Predicting short and long-term exercise intentions and behaviour in patients with coronary artery disease: A test of protection motivation theory

The purpose of this study was to examine the utility of protection motivation theory (PMT) in the prediction of exercise intentions and behaviour in the year following hospitalisation for coronary artery disease (CAD). Patients with documented CAD (n?=?787), recruited at hospital discharge, completed questionnaires measuring PMT's threat (i.e. perceived severity and vulnerability) and coping (i.e. self-efficacy, response efficacy) appraisal constructs at baseline, 2 and 6 months, and exercise behaviour at baseline, 6 and 12 months post-hospitalisation. Structural equation modelling showed that the PMT model of exercise at 6 months had a good fit with the empirical data. Self-efficacy, response efficacy, and perceived severity predicted exercise intentions, which, in turn predicted exercise behaviour. Overall, the PMT variables accounted for a moderate amount of variance in exercise intentions (23%) and behaviour (20%). In contrast, the PMT model was not reliable for predicting exercise behaviour at 12 months post-hospitalisation. The data provided support for PMT applied to short-term, but not long-term, exercise behaviour among patients with CAD. Health education should concentrate on providing positive coping messages to enhance patients’ confidence regarding exercise and their belief that exercise provides health benefits, as well as realistic information about disease severity.     

The relationship between self-reported oral symptoms and life-events

Abstract

This paper investigates whether eight specific life-events were related to self-reported chronic (persistent trouble over the last 12 months) and acute (trouble in the last 14 days) oral symptoms in a sample of 3861 civil servants aged 35-44 years. The results of a logistic regression analysis taking age, social class and gender into account showed that a range of life-events—marital or family problems other than divorce, death of a relative, personal serious illness, serious illness of a close relative, major financial difficulty and mugging and robbery—were significantly associated with either acute or chronic oral symptoms. Further analysis showed that marital or family problems other than divorce was found to be the most important life event studied. The results support the argument that marital dissatisfaction leads to poorer physical and psychological health.     

Work strain and the post-discharge adjustment of patients following a heart attack

Abstract

The role of work characteristics in determining return to work after an acute coronary event was examined. One hundred and forty nine patients were enrolled. One year post-discharge, 74 had returned to work. Work characteristics (decision latitude, and opportunity for social interaction at work), together with age, depression, and medical prognosis, correctly classified work status in 78% of cases. At 12 months post-discharge, patients who had not returned to work recorded significantly poorer levels of adjustment compared to those who had returned to work. A better quality of life is associated with a lower level of depression pre-hospitalization, ownership of a larger home, being male, and having a more positive work environment. The findings suggest that the pre-illness work environment of the patient is a factor influencing return to work, which needs to be considered in rehabilitation programmes.     

Lifestyle effects of group health education for patients with coronary heart disease

Abstract

In the present study, effects of a health education (INFO) and a PsychoEducational Prevention (INFO + PEP) Programme were Investigated in three hospitals. These programmes were offered to groups of coronary heart disease (CHD) patients and their partners alter discharge from hospital. The INFO was offered to 127 CHD patients in addition to FIT (i.e. standard medical care and physical training). The PEP was offered to 90 Patients in, addition to the INFO and FIT. A control group of 122 patients received only FIT. The INFO and the PEP consisted of four weekly two-hour group sessions each. In addition, the PEP was followed by seven telephone follow-up contacts.

On average, patients improved their lifestyles during the first three months. Between three and twelve months an extra improvement was found for eating habits, whereas there was a relapse for smoking and a sedentary lifestyle. In the short term, angina pectoris and a longer period of heart complaints were parallelled with a decrease in the risk of maintaining unhealthy eating habits, whereas in the long term a longer period of heart complaints a younger age and unemployment predicted a lower risk of maintaining unhealthy eating habits In the short term living with a partner and in the long term female gender were predictive of continued smoking behaviour In the short term, older age, a first CABG and a specific hospital setting decreased the risk of a continued sedentary lifestyle.

The FIT + INFO + PEP had a favourable short-term effect on eating habits. For smoking and a sedentary lifestyle, however, there were negative effects. In the short term patients in the FIT +INFO and those in the FIT +INFO+PEP had significantly more problems in quitting a sedentary lifestyle than those in the FIT intervention in the long term, patients in the FIT + INFO had significantly more problems in stopping smoking compared to these in the FIT.     

Rethinking ‘Don't Blame the Victim’

SUMMARY

The psychology of victims and the dynamics of victimhood have been largely ignored by scholars and clinicians. While in past years the tendency has been to blame victims, more recently the tide has turned. It is now politically incorrect to explore the role of victims in violent systems, as exploring the psychology of victims has become synonymous with blaming the victim. While shying away from blame, this article will explore the familial and cultural origins of victimhood, victims' characteristics, their relationships with the perpetrators, and it will offer a victim typology. As we move from btame to a more complex understanding of violent systems, the perpetuation of these systems in our culture, and the role victims play in these systems, we provide ourselves with better tools to predict and prevent further victimization.     

Religious Research in Gerontology, 1980–1994: A Systematic Review

ABSTRACT

This article presents results of an NIA-funded systematic review of research on religion and aging published from 1980–1994 in mainstream gerontology and religion journals, including the Journal of Religious Gerontology. Findings are summarized from 73 empirical studies, a subset of the 115 articles included in NIA's bibliography on this topic. In general, these studies use multiethnic samples, include multiple religious dimensions, and focus on age comparative analyses and on analyses of religious effects on life satisfaction, health, and well-being. Also summarized is gerontological research on patterns, predictors, outcomes, and measures of religious involvement, and an agenda for future research is proposed.     

Diagnosing depression in patients with physical diseases using the beck depression inventory (BDI)

Abstract

Four-hundred-and-forty-three patients with a physical illness (355 with coronary heart disease and 88 with chronic pain), 150 unemployed persons and 623 subjects from the normal population in Jämtland, Sweden were tested using the BDI (Beck Depression Inventory). The aim of the study was to investigate whether scores on both the physical and non-physical components of the BDI differed between the patients and the other groups, or whether only the physical component was significantly higher in the patient group, and in such a case whether this could be interpreted as symptomatic of physical disease and not of depression. A cutoff score of ≥ 10 to determine mild depression and two different alternative physical and non-physical components were used. Forty-three percent of the patients with coronary heart disease and 50% of patients with chronic pain were categorized as being at least mildly depressed. Factor analyses indicated that a physical component comprising five items was the most meaningful and could best discriminate the physical symptoms. The patients' scores were significantly higher than those of the other two groups on the physical component but only higher than the normal population sample on the nun-physical component. This supports the idea that the items for physical symptoms in the BDI might be confounding when determining depression in patients with physical diseases. The non-physical component seems to be the best indicator of depression and is recommended as a complement to the total BDI scale when determining the degree of depression in patients suffering from a physical disease.     

Cognitive-behavioural Treatment of a Patient Suffering from Menière's Disease

Abstract

Vertigo and dizziness may cause considerable discomfort and feelings of uncertainty. It is no surprise that vertigo is the most disabling symptom in Menière's disease, an inner ear disorder. The other two cardinal symptoms are tinnitus and hearing impairment. In this study, one severely disabled woman was treated with a cognitive-behavioural treatment comprising, among other components, relaxation training, stabilization of gaze, cognitive restructuring and behavioural task setting. The patient responded well to the treatment, during which her vertigo attacks disappeared. During the follow-up period, she experienced vertigo attacks again, but after two booster sessions the vertigo attacks vanished for the rest of the follow-up period. The results are further discussed.     

The Portuguese version of Addenbrooke’s Cognitive Examination–Revised (ACE-R) in the diagnosis of subcortical vascular dementia and Alzheimer’s disease

The aim of this study was to investigate the accuracy of the Portuguese version of Addenbrooke’s Cognitive Examination–Revised (ACE-R) in detecting and differentiating early stage subcortical vascular dementia (SVD) from early stage Alzheimer’s disease (AD). Ninety-two subjects (18 SVD patients, 36 AD patients, and 38 healthy controls) were assessed using the ACE-R. Between-group’s differences were evaluated using the Quade’s rank analysis of covariance. The diagnostic accuracy and discriminatory ability of the ACE-R were examined via receiver operating characteristic (ROC) analysis. The ACE-R was able to successfully discriminate between patients and healthy subjects. The mean ACE-R total scores differed between SVD and AD patients; there were also significant differences in attention and orientation and in memory measures between the groups. An optimal cut-off of 72/73 was found for the detection of AD (sensitivity: 97%; specificity: 92%) and SVD (sensitivity: 100%; specificity: 92%).