Distress In Adult Patients Research Articles

A Systematic Review of Trajectories of Clinically Relevant Distress Amongst Adults with Cancer: Course and Predictors.

To improve interventions for people with cancer who experience clinically relevant distress, it is important to understand how distress evolves over time and why. This review synthesizes the literature on trajectories of distress in adult patients with cancer. Databases were searched for longitudinal studies using a validated clinical tool to group patients into distress trajectories. Twelve studies were identified reporting trajectories of depression, anxiety, adjustment disorder or post-traumatic stress disorder. Heterogeneity between studies was high, including the timing of baseline assessments and follow-up intervals. Up to 1 in 5 people experienced persistent depression or anxiety. Eight studies examined predictors of trajectories; the most consistent predictor was physical symptoms or functioning. Due to study methodology and heterogeneity, limited conclusions could be drawn about why distress is maintained or emerges for some patients. Future research should use valid clinical measures and assess theoretically driven predictors amendable to interventions.

SIOG2023-5-P-330 - Age differences in quality of life and distress in adult patients with indolent lymphoma

SIOG2023-5-P-330 - Age differences in quality of life and distress in adult patients with indolent lymphoma

Psychological distress in survivors of childhood cancer and their parents before and after a follow-up appointment: the need for screening and validation of the emotion thermometer

AbstractBackground:Childhood cancer affects patients and their parents. Childhood cancer survivors are at risk of mental health problems. Regular psychological screening is recommended. The emotion thermometer (ET) is a short, validated tool to detect psychological distress in adult patients with cancer. However, its suitability and acceptability in young cancer populations have not yet been reported. We (1) describe mental health in survivors and their parents before and after a follow-up appointment and (2) investigate the ET's usefulness for screening in young childhood cancer survivors.Methods:Survivors (15 years or older at study, ≥1 year after treatment ended) and their parents completed two electronic surveys to assess mental health (including somatization, depression, anxiety, a Global Severity Index [GSI], fear of cancer recurrence/relapse and post-traumatic stress). The first questionnaire was completed in the weeks leading up to the follow-up appointment and the second one after. We assessed survivors' opinion on acceptability of the ET.Results:Forty-five survivors (age at study: 22 years, 54% female) and 46 parents (age: 54 years, 63% female) participated. Scores forsomatization,depression, and theGSIwere lower after the appointment (p<.05 for all). For parents, there was no change. A subset of survivors reported clinically relevant post-traumatic stress (Nbefore= 3 [8%], Nafter= 4 [10%]). Fear of cancer recurrence/relapse remained stable. The ET identified moderate-to-severe distress in 13 survivors (29%), showing good specificity (0.91) and sensitivity (0.91) in relation to the gold standard Symptom Checklist-90-R. Survivors found the ET to be easy to use and understand.Conclusions:Psychological distress in survivors attending follow-up care is common, and screening is imperative. The ET may be helpful for initial psychological screening.

Diabetes distress in adult patients with type 1 and type 2 diabetes.

Background: Diabetes is a chronic and demanding condition, exposing patients to complex physical and mental challenges, and making them particularly vulnerable to distress. Diabetes distress related to disease in diabetic patients is a term encompassing challenges associated with the psychosocial adaptation required of these individuals. Aim of the study: To assess distress in patients with diabetes mellitus. Material and methods: This study was conducted among 107 patients with type 1 and 2 diabetes mellitus reporting for follow-up at a diabetes clinic. The Diabetes Distress Scale (DDS) was used for data collection. Results: Moderate and severe diabetes distress was found in 36.4% and 15% of respondents in the study group, respectively. The total mean score for the DDS was 2.19. The largest percentages of respondents with high levels of distress were observed in patients with a financial situation rated lower than good (30.6%), those having less than secondary education (28.0%), and those under 30 years of age (27.8%). Patients with type 1 diabetes (26.9%), a disease duration > 30 years (30.8%), those using insulin pump therapy (30%) or CGM (Continuous Glucose Monitoring) and FGM (Flash Glucose Monitoring) systems (50%), and those showing ≥ 3 chronic diabetic complications (37.5%) experienced severe distress. Conclusions: Overall, diabetic patients showed a moderate level of distress. The greatest inconveniences caused by the disorder were associated with regimen-related distress and emotional burden. Rural patients with a lower level of education and a lower financial status showed higher levels of distress. Patients experiencing chronic complications from diabetes and those with higher levels of glycated hemoglobin also presented with more severe distress.

The Impact of Palliative Care and Nursing Intervention on the Psychology and Quality of Life of Elderly Patients with Colorectal Cancer.

Colorectal cancer patients face physical, psychological, and social difficulties. Psychosocial therapies appear to be successful in improving cancer patients' psychological and social results. Preoperative and postoperative psychological therapies for colorectal surgery patients have not been extensively studied. During their treatment, up to 35% of cancer patients experience clinically severe psychological discomfort. As a consequence, a greater knowledge of health-related quality of life and its causes can assist oncology nurses in developing effective treatments to improve the health-related quality of life. The palliative care model and the nursing intervention model are used in this study to assess the effectiveness of an individually customized nursing intervention for lowering chemotherapy-related symptom distress in adult patients with colorectal cancer. Initially, the dataset is collected and split into the control group and the experimental group. The patient conditions are evaluated using the novel accelerated gradient boosting regression tree (AGBRT) estimation model. For improving the evaluation process, we have proposed the enriched gravitational search optimization algorithm (EGSOA). The system's success is evaluated in terms of the patients' psychological well-being and quality of life.

Pain and Spiritual Distress at End of Life: A Correlational Study.

Objective: The purpose of this study is to examine the relationship between unmanaged pain and spiritual distress in adults newly admitted to hospice. Background: Current evidence supports the presence of a positive relationship between increased physical pain and spiritual distress for those with advanced cancer and/or receiving palliative care services. Nonetheless, spiritual distress remains a relatively understudied area; anecdotally, assessment and management of physical symptoms often take precedence over interventions for spiritual distress in patients at end of life (EOL) on hospice. Further research is needed to examine the relationships between physical pain, spiritual distress, and factors such as age, gender, and religious affiliation/spiritual practice specific to EOL patients receiving home hospice care. The Total Pain Model underpins this study. Methods: In this cross-sectional correlational study, pre-existing data were extracted from a hospice agency's electronic health record (EHR) to examine age, gender, marital status, race/ethnicity, religious affiliation and/or spiritual practice, hospice diagnosis, pain severity, and spiritual distress in adult patients (age 18 and over) admitted to home hospice services (N = 3484). Descriptive, bivariate, and multivariate analyzes were conducted. Results: The age range for this sample was 25 to 107 years old (M = 82, SD = 12.08). Over half of the sample were female and white. One third of the patients were married or had a designated life partner. Over 85% identified as either Catholic or Protestant. Sixteen percent reported moderate to severe pain and 9.6% experienced spiritual distress. Marital status (χ2 (3, N = 2483) = 20.21, P < .001, Cramer's V = .09), hospice diagnosis (χ2 (5, N = 3481) = 22.66, P < .001, Cramer's V = .08), pain severity (χ2 (1, N = 3464) = 19.75, P < .001, Cramer's V = .08), and age (t (393.17) = 2.84, P = .005, d = .17) were significantly related to spiritual distress. The binary logistic model was statistically significant, χ2 (11) = 45.25, P < .001, and cases indicating the highest odds of experiencing spiritual distress had pulmonary disease (OR = 1.8, P = .02), were single (OR = 1.6, P = .02), and had moderate to severe pain (OR = 1.4, P = .04). Conclusions: Moderate to severe pain, marital status, and diagnosis should be considered for inclusion in a refined spiritual distress hospice admission screening process. Future research should examine the unique contributions of diagnosis in predicting spiritual distress, particularly pulmonary disease.

Financial toxicity and psychological distress in adults with cancer: A treatment-based analysis

ObjectiveTo evaluate disparities in financial toxicity and psychological distress in patients with cancer as a function of treatment and reveal the relationship between financial toxicity and psychological distress. MethodsThis was a multicenter cross-sectional study. Patients were recruited from March 2017 to October 2018, and questionnaires were completed regarding their demographics, financial toxicity, and psychological distress. A multiple linear regression model was used to examine factors associated with financial and psychological distress. ResultsSignificant financial toxicity and psychological distress occurred in 47.9% and 56.5% of patients, respectively. Financial toxicity (P ​= ​0.032) and psychological distress (P ​< ​0.001) were statistically different among the single chemotherapy, adjuvant therapy, and surgery groups. Multivariable analysis revealed that patients aged 50–59 years (P ​= ​0.035), 60–69 years (P ​= ​0.007), and 70 years or older (P ​= ​0.002) had higher the Comprehensive Score for financial Toxicity (COST) scores compared with patients less than 50 years old. Patients with personal annual income > 40,000 CNY reported higher COST scores than those who had < 20,000 CNY (P ​< ​0.001). Patients who had Urban Resident Basic Medical Insurance (URBMI) (P ​= ​0.030) or New Rural Cooperative Medical Scheme (NRCMS) (P ​= ​0.006) compared with Urban Employee Basic Medical Insurance (UEBMI) presented lower COST scores than patients with UEBMI. The multiple analysis model of psychological distress showed that an age of more than 70 years (P ​= ​0.010) was significantly associated with low the Distress Thermometer (DT) scores, and patients with colorectal cancer (P ​= ​0.009), the surgery group (P ​< ​0.001) and adjuvant therapy group (P ​< ​0.001) were significantly associated with high DT scores. The correlations between financial toxicity and psychological distress were mild but statistically significant in the chemotherapy-related treatment groups. ConclusionsThe research highlights the high rates of financial and psychological distress in adult patients. Multidimensional distress screening and psychosocial interventions should be provided for patients with cancer according to related factors.

Efficacy of Meaning-Centered Psychotherapy in adult patients with advanced cancer: A systematic review and meta-analysis

Objective: We conducted a PRISMA-compliant systematic review of clinical trials, and a meta-analysis of randomised clinical trials (RCTs) of manualised Meaning-Centered Psychotherapy (MCP) interventions for adult advanced cancer patients. We searched seven databases for trials published in English and Spanish, until March 27, 2021. Results: Seven trials were included in the systematic review, and four in the meta-analysis. The systematic review favoured the effectiveness of MCP for the improvement of spiritual well-being, quality of life (QoL), sense of meaning and psychological distress, although inconsistencies between the trials were found. In pre-post meta-analytic estimates, MCP had a superior therapeutic effect than control conditions for spiritual well-being (d=0.52, p&lt;0.001), QoL (d=0.60, p&lt;0.001), anxiety symptoms (d=-0.47, p&lt;0.001), depressive symptoms (d=-0.50, p&lt;0.001) and desire for hastened death (d=-0.28, p&lt;0.001). No differences were observed in between-group comparisons. MCP was not associated with an increased risk of abandonment at post-treatment (OR=0.86, p=0.57). Conclusion: Manualised MCP interventions are a promising treatment for the improvement of spiritual well-being and quality of life and the reduction of psychological distress in adult patients with advanced cancer. The evidence base is still in an emerging state and should be expanded by higher methodological quality studies.

Sleep disturbance and psychological distress in adult patients with tinnitus

Sleep disturbance and psychological distress are among the most prevalent comorbidities of tinnitus. We aimed to clarify the dose-response effects of these phenomena with tinnitus severity. This study enrolled adult patients with subjective tinnitus for more than 6 months was conducted from January 2017 to December 2018 in one tertiary medical center and one local hospital. Data collected included demographic data and questionnaires, namely Tinnitus Handicap Inventory (THI), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Hospital Anxiety and Depression Scale (HADS). In total, 1610 patients with tinnitus (1105 male, 68.6%) with mean age of 48.3±14.3 years completed all questionnaires. The average THI score was 9.2±19.4, and 82.4% of patients reported to have slight tinnitus (THI ranged 0-16). The mean PSQI score was 8.4±4.3, and 70.8% of participants had sleep difficulty (PSQI>5). Compared with patients with slight tinnitus, those with catastrophic tinnitus were mostly old women with lower body mass index, and had higher scores in ESS, PSQI, and HADS (all P<0.05). In 1140 patients with sleep difficulty, independent factors influencing THI were age, ESS, and HADS, and positive correlations were observed between age-adjusted THI and ESS, HADS-A, and HADS-D (all P<0.001). Old age, daytime sleepiness, and psychological distress are highly associated with tinnitus severity among patients with sleep difficulty. Management of sleep disturbance and psychological distress is necessary to control tinnitus.

The Feasibility and Efficacy of Self-help Relaxation Exercise in Symptom Distress in Patients With Adult Acute Leukemia: A Pilot Randomized Controlled Trial

AimsTo examine the feasibility and efficacy of self-help relaxation exercises in alleviating symptom distress in adult patients with acute leukemia (AL). MethodsA pilot randomized controlled trial was used. Thirty adult patients with AL who were hospitalized in a teaching hospital were enrolled and randomly divided into a wait-list control group or an intervention group. The intervention group received self-help relaxation exercise twice per day for 4 weeks. The feasibility indicators, patients’ symptom distress were assessed by a blinded data collector. ResultsTwenty-nine patients completed the study. The recruitment rate, retention rate, and adherence rate was 65.2%, 93.3%, and 98.2%, respectively. The intervention group had a significantly decreased distress score for pain symptoms (F1, 27 = 6.594, P = .016, the partial η2 = 0.20, 90% confidence interval = 0.02-0.39). ConclusionsSelf-help relaxation exercises were feasible for the AL patients and significantly reduced their pain symptoms. Minor revision of the protocol for future definitive trials is needed.

Psychosocial Distress in Adult Patients Awaiting Cancer Surgery during the COVID-19 Pandemic.

Cancer causes substantial emotional and psychosocial distress, which may be exacerbated by delays in treatment. The COVID-19 pandemic has resulted in increased wait times for many patients with cancer. In this study, the psychosocial distress associated with waiting for cancer surgery during the pandemic was investigated. This cross-sectional, convergent mixed-methods study included patients with lower priority disease during the first wave of COVID-19 at an academic, tertiary care hospital in eastern Canada. Participants underwent semi-structured interviews and completed two questionnaires: Hospital Anxiety and Depression Scale (HADS) and Perceived Stress Scale (PSS). Qualitative analysis was completed through a thematic analysis approach, with integration achieved through triangulation. Fourteen participants were recruited, with cancer sites including thyroid, kidney, breast, prostate, and a gynecological disorder. Increased anxiety symptoms were found in 36% of patients and depressive symptoms in 14%. Similarly, 64% of patients experienced moderate or high stress. Six key themes were identified, including uncertainty, life changes, coping strategies, communication, experience, and health services. Participants discussed substantial distress associated with lifestyle changes and uncertain treatment timelines. Participants identified quality communication with their healthcare team and individualized coping strategies as being partially protective against such symptoms. Delays in surgery for patients with cancer during the COVID-19 pandemic resulted in extensive psychosocial distress. Patients may be able to mitigate these symptoms partially through various coping mechanisms and improved communication with their healthcare teams.

NCOG-23. PATTERNS OF DISTRESS IN OLDER PATIENTS WITH GLIOBLASTOMA: A FOLLOW-UP TO A SINGLE INSTITUTION CROSS-SECTIONAL STUDY OF DISTRESS IN PRIMARY BRAIN TUMOR PATIENTS

Abstract INTRODUCTION We previously reported to SNO, high levels of psychosocial distress in adult patients with primary brain tumors (PBTs), particularly during the first 6 months following diagnosis. The purpose of this follow-up study was to identify patterns of distress among older (≥ 65 years) patients with glioblastoma (GBM) compared to their younger (ages 18-64) counterparts. METHODS In our initial cross-sectional study, we collected the National Comprehensive Cancer Network’s Distress Thermometer (NCCN-DT) and problem list from adult patients with PBTs (WHO grades I-IV) seen at our institution between December 2013 and February 2016. We performed subsequent analyses on a subset of patients with GBM. RESULTS We identified 343 patients with GBM from the original dataset, of which 23.0% (n= 78) were ≥ 65 years old. The proportion of patients ≥ 65 years old with elevated distress (i.e. DT ≥ 4) was greater than the proportion of younger patients reporting elevated distress (47.4% vs 30.6%; p= 0.0068). Elevated distress was significantly greater during the first 6 months post diagnosis for all ages (p= 0.008). In subgroup analyses, a decrease in distress beyond 6 months was seen in younger patients (45.7% vs 27.4%; p= 0.021), but not in older patients. In older patients, a greater number of problems were selected on the NCCN DT and problem list tool: emotional and physical concerns were reported more frequently compared to their younger counterparts. Older patients were more likely to report difficulty with “bathing” and “getting around” (p= 0.009, p&amp;lt; 0.001, respectively). There were no differences in older versus younger GBM patients with regard to housing, transportation, treatment decisions, depression, fatigue, or memory. CONCLUSIONS In contrast to their younger counterparts, older patients with GBM experienced elevated levels of distress and a greater absolute number of specific psychosocial problems, mostly related to emotional and physical concerns.

Attitudes toward early palliative care in cancer patients and caregivers: a Korean nationwide survey.

Integrated early palliative care (EPC) improves quality of life and reduces psychological distress in adult patients with cancer and caregivers, but attitudes toward EPC have been poorly studied. We aimed to investigate attitudes toward EPC in a nationwide survey of patients with cancer and caregivers. From July to October 2016, we administered nationwide questionnaires examining attitudes toward EPC in patients with cancer (n = 1001) and their families (n = 1006) from 12 Korean hospitals. When an individual considered EPC unnecessary, the reasons were collected and analyzed. Factors associated with perception of EPC were examined. A majority of patients (84.5%) and caregivers (89.5%) had positive attitudes toward EPC. The most common reasons for deeming EPC unnecessary were that EPC may be an obstacle to cancer treatment (patients: 37%; caregivers: 23%; respectively) or that they were not sure if EPC is beneficial (patients: 21%; caregivers: 24%; respectively). Financial burden as a reason was more evident in caregivers (23%) than in patients (17%). Male gender, age <50, early stage, intensive care unit admission, and not believing that dying people should prepare to practice charity were associated with patients’ negative attitudes. In caregivers, opposition to EPC was associated with not thinking death should be feared, not thinking people should be remembered, and lower educational level. Our findings showed that significant numbers of patients with advanced cancer and family caregivers showed positive attitudes toward EPC. However, more than 10% of participants did not consider EPC necessary. Physicians’ communication with patients and caregivers and financial support could help overcome the barriers of EPC.

A Nursing Intervention for Reducing Symptom Burden During Chemotherapy .

To evaluate the efficacy of an individually tailored nursing intervention for reducing chemotherapy-related symptom distress in adult patients with cancer. . A control group (n = 71) received usual care and an intervention group (n = 72) received usual care and the CHEMO-SUPPORT intervention, all at the University Hospitals of Leuven in Belgium. . The intervention effect was evaluated by measuring the difference in outcomes between the two groups. The primary outcome, overall symptom distress, and other symptom-related outcomes were self-reported at the start of treatment (baseline) and at 3, 6, and 12 weeks. . The CHEMO-SUPPORT intervention showed significantly less worsening of overall symptom distress and severity. Self-efficacy and outcome expectations (measured at six weeks) were significantly higher in the intervention group. Self-care (measured at 12 weeks) was statistically similar between the two groups. The results emphasize the importance of nurses in coaching patients to adequately self-manage their symptoms at home. . Providing goal-directed self-management support using motivational interviewing as well as tailoring are promising areas for reducing chemotherapy-related symptom distress.

Psychological interventions for distress in adults undergoing haematopoietic stem cell transplantation: a systematic review with meta-analysis.

To investigate the characteristics, methodology, quality, and efficacy of psychological interventions for distress in adult patients undergoing haematopoietic stem cell transplantation (HSCT). A systematic review of relevant studies was conducted using six databases with supplementary hand searching. Included studies employed an experimental or quasi-experimental design, interventions included at least one psychological component, and outcomes involved psychological distress in affective terms. Data were abstracted, and study quality was assessed using Cochrane Foundation criteria amended to include confounder and common factors control. Data were examined and synthesised using a narrative approach and meta-analysis. Eleven articles for nine interventions met the inclusion criteria out of 11,741 abstracts. The studies varied in quality, general, intervention, and methodological characteristics while findings were mixed. Interventions tended to show better efficacy when incorporating a major psychological component involving cognitive behavioural or emotional processing methods with substantial interventionist input. However, this was also associated with methodological limitations and threats to internal validity such as poor confounder and common factors control. A meta-analysis yielded a small but significant pooled effect size estimate in favour of interventions with inconsequential heterogeneity. Risk of bias remained a concern. Psychological interventions may provide some benefit in alleviating distress in HSCT but conclusions remain tentative in light of methodological limitations and risk of bias. Further research is needed to evidence the individual contribution of intervention components and mechanism of change together with improving intervention efficiency and methodological quality.

Distress in Patients with Bleeding Disorders

Background: Distress can affect a patient’s ability to cope with and manage disease. Patients may feel uncomfortable initiating conversations about distress with their provider. Systematic screening for distress in patients with bleeding disorders may help identify distressed patients and guide treatment services planning.Objectives: Describe prevalence of distress in adult patients with bleeding disorders and the specific problems, health characteristics, and behaviors most associated with distress in this population.Methods: Patients who attended the Emory Comprehensive Bleeding Disorder Clinic for a regularly scheduled visit between January 1st, 2012 through February 28th, 2014 and who completed a distress screen, pain screen, and clinic questionnaire during the visit were evaluated cross-sectionally. Distress was measured by the National Comprehensive Cancer Network Distress Management Tool which allowed patients to rate recent distress on a 0-10 point scale and also asked patients to identify from a checklist whether any of 38 specific issues among 5 different categories were recently problematic. A distress rating of 5 or more was categorized as high distress, 1-4 as mild/moderate distress, and 0 as no distress. Pain was measured by the Brief Pain Inventory Short Form which asked patients to rate their various pain types on 0-10 point scales. Patients reported current behavioral and demographic information including employment status, alcohol, and tobacco use on the clinic questionnaire. Depressive symptoms were measured on a 0-6 point scale using the Patient Health Questionnaire-2 screening tool. Primary diagnosis, age, prophylaxis use, and HIV and HCV status were taken from medical records. Unadjusted logistic regression models to identify predictors of high distress were used. Adjusted logistic regression models that controlled for possible confounders were used to examine whether diagnosis and employment were associated with high distress. In the adjusted model examining employment, because depression and pain were collinear, we ran two models; one including depression and one including pain.Results: Of the 168 patients who formed the cohort, most were male (69%) and most had hemophilia as the primary diagnosis (67%). Nearly three-quarters identified as White race with one-quarter Black or African-American. Average patient age was 36 years and ranged from 18 to 83 years. HCV and HIV prevalence in the cohort were 35% and 13%, respectively. High distress prevalence (distress rating ≥ 5) was 31.6% (Figure 1). Patients who reported at least one emotional concern from the problem checklist were more likely to report high distress (Figure 2). In unadjusted analyses, patients who were older, unemployed or disabled, required assistance in daily life activities, reported opioid use, used crutches, had higher depressive symptoms, exercised less, and who reported high pain levels were more likely to report high distress. Diagnosis, gender, race, alcohol consumption, tobacco use, prophylaxis use, and HIV and HCV status were not associated with high distress. Unemployment, disability, higher depression symptoms, and high pain were associated with high distress in multivariate models (Table 1).Conclusions: Nearly one-third of patients with bleeding disorders reported high distress while an additional 40% reported mild/moderate distress. Further study is needed to determine if high distress impacts clinical outcomes of patients with bleeding disorders as has been demonstrated in other chronic disorders.Table 1Multivariate analysis resultsAdjusted Odds Ratios forHigh Distress (95% CI)PredictorModel 1(n=148)Model 2(n=126)Model 3(n=137)DiagnosisSevere/moderate hemophilia1.0Mild hemophilia1.91 (0.53 - 6.85)Other bleeding disorders1.02 (0.28 - 3.74)EmploymentWork full-time1.01.0Student, part-time, retired, homemaker, other0.51 (0.14 - 1.86)0.29 (0.07 - 1.18)Unemployed6.15 (1.33 - 28.44)5.49 (1.09 - 27.82)Disabled3.41 (1.08 - 10.78)2.37 (0.64 - 8.87)Age1.02 (0.99 - 1.05)1.02 (0.99 - 1.05)1.02 (0.99 - 1.06)Pain Score0 (no pain)1.01-4 (low pain)1.12 (0.34 - 3.73)5-10 (high pain)4.85 (1.29 - 18.33)Depression score2.61 (1.78 - 3.83)2.29 (1.52 - 3.45)All models also adjusted for race and HIV/HCV positivity [Display omitted] [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Emotional reactions to pain predict psychological distress in adult patients with Sickle Cell Disease (SCD).

Differentiating somatic from emotional influences on the experience of chronic pain has been of interest to clinicians and researchers for many years. Although prior research has not well specified these pathways at the anatomical level, some evidence, both theoretical and empirical, suggest that emotional reactions influence the experience of disease and non-disease-related pains. Other studies suggest that treatments directed at negative emotional responses reduce suffering associated with pain. The current study was conducted to explore the influence of emotional reactions to pain as a predictor of psychological distress in a sample of adult Blacks with Sickle Cell Disease (SCD). Using cross-sectional survey data, we evaluated whether negative emotional reactions to the experience of pain were predictive of psychological distress after controlling for the somatic dimension of pain and age in n = 67 Black patients with Sickle Cell Disease (SCD). Results showed that greater negative emotion associated with pain predicted Somatization (p < .01), Anxiety (p < .05), Phobic Anxiety (p < .05), and Psychoticism (p < .05). Increased negative emotion associated with pain was also predictive of the General Symptoms Index (p < .05) and the Positive Symptoms Total from the SCL-90-R (p < .01). We believe the current study demonstrates that negative emotional reactions to the experience of pain in adults with SCD are predictive of psychological distress above and beyond the influences of age and the direct nociceptive experience. We also believe these data to be valuable in conceptualizing the allocation of treatment resources toward a proactive approach with early identification of patients who are responding poorly for the purpose of potentially reducing later psychopathology. A deeper understanding of the ways that subpopulations cope with chronic disease-related pain may produce models that can be ultimately generalized to the consumers of the majority of healthcare resources.

Emotional Reactions to Pain Predict Psychological Distress in Adult Patients with Sickle Cell Disease (SCD)

Emotional Reactions to Pain Predict Psychological Distress in Adult Patients with Sickle Cell Disease (SCD)

Effect of nebulized budesonide in preventing postextubation complications in critically patients: A prospective, randomized, double-blind, placebo-controlled study

Background:The efficacy of steroid administration in the prevention of postextubation complications in critical care remains controversial. The purpose of this study was to determine whether administration of nebulized budesonide in critically ill patients reduces the occurrence of postextubation airway complications.Materials and Methods:This was a prospective, randomized, double-blind, placebo-controlled study. We prospectively followed up 70 adult patients in the intensive care unit who were intubated for more than 48 h. Patients received either nebulized budesonide (1 mg every 12 h; n = 35) or placebo (normal saline; n = 35) until 48 h after extubation. Then, the postextubation complications were assessed and recorded within 48 h of extubation.Results:The incidence of respiratory distress was lower in budesonide group (8.6% vs. 31.4%, P = 0.017). Reintubation with mechanical support was necessary in 8.6% (3.35) of patients in the budesonide group and 31.4% (11.35) of patients in the placebo group (P = 0.017).Conclusion:Nebulized budesonide after extubation is effective in reducing the incidence of reintubation and respiratory distress in adult patients.

Integration of mental health-care with primary health-care services in the occupied Palestinian territory: a cross-sectional study

Background Mental disorders are a leading cause of morbidity and disability worldwide. As part of a WHO-led programme to integrate mental health-care with primary health-care (PHC) services, we estimated the baseline prevalence of psychiatric morbidity in governmental PHC clinics in the Gaza Strip, occupied Palestinian territory. Methods The study sample was recruited from advanced PHC clinics (serving 10 000 people and located in main towns) that were selected by the Palestinian Ministry of Health. One clinic was selected from each of the five districts in the Gaza Strip. Every tenth adult patient attending each of the five clinics was recruited until 100 patients had been recruited from each clinic over 4 weeks. The General Health Questionnaire (GHQ)-12 was completed with a bimodal model of scoring (0-0-1-1, range 0–12, with a cutoff of 3 for caseness) by the 500 adults (280 men; mean age 40·2 years [SD 13·9]) under the supervision of specially trained PHC nurses and then assessed by general practitioners. The patient's physical complaints, diagnosis by a general practitioner, treatment, and referral were then recorded. Moreover, 24 general practitioners were recruited from the five clinics to assess the ability of the patients' general practitioners to detect mental health problems. Binary logistic regression was used to assess the association between caseness on the GHQ-12 and sex, area of residence, age, marital status, education, employment status, chronic medical illness, and number of physical complaints. The diagnoses made by the patients' general practitioners were compared with the findings from the GHQ-12. The Ministry of Health approved the study. Patients provided written informed consent. Findings 189 (38%) of 500 patients had mental health problems (GHQ-12 score >3). Mental health problems were associated positively with female sex (p=0·016), older age (p=0·027), divorced or widowed marital status (p=0·009), lower education (p=0), unemployment (p=0·003), chronic physical illness (p=0·015), and having several somatic symptoms (p=0). General practitioners were unable to detect psychiatric problems, even in patients who had many risk indicators. No referrals were made to mental health services. Interpretation The prevalence of psychological distress in adult patients attending the PHC in the Gaza Strip is high compared with rates reported for people in other countries not exposed to conflicts. Our results show inadequate recognition of mental health problems and therefore imply that referral to mental health services is inadequate in PHCs in the Gaza Strip. The Ministry of Health needs to adopt strategies to enable general practitioners to diagnose and treat patients who are in need of mental health care. Funding WHO West Bank and Gaza.