Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

El Método de auto-confrontación : evaluación, cambio y valoración de los sistemas de significado personal

El método de auto-confrontación, en un intento de unir la brecha existente en psicología entre científicos y profesionales, se diseña, tanto como instrumento de investigación, como procedimiento práctico para ayudar a los clientes en su autoinvestigación. Se describirá un caso en detalle para demostrar las tres funciones del método: (a) como un método de evaluación para la investigación del contenido y estructura del sistema de valoración; (b) como una herramienta para la reorganización de este sistema; y (c) como un instrumento para la valoración de la naturaleza del cambio del sistema. Para finalizar, se resumirán algunas áreas problemáticas y campos de aplicación en los cuales se ha empleado dicho método

El sí mismo ampliado y diseminado : introducción a la teoría de la valoración

En este trabajo se presenta una introducción a la teoría de la valoración con las formulaciones clásicas de William James sobre el sí mismo como punto de partida. En esta teoría dinámica y abierta, el sí mismo es concebido como un proceso organizado de valoración, valoración que es una unidad de significado personal a los ojos de la persona que relata la historia de su vida. La teoría se describe, cronológicamente, en tres partes: (a) la investigación sobre los sueños, los mitos colectivos, y las aplicaciones prácticas en el ámbito de las quejas psicosomáticas, esbozan la primera fase del edificio de la teoría; (b) en la segunda fase, la teoría recibe un nuevo impulso a partir de la noción de Bakhtin de la novela polifónica, que desemboca en una concepción multivocal del sí mismo; (c) la reciente ampliación de la teoría es ilustrada por la influencia que los otros imaginarios tienen en el sistema de valoraciones personales, y por la discusión del caso de una cliente al borde de un trastorno de personalidad múltiple

Bridging traits, story, and self: Prospects and problems

Contains fulltext : 29508.pdf (publisher's version ) (Open Access)In his target article, McAdams brings together three domains in the field of psychology in which challenging developments have been observed over the past decades: trait psychology, narrative psychology, and culture. Trait psychology has been rejuvenated by crossnational and cross-cultural research projects on the "Big Five". The narrative approach has cropped up in a great diversity of psychological subdisciplines, including personality psychology, and is on its way to being accepted as a respected development in academic psychology. The notion of culture has also received enormous interest, particularly in discussions around modernity and postmodernity and their implications for psychology as a science. Scientists in and outside psychology are becoming aware that culture is implicit not only in their personal views, but also in the theories and concepts that form the basis of their professional activities. McAdams's contribution has the merit that it provides an intriguing conceptual framework that aims at integrating a diversity of psychological developments that interact in many ways, but that have never been analyzed on their mutual implications from a metatheoretical point of view

The Self-Confrontation Method: Theory, Research, and Practical Utility

In recent years, the Self Confrontation Method has garnered significant attention as both a method of assessment and change in counseling. In this paper, the authors provide a review of the utility of the Self Confrontation Method as a practical tool for counselors. Toward this end, the conceptual and empirical foundations of the Self Confrontation Method are first examined followed by a focus on its practical application to counseling. Consistent with narrative and constructivist approaches to counseling, the Self Confrontation Method represents a viable procedure for contextualizing client problems, assessing the unique organization of client self-schemas and emotional patterning, and facilitating progressive client change and development. © 2006 Taylor & Francis

Fields of Tension in a Boundary-Crossing World : Towards a Democratic Organization of the Self

In their study of the relationship between self and society, scientists have proposed taking society as a metaphor for understanding the dynamics of the self, such as the analogy between the self and the functioning of a totalitarian state or the analogy between the self and the functioning of a bureaucratic organization. In addition to these models, the present article proposes a democratic society as a metaphor for understanding the workings of a dialogical self in a globalizing, boundary-crossing world. The article follows four steps. In the first step the self is depicted as extended to the social and societal environment and made up of fields of tension in which a multiplicity of self-positions are involved in processes of positioning and counter-positioning and in relationships of social power. In the second step, the fertility of the democratic metaphor is demonstrated by referring to theory and research from three identity perspectives: multicultural, multiracial, and transgender. In the fields of tension emerging between the multiplicity of self-positions, new, hybrid, and mixed identities have a chance to emerge as adaptive responses to the limitations of existing societal structures. In the third step, we place the democratic self in a broader societal context by linking three levels of inclusiveness, proposed by Self-Categorization Theory (personal, social, and human) to recent conceptions of a cosmopolitan democracy. In the fourth and final step, a model is presented which allows the formulation of a series of specific research questions for future studies of a democratically organized self

Self-investigation to explore the impact of juvenile arthritis on adolescent life: A case-study

Objective: To gain insight into the personal experience and feelings of an adolescent with a chronic disease. Methods: We report on the application of the self-confrontation method (SCM), illustrated by a case-example of an adolescent with juvenile idiopathic arthritis. Results: Although taken at face value she was not impeded by the arthritis, through self-assessment with the SCM this adolescent acknowledged and addressed the emotional struggle to keep the arthritis secret and to constantly test the physical limits of her body. After the process of self-reflection, the adolescent showed a better integration of her arthritis experiences into her life story. Conclusion: With the SCM the adolescent could explore her own functioning and well-being on a manifest, as well as on an emotional and motivational level. Practice implications: In future research, by studying the self-investigations of a group of adolescents with chronic diseases, common risk factors for the development of a stable identity during adolescence might be identified. In clinical care, the SCM promotes self-knowledge, allowing for an intrinsic motivation to deal with the emotional impact of the disease

Self-investigation in adolescent chronic fatigue syndrome:Narrative changes and health improvement

Objective: A small-scale intervention study into narrative self-investigation in adolescent chronic fatigue syndrome (CFS). Method: The self-confrontation method (SCM) is an instrument to assess and change personal life stories. Forty-two adolescents diagnosed with CFS were included and randomly assigned to either 6 or 12 sessions with the SCM. Twenty-five healthy adolescents were assigned to 6 sessions. Outcome was measured directly after the self-investigation procedure at 4 months. Follow-up measurements were made 10 months later. The Checklist Individual Strength and the Child Health Questionnaire were used to measure changes in fatigue, physical and psychosocial functioning. Results: Self-investigation resulted in significant changes in participants' narratives. Moreover, after self-investigation there was a significant improvement in fatigue, physical and psychosocial functioning for the adolescents with CFS. The patients who completed 12 sessions improved most. At follow-up, the positive effects were maintained. Conclusion: Self-investigation enables a move beyond the symptoms of CFS in an individualized, patient centered way. Narrative transformation seems to contribute to improved physical and psychosocial outcome in adolescent CFS. Practice implications: The SCM allows adolescents to discover (for themselves) factors that might cause or perpetuate their fatigue. The results suggest that self-investigation is a useful instrument in the management of adolescent CFS