Loneliness, immunological recovery patterns, and health-related quality of life (HRQOL) outcomes in patients receiving hematopoietic stem cell transplantation.

PURPOSE: Loneliness may compromise health-related quality of life (HRQOL) outcomes and the immunological impacts of loneliness via neuroendocrinological mechanisms likely have consequences for patients who have undergone a hematopoietic stem cell transplantation (HSCT). RESEARCH APPROACH AND MEASURES: Loneliness (pre-transplant), immunological recovery (Day 30, Day 100, 1-year post-transplant), and HRQOL (Day 100, 1 year) were measured in a sample of 205 patients completing a HSCT (127 autologous, 78 allogenic). RESULTS: Greater levels of pre-transplant loneliness predicted poorer HRQOL at Day 100 and 1-year follow-up. Loneliness also was associated with higher absolute neutrophil to absolute lymphocyte (ANC/ALC) ratios in the entire sample at Day 30, which in turn was associated with Day 100 HRQOL. CONCLUSIONS: Findings demonstrate that pretransplant loneliness predicts HRQOL outcomes and associates with inflammatory immunological recovery patterns in HSCT patients. The balance of innate neutrophils to adaptive lymphocytes at Day 30 present a distinct profile in lonely individuals, with this immunity recovery profile predicting reduced HRQOL 100 days after the transplant. Addressing perceptions of loneliness before HSCT may be an important factor in improving immunological recovery and HRQOL outcomes.

Do labels matter? Implications of ongoing symptomatic chronic illnesses labeled as conventional diagnoses vs. functional somatic syndromes.

OBJECTIVE: A consideration of chronic illness according to illness labels that are medically understood as opposed to being outside of medical understanding may reveal unique differences in how individuals understand their illness and how such lay understandings relate to health-related quality of life. Study aims are framed according to the commonsense model of self-regulation with a focus on characterizing illness representations according to chronic illness diagnosis type. METHODS: Individuals suffering from symptomatic chronic illnesses (n = 192) completed measures of illness representations, coping, and general health. Participants were categorized into one of two groups based on reported diagnosis/symptoms: (a) conventional diagnosis (CD) or (b) functional somatic syndrome (FSS). RESULTS: FSS participants reported lower illness coherence and greater illness identity than CD participants. Overall, illness coherence predicted negative coping which mediated the relationship between illness coherence and general health. CONCLUSIONS: Minimal differences were found in illness representations across FSS and CD groups with distinctions found only for illness coherence and identity. Illness coherence stands out as particularly important for coping and health-related quality of life for individuals with ongoing symptoms. Healthcare professionals should work carefully with chronically ill populations to address potential impacts of illness coherence, especially among FSS patients.

Integrated smoking cessation and binge drinking intervention for young adults: a pilot investigation.

BACKGROUND: Alcohol consumption is strongly associated with cigarette smoking in young adults. PURPOSE: The aim of this study was to evaluate the acceptability and estimate the magnitude of the effect of a novel-integrated smoking cessation and binge-drinking intervention for young adults compared with standard treatment control. METHODS: Participants were 41 young adult smokers (≥ 10 cigarettes per day) who regularly (≥ 2 times per month) binge drank who were randomly assigned to standard treatment (n = 19) involving eight individual treatment visits plus 8 weeks of nicotine patch therapy or the identical smoking cessation treatment integrated with a binge-drinking intervention (integrated intervention; n = 22). RESULTS: Participants rated integrated intervention as highly acceptable as indicated by 100% of participants rating helpfulness as 5 on 5-point scale. Using an intent-to-treat analysis for tobacco abstinence, at both week 12 end of treatment and week 24 follow-up, more participants who received integrated intervention were biochemically confirmed abstinent from tobacco than those who received standard treatment (36% vs. 21% at week 12; 23% vs. 11% at week 24). At week 24, change from baseline in binge-drinking episodes, drinks consumed, and drinking days between treatment groups were similar (intent-to-treat analysis was not used for alcohol data). CONCLUSIONS: Preliminary data support the intriguing possibility that integrated intervention may enhance smoking cessation and reduce binge drinking.

Personal models for diabetes in context and patients' health status.

In a diverse sample of 452 adult diabetes patients, we investigated: (1) personal model dimensions for diabetes and expanded upon the literature by indexing fatalism, (2) the relationship between contextual factors and patients' beliefs about the seriousness and controllability of diabetes, and (3) the unique contribution of illness representation combinations to clinical outcomes when controlling for baseline disease severity. Major categories of predictors included patients' sociocultural characteristics, illness history (e.g., co-morbidities, diabetes complications) and recent physical symptoms. Illness representations were measured using the Personal Models of Diabetes Interview and questions that index fatalistic beliefs. Clinical outcome measures included patients' glycemic control (HbA1c) and the patient's physical and mental functions as measured by the SF-12. Analyses corroborated the literature by identifying seriousness and treatment effectiveness cognitive model dimensions for diabetes. Physical symptoms and other disease-related factors were strong predictors of patients' seriousness beliefs for diabetes, whereas sociocultural factors (education, ethnicity) best explained representations related to the controllability of diabetes (i.e., treatment effectiveness, fatalism). Seriousness beliefs were good indicators of actual glucose control, except for cases in which patients were more fatalistic and believed diabetes to be less serious. Although patients had medically consistent views of their diabetes, variations in personal models of diabetes were related to specific contextual factors and independently explained diabetes control.

Exoneration reduces adult conflict's effects on preschoolers' cognitions, behavioral distress, and physiology.

In this experiment, the authors investigated the influence of exoneration from blame on children's overt behavioral distress and physiological reactivity following the presentation of overheard adult conflict. The participants were 48 children (48-71 months of age) and their mothers. Through random assignment, the authors presented 16 children with statements that exonerated them from an overheard disagreement between two adults, did not address 16 during a similar disagreement, and presented 16 with a neutral discussion of difficulties. Exonerated children responded with less distress than did nonaddressed children, but did not differ from children presented the neutral discussion, except for overt behavioral distress. Nonaddressed children most often blamed themselves for the argument. Exonerating statements may protect children from attributional error and resultant physiological arousal during adult conflict.

Perceived health status and perceived diabetes control: psychological indicators and accuracy.

OBJECTIVE: The aim of this study is to assess the association of psychological, as well as physical and sociodemographic, indicators with patients' ratings of personal health status and diabetes control and to investigate the association of mental health and depression with errors in the perception of diabetes control. METHOD: A sociodemographically diverse sample of 623 diabetes patients was recruited from the general medicine clinics of a county health care system and a Veterans Affairs health care system. We examined three types of determinants of patients' health perceptions: physical health indicators (symptoms, comorbid diagnoses, and glycosylated hemoglobin or HbA1c levels), psychological health indicators (general mental health and diabetes-related worry), and sociodemographic factors (age, race, gender, income, and education). RESULTS: After controlling for patient' sociodemographic characteristics, perceived general health was associated with patients' symptom burden and emotional distress (but not with patients' HbA1c levels). Perceived diabetes control additionally was associated with HbA1c and diabetes-related worries. Further analyses showed that both mental health and diagnosed depression were associated with errors in personal appraisals of diabetes control, with depressed patients more often inaccurately assessing their glycemic control as poor (false-positive error) and nondepressed patients more often missing poor HbA1c levels (false-negative error). CONCLUSIONS: Findings indicate that patients use a comprehensive model for assessing their general health and that depression may lead to more accurate assessments of poor glucose control.