Luca Vecchio

A short version of a HRQoL questionnaire for Italian and Japanese patients with Primary Biliary Cirrhosis

BACKGROUND The available self-report questionnaire for the quality of life in patients with primary biliary cirrhosis (PBC-40) is currently validated only in the British population but it lacks an evaluation of its dimensionality. AIMS To validate the Italian and Japanese versions of PBC-40 and to assess the dimensionality of the original structure of PBC-40 by a confirmatory factor analysis. PBC-40 was translated to Italian and Japanese using the forward-backward method and then reviewed in focus groups in the framework of a large multicentric study. METHODS A sample of 290 patients with PBC (125 Italian and 165 Japanese) was administered two questionnaires previously validated for PBC-specific (PBC-40) and general quality of life (SF-36). RESULTS The confirmatory model failed to fit adequately the original hypothesized structure. A principal component analysis led to a seven-factor structure, with exclusion of 13 items characterized by lower load; PBC-27 questionnaire was the final instrument. The validity of the PBC-27 was supported by its strong correlation with the SF-36 scores. CONCLUSION We here propose an alternative structure of the quality of life questionnaire for PBC, namely PBC-27, which appears to be effective in detecting the impact of PBC on quality of life in Italian and Japanese patients.

Social Support and Adherence to Treatment in Hypertensive Patients: A Meta-Analysis

BackgroundIt is important to examine factors associated with patient adherence to hypertension control strategies.PurposeA meta-analysis was conducted to examine whether social support was related to adherence to healthy lifestyle and treatment medication in hypertensive patients.MethodsJournal articles were searched in medical (CINAHL, MEDLINE), psychological (PsycINFO, PsycARTICLES), and educational (ERIC) electronic databases; in reference lists of selected papers; and in the reference list of a previous review.ResultsFindings of a set of meta-analyses indicated that (a) structural social support was not significantly related to overall adherence, (b) functional social support was significantly and positively related to overall adherence, (c) these findings were further confirmed in meta-analyses conducted on specific types of adherence, and (d) most results were characterized by heterogeneity across studies that was partially explained by moderator analyses.ConclusionsFunctional social support, but not structural social support, was associated with adherence in hypertensive patients.

L'efficacia di un intervento educativo-promozionale per la prevenzione della guida in stato alterato

Viene qui illustrato un intervento educativo-promozionale volto a prevenire la guida in stato alterato tra i giovani adulti. L’intervento e stato sviluppato facendo riferimento a un modello teorico che integra i modelli socio-cognitivi della psicologia della salute con la teoria delle Life Skills. Esso si propone di rendere le persone consapevoli dei propri comportamenti e di accrescere le loro risorse personali, al fine di aumentare il controllo che possono esercitare sulle proprie decisioni e condotte. L’intervento e articolato in 7 unita di lavoro, da implementare in piccoli gruppi, e prevede l’utilizzo di metodologie attive. L’efficacia dell’intervento e stata verificata confrontando i cambiamenti nei comportamenti e negli orientamenti verso la guida in stato alterato dei partecipanti con quelli riscontrati in un gruppo di controllo coinvolto in un intervento solo informativo. Per la valutazione si e fatto ricorso a metodologie quantitative e qualitative. I risultati hanno messo in luce come l’intervento sia stato in grado di modificare sia i comportamenti legati alla guida in stato alterato sia diverse determinanti psico-sociali che possono essere considerate antecedenti del comportamento attuale e futuro.

Teachers’ ideas about health: Implications for health promotion at school

Objectives: The study explores the relationships among teachers’ health representations, their ideas about health promotion, their working conditions and their involvement in health-promotion activities at school. Methods: A questionnaire was administered to 107 teachers in 86 schools in Milan (Italy). The questionnaire was structured in four parts: teachers’ involvement in health-promotion programmes, teachers’ representations of health and their ideas regarding methods for promoting health; some dimensions of teacher’s job characteristics (job overload, work group, collaboration with relatives); burn-out and job satisfaction; socio-demographics data of teachers and characteristics of the schools. Results: The results show that teachers have ambiguous health representations; however, the traditional idea of health as absence of illness was prevalent among the teachers surveyed. Regarding health-promotion activities, the teachers seemed to prefer health education programmes based on informative techniques. Some representations of health were connected to the importance that teachers attributed to health promotion and to teachers’ participation in health-promotion activities. Teachers’ working conditions appear not to be related to their involvement in health promotion. Conclusions: The majority of teachers involved in this study remained substantially linked to health education models and have not switched to the health-promotion approach. This could be related to teachers’ health representations. To encourage the adoption of the health promotion approach at school, changing teachers’ health representations could be a first step.

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).

[PP.32.04] PREDICTORS OF PWV PROGRESSION OVER A THREE YEARS FOLLOW UP: FOCUS ON PSYCHOLOGICAL CHARACTERISTICS

Objective: Abnormal large artery function plays an important role in the pathogenesis of cardiovascular (CV) diseases. Prior studies have suggested that the principal determinants of arterial stiffening are age, Blood Pressure (BP) and others CV risk factors such as dyslipidemia and diabetes. However the role of psychological characteristics on the long-term progression of arterial stiffness has not yet been evaluated. The aim of the current longitudinal study was to evaluate the psychological determinants of the Pulse Wave Velocity (PWV) progression over a 3 years follow-up period in treated hypertensives subjects. Design and method: We enrolled 350 consecutive 18–80 aged outpatients, followed by the Hypertension Unit of S. Gerardo Hospital (Monza, Italy) affected by essential hypertension. At baseline (T0) anamnestic data, clinical BP, laboratory data and PWV were evaluated; also psychological tests were performed. In a subgroup of 50 subjects, after a median follow-up time of 2.96 ± 0.33 years, we performed again psychological tests and PWV examination (T1). Psychological tests were administered by trained researchers for measuring perceived stress, resiliency factors (self-esteem, sense of coherence), and perceived social support. Results: At T0 the mean age was 55.9 ± 10.1years, SBP and DBP were 135.6 ± 17.7 and 82.5 ± 9.1mmHg and PWV was 8.6 ± 2.1m/s. Despite a significant improvement in the blood pressure control (from 72 to 84%; PAS from 135.6 ± 17.7 to 130.1 ± 14.2, p = 0.08; PAD from 82.5 ± 9.1 to 77.5 ± 9.4, p < 0.05), at follow-up examination PWV didn’t showed significant changes (from 8.6 ± 2.1 to 8.6 ± 2.4, p = 0.87) with a mean deltaPWV of −0.05 ± 2.8m/s. Focusing on PWV changes over the follow-up period and on psychological test, subjects where then divided accordingly to their deltaPWV in those in which an increase was showed and those in which the values decrease. For similar baseline values, subjects with positive deltaPWV showed higher T1 values of stress (37.4 ± 1.1vs36.8 ± 0.8, p = 0.02) and lower values of self-esteem (2.9 ± 0.5 vs 3.3 ± 0.4, p = 0.02), sense of coherence (4.4 ± 0.7vs4.9 ± 0.8, p = 0.02), and a worse family climate (3.5 ± 0.9vs4.1 ± 0.8, p = 0.02). No significant differences were showed regarding BP values and CV risk factors. Conclusions: The current longitudinal study shows that arterial stiffness didn’t shown any significant changes despite BP improvement. PWV increase is related to higher stress and lower self-esteem and familiar support.