Widowed Patients Research Articles

Post-traumatic stress disorder and post COVID 19 syndrome

IntroductionPatients hospitalized in the case of COVID19 have had to face a complex and potentially very stressful situation. In this context a screening program for psychological distress in patients with COVID19 is necessary.ObjectivesTo screen for post-traumatic stress disorder post COVID19 and to identify the epidemiological and clinical factors correlated with this disorder in post COVID19 patients.MethodsA descriptive and analytical cross-sectional study that took place during the period from 1st March to 15th May 2021 with 154 patients who were hospitalized at the COVID19 unit at Hedi Chaker Hospital Sfax.We used a pre-established form to record sociodemographic, clinical and therapeutic data. The post-traumatic stress disorder was assessed by the “Impact of Event Scale-Revised”.ResultsThe mean age was 66.62 ± 13.34 years with a male predominance of 60.4%. In our sample, 77.9% of the patients had a somatic history, of which hypertension was the most frequent pathology (46.1%). The average length of hospitalization was 9.5 days ± 6.3. The form was considered severe in 27.9 cases. According to the IES-R scale, twenty-one patients (13.6%) had post-traumatic stress disorder, with a predominance of women (57.1%).A significant association was found between marital status and post-traumatic stress disorder. Thus, married or widowed patients are more likely to develop PTSD.In the present study, we did not find statistically significant associations between the clinical characteristics of the disease (severity of the disease, length of hospitalization, functional signs) and post-traumatic stress disorder.ConclusionsPsychological support interventions in surviving patients of COVID 19 is necessary aiming to increase resilience, manage coping strategies and decrease the deleterious impact of the pandemic on mental health.Disclosure of InterestNone Declared

Study on the related factors of antiviral treatment in previously reported hepatitis C patients based on the Andersen model

Objective: To understand the basic characteristics of previously reported patients with hepatitis C and analyze the related factors affecting their antiviral treatment. Methods: A convenient sampling method was adopted. Patients who had been previously diagnosed with hepatitis C in the Wenshan Prefecture of Yunnan Province and Xuzhou City of Jiangsu Province were contacted by telephone for an interview study. The Andersen health service utilization behavior model and related literature were used to design the research framework for antiviral treatment in previously reported hepatitis C patients. A step-by-step multivariate regression analysis was used in previously reported hepatitis C patients treated with antiviral therapy. Results: A total of 483 hepatitis C patients, aged 51.73 ± 12.06 years, were investigated. The proportion of male, agricultural occupants who were registered permanent residents, farmers and migrant workers was 65.24%, 67.49%, and 58.18%, respectively. Han ethnicity (70.81%), married (77.02%), and junior high school and below educational level (82.61%) were the main ones. Multivariate logistic regression analysis results showed that married patients with hepatitis C (OR = 3.19, 95% CI: 1.93-5.25, compared with unmarried, divorced, and widowed patients) with high school education or above (OR = 2.54, 95% CI: 1.54-4.20, compared with patients with junior high school education or below) were more likely to receive antiviral treatment in the predisposition module. Patients with severe self-perceived hepatitis C in the need factor module (compared with patients with mild self-perceived disease, OR = 3.36, 95% CI: 2.09-5.40) were more likely to receive treatment. In the competency module, the family's per capita monthly income was more than 1,000 yuan (compared with patients with per capita monthly income below 1,000 yuan, OR = 1.59, 95% CI: 1.02-2.47), and the patients had a high level of awareness of hepatitis C knowledge (compared with patients with a low level of knowledge, OR = 1.54, 95% CI: 1.01-2.35), and the family members who knew the patient's infection status (compared with patients with an unknown infection status, OR = 4.59, 95% CI: 2.24-9.39) were more likely to receive antiviral treatment. Conclusion: Different income, educational, and marital statuses are related to antiviral treatment behavior in hepatitis C patients. Family support of hepatitis C patients receiving hepatitis C-related knowledge and their families knowing the infection status is more important in promoting the antiviral treatment of patients, suggesting that in the future, we should further strengthen the hepatitis C knowledge of hepatitis C patients, especially the family support of hepatitis C patients' families in treatment.

Investigation of Anxiety and Health Locus of Control in Patients Undergoing Hemodialysis.

Hemodialysis is the most frequent treatment modality for End-Stage Renal Disease (ESRD). However, a number of limitations and modifications accompany this treatment, affecting people's physical and psychological well-being and increasing anxiety symptoms. The aim of this study was to investigate the level of anxiety and health locus of control among dialysis patients. One hundred and five patients on hemodialysis treatment completed a questionnaire with demographic characteristics, the State-Trait Anxiety Inventory and the Multidisciplinary Health Locus of Control Scale. Women had significantly higher levels of state anxiety than men (p=0.019). Similarly, patients with primary school education had significantly higher trait and total anxiety levels than those with technological education (p=0.002 and p=0.033, respectively). Widowed patients exhibited significantly higher state, trait, and total anxiety levels than married (p=0.032, p=0.012, and p=0.012, respectively). Participants who did not do any kind of exercise had significantly higher level of state, trait, and total anxiety than those who did (p=0.011, p=0.015, and p=0.006, respectively). Respondents who did not have any self-care skills had significantly higher level of state, trait, and total anxiety than those who had (p=0.011, p=0.015, and p=0.006, respectively). State, trait, and total anxiety levels were significantly (p≤0.05) correlated negatively with internal locus of control and positively with "chance" locus of control scale. Hemodialysis patients had increased anxiety symptoms and believed that others had control over their health to a greater extent. Renal professionals need to apply effective interventions to dialysis patients in order to help them gain a better sense of control over their health and reduce anxiety symptoms.

Prevalence of internalized stigma in patients with psychiatric illness in Abha, Southern Region, Saudi Arabia.

Mental stigma occurs when patients with various mental disorders are labeled by their disorders. Little is known about the burden of mental stigma on patients with mental disorders. The aim of this study was to evaluate the incidence of mental stigma on patients with psychiatric disorder in Saudi Arabia. This cross-sectional study was conducted among previously diagnosed patients with any psychiatric disorder attending King Khalid Hospital, Abha, Saudi Arabia. The patients were interviewed with a sociodemographic questionnaire and a validated Arabic version of the Internalized Stigma of Mental Illness (ISMI-29) scale. Chi-square test and t-test were used to assess the association between various demographic characteristics and presence of stigma. The study included 489 patients with different psychiatric disorders. The mean age of the participants was 32.8 years and 54.6% were females. About 39% participants showed no to minimal internalized stigma, 37.4% of total sample had mild stigma, 20% had moderate stigma, and 3.7% had severe stigma. A signficantly higher proportion (71.4%) of widowed patients had stigma (P = 0.032). Self-stigma is prevalent among patients with psychiatric disorders in Abha, Saudi Arabia, but lower than the prevalence in developing countries. Marital status has a significant impact on the prevalence and severity of the self-stigma of patients. There is a need for awareness program to reduce self-stigma. Psychiatric institutions should also focus on promotion of patients' social life and increase patient's awareness of certain issues that could prevent stigma.

An Evaluation of Death Depression and Death Anxiety in Patients with Chronic Obstructive Pulmonary Disease

Objectives: The study aimed to determine the level of death depression and death anxiety in patients with COPD. Method: The sample of this cross-sectional and descriptive study including patients’ views consisted of 104 patients diagnosed with COPD and hospitalized in a hospital’s pulmonary disease clinic in Turkey. Number, percentage, mean, regression, and correlation analysis were used in the analysis of the data. Results: The most disturbing symptom of COPD was found to be dyspnea (71.2%), cough (17.3%), and sputum (11.5%). 44.2% of the patients had mild, 40.4% had moderate death anxiety levels, and 51% were in a depressive mood. According to the regression analysis, the death depression total score is predictable based on marital status, disease duration, presence of respiratory disease in patients, and patients’ selfcare levels (R: 0.556, R2: 0.310, F: 3.401, p: 0.000). The Anxiety about Death Process-Pain and Suffering subscale score is also predictable depending on the marital status, duration of the disease, desire to know the truth in case of deadly disease, and the level of meeting self-care needs (R: 0.563, R2: 0.317, F: 3.520, p: 0.000). Conclusion: Nurses should monitor the following patients more closely in terms of death depression and death anxiety; those with high dyspnea, those with a history of respiratory disease, single or widowed patients, those with a disease of long duration, those who have difficulties meeting self-care needs and those who do not want to know the diagnosis in case of a deadly disease.

The Clinical Characteristics and Epidemiology of Extramedullary Multiple Myeloma over the Past Two Decades

Background Extramedullary multiple myeloma (EMM) represents a rare and aggressive manifestation of multiple myeloma (MM) in which plasma cells survive outside of the bone marrow microenvironment, arising from a non-medullary site. EMM affects approximately 30% of MM patients and can be present at diagnosis or develop at any timepoint during the disease course [1,2]. Prior studies have demonstrated a higher incidence of high-risk cytogenetics in patients with EMM including gain 1q, translocation (4;14), translocation (14;16) and deletion 17p [3]. There is a paucity of data on clinical characteristics and overall epidemiology of EMM. The purpose of this study is to evaluate the clinical characteristics of patients with EMM over the past 2 decades, and to identify epidemiologic characteristics that may impact overall prognosis. Methods A population-based retrospective cohort study of patients with EMM was conducted using the publicly available Surveillance, Epidemiology, and End Results (SEER) database. In addition, 18 registries in the November 2020 submission database were also utilized (http://www.seer.cancer.gov). All patient-specific information within the databases have been de-identified, and therefore IRB approval was not needed to conduct this study. A total of 858 patients diagnosed with EMM, between 2000 and 2017, were ultimately enrolled in our study. We analyzed demographics, clinical characteristics, and overall mortality (OM) as well as cancer-specific mortality (CSM) of EMM. Variables with a p-value < 0.1 in the univariate Cox regression were incorporated into the multivariate Cox model to determine the independent prognostic factors, with a hazard ratio (HR) of greater than 1 representing adverse prognostic factors. All tests were two-sided, with a confidence interval set as 95% and p value <0.05 deemed statistically significant. All statistical tests were performed by using Software STATA 16.1. Results From a sample of 858 patients with EMM, male gender (63.25%), age range 60-79 years (51.05%) and non-Hispanic whites (66.78%) were the most represented. Central Nervous System (which includes leptomeningeal, intracranial and intraparenchymal involvement) and vertebral column was the most affected site (33.10%). Multivariate cox proportional hazard regression analyses only revealed higher overall mortality (OM) in age group over 80 years (HR = 9.792, 95% CI 4.403-21.774, p=0) and widowed individuals (HR = 1.609, 95% CI 1.101-2.35, p = 0.014). Multivariate cox proportional hazard regression analyses of cancer specific mortality (CSM) also revealed higher mortality of the same groups. Eyes, mouth, and ENT involvement had the lowest CSM in the multivariate analysis. Conclusions EMM is a relatively rare entity that presents in a minority of patients diagnosed with MM [1]. To our knowledge, there is scarcity of data on the clinical characteristics and epidemiology of patients with EMM. This study found that non-Hispanic whites were the most affected population, which contrasts with the overall epidemiology of Multiple Myeloma without extramedullary disease in which the black population is the most affected [4]. Patients were primarily in the 60-79-year age range, and the most commonly affected sites were CNS/vertebral column (33%), bones/soft tissues of the trunk (12.6%) and pelvis/sacrum (11.3%), and eyes/mouth/ears/nose/throat (11.7%). We found that age was the single most important prognostic factor, with older patients having worse outcomes (Table 2). Marital status and tumor location were also found to be independent prognostic factors, with widowed patients having higher mortality rates and patients with EMM affecting eyes/mouth/ears/nose/throat faring better than those with other sites affected (Table 2). We hope that the results of this study will enhance our overall understanding of the clinical presentation of this rare and aggressive manifestation of MM. In better understanding EMM, we hope to inspire larger prospective studies on the management of this subset of patients, which is particularly important in the era of novel agents including immunomodulatory agents, proteasome inhibitors, monoclonal antibodies, and, more recently, the advent of chimeric antigen receptor T-cell therapy (CAR-T) and bispecific agents.

The Causal Effects of Anxiety-Mediated Social Support on Death in Patients with Chronic Heart Failure: A Multicenter Cohort Study.

Chronic heart failure (CHF) affects more than 3.8 million people worldwide. There is a paucity of studies focusing on psychosocial issues in CHF patients. This study aimed to investigate the association of social support, mental adjustment and death to exploring whether mental adjustment could mediate the relationship. From May 2017 to June 2021, we conducted a multicenter clinical study to collect 1552 patients data. The Patient Report Outcome (PRO) scale were disseminated to collect information in the physical, psychological, social and therapeutic domains of patients. Marginal structural model was used to investigate the association of social support and CHF death, and the role of mental adjustment in their mediation. The direct effect of social support accounted for 44.76% of the total effect. High social support (≥14 points) reduced mortality by 46.3% (RR=0.537, P=0.027), medium social support (11-14 points) reduced mortality by 45.3% (RR=0.547, P=0.042). Anxiety (effect percentage: 24.63%) and appetite-sleep quality (effect percentage: 30.61%) played a mediating role between social support and death in CHF patients. In women, aged >75 years, divorced or widowed patients were most prone to anxiety due to inadequate support (RR=0.519, P=0.019; RR=0.403, P=0.002; RR=0.413, P=0.041). Family care and socioeconomic assistance significantly reduced the risk of death (RR=0.689, P=0.040; RR=0.584, P=0.012). Social support can reduce patient mortality, especially family care and social economic assistance. The elderly, female, divorced or widowed patients are more likely to cause mental illness due to inadequate social support.

Influence of marital status on the treatment and survival of middle-aged and elderly patients with primary bone cancer.

The role of spousal support has been recognized to benefit patients with many chronic diseases and cancers. However, the impact of marital status on the survival of middle-aged and elderly patients with primary bone tumors remains elusive. The data of patients aged ≥ 45 years with primary bone tumors diagnosed between 2000 and 2018 were extracted from the Surveillance, Epidemiology, and End Results Database. Kaplan-Meier analysis was used to assess the overall survival and tumor-specific survival of patients. The Cox proportional hazards and Fine-and-Gray models were used to calculate the hazard ratios (HRs) and sub-distribution HRs (sHR) and the corresponding 95% confidence interval (CI) of all-cause mortality and tumor-specific mortality, respectively. A total of 5,640 primary bone tumors were included in the study. In 45-59 years cohort, married, unmarried, divorced and widowed accounted for 66.0, 21.0, 11.2, and 1.8%, respectively; while 64.3, 10.1, 8.8, and 16.8% in 60+ years cohort, respectively. The widowed patients had a lower proportion of early-stage tumors at diagnosis than that married, unmarried, and divorced patients (31.0% vs. 36% vs. 37.1% vs. 39.4%; P = 0.008), and had a higher proportion of patients who did not undergo surgery than that of married, unmarried, and divorced patients (38.6% vs. 21.3% vs. 24.6% vs. 24.4%; P < 0.001). The widowed population had an increased risk of all-cause mortality (HR, 1.68; 95% CI, 1.50-1.88; P < 0.001) and disease-related mortality (HR, 1.33; 95% CI, 1.09-1.61; P = 0.005) compared with the married population. The marital status of middle-aged and elderly people can affect the tumor stage at diagnosis, treatment, and survival prognosis of patients with primary bone cancer. Widowed patients are more inclined to choose non-surgical treatment and have the worst prognosis.

Impact of marital status at diagnosis on the survival of patients with anal canal squamous cell carcinoma: a propensity score-matched analysis.

Marital status has been shown to be an important psychosocial factor that plays an important role in the prognosis of various cancers. The effect of marital status on survival outcomes in anal canal squamous cell carcinoma has not been studied. The purpose of this study was to address this issue. According to the established screening criteria, we obtained 2429 patients with anal canal squamous cell carcinoma from the Surveillance, Epidemiology, and End Results (SEER) database. Kaplan-Meier analysis and multivariate Cox regression analysis were used to analyze the survival of anal canal squamous cell carcinoma patients with different marital status. 1:1 propensity score matching (PSM) was used to match 979 unmarried patients with 979 married patients to further demonstrate the effect of marital status on the survival of patients with anal canal squamous cell carcinoma. The 5-year overall survival (OS) rates of married, divorced/separated, single, and widowed patients with anal canal squamous cell carcinoma were 75.6%, 69.7%, 62.2%, and 51.3%, respectively and the corresponding 5-year cancer-specific survival (CSS) rates were 80.7%, 79.6%, 70.1%, and 68.9%, respectively. Multivariate Cox regression analysis showed that marital status, sex, race, SEER stage, tumor size, regional nodes positive, primary site surgery, chemotherapy, and radiotherapy were independent prognostic factors for OS and CSS, and also demonstrated that the widowed patients suffered the highest risk mortality. Furthermore, married patients were found to have better OS and CSS than unmarried patients both before and after propensity score matching. This study found that married patients with anal canal squamous cell carcinoma had better survival outcomes, while widowed patients had the worst OS and CSS.

The Widowhood Effect on Mortality in Older Patients with Hip Fracture.

ObjectiveWidowed people have increased mortality than married people of the same age, a phenomenon known as the widowhood effect. This study aimed to investigate whether this effect exists in older patients with hip fracture.MethodsUsing our own hip fracture database, a total of 1101 hip fracture patients were consecutively included from January 2014 to December 2021. Marital status was stratified as married (n = 793) and widowed (n = 308). Patients survival status was obtained from medical records or telephone follow-ups, and the outcomes were all-cause mortality at 30 days, 1 year and at latest follow-up. Univariate and multivariate Cox proportional hazard models were used to assess the association between marital status and mortality, and subgroup analyses according to sex were also conducted.ResultsCompared with married patients, widowed patients were more likely to be older, female and intertrochanteric fracture, and were less likely to be urban area, smoking, drinking, and surgical treatment (P < 0.05). After a median follow-up of 37.1 months, the 30-day mortality was 4.3% (n = 47), 1-year mortality was 19.3% (n = 178), and total mortality was 34.2% (n = 376). Multivariate Cox analysis showed that widowed marital status remained an independent risk factor for 1-year mortality (HR = 1.437, 95% CI: 1.054–1.959, P = 0.022), and total mortality (HR = 1.296, 95% CI: 1.038–1.618, P = 0.022), whereas this association was not found in 30-day mortality (HR = 1.200, 95% CI: 0.607–2.376, P = 0.599). Moreover, subgroup analyses also found that the widowhood effect on mortality was present in both male and female.ConclusionWidowed marital status seems to be an independent risk factor for long-term mortality in older patients with hip fracture.

Uveal melanoma and marital status: a relationship that affects survival

BackgroundMarital status influences the presentation and outcome of various cancers. We explored the relationship between marital status and survival of uveal melanoma (UM) and factors influencing this relationship.MethodsWe conducted a retrospective cohort study on patients diagnosed with UM and registered in the Surveillance Epidemiology and End Results program between 1973 and 2017. Cox regression model was conducted to calculate the hazard ratio of overall and cancer-specific survival rate and delineate the effect of each confounder.ResultsThe study involved 10,557 patients with a male-to-female ratio of 1:1.1. Most of the diagnosed patients were aged between 40 and 79 years (81%). Married patients (62%) represented the majority, followed by singles (12%), widowed (11%), and then divorced patients (7%). Single patients were the youngest group (mean age of 59.3 years) while widowed patients were the oldest (mean age of 75.8 years). In the Cox regression model for overall survival, married and single patients exhibited the best overall survival (no significant difference in between them), both surpassing divorced and widowed patients. Married patients were at a significantly lower risk to die from UM than divorced patients. Female patients and younger age groups showed the best overall and cancer-specific survival.ConclusionMaintained marriages improved the survival of UM patients. Widowed and divorced patients should be included in specially designed support programs during their cancer management.

Sociodemographic and Clinical Factors Associated With Radiation Treatment Nonadherence and Survival Among Rural and Nonrural Patients With Cancer

Cancer treatment nonadherence is associated with higher rates of cancer recurrence and decreased survival. Rural patients with cancer experience a 10% higher mortality rate compared with their nonrural counterparts; geographic differences in nonadherence may contribute to this increased mortality. The goal of this study was to assess for geographic disparities and determine sociodemographic and clinical factors associated with radiation therapy (RT) nonadherence and survival among rural and nonrural patients with cancer. We examined cancer registry, medical records, and billing claims data at a safety net academic medical center. Geographic residence was defined as rural versus nonrural by US Department of Agriculture 2013 Rural-Urban Continuum Codes. Other factors assessed were age, sex, race, marital status, insurance type, employment, area median household income, residential distance to cancer treatment center, clinical stage, cancer type, treatment modality, total radiation dose received, and radiation dose per fraction. We used Cox proportional hazards modeling to examine 7 ways of operationalizing nonadherence and selected the definition that resulted in the best model fit statistics and prediction of mortality. Overall survival rates were estimated with the Kaplan-Meier method. We then examined nonadherence as the main exposure along with additional covariates in least absolute shrinkage and selection operator penalized survival analyses and as the outcome in our multivariable generalized linear regression analyses predicting nonadherence. We considered 2-way interaction terms with the main exposure, geographic residence. We identified 3,077 patients with cancer who averaged 62 years old, were 59% female, 34% Black, and 14% rural. Twenty-two percent of patients missed at least 2 fractions and missed an average of 10% of their treatment plan. Rural patients experienced a higher mortality rate than nonrural patients (53% vs 42%, P < .0001). Survival was assessed through December 31, 2021, with a mean follow-up of 4.5 years. Proportion of missed fractions as the indicator of nonadherence provided the best model fit statistics and prediction of survival. Marital status, employment status, tumor, nodes, metastases stage, cancer type, and age at diagnosis significantly affected survival, in addition to a treatment delay by geographic residence interaction effect. Specifically, patients residing in rural areas who experienced a treatment delay were more than twice as likely to die as nonrural residents who also experienced a treatment delay, and nearly twice as likely to die as rural residents who did not experience a treatment delay. The 2-year survival rate was 76% for nonrural residents who did not experience a treatment delay versus 27% for rural residents who experienced a treatment delay. Patients who were widowed, had stage 4 cancer, or lung cancer were more likely to be nonadherent. Finally, patients residing in rural areas who experienced a treatment delay were more likely to subsequently be nonadherent. In a geographically and racially diverse population, RT nonadherence is a significant concern that affects survival, yet it is a modifiable risk factor. We demonstrated that rural residence was associated with both RT nonadherence and poorer overall survival. Rural patients with a treatment delay had the lowest overall survival, compared with both nonrural survivors and rural survivors without delay. Rural residents who are delayed in starting treatment are at heightened risk for poor outcomes and should receive targeted support to mitigate the observed disparities. Additional patient populations that may benefit from targeted treatment adherence support include widowed patients and those with stage 4 cancer or lung cancer.

Effects of marital status on survival of retroperitoneal liposarcomas stratified by age and sex: A population-based study.

Previous studies have shown that marital status is associated with survival in patients with a variety of cancer types, including lung cancer, prostate cancer, and bladder cancer. However, to date, the impact of marital status on the survival of patients with retroperitoneal liposarcomas (RPLs) has not been established. A total of 1211 eligible patients diagnosed with RPLs were identified in the Surveillance, Epidemiology, and End Results (SEER) database. The relationships between marital status and survival in patients with RPLs were assessed. Patients were stratified by age to determine whether an association exists between marital status and age. We also probed the association between marital status and survival in males and females. Our findings suggest that divorced, separated, or widowed patients have more advanced cancer stages, and more of these patients do not undergo surgery. Meanwhile, divorced, separated, or widowed patients have worse survival outcomes than married patients (overall survival (OS): HR=1.66 (95% CI, 1.12, 2.46)); cancer-specific survival (CSS): HR=1.90 (95% CI, 1.13, 3.19)). OS does not differ between single patients and married patients (HR=1.21 [95% CI, 0.81, 1.81]) or CSS (HR=1.36 [95% CI, 0.80, 2.29]). In addition, these results demonstrate that being divorced, separated, or widowed can play a significant detrimental role in mortality in older and female patients. Married patients have earlier disease stages at diagnosis and better survival outcomes than divorced, separated, or widowed patients with RPLs. In addition, this effect is especially pronounced in older people and females.

Evaluation of the relationship between health literacy and self-efficacy: A sample of hemodialysis patients.

The aim of this study was to evaluate self-efficacy and health literacy of patients undergoing hemodialysis, to investigate the relationship between health literacy and self-efficacy, and to determine the factors affecting self-efficacy. The study was conducted in Eskisehir and Gumushane state hospitals affiliated to the Public Hospitals Association with the participation of 198 patients receiving hemodialysis treatment for chronic renal failure. The inclusion criteria were as follows: being ⩾18 years old, receiving hemodialysis, and agreeing to participate in the study. The study data were collected using face-to-face interview technique, and they were analyzed using descriptive statistics, correlation, and regression analysis. The mean age of the patients was 59.73 ± 16.32 years. Of the patients, 46% were primary school graduates, and 63.6% reported having other chronic diseases. The mean health literacy and self-efficacy scores were found to be 79.43 ± 26.09 and 23.98 ± 7.42, respectively. The results showed that the self-efficacy scores of the patients increased as the general health literacy scores increased, with a strong linear correlation between these variables (r = 0.712; p ˂ 0.001). Patients with advanced age, low educational level, and widowed patients had lower self-efficacy and health literacy scores than others (respectively eta2 = 0.263, 0.116, 0.268, 0.141). High score of health literacy positively affects the self-efficacy score of hemodialysis patients.

Surgical Methods and Social Factors Are Associated With Long-Term Survival in Follicular Thyroid Carcinoma: Construction and Validation of a Prognostic Model Based on Machine Learning Algorithms.

BackgroundThis study aimed to establish and verify an effective machine learning (ML) model to predict the prognosis of follicular thyroid cancer (FTC), and compare it with the eighth edition of the American Joint Committee on Cancer (AJCC) model.MethodsKaplan-Meier method and Cox regression model were used to analyze the risk factors of cancer-specific survival (CSS). Propensity-score matching (PSM) was used to adjust the confounding factors of different surgeries. Nine different ML algorithms,including eXtreme Gradient Boosting (XGBoost), Light Gradient Boosting Machine (LightGBM), Random Forests (RF), Logistic Regression (LR), Adaptive Boosting (AdaBoost), Gaussian Naive Bayes (GaussianNB), K-Nearest Neighbor (KNN), Support Vector Machine (SVM) and Multi-Layer Perceptron (MLP),were used to build prognostic models of FTC.10-fold cross-validation and SHapley Additive exPlanations were used to train and visualize the optimal ML model.The AJCC model was built by multivariate Cox regression and visualized through nomogram. The performance of the XGBoost model and AJCC model was mainly assessed using the area under the receiver operating characteristic (AUROC).ResultsMultivariate Cox regression showed that age, surgical methods, marital status, T classification, N classification and M classification were independent risk factors of CSS. Among different surgeries, the prognosis of one-sided thyroid lobectomy plus isthmectomy (LO plus IO) was the best, followed by total thyroidectomy (hazard ratios: One-sided thyroid LO plus IO, 0.086[95% confidence interval (CI),0.025-0.290], P<0.001; total thyroidectomy (TT), 0.490[95%CI,0.295-0.814], P=0.006). PSM analysis proved that one-sided thyroid LO plus IO, TT, and partial thyroidectomy had no significant differences in long-term prognosis. Our study also revealed that married patients had better prognosis than single, widowed and separated patients (hazard ratios: single, 1.686[95%CI,1.146-2.479], P=0.008; widowed, 1.671[95%CI,1.163-2.402], P=0.006; separated, 4.306[95%CI,2.039-9.093], P<0.001). Among different ML algorithms, the XGBoost model had the best performance, followed by Gaussian NB, RF, LR, MLP, LightGBM, AdaBoost, KNN and SVM. In predicting FTC prognosis, the predictive performance of the XGBoost model was relatively better than the AJCC model (AUROC: 0.886 vs. 0.814).ConclusionFor high-risk groups, effective surgical methods and well marital status can improve the prognosis of FTC. Compared with the traditional AJCC model, the XGBoost model has relatively better prediction accuracy and clinical usage.

Factors influencing the successful connection of deliberate self-injury patients to community-based mental health centers.

The emergency department (ED) is a good place to start preventing actions for suicide attempters. As a preventive factor, early intervention, follow-up management, and connection with community-based mental health care are important. We aimed to determine which factors were important for a successful connection to community-based mental health care services. This study was conducted at two tertiary teaching hospitals from January 2018 to December 2020. There were 1016 deliberate self-harm patients who received the four weeks of follow-up intervention. There were 166 patients in the connected group and 850 patients in the non-connected group. In the logistic regression analysis for the successful connection to community-based mental health care, married patients had an odds ratio (OR) 1.627 (95% CI 0.960-2.758), 1.314 OR (95% CI 0.619-2.790) of separated patients and 5.317 OR (CI 1.864-15.168) of widowed patients compared to single patients. And face-to-face follow-up management had 2.630 OR (95% CI 1.815-3.811) to the successful connection rate to community-based mental healthcare compared to the patients in non-face-to-face management. When deliberately self-injured patients who visited the ED received short-term follow-up intervention after emergency treatment, face-to-face follow-up intervention had a higher connection rate to community-based mental healthcare centers than non-face-to-face follow-up intervention. In the future, for deliberate self-harm patients who visit the ED, the ED staff should manage deliberate self-harm through early detection and face-to-face follow-up intervention, and other methods that can compensate for face-to-face follow-up intervention.

Effect of Marital Status on Upper Digestive Tract Tumor Survival: Married Male Patients Exhibited a Better Prognosis.

PurposeMarital status has been associated with the outcomes in several types of cancer, but less is known about upper digestive tract tumors (UDTTs). The study aims to explore the effect of marital status on the survival outcomes of UDTT.MethodsWe collected patient cases of UDTT using the Surveillance, Epidemiology, and End Results (SEER) database between 1975 and 2016. The univariate analyses of overall survival (OS) and cancer-specific survival (CSS) were performed using the Kaplan–Meier method. The multivariate survival analyses were performed using Cox proportional hazard model.ResultsA total of 282,189 patients were included, with 56.42, 16.30, 13.33, and 13.95% of patients married, never married, divorced or separated, and widowed, respectively. The significant differences were observed among married, never-married, divorced or separated, and widowed patients with regard to the year of diagnosis, sex, age, race, pathological type, anatomical site, the number of primary tumor, grade, rate of surgery performed, radiotherapy, chemotherapy (p < 0.001). The proportions of patients with 3-year and 5-year OS were 54.22 and 48.02% in the married group, 46.96 and 41.12% in the never-married group, 44.24 and 38.06% in the divorced or separated group, 34.59 and 27.57% in the widowed group, respectively (p < 0.001); the proportions of patients with 3-year and 5-year CSS were 70.76 and 68.13% in the married group, 62.44 and 59,93% in the never-married group, 63.13 and 60.53% in the divorced or separated group, 62.11 and 58.89% in the widowed group, respectively (p < 0.001); all these data indicated married patients exhibited favorable OS and CSS than never-married, divorced or separated, and widowed patients. Men in the married group showed better OS (HR, 1.16; 95%CI: 1.11–1.22) and CSS (HR, 0.96; 95%CI: 0.92–1.23) than those in the never-married group.ConclusionThis study reveals that marital status is an independent prognostic factor for OS and CSS of patients with UDTT. Married male patients with UDTT trend to have a better prognosis.

Association of marital status with cardiovascular outcome in patients with breast cancer.

BackgroundThe influences of marital status on cardiovascular death risk in patients with breast cancer remained unclear. This study aimed to evaluate the associations of different marital status with cardiovascular death risk in patients with breast cancer.MethodsA total of 182,666 female breast cancer patients were enrolled in this study from the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2014, and was divided into two groups: married (N=107,043) and unmarried (N=75,623). A 1:1 propensity score matching (PSM) was applied to reduce inter-group bias between the two groups. Competing-risks model was used to assess the associations between different marital status and cardiovascular death risk in patients with breast cancer.ResultsAfter PSM, marital status was an independent predictor for cardiovascular death in patients with breast cancer. Unmarried condition was associated with increased cardiovascular death risk than married condition among breast cancer patients [unadjusted model: hazard ratio (HR) =2.012, 95% confidence interval (CI): 1.835–2.208, P<0.001; Model 1: HR =1.958, 95% CI: 1.785–2.148, P<0.001; Model 2: HR =1.954, 95% CI: 1.781–2.144, P<0.001; Model 3: HR =1.920, 95% CI: 1.748–2.107, P<0.001]. With the exception of separated condition (adjusted HR =0.886, 95% CI: 0.474–1.658, P=0.705), further unmarried subgroups analysis showed that the other three unmarried status were associated with increased cardiovascular death risk as follows: single (adjusted HR =1.623, 95% CI: 1.421–1.853, P<0.001), divorced (adjusted HR =1.394, 95% CI: 1.209–1.608, P<0.001), and widowed (adjusted HR =2.460, 95% CI: 2.227–2.717, P<0.001). In particularly, widowed condition showed the highest cardiovascular death risk in all 4 unmarried subgroups.ConclusionsUnmarried condition (e.g., single, divorced and widowed) was associated with elevated cardiovascular death risk compared with their married counterparts in patients with breast cancer, suggesting that more attention and humanistic care should be paid to unmarried breast cancer patients (especially the widowed patients) in the management of female breast cancer patients.

Marital Status and Sex-Based Differences in Outcomes After Transcatheter Aortic Valve Implantation

Studies have shown improved outcomes among married patients who underwent cardiovascular surgery; however, this has not been well studied in transcatheter aortic valve implantation (TAVi). We examined the impact of marital status and patient sex on outcomes after TAVi. Patients who underwent TAVi from January 2015 to June 2018 were reviewed and stratified into 3 groups: single, married, and widowed. The impact of marital status and sex on 30-day outcomes was assessed using a stepwise logistic regression analysis. Cumulative survival was estimated using Kaplan-Meier analysis and adjusted survival with multivariable Cox proportional hazards modeling. A total of 785 patients were included: 149 single, 413 married, and 223 widowed. Widowed patients were older (84 vs 79years) with higher Society of Thoracic Surgeons risk scores (6.79% vs 5.51%, both p ≤0.001) than married patients. Neither marital status nor sex was associated with 30-day mortality or home discharge. However, 1-year survival revealed a differential survival penalty, with married females (p=0.041) having lower survival and married males (p=0.007) having higher survival than their single counterparts. This survival penalty persisted in the adjusted analyses (married females hazard ratio [HR] 2.24, p=0.009; widowed males HR 2.42, p=0.057). For patients who were readmitted in the first year, adjusted analysis showed widowed status was associated with higher 30-day readmissions (HR 1.91, p=0.012) in both sexes. In conclusion, these findings suggest that marital status does not impact both sexes equally after TAVi; identifying at-risk patients and targeted interventions, such as adjusting discharge planning to ensure adequate home social support, may help improve outcomes.

The effect of marital status on the survival of patients with multiple myeloma

ABSTRACT Objectives To investigate the impact of marriage on multiple myeloma (MM) survival, and the role of factors such as age, sex, and income in this relationship. Material and Methods The Surveillance, Epidemiology, and End Results (SEER) database was searched for eligible MM patients between 2007 and 2016. We compared overall survival (OS) and cancer-specific survival (CSS) differences by the Kaplan–Meier method and log-rank tests. The hazard ratios (HRs) with 95% confidence intervals (CIs) for OS and CSS were estimated by Cox regression models. A 1:1 propensity score matching (PSM) analysis was used to minimize the covariates differences between married and unmarried group. Results This study identified 48,952 eligible patients diagnosed with MM, comprising 29,607 married patients, 5,147 divorced/separated patients, 6,851 single patients, and 7,347 widowed patients. Married MM patients were found to be an independent protective prognostic factor for OS and CSS (all P < 0.001). The survival advantage of marriage still remained in 1:1 matched-pair analysis. The stratified analysis further revealed that the OS and CSS was poorer in unmarried than married MM patients across different age of diagnosis, sex, income, race, and period of diagnosis subgroups (all P < 0.05). The beneficial effect of marriage on the survival of MM was particularly prominent in younger (<65 years) patients, males, higher income patients, non-Hispanic whites, and more recent years. Conclusion Married patients with MM tend to have better OS and CSS likely due to their higher income, education level, insurance and receipt of chemotherapy.