Psychosocial Adjustment In Patients Research Articles

Factors related to psychosocial adjustment in patients with enterostomy: Based on a national cross-sectional survey.

This study aimed to explore the psychosocial adjustment of enterostomy patients on a national scale. Based on a national cross-sectional survey. From December 2021 and February 2023, a total of 22,040 enterostomy patients were assessed using the ostomy adjustment inventory-20. Initial analysis involved employing the chi-square test or Kruskal-Wallis H test to identify factors influencing the psychosocial adjustment of these patients. Subsequently, multinomial logistic regression was used to determine the factors affecting the classification of psychosocial adjustment levels of enterostomy patients. The reporting of this study adhered to the STROBE checklist. Eventually 21,124 patients with enterostomy were included in this study, out of which 7788 (36.9%) patients with low level of psychosocial adjustment, 11,803 (55.8%) patients with medium level of psychosocial adjustment and 1533 (7.3%) patients with high level of psychosocial adjustment. The factors influencing the classification of psychosocial adjustment levels of enterostomy patients were gender, educational background, carer, enterostomy self-care knowledge score and medical payment method. The overall psychosocial adjustment level of enterostomy patients is not optimistic, and the factors that may affect the classification of their psychosocial adjustment level are analysed. Individualised intervention should be given according to different psychosocial adjustment levels of enterostomy patients. The number of enterostomy patients with a high level of psychosocial adjustment is small in relation to the total number of enterostomy patients, and caregivers can provide health education to enterostomy patients by analysing the factors affecting the level of psychosocial adjustment of enterostomy patients. None.

High level of psychosocial adjustment in patients on ongoing ventricular assist device support in the years one to three after VAD implantation—A national multi-center Study

BackgroundAdvanced heart failure therapies such as durable ventricular assist device (VAD) support require psychosocial adjustment for those affected. Since VAD implantation has become an established treatment strategy, a focus on psychosocial factors is needed. ObjectivesTo investigate the construct of psychosocial adjustment and to further understand the role of social support. MethodsIn a nation-wide, multi-center, cross-sectional study, we recruited 393 participants with ongoing VAD support (3mts-3yrs on device; clinicaltrials.gov ID: NCT04234230). Patient demographics, psychosocial adjustment (perceived social support, anxiety, depression, and quality of life), and major adverse events (thromboembolic events, bleeding, driveline infections) were assessed. ResultsOverall, 85.8 % of the sample were male; mean age was 58.3 years (range 18-85). The majority of the sample (89.3 %) reported normal to high perceived social support. Participants expressed symptoms of anxiety within the normal range (M=6.0±3.9), mildly elevated depressive symptoms (HADS: M=7.6±2.9; PHQ-9: M=6.2±4.7), and good quality of life (KCCQ: M=65.3±17.9). Higher perceived social support was associated with lower levels of anxiety and depression, and higher levels of quality of life within our sample (all p<0.001). Driveline infection was the most prevalent adverse event (0.304 infections per person-years [32.6 % of patients]). Binary logistic regression models did not identify significant associations for the occurrence of adverse events and variables of psychosocial adjustment. ConclusionOur sample perceived high levels of psychosocial adjustment. High perceived social support was associated with better outcomes in levels of anxiety, depression, and quality of life, demonstrating potential for the future development and evaluation of targeted multi-professional social support interventions including peer- and caregiver support.

A cross-sectional observational study to estimate the psychosocial adjustment in patients with schizophrenia

Abstract Context: Psychosocial dysfunction is the dysfunction in the various psychosocial areas, such as personal, vocational/occupational, familial, and social, which ultimately depends on the cognitive functioning of an individual. Any disturbances and failure to adjust in one or more areas have a sufficient impact on the patient’s quality of life and daily living. For everyday living and maintaining a good quality of life, the influence of the level of dysfunction in different areas needs to be understood, and psychosocial interventions and rehabilitation programs must be designed accordingly to facilitate better psychosocial adjustment. Aims: The aim of this study was to estimate the psychosocial adjustment of individuals with Schizophrenia presenting at the psychiatry outpatient department (OPD) of a teaching hospital. Materials and Methods A cross-sectional study was conducted at the psychiatry OPD of a tertiary care teaching hospital. Eligible subjects were aged between 18 and 65 years and diagnosed with Schizophrenia according to the International Classification of Diseases-10. Sociodemographic characteristics and current treatment details were obtained. The psychosocial adjustment was assessed using the Psychosocial Adjustment to Illness Scale-interview version. Results: Sixty subjects were included, all with some impairment in one or the other social functioning domain. The domain with the highest proportion of subjects showing marked/severe degrees of disability is the vocational environment. Moderate-to-severe impairment of functioning is seen in the domains of domestic environment, social environment, sexual relationship, and extended family relationships. In the health-care environment, mild impairment is seen among most subjects. Only mild psychological distress was found among those with impaired functioning in this domain. It was also found that individuals with mild adjustment problems had a shorter duration of illness. Variables that showed significant statistical associations (P &lt; 0.05) with poor/severe social adjustment were marital status and duration of illness. Age and Gender had a statistically significant association with psychosocial dysfunction in the social environment domain. Conclusion: This study shows that there is definite and substantial psychosocial dysfunction in definitive areas of personal, familial, social, and vocational spheres in patients with schizophrenia. Psychosocial interventions, along with antipsychotics, are needed to target these areas to improve the overall quality of life of patients with schizophrenia.

Personality traits and psychosocial adjustment in patients with limb amputation

Purpose: The aim of this cross-sectional study was to examine the relationship between psychosocial adjustment and personality traits since research regarding psychosocial adjustment and variables that influence adjustment in patients with limb amputation is relatively scarce. Methods: There were 63 (81% male) participants in this study. The sample consisted of 51 men and 12 women between the ages of 27 and 86 (M = 56.63, SD = 13.35). The Next Big Five Inventory (BFI 2; Soto &amp; John, 2017) was used to assess personality traits and The Trinity Amputation and Prosthesis Experience Scales – Revised (TAPES-R; Gallagher &amp; MacLachlan, 2000) was used to measure psychosocial adjustment (general adjustment, social adjustment and adjustment to limitation). Results: Extraversion was positively and negative emotionality negatively associated with general adjustment. No significant associations were found between social adjustment and personality traits. Extraversion, agreeableness and open-mindedness correlated positively with adjustment to limitation. Similar pattern of associations was found between personality facets and general adjustment and adjustment to limitation. The strongest associations were found with negative emotionality facet depression. Conclusions: Results indicate that personality traits are associated with psychosocial adjustment in patients with limb amputation. Since this finding can be useful for adaptation to amputation, further research in larger samples is needed.

Psychosocial adjustment in young and middle-aged adults after coronary stent implantation: A mixed-method study

Currently, the status and principal factors of psychosocial adjustment of young and middle-aged patients after coronary stent implantation (CSI) are understudied. To investigate the psychosocial adjustment and the life experiences of young and middle-aged patients after CSI and the corresponding support necessary to maintain psychosocial health for this patient population. This is a mixed-method study. Self-reported questionnaires were used to survey 236 patients after CSI from November 2019 to November 2020 in Guangdong, China. Eight of these patients were purposefully invited to participate in semi-structured interviews. The mean score of psychosocial adjustment were 55.25 (SD=19.96), 55.91 (SD=17.99) for the young and middle-aged patients after CSI respectively. The results of regression analysis showed that resilience, social support, and having diabetes were predictors of psychosocial adjustment of young patients after CSI (R2=0.703, P<0.001). Resilience, social support, current cardiac function, and need to care for parents with chronic diseases were identified as predictors of psychosocial adjustment among middle-aged patients after CSI (R2=0.640, P<0.001). Two themes and six sub-themes related to adjustment challenges and adjustment efforts were identified from the in-depth interviews. Psychosocial adjustment of young and middle-aged patients after CSI still needs to be improved. Higher level of social support and resilience would promote patient's psychosocial adjustment after CSI. Diabetes was a negative factor of psychosocial adjustment in young patients, whereas limited cardiac function, need to take care of parents with chronic diseases were negative factors in middle-aged patients. After CSI, both young and middle-aged patients faced various challenges of adjustment.

The Effect of Death Anxiety on Psychosocial Adjustment in Individual With Chronic Obstructive Pulmonary Disease.

Objectives:This study was carried out in a descriptive manner to determine the effect of death anxiety on psychosocial adjustment in patients with chronic obstructive pulmonary disease (COPD).Materials and Methods:The study was carried out on 150 inpatients and outpatients who were being treated at the thoracic diseases department of a state hospital during January 1– April 20, 2016. Personal information form, death anxiety scale (DAS) and psychosocial adjustment to illness scale-self report (PAIS-SR) were used for data acquisition. The data were analysed through IBM Statistical Package for the Social Sciences 22 software.Results:The DAS score average of the patients was determined as 6.96 ± 3.45, PAIS-SR total score average was determined as 67.54 ± 14.96. A positive and statistically significant relationship was determined between the death anxiety of the patients and their psychosocial adjustments (P < 0.05).Conclusion:It can be concluded as a result of the study that the death anxieties of COPD patients are at a moderate level, that their psychosocial adjustments to the disease are at a bad level and that their psychosocial adjustments to the illness and to life are disrupted with increasing death anxiety. Psychiatry nurses can contribute to increasing the psychosocial adjustment to the illness of the patient by helping the patient and his/her family in adjusting to the changes in their life styles, preventing non-beneficial adjustments, developing the coping skills of the patient and his/her family and accordingly making the necessary planning.

Relationship between medication adherence and psychosocial adjustment in patients with type 2 diabetes: A cross-sectional study

Adherence to drug treatment is a multidimensional concept. It is affected by many factors, such as physiological, psychological, family, environmental and social conditions. However, relatively little is known about the relationship between adherence to medication and psychosocial adjustment. The aim was to explore the relationship between adherence to antidiabetic drugs and the psychosocial adjustment of patients with type 2 diabetes mellitus. This cross-sectional descriptive correlational study was conducted between March and June 2018. A convenience sample of participants was recruited from seven internal disease outpatient clinics at a public tertiary hospital, located in a large city that serves as a gateway to nearby rural and urban areas in the north-west region of Turkey. Data were collected using the Adherence to Refills and Medications Scale (ARMS-7), and the Psychosocial Adjustment to Illness Scale–Self Report (PAIS–SR). This study is reported in accordance with STROBE. Pearson’s correlation analysis found a significant weak positive correlation between all domains of the PAIS–SR and the total scores on the ARMS‐7. The participants’ scores on medication refill were found to be significantly and positively correlated with all of the PAIS–SR domain scores except the sexual relationships domain. Psychosocial care could play a crucial role in improving drug regimen adherence among patients with diabetes. Therefore, nurses should integrate psychosocial care into daily practice.

Religious coping and psychosocial adjustment in patients with cystic fibrosis.

The role of religious coping (RC) in psychosocial outcomes and health-related quality of life (HRQoL) in adults with cystic fibrosis has not been addressed. Multivariate regressions evaluated the effects of baseline RC on depressive and anxiety symptoms and HRQoL at 3-month follow-up in 123 adult cystic fibrosis patients. Higher positive RC attenuated the effects of perceived stress on greater depressive and anxiety symptoms. Negative RC predicted less vitality and social HRQoL, as well as more digestion symptoms. Positive RC may buffer the impact of stress on patients' psychological distress, whereas negative RC may contribute to lower health-related quality of life.

The Relationship Between Perceived Burdensomeness and Psychosocial Adjustment to Illness in Patients with Chronic Pain: A Mediating Role of Pain Self-Efficacy

Background: The majority of patients living with chronic pain faces several challenges; therefore, factors affecting their adaptation to the disease to provide appropriate therapeutic methods and meditation and relaxation therapy should be identified. Objectives: The present study aimed at investigating the relationship between perceived burdensomeness and psychosocial adjustment, and the mediating role of pain self-efficacy. Methods: This descriptive correlational study was conducted on 240 patients with chronic pain referred to the orthopedic centers in Ardabil in 2019 selected by convenience sampling. Psychosocial Adjustment to Illness Scale, Pain Self-efficacy Questionnaire, and Interpersonal Needs Questionnaire were used for data collection. Also, Pearson correlation and multiple regressions were used for data analysis. Data were analyzed using SPSS V. 19 and AMOS V. 21. Results: The findings confirmed the negative and direct effect of perceived burdensomeness (β = -0.11 and P &lt; 0.01), as well as the positive and direct effect of pain self-efficacy (β = 0.86 and P &lt; 0.01) on psychosocial adjustment. On the other hand, perceived burdensomeness (β = -0.32, P &lt; 0.01) had a negative and direct effect on pain self-efficacy. The indirect effect of perceived burdensomeness and pain self-efficacy on psychosocial adjustment to illness was also confirmed. Conclusions: According to the findings of the present study, it can be concluded that the feelings of pain self-efficacy mediate the relationship between perceived burdensomeness and psychosocial adjustment in patients with chronic pain. That can also be important for the patient and their caregivers in relation to other chronic illnesses. Chronic diseases can also affect patients and their caregivers.

Is The Spirituality Effective on Psychosocial Adjustment in Patients with Chronic Disease?

Chronic diseases are an important cause of mortality and morbidity. Chronic diseases that seriously affect life affect the individual in physiological, psychological and social aspects. Individuals with chronic diseases may need spiritual support in adapting to the disease. In patients receiving spiritual support, depression and anxiety levels can be decreased and quality of life can be improved. The spiritual care that one of the basic elements of nursing care and among the basic requirements of an individual's can be omitted or implicit behind the physical requirements.&#x0D; Keywords: Nurse, chronic disease, spirituality, psychosocial adjustment

Influences of facial disfigurement and social support for psychosocial adjustment among patients with oral cancer in Taiwan: a cross-sectional study

ObjectiveTo explore the influences of facial disfigurement and social support for psychosocial adjustment in patients with oral cancer.DesignA cross-sectional design was used for the study.Participants and settingA convenience sample of...

Factors Affecting Psychosocial Adjustment in Patients with Surgical Removal of Benign Breast Tumor.

To identify factors influencing psychosocial adjustment in patients with surgical removal of benign breast tumor. With a survey design, data were collected using the Psychosocial Adjustment to Illness Scale-Self Report (PAIS-SR), Body Image Scale, Physical Discomfort Scale, and Family Support Scale with patients who had had surgical removal of a benign breast tumor from September to November 2017. Data were analysed with descriptive statistics, t-test, ANOVA, Pearson's correlation coefficients, and stepwise multiple regression. The mean scores for physical discomfort, body image, family support, and psychosocial adjustment were 1.57±0.51, 0.37±0.64, 3.62±0.67, and 4.00±0.45, respectively. Family support, body image, physical discomfort, number of surgical removal of benign breast tumor (twice), and cancer insurance status (yes) were verified as factors influencing psychosocial adjustment. These factors accounted for 57.4% of psychosocial adjustment. In this study, family support, body image, and physical discomfort were identified as significant predictors of psychosocial adjustment. Therefore, this study can be used as fundamental data to develop nursing intervention strategies in order to increase psychosocial adjustment in patients with surgical removal of a benign breast tumor.

Perceived social support and psychosocial adjustment in patients with coronary heart disease.

This study was performed to assess perceived social support and psychosocial adjustment in patients with coronary heart disease. Participants were 250 patients referred to the cardiology outpatient clinic of a university hospital in Ankara, Turkey, between December 2013 and March 2014. Data were collected using a participant information form, the Multidimensional Scale of Perceived Social Support, and the Psychosocial Adjustment to Illness Scale-Self-Report. Data were analysed using frequencies, percentages, mean scores, and Pearson's correlation coefficient. Patients' mean perceived social support scores were relatively low and patients' mean scores for psychosocial adjustment considered to be poor. Subgroups in the psychosocial adjustment and social support scales were significantly associated. This study's results indicate that patients' social support is linked to their psychosocial adjustment to coronary heart disease. As psychosocial adjustment is inhibited in patients who lack sufficient social support, sources of social support of patients should be identified and facilitated.

Quality of Life as Predictor of Psychological Well-being, Self-care and Psychosocial Adjustment in Patients with Type II Diabetes after Initial Unilateral Minor Amputation

OBJECTIVE: The present research investigated the role of perceived quality of life as significant predictor of psychological well-being, self-care and psychosocial adjustment among patients with type II diabetes initially after minor unilateral amputation. HYPOTHESIS: The quality of life is likely to predict the psychological well-being, psychosocial adjustment and self-care in patients with type II diabetes, gone through initial unilateral minor amputation. RESEARCH DESIGN: Cross Sectional descriptive. METHODOLOGY: A sample of 200 patients with type II diabetes was taken; 100 with minor amputation and 100 without amputation. The age ranged between 40 to 60 years. A written informed consent was taken in addition to departmental permission to collect the data from indoor and outdoor units of three main hospitals of Lahore including Jinnah Hospital, Arif Diabetics and Mayo hospital, Lahore. The study was carried between Sep, 2015 to December, 2015. The major study constructs were measured by using Urdu translated measures including Diabetes Related Quality of Life Scale, Psychological Well-being Scale and Social Adjustment Scale- self report (SAS-SR); and Self-care Inventory. Regression analysis was carried out to assess the role of quality of life as significant predictor. RESULTS: The results revealed that quality of life emerged as significant positive predictor of psychological well-being, self-care and psychosocial adjustment in patients with diabetes who have gone through minor amputation. CONCLUSION: Quality of life is significant positive predictor and by enhancing the Perceived quality of life of patients with diabetes and minor amputation through psycho-education and counseling, the psychological well-being, psychosocial adjustment and self-case behaviors can be improved.

Women's adjustment trajectories during IVF and impact on mental health 11-17 years later.

Do patients present different adjustment trajectories during and after IVF treatment? Most women show resilient trajectories during and after IVF treatment but 37% show temporary or chronic maladjustment during IVF and 10% are maladjusted 11-17 years after treatment. Research on patient psychosocial adjustment during treatment has contributed to identifying the most distressful stages of IVF treatment and profiling patients at risk for emotional maladjustment at these specific stages. This knowledge is currently driving the deliverance of psychosocial care at fertility clinics by tailoring it to patients' risk profiles and specific treatment stages. However, current care does not take into consideration how individuals adjust across the entire treatment pathway. This can be assessed by profiling individual adjustment trajectories. A longitudinal cohort study with five assessment moments that combines data from two different studies, the STRESSIVF and OMEGA projects. Participants enrolled in the STRESSIVF study (started IVF in 1998-2000) were assessed before and after the first IVF treatment cycle and 6 months and 2.5 years after the last IVF cycle. A subset participated in the OMEGA project (started IVF in 1995-2000) and reported on their mental health 11-17 years after treatment. Three hundred and forty-eight women participated in the STRESSIVF project and 108 of these in the OMEGA. Anxiety was measured with the State and Trait Anxiety Inventory, depression with the Beck Depression Inventory and mental health with the Mental Health Inventory. Latent class growth mixed modelling was carried out to identify distinct anxiety and depression trajectories over the four STRESSIVF study assessment moments. Multinominal logistic regressions were conducted to investigate predictors of trajectory membership, and stepwise linear regressions were performed to investigate if adjustment trajectories predicted mental health 11-17 years after IVF treatment. A total of 67 and 86% of women showed normal levels of anxiety and depression, respectively, throughout treatment (resilient trajectories), 24 and 33% experienced anxiety and depression only during treatment (recovery trajectories), 4.6 and 4.9% experienced anxiety and depression only after treatment (delayed trajectories), and 4.3% showed chronic anxiety (chronic trajectory, not identified for depression). Non-resilient trajectories were associated with unsuccessful treatment, marital dissatisfaction, lack of social support and negative infertility cognitions. One in 10 women had a delayed or chronic trajectory and these trajectories predicted serious mental health impairment 11-17 years after treatment. The study only focuses on women. In the OMEGA project adjustment was assessed using a mental health measure. Although we could investigate how trajectories predicted mental health, it would have been preferable to map anxiety and depression trajectories up to 11-17 years after treatment. Missing analysis showed selective dropout from the study but this was accounted for by using mixed models and imputation procedures. Finally, data on other life stressors were not collected; therefore any contribution from these events cannot be assessed. Fertility health-care providers have been called upon considering their responsibility in supporting patients in the aftermath of treatment. Results show it is possible to profile different groups of at-risk women at the start of the treatment and tailor psychosocial support to risk profile to promote health adjustment during treatment and thereafter. This study was supported by a grant from the Dutch Cancer Society (2006-3631) and the Praeventiefonds (28-3012). No competing interests exist.

Factors influencing psychosocial adjustment and quality of life in Parkinson patients and informal caregivers.

ObjectiveThe influence that social conditions and personal attitudes may have on the quality of life (QoL) of Parkinson’s disease (PD) patients and informal caregivers does not receive enough attention in health care, as a result of it not being clearly identified, especially in informal caregivers. The aim of this study was to provide a comprehensive analysis of psychosocial adjustment and QoL determinants in PD patients and informal caregivers.MethodsNinety-one PD patients and 83 caregivers participated in the study. Multiple regression analyses were performed including benefit finding, coping, disease severity and socio-demographic factors, in order to determine how these aspects influence the psychosocial adjustment and QoL in PD patients and caregivers.ResultsRegression models showed that severity of PD was the main predictor of psychosocial adjustment and QoL in patients. Nevertheless, multiple regression analyses also revealed that coping was a significant predictor of psychosocial adjustment in patients and caregivers. Furthermore, psychosocial adjustment was significantly related to QoL in patients and caregivers. Also, coping and benefit finding were predictors of QoL in caregivers but not in patients.ConclusionsMultidisciplinary interventions aimed at improving PD patients’ QoL may have more effective outcomes if education about coping skills, and how these can help towards a positive psychosocial adjustment to illness, were included, and targeted not only at patients, but also at informal caregivers.

Psychopathology and psychosocial adjustment in patients with HIV-associated lipodystrophy

ObjectiveTo study whether patients with HIV-1 associated lipodystrophy (LD) on highly active antiretroviral treatment (HAART) have more psychopathology and worse psychosocial adjustment than a similar group without this syndrome. MethodsIn a cross-sectional, observational study we compared 47 HIV-1 infected patients with LD (LD group) with 39 HIV-1 infected patients without LD (non-LD group). All participants were on HAART. The Beck Depression Inventory (BDI), the State and Trait Anxiety Inventory (STAI) and the Goldberg Health Questionnaire (GHQ-60) were administered. Levels of familial, work and social adjustment and adjustment to stressful events were evaluated in a semi-structured interview. Clinical information was extracted from the clinical records. ResultsIn the univariate analysis patients with LD showed higher state anxiety scores (p=0.009) and worse work adjustment (p=0.019) than those without LD. A total of 45.3% of LD patients scored above the cut-off point on the trait anxiety scale, and over 33.3% scored above the cut-off point on the BDI, GHQ and state anxiety scales. However, in multivariate analyses LD was not independently associated with psychopathology or with worse adjustment in the studied areas. ConclusionsThe finding that LD was not a predictor of greater psychopathology or worse psychosocial adjustment in HIV-1 infected patients, despite the high scores found, suggests that factors not taken into account in this study, such as LD severity and self-perception should have been included in the analysis. Further studies including a greater number of variables and a larger sample size will advance our understanding of this complex condition.

Factors influencing peritoneal dialysis patients' psychosocial adjustment

The specific aims of this study were as follows: (1) to describe psychosocial adjustment in adults with end-stage renal disease who underwent maintenance peritoneal dialysis; (2) to explore the influence of demographics, clinical variables, symptom distress and social support on psychosocial adjustment and (3) to determine predictive factors of psychosocial adjustment. Proper psychosocial adjustment is important for patients with end-stage renal disease to cope with multiple stressors of their disease and to balance their lives within the restrictions imposed by peritoneal dialysis treatment. Knowledge on psychosocial adjustment in patients receiving long-term peritoneal dialysis has been limited. The study was based on a predictive correlational design. One hundred peritoneal dialysis patients were recruited from outpatient peritoneal dialysis clinics of a general hospital in Taipei, Taiwan. Data were collected with the study questionnaires, including the Physical Symptom Distress Scale, the Social Support Scale and the Psychosocial Adjustment to Illness Scale - self-report. The mean score on the Psychosocial Adjustment to Illness Scale was 359.7 (SD = 40.0), indicating that these participants were moderately struggling in adjusting to their illness. Symptom distress, family social support and financial status explained 38.3% of the variance in psychosocial adjustment (F3,96 = 21..5, p < 0.001). The level of psychosocial adjustment in peritoneal dialysis patients is suboptimal. Overall, the patients with high physical symptom distress, weak family social support and poor financial status reported deficient psychosocial adjustment to their illness. The findings of this study are relevant to the understanding of preconditions that enable peritoneal dialysis patients to successfully adjust to the disease and its diverse consequences. Patients with insufficient income, higher symptom distress and less family social support have a greater risk of psychosocial maladjustment. Medical professionals may use these variables to identify higher risk groups for early intensive intervention.

Knowledge and Psychosocial Adjustment in Patients With a Permanent Colostomy

The aims of this research were to explore associations among elective versus emergency surgery, type of ostomy (permanent vs temporary), illness perceptions and coping style, anxiety, depression, and health-related quality of life in persons with Crohn's disease. A further aim was to determine the extent of current and past use of psychological care and use of psychotropic medications. The sample comprised 31 persons (17 men and 14 women; mean age 45 years) with Crohn's disease and an ostomy from 2 large teaching hospitals in Melbourne, Australia. Data were collected using a descriptive, cross-sectional design. The questionnaire incorporated 3 validated instruments: the Brief Illness Perceptions Questionnaire, the Hospital Anxiety and Depression Scale, and the Stoma Quality of Life Scale. Poor illness perception correlated significantly with increased anxiety, depression, and reduced health-related quality of life (specifically, sexuality and body image, work and social functioning, stoma function, and financial concerns). Forty-eight percent of patients scored more than the cutoff for anxiety, and 42% scored more than the cutoff for depression on the Hospital Anxiety and Depression Scale. Of these, only 20% and 31%, respectively, reported currently receiving psychological care. The timing of ostomy surgery (planned vs emergency) or ostomy type (permanent vs temporary) was not significantly associated with anxiety, depression, or health-related impaired quality of life. In this exploratory, cross-sectional study, patients with Crohn's disease and a stoma had high rates of psychological comorbidity and low scores on quality of life. Adverse illness perception appeared to explain some of these findings, but most were not receiving psychological help. Psychological care is indicated for many of these patients and further research is indicated.

Breast cancer related lymphedema in patients with different loco-regional treatments

IntroductionLymphedema, a sequela of breast cancer and breast cancer therapy, changes functional abilities and may affect a patient's psychosocial adjustment and overall quality of life. Aim of this prospective observational study was to determine the rate of mid-term and late time period lymphedema in breast cancer patients with different loco-regional treatments, and factors associated with lymphedema. Materials and methodsPatients surgically treated for early-stage breast cancer were prospectively enrolled in the study. Demographic, clinical, pathological, and loco-regional treatments data of patients and lymphedema rates were recorded. Patients were divided into six groups regarding different loco-regional treatments. Pre- and postoperative (12 months, and median 64 months after surgery) circumferences of arms were recorded. Results218 patients, all female with a median age of 48 (19–82) years, were included in the study. The numbers of patients in breast conservation surgery group (BCS) (N = 104), mastectomy group (N = 114), sentinel lymph node biopsy group (SLNB) (N = 80), axillary lymph node dissection group (ALND) (N = 138), group with radiotherapy (RT) (N = 88) and group without radiotherapy (N = 130). Incidence of lymphedema after surgery in mid-term period was 24.8%. The rate of lymphedema at 64 months median follow-up time was 7.3%. (BCS: 11.1%, 4.2% and 0.5%; Mastectomy: 15.0%, 3.2% and 1.4%; SLNB: 8.0%, 1.9% and 0.5%; ALND: 18.0%, 5.3% and 1.4%; RT: 14.7%, 6.3% and 1.4%; without RT: 11.4%, 2.1% and 0.5%). When we excluded patients with both mid-term and late term lymphedema, only four patients developed lymphedema at late time, then re-calculated late term lypmhedema rate was 1.8%. The factors affecting the lymphedema was ALND and radiotherapy (RT) and no lymphedema was detected in patients underwent breast conserving surgery and SLNB. Age and body mass index were not related to lymphedema at any time. ConclusionThe incidence of lymphedema gradually increased in time and a quarter of patients experienced the complication at the end of year. The rate of lymphedema in patients with ALND was significantly higher than patients with SLNB alone. If RT added to SLNB the lymphedema rate was getting higher than SLNB alone. In all patients lymphedema rate was decreased one year after the surgery and further decreased at median 64 months follow-up time period.