening approach for sleep disorders between the serial (first step: sleep self-report measure; second step only in case of positive outcome at the first: objective tool) and parallel (unique step, with the concurrent use of sleep self-report measure and objective tool), a first secondary analysis of previously collected data (study 1) was carried out examining primary insomniacs (PI) and healthy controls (HC). Aiming to verify the implementation of such approaches in clinical populations presenting high comorbidity with sleep disorder, an additional secondary analysis (study 2) was carried out, investigating hypertensive patients (HP) and severe obese patients (SOP). 84 HC and 47 PI were examined in study 1, while 36 SOP, and 30 HP in study 2. All participants originally underwent actigraphic recordings for seven consecutive days, using the Actiwatch device (objective tool). At the end of the recording week, participants filled the Mini Sleep Questionnaire (sleep self-report measure). As regards the study 1, the parallel and serial approaches allowed to correctly identify the 97.87% and 55.32% of PI, respectively. With reference to the study 2, the 36.11% and 80.56% of SOP were identified as positive at the serial and parallel approaches, respectively, while the corresponding percentages of HP were 30% and 70%. Study 1 showed that parallel screening approach is the most effective in PI, allowing to correctly identifying almost the entirety of these patients. Study 2 highlighted that serial screening approach is more useful in SOP and HP, identifying a percentage of positive patients overall in line with the documented comorbidity with sleep disorder in these clinical populations
Unhealthy behaviour modification, psychological distress, and 1-year survival in cardiac rehabilitation
No full textObjective: Cardiac rehabilitation (CR) is considered the recommended secondary prevention treatment for cardiovascular diseases (CVD), in terms of health behaviours and, secondarily, better cardiac outcomes promotion. However, the role of psychiatric and psychosomatic distress on the efficacy of CR is unclear. This research aimed to evaluate the impact of CR on unhealthy behaviour modification and cardiac course, considering the moderating role of depression, anxiety, and psychosomatic syndromes. Design: A longitudinal design between and within groups was employed. The assessment was repeated four times: at admission to CR (T1), at discharge (T2), 6 (T3) and 12 months following CR completion (T4). Method: One hundred and eight patients undergoing CR versus 85 patients with CVD not referred to CR, underwent psychiatric, psychosomatic, and health behaviour assessment. The assessment included the Structured Clinical Interview for DSM-IV (depression and anxiety), the interview based on Diagnostic Criteria for Psychosomatic Research, GOSPEL Study questionnaire (health behaviours), Pittsburgh Sleep Quality Index, and 8-item Morisky Medication Adherence Scale. Results: Cardiac rehabilitation was associated with maintenance of physical activity, improvement of behavioural aspects related to food consumption, stress management, and sleep quality. On the contrary, CR was not associated with weight loss, healthy diet, and medication adherence. Depression and psychosomatic syndromes seem to moderate the modification of specific health-related behaviours (physical activity, behavioural aspects of food consumption, stress management, and pharmacological adherence). Conclusion: In CR settings, an integrated assessment including both psychiatric and psychosomatic syndromes is needed to address psychological factors associated with unhealthy behaviour modification. Statement of contribution : What is already known on this subject? Cardiac rehabilitation (CR) is considered a class 1A treatment recommendation and the most cost-effective model of secondary prevention to reduce cardiovascular events. There is evidence about the association between psychological distress and both unhealthy behaviour and cardiac course. Depression and psychosomatic distress, such as type A behaviour and demoralization, are frequently associated with CVD course. However, the role of psychiatric and psychosomatic distress in CR is not well known. What does this study add? CR exerted a protective effect on physical activity and a positive effect on eating behaviour, stress management, and quality of sleep. CR did not show any particular effect on smoking, overweight/obesity, dietary habits, medication adherence, and patients' 1-year survival. Findings from this study suggest the importance to consider specific psychological and psychosomatic aspects in affecting lifestyle
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
- …
