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A Review of the Korean Cultural Syndrome Hwa-Byung: Suggestions for Theory and Intervention

Mon, 01/05/2015 - 7:09pm

The purpose of this paper is to review Hwa-Byung, a cultural syndrome specific to Koreans and Korean immigrants. Hwa-Byung is a unique diagnosis and differs from other DSM disorders. However, Hwa-Byung has frequent comorbidity with other DSM disorders such as anger disorders, generalized anxiety disorder, and major depressive disorder. There are several risk factors for Hwa-Byung including psychosocial stress caused by marital conflicts and conflicts with their in-laws. Previous interventions of the Hwa-Byung syndrome were based primarily on the medical model. Therefore, based on previous research, we present a new ecological model of Hwa-Byung. We also recommend some areas of future research as well as present some limitations of our ecological model. Finally, we discuss some treatment issues, particularly for Korean women in the United States.

Brief Meditation Training for Migraineurs Affects Emotional and Physiological Stress Reactivity

Mon, 01/05/2015 - 7:09pm

Migraines result in a significant amount of pain and reduce the quality of life for more than 13 percent of the U.S. population. 90 They are related to increases in emotional and physiological stress. Reducing stress may, therefore, lead to fewer headaches. Dr. Wachholtz and her colleagues designed a specific SM program involving meditation to test the hypothesis that decreased reactivity to stressors might reduce the number and intensity of migraines. The study cohort included 88 patients with migraine who had never practiced meditation. Of these patients, 80.7 percent were female, matching the epidemiological profile of migraine. Participants were randomized to the meditation or education control groups. Treatment included 4 weekly 90-minute group sessions with meditation training and meditation practice for 20 minutes per day. Education controls were given information on migraine demographics and treatment options. Anxiety levels were assessed by the State Anxiety Inventory and galvanic skin response; migraines were assessed in a headache journal. Outcomes were measured at baseline, post-trial period, and 4 weeks post-trial period. Meditation significantly reduced the number of headaches by 50 percent. This effect was maintained 4 weeks post trial. Meditation reduced emotional and physiological stress reactivity by 10 percent and 40 percent, respectively, and was sustained during the post-trial period. Patients in the education control group actually experienced a transitory increase in state anxiety at the immediate post-trial evaluation, possibly because of focusing on their disability during the intervention. These results indicate that meditation is a useful and cost-effective tool in the management of chronic migraine pain. Interesting avenues of future research include examining different kinds of meditation, whether there are gender differences, and how long meditation-mediated outcomes can be sustained.

The relationship between spirituality and burnout among medical students

Mon, 01/05/2015 - 7:09pm

Medical student burnout has been associated with depression, loss of empathy, and suicidal ideation. Spirituality has been identified in previous studies as a protective factor in coping with the stress but has not been examined as a factor in medical student burnout. An internet link to an anonymous survey was sent via email to medical students at a public northeastern medical school; 259/469 (55.2%) completed it. The survey included measures of spirituality, burnout, psychological distress, coping, and general happiness. A Pearson-r correlation showed significant inverse correlations between measures of spirituality and measures of psychological distress/burnout (r's ranging from -.62 to -.14; p's < .01). In contrast, a positive correlation was found between life satisfaction and spirituality (r's .53 to .12; p < .05). Using hierarchical multiple regression with demographics (Step 1), mental health variables (Step 2), and satisfaction and Adaptive coping (Step 3), burnout remained significantly related to lower scores on both spirituality measures (FACIT-SP p < .00 and DSE p < .05). Students having higher levels of spiritual well being and daily spiritual experiences described themselves as more satisfied with their life in general, while students with low scores on spiritual well being and daily spiritual experiences had higher levels of psychological distress and burnout. Spirituality may therefore be a protective factor against burnout in medical students and future studies should explore potential causal relationships.

The Religious Dimension of Coping: Advances in Theory, Research, and Practice

Mon, 01/05/2015 - 7:09pm

In this chapter, we review the current theoretical and empirical status of the psychology of religion and coping, the practical interventions that have grown out of this body of work, and future directions for research and practice.

Comorbidity

Mon, 01/05/2015 - 7:09pm

Comorbidity occurs when an individual experiences two or more disorders at the same time (Eaton, 2006). Comorbidities can occur sequentially, or they can become symptomatic simultaneously. Disorders that are considered comorbidities can be either physical or psychological in nature. It is a common occurrence that a disorder in one domain (e.g., a physical disorder of spinal cord injury) will trigger or exacerbate a disorder in another domain (e.g., a psychological disorder of depression). Two disorders within the same domain are also considered comorbidities (e.g., depression and anxiety, or chronic obstructive pulmonary disorder and ischemic heart disease). There are some disorders that are such frequent comorbidities that they may eventually be combined under a single label and treated as a single syndrome (e.g., metabolic syndrome which often includes high blood pressure, Type 2 diabetes, obesity, hypercholesterolemia, and dyslipidemia) ...

Unipolar Depression

Mon, 01/05/2015 - 7:09pm

Unipolar depression is characterized by a combination of two types of symptoms: neurovegetative and emotional-cognitive. Neurovegetative symptoms are those symptoms that are directly related to the body (e.g., insomnia/hypersomnia, dysregulated eating, fatigue, and decreased energy). Emotional-cognitive symptoms involve those symptoms that are related to how a person processes information (e.g., suicidal ideation, decreased concentration, feeling worthless, anhedonia, and depressed mood). A combination of these depression symptoms must be unremitting for more than 2 weeks in order to be diagnosed with depression. Common treatments for depression include cognitive-behavioral psychotherapy, antidepressant medications, or a combination of these treatments. There are also a number of complementary treatments that are gaining empirical research support for use in combination with traditional approaches to enhance treatment outcome ...

Psychosomatic Health Care

Mon, 01/05/2015 - 7:09pm

Guided Imagery

Mon, 01/05/2015 - 7:09pm

A Review of "The Transformed Library: E-Books, Expertise, and Evolution"

Mon, 01/05/2015 - 4:02pm

This is a review of the book, The Transformed Library: E-Books, Expertise, and Evolution, by Jeannette Woodward. Published by American Library Association, 2013.

Internal consistency and factor structure of the Revised Conflict Tactics Scales in a sample of deaf female college students

Mon, 01/05/2015 - 12:39pm

The Revised Conflict Tactics Scales (CTS2) is currently the most widely used measure for identifying cases of intimate partner violence within the hearing population. The CTS2 has been used successfully with individuals from various countries and cultural backgrounds. However, the CTS2 had not yet been used with Deaf individuals. The goal of the present study was to investigate the internal consistency reliability and the factor structure of the CTS2 within a sample of Deaf female college students. Psychometric analyses indicated that subscales measuring Victimization of Negotiation, Psychological Aggression, Physical Assault, and Injury proved both reliable and valid in the current sample. Three subscales did not evidence reliability and the factor structure was not valid for Perpetration items.

Deaf individuals’ bilingual abilities: American Sign Language proficiency, reading skills, and family characteristics

Mon, 01/05/2015 - 12:39pm

The current study investigated the bilingual abilities of 55 Deaf individuals, examining both American Sign Language (ASL) competency and English reading skills. Results revealed a positive relationship between ASL competency and English skills, with highly competent signers scoring higher on a measure of reading comprehension. Additionally, family characteristics (e.g., parental education level, family hearing status) were entered into the analysis to ascertain their effect on Deaf individuals’ bilingual abilities. The findings support the theory that competency in ASL may serve as a bridge to the acquisition of English print. Moreover, the findings provide support for the critical period hypothesis for first language acquisition and its later impact on other cognitive and academic skills.

Morphological knowledge and decoding skills of deaf readers

Mon, 01/05/2015 - 12:39pm

Many studies have reported the necessity of phonological awareness to become a skilled reader, citing barriers to phonological information as the cause for reading difficulties experienced by deaf individuals. In contrast, other research suggests that phonological awareness is not necessary for reading acquisition, citing the importance of higher levels of syntactic and semantic knowledge. To determine if deaf students with higher language skills have better word decoding strategies, students responded to a morphological test, where monomorphemic words and multimorphemic words were matched to their definitions. Two studies are reported, one focusing on English placement levels and a second with formal measures of both ASL and English language proficiency. Results in-dicated that performance on the morphological decoding test was related to language proficiency scores, but not to phonological awareness scores.

Intimate partner violence against deaf women: A review

Mon, 01/05/2015 - 12:39pm

A common theme among writings on intimate partner violence against Deaf women is the concern that there is little empirical work conducted in this field in comparison to research conducted with hearing populations. However, it is important to acknowledge that an increased amount of research has been conducted in recent years and that a foundation of research has been established, on which future researchers can build and expand. The goal of the current review is to summarize and synthesize the recent work in this area, as well as identify remaining gaps and needs for future empirical work. While there are substantial issues and gaps in the current research base, the most critical issue is that of dissemination and networking—many of the studies in the current review remain unpublished, making this information difficult to obtain. As such, it is similarly difficult to locate other investigators in the field, hindering our ability to build on one another's work, as well as develop effective research collaborations. The foundation has been established. The researchers are out there. The next step is to work together to expand our knowledge of intimate partner violence against Deaf women.

Do deaf individuals’ dating scripts follow the traditional sexual script?

Mon, 01/05/2015 - 12:39pm

The current study investigated Deaf individuals’ dating expectations. Prior research on dating expectations has identified three common scenes: initiation/meeting, activities, and outcomes/conclusions. Participants were asked to report their expectations for each scene on a typical date. Talking was the most frequently occurring initiation activity. Dinner and a movie were among the top date activities in the activities scene. Activities were often reported as group gatherings. Dating outcomes included a good night kiss and making plans for another date. These expectations do not match prior research with hearing participants where the Traditional Sexual Script could be identified. Comparisons and suggestions for future research are discussed.

An Outcome Study of Seeking Safety With Rural Community-Based Women

Mon, 01/05/2015 - 12:39pm

This pilot study investigated the impact of Seeking Safety (SS) on rural women with comorbid substance abuse and trauma problems. SS is an evidence-based, present-focused therapy that provides coping skills and psychoeducation. Despite its demonstrated effectiveness, this is the first known study using SS with rural women. Investigating the efficacy of evidence-based treatments with rural populations is especially important because, compared with urban residents, they are more likely to meet criteria for comorbid mental illness and substance abuse, exhibit more severe symptoms of both disorders, but are much less likely to receive formal treatment. Such disparities highlight the need for effective treatments to enhance coping skills and reduce unsafe behavior within this population. Data were collected from 23 community-based rural women who voluntarily participated in SS treatment groups twice weekly (a total of 24 1.5-hr sessions were offered). The Trauma Symptom Inventory (TSI) was administered pre- and posttreatment. Results showed reductions on all 10 TSI subscales. Effect sizes were large across all subscales, except sexual concerns, which was medium to large. Our findings align with previous SS outcome studies, which report consistent positive results among vulnerable populations with trauma symptoms and substance abuse. (PsycINFO Database Record (c) 2014 APA, all rights reserved)

Reply: To PMID 23910457

Tue, 12/30/2014 - 10:57am

Institutional differences in carotid artery duplex diagnostic criteria result in significant variability in classification of carotid artery stenoses and likely lead to disparities in care

Tue, 12/30/2014 - 10:57am

BACKGROUND: The indications for carotid revascularization are based almost exclusively on the results of carotid duplex ultrasonography. Noninvasive vascular laboratories show large variation in the diagnostic criteria used to classify degree of carotid artery stenosis. We hypothesize that variability of these diagnostic criteria causes significant variation in stenosis classification directly affecting the number of revascularizations and associated costs.

METHODS AND RESULTS: The diagnostic criteria to interpret carotid duplex ultrasounds were obtained from 10 New England institutions. All carotid duplex scans performed at our institution were reviewed from 2008 to 2012. Using the diagnostic criteria from each institution, the degree of stenosis that would have been reported was classified as 70% to 99% asymptomatic, 80% to 99% asymptomatic, and 50% to 99% symptomatic. We then calculated the theoretical number of carotid revascularization procedures that this cohort would be offered using each institution's diagnostic criteria and the costs of these procedures based on reimbursement rates. Among 10614 patients who underwent 15534 carotid duplex scans, 31025 arteries were reviewed. Application of the 10 institutions' criteria to the patients from our institution yielded marked variation in the number classified as 70% to 99% asymptomatic (range, 186-2201), 80% to 99% asymptomatic (range, 78-426), and 50% to 99% symptomatic (range, 157-781). If revascularizations were based on these results, costs would range from $2.2 to $26 million, $0.9 to $5.0 million, and $1.9 to $9.2 million, respectively.

CONCLUSIONS: Differences in diagnostic criteria to interpret carotid ultrasound result in significant variation in classification of carotid artery stenosis, likely leading to differences in the number and subsequent costs of revascularizations. This theoretical model highlights the need for standardization of carotid duplex criteria.

Outcomes reported by the Vascular Quality Initiative and the National Surgical Quality Improvement Program are not comparable

Tue, 12/30/2014 - 10:57am

OBJECTIVE: The Vascular Quality Initiative (VQI) and National Surgical Quality Improvement Program (NSQIP) have emerged as the primary vascular surgery quality measurement tools with the purpose of evaluating perioperative outcomes and assessing hospital and physician quality. VQI uses self-reporting to capture all index vascular procedures during the inpatient period. NSQIP employs nurse abstractors to capture a sample of procedures and covers 30-day events. We hypothesize that patients undergoing lower extremity bypass (LEB) will exhibit high concordance for preoperative variables and low concordance for postoperative variables between these data sets.

METHODS: All patients undergoing LEB for peripheral arterial disease at the University of Massachusetts captured in both VQI and NSQIP databases were reviewed (2007-2012). Concordance between categorical variables was assessed by kappa correlation coefficient. All postoperative variables were compared during equivalent inpatient stay. Events between discharge and 30 days postoperatively were tabulated with use of the NSQIP data set.

RESULTS: We identified 240 patients undergoing LEB captured in both VQI and NSQIP. Comparison of this identical patient cohort between VQI and NSQIP revealed a moderate to strong agreement for most preoperative variables except for congestive heart failure (kappa = 0.14) and hypertension (kappa = 0.35), which showed poor agreement. Concordance for inpatient postoperative variables was high for mortality (kappa = 1.0) and myocardial infarction (kappa = 0.86) but moderate for pulmonary complications (kappa = 0.57) and poor for unplanned return to the operating room (kappa = 0.41), wound infection (kappa = -0.01), and change in renal function (kappa = -0.01). A majority of postoperative events (71%) occurred between discharge and 30 days postoperatively, with a significantly higher incidence of wound infections in the outpatient setting (4.2% vs 95.8%; P < .0001).

CONCLUSIONS: VQI and NSQIP demonstrate substantial concordance for most preoperative variables and poor concordance for most postoperative variables, even at identical collection periods. This discordance is a result of differences in data collection methods and variable definitions. On the basis of these findings, VQI and NSQIP data sets cannot be used to directly compare risk-adjusted patient outcomes between institutions. rights reserved.

Statin therapy after infrainguinal bypass surgery for critical limb ischemia is associated with improved 5-year survival

Tue, 12/30/2014 - 10:57am

OBJECTIVE: Although statin therapy has been linked to fewer short-term complications after infrainguinal bypass, its effect on long-term survival remains unclear. We therefore examined associations between statin use and long-term mortality, graft occlusion, and amputation after infrainguinal bypass.

METHODS: We used the Vascular Study Group of New England registry to study 2067 patients (71% male; mean age, 67 +/- 11 years; 67% with critical limb ischemia [CLI]) who underwent infrainguinal bypass from 2003 to 2011. Of these, 1537 (74%) were on statins perioperatively and at 1-year follow-up, and 530 received no statin. We examined crude, adjusted, and propensity-matched rates of 5-year surviva1, 1-year amputation, graft occlusion, and perioperative myocardial infarction.

RESULTS: Patients taking statins at the time of surgery and at the 1-year follow-up were more likely to have coronary disease (38% vs 22%; P < .001), diabetes (51% vs 36%; P < .001), hypertension (89% vs 77%; P < .001), and prior revascularization procedures (50% vs 38%; P < .001). Despite higher comorbidity burdens, long-term survival was better for patients taking statins in crude (risk ratio [RR], 0.7; P < .001), adjusted (hazard ratio, 0.7; P = .001), and propensity-matched analyses (hazard ratio, 0.7; P = .03). In subgroup analysis, a survival advantage was evident in patients on statins with CLI (5-year survival rate, 63% vs 54%; log-rank, P = .01) but not claudication (5-year survival rate, 84% vs 80%; log-rank, P = .59). Statin therapy was not associated with 1-year rates of major amputation (12% vs 11%; P = .84) or graft occlusion (20% vs 18%; P = .58) in CLI patients. Perioperative myocardial infarction occurred more frequently in patients on a statin in crude analysis (RR, 2.2; P = .01) but not in the matched cohort (RR, 1.9; P = .17).

CONCLUSIONS: Statin therapy is associated with a 5-year survival benefit after infrainguinal bypass in patients with CLI. However, 1-year limb-related outcomes were not influenced by statin use in our large observational cohort of patients undergoing revascularization in New England.

Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Human type I pancreatic elastase treatment of arteriovenous fistulas in patients with chronic kidney disease

Tue, 12/30/2014 - 10:57am

OBJECTIVE: This study explored the safety and efficacy of recombinant type I pancreatic elastase (PRT-201) topically applied once to the external surface of an arteriovenous fistula.

METHODS: This was a randomized, double-blind, placebo-controlled trial. Adults with kidney disease undergoing creation of a radiocephalic fistula (RCF) or brachiocephalic fistula were randomized to treatment with placebo (n = 51), PRT-201 at 10 mug (n = 51), or PRT-201 at 30 mug (n = 49). The primary efficacy measure was unassisted primary patency (PP) over 1 year. Secondary efficacy measures were secondary patency (SP), unassisted maturation by ultrasound interrogation, use for hemodialysis, and hemodynamically significant lumen stenosis.

RESULTS: Median PP was 224 days for placebo and > 365 days for the PRT-201 groups. At 1 year, 45%, 54%, and 53% of placebo, 10-mug, and 30-mug patients retained PP. The risk of PP loss was nonsignificantly reduced for 10 mug (hazard ratio [HR], 0.69; P = .19) and 30 mug (HR, 0.67; P = .17) vs placebo. In the subset (44% of patients) with a RCF, the median PP was 125 days for placebo and > 365 days for the PRT-201 groups. At 1 year, 31%, 50%, and 63% of placebo, 10-mug, and 30-mug RCFs retained PP. The risk of RCF PP loss was nonsignificantly reduced by 10 mug (HR, 0.59; P = .18) and significantly reduced by 30 mug (HR, 0.37; P = .02) vs placebo. At 1 year, 77%, 81%, and 83% of placebo, 10-mug, and 30-mug patients retained SP. The risk of SP loss was nonsignificantly reduced for 10 mug (HR, 0.79; P = .61) and 30 mug (HR, 0.76; P = .55) vs placebo. In the subset with RCFs, 65%, 82%, and 90% of placebo, 10-mug, and 30-mug patients retained SP at 1 year. The risk of RCF SP loss was nonsignificantly reduced for 10 mug (HR, 0.45; P = .19) and 30 mug (HR, 0.27; P = .08) vs placebo. At month 3, 67%, 87% (P = .03), and 92% (P < .01) of the placebo, 10-mug, and 30-mug group fistulas had unassisted maturation by ultrasound interrogation. At month 3 in the subset with an RCF, 47%, 74% (P = .17), and 93% (P < .01) of placebo, 10-mug, and 30-mug group fistulas had unassisted maturation by ultrasound interrogation. Adverse event reports were not meaningfully different between groups.

CONCLUSIONS: PRT-201 appeared safe. The primary efficacy end point was not met. However, both PRT-201 doses were associated with improved unassisted maturation. The 30-mug dose was associated with increased PP in the subset with RCF.