Asthma patients and their partners: gender differences in the relationship between psychological distress and patient functioning

Mediation analysis of relationships between chronic inflammation and quality of life in older adults

Background

This article summarizes exploratory analyses of relationships between chronic inflammation, its physical consequences, and quality of life (QoL). It summarizes key findings from preliminary analyses, and contextualizes these results with extant sociomedical literature to recommend directions for future research.

Methods

Cross-sectional data from the National Social Life, Health, and Aging Project (NSHAP) were used to explore these relationships. Inflammation was assessed via the biomarker C-reactive protein (CRP). We examined associations between CRP levels and two different domains of QoL: happiness with life in general and happiness with intimate relationships. We used ordinal logistic regression with companion OLS models and Sobel-Goodman tests to assess potential mediation, and also conducted a variety of sensitivity analyses.

Results

Findings suggest that mediation pathways for the overall association between chronic inflammation and QoL may differ markedly across particular outcome constructs. Specifically, it shows mediation potential for the clinical sequelae of chronic inflammation in frameworks using happiness as an outcome measure, but not in those using relationship satisfaction. Disability appears to mediate the effect of inflammation by 27 %; chronic pain appears to exert a similar mediation effect of 21 %.

Conclusions

Pain and disability linked to chronic inflammation appear to play a small but significant mediating role in the overall reduction in QoL observed among older adults with biomarker evidence of chronic inflammation. We note that these patterns are best framed as dynamic elements of a complex causal fabric, rather than powerful determinants that override other factors contributing to QoL. Hypotheses for further exploration using longitudinal data from the NSHAP are thus offered, pending availability of Wave III data in future years.

The importance of relationship in understanding the experiences of spouse mental health carers

The burden of caring for family members with mental illness has been researched extensively; however, knowledge of spouse carers' experiences is limited. In this article, we explore this from a carers' perspective, with 28 spouse carers, using qualitative open-ended semistructured interviews and a grounded theory approach informed by the social interactionism tradition to collect and analyze the data. We present six interrelated themes around the central theme of this being "a real and genuine relationship." The findings indicate that caring for a spouse with severe mental illness is a unique role compared with other caring roles. First and foremost, spouse carers strive for the relationship with their partner and accommodate mental illness into their lives to protect the relationship. Because of this, they often lead surreal lives marked by significant emotional pressure and isolation. This has implications for how mental health service providers work with and support spouse carers.

Understanding and resolving adherence problems

The expert panel report version 2 (EPR-2) is a comprehensive set of recommendations for the evaluation and treatment of asthma. However, physicians demonstrate scant adoption of many of the key evaluation and treatment components of the EPR-2, with primary care physicians being less likely to adopt EPR-2 recommendations than specialist physicians. Patients also demonstrate very limited adoption of physician recommendations, such as the use of medications as prescribed. Predictors of physician and patient nonadherence are reviewed, as modifiable predictors may be targets for interventions to enhance adherence. Finally, areas for future efforts are identified.

Men's cardiovascular and pulmonary health

Heart disease in men is declining steadily, but it remains the number one killer of men in the United States. CLRD, influenza/pneumonia, and lung cancer are three more causes of top 10 mortalities in men. Epidemiological and clinical studies conclude that CVD is largely preventable through lifestyle modification. CHD, COPD, occupational lung disease, and lung cancer are all preventable by primary prevention (ie, no cigarette smoking). All men should be counseled about the grave significance of heart and lung disease as a cause of illness and death, the importance of primary prevention, and the great variability in symptom presentation. Nurses are in the ideal position to educate patients, families, and colleagues about heart and lung disease.

Psychiatric issues in pulmonary disease

This article has attempted to provide an overview of the clinical literature regarding the psychological issues facing patients with pulmonary disease, depending on when the illness begins in the life span, because different developmental tasks are disrupted. Patients must contend with side effects of medication that may mimic or exacerbate psychiatric disorders. The main drug interactions for psychiatrists to be aware of in this patient population occur between rifampin, or theophylline and psychotropic medications. In lung transplant recipients on cyclosporine therapy, the antidepressant drug nefazadone may cause increased cyclosporine levels. Psychiatrists must be aware of the risks, benefits, and survival statistics; educate patients; and ascertain whether the patient is competent to make medical decisions regarding treatment procedures.