Valuation of depression co-occurring with a somatic condition: feasibility of the time trade-off task.

Valuation of depression co-occurring with a somatic condition: feasibility of the time trade-off task.

Health Expect. 2014 Nov 13;

Authors: Papageorgiou K, Vermeulen KM, Leijten FR, Buskens E, Ranchor AV, Schroevers MJ

Abstract

BACKGROUND: Health state valuations obtained from the general population are used for cost-utility analyses of health-care interventions. Currently, most studies have focused on valuations of somatic conditions, to a much lesser extent of mental states, that is, depression and even less on valuations of depression co-occurring with somatic conditions.

OBJECTIVE: We tested the feasibility of the time trade-off (TTO) task to elicit valuations for depression solitary or co-occurring with a somatic condition. Moreover, we explored person- and state-related factors that may affect valuations.

DESIGN: During semi-structured interviews, 10 individuals (five women, mean age: 36 years) used a TTO task to value vignettes describing mild and severe depression; and mild depression co-occurring with moderate and severe states of cancer, diabetes or heart disease. During valuations, participants were thinking aloud. Feasibility criteria were successful completion and difficulty/concentration (1-10); logical consistency of values; and comprehension of the TTO, based on qualitative analysis of think aloud data. Factors influencing valuations were generated from think aloud data.

RESULTS: Participants reported satisfactory levels of difficulty (mean: 1.9) and concentration (mean: 8.3) and assigned consistent values. Qualitative analysis revealed difficulties with imagining: living with depression for lifetime (n = 4); reaching the age of 80 (n = 6); and living with a somatic condition and mentally healthy (n = 6). Person- and state-related factors, for example perceived susceptibility to depression (n = 4), appeared to affect valuations.

CONCLUSION: Quantitative findings supported feasibility of the valuation protocol, yet qualitative findings indicated that certain task aspects should be readdressed. Factors influencing valuations can be explored to better understand valuations.

PMID: 25393599 [PubMed - as supplied by publisher]

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A critical reanalysis of the relationship between genomics and well-being.

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A critical reanalysis of the relationship between genomics and well-being.

Proc Natl Acad Sci U S A. 2014 Sep 2;111(35):12705-9

Authors: Brown NJ, MacDonald DA, Samanta MP, Friedman HL, Coyne JC

Abstract

Fredrickson et al. [Fredrickson BL, et al. (2013) Proc Natl Acad Sci USA 110(33):13684-13689] claimed to have observed significant differences in gene expression related to hedonic and eudaimonic dimensions of well-being. Having closely examined both their claims and their data, we draw substantially different conclusions. After identifying some important conceptual and methodological flaws in their argument, we report the results of a series of reanalyses of their dataset. We first applied a variety of exploratory and confirmatory factor analysis techniques to their self-reported well-being data. A number of plausible factor solutions emerged, but none of these corresponded to Fredrickson et al.’s claimed hedonic and eudaimonic dimensions. We next examined the regression analyses that purportedly yielded distinct differential profiles of gene expression associated with the two well-being dimensions. Using the best-fitting two-factor solution that we identified, we obtained effects almost twice as large as those found by Fredrickson et al. using their questionable hedonic and eudaimonic factors. Next, we conducted regression analyses for all possible two-factor solutions of the psychometric data; we found that 69.2% of these gave statistically significant results for both factors, whereas only 0.25% would be expected to do so if the regression process was really able to identify independent differential gene expression effects. Finally, we replaced Fredrickson et al.’s psychometric data with random numbers and continued to find very large numbers of apparently statistically significant effects. We conclude that Fredrickson et al.’s widely publicized claims about the effects of different dimensions of well-being on health-related gene expression are merely artifacts of dubious analyses and erroneous methodology.

PMID: 25157145 [PubMed - indexed for MEDLINE]

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Weight and height in children newly diagnosed with cancer.

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Weight and height in children newly diagnosed with cancer.

Pediatr Blood Cancer. 2014 Oct 30;

Authors: Brinksma A, Roodbol PF, Sulkers E, Hooimeijer HL, Sauer PJ, van Sonderen E, de Bont ES, Tissing WJ

Abstract

BACKGROUND: Although weight loss and lack of linear growth occur in children with cancer, growth history is not included in research that aims to determine nutritional status in children newly diagnosed with cancer. Therefore, this study aimed to determine weight loss and lack of linear growth in this patient group.

PROCEDURE: Weight and height were recorded in 95 children (ages 1.5-10 years) at diagnosis and compared with data predicted from growth curves. Age, gender, type of malignancy, extent of disease, and prior weight and height were tested for their potential relation to differences between actual and predicted data.

RESULTS: The incidence of undernutrition, based on z-scores for weight-for-age (WFA), height-for-age (HFA), and weight-for-height (WFH), was 2%, 4%, and 7%, respectively. Actual z-scores were lower than predicted z-scores. Differences between actual and predicted z-scores of <-0.5 standard deviation score (SDS) in WFA, HFA, or WFH were found in 25%, 23%, and 29% of the children, respectively. Children with advanced cancer had the highest risk of significant weight loss (<-0.5 SDS in WFA) (ORWFA  = 3.45, P = 0.012) prior to diagnosis. Differences were unrelated to type of malignancy, age, gender, and weight and height prior to diagnosis.

CONCLUSIONS: At diagnosis, approximately 25% of the children showed a significant reduction in z-scores for weight-for-age, height-for-age, and weight-for-height. This reduction may indicate a deteriorated nutritional status. Therefore, assessment of growth history should be standard of care to ensure appropriate nutritional interventions and should be included in research that aims to evaluate nutritional status in children newly diagnosed with cancer. Pediatr Blood Cancer © 2014 Wiley Periodicals, Inc.

PMID: 25359660 [PubMed - as supplied by publisher]

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Distress, problems and referral wish of cancer patients: differences according to relationship status and life phase.

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Distress, problems and referral wish of cancer patients: differences according to relationship status and life phase.

Psychooncology. 2014 Oct 24;

Authors: Tuinman MA, Van Nuenen FM, Hagedoorn M, Hoekstra-Weebers JE

Abstract

OBJECTIVE: The aim of this study is to examine differences in distress, problems and referral wish in cancer patients according to relationship status and life phase.

METHODS: A cross-sectional group of 1340 patients (response = 51%) completed socio-demographic and illness-related questions, and the Dutch version of the Distress Thermometer and Problem List that also assesses desire for additional care (yes, maybe and no). Relationship status was categorized into six groups (married, cohabiting, LAT (=living-apart-together: have a partner but live alone), divorced, widowed or single) and age into young (18-50), middle aged (51-65) and older (65+) cohorts.

RESULTS: Relationship status and life phase were independently related to high distress, referral wish and accordance between the latter two. Single and LAT patients were around two times more likely than married patients to be highly distressed, and wanting additional care. The same was found for younger patients as compared to 65+ patients. Whereas high distress is usually not a strong indication for additional care needs, single, LAT and younger patients most often wanted care when they were highly distressed.

CONCLUSION: Health care professionals who implement distress screening in practice can expect a higher need for additional care in single and LAT patients, but only when they are younger or middle aged. The benefit of having a partner around on a daily basis seems less important in dealing with cancer-related problems when patients are older. Copyright © 2014 John Wiley & Sons, Ltd.

PMID: 25345693 [PubMed - as supplied by publisher]

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[Teleradiology in a family practice on the Dutch island of Ameland: a cost-benefit analysis].

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[Teleradiology in a family practice on the Dutch island of Ameland: a cost-benefit analysis].

Ned Tijdschr Geneeskd. 2013;156(51):A5428

Authors: Jacobs JJ, Jacobs JP, Wiersma D, Sanderman R

Abstract

OBJECTIVE: To calculate the costs and benefits of the introduction of teleradiology at a general practice on the Dutch island of Ameland from the perspectives of three different entities: (a) the family doctor (investor); (b) patients; and (c) health insurance companies.

DESIGN: Descriptive, cost-benefit analysis.

METHOD: For the year 2009, one and a half years after the introduction of a teleradiology facility at a general practice in Ameland, the operational and financing costs, the patient’s saved travel time and expenses and the teleradiology costs for health insurance companies were compared with the costs that would have been made without teleradiology.

RESULTS: In 2009, 426 X-rays had been taken at the general practice of which 241 for trauma and 185 for non-traumatic cases. With a reimbursement of € 100 per X-ray taken during normal working hours and € 200 for those taken during evenings and weekends, benefits for the family doctor (investor) were € 46,698 and the costs amounted to € 45,710, or a positive balance of € 980. Patients’ savings in travel time and expenses were calculated at € 111,068. Health insurance companies reimbursed a minimum of € 89,265 less on diagnosis and treatment.

CONCLUSION: The introduction of teleradiology a general practice in Ameland resulted in a considerable cost reduction for patients as well as for health insurance companies. In the future, diagnosing in this manner could be expanded in particular to regions in which the distances to hospitals are greater: a part of secondary healthcare could be conducted at a reduced cost.

PMID: 24472309 [PubMed - indexed for MEDLINE]

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Development of a brief questionnaire (ICQ-S) to monitor inhaled corticosteroid side-effects in clinical practice.

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Development of a brief questionnaire (ICQ-S) to monitor inhaled corticosteroid side-effects in clinical practice.

Allergy. 2014 Mar;69(3):372-9

Authors: Foster JM, Schokker S, Sanderman R, Postma DS, van der Molen T

Abstract

BACKGROUND: Side-effect concerns impede adherence with inhaled corticosteroids (ICS) and often underlie poor asthma control. We developed a brief version (ICQ-S) of the 57-item Inhaled Corticosteroids side-effect Questionnaire (ICQ) to facilitate side-effect monitoring in busy clinics.

METHODS: Part 1: After completion by 482 patients with doctor-diagnosed asthma, each ICQ item underwent item reduction analysis. Part 2: Patients prescribed ICS for asthma completed the ICQ at baseline (BL), ICQ-S at day 14 (D14) and day 28 (D28), and 6-item Asthma Control Questionnaire (ACQ) and Mini Asthma Quality of Life Questionnaire (MiniAQLQ) at BL, D14 and D28. 14-day test-retest reliability was assessed by intraclass correlation coefficient (ICC) between ICQ-S scores and internal consistency by Cronbach’s alpha (α) coefficient and item-total correlations of ICQ-S. Criterion validity was assessed by correlations (Spearman’s rho) between ICQ and ICQ-S total score. Patients reported duration and difficulty of ICQ-S completion at D28.

RESULTS: Part 1: The ICQ-S consists of fifteen local/systemic ICS side-effects of similar range to the full ICQ. Part 2: 62 asthma patients (mean ACQ score 0.79 ± SD 0.83) prescribed daily ICS [BDP-equivalent median dose 1000 μg (IQR: 500, 1000)] participated. ICC between ICQ-S scores was 0.90. All item-total correlations were rho ≥ 0.20. The ICQ-S demonstrated criterion validity, for example, ICQ and ICQ-S were strongly associated (rho = 0.86). 81% of patients completed the ICQ-S within 5 minutes and 97% found completion ‘not difficult’.

CONCLUSION: The ICQ-S is a brief, patient-friendly tool with good reliability and validity, which may be useful for monitoring ICS side-effects in clinical practice.

PMID: 24444382 [PubMed - indexed for MEDLINE]

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Mindfulness, acceptance and catastrophizing in chronic pain.

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Mindfulness, acceptance and catastrophizing in chronic pain.

PLoS One. 2014;9(1):e87445

Authors: de Boer MJ, Steinhagen HE, Versteegen GJ, Struys MM, Sanderman R

Abstract

OBJECTIVES: Catastrophizing is often the primary target of the cognitive-behavioral treatment of chronic pain. Recent literature on acceptance and commitment therapy (ACT) suggests an important role in the pain experience for the concepts mindfulness and acceptance. The aim of this study is to examine the influence of mindfulness and general psychological acceptance on pain-related catastrophizing in patients with chronic pain.

METHODS: A cross-sectional survey was conducted, including 87 chronic pain patients from an academic outpatient pain center.

RESULTS: The results show that general psychological acceptance (measured with the AAQ-II) is a strong predictor of pain-related catastrophizing, independent of gender, age and pain intensity. Mindfulness (measured with the MAAS) did not predict levels of pain-related catastrophizing.

DISCUSSION: Acceptance of psychological experiences outside of pain itself is related to catastrophizing. Thus, acceptance seems to play a role in the pain experience and should be part of the treatment of chronic pain. The focus of the ACT treatment of chronic pain does not necessarily have to be on acceptance of pain per se, but may be aimed at acceptance of unwanted experiences in general. Mindfulness in the sense of “acting with awareness” is however not related to catastrophizing. Based on our research findings in comparisons with those of other authors, we recommend a broader conceptualization of mindfulness and the use of a multifaceted questionnaire for mindfulness instead of the unidimensional MAAS.

PMID: 24489915 [PubMed - indexed for MEDLINE]

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A prospective analysis on fatigue and experienced burden in informal caregivers of cancer patients during cancer treatment in the palliative phase.

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A prospective analysis on fatigue and experienced burden in informal caregivers of cancer patients during cancer treatment in the palliative phase.

Acta Oncol. 2014 Oct 7;:1-7

Authors: Peters ME, Goedendorp MM, Verhagen SA, Smilde TJ, Bleijenberg G, van der Graaf WT

Abstract

Background. Although fatigue is the most frequently occurring symptom in patients with cancer, hardly anything is known about fatigue of their informal caregivers and the impact fatigue might have on perceived burden with providing care. We investigated the presence of fatigue in caregivers, its course and the relation of fatigue severity between caregivers and patients. Furthermore, we explored in caregivers whether fatigue severity was correlated to experienced burden. Material and methods. Informal caregivers and patients on cancer treatment in the palliative phase completed questionnaires at baseline and follow-up (6 months later). To measure fatigue severity, both groups completed the Checklist Individual Strength. Additionally, caregivers completed the Caregivers Strain Index to assess experienced burden with providing care. Descriptive analyses, paired t-tests, χ(2)-tests, Pearson’s correlations and regression analysis were performed. Results. At baseline 111 couples (patients and caregivers) participated, at follow-up 75 couples. At both time points 23% of caregivers were severely fatigued. There was no significant correlation between patients and caregivers on fatigue. Higher fatigue in both patients and caregivers was correlated with higher burden in caregivers and over 30% of burden could be explained by fatigue. Conclusion. Almost a quarter of caregivers of patients on active palliative treatment were severely fatigued, which figure remained stable over time. Fatigue in both patients and caregivers was related to caregivers’ burden. This observation should be taken into account with the growing demand on caregivers and the increase in cancer treatment options in the palliative setting.

PMID: 25291079 [PubMed - as supplied by publisher]

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The mediating role of disability and social support in the association between low vision and depressive symptoms in older adults.

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The mediating role of disability and social support in the association between low vision and depressive symptoms in older adults.

Qual Life Res. 2014 Apr;23(3):1039-43

Authors: Kempen GI, Ranchor AV, Ambergen T, Zijlstra GA

Abstract

PURPOSE: Vision loss is highly prevalent in old age and has a substantial impact on different aspects of quality of life including depressive symptoms. Our objective was to examine the mediating role of disability and social support in the association between low vision and depressive symptoms.

METHODS: Differences in disability, social support, and depressive symptoms between 148 persons with low vision and a reference population (N = 4,792) all ≥57 years were compared. The association between low vision and depressive symptoms and the mediating role of disability and social support was examined by the means of regression.

RESULTS: A significant effect of low vision on depressive symptoms was identified even after the adjustment for disability and social support (standardized beta 0.053, P < 0.001). The association between low vision and symptoms of depression was partially mediated by disability, while social support was identified as a suppressor variable. Low vision, disability, and social support showed unique contributions to depressive symptoms.

CONCLUSIONS: Prevention of disability and the increase in social support may help to reduce symptoms of depression in older adults with low vision. By taking such information into account in their intervention work, health professionals working in this area may improve their care quality.

PMID: 24081872 [PubMed - indexed for MEDLINE]

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The role of goal adjustment in symptoms of depression, anxiety and fatigue in cancer patients receiving psychosocial care: a longitudinal study.

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The role of goal adjustment in symptoms of depression, anxiety and fatigue in cancer patients receiving psychosocial care: a longitudinal study.

Psychol Health. 2014 Sep 29;:1-35

Authors: Zhu L, Ranchor AV, van der Lee M, Garssen B, Sanderman R, Schroevers MJ

Abstract

Abstract Objective: This study examined whether cancer patients reported increases in their goal adjustment capacities while receiving psychosocial care and whether these increases were related to changes in symptoms of depression, anxiety, and fatigue. Goal adjustment was conceptualized as two independent capacities: goal disengagement (i.e. disengage from unattainable goals) and goal reengagement (i.e. reengage into new goals). Design: This naturalistic, longitudinal study focused on 241 cancer patients receiving psychosocial care at one of the seven psycho-oncology institutions in the Netherlands. Data was collected before the start of psychosocial care (T1) and nine months thereafter (T2). Hierarchical regression analysis was used to examine the research questions. Main Outcome Measures: Goal adjustment, and symptoms of depression, anxiety and fatigue. Results: At group level, patients reported small increases in goal disengagement (d = 0.22) but no significant change in goal reengagement (d = 0.09). At an individual level, 34% of cancer patients reported an increase in goal disengagement and 30% an increase in goal reengagement. Increases in goal reengagement were significantly associated with decreases in both depressive and anxiety symptoms, but not to changes in fatigue. Conclusion: Findings indicate that particularly improvements in goal reengagement are beneficial for cancer patients’ psychological functioning.

PMID: 25264270 [PubMed - as supplied by publisher]

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