Psychological changes in successful completers of an HIV-tailored smoking cessation program: mood, attachment and self-efficacy.

High rates of cigarette smoking is the leading contributor to the increasing risk of cardiovascular disease (CVD) among people living with HIV (PLH). Relapse rates among PLH who quit smoking are high among those receiving standard care, which may be due to several unique social and psychological challenges PLH face when they attempt to quit smoking. The purpose of the current study was to examine change in relevant psychological factors in a subgroup of participants (n = 14) who remained smoke-free at 6-months follow-up in an HIV-tailored smoking cessation counselling program (N = 50). We examined self-reported depressive symptoms, attachment style and self-efficacy across 5 time points (baseline, quite date, 4, 12 and 24 weeks). At study baseline, mean depression scores fell above the clinical cut off of 16 (M = 16.31; SD = 13.53) on the Centre for Epidemiological Studies - Depression (CES-D) scale and fell below the clinical cut off at 24 weeks post quit date (M = 13.36; SD = 10.62). Results of multi-level modeling indicated a significant linear reduction in depressive symptoms and a significant linear improvement in self-efficacy to refrain from smoking across study visits. These results suggest that positive change in mood and self-efficacy may be helpful for PLH who remain smoke-free during a quit attempt.

Correction to: Assessment of stigma in patients with cystic fibrosis.

An amendment to this paper has been published and can be accessed via the original article.

A Randomized Trial of a Multicomponent Intervention to Promote Medication Adherence: The Teen Adherence in Kidney Transplant Effectiveness of Intervention Trial (TAKE-IT).

BACKGROUND: Poor adherence to immunosuppressive medications is a major cause of premature graft loss among children and young adults. Multicomponent interventions have shown promise but have not been fully evaluated. STUDY DESIGN: Unblinded parallel-arm randomized trial to assess the efficacy of a clinic-based adherence-promoting intervention. SETTING & PARTICIPANTS: Prevalent kidney transplant recipients 11 to 24 years of age and 3 or more months posttransplantation at 8 kidney transplantation centers in Canada and the United States (February 2012 to May 2016) were included. INTERVENTION: Adherence was electronically monitored in all participants during a 3-month run-in, followed by a 12-month intervention. Participants assigned to the TAKE-IT intervention could choose to receive text message, e-mail, and/or visual cue dose reminders and met with a coach at 3-month intervals when adherence data from the prior 3 months were reviewed with the participant. "Action-Focused Problem Solving" was used to address adherence barriers selected as important by the participant. Participants assigned to the control group met with coaches at 3-month intervals but received no feedback about adherence data. OUTCOMES: The primary outcomes were electronically measured "taking" adherence (the proportion of prescribed doses of immunosuppressive medications taken) and "timing" adherence (the proportion of doses of immunosuppressive medications taken between 1 hour before and 2 hours after the prescribed time of administration) on each day of observation. Secondary outcomes included the standard deviation of tacrolimus trough concentrations, self-reported adherence, acute rejection, and graft failure. RESULTS: 81 patients were assigned to intervention (median age, 15.5 years; 57% male) and 88 to the control group (median age, 15.8 years; 61% male). Electronic adherence data were available for 64 intervention and 74 control participants. Participants in the intervention group had significantly greater odds of taking prescribed medications (OR, 1.66; 95% CI, 1.15-2.39) and taking medications at or near the prescribed time (OR, 1.74; 95% CI, 1.21-2.50) than controls. LIMITATIONS: Lack of electronic adherence data for some participants may have introduced bias. There was low statistical power for clinical outcomes. CONCLUSIONS: The multicomponent TAKE-IT intervention resulted in significantly better medication adherence than the control condition. Better medication adherence may result in improved graft outcomes, but this will need to be demonstrated in larger studies. TRIAL REGISTRATION: Registered at ClinicalTrials.gov with study number NCT01356277.

An HIV-tailored quit-smoking counselling pilot intervention targeting depressive symptoms plus Nicotine Replacement Therapy.

Cardiovascular disease (CVD) rates among people living with HIV/AIDS (PHAs) are high. Rates of cigarette smoking, a leading contributor to CVD among PHAs, are 40-70% (2-3 times higher than the general population). Furthermore, PHAs have high rates of depression (40-60%), a risk factor for smoking cessation relapse. The current pilot study examined the effectiveness of a specifically tailored 5-session smoking cessation counselling programme for PHAs, which addressed depression, in combination with Nicotine Replacement Therapy (NRT) in a cohort of PHA smokers (n = 50). At 6-month follow-up, 28% of participants demonstrated biochemically verified abstinence from smoking. This result compares favourably to other quit-smoking intervention studies, particularly given the high percentage of HIV+ smokers with depression. At study baseline, 52% of HIV+ smokers scored above the clinical cut-off for depression on the Centre for Epidemiological Studies - Depression (CES-D) scale. HIV+ smokers with depression at study baseline demonstrated quantitatively lower depression at 6-month follow-up with a large effect size (d = 1), though it did not reach statistical significance (p = .058). Furthermore, those with depression were no more likely to relapse than those without depression (p = .33), suggesting that our counselling programme adequately addressed this significant barrier to smoking cessation among PHAs. Our pilot study indicates the importance of tailored programmes to help PHAs quit smoking, the significance of addressing depressive symptoms, and the need for tailored counselling programmes to enhance quit rates among PHAs.

Development and psychometric validation of a cystic fibrosis knowledge scale.

BACKGROUND AND OBJECTIVE: Well-developed and validated measures of cystic fibrosis (CF) knowledge are scarce. The purpose of the present study is to develop and validate a CF knowledge scale that is brief, easy to use, self-administered and demonstrates clinical utility. METHODS: A comprehensive literature search generated a pool of scale items; an expert panel of CF team members reviewed and provided recommendations for item inclusion. A focus group of CF patients and family members (n = 12) then reviewed the items for face validity and reading clarity. To evaluate the validity and reliability of the newly developed CF knowledge scale, it was administered to several different samples including CF patients (n = 45), respirology patients (n = 100), health-care providers (n = 74) and university student samples (psychology students, n = 71; medical students, n = 36). RESULTS: Internal consistency of the scale was high, with an alpha coefficient for the overall sample of .95 (n = 326). The scale also demonstrated excellent construct validity. CONCLUSIONS: This study is an important first step in a line of research that aims to develop and empirically validate a psycho-educational adherence intervention for improving quality of life and treatment outcomes among adult CF patients. The CF knowledge scale has potential applications as a clinical teaching tool with patients and health-care providers and could be used as an outcome measure in CF educational intervention studies aimed at optimizing CF treatment knowledge, adherence and quality of life among CF patients.

Assessment of stigma in patients with cystic fibrosis.

BACKGROUND: Research that explores stigma in Cystic Fibrosis (CF) is limited. Productive cough, repeated lung infections, and periods of serious illness requiring hospitalizations are among common symptoms of CF. These symptoms may cause a negative perception by others. We developed a CF-specific Stigma Scale and tested its psychometric properties. METHODS: We conducted a focus group with 11 participants including adult patients with CF (n = 5) and their informal caregivers (n = 6). The thematic content of the focus group was analyzed to find key themes. We developed a CF-specific Stigma Scale and assessed its psychometric properties in a 3-month prospective cohort study of adult CF outpatients (n = 45). RESULTS: Stigma emerged as consistent concern for people living and caring for those with CF, affecting both patients' lives and health through the focus group. Using the newly developed CF Stigma scale, the mean baseline score was 16.6 (SD = 4.5, Range = 10-25). The CF Stigma Scale demonstrated robust psychometric properties: 1) Internal consistency: α = 0.79; 2) Mean inter-item correlation: 0.30 with good test-retest reliability; 3) Convergent validity: Positive associations with depression, severity of CF symptoms and anxiety; negative associations with validated quality of life scores were observed. CONCLUSIONS: Stigma is measurable and significantly impacts the lives of CF patients. Further research should investigate the role of stigma in patients living with CF.

Applied tension and coping with blood donation: a randomized trial.

BACKGROUND: Despite the ongoing need for blood donation, few people give blood. A common reason is concern about vasovagal symptoms. PURPOSE: The aim of this study was to evaluate the effectiveness of applied tension in reducing vasovagal symptoms during blood donation and the mechanisms of action. METHOD: Two hundred eighty-two young adult blood donors were randomly assigned to conditions involving applied tension during the pre-donation wait period, during the blood draw, both, or no applied tension at all. RESULTS: Applied tension was effective in reducing vasovagal symptoms in blood donors, particularly when practiced during the pre-donation wait period (p < 0.001). People who practiced applied tension during the pre-donation wait period required less treatment for vasovagal reactions than people who did not (8% vs. 16%). CONCLUSIONS: The results of this study suggest that the effects of applied tension on vasovagal symptoms are not mediated entirely by exercise-related changes in blood pressure and heart rate. Rather, it may reduce anxiety or physiological consequences of anxiety. Applied tension is a useful treatment which can help people cope during blood donation and other invasive medical interventions.

Relation between perceived blood loss and vasovagal symptoms in blood donors.

UNLABELLED: INTRODUCTION/RESULTS: This study examined whether a belief of significant blood loss may be associated with vasovagal symptoms, irrespective of actual blood loss. Individual differences in vasovagal symptoms among blood donors who had an equivalent amount of blood withdrawn were significantly associated with their rating of perceived blood loss. CONCLUSION: The anticipation or belief of blood loss, and perhaps more remotely associated ideas, may trigger processes similar to those induced by actual hemorrhage though further research is required to address other possibilities such as the inflation of ratings by vasovagal symptoms.

Fear-related predictors of vasovagal symptoms during blood donation: it's in the blood.

A recent theory proposes that emotional fainting developed from an earlier adaptive characteristic, fainting in response to hemorrhage. Despite potential loss of consciousness, a dramatic decrease in blood pressure improves chances of survival in animals with severe wounds by reducing blood loss and facilitating clotting. Humans may have developed the characteristic of emotional fainting as a response to anticipated blood loss. This idea suggests that people with stronger fears of blood should be especially susceptible to fainting and milder vasovagal symptoms such as dizziness and lightheadedness. Two samples of young adult blood donors (N = 276 and 663) who completed the Medical Fears Survey (MFS) were studied. Items from the MFS related to fears of blood, needles, and mutilation were used to predict self-reported dizziness and nurse-initiated treatment for vasovagal reactions. In both samples, fears of experiencing or seeing blood loss were more closely associated with both subjective and objective measures of vasovagal reactions, despite the fact that other fears (e.g., fears related to needles) were more common overall. Better understanding of the mechanisms of vasovagal reactions has both theoretical and clinical implications, such as improving means of coping with invasive medical procedures.

Physiological correlates of applied tension may contribute to reduced fainting during medical procedures.

BACKGROUND: Applied tension (AT) is a behavioral technique used to reduce symptoms such as dizziness and fainting in people with blood and injury phobias as well as medical patients undergoing invasive procedures. AT has been found to reduce dizziness and fainting in several studies of blood donors. PURPOSE: The purpose of this study was to examine the psychophysiological effects of AT in the context of blood donation. METHODS: Ninety-eight young adult blood donors wore ambulatory physiological monitors and were randomly assigned to one of two groups that practiced AT or one that did not. Measures of blood pressure, heart rate, stroke volume, and other physiological parameters were obtained while participants gave blood. RESULTS: Donors who did not practice AT were more likely to report symptoms in the donation chair and generally displayed a pattern of physiological activity consistent with risk for a vasovagal reaction. For example, heart rate and total peripheral resistance decreased. The drop in heart rate was probably due at least in part to an increase in vagal parasympathetic nervous system activity, as suggested by an increase in high-frequency heart rate variability. In contrast, donors who practiced AT displayed stable heart rate and high-frequency heart rate variability. CONCLUSIONS: The results suggest that the physiological effects of AT, particularly the inhibition of vagal activity, interfere with those promoting a vasovagal reaction. There may be a number of useful applications for AT in medical settings.

A retrospective study of head and neck re-irradiation for patients with recurrent or second primary head and neck cancer: the McGill University experience.

BACKGROUND: We report our experience with patients who received re-irradiation to the head and neck area for locoregional recurrences (LRR) or second primaries (SP) in a previously irradiated field. METHODS: We reviewed 27 consecutive patients with a diagnosis of LRR or SP head and neck carcinoma treated with a second course of radiotherapy between April 2004 and July 2012. The main outcome measures were local control, overall survival, and complications. The results are expressed as actuarial values using the Kaplan-Meier estimates. RESULTS: The median follow-up time was 24.7 months (range: 11 days-79.3 months). There were 23 males and four females with a median age of 61 years (range: 40-87 years). The actuarial overall survival rates at 1, 2, and 5 years were 77, 59, and 57%, respectively. The actuarial local control rate was 80, 52, and 52% at 1, 2, and 5 years, respectively. Three patients developed systemic metastases. The rate of grade 3 toxicity was 26%, and that of grade 4 toxicity was 3%. There were two treatment-related deaths (grade 5 toxicity). CONCLUSIONS: Continuous course re-irradiation in patients with LRR or SP head and neck cancer is feasible with acceptable toxicity. With current encouraging rates of local control and overall survival, this option should be discussed with patients who have few alternative therapeutic options.

Cognitive-behavioural treatment of recurrent abdominal pain in children: A primer for paediatricians.

Recurrent abdominal pain (RAP) is a common childhood complaint for which pharmacological and dietary interventions have yielded mixed results. There is good evidence in support of psychological interventions, primarily cognitive-behavioural therapy (CBT), in treating RAP in children. The purpose of CBT is to facilitate effective coping in children and their parents and to alter environmental factors that may serve to reinforce pain behaviour in children. Unfortunately, many paediatricians are unaware of the value and role of cognitive-behavioural approaches in assisting children with RAP. This current review summarizes the data in support of CBT for RAP, describes common elements of a CBT program for RAP, and provides practical recommendations for paediatricians in their management of these patients.

Social contagion of vasovagal reactions in the blood collection clinic: a possible example of mass psychogenic illness.

OBJECTIVE: Observing or hearing about illness in another person can lead to reports of similar symptoms. Reports can occasionally be widespread. However, it has been difficult to document whether this is the result of genuine illness or the expression of anxiety with physical terminology. This study examined the effects of being able to see another blood donor experience vasovagal symptoms. METHODS: Data were collected in mobile university blood collection clinics. Bedside research assistants coded whether the donor was able or not able to see another donor being treated for vasovagal symptoms. Dependent variables included subjective vasovagal symptoms indicated on the Blood Donation Reactions Inventory (BDRI) and the need for treatment oneself. Given the population of inexperienced donors, many (26% of the 1,209 participants) were able to see another donor treated for symptoms. RESULTS: Being able to see another donor treated was associated with higher scores on the BDRI and an increased likelihood of treatment for vasovagal symptoms oneself. However, this was limited to non-first-time blood donors, perhaps because of higher levels in first-time donors (ceiling effects) or greater attention to the environment in less "overwhelmed" repeat donors. In general, donors who were able to see another react rated themselves as less relaxed and had smaller increases in heart rate. During the 2-year follow-up, first-time donors who were able to see another react were slower to return to give blood again. CONCLUSIONS: Seeing another donor being treated for symptoms contributed to the vasovagal process in many donors. This environment provides a useful context to study social influences on symptoms and illness.

The association between sleep disturbance, depressive symptoms, and health-related quality of life among cardiac rehabilitation participants.

PURPOSE: Recent guidelines from the Canadian Association of Cardiac Rehabilitation highlight the importance of addressing sleep disturbance among participants of cardiac rehabilitation (CR) programs. The primary objective of this study was to examine the relationship between depressive symptoms, health-related quality of life, and sleep disturbance in CR participants. The secondary objective was to estimate the prevalence of sleep disturbance among CR participants with and without depressive symptoms and explore demographic, medical, and psychological predictors of poor sleep quality. METHODS: Cardiac rehabilitation participants (N = 259) were included in this study. Participants completed a standardized questionnaire package including demographic, health-related, and psychosocial measures. Physiologic and anthropometric measurements were taken at baseline. Descriptive statistics were calculated for all variables, and data were analyzed using multivariate logistic regression. RESULTS: Poor sleep quality was reported by 52% of participants in the sample, and 47% of participants in the sample reported experiencing at least mild depressive symptoms. Poor sleep occurred more often in individuals with depressive symptoms, and after adjustment for medical factors and health-related quality of life, participants with symptoms of depression were still more likely to experience sleep disturbance than those without depressive symptoms (OR = 2.80; 95% CI, 1.37-5.77). An important gender difference emerged in the relationship between symptoms of depression and sleep disturbance. CONCLUSION: Among participants of a CR program, disturbed sleep was strongly associated with depressive symptoms and decreased health-related quality of life. Results demonstrate the importance of sleep evaluation in CR programs.

Applied tension and blood donation symptoms: the importance of anxiety reduction.

OBJECTIVE: Despite being a voluntary activity, many blood donors experience anxiety, and fainting (syncope) is not unusual. The muscle-tensing technique applied tension (AT) has been found to be effective in reducing vasovagal symptoms and syncope. A series of studies was developed to investigate the role of AT on anxiety and fainting. METHODS: The mechanisms of AT were examined in the laboratory and the blood donor clinic. In Study 1, 70 participants were assigned randomly to either a control group or an experimental group who learned AT before watching a video depicting blood draws. In Study 2, 667 volunteer blood donors completed similar questionnaires. RESULTS: In Study 1, a significant Condition × Sex × Needle Fear interaction, F(1, 59) = 4.97, p = .03, indicated that AT reduced vasovagal symptoms in higher-fear women. Study 2 also found a significant Condition × Sex × Needle Fear effect on vasovagal symptoms, F(2, 653) = 3.95, p = .02, indicating that AT reduced symptoms but primarily among women with more pronounced fear of needles. CONCLUSIONS: Analysis of the physiological data and self-reported anxiety supports the conclusion that the reduction in vasovagal symptoms was due more to decreased anxiety rather than exercise-related cardiovascular change. These results suggest that AT may provide a useful means of coping with invasive medical procedures in part by reducing anxiety.

Attitudes and practices of cardiologists and surgeons who manage HLHS.

OBJECTIVE: We conducted a survey to determine which management options pediatric cardiologists and cardiac surgeons in North America discuss and recommend when counseling parents after the diagnosis of hypoplastic left heart syndrome (HLHS). METHODS: Pediatric cardiologists and cardiac surgeons across North America were asked to complete an anonymous, Internet-based survey about their attitudes and practices regarding the management of HLHS. RESULTS: We contacted 1621 pediatric cardiologists and surgeons, of whom 749 (46%) completed the survey. When counseling parents of newborns with HLHS, 99.7% of respondents discussed staged palliative surgery, 67% discussed cardiac transplantation, and 62.2% discussed compassionate care without surgery. Only a minority (14.9%) discussed all of those options. Staged palliative surgery was recommended over cardiac transplantation or compassionate care without surgery by 76.2% of respondents. When counseling parents after prenatal diagnosis of HLHS, 98.8% of respondents discussed continuation of pregnancy with staged palliative surgery after birth, 53.5% discussed continuation of pregnancy with cardiac transplantation after birth, 56.9% discussed continuation of pregnancy with compassionate care after birth, and 74.3% discussed termination of pregnancy. Only 36.5% discussed all of those options. Continuation of pregnancy with staged palliative surgery after birth was recommended over the other options by 56% of respondents. CONCLUSIONS: Virtually all North American pediatric cardiologists and cardiac surgeons surveyed discuss a surgical intervention when counseling parents about the care of their child or fetus with HLHS. However, only a minority discuss all options. Most physicians recommend staged palliative surgery for management of HLHS.