Quality of Life in a Mixed Ethnic Population after Myocardial Infarction

Background: Although South Asian people are a significant ethnic group at increased risk of coronary heart disease and high mortality rates and experience greater delays with respect to diagnosis, referral and treatment, comparatively little is known about their quality of life during recovery from a myocardial infarction.Objectives: We sought to determine and compare the impact of ethnicity on quality of life after myocardial infarction (MI) in a mixed ethnic population (South Asian and white people) in the UK.Methods: A 2x2 mixed-group design with repeated measures on the second factor. The independent variables were ethnic group (white/South Asian) and time since MI (2 weeks/3 months). The dependent variables were the subscale scores on the Short-Form 36-item health survey (SF-36) and the Hospital Anxiety and Depression Scale (HADS).Results: At 2 weeks, significant differences were observed between groups on 5 of the 8 SF-36 subscale domain scores, with the white group reporting higher quality of life. Significant improvement in reported quality of life occurred in both groups over time on all domains of the SF-36, except bodily pain. There was a significantly greater improvement in favour of the white group for the role-physical domain. There was no significant difference between groups in terms of anxiety or depression at 2 weeks. Both groups showed a significant reduction in anxiety and depression by 3 months, but the degree of reduction was not significantly different between them. At 3 months, there was no significant difference between groups in terms of anxiety scores, but the South Asian group scored significantly higher on the depression scale.Conclusions: South Asian people have significantly poorer quality of life than white people after MI. While both groups showed improvement over time, South Asian people reported significantly less improvement in physical role function and were more depressed at 3 months. Identifying the factors accounting for such differences is important to develop models of care for delivering the most effective and culturally-sensitive interventions to this group

Clinical and psychological course of diabetes from adolesence to young adulthood: a longitudinal cohort study

OBJECTIVE—To determine the clinical and psychological course of diabetes through adolescence and the relationship with glycemic control in young adulthood. RESEARCH DESIGN AND METHODS—A longitudinal cohort study of adolescents recruited from the register of the outpatient pediatric diabetes clinic. A total of 76 individuals (43 male patients, 33 female patients) aged 11–18 years completed baseline assessments, and 65 individuals (86%) were reinterviewed as young adults (20–28 years of age). Longitudinal assessments were made of glycemic control (HbA1c), weight gain (BMI), and development of complications. Adolescents completed self-report questionnaires to assess emotional and behavioral problems as well as self-esteem. As young adults, psychological state was assessed by the Revised Clinical Interview Schedule and the self-report Brief Symptom Inventory. RESULTS—Mean HbA1c levels peaked in late adolescence and were worse in female participants (average 11.1% at 18–19 years of age). The proportion of individuals who were overweight (BMI &gt;25.0 kg/m2) increased during the 8-year period from 21 to 54% in female patients and from 2 to 28% in male patients. Serious diabetes-related events included death in one patient and cognitive impairment in two patients. Individuals in whom diabetic complications developed (25% of male patients and 38% of female patients) had significantly higher mean HbA1c levels than those without complications (difference 1.9%, 95% CI 1.1–2.7, P &lt; 0.0001). Behavioral problems at baseline were related to higher mean HbA1c during the subsequent 8 years (ß = 0.15, SEM (ß) 0.04, P &lt; 0.001, 95% CI 0.07–0.24). CONCLUSIONS—The outcome for this cohort was generally poor. Behavioral problems in adolescence seem to be important in influencing later glycemic control. <br/

Clinical and psychological course of diabetes from adolesence to young adulthood: a longitudinal cohort study

OBJECTIVE—To determine the clinical and psychological course of diabetes through adolescence and the relationship with glycemic control in young adulthood. RESEARCH DESIGN AND METHODS—A longitudinal cohort study of adolescents recruited from the register of the outpatient pediatric diabetes clinic. A total of 76 individuals (43 male patients, 33 female patients) aged 11–18 years completed baseline assessments, and 65 individuals (86%) were reinterviewed as young adults (20–28 years of age). Longitudinal assessments were made of glycemic control (HbA1c), weight gain (BMI), and development of complications. Adolescents completed self-report questionnaires to assess emotional and behavioral problems as well as self-esteem. As young adults, psychological state was assessed by the Revised Clinical Interview Schedule and the self-report Brief Symptom Inventory. RESULTS—Mean HbA1c levels peaked in late adolescence and were worse in female participants (average 11.1% at 18–19 years of age). The proportion of individuals who were overweight (BMI &gt;25.0 kg/m2) increased during the 8-year period from 21 to 54% in female patients and from 2 to 28% in male patients. Serious diabetes-related events included death in one patient and cognitive impairment in two patients. Individuals in whom diabetic complications developed (25% of male patients and 38% of female patients) had significantly higher mean HbA1c levels than those without complications (difference 1.9%, 95% CI 1.1–2.7, P &lt; 0.0001). Behavioral problems at baseline were related to higher mean HbA1c during the subsequent 8 years (ß = 0.15, SEM (ß) 0.04, P &lt; 0.001, 95% CI 0.07–0.24). CONCLUSIONS—The outcome for this cohort was generally poor. Behavioral problems in adolescence seem to be important in influencing later glycemic control. <br/

Can oncology nurses treat depression? A pilot project

BACKGROUND: Depression is a common problem in all medically ill populations. Reported prevalence rates of major depression in patients with cancer are up to 50%. Cancer patients attending primary care and medical outpatient clinics with comorbid major depressive disorder frequently do not receive effective treatment. More effective ways of identifying and treating patients with both cancer and depression are therefore urgently required. AIM: The paper reports a study addressing the question of whether oncology nurses can be trained to take on a greater role in the management of major depression in their patients. METHOD: We developed and piloted an intervention that can be delivered by a specially trained oncology nurse. The intervention is multifaceted and based on a problem-solving model. It requires a widening of the role and expertise of specialist nurses. DISCUSSION: The challenges this role presents to the nurses are discussed. We suggest that they must have a varied work programme that is not exclusively about managing depression, that they require adequate peer support and are likely to be most effective when working as part of a multidisciplinary psycho-oncology team. CONCLUSION: We conclude that it is possible to train selected specialist oncology nurses to manage major depression in patients with cancer in the context of an appropriately constituted multidisciplinary team