Peri-operative individually tailored psychological intervention in breast cancer patients improves psychological indices and molecular biomarkers of metastasis in excised tumors.

Perioperative stress and inflammatory signaling can invigorate pro-metastatic molecular processes in patients' tumors, potentially worsening long-term survival. Yet, it is unknown whether pre-operative psychotherapeutic interventions can attenuate such effects. Herein, three weeks before surgery, forty women diagnosed with stage I-III invasive ductal/lobular breast carcinoma were randomized to a 6-week one-on-one psychological intervention (6 meetings with a medical psychologist and bi-weekly phone calls) versus standard nursing-staff-attention. The intervention protocol was individually tailored based on evaluation of patients' emotional, cognitive, physiological, and behavioral stress response-patterns, and also included psychoeducation regarding medical treatments and recruitment of social support. Resected primary tumors were subjected to whole-genome RNA sequencing and bioinformatic analyses, assessing a priori hypothesized cancer-relevant molecular signatures. Self-report questionnaires (BSI-18, Hope-18, MSPSS, and a stress-scale) were collected three (T1) and one (T2) week before surgery, a day before (T3) and after (T4) surgery, and three weeks (T5) and 3-months (T6) following surgery. The intervention reduced distress (GSI), depression, and somatization scores (BSI-18: p < 0.01, p < 0.05, p < 0.05; T5 vs. T1). Additionally, tumors from treated patients (vs. controls) showed: (i) decreased activity of transcription control pathways involved in adrenergic and glucocorticoid signaling (CREB, GR) (p < 0.001), pro-inflammatory signaling (NFkB) (p < 0.01), and pro-malignant signaling (ETS1, STAT and GATA families) (p < 0.001, p < 0.01, p < 0.005); (ii) increased M1 macrophage polarization (p < 0.05), and CD4+ T cell activity (p < 0.01); and an unexpected increase in epithelial-to-mesenchymal-transition (EMT) signature (p < 0.005). This is the first randomized controlled trial to show beneficial effects of a psychological perioperative intervention on tumor pro-metastatic molecular biomarkers.

The Associations Among Observers' Openness to Experience and Agreeableness With Social Distance: The Moderating Role of Disability Type.

ABSTRACT: Despite abundant literature on personality and stigma, the role of disability type in this relationship has remained unaddressed. In the current study, we examined whether the relationship between observers' openness to experience and agreeableness on the one hand, and social distance on the other, was moderated by the target person's type of disability (psychiatric vs. physical). One hundred thirty-nine participants were randomly assigned to complete a social distance questionnaire referring to a vignette of a person in three conditions (physical disability, psychiatric disability, and control). A main effect of openness on social distance was found. Additionally, we found an interaction effect of agreeableness and the type of disability. Namely, the relationship between agreeableness and social distance was significant only in the physical disability condition but not in the other two conditions. To conclude, the current study emphasizes the role of personality traits in social distance toward individuals with disabilities.

Secondary traumatic stress among pediatric nurses: Relationship to peer-organizational support and emotional labor strategies.

BACKGROUND: Even though the cost of caring is acknowledged in multiple helping professions, research into secondary traumatic stress in pediatric nursing remains limited. This study aimed to determine the prevalence of secondary traumatic stress among pediatric nurses and examine its correlation with demographics, perceived organizational support, peer support, and emotional labor strategies. DESIGN AND METHODS: A total of 186 nurses working in a pediatric hospital completed questionnaires addressing secondary traumatic stress, perceived organizational support, peer support, and emotional labor strategies. Through correlational and mediation analyses, we explored the relationships between the study variables. RESULTS: Approximately 77.8% of the pediatric nurses surveyed exhibited moderate to severe secondary traumatic stress. Notably, the level of secondary traumatic stress did not correlate with demographic variables. Increased peer support was significantly associated with a heightened use of all emotional labor strategies (surface acting, deep acting, and natural expression) and with elevated levels of secondary traumatic stress. However, surface acting was the sole mediator of this relationship. Conversely, greater perceived organizational support correlated with decreased levels of surface acting and secondary traumatic stress, with surface acting serving as the mediator. CONCLUSIONS: Pediatric nurses are greatly impacted by secondary traumatic stress. Enhancing organizational support and carefully assessing peer support can reduce this, by decreasing nurses' need to suppress or feign genuine emotions. PRACTICE IMPLICATIONS: To enhance nurses' psychological well-being, healthcare institutions should raise awareness of secondary traumatization and foster a supportive organizational environment that prioritizes effective team emotional support and evaluates collegial emotional labor.

A pilot randomized controlled trial comparing a novel compassion and metacognition approach for schizotypal personality disorder with a combination of cognitive therapy and psychopharmacological treatment.

BACKGROUND: Schizotypal personality disorder is characterized by a pervasive pattern of maladaptive behavior that has been associated with the liability for schizophrenia. Little is known about effective psychosocial interventions. This pilot non-inferiority randomized controlled trial aimed to compare a novel form of psychotherapy tailored for this disorder and a combination of cognitive therapy and psychopharmacological treatment. The former treatment - namely, Evolutionary Systems Therapy for Schizotypy-integrated evolutionary, metacognitively oriented, and compassion focused approaches. METHODS: Thirty-three participants were assessed for eligibility, twenty-four randomized on a 1:1 ratio, nineteen included in the final analysis. The treatments lasted 6 months (24 sessions). The primary outcome was change across nine measurements in personality pathology, the secondary outcomes were remission from diagnosis and pre-post changes in general symptomatology and metacognition. RESULTS: Primary outcome suggested a non-inferiority of the experimental treatment in respect to control condition. Secondary outcomes reported mixed results. There was no significant difference in terms of remission, but experimental treatment showed a larger reduction of general symptomatology (η2 = 0.558) and a larger increase in metacognition (η2 = 0.734). CONCLUSIONS: This pilot study reported promising results about the effectiveness of the proposed novel approach. A confirmatory trial on large sample size is needed to provide evidence about relative effectiveness of the two treatment conditions. TRIAL REGISTRATION: ClinicalTrials.gov; NCT04764708; Registration day 21/02/2021.

A Rejoinder to Otaiku: Religiosity and Risk of Parkinson's Disease in England and the USA-The Health Determinants of Spirituality, Religiosity and the Need for State of the Art Research.

This rejoinder refers to the research of Otaiku (J Religion Health 1-17, 2022), which concluded that low religiosity in adulthood is associated with an increased risk of developing Parkinson's disease. Although Otaiku points to a number of limitations of their own research and thus clearly qualifies that further work is needed to verify the findings, a number of concerns still need to be raised about this research. Five points are highlighted in this article, namely (1) it is not clear why and how the variables of religiosity and spirituality were combined; (2) it is not reported whether other variables were tested; (3) they refer to the four different groups of how religiosity plays a role, which include extremely small samples of 11, 16, 25, 22 participants, (4) the final conclusion is based only on the two extreme groups with Parkinson's disease, (5) it remains unclear whether all patients had Parkinson's disease. Consequently, we are of opinion that Otaiku's findings and conclusions are questionable, but agree that future studies are warranted that require state-of-the-art research. [Note: A detailed response to this rejoinder has been provided in a subsequent commentary; Koenig (Journal Religion Health 62, 2023)].

Risk perception, treatment adherence, and personality during COVID-19 pandemic: An international study on cancer patients.

OBJECTIVE: To explore the role of personality traits in moderating the relation between COVID-19 risk perception and treatment adherence, and between risk perception and psychosocial distress in patients diagnosed with cancer. METHODS: An online survey (n = 1281) was conducted worldwide in seven countries (Austria, Germany, Hong Kong, Italy, Spain, Sweden, and Turkey). Inclusion criteria were to be 18 years of age or older, have received a cancer diagnosis, and be in treatment or follow-up. A few moderated regression models were performed with both personality traits and Hierarchical Taxonomy of Psychopathology super-spectra as moderators. RESULTS: Detachment, negative affectivity, psychoticism and all the super-spectra significantly moderated the relation between coronavirus risk perception and psychosocial distress, after the adjusting effect of confidence in safeguards. Only negative affectivity moderated the association between coronavirus risk perception and treatment adherence. CONCLUSIONS: Personality traits may foster the understanding of how a patient might adjust to cancer treatment and, more generically, to highly stressful events such as the COVID-19 pandemic. Further research is needed to confirm the results in different cancer stages and types.

The paradox: guilt as an antidote to helplessness among oncologists.

PURPOSE: Oncologists are exposed to suffering, loss, and death, and as a result may experience guilt. The study examined two competing hypotheses regarding the relation between locus of control (LOC) and guilt among oncologists and the mediating role of helplessness. METHOD: Eighty-three oncologists answered a demographic questionnaire; the Levenson's "Internal, Powerful Others, and Chance" scale; the Guilt Inventory; and the Learned Helplessness Scale. RESULTS: Oncologists reported moderate levels of guilt, high levels of internal LOC, and low levels of external LOC and helplessness. The results indicate a significant negative relationship between internal LOC and guilt and a significant positive relationship between external LOC (powerful others) and guilt, both mediated by helplessness. It seems that oncologists with external LOC feel helplessness and this metamorphoses into guilt, due to its potentially protective role against feelings of helplessness. CONCLUSIONS: Oncologists are at risk for guilt. Whereas an internal LOC plays an important role as a resilience factor in terms of helplessness, an external LOC is a risk factor for helplessness and guilt. A paradoxical association between guilt and helplessness was found. The implication of which is that guilt may be produced to avoid helplessness; in other words, guilt, however painful, might be preferable to feeling helpless. Interventions focusing on oncologists' coping with uncontrolled situations in their daily work, decreasing their sense of helplessness and guilt, should be implanted.

Depression, hope and social support among older people with cancer: a comparison of Muslim Palestinian and Jewish Israeli cancer patients.

OBJECTIVES: Studies of depression in older Muslim Palestinians diagnosed with cancer are scarce. To gain insight into the psychological response and coping ability of this very large, globally distributed population, we collected data from older Muslim Palestinian people diagnosed with cancer concerning depression hope and perceived social support. Both hope and social support were selected because they can be manipulated through intervention and education, as shown in the geriatric literature. Data were compared to data collected from older Jewish Israeli people diagnosed with cancer. DESIGN: The study sample comprised 143 Muslim Palestinian and 110 Jewish Israeli people diagnosed with cancer, aged ≥ 65. All participants were either in treatment for active disease or within 6 months of such treatment. Self-administered measures included depression (the Five-Item Geriatric Depression Scale), perceived social support (Cancer Perceived Agents of Social Support Questionnaire) and hope (Snyder's Adult Hope Scale). RESULTS: Hope and depression were both found to be significantly higher among the Muslim Palestinian patients than in the Jewish Israeli participants. In both samples, higher levels of hope were associated with lower levels of depression, with this correlation stronger in the Jewish Israeli group. CONCLUSION: To improve the psychological wellbeing of patients, healthcare providers must exercise cultural sensitivity in their interactions, respecting the perspectives of both the patients and their families. Incorporating the concept of hope into the therapeutic dialogue and language may improve psychological wellbeing and synchronize the needs and expectations of patients, caregivers, and healthcare professionals, resulting in more equitable, effective and value-oriented care.

Illness Perception Regarding Early-stage Mycosis Fungoides among Dermatologists: A Multi-centre Cross-sectional Study.

Early-stage mycosis fungoides is a rare cutaneous T-cell lymphoma with a good prognosis. Data regarding patients' illness perception of mycosis fungoides are accumulating. However, investigating the dermatologists' viewpoint is also essential, as it shapes the therapeutic relationship and doctor-patient communication. The aim of this study was to investigate the aspects of dermatologists' illness perception towards early-stage mycosis fungoides and the way they present it to patients. Twenty-five dermatology residents and 55 attending physicians from all Israeli dermatology departments and the community completed the study questionnaires online. Dermatologists viewed mycosis fungoides as a chronic disease, causing a moderate emotional burden. In contrast to previously published data regarding patients' illness perception, dermatologists demonstrated dominancy in the notion that patients were able to control their disease. Most dermatologists thought that patients perceived mycosis fungoides as an indolent lymphoma that causes anxiety. Dermatologists used a high diversity of themes when presenting mycosis fungoides to patients. The differences between the residents' and attending physicians' perceptions were minimal. Dermatologists have a kaleidoscope of views regarding the way they perceive mycosis fungoides, the way they think patients perceive it, and the way they communicate with patients. Maintaining patient-centred communication enables dermatologists to identify these gaps and view mycosis fungoides from their patients' perspective.

Exploring the relation between clinician ratings and patient-reported experience and outcomes.

BACKGROUND: Patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) are increasingly recognized as important ways for patients to be more actively involved in their treatment and enhance shared decision-making. OBJECTIVE: The current study investigated the associations between PROMs, PREMs and various symptoms measures reported by clinicians and psychiatric patients. METHOD: One hundred and twenty people admitted to a psychiatric hospital completed two PREMs, one PROM (the shortened version of the Manchester Short Assessment of Quality of Life scale) and Effects of Symptoms on Daily Functioning (the Sheehan Disability Scale), the Patient Clinical Global Impression and the Modified Colorado Symptom Index. Their psychiatrists rated them using the Global Assessment of Functioning scale, the Health of the Nation Outcome Scales and the Therapist Clinical Global Impression. RESULTS: There was a strong correlation between patient's evaluation of their quality of life (PROM), experience of their care (PREM) and the overall severity of their condition and their progress. The pattern of correlation between patients' and clinicians' measures revealed a three-layer structure representing a continuum from inner experience to external presentation of experiences. CONCLUSION: Together these findings help identify and emphasize various domains of subjective experiences and their relation to external ratings.

Perfectionism, Big Five and biopsychosocial functioning among parents of children with and without acquired brain injury (ABI).

BACKGROUND AND OBJECTIVE: Personality factors are often investigated in the context of parenting but are rarely studied in relation to coping with child disabilities like pediatric acquired brain injury (pABI). This study (1) compares Biopsychosocial functioning (BPSF), Big Five personality traits, and dimensions of perfectionism of parents of children with and without pABI, and (2) examines the role personality factors play in parental BPSF in each group. METHOD: 57 parents of children who sustained a significant pABI and 50 parents of typically developing children participated in this cross-sectional study. Parents completed scales measuring Multidimensional Perfectionism, Big Five inventory, and BPSF. RESULTS: Among the pABI group, multivariate analysis indicated significantly poorer BPSF, higher levels of neuroticism, socially prescribed perfectionism, and lower levels of openness, than controls. Regression analysis showed that personality explained 60.5% of the variance in parental BPSF post pABI. In both samples, neuroticism and socially prescribed perfectionism appeared as two prominent personality factors with a significant negative effect on parental BPSF, while self-perfectionism appeared prominent only in the pABI group, indicating a significant positive effect. IMPLICATIONS: pABI may result in changes to parents` personality. Personality characteristics significantly contribute to parental BPSF post-injury and should be addressed in clinical practice.

"Mind the gap": Exploring pediatric nurses` perceptions of the theory and practice of caring for children and families.

PURPOSE: To investigate how pediatric nurses interpret and conceptualize theoretical underpinnings and daily practice scenarios pertaining to their role in pediatric care. DESIGN AND METHODS: 139 pediatric nurses completed a survey in which they were asked to endorse to what extent practices related to pediatric concepts are expected from their role ("Expected") or are actually implemented in their clinical work ("Actual"). Survey items were derived from a nursing textbook that outlines the theoretical tenets of the "art of pediatric nursing", along with scenarios and conflicts encountered in everyday practice, covering family-child centered care, child growth and development, and emotional boundaries. RESULTS: In both Expected and Actual practices, the highest level of endorsement was for items focused on core elements of family-centered care (80-96%), and moderate-low endorsement levels were observed for items related to therapeutic relationship management and emotional boundaries. A factor analysis yielded 12 factors representing themes related to pediatric nursing. However, the division of items per factor indicated diffusion between key concepts and a discrepancy between theory and practice, especially in regard to maintaining emotional separateness and objectivity, advocacy, managing conflicts within the nurse-child-family triad, and navigating oneself boundaries. CONCLUSIONS: Nurses' ability to manage and contain various types of unclear boundaries is crucial for optimal care provision when working with children and families. PRACTICE IMPLICATION: Variability in nurses' theoretical role-perception and practical care provision is largely attributed to the way they navigate various ambiguous boundaries in practice and this could be a focal point in educational programs and on-the-job training.

Patient-oncologist working alliance and its relation to locus of control.

OBJECTIVES: In this study, we assessed the patient-oncologist relationship, conceptualized as the working alliance from a dyadic perspective, and its relation to locus of control. METHODS: One hundred and three oncologist-patient dyads were recruited. Measures included a sociodemographic and medical questionnaire; the "internal, powerful others, and chance" locus of control scale; and the working alliance inventory. RESULTS: Application of the actor-partner interdependence model yielded 2 actor effects: a positive association between oncologist "internal" locus of control and oncologist working alliance, and a negative association between oncologist "chance" locus of control and oncologist working alliance. It also yielded one partner effect: a positive association between oncologist "internal" locus of control and patient working alliance. SIGNIFICANCE OF RESULTS: The actor-partner effect suggests that oncologists' locus of control has a role in the establishment of the patient-oncologist working alliance; oncologists' internal locus of control is a dominant factor affecting not only their own perceived alliance but patients' perceived alliance as well.

Nurturing Socioculturally and Medically Appropriate Palliative Care Delivery: Lessons Learned by Israeli Medical Faculty.

Israel is one of the few countries worldwide with a national policy and defined standards of palliative care (PC); its culture is highly diverse and more traditionally oriented in comparison with Western countries. This study describes the current state of PC in Israel through examination of: (1) its current status, self-image and structural factors; (2) its relation to cultural and political characteristics; and (3) the chances, goals and obstacles of advancing PC in Israel. Face-to-face interviews were conducted at all five public medical faculties in Israel from November 2017 to February 2018. The following findings are reported: (1) definition of palliative care, (2) multidisciplinary approach, (3) special role of nurses, (4) personal perceptions of death, (5) understanding the role of medicine, (6) specialty palliative medicine, (7) religious, spiritual and cultural aspects, (8) political and economic aspects, (9) obstacles and weaknesses, and (10) prospects and goals of palliative care. Participants perceive PC as an integrative healthcare service that should be available to all patients, including children and their families, at any stage of illness. They internalize that PC principles apply regardless of ethnic, cultural, and religious background. Utilizing nurses' leadership, enhancing multidisciplinary teamwork, and person-centered approach, supports better PC to more people.

An Analysis of Factors Predicting Post-Traumatic Stress Disorder and Grief Following Comrade Loss.

This study explored how "inhibiting factors" associated with military-bereavement impact combatants' psychological sequelae following comrade loss. One hundred six eligible Israeli combat male-soldiers completed the Texas-Revised-Inventory of Grief, the post-traumatic-stress-disorder symptoms scale (PSS), the Male Role Norms Scale, the Social Acknowledgment Questionnaire, and a scale assessing Military Encouragement to Grieve (MEG-8). Time since loss had no impact on soldiers' levels of PSS or prolonged grief. Regression analysis indicated that higher masculinity-perception and disapproval from the family predicated higher PSS, above and beyond grief. Conversely, lower disapproval from the family, and higher disapproval from the general community, predicted higher grief, above and beyond PSS. Also, military encouragement significantly mediated the positive relationship between masculinity and sense of social-recognition. The results show how inhibiting factors contribute differently to the perpetuation of PSS and grief. This interplay sheds light on soldiers' "external" and "internal" loss processes of traumatic bereavement. The practical implications to treatment are also discussed.

Predictors of death at home among cancer patients in Israel: a population-based study.

BACKGROUND: Most cancer patients prefer to die at home; however, many die in hospital. The aim of the current study is to elucidate the association between dying at home and various personal factors in the Israeli population of cancer patients. METHODS: Data on cancer incidence (2008-2015) and death (2008-2017) was provided by the Israeli Central Bureau of Statistics and the Israel National Cancer Registry. Binary logistic regression analyses were performed to assess odds ratios for death at home following cancer diagnosis while controlling for age, sex, ethnicity, years of education, residential socioeconomic score, and time from diagnosis. We also assessed the relation between place of death and specific cancer sites, as well as the time trend from 2008 to 2017. RESULTS: About one quarter (26.7%) of the study population died at home. Death at home was most frequent among patients diagnosed with brain tumors (37.0%), while it was the lowest among patients with hematologic malignancies (lymphoma and leukemia, 20.3 and 20.0%, respectively). Rates of dying at home among patients with residential socioeconomic scores of 1, 2-9, and 10 were about 15, 30, and 42.9%, respectively. In patients from the 4th to the 7th decades of life, rates of death at home increased at a linear rate that increased exponentially from the 8th decade onwards. After controlling for potential confounders, predictive variables for death at home included age (OR = 1.020 per year, 95% CI 1.017-1.024), male sex (OR = 1.18, 95% CI 1.077-1.294), years of education (OR = 1.029 per year, 95% CI 1.018-1.040), and time from diagnosis (OR = 1.003 per month, 95% CI 1.001-1.005 all p < 0.001). No trend was seen from 2008 to 2013, while from 2014 to 2017 a slight increase in the rate of death at home was seen each year. CONCLUSIONS: These results indicate wide variability in death at home exists among patients of different ages, sex, education, socioeconomic status and time from diagnosis. These findings stress the importance of delivering quality palliative care at home, mainly for patients with hematologic malignancies, younger patients, and patients of very low socioeconomic status. Understanding the complex mechanisms whereby patient preferences and the above variables may determine the preferred place of death remains an important research priority.

Illness Perception, Perceived Social Support and Quality of Life in Patients with Pemphigus Vulgaris: What Should Dermatologists Know?

Data regarding the impact of psychological factors in patients with pemphigus is sparse. This study evaluated the correlation of demographic, clinical, and psychological parameters with quality of life in 58 patients with pemphigus. Illness perception showed a realistic view, with the highest scores for cyclical course (3.35 ± 0.09) and treatment control (3.08 ± 0.06). Mean scores for perceived social support were relatively high from family and significant others (5.89 ± 0.18 and 5.66 ± 0.23, accordingly), and relatively low from friends (4.55 ± 0.24). There were no correlations be-tween demographic, clinical parameters, perceived social support, and Dermatology Life Quality Index. Beliefs in cyclical course, emotional influence, psychological cause, and treatment control correlated significantly with quality of life. Stronger beliefs in self-control, chronicity, and accidental cause predicted higher quality of life, while stronger beliefs in cyclical course, psychological cause, and risk factors predicted lower quality of life. In order to enhance QoL, dermatologists should deliver the message to the patients that pemphigus is a chronic disease rather than cyclical and unexpected, and stress the patients' role in controlling it.

Coping With Information Style, Self-Concealment, Internalized Stigma, and Family Burden Among Parents of Children With Psychiatric Disorders.

Parents of children with psychiatric disorders who are hospitalized in a psychiatric unit often experience family burden. Family burden has been found to be affected by many variables related to parents' personal traits and ways of reacting to the disorder. The current study examined the association between information coping styles (monitoring and blunting) and family burden, among parents of children who were hospitalized in a day care unit. The possible role of self-stigma as a mediator between coping style and family burden and the role of self-concealment as a moderator between coping style and self-stigma were examined. A total of 41 parents completed questionnaires assessing their levels of self-stigma, information coping style, self-concealment, and family burden. Self-stigma was found to mediate the positive association between the monitoring coping style and family burden. Moreover, a moderation effect of self-concealment was found, indicating that monitoring parents suffered from higher levels of self-stigma particularly if they had a high tendency toward self-concealment. Taking into account parents' information, coping style, self-stigma, and self-concealment can help professionals tailor family interventions according to parents' diverse needs. A monitoring coping style may not be beneficial especially when combined with concealment, suggesting the need to promote other coping styles.

Los padres de niños con trastornos psiquiátricos que están internados en una clínica psiquiátrica con frecuencia sufren agobio familiar. Se ha descubierto que el agobio familiar está afectado por muchas variables relacionadas con las características personales de los padres y las maneras de reaccionar al trastorno. En el presente estudio se analizó la asociación entre los estilos de afrontamiento de la información (supervisión y evitación) y el agobio familiar entre padres de niños que estaban internados en un hospital de día. Se examinó el posible rol del autoestigma como mediador entre el estilo de afrontamiento y el agobio familiar, y el rol del autoocultamiento como moderador entre el estilo de afrontamiento y el autoestigma. Un total de 41 padres contestaron cuestionarios donde se evaluaron sus niveles de autoestigma, el estilo de afrontamiento de la información, el autoocultamiento y el agobio familiar. Se descubrió que el autoestigma medió la asociación positiva entre el estilo de afrontamiento de supervisión y el agobio familiar. Además, se descubrió un efecto moderador del autoocultamiento, lo cual indica que los padres supervisores sufrían de niveles más altos de autoestigma, particularmente si tenían una alta tendencia hacia el autoocultamiento. Tener en cuenta el estilo de afrontamiento de la información, el autoestigma y el autoocultamiento de los padres puede ayudar a los profesionales a adaptar las intervenciones familiares de acuerdo con las distintas necesidades de los padres. Es posible que un estilo de afrontamiento de supervisión no sea beneficioso, especialmente si está combinado con el ocultamiento, lo cual sugiere la necesidad de promover otros estilos de afrontamiento.

Informal caregivers of older Muslims diagnosed with cancer: A portrait of depression, social support, and faith.

OBJECTIVE: Islamic population constitute more than 20% of the world population and is growing rapidly. Nevertheless, data concerning informal caregiving to older Muslim patients diagnosed with cancer are scarce. Improving the well-being of caregivers is a vital step to optimal care for the patients themselves throughout the Muslim community and the world. This study focuses on a sample of Palestinian caregivers of older Muslim patients diagnosed with cancer living in East Jerusalem, the West Bank, and Gaza. The study aims to describe the socio-demographic characteristics of the caregivers and to understand their social support, and identify predictors of caregivers' depression. METHODS: A cross-sectional study of a convenience sample of 99 dyads of Palestinian patients (age ≥65) and their informal caregivers. Depression and social support were measured using the five items of the Geriatric Depression Scale and the Cancer Perceived Agents of Social Support questionnaire. RESULTS: Caregivers were most frequently adult children (52%) or spouses (32%), with male patients cared for by spouses (47.5%) or sons (32%), and female patients by daughters (50%). Clinical levels of depression were reported by 76% of the caregivers and 85% of patients. The significant predictors of caregiver depression were female gender, lower education, lower perceived social support from spouse and family, and higher perceived support from faith. SIGNIFICANCE OF RESULTS: Healthcare providers serving the study population should determine the position and role of the caregiver within the social and family structure surrounding the patients' families. This understanding may facilitate overcoming barriers to effective and meaningful social support.

Preoperative body-related emotional distress and culture as predictors of outcomes of bariatric surgery.

PURPOSE: Findings concerning the impact of bariatric surgical intervention on both psychological variables and weight loss are often controversial and misconstrued the world over. The aim of this study was to classify bariatric surgery patients according to patterns of preoperative measures that may predict postoperative psychological and physiological outcomes and to compare these patterns between two distinct cultures. METHODS: Of 169 consecutive bariatric surgery candidates from Israel and 81 candidates from the United States, 73 and 35 patients, respectively consented to be included in a follow-up phase. Body image dissatisfaction, emotional eating behaviors, risk of suicide, depressive symptoms, anxious symptoms, and percent excess weight loss were measured. K-means clustering procedure was used to classify bariatric surgery patients according to their preoperative body-related emotional distress, which was composed of body image dissatisfaction and emotional eating. The joint effect of culture and body-related emotional distress cluster on psychological distress was tested. RESULTS: The cluster analysis revealed two preoperative body-related emotional distress patterns: high body-related emotional distress and low body-related emotional distress. Following surgery, US patients showed a higher risk of suicide and lower excess weight loss than Israeli patients within only the high body-related emotional distress cluster (a significant interaction effect). CONCLUSION: Preoperative assessment of body-related emotional distress patterns among bariatric surgery candidates may enable professionals to identify potential postoperative risks of suicide, anxiety, and decreased weight loss. The relationship between the body-related emotional distress cluster and outcome measures is culture dependent. LEVEL III: Case-control analytic study.