Psychosocial factors and cancer incidence (PSY-CA): Protocol for individual participant data meta-analyses

Brain Behav. 2021 Sep 2:e2340. doi: 10.1002/brb3.2340. Online ahead of print.


OBJECTIVES: Psychosocial factors have been hypothesized to increase the risk of cancer. This study aims (1) to test whether psychosocial factors (depression, anxiety, recent loss events, subjective social support, relationship status, general distress, and neuroticism) are associated with the incidence of any cancer (any, breast, lung, prostate, colorectal, smoking-related, and alcohol-related); (2) to test the interaction between psychosocial factors and factors related to cancer risk (smoking, alcohol use, weight, physical activity, sedentary behavior, sleep, age, sex, education, hormone replacement therapy, and menopausal status) with regard to the incidence of cancer; and (3) to test the mediating role of health behaviors (smoking, alcohol use, weight, physical activity, sedentary behavior, and sleep) in the relationship between psychosocial factors and the incidence of cancer.

METHODS: The psychosocial factors and cancer incidence (PSY-CA) consortium was established involving experts in the field of (psycho-)oncology, methodology, and epidemiology. Using data collected in 18 cohorts (N = 617,355), a preplanned two-stage individual participant data (IPD) meta-analysis is proposed. Standardized analyses will be conducted on harmonized datasets for each cohort (stage 1), and meta-analyses will be performed on the risk estimates (stage 2).

CONCLUSION: PSY-CA aims to elucidate the relationship between psychosocial factors and cancer risk by addressing several shortcomings of prior meta-analyses.

PMID:34473425 | DOI:10.1002/brb3.2340

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Understanding care needs of cancer patients with depressive symptoms: The importance of patients’ recognition of depressive symptoms

Psychooncology. 2021 Aug 10. doi: 10.1002/pon.5779. Online ahead of print.


OBJECTIVE: The majority of cancer patients with depressive symptoms does not perceive a need for psychological care. Reasons for this are still unclear. We examined the mediating role of cancer patients’ perceptions of depressive symptoms in the relationship between depressive symptoms and perceived need for psychological care.

METHODS: For this cross-sectional study, we recruited 127 Dutch cancer patients with moderate to severe levels of depressive symptoms (Patient Health Questionnaire [PHQ]-9≥10) who did not receive professional psychological care. Depressive symptoms were measured with the PHQ-9 questionnaire, by using three different depression score operationalizations. We used mediation analyses to test the mediating role of patients’ illness perceptions (measured with subscales of the Brief Illness Perception Questionnaire) in the relation between depressive symptoms and need for care.

RESULTS: Whilst results did not show significant direct associations between depressive symptoms and perceived need for psychological care, we found positive indirect effects of severity (B = 0.07, SE = 0.04, p < 0.02), meeting the DSM-5 diagnosis (B = 0.45, SE = 0.26, p < 0.02) and having relatively more affective symptoms (B = 2.37, SE = 1.10, p < 0.02) on need for care through the identity perception.

CONCLUSIONS: Including assessments of patients’ recognition of depressive symptoms and their perceptions of depression treatment efficacy might improve depression screening in cancer patients by more accurately identifying those with a need for psychological care. Moreover, improving patients’ knowledge and recognition of symptoms as being depressive symptoms might be a possible target point in increasing care needs and hereby optimizing the uptake of psychological care in cancer patients with depressive symptoms.

PMID:34378278 | DOI:10.1002/pon.5779

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A healthy view? exploring the positive health perceptions of older adults with a lower socioeconomic status using photo-elicitation interviews

Int J Qual Stud Health Well-being. 2021 Dec;16(1):1959496. doi: 10.1080/17482631.2021.1959496.


Purpose: The health perceptions of older adults with a lower socioeconomic status still seems to be unsettled. To gain more insight in these perceptions, 19 older adults were interviewed with the use of a photo-elicitation method.Methods: Participants reflected on ten photographs covering aspects of physical, social and mental health, and were also asked if and how they experience to have control over their health.Results: The results showed that the perception of health depended on the background of the participant, was experience-oriented and was mostly focused on the negative aspects of physical and mental health. Social contacts were an important contributor to well-being, especially when physical health declined. Although most participants seem hardly aware of having influence on their own health, several participants showed automatic self-management abilities.Conclusion: For participants who need more support to improve, or become more aware of their self-management abilities, interventions with an experience-oriented approach are needed.

PMID:34369312 | PMC:PMC8354017 | DOI:10.1080/17482631.2021.1959496

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Putting mindfulness-based cognitive therapy to the test in routine clinical practice: A transdiagnostic panacea or a disorder specific intervention?

J Psychiatr Res. 2021 Jul 24;142:144-152. doi: 10.1016/j.jpsychires.2021.07.043. Online ahead of print.


BACKGROUND: Over the past two decades there has been a growing number of randomized clinical trials supporting the efficacy of mindfulness-based cognitive therapy (MBCT) in the treatment of several psychiatric disorders. Since evidence for its effectiveness in routine clinical practice is lagging behind, we aimed to examine adherence, outcome and predictors of MBCT in a well-characterized, heterogeneous outpatient population in routine clinical practice.

METHODS: Data were collected from a naturalistic uncontrolled cohort of 998 patients formally diagnosed with mainly depression, anxiety disorders, personality disorders, somatoform disorders and/or ADHD. Patients received protocolized MBCT and completed self-report questionnaires pre- and post-treatment on overall functioning (Outcome Questionnaire, primary outcome), depressive symptoms, worry, mindfulness skills and self-compassion. Pre-to post-treatment changes were analysed for the overall sample and each diagnostic category separately with paired sample t-tests, reliable change indices (only overall sample) and repeated measures ANOVA for groups with and without comorbidity. Multiple linear regression was carried out to assess possible predictors of adherence and change in overall functioning.

RESULTS: Adherence was high (94%) but negatively affected by lower levels of education, more comorbidity and presence of ADHD. Outcome in terms of improvement in overall functioning was good in the overall sample (Cohen’s d = 0.50, 30% showed reliable improvement vs. 3.5% reliable deterioration) and within each diagnostic category (Cohen’s d range = 0.37-0.61). Worse overall functioning at baseline was the only predictor for a larger treatment effect.

CONCLUSIONS: After MBCT, overall functioning improved in a large heterogeneous psychiatric outpatient population independent of diagnosis or comorbidity.

PMID:34352560 | DOI:10.1016/j.jpsychires.2021.07.043

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Smoking Cessation Experience in Indonesia: Does the Non-smoking Wife Play a Role?

Front Psychol. 2021 Jul 14;12:618182. doi: 10.3389/fpsyg.2021.618182. eCollection 2021.


OBJECTIVE: More than 63% of Indonesian men are smokers, and smoking has long been a part of Indonesian culture and the concept of masculinity in Indonesian culture. Given the pro-smoking environment, we were interested in examining why smokers would willingly quit and whether their wives played a role in their quitting process as social factors are mentioned second most frequent as a reason for quitting smoking.

DESIGN: In-depth interviews.

METHOD: We interviewed 11 couples (N = 22)-ex-smoking husbands and non-smoking wives-in Yogyakarta, Indonesia. The data were analysed by using the thematic analysis approach.

RESULTS: Four themes were discussed: (1) reasons for stopping smoking, (2) the process of quitting smoking, (3) the wives’ attitudes toward smoking, and (4) the families’ attempts to make the (ex-)smokers quit. The most commonly cited reasons for quitting were family and personal motivation. The (ex-)smokers preferred to quit without assistance and in private. The wives’ attitude toward smoking ranged from dislike to tolerance, and most did not know when their husbands were trying to quit. Both husbands and wives reported that the wives did not influence the smoking cessation process.

CONCLUSION: Indonesian ex-smokers often had multiple reasons for quitting smoking. The process was typically difficult and kept private. While wives had little influence on the cessation process, they provided support and could institute a smoking ban in the house.

PMID:34335352 | PMC:PMC8316595 | DOI:10.3389/fpsyg.2021.618182

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Moderation of the Stressor-Strain Process in Interns by Heart Rate Variability Measured with a Wearable and Smartphone App: a Within-Subject Design Using Continuous Monitoring

JMIR Cardio. 2021 Jul 27. doi: 10.2196/28731. Online ahead of print.


BACKGROUND: The emergence of smartphones and wearable sensor technologies enables opportunities to easily and unobtrusively monitor physiological and psychological data related to an individual’s resilience. Heart Rate Variability (HRV) has promise as a biomarker for resilience based on between-subject population studies, but observational studies that apply a within-subject design and use wearable sensors in order to observe HRV in a naturalistic context of real-life are needed.

OBJECTIVE: This study explores whether resting HRV and Total Sleep Time (TST) are indicative of and predictive for the within-day accumulation of the negative consequences of stress and mental exhaustion. The tested hypotheses are that (1) demands are positively associated with stress and resting HRV buffers against this association, (2) stress is positively associated with mental exhaustion and resting HRV buffers against this association, (3) stress negatively impacts subsequent-night Total Sleep Time (TST) and (4) prior-evening mental exhaustion negatively impacts resting HRV, while prior-night TST buffers against this association.

METHODS: Twenty-six interns used consumer-available wearables (Fitbit Charge 2 and Polar H7), a consumer-available smartphone app (Elite HRV), and an Ecological Momentary Assessment (EMA) smartphone app to collect resilience-related data on resting HRV, TST, as well as perceived demands, stress and mental exhaustion on a daily basis during 15 weeks.

RESULTS: Multiple linear regression analysis of within-subject standardized data collected on 2379 unique person-days showed that having a high resting HRV buffered against the positive association between demands and stress (hypothesis 1), as well as between stress and mental exhaustion (hypothesis 2). Stress did not affect TST (hypothesis 3). Finally, mental exhaustion negatively predicted resting HRV on the subsequent morning, but TST did not buffer against this (hypothesis 4).

CONCLUSIONS: To our knowledge, this study provides first evidence that having a low within-subject resting HRV may be both indicative of and predictive for the short-term accumulation of the negative effects of stress and mental exhaustion, potentially forming a negative feedback loop. If these findings can be replicated and expanded upon in future studies, they may contribute to the development of automated resilience interventions that monitor daily resting HRV and aim to give users an early warning signal when a negative feedback loop forms in order to prevent the negative impact of stress on long-term health outcomes.

PMID:34319877 | DOI:10.2196/28731

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Prehabilitation to prevent complications after cardiac surgery – A retrospective study with propensity score analysis

PLoS One. 2021 Jul 16;16(7):e0253459. doi: 10.1371/journal.pone.0253459. eCollection 2021.


BACKGROUND: The rising prevalence of modifiable lifestyle-related risk factors (e.g. overweight and physical inactivity) suggests the need for effective and safe preoperative interventions to improve outcomes after cardiac surgery. This retrospective study explored potential short-term postoperative benefits and unintended consequences of a multidisciplinary prehabilitation program regarding in-hospital complications.

METHODS: Data on patients who underwent elective cardiac surgery between January 2014 and April 2017 were analyzed retrospectively. Pearson’s chi-squared tests were used to compare patients who followed prehabilitation (three times per week, at a minimum of three weeks) during the waiting period with patients who received no prehabilitation. Sensitivity analyses were performed using propensity-score matching, in which the propensity score was based on the baseline variables that affected the outcomes.

RESULTS: Of 1201 patients referred for elective cardiac surgery, 880 patients met the inclusion criteria, of whom 91 followed prehabilitation (53.8% ≥ 65 years, 78.0% male, median Euroscore II 1.3, IQR, 0.9-2.7) and 789 received no prehabilitation (60.7% ≥ 65 years, 69.6% male, median Euroscore II 1.6, IQR, 1.0-2.8). The incidence of atrial fibrillation (AF) was significantly lower in the prehabilitation group compared to the unmatched and matched standard care group (resp. 14.3% vs. 23.8%, P = 0.040 and 14.3% vs. 25.3%, P = 0.030). For the other complications, no between-group differences were found.

CONCLUSIONS: Prehabilitation might be beneficial to prevent postoperative AF. Patients participated safely in prehabilitation and were not at higher risk for postoperative complications. However, well-powered randomized controlled trials are needed to confirm and deepen these results.

PMID:34270545 | PMC:PMC8284810 | DOI:10.1371/journal.pone.0253459

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Geographical life-space and subjective wellbeing in later life

Health Place. 2021 Jul;70:102608. doi: 10.1016/j.healthplace.2021.102608. Epub 2021 Jun 19.


Geographical life-space is an important factor to consider when studying subjective wellbeing of older adults. The purpose of this article is twofold: to provide an in-depth understanding of 1) the geographical life-spaces in which the lives of older adults take place and 2) the relation between life-space and experienced levels of subjective wellbeing. Seventy-six older adults (aged 65 and older) participated in our qualitative study. We applied a qualitative research approach, through combining indepth-interviews with visual life-space diagrams. Our findings show that most older adults continue to experience a high level of subjective wellbeing, regardless of the extent of their life-space. We conclude that the possibility to fulfill one’s needs, even in a restricted life-space, is more conducive to maintaining subjective wellbeing than the extent of life-space itself.

PMID:34157506 | DOI:10.1016/j.healthplace.2021.102608

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Aesthetic Outcomes of Perineal Reconstruction with the Lotus Petal Flap

Plast Reconstr Surg Glob Open. 2021 Jun 10;9(6):e3621. doi: 10.1097/GOX.0000000000003621. eCollection 2021 Jun.


The lotus petal flap can be applied for reconstruction of extensive defects in the vulvoperineal area. Studies on aesthetic outcomes are lacking. This study aimed to fill this gap.

METHODS: All patients who underwent lotus petal flap reconstruction between October 2011 and December 2015 were asked permission to have their photographs used. Two questionnaires were used: (1) the Strasser score to assess the overall aesthetic results (range 0-15) and (2) the Patient and Observer Scar Assessment Scale (POSAS; range 6-60). Six plastic surgeons and 6 laymen filled in the Strasser score and the Observer scale of the POSAS. Patients filled in the Strasser score, the Patient scale of the POSAS and scored their overall satisfaction with the aesthetic results on a Likert scale (0-10).

RESULTS: The photographs of 11 patients were included. The median Strasser score of all observers of 11.9 (range 0.0-75.0) indicated a mediocre aesthetic result. The median total POSAS score of 15.6 (range 6.0-41.0) indicated an aesthetically acceptable scar. Strasser and POSAS scores of the plastic surgeons and laymen did not differ significantly from the patients’ scores. The patient satisfaction score with the aesthetic result was a median of 6.0 of 10.

CONCLUSIONS: The findings indicate that, overall, patients were moderately satisfied with the aesthetic results of their lotus petal flap reconstructions, as were the plastic surgeons and laymen. For clinical practice, it is important that the plastic surgeon manages expectations carefully before surgery, as it is possible that patients might experience a rather low aesthetic outcome after perineal reconstruction.

PMID:34123687 | PMC:PMC8191695 | DOI:10.1097/GOX.0000000000003621

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Couple-based expanded carrier screening provided by general practitioners to couples in the Dutch general population: psychological outcomes and reproductive intentions

Genet Med. 2021 Jun 10. doi: 10.1038/s41436-021-01199-6. Online ahead of print.


PURPOSE: The aim of expanded preconception carrier screening (ECS) is to inform any couple wishing to conceive about their chances of having children with severe autosomal or X-linked recessive conditions. Responsible implementation of ECS as reproductive genetic screening in routine care requires assessment of benefits and harms. We examined the psychological outcomes of couple-based ECS for 50 autosomal recessive (AR) conditions provided by general practitioners (GPs) to couples from the Dutch general population.

METHODS: Dutch GPs invited 4,295 women aged 18-40. We examined anxiety (State-Trait Anxiety Inventory, STAI-6), worry, decisional conflict (DCS) over time in participants declining GP counseling or attending GP counseling with/without testing.

RESULTS: One hundred ninety couples participated; 130 attended counseling, of whom 117 proceeded with testing. No carrier couples were identified. Before counseling, worry (median 6.0) and anxiety (mean 30-34) were low and lower than the population reference (36.4), although some individuals reported increased anxiety or worry. At follow-up, test acceptors reported less anxiety than test decliners (mean 29 vs. 35); differences in anxiety after testing compared to before counseling were not meaningful. Most participants (90%) were satisfied with their decision (not) to undergo testing.

CONCLUSION: Some individuals reported temporarily clinically relevant distress. Overall, the psychological outcomes are acceptable and no barrier to population-wide implementation.

PMID:34112999 | DOI:10.1038/s41436-021-01199-6

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