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This study tested the applicability of the individual and family self-management theory (IFSMT) to self-management (SM) in patients with left ventricular assist devices (LVADs). From an existing data set, we extracted the following variables that correspond to IFSMT's conceptual dimensions: anxiety, depression, and cognition (context dimension); self-efficacy (SM process dimension); adherence and quality of life (QOL; outcome dimensions). Descriptive statistics and partial least squares path modeling procedures were used for data analyses. A total of 100 patients (mean age 52 ± 13.4 years) with continuous flow LVAD designs comprised the present study. Most patients were White (78%), married (69%), college-educated (72%), and on disability (53%). Their mean anxiety and depression scores were slightly above normal, while their cognitive function scores were slightly lower than normal. LVAD care self-efficacy, adherence, and QOL were within normal ranges. Factor loadings ranged from 0.50 to 1.0, and there were significant forward path relationships among the context, process, and outcome dimensions (β ranges from 0.02 to 0.60, all P values < 0.05). In conclusion, the IFSMT provides a good fit for SM in LVAD. Further research is needed to clarify how best to improve LVAD SM practice and treatment outcomes., (© 2018 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.)

Aims Although depression has weak associations with several Type 2 diabetes mellitus (DM) outcomes, it is possible that these associations are concentrated within certain patient subgroups that are more vulnerable to their effects. This study tested the hypothesis that depression is related to glycaemic control and diabetes-related quality of life (DQOL) in patients who are prescribed injected insulin, but not those on oral glucose-lowering agents alone. Methods Participants (103 on insulin, 155 on oral glucose-lowering agents alone) with Type 2 DM were recruited from a large US healthcare system and underwent assessment of glycaemic control (glycated haemoglobin; HbA1c), medication adherence and diabetes self-care behaviours, DQOL and depression (none, mild, moderate/severe). Results There was a significant regimen × depression interaction on HbA1c ( P = 0.002), such that depression was associated with HbA1c in patients using insulin (β = 0.35, P < 0.001) but not in patients using oral agents alone (β = –0.08, P = NS). There was a similar interaction when quality of life was analysed as an outcome ( P = 0.002). Neither effect was mediated by regimen adherence. Conclusions The generally weak association between depression and glycaemic control is concentrated among patients who are prescribed insulin. Similarly, the association between depression and illness quality of life is strongest in patients prescribed insulin. Because this is not attributable to depression-related adherence problems, psychophysiological mechanisms unique to this group ought to be carefully investigated. Clinicians might be especially vigilant for depression in Type 2 DM patients who use insulin and consider its potential impact upon their illness course. [ABSTRACT FROM AUTHOR]

Although establishing sexual relationships is viewed as an important developmental milestone for adults, sexual functioning has been a neglected area of investigation for survivors of gynecological cancer. This article describes the long-term effects of clear-cell adenocarcinoma, with a specific focus on sexual functioning as a major quality-of-life concern. The authors hypothesized that respondents with multiple factors that interfered with their sexual functioning would report greater sexual dysfunction, poorer adjustment, and relationship difficulties. Two additional goals were to describe late psychological effects, such as depressive symptoms, and to explore the relationship between health status, coping behavior, social support variables, and depressive symptoms. The findings provide preliminary support for a complex relationship between medical complications, sexual dysfunction, emotional adjustment, and marital/partner relationships: 38% of the respondents reported physical and psychosexual factors interfering with their sexual functioning. Although chronic sexual dysfunction is a legitimate concern by itself, the findings also suggest that sexual difficulties are associated with diverse problems involving mood, quality of life, and adjustment. [ABSTRACT FROM AUTHOR]