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Wang S, Song J, Lee C, Jiang J, Wang M, Liu D, Wang Z, Yuan Y, Li W, Zhou R, Zheng H, Wei J, Hu Y, Wu T, Tian Z, Chen H. Gender disparities in the mediating role of symptom knowledge level in reducing acute coronary syndrome (ACS) decision delay: Findings from a community-based study in China. BMC Emerg Med 2023; 23:146. [PMID: 38104084 PMCID: PMC10725594 DOI: 10.1186/s12873-023-00916-5] [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: 02/13/2023] [Accepted: 12/07/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Implementing training programs to educate patients on the prodromal symptoms of acute coronary syndrome (ACS) may assist patients in accurately recognizing these symptoms, and ultimately decrease their time delay in seeking emergency medical services (EMS). However, the effectiveness of this approach remains uncertain, particularly among the Chinese population. METHODS A cross-sectional study was conducted within 22 communities in Beijing, China between 2015 and 2018, with a total of 1099 participants recruited. The study utilized a standardized questionnaire to evaluate the presence of intentional decision delay in turning to EMS under a hypothetical chest pain, the participants' knowledge of ACS prodromal symptoms, and whether they had ever received any training programs aimed at increasing their symptom knowledge. Mediation analysis was performed with regression models and bootstrapping methods, and gender difference was further analyzed through moderated mediation analysis. RESULTS A total of 1099 participants (58.2% female, median [IQR] age 34 [20]) were included in the study. The results of the mediation analysis indicated that training programs were associated with a decrease risk in decision delay, with increased knowledge playing a mediating role (mediation effect/total effect = 36.59%, P < 0.0001). Gender modified this mediation effect, with it being observed only in the male group. Specifically, training programs were not found to significantly decrease decision delay among females (P > 0.05), even though they did improve women's knowledge of ACS prodromal symptoms (β = 0.57, P = 0.012). CONCLUSION The results suggested a relationship between prior training programs and reduced decision delay, with increased knowledge of prodromal symptoms of ACS serving as a mediator. However, the effect was only observed in male participants and not in female participants. This highlights the notion that mere transfer of knowledge regarding ACS prodromal symptoms may not be sufficient to mitigate decision delay in the female population. Further research is needed to corroborate these results and to gain deeper insights into the gender-specific barriers encountered in this study.
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Affiliation(s)
- Siyue Wang
- Peking University Health Science Center, Beijing, China
| | - Junxian Song
- Center for Cardiovascular Translational Research, Peking University People's Hospital Beijing, Beijing, China
| | - Chongyou Lee
- Center for Cardiovascular Translational Research, Peking University People's Hospital Beijing, Beijing, China
| | - Jin Jiang
- Peking University Health Science Center, Beijing, China
| | - Mengying Wang
- Peking University Health Science Center, Beijing, China
| | - Dongjing Liu
- Peking University Health Science Center, Beijing, China
| | - Zhuqing Wang
- Peking University Health Science Center, Beijing, China
| | - Yuan Yuan
- Peking University Health Science Center, Beijing, China
| | - Wenyong Li
- Peking University Health Science Center, Beijing, China
| | - Ren Zhou
- Peking University Health Science Center, Beijing, China
| | | | - Jianmin Wei
- Beijing Red Cross Emergency Rescue Center, Beijing, China
| | - Yonghua Hu
- Peking University Health Science Center, Beijing, China.
| | - Tao Wu
- Peking University Health Science Center, Beijing, China.
- Institute of Reproductive and Child Health/Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Beijing, China.
| | - Zhenbiao Tian
- Beijing Red Cross Emergency Rescue Center, Beijing, China
| | - Hong Chen
- Center for Cardiovascular Translational Research, Peking University People's Hospital Beijing, Beijing, China
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Patierno C, Fava GA, Carrozzino D. Illness Denial in Medical Disorders: A Systematic Review. PSYCHOTHERAPY AND PSYCHOSOMATICS 2023; 92:211-226. [PMID: 37429268 DOI: 10.1159/000531260] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 05/23/2023] [Indexed: 07/12/2023]
Abstract
INTRODUCTION Illness denial pertains to medical patients who do not acknowledge the presence or severity of their disease or the need of treatment. OBJECTIVE This systematic review was performed to clarify the clinical role and manifestations of illness denial, its impact on health attitudes and behavior, as well as on short- and long-term outcomes in patients with medical disorders. METHODS The systematic search according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines was conducted on PubMed, Scopus, and Web of Science. RESULTS The initial search yielded a total of 14,098 articles; 176 studies met the criteria for inclusion. Illness denial appeared to be a relatively common condition affecting a wide spectrum of health attitudes and behavior. In some cases, it may help a person cope with various stages of illness and treatment. In other situations, it may determine delay in seeking treatment, impaired adherence, and reduced self-management, leading to adverse outcomes. The Diagnostic Criteria for Psychosomatic Research (DCPR) were found to set a useful severity threshold for the condition. An important clinical distinction can also be made based on the DCPR for illness denial, which require the assessment of whether the patient has been provided with an adequate appraisal of the medical situation. CONCLUSIONS This systematic review indicates that patients with medical disorders experience and express illness denial in many forms and with varying degrees of severity. The findings suggest the need for a multidimensional assessment and provide challenging insights into the management of medical disorders.
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Affiliation(s)
- Chiara Patierno
- Department of Psychology "Renzo Canestrari," University of Bologna, Bologna, Italy
| | - Giovanni A Fava
- Department of Psychiatry, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Danilo Carrozzino
- Department of Psychology "Renzo Canestrari," University of Bologna, Bologna, Italy
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Human umbilical cord mesenchymal stem cells ameliorate depression by regulating Jmjd3 and microglia polarization in myocardial infarction mice. Psychopharmacology (Berl) 2021; 238:2973-2984. [PMID: 34374805 DOI: 10.1007/s00213-021-05912-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 06/24/2021] [Indexed: 10/20/2022]
Abstract
RATIONALE Microglia regulate the inflammation of the central nervous system and play a crucial role in the pathogenesis of depression. Moreover, Jmjd3 is involved in microglia polarization. Mounting studies reported the beneficial effects of human umbilical cord mesenchymal stem cells (HUC-MSCs) on myocardial infarction (MI), Unfortunately, its effects on MI-induced depression and its underlying mechanisms remain unclear. OBJECTIVES We aimed to investigate the antidepressant effects of HUC-MSCs and their impacts on microglia polarization. METHODS In the current study, the MI model was established by ligating the left anterior descending coronary artery. Mice were injected with HUC-MSCs or PBS through the tail vein 1week after the surgery. The sucrose preference test (SPT), tail suspension test (TST), and forced swim test (FST) were performed to evaluate depression-like behavior. Cardiac function and myocardial fibrosis were evaluated at the end of the experiments. Immunofluorescence, Western blot, ELISA, and qRT-PCR were used to detect the levels of Jmjd3 and microglia-related markers and inflammatory factors. RESULTS HUC-MSC treatment significantly improved cardiac function, reduced the area of myocardial fibrosis, and alleviated depression-like behaviors induced by MI. HUC-MSCs inhibited the expression of Jmjd3 and promoted the switch of microglia in the prefrontal cortex, hypothalamus, and hippocampus from M1 to M2, thereby decreased the level of pro-inflammatory factors. CONCLUSION HUC-MSCs have cardioprotective and potential anti-depressive effects induced by MI related to the inflammation improved by regulating Jmjd3 and microglial polarization.
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Zhang Y, Wu S, Pan J, Hoschar S, Wang Z, Tu R, Ladwig KH, Ma W. The impact of the Type D Personality pattern on prehospital delay in patients suffering from acute myocardial infarction. J Thorac Dis 2020; 12:4680-4689. [PMID: 33145041 PMCID: PMC7578491 DOI: 10.21037/jtd-20-1546] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background The Type D Personality (TDP) has been specifically linked to acute myocardial infarction (AMI). However, the impact on prehospital delay of AMI patients is unclear. The aim of this study was to assess the relationship between TDP and pre-hospital delay time (PHT) in a Chinese population. Methods A total of 256 AMI patients (47 women and 209 men) were taken from the Multicenter Delay in Patients Experiencing AMI in Shanghai (MEDEA FAR-EAST) study. Sociodemographic and psycho-behavioral characteristics were assessed by bedside interviews and questionnaires. TDP was evaluated according to the Type D Personality Scale (DS14) subdivided in social inhibition (SI) and negative affectivity (NA). Based on a significant interaction analysis of TDP and sex on PHT, all analyses were stratified by sex. Results PHT of female patients with TDP were substantially shorter compared to non-TDP female patients (108 vs. 281 min, P=0.029). In male patients, no effect of TDT on PHT was found. Spearman correlation analysis suggests that NA was negatively correlated with PHT (r=−0.358, P=0.014). Further age-adjusted logistic regression analyses showed that female patients with TDP were generally less likely to prehospital delay compared with non-TDP patients (OR =0.28; 95% CI, 0.08–0.98) and had a lower risk of PHT >360 minutes (OR =0.10; 95% CI, 0.01–0.91). However, statistical significance disappeared after adjustment for psychological factors (anxiety, depression, suboptimal wellbeing, cardiac denial and stress event). Conclusions TDP is associated with less prehospital delay in female patients during AMI—an effect which may be particularly mediated by NA.
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Affiliation(s)
- Youyang Zhang
- Department of Cardiology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shihao Wu
- Department of Geriatrics, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jiangqi Pan
- Department of Cardiology, Gongli Hospital, Navy Military Medical University, Shanghai, China
| | - Sophia Hoschar
- Institute of Epidemiology, Mental Health Research Unit, Helmholtz Zentrum München, German Research Center for Environmental Health (HMGU), Neuherberg, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Zhen Wang
- Department of General Practice, Jiangning Hospital, Nanjing Medical University, Nanjing, China
| | - Rongxiang Tu
- Department of Cardiology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Karl-Heinz Ladwig
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Rechts der Isar, Technische Univerität Munich (TUM), Munich, Germany
| | - Wenlin Ma
- Department of Cardiology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China.,Department of Geriatrics, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
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Chen Y, Fang X, Shuai X, Fritzsche K, Leonhart R, Hoschar S, Li L, Ladwig KH, Ma W, Wu H. Psychometric Evaluation of the Major Depression Inventory (MDI) as a Depression Severity Scale in Chinese Patients With Coronary Artery Disease. Findings From the MEDEA FAR-EAST Study. Front Psychiatry 2019; 10:493. [PMID: 31379618 PMCID: PMC6656859 DOI: 10.3389/fpsyt.2019.00493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 06/24/2019] [Indexed: 12/19/2022] Open
Abstract
Background: It is highly recommended that all patients with coronary artery disease should be screened for depression. The Major Depression Inventory (MDI) is a widely used self-rating scale for the assessment of depression but is not valid in Chinese language. The present study was designed to assess the reliability and validity of a version of the MDI translated into Chinese among patients with acute myocardial infarction (AMI). Methods: Data were derived from the "Multicenter Delay in Patients Experiencing Acute Myocardial Infarction in Shanghai" (MEDEA FAR-EAST) study. Using a cross-sectional study design, the Chinese version of the MDI was administered to a total of 267 inpatients. The internal consistency reliability of the MDI scale was evaluated based on the Cronbach's coefficient and the binary coefficient for the whole scale. Exploratory factor analysis was performed to assess the internal consistency of the MDI. To examine discriminant validity, we analyzed the correlation of the MDI score with the General Anxiety Disorder-7 (GAD-7) and World Health Organization-5 Well-Being Index (WHO-5) scale scores. Results: The Chinese version of the MDI showed high reliability (Cronbach's alpha = 0.909, split-half reliability = 0.866). We identified one factor that explained 52% of the variance, which indicated that the MDI has satisfactory structural validity. The correlations of the MDI scores with the GAD-7 scores (r = 0.425) and the WHO-5 scores (r = -0.365) were moderate, suggesting that the MDI has acceptable discriminant validity. Conclusions: The MDI was proved to be a highly reliable and satisfactory valid diagnostic screening tool to assess depression in Chinese cardiac patients.
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Affiliation(s)
- Yixiao Chen
- Department of Psychosomatic Medicine, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaoyan Fang
- Institute of Epidemiology II, Mental Health Research Unit, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Technical University Munich, Munich, Germany
| | - Xueqian Shuai
- Department of Psychosomatic Medicine, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Kurt Fritzsche
- Department of Psychosomatic Medicine and Psychotherapy, Faculty of Medicine, Medical Center University of Freiburg, Freiburg, Germany
| | - Rainer Leonhart
- Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Sophia Hoschar
- Institute of Epidemiology II, Mental Health Research Unit, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Faculty of Medicine, Medical Center University of Freiburg, Freiburg, Germany
| | - Li Li
- College of Electronics and Information Engineering, Tongji University, Shanghai, China
| | - Karl-Heinz Ladwig
- Institute of Epidemiology II, Mental Health Research Unit, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Technical University Munich, Munich, Germany
| | - Wenlin Ma
- Department of Cardiology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Heng Wu
- Department of Psychosomatic Medicine, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
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