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Medicine Apr 2021Gallbladder neuroendocrine carcinoma (GB-NEC) is rare and there are few reports at present. We sought to review the current knowledge of GB-NEC and provide... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Gallbladder neuroendocrine carcinoma (GB-NEC) is rare and there are few reports at present. We sought to review the current knowledge of GB-NEC and provide recommendations for clinical management.
METHODS
A systemic literature research was conducted in the websites of Pubmed, Medline, Web of Science, CNKI, Wanfang Data using the keywords including gallbladder combined with neuroendocrine carcinoma or neuroendocrine tumor or neuroendocrine neoplasm. Two reviewers independently screened the articles by reading the title, abstract and full-text.
RESULTS
In computed tomography (CT) and magnetic resonance imaging (MRI) examination, a well-defined margin, gallbladder replacing type with larger hepatic and lymphatic metastases could be helpful for differential diagnosis of GB-NEC and gallbladder adenocarcinoma (GB-ADC). Older age, unmarried status, large tumor size (>5 cm), positive margins, and distant Surveillance, Epidemiology and End result (SEER) stage are independently associated with poor survival. Surgical resection remains as the preferred and primary treatment. The potential survival benefit of lymphadenectomy for patients remains controversial. Platinum-based postoperative adjuvant chemotherapy may improve the survival. The efficacy of other treatments including immunotherapy, targeted therapy and somatostatin analogue needs further investigation.
CONCLUSION
Typical imaging features could be helpful for preoperative diagnosis. Age, margin status, tumor size, marital status, histopathologic subtype and SEER stage may be independent predictors for the survival. Remarkable advances regarding the treatment for GB-NEC have been achieved in recent years. Further studies are needed to investigate the survival benefit of lymphadenectomy for patients with GB-NEC.
Topics: Carcinoma, Neuroendocrine; Combined Modality Therapy; Gallbladder Neoplasms; Humans; Prognosis; Survival Rate
PubMed: 33832150
DOI: 10.1097/MD.0000000000025449 -
BMC Psychiatry Dec 2023Population and aging are major contributing factors influencing the increase in substance use disorder (SUD), which in itself affects mental health, particularly anxiety... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND & OBJECTIVES
Population and aging are major contributing factors influencing the increase in substance use disorder (SUD), which in itself affects mental health, particularly anxiety and depression. Cognitive behavioral therapy (CBT) and pharmacotherapy co-treatment are considered the gold standard for the treatment of SUD. Thus, the present study has been carried out to investigate the efficacy of brief CBT on the general health of opioid users.
METHODS
A randomized controlled trial (RCT) was conducted with forty opioid users whose addiction was dully confirmed by a psychiatrist at the drop-in center of the Ahvaz Jundishapur University of Medical Sciences. The patients were then randomly divided into two equal groups (n = 20). The control group was treated solely using methadone maintenance therapy (MMT); however, the intervention group underwent four sessions of CBT in addition to MMT. The general health questionnaire (GHQ) consisting of 28 items (Goldberg, 1979) was applied to both groups at the beginning and end of the study. The collected data was analyzed using IBM SPSS ver. 26, and data analysis was carried out using chi-square, t-test, Mann-Whitney, and Poisson regression model. P < 0.05 was statistically significant for all the aforementioned tests.
RESULTS
The mean age for the control and intervention groups were 37.95 ± 7.64 and 43.85 ± 9.92, respectively (p = 0.042). There was no statistically significant difference in terms of gender and levels of education (p = 0.311 and p = 0.540). Both groups differed statistically regarding marital status and occupation (p = 0.025 and 0.002). There was no significant statistical difference in all subclasses and the total scores of GHQ-28 for both groups, except for anxiety and insomnia in the intervention group (p = 0.038). After applying a Likert scale with a 23-point cut-off score, there was no statistically significant difference in terms of psychosis after intervention in the intervention group (p = 0.077).
CONCLUSION
The results of the current study show that brief CBT is effective on psychiatric health, especially anxiety and sleep disorders, whereas brief CBT fails to affect the patient's depression, somatic symptoms, and social dysfunction.
TRIAL REGISTRATION
The Iranian Registry of Clinical Trials (IRCT) approved the study design (IRCT registration number: IRCT20190929044917N1, registration date: 13/01/2020).
Topics: Humans; Mental Health; Analgesics, Opioid; Treatment Outcome; Substance-Related Disorders; Cognitive Behavioral Therapy
PubMed: 38066514
DOI: 10.1186/s12888-023-05413-4 -
Clinical Practice and Epidemiology in... 2021Divorce rates have increased during the last decade, leading to a greater focus of marital scholars on the importance of understanding couple-maintaining strategies...
BACKGROUND
Divorce rates have increased during the last decade, leading to a greater focus of marital scholars on the importance of understanding couple-maintaining strategies within marital life. Distresses in couples are attributable to difficulties controlling felt, experienced, and expressed emotions; thus, emotion dysregulation is a core stressor in couples with maladaptive responses.
OBJECTIVE
The aim of the study was to evaluate the effect of Dialectical Behaviour Therapy (DBT) on outpatient couples to treat emotion dysregulation.
METHODS
We recruited 20 couples with marital distress in which partners presented emotion dysregulation. We offered the couples the opportunity to join a couple DBT group at their convenience and based on the immediate availability of treatment slots. We measured the treatment efficacy using psychometric tools (the Difficulties in Emotion Regulation Scale (DERS) and the Dyadic Adjustment Ccale (DAS) at baseline and after DBT therapy.
RESULTS
Both male and female partners presented significant improvements in marital adjustment DAS and emotion regulation scores. Female partners showed significantly greater amplitude changes in both scales. Female partners showed significant improvement in most DERS subscales (except the GOALS subscale); on the other hand, male partners showed significant improvements in impulse, awareness, strategies, and clarity subscales. We found significant improvements in most DAS subscales in both sexes; only affectional expression remained unchanged before and after therapy.
CONCLUSION
DBT for couples is an effective approach to treat emotion dysregulation.
PubMed: 34733351
DOI: 10.2174/1745017902117010121 -
Reproductive Health Feb 2020Studies showed that decreased marital satisfaction and increased risk of depression and anxiety were mutually related. Therefore, this study was conducted to evaluate... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Studies showed that decreased marital satisfaction and increased risk of depression and anxiety were mutually related. Therefore, this study was conducted to evaluate the effect of communication skills training with a couple focused approach on marital satisfaction and psychological symptoms among pregnant women.
METHODS
This experimental study was performed on 60 pregnant women with low marital satisfaction who were divided into two groups of intervention and control. The women in the intervention group and their husbands participated in a communication training program based on the couple focused approach. The levels of anxiety, depression, and marital satisfaction were evaluated before and then one and three months after the intervention using valid questionnaires.
RESULTS
The results indicated that after the intervention, compared to the pre-intervention period, the levels of marital satisfaction increased while the levels of depression and anxiety decreased significantly in the intervention group (p < 0.05). The comparison of the groups revealed significant differences in the scores of marital satisfaction, depression, and anxiety in the intervention and control groups at the intervals of one month and three months after the intervention (p < 0.05).
CONCLUSIONS
The research findings indicated that communication skills training program based on the couple focused approach and an emphasis on the needs of pregnant women during the pregnancy can improve the marital satisfaction and psychological health of pregnant women.
TRIAL REGISTRATION
Iranian Registry of Clinical Trials IRCT2017012932264N2, Date of registration: 2017-06-28 Retrospectively registered.
Topics: Adult; Anxiety; Communication; Depression; Female; Humans; Male; Marital Therapy; Marriage; Pregnancy; Pregnancy Complications
PubMed: 32041615
DOI: 10.1186/s12978-020-0877-4 -
Journal of Education and Health... 2023Marital satisfaction and positive emotional experience towards one's spouse has always been effective in preserving and surviving the family, therefore one of the...
BACKGROUND
Marital satisfaction and positive emotional experience towards one's spouse has always been effective in preserving and surviving the family, therefore one of the concerns of family specialists is to improve these two structures in the family. This research was conducted with the aim of the effectiveness of imago therapy on marital satisfaction and emotional experience towards spouse among married men with conflict in Isfahan city.
MATERIALS AND METHODS
The research was semi-experimental with a pre-test and post-test design with experimental and control groups. The statistical population was all married and conflicted men of Isfahan city in the year 1400, from whom a sample of 40 people was selected as available and non-randomly placed in an experimental group and a control group. The measurement tools were Inridge marital satisfaction scale with Cronbach's alpha above 0.80 and emotional experience towards spouse with Cronbach's alpha above 0.92 for each subscale). Both research groups were evaluated by research tools before and after training. While the control group was on the waiting list, the experimental group received Imago therapy. The collected data were analyzed using descriptive statistics (mean and standard deviation) and inferential statistics (multivariate covariance analysis).
RESULTS
The results showed that imago therapy had a significant effect on the improvement of marital satisfaction and the dimensions of emotional experience towards the spouse ( = 0.01).
CONCLUSION
According to the present results, it can be said that this method can help family counselors to use this method to improve marital satisfaction and emotional experience towards the spouse and thereby reduce marital conflicts. He used this integrated method.
PubMed: 38333153
DOI: 10.4103/jehp.jehp_520_22 -
Journal of Marital and Family Therapy Oct 2022A paradigmatic shift toward postmodern, collaborative practice in family therapy raises questions about how therapists can use professional authority to facilitate...
A paradigmatic shift toward postmodern, collaborative practice in family therapy raises questions about how therapists can use professional authority to facilitate change and how clients can assert their knowledge and agency. We used conversation analysis to investigate how the authority to know and to determine here-and-now action (i.e., who does what, and how, in therapy) was negotiated and accomplished in 10 sessions of emotion-focused therapy involving chair work. Therapists were observed to rely on a particular interactional sequence structure: stepwise entry into a directive, in which directives were preceded by a question-answer sequence. We show how instances where clients' views were elicited prior to the delivery of a directive resulted in different interactional consequences from instances where therapists straightforwardly directed clients to perform some action. The study offers evidence concerning how therapists can facilitate chair work collaboratively and responsively.
Topics: Communication; Family Therapy; Humans; Professional-Patient Relations
PubMed: 33629443
DOI: 10.1111/jmft.12471 -
JAMA Network Open Aug 2023In addition to technical barriers, public attitudes about the use of gene therapy have an important association with the clinical implementation of gene therapy.
IMPORTANCE
In addition to technical barriers, public attitudes about the use of gene therapy have an important association with the clinical implementation of gene therapy.
OBJECTIVE
To investigate the factors associated with public acceptance of gene therapy among individuals in China.
DESIGN, SETTING, AND PARTICIPANTS
This cross-sectional study used data from a survey conducted among 21 880 individuals in mainland China from June 20 to August 31, 2022.
MAIN OUTCOMES AND MEASURES
Stepwise linear regression was used to analyze factors associated with public acceptance of gene therapy in 5 key areas: basic personal information (gender, region, age, and educational level), family situation (marital status, children, and cousins), economic status (assets, debts, and insurance coverage), health knowledge (health literacy score and media use), and physical health status (chronic illness, cancer, European Quality of Life 5-Dimension 5-Level version [EQ-5D-5L] score, and Brief Illness Perception Questionnaire [BIPQ] score). Acceptance scores were calculated based on a visual analog scale (range, 0-100, with higher scores indicating higher acceptance of gene therapy). Further subgroup analysis was carried out in different age subgroups and populations with or without chronic diseases.
RESULTS
A total of 21 880 participants (mean [SD] age, 39.4 [18.9] years; 10 947 female participants [50.0%]; 10 933 male participants [50.0%]) were analyzed in this study. The mean (SD) acceptance score of gene therapy in the survey was 60.56 (27.60). Compared with people aged 60 years or older, those aged 12 to 18 years had higher acceptance of gene therapy (β = 1.48 [95% CI, 0.09-2.88]), while groups aged 19 to 30 years (β = -3.43 [95% CI, -4.80 to -2.07]), 31 to 44 years (β = -1.44 [95% CI, -2.76 to -0.12]), and 45 to 59 years (β = -2.05 [95% CI, -3.27 to -0.83]) had lower acceptance. Compared with people living in Eastern China, those in Central China had lower acceptance of gene therapy (β = -1.58 [95% CI, -2.54 to -0.62]), while those in Western China had higher acceptance (β = 0.92 [95% CI, 0.09-1.76]). Higher educational level (undergraduate or above vs junior high or below) was associated with higher acceptance of gene therapy (β = 1.56 [95% CI, 0.49-2.63]). Number of properties owned was also associated with higher acceptance of gene therapy (2 vs 0: β = 2.38 [95% CI, 1.04-3.72]; ≥3 vs 0: β = 4.66 [95% CI, 2.92-6.39]). Diagnosis of chronic disease was associated with lower acceptance of gene therapy (β = -17.86 [95% CI, -20.49 to -15.24]), while diagnosis of cancer was associated with higher acceptance (β = 6.99 [95% CI, 1.84-12.14]). Higher BIPQ score (β = 0.40 [95% CI, 0.34-0.45]), higher health literacy score (β = 0.70 [95% CI, 0.62-0.78]), and media use (β = 0.49 [95% CI, 0.41-0.57]) were all associated with high acceptance of gene therapy, while a higher EQ-5D-5L score was associated with lower acceptance (β = -0.29 [95% CI, -0.47 to -0.11]). For older people, being in debt, not having health insurance, and the EQ-5D-5L score were uniquely relevant factors. For people with chronic disease, having an undergraduate degree or higher, a diagnosis of cancer, and the BIPQ score were uniquely relevant factors.
CONCLUSIONS AND RELEVANCE
These results suggest that basic personal information, economic status, health knowledge, and physical health status were the main factors associated with the acceptance of gene therapy. Improving the health literacy of the population and promoting trust in gene therapy may be effective ways to increase the acceptance of gene therapy. Poorer economic levels and worse disease states may reduce the public's willingness to accept gene therapy.
Topics: Child; Humans; Male; Female; Aged; Adult; Quality of Life; Cross-Sectional Studies; China; Neoplasms; Chronic Disease; Attitude
PubMed: 37566417
DOI: 10.1001/jamanetworkopen.2023.28352 -
BMC Public Health Nov 2020The importance of socioeconomic status for survival in cirrhosis patients is more or less pronounced within different populations, most likely due to cultural and...
BACKGROUND
The importance of socioeconomic status for survival in cirrhosis patients is more or less pronounced within different populations, most likely due to cultural and regional differences combined with dissimilarities in healthcare system organisation and accessibility. Our aim was to study the survival of patients with cirrhosis in a population-based Swedish cohort, using available data on marital status, employment status, and occupational skill level.
METHODS
We conducted a retrospective cohort study of 582 patients diagnosed with cirrhosis in the Region of Halland (total population 310,000) between 2011 and 2018. Medical and histopathologic data, obtained from registries, were reviewed. Cox regression models were used to estimate associations between survival and marital status (married, never married, previously married), employment status (employed, pensioner, disability retired, unemployed), and occupational skill level (low-skilled: level I; medium-skilled: level II; medium-high skilled: level III; professionals: level IV); adjusting for sex, age, aetiology, Model for End-stage Liver Disease (MELD) score, Child-Pugh class, and comorbidities.
RESULTS
Alcohol was the most common aetiology (51%). Most patients were male (63%) and the median age was 66 years. Occupational skill level was associated with the severity of cirrhosis at diagnosis and the prevalence of Child-Pugh C gradually increased from professionals through low-skilled. The mean survival for professionals (6.39 years, 95% CI 5.54-7.23) was higher than for low-skilled (3.00 years, 95% CI 2.33-3.67) and medium-skilled (4.04 years, 95% CI 3.64-4.45). The calculated hazard ratios in the multivariate analysis were higher for low-skilled (3.43, 95% CI 1.89-6.23) and medium-skilled (2.48, 95% CI 1.48-4.12), compared to professionals. When aggregated, low- and medium-skilled groups also had poorer mean survival (3.79 years, 95% CI 3.44-4.14; vs 5.64 years, 95% CI 5.00-6.28) and higher hazard ratios (1.85, 95% CI 1.32-2.61) compared to the aggregated medium-high skilled and professional groups. Marital and employment status were not statistically significant predictors of mortality in the multivariate analysis.
CONCLUSIONS
Occupational skill level was strongly associated with mean survival and mortality risk. Poorer prognosis among patients with low and medium occupational skill level could not be explained by differences in sex, age, marital status, employment status, MELD score, Child-Pugh class, or comorbidity.
Topics: Adult; Aged; Aged, 80 and over; Female; Health Status Disparities; Humans; Liver Cirrhosis; Male; Marital Status; Middle Aged; Retrospective Studies; Risk Assessment; Social Class; Sweden
PubMed: 33256682
DOI: 10.1186/s12889-020-09783-2 -
Advanced Biomedical Research 2023Sexual desire and sexual activity are natural needs of human beings, which can be problematic and lead to various sexual disorders, if not used in the right way,...
BACKGROUND
Sexual desire and sexual activity are natural needs of human beings, which can be problematic and lead to various sexual disorders, if not used in the right way, including hypersexuality. The present study aimed to compare the effect of dialectical behavior therapy (DBT) and aripiprazole drug on marital instability in patients with hypersexuality.
MATERIALS AND METHODS
This experimental case--control Pretest--Posttest Control Group Design with follow up was done on 27 male and female patients with hypersexuality having at least a higher education degree selected from four hospitals and psychiatric centers including Khorshid Hospital, Asgariyeh Specialized Hospital, Farhangian Clinic and Imam Reza Medical Center in Isfahan and were randomly assigned to two groups of treatment (nine patients in every group) and one group of control (nine patients) after adjusting the age and gender. Pretest phase was done for both three groups using Marital Instability Index (MII). The first treatment group underwent DBT intervention for eight sessions of 2 hours (once a week), and the second experimental group was prescribed aripiprazole for 2 months. Afterwards, the posttest and follow-up were performed for all the three groups. The data were analyzed using SPSS 24 and multivariate analysis of covariance (MANCOVA).
RESULTS
The findings showed that DBT and aripiprazole had little effect on the problem of marital instability in patients with hypersexuality ( > 0.05); also, there was no significant difference between the effect of DBT and aripiprazole ( > 0.05).
CONCLUSION
DBT and the drug aripiprazole cannot have a significant effect on the marital instability in patients.
PubMed: 37694240
DOI: 10.4103/abr.abr_161_22 -
International Journal of Environmental... Nov 2022Rheumatoid arthritis (RA) is a chronic systemic disease of connective tissue with periods of exacerbation and remission. Fatigue is excessive strain throughout the body...
Rheumatoid arthritis (RA) is a chronic systemic disease of connective tissue with periods of exacerbation and remission. Fatigue is excessive strain throughout the body that is disproportionate or unrelated to an activity or lifestyle. Fatigue is an integral part of RA in most patients. The study aimed to assess the level of fatigue in RA patients and establish the relationship between fatigue and demographic and clinical factors. The study group consisted of 128 RA patients according to European League Against Rheumatism (EULAR) criteria. The Functional Assessment of Chronic Illness Therapy-Fatigue and -Medical Outcomes Study Short Form 36 (SF-36) vitality scores were used to assess the severity of fatigue symptoms. The analyzed variables were gender, age, disease duration, education, marital status, place of residence, work and residence status, pharmacological treatment, pain, morning stiffness, hemoglobin, C-reactive protein (CRP), rheumatoid factor (RF), compression soreness, Richie Articular Index, and DAS28 disease activity. The examined patients experience chronic fatigue-the mean value on the FACIT-F scale was 24.1 ± 9.1 points and on the SF-36 Vitality score was 14.2 ± 1.8 points. There is a relationship between the level of fatigue and pain, long-lasting morning stiffness, active disease, increased soreness of joints, and low hemoglobin values. When analyzing the symptom of fatigue, each patient should be approached individually, using the existing questionnaires or asking key questions to recognize the situation. The presence of fatigue symptoms should be considered during therapy and patient care by searching for and eliminating additional, intensifying stimuli and increasing its level.
Topics: Humans; Severity of Illness Index; Arthritis, Rheumatoid; Pain; Chronic Disease; Hemoglobins; Demography
PubMed: 36429400
DOI: 10.3390/ijerph192214681