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Lekha PPS, Azeez EPA. Psychosocial Facilitators and Barriers to Type 2 Diabetes Management in Adults: A Meta-Synthesis. Curr Diabetes Rev 2024; 20:110-123. [PMID: 38310483 DOI: 10.2174/0115733998283436231207093250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/10/2023] [Accepted: 11/29/2023] [Indexed: 02/05/2024]
Abstract
BACKGROUND Globally, the cases of type 2 diabetes are increasing, and this is largely attributed to lifestyle changes. Though diabetes is primarily a metabolic disease determined by biological factors, psychosocial aspects play a crucial role in its progression and management. However, the literature on psychosocial dimensions of diabetes management is minuscule and scattered. OBJECTIVE This synthesis sought to understand the psychosocial facilitators and barriers to type 2 diabetes management and coping among adults. METHODS We have adopted a meta-synthesis to review available qualitative studies using Pub- Med and Scopus databases. Based on inclusion criteria, we have chosen 24 studies published between 2010 and 2023. We have considered studies across countries, among which 63% of the studies included were from Western countries, and most have employed qualitative descriptive design. The selected studies were analyzed thematically using a deductive framework. RESULTS Six themes emerged as the psychosocial barriers and facilitators of managing and coping with type 2 diabetes: 1) cognitive-emotional factors, 2) faith, 3) constraints to behavioural change, 4) social constraints and support, 5) healthcare provider-patient relationship, and 6) awareness. Further, a conceptual framework was developed from the synthesis. CONCLUSION The patients' experiences evident from this synthesis signify the crucial role of psychosocial factors in diabetes management and coping. This evidence emphasizes the need for integrated care so that psychosocial aspects are addressed by healthcare providers and behavioural health professionals, which may lead to the promotion of facilitators and the minimization of barriers.
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Affiliation(s)
- P Padma Sri Lekha
- School of Social Sciences and Languages, Vellore Institute of Technology, Vellore, India
| | - E P Abdul Azeez
- School of Social Sciences and Languages, Vellore Institute of Technology, Vellore, India
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2
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Noh Y, Kim M, Hong SH. Identification of Emotional Spectrums of Patients Taking an Erectile Dysfunction Medication: Ontology-Based Emotion Analysis of Patient Medication Reviews on Social Media. J Med Internet Res 2023; 25:e50152. [PMID: 38019570 PMCID: PMC10719816 DOI: 10.2196/50152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/01/2023] [Accepted: 10/25/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Patient medication reviews on social networking sites provide valuable insights into the experiences and sentiments of individuals taking specific medications. Understanding the emotional spectrum expressed by patients can shed light on their overall satisfaction with medication treatment. This study aims to explore the emotions expressed by patients taking phosphodiesterase type 5 (PDE5) inhibitors and their impact on sentiment. OBJECTIVE This study aimed to (1) identify the distribution of 6 Parrot emotions in patient medication reviews across different patient characteristics and PDE5 inhibitors, (2) determine the relative impact of each emotion on the overall sentiment derived from the language expressed in each patient medication review while controlling for different patient characteristics and PDE5 inhibitors, and (3) assess the predictive power of the overall sentiment in explaining patient satisfaction with medication treatment. METHODS A data set of patient medication reviews for sildenafil, vardenafil, and tadalafil was collected from 3 popular social networking sites such as WebMD, Ask-a-Patient, and Drugs.com. The Parrot emotion model, which categorizes emotions into 6 primary classes (surprise, anger, love, joy, sadness, and fear), was used to analyze the emotional content of the reviews. Logistic regression and sentiment analysis techniques were used to examine the distribution of emotions across different patient characteristics and PDE5 inhibitors and to quantify their contribution to sentiment. RESULTS The analysis included 3070 patient medication reviews. The most prevalent emotions expressed were joy and sadness, with joy being the most prevalent among positive emotions and sadness being the most prevalent among negative emotions. Emotion distributions varied across patient characteristics and PDE5 inhibitors. Regression analysis revealed that joy had the strongest positive impact on sentiment, while sadness had the most negative impact. The sentiment score derived from patient reviews significantly predicted patient satisfaction with medication treatment, explaining 19% of the variance (increase in R2) when controlling for patient characteristics and PDE5 inhibitors. CONCLUSIONS This study provides valuable insights into the emotional experiences of patients taking PDE5 inhibitors. The findings highlight the importance of emotions in shaping patient sentiment and satisfaction with medication treatment. Understanding these emotional dynamics can aid health care providers in better addressing patient needs and improving overall patient care.
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Affiliation(s)
- Youran Noh
- College of Pharmacy, Seoul National University, Seoul, Republic of Korea
- Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea
| | - Maryanne Kim
- College of Pharmacy, Seoul National University, Seoul, Republic of Korea
- Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea
| | - Song Hee Hong
- College of Pharmacy, Seoul National University, Seoul, Republic of Korea
- Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea
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Li Y, Phan H, Law AV, Baskys A, Roosan D. Gamification to Improve Medication Adherence: A Mixed-method Usability Study for MedScrab. J Med Syst 2023; 47:108. [PMID: 37857930 DOI: 10.1007/s10916-023-02006-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/09/2023] [Indexed: 10/21/2023]
Abstract
Medication non-adherence is a prevalent healthcare problem with poor health outcomes and added healthcare costs. MedScrab, a gamification-based mHealth app, is the first attempt to deliver crucial life-saving medication information to patients and increase their medication adherence. The paper presents the development of MedScrab and a two-phase mixed-method usability evaluation of MedScrab. Phase I qualitatively evaluated MedScrab using a think-aloud protocol for its usability. With 51 participants, qualitative data analysis of Phase I revealed two themes: positive functionality of the app and four areas of improvement. The improvement recommendations were incorporated into MedScrab's design. Phase I also validated a widely used mHealth App Usability Questionnaire (MAUQ). Quantitative data analysis of Phase I reduced the original 18-item MAUQ scale to a 15-item scale with two factors: ease of use (4 items) and usefulness and satisfaction (11 items). Phase II surveyed 83 participants from Amazon's Mechanical Turk using a modified MAUQ. The modified MAUQ scale showed strong internal consistency (Cronbach alpha = 0.959) and high factor loadings (between 0.623 and 0.987). The study design of the usability evaluation can serve as a methodological guide for designing, evaluating, and improving mHealth apps.The usability study showed that MedScrab was perceived as ease of use (6.24 out of 7) with high usefulness and satisfaction (5.72 out of 7). The quantitative data analysis results support the use of the modified MAUQ as a valid instrument to measure the usability of the MedScrab. However, the instrument should be used with adaptation based on the app's characteristics.
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Affiliation(s)
- Yan Li
- Center for Information Systems and Technology (CISAT), Claremont Graduate University, 130 E. Ninth St. ACB225, Claremont, CA, 91711, USA.
| | - Huong Phan
- College of Pharmacy, Western University of Health Sciences, Pomona, CA, USA
| | - Anandi V Law
- College of Pharmacy, Western University of Health Sciences, Pomona, CA, USA
| | - Andrius Baskys
- Graduate College of Biomedical Sciences, Western University of Health Sciences, Pomona, CA, USA
| | - Don Roosan
- College of Pharmacy, Western University of Health Sciences, Pomona, CA, USA
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Horner FS, Helgeson VS, Korytkowski MT. Links of positive affect and stress to HbA1c: a prospective longitudinal study. J Behav Med 2023; 46:849-859. [PMID: 37071343 PMCID: PMC10111289 DOI: 10.1007/s10865-023-00408-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 03/06/2023] [Indexed: 04/19/2023]
Abstract
While affect is linked to a number of diabetes outcomes, the specific role of positive affect (PA) in HbA1c remains unclear. The present study examined whether PA prospectively predicted lower HbA1c among adults with type 2 diabetes and whether this relation was moderated by stress. Participants were 123 adults (44.7% female; 60.2% White, 39.8% Black) recently diagnosed with type 2 diabetes. Perceived stress, diabetes-specific distress, and PA were assessed at baseline; HbA1c was assessed at baseline (T1), six months (T2), and five years (T3). PA was cross-sectionally associated with lower HbA1c at T1 and prospectively predicted lower HbA1c at T3. PA interacted with both measures of T1 stress to predict T1 HbA1c, and PA interacted with T3 perceived stress to predict T3 HbA1c. Interactions were consistent with stress buffering. Sensitivity analyses attentuated findings, but robust evidence remained for PA as a protective factor for blood glucose five years later and for a stress-buffering effect of PA on diabetes-specific distress. Findings suggest PA may be a clinically useful indicator among adults with type 2 diabetes and may be particularly important for those experiencing the greatest stress from their disease.
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Affiliation(s)
- Fiona S Horner
- Department of Psychology, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA, 15213, USA.
| | - Vicki S Helgeson
- Department of Psychology, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA, 15213, USA
| | - Mary T Korytkowski
- Center for Diabetes and Endocrinology, University of Pittsburgh Medical Center, Pittsburgh, USA
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Saslow LR, Missel AL, O'Brien A, Kim S, Hecht FM, Moskowitz JT, Bayandorian H, Pietrucha M, Raymond K, Richards B, Liestenfeltz B, Mason AE, Daubenmier J, Aikens JE. Psychological Support Strategies for Adults With Type 2 Diabetes in a Very Low-Carbohydrate Web-Based Program: Randomized Controlled Trial. JMIR Diabetes 2023; 8:e44295. [PMID: 37166961 PMCID: PMC10214122 DOI: 10.2196/44295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/09/2023] [Accepted: 04/03/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND A very low-carbohydrate (VLC) nutritional strategy may improve glycemic control and weight loss in adults with type 2 diabetes (T2D). However, the supplementary behavioral strategies that might be able to improve outcomes using this nutritional strategy are uncertain. OBJECTIVE This study aims to compare the impact of adding 3 different supplementary behavioral strategies to a web-based VLC diet intervention. To our knowledge, this is the first trial to randomize participants to different frequencies of dietary self-monitoring. METHODS The study included 112 overweight adults with T2D (hemoglobin A1c ≥6.5%) taking no antiglycemic medications or only metformin. They received a remotely delivered 12-month VLC diet intervention. Participants were randomly assigned through a full factorial 2×2×2 design to supplementary strategies: either daily or monthly dietary self-monitoring, either mindful eating training or not, and either positive affect skills training or not. Our research goal was to determine whether 3 different supplemental strategies had at least a medium effect size (Cohen d=0.5). RESULTS Overall, the VLC intervention led to statistically significant improvements in glycemic control (-0.70%, 95% CI -1.04% to -0.35%; P<.001), weight loss (-6.82%, 95% CI -8.57% to -5.08%; P<.001), and depressive symptom severity (Cohen d -0.67, 95% CI -0.92 to -0.41; P<.001). Furthermore, 30% (25/83) of the participants taking metformin at baseline reduced or discontinued their metformin. Only 1 Cohen d point estimate reached 0.5; daily (vs monthly) dietary self-monitoring had a worse impact on depressive symptoms severity (Cohen d=0.47, 95% CI -0.02 to 0.95; P=.06). None of the strategies had a statistically significant effect on outcomes. For changes in our primary outcome, hemoglobin A1c, the daily (vs monthly) dietary self-monitoring impact was 0.42% (95% CI -0.28% to 1.12%); for mindful eating, it was -0.47% (95% CI -1.15% to 0.22%); and for positive affect, it was 0.12% (95% CI -0.57% to 0.82%). Other results for daily (vs monthly) dietary self-monitoring were mixed, suggesting an increase in weight (0.98%) and depressive symptoms (Cohen d=0.47), less intervention satisfaction (Cohen d=-0.20), more sessions viewed (3.02), and greater dietary adherence (Cohen d=0.24). For mindful eating, the results suggested a benefit for dietary adherence (Cohen d=0.24) and intervention satisfaction (Cohen d=0.30). For positive affect, the results suggested a benefit for depressive symptoms (Cohen d=-0.32), the number of sessions viewed (3.68), dietary adherence (Cohen d=0.16), and intervention satisfaction (Cohen d=0.25). CONCLUSIONS Overall, our results support the use of a VLC diet intervention in adults with T2D. The addition of monthly (not daily) dietary self-monitoring, mindful eating, and positive affect skills training did not show a definitive benefit, but it is worth further testing. TRIAL REGISTRATION ClinicalTrials.gov NCT03037528; https://clinicaltrials.gov/ct2/show/NCT03037528.
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Affiliation(s)
- Laura R Saslow
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Amanda L Missel
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, United States
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Alison O'Brien
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, United States
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States
| | - Sarah Kim
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, San Francisco General Hospital, San Francisco, CA, United States
| | - Frederick M Hecht
- Osher Center for Integrative Health, University of California San Francisco, San Francisco, CA, United States
| | - Judith T Moskowitz
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | | | - Martha Pietrucha
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Kate Raymond
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Blair Richards
- Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, MI, United States
| | - Bradley Liestenfeltz
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Ashley E Mason
- Osher Center for Integrative Health, University of California San Francisco, San Francisco, CA, United States
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, United States
| | - Jennifer Daubenmier
- Institute of Holistic Health Studies, San Francisco State University, San Francisco, CA, United States
| | - James E Aikens
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI, United States
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Zuccarella-Hackl C, Princip M, Auschra B, Meister-Langraf RE, Barth J, Käne RV. Association of positive psychological well-being with circulating inflammatory markers: A systematic review and meta-analysis. Neurosci Biobehav Rev 2023; 150:105186. [PMID: 37076058 DOI: 10.1016/j.neubiorev.2023.105186] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/11/2023] [Accepted: 04/16/2023] [Indexed: 04/21/2023]
Abstract
Accumulating evidence shows a protective effect of positive psychological well-being (PPWB) on health outcomes. However, the underlying mechanisms remain poorly understood. One pathway relates to enhanced immune functioning (Boehm, 2021). The aim of this project was to conduct a systematic review and meta-analysis of the association between PPWB and circulating inflammatory biomarkers and determine the magnitude of this association. After examining 748 references, 29 studies were included. Results from over 94'700 participants revealed a significant association between PPWB and reduced levels of interleukin (IL)-6 (r=-0.05; P<.001) and C-reactive protein (CRP) (r=-0.06; P<.001) with a heterogeneity of I2 = 31.5% and I2 = 84.5%, respectively. Only the association of PPWB with CRP was independent of co-variates included in the individual studies (r=-0.04; P=.027),. The findings of this systematic review and meta-analysis suggest that PPWB is associated with lower levels of inflammatory biomarkers IL-6 and CRP in the circulation. Such relationships with inflammatory biomarkers may partly explain positive effects of PPWB on health.
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Affiliation(s)
- Claudia Zuccarella-Hackl
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Mary Princip
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Bianca Auschra
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Rebecca E Meister-Langraf
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Clienia Schlössli AG, Oetwil am See, Zurich, Switzerland
| | - Jürgen Barth
- Institute for Complementary and Integrative Medicine, University Hospital Zurich, University of Zurich, Switzerland
| | - Roland von Käne
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Huffman JC, Feig EH, Zambrano J, Celano CM. Positive Psychology Interventions in Medical Populations: Critical Issues in Intervention Development, Testing, and Implementation. AFFECTIVE SCIENCE 2023; 4:59-71. [PMID: 37070006 PMCID: PMC10105001 DOI: 10.1007/s42761-022-00137-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 06/20/2022] [Indexed: 11/05/2022]
Abstract
Positive psychological well-being is prospectively associated with superior health outcomes. Positive psychology interventions have promise as a potentially feasible and effective means of increasing well-being and health in those with medical illness, and several initial studies have shown the potential of such programs in medical populations. At the same time, numerous key issues in the existing positive psychology literature must be addressed to ensure that these interventions are optimally effective. These include (1) assessing the nature and scope of PPWB as part of intervention development and application; (2) identifying and utilizing theoretical models that can clearly outline potential mechanisms by which positive psychology interventions may affect health outcomes; (3) determining consistent, realistic targets for positive psychology interventions; (4) developing consistent approaches to the promotion of positive psychological well-being; (5) emphasizing the inclusion of diverse samples in treatment development and testing; and (6) considering implementation and scalability from the start of intervention development to ensure effective real-world application. Attention to these six domains could greatly facilitate the generation of effective, replicable, and easily adopted positive psychology programs for medical populations with the potential to have an important impact on public health.
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Affiliation(s)
- Jeff C. Huffman
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114 USA
- Department of Psychiatry, Harvard Medical School, MB Boston, USA
| | - Emily H. Feig
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114 USA
- Department of Psychiatry, Harvard Medical School, MB Boston, USA
| | - Juliana Zambrano
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114 USA
- Department of Psychiatry, Harvard Medical School, MB Boston, USA
| | - Christopher M. Celano
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114 USA
- Department of Psychiatry, Harvard Medical School, MB Boston, USA
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Granata N, Torlaschi V, Zanatta F, Giardini A, Maestri R, Pavesi C, Sommaruga M, Gazzi L, Bertolotti G, Sarzi Braga S, Monelli M, Zanelli E, Pierobon A. Positive affect as a predictor of non-pharmacological adherence in older Chronic Heart Failure (CHF) patients undergoing cardiac rehabilitation. PSYCHOL HEALTH MED 2023; 28:606-620. [PMID: 35603663 DOI: 10.1080/13548506.2022.2077394] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In Chronic Heart Failure (CHF) patients, psychological and cognitive variables and their association with treatment adherence have been extensively reported in the literature, but few are the investigations in older people. The present study aimed to evaluate the psychological, cognitive, and adherence to treatment profile of older (>65 years) CHF patients, the interrelation between these variables, and identify possible independent predictors of self-reported treatment adherence. CHF inpatients undergoing cardiac rehabilitation were assessed for: anxiety, depression, cognitive impairment, positive and negative affect, and self-reported adherence (adherence antecedents, pharmacological adherence, and non-pharmacological adherence). 100 CHF inpatients (mean age: 74.9 ± 7.1 years) were recruited. 16% of patients showed anxiety and 24.5% depressive symptoms; 4% presented cognitive decline. Cognitive functioning negatively correlated to depression, anxiety, and negative affect (p < 0.01). The adherence antecedents (disease acceptance, adaptation, knowledge, and socio-familiar support) negatively correlated to anxiety (p < 0.05), depression (p < 0.001), and negative affect (p < 0.05), while they positively correlated to positive affect (p < 0.01). Pharmacological adherence negatively correlated to anxiety and negative affect (p < 0.05). Conversely, non-pharmacological adherence and positive affect positively correlated (p < 0.05). Furthermore, depression and anxiety negatively predicted adherence antecedents (β = -0.162, p = 0.037) and pharmacological adherence (β = -0.171, p = 0.036), respectively. Finally, positive affect was found as an independent predictor of non-pharmacological adherence (β = 0.133, p = 0.004). In cardiac rehabilitation, a specific psychological assessment focused on anxiety, depression, and affect can provide useful information to manage CHF older patients' care related to treatment adherence. In particular, positive affect should be targeted in future interventions to foster patients' non-pharmacological adherence.
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Affiliation(s)
- Nicolò Granata
- Psychology Unit, Istituti Clinici Scientifici Maugeri IRCSS, Istituto Di Montescano, Pavia, Italy
| | - Valeria Torlaschi
- Psychology Unit, Istituti Clinici Scientifici Maugeri IRCSS, Istituto Di Montescano, Pavia, Italy
| | - Francesco Zanatta
- Department of Psychology, University of Milano-Bicocca, Milano, Italy
| | - Anna Giardini
- Information Technology Department, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Roberto Maestri
- Department of Biomedical Engineering, Istituti Clinici Scientifici Maugeri IRCSS, Istituto Di Montescano, Pavia, Italy
| | - Claudia Pavesi
- Department of Cardiac Rehabilitation, Istituti Clinici Scientifici Maugeri IRCSS, Istituto Di Montescano, Pavia, Italy
| | - Marinella Sommaruga
- Psychology Unit, Istituti Clinici Scientifici Maugeri IRCSS, Istituto Di Camaldoli, Milano, Italy
| | - Lidia Gazzi
- Psychology Unit, Istituti Clinici Scientifici Maugeri IRCSS, Istituto di Lumezzane, Brescia, Italy
| | - Giorgio Bertolotti
- Psychology Unit, Istituti Clinici Scientifici Maugeri IRCSS, Istituto di Tradate, Varese, Italy
| | - Simona Sarzi Braga
- Department of Cardiac Rehabilitation, Istituti Clinici Scientifici Maugeri IRCSS, Istituto di Tradate, Varese, Italy
| | - Mauro Monelli
- Subacute Care, Istituti Clinici Scientifici Maugeri IRCSS, Istituto Di Camaldoli, Milano, Italy
| | - Emanuela Zanelli
- Department of Cardiac Rehabilitation, Istituti Clinici Scientifici Maugeri IRCSS, Istituto di Lumezzane, Brescia, Italy
| | - Antonia Pierobon
- Psychology Unit, Istituti Clinici Scientifici Maugeri IRCSS, Istituto Di Montescano, Pavia, Italy
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9
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Schwartz J, Ballard DH. Feasibility of Customized Pillboxes to Enhance Medication Adherence: A Randomized Controlled Trial. Arch Phys Med Rehabil 2022; 103:2288-2295. [PMID: 35430239 DOI: 10.1016/j.apmr.2022.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 03/16/2022] [Accepted: 03/29/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To test the (1) feasibility of an assistive technology based pillbox intervention on medication adherence; (2) feasibility of trial procedures; and (3) preliminary effectiveness of the pillbox intervention on medication adherence. DESIGN A single-blinded randomized controlled clinical trial was conducted during 2-4 weeks. SETTING Researchers recruited a convenience sample to participate in this university laboratory-based study. PARTICIPANTS English-speaking consumers of 2 or more daily medications (N=15) participated in the study. Individuals with cognitive impairment or who did not manage their own medications were excluded. INTERVENTIONS Participants were randomized to 1 of 3 pillbox interventions: (1) standard-of-care pillbox; (2) customized off-the-shelf pillbox; or (3) customized 3-dimensional (3D) printed pillbox. MAIN OUTCOME MEASURES Outcome measures were divided among the 3 goals of the study. In addition to feasibility metrics, the Adherence to Refills and Medications Scale was used to measure the primary outcome measure, medication adherence. The Quebec User Evaluation of Satisfaction with Assistive Technology was used to measure pillbox satisfaction. RESULTS Researchers successfully administered 6 standard-of-care, 5 custom off-the-shelf, and 4 custom 3D printed pillboxes. Compared with the standard-of-care pillboxes, customized 3D printed pillboxes had large (d=1.04) and customized off-the-shelf pillboxes had medium (d=0.67) effects on medication adherence. CONCLUSIONS Prescription of customized pillboxes using a manualized and novel assistive technology approach that leverages 3D printing is feasible.
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Affiliation(s)
- Jaclyn Schwartz
- Program in Occupational Therapy, Washington University in St. Louis School of Medicine, St. Louis, MO.
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO
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10
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Ong AD, Moskowitz JT, Wethington E, Addington EL, Sanni M, Goktas S, Sluys E, Swong S, Kim P, Reid MC. Lessons in Affect Regulation to Keep Stress and Pain UndeR control (LARKSPUR): Design of a randomized controlled trial to increase positive affect in middle-aged and older adults with fibromyalgia. Contemp Clin Trials 2022; 120:106880. [PMID: 35964867 PMCID: PMC9752979 DOI: 10.1016/j.cct.2022.106880] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 08/04/2022] [Accepted: 08/06/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Fibromyalgia syndrome (FMS) is a leading cause of functional limitations and disability for which there is no cure. Positive psychological interventions for improving health have received increasing attention, but evidence of the feasibility, acceptability, and impact of such interventions in adult populations with FMS is limited. OBJECTIVES To describe the rationale and design of a 5-week, online positive affect skills intervention, LARKSPUR: Lessons in Affect Regulation to Keep Stress and Pain UndeR control. METHODS FMS participants (N = 90) will be randomized to one of two conditions: (1) LARKSPUR or (2) emotion reporting/attention control. LARKSPUR is an online multicomponent intervention that targets eight skills to help foster positive affect: (1) noticing positive events, (2) savoring positive events, (3) identifying personal strengths, (4) behavioral activation to set and work toward attainable goals, (5) mindfulness, (6) positive reappraisal, (7) gratitude, and (8) acts of kindness. The primary outcomes include feasibility (i.e., recruitment, retention, adherence) and acceptability (i.e., helpfulness, usability, satisfaction). Secondary outcomes include pain intensity and pain interference. SIGNIFICANCE If feasibility and acceptability metrics are met and reductions in pain outcomes are achieved, we will undertake future efficacy and effectiveness trials of LARKSPUR among older adults with FMS. TRIAL REGISTRATION NCT04869345.
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Affiliation(s)
- Anthony D Ong
- Department of Psychology, Cornell University, USA; Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, USA.
| | - Judith T Moskowitz
- Department of Medical Social Sciences, Northwestern Feinberg School of Medicine, USA
| | - Elaine Wethington
- Department of Psychology, Cornell University, USA; Department of Sociology, Cornell University, USA; Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, USA
| | - Elizabeth L Addington
- Department of Medical Social Sciences, Northwestern Feinberg School of Medicine, USA
| | - Mubarak Sanni
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, USA
| | - Selin Goktas
- Department of Psychology, Cornell University, USA
| | - Erica Sluys
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, USA
| | - Sarah Swong
- Grossman School of Medicine, New York University, USA
| | - Patricia Kim
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, USA
| | - M Carrington Reid
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, USA
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Schwartz R, Osterberg LG, Hall JA. Physicians, emotion, and the clinical encounter: A survey of physicians' experiences. PATIENT EDUCATION AND COUNSELING 2022; 105:2299-2306. [PMID: 35287992 DOI: 10.1016/j.pec.2022.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Training in emotion management is not a standard part of medical education. This study's objective was to understand physicians' challenges navigating emotion (their own and their patients') and identify areas for intervention to support physician wellness and enhance patient care. METHODS In 2019, we surveyed 103 physicians in emergency medicine, internal medicine, family medicine, and neurology. Participants quantitatively reported emotion training, emotions that were challenging, and barriers to addressing emotion. They provided qualitative examples of emotion challenges and successes that we analyzed using an inductive thematic analysis. RESULTS There were no significant differences in responses by specialty. Only 10% reported receiving emotion management training, with no evidence that more recently trained physicians received more. Those who had received training on emotion reported greater comfort in dealing with patients' emotions and were more likely to engage in teaching on emotion. There were gender and career stage differences regarding which emotions physicians found most challenging. The authors identified central themes of emotion-related challenges and successes. CONCLUSIONS Targeted educational initiatives are needed to advance physicians' ability to navigate emotion in clinical encounters. PRACTICE IMPLICATIONS Developing strategies for managing patients' emotions may better prepare physicians for navigating the emotional demands of practicing medicine.
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Affiliation(s)
- Rachel Schwartz
- Stanford University School of Medicine, 1265 Welch Road, Stanford, CA 94305, USA.
| | - Lars G Osterberg
- Stanford University School of Medicine, 1265 Welch Road, Stanford, CA 94305, USA.
| | - Judith A Hall
- Department of Psychology, Northeastern University, 125 NI, Boston, MA 02115, USA.
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12
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Park KH, Tickle L, Cutler H. A systematic review and meta-analysis on impact of suboptimal use of antidepressants, bisphosphonates, and statins on healthcare resource utilisation and healthcare cost. PLoS One 2022; 17:e0269836. [PMID: 35767543 PMCID: PMC9242484 DOI: 10.1371/journal.pone.0269836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 05/28/2022] [Indexed: 12/02/2022] Open
Abstract
Background Depression, osteoporosis, and cardiovascular disease impose a heavy economic burden on society. Understanding economic impacts of suboptimal use of medication due to nonadherence and non-persistence (non-MAP) for these conditions is important for clinical practice and health policy-making. Objective This systematic literature review aims to assess the impact of non-MAP to antidepressants, bisphosphonates and statins on healthcare resource utilisation and healthcare cost (HRUHC), and to assess how these impacts differ across medication classes. Methods A systematic literature review and an aggregate meta-analysis were performed. Using the search protocol developed, PubMed, Cochrane Library, ClinicalTrials.gov, JSTOR and EconLit were searched for articles that explored the relationship between non-MAP and HRUHC (i.e., use of hospital, visit to healthcare service providers other than hospital, and healthcare cost components including medical cost and pharmacy cost) published from November 2004 to April 2021. Inverse-variance meta-analysis was used to assess the relationship between non-MAP and HRUHC when reported for at least two different populations. Results Screening 1,123 articles left 10, seven and 13 articles on antidepressants, bisphosphonates, and statins, respectively. Of those, 27 were rated of good quality, three fair and none poor using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. In general, non-MAP was positively associated with HRUHC for all three medication classes and most prominently for bisphosphonates, although the relationships differed across HRUHC components and medication classes. The meta-analysis found that non-MAP was associated with increased hospital cost (26%, p = 0.02), outpatient cost (10%, p = 0.01), and total medical cost excluding pharmacy cost (12%, p<0.00001) for antidepressants, and increased total healthcare cost (3%, p = 0.07) for bisphosphonates. Conclusions This systematic literature review is the first to compare the impact of non-MAP on HRUHC across medications for three prevalent conditions, depression, osteoporosis and cardiovascular disease. Positive relationships between non-MAP and HRUHC highlight inefficiencies within the healthcare system related to non-MAP, suggesting a need to reduce non-MAP in a cost-effective way.
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Affiliation(s)
- Kyu Hyung Park
- Macquarie Business School, Macquarie University, North Ryde, New South Wales, Australia
- * E-mail:
| | - Leonie Tickle
- Macquarie Business School, Macquarie University, North Ryde, New South Wales, Australia
| | - Henry Cutler
- Macquarie Business School, Macquarie University, North Ryde, New South Wales, Australia
- Macquarie University Centre for the Health Economy, North Ryde, Australia
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13
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Newcomb ME, Sarno EL, Bettin E, Conway A, Carey J, Garcia C, Hill R, Jozsa K, Swann G, Addington EL, Ciolino JD, Macapagal K, Moskowitz JT, Mustanski B, Whitton SW. Protocol for an attention-matched randomized controlled trial of 2GETHER: a relationship education and HIV prevention program for young male couples. Trials 2022; 23:514. [PMID: 35725624 PMCID: PMC9207885 DOI: 10.1186/s13063-022-06457-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Young men who have sex with men (YMSM) are disproportionately impacted by the HIV epidemic in the USA, and a large number of new infections among YMSM occur in the context of main or primary partnerships. At the same time, healthy romantic relationships promote health and wellbeing by improving social support and encouraging healthy behaviors. Thus, we created 2GETHER: a relationship education and HIV prevention program for young male couples. 2GETHER is delivered face-to-face in a university setting and is composed of two group sessions and two individualized skills coaching sessions. We observed strong support of the feasibility, acceptability, and preliminary efficacy of 2GETHER in a pilot trial. METHODS We are conducting an attention-matched randomized controlled trial (RCT) to test the efficacy of 2GETHER relative to a control condition based on a well-validated positive affect enhancement program. Enrollment occurred between August 2017 and March 2021 in Chicago and surrounding areas, and we enrolled and randomized 128 dyads (N = 256 individuals). Follow-up is ongoing and we will examine primary and secondary behavioral outcomes at 12 months post-intervention, with interim follow-up at 3, 6, and 9 months post-intervention. The primary biomedical outcome is sexually transmitted infection incidence at a 12-month follow-up. DISCUSSION 2GETHER is innovative in that it places an equal emphasis on relationship skill building and HIV prevention. Thus, the program has the potential to impact numerous health-related outcomes. Despite challenges related to the recruitment of couples and the COVID-19 pandemic, we were able to enroll a robust sample of young male couples with sufficient power to detect effects on study outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT03186534 .
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Affiliation(s)
- Michael E. Newcomb
- grid.16753.360000 0001 2299 3507Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL USA ,grid.16753.360000 0001 2299 3507Department of Medical Social Sciences, Northwestern University, Chicago, IL USA
| | - Elissa L. Sarno
- grid.16753.360000 0001 2299 3507Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL USA ,grid.16753.360000 0001 2299 3507Department of Medical Social Sciences, Northwestern University, Chicago, IL USA
| | - Emily Bettin
- grid.16753.360000 0001 2299 3507Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL USA ,grid.16753.360000 0001 2299 3507Department of Medical Social Sciences, Northwestern University, Chicago, IL USA
| | - Adam Conway
- grid.16753.360000 0001 2299 3507Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL USA ,grid.16753.360000 0001 2299 3507Department of Medical Social Sciences, Northwestern University, Chicago, IL USA
| | - James Carey
- grid.16753.360000 0001 2299 3507Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL USA ,grid.16753.360000 0001 2299 3507Department of Medical Social Sciences, Northwestern University, Chicago, IL USA
| | - Christopher Garcia
- grid.16753.360000 0001 2299 3507Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL USA ,grid.16753.360000 0001 2299 3507Department of Medical Social Sciences, Northwestern University, Chicago, IL USA
| | - Ricky Hill
- grid.16753.360000 0001 2299 3507Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL USA
| | - Kyle Jozsa
- grid.16753.360000 0001 2299 3507Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL USA
| | - Gregory Swann
- grid.16753.360000 0001 2299 3507Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL USA ,grid.16753.360000 0001 2299 3507Department of Medical Social Sciences, Northwestern University, Chicago, IL USA
| | - Elizabeth L. Addington
- grid.16753.360000 0001 2299 3507Department of Medical Social Sciences, Northwestern University, Chicago, IL USA
| | - Jody D. Ciolino
- grid.16753.360000 0001 2299 3507Department of Preventive Medicine, Northwestern University, Chicago, IL USA
| | - Kathryn Macapagal
- grid.16753.360000 0001 2299 3507Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL USA ,grid.16753.360000 0001 2299 3507Department of Medical Social Sciences, Northwestern University, Chicago, IL USA
| | - Judith T. Moskowitz
- grid.16753.360000 0001 2299 3507Department of Medical Social Sciences, Northwestern University, Chicago, IL USA
| | - Brian Mustanski
- grid.16753.360000 0001 2299 3507Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL USA ,grid.16753.360000 0001 2299 3507Department of Medical Social Sciences, Northwestern University, Chicago, IL USA
| | - Sarah W. Whitton
- grid.24827.3b0000 0001 2179 9593Department of Psychology, University of Cincinnati, Cincinnati, OH USA
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Brody LR, Firpo-Perretti Y, Bruck-Segal D, Dale SK, Ruffing EG, Cassiello-Robbins C, Weber KM, Cohen MH. Positive Psychological Factors and Life Themes in Relation to Health Outcomes in Women Living with HIV. Int J Behav Med 2021; 29:469-479. [PMID: 34713412 PMCID: PMC9046468 DOI: 10.1007/s12529-021-10032-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND This mixed methods study identified positive psychological factors and life themes expressed in autobiographical narratives of predominantly Black women living with HIV (WLWH) and investigated these in relation to depressive symptoms, antiretroviral therapy (ART) adherence (≥ 95% of time), and undetectable HIV viral load (VL) (< 80 copies/ml). METHOD Ninety-eight WLWH from the Women's Interagency HIV Study Chicago site (M age = 45.3; 91% Black) narrated three autobiographical life turning points, reliably coded for positive factors and life themes. ART adherence, VL and depressive symptoms, assessed with Center for Epidemiologic Studies Depression Scale total score (TOT) including its four factors (negative affect (NA), positive affect (PA), somatic symptoms (SS), and interpersonal problems (IP)), were collected over two time points: concurrently with narratives and 6 months later. Composite scores across the two time points were used in all analyses. RESULTS Ten positive psychological factors (gratitude, insight, compassion, meaning-making, acceptance, mindfulness, generativity, optimism, self-reliance, and benevolent God beliefs) and three positive life themes (health improvements, positive relationships, and accomplishments) were identified in narratives. Higher accomplishments, overall positive factors, insight, mindfulness, self-reliance, optimism, meaning-making, and acceptance related to lower depressive symptoms (TOT, NA, SS, or IP). Positive factors and life themes did not significantly relate to PA. Higher compassion related to higher ART adherence. Higher accomplishments related to undetectable VL independent of ART adherence. CONCLUSION Findings that positive psychological factors and life accomplishments may relate to better health, especially to lower depression, potentially contribute to developing positive psychology interventions for Black WLWH.
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Affiliation(s)
- Leslie R Brody
- Department of Psychological and Brain Sciences, Boston University, Boston, USA.
| | | | - Dana Bruck-Segal
- Department of Psychological and Brain Sciences, Boston University, Boston, USA
| | | | - Elizabeth G Ruffing
- Department of Psychological and Brain Sciences, Boston University, Boston, USA
| | | | - Kathleen M Weber
- Hektoen Institute of Medicine, Cook County Health and Hospitals System, Chicago, USA
| | - Mardge H Cohen
- Departments of Medicine, Stroger Hospital, Cook County Health and Hospitals System and Rush Medical School, Chicago, USA
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15
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Castillo-Mayén R, Luque B, Rubio SJ, Cuadrado E, Gutiérrez-Domingo T, Arenas A, Delgado-Lista J, Pérez-Martínez P, Tabernero C. Positive psychological profiles based on perceived health clustering in patients with cardiovascular disease: a longitudinal study. BMJ Open 2021; 11:e050818. [PMID: 34006562 PMCID: PMC8130737 DOI: 10.1136/bmjopen-2021-050818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES Psychological well-being and sociodemographic factors have been associated with cardiovascular health. Positive psychological well-being research is limited in the literature; as such, this study aimed to investigate how patients with cardiovascular disease could be classified according to their perceived mental and physical health, and to identify positive psychological profiles based on this classification and test their stability over time. DESIGN AND SETTING Longitudinal study with patients from a public hospital located in Córdoba (Spain). PARTICIPANTS This study comprised 379 cardiovascular patients (87.3% men) tested at three measurement points. OUTCOME MEASURES Participants reported their sociodemographic variables (age, sex, educational level, employment and socioeconomic status) at phase 1, while their perceived health and variables relating to positive psychological well-being were tested at this and two subsequent time points (average interval time: 9 months). RESULTS The two-step cluster analysis classified participants into three groups according to their mental and physical health levels, p<0.001: high (n=76), moderate (n=113) and low (n=189) perceived health clusters. Low perceived health was the largest cluster, comprising almost half of patients. Clusters significantly differed according to sex, p=0.002, and socioeconomic level, p=0.004. The profile analysis indicated that participants in the high perceived health cluster showed high positive affect, positivity, life satisfaction, and self-efficacy in emotion regulation, and less negative affect and use of passive strategies over the three measurement points (95% CI, all ps<0.01). Moreover, psychological profile stability for each cluster was generally found over an 18-month period, all ps<0.05. CONCLUSION Cardiovascular patients may differ in terms of their perceived health and, accordingly, in terms of other relevant variables. Perceived health clusters generated varying and generally stable psychological profiles based on positive psychological well-being variables. Psychological interventions should be adapted to patients' requirements.
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Affiliation(s)
- Rosario Castillo-Mayén
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
- Department of Psychology, University of Cordoba, Córdoba, Spain
| | - Bárbara Luque
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
- Department of Psychology, University of Cordoba, Córdoba, Spain
| | - Sebastián Jesús Rubio
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
- Department of Specific Didactics, University of Cordoba, Córdoba, Spain
| | - Esther Cuadrado
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
- Department of Psychology, University of Cordoba, Córdoba, Spain
| | - Tamara Gutiérrez-Domingo
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
- Department of Psychology, University of Cordoba, Córdoba, Spain
| | - Alicia Arenas
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
- Department of Social Psychology, University of Seville, Sevilla, Spain
| | - Javier Delgado-Lista
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Reina Sofia University Hospital, Córdoba, Spain
| | - Pablo Pérez-Martínez
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Reina Sofia University Hospital, Córdoba, Spain
| | - Carmen Tabernero
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
- Instituto de Neurociencias de Castilla y León, University of Salamanca, Salamanca, Spain
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16
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Kumar SR, Mehta CH, Nayak UY. Long-Acting Formulations: A Promising Approach for the Treatment of Chronic Diseases. Curr Pharm Des 2021; 27:876-889. [PMID: 32634073 DOI: 10.2174/1381612826666200707122012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 06/28/2020] [Indexed: 11/22/2022]
Abstract
Medication and patient adherence are the two main aspects of any successful treatment of chronic disease. Even though diseases and its treatment existed for several hundred years, the treatment optimization for a given patient is still a researcher question for scientists. There are differences in treatment duration, prognostic signs and symptoms between patient to patient. Hence, designing ideal formulation to suit individual patient is a challenging task. The conventional formulations like oral solids and liquids gives a partial or incomplete treatment because the patient needs to follow the daily pills for a longer time. In such cases, the long-acting formulations will have better patient compliances as drug will be released for a longer duration. Many such approaches are under the clinical investigation. The favorable pharmacokinetic and pharmacodynamic relationships, will be promising option for the treatment of chronic diseases. In this review, we have highlighted the importance of long-acting formulations in the treatment of chronic diseases and the advent of newer formulation technologies.
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Affiliation(s)
- Somaraju R Kumar
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Chetan H Mehta
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Usha Y Nayak
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
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Boehm JK. Positive psychological well‐being and cardiovascular disease: Exploring mechanistic and developmental pathways. SOCIAL AND PERSONALITY PSYCHOLOGY COMPASS 2021; 15:e12599. [PMID: 35860033 PMCID: PMC9285725 DOI: 10.1111/spc3.12599] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 01/15/2021] [Accepted: 03/18/2021] [Indexed: 12/29/2022]
Abstract
Empirical research regarding the health benefits of positive psychological well‐being (e.g., positive emotions, life satisfaction, purpose in life, and optimism) has flourished in recent years, particularly with regard to cardiovascular disease. This paper reviews the state of evidence for well‐being's association with cardiovascular disease in both healthy individuals and those diagnosed with a disease. Prospective studies consistently indicate well‐being reduces cardiovascular events in healthy and, to a lesser extent, patient populations. Potential pathways that link well‐being with cardiovascular disease are discussed (including health behaviors, physiological processes, and stress buffering), although the existing evidence is mostly cross‐sectional which limits conclusions about directionality. Issues related to development across the lifespan are considered and childhood is identified as a crucial period for establishing healthy cardiovascular trajectories. Outstanding questions for future research are provided with recommendations to focus on well‐powered and prospective study designs with rigorous assessment of both well‐being and cardiovascular‐related outcomes.
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Affiliation(s)
- Julia K. Boehm
- Department of Psychology Chapman University Orange California USA
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18
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Levine GN, Cohen BE, Commodore-Mensah Y, Fleury J, Huffman JC, Khalid U, Labarthe DR, Lavretsky H, Michos ED, Spatz ES, Kubzansky LD. Psychological Health, Well-Being, and the Mind-Heart-Body Connection: A Scientific Statement From the American Heart Association. Circulation 2021; 143:e763-e783. [PMID: 33486973 DOI: 10.1161/cir.0000000000000947] [Citation(s) in RCA: 233] [Impact Index Per Article: 77.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
As clinicians delivering health care, we are very good at treating disease but often not as good at treating the person. The focus of our attention has been on the specific physical condition rather than the patient as a whole. Less attention has been given to psychological health and how that can contribute to physical health and disease. However, there is now an increasing appreciation of how psychological health can contribute not only in a negative way to cardiovascular disease (CVD) but also in a positive way to better cardiovascular health and reduced cardiovascular risk. This American Heart Association scientific statement was commissioned to evaluate, synthesize, and summarize for the health care community knowledge to date on the relationship between psychological health and cardiovascular health and disease and to suggest simple steps to screen for, and ultimately improve, the psychological health of patients with and at risk for CVD. Based on current study data, the following statements can be made: There are good data showing clear associations between psychological health and CVD and risk; there is increasing evidence that psychological health may be causally linked to biological processes and behaviors that contribute to and cause CVD; the preponderance of data suggest that interventions to improve psychological health can have a beneficial impact on cardiovascular health; simple screening measures can be used by health care providers for patients with or at risk for CVD to assess psychological health status; and consideration of psychological health is advisable in the evaluation and management of patients with or at risk for CVD.
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Majeed A, Rehman M, Hussain I, Imran I, Saleem MU, Saeed H, Hashmi FK, Akbar M, Abrar MA, Ramzan B, Chaudhry MO, Islam M, Nisar N, Rasool MF. The Impact of Treatment Adherence on Quality of Life Among Type 2 Diabetes Mellitus Patients - Findings from a Cross-Sectional Study. Patient Prefer Adherence 2021; 15:475-481. [PMID: 33664567 PMCID: PMC7924113 DOI: 10.2147/ppa.s295012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 02/06/2021] [Indexed: 12/31/2022] Open
Abstract
AIM The current study was conducted to assess the factors contributing to treatment adherence and its impact on the quality of life (QoL) in type 2 diabetes mellitus (T2DM) patients. METHODS A cross-sectional study was conducted between January 2020 to March 2020 among T2DM patients. The data was collected from T2DM out-patient clinics. The participants were recruited by using a simple random sampling method. To assess the association of demographics with the level of adherence, binary logistics regression analysis was applied. Moreover, the Mann-Whitney U-test was used to evaluate the impact of adherence on QoL. RESULTS A total of 384 patients participated in this study. Amongst them, 60.2% were male and 39.8% were female. Low adherence was seen in illiterate patients and patients older than 40 years. The results showed that good QoL in T2DM patients was significantly associated with treatment adherence (p= 0.004). CONCLUSION The finding of the current study showed that the non-adherence prevailed in illiterate strata of the study population and the medication adherence significantly affects the QoL in T2DM patients. These findings suggest that health regulatory agencies should focus on implementing disease-education interventions for improving the adherence to medications in patients with long-term conditions.
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Affiliation(s)
- Abdul Majeed
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, 60800, Pakistan
| | - Muhammad Rehman
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, 60800, Pakistan
| | - Iltaf Hussain
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, 60800, Pakistan
| | - Imran Imran
- Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, 60800, Pakistan
| | - Muhammad Usman Saleem
- Department of Biosciences, Faculty of Veterinary Sciences, Bahauddin Zakariya University, Multan, 60800, Pakistan
| | - Hamid Saeed
- University College of Pharmacy, University of the Punjab, Allama Iqbal Campus, Lahore, 54000, Pakistan
| | - Furqan K Hashmi
- University College of Pharmacy, University of the Punjab, Allama Iqbal Campus, Lahore, 54000, Pakistan
| | - Muqarrab Akbar
- Department of Political Science, Bahauddin Zakariya University, Multan, 60800, Pakistan
| | - Muhammad Asad Abrar
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, 60800, Pakistan
| | | | | | - Muhammad Islam
- University College of Pharmacy, University of the Punjab, Allama Iqbal Campus, Lahore, 54000, Pakistan
| | - Naveed Nisar
- Department of Pharmaceutics, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, 60800, Pakistan
| | - Muhammad Fawad Rasool
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, 60800, Pakistan
- Correspondence: Muhammad Fawad Rasool Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University Multan, Multan, PakistanTel +923008639046 Email
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Positive and negative emotional expression measured from a single written essay about trauma predicts survival 17 years later in people living with HIV. J Psychosom Res 2020; 136:110166. [PMID: 32559504 DOI: 10.1016/j.jpsychores.2020.110166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 06/01/2020] [Accepted: 06/04/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To determine whether expression of positive and negative emotions measured within a single written trauma essay predicts survival over 17 years in people living with HIV. METHODS This is a longitudinal, observational study of a volunteer sample of HIV-seropositive individuals at the mid-range of disease (150-500 CD4-cells/mm3 with no prior AIDS-defining symptoms). Exclusion criteria included substance dependence, dementia, and/or psychosis. Baseline assessments occurred between 1997 and 1999 and survival data was collected in 2014 (17 year follow up). At baseline, participants wrote an essay about the most traumatic event in their life. Emotional expression was measured by the number of positive and negative emotional words in the essay. The primary study outcome measure was survival from baseline. Biomedical covariates included CD4 count, viral load, age, and antiretroviral medications. Sociodemographic covariates included gender, race, and education. RESULTS The sample was diverse in terms of age (M [SD] 37.60 [9.07]), sex (70.7% male), sexual orientation (55.5% gay or bisexual), and race/ethnicity (37.2% African American, 30.5% white, 28.0% Hispanic, and 4.3% other). Positive, negative, and total emotional expression predicted greater survival (ps < 0.015). Those in the top third of total emotional expression had 3.83 times the survival rate (95% CI: 1.62, 9.02) of those in the bottom third. Odds ratios were 1.85 for positive emotion expression and 2.18 for negative emotion expression. CONCLUSIONS Both positive and negative emotions expressed in a written trauma essay predict survival over 17 years in people living with HIV. Expressing emotions may have benefits for health.
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Moskowitz JT, Cheung EO, Freedman M, Fernando C, Zhang MW, Huffman JC, Addington EL. Measuring Positive Emotion Outcomes in Positive Psychology Interventions: A Literature Review. EMOTION REVIEW 2020. [DOI: 10.1177/1754073920950811] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Accumulating evidence for the unique social, behavioral, and physical health benefits of positive emotion and related well-being constructs has led to the development and testing of positive psychological interventions (PPIs) to increase emotional well-being and enhance health promotion and disease prevention. PPIs are specifically aimed at improving emotional well-being and consist of practices such as gratitude, savoring, and acts of kindness. The purpose of this narrative review was to examine the literature on PPIs with a particular focus on positive emotion outcomes. We evaluated the evidence on the effects of PPIs on positive emotion specifically, and discussed the range of evidence regarding the relative responsiveness of emotion measures to PPIs in order to gain a better understanding of the specific emotional pathways through which PPIs influence psychological and physical well-being. We conclude with recommendations for best evaluating effects of PPIs on positive emotion outcomes.
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Affiliation(s)
| | | | | | - Christa Fernando
- Department of Biomedical Sciences, Grand Valley State University, USA
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22
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Parks AC, Williams AL, Kackloudis GM, Stafford JL, Boucher EM, Honomichl RD. The Effects of a Digital Well-Being Intervention on Patients With Chronic Conditions: Observational Study. J Med Internet Res 2020; 22:e16211. [PMID: 31922491 PMCID: PMC6996718 DOI: 10.2196/16211] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/01/2019] [Accepted: 12/10/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Chronic conditions account for 75% of health care costs, and the impact of chronic illness is expected to grow over time. Although subjective well-being predicts better health outcomes, people with chronic conditions tend to report lower well-being. Improving well-being might mitigate costs associated with chronic illness; however, existing interventions can be difficult to access and draw from a single theoretical approach. Happify, a digital well-being intervention program drawing from multiple theoretical traditions to target well-being, has already been established as an efficacious means of improving well-being in both distressed and nondistressed users. OBJECTIVE This study aimed to compare change in well-being over time after using Happify for users with and without a chronic condition. METHODS Data were obtained from Happify users, a publicly available digital well-being program accessible via website or mobile phone app. Users work on tracks addressing a specific issue (eg, conquering negative thoughts) composed of games and activities based on positive psychology, cognitive behavioral therapy, and mindfulness principles. The sample included 821 users receiving at least 6 weeks' exposure to Happify (ranging from 42 to 179 days) who met other inclusion criteria. As part of a baseline questionnaire, respondents reported demographic information (age and gender) and whether they had any of the prespecified chronic conditions: arthritis, diabetes, insomnia, multiple sclerosis, chronic pain, psoriasis, eczema, or some other condition (450 reported a chronic condition, whereas 371 did not). Subjective well-being was assessed with the Happify Scale, a 9-item measure of positive emotionality and life satisfaction. To evaluate changes in well-being over time, a mixed effects linear regression model was fit for subjective well-being, controlling for demographics and platform usage. RESULTS At baseline, users with a chronic condition had significantly lower subjective well-being (mean 38.34, SD 17.40) than users without a chronic condition (mean 43.65, SD 19.13). However, change trajectories for users with or without a chronic condition were not significantly different; both groups experienced equivalent improvements in well-being. We also found an effect for time from baseline (b=0.071; SE=0.010; P<.01) and number of activities completed (b=0.03; SE=0.009; P<.01), and a 2-way interaction between number of activities completed and time from baseline (b=0.0002; SE=0.00006; P<.01), such that completing more activities and doing so over increasingly longer periods produced improved well-being scores. CONCLUSIONS Data from this study support the conclusion that users with a chronic condition experienced significant improvement over time. Despite reporting lower subjective well-being on the whole, their change trajectory while using Happify was equivalent to those without a chronic condition. Consistent with past research, users who completed more activities over a longer period showed the most improvement. In short, the presence of a chronic condition did not prevent users from showing improved well-being when using Happify.
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