Psychological impact of working with patients with cystic fibrosis at end-of-life, pre-transplant stage.

OBJECTIVE: Multidisciplinary staff who work with end-of-life, pre-transplant patients with cystic fibrosis (CF) have to juggle two seemingly opposing care approaches; active care to maintain their patients' health and condition in anticipation of a transplant, and sensitive palliative care that takes their end-of-life wishes into consideration should they not receive a transplant. Little is known about the psychological impact on staff working within this care dichotomy. The aim of this study is to explore staff's experiences and understand more about the psychological impact of this work on them professionally and personally, and how this affects their ability to provide appropriate care for their patients. METHOD: A qualitative explorative research design was used. Ten semistructured interviews with multidisciplinary staff working in cystic fibrosis centers and units across the United Kingdom were analyzed using interpretative phenomenological analysis (IPA). RESULTS: Two superordinate themes emerged from the analysis: factors contributing to the "juggle" of active and palliative care, and extent of emotional impact on staff. SIGNIFICANCE OF RESULTS: The study indicates that there is an emotional impact on staff working with patients with CF at end-of-life, pre-transplant stages. Specifically, it reveals the extent of the unpredictability that staff work with, and the range of emotions that staff experience, including uncertainty about professional identity and anxiety about working practices. The depth and intimacy of professional-patient relationships is highlighted, particularly for staff in close contact with and similar in age to their patients. Additionally, the strength of staff's commitment and desire to care for patients within broader humanistic terms that mesh with their own personal values is brought to light. Despite the difficulties with their work, the majority of staff adopted numerous coping strategies to manage their emotions, many of which emphasized the link between their professional and personal values in undertaking their roles.

Bloodmeal regulation in mosquitoes curtails dehydration-induced mortality, altering vectorial capacity.

Mosquitoes readily lose water when exposed to any humidity less than that of near saturated air unless mitigated, leading to shifts in behavior, survival, distribution, and reproduction. In this study, we conducted a series of physiological experiments on two prominent species in the Culicinae subfamily: Culex pipiens, a vector of West Nile virus, and Aedes aegypti, a vector of yellow fever and Zika to examine the effects of dehydration. We exposed C. pipiens and A. aegypti to non-dehydrating conditions (saturated air), dehydrating conditions (air at a 0.89 kPa saturation vapor pressure deficit), several recovery conditions, as well as to bloodfeeding opportunities. We show that dehydrated mosquitoes increase bloodfeeding propensity, improve retention, and decrease excretion of a post-dehydration bloodmeal. In addition, mosquitoes that take a bloodmeal prior to dehydration exposure show increased survival over non-bloodfed counterparts. Dehydration-induced alterations in survival, reproduction, and bloodfeeding propensity of C. pipiens and A. aegypti resulted in marked changes to vectorial capacity. Ultimately, these results become increasingly important as drought intensifies in association with climate change and mosquitoes become more likely to experience arid periods.

Indoleamine 2,3-diooxygenase in periaortic fat: mechanisms of inhibition of contraction.

Indoleamine 2,3-dioxygenase (IDO) metabolizes L-tryptophan to L-kynurenine, promotes immunosuppression, and has been described as a consumer of superoxide. We discovered IDO expression in periaortic fat and tested the hypothesis that periarterial IDO functionally reduces agonist-induced contraction. Our model was the thoracic aorta, abdominal aorta, and superior mesenteric artery of the male Sprague-Dawley rat. Periaortic fat from the thoracic aorta stained intensely for IDO, the brown fat marker uncoupling protein-1, and oil red O as a general lipid marker. White fat around the mesenteric artery and abdominal aorta stained less for IDO; brown fat was less abundant. IDO activity (kynurenine-to-tryptophan ratio via HPLC) was detected in visceral and mesenteric artery fat (ratio: ∼4) but was highest in perithoracic aortic fat (ratio: 10 ± 1.1). In isometric contractile experiments, periadventitial fat reduced ANG II-induced thoracic aortic (with fat: 34% of without fat) and mesenteric artery (with fat: 63% of without fat) maximal contraction. In contrast, periadventitial fat did not reduce agonist-induced contraction in the abdominal aorta. The IDO inhibitor 1-L-methyltryptophan (1-MT) reversed the fat-induced reduction of ANG II-induced contraction in the thoracic aorta but not in the mesenteric artery. The IDO metabolite kynurenine relaxed the thoracic aorta only at high (9 mM) concentrations, whereas the downstream metabolite quinolinic acid (1 mM) relaxed the contracted thoracic aorta (∼80%). 1-MT did not correct the reduction in basal superoxide levels observed in the presence of perithoracic aortic fat. We conclude that IDO is an enzyme active primarily in brown fat surrounding the thoracic aorta and depresses aortic contractility.

Depression in female adolescents: an IPA analysis.

Six female adolescents participated in open-ended interviews regarding their experiences of depression. The transcripts of their interviews were explored using Interpretative Phenomenological Analysis (Smith, 1991). The analysis revealed three inter-connected super-ordinate themes which were: communication, hurt self, and difference. These themes centred on communication processes in participants' families and with peers, issues relating to shifts in identity through adolescence, and feelings of being damaged, distressed, and hurt. Amongst a range of potentially relevant perspectives, an attachment theory (Bowlby, 1969) orientation was found to be particularly relevant and helpful in interpreting the themes that captured these young women's experiences. Some implications for clinical practice are discussed.

It has certainly been good just to talk: an interpretative phenomenological analysis of coping with myocardial infarction.

OBJECTIVES: The experience of a myocardial infarction (MI), its potential meaning and consequences arouse a high level of emotional responsiveness in the individual. Researchers to date have argued that implementing adaptive coping strategies is necessary for emotional adjustment. This study aimed to advance coping research by providing more detailed insight into middle-aged men's personal experiences of coping with MI and the meaning they ascribe to these experiences. DESIGN: Interpretative Phenomenological Analysis (IPA) was used to conduct an in-depth study of a small sample of patients who had suffered their first MI. METHOD: Semi-structured interviews were conducted with six men within 6 months of their first MI. Verbatim transcripts of these interviews were analysed using IPA. RESULTS: Three superordinate themes emerged, which are described under the headings of 'Difficulty in Reflecting', 'Needing to Talk' and 'Back to Normal'. CONCLUSIONS: Participants seemed to share difficulties in reflecting on their coping strategies and the concept of coping generally, but were keen to talk about specific events in relation to the MI. The findings suggest that cardiac rehabilitation needs to focus on individual priorities for recovery. Providing opportunities for patients to talk through their experiences individually may be an important aspect of such care. Further research is needed to investigate the challenges that patients confront and the support they require post-MI.

Attachment and adolescent depression: the impact of early attachment experiences.

Bowlby's (1969/1982) ideas of attachment as an interactional system provide the basis for an understanding of the development of adaptive and maladaptive working models of the self and other. More specifically, attachment theory can offer an in-depth understanding into the development of a depressotypic self-schema. Attachment theory is set alongside research into adolescent depression in order to illustrate the importance of the primary attachment relationship in protecting adolescents in our society from developing depressive symptomatology. Therefore, current research in adolescent depression is viewed through the lens of attachment theory. This view is complemented by an exploration of the role of culture in the production of gender differences in depression. Thus, a tripartite model of adolescent depression, including the individual, family relationships, and socio-cultural factors is offered as being of potential value for clinicians and researchers in this area.

Enhancement of antibody responses to influenza vaccination in the elderly following a cognitive-behavioural stress management intervention.

BACKGROUND: Previous research has demonstrated that the psychological morbidity experienced by informal caregivers is associated with increased vulnerability to infectious diseases, in particular influenza. A pragmatic trial was conducted to examine whether a stress management intervention (SMI) could reduce psychological morbidity and enhance the antibody response to influenza vaccination in the elderly, and whether changes in immune response of SMI participants were associated with hypothalamic-pituitary-adrenal (HPA) axis activity. METHODS: Forty-three elderly spousal carers of dementia patients and 27 non-carer controls were recruited. Sixteen carers were allocated to an 8-week SMI or a non-intervention condition (n = 27). The non-carers formed a no treatment, 'normal' comparison group. At the end of the SMI or its equivalent time period, all participants received an influenza vaccination. IgG antibody titres to the vaccine were measured 0, 2, 4 and 6 weeks post-vaccine. RESULTS: There was evidence of elevated distress in both carer groups compared with non-carer controls throughout the SMI period, but no between-group differences in salivary cortisol. Immune responses to the vaccine revealed that 50% of SMI carers, 7% of non-intervention carers and 29% of non-carer controls produced a four-fold increase in antibody titre. CONCLUSIONS: The immune response to influenza vaccination appears amenable to improvement through stress management, although the mechanisms underlying this effect remain unclear.