Examination of Adherence, the Quality of the Physician/Patient Relationship, and Illness-Related Beliefs Among Adults with Long QT Syndrome

Long QT Syndrome (LQTS) is a cardiac arrhythmia disorder that affects 1 in 2,000 individuals and is a precursor to various cardiac events, including sudden cardiac arrest (Schwartz et al., 2016). As a precaution, individuals with all types of LQTS have been advised to modify their lifestyles to avoid triggers, including limiting physical activity (PA). Nonadherence to treatment recommendations could result in devastating outcomes. The purpose of the study was to explore characteristics pertaining to adherence and nonadherence to PA recommendations, including the quality of the physician/patient relationship and illness beliefs among adults with LQTS. An Internet survey was completed by 91 adults with LQTS who were recruited through various social media and medical group venues. The findings indicated that agreement on treatment goal between participants and cardiologists accounted for 3% and 4% of the variances, respectively, of perceptions of personal and treatment control over LQTS. Positive perceptions of personal and treatment control significantly predicted adherence. These results can be explained by the self-regulatory model, which describes the connection between health behaviors and illness perceptions. The findings generate many opportunities for future directions with the LQTS population and other medical populations, including research, intervention development, and advocacy

Information Shared on YouTube by Individuals Affected by Long QT Syndrome: A Qualitative Study

Objectives: Little is known about the role of social media and YouTube, in people coping with serious medical diagnoses (Bane et al., 2005). Long QT Syndrome (LQTS) is an inherited cardiac condition affecting 1:2500 people that predisposes them to life threatening arrhythmias, and is often diagnosed in childhood. Few studies address the psychosocial impact of LQTS (Lane et al., 2009), though dietary, physical, and social restrictions are required (Chattha & Zelenietz, 2011), and lifelong medication and implantable devices may be needed. This study investigates what individuals share with others about LQTS via YouTube. Information may help professionals effectively use or moderate the effects of social media for patients, and identify areas for intervention for those with LQTS. Methods: Inclusion: YouTube videos from 2008 to 2013; individuals in videos have personal experience with LQTS. Exclusion: Videos without verbal or written narratives were excluded. Procedure: Of 1790 videos in a “long qt syndrome†YouTube search, 35 met inclusion criteria. Excluded videos were professionally filmed hospital testimonials, medical lectures, and videographies. LQTS patients in the included videos represent ages across the lifespan. Qualitative analysis was used to interpret the videos. Three coders used open and axial coding to determine key themes in data and achieve saturation. Grounded theory was used to explain results in a theoretical and evidence-based context. Results: Findings revealed individuals’ thoughts, feelings, and behaviors about biopsychosocial aspects of LQTS. Themes include experiences with initial diagnosis, survival stories, treatment, misdiagnoses, and mistreatment. Conclusions: YouTube offers cost-effective means to learn about patient populations’ psychological needs, experiences, and useful sources of information. Specific to LQTS, YouTube may provide an understanding of informal information communicated among patients and families that may impact questions asked of their physicians and psychosocial aspects of the condition

Effects of yohimbine and hydrocortisone on panic symptoms, autonomic responses, and attention to threat in healthy adults

Rationale: research in rodents and non-human primates implicates the noradrenergic system and hypothalamic–pituitary–adrenal axis in stress, anxiety, and attention to threat. Few studies examine how these two neurochemical systems interact to influence anxiety and attention in humans. Objective: the objective of this paper is to examine the effects of exogenous yohimbine and hydrocortisone, as well as their combination (Y?+?H), on panic symptoms and attention to social threat cues. Methods: thirty-two healthy adults underwent a pharmacological challenge in which they were blindly randomized to either yohimbine, hydrocortisone, Y?+?H, or placebo. Thirty minutes after drug infusion, attention to threat was measured using the dot probe task, a visual attention task that presents angry, happy, and neutral faces and measures the degree of attention allocated towards or away from the emotional faces. Panic and autonomic measures were assessed before and 30 min after drug infusion. Results: there was a significant increase in panic symptoms in the yohimbine and Y?+?H groups, but not in the hydrocortisone or placebo groups. Yohimbine resulted in a greater increase in panic symptoms than Y?+?H. On the dot probe task, the placebo group exhibited an attention bias to angry faces, whereas this bias was absent after yohimbine. When collapsing across groups, increased panic symptoms was associated with less attention to angry faces. Conclusions: exogenous hydrocortisone may attenuate noradrenergic-induced panic symptoms. The inverse relationship between panic symptoms and attention to angry faces extends prior research demonstrating attention modulation by stressful conditions. <br/

Essential for what? A global social reproduction view on the re-organisation of work during the COVID-19 pandemic

COVID-19 has shaken a foundational pillar of global capitalism: the organisation of work. A pivotal dimension of such re-organisation has been the classification of work as essential or not. This article explores the concept of essential work using a global feminist social reproduction perspective. We show that the meaning of essential work is more ambiguous and politicised than it may appear and, although it can be used as a basis to reclaim the value of socially reproductive work, its transformative potential hinges on the possibility to encompass the most precarious and transnational dimensions of (re)production

Postoperative continuous positive airway pressure to prevent pneumonia, re-intubation, and death after major abdominal surgery (PRISM): a multicentre, open-label, randomised, phase 3 trial

Background: Respiratory complications are an important cause of postoperative morbidity. We aimed to investigate whether continuous positive airway pressure (CPAP) administered immediately after major abdominal surgery could prevent postoperative morbidity. Methods: PRISM was an open-label, randomised, phase 3 trial done at 70 hospitals across six countries. Patients aged 50 years or older who were undergoing elective major open abdominal surgery were randomly assigned (1:1) to receive CPAP within 4 h of the end of surgery or usual postoperative care. Patients were randomly assigned using a computer-generated minimisation algorithm with inbuilt concealment. The primary outcome was a composite of pneumonia, endotracheal re-intubation, or death within 30 days after randomisation, assessed in the intention-to-treat population. Safety was assessed in all patients who received CPAP. The trial is registered with the ISRCTN registry, ISRCTN56012545. Findings: Between Feb 8, 2016, and Nov 11, 2019, 4806 patients were randomly assigned (2405 to the CPAP group and 2401 to the usual care group), of whom 4793 were included in the primary analysis (2396 in the CPAP group and 2397 in the usual care group). 195 (8\ub71%) of 2396 patients in the CPAP group and 197 (8\ub72%) of 2397 patients in the usual care group met the composite primary outcome (adjusted odds ratio 1\ub701 [95% CI 0\ub781-1\ub724]; p=0\ub795). 200 (8\ub79%) of 2241 patients in the CPAP group had adverse events. The most common adverse events were claustrophobia (78 [3\ub75%] of 2241 patients), oronasal dryness (43 [1\ub79%]), excessive air leak (36 [1\ub76%]), vomiting (26 [1\ub72%]), and pain (24 [1\ub71%]). There were two serious adverse events: one patient had significant hearing loss and one patient had obstruction of their venous catheter caused by a CPAP hood, which resulted in transient haemodynamic instability. Interpretation: In this large clinical effectiveness trial, CPAP did not reduce the incidence of pneumonia, endotracheal re-intubation, or death after major abdominal surgery. Although CPAP has an important role in the treatment of respiratory failure after surgery, routine use of prophylactic post-operative CPAP is not recommended