Functional Social Support Research Articles

Patient-defined goals and preferences among older adults with cancer starting chemotherapy (CT).

10009 Background: Older adults with cancer facing decisions with competing health outcomes may favor maintaining quality of life (QOL), independence, or cognition over prolonging survival. The goal of this study was to elicit preferences among outcomes from older adults starting CT. Methods: This is a secondary analysis of an ongoing prospective study aimed at identifying and addressing vulnerabilities in older adults (age ≥65) starting CT (NCT02517034). Patients completed 3 tools assessing preferences in health outcomes: 1) Health Outcomes Tool: rates the relative importance of 4 outcomes (survival, function, freedom from pain, and freedom from symptoms) using a visual analog scale (VAS); 2) Now vs. Later Tool: rates the relative importance of QOL at 3 times: today,1 year (y) in the future , and 5y in the future using a VAS; and 3) Attitude Scale: rates subjects’ agreement with statements related to outcomes. We measured the proportion of patients reporting other outcomes being “as important” or “more important” than survival and studied their characteristics. Results: 121 patients (median age 71y, 47% male, 72% Stage IV, 31% gastrointestinal cancer) were included. 52% had poor physical function, 50% needed help with instrumental activities of daily living (e.g. cooking or transportation), and 73% had poor social support. On the Health Outcomes Tool, 44% rated other outcomes as more important than survival. On the Now vs. Later tool, 59% considered current QOL more/as important as QOL at 1y, and 58% considered current QOL more/as important as QOL at 5y. On the Attitude Scale, 58% agreed/strongly agreed with: “I would rather live a shorter life than lose my ability to take care of myself”; and 81% agreed/strongly agreed with: “It is more important to me to maintain my thinking ability than to live as long as possible”. Patients with good physical function and/or good social support were more likely to consider survival as the most important outcome, regardless of stage. Conclusions: Half of older patients rated other outcomes (particularly cognitive ability) as being more important than survival. Eliciting which outcomes are the most important for older patients can help define treatment goals and improve shared decision-making.

Active aging \u2013 resilience and external support as modifiers of the disablement outcome: AGNES cohort study protocol

BackgroundPopulation aging increases the need for knowledge on positive aspects of aging, and contributions of older people to their own wellbeing and that of others. We defined active aging as an individual’s striving for elements of wellbeing with activities as per their goals, abilities and opportunities. This study examines associations of health, health behaviors, health literacy and functional abilities, environmental and social support with active aging and wellbeing. We will develop and validate assessment methods for physical activity and physical resilience suitable for research on older people, and examine their associations with active aging and wellbeing. We will examine cohort effects on functional phenotypes underlying active aging and disability.MethodsFor this population-based study, we plan to recruit 1000 participants aged 75, 80 or 85 years living in central Finland, by drawing personal details from the population register. Participants are interviewed on active aging, wellbeing, disability, environmental and social support, mobility, health behavior and health literacy. Physical activity and heart rate are monitored for 7 days with wearable sensors. Functional tests include hearing, vision, muscle strength, reaction time, exercise tolerance, mobility, and cognitive performance. Clinical examination by a nurse and physician includes an electrocardiogram, tests of blood pressure, orthostatic regulation, arterial stiffness, and lung function, as well as a review of chronic and acute conditions and prescribed medications. C-reactive protein, small blood count, cholesterol and vitamin D are analyzed from blood samples. Associations of factors potentially underlying active aging and wellbeing will be studied using multivariate methods. Cohort effects will be studied by comparing test results of physical and cognitive functioning with results of a cohort examined in 1989–90.ConclusionsThe current study will renew research on positive gerontology through the novel approach to active aging and by suggesting new biomarkers of resilience and active aging. Therefore, high interdisciplinary impact is expected. This cross-sectional study will not provide knowledge on temporal order of events or causality, but an innovative cross-sectional dataset provides opportunities for emergence of novel creative hypotheses and theories.

Subjective well-being among the oldest old: The role of personality traits

Very little work has been carried out to identify the determinants of subjective well-being among the oldest old. The aim of this study was to analyze whether individual characteristics (i.e. functional capacity, physical and perceived health, cognition and personality) and social resources (i.e. perceived social support) predict subjective well-being (SWB) among this age group.Participants were 102 community-dwelling healthy older adults aged between 85 and 104 (M = 92.53; SD = 5.91). The sample group consisted of only those not in a state of ADL (Activities of Daily Living) dependence who were not suffering from either mood disorders or cognitive impairment associated with neurodegenerative disease.Personality traits (conscientiousness, extraversion and openness) emerged as the strongest predictors of positive affect. Neuroticism and perceived mental health were found to predict negative affect, whereas neuroticism and extraversion emerged as the strongest predictors of life satisfaction.Subjective well-being among the oldest old was mainly predicted by personality traits. Functional capacity, physical health, cognition and social support were not found to be influential factors of subjective well-being. These findings suggest that researchers and clinicians should consider the relationship between personality and subjective well-being among the oldest old.

Dementia and Atrial Fibrillation: A Dangerous Combination for Ischemic Stroke and Mortality.

The risk of developing dementia is increased in patients with atrial fibrillation (AF), with the incidence of both conditions increasing with aging. Patients with dementia frequently do not receiving adequate thrombo-prophylaxis, because of the inability to monitor INR and/or to achieve and maintain good compliance with anticoagulant treatment. Under-treatment is therefore an important contributor to the increased risk of ischemic stroke and mortality in this subgroup of AF patients. In newly-diagnosed patients with AF starting oral anticoagulation, the presence of cognitive impairment should be considered in addition to the calculation of the SAMe-TT2R2 score, as part of an integrated decision management pathway to choose the most appropriate oral anticoagulant [i.e., vitamin K antagonists (VKAs) or non-vitamin K oral anticoagulants (NOACs)]. Moreover, in patients with low or worsening time in therapeutic range during VKAs therapy, the assessment of cognitive impairment may help identify those patients who may benefit from switching to NOACs. In conclusion, patients with AF and dementia benefit from anticoagulation and should not be denied receiving adequate stroke prevention. Cognitive function assessment and social support are pivotal elements in the management of these AF patients.

PROTECTIVE FACTORS AGAINST DEPRESSION IN PATIENTS WITH PERIPHERAL ARTERIAL DISEASE WITH CRITICAL LIMB ISCHEMIA

Introduction. The aim of the study was to assess the extent to which psychosocial factors (social support and coping strategies) may have a protective role against depression in patients with peripheral arterial disease (PAD). Methods. The design of the study was transversal and included 37 patients with PAD with critical ischemia (32 men, 5 women, mean age = 62.41). They were administered Center for Epidemiologic Studies Depression Scale, Duke-UNC Functional Social Support Questionnaire and COPE inventory. Results. Depressive symptoms were found at 28.6% of the patients. There were low scores of perceived social support at 32.4% of the patients. Depression correlated (p<.001) positively with mental disengagement (r=.791), denial (r=.672), behavioral disengagement (r=.760), restraint (r=.075) and negatively with social support (r= -.879) and positive reinterpretation (r=-.844), active coping (r=-.776), use of emotional support (r=-.624). Discussion. PAD patients experience depression. Is highlighted the buffer role of social support and of active coping strategies in facing a chronic disease. Conclusions. Recognition and evaluation for depression in patients with PAD followed by identifying psychosocial interventions may be useful in improving outcomes of these patients.

DISTRESS VULNERABILITY AND SOCIAL SUPPORT IN PATIENTS WITH PERIPHERAL ARTERIAL DISEASE AND PATIENTS WITH VARICOSE DISEASE

Introduction. Both peripheral arterial disease (PAD) and varicose disease (VD), as chronic diseases, can generate high levels of emotional distress, with negative affects, which will influence treatment adherence and quality of life. The study’s aim was to analyze the relationship between anxiety, depression, perceived stress and social support in patients with PAD and with VD. Method. The study included a number of 54 patients (38 men and 16 women) diagnosed with PAD (39 patients) and with VD (15 patients).There were applied (before surgery) psychological tests: Hospital Anxiety and Depression Scale (HADS), Perceived Stress Scale (PSS), The Duke-UNC Functional Social Support Questionnaire (FSSQ). Results. Women had higher levels of anxiety and depression than men (ns), higher scores on perceived stress scale (32,94 vs 29, t=-2,26; p<0,028), but lower scores on social support scale (25,50 vs 30,42, t=2,13; p<0,038). Patients with PAD had higher scores at anxiety (10,31 vs 8,33, t=2,58; p<0,012), depression (7,36 vs 5,40, t=2,05; p<0,045) and perceived stress (31 vs 28, ns) and lower scores at social support scale (27,62 vs 32,47, t=-2,05; p<0,045) than patients with VD. Both anxiety and depression positively correlated with perceived stress (0,639 respective 0,410; p=0,01) and negatively with social support (-0,574, respective -0,522; p=0,01). Age negative correlated with social support (-0,464; p=0,01). Conclusions. The indication for surgical treatment of vascular disease is a distress factor, leading to anxiety and depression. The increased anxiety at patients with PAD compared with those with VD can be explained by greater severity of this group of diseases, higher surgical risks, more frequent complications and a high risk of amputation. Low social support mainly observed in some elderly patients indicate, on the one hand the restriction of support network at this age and, on the other hand, its usefulness especially in the case of diseases that require surgery and postoperative recovery.

Loneliness among elder people and its correlation with frailty and social support

Objective To understand the loneliness of elderly people, and to analyze the correlation between frailty, family social support and loneliness. Methods The elderly people aged 75 and over from 10 community health service centers in Tangshan were selected and evaluated with the CFAI comprehensive evaluation tool and the loneliness scale. Results The frailty rate was 100% in 3 448 elderly people.The score of the frailty of elderly was (47.27±0.77), and the degree of frailty was increased with the increase of age.The social support level of general and below accounted for 95.92%.The total average score of social support for the elderly was (32.72±6.21); and the medium or above loneliness accounted for 68.94%.The total average score of loneliness in the elderly was(40.24±10.23). The most needed caregiver was the children and their daughters. Multivariate analysis showed that the degree of education, the degree of frailty, family support (the relationship with children, with the children who do not support the elderly, communicating with children, taking the views of the elderly, importance of being at home and the visiting frequency of the children), community support (received the services provided by the neighborhood committee, often keep up with relatives and friends, the frequency of neighborhood interaction, have received community psychological counseling and have received volunteer service) and social support entered the regression equation.The regression coefficient were -0.084, 1.167, 1.016, 1.212, 0.914, 1.029, 1.025, 1.264, 1.400, 0.889, 1.053, 1.307, 1.466, 1.332, -0.405, respectively. Conclusion Frailty, family function and community social support are important factors of loneliness among the elderly.The support system construction should be strengthened to reduce the loneliness of the elderly, and improve the quality of life. Key words: The elderly; Loneliness; Frailty; Social support

Acute Predictors of Social Integration Following Mild Stroke

Despite an acknowledged need to accurately predict stroke outcome, there is little empirical evidence regarding acute predictors of participation restriction post stroke. The current study examines prediction of social integration following mild stroke, using combinations of acute poststroke factors. In a prospective, longitudinal study, a cohort of 60 stroke survivors was followed up at 6 months post stroke. Hierarchical multiple regression analyses were employed to evaluate the value of acute poststroke variables in predicting social integration at 6 months post stroke. A combination of age, number of comorbidities, stroke severity, social support factors, and general self-efficacy in the acute poststroke period accounted for 42% of the variance in 6-month social integration. The largest amount of variance (20%) was explained by inclusion of social support factors, including number and types of support. Post hoc analysis was conducted to establish whether marital status was the mediating variable through which early poststroke social support factors exerted influence upon subsequent social integration. The new combination of acute variables accounted for 48% of the variance in 6-month social integration. Results suggested that subjects with partners perceived higher levels of functional social support and lower levels of participation restriction. Stroke survivors with partners may receive greater amounts of companionship and encouragement from their partners, which enhances self-esteem and confidence. Such individuals are possibly more able to participate in and maintain relationships, thus improving social integration. Social support factors, mediated via marital status, are the strongest predictors of subsequent social integration following mild stroke.

Adolescent Coordinated Transition (ACT) to improve health outcomes among young people living with HIV in Nigeria: study protocol for a randomized controlled trial

BackgroundAdolescents living with HIV (ALHIV) have worse health outcomes than other populations of people living with HIV. Contributing factors include lack of standard and comprehensive procedures for ALHIV transitioning from pediatric to adult care. This has contributed to poor retention at, and following transition, which is problematic especially in high ALHIV-burden, resource-limited settings like Nigeria.MethodsUsing a two-arm cluster randomized control design, the Adolescent Coordinated Transition (ACT) trial will measure the comparative effectiveness of a graduated transition and organized support group intervention against the usual practice of abrupt transfer of Nigerian ALHIV from pediatric to adult care. This study will be conducted at 12 secondary and tertiary healthcare facilities (six intervention, six control) across all six of Nigeria’s geopolitical zones. The study population is 13- to 17-year-old ALHIV (N = 216, n = 108 per study arm) on antiretroviral therapy. Study participants will be followed through a 12-month pre-transfer/transition period and for an additional 24 months post transfer/transition. The primary outcome measure is the proportion of ALHIV retained in care at 12 and 24 months post transfer. Secondary outcome measures are proportions of ALHIV achieving viral suppression and demonstrating increased psychosocial wellbeing and self-efficacy measured by psychometric tests including health locus of control, functional social support, perceived mental health, and sexual risk and behavior.DiscussionWe hypothesize that the ACT intervention will significantly increase psychosocial wellbeing, retention in care and ultimately viral suppression among ALHIV. ACT’s findings have the potential to facilitate the development of standard guidelines for transitioning ALHIV and improving health outcomes in this population. The engagement of a consortium of local implementing partners under the Nigeria Implementation Science Alliance allows for nationwide study implementation and expedient results dissemination to program managers and policy-makers. Ultimately, ACT may also provide evidence to inform transitioning guidelines not only for ALHIV but for adolescents living with other chronic diseases in resource-limited settings.Trial registrationClinicalTrials.gov, ID: NCT03152006. Registered on May 12, 2017.

MENORES EN SITUACIÓN DE DESPROTECCIÓN ACOGIDOS EN CENTROS Y RED SOCIAL DE APOYO

Abstract.MINORS IN DEPROTECTION SITUATION LIVING IN RESIDENTIAL CENTERS AND SUPPORT SOCIAL NETWORKThe present work focuses on the study of the influence of the support social network for minors in deprotection situation, because the importance that achieves the person-society relationship is irrefutable. The study deals with the Ecological Systems Theory by Bronffernbrenner, which emphasizes the importance of the influence that some agents have over the others within the support social network of the minors. Socialization is an everlasting process by which a biological being transforms into a social being belonging to a given society. If the main social agents (family, school, peer groups, media and new technologies, professionals of the social fields of the minors, etc.) do not adequately fulfill their functions, the biopsychosocial development of the institutionalized minors is at risk, having negative consequences in the rest of the agents also. Thus, it was considered and checked if the support social network is damaged in minors with protective measures. An analytical empirical research based on the positivist paradigm was performed belongs to a non-experimental methodology. The sample consisted of 104 subjects, minors with measures of protection (residents in centers) and without protection measures (residents in their family home). The measurement instrument used was the adaptation of the Functional Social Support Questionnaire by Duke-UNK and data processing was performed by using the SPSS statistical package. It was observed that minors living in a normalized family nucleus shown significantly higher scores on perceived social support than minors living in centers. Due to the dynamic nature of the socialization process, the necessity of intervene in this respect is undeniable in order to improve the biopsychosocial development of minors in lack of protection situation.Keywords: Social support; Support social network; Minors; Deprotection situationResumen.El presente trabajo se centra en el estudio de la influencia de la red social de apoyo en menores en situación de desprotección, pues es irrefutable la importancia que adquiere la relación personasociedad. El estudio gira en torno a la Teoría Ecológica de Bronffernbrenner, que enfatiza la importancia de la influencia que tienen unos agentes sobre otros dentro de la red social de apoyo de los menores. La socialización es un proceso imperecedero mediante el cual un ser biológico pasa a transformarse en un ser social propio de una sociedad determinada. Si los principales agentes sociales (familia, escuela, grupo de iguales, medios de comunicación y nuevas tecnologías, profesionales del ámbito social del menor, etc.) no cumplen sus funciones adecuadamente, el desarrollo biopsicosocial del menor institucionalizado está en riesgo, teniendo también consecuencias negativas en el resto de los agentes. Así, se planteó y se llevó a comprobación si la red social de apoyo se ve dañada en menores con medidas de protección. Se realizó una investigación empírico analítica basada en el paradigma positivista, enmarcada dentro de una metodología no experimental. La muestra estuvo conformada por 104 sujetos, menores con medidas de protección –en acogimiento residencial– y sin medidas de protección –residentes en su vivienda familiar–. El instrumento de medida utilizado fue la adaptación del Cuestionario de Apoyo Funcional de Duke-UNK y el tratamiento de datos se realizó mediante el paquete estadístico SPSS. Se observó cómo aquellos menores que viven en un núcleo familiar normalizado presentan puntuaciones significativamente mayores en el apoyo social percibido que los menores institucionalizados. Debido al carácter dinámico del proceso de socialización, es innegable la necesidad de intervenir en este aspecto para mejorar el desarrollo biopsicosocial de los menores en situación de desprotección.Palabras clave: Apoyo social, Red social de apoyo; Menores; Situación de desprotección

Functional Social Support for Hypertensive Patients in Primary Care Setting in Poland: What Is Expected and What Is Received?

ObjectivesTo measure expected and received functional social support (FSS) from doctors, nurses, and family members in the population of patients with primary arterial hypertension and to explore the gap between the expected and received support. MethodsThis cross-sectional study involved 232 adults in a primary arterial hypertension group and 115 healthy individuals in a control group. The sample was drawn from six family doctor surgeries in Szczecin, Poland. Three categories of expected and received FSS were examined, that is, emotional, informational, and instrumental, using the self-administered questionnaire. The Mann-Whitney U test was used to compare the means of received and expected support from different sources. Indexes of adequacy of FSS were established. ResultsA deep deficit of emotional support and a smaller deficit of informational and instrumental support from family members were observed in both groups. Hypertensive patients reported receiving a higher level of emotional and informational support than expected from doctors. Instrumental support from doctors and all three types of support from nurses met hypertensive patients’ expectations. Healthy controls reported a distinct deficit in all kinds of support from doctors and nurses. Their expectations of informational and instrumental support from health professionals, and from family, were higher than those of the hypertensive patients. ConclusionsThe study hypothesis predicting that Polish patients will perceive FSS received from family members as adequate and observe deficiencies in support from doctors and nurses was not confirmed. The low level of perceived emotional support from family requires attention from health educators to alleviate this deficiency.

Association between Social Support and Self-Care Behaviors in Adults with Chronic Obstructive Pulmonary Disease.

Higher social support is associated with a better quality of life and functioning in adults with chronic obstructive pulmonary disease (COPD). To determine the association between structural and functional social support and self-care behaviors in adults with COPD. This was a longitudinal study using data from the CASCADE (COPD Activity: Serotonin Transporter, Cytokines, and Depression) study, which was focused on depression and functioning in COPD. Physical activity was measured with a validated accelerometer at baseline, year 1, and year 2. Additional self-care behaviors included pulmonary rehabilitation attendance, smoking status, receipt of influenza and/or pneumococcal vaccinations, and medication adherence. Structural social support indicators included living status, being partnered, number of close friends/relatives, and presence of a family caregiver. Functional social support was measured with the Medical Outcomes Social Support Survey (MOSSS). Mixed-effects and logistic regression models were used. A total of 282 participants with Global Initiative for Chronic Obstructive Lung Disease stage II to IV COPD were included (age, 68 ± 9 yr; 80% men; FEV1% predicted, 45 ± 16). For physical activity, participants who lived with others accrued 903 more steps per day than those who lived alone (95% confidence interval [CI], 373-1,433; P = 0.001); increases in the MOSSS total score were associated with more steps per day (β = 10; 95% CI, 2-18; P = 0.02). The odds of pulmonary rehabilitation participation were more than 11 times higher if an individual had a spouse or partner caregiver compared with not having a caregiver (odds ratio [OR], 11.03; 95% CI, 1.93-62.97; P < 0.01). Higher functional social support (MOSSS total score) was associated with marginally lower odds of smoking (OR, 0.99; 95% CI, 0.98-1.00; P = 0.03) and higher odds of pneumococcal vaccination (OR, 1.02; 95% CI, 1.00-1.03; P = 0.02). Social support was not associated with influenza vaccination or medication adherence. Structural social support, which was measured by reports of living with others and having a caregiver, was respectively associated with higher levels of physical activity and greater participation in pulmonary rehabilitation in adults with COPD. Our findings reinforce the critical importance of the social environment in shaping patients' success with self-care. Clinical Trial registered with clinicaltrials.gov (NCT01074515).

A Health Behavior Prediction Model for Patients With Coronary Artery Disease.

The aim of this study was to determine the relationships among functional status, hostility, social support, illness perceptions, and health behaviors in patients with coronary artery disease using structural equation modeling. Participants comprised 215 patients with coronary artery disease who had received percutaneous coronary artery intervention or a coronary artery bypass graft in two general hospitals in Seoul, Korea. Using structured interviews with questionnaires, data accrued from July to August, 2015. Fitness of the model was verified with AMOS 21.0. As social support increased, it negatively aligned with cognitive-illness perceptions. Higher levels of hostility and greater negative cognitive-illness perceptions aligned with negative emotional-illness perceptions. Social support indirectly affected emotional-illness perceptions. Lower levels of functional status, greater social support, and more positive cognitive-illness perceptions aligned with health behaviors. Social support indirectly affected health behaviors. In conclusion, nurses should focus on coronary artery disease patients' physical functions and cognitive-illness perceptions to provide support.

Change in Psychological, Physiological, and Situational Factors in Adults After Treatment of Chronic Cough

We hypothesized that addressing anxiety and depressive mood disorders will improve chronic cough severity and cough quality of life (CQOL). Major tenets of the theory of unpleasant symptoms were examined in a longitudinal observational study of consecutive adults with cough of > 8weeks' duration treated in our cough clinic. At baseline and 3 and 6months, subjects completed 3 Punum Ladders rating cough severity, the CQOL Questionnaire, the Depression, Anxiety, and Stress Scales-21, and the Duke Functional Social Support Questionnaire. Cross-sectional baseline and longitudinal regression analyses were conducted. Eighty subjects (55 women) with a mean age of 58.5 ± 11.1 years and a cough duration of 86.0 ± 123.7months were enrolled. At baseline, worse cough severity was significantly associated with less education and worse ability to speak bothered by cough and the urge to cough. Worse CQOL was significantly associated with worse depression symptoms, urinary incontinence, and ability to speak; use of self-prescribed remedies; and younger age. Significant improvements in depression and stress symptoms occurred at 3 and 6months. Anxiety symptoms improved, particularly in the first 3months. Improvement in cough severity was significantly associated with less education, male sex, and improvement in ability to speak and urge to cough. Improvement in CQOL was significantly associated with improvement in urinary incontinence, urge to cough, anxiety symptoms, and use of self-prescribed remedies. Using the theory of unpleasant symptoms, we have come to appreciate that managing psychological, physiological, and situational factors in addition to focusing on identifying the cause of cough is important to maximize improvement in CQOL.

Geriatric Assessment and Tools for Predicting Treatment Toxicity in Older Adults With Cancer.

Cancer is a disease of older adults, and the majority of new cancer cases and deaths occur in people 65 years or older. However, fewer data are available regarding the risks and benefits of cancer treatment in older adults, and commonly used assessments in oncology fail to adequately evaluate factors that affect treatment efficacy and outcomes in the older patients. The geriatric assessment is a multidisciplinary evaluation that provides detailed information about a patient's functional status, comorbidities, psychological state, social support, nutritional status, and cognitive function. Among older patients with cancer, geriatric assessment has been shown to identify patients at risk of poorer overall survival, and geriatric assessment-based tools are significantly more effective in predicting chemotherapy toxicity than other currently utilized measures. In this review, we summarize the components of the geriatric assessment and provide information about existing tools used to predict treatment toxicity in older patients with cancer.

Attributing Responsibility, Sexist Attitudes, Perceived Social Support, and Self-Esteem in Aggressors Convicted for Gender-Based Violence.

This work analyzes how the assumption of responsibility by aggressors convicted for gender-based violence is related to sexist attitudes, self-esteem and perceived functional social support. Similarly, the predictive capacity of these variables is studied with respect to the aggressors' minimization of the harm done and a lack of attributing responsibility to themselves. The participants in the research were males condemned to prison sentences for crimes related with gender-based violence in Spain. The instruments applied were the Attribution of Responsibility and Minimization of Harm Scale, the Ambivalent Sexism Inventory (ASI), the Rosenberg Self-Esteem Scale (RSE), the Functional Social Support Questionnaire (FSSQ), and the Social Desirability Scale (SDS). The study concludes that sexist attitudes are related with a greater lack of attribution of responsibility, as well as with a greater tendency to minimize the harm done by the aggression. In addition, the aggressors with low self-esteem use self-defense as a strategy to justify the violence. Similarly, the presence of an adequate social support network for the aggressor increases the attribution of responsibility on the part of those convicted for gender-based violence.

Correlates of HIV Risks Among Women on Probation and Parole.

This article examines HIV risks among a sample of 406 women on probation and parole with lifetime histories of victimization who were recruited from an urban community in the southern U.S. Guided by the Comprehensive Health Seeking and Coping Paradigm, we analyze the significance of sociodemographic characteristics, substance use, posttraumatic stress disorder, and social support in relationship to three sexual risks and one drug use risk using multivariable regression. Findings indicate that substance use is a significant correlate of nearly all HIV risks examined, including lifetime sexual partners and sexual partners during the past 12 months. Age, race/ethnicity, homelessness, lifetime traumatic event exposure, regular use of alcohol to intoxication and other drugs, functional social support, and substance use treatment in the past 12 months are associated with specific HIV risks. The findings identify potential targets to address in HIV prevention with women on probation and parole who have experienced victimization.

Illness perception is a strong parameter on anxiety and depression scores in early-stage breast cancer survivors: a single-center cross-sectional study of Turkish patients.

Illness perception has been suggested to have a significant effect on anxiety and depression in cancer patients. In this cross-sectional study, we aimed to evaluate this on Turkish breast cancer patients with follow-up periods up to 12years. A total of 225 patients (with 6months to 12years follow-up) were recruited in this cross-sectional study. The patients were divided into three groups of follow-up: 6months-2years, 2-5years, and >5years. Beck Depression Inventory, Beck Anxiety Inventory, Duke-University of North Carolina Functional Social Support Questionnaire, and Brief Illness Perception Questionnaire were used to assess the depression, anxiety, functional social support (FSS), and illness perception, respectively. Statistical significance of the associations was analyzed using Spearman correlation, Student's t, Mann-Whitney U, and ANOVA tests. Rates of moderate-severe anxiety and depression scores were not correlated with follow-up period and disease stage, whereas all these parameters were associated significantly with FSS and age. Parameters of illness perception were also not correlated with follow-up period and stage of disease. However, illness perception scores were noticeably better with increments in FSS. Also, the parameters of illness perception were strongly associated with the depression/anxiety score. Illness perception is an important determinant of the depression/anxiety score in Turkish breast cancer patients.

Evaluation of the Yale New Haven Readmission Risk Score for Pneumonia in a General Hospital Population

BackgroundThe Yale New Haven Readmission Risk Score (YNHRRS) for pneumonia is a clinical prediction tool developed to assess risk for 30-day readmission. This tool was validated in a cohort of Medicare patients; generalizability to a broader patient population has not been evaluated. In addition, it lacks indicators of functional status or social support, which have been shown in other studies to be predictors of readmission. The objective of this study was to evaluate the generalizability of the YNHRRS for pneumonia in a general population of hospitalized patients, and assess the impact of incorporating measures of functional status and social support on its predictive value. MethodsThis retrospective chart review comprised all patients admitted to a 563-bed academic medical center with a primary diagnosis of pneumonia between March 2014 and March 2015. Abstraction of clinical variables allowed calculation of the YNHRRS and additional indicators of functional status and social support. The primary outcome was 30-day readmission rate. We created a logistic regression model to predict readmission using the YNHRRS, functional status, and social support as covariates. ResultsAmong 270 discharges with pneumonia, the observed readmission rate was 23%. The YNHRRS was a significant predictor of readmission in our multivariate model, with an odds ratio of 2.20 (95% confidence interval, 1.29-3.73) for each 10% increase in calculated risk. Indicators of functional status and social support were not significant predictors of readmission. ConclusionsThe YNHRRS can be applied to an unselected population as a tool to predict patients with pneumonia at risk for readmission.

Association between health status and social integration/loneliness in survivors of adolescent and young adult (AYA) cancers.

e21563 Background: AYA cancer survivors are at risk of various adverse health outcomes, but the relation between health status, social integration (i.e., social network and support) and loneliness is understudied. Methods: 102 AYA survivors (mean age = 25 years; diagnoses = leukemia 27%; lymphoma 24%; brain tumors 9%; solid tumors 41%) and 102 age-sex-matched controls were recruited from a community-based online panel. Participants reported social network information (e.g., contact frequency, resources for health counseling) for up to 25 of closest friends/relatives, which was used to create a functional social network index. UCLA Loneliness Scale, Duke-UNC Functional Social Support Questionnaire and PROMIS Health Profile were used to measure loneliness, social support and health-related outcomes (physical functioning, depression, anxiety, fatigue and pain), respectively. Multiple linear regression was used to compare functional social network, social support and loneliness between survivors and controls, and to assess the relation between health outcomes and perceived loneliness. Results: Compared to controls, survivors of lymphoma (b = 1.98; p = 0.005), leukemia (b = 1.67; p = 0.012) and solid tumors (b = 1.22; p = 0.030) had a higher functional social network index. However, social support did not differ between survivors and controls (p’s &gt; 0.05). Brain tumor survivors (b = 15.65; p = 0.006) and solid tumor survivors (b = 10.83; p &lt; 0.001) had more loneliness than controls. Compared to low loneliness controls, high loneliness survivors had significantly lower physical functioning (b = -7.72; p &lt; 0.001) and higher anxiety (b = 8.35; p &lt; 0.001), depression (b = 10.57; p &lt; 0.001), fatigue (b = 5.52; p = 0.011) and pain (b = 6.37; p &lt; 0.001) after adjusting for age, sex, education, social integration, and number of self-reported chronic health conditions. Conclusions: Loneliness is significantly associated with poor health-related outcomes in AYA survivors, which is independent of the influence of social integration. Future research is warranted to understand the relation between health status and social interactions among AYA survivors to inform intervention-based strategies.