Aims Sense of coherence (SOC) allows individuals to be more resilient to adverse life events, and it is associated with quality of life (QoL), but its long-term effects are unknown in patients with myocardial infarction. This study aimed to examine longitudinal variations of SOC and associations between SOC at baseline and QoL at a 10-year follow-up in relation to gender.Methods and results This longitudinal study included 61 patients, 16 women and 45 men with a mean age of 57.1 +/- 6.5 years, who completed a questionnaire package in relation to hospital discharge, 2 years, 5 years, and 10 years later. The questionnaire package included the Sense of Coherence Scale (SOC-13), 12-item Short Form Health Survey, and Seattle Angina Questionnaire. Data were analysed with repeated measure ANOVA and linear regression. Overall, SOC was stable over the 10-year follow-up, but comprehensibility improved significantly (P = 0.003). A significant main effect for gender was shown regarding SOC total (P = 0.032) and comprehensibility (P = 0.034); women reported lower SOC compared with men. An interaction effect between gender and time was shown in comprehensibility (P = 0.007), as the differences between genders decreased over time. The SOC-13 was significantly associated with all dimensions of QoL; three significant interaction effects showed that the associations were true for women but not for men.Conclusion The SOC is an important aspect to consider in the care of patients with myocardial infarction, as it is associated with long-term QoL, particularly for women. This means that SOC can also be used to identify patients who are at risk for poor QoL after a myocardial infarction.

Objectives: The impact of dental occlusion on the experiences of head and neck cancer patients and their oral, social and psychological functioning has been sparsely investigated. There is a lack of knowledge regarding the experience of tooth loss and dentures among patients treated for head and neck cancer. The aim of this study was to describe the experiences of head and neck cancer patients of prophylactic tooth extractions and temporary removable dentures, 6 months after radiotherapy treatment.

Material and methods: An individual interview with 25 patients 6 months after radiotherapy was subjected to a qualitative content analysis.

Results: Two categories, Impaired oral function and Belief in the future, and seven subcategories described the patients' experiences of temporary removable dentures during the first 6 months after prophylactic tooth extractions. The temporary removable dentures affected the patients' ability to chew, swallow and speak, caused pain, and were experienced as an enemy. Despite that, the patients were hopeful and had a wish for recovery, which gave them the energy to live.

Conclusion: Prophylactic tooth extractions and temporary removable dentures 6 months after radiotherapy treatment affect head and neck cancer patients' recovery and everyday life. However, they have the will to take on these challenges, pertaining not only to themselves, but also to relatives and health professionals. At the individual level, the patient needs individualized professional support to get through the arduous procedure, from the acute situation until the end of the rehabilitation phase.

BACKGROUND: Over the past decade, the importance of person-centered care has led to increased interest in patient-reported outcome measures (PROMs). In cardiovascular care, selecting an appropriate PROM for clinical use or research is challenging because multimorbidity is often common in patients. The aim was therefore to provide an overview of heart-disease specific PROMs and to compare the content of those outcomes using a bio-psycho-social framework of health.

METHODS: A scoping review of heart disease-specific PROMs, including arrhythmia/atrial fibrillation, congenital heart disease, heart failure, ischemic heart disease, and valve diseases was conducted in PubMed (January 2018). All items contained in the disease-specific PROMs were mapped to WHO's International Classification of Functioning, Disability and Health (ICF) according to standardized linking rules.

RESULTS: A total of 34 PROMs (heart diseases in general n = 5; cardiac arrhythmia n = 6; heart failure n = 14; ischemic heart disease n = 9) and 147 ICF categories were identified. ICF categories covered Body functions (n = 61), Activities & Participation (n = 69), and Environmental factors (n = 17). Most items were about experienced problems of Body functions and less often about patients' daily activities, and most PROMs were specifically developed for heart failure and no PROM were identified for valve disease or congenital heart disease.

CONCLUSIONS: Our results motivate and provide information to develop comprehensive PROMs that consider activity and participation by patients with various types of heart disease.

BACKGROUND: Two important aspects for the development of anxiety disorders are genetic predisposition and alterations in the hypothalamic-pituitary-adrenal (HPA) axis. In order to identify genetic risk-factors for anxiety, the aim of this exploratory study was to investigate possible relationships between genetic polymorphisms in genes important for the regulation and activity of the HPA axis and self-assessed anxiety in healthy individuals. METHODS: DNA from 72 healthy participants, 37 women and 35 men, were included in the analyses. Their DNA was extracted and analysed for the following Single Nucleotide Polymorphisms (SNP)s: rs41423247 in the NR3C1 gene, rs1360780 in the FKBP5 gene, rs53576 in the OXTR gene, 5-HTTLPR in SLC6A4 gene and rs6295 in the HTR1A gene. Self-assessed anxiety was measured by the State and Trait Anxiety Inventory (STAI) questionnaire. RESULTS: Self-assessed measure of both STAI-S and STAI-T were significantly higher in female than in male participants (p = 0.030 and p = 0.036, respectively). For SNP rs41423247 in the NR3C1 gene, there was a significant difference in females in the score for STAI-S, where carriers of the G allele had higher scores compared to the females that were homozygous for the C allele (p < 0.01). For the SNP rs53576 in the OXTR gene, there was a significant difference in males, where carriers of the A allele had higher scores in STAI-T compared to the males that were homozygous for the G allele (p < 0.01). CONCLUSION: This study shows that SNP rs41423247 in the NR3C1 gene and SNP rs53576 in the OXTR gene are associated with self-assessed anxiety in healthy individuals in a gender-specific manner. This suggests that these SNP candidates are possible genetic risk-factors for anxiety.

Background: The aim of this study was to evaluate the effects of a brief dyadic cognitive behavioural therapy (CBT) programme on the health-related quality of life (HRQoL), as well as the sense of coherence in atrial fibrillation patients, up to 12 months post atrial fibrillation.

Methods: A longitudinal randomised controlled trial with a pre and 12-month post-test recruitment of 163 persons and their spouses, at a county hospital in southern Sweden. In all, 104 persons were randomly assigned to either a CBT (n=56) or a treatment as usual (TAU) group (n=55). The primary outcome was changes in the HRQoL (Euroqol questionnaire; EQ-5D), and the secondary outcomes were changes in psychological distress (hospital anxiety and depression scale; HADS) and sense of coherence (sense of coherence scale; SOC-13).

Results: At the 12-month follow-up, the CBT group experienced a higher HRQoL than the TAU group (mean changes in the CBT group 0.062 vs. mean changes in the TAU group −0.015; P=0.02). The sense of coherence improved in the CBT group after the 12-month follow-up, compared to the TAU group (mean changes in the CBT group 0.062 vs. mean changes in the TAU group −0.16; P=0.04). The association between the intervention effect and the HRQoL was totally mediated by the sense of coherence (z=2.07, P=0.04).

Conclusions: A dyadic mindfulness-based CBT programme improved HRQoL and reduced psychological distress up to 12 months post atrial fibrillation. The sense of coherence strongly mediated the HRQoL; consequently, the sense of coherence is an important determinant to consider when designing programmes for atrial fibrillation patients. 

Background:

Atrial fibrillation is a prevalent cardiac arrhythmia. Effective communication of risks (e.g. stroke risk) and benefits of treatment (e.g. oral anticoagulants) is crucial for the process of shared decision making.

Aim:

The aim of this study was to explore factors associated with confidence in decision making and satisfaction with risk communication after a follow-up visit among patients who three months earlier had visited an emergency room for atrial fibrillation related symptoms.

Methods:

A cross-sectional design was used and 322 patients (34% women), mean age 66.1 years (SD 10.5 years) with atrial fibrillation were included in the south of Sweden. Clinical examinations were done post an atrial fibrillation episode. Self-rating scales for communication (Combined Outcome Measure for Risk Communication and Treatment Decision Making Effectiveness), uncertainty in illness (Mishel Uncertainty in Illness Scale–Community), mastery of daily life (Mastery Scale), depressive symptoms (Hospital Anxiety and Depression Scale) and vitality, physical health and mental health (36-item Short Form Health Survey) were used to collect data.

Results:

Decreased vitality and mastery of daily life, as well as increased uncertainty in illness, were independently associated with lower confidence in decision making. Absence of hypertension and increased uncertainty in illness were independently associated with lower satisfaction with risk communication. Clinical atrial fibrillation variables or depressive symptoms were not associated with satisfaction with confidence in decision making or satisfaction with risk communication. The final models explained 29.1% and 29.5% of the variance in confidence in decision making and satisfaction with risk communication.

Conclusion:

Confidence in decision making is associated with decreased vitality and mastery of daily life, as well as increased uncertainty in illness, while absence of hypertension and increased uncertainty in illness are associated with risk communication satisfaction.

Objective: Patients undergoing coronary artery bypass graft (CABG) surgery are required to take a complex regimen of medications for a long time, and they may have negative outcomes because they struggle to adhere to this regimen. Designing effective interventions to promote medication adherence is therefore important. The present study aimed to evaluate the long-term effects of a multifaceted intervention (psycho-education, motivational interviewing, and short message services) on medication adherence, quality of life (QoL), and mortality rates in older patients undergoing CABG surgery.

Methods: Patients aged over 65 years from 12 centers were assigned to the intervention (EXP; n = 144) or treatment as usual (TAU; n = 144) groups using cluster randomization with center level. Medication adherence was evaluated using Medication Adherence Rating Scale (MARS), pharmacy refill rate, and lipid profile; QoL using Short-Form 36.Data were collected at baseline; three, six, and eighteen months after intervention. Survival status was followed up at eighteen months. Multi-level regressions and survival analyses for hazard ratio (HR) were used for analyses.

Results: Compared to patients who received TAU, the MARS, pharmacy refill rate, and lipid profile of patients in the EXP group improved six months after surgery (p <0.01) and remained so eighteen months after surgery (p< 0.01). QoL also increased among patients in the EXP group as compared to those who received TAU at eighteen month post-surgery (physical component summary score p= 0.02; mental component summary score p = 0.04). HR in the EXP group compared to the TAU group was 0.38 (p = 0.04).

Conclusion: The findings suggest that a multifaceted intervention can improve medication adherence in older patients undergoing CABG surgery, with these improvements being maintained after eighteen months. QoL and survival rates increased as a function of better medication adherence.

Background: Patients undergoing coronary artery bypass graft (CABG) surgery are required to take a complex regimen of medications for extended periods, and they may have negative outcomes because they struggle to adhere to this regimen. Designing effective interventions to promote medication adherence in this patient group is therefore important.

Objective: The present study aimed to evaluate the long-term effects of a multifaceted intervention (psycho-education, motivational interviewing, and short message services) on medication adherence, quality of life (QoL), and mortality rates in older patients undergoing CABG surgery.

Methods: Patients aged over 65 years from 12 centers were assigned to the intervention (EXP; n = 144) or treatment-as-usual (TAU; n = 144) groups using cluster randomization at center level. Medication adherence was evaluated using the Medication Adherence Rating Scale (MARS), pharmacy refill rate, and lipid profile; QoL was evaluated using Short Form-36. Data were collected at baseline; 3, 6, and 18 months after intervention. Survival status was followed up at 18 months. Multi-level regressions and survival analyses for hazard ratio (HR) were used for analyses.

Results: Compared with patients who received TAU, the MARS, pharmacy refill rate, and lipid profile of patients in the EXP group improved 6 months after surgery (p < 0.01) and remained so 18 months after surgery (p < 0.01). QoL also increased among patients in the EXP group as compared with those who received TAU at 18 months post-surgery (physical component summary score p = 0.02; mental component summary score p = 0.04). HR in the EXP group compared with the TAU group was 0.38 (p = 0.04).

Conclusion: The findings suggest that a multifaceted intervention can improve medication adherence in older patients undergoing CABG surgery, with these improvements being maintained after 18 months. QoL and survival rates increased as a function of better medication adherence. ClinicalTrials.gov NCT02109523.

Background: Patients with Takotsubo cardiomyopathy (TSCM) especially female, may be at risk of poor psychological adjustment and deteriorated health related quality of life. Sexual dysfunction is a significant problem for patients with TSCM. Therefore, Sexual counseling should be integrated into the cardiac rehabilitation services. However, cardiac rehabilitation teams reluctant to address patient’s sexual problems. The aim of this study was to determine factors which effect on performing sexual counseling among cardiac rehabilitation team.

Methods: In this longitudinal study, two hundred and forty-four specialists (i.e., physical therapists, nurses, psychologists, social workers, rehabilitation specialists and cardiologists), who were working in cardiac rehabilitation teams participated in the study at eight referral hospitals in Iran (i.e., Tehran, Qazvin, Tabriz and Zahedan). The teams were asked to complete study measures including sexual knowledge (25 items), attitude (12 items), subjective norm (5 items), perceived behavioral control (8 items), behavioral intention (2 items) and perceived barriers (17 items). Six month later, the teams were then contacted to ask the frequency of the sexual counseling sessions during the past six months.

Results: Cardiac rehabilitation teams reported that sex was rarely discussed with patients (14.3%). Attitudes, subjective norms and perceived behavioral control (PBC) emerged as significant direct predictors of intention to perform sexual consulting. Multiple logistic regression analysis showed that cardiac rehabilitation teams with strong behavioral intention (OR = 1.83, 95 % CI, 1.08  to 3.10) and low perceived barriers (OR = 0.69, 95 % CI, 0.49 to 0.97) were more likely to perform the subsequent sexual consulting.

Conclusions: Existing cardiac rehabilitation activities are likely to continue to fail to promote patient’s sexual functioning after cardiac events in the absence of effective strategies to reduce the underlying barriers toward sexual counseling. Interventions should be targeted on reducing barriers toward sexual counseling in cardiac rehabilitation teams.

Background: Atrial fibrillation (AF) is a highly prevalent arrhythmia. Effective communication of risks (e.g., risk for stroke) and benefits to patients (e.g., treatment with oral anticoagulants) is crucial for shared decision making. Knowledge about how patients experience confidence and satisfaction in communication in relation to their health status is limited.

Aim: The aim was to explore factors associated with involvement in risk communication and confidence in shared decision making among patients with AF.

Method: A cross-sectional design was used and 322 patients (39 % women), mean age 67 years (SD 10.3 years) with AF were included at four hospitals in Sweden. Clinical examinations and self-rating scales for risk communication (COMRADE), uncertainty in illness (MUIS-C), depressive symptoms (HADS), mastery of daily life (MDL), as well as physical and mental health (SF-36) were used to collect data after a follow-up visit at the outpatient clinic 3 months post an AF episode.

Results: Paroxysmal, persistent and permanent AF occurred among 32%, 34% and 7% of the patients, respectively. Patients whom had undergone DC-conversion (53%) and had anticoagulants (37%). Seven percent had been treated by a percutan ablation. Heart failure (15%) and ischemic heart disease (12%) were the most common co-morbidities. CHA2DS2-VASc >2 were seen among 62% of the patients. Overall, multiple regression analyses showed that uncertainty in illness and mastery of daily life were significantly associated with confidence in decisions and uncertainty in illness and hypertension were significantly associated with satisfaction in communication. Higher uncertainty in illness and poorer mastery of daily life were associated with poor confidence in decisions. Higher uncertainty in illness and occurrence of hypertension were associated with poor satisfaction in communication. Clinical AF variables (i.e.,symptom or treatment related) or depressive symptoms were not significantly associated with satisfaction in communication or confidence in decisions in the multiple regression analysis. The final models explained 29% and 30% of the variance in confidence in decision making and satisfaction in communication.

Conclusion: In this cross-sectional study, including patients with AF, confidence in decision making and satisfaction in communication are associated with uncertainty in illness, mastery of daily life and hypertension.