A psychoeducational intervention (SWEEP) for depressed women with diabetes.

BACKGROUND: Clinically significant depression is present in 25 % of individuals with type 2 diabetes, its risk being doubled in women. PURPOSE: To examine the effectiveness of the Study of Women's Emotions and Evaluation of a Psychoeducational (SWEEP), a group therapy for depression treatment based on cognitive behavioral therapy principles that was developed for women with type 2 diabetes was conducted. METHODS: Women with significantly elevated depression symptoms (Center for Epidemiologic Studies Depression Scale ≥16) were randomized to SWEEP (n = 38) or usual care (UC, n = 36). RESULTS: Multilevel modeling indicated that SWEEP was more effective than UC in reducing depression (mean difference of -15 vs. -7, p < .01), decreasing trait anxiety (mean difference of -15 vs. -5, p < .01), and improving anger expression (mean difference of -12 vs. -5, p < .05). Although SWEEP and UC had improvements in fasting glucose (mean difference of -24 vs. -1 mg/dl) and HbA1c (mean difference of -0.4 vs. -0.1 %), there were no statistically significant differences between groups. CONCLUSIONS: SWEEP was more effective than UC for treating depressed women with type 2 diabetes. Addition of group therapy for depression meaningfully expands the armamentarium of evidence-based treatment options for women with diabetes.

Recent advances in understanding depression in adults with diabetes.

The authors review the science linking depression with diabetes. Some recent heuristic research is identified that highlights progress in the field and is directing future research. Issues in the management of depression in diabetes are outlined, including interactions of depression and insulin resistance.

Health-related quality of life of patients following selected types of lumbar spinal surgery: a pilot study.

BACKGROUND: Over 500,000 spinal surgeries are performed annually in the United States. Although pain relief and improved health-related quality of life (HRQOL) are expectations following lumbar spinal surgery, there is limited research regarding this experience from the individual's perspective. In addition, no studies have examined the HRQOL of persons who have had this surgery using a comprehensive approach. The intent of this study was to address this deficiency by an assessment of both the individual and environmental factors that impact perceived HRQOL using the Wilson and Cleary Model for Health-Related Quality of Life in persons who have undergone lumbar spinal surgery. METHODS: This was a pilot study of 57 adult patients undergoing elective lumbar spinal surgery for either herniated disk and/or degenerative changes. Individuals completed questionnaires measuring perceived pain, mood, functional status, general health perceptions, social support and HRQOL preoperatively and three months following surgery. Descriptive statistics, dependent t-tests, and MANOVAs were used to describe and compare the differences of the study variables over time. RESULTS: Preliminary results indicate overall perceived physical HRQOL was significantly improved postoperatively (t [56] = 6.45, p < .01), however, it was lower than the published norms for patients with low back pain. Both functional disability (t [56] = 10.47, p < .001) and pain (t [56] = 10.99, p < .001) were significantly improved after surgery. Although levels of fatigue and vigor were also significantly improved after surgery, both were less than the published norms. There was no change in the level of social support over time; however, level of support was consistent with that reported by patients with chronic illness. CONCLUSION: Although perceived physical HRQOL was significantly improved three months postoperatively, fatigue and lack of vigor were issues for subjects postoperatively. Excessive fatigue and low vigor may have implications for successful rehabilitation and return to work for patients following lumbar spinal surgery. Further research is needed with a larger sample size and subgroup analyses to confirm these results.

Patient expectations of quality of life following lumbar spinal surgery.

Spinal surgery is one of the most frequently performed surgeries in the United States. In 2003, almost 450,000 cases were performed for problems related to lumbar herniated disks, stenosis, and degenerative changes. It has been reported that patient expectations play a role in perceived quality of life (QOL). Because surgery is frequently a last resort for patients with spinal disease, patients often have high expectations of their outcomes of surgery. Patient expectations of surgical outcome may play an important role in recovery and perceived QOL. The research on patient expectations of surgery in the spinal surgery literature is limited. This study examined the relationships between perceived QOL, expectations, and level of optimism. A sample of 57 patients completed questionnaires designed to measure perceived QOL, expectations, and optimism before lumbar spinal surgery and 3 months after surgery. The major findings of the study are as follows: (a) patients with higher degrees of optimism reported better perceived QOL; (b) increased fulfillment of expectations was associated with better postoperative QOL; and (c) both expectations and level of optimism were significant predictors of postoperative QOL. These findings will help nurses better understand how patients' expectations can affect their perceived QOL while recovering from lumbar spinal surgery.

Fatigue in women with type 2 diabetes.

PURPOSE: The purpose of this study was to explore the relationship between fatigue and physiological, psychological, and lifestyle phenomena in women with type 2 diabetes (T2DM) in order to establish the magnitude and correlates of fatigue in women with T2DM and explore the interrelationships between fatigue and specific diabetes-related factors that may be associated with increased levels of fatigue. These factors included physiological factors (glucose control, diabetes symptoms), psychological factors (diabetes emotional distress, depressive symptoms in general), and lifestyle factors (body mass index, physical activity). METHODS: A cross-sectional, descriptive design was used. Women who reported conditions known to cause fatigue were excluded. Physiological measures included fasting blood glucose (FBG), hemoglobin A1C (A1C), glucose variability, and body mass index (BMI). Women completed questionnaires about health, fatigue levels, diabetes symptoms, diabetes emotional distress, depressive symptoms, physical activity, and current diabetes self-care practices. A subset of the women wore a Medtronic Gold CGM sensor for 3 days for assessment of glucose variability. RESULTS: Eighty-three women aged 40 to 65 years with T2DM completed the study. Fatigue was significantly related to diabetes symptoms, diabetes emotional distress, depressive symptoms, higher BMI, and reduced physical activity. There was no relationship between fatigue and FBG or A1C. The strongest explanatory factors for fatigue were diabetes symptoms, depressive symptoms, and BMI, which accounted for 48% of the variance in fatigue scores. Glucose variability was not significantly associated with fatigue in these women. CONCLUSIONS: Fatigue is a persistent clinical complaint among women with T2DM and may signal the presence of physiological, psychological, and lifestyle-related phenomena that could undermine diabetes health outcomes.

Recent advances in understanding depression in adults with diabetes.

The authors review the science linking depression with diabetes. Some recent heuristic research is identified that highlights progress in the field and is directing future research. Issues in the management of depression in diabetes are outlined, including interactions of depression and insulin resistance.

Symptoms of unstable angina in patients with and without diabetes.

Patients with diabetes experience cardiac autonomic neuropathy that may affect the way they perceive the symptoms of unstable angina (UA). The purpose of this study was to examine symptom differences in patients with and without diabetes during an episode of UA. A convenience sample of 50 women and 50 men were recruited. Patients with diabetes were more likely to have a history of hypercholesterolemia (83% vs. 60%), prior history of heart disease (85% vs. 65%), and prior angiogram (85% vs. 67%). Patients with diabetes reported having less nausea (20% vs. 40%), less squeezing (25% vs. 48%) and less aching (25% vs. 45%) type pain, and more hyperventilation (27.5% vs. 11.7%). Other cardiac symptoms were similar between the groups. Further study of symptom presentation in patients with diabetes is warranted given their high levels of morbidity and mortality from cardiac disease.

Estrogen plus progestin therapy: the cardiovascular risks exceed the benefits.

The surprising results of the Women's Health Initiative (WHI) reported in 2002 had a profound effect on women as well as health care practitioners. The WHI was the largest, randomized clinical trial designed to determine if postmenopausal hormone use prevented cardiovascular disease as well as other age-related disorders in women. While observational studies suggested that postmenopausal use of estrogen could decrease cardiovascular risk by 40% to 50%, the WHI demonstrated that use of continuous-combined estrogen plus progestin was not cardioprotective and was even associated with increased health risks. The estrogen alone trial of the WHI is still in progress, leaving practitioners and some women still in a dilemma. This article addresses the WHI in the context of other studies and discusses possible reasons for the unexpected results.