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Attachment style predict compliance, quality of life and renal function in adult patients after kidney transplant: Preliminary results
Abstract
Aim:
Aim of this study was to evaluate the association between attachment style, compliance, quality of life and renal function in adult patients after kidney transplantation.
Methods:
A total of 43 adult patients who received a kidney transplant more than 3 months before were enrolled and were asked to complete two Self-Report questionnaires: Attachment Style Questionnaire (ASQ-40) and Short Form Health Survey (SF-36). Also compliance was measured using appropriate questions.
Results:
Linear regression analysis showed associations between the confidence in relationships (ASQ-40) and compliance [beta = -0.37; B = -0.02; t(41) = -2.51; p = 0.02]; aspects of anxious attachment style (ASQ-40) and creatinine levels [beta = 0.3; B = 0.13; t(41) = 2.03; p = 0.04]; aspects of avoidant attachment style (ASQ-40) and compliance [beta = -0.37; B = -3.15; t(41) = -2.35; p = 0.02]. Patients who exhibited avoidant attachment had a significantly better perception of their own general health than patients with anxious [F(2,37) = 6.8; p < 0.05] or secure attachment; however, they had a worse perception regarding role limitations due to emotional problems, compared to patients with anxious attachment [F(2,37) = 6.4; p < 0.05].
Discussion:
The results of this study suggest that the evaluation of the attachment style in adult kidney transplant patients can contribute to plan a goal-directed psychological support program for these patients, in order to increase their compliance. The association between aspects of anxious attachment style and creatinine level needs more investigations.
... Following the medical procedure, certain aspects of convalescence (e.g., side effects of drugs such as corticosteroids, fear of transplant rejection, sense of carrying a foreign organ) may lead to the development of mental disorders such as anxiety and depression (De Pasquale et al., 2014;Landreneau, Lee, & Landreneau, 2010;Pawar et al., 2006;Vásquez, Novarro, Valdés, & Britton, 2013). These psychological disorders have been associated with noncompliance with medication use and personal care instructions, compromised quality of life, and difficulty in integrating the newly acquired graft into their sense of self (Baines, Joseph, & Jindal, 2004;Calia et al., 2015aCalia et al., , 2015b. ...
... In this regard, individuals with greater resources are often less vulnerable to resource loss, more capable of resource gain, and able to take risks than their resource-challenged counterparts (Hobfoll, 1998). Thus, we focus on two of the main personal resources, which were previously found to be central in dealing with chronic conditions, namely, coping flexibility (e.g., Roussi, Krikeli, Hatzidimitriou, & Koutri, 2007, among women with breast cancer), and attachment patterns (e.g., Calia et al., 2015b, among patients after kidney transplant). ...
... Both anxious and avoidant attachment patterns were found to be linked with increased reports of health problems (see Mikulincer & Shaver, 2016), and with long-term negative effects on physical well-being (Puig, Englund, Simpson, & Collins, 2013). Moreover, Calia et al.'s (2015b) findings indicated that higher levels of attachment anxiety/avoidance were significantly associated with reduced levels of compliance and quality of life in adult patients after kidney transplantation. Thus, attachment patterns may be an important factor for adjusting to organ transplants. ...
Background and Objectives: Post-transplant kidney recipients may experience psychological concerns which have been associated with negative health behaviors. Illness acceptance might have an important role in this process. In line with the Conservation of Resources Theory (COR), the current study aimed to examine the relationship between coping flexibility, attachment patterns and illness acceptance among post-transplant kidney recipients, and to evaluate whether attachment patterns moderate the link between coping flexibility and illness acceptance.
Design: The study employed a cross-sectional design.
Methods: Ninety-four post-transplant kidney recipients completed questionnaires assessing demographic and medical characteristics, illness acceptance, coping flexibility and attachment patterns.
Results: Our results indicated that coping flexibility was positively associated with illness acceptance. Moreover, attachment moderated this link, as high coping flexibility was associated with increased illness acceptance among individuals with low levels of attachment anxiety, a finding which was not significant when high levels of anxiety were reported.
Conclusions: This study highlights the potential importance of building greater flexibility in order to enhance illness acceptance among kidney transplants recipients. Moreover, the role of insecure attachment patterns in health-related outcomes among kidney transplants recipients is emphasized.
... It has been shown that some psychological characteristics such as attachment style and alexithymia may affect compliance, quality of life, and renal function in patients undergoing kidney transplant. A greater difficulty in emotional, social, and mental health functioning was found in recipients receiving kidney from mother living donor indicating that the donor characteristics (parent derived or multi-organderived) may affect psychological status and quality of life (Calia et al., 2015a(Calia et al., , 2015b(Calia et al., , 2015c. Even though only a little portion of patients demonstrate depression and anxiety states after transplantation, some authors argue that both depression and anxiety can be reduced in the post-transplant period (Kadioglu et al., 2012). ...
... In addition to the autonomic benefits, exercise training promotes a better quality of life and reduces the rates of anxiety and depression (Calia et al., 2015a;Romano et al., 2010). As seen in our study, renal transplant recipients subjected to 10 weeks of exercise showed improved quality and quantity of sleep (Calia et al., 2015a;Pooranfar et al., 2014). ...
... In addition to the autonomic benefits, exercise training promotes a better quality of life and reduces the rates of anxiety and depression (Calia et al., 2015a;Romano et al., 2010). As seen in our study, renal transplant recipients subjected to 10 weeks of exercise showed improved quality and quantity of sleep (Calia et al., 2015a;Pooranfar et al., 2014). ...
The aim of this study was to compare the sleep quality (PSQI), depression, anxiety and, autonomic function of a group of kidney-transplanted recipients (KTR) who joined a combined exercise program (KTRt) or remained sedentary (KTRs). 20 kidney-transplanted split into two groups (10 KTRt and 10 KTRs) joined the study. Heart rate variability, cardiorespiratory capacity, depression and sleep questionnaires were evaluated. KTRt presented lower PSQI and greater entropy, increased parasympathetic and decreased sympathetic modulation than KTRs. Anxiety level was minimal and depression absent in both groups. KTRt group presented better sleep quality and better autonomic modulation than KTRs.
Keywords: Kidney transplantation, exercise, autonomic balance, sleep, anxiety
... A study of Calia et al. evaluated the association between attachment style, compliance, quality of life, and renal function in adult patients after kidney transplantation [44]. Although this study did not directly assess personality functioning, it included measures of alexithymia, emotional self-efficacy and attachment, which are all considered part of personality functioning/structural integration. ...
... Patients with avoidant attachment had a significantly better perception of their own general health than patients with anxious attachment. Calia et al. suggested that the evaluation of the attachment style in adult kidney transplant patients can increase compliance with goal-directed psychological support program for these patients [44]. In another study, they evaluated the associations between alexithymia or emotional self-efficacy and compliance in renal transplant patients. ...
Background
Personality functioning, also referred to as structural integration, describes basic emotion-related perception and regulation capacities directed towards the self and others. Patients with impairments of personality functioning experience difficulties in self-regulation and interpersonal relations. Although personality functioning has become increasingly important in psychotherapeutic and psychiatric diagnoses and treatment planning, there is little systematic evidence on the role of personality functioning in patients with chronic and somatic diseases. This article reviews empirical studies using standardized assessments of personality functioning in patients with chronic and somatic diseases and discusses the role of personality structure in psychosomatic medicine.
Results
Currently, there are only a limited number of studies using standardized assessments of personality functioning in patients with chronic or somatic diseases. The available evidence points to correlations of personality functioning with pain perception and the development of chronic pain. In addition, patients with lower levels of personality functioning may have difficulties in managing chronic conditions that require enduring changes in health behavior, such as in diabetes or posttransplantation therapy.
Conclusion
The review suggests a systematic link between personality functioning and health behavior in patients with chronic diseases that relate to self-regulation and coping strategies. These findings underline the importance of assessing personality functioning for diagnostics and treatment planning in psychosomatic medicine. Finally, an assessment of personality functioning could be helpful in choosing specific psychotherapeutic treatment strategies; however, more empirical studies are needed to comprehensively prove these assumptions.
... The medical adherence, definable as the extent to which a person's behavior coincides with medical or therapeutic advice, is pivotal to prevent organ rejection in every type of solid organ transplant [9]. There are few studies focused on the medical adherence and the organ functioning after transplantation, however it has been found that psychological symptoms and insecure attachment style can be risk factors for the aforementioned outcomes, resulting in an increased risk of organ rejection [12,19]. ...
... As previously noted, it was relevant that in 19 studies, the organ functioning has been never considered as an outcome. It seems important to plan future studies considering the effect of the psychosocial treatment also on the adherence to the medical care and on the biological outcome in order to increase an integrative and holistic insight in taking care of the patients and to plan intervention oriented to increase acceptance of the organ, to reduce mortality and health costs [19]. ...
Objective
Transplantation represents an important source of hope for the candidates and produces an intense emotional effect. Psychosocial interventions can be helpful in all transplantation stages to better manage this extraordinarily stressful situation. Aim of the work is to verify the effects of the psychosocial interventions on recipients on psychological symptoms, medical adherence and transplanted solid organ functioning.
Methods
This work adhered to PRISMA, STROBE, Cochrane and New Castle Ottawa bias scales and it is registered in PROSPERO. Inserting “Transplant” and “Psychological intervention” as key words in PubMed, Psycinfo, Cochrane database resulted 977 studies from 2001 to 2021. A systematic review and metanalyses were processed on nineteen randomized controlled trials and observative prospective cohort studies. The difference between pre- and post- psychosocial intervention assessment on the psychological variables, medical adherence, and organ functioning outcome was processed.
Results
Main findings showed that the psychosocial interventions were effective on depression (0.62; CI: 0.32–0.92) and anxiety on kidney recipients (0.49; CI: 0.17–0.81), and on anxiety on heart recipients, mainly when administrated after the surgery (0.68; CI: 0.30–1.06). Moreover, the findings showed a lack of studies on the effectiveness of the psychosocial intervention on organ functioning.
Conclusion
The work highlighted the effectiveness of the psychosocial interventions on psychological outcome, particularly after the surgery and the need to address the research on the evaluation of the effectiveness of the psychosocial interventions on the organ functioning. The findings suggest to integrate the transplantation procedures with psychosocial interventions considering the different needs of recipients in relation to the specific transplanted organ.
... Enhancing encouragement from family members is very important to support their patient and making him co-responsible for treatment and is considered the best way to fight patient absenteeism from dialysis sessions. This result is inconsistent with Calia et al., (2015) [27] who showed that, there was no statistically significant relation between social function and compliance. ...
... Enhancing encouragement from family members is very important to support their patient and making him co-responsible for treatment and is considered the best way to fight patient absenteeism from dialysis sessions. This result is inconsistent with Calia et al., (2015) [27] who showed that, there was no statistically significant relation between social function and compliance. ...
Hemodialysis is the most common treatment modality for patients with end stage renal disease. The functional status of patients who underwent hemodialysis is decreased over time and may affect the patients' compliance with the treatment process. Aim: This study aimed to determine the relation between therapeutic compliance and functional status of patients undergoing hemodialysis through the following: (1) Assessment of functional status of patients undergoing hemodialysis. (2) Assessment of therapeutic compliance of patients undergoing hemodialysis. (3) Determine the relation between functional status and therapeutic compliance for patients undergoing hemodialysis. Study design: A descriptive-correlational research design was used to achieve the aim of this study. Setting: This study was carried out in the Hemodialysis Unit at Edku General Hospital affiliated to Health Insurance Hospitals at Elbeheira Governorate, Egypt. Subjects: A convenience sample of all patients (n=100 patients) undergoing hemodialysis in Hemodialysis Unit in Edku General Hospital were recruited to participate in this study. Data collection tools: (1) Patients' assessment tool: to assess demographic characteristics and clinical data of patients. (2) End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ): to assess therapeutic compliance for patients undergoing hemodialysis. (3) Choice Health Experience Questionnaire (CHEQ): to assess functional status of patients undergoing hemodialysis. Results: The results of the study showed that 69% of the studied patients were non-compliant to their therapeutic regimen, and 81% of them had poor level of functional status. Conclusion: The study concluded that there was statistically significant relation between overall functional status of patients undergoing hemodialysis and overall compliance with the therapeutic regimen. Recommendations: It is recommended to develop and educational booklet for patients undergoing hemodialysis to improve their adherence to the treatment regimen.
... 12 In this context, factors such as negative beliefs and attitudes towards medication or treatment, [13][14][15][16] as well as adherence barriers 14,16,17 were previously examined and found to be significantly associated with adherence behavior. However, various other patient-related factors have been linked to medication NA in renal transplant recipients as well, such as depression, 13,15,[18][19][20] anxiety, 13,18 sex, [21][22][23] education, 20,21 marital status, 13,24 lower self-efficacy, 22,25,26 avoidant attachment, 27 lower social support, 18,21,28,29 lower quality of life, 14,28 non-white ethnicity, 4,20 higher frequency of medication intake, [30][31][32][33][34] type of renal graft, 20,35 longer time since transplantation, 20,23,36 and younger age. 2,4,20,24,28,36 Still, there are many contradictory findings in the current research, due to different measurement methods of NA. 28 A bandwidth of direct and indirect measurement methods for NA has emerged lately: Direct measures include direct observation, measurement of immunosuppressive (IS) levels or biomarkers in the blood, whilst indirect measures comprise pill counts, self-reports, physicians' reports, pharmacy records, or electronic monitoring (EM). ...
... [41][42][43][44][45] Although highly debated, some research considers EM the best measure of adherence currently available. 4,11,46 To our knowledge, most studies rely on self-reports, physician's estimates, or IS levels in the blood when examining possible determinants for NA, 13,15,17,18,21,23,[25][26][27][28]36 whilst only a few have examined this association by applying EM. 22,24,30,31,35 Therefore, the aim of this study was to investigate the associations between electronically monitored adherence and patient-related factors in order to unravel the etiology of adherence as well as to optimize future adherence interventions. ...
Background:
Non-adherence (NA) after renal transplantation poses a major risk for allograft rejection, graft loss, and patient mortality. Yet, there is still ambiguity about its etiology and its possible relationships with patient-related factors. In order to prevent poor outcomes after transplantation, it is crucial to gain a more refined understanding of potential determinants, to identify patients at risk, and to intervene accordingly. The objective of this study was to assess potential risk factors of NA by prospectively applying electronic monitoring.
Materials and methods:
This was a single-center prospective observational study. Prior to study initiation, sociodemographic, biomedical, and psychosocial variables (depression, health-related quality of life, self-efficacy, social support, attachment, experiences and attitudes towards immunosuppressive medication, emotional responses after organ transplantation, satisfaction with information about immunosuppressive medication, and perceptions and beliefs about medications) were assessed. Thereafter, immunosuppressive adherence behavior was measured prospectively via electronic monitoring (EM, VAICA©) during a 3-month period to receive the percentage frequency of Taking and Timing Adherence (±2h, ±30min) for each patient. Focus of this study was the phase of medication implementation.
Results:
A total of 78 patients participated in our study (mean age 55.28, 56% male). We found rates of 99.39% for Taking Adherence, 98.34% for Timing Adherence ±2h, and 93.34% for Timing Adherence ±30min, respectively. Multiple regression analyses revealed that the type of medication could significantly predict Taking Adherence. Patients receiving Advagraf© (once daily) depicted better Taking Adherence than patients receiving Prograf© (twice daily) (p=0.04). No associations were found for Timing Adherence (±2h, ±30min). Sociodemographic, biomedical, or psychosocial variables were not found to be associated with adherence behavior.
Discussion:
In highly adherent populations, only a few factors can be altered to improve adherence. Changing the immunosuppressive regimen from twice-daily to once-daily could be an option for optimizing adherence. However, risk factors for NA could be different in a less adherent population.
... 18,13 Coherently with a previous study, 19 the findings of the present study suggest that despite the peritoneal treatment allows the patients to take responsibility about self-control and management of dietetic regimen, it seems that this greater autonomy could produce a lower self-management and a lower adherence to medication regimen. Patients undergoing PD need more attention by medical staff as their experienced psychological stress could affect adherence to treatment, as shown in previous studies in patients undergoing KT. 20,21 HD and PD patients showed significantly lower levels of hemoglobin than CT and KT patients. Moreover, only in PD patients, hemoglobin levels were inversely correlated with TAS-20 F3 dimension. ...
... The results suggest to plan psychosocial intervention in order to increase emotional ability and the adherence to the therapeutic regimen, reducing cardiovascular risk since the first stages of CKD. 20 Disclosure statement ...
The aim of the study was to investigate the association between psychological characteristics and biological markers of adherence in chronic kidney disease patients receiving conservative therapy, hemodialysis, peritoneal dialysis (PD), or kidney transplantation.
Seventy-nine adult patients were asked to complete the following questionnaires: Toronto Alexithymia scale, Snaith–Hamilton Pleasure Scale, and Short Form Health Survey. Biological markers of adherence to treatment were measured.
Peritoneal dialysis patients showed a lower capacity to feel pleasure from sensorial experience (p = .011) and a higher values of phosphorus compared to the other patients’ groups (p = .0001).
The inability to communicate emotions was negatively correlated with hemoglobin levels (r = −(0).69; p = .001) and positively correlated with phosphorus values in the PD patients (r = .45; p = .050).
Findings showed higher psychological impairments and a lower adherence to the treatment in PD patients and suggest the implication of emotional competence in adherence to treatment.
... Chronic kidney failure is currently a prevalent issue and is recognized as a significant contributor to reduced quality of life and disability [14,15]. The estimated global prevalence of the disease ranges from 8% to 16%, with a higher incidence observed in developed and developing countries [16]. ...
Aim
This study aimed to assess the effectiveness of a family-centered support intervention utilizing virtual education on the mental health of hemodialysis patients and their family caregivers amidst the COVID-19 pandemic.
Background
Patients undergoing hemodialysis and their family caregivers may experience mental health disruptions.
Methods
In this quasi-experimental study, 30 family caregivers of hemodialysis patients who visited the hemodialysis center of the 22nd-Bahman Hospital of Khaf in 2022 were selected using convenience sampling. All patients and family caregivers completed a demographic characteristics form and a mental health scale over the phone at baseline. The experimental group received targeted mental health education content for four weeks on the Eitaa social media platform. At this time, the mental health questionnaire was completed once more over the phone for all patients and their family caregivers. Independent t-tests and paired t-tests were used to analyze the data in SPSS-22. The significance level was set to p <0.05.
Results
The mean age values of the patients and family caregivers were 47.63±8.36 and 33.53±4.86 years, respectively. Prior to the intervention, there was no significant difference (p <0.05) in the mean scores of mental health and its components between the experimental and control groups. Following the intervention, statistically significant reductions were observed in the scores of both the patients and caregivers of the experimental group compared to the controls (p <0.001).
Conclusion
The virtual family-centered support intervention could positively impact the mental health of hemodialysis patients and their family caregivers. Thus, the present intervention is suggested as a viable program to enhance the mental health of this group of patients and their respective caregivers.
... Insecure attachment is also associated with several negative health and lifestyle behaviors, including poor nutrition, physical inactivity, reduced use of health care services, and poor compliance with lifestyle recommendations (11). The implications of attachment theory on physical health have been specifically addressed in practice areas such as ageing (17), cancer (18,19), renal transplant (20), diabetes (21,22), coronary artery disease (23), chronic pain (24,25), and other chronic conditions (26). Attachment theory has similarly been implicated in various psychological conditions including borderline personality disorder (27,28), depression (29), history of suicidal ideation (30), psychosis (31), infant mental health (32,33), postnatal depression (34), substance misuse (35), and quality of life (36). ...
Globally physical inactivity is a leading, independent, and significant risk factor for disease and mortality. Exercise scientists and clinical exercise physiologists have a key role in supporting client participation in physical activity. However, with the rates of physical activity continuing to be low, we argue for a paradigm shift in the way practitioners engage with clients. Attachment theory, a theory which focuses on social relationships and bonds, has received increased attention within physical activity and broader health literature. Awareness of attachment theory provides insight into individual health-related responses and physical activity motivation and guides key professional practices and processes relevant to both exercise scientists and clinical exercise physiologists. However, there remains no research specific to the application of attachment theory by these 2 professions. This narrative review provides an overview of the literature on attachment theory applicable to exercise science and exercise physiology and highlights the potential for attachment theory to inform future practice, education, and research, concluding with 3 recommendations for future research priorities.
... Sie finden aber ebenfalls negative Einflüsse von bindungsbezogener Angst und Vermeidung bzw. unsicherer Bindung auf die gesundheitsbezogene Lebensqualität [47][48][49][50]. Überdies zeigten Bindungsmerkmale des Patienten auch einen relevanten Einfluss auf die Annahme therapeuti-scher Maßnahmen [51] ...
Zusammenfassung
Ziel der Studie Untersuchung der Einflussfaktoren auf die psychische und körperliche Lebensqualität bei älteren, multimorbiden Patientinnen und Patienten ab 50 Jahren in Hausarztpraxen.
Methodik 219 Patienten mit multiplen chronischen Erkrankungen wurden zu Lebensqualität, Bindung, Depression und dem Gesundheitszustand zu Baseline und Follow-up nach 12 Monaten untersucht. Multivariate Analysen wurden durchgeführt, um potenzielle Prädiktoren zu identifizieren.
Ergebnisse Depression, Alter und die bindungsbezogene Vermeidung hatten einen negativen, der Gesundheitszustand einen positiven Einfluss auf die körperbezogene Lebensqualität. Die psychische Lebensqualität wurde negativ durch die bindungsbezogene Angst und Depression beeinflusst. Relevante Prädiktoren, welche die Lebensqualität in einem Jahr vorhersagen konnten, waren der Gesundheitszustand, Depression und Bindungsangst.
Schlussfolgerung Zur Erhaltung der Lebensqualität sollten bei multimorbiden Patienten die mentale Gesundheit und die Bindungsbedürfnisse der Patienten berücksichtigt werden.
... Furthermore, the psychological aspect was not evaluated in the present study. The psychological support is critical in the patient-doctor relationship, which may affect indirectly the overall HRQoL, as reported in several conditions including kidney disease where patients experiencing chronic pain similar to patients with SCD [34,35]. Thus, the results of this study cannot be generalized at the moment since further research and studies have to be done to reduce the limitations and better understand the effects of other factors, in addition to taking a larger population sample from different health centers and regions in Oman. ...
Purpose
As treatment options for children with sickle cell anemia (SCA) continue to expand survival, evaluation of factors associated with health-related quality of life (HRQoL) is becoming an important aspect for further improving clinical management. Although the general features of SCA are similar, factors influencing HRQoL within a country may differ from those of other countries, therefore this study aimed to explore factors affecting HRQoL in children with SCA living in the Sultanate of Oman.
Methods
This was a cross-sectional study in which the PedsQL™ Sickle Cell Disease Module was used to evaluate the overall HRQoL in children with SCA. The socio-demographic data, clinical, and treatment outcomes were collected. Univariate and multivariate linear regression analyses were used to identify predictors of HRQoL.
Results
A total of 123 children with SCA, aged from 2 to 16 years were enrolled. The mean total HRQoL score was 52 ± 15% (9–94), where Worry II scale recorded the highest score. The multiple regression analysis revealed that the only predictors of total HRQoL score were hemoglobin F (B = 0.64, 95% confidence interval [CI] 0.149–1.118, P = 0.009) and to a lesser degree white blood cell count (B = − 0.99, 95% CI − 1.761 to − 0.198, P = 0.01), independently of other study parameters such as age, gender, spleen status, and hydroxyurea therapy.
Conclusions
Collectively, these findings indicated that hemoglobin F out-weighted white blood cell count in predicting HRQoL in Omani children with SCA. Recognition of these factors could help health professionals to develop effective strategies to improve the overall HRQoL in these young patients.
... ESRD patients are dependent on renal replacement therapy for survival. At the end of 2005, 1,900,000 patients with ESRD around the world had undergone renal replacement therapy, while 68% of them were undergoing hemodialysis, 8% undergoing peritoneal dialysis, and 23% undergoing kidney transplantation surgery (5). In Iran, 52.7% of pa-tients undergo hemodialysis, 45.5% of them undergo kidney transplantation surgery, and less than 1% undergo peritoneal dialysis (6,7). ...
... A recent study (Calia et al., 2015) investigated the association between attachment style, compliance, quality of life and renal function in adult patients after kidney transplantation. The results showed that higher levels of insecure attachment (anxious or avoidant) were significantly associated with a worse compliance level and low quality of life. ...
Attachment styles are relational models that lead an individual to seek proximity to a safe or powerful person when threatened. As suggested by attachment theory, the quality of early interpersonal experiences shapes the self-regulate ability during the entire life span and modulate the complex relationship between social, cognitive, and emotional variables. The attachment system seems to be strongly involved in the health-related events, due to its self-regulation function. Individuals with physical illness are forced to cope with new people, contexts and experiences that are potential stressors of attachment system. Relational models, thus, seem to have a significant role in health-related psychological processes, in particular, on patients' ability to engage in a fruitful alliance with their physicians. Major chronic conditions and their complex management could broadly take advantage from a safely and trustful relationship between patient and physician. Patient medical adherence is a basic statement in health care and recent studies reported that it is closely associated with the affective relationship between patient and practitioner. Investigating the patient attachment style as a moderator of this relationship could promote clinical interventions aimed to enhance the adherence to medical care, improving health-care outcomes and patient quality of life.
... A recent study (Calia et al., 2015) investigated the association between attachment style, compliance, quality of life and renal function in adult patients after kidney transplantation. The results showed that higher levels of insecure attachment (anxious or avoidant) were significantly associated with a worse compliance level and low quality of life. ...
Sudden death can be defined as an unexpected event that happens in healthy people or in stable patients. It must occur within one hour from the onset of the first symptoms, and it is precipitated by a cardiac arrest, which is irreversible for the absence of an adequate and prompt assistance or for an intrinsic cardiac disease. Heart block is usually preceded by severe disturbances of the cardiac rhythm, as ventricular fibrillation or bradycardia. In a first group of diseases, at the basis of this event, a primitive disorder, directly correlated with an abnormality of cell membrane channels involved in the exchange of electrolytes, can be found, as in Brugada's syndrome. A more common condition is represented by infarct or severe ischemia, sometimes known before, that determine significant alterations in the cardiac rhythm, followed by ventricular fibrillation and cardiac arrest. Rarer is an acute hemopericardium, where a sudden severe haemorrhage takes place inside the pericardium, with a primary effect of acute cardiac tamponade; in absence of recent cardio-thoracic surgery, a cause can be the rupture of an aortic aneurysm, involving its first intrapericardic tract. Many other cardiac diseases, as acute myocarditis, left ventricular hypertrophy, hypertrophic cardiomyopathy, dilatative cardiomyopathy, restrictive cardiomyopathy, Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC), pulmonary or aortic stenosis, atrial myxoma, and, rarely, Cyanotic Congenital Heart Diseases (CCHD), can induce a sudden cardiac arrest. In other conditions, the cardiac arrest follows an acute primary disease of one or multiple apparatuses. At first, an abrupt and massive haemorrhage, followed by a fall in the venous return, can produce an electro-mechanical cardiac dissociation, with subsequent cardiac arrest. A similar condition is represented by anaphylactic shock, where a sudden peripheral vasodilatation with an abrupt fall in blood venous return can be associated with an increased pulmonary vascular resistance, bronchospasm and coronary vasoconstriction by circulating histamine. A characteristic condition is the onset of an acute respiratory failure, followed by acute hypoxia, hypercapnia and acidosis. It can happen after tension pneumothorax, complicating a respiratory insufficiency, or in case of bilateral pneumothorax. Moreover, a sudden increase in pulmonary resistance accompanied by severe hypoxia, as in acute thrombo-embolism of the pulmonary artery, can determine a sudden cardiac arrest. Another cause, even rarer, of cardiac arrest is finally represented by a spontaneous cerebral haemorrhage, where a rapid rise of intracranial pressure, but more often a direct damage of vital cerebral centres, leads to a direct acute cardio-respiratory failure.
... Based on this result, one can reasonably suggest to further consider composite patient-centered outcomes in future clinical trials, especially for those published in journals with high-impact. Future studies should also take into consideration some psychological aspects that may affect HRQoL [75,76] and the important role of the family [77]. ...
Background:
Patients with prostate cancer (PC) may be ready to make trade-offs between their quantity and their quality of life. For instance, elderly patients may prefer the absence of treatment if it is associated with a low-risk of disease progression, compared to treatments aiming at preventing disease progression but with a substantial deterioration of their Health-Related Quality of Life (HRQoL). Therefore, it seems relevant to compare the treatments by considering both survival and HRQoL. In this mini-review, the aim was to question whether the potential trade-offs between survival and HRQoL are considered in high impact factor journals.
Methods:
The study was conducted from the PubMed database for recent papers published between May 01, 2013, and May 01, 2015. We also restricted our search to nine medical journals with 2013 impact factor > 15.
Results:
Among the 30 selected studies, only six collected individual HRQoL as a secondary endpoint by using the Functional Assessment of Cancer Therapy-Prostate (FACT-P) questionnaire. In four studies, the time to HRQoL change was analyzed, but its definitions varied. In two studies, the mean changes in HRQoL between the baseline and the 12- or 16-week follow-up were analyzed. None of the six studies reported in a single endpoint both the quantity and the quality of life.
Conclusions:
Our mini-review, which only focused on recent publications in journals with high-impact, suggests moving PC clinical research towards patient-centered outcomes-based studies. This may help physicians to propose the most appropriate treatment on behalf of patients. We recommend the use of indicators such as Quality-Adjusted Life-Years (QALYs) as principal endpoint in future clinical trials.
... Perhaps avoidant attachment could be a common cause of these findings. It has been shown to be associated with poor adherence to medical treatment in patients with various chronic medical conditions [71,72]. It can be assumed this is also true for CAD patients and that this could adversely affect the course of the disease. ...
Objective: The relationship between attachment orientations and the recovery from depressive symptoms in patients diagnosed with coronary artery disease (CAD) with and without a psychotherapeutic intervention was examined in this study.
Methods: In a multicenter trial of 570 depressed CAD patients (SPIRR-CAD), assigned to usual care plus either a stepwise psychotherapy intervention or one information session, 522 patients provided attachment data at baseline. Attachment was measured with the Relationship Scales Questionnaire (RSQ), yielding four attachment orientations. The primary outcome was change in Hospital Anxiety and Depression Scale depression (HADS-D) scores from baseline to follow-up at 18 months. Secondary outcomes were HADS-D scores at 1, 6, 12, and 24 months.
Results: Independent of treatment assignment, attachment was related to change in depression at 18 months (p <. 01) with secure attachment resulting in a significant reduction ( 2.72, SE = 0.27) in depression compared to dismissive-avoidant (-1.51, SE = 0.35, p = .040) and fearful-avoidant (-0.65, SE = 0.61, p = .012) attachment. Patients with anxious-preoccupied attachment showed changes similar to secure attachment (-2.01, SE = 0.47). An explorative subgroup analysis across all assessment time points revealed patients with a dismissive-avoidant attachment benefitted from psychotherapy (average mean difference = .93, SE = .47, p = .048).
Conclusion: Attachment played an important role for improvement in depressive symptoms. Only dismissive-avoidant patients seemed to benefit from the intervention. The lack of improvement in fearful-avoidant patients shows a need for specific interventions for this group.
Trial Registration: www.clinicaltrials.gov NCT00705965; www.isrctn.com ISRCTN76240576
... These problems are considered a global concern (21). According to studies, most of these patients suffer a low quality of life and performance (22). A study on locus of control, indicates that people who feel capable of affecting their life events, enjoy more behavioral and social health than those lacking such a belief (23). ...
Background
Many of the cognitive behavioral models and therapeutic protocols developed so far for psychological disorders and chronic diseases have proved effective through clinical research.
Objective
This study aimed to determine the effectiveness of teaching cognitive-behavioral techniques on locus of control in hemodialysis patients.
Methods
This controlled clinical trial study was conducted in 2015 with 76 patients selected by census and treated with a hemodialysis machine in the dialysis department of Vali-Asr Hospital in the city of Meshkinshahr. A total of four patients were excluded because of their critical conditions while the rest, who were recruited, were randomly divided into two equal groups of 36 patients as the intervention and control groups. First, the locus of control was measured in both groups through a pretest, and cognitive-behavioral techniques were then taught to the intervention group during eight 45 to 90-minute sessions. The locus of control in patients of both groups was finally re-measured through a posttest. Data were collected using Rotter’s Locus of Control Inventory. The Wilcoxon test and Mann–Whitney U test were respectively used in SPSS18 for data analysis.
Results
In the pretest and posttest stages respectively, 4.8% and 14.3% of samples in the control group as well as 14.3% and 33.3% of samples in the intervention group enjoyed internal locus of control. The difference between the pretest and posttest scores of internal locus of control in the intervention group was significant (p=0.004), which indicates the positive effect of cognitive-behavioral psychotherapeutic intervention on internalization of locus of control in this group.
Conclusions
Given the external locus of control in most of the study patients and also the positive significant effect of cognitive-behavioral psychotherapy on internalization of locus of control in this group of patients, it appears necessary to have a psychology resident present in the hemodialysis department to teach the necessary cognitive-behavioral techniques to internalize the locus of control.
Trial registration
The trial was registered at the Thai Clinical Trial Registry (http://www.clinicaltrials.in.th) with the TCTID: TCTR20170707003.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
... Although mechanisms underlying the "pet-effect" are unclear, one theory which has received considerable attention is that pets act as secure attachment figures, providing comfort and support in times of need [7][8][9]. Attachment styles are shown to be significant predictors of quality of life across a range of ailments and demographic factors [10][11][12][13][14]. One cohort of individuals who may, in particular, experience the benefits of attachment to a pet are those who own an assistance dog, since these individuals rely on their dog for support with essential daily tasks. ...
Attachment styles have been shown to affect quality of life. Growing interest in the value of companion animals highlights that owning a dog can also affect quality of life, yet little research has explored the role of the attachment bond in affecting the relationship between dog ownership and quality of life. Given that the impact of dog ownership on quality of life may be greater for assistance dog owners than pet dog owners, we explored how anxious attachment and avoidance attachment styles to an assistance dog affected owner quality of life (n = 73). Regression analysis revealed that higher anxious attachment to the dog predicted enhanced quality of life. It is suggested that the unique, interdependent relationship between an individual and their assistance dog may mean that an anxious attachment style is not necessarily detrimental. Feelings that indicate attachment insecurity in other relationships may reflect more positive aspects of the assistance dog owner relationship, such as the level of support that the dog provides its owner.
... Perhaps avoidant attachment could be a common cause of these findings. It has been shown to be associated with poor adherence to medical treatment in patients with various chronic medical conditions [71,72]. It can be assumed this is also true for CAD patients and that this could adversely affect the course of the disease. ...
Einleitung: Depression gilt als wichtiger Risikofaktor für eine ungünstige Prognose bei koronarer Herzkrankheit (KHK). Bindungsstile sind ein wichtiger Prädiktor für die Prognose einer depressiven Störung und auch für die Wirkung von Psychotherapie. Im Rahmen einer Sekundäranalyse der SPIRR-CAD Studie (Herrmann-Lingen et al., 2016) wurde der Einfluss von Bindungsstilen auf den Verlauf der Depressivität bei KHK-Patienten untersucht. Methodik: In einer randomisierten, kontrollierten, multizentrischen Studie wurden 570 KHK-Patienten mit depressiven Symptomen (Hospital Anxiety and Depression Scale, HADS-D > 7) je einer von zwei Bedingungen zugeteilt: Übliche Behandlung plus entweder eine Informationssitzung oder ein stufenweises Psychotherapieprogramm. Von 522 dieser Patienten lagen Daten zu Bindungsstilen zur Baseline vor; diese wurden in der vorliegenden Studie verwendet. Die Intervention bestand aus drei Einzelsitzungen, gefolgt von 25 Gruppentherapiesitzungen für Patienten, die weiterhin erhöhte Depressionswerte aufzeigten. Patienten wurden anhand des Relationship Scales Questionnaire (RSQ) einem von vier Bindungsstilen (sicher, anklammernd, abweisend, ängstlich-vermeidend) zugeordnet. Abhängige Variablen waren Depressivität (HADS-D) nach einem (Abschluss der Einzelsitzungen), 6, 12, 18 (Abschluss der Psychotherapie) und 24 (Follow-Up) Monaten. Lineare gemischte Modelle mit Messwiederholung wurden in einer intention-to-treat-Analyse berechnet. Ergebnisse: Sichere Bindung war, unabhängig von der Versuchsbedingung, mit einer Verringerung von Depressivität (nach 18 Monaten: 2.65, SE = .26) verknüpft. Patienten mit anklammerndem Bindungsstil zeigten ein ähnliches Ausmaß an Verbesserung ( 2.05, SE = .42), nicht jedoch Patienten mit abweisendem oder ängstlich-vermeidendem Bindungsstil. Für den abweisenden Bindungsstil zeigte eine Subgruppenanalyse, dass diese Patienten vom Psychotherapieprogramm profitierten. Ängstlich-vermeidende Patienten wiesen hingegen keine signifikante Verringerung ihrer Depressivität auf. Schlussfolgerungen: Bindungsstile spielen eine wichtige Rolle bei der Reduktion depressiver Symptome bei KHK-Patienten und beeinflussen möglicherweise auch die Effektivität von Psychotherapie bei diesen Patienten. Insbesondere für Patienten mit ängstlich-vermeidendem Bindungsstil scheint eine spezielle Anpassung des Therapieprogramms indiziert zu sein. Clinical Trial Registration: www.clinicaltrials.gov NCT00705965; www.isrctn.com ISRCTN76240576
... Denial and focusing on venting emotions are coping skills strongly correlated with depression in heart transplant recipients [59]. Kidney transplant recipients with anxious attachment style tend to have higher creatinine levels, which may have treatment implications [60]. Non adherent kidney recipients tend to be significantly less authority abiding, less concerned about their illness, and less spiritually-oriented [61]. ...
Purpose: To offer a uniform framework for the participation of psychiatrists and mental health professionals involved in the multidisciplinary evaluation leading to decision about listing patients for organ transplantation. Method: Literature review of evidence regarding the impact of psychiatric disease upon post-transplantation outcomes; literature review and opinion review regarding psychological implications of decision to list or decline from organ transplantation for patients, family and medical staff. Results: The authors propose three areas of knowledge which can help the mental health professionals who participate in the decision to list or decline patients from listing for organ transplantation. The first area consists of the body of knowledge regarding the impact of psychiatric illness upon medical outcomes post transplantation. A second domain consists in structural and administrative factors related to the transplant program. Third area of interest is represented by the psychodynamic implications of the decision about listing upon patients, family and medical staff. These areas are discussed based on the existing literature and author’s experience. Conclusion: In addition to the psychiatric evaluation of the transplant candidate, psychiatrists can help the transplant teams with the difficult process of declining from listing.
... Moreover, a recent review of litera- ture concluded that relevant psychological predic- tors of weight loss after bariatric surgery have not been well identified ( Wimmelmann et al., 2014), despite they could explain the wide difference in surgical outcome. Alexithymia, beside other more common psychological characteristics such as anxiety and depression, has been found able to affect adherence to the medical and dietary rec- ommendations in other clinical conditions Calia et al., 2011aCalia et al., , 2011bCalia et al., , 2011cCalia et al., , 2015aCalia et al., , 2015bCalia et al., , 2015cLai et al., 2016). Therefore, the role of alexithymia could be crucial in affect- ing weight loss in bariatric patients. ...
Aim of this study was to investigate relationship between preoperative psychological factors and % total weight loss after gastric bypass. 76 adult patients scheduled for bariatric surgery were preoperatively asked to complete anxiety and depression Hamilton scales and Toronto Alexithymia Scale. At 3- and 6-month follow-up, body weight was assessed. At 6-month follow-up, alexithymic patients showed a poorer % total weight loss compared with non-alexithymic patients (p = .017), and moderately depressed patients showed a lower % total weight loss compared with non-depressed patients (p = .011). Focused pre- and postoperative psychological support could be useful in bariatric patients in order to improve surgical outcome.
... These problems are a global issue (Erdley et al., 2014). According to different studies, the majority of these patients suffer from a low quality of life (Calia et al., 2015). ...
p> INTRODUCTION: Despite the positive effects of hemodialysis on end-stage renal disease, patients face many physical and psychological stressors while receiving this treatment. These physical and psycho-social problems lead to serious problems that ultimately affect the patients’ quality of life. The present study was conducted to determine the effectiveness of teaching cognitive-behavioral techniques in enhancing resilience in hemodialysis patients.
METHODS: The present clinical trial was conducted on 74 hemodialysis patients selected through census sampling from the dialysis department of Valiasr Hospital, Meshkin Shahr, Iran, in 2015. Four of the patients were excluded from the study due to their worsened conditions and inadequate cooperation and the rest were divided into an intervention and a control group of 35. A pretest was first carried out to measure resilience levels in the two groups; the intervention group then received cognitive-behavioral interventions in eight 45-90-minute sessions. After the intervention ended, resilience levels were measured in both groups through a posttest. The Connor-Davidson Resilience Scale was used to collect the data. The relationship between the pretest and posttest data was analyzed using the Wilcoxon test and the relationship between the intervention and control data using Mann-Whitney’s U-Test in SPSS-18.
RESULTS: The mean pretest and posttest scores of resilience were 3.37 and 4.02 in the intervention group, indicating that the educational intervention increased the patients’ resilience significantly. In addition to increasing the mean score of resilience, cognitive-behavioral psychotherapy also increased the posttest score of resilience score in each one of the 35 patients in the intervention group and no single subject witnessed a reduced resilience score.
CONCLUSION: Given that teaching cognitive-behavioral techniques improves resilience levels and consequently quality of life in hemodialysis patients, the continuous presence of clinical psychologists in hemodialysis departments appears necessary.</p
... The association between patient's outcomes and both HRQOL and mental health is a new field of research requiring validated psychosocial assessment. [42][43][44][45][46] We used recent statistical approaches previously applied in other areas but never in transplantation. The combination of methods as longitudinal cluster, random forest, and mixed effects models allowed multivariate analyses of HRQOL (without limitation of covariates tested) appropriate to better understand determinants and source of HRQOL variability. ...
Background:
Health-related quality of life (HRQOL) usually improved after kidney transplantation; however, a non-negligible number of patients did not benefit from transplantation in HRQOL. The aims of this cohort study were to describe the evolution of HRQOL in kidney transplant recipients to search for subgroups with distinct time profiles and to investigate these determinants.
Methods:
Three hundred thirty-seven adult patients were followed up from 1 to 36 months after kidney transplantation. Each patient completed repeated HRQOL assessments (median, 5; range, 2-9). K-means for longitudinal data was used to identify homogeneous clusters of HRQOL time profiles obtained for the mental and physical composite scores (MCS and PCS) and for the 8 dimensions of the short-form 36 scale. Covariates associated with these clusters were investigated using random forest analysis. Magnitude and shape of the HRQOL variations over time were investigated using linear regression mixed models.
Results:
Two longitudinal clusters were identified for the time profiles of PCS and MCS. Patients classified in the higher cluster (i.e., 60% of the population) exhibited a steady-state HRQOL, similar on average to the general population, whereas in the lower cluster, PCS and MCS scores were significantly lower than in the general population. Muscular weakness in the first year after transplantation explained 19% of the interpatient variability of PCS 3 months after transplantation, whereas associated with anxiety, it explained 24% of interpatient MCS variability.
Conclusions:
This work suggests to promote (i) physical rehabilitation programs after transplantation to curb the muscular loss and (ii) systematic attention to the patient's anxiety.
... Moreover, the emotional impairment was significantly and negatively correlated with QoL, showing the important role of the ability to manage emotions on post-transplantation outcome. In previous studies, we demonstrated that there are psychological risk factors for graft rejection in patients undergoing kidney (Calia et al., 2011a) and liver transplantation (Calia et al., 2011b) and that specific attachment style dimensions, together with alexithymia, were able to predict non-compliance to immunosuppressant treatment, poor QoL, and reduced renal function after multi-organ kidney transplantation (Calia et al., 2015a). ...
The aim of this study was to evaluate psychological differences and quality of life between kidney recipients from living (mother) and multi-organ donor. Overall, 40 patients who had undergone both living (mother) and multi-organ kidney transplantation 3-6 months before were asked to complete four self-report instruments: Toronto Alexithymia Scale, Short Form Health Survey, Regulatory Emotional Self-efficacy, and Attachment Style Questionnaire. A greater difficulty in emotional, social, and mental health functioning was found in recipients receiving kidney from mother living donor. Moreover, in these patients, higher levels of avoidant attachment dimensions were associated with a worse quality of life.
... Moreover, other psychological variables had been highlighted to interfere with well-being in kidney transplant patients. For instance, high levels of alexithymia (Calia et al., 2015a) or insecure attachment dimensions (anxious or avoidant) had been positively associated with worse adherence to immunosuppressive treatment and negatively with health-related quality of life after kidney transplantation (Calia et al., 2015b). This study has some limitations that must be acknowledged. ...
Health-related behaviours and psychological distress were examined after kidney transplantation. Patients were evaluated at 1 month, 6 months and 1 year after transplantation. Participants completed the Healthy Behaviours Questionnaire and the Hospital Anxiety and Depression Scale. No significant differences in Healthy Behaviours Questionnaire's total score and psychological comorbidity were observed at three time points. However, there was an increase in drug-consumer habits (p < 0.05) and a reduction in sedentary lifestyle (p < 0.05) at 6 months and 1 year. Moreover, at 1 year, post-transplant had increased the harmful health habits (p < 0.05). In regression analysis, anxiety symptoms were significant predictors of Healthy Behaviours Questionnaire change at a year post-transplantation.
... In addition, there are a number of articles in literature that focus on the psychological aspects affecting graft survival and compliance that could also apply to living kidney donation. 20,21 We also noticed that trend but did not analyze it in our manuscript. Therefore, our findings require further validation by longer prospective studies involving a larger sample size across multiple clinical centers involving more donor-recipient pairings including father-to-child and mother-to-child parings, as well as preand postoperative psychological aspects of recipients. ...
To study the impact of parent-to-child transplant and older donor age on recipients' post-transplant creatinine levels, a total of 236 patients who received living donor kidney transplantation were evaluated for kidney viability based on creatinine (Cr) level. Of the 236 pairings, 113 (48%) were parent-to-child followed by sibling transplants (66, 30%). Recipient Cr levels were significantly higher at 6 months and 3 years post-transplant in the parent-to-child transplants compared to other donor–recipient relationships. In addition, donor age (average age: 44.1 ± 11.5; range: 19–66) contributed to higher recipient post-transplant Cr levels (p < 0.01). Pre-transplant donor and recipient Cr levels tended to result in higher post-transplant Cr levels in recipients (p < 0.05). Multivariate logistic regression analysis revealed that the presence of both parent-to-child transplant and older donor significantly increased the risk of elevated post-transplant Cr levels in recipients with an estimated odds ratios ranging from 3.46 (95% CI: 1.71–6.98) at 6 months to 8.04 (3.14–20.56) at 3 years post-transplant. Donor age significantly affected transplant survival as measured by higher recipient post-transplant Cr levels. In addition, parent-to-child transplant pairings, along with older donor age, significantly increased the risk of elevated post-transplant Cr levels in recipients.
... It has also been outlined that coping strategies may be associated with negative compliance among patients who have difficulty in processing emotion [11]. In a previous analysis on the same patients sample population, also some quantitative dimensions of attachment style has been indicated as a predictors of compliance perception and creatinine levels after transplantation [13]. Thus, the role played by emotional pattern in influencing compliance to medical treatment should be taken into consideration during preoperative evaluation [5]. ...
The present study aimed to assess the effectiveness of an expressive writing (EW) intervention on psychological and physiological variables after kidney transplant. The final sample of 26 were randomly assigned to an expressive writing group (EWG) and control group (CG). Outcomes were focused on depression, anxiety, alexithymia, empathy, resilience, locus of control, creatinine, CDK-EPI, and azotemia. Depressive symptoms and alexithymia levels decreased in the EWG, with better adherence. Resilience declined over time in both groups. The EWG showed a significantly higher CDK-EPI, indicating better renal functioning. EW seems an effective intervention to improve the psychological health of transplanted patients, with a possible effect on renal functioning. These findings open the possibility of planning brief psychological interventions aimed at processing emotional involvement, in order to increase adherence, the acceptance of the organ, and savings in healthcare costs.
Hintergrund: Non-Adhärenz bezüglich immunsuppressiver Medikation nach Nierentransplantation hat sich als bedeutsamer Risikofaktor für Abstoßungsreaktionen und Organverlust erwiesen. Trotz einer enormen Verbesserung der Lebensqualität und einer geringeren Morbidität und Mortalität nach einer Transplantation, weist ein erheblicher Teil nierentransplantierter Patienten non-adhärentes Verhalten auf. Die Prävalenzraten schwanken hierbei jedoch enorm, was auf unterschiedliche Definitionen und Messmethoden zurückgeführt werden kann. Für eine exakte Erfassung spielen jedoch präzise Messverfahren eine unverzichtbare Rolle. Aufgrund der drastischen Konsequenzen von Non-Adhärenz, welche sowohl gesundheitlicher als auch ökonomischer Natur sein können, tritt auch die Untersuchung der Ätiologie immunsuppressiver Non-Adhärenz immer weiter in den Vordergrund. Ein umfassendes Verständnis potentieller Determinanten von Non-Adhärenz bietet die Grundlage zur Identifizierung möglicher Risikogruppen sowie für die Entwicklung zielgerichteter individuell angepasster Interventionen. Ziel der Studie im Rahmen der vorgelegten Dissertation war zum einen die Analyse des Zusammenhangs diverser Messmethoden für Non-Adhärenz, zum anderen die Untersuchung möglicher mit dem Adhärenzverhalten in Verbindung stehender Faktoren. Methoden: Die Studie wurde als monozentrische prospektive Beobachtungsstudie konzipiert. Zu Beginn der Studie wurde die Non-Adhärenz mit Hilfe von Fremd- und Selbstbeurteilungen sowie durch die Variabilität der immunsuppressiven Blutspiegelwerte erfasst. Zudem wurde allen teilnehmenden Patienten eine Fragebogenbatterie ausgehändigt, mit welcher soziodemographische, biomedizinische sowie psychosoziale Variablen wie Depressivität, gesundheitsbezogene Lebensqualität, Selbstwirksamkeit, Soziale Unterstützung, Bindung, Einstellungen zur Medikation, emotionale Verarbeitung der Transplantation, Zufriedenheit mit Informiertheit über die Immunsuppression sowie Wahrnehmung und Überzeugungen über Medikamente erhoben wurden. Im Anschluss wurde den Patienten eine elektronische Pillenbox ausgehändigt, welche über einen dreimonatigen Zeitraum das Adhärenzverhalten bezüglich der immunsuppressiven Medikation aufzeichnen sollte. Es wurden neben der tatsächlichen Einnahme der Immunsuppression auch Zeitintervalle von ±2 Stunden und ±30 Minuten als Einnahmerahmen untersucht. Während des Erhebungszeitraums erhielten die Teilnehmer insgesamt sechs Anrufe im Zweiwochenrhythmus, wobei bei jedem Telefonat eine Selbsteinschätzung der aktuellen Adhärenz ersucht wurde. Ergebnisse: Insgesamt nahmen 78 Nierentransplantierte an der Studie teil. Die drei Messmethoden zu Beginn der Studie ergaben Non-Adhärenzraten von 6.4% (Fremdbeurteilung), 28.6% (Selbstbeurteilung) und 15.4% (Blutspiegelvariabilität), wobei kein Zusammenhang zwischen diesen Verfahren festgestellt werden konnte. Während des Studienverlaufs zeigte sich eine kontinuierlich hohe elektronisch gemessene Adhärenz mit Mittelwerten von 99.39% für die tatsächliche Einnahme, 98.39% für das zweistündige Einnahmeintervall sowie 93.34% für die konservativste Adhärenzmessung mit ±30Minuten als Toleranzfenster. Insgesamt zeigte sich eine moderate bis gute Übereinstimmung der elektronischen Messung und der Selbstbeurteilung während des dreimonatigen Studienverlaufs. Die Selbstbeurteilung zu Beginn der Studie konnte zudem die darauffolgende elektronische Adhärenzmessung signifikant vorhersagen. Insgesamt wurde eine Abnahme des Adhärenzverhaltens von Beginn bis zum Ende der dreimonatigen Erhebung festgestellt. Bis auf die Art der immunsuppressiven Medikation konnten keine Faktoren identifiziert werden, welche einen Einfluss auf die elektronisch gemessene Adhärenz aufwiesen. Es zeigte sich, dass Patienten, welche das Immunsuppressivum Advagraf© mit einer einmaligen täglichen Dosis einnahmen, eine bessere Adhärenz aufwiesen als jene mit Prograf©, welches eine zweimalige tägliche Einnahme verlangt. Auf die Pünktlichkeit der Einnahme hatte dies jedoch keinen Einfluss. Diskussion: Die gute Übereinstimmung der Selbstbeurteilung mit der elektronischen Messung lässt auf eine gleichwertige Messung beider Messmethoden schließen. Die Selbstbeurteilung scheint somit eine gute und ökonomische Möglichkeit darzustellen die Non-Adhärenz besonders im Klinikalltag präzise zu erfassen. Die erhöhte Adhärenz zu Beginn sowie deren anschließende stetige Abnahme während des Studienverlaufs deuten auf einen möglichen kurzfristigen Interventionseffekt hin, welcher in weiteren Studien untersucht werden könnte. Des Weiteren scheint es in sehr adhärenten Populationen wenige Faktoren zu geben, welche zur weiteren Steigerung der Adhärenz beitragen könnten. Allerdings stellt der Wechsel einer zweimaligen Medikamenteneinnahme auf eine einmalige Dosis pro Tag eine potentielle Option zur Adhärenzverbesserung dar. Einfluss- und Risikofaktoren könnten jedoch bei weniger adhärenten Population abweichen und müssten in weiteren Forschungsarbeiten berücksichtigt werden.
Introduction:
In heart transplant recipients (HTRs), non-adherence (NA) to immunosuppressive (IS) medication and to recommended lifestyle behaviours are a common phenomenon and associated with higher risk of allograft rejection, organ loss and mortality. Risk factors for NA are highly diverse and still insufficiently researched. Precise measures of NA and an accurate understanding of its aetiology are of undisputable importance to detect patients at risk and intervene accordingly. The aim of this study is to assess the accuracy and concordance of different measures for NA as well as to determine potential risk factors.
Methods and analysis:
This is a single-centre prospective observational trial. HTRs who are at least aged 18 are no less than 6 months post-transplant and receive tacrolimus (Prograf or Advagraf), cyclosporine (Sandimmun) or everolimus (Certican) as their prescribed IS medication are eligible for participation. We only include patients during the phase of medication implementation. At study enrolment, we assess depression, health-related quality of life, self-efficacy, social support, attachment, experiences and attitudes towards IS medication, emotional responses after transplantation, satisfaction with information about IS medication and perceptions and beliefs about medications. We further ask patients to rate their lifestyle behaviours concerning alcohol, smoking, diet, physical activity, sun protection and appointment keeping via questionnaires. Three different measurement methods for NA are applied at T0: self-reports, physician's estimates and IS trough levels. NA is monitored prospectively using an electronic multicompartment pillbox (MEMS, VAICA) over a 3-month period. Meanwhile, participants receive phone calls every second week to obtain additional self-reports, resulting in a total of seven measurement points.
Ethics and dissemination:
The study was approved by the Clinical Ethics Committee of the University Hospital Erlangen (Friedrich-Alexander-University, Erlangen-Nürnberg). Written informed consent is attained from all participants. The results of this study will be published in peer-reviewed journals and presented at conferences.
Trial registration number:
DRKS00020496.
Aims
Psychosocial variables influence chronic diseases, such as type 2 diabetes mellitus. While there is evidence for a negative impact of depression, much less is known about stable, personality oriented factors. Aim of the study was to assess the impact of depression and personality functioning on glucose regulation in patients with type 2 diabetes.
Methods
Seventy-five adult individuals with a first diagnosis of type 2 diabetes were consecutively recruited in an outpatient medical practice. Plasma glucose (HbA1c) was measured at initial contact, and after three and six months of a standardized disease management program. Depression was assessed by self-report (Patient Health Questionnaire, PHQ-D), levels of personality functioning with the screening version of the Operationalized Psychodynamic Diagnosis structure questionnaire (OPD-SQS).
Results
Using mixed regression models, OPD-SQS scores were associated with lower baseline levels of HbA1c, but a less steep decline over time. PHQ-D scores were neither associated with intercept nor with slopes of HbA1c.
Conclusions
In type 2 diabetes, levels of personality functioning but not depression predicted decline in plasma glucose during the first six months of a standardized disease management program. Personality functioning may be especially important in chronic diseases that demand a high level of compliance and lifestyle change.
Introduction
Non-adherence to immunosuppressive medication is regarded as an important factor for graft rejection and loss after successful renal transplantation. Yet, results on prevalence and relationship with psychosocial parameters are heterogeneous. The main aim of this study was to investigate the association of immunosuppressive medication non-adherence and psychosocial factors.
Methods
In 330 adult renal transplant recipients (≥12 months posttransplantation), health-related quality of life, depression, anxiety, social support, and subjective medication experiences were assessed, and their associations with patient-reported non-adherence was evaluated.
Results
33.6% of the patients admitted to be partially non-adherent. Non-adherence was associated with younger age, poorer social support, lower mental, but higher physical health-related quality of life. There was no association with depression and anxiety. However, high proportions of clinically relevant depression and anxiety symptoms were apparent in both adherent and non-adherent patients.
Conclusion
In the posttransplant follow-up, kidney recipients with lower perceived social support, lower mental and higher physical health-related quality of life, and younger age can be regarded as a risk group for immunosuppressive medication non-adherence. In follow-up contacts with kidney transplant patients, physicians may pay attention to these factors. Furthermore, psychosocial interventions to optimize immunosuppressive medication adherence can be designed on the basis of this information, especially including subjectively perceived physical health-related quality of life and fostering social support seems to be of importance.
Background:
The aim of the present study was to investigate the association between alexithymia scores and biological markers of adherence in dialyzed patients. The hypothesis was that higher scores of alexithymia would be associated with lower adherence to treatment.
Methods:
Fifty-four adult dialyzed patients were enrolled during a follow-up visit. Participants were asked to complete a self-report questionnaire, namely, the Toronto Alexithymia Scale (TAS-20). Moreover, biological markers levels of adherence to treatment (phosphorus, creatinine, and serum uric acid) were measured.
Results:
A positive correlation was found between phosphorous levels and TAS-F2 (r = 0.28; P = .04) and TAS-F3 (r = -0.31; P = .02). Stepwise regression with TAS-F2 and TAS-F3 as predictors of adherence to treatment showed a significant model, adjusted R(2) = 0.08, F(1,52) = 5.4; P < .02, where only TAS-F3 was able to predict phosphorous levels (P = .02).
Conclusions:
Findings showed that external oriented thinking was able to predict a biological marker of adherence to treatment in dialyzed patients.
Background and Objective: Chronic renal failure can eventually lead to various complications such as impaired sleep quality of patient, so the adequacy of dialysis in these patients is very important .This study was done aimed to determine the effect of continuous care model on sleep quality and dialysis adequacy of hemodialysis patients in Jahrom.
Materials and Method:In this clinical trial study, 40 patients in hemodialysis ward were selected through simple random sampling in Motahari Hospital in Jahrom in 2013. To survey the quality of sleep, the Pittsburg Sleep Quality Index and to measure the adequacy of dialysis, the formula kt/v was used. For applying the continuous care model, patients were divided into 5 groups and for each group, 4 to 6 training sessions were held during the 4 weeks. Sleep quality and dialysis adequacy were measured during four stages 1 month and immediately before intervention, immediately and 1 month after intervention. Data analysis was done through SPSS16 and using the independent t-test, repeated measures analysis and Pearson’s correlation coefficient.
Results:The mean score of sleep quality was significantly higher before the intervention (9.96±1.87) in compare to after (9.07±2.19) the intervention (p=0.002). Also the mean score of dialysis adequacy was improved immediately after the intervention (1.13± 0.3), but it decreased again one month (0.97±0.31) after the intervention (p=0.034).
Conclusion: The implementing of continuous care model caused an improvement in sleep quality, but there was no positive effect on dialysis adequacy. It is recommended that the nurses implement this model in caring of other patients through doing further research in this area.
The objective of this study was to assess the cost-utility of renal transplantation compared with dialysis. To accomplish this, a prospective cohort of pre-transplant patients were followed for up to two years after renal transplantation at three University-based Canadian hospitals. A total of 168 patients were followed for an average of 19.5 months after transplantation. Health-related quality of life was assessed using a hemodialysis questionnaire, a transplant questionnaire, the Sickness Impact Profile, and the Time Trade-Off Technique. Fully allocated costs were determined by prospectively recording resource use in all patients. A societal perspective was taken. By six months after transplantation, the mean health-related quality of life scores of almost all measures had improved compared to pre-transplantation, and they stayed improved throughout the two years of follow up. The mean time trade-off score was 0.57 pre-transplant and 0.70 two years after transplantation. The proportion of individuals employed increased from 30% before transplantation to 45% two years after transplantation. Employment prior to transplantation [relative risk (RR) = 23], graft function (RR 10) and age (RR 1.6 for every decrease in age by one decade), independently predicted employment status after transplantation. The cost of pre-transplant care ($66,782 Can 1994) and the cost of the first year after transplantation ($66,290) were similar. Transplantation was considerably less expensive during the second year after transplantation ($27,875). Over the two years, transplantation was both more effective and less costly than dialysis. This was true for all subgroups of patients examined, including patients older than 60 and diabetics. We conclude that renal transplantation was more effective and less costly than dialysis in all subgroups of patients examined.
This study investigated whether switching from the twice-daily (Prograf; TAC) to the once-daily formulation of tacrolimus with extended release (Advagraf; XL) affected quality of life, anxiety, and transplant benefit perception after allogeneic kidney transplantation.
After local Institutional Review Board approval, 78 adult patients prescribed twice-daily tacrolimus for ≥1 year after kidney transplantation were asked to participate in this study. All patients were evaluated at T0 (before the switch), and the 49 who accepted the change were reassessed after 6 months (T1). The following tests were used: (State and Trait Anxiety Inventories Y1 and Y2, (Psychologic General Well-Being Index), and modified Transplant Effect Questionnaire for posttransplantation symptoms. Blood samples for laboratory profiles and determinations of drug concentrations were obtained throughout the study period.
There were no significant differences between the psychologic variables at T0 among patients who switched from TAC to XL (n=49) versus those who did not participate (n=29). Eight of the 49 patients who accepted the drug conversion were reswitched to TAC because of adverse events. At T1, the remaining switched patients (n=41) showed an increase in the disclosure of having undergone transplantation (P<.05) versus nonswitched patients; whereas reswitched patients (n=8) showed less positivity and well-being (P<.05) compared with those who remained in the switched regimen.
The findings suggested increased disclosure of having undergone transplantation among patients who decided to switch from TAC to XL.
The aim of this study was to investigate whether pretransplant psychological variables included in the CBA 2.0 Primary Scale-fear, personality, obsessive-compulsive symptoms, state and trait anxiety, psychological reactions, and depression-could predict graft rejection among patients undergoing kidney transplantation.
After ethical committee approval we enrolled 33 consecutive adult patients undergoing kidney transplantation. The inclusion criteria were a stable clinical situation in an out-of-hospital setting; Italian language literacy; a minimum of secondary school-level education, and written informed consent. We excluded patients with a psychotic disturbance, neurocognitive deficit, dementia, serious mental delay (IQ <50), current alcohol or drug abuse, recent ideation or attempted suicide or nonadherence to the therapeutic protocol. Acute and/or chronic graft rejection was diagnosed according to clinical and histopathologic criteria. CBA-2,0 "Primary Scale" series of questionnaires were handed out to patients at the time of the examinations to discrem eligibility for transplantation. Analyses of variance were performed to compare psychological scores among patients with versus without graft rejection. Logistic regression analyses of psychological variables were performed to detect possible predictors for graft rejection. The results of the analysis showed that higher psychoticism scores were able to predict graft rejection (P<.05).
The findings of this study suggest that it is mandatory to preoperatively plan an holistic treatment including psychological intervention mainly focused on psychoticism.
Explicit incorporation of patients' values and preferences is important in health care decision making. However, there are few data about this topic for patients with chronic kidney disease (CKD). We conducted 9 focus groups (3 each for CKD stages 1 to 5, CKD stage 5D, and CKD stages 1 to 5T). Five major themes were identified: (1) personal meaning of CKD, (2) managing and monitoring health, (3) lifestyle consequences, (4) family impact, and (5) informal support structures. Patients had to adjust to the disruptive and permanent implications of the illness on their physical health, identity, emotions, family, lifestyle, relationships, and employment. The overwhelming fatigue, complex treatment regimens, side effects, and liquid and diet restrictions constrained patients' lives. Patients appreciated specialist care, but described the health care system as nonintegrated and believed they received insufficient information and psychosocial support. Choice of treatments was based on lifestyle, family impact, and physical comfort, seldom on clinical outcomes. Time was needed to comprehend the diagnosis, cope with uncertainty, integrate their treatment regimen into their daily routine, and reestablish a sense of normality in their lives. Rather than focusing on clinical targets, greater attention may need to be given to providing information and psychosocial and practical support at a patient-level not organ-specific level, to maximize patient quality of life.
The object of this study was to evaluate the evidence linking attachment insecurity to illness. Attachment theory describes lifelong patterns of response to threat that are learned in the interaction between an infant and his or her primary caregiver. Despite its biopsychosocial domain, attachment theory has only recently been applied to psychosomatic medicine.
MEDLINE and PsychInfo databases were searched from 1966 to 2000 for English language papers with key words "attachment" and "object relations." Papers and their cited references were reviewed if they were directly related to physical illness, symptoms, or physiology. A hypothetical causal model was developed.
Direct and indirect evidence from survey studies supports an association between attachment insecurity and disease. Animal studies and human experiments suggest that attachment contributes to individual differences in physiological stress response. There is also less robust support for insecure attachment leading to symptom reporting and to more frequent health risk behaviors, especially substance use and treatment nonadherence. Evidence supports the prediction from attachment theory that the benefits of social support derive more from attachment relationships than nonattachment relationships.
Although the available data are suggestive rather than conclusive, the data can be organized into a model that describe attachment insecurity leading to disease risk through three mechanisms. These are increased susceptibility to stress, increased use of external regulators of affect, and altered help-seeking behavior. This model warrants further prospective investigation.