The relationship between patients' illness beliefs and recovery after stroke.

The Common Sense Model (CSM) is a useful framework for understanding mood and treatment adherence amongst survivors in the acute phase of stroke. CSM stroke studies have thus far focused on the single outcomes, mood and medication adherence, neglecting other aspects of post-stroke recovery (i.e., Health-Related Quality of Life (HRQL) and disability). The purpose of this study was to examine relationships between baseline illness beliefs and three-month post-stroke HRQL, mood and disability. A longitudinal observational design was adopted, involving 50 survivors (mean age = 66.9 years, 68% male). The primary outcome, HRQL, was measured using EQ-5D-5L. The secondary outcome, mood was measured using the Patient Health Questionnaire-9; and disability, using the Nottingham Extended Activities of Daily Living Scale. The Stroke Illness Perception Questionnaire-Revised measured illness beliefs. Spearman's correlations showed that beliefs about the fluctuating effects of stroke (ρ = 0.50, p < 0.001) and considerable distress at baseline were significantly associated with worse mood three-months post-stroke (ρ = 0.41, p < 0.001). Baseline illness beliefs were not significantly related to three-month post-stroke HRQL or disability. Despite being limited by a modest sample size, the findings reiterated the need for routine clinical assessment of mood immediately after stroke, and indicated that simultaneous measurement of illness beliefs may also be beneficial.

Can illness beliefs, from the common-sense model, prospectively predict adherence to self-management behaviours? A systematic review and meta-analysis.

OBJECTIVE: To determine whether people's beliefs about their illness, conceptualised by the common sense model (CSM), can prospectively predict adherence to self-management behaviours (including, attendance, medication, diet and exercise) in adults with acute and chronic physical illnesses. DESIGN AND MAIN OUTCOME MEASURES: Electronic databases were searched in September 2014, for papers specifying the use of the 'CSM' in relation to 'self-management', 'rehabilitation' and 'adherence' in the context of physical illness. Six hundred abstracts emerged. Data from 52 relevant studies were extracted. Twenty-one studies were meta-analysed, using correlation coefficients in random effects models. The remainder were descriptively synthesised. RESULTS: The effect sizes for individual illness belief domains and adherence to self-management behaviours ranged from .04 to .13, indicating very weak, predictive relationships. Further analysis revealed that predictive relationships did not differ by the: type of self-management behaviour; acute or chronic illness; or duration of follow-up. CONCLUSION: Individual illness belief domains, outlined by the CSM, did not predict adherence to self-management behaviours in adults with physical illnesses. Prospective relationships, controlling for past behaviour, also did not emerge. Other factors, including patients' treatment beliefs and inter-relationships between individual illness beliefs domains, may have influenced potential associations with adherence to self-management behaviours.

The association between body mass index and health-related quality of life: influence of ethnicity on this relationship.

AIMS: The association between obesity and a poorer health-related quality of life (HRQL) has previously been explored. The influence of ethnicity on this relationship has less frequently been considered. We aimed to explore the relationship between body mass index (BMI) and HRQL in a mixed population of White European (WE) and South Asian (SA) ethnicity. METHODS: Cross-sectional data were analysed (n = 4989, 16% SA) from a population-based diabetes screening study. BMI categories were based on ethnic-specific cut-points. HRQL was categorized low (<0.848) or high (≥0.848) according to the median EQ5D score. Logistic regression was used to examine the relationship between BMI and HRQL. Interaction analysis was conducted to determine the effect of ethnicity. RESULTS: Overweight (OR = 1.22, 95% CI: 1.10-1.41, p < 0.001) and obese people (OR = 1.81, 95% CI: 1.56-2.10, p < 0.001) had increased odds of having a low HRQL compared to normal weight people. After adjusting for potential confounders, age, gender, ethnicity, deprivation score, fruit and vegetable intake, physical activity, cardiovascular disease, chronic kidney disease and smoking, this association was strengthened further. However, for obese people, SA ethnicity significantly reduced the risk of having a low HRQL when compared to WEs (adjusted OR = 0.58, 95% CI: 0.34-0.97). CONCLUSIONS: Our findings provide further evidence of an association between increasing BMI and low HRQL but suggest that SA ethnicity modifies this relationship. These results could have important health implications and are a basis for further research.

The association between anxiety and measures of glycaemia in a population-based diabetes screening programme.

AIM: To investigate associations between anxiety and measures of glycaemia in a White European and South Asian population attending community-based diabetes screening. METHODS: In total, 4688 White European and 1353 South Asian participants (aged 40-75 years) without a previous diagnosis of Type 2 diabetes underwent an oral glucose tolerance test and HbA(1c) measurement, detailed history, anthropometric measurements and completed the short-form Spielberger State Trait Anxiety Inventory. RESULTS: Anxiety was significantly higher in South Asian participants (mean 34.1; sd 0.37) compared with White European participants (mean 29.8; sd 0.13). Significant correlations were not identified between anxiety and fasting (r = -0.01, P = 0.75), 2-h glucose (r = -0.10, P = 0.24) or HbA(1c) (r = 0.01, P = 0.40). CONCLUSIONS: Anxiety levels at screening were greater among South Asian people. Fasting, 2-h plasma glucose and HbA(1c) are not affected by anxiety during screening tests for diabetes. Current and proposed screening methods for diagnosis of diabetes are not affected by anxiety at screening.

The prevalence of depressive symptoms in a white European and South Asian population with impaired glucose regulation and screen-detected Type 2 diabetes mellitus: a comparison of two screening tools.

AIMS: To compare the identification of prevalent depressive symptoms by the World Health Organization-5 Wellbeing Index (WHO-5) and Centre for Epidemiological Studies Depression Scale (CES-D) for South Asian and white European people, male and female, attending a diabetes screening programme, and to explore the adequacy of the screening tools for this population. An additional aim was to further explore associations of depressive symptoms with impaired glucose regulation (IGR) and Type 2 diabetes mellitus (Type2 DM). METHODS: Eight hundred and sixty-four white European (40-75 years old) and 290 South Asian people (25-75 years old) underwent an oral glucose tolerance test (OGTT), detailed history and anthropometric measurements and completed the WHO-5 and CES-D. Depressive symptoms were defined by a WHO-5 score or= 16. RESULTS: Unadjusted prevalence of depressive symptoms with the WHO-5, for people with Type2 DM was 42.3% (47.4% in white European; 28.6% in South Asian) and for IGR 30.7% (26% in white European; 45.8% in South Asian). With the CES-D, the prevalence in Type2 DM was 27.2% (25.4% in white European; 31.8% in South Asian) and for IGR 30.7% (27.8% in white European; 40.7% in South Asian). Statistically significant differences in the prevalence of depressive symptoms for sex or ethnicity were not identified. Odds ratios adjusted for age, sex and ethnicity showed no significant association of depression with Type2 DM or IGR, with either WHO-5 or CES-D. Agreement was moderate (kappa = 0.48, 95% confidence intervals 0.42-0.54), and reduced when identifying depressive symptoms in people with Type2 DM. For this group, a WHO-5 cut-point of

Superior vena cava syndrome due to subclavian hemodialysis catheters.

The widespread use of subclavian dialysis catheters has revealed a high incidence of venous thrombosis and exposed their potential to cause major obstructive complications that may compromise permanent vascular access. We describe for the first time a patient who developed superior vena cava syndrome secondary to central vein stenosis caused by multiple uses of subclavian dialysis catheters. Central vein stenosis in our patient probably caused the failure of permanent vascular accesses in the upper extremities and rendered both arms useless for any further temporary or permanent vascular access. In view of these late vascular complications, use of subclavian dialysis catheters should be kept to a minimum by creating an early permanent vascular access.

An intraperitoneal insulin regimen for diabetics on continuous cyclic peritoneal dialysis.

Intraperitoneal insulin requirements were evaluated in six diabetic patients who were switched from continuous ambulatory peritoneal dialysis to continuous cyclic peritoneal dialysis. The mean total daily intraperitoneal insulin dose on continuous cyclic peritoneal dialysis was 85% of the mean dose on continuous ambulatory peritoneal dialysis (66 +/- 33 vs. 78 +/- 47 units/day, respectively, not significant), with comparable glycemic control. Twenty-five to 58% (mean value, 41%) of the total daily intraperitoneal insulin was administered in the diurnal exchange of the patients on continuous cyclic peritoneal dialysis. The ratio of the total intraperitoneal insulin dose on continuous cyclic peritoneal dialysis to the subcutaneous insulin dose predialysis was between 1.2 and 2.4 (mean value, 1.9). As guidelines for converting intraperitoneal insulin doses for patients switched from continuous ambulatory peritoneal dialysis to continuous cyclic peritoneal dialysis, we recommend starting continuous cyclic peritoneal dialysis with a total daily insulin dose 15% less than the continuous ambulatory peritoneal dialysis dose and giving approximately 40% of the total daily insulin dose in the diurnal exchange.

Atheroembolic involvement of renal allografts.

Renal atheroembolism is a well-recognized cause of renal insufficiency. Two renal allograft recipients with cholesterol atheroemboli in their allograft biopsies are described. In one patient, the origin of the atheroemboli was the recipient aorta while in the second patient the source was the donor. Renal allograft atheroembolism should be considered in elderly recipients or recipients of kidneys from older donors.