In addition to the use of coping strategies generally shared by all Americans, research has shown that African Americans tend to make use of culture and race-specific coping styles that distinguish ...them from other racial/ethnic group populations. These coping styles are important for the negotiation of multiple types of stressors. Little has been written on the antecedents of culture and race-specific coping (i.e., Africultural coping and John Henryism). This exploratory online investigation sought to determine if childhood racial-ethnic socialization (i.e., a cultural practice and protective factor) experiences predicted present self-reported culture and race-specific coping among a group of African American college students (N = 191). Results indicated that past racial socialization messages encouraging participants to engage in positive cross-racial interactions (i.e., cross-racial relationship messages) were positively predictive of spiritual-centered and collective coping. Racial socialization messages that prescribed how participants should cope with racism were negatively associated with prolonged, active high-effort coping (i.e., John Henryism). Ethnic socialization messages emphasizing participation in African American cultural activities (i.e., African American heritage messages) positively predicted spiritual-centered, collective, and ritual-centered coping. Finally, ethnic socialization messages encouraging participants to have respect for authority figures, retain close relationships with family members, and maintain a collectivistic orientation (i.e., African American cultural values messages) were negatively predictive of John Henryism. Taken together, childhood racial-ethnic socialization experiences are an important resource for coping during college.
Abstract Background The quality of life (QOL) of caregivers of patients with LVAD-DT (Left Ventricular Assist Device as Destination Therapy) has not been well explored. Methods We used a concurrent ...mixed methods design. Caregivers (n = 42; average 60 years old, 82% female, 75% white) of patients (n = 39; average 68.3 years old, 83% male, 90% white) and providers (n = 27) from 6 LVAD-DT programs were recruited. We used the City of Hope Quality of Life Family Caregiver instrument, modified for LVAD-DT. Lower scores indicate poorer QOL. We analyzed open-ended questions with the use of Nvivo 10.0, using a modified grounded theory approach. Results The Psychologic subscale had the lowest average QOL score, followed by Social, Spiritual, and then Physical subscales. The composite mean average QOL score across the subscales was highest in caregivers <40 years of age and ≥70 years of age. There was a nonsignificant trend toward better QOL in male caregivers ( P = .06). We sorted QOL items into tertiles based on the percentage of responses <5 (10-point Likert scale). Scores <5 in the 2nd tertile (items from Social and Spiritual subscales) were reported by many fewer respondents than the 1st tertile (items from the Psychologic subscale). In the 3rd tertile, <10% of respondents scored <5 on 15 of the items. In qualitative interviews psychologic and social themes predominated in discussing requisites for competent caregivers, stress in pre-implantation decision making, lack of psychologic preparation, impact on freedom/independence, daily worry about pump performance, and value of psychologic and social support. Conclusion Support interventions for caregivers of patients with LVAD-DT should address the psychologic and social aspects that lead to poor QOL.
This study examined hope, optimism, self‐esteem, social support, stress, and indices of subjective well‐being (SWB) in 137 low‐income, urban, ethnic minority adolescents. Hope, optimism, and ...self‐esteem were significant predictors of SWB indices, but stress predicted only 1 SWB index: negative affect. No moderators of stress and negative affect were identified.
Este estudio examinó la esperanza, optimismo, autoestima, apoyo social, estrés e índices de bienestar subjetivo (SWB, por sus siglas en inglés) de 137 adolescentes urbanos de minorías étnicas y bajo nivel de ingresos. La esperanza, el optimismo y la autoestima fueron indicadores de predicción de los índices de SWB, pero el estrés predijo solamente un índice de SWB: el afecto negativo. No se identificaron moderadores del estrés y el afecto negativo.
The purpose of this study was to determine whether uncontrollable stress related to levels of subjective well-being (SWB) in a group of ethnically diverse urban adolescents. Additionally, the ...researchers examined what types of coping skills were utilized in the face of high levels of uncontrollable stress. Finally, a moderation model was proposed, wherein active coping was hypothesized to exacerbate the inverse relationship between uncontrollable stress and SWB. A group of 147 diverse, urban adolescents were surveyed. Data were analyzed using correlational analysis, hierarchical multiple regression, and stepwise multiple regression. Results revealed that uncontrollable stress was significantly related to negative affect (NA) and active coping strategies were associated with positive affect (PA) and NA. Active coping did serve as a moderator of the relationship between NA and uncontrollable stress, but in an unpredicted direction. Higher levels of uncontrollable stress were related to higher levels of NA and the use of active coping strategies was associated with higher levels of PA. The finding that active coping did not exacerbate the relationship between NA and uncontrollable stress suggests that adolescents may benefit psychologically from exercising agency over stressors in their lives.
High rates of right ventricular failure continue to affect postoperative outcomes in patients implanted with left ventricular assist devices (LVADs). Development of right ventricular failure and ...implantation with right ventricular assist devices is known to be associated with significantly increased mortality. The model for end-stage liver disease (MELD) score is an effective means of evaluating liver dysfunction. We investigated the prognostic utility of postoperative MELD on post-LVAD implantation outcomes. MELD scores, demographic data, and outcomes including length of stay, survival, and postoperative right ventricular failure were collected for 256 patients implanted with continuous flow LVADs. Regression and Kaplan–Meier analyses were used to investigate the relationship between MELD and all outcomes. Increased MELD score was found to be an independent predictor of both right heart failure and necessity for RVAD implantation (OR 1.097, CI 1.040–1.158,
p
= 0.001; OR 1.121, CI 1.015,
p
= 0.024, respectively). Patients with RV failure and who underwent RVAD implantation had reduced postoperative survival compared to patients with RV dysfunction (no RV failure = 651.4 ± 609.8 days, RV failure = 392.6 ± 444.8 days, RVAD = 89.3 ± 72.8 days;
p
< 0.001). In conclusion, MELD can be used to reliably predict postoperative right heart failure and the necessity for RVAD implantation. Those patients with RV failure and RVADs experience significantly increased postoperative mortality compared to those without RV dysfunction.
The association between extreme body mass index (BMI) and outcomes in left ventricular assist device (LVAD) patients has not been well established. With the commercial use of LVADs a larger number of ...patients with a BMI >40 have undergone device implantation. The purpose of this study was to evaluate the short and long-term outcomes of LVAD patients with extreme obesity.
A retrospective review of all patients (n=383) at our center who received a LVAD as primary implant between 2005-2015 was performed. Demographics, preoperative laboratory values, and postoperative outcomes were analyzed. Patients were divided into three groups based on BMI (kg/m
) classification (group 1: ≤25; group 2: 25 to 35; group 3: ≥35) and compared using one-way analysis of variance (ANOVA), Kruskal-Wallis and Chi-squared analysis as appropriate.
Comparison of postoperative outcomes demonstrated an increased risk of respiratory failure and right ventricular (RV) failure in patients with a BMI ≥35 (range, 35-59). Length of stay, sternal infection, driveline/pocket infection, systemic infection, GI-bleeding, and neurological events within the first year of device therapy were not related to BMI. Survival at 30-day, 1- and 2-year was not significantly different among the three groups. The group with the smallest BMI demonstrated an increased risk for re-operative bleeding.
Despite an increased risk of early morbidity in patients with extreme obesity, long term survival was not significantly different between the BMI groups. Careful consideration is recommended when evaluating patients with an excessive BMI for LVAD therapy although it should not be a contraindication for device placement.
This study examined the relationship between subjective well-being criteria (negative affect, positive affect, and subjective well-being) and individual, family, friend, school, and neighborhood ...predictor variables in 159 ethnically diverse, urban adolescents. Results indicated that negative affect was significantly predicted by family variables, positive affect was significantly predicted by individual, school, and friend variables, and satisfaction with life was significantly predicted by individual and family variables. Limitations, directions for future research, and clinical implications of these findings are discussed.
Left ventricular assist devices (LVADs) have become an increasingly popular and effective means for treating advanced heart failure. LVAD implantation requires extensive surgery and postoperative ...rehabilitation. The Functional Independence Measure (FIM) has been used to quantify functional gains in numerous patient populations, including those with stroke and spinal cord injury. This study investigated functional improvements in patients undergoing LVAD implantation using the FIM score.
To assess functional improvements in patients with advanced heart failure who underwent LVAD implantation.
Retrospective.
Inpatient rehabilitation unit.
Ninety consecutive patients who received acute inpatient rehabilitation after continuous flow LVAD implantation.
Demographic, laboratory, and functional outcomes data including inpatient rehabilitation unit (IRU) length of stay (LOS), discharge disposition, and FIM score were collected for all patients. Paired t-tests were used to assess change in functional measures and laboratory data.
Primary outcome measures included FIM gain, FIM efficiency, discharge disposition, rates of readmission after discharge from rehabilitation, and LOS in the rehabilitation unit.
The FIM gain was statistically significant at 28.4 ± 12.3 (P < .001) and compared favorably with benchmarks for mean FIM gains at our facility (26.4), regionally (21.5), and nationally (22.7) for patients admitted to IRUs with a cardiac diagnosis. FIM efficiency (FIM gain/IRU LOS) was 1.9 ± 1.0 compared with the mean FIM efficiency at our facility (2.2), regionally (2.1), and nationally (2.2). Seventy-four percent (n = 67) of patients were discharged directly home after inpatient rehabilitation, 17% (n = 16) were readmitted to the acute hospital service, and 8% (n = 7) required additional rehabilitation at a subacute rehabilitation facility. The IRU LOS was 16.2 ± 6.9 days.
Our study indicates that most patients with an LVAD achieve clinically meaningful functional gains from acute inpatient rehabilitation, with the majority of patients being discharged home. Further studies need to be performed to analyze clinical outcomes after acute inpatient rehabilitation.
IV.
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