Ability of Hypnosis to Facilitate Movement Through Stages of Change for Smoking Cessation

On the basis of the transtheoretical model of change, we hypothesized that hypnosis would facilitate significantly greater movement through the stages of change toward smoking cessation in contrast to psychoeducation. Thirty participants were pretested for hypnotizability using the Elkins Hypnotizability Scale (EHS). Participants’ readiness for change was assessed using the University of Rhode Island Change Assessment scale (URICA). The EHS relaxation induction was used to induce hypnosis. Hypnotic suggestions addressed motivation and ambivalence. The URICA was administered following the intervention and at a 10-day follow-up. Two-factor split-plot ANOVAs showed significant changes within groups on the contemplation subscale (p = .002), action subscale (p = .00007), and the number of cigarettes smoked per day (p = .003).     

Cardiovascular Disease and Homelessness

Cardiovascular disease (CVD) is a major cause of death among homeless adults, at rates that exceed those in nonhomeless individuals. A complex set of factors contributes to this disparity. In addition to a high prevalence of cigarette smoking and suboptimal control of traditional CVD risk factors such as hypertension and diabetes, a heavy burden of nontraditional psychosocial risk factors like chronic stress, depression, heavy alcohol use, and cocaine use may confer additional risk for adverse CVD outcomes beyond that predicted by conventional risk estimation methods. Poor health care access and logistical challenges to cardiac testing may lead to delays in presentation and diagnosis. The management of established CVD may be further challenged by barriers to medication adherence, communication, and timely follow-up. The authors present practical, patient-centered strategies for addressing these challenges, emphasizing the importance of multidisciplinary collaboration and partnership with homeless-tailored clinical programs to improve CVD outcomes in this population.     

Echocardiographic diagnosis of atrial flutter in a neonate

A pregnant female presented at 37 weeks of gestation in labor. The fetus was noted to be tachycardic on fetal monitor. Postnatally, the male neonate was still noted to be tachycardic with heart rates in the low 200 bpm range. EKG was consistent with tachycardia, but rhythm diagnosis was not definitively made. Echocardiogram with M‐mode analysis clearly demonstrated 2:1 atrial to ventricular contraction pattern consistent with atrial flutter. The neonate was subsequently transferred to a tertiary pediatric hospital where the diagnosis of atrial flutter was confirmed.     

S-100B as an extra selection tool for FDG PET/CT scanning in follow-up of AJCC stage III melanoma patients

Background and Objectives

This current study assessed the value of S-100B measurement to guide fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) scanning for detecting recurrent disease in stage III melanoma patients.

Methods

This study included 100 stage III melanoma patients in follow-up after curative lymph node dissection. Follow-up visits included physical examination and S-100B monitoring. FDG PET/CT scanning was indicated by clinical symptoms and/or elevated S-100B.

Results

Of 100 patients, 13 (13%) had elevated S-100B without clinical symptoms, of whom 7 (54%) showed disease evidence upon FDG PET/CT scanning. Twenty-six patients (26%) had clinical symptoms with normal S-100B and FDG PET/CT revealed metastasis in 20 (77%). Three patients had clinical symptoms and elevated S-100B, and FDG PET/CT revealed metastasis in all three (100%). Overall, FDG PET/CT scanning revealed metastasis in 30 of the 42 patients (71.4%). For seven recurrences, elevated S-100B prompted early detection of asymptomatic disease; 10% of all asymptomatic patients in follow-up, 23% of all patients with recurrent disease.

Conclusion

S-100B cannot exclude recurrent disease during follow-up of stage III melanoma. However, adding S-100B measurement to standard clinical assessment can guide FDG PET/CT scanning for detecting recurrent melanoma.     

A review of factors affecting patient fertility preservation discussions & decision‐making from the perspectives of patients and providers

Women undergoing cancer treatments and their healthcare providers encounter challenges in fertility preservation (FP) discussions and decision‐making. A systematic review of qualitative research was conducted to gain in‐depth understanding of factors influencing FP discussions and decision‐making. Major bibliographic databases and grey literature in English from 1994 to 2016 were searched for qualitative research exploring patient/provider perspectives on barriers and facilitators to FP decision‐making. Two researchers screened article titles, abstracts and full‐texts. Verbatim data on research questions, study methodology, participants, findings and discussions of findings were extracted. Quality assessment and thematic analysis were conducted. The search yielded 74 studies dating from 2007 onwards; 29 met the inclusion criteria. Analysis revealed three types of barriers: (a) FP knowledge, skills and information deficits contributed to discomfort for providers and discontent for patients; (b) psychosocial factors and clinical issues influenced providers’ practices around FP discussions and patients’ decision‐making; and (c) material, social and structural factors (e.g., lack of resources and accessibility) posed challenges to FP discussions. Potential facilitators to FP discussions and decision‐making were also identified. A discussion of ways to improve physician's knowledge and facilitate women's decision‐making and access to FP is presented, along with areas for policy development and further research.     

How common is depression in patients with polymyalgia rheumatica?

Clinical Rheumatology - Depression is common in inflammatory disorders such as rheumatoid arthritis and systemic lupus erythematosus and negatively impacts on outcomes. Given the long-term nature...     

Urogynaecological complications in pregnancy: an overview

The urinary tract undergoes numerous physiological adaptions in response to pregnancy. These normal adaptions can increase the risk of complications, such as acute infection and urinary retention, which in turn increase the risk of poor outcomes for the pregnancy. Other urogynaecological complications, for example urological injury at caesarean section, can significantly increase long term morbidity. Therefore, it is important that obstetricians are aware of the potential complications that can occur. This article aims to give a general overview of urogynaecological complications that can arise in pregnancy and how to manage them.     

Meta‐Analysis of the Association of Alcohol‐Related Social Media Use with Alcohol Consumption and Alcohol‐Related Problems in Adolescents and Young Adults

Despite the pervasive use of social media by young adults, there is comparatively little known about whether, and how, engagement in social media influences this group's drinking patterns and risk of alcohol‐related problems. We examined the relations between young adults’ alcohol‐related social media engagement (defined as the posting, liking, commenting, and viewing of alcohol‐related social media content) and their drinking behavior and problems. We conducted a systematic review and meta‐analysis of studies evaluating the association of alcohol consumption and alcohol‐related problems with alcohol‐related social media engagement. Summary baseline variables regarding the social media platform used (e.g., Facebook and Twitter), social media measures assessed (e.g., number of alcohol photographs posted), alcohol measures (e.g., Alcohol Use Disorders Identification Test and Timeline Follow back Interview), and the number of time points at which data were collected were extracted from each published study. We used the Q statistic to examine heterogeneity in the correlations between alcohol‐related social media engagement and both drinking behavior and alcohol‐related problems. Because there was significant heterogeneity, we used a random‐effects model to evaluate the difference from zero of the weighted aggregate correlations. We used metaregression with study characteristics as moderators to test for moderators of the observed heterogeneity. Following screening, 19 articles met inclusion criteria for the meta‐analysis. The primary findings indicated a statistically significant relationship and moderate effect sizes between alcohol‐related social media engagement and both alcohol consumption (r = 0.36, 95% CI: 0.29 to 0.44, p < 0.001) and alcohol‐related problems (r = 0.37, 95% CI: 0.21 to 0.51, p < 0.001). There was significant heterogeneity among studies. Two significant predictors of heterogeneity were (i) whether there was joint measurement of alcohol‐related social media engagement and drinking behavior or these were measured on different occasions and (ii) whether measurements were taken by self‐report or observation of social media engagement. We found moderate‐sized effects across the 19 studies: Greater alcohol‐related social media engagement was correlated with both greater self‐reported drinking and alcohol‐related problems. Further research to determine the causal direction of these associations could provide opportunities for social media‐based interventions with young drinkers aimed at reducing alcohol consumption and alcohol‐related adverse consequences.     

Mental health,relationships, and sex: exploring patterns among bisexual individuals in mixed orientation relationships

ABSTRACT

Drawing on minority stress theory and sexual health literature, this exploratory study tested the relations of bisexual identity factors (e.g. anticipated binegativity, identity affirmation), minority stressors (e.g. isolation and vicarious trauma), and sexual and relationship variables (e.g. sexual functioning, relationship satisfaction) with mental health. Participants were 53 self-identified bisexual individuals in a mixed orientation relationship (MORE) with partners who did not also identify as bisexual. Moderate or above levels of depression, anxiety, and stress were reported by 34.5%, 25.4%, and 27.3% of the sample, respectively. Minority stressors were examined as mediators of the relations of bisexual identity factors and mental health outcomes. Isolation significantly mediated anticipated binegativity and depression, anxiety, and stress. Additionally, vicarious trauma mediated the relation of bisexual identity affirmation with anxiety. Consistent with existing literature, mental health concerns were negatively correlated with various aspects of sexual functioning and relationship satisfaction. Bisexual individuals in monogamous relationships with lesbian-identified partners reported lower stress levels than those with heterosexual partners. Results from the current study provide preliminary information about the health of bisexual individuals in MOREs, and point to minority stressors as potentially fruitful targets of prevention and intervention efforts to reduce negative mental health outcomes among bisexual populations.