Kaip padėti žmogui po bandymo nusižudyti

Suicidologijos moksle gerai žinoma, kad bandę nusižudyti asmenys turi didesnę vėlesnės mirties dėl savižudybės riziką (Hawton, Zall & Weatherall, 2003; Runeson, 2002), ypač pirmaisiais mėnesiais po bandymo nusižudyti (Cedereke & Ojehagen, 2005). Taip pat žmonės po mėginimo nusižudyti dažnai patenka į ligoninę, taigi tai yra gera proga savižudybių prevencijai – būnant ligoninėje galima užmegzti pirmąjį kontaktą su pacientu. Šiame straipsnyje pateikiame rekomendacijas, kaip bendrauti su asmeniu netrukus po jo (jos) bandymo nusižudyti. Jas suformulavome mūsų su kolegomis Vilniaus universitete atlikto mokslinio tyrimo metu (Dadašev, 2017), remdamiesi interviu su 21 asmeniu, kurie po mėginimo nusižudyti buvo patekę į bendrojo profilio arba psichiatrijos ligoninę.Suicidologijos moksle gerai žinoma, kad bandę nusižudyti asmenys turi didesnę vėlesnės mirties dėl savižudybės riziką (Hawton, Zall & Weatherall, 2003; Runeson, 2002), ypač pirmaisiais mėnesiais po bandymo nusižudyti (Cedereke & Ojehagen, 2005). Taip pat žmonės po mėginimo nusižudyti dažnai patenka į ligoninę, taigi tai yra gera proga savižudybių prevencijai – būnant ligoninėje galima užmegzti pirmąjį kontaktą su pacientu. Šiame straipsnyje pateikiame rekomendacijas, kaip bendrauti su asmeniu netrukus po jo (jos) bandymo nusižudyti. Jas suformulavome mūsų su kolegomis Vilniaus universitete atlikto mokslinio tyrimo metu (Dadašev, 2017), remdamiesi interviu su 21 asmeniu, kurie po mėginimo nusižudyti buvo patekę į bendrojo profilio arba psichiatrijos ligoninę

Evaluation of a chronic fatigue in patients with moderate-to-severe chronic heart failure

The aim of the study. To evaluate the chronic fatigue and its relation to the function of hypothalamus-pituitary-adrenal axis in patients with New York Heart Association (NYHA) functional class III–IV chronic heart failure. Material and methods. A total of 170 patients with NYHA functional class III–IV chronic heart failure completed MFI-20L, DUFS, and DEFS questionnaires assessing chronic fatigue and underwent echocardiography. Blood cortisol concentration was assessed at 8:00 AM and 3:00 PM, and plasma N-terminal brain natriuretic pro-peptide (NT-proBNP) concentration was measured at 8:00 AM. Neurohumoral investigations were repeated before cardiopulmonary exercise test and after it. Results. The results of all questionnaires showed that 100% of patients with NYHA functional class III–IV heart failure complained of chronic fatigue. The level of overall fatigue was 54.5±31.5 points; physical fatigue – 56.8±24.6 points. Blood cortisol concentration at 8:00 AM was normal (410.1±175.1 mmol/L) in majority of patients. Decreased concentration was only in four patients (122.4±15.5 mmol/L); one of these patients underwent heart transplantation. In the afternoon, blood cortisol concentration was insufficiently decreased (355.6±160.3 mmol/L); reaction to a physical stress was attenuated (D 92.9 mmol/L). Plasma NTproBNP concentration was 2188.9±1852.2 pg/L; reaction to a physical stress was diminished (D 490.3 pg/L). Conclusion. All patients with NYHA class III–IV heart failure complained of daily chronic fatigue. Insufficiently decreased blood cortisol concentration in the afternoon showed that in the presence of chronic fatigue in long-term cardiovascular organic disease, disorder of a hypothalamus-pituitary-adrenal axis is involved

Impact of a long-term complex rehabilitation on chronic fatigue and cardiorespiratory parameters in patients with chronic heart failure

The aim of the study was to evaluate the impact of a long-term rehabilitation on chronic fatigue and cardiorespiratory parameters in patients with chronic heart failure. Material and methods. One hundred seventy patients with class III–IV (NYHA) chronic heart failure were examined. The study population was divided into two groups: long-term rehabilitation group and control group. They underwent cardiopulmonary exercise test and completed questionnaires on chronic fatigue (MFI- 20L, DUFS, and DEFS). Measurements were repeated 3 and 6 months after long-term complex rehabilitation. Results. According to the data of MFI-20L, DUFS, and DEFS questionnaires, 170 patients (100%) with class III–IV (NYHA) chronic heart failure complained of fatigue. Overall daily fatigue was 56.8±28.5 points on a 100-point scale, and after 6-month rehabilitation, this parameter was statistically significantly reduced on all scales (P<0.05). Physical fatigue and self-care improved in controls. Cardiopulmonary exercise test showed that parameters of hyperventilation, ventilatory equivalents, and pCO2 were significantly improved in rehabilitation group after 6 months as compared to baseline data (P<0.05), but not in the control group. Conclusion. Patients with class III–IV (NYHA) chronic heart failure experience chronic fatigue, which reduces their motivation and self-care abilities. Long-term complex rehabilitation programs improve all parameters of chronic fatigue, respiratory efficiency, and prognostic indicator of chronic heart failure – ventilatory equivalent for carbon dioxide

Left ventricular remodeling in ischemic heart disease patients with signs and symptoms of chronic heart failure: an impact of the long-term exercise training

Our study aimed at determining the effects of long-term exercise training on cardiorespiratory function and left ventricular remodeling in ischemic heart disease patients with the evidence of chronic heart failure, who had undergone a successful coronary angioplasty. One hundred thirty-five patients were entered into one-year study: 70 patients were assigned to the long-term exercise training group, and the remaining 65 persons – to the control group. All the patients were subjected to ergospirometry and echocardiography at study entry and at 6 and 12 months. At the outset, both groups showed no significant difference (P>0.05) in terms of ergospirometry findings. However, after 6 months, the rehabilitation group demonstrated significant changes (P<0.05) in exercise time, double product, RQ, AT VO2, VE/VO2, while the control group displayed no significant changes. After 12 months, the patients of rehabilitation group showed further increase in exercise time (from 5.6±1.9 min to 6.5±2.1 min) and AT VO2 (from 17.3±7.2 ml/kg/min to 20.8±5.4 ml/kg/min) indices (P<0.05). Those of double product and VE/VO2 decreased slightly when compared with findings at 6 months. RQ remained virtually at the same level, but significantly differed from the corresponding indices at the outset. Echocardiography performed at the entry and at 6 and 12 months revealed significant changes in systolic left ventricular function among the patients of rehabilitation group: wall movement index, ejection fraction as well as the left atrial long axis and left ventricular wall thickness. Echocardiographic changes indicate a positive impact of complex rehabilitative measures on systolic left ventricular function as evidenced by the ejection fraction and wall movement index values, as well as by regression of left ventricular wall thickness and left atrial long axis [...]