Protamine use in transcarotid arterial revascularization.

OBJECTIVE: The literature suggests that heparin reversal with protamine in transcarotid arterial revascularization (TCAR) decreases postoperative bleeding complications without an increase in stroke or death. However, the dosing of protamine in TCAR has not yet been evaluated. We aimed to evaluate our experience with intraoperative heparin reversal with protamine. METHODS: This was a single-center, retrospective, observational study that evaluated the heparin and protamine doses used during TCAR. All adult patients who underwent TCAR between 9/1/2019 and 4/2/2021 were included. Demographic data was obtained from the Vascular Quality Initiative and protamine/heparin doses were obtained from a chart review. Multivariate logistic regression models were used to assess the association between the protamine/heparin dose ratio and other variables. RESULTS: Sixty-two patients were included. The average protamine/heparin dose ratio used was 0.96 ± 0.12 mg/U; seven had a ratio less than 0.8 mg/U, and one was greater than 1.2 mg/U. Two patients experienced bleeding complications, which were managed non-operatively. No patient with a protamine/heparin ratio greater than 0.8 mg/U had postoperative bleeding. Postoperative bradycardia was observed in 32.3% of patients and hypotension in 35%, with 19% requiring vasopressors. No relationship was identified between the protamine/heparin ratio and bleeding, bradycardia, or hypotension. No 30-day myocardial infarction, stroke or death occurred. CONCLUSIONS: We identified a near 1:1 ratio of a protamine/heparin dosing regimen for the reversal of heparin during TCAR, with postoperative bleeding complications similar to those reported in the literature. However, patients who received a lower protamine/heparin ratio did not experience bleeding complications. In the era of protamine shortages, a future larger-scale study is needed to evaluate the impact of a lower protamine dose on postoperative complications.

The association of psychiatric and neurological comorbidities with outcomes in traumatic injury patients.

INTRODUCTION: Mental illness is a well-known risk factor for injury and injury recidivism. The impact of pre-existing psychiatric illness on trauma outcomes, however, has received less attention. Our study examines the relationship of pre-existing psychiatric illness on trauma outcomes including length of stay, cost, and mortality. METHODS: Patient data were obtained from the Healthcare Cost and Utilization Project's State Inpatient Database. All patients admitted for trauma in the Detroit metropolitan area from 1/1/2006 to 12/31/2014 were included. The relationship between individual psychiatric comorbidities (depression, psychosis, and other neurological disorders) and outcomes were evaluated with logistic regression (mortality) and generalized linear modeling (length of stay and cost). RESULTS: Over 260,000 records were reviewed. Approximately one-third (29.9%) of patients had one or more psychiatric diagnoses. Patients with depression had longer hospital stays (RR = 1.12, p < 0.001) and higher costs (RR = 1.07, p < 0.001), but also lower mortality (OR = 0.69, p < 0.001). Patients with psychosis had longer stays (RR = 1.18, p < 0.001), higher costs (RR = 1.02, p = 0.002), and lower mortality (OR = 0.61, p < 0.001). Patients with other neurological comorbidities had higher mortality (OR = 1.23, p < 0.001), longer stays (RR = 1.29, p < 0.001), and higher costs (RR = 1.10, p < 0.001). CONCLUSION: Patients with a psychiatric disorder required longer care and incurred greater costs, whereas mortality was higher for only those with a neurological disorder. Identifying patients' psychiatric comorbidities at the time of admission for trauma may help optimize treatment. Addressing these conditions may help reduce the cost of trauma care.

Malfunctioning temporary hemodialysis catheters in patients with novel coronavirus disease 2019.

OBJECTIVE: The hypercoagulability seen in patients with novel coronavirus disease 2019 (COVID-19) likely contributes to the high temporary hemodialysis catheter (THDC) malfunction rate. We aim to evaluate prophylactic measures and their association with THDC patency. METHODS: A retrospective chart review of our institutions COVID-19 positive patients who required placement of a THDC between February 1 to April 30, 2020, was performed. The association between heparin locking, increased dosing of venous thromboembolism (VTE) prophylaxis and systemic anticoagulation on THDC patency was assessed. Proportional hazards modeling was used to perform a survival analysis to estimate the likelihood and timing of THDC malfunction with the three different prophylactic measures. We also determined the mortality, rate of THDC malfunction and its association with d-dimer levels. RESULTS: A total of 48 patients with a mortality rate of 71% were identified. THDC malfunction occurred in 31.3% of patients. Thirty-seven patients (77.1%) received heparin locking, 22 (45.8%) received systemic anticoagulation, and 38 (79.1%) received VTE prophylaxis. Overall, the rate of THDC malfunction was lower at a trend level of significance, with heparin vs saline locking (24.3% vs 54.6%; P = .058). The likelihood of THDC malfunction in the heparin locked group is lower than all other groups (hazard ratio [HR], 0.07; 95% confidence interval [CI], 0.01-0.45]; P = .005). The rate of malfunction in patients with subcutaneous heparin (SQH) 7500 U three times daily is significantly lower than of the rate for patients receiving none (HR, 0.03; 95% CI, 0.001-0.74; P = .032). A trend level significant association was found for SQH 5000 U vs none (P = .417) and SQH 7500 vs 5000 U (P = .059). Systemic anticoagulation did not affect the THDC malfunction rate (P = .240). Higher d-dimer levels were related to greater mortality (HR, 3.28; 95% CI, 1.16-9.28; P = .025), but were not significantly associated with THDC malfunction (HR, 1.79; 95% CI, 0.42, 7.71; P = .434). CONCLUSIONS: Locking THDCs with heparin is associated with a lower malfunction rate. Prospective randomized studies will be needed to confirm these findings to recommend locking THDC with heparin in patients with COVID-19. Increased VTE prophylaxis suggested a possible association with improved THDC patency, although the comparison lacked sufficient statistical power.

Associations of Alcohol and Drug Misuse with Hospital Outcomes in Traumatic Injury Patients.

Background: Traumatic injury is one of the most common causes of mortality worldwide. Previous research suggests that alcohol and drug misuse can increase the risk of experiencing these injuries. Method: Data on all hospital admissions due to traumatic injury in the Detroit metropolitan area between 2006 and 2014 were obtained from the Michigan State Inpatient Database. Patients with no recorded substance misuse comorbidity were compared with those who had (a) alcohol misuse comorbidity only, (b) drug misuse comorbidity only, and (c) both alcohol and drug misuse comorbidities. Outcomes examined included in-hospital mortality, length of stay, and total cost of care. Results: Generalized linear modeling was used to examine the relationship between substance misuse comorbidities and each of the three outcomes. Lower mortality was related to drug and drug/alcohol misuse. Longer length of stay was related to alcohol, drug, and alcohol/drug misuse. Total costs were higher for patients with comorbid alcohol misuse, but lower for those with comorbid drug misuse. These patterns of results were not changed after controlling for differences in background demographics and injury characteristics. Discussion: Alcohol and drug misuse were highly prevalent in trauma patients, in comparison to estimate for the US population as a whole. The relationship between substance misuse comorbidity and outcomes among trauma patient is not straightforward. Substance misuse of all types was related to longer hospitalization, but its association with cost and mortality was mixed. Assessment of substance misuse background at intake may help optimize care for trauma patients.

Risk factors for recurrent neurotrauma: a population-based study in Southeastern Michigan.

INTRODUCTION: Studies have shown an increased risk of traumatic brain injury (TBI) for individuals who suffer an initial TBI. The current study hypothesized that individuals with recurrent neurotrauma would originate from populations considered 'vulnerable', i.e. low income and/or with psychiatric comorbidities. METHODS: Data from the Michigan State Inpatient Database from 2006 to 2014 for the Detroit metropolitan area enlisted a study population of 50 744 patients with neurotrauma. Binary logistic regression was used to assess risk factors associated with admission for subsequent neurotrauma compared with single neurotrauma admission. RESULTS: Patients with repeated neurotrauma admissions were similar to those with one-time trauma in terms of age at first admission and neighbourhood income levels. However, patients with repeated neurotrauma admissions were more likely to be male (p < .001) and African-American (p < .001). Comorbid alcohol use and drug use were 39% and 15% less likely to be readmitted with neurotrauma, respectively. Comorbid conditions associated with greater risk of repeat neurotrauma included depression, psychosis, and neurological disorders, increasing risk by 38%, 22%, and 58%, respectively. CONCLUSION: This study validated the hypothesis that comorbid psychiatric conditions are a significant risk factor for recurrent neurotrauma and validate prior studies showing gender and race as significant risk factors.

Family Interdependence, Spiritual Perspective, Self-Transcendence, and Depression Among Korean College Students.

The purpose of this study was to examine the mechanisms that might account for the effects of spirituality and self-transcendence on Korean college students' depression among 197 Korean fathers, mothers, and children. A structural equation analysis indicated that spiritual perspective related to lower depression through the mediating pathway of self-transcendence for individuals. Mothers' spiritual perspective and self-transcendence related to their children's depression through the mediating pathway of their own depression, but the same was not true for fathers. Findings help explicate the intergenerational transmission of depression and important predictors of depression related to spirituality.

The Prevalence and Antecedents of Religious Beliefs About Health Control in the US Population: Variations by Race and Religious Background.

The ways in which religious beliefs influence beliefs about health have important implications for motivation to engage in positive health behaviors and comply with medical treatment. This study examines the prevalence of two health-related religious beliefs: belief in healing miracles and deferral of responsibility for health outcomes to God. Data came from a representative nationwide US survey of religion and health (N = 3010). Full-factorial ANOVA indicated that there were significant differences in both dimensions of belief by race, by religious background, and by the interaction between the two. Black people believed religion played the largest role in health regardless of religious background. Among White and Hispanic groups, Evangelical Protestants placed more responsibility for their health on God in comparison with other religious groups. ANCOVA controlling for background factors socioeconomic status, health, and religious involvement partially explained these group differences.

Externalizing religious health beliefs and health and well-being outcomes.

Certain religious beliefs related to perceptions of internal or external health control (including belief in the existence of miraculous healing, and beliefs deferring responsibility for health outcomes from the self and onto God) may be related to health behaviors and in turn to health outcomes. Using data from a nationally representative US survey of religion and health (N = 2948) this study evaluates a series of two structural equation models of the relationships between religious activity, externalizing religious health beliefs (belief in healing miracles and divine health deferral), health outcomes, and life satisfaction. Believing in healing miracles was related to greater divine health deferral. Greater divine health deferral was associated with poorer symptoms of physical health. Belief in miracles was related to greater life satisfaction. Comparison of coefficients across models indicated that externalizing beliefs had a significant suppressor effect on the relationship between religious activity and physical symptoms, but did not significantly mediate its relationship with life satisfaction. Religious beliefs emphasizing divine control over health outcomes may have negative consequences for health outcomes, although the same beliefs may contribute to a better sense of life satisfaction.

Forms of Attrition in a Longitudinal Study of Religion and Health in Older Adults and Implications for Sample Bias.

The use of longitudinal designs in the field of religion and health makes it important to understand how attrition bias may affect findings in this area. This study examines attrition in a 4-wave, 8-year study of older adults. Attrition resulted in a sample biased toward more educated and more religiously involved individuals. Conditional linear growth curve models found that trajectories of change for some variables differed among attrition categories. Ineligibles had worsening depression, declining control, and declining attendance. Mortality was associated with worsening religious coping styles. Refusers experienced worsening depression. Nevertheless, there was no evidence of bias in the key religion and health results.

Health and Well-Being Among the Non-religious: Atheists, Agnostics, and No Preference Compared with Religious Group Members.

Although recent research suggests that the proportion of the US population identifying as non-religious has been rapidly expanding over the course of the last decade, relatively little research has examined the implications of this development for health and well-being. This study uses data from a large representative survey study of religion and health in the adult US population (N = 3010) to examine group differences among religious group members (N = 2401) and three categories of non-religious individuals: atheists (N = 83), agnostics (N = 189), and those stating no religious preference (N = 329). MANCOVA was used to analyze group differences on five outcome dimensions, incorporating 27 outcome variables. Religious non-affiliates did not differ overall from affiliates in terms of physical health outcomes (although atheists and agnostics did have better health on some individual measures including BMI, number of chronic conditions, and physical limitations), but had worse positive psychological functioning characteristics, social support relationships, and health behaviors. On dimensions related to psychological well-being, atheists and agnostics tended to have worse outcomes than either those with religious affiliation or those with no religious preference. If current trends in the religious composition of the population continue, these results have implications for its future healthcare needs.

Voluntary leadership roles in religious groups and rates of change in functional status during older adulthood.

Linear growth curve modeling was used to compare rates of change in functional status between three groups of older adults: Individuals holding voluntary lay leadership positions in a church, regular church attenders who were not leaders, and those not regularly attending church. Functional status was tracked longitudinally over a 4-year period in a national sample of 1,152 Black and White older adults whose religious backgrounds were either Christian or unaffiliated. Leaders had significantly slower trajectories of increase in both the number of physical impairments and the severity of those impairments. Although regular church attenders who were not leaders had lower mean levels of impairment on both measures, compared with those not regularly attending church, the two groups of non-leaders did not differ from one another in their rates of impairment increase. Leadership roles may contribute to longer maintenance of physical ability in late life, and opportunities for voluntary leadership may help account for some of the health benefits of religious participation.

Self-transcendence, spiritual perspective, and sense of purpose in family caregiving relationships: a mediated model of depression symptoms in Korean older adults.

OBJECTIVES: This study used structural equation modeling to test the mediated model of late-life depression to understand the mechanisms that account for the direct and indirect effects of spiritual variables and purpose in life on depression within the context of Korean family caregiving relationships. METHOD: A secondary analysis study design used data from a study that tested a theory of family interdependence of 157 Korean elder-family caregiver dyads in Seoul, Korea. RESULTS: Both caregivers' and elders' self-transcendence was positively related to their own sense of purpose in life. However, only elders' spiritual perspective was related to purpose in life. Also, elders' purpose in life was positively associated with caregivers' purpose in life. Furthermore, there was a strong negative relationship between elders' purpose in life and their depressive symptoms, but there was not a significant negative relationship between caregivers' purpose in life and elders' depressive symptoms. Last, elders' purpose in life mediated the negative effects of elders' self-transcendence and spiritual perspective and of caregivers' self-transcendence and purpose in life on elders' depression. CONCLUSION: The findings suggest that purpose in life for both the caregiver and elder played an important role in elders' depression. Self-transcendence also was related to decreased depression in elders. It is suggested that more attention be given to caregiver and elder purpose in life in developing interventions to reduce or avoid elder depression in Korean elders.

Assessing Stability and Change in a Second-Order Confirmatory Factor Model of Meaning in Life.

Research indicates that meaning in life is an important correlate of health and well-being. However, relatively little is known about the way a sense of meaning may change over time. The purpose of this study is to explore two ways of assessing change in meaning within a second-order confirmatory factor analysis framework. First, tests are conducted to see if the first and second-order factor loadings and measurement error terms are invariant over time. Second, a largely overlooked technique is used to assess change and stability in meaning at the second-order level. Findings from a nationwide survey reveal that the first and second-order factor loadings are invariant of time. Moreover, the second-order measurement error terms, but not the first-order measurement error terms, are invariant, as well. The results further reveal that standard ways of assessing stability mask significant change in meaning that is due largely to regression to the mean.

Church-based social support, functional disability, and change in personal control over time.

The purpose of this study is to see whether measures of church-based and secular social support offset the effects of functional disability on change in feelings of personal control over time. Survey data were obtained from Wave 2 and Wave 3 of a nationwide sample of older adults (N = 583). The findings suggest that spiritual support from fellow church members offsets the effects of functional disability on change in feelings of personal control over time. In contrast, neither emotional support from fellow church members nor emotional support from secular social network members exerted a similar effect.

Trust-based prayer expectancies and health among older Mexican Americans.

This study assesses the health-related effects of trust-based prayer expectancies, which reflect the belief that God answers prayers at the right time and in the best way. The following relationships are evaluated in our conceptual model: (1) older Mexican Americans who attend worship services more often tend to develop a closer relationship with God; (2) people who feel close to God will be more likely to develop trust-based prayer expectancies; (3) people who endorse trust-based prayer expectancies will have greater feelings of self-esteem; and (4) higher self-esteem is associated with better self-rated health. The data support each of these relationships.

Association of five-factor model personality domains and facets with presence, onset, and treatment outcomes of major depression in older adults.

OBJECTIVES: To assess the relationship of multiple domains and facets of the five-factor model of personality with presence, onset, and severity of late-life depression. DESIGN: Cross-sectional analysis of depression status, and age of onset. Retrospective analysis of baseline severity. Longitudinal analysis of severity after 3 and 12 months of psychiatric treatment. SETTING: Private university-affiliated medical center in the Southeastern United States. PARTICIPANTS: One hundred twelve psychiatric patients with a current episode of unipolar major depression, and 104 nondepressed comparison subjects, age 60 and older (mean: 70, SD: 6). MEASUREMENTS: Revised NEO Personality Inventory, Diagnostic Interview Schedule, and Montgomery-Åsberg Depression Rating Scale. RESULTS: Binary logistic regression found that depression was related to higher neuroticism (and all its facets) and to lower extraversion (and facets of assertiveness, activity, and positive emotionality) and conscientiousness (and facets of competence, order, dutifulness, and self-discipline). Multinomial logistic regression found some of these relationships held only for depression with onset before age 50 (hostility, self-consciousness, extraversion, assertiveness, positive emotions, order, and dutifulness). Linear regression found that personality was unrelated to depression severity at the beginning of treatment, but improvement after 3 months was related to lower neuroticism (and facets depressiveness and stress-vulnerability) and higher warmth and competence. Improvement after 12 months was related to lower neuroticism, depressiveness, and stress-vulnerability. CONCLUSIONS: Specific personality facets are related with depression and treatment outcomes. Screening for certain personality traits at the start of treatment may help identify patients at risk of worse response to treatment after 3 months.

Trajectories of disability in older adulthood and social support from a religious congregation: a growth curve analysis.

This study examined the role of congregational support as a mechanism by which religious involvement may slow the decline of functional ability during late life. Disability was tracked longitudinally over a 4-year period in a national sample of 805 Black and White older adults from the religion, aging, and health survey. Individuals with more extensive disability reported receiving greater amounts of tangible support from their congregations. However, receiving higher levels of tangible support was also associated with a slower trajectory of increase in disability over time. The relationship between congregational support and disability did not differ significantly between Blacks and Whites. Results support the hypothesis that social support networks based in the religious group are responsible for some of the association between religious involvement and reduced risk of late life disability.

Psychological, physical, social, and spiritual well-being similarities between Korean older adults and family caregivers.

There is a growing recognition that the similarities between older adults and family caregivers has both practical and research implications; caregivers' well-being influences older adults' well-being and vice versa. There has been a paucity of studies that explore the similarities between Korean older adults and their caregivers. This study aims to examine psychological, physical, social, and spiritual well-being similarities among 157 older adult-caregiver dyads in Seoul, Korea. There was a significant degree of similarities between older adults and their caregivers with respect to psychological, social, and spiritual well-being, but not to physical well-being. Present findings suggest that nurses and other health care professionals should be involved and collaborate with family caregivers to take care of older adults; to understand the dynamic, caring relationships between older adults and their family caregivers; and to improve the well-being of older adults as well as their family caregivers.

Prayer beliefs and change in life satisfaction over time.

A considerable number of studies have focused on the relationship between prayer, health, and well-being. But the influence of some types of prayer (e.g., petitionary prayer) has received more attention than others. The purpose of this study is to examine an overlooked aspect of prayer: trust-based prayer beliefs. People with this orientation believe that God knows that best way to answer a prayer and He selects the best time to provide an answer. Three main findings emerge from data that were provided by a nationwide longitudinal survey of older people reveals. First, the results reveal that Conservative Protestants are more likely to endorse trust-based prayer beliefs. Second, the findings suggest that these prayer beliefs tend to be reinforced through prayer groups and informal support from fellow church members. Third, the data indicate that stronger trust-based prayer beliefs are associated with a greater sense of life satisfaction over time.

Religious service attendance and major depression: a case of reverse causality?

Although previous studies have found a protective association between attendance at religious services and depression, the extent to which this association is driven by depressed persons' dropping out of religious activities is not clear. The authors examined whether early onset of a major depressive episode (MDE) predicted a subsequent decrease in religious service attendance. Data came from 3 follow-up studies of the National Collaborative Perinatal Project birth cohort (mean age = 37 years at last follow-up; n = 2,097; 1959-2001). The generalized estimating equations method was used to calculate the impact of an early MDE diagnosis (before age 18 years) on the likelihood of change in level of religious service attendance from childhood to adulthood. Twenty-seven percent of study participants met the criteria for lifetime MDE (n = 567), of whom 31% had their first onset prior to age 18 years. Women with early MDE onset were 1.42 times more likely (95% confidence interval: 1.19, 1.70) than women with adult-onset MDE or no lifetime MDE to stop attending religious services by the time of the first adult follow-up wave. No significant associations were observed among men. These findings suggest that women are more likely to stop attending religious services after onset of depression. Selection out of religious activities could be a significant contributor to previously observed inverse correlations between religious service attendance and psychopathology during adulthood.