RESUMEN
There are no evidence-based interventions to prevent adverse psychosocial consequences after living donation. We conducted a single-site randomized controlled trial to examine the postdonation impact of a preventive intervention utilizing motivational interviewing (MI) to target a major risk factor for poor psychosocial outcomes, residual ambivalence (i.e. lingering hesitation and uncertainty) about donating. Of 184 prospective kidney or liver donors, 131 screened positive for ambivalence; 113 were randomized to (a) the MI intervention, (b) an active comparison condition (health education) or (c) standard care only before donation. Ambivalence was reassessed postintervention (before donation). Primary trial outcomes-psychosocial variables in somatic, psychological and family interpersonal relationship domains-were assessed at 6 weeks and 3 months postdonation. MI subjects showed the greatest decline in ambivalence (p = 0.050). On somatic outcomes, by 3 months postdonation MI subjects reported fewer physical symptoms (p = 0.038), lower rates of fatigue (p = 0.021) and pain (p = 0.016), shorter recovery times (p = 0.041) and fewer unexpected medical problems (p = 0.023). Among psychological and interpersonal outcomes, they had a lower rate of anxiety symptoms (p = 0.046) and fewer unexpected family-related problems (p = 0.045). They did not differ on depression, feelings about donation or family relationship quality. The findings suggest that the intervention merits testing in a larger, multisite trial.
Asunto(s)
Consejo , Donadores Vivos/psicología , Trastornos Mentales/prevención & control , Trasplante de Órganos/psicología , Calidad de Vida , Adulto , Estudios de Factibilidad , Femenino , Humanos , Relaciones Interpersonales , Masculino , PronósticoRESUMEN
Sleep onset growth hormone secretion is a reliable and reproducible finding in young adults and children. Secretion typically occurs during the first non-REM period of sleep and, despite some evidence to the contrary, growth hormone secretion has frequently been associated with the first period of slow wave sleep. By measuring delta wave activity (0.5-2 Hz) instead of slow wave sleep and, accounting for the within subject variability, it has not been possible to demonstrate a consistent or statistically significant linear relationship between delta wave activity and sleep-related growth hormone secretion. This suggests the presence of more complex mediating factors and the possibility that sleep onset and growth hormone secretion are two separate processes which are independently stimulated by events associated with sleep onset.
Asunto(s)
Ritmo Delta , Electroencefalografía , Hormona del Crecimiento/sangre , Fases del Sueño/fisiología , Adolescente , Adulto , Electroencefalografía/instrumentación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procesamiento de Señales Asistido por ComputadorRESUMEN
The discovery of clinical and biological variables which correlate with the rate of treatment response is an important aim of outcome research. In this report, such items were assessed in a large group of patients with recurrent depression to determine what variables contribute to stabilization during treatment. Relatively few items were strongly related to time to stabilization aside from age, clinical severity of illness, and number of previous episodes. One biological variable, cortisol nadir, was positively related to the time of stabilization. Similar assessments of non-responders did not yield any specific predictors.