Mental Well-being Of Patients Research Articles

Identification of potential drug targets for insomnia by Mendelian randomization analysis based on plasma proteomics.

Insomnia, a common clinical disorder, significantly impacts the physical and mental well-being of patients. Currently, available hypnotic medications are unsatisfactory due to adverse reactions and dependency, necessitating the identification of new drug targets for the treatment of insomnia. In this study, we utilized 734 plasma proteins as genetic instruments obtained from genome-wide association studies to conduct a Mendelian randomization analysis, with insomnia as the outcome variable, to identify potential drug targets for insomnia. Additionally, we validated our results externally using other datasets. Sensitivity analyses entailed reverse Mendelian randomization analysis, Bayesian co-localization analysis, and phenotype scanning. Furthermore, we constructed a protein-protein interaction network to elucidate potential correlations between the identified proteins and existing targets. Mendelian randomization analysis indicated that elevated levels of TGFBI (OR = 1.01; 95% CI, 1.01-1.02) and PAM ((OR = 1.01; 95% CI, 1.01-1.02) in plasma are associated with an increased risk of insomnia, with external validation supporting these findings. Moreover, there was no evidence of reverse causality for these two proteins. Co-localization analysis confirmed that PAM (coloc.abf-PPH4 = 0.823) shared the same variant with insomnia, further substantiating its potential role as a therapeutic target. There are interactive relationships between the potential proteins and existing targets of insomnia. Overall, our findings suggested that elevated plasma levels of TGFBI and PAM are connected with an increased risk of insomnia and might be promising therapeutic targets, particularly PAM. However, further exploration is necessary to fully understand the underlying mechanisms involved.

Graph modeling of relational structures among functioning variables with low back pain: an exploratory analysis based on international classification of functioning, disability and health.

Given the complex etiology, multidimensional impact, and widespread prevalence of low back pain (LBP), it is crucial to prioritize intervention targets based on understanding the relationships between functional impairments in patients. This prioritization maximizes the physical and psychological benefits for patients, and graph modeling holds promise in achieving these objectives. The aim of this study was establishing a graphical model of functioning variables for LBP based on the International Classification of Functioning, Disability, and Health (ICF) to identify the most influential items (i.e., functioning variables) on the physical and mental well-being of patients. Exploring feasible intervention measures by understanding the dysfunction correlations among these variables. Cross-sectional survey. Nine hospitals in Jiangsu Province, China. Three hundred and six persons with LBP aged ≥18 years. All patients were assessed using the Comprehensive ICF Core Sets for LBP. The scoring system was converted to dichotomous data, with 1 indicating dysfunction and 0 indicating no dysfunction. In the graphical model, network parameters and the results of Item Response Theory modeling (as detailed in our other article) were used to determine the importance of items, while partial correlations were utilized to estimate the dysfunction correlations between functioning variables. 1) A total of 56 ICF items were located in the backbone structure of LBP, among which d430 (Lifting and carrying objects) occupied the most central position, followed by b126 (Temperament and personality functions). 2) In the main component of backbone structure, d430 has moderate dysfunction correlation with looking after one's health (0.6027), social norms, practices and ideologies (0.597), stability of joint functions (0.5759), and emotional functions (0.4078). b126 has moderate dysfunction correlation with basic interpersonal interactions (0.6595). d430 and b126 significantly impact the physical and mental well-being of LBP patients. To improve d430, maintaining exercise habits, reducing working hours, enhancing lumbar stability, and overcoming fear-related emotions are recommended. Similarly, improving b126 can be achieved through enhancing interpersonal relationships. Through the identification of crucial functioning variables and the associated dysfunctional correlation relationships, graphical model of Comprehensive ICF Core Set for LBP can offer healthcare decision-makers valuable insights into potential treatment targets and pathways aimed at improving the condition of LBP patients.

Prediction of future research trends in bladder urothelial carcinoma: Bibliometric analysis.

Bladder urothelial carcinoma (BLCA) is a prevalent malignant tumor of the urinary system and, ranks 13th worldwide. Its incidence and mortality rates are consistently increasing, posing a significant threat to the physical and mental well-being of patients. We conducted a literature search in the field of BLCA from 2010 to 2023 using the Web of Science Core Collection (WoSCC) database. CiteSpace 6.2.R4 and VOSviewer 1.6.19 were utilized to visually represent the annual publications, countries, institutions, authors, journals, keywords, and references in the literature. A total of 10,378 articles were included in this study. Since 2010, the number of published articles has been increasing. The countries and institutions that contributed the most were the USA and Medical University Vienna. The most frequently cited author was Bellmunt J, with 2551 citations. Shariat Shahrokh F holds the record for most published articles with 445. The journal "Urologic Oncology-Seminars and Original Investigations" had the largest number of publications, while "Eur Urol" was the most frequently cited journal. "survival" and "radical cystectomy" were identified as the most frequent keywords in recent years. Burst detection analysis revealed that the keyword with the highest intensity value was "Transitional-Cell Carcinoma," and the reference with the highest intensity value was Babjuk M, 2013. This study aimed to analyze and predict the research hotspots and trends in BLCA to provide reference value for further research in this field. The findings of this study can contribute to the research progress in BLCA.

P1184 Two simple tools for assessing depression and anxiety in patients with Inflammatory Bowel Diseases

Abstract Background Inflammatory bowel diseases (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), can trigger the onset of depressive and anxiety symptoms. The evaluation of mental well-being in patients with a chronic medical condition is considered a good clinical practice and it is strongly recommended by the World Health Organization. Nevertheless, mental health is not routinely investigated in this context for several reasons, including lack of training by healthcare professionals, stigma associated to mental health and gender-relatedstereotypes. The objectives of our study were to assess the presence of depressive and anxiety symptoms inpatients affected by IBD using two simple validated questionnaires and to identify potential related factors, particularly gender differences. Methods We conducted a single center observational study evaluating anxiety and depressive symptoms in patients with IBD treated with biological therapy at the IBD Unit of Ospedale Policlinico of Milan during October 2022. We assessed depressive and anxiety symptoms using respectively the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7) that are easy self-administered rating scales. Univariate analyses and regression models were applied for the purpose of the study. Results Among a total of 174 consecutive patients, 158 completed the questionnaires. The prevalence of moderate tosevere depression (PHQ-9 score > 9) in the total sample was 18.4%, and it was higher in CD than in UC (21% vs 9.7%). The prevalence of clinically significant anxiety symptoms (GAD-7 score > 9) was 24% (25.7% in CD and 19.3% in UC). Focusing on gender differences, similar prevalence of significant anxiety anddepression was observed between males (M) and females (F); respectively 18.6% M vs 17.6% F for depression (PHQ-9 > 9) and 22.2% M vs 25.4% F for anxiety (GAD-7 > 9). Of note, a relevant association was observed between younger age and higher GAD-7 (β =-0.639; p=0.021) and PHQ-9 (β =-0.604, p=0.055) scores. Conclusion Both males and females (especially younger) IBD patients in biological therapy are largely affected bysignificant depressive and anxiety symptoms. The administration of simple questionnaires like PHQ-9 andGAD-7 in routine clinical practice can facilitate early identification of patients requiring mental health support, this is crucial as psychiatric conditions can complicate the course of the disease and adherence to treatments.

Association between gut microbiota and glioblastoma: a Mendelian randomization study.

Background: Glioblastoma (GBM) is the most prevalent malignant brain tumor, significantly impacting the physical and mental wellbeing of patients. Several studies have demonstrated a close association between gut microbiota and the development of GBM. In this investigation, Mendelian randomization (MR) was employed to rigorously evaluate the potential causal relationship between gut microbiota and GBM. Methods: We utilized summary statistics derived from genome-wide association studies (GWAS) encompassing 211 gut microbiota and GBM. The causal association between gut microbiota and GBM was scrutinized using Inverse Variance Weighted (IVW), MR-Egger, and Weighted Median (WM) methods. Cochrane's Q statistic was employed to conduct a heterogeneity test. MR-Pleiotropic Residuals and Outliers (MR-PRESSO) were applied to identify and eliminate SNPs with horizontal pleiotropic outliers. Additionally, Reverse MR was employed to assess the causal relationship between GBM and pertinent gut microbiota. Results: The MR study estimates suggest that the nine gut microbiota remain stable, considering heterogeneity and sensitivity methods. Among these, the family.Peptostreptococcaceae and genus.Eubacterium brachy group were associated with an increased risk of GBM, whereas family.Ruminococcaceae, genus.Anaerostipes, genus.Faecalibacterium, genus.LachnospiraceaeUCG004, genus.Phascolarctobacterium, genus.Prevotella7, and genus.Streptococcus were associated with a reduced risk of GBM. Following Benjamini and Hochberg (BH) correction, family.Ruminococcaceae (OR = 0.04, 95% CI: 0.01-0.19, FDR = 0.003) was identified as playing a protective role against GBM. Conclusion: This groundbreaking study is the first to demonstrate that family.Ruminococcaceae is significantly associated with a reduced risk of GBM. The modulation of family_Ruminococcaceae for the treatment of GBM holds considerable potential clinical significance.

363P Effect of financial distress and mental well-being of patients with early vs advanced oral cancer on informal caregiver's quality of life: A prospective real-world data from public health sector hospital

363P Effect of financial distress and mental well-being of patients with early vs advanced oral cancer on informal caregiver's quality of life: A prospective real-world data from public health sector hospital

Prevalence of depression in women diagnosed with breast cancer in Georgia

Abstract Background: Depression commonly occurs in patients with breast cancer (BC), significantly affecting their quality of life. We screened Georgian women diagnosed with BC for depressive symptoms to determine their prevalence and examine associations with various sociodemographic and clinical characteristics. This is the first study focusing on mental well-being in patients with cancer in Georgia. Methods: In a multicenter observational study, 177 women receiving BC treatment were examined at three tertiary oncology hospitals in Georgia. Patient Health Questionnaire 9 (PHQ-9) was used for the identification of depressive symptoms. Patients were stratified using basic information on age, marital status, educational level, social and financial support, employment status, and clinical characteristics. Results: The average age was 52.9 years (34–77); 117 (66%) were married; 79 (45%) were working, but only 30 (17%) reported having adequate financial status; 128 (72%) had stage I-III disease; and 64 (36%) reported some degree of pain. Using pro-rated PHQ-9 scores, 46 patients (44%; 95% CI, 37–51) reported some level of depressive symptoms while 25 women (14%; 95% CI, 9–19) met the criteria for probable depressive disorder. A higher proportion of patients reporting pain also reported depressive symptoms (37/66, 56%) compared with those reporting no pain (41/111, 34%) (P = .013); women with stage IV disease were more likely to report depressive symptoms (26/44, 57%) compared with those with stages I-III (53/133, 40%) (P = .049); and single/previously married women (42/60, 70%) were more likely to report depressive symptoms than married women (51/117, 44%) (P = .001). Depressive symptom reporting did not differ by age or reported support. Conclusion: One in six of this sample of Georgian patients with BC had depressive symptom levels consistent with a depressive disorder. Depressive symptoms covaried by marital status, staging, and reported pain. These results can inform practitioner oncologists in Georgia of the needs for psychological support for patients with cancer and assist in building such support services.

The outcome of a multicomponent lifestyle intervention in patients with obesity: A cohort study

Persons with obesity are at risk of developing diseases. Furthermore, people with obesity are often stigmatized and struggle with how to improve their lifestyle despite perhaps already knowing what healthy habits consist of. Hence, there is a need for lifestyle interventions aimed at improving mental well-being in patients with obesity in order to induce lifestyle change. The aim of the study was to investigate the outcome of a multicomponent lifestyle intervention in a group of Danish patients with obesity (Body Mass Index (BMI) ≥30). The study was a cohort study for patients referred for a multicomponent lifestyle intervention (3 times/6 months) at a lifestyle rehabilitation center from 2016 to 2019 with a BMI ≥30. Patients completed questionnaires at baseline, 6 and 18 months regarding diet, physical activity, body weight, the Short-Form 12-Item Health Survey (SF-12) (minimal important change ≥5 points) and a question regarding satisfaction with treatment. A total of 1336 patients (mean age (standard deviation) 51(14) years, 25% men) were included. Median weight change (25th;75th quartile) was -5% (-2;-8%), p<0.001 from baseline to 6 months and -4% (0;-9%), p<0.001 at 18 months. After the intervention, only 8% patients had an unhealthy diet and patients reported increased participation in physical activities (+1 day/week) (p<0.001). Patients changed their mean [95%confidence interval] SF-12 physical score 4.0 [3.4;4.5] points (p<0.001) at 6 months follow up and 3.2 [2.4;3.8] points (p<0.001) at 18 months. Their SF-12 mental scores were changed 2.8 [2.2;3.4] points (p<0.001) at 6 months and 2.3 [1.5;3.1] points (p<0.001) at 18 months. 40–45% patients had a minimal important change in their SF-12 scores. 91% of the patients were highly satisfied with the treatment. Patients participating in a multicomponent lifestyle intervention focusing on improving mental factors had improved outcomes at 6 and 18 months follow up.

Symptoms, Health Status, and Mental Well-Being of Patients After COVID-19

Persistence of symptoms post-COVID-19 infection, commonly known as “long COVID”, is a significant issue, affecting nearly one in five individuals. The aim was to assess whether the persistence of COVID-19 symptoms beyond infection was associated with poorer overall health status. Additionally, The investigators assessed the frequency and severity of the symptoms associated with long COVID in the patient population. They surveyed patients verbally at the Vanderbilt University Medical Center Emergency Department, a Level 1 Urban Trauma Center. The investigators gathered patients’ demographic data and perspectives on their symptoms before, during, and after COVID-19 infection. They enrolled a total of 100 patients and analyzed the data descriptively, proportions with Pearson Goodness-of-fit Test and differences between paired samples with Wilcoxon signed-ranked test. Nearly one-fourth of the local population experienced long COVID symptoms, including shortness of breath and fatigue (p = 0.009372). Additionally, there was a significant difference between patient health rankings before and after testing positive for COVID-19 (p = 1.6 x 10-10), which may suggest COVID-19 has a negative impact on overall health or perception of health in the patient population.

Moderate dietary salt restriction improves blood pressure and mental well-being in patients with primary aldosteronism: The salt CONNtrol trial.

Primary aldosteronism (PA) is a frequent cause of hypertension. Aldosterone excess together with high dietary salt intake aggravates cardiovascular damage, despite guideline-recommended mineralocorticoid receptor antagonist (MRA) treatment. To investigate the antihypertensive impact of a moderate dietary salt restriction and associated physiological changes, including mental well-being. A total of 41 patients with PA on a stable antihypertensive regimen-including MRA-followed a dietary salt restriction for 12 weeks with structured nutritional training and consolidation by a mobile health app. Salt intake and adherence were monitored every 4 weeks using 24-h urinary sodium excretion and nutrition protocols. Body composition was assessed by bioimpedance analysis and mental well-being by validated questionnaires. Dietary salt intake significantly decreased from 9.1 to 5.2g/d at the end of the study. In parallel, systolic (130 vs. 121mmHg) and diastolic blood pressure (BP) (84 vs. 81mmHg) improved significantly. Patients' aptitude of estimating dietary salt content was refined significantly (underestimation by 2.4 vs. 1.4g/d). Salt restriction entailed a significant weight loss of 1.4kg, improvement in pulse pressure (46 vs. 40mmHg) and normalization of depressive symptoms (PHQD scale, p<0.05). Salt restriction, cortisol after dexamethasone suppression test and dosage of renin-angiotensin-aldosterone-system (RAAS) blockers were independently associated with BP reduction. A moderate restriction of dietary salt intake in patients with PA substantially reduces BP and depressive symptoms. Moreover, the findings underline that a sufficient RAAS blockade seems to augment the effects of salt restriction on BP and cardiovascular risk.

Efficacy of autologous platelet-rich fibrin (PRF) in management of non-healing ulcers in Hansen’s disease

Non-healing ulcers are a major cause of disability and impairment, interfering with physical and mental well-being of patients with Hansen’s disease. They are difficult to manage having longer duration of treatment and increased financial burden. Minimizing the duration of healing can be a major step in rehabilitation of such patients. Platelet rich fibrin (PRF) is a newer modality to hasten wound healing. It is a concentration of platelets suspended in plasma extracted after centrifuging patient’s own blood.: To study the efficacy of platelet-rich fibrin (PRF) in management of non-healing ulcers.: 13 patients with 16 non-healing ulcers of more than 8 weeks duration were included in our study but 2 patients were lost to follow up after first sitting. Written consent for the procedure and ethical clearance from Institutional Ethical Committee was taken. Detailed history was noted, baseline photographs and measurement of area and volume were done at every sitting at an interval of 1 week. An average of 2-3 sittings of PRF was done in each patient and then the ulcer was spontaneously allowed to heal with regular dressing till complete closure was achieved.: The mean age of cases in our study was 39.4 years. The average percentage improvement in area and volume was 97.12% and 98.72% respectively. Out of 14 ulcers, 12 (85.71%) ulcers showed complete healing within 4 weeks. The mean duration of healing was found to be 2.41 weeks. The procedure was safe with no noted adverse events. The limitation of our study was small sample size. More studies are needed with larger sample size to confirm the results.: PRF is an inexpensive, safe, feasible and effective procedure in the management of non-healing ulcers.

A Model of Social Support for a Patient-Informal Caregiver Dyad.

Background Close persons (informal caregivers) are the most important providers of support indicated by cancer patients. Cancer affects couples as a codependent system. The aim of this study was to investigate the factors influencing the multidimensional aspect of social support in a cancer patient–informal caregiver dyad. Methods The research project was cross-sectional. The diagnostic survey method and the survey technique were used. The study was conducted using standardised research tools: BSSS, POS, SSCS, TIPI, ET, SPT, and the authors' own tool for sociodemographic assessment. Results Patients and caregivers experienced injustice, exclusion, and a sense of loss with a similar intensity. Statistically significant differences between the examined patients and their caregivers were obtained for the support currently received (p < 0.01), emotional support (p < 0.05), and the general level of protective buffering support (p < 0.001). A higher level of information support for caregivers increases the need for support and a sense of support for patients. Conclusion The quality of functioning and mental well-being of patients is directly influenced by the way their caregivers experience the situation of caring for them; negative or positive states of caregivers, affecting the condition of patients, may affect the course of treatment and contribute to or delay the improvement of the state of health. The subjective sense of support in patients during treatment depends on the need for help that is shown to their caregivers. The sense of support variable is subjective and sometimes disproportionate to the support received and given. Therefore, both the patient and their loved one should be provided with care during the treatment process. In the treatment process, both patients and their caregivers need more protective buffering support that allows them to overcome difficulties related to stress, anxiety, and insecurity, thus weakening their negative effects rather than functional support: emotional, information, instrumental, or material.

Associations of Use of Social Media and Psychopathology and Body Image in Pre- and Post-surgical Bariatric Samples: a Cross-sectional Analysis.

PurposeInterest has grown regarding the impact of social media platforms on mental health including body image and internalized weight bias (IWB) in those who have struggled with weight issues. However, few studies have addressed social media usage in bariatric patient samples. The objective of this study was to understand how the amount of time spent on social media could serve as a predictor for IWB in both pre- and post-operative bariatric patients.Materials and MethodsPre- and post-operative patients at one academic medical center completed self-report measures assessing patients’ IWB, depression, anxiety, body dissatisfaction, sociodemographic variables, and social media usage. Data were collected from March 2019 to April 2020. Statistical methods that included correlations, logistical regression models, and ANOVA analysis were used to determine the relationship between time spent on social media and other covariates.ResultsA total of 148 responses were collected from the pre-surgical population, with 81 responses from the post-surgical sample. At baseline, the majority of respondents used social media for approximately 1 h per day (n = 37; 27.82%). Time spent on social media was negatively associated with age (r = − 0.24 [− 0.40, − 0.08]), and positively associated with IWB (r = 0.20 [0.02, 0.36]) and anxiety (r = 0.21 [0.01, 0.39]). In the post-operative group, only the 6-month BMI (r = 0.29 [0.05, 0.49]) was positively associated with time spent on social media.ConclusionGiven this study’s findings, providers are encouraged to become aware of patients’ use of social media, and to understand the impact social media usage can have on the mental well-being of patients.Graphical abstract Supplementary InformationThe online version contains supplementary material available at 10.1007/s11695-022-06206-6.

Determinants of weight, psychological status, food contemplation and lifestyle changes in patients with obesity during the COVID-19 lockdown: a nationwide survey using multiple correspondence analysis

IntroductionThe corona virus disease 2019 (COVID-19) pandemic forced most of the Italian population into lockdown from 11 March to 18 May 2020. A nationwide survey of Italian Clinical Nutrition and Dietetic Services (Obesity Centers or OCs) was carried out to assess the impact of lockdown restrictions on the physical and mental wellbeing of patients with obesity (PWO) who had follow-up appointments postponed due to lockdown restrictions and to compare determinants of weight gain before and after the pandemic.MethodsWe designed a structured 77-item questionnaire covering employment status, diet, physical activity and psychological aspects, that was disseminated through follow-up calls and online between 2 May and 25 June 2020. Data were analyzed by multiple correspondence analysis (MCA) and multiple linear regression.ResultsA total of 1,232 PWO from 26 OCs completed the questionnaires (72% female, mean age 50.2 ± 14.2 years; mean BMI 34.7 ± 7.6 kg/m2; 41% obesity class II to III). During the lockdown, 48.8% gained, 27.1% lost, while the remainder (24.1%) maintained their weight. The mean weight change was +2.3 ± 4.8 kg (in weight gainers: +4.0 ± 2.4 kg; +4.2% ± 5.4%). Approximately 37% of participants experienced increased emotional difficulties, mostly fear and dissatisfaction. Sixty-one percent reduced their physical activity (PA) and 55% experienced a change in sleep quality/quantity.The lack of online contact (37.5%) with the OC during lockdown strongly correlated with weight gain (p < 0.001). Using MCA, two main clusters were identified: those with unchanged or even improved lifestyles during lockdown (Cluster 1) and those with worse lifestyles during the same time (Cluster 2). The latter includes unemployed people experiencing depression, boredom, dissatisfaction and increased food contemplation and weight gain. Within Cluster 2, homemakers reported gaining weight and experiencing anger due to home confinement.ConclusionsAmong Italian PWO, work status, emotional dysregulation, and lack of online communication with OCs were determinants of weight gain during the lockdown period.

Exploring the experiences of student mental health nurses from ethnic minority backgrounds working through the COVID-19 pandemic: a phenomenological approach

Background/aims The COVID-19 pandemic has impacted individuals from ethnic minority backgrounds more than any other group. The purpose of this study was to explore the experience of mental health students from ethnic minorities who worked during the COVID-19 pandemic in a mental health NHS trust. Methods This study used phenomenology as the theoretical framework and thematic analysis as a method for data analysis. Data were collected through semi-structured interviews with 12 student mental health nurses, which were held via Microsoft Teams. Results The four themes that emerged from this study were altruism, a sense of connectedness, support and learning opportunities, and role clarity. Students described a sense of altruism while deciding to opt-in to the extended placement. Some also found their faith to be a source of support and resilience, which provided a sense of connectedness. Support was an essential element that emerged in this study where students could rely on both the university and the mental health NHS trust. The learning opportunities that COVID-19 has presented have helped bridge the gap between the physical and mental wellbeing of patients; however, a lack of clarity in their roles was highlighted. Conclusions Adequate and appropriate policies and guidance to support student nurses are needed when working in crisis situations.

Measuring perception of mental well-being in patients under isolation precautions: a prospective comparative study

ObjectivesIsolation precautions (IP) are applied to prevent transmission of pathogens in healthcare settings. Potential negative health outcomes experienced by patients have been previously described but results remain conflicting. We aimed...

Functional Hydrogels for Treatment of Chronic Wounds.

Chronic wounds severely affect 1–2% of the population in developed countries. It has been reported that nearly 6.5 million people in the United States suffer from at least one chronic wound in their lifetime. The treatment of chronic wounds is critical for maintaining the physical and mental well-being of patients and improving their quality of life. There are a host of methods for the treatment of chronic wounds, including debridement, hyperbaric oxygen therapy, ultrasound, and electromagnetic therapies, negative pressure wound therapy, skin grafts, and hydrogel dressings. Among these, hydrogel dressings represent a promising and viable choice because their tunable functional properties, such as biodegradability, adhesivity, and antimicrobial, anti-inflammatory, and pre-angiogenic bioactivities, can accelerate the healing of chronic wounds. This review summarizes the types of chronic wounds, phases of the healing process, and key therapeutic approaches. Hydrogel-based dressings are reviewed for their multifunctional properties and their advantages for the treatment of chronic wounds. Examples of commercially available hydrogel dressings are also provided to demonstrate their effectiveness over other types of wound dressings for chronic wound healing.

The Impact of the COVID-19 Pandemic on Avoidance of Health Care, Symptom Severity, and Mental Well-Being in Patients With Coronary Artery Disease.

The COVID-19 pandemic affected regular health care for patients with chronic diseases. However, the impact of the pandemic on primary care for patients with coronary artery disease (CAD) who are enrolled in a structured disease management program (DMP) in Germany is not clear. We investigated whether the pandemic affected primary care and health outcomes of DMP-CAD patients (n = 750) by using a questionnaire assessing patients' utilization of medical care, CAD symptoms, as well as health behavior and mental health since March 2020. We found that out of concern about getting infected with COVID-19, 9.1% of the patients did not consult a medical practitioner despite having CAD symptoms. Perceived own influence on infection risk was lower and anxiety was higher in these patients compared to symptomatic CAD patients who consulted a physician. Among the patients who reported chest pain lasting longer than 30 min, one third did not consult a medical practitioner subsequently. These patients were generally more worried about COVID-19. Patients with at least one worsening CAD symptom (chest pain, dyspnea, perspiration, or nausea without apparent reason) since the pandemic showed more depressive symptoms, higher anxiety scores, and were less likely to consult a doctor despite having CAD symptoms out of fear of infection. Our results provide evidence that the majority of patients received sufficient medical care during the COVID-19 pandemic in Germany. However, one in ten patients could be considered particularly at risk for medical undersupply and adverse health outcomes. The perceived infection risk with COVID-19 might have facilitated the decision not to consult a medical doctor.

World COPD Day: supporting people to live well with COPD

The theme of this World COPD Day is supporting people to live well. Pam Parry explains the role practice nurses can play in checking on the physical and mental well-being of patients

Patient Perceptions and Determinants of Choice for Breast Reconstruction after Mastectomy among Saudi Patients.

Background:Undergoing mastectomy is often associated with a negative impact on the mental well-being of patients. Patients who undergo postmastectomy breast reconstruction (BR) have a better self-image and higher self-esteem. Many patients with breast cancer (BC) are unaware of the availability of BR options. This study aimed to assess BC patient perceptions and identify the determinants of patient choices to undergo BR after mastectomy.Methods:This study was conducted between May 10, 2019 and February 29, 2020 via an interview-based questionnaire, among BC patients at King Abdul Aziz University Hospital, Jeddah, Saudi Arabia. Ethical approval was obtained from the research ethics committee before the data collection.Results:Altogether, 400 patients (an overall 82% response rate) were included, of whom 155 (38.75%) were group 1 (willing to undergo BR). The mean age for group 1 was 46.04 ± 8.79, which was younger than for group 2 (unwilling to undergo BR) (P < 0.001). Furthermore, 117 (75.5%) of group 1 had no history of any chronic illness compared with 145 (59.2%) of group 2 (P < 0.001). Group 1 had more knowledge about BR (69.7%, P < 0.001), and the main reason to undergo BR was to regain femininity (26.8%). The remaining patients (31.3%) were unwilling to undergo BR in order to avoid additional surgery.Conclusions:The lack of knowledge and misconception about BR is one factor preventing BC patients from undergoing BR. Spreading awareness and providing accurate information regarding the procedure will allow women with BC to overcome postmastectomy fear.