Development of a rabbit's urethral sphincter deficiency animal model for anatomical-functional evaluation.

OBJECTIVE: The aim of the study was to develop a new durable animal model (using rabbits) for anatomical-functional evaluation of urethral sphincter deficiency. MATERIALS AND METHODS: A total of 40 New Zealand male rabbits, weighting 2.500 kg to 3.100 kg, were evaluated to develop an incontinent animal model. Thirty-two animals underwent urethrolysis and 8 animals received sham operation. Before and at 2, 4, 8 and 12 weeks after urethrolysis or sham operation, it was performed cystometry and leak point pressure (LPP) evaluation with different bladder distension volumes (10, 20, 30 mL). In each time point, 10 animals (8 from the study group and 2 from the sham group) were sacrificed to harvest the bladder and urethra. The samples were evaluated by H&E and Masson 's Trichrome to determine urethral morphology and collagen/smooth muscle density. RESULTS: Twelve weeks after urethrolysis, it was observed a significant decrease in LPP regardless the bladder volume (from 33.7 ± 6.6 to 12.8 ± 2.2 cmH2O). The histological analysis evidenced a decrease of 22% in smooth muscle density with a proportional increase in the collagen, vessels and elastin density (p < 0.01). CONCLUSIONS: Transabdominal urethrolysis develops urethral sphincter insufficiency in rabbits, with significant decrease in LPP associated with decrease of smooth muscle fibers and increase of collagen density. This animal model can be used to test autologous cell therapy for stress urinary incontinence treatment.

Development of a rabbit's urethral sphincter deficiency animal model for anatomical-functional evaluation

OBJECTIVE: The aim of the study was to develop a new durable animal model (using rabbits) for anatomical-functional evaluation of urethral sphincter deficiency. MATERIALS AND METHODS: A total of 40 New Zealand male rabbits, weighting 2.500 kg to 3.100 kg, were evaluated to develop an incontinent animal model. Thirty-two animals underwent urethrolysis and 8 animals received sham operation. Before and at 2, 4, 8 and 12 weeks after urethrolysis or sham operation, it was performed cystometry and leak point pressure (LPP) evaluation with different bladder distension volumes (10, 20, 30 mL). In each time point, 10 animals (8 from the study group and 2 from the sham group) were sacrificed to harvest the bladder and urethra. The samples were evaluated by H&E and Masson's Trichrome to determine urethral morphology and collagen/smooth muscle density. RESULTS: Twelve weeks after urethrolysis, it was observed a significant decrease in LPP regardless the bladder volume (from 33.7 ± 6.6 to 12.8 ± 2.2 cmH2O). The histological analysis evidenced a decrease of 22% in smooth muscle density with a proportional increase in the collagen, vessels and elastin density (p < 0.01). CONCLUSIONS: Transabdominal urethrolysis develops urethral sphincter insufficiency in rabbits, with significant decrease in LPP associated with decrease of smooth muscle fibers and increase of collagen density. This animal model can be used to test autologous cell therapy for stress urinary incontinence treatment.

Predicting diabetes distress in patients with Type 2 diabetes: a longitudinal study.

AIMS: Diabetes distress (DD) is a condition distinct from depression that is related to diabetes outcomes. In those without distress initially, little is known about what indicators place patients at risk for subsequent distress over time. METHODS: From a community-based, three-wave, 18-month study of Type 2 diabetic patients (n = 506), we identified patients with no DD at T1 who displayed DD at T2, T3 or both (n = 57). Using logistic regression with full and trimmed models, we compared them with patients with no DD at all three time points (n = 275) on three blocks of variables: patient characteristics (demographics, depression, extra-disease stress), biological (HbA(1c), body mass index, comorbidities, complications, blood pressure, non-high-density lipoprotein-cholesterol), and behavioural variables (diet, exercise). Selected interactions with stress and major depressive disorder (MDD) were explored. RESULTS: The odds of becoming distressed over time were higher for being female, previously having had MDD, experiencing more negative events or more chronic stress, having more complications, and having poor diet and low exercise. Negative life events increased the negative effects of both high HbA(1c) and high complications on the emergence of distress over time. CONCLUSIONS: We identified a list of significant, independent direct and interactive predictors of high DD that can be used for patient screening to identify this high-risk patient cohort. Given the impact of high DD on diabetes behavioural and biological indicators, the findings suggest the usefulness of regularly appraising both current life and disease-related stressors in clinical care.

A longitudinal study of affective and anxiety disorders, depressive affect and diabetes distress in adults with Type 2 diabetes.

AIMS: To report the prevalence and correlates of affective and anxiety disorders, depressive affect and diabetes distress over time. METHODS: In a non-interventional study, 506 patients with Type 2 diabetes were assessed three times over 18 months (9-month intervals) for: major depressive disorder (MDD), general anxiety disorder (GAD), panic disorder (PANIC), dysthymia (DYS) (Composite International Diagnostic Interview); depressive affect [Center for Epidemiological Studies-Depression (CES-D)]; Diabetes Distress Scale (DDS); HbA(1c); and demographic data. RESULTS: Diabetic patients displayed high rates of affective and anxiety disorders over time, relative to community adults: 60% higher for MDD, 123% for GAD, 85% for PANIC, 7% for DYS. The prevalence of depressive affect and distress was 60-737% higher than of affective and anxiety disorders. The prevalence of individual patients with an affective and anxiety disorder over 18 months was double the rate assessed at any single wave. The increase for CES-D and DDS was about 60%. Persistence of CES-D and DDS disorders over time was significantly greater than persistence of affective and anxiety disorders, which tended to be episodic. Younger age, female gender and high comorbidities were related to persistence of all conditions over time. HbA(1c) was positively related to CES-D and DDS, but not to affective and anxiety disorders over time. CONCLUSIONS: The high prevalence of comorbid disorders and the persistence of depressive affect and diabetes distress over time highlight the need for both repeated mental health and diabetes distress screening at each patient contact, not just periodically, particularly for younger adults, women and those with complications/comorbidities.

Contributors to depression in Latino and European-American patients with type 2 diabetes.

OBJECTIVE: To determine the independent and cumulative contributions of diabetes and other life stresses on depression and anxiety in Latino and European-American (EA) patients with diabetes. RESEARCH DESIGN AND METHODS: A total of 75 Latino and 113 EA patients with type 2 diabetes, recruited from managed care settings, were assessed regarding three groups of potential stresses: demographics (age, sex, and education), disease status (functional impact, time since diagnosis, comorbidities, HbA(1c), and BMI), and family stress (financial stress, spouse conflict resolution, and family closeness). Dependent variables were depression (Center for Epidemiological Studies-Depression scale [CES-D]) and anxiety (Symptom Checklist [SCL-90]). Multiple regression equations assessed the independent contribution of each predictor on depression and anxiety. RESULTS: For both ethnic groups, education, functional impact, and financial stress significantly and independently predicted depression; poor spouse conflict resolution was a fourth significant predictor for EA patients only. The equations accounted for a high percentage of variance (43- 55%). Excluding education, the same variables predicted anxiety for both ethnic groups. The disease status and family stress variable groups significantly predicted outcomes independently. The relationships among these variables and depression and anxiety generally occurred for all patients, not only for those classified as likely depressed. CONCLUSIONS: The findings suggest the utility of considering many life stresses, not just diabetes alone, that combine to affect depression and anxiety. We suggest that these effects are experienced cumulatively as general psychological distress for all patients with diabetes, not just those classified as likely depressed. Taken together, the findings emphasize a life-centered, patient-focused approach to the treatment of depression, rather than an exclusive disease-related perspective.

Differences in personal models among Latinos and European Americans: implications for clinical care.

OBJECTIVE: To describe and contrast the personal models of type 2 diabetes in European Americans (EAs) and Latinos and to highlight differences that require a reorientation of clinical care. RESEARCH DESIGN AND METHODS: A total of 116 EAs and 76 Latino individuals with type 2 diabetes were interviewed about their personal model of diabetes. Responses to open-ended questions about the perceived cause, nature, seriousness, course, and future course of diabetes and its impact on everyday life were analyzed using an iterative process, and categories of response were established. Responses were examined within ethnic group, and comparisons across ethnic groups were made for clinically significant differences. RESULTS: Disease descriptions about the nature of the disease were categorized as experiential, biomedical, or psychosocial. Disease descriptions varied significantly by ethnicity (chi2 = 35.92, 2 df, P < 0.001), with more Latinos using an experiential model and more EAs using a biomedical model. Significant differences in life changes caused by the disease were found, with EAs reporting changes in exercise and spontaneity and Latinos in fatigue and mood. Individuals with diabetes from both ethnic groups gave comparable assessments about the cause, seriousness, and effectiveness of treatments for the disease. CONCLUSIONS: Clinical practice that attends to the concerns and experiences of individuals with diabetes from diverse ethnic groups is warranted. Broad assessment of personal models in diverse ethnic groups is recommended.

The family and disease management in Hispanic and European-American patients with type 2 diabetes.

OBJECTIVE: To determine the relationship between the characteristics of families involved in disease management and the self-care practices of Hispanic and European-American (EA) patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: A total of 74 Hispanic patients and 113 EA patients with type 2 diabetes recruited from managed care settings were assessed on three domains of family life (family structure/organization, family world view, and family emotion management [four scales]) and five areas of disease management (biological, general health and function status, emotional tone, quality of life, and behavioral [seven scales]). Analyses assessed the independent associations of patient sex, family, and sex by family interactions with disease management. RESULTS: Both sex and the three domains of family life were related to disease management, but the results varied by ethnic group. For EA patients, sex, family world view, and family emotion management were related to disease management (scores for Family Coherence were negatively associated with HbA1c level and depression, and poor scores for Conflict Resolution were linked with high depression); for Hispanic patients, sex and family structure/organization were related to disease management (high scores for Organized Cohesiveness were associated with good diet and exercise, and high scores for Family Sex-Role Traditionalism were related to high quality of life). No significant interactions with sex occurred. CONCLUSIONS: Characteristics of the family setting in which disease management takes place are significantly linked to patient self-care behavior, and these linkages vary by patient ethnicity. A family's multiple independent dimensions provide multiple targets for intervention, and differences in family norms, structures, and emotion management should be considered to ensure that interventions are compatible with the setting of disease management.

Disease management status: a typology of Latino and Euro-American patients with type 2 diabetes.

The number of indicators of chronic disease management is large and no practical framework is available to guide selection for use in intervention programs. In addition, it is often difficult to integrate multiple disease management indicators into a comprehensive picture of patient functioning. The authors present a heuristic framework for creating a profile of disease management and an empirically based descriptive typology of disease management behavior. From the literature, they identified 5 domains of disease management indicators: biologic, general health and functional status, emotional tone, quality of life, and behavioral. They selected 11 scales and assessed 187 patients with type 2 diabetes. Five statistically replicable patient disease management types were derived from exploratory and confirmatory cluster analyses and a descriptive narrative was created for each: balanced (33%), problematic (6%), coasters (34%), discouraged (16%), and distressed (11%). The typology describes different presentations of disease management that can be linked with patient-tailored interventions for patients with type 2 diabetes.

Resolving disease management problems in European-American and Latino couples with type 2 diabetes: the effects of ethnicity and patient gender.

The management of type 2 diabetes requires major life style changes. How patients and family members resolve disagreements about disease management affects how well the disease is managed over time. Our goal was to identify differences in how couples resolved disagreements about diabetes management based on ethnicity and patient gender. We recruited 65 Latino and 110 European-American (EA) couples in which one spouse had type 2 diabetes. Couples participated in a 10-minute videotaped, revealed differences interaction task that was evaluated with 7 reliable observer ratings: warm-engagement, hostility, avoidance, amount of conflict resolution, off-task behavior, patient dominance, and dialogue. A series of 2 x 2, Ethnicity x Sex ANOVAs indicated significant effects for Ethnicity and for the Ethnicity x Sex interaction, but not for Sex. Latino couples were rated as significantly more emotionally close, less avoidant, less hostile toward each other, and had less dominant patients than EA couples; however, Latino couples achieved significantly less problem resolution and were more frequently off-task than EA couples. These findings were qualified by patient gender. The findings highlight important differences

Gender differences in problem drinking and depression: different "vulnerabilities?".

This study examines the relationship between stressors and resources and the functioning of a sample of 515 men and women who had a drinking problem. At a one-year follow-up, both women and men had improved on three functioning measures: alcohol consumption, days intoxicated, and depression. There were no gender differences at Time 2 on alcohol consumption, but men had more days intoxicated and women had more symptoms of depression. The impact of stressors and resources varied by life domain, functioning criterion, and gender. Although the predictors varied, the amount of variance in depression accounted for was the same for women and men. The most striking gender difference was the stronger impact of friendships for women on all aspects of functioning. This study provides support for reconsideration of the stress vulnerability of women and men.

The family and type 2 diabetes: a framework for intervention.

Four broad groups of factors have been linked with self-management behavior in type 2 diabetes over time: (1) characteristics of patients, (2) amount and management of stress, (3) characteristics of providers and provider-patient relationships, and (4) characteristics of the social network/context in which disease management takes place. Of these four, social network/context has received the least amount of study and has been described in terms not easily applicable to intervention. In this paper, we identified the social network/context of diabetes management as residing within the family. We defined the family for clinical purposes, reviewed the literature concerning what is known about the link between properties of the family context of care and outcomes in type 2 diabetes and other chronic diseases, and identified areas of family life that are relevant to diabetes management. This information was then used to demonstrate how a family context of care can serve as a clinical framework for integrating all four groups of factors that affect disease management. Implications of this approach for practice and research are described.

Perceived continuity of self in very old age.

Little is known about how the changes of very late life affect identity. One hundred fifty of the oldest old were asked how they thought they had changed over the years and how they had remained the same. Responses were coded for perceived change in both core self ("I") and self-descriptors ("me"). Almost all the respondents thought they were still essentially the same person ("I"), and although they could point to ways in which they had changed in specific characteristics of self-concept ("me"), there was considerable stability in that as well. Also, not all the changes identified were negative. Perceived continuity was related to positive affect but apparently not to either recent disruptive events or mortality.

Transitions in the caregiving career: effects on sense of mastery.

Although a sense of mastery is usually treated as a stable personal resource that can moderate the effects of stress on well-being, in this article we are interested in mastery as an outcome, examining the impact of transitions in the careers of Alzheimer's caregivers on their sense of mastery. Using longitudinal data collected from 456 spouses and adult children caring for a family member with Alzheimer's disease, we found that for those who continue to care for their relative, mastery declines; for those who place their relative in a care facility, mastery remains unchanged; and for those who experience the death of their relative, mastery increases. A series of regression analyses revealed different patterns of predictors of change in mastery over time and across transitions.

Stress and the life course: a paradigmatic alliance.

Research both into the stress process and into the life course is concerned with changing lives. Yet, the conceptual paradigms that guide the work of these two fields are largely segregated, borrowing little from each other. This article explores some of the junctures at which the study of social stress might benefit from life-course perspectives and, conversely, those at which life-course research might profitably employ the vantage points of stress research. In the first case, an awareness of life-course trajectories can sensitize stress researchers to the restructuring of lives across time, particularly to the shifting landscape of stressors to which people are exposed and changes in their access to resources in dealing with the stressors. For its part, stress research may be useful in clarifying some basic life-course constructs. Thus, it can direct attention to conditions that help to define the experiential distinctiveness of historical cohorts and to conditions that produce intracohort variations. It is also useful in providing an interpretive framework for understanding how the timing and sequencing of transitional events impact people's lives. The perspectives of the stress process, finally, are also relevant to the critical appraisal of the constructs of life satisfaction and successful aging.

Personality change in Parkinson's disease patients: chronic disease and aging.

Parkinson's disease patients (N = 41, mean age = 65 years) were described by themselves and their spouses as they were presently and before their illness using the Adjective Check List. Equivalent self- and spouse descriptions were obtained from the members of a matched community sample (N = 96). Descriptions of patients and their spouses converged, both reporting sharp, pervasive (e.g., on all of the Big Five dimensions), and uniformly negative change in personality. Similar, but much less marked change was found in the community sample. The data as a set suggest that the reported changes in the patients were veridical and that their magnitude was primarily the result of the disease rather than aging. Evidence of continuities in personality (for example, differential stability) was also noted. We argued that the illness accelerated and intensified changes normally expected in later life.

Caregiving: role engulfment and the loss of self.

"Loss of self" was examined in a sample of spouses and adult children caring for a relative with Alzheimer's disease. Defined as a loss of identity that comes about as a result of engulfment in the caregiver role, it was found to be more common among spouses, females, and younger caregivers. Limited social contact and lack of social roles outside that of caregiver were found to be related to greater loss of self. It is associated with lower self-esteem and mastery and with greater depressive symptomatology.

Caregiving and the stress process: an overview of concepts and their measures.

This paper views caregiver stress as a consequence of a process comprising a number of interrelated conditions, including the socioeconomic characteristics and resources of caregivers and the primary and secondary stressors to which they are exposed. Primary stressors are hardships and problems anchored directly in caregiving. Secondary stressors fall into two categories: the strains experienced in roles and activities outside of caregiving, and intrapsychic strains, involving the diminishment of self-concepts. Coping and social support can potentially intervene at multiple points along the stress process.