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Biomedical subjects

James A Fauerbach

Publications and source records attributed to James A Fauerbach.

At least 19 recordsLinked to original sources
PubMed2006

The reliability and validity of the Perceived Stigmatization Questionnaire (PSQ) and the Social Comfort Questionnaire (SCQ) among an adult burn survivor sample.

In this study, 361 adult burn survivors completed the Perceived Stigmatization Questionnaire (PSQ), the Social Comfort Questionnaire (SCQ), and other measures. Both the PSQ and SCQ had good internal consistency indices. Factor analysis of the PSQ yielded 3 factors (absence of friendly behavior, confused/staring behavior, and hostile behavior). The SCQ had 1 factor. Conjoint factor analysis with measures of related constructs (body esteem, body-esteem importance, depression, social support) suggested that PSQ and SCQ measure distinct constructs. Correlations with the related psychosocial constructs and burn characteristics suggested the PSQ and SCQ have good convergent and discriminant validity. Limitations of the study are discussed.

Adult↗
PubMed2006

Prevalence of depression in survivors of acute myocardial infarction.

OBJECTIVES: To assess the prevalence and persistence of depression in patients with acute myocardial infarction (AMI) and the relationship between assessment modality and prevalence. DATA SOURCES: MEDLINE, Cochrane, CINAHL, PsycINFO, and EMBASE. REVIEW METHODS: A comprehensive search was conducted in March 2004 to identify original research studies published since 1980 that used a standardized interview or validated questionnaire to assess depression. The search was augmented by hand searching of selected journals from October 2003 through April 2004 and references of identified articles and reviews. Studies were excluded if only an abstract was provided, if not in English, or if depression was not measured by a validated method. RESULTS: Major depression was identified in 19.8% (95% confidence interval [CI] 19.1% to 20.6%) of patients using structured interviews (N=10,785, 8 studies). The prevalence of significant depressive symptoms based on a Beck Depression Inventory score > or =10 was 31.1% (CI 29.2% to 33.0%; N=2,273, 6 studies), using a Hospital Anxiety and Depression Scale (HADS) score > or =8%, 15.5% (CI 13.2% to 18.0%; N=863, 4 studies), and with a HADS score > or =11%, 7.3% (CI 5.5% to 9.3%; N=830, 4 studies). Although a significant proportion of patients continued to be depressed in the year after discharge, the limited number of studies and variable follow-up times precluded specification of prevalence rates at given time points. CONCLUSIONS: Depression is common and persistent in AMI survivors. Prevalence varies depending on assessment method, likely reflecting treatment of somatic symptoms.

Depressive Disorder↗
PubMed2004

Quality of life in physical health domains predicts adherence among myocardial infarction patients even after adjusting for depressive symptoms.

OBJECTIVE: To prospectively study the relationship of quality of life (QOL) to adherence among myocardial infarction (MI) patients and also to determine if either QOL or depressive symptoms (DEP) has a primary role in predicting adherence. METHODS: Acute-MI patients (N=285) were administered questionnaires on QOL, DEP, and adherence in-hospital and 4 months post-MI. The seven adherence behaviors measured included (1). following a low-salt diet, (2). following a low-fat or weight loss diet, (3). taking prescribed medication, (4). exercising regularly, (5). decreasing stress, (6). carrying medical supplies for self-care, and (7). trying to socialize more with others. Hierarchical regression analyses examined cross-sectional and prospective relations between adherence and both physical and mental health QOL domains. Each QOL domain was modeled as "adherence=QOL domain+DEP." RESULTS: Physical health QOL was related to adherence using cross-sectional and prospective approaches even with DEP independently still related to adherence. Conversely, in separate models using cross-sectional and prospective approaches, mental health QOL was not related to adherence while DEP was related to adherence. CONCLUSION: Focused attention on those with low scores in physical health QOL or greater DEP may be an efficient approach to improve adherence in patients recovering from an MI.

Adult↗
PubMed2002

The significance of depression in older patients after myocardial infarction.

OBJECTIVES: Depression is common in patients recovering from a myocardial infarction (MI) and is an independent risk factor for early mortality. Although most patients with MI are aged 65 and older, there is little information about post-MI depression in this age group. This study was performed to determine the significance of post-MI depression in individuals aged 65 and older. DESIGN: A cohort study of hospitalized patients and a telephone interview 4 months later. SETTING: A university-affiliated teaching hospital in Baltimore, Maryland. PARTICIPANTS: Patients admitted with an acute MI (N = 284), 153 (53.9%) of whom were aged 65 and older; 101 of these (66.0%) completed the 4-month follow-up interview. MEASUREMENTS: Patients were interviewed 3 to 5 days post-MI to evaluate for the presence of symptoms of depression (a score of > or =10 on the Beck Depression Inventory and for the presence of mood disorder using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Revised, Third Edition. Survivors were then interviewed by telephone 4 months after discharge to assess adherence to recommendations to reduce cardiac risk by using the Medical Outcomes Study Specific Adherence Scale. Comorbidities and prescribed medications were determined by review of hospital charts and computerized medical records. RESULTS: Older patients with depression were more likely to die in the first 4 months than older patients without depression (26.5% vs 7.3%, P =.002). Older patients with depression were also more likely than older patients without depression to have had a prior MI (54.3% vs 31.0%, P =.012) and were somewhat more likely to have chronic lung disease (28.6% vs 14.4%, P =.054), a non-Q wave MI (88.6% vs 72.8%, P =.054), diabetes mellitus (48.6% vs 32.5%, P =.082), and a left ventricular ejection fraction below 35% (50.0% vs 33.3%, P =.084). Compared with older patients without depression, depressed older patients were also marginally less likely at discharge to be prescribed a beta-blocker (74.3% vs 86.3%, P =.092) or a lipid-lowering agent (31.4% vs 49.6%, P =.059). Depressed patients aged 65 and older were less likely to adhere to a low-fat/low-cholesterol diet (P <.01) or a diabetic diet (P <.01), or to be taking prescribed medications (P <.05), exercising regularly (P <.01), reducing stress (P <.01), and increasing social support (P <.01). CONCLUSION: Depression is prevalent after an acute MI in patients aged 65 and older. Older post-MI patients with depression have more comorbidities than older patients without depression and have almost four times the risk of dying within the first 4 months after discharge. Although this increased risk is likely to be related to many factors, our data suggest that sicker patients who are older and depressed may less often be prescribed medications known to reduce post-MI mortality and may also have greater difficulty following recommendations to reduce cardiac risk than their counterparts without depression. Efforts to improve adherence to post-MI treatment guidelines and to enhance patient compliance may improve prognosis in this high-risk group.

Age Factors↗
PubMed2002

Coping with body image changes following a disfiguring burn injury.

The influence of emotion-focused coping on distress following disfiguring injury was examined. Two types of emotion-focused coping (i.e., venting emotions vs. mental disengagement) were assessed in 78 patients with burn injury at baseline during acute hospitalization. Body image dissatisfaction (BID) was assessed 1 week and 2 months following discharge. Use at baseline of both venting emotions and mental disengagement, compared with use of only one or neither of these coping methods, was associated at the 2-month postdischarge follow-up with significantly higher BID related to nonfacial aspects of appearance and with a greater negative social impact of disfigurement. D. M. Wegner's (1994) theoretical model of mental control and a proposed motivational analysis are used to interpret these findings.

Adaptation, Psychological↗
PubMed2002

Marital interaction of agoraphobic women: a controlled, behavioral observation study.

Married couples with a female agoraphobic spouse (n = 22) were compared with demographically similar community control couples (n = 21) on self-report and observational measures of marital interaction. Consistent with hypotheses, husbands of agoraphobic women were more critical of their wives than were control husbands, and clinical couples were less likely to engage in positive problem solution than control couples. Contrary to hypothesis, clinical husbands were not less supportive than control husbands. Where general measures of marital distress were concerned, clinical couples, relative to control couples, evinced more distress by self-report, by their higher rate of negative nonverbal behavior, and by their longer sequences of negative exchanges.

Adaptation, Psychological↗
PubMedDate not supplied

Depression in burn reconstruction patients: symptom prevalence and association with body image dissatisfaction and physical function.

OBJECTIVE: This study investigated the prevalence and the clinical correlates of symptoms of depression among burn reconstruction patients. METHOD: A sample of 224 burn reconstruction patients completed the Beck Depression Inventory (BDI), the SF-36 Health Survey and the Satisfaction with Appearance Scale. RESULTS: The prevalence of at least mild to moderate symptoms of depression (BDI > or =10) was 46%. Female patients were disproportionately represented in this burn reconstruction population (46%) compared to all survivors from the burn center (29%; P<.001) and compared to a national sample of burn survivors (27%; P<.001). Compared to males, female patients presented for consultation much longer after a burn injury (P<.001), tended to have smaller burns (P=.06) and were less likely to have facial burns (P=.08). Depressive symptoms were largely predicted by body image dissatisfaction (beta=.58; P<.001), with additional variance predicted by physical function (beta=-.13; P=.07). The effect of patient and burn injury variables on depressive symptoms was mediated by body image dissatisfaction and physical function. CONCLUSION: The high prevalence of significant symptoms of depression in burn reconstruction patients and their relationship with body image suggest the importance of the routine psychological screening of patients seeking reconstruction services.

Adult↗
PubMedDate not supplied

Psychosocial forum.

Explore the source record for details and available documents.

Burns↗
PubMedDate not supplied

Regulating acute posttrauma distress.

The influence of emotion-approach and emotion-avoidance methods of coping on the development (cohort 1) and persistence (cohort 2) of posttraumatic stress symptoms was examined. The two coping methods and the frequency and intensity of intrusive, avoidant, and hyperarousal symptoms were assessed in separate series of 71 and 94 hospitalized acute burn-injured patients. In both samples, subjects who frequently used both mental distancing (emotion-avoidance) and venting emotions (emotion-approach), relative to subjects who used only one or neither of the two coping methods, had higher levels of posttraumatic stress disorder symptoms even when controlling for baseline symptoms. Higgins' (1997) motivational framework, incorporating the needs for controllability and predictability, and Wegner's (1994) theory of mental control are used to interpret the findings.

Adaptation, Psychological↗
PubMedDate not supplied

Personality, coping, chronic stress, social support and PTSD symptoms among adult burn survivors: a path analysis.

This paper presents a longitudinal study of the relationship between personality, coping, chronic stress, social support and posttraumatic stress disorder (PTSD). A hypothesized model of the relationship between the predictor variables and PTSD symptoms was proposed. Path analyses was completed to test the model. One hundred fifty-eight adult burn survivors completed questionnaires measuring each of the variables in the hospital. Of those 124 and 94 completed the PTSD measure at 1 month and 6 months postdischarge, respectively. The hypothesized model fit the data at each time point with slight variations. The model accounted for 46 and 29% of the variance of PTSD symptoms at hospitalization and 1 month. Neuroticism was the most important personality dimension in predicting PTSD. Avoidant Coping and Social Support mediated a high percentage of the relationship between Neuroticism and PTSD. The best predictor of PTSD symptoms at 1 and 6 months was PTSD symptoms at hospitalization.

Adaptation, Psychological↗
PubMedDate not supplied

Visible vs hidden scars and their relation to body esteem.

This study examined the relationship among burn scarring, severity and visibility, and body esteem. Previous work addressing this question has relied on case studies and small samples. We mailed a survey to 2500 members of a national burn survivor support group. Survivors were asked to complete and return the mailed survey or complete the survey on line at our Web site. Three hundred sixty-one survivors completed all questionnaires in the survey relevant to this study, which included measures of burn characteristics, social stigmatization, social support, depression, and body esteem. The sample characteristics were as follows: 52% were women, the mean age was 44.1 years, the mean age burned was 26 years, 88% were European American, 5% were African American, 4% were multiracial, 3% were other, the average TBSA was 48%, and the mean educational level was high school graduate. We measured scar visibility by asking survivors to rate "how often are your burn scars visible to others" on a six-point scale. We also asked them to rate the presence or absence of scars on 15 body parts, total TBSA, and number of surgeries. The correlation between visible scarring and different aspects of body esteem, that is, self-satisfaction with appearance (-.19) and perception of others reaction to your appearance (-.27), was statistically significant but low. Visible scarring was unrelated to self-satisfaction with weight (.01). Visible scarring had a low but significant correlation with perceived stigmatization (.23) and was not correlated with depression (0.01). Other measures of scarring also had low correlations with social and emotional outcome variables. Because scar severity and visibility are hypothesized to be particularly relevant to body esteem, we performed a multiple regression predicting body esteem. We entered the variables in three blocks: burn characteristics, demographic characteristics, and social and emotional characteristics. Burn characteristics accounted for less than 20% of the variance. R square for the final equation equaled.62, with social adjustment and depression accounting for the largest portion of the variance. In this sample, burn scar visibility and severity did not have a strong relationship with social and emotional adjustment variables. More effort must be placed into developing psychosocial interventions that help survivors accept scars, reduce depression, and build a strong loving support system.

Adult↗
PubMedDate not supplied

Burden of burn: a norm-based inquiry into the influence of burn size and distress on recovery of physical and psychosocial function.

This prospective, longitudinal study examined the influence of baseline physical and psychological burden on serial assessments of health-related quality of life among adults with major burns from three regional burn centers (n = 162). Physical burden groups were defined by % TBSA burned: <10%, 10% to 30%, or >30%. Psychological burden groups were defined by in-hospital distress using the Brief Symptom Inventory Global Severity Index T-score with scores of < 63 or > or = 63. Analyses compared groups across level of burden and with published normative data. Assessments reflected health and function (Short Form 36) during the month before burn, at discharge, and at 6 and 12 months after burn. Physical functioning was significantly more impaired and the rate of physical recovery slower among those with either large physical burden or large psychological burden. Notably, psychosocial functioning also was more impaired and the rate of psychosocial recovery slower among those with greater psychological burden. These results suggest that, in addition to aggressive wound closure, interventions that reduce in-hospital distress may accelerate both physical and psychosocial recovery.

Adult↗
PubMedDate not supplied

Profile of patients lost to follow-up in the Burn Injury Rehabilitation Model Systems' longitudinal database.

We sought to identify whether patterns exist in the Burn Injury Rehabilitation Model Systems' database among participants lost to follow-up at 6, 12, or 24 months after injury and to define characteristics that reliably discriminate between persons who are lost to follow-up and those who are not. All participants met the American Burn Association criteria for major burn injury, were 18 years of age or older, received care from one of four burn model systems, and consented to participate in a 2-year prospective data-collection process. Step-wise logistic regression was used to develop three prediction models for the probability of loss to follow-up. The percent of individuals successfully contacted for follow-up were 64% at 6 months, 54% at 12 months, and 42% at 24 months after injury. Individuals who were younger, not employed at time of burn, with less than a high school level education, a history of drug abuse, circumstances of injury involving suspected assault, and having no insurance for care were lost to follow-up. Longer stay in the hospital, on the other hand, increased the likelihood of follow-up. The same risk factors remained significant with or without adjusting for site indicating that these factors are independent and significant in spite of any potential site differences. Successful follow-up at 6- and 12-month intervals increased the likelihood of achieving a follow-up at 24 months after injury. The sociodemographic risk factors for attrition identified in this study represent significant enduring vulnerabilities. The findings necessitate a close examination of several factors and the use of strategies to reduce the risk of attrition.

Adult↗
PubMedDate not supplied

Can doctors and nurses recognize depression in patients hospitalized with an acute myocardial infarction in the absence of formal screening?

OBJECTIVE: The objective of this study was to determine the ability of cardiovascular healthcare workers to assess the presence or absence of symptoms of depression in patients hospitalized with acute myocardial infarction (AMI) in the absence of formal screening. METHODS: Patients admitted with AMI underwent screening using the Beck Depression Inventory (BDI) administered by a research assistant. The cardiovascular nurse, medicine resident or intern, and attending cardiologist caring for the patient were then approached (blinded to the BDI results) and asked to assess, using a visual analog scale, whether the patient had symptoms that would warrant further evaluation for depression. RESULTS: BDI screening and at least one provider assessment were completed for 60 patients with AMI. A total of 18 of 60 patients (30.0%) had a BDI score of > or =10. Symptoms of depression were considered not present in 24 of 32 patient assessments when the BDI was > or =10 (75% false-negatives). The mean BDI score of patients assessed as depressed by at least one provider (6.7 +/- 6.3) was no different from the mean BDI score of patients assessed as not depressed (7.5 +/- 7.2, p = .67). Overall, there was little correlation between BDI scores and provider assessments, and this was not influenced by provider type or provider gender. CONCLUSIONS: Cardiovascular nurses and medicine residents and interns underrecognize depression in patients with AMI in the absence of formal screening. Formal screening for symptoms of depression should be considered part of routine AMI care.

Clinical Competence↗
PubMedDate not supplied

The National Institute on Disability and Rehabilitation Research burn model system database: a tool for the multicenter study of the outcome of burn injury.

Advances in critical care and surgical management have significantly improved survival after burn injury over the past several decades. However, today, survival alone is an insufficient outcome. In 1994, the National Institute on Disability and Rehabilitation Research (NIDRR) created a burn model system program to evaluate the long-term sequelae of burn injuries. As part of this multicenter program, a comprehensive demographic and outcome database was developed to facilitate the study of a number of functional and psychosocial outcomes after burns. The purpose of this study is to review the database design and structure as well as the data obtained during the last 10 years. This is a descriptive study of the NIDRR database structure as well as the patient data obtained from the four participating burn centers from 1994 to 2004. Data obtained during hospitalization and at 6, 12, and 24 months after discharge were reviewed and descriptive statistics were calculated for select database fields. The database is divided into several subsections, including demographics, injury complications, patient disposition, and functional and psychological surveys. A total of 4600 patients have been entered into the NIDRR database. To date, 3449 (75%) patients were alive at discharged and consented to follow-up data collection. The NIDRR database provides an expansive repository of patient, injury, and outcome data that can be used to analyze the impact of burn injury on physical and psychosocial function and for the design of interventions to enhance the quality of life of burn survivors.

Adolescent↗
PubMedDate not supplied

Burns as a result of assault: associated risk factors, injury characteristics, and outcomes.

The purpose of this study was to identify specific premorbid factors and injury characteristics associated with intentional burn injuries and to compare outcomes for individuals injured by assault and those with unintentional injuries. Participants sustaining major burns from May 1994 to August 2005 and consenting to a multisite, prospective, longitudinal outcome study were included. Etiology of the injury was classified as intentional (i.e., assault) or unintentional. Subjects <18 years old or with self-inflicted burns were excluded. Statistical analysis was performed with t-tests, chi2 tests, and analysis of variance. Eighty patients sustained intentional burn injuries and 1982 subjects sustained nonintentional burn injuries. Compared to patients with nonintentional burns, those with burns related to assault were more likely to be female, black, and unemployed and to have higher rates of premorbid substance use. Between the groups, there were no significant differences in preinjury living situation, education level, history of psychiatric treatment, or hospital length of stay. The intentional-burn group had larger burns and a greater in-hospital mortality rate, and these patients were less likely to be discharged to home. They also demonstrated significantly greater levels of psychological distress during the acute hospitalization but not at follow-up. Understanding the unique characteristics and needs of patients with intentional burn injuries is important because these individuals are less likely to have a steady income and more likely to rely on community social services. Affordable and accessible community-based health services are necessary in order to improve their outcomes.

Accidents↗