Luca Pancani

Self-care confidence may be more important than cognition to influence self-care behaviors in adults with heart failure: Testing a mediation model

BACKGROUND Cognitive impairment can reduce the self-care abilities of heart failure patients. Theory and preliminary evidence suggest that self-care confidence may mediate the relationship between cognition and self-care, but further study is needed to validate this finding. OBJECTIVES The aim of this study was to test the mediating role of self-care confidence between specific cognitive domains and heart failure self-care. DESIGN Secondary analysis of data from a descriptive study. SETTINGS Three out-patient sites in Pennsylvania and Delaware, USA. PARTICIPANTS A sample of 280 adults with chronic heart failure, 62 years old on average and mostly male (64.3%). METHODS Data on heart failure self-care and self-care confidence were collected with the Self-Care of Heart Failure Index 6.2. Data on cognition were collected by trained research assistants using a neuropsychological test battery measuring simple and complex attention, processing speed, working memory, and short-term memory. Sociodemographic data were collected by self-report. Clinical information was abstracted from the medical record. Mediation analysis was performed with structural equation modeling and indirect effects were evaluated with bootstrapping. RESULTS Most participants had at least 1 impaired cognitive domain. In mediation models, self-care confidence consistently influenced self-care and totally mediated the relationship between simple attention and self-care and between working memory and self-care (comparative fit index range: .929-.968; root mean squared error of approximation range: .032-.052). Except for short-term memory, which had a direct effect on self-care maintenance, the other cognitive domains were unrelated to self-care. CONCLUSIONS Self-care confidence appears to be an important factor influencing heart failure self-care even in patients with impaired cognition. As few studies have successfully improved cognition, interventions addressing confidence should be considered as a way to improve self-care in this population.

The Situational Version of the Brief COPE: Dimensionality and Relationships With Goal-Related Variables.

This study is aimed at investigating the dimensionality of the situational version of the Brief COPE, a questionnaire that is frequently used to assess a broad range of coping responses to specific difficulties, by comparing five different factor models highlighted in previous studies. It also aimed at exploring the relationships among coping responses, personal goal commitment and progress. The study involved 606 adults (male = 289) ranging in age from 19 to 71. Using confirmatory factor analysis, we compared five models and assessed relationships of coping responses with goal commitment and progress. The results confirmed the theoretical factor structure of the situational Brief COPE. All the 14 dimensions showed acceptable reliability and relationships with goal commitment and progress, attesting the reliability and usefulness of this measure to evaluate coping responses to specific events.

Psychometric characteristics of the caregiver burden inventory in caregivers of adults with heart failure

Background: A better understanding of caregiver burden and its determinants is essential to support caregivers. Many instruments have been developed to measure caregiver burden in various illness contexts, but few have been psychometrically tested for caregivers of heart failure patients. Aims: The aim of this study was to test the validity (factorial and concurrent validity) and reliability (internal consistency) of the caregiver burden inventory (CBI) in a cohort of caregivers of heart failure patients. Methods: This was a secondary analysis from a cross-sectional study on heart failure patients and their caregivers enrolled from various Italian outpatient centres. The factorial validity of the CBI was tested with confirmatory factor analysis, and concurrent validity was tested correlating CBI scores with the short form-12 health survey scores. The internal consistency reliability was assessed with Cronbach’s alpha. Results: In total, 505 caregivers of heart failure patients (52.2% women, mean age 56.59±14.9 years) were enrolled. Confirmatory factor analyses confirmed the original five-factor model: time-dependence, developmental, physical, social and emotional burden. This model fits the data better than the single-factor model, and the dimensions showed high internal consistency reliability (Cronbach’s alpha 0.91 for time-dependence burden, 0.92 for developmental burden, 0.88 for physical burden, 0.89 for social burden and 0.93 for emotional burden; 0.96 for the total score of burden). Conclusion: The CBI proved to be a good multidimensional instrument for evaluating the burden in caregivers of heart failure patients and can be used in clinical practice and research. This tool can be considered to tailor interventions aimed at improving caregiver outcomes.

A Type A and Type D Combined Personality Typology in Essential Hypertension and Acute Coronary Syndrome Patients: Associations with Demographic, Psychological, Clinical, and Lifestyle Indicators.

Many studies have focused on Type A and Type D personality types in the context of cardiovascular diseases (CVDs), but nothing is known about how these personality types combine to create new profiles. The present study aimed to develop a typology of Type A and Type D personality in two groups of patients affected by and at risk for coronary disease. The study involved 711 patients: 51.6% with acute coronary syndrome, 48.4% with essential hypertension (mean age = 56.4 years; SD = 9.7 years; 70.7% men). Cluster analysis was applied. External variables, such as socio-demographic, psychological, lifestyle, and clinical parameters, were assessed. Six groups, each with its own unique combined personality profile scores, were identified: Type D, Type A-Negatively Affected, Not Type A-Negatively Affected, Socially Inhibited-Positively Affected, Not Socially Inhibited, and Not Type A-Not Type D. The Type A-Negatively Affected cluster and, to a lesser extent, the Type D cluster, displayed the worst profile: namely higher total cardiovascular risk index, physical inactivity, higher anxiety and depression, and lower self-esteem, optimism, and health status. Identifying combined personality profiles is important in clinical research and practice in cardiovascular diseases. Practical implications are discussed.

A longitudinal study on the information needs and preferences of patients after an acute coronary syndrome

BackgroundResearch has shown that the provision of pertinent health information to patients with cardiovascular disease is associated with better adherence to medical prescriptions, behavioral changes, and enhanced perception of control over the disease. Yet there is no clear knowledge on how to improve information pertinence. Identifying and meeting the information needs of patients and their preferences for sources of information is pivotal to developing patient-led services. This prospective, observational study was aimed at exploring the information needs and perceived relevance of different information sources for patients during the twenty-four months following an acute coronary syndrome.MethodsTwo hundred and seventeen newly diagnosed patients with acute coronary syndrome were enrolled in the study. The patients were primarily men (83.41 %) with a mean age of 57.28 years (range 35–75; SD = 7.98). Patients’ needs for information and the perceived relevance of information sources were evaluated between 2 and 8 weeks after hospitalization (baseline) and during three follow-ups at 6, 12 and 24 months after baseline. Repeated measures ANOVA, Bonferroni post hoc tests and Cochran’s Q Test were performed to test differences in variables of interest over time.ResultsResults showed a reduction in information needs, but this decrease was significant only for topics related to daily activities, behavioral habits, risk and complication. At baseline, the primary sources of information were specialists and general practitioners, followed by family members and information leaflets given by physicians. Relevance of other sources changed differently over time.ConclusionThe present longitudinal study is an original contribution to the investigation of changes in information needs and preferences for sources of information among patients who are diagnosed with acute coronary syndrome. One of the main results of this study is that information on self-disease management is perceived as a minor theme for patients even two years after the event. Knowledge on how patients’ information needs and perceived relevance of information sources change over time could enhance the quality of chronic disease management, leading health-care systems to move toward more patient-tailored care.

Changes in physical activity among coronary and hypertensive patients: A longitudinal study using the Health Action Process Approach

Objectives: Physical activity (PA) is a key factor in cardiovascular disease prevention. Through the Health Action Process Approach (HAPA), the present study investigated the process of change in PA in coronary patients (CPs) and hypertensive patients (HPs). Design: Longitudinal survey study with two follow-up assessments at 6 and 12 months on 188 CPs and 169 HPs. Main outcome measures: Intensity and frequency of PA. Results: A multi-sample analysis indicated the equivalence of almost all the HAPA social cognitive patterns for both patient populations. A latent growth curve model showed strong interrelations among intercepts and slopes of PA, planning and maintenance self-efficacy, but change in planning was not associated with change in PA. Moreover, increase in PA was associated with the value of planning and maintenance self-efficacy reached at the last follow-up Conclusions: These findings shed light on mechanisms often neglected by the HAPA literature, suggesting reciprocal relationships between PA and its predictors that could define a plausible virtuous circle within the HAPA volitional phase. Moreover, the HAPA social cognitive patterns are essentially identical for patients who had a coronary event (i.e. CPs) and individuals who are at high risk for a coronary event (i.e. HPs).

Communication and disease management: a qualitative study on coronary disease

This study investigated doctor–patient communication and its role in the management of coronary disease. The aim was to identify patients’ information needs and related issues and to compare these findings with doctors’ perceptions of patients’ needs and communication barriers. Two focus groups were conducted with eight patients who suffered from coronary disease and six cardiologists. Recorded sessions were coded thematically and analyzed with interpretative phenomenological analysis. The results showed a “frustration of understanding” in both groups. Patients reported difficulty in understanding experts’ language, and physicians found it difficult to translate the medical terminology into simple words. However, they accused each other of creating these difficulties. Patients described physicians as an “elite” group with excessive technical language, and physicians reported that patients’ age and education (respectively, high and low) are real obstacles to good communication. Patients evaluated an autonomous search for health information as a way to better manage fear and anxiety related to the illness, but physicians considered it as a lack of trust and, thus, judged it negatively. Patients reported multiple unfilled needs, which were mainly related to information about how other people experienced the same illness and to specific information for their relatives, especially their spouses. Physicians stressed the need to transmit information about drug therapy and the need for adherence to manage chronic conditions. The analysis of patients’ information preferences and the awareness of patients’ information needs might strongly improve the overall quality of chronic disease management by suggesting new communication strategies.

The onset time delaying effect: smokers vs non-smokers place the adverse consequences of smoking further in the future

ABSTRACT Despite all the information about the risks, many people still smoke. Several studies investigated risk perceptions in smokers. The adequate perceptions of the risks from smoking is particularly important and this study investigated the risk perception of young smokers vs non-smokers by a new time-estimation task in which we required participants (smokers and non-smokers) to estimate the onset time of smoking-related conditions in an average young smoker. The findings supported our main hypothesis that smokers, compared to non-smokers, postponed the onset of both mild and severe smoking-related conditions. The results also revealed that the onset time estimates for mild conditions given by both smokers and non-smokers were associated with their self-perceptions of risk and level of fear of developing smoking-related conditions. The findings cast light on smokers’ distorted temporal perception of the health-damaging consequences of smoking. Implications for the adequacy of risk perception in smokers are discussed.

Connecting with a Slot Machine: Social Exclusion and Anthropomorphization Increase Gambling

Two studies tested whether social exclusion can increase gambling behavior. In Study 1, participants were asked to relive a socially painful instance, a physically painful instance or a control condition and were then presented with a real online gambling device (i.e., a slot machine). The results revealed that participants who relived a socially painful instance played longer on the gambling device. In Study 2, we induced actual feelings of social disconnection and manipulated slot machine anthropomorphization. The results revealed a significant interaction between inclusionary status and anthropomorphism in predicting gambling. More specifically, excluded participants gambled longer when presented with an anthropomorphized slot machine. However, the gambling behavior of excluded and included participants was no different when participants were reminded that slot machines are inanimate objects. Finally, positive and negative game experience mediated the influence of both inclusionary status and anthropomorphism on gambling. Overall, this research identifies another potential vulnerability produced by experiences of social exclusion, namely, gambling behavior. Implications for pathological gambling and future research directions are outlined.

The hidden side of the Ultimatum Game: The role of motivations and mind-reading in a two-level one-shot Ultimatum Game

The main aim of our study is to investigate the role of motivations and mind-reading in a two-level one-shot Ultimatum Game with three players. Our intention is to analyse subjects’ behaviour in both the responder and proposer roles. In the responder role, we found that the difference between the subjects’ expectations and the actual offers was the major factor that influenced their decisions and motivations in receiving money. In the proposer role, our results showed a significant influence of mind-reading, with a positive association between the fairness of subjects’ offers and the subjects’ expectations about the recipients’ willingness to accept. Although a shared concept of fairness exists findings suggest that decisions and motivations seem to depend on expectations, either when they are directly experienced or when they are ascribed to the counterpart.