Risk factors for pressure ulcers in adult patients: A meta-analysis on sociodemographic factors and the Braden scale.

AIMS AND OBJECTIVES: Providing the first meta-analysis of risk factors for pressure ulcer development in adult patients. BACKGROUND: Pressure ulcers remain a serious health complication for patients and nursing staff. However, there is a lack of statistical evidence for risk factors as previous research did not include any quantitative synthesis. DESIGN: Meta-analysis, using PRISMA guidelines. METHODS: Studies from PubMed, Embase, CINAHL Complete, Web of Science, Cochrane Library, and other reviews and sources were screened and checked against the inclusion criteria. The risk of bias was evaluated using a slightly modified QUIPS tool. Data regarding population, design, statistical analysis and risk factors were extracted. Meta-analysis with comparable studies was conducted for age, sex, and Braden scale. The sub-group analysis was used to account for heterogeneity. RESULTS: 28 studies with 570,162 patients were entered in meta-analysis. Older age and a low total Braden scale score increased the risk for pressure ulcers. All subscales excluding 'moisture' reached significance in meta-analysis based only on few studies, however, limiting overall evidence. Male sex achieved mixed results, too. CONCLUSION: The first meta-analytic analysis shows evidence for age and Braden scale as risk factors for pressure ulcer development. Limitations regarding study quality and heterogeneity must be considered, highlighting the need for unifying certain conditions in risk factor research. RELEVANCE TO CLINICAL PRACTICE: Patients at risk for new pressure ulcers can be identified by their total Braden score and age, whereas the latter is also connected to deeper pressure ulcers. Nurses and health personnel should pay great attention to patients in older age and undergo specific training to utilise and evaluate the Braden scale effectively, if necessary.

Personality subtypes in adults with social anxiety disorder - novelty seeking makes the difference.

BACKGROUND: Up to now several subtypes of social anxiety disorder (SAD) have been proposed. METHODS: In the present study, we used a cluster analytic approach to identify qualitatively different subgroups of SAD based on temperament characteristics, that is, harm avoidance (HA) and novelty seeking (NS) dimensions of Cloninger's Temperament and Character Inventory. RESULTS: Based on a large, diverse clinical sample (n = 575), we found evidence for two distinct subgroups of SAD: a larger (59%) prototypic, inhibited cluster characterized by high HA and low NS, and a smaller atypic, and comparatively more impulsive cluster characterized by medium to high HA and increased NS. The subgroups differed regarding a variety of sociodemographic and clinical variables. While the prototypic SAD subtype suffered from more severe SAD and depressive symptoms, suicidal ideation, and reduced social functioning, the atypic NS subtype showcased higher reproductive behaviour, self-directedness and -transcendence, comparatively. Additional hierarchical logistic regression highlights the contribution of age and education. CONCLUSIONS: Our results valuably extend previous evidence for the existence of at least two distinct subtypes of SAD. A better knowledge of the characteristic differences in prototypic behaviour, personality, coping strategies and comorbidities between the identified (and further) subtypes can contribute to the development of effective prevention interventions and promotes the conceptualization of tailored treatments.

Risk Factors for Pressure Injuries in Adult Patients: A Narrative Synthesis.

Pressure injuries remain a serious health complication for patients and nursing staff. Evidence from the past decade has not been analysed through narrative synthesis yet. PubMed, Embase, CINAHL Complete, Web of Science, Cochrane Library, and other reviews/sources were screened. Risk of bias was evaluated using a slightly modified QUIPS tool. Risk factor domains were used to assign (non)statistically independent risk factors. Hence, 67 studies with 679,660 patients were included. In low to moderate risk of bias studies, non-blanchable erythema reliably predicted pressure injury stage 2. Factors influencing mechanical boundary conditions, e.g., higher interface pressure or BMI < 18.5, as well as factors affecting interindividual susceptibility (male sex, older age, anemia, hypoalbuminemia, diabetes, hypotension, low physical activity, existing pressure injuries) and treatment-related aspects, such as length of stay in intensive care units, were identified as possible risk factors for pressure injury development. Health care professionals' evidence-based knowledge of above-mentioned risk factors is vital to ensure optimal prevention and/or treatment. Openly accessible risk factors, e.g., sex, age, BMI, pre-existing diabetes, and non-blanchable erythema, can serve as yellow flags for pressure injury development. Close communication concerning further risk factors, e.g., anemia, hypoalbuminemia, or low physical activity, may optimize prevention and/or treatment. Further high-quality evidence is warranted.

Predictors of suicidal ideation in social anxiety disorder - evidence for the validity of the Interpersonal Theory of Suicide.

BACKGROUND: This study aims to identify covariates of suicidal ideation (SI) in a large sample of individuals diagnosed with social anxiety disorder (SAD). METHODS: In a cross-sectional design, 305 individuals (38.4 ± 14.1 years, 59% female) with SAD were assessed by the Social Phobia Inventory, Beck Depression Inventory, Adverse Childhood Experience Questionnaire, State Trait Anger Expression Inventory, Beck Scale for Suicidal Ideation and the Interpersonal Needs Questionnaire. RESULTS: SAD individuals with SI (n = 142, 46.6%) reported higher SAD and depression symptoms, more adverse childhood experiences (ACE), higher state anger (SA), perceived burdensomeness (PB) and higher thwarted belongingness (TB) compared to SAD individuals without SI (n = 163, 53.4%). In binary logistic regression, PB (odds ratio (OR) = 1.11, 95% confidence interval (CI) = 1.06-1.15), TB (OR = 1.05, 95% CI = 1.02-1.07), SA (OR = 1.07, 95% CI = 1.01-1.13) and ACE (OR = 1.18, 95% CI = 1.03-1.35) emerged as significant covariates of acute SI (Nagelkerke's R2 = 0.39). Receiver operating characteristic (ROC) curves showcased the following areas under the curve (AUC): PB (AUC = 0.78), TB (AUC = 0.76), SA (AUC = 0.62) and ACE (AUC = 0.62). Multinomial logistic regression (no SI = ref.) showcased similar results for passive and active SI (n = 42), with SA reaching significance only for active SI. The Youden index identified appropriate cut-off values for PB, TB, SA and ACEQ by maximizing sensitivity and specificity. LIMITATIONS: Cross-sectional design and self-reporting measures limit generalization. CONCLUSION: Our findings confirm the validity of the Interpersonal Theory of Suicide concerning SI in SAD. PB and TB with SA and ACE may support the valid assessment of SI in therapeutic settings.

Significance of anger suppression and preoccupied attachment in social anxiety disorder: a cross-sectional study.

BACKGROUND: There is evidence for the relevance of attachment style and anger expression for the manifestation of social anxiety disorder (SAD). METHOD: In a cross-sectional study 321 individuals with social anxiety disorder (41% men, age 38.8 ± 13.9) were compared with 94 healthy controls (37% men, age 35.8 ± 15.1) on several questionnaires (Attachment Styles Questionnaire, State Trait Anger Inventory, Social Phobia Inventory, Beck Depression Inventory). RESULTS: Individuals with SAD showed moderate-sized reduced levels of secure and large-sized increased levels of fearful and preoccupied attachment style compared to healthy controls (all p < 0.001) as well as small-sized increased levels of trait anger (p = 0.03) and moderate-sized increased levels of anger-in (p < 0.001). Attachment style and anger regulation could predict 21% (R2 = 0.21, p < 0.001) of the extent of social anxiety (SPIN) in SAD; secure (ß = - 0.196, p < 0.01) and preoccupied attachment style (ß = 0.117, p < 0.05), as well as anger-in (ß = 0.199, p < 0.01) were significant cross-sectional predictors. Further analysis revealed that the relationship between preoccupied attachment and social anxiety is partially mediated by anger-in. CONCLUSION: Study findings confirm the relevance of preoccupied attachment style and anger suppression for social anxiety. Disentangling the role of anger regulation in early attachment patterns has significant therapeutic implications in SAD.