• Anxiety, Apathy, and Depression in First-Time Stroke Survivors with Aphasia in the Post-Stroke Period

      Jackson, Maranda Christine; Thomas, Sue Ann, 1947- (2013)
      Emotional disorders specifically, anxiety, apathy and depression, in the post-stroke period are prevalent, long lasting and detrimental. Aphasia, an acquired communication disorder, is experienced by 40% of all stroke survivors. As the leading cause for disability, stroke affects multiple aspects of the stroke survivors life. Moreover, physical disability, social isolation, and emotional distress further complicate stroke rehabilitation compromising recovery and increasing mortality. Seventy-one percent of stroke studies exclude stroke survivors with aphasia. Thus, the impact of emotional distress in aphasic stroke survivors remains a gap within the stroke literature. This study examined emotional distress in first-time stroke survivors with aphasia in the post-stroke period. A descriptive, cross-sectional study design using non-probability sampling was used. Participants were recruited from rehabilitation hospitals, the community and a stroke database. Using primary data collection a sample size of 16 stroke survivors was obtained. A battery of instruments assessing aphasia, physiological, sociological, and neuropsychological aspects of stroke recovery were administered in a 2-hour interview session. Within this sample of stroke survivors with aphasia, 68.8% reported anxiety, 100% reported apathy, and 43.8% reported depression. With the majority of the population reporting apathy mixed disorders were identified. Sixty-eight percent of stroke survivors screened for anxiety and apathy and 66.7% reported depression and apathy. The mean stroke severity score was 2.2. Forty-three percent were functionally independent, 93.8% had below average neuropsychological scores, and 62.5% had left hemisphere lesions. Ethnicity and gender was associated with depression. Chi square analysis (p = .041, Fishers exact test) and Mann Whitney U associate non-blacks (n=8, Mdn=6.0) with higher depression scores than blacks (n=8, Mdn=2.5) (U= 12.000, z= -2.11, p=, 03). Emotional distress is a pervasive in stroke survivors with aphasia. Thoughtful selection of instruments modified for this stroke population may effectively detect post-stroke emotions. Despite the small sample size, this study contributes to the body of research by screening for social isolation, apathy, and neuropsychological status within this stroke sub-population. Going forward, incorporation of social, neuropsychological and psychological screening as standard of care in facilities serving the stroke population, will improve stroke outcomes in the stroke survivor with aphasia.
    • Coping in post-myocardial infarction patients and spouses/companions at risk for sudden cardiac death

      Rockelli, Laurie Ann; Thomas, Sue Ann, 1947- (2008)
      Families use coping to restore stability after introduction of an acute stressor. Depression and anxiety influence patient coping in post-MI patients and their spouse/companion. The Resiliency Model of Family Stress, Adjustment, and Adaptation explains how family type, severity of illness, prior stressors, resources, and psychological status predict coping. This study examined the contributions of these factors to coping in post-MI patients and their spouses/companions during acute stress. The "The Patients' and Families' Psychological Response to Home Automatic Defibrillator Trial (PRHAT)" surveyed 462 post-MI patients and their spouses/companions participating in a study of home defibrillators. Data included scores on the Family Crisis Oriented Personal Evaluation Scales (F-COPES), Beck Depression Inventory-II (BDI-II), and State-Trait Anxiety Inventory (STAI). Hypotheses were tested with correlations, multiple regressions, and hierarchical regressions.;Depression (15.5 spouse/companion-20.2% patient) and anxiety (19.1 spouse/companion-25.6% patient) were common in study participants. Family type was a significant predictor of patient (R2=.037, p=.001) and spouse/companion (R2=.077, p=.001) coping (total F-COPES). Patients' coping predicted spouses/companions' coping (p<.01) after controlling for the contributions of spouse/companion and patient age, gender, education, and employment; and the mediating or moderating effects of spouse/companion anxiety, depression, and resources. Patient state anxiety mediated the relationships between patient family type and severity of illness, and coping. Patient anxiety and depression moderated the relationships of patient family type and illness severity to coping. Spouse/companion psychological status mediated and moderated the relationships of family type and prior stressors to spouse/companion coping. Higher depression and anxiety were related to poorer coping in both groups.;Family type and psychological status predicted coping in post-MI patients and their spouses/companions during a period of stress. Interventions to reduce stress and anxiety may improve coping ability of post MI patients and their families.
    • Depression and autonomic nervous system dysfunction in patients with heart failure

      Chapa, Deborah Wince; Thomas, Sue Ann, 1947- (2006)
      Background. Heart failure is a significant public health concern. It is the end stage for many heart related diseases and is a major cause of morbidity and mortality. Psychosocial variables influence disease outcomes. The full impact of psychosocial variables is unknown. The purpose of the study was to explore the interrelationship of degree of depression, heart rate variability (HRV), social support and quality of life (QOL) in patients with heart failure (HF) who had symptoms of mild to moderate depression. Methods. Secondary exploratory analyses were completed from a randomized controlled trial of heart failure patients (N=23) who were mildly to moderately depressed. Participants in the original study received Selective Serotonin Re-uptake Inhibitors (SSRI) or placebo. Instruments used in the trial included Beck Depression Inventory-II, Sarason Support Scale, Medical Outcomes Study 36-Item Survey, Version 2 and the Minnesota Living with Heart Failure Questionnaire. Results. At the end of the study after patients had received SSRI's or placebo, depression and amount of social support explained 50% of the variance of HRV parameter SDNN. A more parsimonious model illustrated that social support explained 33% of the variance. There was a moderate negative correlation between degree of depression and HRV. There was a moderate negative correlation between degree of depression and QOL. Patients who were depressed experienced more problems with physical functioning and symptoms from HF. Patients who received Selective Serotonin Re-uptake Inhibitors experienced improved HRV. Conclusion. When measuring quality of life in heart failure patients, depression measurement must be included. Psychosocial variables, most specifically social support, influence heart rate variability in heart failure patients; and thereby, theoretically impact mortality. As a result, further study is needed to explore the interaction of psychosocial variables and their impact on the autonomic nervous system in heart failure patients.
    • Effect of a Nurse Led Mindfulness Intervention with At-Risk Adolescents

      Rawlett, Kristen Englehart; Thomas, Sue Ann, 1947- (2014)
      Introduction: At-risk behaviors are related to poor outcomes among adolescents. Increasing evidence supports adolescence as a vital time to introduce stress reduction techniques to reduce risk and improve mental health. The current study implemented and evaluated a mindfulness based intervention for at-risk adolescents in a randomized control pre-test, post-test design with an attentional comparison group. Methods: Participants were sixth grade female students from a public boarding school for at risk youth in Maryland. After informed consent by parents and signing assent, students (N=23) were randomized by dormitory to participate in the mindfulness (MC) group (n=12) or the attentional comparison group (n = 11) once per week for 6 weeks. MC sessions were led by an investigator trained in mindfulness techniques and curriculum. A nurse led the attention only group. Baseline evaluation consisted of demographics plus outcome variable tools administered before and after the program: coping (Response to Stress Questionnaire, RSQ), positive affect (10 item Positive and Negative Affect Scale for Children, PANAS-C) and mindfulness (Mindfulness Attention Awareness Scale, MAAS). Statistical analysis was performed using SPSS version 20. Results: There were no statistically significant differences between the two intervention groups at baseline. Twenty-two of 23 (95.7%) enrolled participants completed the inter- ventions. Participants completed 86.4% of study measures. In separate repeated measures analyses of variance for each outcome, there were no significant interactions between group and time for primary coping [F(1,17)=0.48,p=0.498], positive affect [F(1,17)=1.285,p=0.273], or mindfulness [F(1,17)=0.492,p=0.493]. Positive affect increased significantly [F(1,17)=10.675,p<=0.005], mindfulness scores increased [F(1,17)=3.117,p=0.095], and primary coping [F(1,17)=0.15,p=0.903] did not change over time. Discussions & Conclusions: The study demonstrated excellent feasibility for MC in this at risk population. The most important limitations are the size of the sample, potential for intervention cross contamination, homogeneity of the sample, and timing at the end of the school year all limiting the generalizability of the findings. Group interventions were effective at improving mindfulness and positive affect. Implications for nursing practice suggest mindfulness can be a part of reducing risks and improving mental health. Diverse and larger samples with longitudinal measures may guide best practices in using mindfulness with at risk adolescents going forward.
    • The Effects of Reiki on Stress and Pain in the Hospitalized Trauma Patient

      Foster, Dawn; Thomas, Sue Ann, 1947- (2010)
      Stress and pain can detrimentally impact the recovery of patients in the hospital setting. Complementary and Alternative Medicine (CAM) therapies have seen an upsurge in healthcare settings. The utilization of Reiki is increasingly employed in hospitals to assist in the alleviation of stress and pain for hospitalized patients. Although progressively used with hospitalized patients, little scientific evidence as to the efficacy of this practice has been established. This study examines the effects of Reiki on both physiological measures of stress and pain (blood pressure and heart rate) and subjective measures (pain scores, amount of pain medication utilized and the State Anxiety Inventory) in hospitalized trauma patients. A quasi-experimental repeated measures study was conducted in the trauma setting. Adults (8 males and 2 females) between 23 and 59 years participated in Reiki and Standard of Care (SOC) visits on 4 consecutive days. Subjects either received Reiki or Standard of Care on day 2 and the alternate on day 3. Blood pressure and heart rate were recorded 12 times, four times during each session, with pre and post pain scores. The amount of pain medication utilized in the previous 24 hours prior to each session was recorded, as well as, the post-session State Anxiety Inventory. No significant relationship was found between age and anxiety levels (p>.05). State anxiety at the final session was found to be significantly lower than at the baseline session (p<.05). Results offered no support that Reiki reduced the need for pain medication in this population (p>.10). No significant differences were found in heart rate and blood pressure either during sessions (p>.10) or between those receiving Reiki and those monitored for SOC (p>.10). While this study offers no support to the utilization of Reiki as an intervention for stress and pain in the hospitalized trauma patient, a discussion as to the problems and pitfalls of clinically-based research and the use of CAM is presented.
    • Feasibility and Effect of a Mindfulness Based Stress Reduction Program on Anxiety, Depression, and Coping in a Sample of Adolescents with Implantable Cardioverter Defibrillators or Pacemakers

      Freedenberg, Vicki Ann; Friedmann, Erika; Thomas, Sue Ann, 1947- (2013)
      Background: Sudden cardiac death (SCD) is a major health problem in the United States, causing approximately 300,000 to 400,000 deaths annually. Adolescents who have implantable cardioverter defibrillators (ICDs) or pacemakers due to arrhythmias have increased risk of SCD and face unique challenges that can cause psychosocial distress. Psychosocial interventions are effective for adults with cardiac devices and could positively impact adolescents' adjustment to these devices. It is crucial to establish the feasibility and efficacy of psychosocial interventions in this population. Purpose: This study examines the feasibility of a Mindfulness Based Stress Reduction (MBSR) program for adolescents with ICDs/pacemakers and evaluates anxiety, depression, and coping before and after the six week intervention. Methods: The MBSR intervention was evaluated in a one group pre-post prospective study. Participants' coping (Response to Stress Questionnaire) and anxiety and depression (Hospital Anxiety and Depression Scale) were assessed before and after the MBSR intervention. Qualitative data were obtained from post intervention interviews. Ten adolescent patients with either an ICD or pacemaker who are followed in the cardiology clinic at Children's National Medical Center in Washington, D.C. participated in the intervention. Hypotheses were tested with paired-sample t-tests, Pearson's correlations and Fisher's exact tests. Results: Feasibility was demonstrated by successful recruitment of 10 participants, 100% participation, and 100% completion. Anxiety decreased significantly following the 6-week MBSR intervention, with a large effect size. Coping skills were related negatively to anxiety and depression. Conclusion: The small but growing research literature on MBSR interventions in adolescents supports a positive effect on anxiety, depression, and coping. This study verifies the efficacy and tolerability of an MBSR intervention in a population of adolescents previously unexamined in the research literature, adolescents with ICDs/pacemakers. This study provides clinicians and researchers with specific data about types of coping strategies and their relationships to anxiety and depression. Due to the small sample size, it will be difficult to generalize the findings without additional research. This study will pave the way for larger, more rigorous studies to further examine the efficacy of MBSR interventions in adolescents with high risk cardiac diagnoses.  
    • Home environmental health risks of people with developmental disabilities

      Del Bene Davis, Allison; Thomas, Sue Ann, 1947- (2006)
      People with developmental disabilities are recognized as a vulnerable population and are frequently at increased risk due to their physical, social, economic and societal disparities. Despite these vulnerabilities, the regulations that govern community-based residential settings for the developmentally disabled provide little oversight with regard to home environmental health hazards such as lead, mercury, carbon monoxide, pesticides, radon and volatile organic compounds. Minimal data are available about the environmental health risks experienced by people in residential settings for the developmentally disabled and about how the behaviors and choices of support staff affect the indoor air quality in these residences. This study assessed the home characteristics, household behaviors and practices that place people with developmental disabilities at health risk from environmental hazards in their homes. Homes (N=57) run by three major service providers of residential services for the developmentally disabled in Anne Arundel County, Maryland were selected using random stratified sampling for evaluation. A survey and a home environmental assessment conducted by an observational walk-through of each home were used to assess the presence of neurotoxicants such as lead and mercury in the home, protective devices such as carbon monoxide detectors and radon testing, and the use of behaviors and practices that contribute to indoor pollution from pesticides, environmental tobacco smoke and cleaning products.;Twenty-eight homes (49%) had at least one source of carbon monoxide exposure and 21 (72%) of these homes had no carbon monoxide detector. **Carbon monoxide detectors tended to be more likely in homes with than in homes without carbon monoxide sources. Radon was a concern. Fifty-six of 57 homes were not tested for radon. In 41 of the homes basements, where carbon monoxide and radon are likely to accumulate, were used as living space for staff and developmentally disabled residents. Forty-nine homes reported professional pesticide contracts and 56 homes contained products with volatile organic compounds. Regulation and education of providers is necessary to prevent environmental health risks in this vulnerable population. More research is needed to investigate the home environmental health risks of people with developmental disabilities and their staff living in residential settings.
    • Leaving an abusive relationship: A hermeneutic phenomenological study of lifetime experiences of women who have left abusive relationships

      Bracken, Michele; Thomas, Sue Ann, 1947- (2008)
      The purpose of this study was to make a contribution to what is known about the leaving process by providing a voice for abused women to determine meaningful patterns associated with the life experiences of 10 women who had left an abusive relationship. Through a qualitative, hermeneutic, phenomenological research design, meaningful life experiences of women who left abusive relationships were interpreted through life patterns. Max Van Manen's (1990) specific methodology was used because of its descriptive and interpretative blend as well as strong orientation to the nature of the phenomenon. This design allowed development of a comprehensive understanding and interpretation of the phenomenon as a whole. Margaret Newman's Theory of Expanding Consciousness (1994) was interwoven within this study, which enhanced the interview process, provided a method of chronology for the collected data as well as provided a nursing focus to the interpretation. Three essential themes emerged from the in-depth interview analyses: (1) Disconnection from self and others, especially mothers; (2) Experiencing chaos related to extreme shame and terror; and (3) Experiencing strength and resilience in the face of minimal resources and support. None of these participants utilized the health care system to help them. These findings provide the foundation for future research on how nurses can help women to disclose their abusive situations. Providing compassion, acknowledgement, and support will allow women to trust the nurse and seek help. By listening to the stories these women have to tell, a nurse will be better equipped to individualize her care.
    • Physiologic, well-being, and coping resource predictors of functional performance in people with chronic obstructive pulmonary disease

      Wall, Mary Patricia; Thomas, Sue Ann, 1947- (2004)
      This cross-sectional study was conducted to examine the relationships among physiologic, well-being, and coping resource variables and their influence on functional performance in community-dwelling people with chronic obstructive pulmonary disease (COPD). The sample consisted of 119 patients (53.8% male, Mage = 68.17 +/- 8.45 years, 99.1% Caucasian). Two physiologic variables (forced expiratory volume in one second converted to a percent of a predicted value that is adjusted for height, age, gender, and race [FEV1%pred] and concomitant medical comorbidity), four well-being variables (depression, anxiety, happiness, and life satisfaction), two coping resource variables (perceived social support and mastery) and gender were proposed as predictors of functional performance. When functional performance was regressed on each proposed predictor individually (controlling for age) all except comorbidity and gender were significant predictors. However, the multiple regression of functional performance in all proposed predictors plus gender simultaneously showed that only depression (beta = -.707, p = .000), FEV1%pred (beta =.242, p =.000), gender (beta = -.189, p =.012), and the control variable of age (beta = -.322, p = .000) were significant predictors. These variables combined to explain 46% of the variance in functional performance. The low tolerance of depression (.411) indicates the possibility of multicollinearity with the other well-being and coping resource variables, although the bivariate correlations did not suggest this. Neither social support nor mastery was a mediator between depression and functional performance. Social support mediated the effects between anxiety and functional status, but mastery did not. Depressed participants reported worse functional performance than did non-depressed participants. Anxious participants reported worse functional performance than did non-anxious participants. Additional analyses showed that depression was a mediator between social support and functional performance, and between mastery and functional performance. Anxiety (beta = .253, p = .001), life satisfaction (beta = .230, p =.004), mastery (beta = -.236, p = .003), and social support (beta = -.152, p = .036) (but neither happiness nor the control variable of age) were significant predictors of depression.
    • Predictors of all-cause 30-day hospital readmission among patients with heart failure

      Dordunoo, Dzifa; Thomas, Sue Ann, 1947- (2014)
      Background: All-cause 30-day hospital readmission among patients with heart failure (HF) is a quality of care indicator and cost the healthcare system $30.7 million in 2012. Although Centers for Medicare & Medicaid has started penalizing hospitals, it unclear how hospitals can best use limited resources to decrease readmissions. Purpose: The purpose of this study is to determine whether the addition of hospital level factors (discharging nursing unit, attending medical service and unit HF volume), predict all-cause 30-day readmission beyond patient factors alone at a large, urban academic center. Methods: The primary data were from a retrospective chart review of 461 patients discharged with the primary diagnosis of HF in 2011. Generalized estimating equations were used to control for clustering and hypotheses testing. Results: The patients studied were mostly (63%) Black/African American with the mean age of 62.1 (±14.6). Gender was evenly distributed with men representing 49.7%. Thirty-three percent had non-ischemic HF, 30% had preserved ejection fraction, 27% with implantable cardioverter defibrillator, and 17% had permanent pacemaker. The average length of stay for the cohort was 6.0 days and all-cause 30-day hospital readmission rate was 20%. Of all the investigated patient and hospital level factors, only patient factors were associated with all-cause 30-day hospital readmission: hyponatremia (OR=2.54, 95% CI 1.61-4.01), abnormal creatinine (OR=1.83, 95% CI 1.36-2.48), discharge without loop diuretics (OR=. 44 95% CI-.20-.98), discharge without beta blockers (OR=20.25, 95% CI 2.41-183.02), and discharge heart rate (OR=1.03, 95% CI 1.01-1.06). There was a statistically significant interaction between heart rate and discharge without beta blockers suggesting on average, the lower discharge heart rate, the lower the association of no beta blockers with the odds of all-cause 30-day hospital readmission (OR=.97, 95% CI=.95-.997). Median household income, emergency room presentation time and being married had conflicting associations with all-cause 30-day hospital readmission. Conclusion: Biological patient factors were associated with increased odds while discharge without loop diuretics was associated with reduced odds of all-cause 30-day hospital readmission. These findings suggest hospitals can use clinical factors to identify patients needing additional monitoring due to inability to optimize HF regimen to reduce readmissions.
    • Psychological and physical health of Chinese immigrants in the Howard County, Maryland: A community survey

      Lee, Mei Ching; Thomas, Sue Ann, 1947- (2011)
      Background: Immigrants are the fastest growing fraction of the United States (USA) population. One in every ten people in USA is foreign born. Migration is a stressful event. Immigrants are vulnerable to psychological distress symptoms which increase their risk of heart disease, stroke and diabetes. Chinese are the third largest immigrant group in USA. From 1980 to 2006, the numbers of Chinese immigrants has increased by five-fold. However, little is known about their psychological health. Study of Chinese immigrants increases our understanding of their psychological health condition and the relationship to physical health and can inform the development of culturally sensitive community programs to improve psychological health in Chinese immigrants. Purpose: The purpose of this study was to identify risk factors for psychological distress of Chinese immigrants using a biopsychosocial model. The intention was to identify modifiable factors for psychological distress in Chinese immigrants. Methods: A cross-sectional design was used to conduct a descriptive-correlation survey study. A total of 247 Chinese speaking immigrants in Howard County were recruited. All instruments used in the study were written in Chinese including the Chinese Cultural Orientation Scale, Chinese Bicultural Identity Integration Scale, Chinese Riverside Acculturation Stress Inventory and Chinese Kessler Psychological Distress Scale. Data were analyzed using descriptive statistics, Chi squares, t-tests, Pearson's correlations and hierarchical linear multiple regressions. Results: The psychological distress rate among Chinese immigrants in the study was 22.3%. Biological and social factors explained 17.8% of the variability in psychological distress scores, adjusted R2 = .155 (p<.001). Adding acculturation factors into the regression model increased R2 by .104 (p<.001). The interaction effect of acculturation stress and English proficiency was the strongest predictor of psychological distress scores in Chinese immigrants. Other predictors in the model included age, self-reported health status and financial strain. The final model explained 26.1% of the variability in psychological distress scores. Conclusion: Howard County is the third richest county by per capita income in the nation. Yet, financial uncertainty remains a strong predictor of psychological distress for Chinese immigrants. Interventions of social services could be developed to meet Chinese immigrants' needs. English proficiency is important for psychological health in Chinese immigrants, especially when facing acculturation stress. Participants with low Englishproficiency are more susceptible to acculturation stress to develop psychological distress symptoms. Culturally sensitive strategies are recommended to improve English proficiency in Chinese immigrants. In this sample, there was a fairly low rate of chronic disease. However self-reported health remained a significant risk factor in the model. Further study is needed to examine what factors contribute to an individuals' perception of health and how that perception of health influences psychological health.
    • Psychosocial, Clinical, and Demographic Predictors of Quality of Life in Pharmacologically Managed and Catheter Ablation Atrial Fibrillation and Atrial Flutter Patients

      Akintade, Bim Fola; Thomas, Sue Ann, 1947- (2011)
      Background: Atrial fibrillation (AF) and atrial flutter (AFL) are the most diagnosed symptomatic cardiac arrhythmias in the United States. Much is known about the Quality of Life (QoL) of AF/AFL patients, but no published study specifically examined the impact of ablation procedures on the QoL of AF/AFL patients with comorbid depression and/or anxiety. Purpose: This study evaluates the contributions of psychosocial, clinical, and demographic variables to QoL in pharmacologically managed and pre-ablated AF and AFL patients, and the change in QoL of these patients after successful catheter ablation procedures. Methods: This was a prospective hypothesis-generating quasi-experimental study with a control group. The study consisted of 75 pharmacologically managed AF/AFL patients and 75 consecutive individuals scheduled for catheter ablation procedures for AF/AFL at the Washington Hospital Center and University of Maryland Medical Center Arrhythmia Center's from April 2010 to March 2011. Hypotheses were tested with cross tabulations, t-tests, ANOVAs, repeated measures ANOVAs, and linear regression analyses. The instruments utilized in the current study include the Beck Depression Inventory II to measure depression, the STAI to measure anxiety, and the subscales of SF-36v2, and SSCL to evaluate QoL. Results: Female and younger AF/ AFL patients have worse QoL, and elevated baseline depressive and anxiety symptoms were significant predictors of baseline QoL. After successful catheter ablation procedures, AF/ AFL patient's demonstrated significant improvements in QoL and depressive and anxiety symptoms compared to control patients over 1 month. Results also demonstrated that females, elevated baseline depressive symptoms, and baseline scores on QoL questionnaire subscales were significant predictors of change in QoL over 1 month. Conclusion: Depression, anxiety, and female gender should be considered as risk factors identifying patients who may require additional evaluation and treatment efforts to manage their cardiac conditions. The implementation of early depressive and anxiety symptom screening may provide information for cost effective and comprehensive approaches to the management of AF/ AFL patients.
    • Quality of life and physiological status as predictors of mortality in patients with implantable cardioverter defibrillators

      Kao, Chi-Wen; Thomas, Sue Ann, 1947- (2006)
      Background. Sudden cardiac death (SCD) is one of the most common causes of death in developed countries throughout the world. The implantable cardioverter-defibrillator (ICD) has been established as an efficient treatment for prevention of SCD. Patients with ICDs commonly experience psychological distress and life change. It is important to assess the impact of the ICD treatment not only on improving survival but also on patients' life quality. Purpose. This study aimed to examine the predictors of quality of life and mortality, and to determine the relationship between quality of life and mortality in patients with ICDs. Methods. This study used the dataset from the Antiarrhythmic Versus Implanted Defibrillator (AVID) controlled clinical trial conducted by the National Institutes of Health (NIH), National Heart, Lung, and Blood Institute. The 507 patients randomly assigned to the ICD treatment in AVID study were recruited in the analysis. The subjects were mostly male (78.3%), with mean age of 64.85+/-10.81 years, mean ejection fraction (EF) of 32.2+/-13.45%, and 19.7% in NYHA (New York Heart Association) I, 28.4% in NYHA II, and 6.7% in NYHA III. The QOL was measured by the SF-36 at baseline, 3 months, 6 months, and 1 year follow-up and by the Quality of Life Index-Cardiac Version (QLI-CV) at baseline and 1 year follow-up. Depression was evaluated by the Mental Health Inventory-5 Items (MHI-5). Data were analyzed by descriptive statistics, multiple regression, logistic regression and Cox regression. Results. The mean total survival time for the ICD patients was 2.61+/-1.24 years. Approximately 25% of the ICD patients (n = 125) died during the period of AVID study. Among these 125 patients, 54 patients survived less than one year. Comparing the scores of QOL measurement at baseline with the scores at one year, PCS (physical component summary score) and MCS (mental component summary score) significantly improved, and QOL-CV increased but did not achieve significance. The ICD patients who received ACEI (angiotensin-converting enzyme inhibitor) therapy, who were younger, who had more stress perception at baseline, and who had better QOL (QLI-CV) had higher possibility of surviving more than one year after ICD implantation. Beyond the effect of bio-psycho-social factors, better QOL (QLI-CV) predicted more than one year survival. For the long-term mortality, the ICD patients who were older, who had more abnormal ECGs (electrocardiogram), who had a history of diabetes, and who perceived their physical health status as worse at last assessment (PCS time-dependent covariate) had a higher risk of dying. Adjusting for the bio-psycho-social factors, worse physical health status (PCS time-dependent covariate) still predicted mortality. Conclusion. Quality of life is an important factor predicting mortality in patients with ICDs. Large numbers of abnormal ECGs, having a history of diabetes, without receiving ACEI therapy, less stress perception at baseline, and older age predict mortality as well.
    • The Relationship of Yoga to Aspects of Health: Results of a National Survey of Yoga Practitioners

      Ross, Alyson Coleen; Thomas, Sue Ann, 1947- (2012)
      Unhealthy lifestyles in America have resulted in an explosion of chronic health conditions. Purpose: To better understand the interrelationship among yoga practice and aspects of health. Primary aims: (1) to describe the practice habits/characteristics and health habits/characteristics of individuals who practice yoga; and (2) to examine the relationship between yoga practice and aspects of health. Methods: Cross-sectional design using anonymous Internet survey; 4307 yoga practitioners randomly selected from 15 US Iyengar yoga studios; 1045 (24.3%) surveys completed. Results: Sixty percent indicated 1+ chronic/serious health conditions, yet most reported very good (46.3%) or excellent (38.8%) health. Participants agreed yoga improved health (89.5%), particularly: energy (84.5%), happiness (86.5%), social relationships (67%), sleep (68.5%), and weight (57%). Frequency of home practice was a more important predictor of aspects of health than years of practice or class frequency. Frequency of home practice favorably predicted aspects of health including: mindfulness (beta = .106, p <.001), subjective well-being (beta = .183, p <.001), BMI (beta = -.043, p <.001), fruit and vegetable consumption (beta = .031, p <.001), vegetarian status (r = .162, p <.001), and sleep disturbance (r = -170, p < 0.01). Physical yoga poses (standing, vigorous, inversions, and gentle) were each related to 1+ aspects of health. Breath work, meditation, and philosophy study predicted multiple health outcomes. Conclusions: Yoga is potentially an important therapeutic tool. Individuals who practice yoga are not necessarily healthy at the outset. Emphasis should be placed less on delivery and more on incorporating healthy interventions like yoga into one's daily life.
    • University of Maryland School of Nursing PhD Program Review, External 2008

      Mishel, Merle Helaine; Redman, Richard W.; Thomas, Sue Ann, 1947-; Morton, Patricia Gonce, 1952- (2008-09)