Overall Well-being Of Patients Research Articles

Impact of pelvic floor muscle training on sphincter function and quality-of-life in patients who underwent low anterior resection: A comparative evaluation.

Our study aimed to determine the impact of pelvic floor muscle training (PFMT) on sphincter function and overall well-being in patients who underwent low anterior resection (LAR) and diverting ileostomy due to rectal cancer. For this purpose, anal electromyography (aEMG), low anterior resection syndrome (LARS) score, and the European Organization for Research and Treatment of Cancer quality-of-life questionnaires (EORTC-QLQ)-C30 (generic for cancer) and CR29 (specific to colorectal cancer) were used. The primary endpoint of our study is to determine the effect of PFMT on sphincter function by aEMG, the secondary endpoint is to evaluate the effect on quality-of-life using the LARS score, EORTC-QLQ-C30 and CR-29 questionnaires. Conducted between January 2017 and April 2018 at a tertiary hospital's general surgery clinic, the study included 32 patients between the ages of 18 and 75 who underwent low anterior resection and diverting ileostomy surgery. The patients were divided into two: the Study Group (SG), which started PFMT after surgery, and the Control Group (CG), which was not subjected to additional exercises. Six months after closure of the diverting ileostomy, both groups were evaluated with aEMG, LARS scores, and EORTC-QLQ-C30 and CR-29. aEMG duration values were significantly lower in the SG (17.6 m/sec vs. 19.9 m/sec; p=0.001). Additionally, a significant decrease in SG, major LARS rates (12.5% vs. 62.5%; p=0.004) and LARS scores (23.1 vs. 30.0; p=0.003) was observed. While there was no significant difference between the groups in EORTC-QLQ C30, increased sexual interest and decreased fecal incontinence were observed in SG in EORTC-QLQ-CR29. PFMT significantly improves LARS scores, quality-of-life questionnaires and aEMG parameters, positioning PFMT as an accessible, non-invasive, easy-to-use first-line treatment option in the treatment of LARS.

The influence of parenteral nutrition on the condition of the oral cavity: literature review.

Oral health plays a pivotal role in the overall well-being of patients. This article delves into the intricate interplay between oral health and systemic health outcomes in various patient populations, including those undergoing parenteral nutrition in childhood, individuals with impaired swallowing function, and those reliant on long-term enteral or parenteral nutrition. Through a comprehensive review of existing literature, the multifaceted role of oral health maintenance in optimizing nutritional therapy outcomes and enhancing overall quality of life is explored. Alternative forms of nutrition have a profound impact on Oral microbiota, which in turn is reflected in general health and wellbeing. Despite its significance, the importance of systematic oral health assessments and nurse involvement in providing holistic care to patients with complex medical needs has been underestimated. By elucidating critical connections between oral health and systemic health outcomes, this article aims to underscore the significance of oral health in comprehensive patient care and stimulate further research to advance our understanding of this crucial aspect of healthcare management.

Integration of Ethnomedicine in Basic Medicine: A Literature Review and Its Potential for Medical Practice

Background: The integration of ethnomedicine into primary medicine has become an increasingly relevant topic in recent decades. Ethnomedicine, which refers to traditional healing practices passed down through generations and used by various cultures worldwide, offers significant potential to complement modern medical practices. Objective: This literature review aims to explore the potential created by the integration of ethnomedicine into primary medicine. Methods: This review utilizes a literature review method across multiple databases such as PubMed, Google Scholar, and SCISPACE. Results: Ethnomedicine, with its holistic approach, can enhance healthcare delivery and provide insights into alternative health practices. The integration of ethnomedicine with primary medical sciences offers significant potential to create a more comprehensive functional medicine, focusing on the root causes of diseases and emphasizing prevention and the maintenance of optimal health. Conclusion: The integration of ethnomedicine with primary medicine can create healthcare solutions that enhance the overall well-being of patients.

Rib cage contributions to inspiratory capacity in patients with cervical spinal cord injury

BackgroundCervical spinal cord injury (CSI) often leads to impaired respiratory function, affecting the overall well-being of patients. This study aimed to investigate the influence of rib cage motion on inspiratory capacity in CSI patients. MethodsWe conducted a study with 11 CSI patients, utilising respiratory inductance plethysmography (RIP). We measured ventilatory volume by spirometry concurrently with RIP. Participants were instructed to perform maximal inspiratory efforts. Inspiratory capacity (IC) was calculated from spirometry waveforms. We converted the respiratory waveforms of the chest and abdomen into inspiratory volume measured by a spirometer. The inspiratory volume measured by the chest sensor was defined as VRIP-rib cage (VRIP-rc), and the inspiratory volume measured by the abdominal sensor was defined as VRIP-abdomen (VRIP-ab). Subsequently, the relationships of IC with VRIP-rc and VRIPab were assessed. ResultsThe mean IC was 1.828 ± 0.459 L, with the mean VRIP-rc at 1.343 ± 0.568 L and the mean VRIP-ab at 0.485 ± 0.427 L. A significant correlation was observed between IC and VRIP-rc (r = 0.67, p = 0.02), indicating that rib cage motion significantly influences IC in CSI patients. ConclusionThis study highlights the importance of rib cage motion in assessing inspiratory capacity in patients with CSI.

The importance of movement in human life with Parkinson's disease

The contribution is focused on the issue of movement in human life, as its natural part. It specifically focuses on the use of movement and movement activities in patients with Parkinson's disease. It presents research studies from abroad focused on the use of dance as a non-pharmacological therapy in supporting the overall wellbeing of patients with Parkinson's disease.

Evaluation of the Continuous Positive Airway Pressure Effect on Neurotrophins’ Gene Expression and Protein Levels

Neurotrophins (NT) might be associated with the pathophysiology of obstructive sleep apnea (OSA) due to concurrent intermittent hypoxia and sleep fragmentation. Such a relationship could have implications for the health and overall well-being of patients; however, the literature on this subject is sparse. This study investigated the alterations in the serum protein concentration and the mRNA expression of the brain-derived neurotrophic factor (BDNF), glial cell line-derived neurotrophic factor (GDNF), neurotrophin-3 (NTF3), and neurotrophin-4 (NTF4) proteins following a single night of continuous positive airway pressure (CPAP) therapy. This study group consisted of 30 patients with OSA. Venous blood was collected twice after a diagnostic polysomnography (PSG) and PSG with CPAP treatment. Gene expression was assessed with a quantitative real-time polymerase chain reaction. An enzyme-linked immunosorbent assay was used to determine the protein concentrations. After CPAP treatment, BDNF, proBDNF, GDNF, and NTF4 protein levels decreased (p = 0.002, p = 0.003, p = 0.047, and p = 0.009, respectively), while NTF3 increased (p = 0.001). Sleep latency was correlated with ΔPSG + CPAP/PSG gene expression for BDNF (R = 0.387, p = 0.038), NTF3 (R = 0.440, p = 0.019), and NTF4 (R = 0.424, p = 0.025). OSA severity parameters were not associated with protein levels or gene expressions. CPAP therapy could have an impact on the posttranscriptional stages of NT synthesis. The expression of different NTs appears to be connected with sleep architecture but not with OSA severity.

Enhancing Quality of Life in Parkinson’s Disease: A Systematic Review of Occupational Therapy Interventions on Balance and Reaction Time

Background: Parkinson's disease (PD) is a common neurodegenerative disorder affecting the elderly population and can lead to impaired balance, reaction time, and overall quality of life (QoL). Occupational therapy interventions have shown promise in managing the motor and non-motor symptoms of PD. This systematic review aims to evaluate the effectiveness of occupational therapy intervention on balance and reaction time to enhance the quality of life in patients with Parkinson's disease.
 Methods: A comprehensive search was conducted on various electronic databases, including PubMed, Google Scholar, and ResearchGate. Studies published between 2010 and 2022 were included in the review. Inclusion criteria were set for age, clinical diagnosis of Parkinson's disease, MoCA score, and cooperation for participation. Studies that did not meet the inclusion criteria or reported other interventions were excluded. Data from selected studies were analyzed for relevance, appropriateness, clarity, and methodology.
 Results: Out of the initial 250 potentially relevant articles, 200 were identified as duplicates and removed. Another 25 studies did not meet the inclusion criteria, and 15 studies did not provide sufficient information on the interventions. Eventually, 10 studies were included in this systematic review. All the studies were qualitative in nature and were published between 2010 and 2023.
 Conclusion: Occupational therapy interventions have shown promising results in enhancing balance, reaction time, and quality of life in patients with Parkinson's disease. The review emphasizes the importance of goal-oriented occupational therapy programs to improve the overall well-being of patients with PD. Further research in this area is warranted to strengthen the evidence and guide clinical practice for better management of Parkinson's disease.

Chronic Recurrent Multifocal Osteomyelitis: A Comprehensive Literature Review.

Chronic recurrent multifocal osteomyelitis (CRMO) is a non-infectious, inflammatory disorder of the bones. CRMO typically affects children, with a predisposition to females. Bone-related pain is often felt in the metaphysis of long bones, particularly of the lower extremities, but it can also target other sites at varied time intervals. Patients are likely to complain of tenderness and swelling that may cause considerable disability and adversely impact quality of life. There are three main pathophysiological mechanisms that have been hypothesized to drive CRMO including imbalanced cytokine expression, increased inflammasome activation, and enhanced osteoclast differentiation. Therapies have been based on targeting and suppressing these key players in CRMO patients.The first step in management involves pain control. Non-steroidal anti-inflammatory drugs should provide initial relief, albeit temporarily. It is imperative to initiate immunosuppressive medication that will help limit bone involvement and thereby prevent the development of fractures or leg-length discrepancies, for example. The purpose of this literature review is to study the pathophysiology of CRMO and carefully dissect the agents that have been previously employed in the management of CRMO patients. This could allow for the purposeful formulation of individualized care plans and improving the overall well-being of patients. The authors included a multitude of PubMed-indexed articles published from 2000 onwards in this review.

Efficacy and safety of crisaborole ointment in Chinese and Japanese patients aged ≥2 years with mild-to-moderate atopic dermatitis.

Atopic dermatitis is a chronic inflammatory skin disease with a significant impact on the overall wellbeing of patients and their families. Crisaborole ointment, 2%, is a nonsteroidal phosphodiesterase 4 inhibitor approved for the treatment of mild-to-moderate atopic dermatitis in multiple countries. However, in the key pivotal trials, a low proportion of the overall patient population was Asian, therefore the safety and efficacy of crisaborole in the Asian population with atopic dermatitis remains unclear. CrisADe CLEAR was a multicenter, randomized, double-blind, vehicle-controlled, phase 3 study (NCT04360187) to assess the efficacy and safety of crisaborole ointment in Chinese and Japanese patients aged ≥2 years with mild-to-moderate atopic dermatitis involving ≥5% treatable body surface area. Patients were randomly assigned 2:1 to receive crisaborole or vehicle twice daily for 28 days. The primary endpoint was percentage change from baseline in the Eczema Area and Severity Index total score at day 29. Additional endpoints were improvement and success per Investigator's Static Global Assessment score at day 29 and change from baseline on the Peak Pruritus Numerical Rating Scale at week 4. Safety was assessed using rates of treatment emergent adverse events, serious adverse events, and clinically significant changes in vital signs and clinical laboratory parameters. Crisaborole-treated patients showed a significantly greater reduction versus vehicle in percentage change from baseline in Eczema Area and Severity Index total score at day 29 (P = 0.0002). Response rates for achievement of Investigator's Static Global Assessment improvement and success at day 29 were significantly higher for patients treated with crisaborole versus vehicle (P = 0.0124 and P = 0.0078, respectively). Crisaborole-treated patients showed a significantly greater reduction versus vehicle in change from baseline on the Peak Pruritus Numerical Rating Scale at week 4 (P = 0.0009). No new safety signals were identified. Treatment with crisaborole was effective and well tolerated in Chinese and Japanese patients with mild-to-moderate atopic dermatitis.

Patient-reported well-being in value-based care using tildrakizumab in a real-world setting: protocol of a multinational, phase IV, 1-cohort prospective observational study (the POSITIVE study)

IntroductionPsoriasis is a chronic inflammatory skin disease that negatively impacts the quality of life of patients and their families. However, the most commonly used decision-making tools in psoriasis, Psoriasis Area...

Application of MALDI-TOF Mass Spectrometry for Non-invasive Diagnostics of Mucopolysaccharidosis IIIA

Mucopolysaccharidosis IIIA (MPS IIIA) is a lysosomal storage disorder (LSD) caused by deficiency of lysosomal N-sulphoglucosamine sulphohydrolase, which is one of four enzymes involved in heparan sulfate degradation. Traditional methods used for MPS IIIA diagnostics usually constitute of selective screening, based on the analysis of urinary glycosaminoglycans, further enzymatic assays in leukocytes, and mutation analysis. Nowadays, some LSDs, including mucopolysaccharidoses, can be precisely diagnosed by mass spectrometry-based techniques. Up to this date, there are no comprehensive studies of MPS IIIA diagnostics by MALDI-TOF analysis of free oligosaccharides in urine published. In the presented work, MALDI-TOF/TOF analysis of permethylated oligosaccharides was performed to obtain the set of glyco-biomarkers that together form the specific fingerprint of this disease. Early and accurate diagnostics of MPS IIIA is crucial to stabilize the progressive cellular damage and improve the overall well-being of patients.

Optimizing quality of care by integrating orem's self-care deficit theory with orlando's nursing process theory

This study proposes the integration of Dorothea Orem's Self-Care Deficit Theory with Ida Jean Orlando's Nursing Process Theory to enhance the quality of patient care. Orem's theory emphasizes the importance of self-care for maintaining health and well-being, suggesting that individuals actively participate in their care to address self-care deficits. Orlando's theory focuses on the nurse-patient interaction and the nurse's role in identifying and meeting patient needs through deliberate action. Orem's theory provides a structured approach for assessing patients' self-care abilities and identifying deficits, empowering patients to participate in their care. Orlando's theory complements this by emphasizing the nurse's observational skills and their capacity to perceive and address unmet patient needs. By combining these theories, nurses can systematically assess self-care deficits, engage patients in their care, and respond to patients' immediate concerns, leading to a more holistic and patient-centered approach. By optimizing the quality of care through the integration of these two influential theories, nurses can better understand patients' self-care requirements and provide tailored interventions that not only address deficits but also enhance the overall well-being of patients. This approach holds the potential to improve patient outcomes, enhance patient satisfaction, and contribute to the advancement of nursing theory and practice. Further research and practical application of this integrated framework are warranted to fully explore its impact on the quality of patient care.

Active Study: Impact of Voxelotor on Sleep Quality, Physical Activity, and Patient-Reported Outcomes

Background: Sickle cell disease (SCD) is an inherited disorder in which sickle hemoglobin (HbS) polymerization causes red blood cell sickling, resulting in complications such as chronic hemolytic anemia, vaso-occlusion, end-organ damage, and decreased quality of life. Voxelotor is a first-in-class HbS polymerization inhibitor approved in the US for the treatment of SCD in patients aged ≥4 years. The pivotal phase 3 HOPE and phase 2a HOPE-KIDS 1 trials demonstrated the safety and efficacy of voxelotor in increasing hemoglobin (Hb) and decreasing hemolytic markers. Objective: Here we report Hb response, patient-reported quality-of-life (QOL) outcomes, and safety data from the ongoing ActIVe study (NCT04400487), a phase 4, multicenter, open-label study evaluating the effect of voxelotor on physical activity, sleep quality, and overall well-being in patients with SCD. Methods: Patients aged 12 to 55 years with SCD received voxelotor 1500 mg/day for up to 24 weeks across 10 US sites. QOL assessments were completed during baseline (BL) run-in before the start of voxelotor. Hb levels were measured via laboratory assessments at BL and at weeks 2, 12, and 24. The proportion of patients with any increase in Hb from BL was noted. Patient-reported outcomes were evaluated using the Patient Global Impression of Change (PGI-C) scale, the National Institutes of Health Patient-Reported Outcome Measurement Information System-43 (PROMIS-43) for adults (>17 years), PROMIS-37 for adolescents (≤17 years), and a 10-point numeric rating scale (NRS) for pain intensity. A minimum response deemed meaningful was interpreted at the group level as a ≥5-point change from BL (CFB) in PROMIS domains and a ≥2-point change on the NRS. Clinicians' perceptions of the impacts of voxelotor on patients' overall health status were captured using the Clinical Global Impression of Change (CGI-C). All treatment-emergent adverse events (TEAEs) were recorded from the time of consent/assent to 28 days after the last dose of voxelotor. Results: A total of 25 patients were enrolled, with a median (range) age of 20.0 (12-51) years; 64.0% of patients were female and 92.0% were Black or African American. Two (8.0%) patients permanently discontinued voxelotor due to non-compliance and loss to follow-up. A total of 14 of 18 (78%) patients had an increase in Hb at week 24; the mean (SD) increase was 0.53 (0.839) g/dL. Clinicians reported an improvement in health status among 84.6% (11/13) of patients at week 24: 7.7% (1/13) were "very much improved," 46.2% (6/13) were "much improved," and 30.8% (4/13) were minimally improved; 2 patients had no change. At week 24, 92.9% (13/14) of patients self-reported improved health status: 21.4% (3/14) were "very much improved," 42.9% (6/14) were "much improved," and 28.6% (4/14) were minimally improved; 1 patient reported minimally worse health status. At week 24, 14 patients (9 adults, 5 adolescents) completed PROMIS measures; improvements in the mean CFB were reported across several PROMIS health domains. In adults, a meaningful CFB was found for both fatigue and pain interference. Some domains reached near-meaningful improvements, including anxiety, sleep disturbance, and ability to participate (in social roles/other activities), and others improved more modestly (Table 1). While some domains improved among adolescents, none reached a meaningful level (Table 2). A total of 18 (72.0%) patients had ≥1 non-SCD-related TEAE, and 3 (12.0%) patients had ≥1 grade 3 non-SCD-related TEAE. No non-SCD TEAEs of grade 4 or higher were reported. The most common non-SCD-related TEAEs (>10%) were diarrhea (32.0%), headache (20.0%), nausea (20.0%), and vomiting (12.0%). Conclusions: Over three-quarters of voxelotor-treated patients achieved an increase in Hb at week 24, and most patients and clinicians reported improvement in patients' overall health status. The PROMIS data in voxelotor-treated adults provided insights into improvements in general well-being, such as fatigue, pain interference, and ability to participate; most notable were fatigue and pain interference, both of which reached a CFB threshold considered meaningful. The safety profile reported in ActIVe is consistent with previous studies of voxelotor treatment. Overall, results suggest that voxelotor-treated patients may experience improvements in QOL, including in their physical and emotional well-being. Funding: Global Blood Therapeutics. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

The Role of Gut Microbiota in Heart Failure: When Friends Become Enemies.

Heart failure is a complex health issue, with important consequences on the overall wellbeing of patients. It can occur both in acute and chronic forms and, in the latter, the immune system appears to play an important role in the pathogenesis of the disease. In particular, in the forms with preserved ejection fraction or with only mildly reduced ejection fraction, some specific associations with chronic inflammatory diseases have been observed. Another interesting aspect that is worth considering is the role of microbiota modulation, in this context: given the importance of microbiota in the modulation of immune responses, it is possible that changes in its composition may somewhat influence the progression and even the pathogenesis of heart failure. In this narrative review, we aim to examine the relationship between immunity and heart failure, with a special focus on the role of microbiota in this pathological condition.

Effects of Metformin Combined With Antifolates on HepG2 Cell Metabolism and Cellular Proliferation.

Hepatocellular carcinoma (HCC), one of the most prevalent types of cancers worldwide, continues to maintain high levels of resistance to standard therapy. As clinical data revealed poor response rates, the need for developing new methods has increased to improve the overall wellbeing of patients with HCC. Furthermore, a growing body of evidence shows that cancer metabolic changes are a key feature of many types of human malignancies. Metabolic reprogramming refers to cancer cells’ ability to change their metabolism in order to meet the increased energy demand caused by continuous growth, rapid proliferation, and other neoplastic cell characteristics. For these reasons, metabolic pathways may become new therapeutic and chemopreventive targets. The aim of this study was to investigate the metabolic alterations associated with metformin (MET), an anti-diabetic agent when combined with two antifolate drugs: trimethoprim (TMP) or methotrexate (MTX), and how metabolic changes within the cancer cell may be used to increase cellular death. In this study, single drugs and combinations were investigated using in vitro assays including cytotoxicity assay (MTT), RT-qPCR, annexin V/PI apoptosis assay, scratch wound assay and Seahorse XF analysis, on a human HCC cell line, HepG2. The cytotoxicity assay showed that the IC50 of MET as single therapy was 44.08 mM that was reduced to 22.73 mM and 29.29 mM when combined with TMP and MTX, respectively. The co-treatment of both drugs increased p53 and Bax apoptotic markers, while decreased the anti-apoptotic marker; Bcl-2. Both combinations increased the percentage of apoptotic cells and halted cancer cell migration when compared to MET alone. Furthermore, both combinations decreased the MET-induced increase in glycolysis, while also inducing mitochondrial damage, altering cancer cell bioenergetics. These findings provide an exciting insight into the anti-proliferative and apoptotic effects of MET and anti-folates on HepG2 cells, and how in combination, may potentially combat the aggressiveness of HCC.

Neuro-Oncology Patients as Human Research Subjects: Ethical Considerations for Cognitive and Behavioral Testing for Research Purposes.

Simple SummaryPrevious publications have elaborated on the exposure of ethical issues surrounding the enrollment and neurological testing of brain cancer patients into clinical studies. Existing literature has been tailored to provide insight on how to overcome ethical challenges for clinical team members but not for the research component that runs in parallel. The aim of this paper is to highlight the obstacles that researchers encounter when obtaining informed consent and administering language, cognitive or behavioral tasks for the sole purpose of research. Researchers should be encouraged to practice their best judgment and effectively communicate the purpose of the study while emphasizing the voluntary participation of neurologically impaired cancer patients. The solutions proposed in this paper can serve as future reference and a guide on maintaining a transparent balance between research and clinical testing for both researchers and clinical team members in the neuro-oncology field.Language, cognition, and behavioral testing have become a fundamental component of standard clinical care for brain cancer patients. Many existing publications have identified and addressed potential ethical issues that are present in the biomedical setting mostly centering around the enrollment of vulnerable populations for therapeutic clinical trials. Well-established guides and publications have served as useful tools for clinicians; however, little has been published for researchers who share the same stage but administer tests and collect valuable data solely for non-therapeutic investigational purposes derived from voluntary patient participation. Obtaining informed consent and administering language, cognition, and behavioral tasks for the sole purpose of research involving cancer patients that exhibit motor speech difficulties and cognitive impairments has its own hardships. Researchers may encounter patients who experience emotional responses during tasks that challenge their existing impairments. Patients may have difficulty differentiating between clinical testing and research testing due to similarity of task design and their physician’s dual role as a principal investigator in the study. It is important for researchers to practice the proposed methods emphasized in this article to maintain the overall well-being of patients while simultaneously fulfilling the purpose of the study in a research setting.

Relationship between COVID-19 and movement disorders: A narrative review.

The scientific literature on COVID-19 is increasingly growing. In this paper, we review the literature on movement disorders in the context of the COVID-19 pandemic. First, there are a variety of transient movement disorders that may manifest in the acute phase of COVID-19, most often myoclonus, with more than 50 patients described in the literature. New onset parkinsonism, chorea, and tic-like behaviours have also been reported. Movement disorders as a side effect after COVID-19 vaccination are rare, occurring with a frequency of 0.00002-0.0002 depending on the product used, mostly manifesting with tremor. Current evidence for potential long-term manifestations, for example, long COVID parkinsonism, is separately discussed. Second, the pandemic has also had an impact on patients with pre-existing movement disorder syndromes, with negative effects on clinical status and overall well-being, and reduced access to medication and health care. In many parts, the pandemic has led to reorganization of the medical system, including the development of new digital solutions. The movement disorder-related evidence for this is reviewed and discussed. The pandemic and the associated preventive measures have had a negative impact on the clinical status, access to health care, and overall well-being of patients with pre-existing movement disorders.

Psychosocial symptoms of ventricular arrhythmias: Integrating patient-reported outcomes into clinical care.

Patient-reported outcome measures (PROMs) are a valuable metric for assessing the quality of life and overall well-being in patients with ventricular arrhythmias (VAs) and/or implantable cardioverter-defibrillators (ICDs). The incorporation of PROMs into the workflow of a VA clinic not only allows for more patient-centered care but also may improve detection and treatment of clinically relevant anxiety or depression symptoms. Awareness of the factors known to correlate with adverse PROM scores may guide PROM administration and subsequent referral to mental health services. Further, change or stability in PROM scores can be used as a gauge to guide the effectiveness of cardiac and psychological treatment in certain populations that are the focus of this manuscript: patients with ICDs (with and without shocks), cardiac arrest survivors, and those with inherited arrhythmia syndromes.

Body image, internalized stigma and enacted stigma predict psychological distress in women with breast cancer: A serial mediation model.

To investigate the roles of total stigma, enacted stigma, and internalized stigma in the prediction of psychological distress among breast cancer patients, and to evaluate the mediating effect of body image in this process. Cross-sectional. Between Oct-2014 to May-2015, a cross-sectional study was conducted with participation of 223 patients from three cancer centres located in Tehran, Iran. The study variables were assessed using the stigma scale for chronic illnesses 8-item version (SSCI-8), body image scale (BIS), and depression anxiety stress scale (DASS-21). Structural equation modelling using MLR estimator was employed based on the two-step procedure to validate both the full measurement models and the structural models. Five models were tested to determine predictability of all stigma constructs for psychological distress, including stress, anxiety, and depression, through the mediation of body image. Three equivalent models were further examined to re-evaluate the direction of the relationships. Psychological distress and body image were largely predicted by total stigma, enacted stigma, and internalized stigma. The effect of stigma on psychological distress was mediated through body image. In a serial mediation model, the significance of the pathway of enacted stigma > internalized stigma > body image > psychological distress was confirmed. The serial model in which internalized stigma precedes body image was also supported by the equivalent models. Stigma has been identified as a major source of psychological distress among women with breast cancer. Enacted stigma not only psychologically disturbs the patients but also triggers a chain of other identity transformations (i.e. internalization of stigma and distortion of body image), their ultimate result being a full-blown psychological distress. Both enacted and internalized stigma distorts breast cancer patients' perception of their body image, which in turn renders them psychologically distressed. The serial process of enacted stigma, internalized stigma, and body image plays an important role in perpetuating distress in these patients. To break this chain of psychological consequences and for interventions to have a greater impact on overall well-being of patients, the effect of enacted stigma on distress via the sequence of two mediators needs to be specifically targeted at each stage.

Quality of life and abstinence in alcohol use disorders

IntroductionThe analysis of the impact of individuals’ behaviors on their health involves several variables, namely alcoholism. It is necessary to take in account that when anxiety is excessive it may be very disabling and produce many adverse effects, such as unsatisfactory work performance, anxiety disorders, depressive mood and somatic symptoms. These elements affect the Quality of Life (QOL) drastically, while social support of the patients protect QOL.ObjectivesTo assess the quality of life of patients with alcohol use disorders in treatment for alcohol use disorder (AUD).MethodsAn exploratory, descriptive and correlational study was carried out. A sociodemographic scale was used, an instrument constructed by the authors that assesses the existence of risk behaviors and protective health behaviors, the Social Support Satisfaction Scale (ESSS), and a quality of life assessment scale (WHOQOL-Bref). Data analysis was performed using IBM SPSS 25 statistics.ResultsSample consisting of 34 patients with Alcohol Use Disorders. Abstinence time is positively correlated with QOL and negatively correlated with social support satisfaction.ConclusionsThis study shows that in treatment of patients with AUD, longer abstinence times have a positive effect on QOL and overall wellbeing of patients, while being associated with a lower satisfaction with social support. Treatment Units dedicated to AUD should keep striving for maintenance of abstinence due to these positive effects.