Paroxysmal atrial fibrillation, quality of life and neuroticism

BACKGROUND: Paroxysmal atrial fibrillation (AF) is associated with significant impairment of quality of life (QoL), which is to a large extent independent of objective measures of disease severity. We sought to investigate the potential role of neuroticism in the impairment of QoL in patients with paroxysmal AF. METHODS: The study group (AF group) comprised 73 patients with paroxysmal AF (mean age 55.5 +/- 113.3 years, 50 males). On average, patients had a three-year history of one symptomatic paroxysm a week lasting two hours. QoL was assessed using the Medical Outcomes Study Short Form (SF-36) and neuroticism was assessed using the short-scale Eysenck Personality Questionnaire (EPQ). RESULTS: The degree of neuroticism in the AF patient group did not differ from the degree of neuroticism in a group of age- and sex-matched controls (mean EPQ score on neuroticism 4.1 +/- 3.0 and 3.9 +/- 3.1, respectively; p = NS). Within the AF group, multivariate regression analyses showed that QoL in the physical domain (SF-36 physical functioning, physical role function, vitality and pain subscales) was not related the degree of neuroticism. In contrast, significant inverse relations were observed between scores on the mental health and social functioning subscales and the degree of neuroticism (beta coefficients p < .05), independent of age, sex and symptoms. CONCLUSION: Based on the present study, patients with paroxysmal AF appear to have on average a degree of neuroticism similar to age- and sex-matched controls. However, the impairment of QoL in these patients, in particular regarding social functioning and mental health, seems to be related to a relatively high degree of neuroticism, independent of age and sex

Social comparison and the subjective well-being of cancer patients

Although cancer patients may suffer from more physical and psychological distress than healthy persons, they seem not to differ in subjective well-being In this article the influence of social comparison on the relation between physical distress and subjective well-being was examined among cancer patients. LISREL analyses provided support for the following model: First, the psychological distress that resulted from physical distress induced a need for comparison. This need, in turn, affected the frequency of downward comparison. Whereas psychological distress negatively affected perceptions of how well one was doing in comparison with others, selectively comparing downward had the reverse impact, contributing to a feeling of relative well-being Unexpectedly, these relative evaluations also seemed to be affected directly by the amount of physical distress patients experienced. Finally, although both the amount of physical and psychological distress had strong direct effects on subjective well-being, the perception of how well one was doing compared to most others explained an additional significant amount of variance. Interestingly, this model was also supported in a healthy control group, suggesting that we are dealing here with a general behavioral model that suggests that social comparison processes may contribute to well-being when well-being is threatened by stress

Social comparison and the subjective well-being of cancer patients

Although cancer patients may suffer from more physical and psychological distress than healthy persons, they seem not to differ in subjective well-being In this article the influence of social comparison on the relation between physical distress and subjective well-being was examined among cancer patients. LISREL analyses provided support for the following model: First, the psychological distress that resulted from physical distress induced a need for comparison. This need, in turn, affected the frequency of downward comparison. Whereas psychological distress negatively affected perceptions of how well one was doing in comparison with others, selectively comparing downward had the reverse impact, contributing to a feeling of relative well-being Unexpectedly, these relative evaluations also seemed to be affected directly by the amount of physical distress patients experienced. Finally, although both the amount of physical and psychological distress had strong direct effects on subjective well-being, the perception of how well one was doing compared to most others explained an additional significant amount of variance. Interestingly, this model was also supported in a healthy control group, suggesting that we are dealing here with a general behavioral model that suggests that social comparison processes may contribute to well-being when well-being is threatened by stress

Survival outcomes of patients with advanced mucosal melanoma diagnosed from 2013 to 2017 in the Netherlands: a nationwide population-based study

Background: Mucosal melanoma (MM) is rare and has a poor prognosis. Since 2011, new effective treatments are available for advanced melanoma. It is unclear whether patients with mucosal melanoma equally benefit from these new treatments compared with patients with cutaneous melanoma (CM).Methods: Patients with advanced MM and CM diagnosed between 2013 and 2017 were included from a nationwide population-based registry the Dutch Melanoma Treatment Registry. Overall survival (OS) was estimated with the Kaplan-Meier method (also for a propensity score-matched cohort). A Cox model was used to analyse the association of possible prognostic factors with OS.Results: In total, 120 patients with MM and 2960 patients with CM were included. Median OS was 8.7 months and 14.5 months, respectively. Patients with MM were older (median age 70 versus 65 years) and more often female (60% versus 41%), compared with CM. In total, 77% and 2% of the MM patients were treated with first-line immunotherapy and targeted therapy, respectively, compared with 49% and 33% of the CM patients. In contrast to CM, OS for MM did not improve for patients diagnosed in 2015-2017, compared with 2013-2014. ECOG performance score >= 1 (HR = 1.99 [1.26-3.15; p = 0.003]) and elevated LDH level (HR = 1.63 [0.96-2.76]; p = 0.069) in MM were associated with worse survival.Conclusions: Within the era of immune and targeted therapies, prognosis for patients with advanced MM has not improved as much as for CM. Collaboration is necessary to enlarge sample size for research to improve immunotherapeutic strategies and identify targetable mutations. (C) 2020 Elsevier Ltd. All rights reserved