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Biomedical subjects

Stanislav V Kasl

Publications and source records attributed to Stanislav V Kasl.

At least 37 records · Page 2Linked to original sources
PubMed2004

Development of the chronic fatigue syndrome in severely fatigued employees: predictors of outcome in the Maastricht cohort study.

STUDY OBJECTIVE: To identify risk factors of the development of the chronic fatigue syndrome (CFS), the persistence or recurrence of fatigue, or recovery from fatigue in a large sample of fatigued employees. DESIGN: Analyses were based on the Maastricht cohort study (MCS), a prospective population based cohort study among more than 12 000 employees. Multiple regression models were used to identify predictors of CFS-like caseness (meeting research criteria for CFS), non-CFS fatigue caseness, or no fatigue caseness. SETTING: The working population in the Netherlands. PARTICIPANTS: 1143 employees with medically unexplained fatigue were followed up prospectively for 44 months. MAIN RESULTS: At 44 month follow up, 8% of the employees were CFS-like cases (none of who reported to have received a CFS diagnosis), 40% were non-CFS fatigue cases, and 52% were no longer fatigue cases. Factors that predicted CFS-like caseness compared with non-CFS fatigue caseness were high age, exhaustion, female sex, low education, and visits to the general practitioner. Factors that predicted CFS-like caseness compared with no fatigue caseness were fatigue, exhaustion, low education, visits to the GP and occupational physician, and bad self rated health. Factors that predicted non-CFS fatigue caseness compared with no fatigue caseness were fatigue, low self perceived activity, exhaustion, anxious mood, and bad self rated health. CONCLUSIONS: Unexplained fatigue among employees in some instances is a precursor of the development of CFS. The prognostic role of self rated health suggests that prevention and treatment of chronic fatigue should be aimed at changing the perception of health or illness. Less clear is the role of health care seeking or receiving a CFS diagnosis.

Adult↗
PubMed2004

Depression among surviving caregivers: does length of hospice enrollment matter?

OBJECTIVE: Many terminally ill patients enroll in a hospice late in their illness, and recent data indicate decreasing lengths of hospice enrollment, yet we know little about the impact of hospice enrollment length on surviving caregivers. This is the first study the authors know of that examines the association between hospice enrollment length and subsequent major depressive disorder among surviving caregivers. METHOD: The authors conducted a prospective cohort study with 174 primary family caregivers of consecutively enrolled hospice patients with cancer between October 1999 and September 2001. Using data from in-person interviews at the time of enrollment and 6-8 months after the patient's death, they estimated with logistic regression the adjusted risk of major depressive disorder with the Structured Clinical Interview for the DSM-IV axis I modules based on the number of days of hospice care before death. RESULTS: Caregivers of patients enrolled with hospice for 3 or fewer days were significantly more likely to have major depressive disorder at the follow-up interview than caregivers of those with longer hospice enrollment (24.1% versus 9.0%, respectively), adjusted for baseline major depressive disorder and other potential confounders. CONCLUSIONS: The findings identify a target group for whom bereavement services might be most needed. The authors also suggest that earlier hospice enrollment may help reduce the risk of major depressive disorder during the first 6-8 months of bereavement, which raises concerns about recent trends toward decreasing lengths of hospice enrollment before death.

Aged↗
PubMed2004

The effect of spousal mental and physical health on husbands' and wives' depressive symptoms, among older adults: longitudinal evidence from the Health and Retirement Survey.

OBJECTIVE: To estimate the effect of spousal depressive symptoms and physical health on respondents' depressive symptoms in a national sample of older married couples. METHOD: We used data on 5,035 respondent husbands and wives from the 1992 and 1994 waves of the Health and Retirement Survey. Multivariate regression models were estimated to examine the impact of spousal depressive symptoms and physical health on respondents' depressive symptoms. RESULTS: Adjusting for respondent mental and physical health and sociodemographic traits, having a spouse with more depressive symptoms was associated with significantly higher follow-up depressive symptoms in the respondent (p < .001). Controlling for spousal depressive symptoms, a decline in the spouses' physical health was associated with a significant reduction in respondent depressive symptoms (p < .05). DISCUSSION: Our findings suggest that health care providers treating older adults should be sensitive to the possibility that spouses may be affected when clients suffer poor mental or physical health.

Aged↗
PubMed2004

Image of aging scale.

The development of the Image of Aging Scale is described. It ineludes positive and negative images of elders within nine domains. The scale showed good 1-wk. test-retest reliability, internal consistency, and convergent validity.

Aged↗
PubMed2004

Factors associated with caregiver burden among caregivers of terminally ill patients with cancer.

OBJECTIVE: To identify factors associated with caregiver burden among those caring for terminally ill patients with cancer. DESIGN: Cross-sectional study of interviews with primary caregivers (n = 206) of consecutive patients with cancer enrolled in the largest hospice in Connecticut. METHODS: Data were collected on the caregivers' sociodemographic characteristics, social network index, and number of restrictions in their own activities due to their caregiving role. The outcome was a nine-item questionnaire adapted from the Zarit Burden Inventory. RESULTS: The highest burden was reported among caregivers with more limited social networks (OR 1.38, Cl 1.02-1.87), more restrictions in their daily activities (OR 1.35, Cl 1.13-1.61), and who were younger (OR 1.46, Cl 1.10-1.93). CONCLUSIONS: Variations exist in the intensity of caregiver burden based on subjective experiences and social support, rather than on the amount of assistance provided. Clinicians should consider factors such as these when targeting caregivers for interventions to alleviate burden.

Activities of Daily Living↗
PubMed2004

A prospective study of perceived susceptibility to breast cancer and nonadherence to mammography screening guidelines in African American and White women ages 40 to 79 years.

This prospective study examined the influence of perceived susceptibility to breast cancer on nonadherence to recommended mammography screening guidelines. The study population included 1,229 African American and White women ages 40 to 79 years who obtained an index mammography screening examination at one of five urban hospitals in Connecticut between October 1996 and January 1998. Information on perceived susceptibility to breast cancer and on multiple covariates was obtained by telephone interview on average 1.5 months after the index screening. Subsequent adherence to mammography screening guidelines was ascertained by follow-up interview on average 29 months after the index exam. Across race, age, and family breast cancer history, women who believed that their susceptibility was high (i.e., "very likely" to develop breast cancer) were less likely to adhere to screening guidelines than women who believed that their susceptibility was moderate [adjusted odds ratio (OR), 2.83; 95% confidence interval (CI), 1.51-5.30], but the effect was stronger in older women. Women ages 40 to 49 years (but not ages 50-79 years) who believed that their susceptibility was low (i.e., "not likely" or "a little likely" to develop breast cancer) were also less likely to adhere to guidelines than those who reported moderate susceptibility (adjusted OR, 3.07; 95% CI, 1.66-5.68, and adjusted OR, 2.78; 95% CI, 1.63-4.73). In contrast to most previous studies that found a positive linear relationship between perceived susceptibility to breast cancer and mammography screening, these findings suggest a more complex relationship that should be considered when developing interventions to improve adherence to mammography screening guidelines.

Adult↗
PubMed2003

Sex differences in health status after coronary artery bypass surgery.

BACKGROUND: Although previous studies have shown functional improvements in patients who undergo coronary artery bypass graft (CABG) surgery, data are conflicting on whether the gains achieved by women are similar to or less than those achieved by men. METHODS AND RESULTS: We compared physical and psychological functional gains and readmission rates between 777 men and 295 women who underwent first CABG consecutively between February 1999 and February 2001. Physical function and mental health were measured by means of the Short Form 36-Item Health Survey (SF-36). At 6 months, both men and women showed, on average, a significant improvement in physical function and mental health, but men improved significantly more than women. After adjustment for baseline characteristics, the mean score improvement in women was half that of men for physical function (7.3 versus 14.0, P=0.0002) and 25% less than that of men for mental health (-3.0 versus 8.9, P=0.026). The absolute rates of adverse outcomes, such as hospital readmission, worsening functional status, and worsening mental health, were significantly higher in women (32.6%, 25.7%, and 17.5%, respectively) than in men (21.2%, 11.1%, and 12.6%, respectively) and remained significantly different in multivariable analysis. CONCLUSIONS: CABG surgery is associated with lower functional gains and higher readmission rates in women compared with men 6 months after operation.

Aged↗
PubMed2003

Prognostic significance of psychosocial factors in African-American and white breast cancer patients: a population-based study.

BACKGROUND: It has been suggested that psychosocial factors, such as coping and emotional support, influence cancer survival, but results have been inconclusive. Given the scarce data from racially/ethnically diverse populations, the authors investigated the prognostic significance of selected psychosocial variables in a cohort of African-American women and white women with breast cancer. METHODS: The authors examined the effects of coping styles, perceived emotional support, fatalism, and health locus of control on survival for a population-based cohort of 145 African-American women and 177 white women who were diagnosed with breast cancer in Connecticut between January 1987 and March 1989 and were followed for survival for approximately 10 years. Cox proportional hazards models were adjusted for sociodemographic factors, biomedical factors (American Joint Committee on Cancer stage at diagnosis, histologic grade, comorbidity, obesity, menopausal status, and treatment), and lifestyle factors. RESULTS: Fully adjusted models showed that lower perceived emotional support (disagreeing with the statement, "cancer is a topic I can talk about freely with my friends/relatives") at diagnosis was associated with a higher risk of death from any cause (hazard ratio, 1.39; 95% confidence interval, 1.09-1.79). Adjustment for additional tumor characteristics (nuclear grade, estrogen and progesterone receptor status) and genetic alterations (p53, HER-2) did not alter the findings. No other psychosocial factors significantly predicted survival in patients with breast cancer. CONCLUSIONS: Higher levels of perceived emotional support showed a moderate but significant association with increased survival in African-American and white women with breast cancer who were followed for 10 years after diagnosis when adjusting for known prognostic factors. Survival was not related to coping styles, fatalism, or health locus of control.

Adaptation, Psychological↗
PubMed2003

Gender differences in recovery after coronary artery bypass surgery.

OBJECTIVES: This study was designed to examine whether female gender is associated with poorer recovery after coronary artery bypass graft (CABG) surgery. BACKGROUND: The risks and benefits associated with CABG surgery in women are not as well established as they are in men, and there are concerns that women may have worse outcomes. The recovery period after CABG (the first four to eight weeks after the surgery) is a vulnerable time, with higher risks of complications and hospital readmission. There is little information on patients' experiences during this phase, particularly among women. METHODS: We prospectively followed 1,113 patients (804 men and 309 women) who underwent first CABG consecutively between February 1999 and February 2001. Patients were interviewed at baseline and between six and eight weeks after surgery. Clinical data were abstracted from medical records. RESULTS: Compared with men, women were older and more often had unstable angina and congestive heart failure, lower physical function (PF), and more depressive symptoms in the month before surgery. At six to eight weeks after CABG surgery, after adjustment for baseline characteristics, the rate of hospital readmission was 20.5% in women and 11.0% in men (p = 0.005), and the mean number of physical symptoms and side effects was 2.5 in women and 2 in men (p = 0.0009). Whereas, on average, PF remained unchanged in men (an increase in score of 0.3 points, 95% confidence interval [CI], -1.1 to 1.8) and depressive symptoms improved (a decrease of 0.2 depressive symptoms, 95% CI, -0.4 to -0.04), women showed, on average, a 13-point decline in physical function (95% CI, -15.8 to -10.4) and an increase of 0.5 in depressive symptoms (95% CI, 0.1 to 0.9). CONCLUSIONS: After CABG surgery, women have a more difficult recovery compared with men, which is not explained by illness severity, presurgery health status, or other patient characteristics.

Aged↗
PubMed2003

Religion and cognitive dysfunction in an elderly cohort.

OBJECTIVES: This study examines whether attendance at religious services has an inverse association with cognitive dysfunction in an elderly cohort in whom it has already been shown that religious attendance has an inverse association with physical disability and that social engagement has an inverse association with cognitive decline. METHODS: The study population is a racially and religiously diverse sample of 2,812 community-dwelling men and women from New Haven, Connecticut; it was representative of New Haven in 1982, but not of the United States then or now. The primary study hypothesis proposes that attendance at religious services as measured in 1982 contributes to the prediction of lower levels of cognitive dysfunction in 1985 and 1988. A multivariate logistic regression analysis controlling for seven sociodemographic, four behavioral, and seven biomedical covariables is conducted. RESULTS: Study results show an inverse association between religious attendance in 1982 and cognitive dysfunction in 1985 (odds ratio = 0.64; 95% confidence interval = 0.49, 0.85). Religious attendance as measured in 1982 no longer contributes to the prediction of cognitive dysfunction in 1988. DISCUSSION: The short-term nature of the effect is partially explained by differential mortality. Persons with infrequent religious service attendance and with high levels of cognitive dysfunction in 1982 were more likely to die in the period from 1985 to 1988.

Aged↗
PubMed2003

Impact of husbands' involuntary job loss on wives' mental health, among older adults.

OBJECTIVES: This study estimates the consequences of older husbands' involuntary job loss for their wives' mental health. METHODS: Using longitudinal data from the 1992, 1994, and 1996 waves of the Health and Retirement Study, multivariate regression models were estimated to measure the impact of older husbands' involuntary job loss on wives' mental health. We created two longitudinal data sets of two waves each to use in our analysis. The first data set, or period, combined Waves 1 and 2 of the Health and Retirement Study and described the 1992-1994 experience of spouse pairs in our sample. It included the wives of 55 husbands who experienced involuntary job loss between these survey dates and a comparison group of wives of 730 continuously employed husbands. The second data set described the 1994-1996 experience of couples. In particular, it included the wives of an additional 38 husbands who were displaced from their jobs between Waves 2 and 3, and a comparison group of wives of 425 husbands who were continuously employed from 1994 to 1996. RESULTS: Husbands' involuntary job loss did not have a statistically significant effect on wives' mental health. We found no evidence that changes in husbands' depressive symptoms modified the effect of his job loss on wives' mental health. In the first period only, the effect of husbands' job loss on wives' mental health was more pronounced for wives who were more financially satisfied at baseline. DISCUSSION: There is limited evidence among this cohort that husbands' job loss increases wives' subsequent depressive symptoms. However, the effect of husbands' job loss on wives' mental health appears to be magnified when wives report being financially satisfied pre-job loss. This suggests that, for subgroups of older couples, mental health services specifically targeted at displaced men should also be made available to wives.

Aged↗
PubMed2003

Religion, race, and breast cancer survival.

OBJECTIVE: The study investigated whether any of four measures of religiousness predicted longer survival for 145 African-American and 177 White women diagnosed with breast cancer in Connecticut between January 1987 and March 1989. METHOD: Multivariate Cox proportional hazards models included a religious predictor and sociodemographic, biomedical, treatment, behavioral, and medical care covariables. RESULTS: The no denomination group had a hazard ratio (HR) of 4.39 (95% Confidence Interval (CI) = 1.42, 13.64). Other measures of religiousness did not yield statistically significant results but showed a consistent pattern of nonreligiousness being more strongly and negatively related to breast cancer survival in African Americans than in Whites. CONCLUSIONS: Exploratory models confirmed that lack of religiousness was associated in this sample with poor breast cancer survival among African American women.

Black or African American↗
PubMed2002

Fatigue and psychological distress in the working population: psychometrics, prevalence, and correlates.

OBJECTIVE: The purposes of this study were: (1) to explore the relationship between fatigue and psychological distress in the working population; (2) to examine associations with demographic and health factors; and (3) to determine the prevalence of fatigue and psychological distress. METHODS: Data were taken from 12,095 employees. Fatigue was measured with the Checklist Individual Strength, and the General Health Questionnaire (GHQ) was used to measure psychological distress. RESULTS: Fatigue was fairly well associated with psychological distress. A separation between fatigue items and GHQ items was shown. No clear, distinct pattern of associations was found for fatigue vs. psychological distress with respect to demographic factors. The prevalence was 22% for fatigue and 23% for psychological distress. Of the employees reporting fatigue, 43% had fatigue only, whereas 57% had fatigue and psychological distress. CONCLUSIONS: The results indicate that fatigue and psychological distress are common in the working population. Although closely associated, there is some evidence suggesting that fatigue and psychological distress are different conditions, which can be measured independently.

Adolescent↗
PubMed2002

Longevity increased by positive self-perceptions of aging.

This research found that older individuals with more positive self-perceptions of aging, measured up to 23 years earlier, lived 7.5 years longer than those with less positive self-perceptions of aging. This advantage remained after age, gender, socioeconomic status, loneliness, and functional health were included as covariates. It was also found that this effect is partially mediated by will to live. The sample consisted of 660 individuals aged 50 and older who participated in a community-based survey, the Ohio Longitudinal Study of Aging and Retirement (OLSAR). By matching the OLSAR to mortality data recently obtained from the National Death Index, the authors were able to conduct survival analyses. The findings suggest that the self-perceptions of stigmatized groups can influence longevity.

Aged↗
PubMed2002

Differences between African Americans and whites in the outcome of heart failure: Evidence for a greater functional decline in African Americans.

BACKGROUND: National statistics indicate that African Americans are disproportionately affected by mortality and hospitalizations resulting from heart failure when compared with other racial/ethnic groups. This might, in part, reflect a poorer course of heart failure among African Americans. METHODS: We conducted a prospective cohort study of 316 white and 82 African American consecutive patients aged > or =50 years with decompensated heart failure on hospital admission. The outcome of the study was death or decline in activities of daily living function at 6 months relative to baseline. RESULTS: African American patients were on average 8 years younger and had less favorable socioeconomic and access-to-care indicators. African Americans more often had a history of hypertension, renal insufficiency, and diabetes, but there were no differences in functional status, self-reported health status, signs of decompensation, or left ventricular ejection fraction. Quality-of-care indicators did not differ by race. Mortality rates at 6 months were similar in African Americans and whites (19.5% vs 17.2%, age adjusted), but African Americans had a greater functional decline (37.6% vs 24.7%). After adjusting for baseline characteristics, African Americans had an almost 50% higher risk of either death or decline in activities of daily living functioning (relative risk 1.45, 95% CI, 1.06-1.81). Adjustment for socioeconomic, access-to-care and quality-of-care indicators did not substantially change this estimate. CONCLUSIONS: African Americans have similar mortality but greater functional decline than whites after hospitalization for heart failure. This outcome is not explained by clinical, socioeconomic, access-to-care or quality-of-care differences.

Activities of Daily Living↗
PubMed2002

Rates and risks of complicated grief among psychiatric clinic patients in Karachi, Pakistan.

The aim of this study was to determine rates and risks of Complicated Grief (CG) among psychiatric clinic patients in Karachi, Pakistan. The Inventory of Traumatic Grief, an early version of Inventory of Complicated Grief--Revised, was administered to 151 recently bereaved patients, with validated criteria applied to determine CG "caseness." Thirty-four percent of the sample met criteria for CG. Although violent deaths did not pose a heightened CG risk, gender and kinship to the deceased did significantly increase the likelihood of meeting of criteria for CG.

Family Relations↗
PubMed2002

Longitudinal benefit of positive self-perceptions of aging on functional health.

We examined whether those with more positive self-perceptions of aging (older individuals' beliefs about their own aging) report better functional health over an 18-year period than do those with more negative self-perceptions of aging. We found that those with more positive self-perceptions of aging in 1975 reported better functional health from 1977 to 1995, when we controlled for baseline measures of functional health, self-rated health, age, gender, race, and socioeconomic status. We also demonstrated that perceived control partially mediates the relationship between self-perceptions of aging and functioning. The sample consisted of 433 participants in the Ohio Longitudinal Study of Aging and Retirement, a community-based study of individuals aged 50 and older, who were interviewed in 6 waves. Our study suggests that the way in which individuals view their own aging affects their functional health.

Adult↗