Depression, anxiety, stress, social interaction and health-related quality of life in men and women with unexplained chest pain

<p>Abstract</p> <p>Background</p> <p>Unexplained chest pain (UCP) is a common reason for emergency hospital admission and generates considerable health-care costs for society. Even though prior research indicates that psychological problems and impaired quality of life are common among UCP patients, there is lack of knowledge comparing UCP patients with a reference group from the general population. The aim of this study was to analyse differences between men and women with UCP and a reference group in terms of psychosocial factors as depression, anxiety, stress, social interaction and health-related quality of life (HRQOL).</p> <p>Methods</p> <p>A self-administered questionnaire about psychosocial factors was completed by 127 men and 104 women with acute UCP admitted consecutively to the Emergency Department (ED) or as in-patients on a medical ward. A reference group from the general population, 490 men and 579 women, participants in the INTERGENE study and free of clinical heart disease, were selected.</p> <p>Results</p> <p>The UCP patients were more likely to be immigrants, have a sedentary lifestyle, report stress at work and have symptoms of depression and trait-anxiety compared with the reference group. After adjustment for differences in age, smoking, hypertension and diabetes, these factors were still significantly more common among patients with UCP. In a stepwise multivariate model with mutual adjustment for psychosocial factors, being an immigrant was associated with a more than twofold risk in both sexes. Stress at work was associated with an almost fourfold increase in risk among men, whereas there was no independent impact for women. In contrast, depression only emerged as an independent risk factor in women. Trait-anxiety and a low level of social interaction were not independently associated with risk in either men or women. Patients with UCP were two to five times more likely to have low scores for HRQOL.</p> <p>Conclusion</p> <p>Both men and women with UCP had higher depression scores than referents, but an independent association was only found in women. Among men, perceived stress at work emerged as the only psychosocial variable significantly associated with UCP.</p

Coping strategies, stress, physical activity and sleep in patients with unexplained chest pain

BACKGROUND: The number of patients suffering from unexplained chest pain (UCP) is increasing. Intervention programmes are needed to reduce the chest pain and suffering experienced by these patients and effective preventive strategies are also required to reduce the incidence of these symptoms. The aim of this study was to describe general coping strategies in patients with UCP and examine the relationships between coping strategies, negative life events, sleep problems, physical activity, stress and chest pain intensity. METHOD: The sample consisted of 179 patients younger than 70 years of age, who were evaluated for chest pain at the emergency department daytime Monday through Friday and judged by a physician to have no organic cause for their chest pain. The study had a cross-sectional design. RESULTS: Emotive coping was related to chest pain intensity (r = 0.17, p = 0.02). Women used emotive coping to a greater extent than did men (p = 0.05). In the multivariate analysis was shown that physical activity decreased emotive coping (OR 0.13, p < 0.0001) while sex, age, sleep, mental strain at work and negative life events increased emotive coping. Twenty-seven percent of the patients had sleep problems 8 to14 nights per month or more. Permanent stress at work during the last year was reported by 18% of the patients and stress at home by 7%. Thirty-five percent of the patients were worried often or almost all the time about being rushed at work and 23% were worried about being unable to keep up with their workload. Concerning total life events, 20% reported that a close relative had had a serious illness and 27% had reasons to be worried about a close relative. CONCLUSION: Our results indicated that patients with more intense UCP more often apply emotive coping in dealing with their pain. Given that emotive coping was also found to be related to disturbed sleep, negative life events, mental strain at work and physical activity, it may be of value to help these patients to both verbalise their emotions and to become cognizant of the influence of such factors on their pain experience

Severe MUPS in a sick-listed population: a cross-sectional study on prevalence, recognition, psychiatric co-morbidity and impairment

Background: Medically unexplained physical symptoms (MUPS) have a high prevalence in the general population and are associated with psychiatric morbidity. There are indications that MUPS are an important determinant of frequent and long-term disability. The primary objective was to assess the prevalence of MUPS in sick-listed-employees and its associations with depressive disorders, anxiety disorders, health anxiety, distress and functional impairment. Secondary objectives were to investigate the classification of the occupational health physicians (OHPs), their opinions about the causes as well as the attributions of the employee. Methods: In a cross- sectional study of 489 sick-listed employees from 5 OHP group practices, MUPS, depressive disorders, anxiety disorders, health anxiety, distress and functional impairment were assessed with the Patient Health Questionnaire (PHQ), the Whitely Index (WI), the Four-Dimensional Symptom Questionnaire (4DSQ) and the Short-Form 36 Health Survey (SF-36). We used a cut off score of 15 on the PHQ for the categorisation of severe MUPS. The opinions of the OHPs were evaluated by means of a separate questionnaire with regard to the presence of employees physical symptoms, and the symptoms attributions, and the diagnoses of the OHPs. Results: Severe MUPS had a prevalence of 15.1% in this population of sick-listed employees. These employees had 4-6 times more depressive and anxiety disorders, and were more impaired. Female gender and PHQ-9 scores were determinants of severe MUPS. Most of the time the OHPs diagnosed employees with severe MUPS as having a mental disorder. The employees attributed their physical symptoms in 66% to mental or to both mental and physical causes. Conclusion: The prevalence of severe MUPS is higher in long-term sick-listed employees than in the non-sick-listed working population and at least equals the prevalence in the general practice population. Severe MUPS are associated with psychiatric morbidity and functional impairment and must therefore be specifically recognised as such. Validated questionnaires, such as the PHQ-15, are useful instruments in order to help OHPs to recognise severe MUPS

Noncardiac Chest Pain: Epidemiology, Natural Course and Pathogenesis

Noncardiac chest pain is defined as recurrent chest pain that is indistinguishable from ischemic heart pain after a reasonable workup has excluded a cardiac cause. Noncardiac chest pain is a prevalent disorder resulting in high healthcare utilization and significant work absenteeism. However, despite its chronic nature, noncardiac chest pain has no impact on patients' mortality. The main underlying mechanisms include gastroesophageal reflux, esophageal dysmotility and esophageal hypersensitivity. Gastroesophageal reflux disease is likely the most common cause of noncardiac chest pain. Esophageal dysmotility affects only the minority of noncardiac chest pain patients. Esophageal hypersensitivity may be present in non-GERD-related noncardiac chest pain patients regardless if esophageal dysmotility is present or absent. Psychological co-morbidities such as panic disorder, anxiety, and depression are also common in noncardiac chest pain patients and often modulate patients' perception of disease severity

Unexplained chest pain in men and women - symptom perception and outcome

Patients with chest pain account for a large number of all patients seeking health care. The majority of these patients are referred to emergency departments (ED) and many of them are given a discharge diagnosis of unexplained chest pain (UCP). Our knowledge of this increasing number of patients with UCP is limited. The overall aim of the thesis was to describe and analyse symptom perception, psychosocial factors, health-related quality of life (HRQOL) and outcome of unexplained chest pain (UCP) in men and women. The UCP patients’ symptoms and their influence on daily life in a gender perspective were explored in Paper I using open interview questions (11 men and 9 women). A cross-sectional design was used in Paper II, assessing pain characteristics using the Pain-O-Meter and measuring psychosocial factors and HRQOL with a self-administered questionnaire. The results were based on 101 men and 78 women consecutively admitted to an ED. In Paper III, psychosocial factors and HRQOL were compared between the UCP patients (127 men and 104 women) and a reference group, i.e. a subsample (490 men and 579 women) from the INTERGENE population study. Paper IV was a register study with data from the Swedish National Hospital Discharge Register, investigating trends in incidence and outcome among patients hospitalised with UCP, angina pectoris or acute myocardial infarction (AMI) in Sweden in 1987-2003 (n=559 879). The results showed that the men and women with UCP are generally middle-aged. More than a third of both UCP men and women were born outside Sweden and, compared with the reference group, the percentage of immigrants was significantly higher. UCP impacted negatively on the patients’ daily life, which was filled with worries due to the chest pain. Feelings of panic and fear of death in connection with the chest pain were reported. Words like “pressure” and “cramp” were used when describing the chest pain, with few gender differences. Significant correlations were found between pain intensity and smoking in men (p<0.01) and between pain intensity and age in women (p<0.05). Chest pain intensity was not significantly associated with the UCP patients’ reported HRQOL, apart from physical functioning in men (p<0.05), but it was rated lower than the reference group of both UCP men and women. The UCP men in particular reported stress at work. The women with UCP presented more depressive symptoms and more symptoms of trait anxiety than the men. Mental strain in marriage/cohabitation and a low level of social integration were significant risk factors only among women. Compared with the reference group, both men and women with UCP perceived more stress at work, symptoms of depression and trait anxiety and had less social interaction. Gender differences in physical activity during leisure time were reported, as more UCP males than females were physically active, although the UCP patients, both genders, were significantly more sedentary compared with the reference group. The UCP patients, both sexes, had a higher BMI and reported a lower alcohol consumption/week than the reference group. After increasing until about 2000, the number of hospitalisations with a discharge diagnosis of UCP appears to have stabilised, while hospitalisations for angina and AMI have continuously declined. Compared with patients with angina and AMI, the overall one-year observed mortality rate in UCP patients was lower. Between 1997 and 2003 the oneyear mortality among men with UCP was elevated by about one third, whereas women with UCP had no significant increase. In conclusion, UCP was related to symptoms that influenced life in several ways. In general the gender differences were few and the mortality within one year was low. The thesis illustrates the importance of a deeper understanding of symptom perception to achieve an individualised care of patients with UCP

Unexplained chest pain in men and women - symptom perception and outcome

Patients with chest pain account for a large number of all patients seeking health care. The majority of these patients are referred to emergency departments (ED) and many of them are given a discharge diagnosis of unexplained chest pain (UCP). Our knowledge of this increasing number of patients with UCP is limited. The overall aim of the thesis was to describe and analyse symptom perception, psychosocial factors, health-related quality of life (HRQOL) and outcome of unexplained chest pain (UCP) in men and women. The UCP patients’ symptoms and their influence on daily life in a gender perspective were explored in Paper I using open interview questions (11 men and 9 women). A cross-sectional design was used in Paper II, assessing pain characteristics using the Pain-O-Meter and measuring psychosocial factors and HRQOL with a self-administered questionnaire. The results were based on 101 men and 78 women consecutively admitted to an ED. In Paper III, psychosocial factors and HRQOL were compared between the UCP patients (127 men and 104 women) and a reference group, i.e. a subsample (490 men and 579 women) from the INTERGENE population study. Paper IV was a register study with data from the Swedish National Hospital Discharge Register, investigating trends in incidence and outcome among patients hospitalised with UCP, angina pectoris or acute myocardial infarction (AMI) in Sweden in 1987-2003 (n=559 879). The results showed that the men and women with UCP are generally middle-aged. More than a third of both UCP men and women were born outside Sweden and, compared with the reference group, the percentage of immigrants was significantly higher. UCP impacted negatively on the patients’ daily life, which was filled with worries due to the chest pain. Feelings of panic and fear of death in connection with the chest pain were reported. Words like “pressure” and “cramp” were used when describing the chest pain, with few gender differences. Significant correlations were found between pain intensity and smoking in men (p<0.01) and between pain intensity and age in women (p<0.05). Chest pain intensity was not significantly associated with the UCP patients’ reported HRQOL, apart from physical functioning in men (p<0.05), but it was rated lower than the reference group of both UCP men and women. The UCP men in particular reported stress at work. The women with UCP presented more depressive symptoms and more symptoms of trait anxiety than the men. Mental strain in marriage/cohabitation and a low level of social integration were significant risk factors only among women. Compared with the reference group, both men and women with UCP perceived more stress at work, symptoms of depression and trait anxiety and had less social interaction. Gender differences in physical activity during leisure time were reported, as more UCP males than females were physically active, although the UCP patients, both genders, were significantly more sedentary compared with the reference group. The UCP patients, both sexes, had a higher BMI and reported a lower alcohol consumption/week than the reference group. After increasing until about 2000, the number of hospitalisations with a discharge diagnosis of UCP appears to have stabilised, while hospitalisations for angina and AMI have continuously declined. Compared with patients with angina and AMI, the overall one-year observed mortality rate in UCP patients was lower. Between 1997 and 2003 the oneyear mortality among men with UCP was elevated by about one third, whereas women with UCP had no significant increase. In conclusion, UCP was related to symptoms that influenced life in several ways. In general the gender differences were few and the mortality within one year was low. The thesis illustrates the importance of a deeper understanding of symptom perception to achieve an individualised care of patients with UCP

Att förebygga CVK-relaterade infektioner - en litteraturstudie om sjuksköterskans åtgärder

Bakgrund: Centrala venkatetrar förekommer idag inte bara på intensivvårdsavdelningar utan har även blivit en vanlig företeelse på vårdavdelningar där allmänsjuksköterskan arbetar. Med CVK följer risker för infektioner, både lokala och systemiska. Vårdrelaterade infektioner, specifikt kateterrelaterade sådana, är ett stort problem inom sjukvården och medför såväl ökade vårdtider som ökade kostnader. Allmänsjuksköterskan ansvarar för handhavande och skötsel av CVK och har därmed en nyckelroll i att förebygga infektioner. Syfte: Att sammanställa vetenskaplig litteratur rörande hur allmänsjuksköterskan kan förebygga infektioner hos patienter med CVK inneliggande på vårdavdelning.Metod: Den valda undersökningsmetoden var en litteraturstudie. Databassökningar utfördes i Cinahl, PubMed och Cochrane Library. Efter kvalitetsgranskning inkluderades tio vetenskapliga artiklar med kvantitativ metod. Resultat: Åtgärder för förebyggande av infektion sorterades in under fyra rubriker: desinfektion, utbildning, omläggning och teknik vid byte av koppling. Åtgärderna inom dessa grupper visades minska förekomsten av kateterrelaterad infektion.Konklusion: Klorhexidinlösningar, desinfektionsproppar, utbildning samt semipermeabla förband kan leda till minskad förekomst av kateterrelaterade infektioner hos patienter med CVK. Eventuellt kan ”non-touch”-teknik vara ett alternativ vid byte av kopplingar. Mer forskning krävs gällande sjuksköterskans förebyggande åtgärder utanför IVA samt en mer enhetlig forskning för att skapa tydligare riktlinjer.Background: Central venous catheters today are not only common in intensive care units but have become a regular phenomenon in wards where non-specialised nurses work. With CVCs comes a risk for infections, both local and systemic. Hospital acquired infections, in particular catheter-related infections, are a major problem in health care and cause prolonged length of hospital stay as well as increased costs. The general nurse is responsible for the handling and care of CVCs, and therefore has a key part in preventing infections. Aim: To compile scientific literature regarding how the general nurse can prevent infections in patients with CVCs on general wards. Method: The chosen method of investigation was a literature review. A literature search was undertaken using Cinahl, PubMed and Cochrane Library. Following a quality assessment, ten scientific papers with a quantitative method were included. Results: Measures to prevent infection were sorted under four headlines: disinfection, education, dressing care, and technique for line changes. The measures within these groups were shown to reduce prevalence of catheter-related infections.Conclusion: Chlorhexidine solutions, disinfection caps, education and semipermeable dressings can lead to reduced prevalence of catheter-related infections in patients with CVCs. A “non-touch” technique may be a possible alternative when changing lines. More research is needed regarding preventive nursing measures outside the intensive care units, as well as more unified research to create clear guidelines

Att förebygga CVK-relaterade infektioner - en litteraturstudie om sjuksköterskans åtgärder

Bakgrund: Centrala venkatetrar förekommer idag inte bara på intensivvårdsavdelningar utan har även blivit en vanlig företeelse på vårdavdelningar där allmänsjuksköterskan arbetar. Med CVK följer risker för infektioner, både lokala och systemiska. Vårdrelaterade infektioner, specifikt kateterrelaterade sådana, är ett stort problem inom sjukvården och medför såväl ökade vårdtider som ökade kostnader. Allmänsjuksköterskan ansvarar för handhavande och skötsel av CVK och har därmed en nyckelroll i att förebygga infektioner. Syfte: Att sammanställa vetenskaplig litteratur rörande hur allmänsjuksköterskan kan förebygga infektioner hos patienter med CVK inneliggande på vårdavdelning. Metod: Den valda undersökningsmetoden var en litteraturstudie. Databassökningar utfördes i Cinahl, PubMed och Cochrane Library. Efter kvalitetsgranskning inkluderades tio vetenskapliga artiklar med kvantitativ metod. Resultat: Åtgärder för förebyggande av infektion sorterades in under fyra rubriker: desinfektion, utbildning, omläggning och teknik vid byte av koppling. Åtgärderna inom dessa grupper visades minska förekomsten av kateterrelaterad infektion. Konklusion: Klorhexidinlösningar, desinfektionsproppar, utbildning samt semipermeabla förband kan leda till minskad förekomst av kateterrelaterade infektioner hos patienter med CVK. Eventuellt kan ”non-touch”-teknik vara ett alternativ vid byte av kopplingar. Mer forskning krävs gällande sjuksköterskans förebyggande åtgärder utanför IVA samt en mer enhetlig forskning för att skapa tydligare riktlinjer.Background: Central venous catheters today are not only common in intensive care units but have become a regular phenomenon in wards where non-specialised nurses work. With CVCs comes a risk for infections, both local and systemic. Hospital acquired infections, in particular catheter-related infections, are a major problem in health care and cause prolonged length of hospital stay as well as increased costs. The general nurse is responsible for the handling and care of CVCs, and therefore has a key part in preventing infections. Aim: To compile scientific literature regarding how the general nurse can prevent infections in patients with CVCs on general wards. Method: The chosen method of investigation was a literature review. A literature search was undertaken using Cinahl, PubMed and Cochrane Library. Following a quality assessment, ten scientific papers with a quantitative method were included. Results: Measures to prevent infection were sorted under four headlines: disinfection, education, dressing care, and technique for line changes. The measures within these groups were shown to reduce prevalence of catheter-related infections. Conclusion: Chlorhexidine solutions, disinfection caps, education and semipermeable dressings can lead to reduced prevalence of catheter-related infections in patients with CVCs. A “non-touch” technique may be a possible alternative when changing lines. More research is needed regarding preventive nursing measures outside the intensive care units, as well as more unified research to create clear guidelines

Pre-Hospital Decision Process and Prognosis in Men and Women with Coronary Heart Disease

The overall aim of this thesis was to describe experiences, strategies and actions in the prehospital phase among patients with a first acute myocardial infarction and to examine long-term trends in survival among patients with coronary heart disease. The thesis consists of two qualitative and two quantitative studies. Interviews were conducted with 21 men and 17 women, experiencing symptoms from a first acute myocardial infarction (AMI) and analyzed with Grounded Theory. Two national prospective cohort studies were performed by using the Swedish Inpatient register (IPR). From this, prognosis for 37,276 adult patients 18 years who underwent a first coronary artery bypass (CABG) 1987-2006 could be estimated. During the decision process, various spectra of bodily changes were described in both men and women, sometimes over an extended period before submission to hospital. Intermittent, vague and insidious symptoms caused confusion about how to act. Vague symptoms sometimes experienced by the men did not match their preconception of typical symptoms in a myocardial infarction. To come to an understanding they compared with their past experiences which led to an awareness of the abnormality, the severity and the need for contact medical attention. The women usually attributed their symptoms to harmless conditions and struggled to continue with their responsibilities in their daily lives. Intensified symptoms made the women unable to perform their daily task and they could no longer maintain earlier explanations for their discomfort which contributed to an understanding for the need of professional help. Sometimes, when men and women sought medical attention for their discomfort, and had no objective signs of an AMI they were dismissed, with no diagnosis, which caused a hesitation to contact medical care once again. This emphasizes that health care professionals have to pay more attention to the patient’s narrative. In the quantitative part of the thesis younger men with a first AMI had a 2 to 4-fold risk for mortality compared to men in the same age in the general population while women had a 6 to 14-fold risk during the last study period (2002-2006). Survival increased during the study period in men. In women there was a favorable trend in survival until the last period 2002-2006 but survival then reverted to that in the second period (1992-1996) in the last period. Men and women ≥55 years surviving the first 30 days after CABG (coronary artery bypass grafting) showed a lower mortality risk than those in the general population and showed a decreasing trend in mortality during the study period. Women below the age of 55 showed no significant improvement in survival and had a 4-fold risk for mortality compared to women in the same age in the general population. Men <55 displayed improved survival, which was higher than that for men in the general population