Adaptability and psychological flexibility: Overlapping constructs?

Adaptability is purported to be a key mental resource and refers to an individual's cognitive, behavioral, and emotional regulation (or adjustment) in situations of change, novelty, and uncertainty. Psychological flexibility refers to a person's capacity to allow experience and acceptance of negative thoughts and feelings with mindful awareness guided by a commitment to goal-driven action according to their self-chosen values. It is important to disentangle these cognate constructs—adaptability and psychological flexibility—so that the unique variance attributable to each can be estimated, and interventions and resources can be directed with greater precision. The current study explored the potential overlap between adaptability and psychological flexibility by conducting an online cross-sectional survey (n = 205), with measures of adaptability, psychological flexibility, wellbeing, and psychological distress. A confirmatory factor analysis suggested considerable overlap, but sufficient discrimination between the two constructs. Structural equation modelling showed that adaptability was related to psychological wellbeing, but not related to psychological distress after accounting for the effects of psychological flexibility

The situational version of the brief COPE: Dimensionality and relationships with goal-related variables

This study is aimed at investigating the dimensionality of the situational version of the Brief COPE, a questionnaire that is frequently used to assess a broad range of coping responses to specific difficulties, by comparing five different factor models highlighted in previous studies. It also aimed at exploring the relationships among coping responses, personal goal commitment and progress. The study involved 606 adults (male = 289) ranging in age from 19 to 71. Using confirmatory factor analysis, we compared five models and assessed relationships of coping responses with goal commitment and progress. The results confirmed the theoretical factor structure of the situational Brief COPE. All the 14 dimensions showed acceptable reliability and relationships with goal commitment and progress, attesting the reliability and usefulness of this measure to evaluate coping responses to specific events

Patients’ health locus of control and preferences about the role that they want to play in the medical decision-making process

Health locus of control (HLOC) may influence people’s behavior regarding their health as well as their desires to be involved in the medical decision-making. Our study aimed to examine HLOC’s relations with people’s control preferences about the medical decision-making. A total of 153 people filled out the self-administered version of the Control Preference Scale and the Multidimensional Health Locus of Control Scale–form C. The most preferred role is the collaborative one. However, HLOC explained heterogeneity in people’s control preferences: lower scores in external HLOC were related to a greater preference for the active and the collaborative role. From the personalized medicine perspective, an accurate evaluation of the patient’s HLOC could help tailoring the decision-making process within the clinical context

Lower limb deep vein thrombosis in COVID-19 patients admitted to intermediate care respiratory units

COVID-19 has been associated with an increased risk of thrombotic events; however, the reported incidence of deep vein thrombosis varies depending, at least in part, on the severity of the disease. Aim of this prospective, multicenter, observational study was to investigate the incidence of lower limb deep vein thrombosis as assessed by compression ultrasound in consecutive patients admitted to three pulmonary medicine wards designated to care for patients with COVID-19 related pneumonia, with or without respiratory failure but not requiring admission to an intensive care unit. Consecutive patients admitted between March 27 and May 6, 2020 were enrolled. Patients were excluded if they were less than 18-year-old or if compression ultrasound could not be performed for any reason. Patients were assessed at admission (t0) and after 7 days (t1). Major and non-major clinically relevant bleedings were recorded. Sixty-eight patients were enrolled. Two were excluded due to anatomical abnormalities that prevented compression ultrasound; sixty patients were retested at (t1). All patients were started on antithrombotic prophylaxis, unless therapeutic anticoagulation was required. Deep vein thrombosis as assessed by compression ultrasound was observed in 2 patients (3%); one of them was later deemed to represent a previous episode. No new episodes were detected at t1. One major and 2 non-major clinically relevant bleedings were observed. In the setting of patients with COVID-related pneumonia not requiring admission to an intensive care unit, the incidence of deep vein thrombosis is low and our data support not screening asymptomatic patients

Sexism Interacts with Patient–Physician Gender Concordance in Influencing Patient Control Preferences: Findings from a Vignette Experimental Design

Background: Patient preferences regarding their involvement in shared treatments decisions is fundamental in clinical practice. Previous evidences demonstrated a large heterogeneity in these preferences. However, only few studies have analysed the influence of patients’ individual differences, contextual and situational qualities, and their complex interaction in explaining this variability. Methods: We assessed the role of the interaction of patient’s sociodemographic and psychological factors with a physician’s gender. Specifically, we focused on patient gender and attitudes toward male or female physicians. One hundred fifty-three people participated in this randomised controlled study and were randomly assigned to one of two experimental conditions in which they were asked to imagine discussing their treatment with a male and a female doctor. Results: Analyses showed an interplay between attitude towards women and the gender of patients and doctors, explaining interindividual variability in patient preferences. Conclusions: In conclusion, patients’ attitudes toward the physicians’ gender constitutes a relevant characteristic that may influence the degree of control patients want to have and the overall patient-physician relationship

A longitudinal study on the information needs and preferences of patients after an acute coronary syndrome

Background: Research has shown that the provision of pertinent health information to patients with cardiovascular disease is associated with better adherence to medical prescriptions, behavioral changes, and enhanced perception of control over the disease. Yet there is no clear knowledge on how to improve information pertinence. Identifying and meeting the information needs of patients and their preferences for sources of information is pivotal to developing patient-led services. This prospective, observational study was aimed at exploring the information needs and perceived relevance of different information sources for patients during the twenty-four months following an acute coronary syndrome. Methods: Two hundred and seventeen newly diagnosed patients with acute coronary syndrome were enrolled in the study. The patients were primarily men (83.41 %) with a mean age of 57.28 years (range 35-75; SD = 7.98). Patients' needs for information and the perceived relevance of information sources were evaluated between 2 and 8 weeks after hospitalization (baseline) and during three follow-ups at 6, 12 and 24 months after baseline. Repeated measures ANOVA, Bonferroni post hoc tests and Cochran's Q Test were performed to test differences in variables of interest over time. Results: Results showed a reduction in information needs, but this decrease was significant only for topics related to daily activities, behavioral habits, risk and complication. At baseline, the primary sources of information were specialists and general practitioners, followed by family members and information leaflets given by physicians. Relevance of other sources changed differently over time. Conclusion: The present longitudinal study is an original contribution to the investigation of changes in information needs and preferences for sources of information among patients who are diagnosed with acute coronary syndrome. One of the main results of this study is that information on self-disease management is perceived as a minor theme for patients even two years after the event. Knowledge on how patients' information needs and perceived relevance of information sources change over time could enhance the quality of chronic disease management, leading health-care systems to move toward more patient-tailored care

The Acceptance and Action Questionnaire-II (AAQ-II) as a measure of experiential avoidance: Concerns over discriminant validity

Psychological inflexibility and experiential avoidance are key constructs in the Acceptance and Commitment Therapy (ACT) model of behavior change. Wolgast (2014) questioned the construct validity of the Acceptance and Action Questionnaire-II (AAQ-II), the most used self-report instrument to assess the efficacy of ACT interventions. Wolgast suggested that the AAQ-II measured psychological distress rather than psychological inflexibility and experiential avoidance. The current study further examined the construct validity of the AAQ-II by conducting an online cross-sectional survey (n = 524), including separate measures of experiential avoidance and psychological distress. Confirmatory factor analyses indicated that items from the AAQ-II correlated more highly with measures of depression, anxiety, and stress than the Brief Experiential Avoidance Questionnaire (BEAQ). Implications include that, as broad measures of experiential avoidance, the AAQ-II and BEAQ may not measure the same construct. In terms of psychological distress, the BEAQ has greater discriminant validity than the AAQ-II, and perhaps an alternative instrument of psychological inflexibility might be needed to assess core outcomes in ACT intervention research

A type A and type D combined personality typology in essential hypertension and acute coronary syndrome patients: Associations with demographic, psychological, clinical, and lifestyle indicators

Many studies have focused on Type A and Type D personality types in the context of cardiovascular diseases (CVDs), but nothing is known about how these personality types combine to create new profiles. The present study aimed to develop a typology of Type A and Type D personality in two groups of patients affected by and at risk for coronary disease. The study involved 711 patients: 51.6% with acute coronary syndrome, 48.4% with essential hypertension (mean age = 56.4 years; SD = 9.7 years; 70.7% men). Cluster analysis was applied. External variables, such as socio-demographic, psychological, lifestyle, and clinical parameters, were assessed. Six groups, each with its own unique combined personality profile scores, were identified: Type D, Type A-Negatively Affected, Not Type A-Negatively Affected, Socially Inhibited-Positively Affected, Not Socially Inhibited, and Not Type A-Not Type D. The Type A-Negatively Affected cluster and, to a lesser extent, the Type D cluster, displayed the worst profile: namely higher total cardiovascular risk index, physical inactivity, higher anxiety and depression, and lower self-esteem, optimism, and health status. Identifying combined personality profiles is important in clinical research and practice in cardiovascular diseases. Practical implications are discussed

Effects of Long-Term Pioglitazone Treatment on Peripheral and Central Markers of Aging

BACKGROUND: Thiazolidinediones (TZDs) activate peroxisome proliferator-activated receptor gamma (PPARgamma) and are used clinically to help restore peripheral insulin sensitivity in Type 2 diabetes (T2DM). Interestingly, long-term treatment of mouse models of Alzheimer\u27s disease (AD) with TZDs also has been shown to reduce several well-established brain biomarkers of AD including inflammation, oxidative stress and Abeta accumulation. While TZD\u27s actions in AD models help to elucidate the mechanisms underlying their potentially beneficial effects in AD patients, little is known about the functional consequences of TZDs in animal models of normal aging. Because aging is a common risk factor for both AD and T2DM, we investigated whether the TZD, pioglitazone could alter brain aging under non-pathological conditions. METHODS AND FINDINGS: We used the F344 rat model of aging, and monitored behavioral, electrophysiological, and molecular variables to assess the effects of pioglitazone (PIO-Actos® a TZD) on several peripheral (blood and liver) and central (hippocampal) biomarkers of aging. Starting at 3 months or 17 months of age, male rats were treated for 4-5 months with either a control or a PIO-containing diet (final dose approximately 2.3 mg/kg body weight/day). A significant reduction in the Ca2+-dependent afterhyperpolarization was seen in the aged animals, with no significant change in long-term potentiation maintenance or learning and memory performance. Blood insulin levels were unchanged with age, but significantly reduced by PIO. Finally, a combination of microarray analyses on hippocampal tissue and serum-based multiplex cytokine assays revealed that age-dependent inflammatory increases were not reversed by PIO. CONCLUSIONS: While current research efforts continue to identify the underlying processes responsible for the progressive decline in cognitive function seen during normal aging, available medical treatments are still very limited. Because TZDs have been shown to have benefits in age-related conditions such as T2DM and AD, our study was aimed at elucidating PIO\u27s potentially beneficial actions in normal aging. Using a clinically-relevant dose and delivery method, long-term PIO treatment was able to blunt several indices of aging but apparently affected neither age-related cognitive decline nor peripheral/central age-related increases in inflammatory signaling

第964回千葉医学会例会・第31回麻酔科例会

Background: Research has shown that the provision of pertinent health information to patients with cardiovascular disease is associated with better adherence to medical prescriptions, behavioral changes, and enhanced perception of control over the disease. Yet there is no clear knowledge on how to improve information pertinence. Identifying and meeting the information needs of patients and their preferences for sources of information is pivotal to developing patient-led services. This prospective, observational study was aimed at exploring the information needs and perceived relevance of different information sources for patients during the twenty-four months following an acute coronary syndrome. Methods: Two hundred and seventeen newly diagnosed patients with acute coronary syndrome were enrolled in the study. The patients were primarily men (83.41 %) with a mean age of 57.28 years (range 35-75; SD = 7.98). Patients' needs for information and the perceived relevance of information sources were evaluated between 2 and 8 weeks after hospitalization (baseline) and during three follow-ups at 6, 12 and 24 months after baseline. Repeated measures ANOVA, Bonferroni post hoc tests and Cochran's Q Test were performed to test differences in variables of interest over time. Results: Results showed a reduction in information needs, but this decrease was significant only for topics related to daily activities, behavioral habits, risk and complication. At baseline, the primary sources of information were specialists and general practitioners, followed by family members and information leaflets given by physicians. Relevance of other sources changed differently over time. Conclusion: The present longitudinal study is an original contribution to the investigation of changes in information needs and preferences for sources of information among patients who are diagnosed with acute coronary syndrome. One of the main results of this study is that information on self-disease management is perceived as a minor theme for patients even two years after the event. Knowledge on how patients' information needs and perceived relevance of information sources change over time could enhance the quality of chronic disease management, leading health-care systems to move toward more patient-tailored care