Objective: Judicious selection of potential liver transplant candidates and close monitoring of progress are essential to successful outcomes. Pretransplant psychosocial evaluations are the norm, but the relationship between psychosocial (and neurocognitive status) and longer term medical outcomes is understudied. This exploratory study sought to examine the relationship between objective measures of pretransplant psychosocial and neurocognitive status and service utilization, transplant status, and all-cause mortality. Methods: This retrospective chart review examined outcomes among 108 psychiatric, high-risk liver transplant candidates up to four years following initial evaluation. Predictor variables of outcomes included demographic, medical, neurocognitive, psychological, and mental health treatment variables. Results: Transplant status and neurocognitive functioning were independently associated with all-cause mortality. None of the other variables were associated with outcomes. Conclusions: Better neurocognitive functioning in high-risk liver transplant candidates may allow for greater involvement in medical care and/or compliance with treatment recommendations. More aggressive assessment and management of neurocognitive dysfunction may improve outcomes. Objective measures identified significant psychopathology typical of liver transplant candidates but were not associated with outcomes; engagement in specialized mental health care may have attenuated this relationship. Further study is needed to better understand the relationship between psychosocial functioning and outcomes.

Background: Fanconi anaemia (FA) is a rare genetic disorder associated with bone marrow failure (BMF), congenital anomalies and cancer susceptibility. Stem cell transplantation (SCT) offers a potential cure for BMF or leukaemia, but incurs substantial risks. Little is known about factors influencing SCT decision making. Objective: The study objective was to explore factors influencing patients' with FA and family members' decision making about SCT. Design: Using a mixed-methods exploratory design, we surveyed US and Canadian patients with FA and family members who were offered SCT. Main variables studied: Closed-ended survey items measured respondents' beliefs about the necessity, risks and concerns regarding SCT; multivariable logistic regression was used to examine the association between these factors and the decision to undergo SCT. Open-ended survey items measured respondents' perceptions of factors important to the SCT decision; qualitative analysis was used to identify emergent themes. Results: The decision to undergo SCT was significantly associated with greater perceived necessity (OR = 2.81, P = 0.004) and lower concern about harms of SCT (OR = 0.31, P = 0.03). Qualitative analysis revealed a perceived lack of choice among respondents regarding the use of SCT, which was related to physician influence and respondent concerns about patients' quality of life. Conclusions: Overall, study results emphasize the importance of the delicate interplay between provider recommendation of a medical procedure and patient/parental perceptions and decision making. Findings can help providers understand the need to acknowledge family members' perceptions of SCT decision making and offer a comprehensive discussion of the necessity, risks, benefits and potential outcomes.

Bakgrund: Allt fler lever idag med ett transplanterat hjärta. En hjärttransplantation kan vara en omställning både kroppsligt och känslomässigt. I väntan på ett nytt hjärta är det vanligt att patienten upplever stor rädsla och oro inför framtiden. De känslor patienten erfar innan hjärttransplantationen kan höra ihop med hur patienten erfar situationen efteråt, här kan sjuksköterskans roll vara betydelsefull. Syfte: Syftet med studien var att belysa patienters känslor och upplevelser efter hjärttransplantation.  Metod: En litteraturstudie innehållande kvalitativa och kvantitativa artiklar analyserades och sammanställdes. Resultatet: Resultatet bestod av tre Huvudkategorier: Komplexa känslor, Upplevelser av stöd och Det nya livet. Patienterna upplevde en tacksamhet gentemot donatorn. Flera av de hjärttransplanterade kände rädsla, oro och skuld. Vissa av patienterna upplevde en period av nedstämdhet efter hjärttransplantationen. Upplevelsen av stöd var betydelsefullt. Det nya livet bestod av olika känslor och upplevelser kring den nya situationen och en kamp med självidentiteten. Slutsats: Litteraturstudiens resultat visade på att det är en omfattande process för patienten att genomgå en hjärttransplantation, både fysiskt och psykiskt. Patienterna genomgår många komplexa känslor som kan liknas vid en berg- och dalbana där önskan och hopp blandas med sorg, nedstämdhet och rädsla. Det är grundläggande att sjuksköterskan har kunskap och förståelse för patientens livsvärld för att kunna stödja patienten i den situationen.

Low back pain (LBP) is the most prevalent work-related musculoskeletal disorder. Occupational risk factors have been studied for current ergonomic prevention strategies; however, other underlying mechanisms may exist since not all workers performing the same task develop the same severity. Previous research has identified personal and psychosocial risk factors that also contribute to LBP. Research quantifying the interactive effects of the various personal, psychosocial and occupational factors is limited, along with research on the effect of risk factor combinations on LBP severity. The objectives of this study were to: 1) study the various factors that are known to be involved in low back pain and analyze interactions, and 2) develop a model to predict low back pain and validate it. In order to address these objectives, 2 studies were conducted. The first study investigated the effects of various personal, genetic, occupational and psychosocial factors on two subjective LBP severity ratings: Oswestry Disability Index (ODI) and a Visual Analog Scale (VAS), and three physician-based ratings: MRI severity, canal stenosis and nerve impingement. Personal and psychosocial factors, in addition to occupational factors, were found to significantly affect the severity ratings. The second study involved building predictive models of LBP severity for each risk factor category as well as a combined risk factor model. Results showed that the combined risk factor models considering interaction effects both within and across risk factor categories were significantly better in predicting severity ratings than the individual models. However, validation conducted using 5 random samples showed inconsistent accuracies. Results obtained may help to develop a more reliable way to predict and, hence, prevent chronic LBP.

Indiana University-Purdue University Indianapolis (IUPUI) / Many persons with cirrhosis and eventually end stage liver disease (ESLD) are unable to meet the eligibility criteria for becoming a candidate for a liver transplant (LT). Currently, approximately 17,000 persons in the United States (U.S.) need a LT to survive, though only about 8,000 LT’s are performed each year; a LT is the only option for survival. The genesis of ESLD is most typically attributed to alcohol abuse, chronic hepatitis B or C, non-alcoholic fatty liver disease, autoimmune hepatitis, biliary atresia (new-born liver disease), or metabolic disorders. The etiology of adult LT recipients in 2017 for the U.S. were non-alcoholic fatty liver disease (31%) and alcoholic liver disease (25.1%). This study is guided by the Critical Social and Stress Coping Theories to assist in exploring potential health disparities prevalent in LT recipients. The aim of this study is to explore the psychological and demographic characteristics of 1297 LT recipients between 2010-2020 in an Indiana transplant center and identify potential disparities impacting 10-year survival rates. This exploratory, cross-sectional secondary analysis found that race/ethnicity, histories of mental illness, substance use/abuse, social support networks, education, marital status, and insurance sources held no statistical significance for 10-year survival rates. To date the screening process for each of those demographics appears to be effective and efficient. A Cox regression analysis revealed having a history of criminality significantly impacts 10-year survival rates. To address these findings the consideration for increased support and follow-up for patients with a history of criminality may positively impact 10-year survival rates.

This study explored the acceptability of Relationship-Centered Communication Partner Training (RC-CPT) for couples impacted by aphasia. Three couples participated in the program across two sessions. Surveys were administered to assess outcome measures of their marital relationship and communication confidence before and after participation in RC-CPT. The quantitative findings were analyzed using descriptive statistics. Overall, participants generally maintained or experienced improvements in accessibility, responsiveness, engagement, conflict, conflict resolution, and communication within their marriage after participating in RC-CPT. Additionally, individuals with aphasia demonstrated enhanced communication confidence scores. During the third session, couples completed a semi-structured interview to share their experiences with the program. The interviews were transcribed orthographically and coded using reflexive codebook analysis. Reflexive codebook analysis of the semi-structured interviews revealed four prominent themes: (I) "Impact on Communication," (II) "Impact on Relationship," (III) "Impact on Psychosocial Well-Being," and (IV) "Feedback for Future Development". The convergence of the quantitative and qualitative data revealed that couples indicated positive changes in their communication, relationship, and psychosocial well-being. These findings suggest that RC-CPT has the potential to effectively address both communicative and psychosocial impacts of aphasia on couples. Moreover, this study highlights the promise of RC-CPT as a relationship-centered counseling tool, warranting further exploratory and experimental research.

No description available.

No / It is now recognised that psychosocial factors – anxiety and depression, social isolation, low economic status and pain, for example – are associated with delayed healing of wounds. However, little research has been undertaken to examine how these factors may not only be a consequence of delayed healing, but may also play an important role in delaying healing. It is suggested that an evaluation of a patient’s psychosocial status should therefore be included as part of a general wound assessment.

Recent global statistics estimate 20% of all cancer incidence could be prevented if Americans would modify their eating habits to increase fruit and vegetable intake to the minimum recommended level of five servings daily. Educational strategies to change eating behavior would benefit from a greater understanding of psychosocial and demographic factors related dietary behavior. Secondary analysis of a nationally representative survey of 2655 adults was completed to assess differences between low-income and high-income adults in psychosocial, demographic, and educational factors related to fruit and vegetable intake. Significant differences in self-efficacy, awareness/knowledge, and cost and availability of fruits and vegetables were found between the low-income and high-income groups. In the low-income group, 37% of the variance in total fruit and vegetable consumption was explained by psychosocial and demographic factors, with demographics, self-efficacy and awareness/knowledge being the most significant predictors. In the high-income group, 34% of the variance in total fruit and vegetable consumption was explained by psychosocial and demographic factors, with self-efficacy alone accounting for 14% of the variance. This research suggests that, regardless of income category, social cognitive factors, in particular self-efficacy and knowledge/awareness of the health message, are stronger predictors of fruit and vegetable consumption than are perceived barrier factors. Given the weaknesses of the survey instrument, the findings need to interpreted with caution. Policy inferences can be suggested from this research, but would need further research findings before implementation of nutrition policy recommendations. The implications of these research findings are that nutrition education interventions to increase fruit and vegetable consumption should be aimed at affecting those psychosocial factors that are predictive of behavior change. In particular, differences by income level between psychosocial, education, and behavior responses underscore the need for tailoring educational interventions by income group for greater impact. The most relevant psychosocial predictors of fruit and vegetable consumption in adults are self-efficacy, awareness/knowledge of the health message, social support, and weak intent. The most relevant demographic predictors were smoking status, educational level, and age. Income level appears to share variance with other demographic variables and should be explored in further research. / Ph. D.

This thesis has developed a local theory of German immigration to New Zealand by exploring the experiences of migrants throughout the whole migration process, the particular meaning they assigned to their experiences, and how these experiences were influenced by cultural and historical context. This local theory identifies the psychological and social factors, and the interrelations between them, that contribute to resilience and adaptation or to vulnerability and poor adaptation, and that influence the decision whether to stay in New Zealand or to return to Germany.To gain these insights, this research drew on the theoretical perspectives of the salutogenic paradigm, social interactionism, and social constructionism in narrative theory; and adapted a grounded theory methodology. The study sampled social artifacts, with particular emphasis on actions/interactions, narratives, and answers to concrete questions. Eight German immigrant couples, four who live in New Zealand and decided to stay in New Zealand (stayers) and four who had immigrated to New Zealand, but decided to return to Germany and live now in Germany (returners), were interviewed in-depth via episodic interviews. The interview data was complemented with data from participant observation, the latest census, and the history of German settlement in New Zealand in order to capture the context of the immigration experiences. The data gathered was analysed by using grounded theory analysis strategies.The processes that underpin decisions to migrate, decisions to remain, and decisions to return are discussed. The most important psychosocial process influencing the experiences of German immigrants to New Zealand was 'Living the Dream'. The migration process presented many different and substantial challenges simultaneously. Thus, stress was an inevitable aspect of the migration process. Each sub-phase of the migration process influenced, and was influenced by, individual characteristics and values, beliefs/attitudes, strategies, and the social conditions in Germany, New Zealand, and Britain. These psychosocial factors, in turn, interacted with one another also. Taken together, these psychosocial factors either increased the likelihood of staying or of returning. Regardless of whether German immigrants stayed or returned, dealing with the challenges and the associated stress acted as a force for exhilarated evolvement, which was linked to the characteristics that prompted their initial migration decision. The experiences, interpretations, and outcomes of female and male German immigrants were remarkably similar. However,some gender differences were identified. The study provides detailed recommendations that aim at providing resource structures that assist German immigrants to unfold their potential, to learn as much as possible, and to evolve and adapt.