Christina Maar Andersen

Risk of Burnout in Danish GPs and Exploration of Factors Associated with Development of Burnout: A Two-Wave Panel Study

Background. We assessed risk of burnout in GPs during a 7-year followup and examined whether (1) thoughts about changing medical specialty increased the risk of burnout and (2) burned out GPs had higher job turnover rates than burnout-free GPs. Methods. In 2004 and 2012, all GPs in the county of Aarhus, Denmark, were invited to participate in a survey. Retirement status of physicians who participated in 2004 was obtained through the Registry of Health Providers in 2012. Results. 216 GPs completed both surveys. The risk of developing burnout during the 7-year followup was 13.2% (8.2–19.6%). GPs who in 2004 were burnout-free and reported that they would not select general practice as medical specialty again had a statistically significant increased risk of burnout in 2012 (ORu2009=u20094.5; 95% CIu2009=u20091.2–16.5; P = 0.023). Among GPs with burnout in 2004, 25.0% had withdrawn from general practice during followup compared to 28.8% of burnout-free GPs in 2004 (adj. ORu2009=u20090.99; 95% CIu2009=u20090.48–2.02; P = 0.975). Conclusion. The 7-year incidence of burnout was 13%. Thoughts about changing medical specialty were an important predictor of burnout. Burned out GPs had not higher job turnover rates than burnout-free GPs.

Depressive symptoms in patients with an implantable cardioverter defibrillator: Does treatment expectations play a role?

OBJECTIVEnPatients with an implantable cardioverter defibrillator (ICD) and co-morbid depression are at greater risk of poor quality of life and premature death. We examined if treatment expectations predict depressive symptoms 12months post implant.nnnMETHODSnFirst-time implant patients from the WEBCARE study (n=177; 83.1% men) completed the EXPECTations towards ICD therapy questionnaire and the Type D Scale at baseline, and the Patient Health Questionnaire at baseline and 12months.nnnRESULTSnUsing hierarchical linear regression with 3 models, we identified the following independent predictors of 12-months depressive symptoms: Model 1: Negative treatment expectations (β=0.202; p=0.020) and baseline depression (β=0.376; p<0.0001). Model 2: Baseline depression (β=0.350; p<0.0001) and Type D personality (β=0.162; p=0.042); negative treatment expectations was borderline significant (β=0.169; p=0.051). Model 3: Baseline depression (β=0.353; p<0.0001) and negative treatment expectations (β=0.180; p=0.043); Type D personality was not significant (β=0.150; p=0.067), adjusting for positive treatment expectations, heart failure, sex, and shocks during follow-up. The models accounted for 22.2%, 24.1%, and 23.3% of the variance in 12-months depressive symptoms, respectively.nnnCONCLUSIONnFurther research is warranted to explore the role of treatment expectations at the time of implant and its overlap with personality as a determinant of depression in patients with an ICD.

Minding the heart: Why are we still not closer to treating depression and anxiety in clinical cardiology practice?

Psychological comorbidities are common in patients with ischaemic heart disease (IHD) and other cardiovascular conditions, such as peripheral arterial disease, atrial fibrillation and cardiomyopathies, with as many as 20% of patients suffering from depression and/or anxiety. Not only a clinical diagnosis but also subthreshold levels have prognostic implications, as depression is a barrier for appropriate risk factor management, increases risk of non-adherence, refusal or drop-out from cardiac rehabilitation, readmission and premature death despite state-of-the-art treatment. Unfortunately, depression and anxiety tend to be overlooked and undertreated in cardiac patients, although depression alone in cardiac patients adds an extra cost of 33% compared with patients without depression. Both IHD and depression are associated with a high economic burden and will be among the top 10 contributors to the disease-burden worldwide in 2020. Paradoxically, despite this consistent evidence and recognition of depression, anxiety and psychosocial factors as risk factors by European and National Societies already in 2012, this has had little impact on changing clinical practice. Given that the number of patients with IHD has increased considerably due to better treatment options and ageing of the population, there is an urgent need to treat heart and mind in concert and not only the underlying somatic disease but also psychological comorbidity, in order to bridge this gap in clinical practice. The state-of-the-art Cochrane review by Richards et al. published in this issue may comprise an important piece of the puzzle in terms of helping us to understand why we are not closer to implementing screening for depression and anxiety combined with interventions targeting depression and anxiety in clinical practice. Although no randomized controlled trial (RCT) to date has examined the effectiveness of screening combined with intervention targeting depression and anxiety, the review by Richards et al. pinpoints other challenges, such as uncertainty about treatment effects due to low quality of evidence across different endpoints from cardiovascular morbidity and mortality to psychological outcomes. In addition, the heterogeneity between studies is significant and the level of quality varies from moderate to low and very low. Although the review demonstrates an effect of psychological interventions on cardiovascular mortality, no effects are seen on total mortality and major adverse cardiac events, such as myocardial infarction and revascularization procedures. In addition, only small to moderate improvements are seen in symptoms of depression, stress and anxiety, and these estimates are plagued by some uncertainty. This despite the inclusion of 35 randomized studies and 10,703 participants (median follow-up of 12 months) with data added from 14 new studies as compared with the previous Cochrane review in 2011. It is disappointing and of great concern to see that little has changed in the cardiovascular behavioural field in terms of demonstrated effects of psychological interventions since 2011, with the fear that the next update of this Cochrane review will show similar results. Although challenged health care budgets and hospital resources across the world combined with an increasing number of patients with complex chronic disease and multi-morbidities may constitute another piece of the puzzle why clinical practice has not changed, the time may be ripe for behavioural scientists and mental health professionals engaged in research and working in the cardiovascular field to take a step back and evaluate whether we are on the right path. If we take a critical look at the field, there has been a tendency to use a simplistic one-size-fits-all approach. However, the Cochrane review clearly demonstrates that this approach does not work, as patients are

Data quality and factor analysis of the Danish version of the Relationship Scale Questionnaire

Background The Relationship Scale Questionnaire (RSQ) is a widely-used measure of adult attachment, but whether the results obtained by the RSQ fit the attachment construct has only been examined to a limited extent. Objective The objectives of this study were to investigate the psychometric properties of the Danish translation of the RSQ and to test whether the results are consistent with the hypothesized model of attachment. Methods The study included two samples: 602 general practitioners and 611 cancer patients. The two samples were analyzed separately. Data quality was assessed by mean, median and missing values for each item, floor and ceiling effects, average inter-item correlations and Cronbach’s α for each subscale. Test-retest was assessed by intra-class correlations among 76 general practitioners. A confirmatory factor analysis was conducted to establish evidence of the four proposed subscales. Due to an inadequate fit of the model, data was randomly split into two equally sized subsamples and an exploratory factor analysis was conducted for all 30 items in the first subsample comprised of 286 cancer patients and 285 general practitioners. The EFA yielded a three-factor structure which was validated through a confirmatory factor analyses in a second subsample comprised of 278 cancer patients and 289 general practitioners. Results The data quality of the RSQ was generally good, except low internal consistency and low to moderate test-retest reliability. The four subscales of the RSQ were not confirmed by the confirmatory factor analysis. An exploratory factor analysis suggested a three-factor solution for both general practitioners and patients, which accounted for 61.1% of the variance among general practitioners and 62.5% among patients. The new three-factor solution was verified in a confirmatory factor analyses. Conclusion The proposed four-factor model of the RSQ could not be confirmed in this study. Similar challenges have been found by other studies validating the RSQ. An alternative three-factor structure was found for the RSQ.

Psychological distress in patients with an implantable cardioverter defibrillator and their partners

OBJECTIVESnAdjustment to life with an implantable cardioverter defibrillator (ICD) may be challenging for some patients and their partners, with disease and individual characteristics likely influencing the process. We examined whether perceived social support and clinical patient characteristics are associated with change in couples symptoms of anxiety and depression in the first year after ICD implantation, and explored whether the associations differ between patients and partners.nnnMETHODnA cohort of consecutively implanted patients (nu202f=u202f286; 21% women) and their partners completed questionnaires on social support and symptoms of anxiety and depression prior to ICD implantation and 12u202fmonths later. Information on demographic and clinical characteristics were captured from patients medical records or purpose-designed questions. Data were analyzed using multilevel models accounting for the interdependency of scores within couples with adjustment for possible confounders.nnnRESULTSnHigher ratings of perceived social support prior to ICD implantation were associated with greater reductions in couples symptoms of anxiety and depression, whereas having received an ICD shock was associated with less improvement. Secondary prevention indication for ICD implantation and symptomatic heart failure were associated with less improvement in anxiety symptoms. These associations applied to both patients and partners levels of distress.nnnCONCLUSIONnThe patients heart disease affects both patients and partners psychological adjustment in the first year after ICD implantation. Interventions are warranted that address this issue not only in patients but also in partners. Targeting social support as a resource for both could be one avenue to pursue.

SensiScreen® KRAS exon 2-sensitive simplex and multiplex real-time PCR-based assays for detection of KRAS exon 2 mutations

Activating mutations in codon 12 and codon 13 of the KRAS (Kirsten rat sarcoma viral oncogene homolog) gene are implicated in the development of several human cancer types and influence their clinical evaluation, treatment and prognosis. Numerous different methods for KRAS genotyping are currently available displaying a wide range of sensitivities, time to answer and requirements for laboratory equipment and user skills. Here we present SensiScreen® KRAS exon 2 simplex and multiplex CE IVD assays, that use a novel real-time PCR-based method for KRAS mutation detection based on PentaBase’s proprietary DNA analogue technology and designed to work on standard real-time PCR instruments. By means of the included BaseBlocker™ technology, we show that SensiScreen® specifically amplifies the mutated alleles of interest with no or highly subdued amplification of the wild type allele. Furthermore, serial dilutions of mutant DNA in a wild type background demonstrate that all SensiScreen® assays display a limit of detection that falls within the range of 0.25–1%. Finally, in three different colorectal cancer patient populations, SensiScreen® assays confirmed the KRAS genotype previously determined by commonly used methods for KRAS mutation testing, and notably, in two of the populations, SensiScreen® identified additional mutant positive cases not detected by common methods.

Does Aging and Disease Increase the Importance of Cognitive Strategies? Social and Temporal Comparisons in Healthy Younger and Older Adults and in Younger and Older Cancer Patients

Social and temporal comparisons may help the individual anchor his or her self-image in a social and temporal context. In the Life-Span Theory of Control, comparisons are included in the repertoire of secondary control strategies individuals may apply when primary control strategies are obstructed, for example, by age-related losses or physical decline. The aim of this study was to explore differences in prevalence and effects of social and temporal comparisons in younger and older adults and healthy and diseased individuals (nu2009=u200934). Semistructured interviews were conducted and analyzed using a mixed-methods approach combining qualitative and quantitative data analysis. The results revealed that older adults engaged in more comparisons than younger adults and that the outcomes of comparisons were more positive for older adults, particularly older cancer patients. The results indicate that comparisons may be applied more often by older and diseased individuals in the service of maintaining well-being.