Social network and social support predict improvement of physical working capacity in rehabilitation of patients with first myocardial infarction

Psychosocial stress and social capital pathways and health: Perspectives from Lund University, Malmö

AIMS

The aim of this Commentary is to outline a few steps of the process by which psychosocial stress and later social capital have been investigated as health determinants at Lund University, Malmö since the 1980s. References to the international literature and literature from Malmö from the mid-1980s and onwards will be used.

RESULTS

The development of research on psychosocial factors and social capital has followed international progress, with a complementary focus on social capital from the late 1990s onwards. Social participation, entailing a number of social activities, seems to be both the common connection between psychosocial stress theory and social capital and the common denominator between cohesion and structural/network approaches to social capital and health.

CONCLUSIONS

The impact of this research area has been considerable in Sweden. Both psychosocial factors and social capital have been acknowledged as health determinants in national Swedish health policy, although a setback may be discerned in recent years.

Coping, social support and quality of life over time after myocardial infarction

AIM

This paper describes gender differences in perceived coping, social support and quality of life 1, 4 and 12 months after myocardial infarction.

BACKGROUND

There is a shortage of studies with a longitudinal research design investigating coping, social support and quality of life in women and men after myocardial infarction.

METHODS

A longitudinal, descriptive and comparative design was used for the study, which included 74 women and 97 men. At 12 months, 60 women and 88 men remained. Data were collected using the Jalowiec Coping Scale, a social support questionnaire, the SF-36 Health Survey (health-related quality of life) and the Quality of Life Index-Cardiac version (quality of life). The data were collected during the period 1999-2001.

RESULTS

No statistically significant changes over time in coping assessments emerged in the study group, except for fatalistic coping, which diminished over time in men. Women used more evasive coping than men at 4 and 12 months. The perceived efficiency in coping with physical aspects of the heart disease increased. More women than men perceived available support from grandchildren and staff of the church. Health-related quality of life increased in women and men in physical functioning, role-physical, vitality, social functioning, and role-emotional scales. Moreover, an improvement in the mental health scale was evident in women and a reduction in pain in men. No statistically significant gender differences were found for quality of life at any point in time.

CONCLUSIONS

The findings can be used to inform caregivers that optimistic, self-reliant and confrontational coping were the most frequently used by both women and men over the first year after myocardial infarction, and that confrontational coping has been shown to have positive outcomes in the longer term. Nurses should tell women about the importance of seeking prompt treatment and discuss health problems with caregivers and significant others. Care planning should include family members and significant others so that they can support and encourage patients to cope with problems in daily life.

Social relations as determinants of oral health among persons over the age of 80 years

OBJECTIVE

To analyze whether social relations during a 7-year follow-up influence oral health among generally healthy, community-dwelling persons over the age of 80 years.

METHOD

The present investigation is based on a subsample of 129 dentate community-dwelling individuals from The Kungsholmen Elders Oral Health Study (KEOHS), which included data from interviews and oral examinations. Social relations were measured in terms of marital status, living alone, frequency of contacts, number of confidants, and satisfaction with social contacts and with the frequency of contacts. Oral health was measured in terms of coronal caries and root caries.

RESULTS

The primary findings of the adjusted multivariate logistic regression analysis were that persons who lived alone or who became alone during the 7 years prior to the dental examination had greater odds of having coronal caries (odds ratio (OR): 2.4, 95% CI: 1.0-5.7) than those who continually lived with others, and that persons who were continuously dissatisfied with the frequency of their social contacts were more likely to have root caries than those who reported a sustained satisfaction with the frequency of their social contacts (OR: 2.9, 95% CI: 1.2-7.2).

CONCLUSION

This study suggests that social relations are related to the oral health status of old-old individuals. From a psychosocial perspective, our findings contribute to a deeper understanding of the background of oral health status in older adults.

Social support and physical and psychological recovery one year after myocardial infarction or coronary artery bypass surgery

The aim of this study was to evaluate the role of different support factors supposed to explain physical and psychological recovery after myocardial infarction (MI) or coronary artery bypass surgery (CABS). The subjects comprised 147 MI patients and 159 CABS patients. Support factors included formal services, semi-formal assistance, and informal social support. The outcome measures used for analysis were functional activities level (Duke Activity Status Index, DASI), physical working capacity, anxiety, and depression one year after MI or CABS. In general, support factors had a limited role in this study. The patient's functional and psychological status at three months was the main determinant to recovery at one year. The outcome factors measured at three months explained 36-56% of their variance at one year, and the support factors increased the explanatory power by 0-10%. The support model employed in this study revealed that some single factors may have a positive or negative role in the recovery after MI or CABS.

Evidence for the effectiveness of cardiac rehabilitation

Cardiac rehabilitation is a relatively recent development and, though it is increasingly being recognized as an important part of comprehensive cardiac care, there remains some scepticism regarding its effectiveness and some ignorance of its potential. This article reviews the literature pertaining to the effectiveness of cardiac rehabilitation for patients with coronary heart disease (CHD).

Social network, social support and the concept of control--a qualitative study concerning the validity of certain stressor measures used in quantitative social epidemiology

Twenty-five in-depth interviews were made with middleaged persons of both sexes, who had suffered a first myocardial infarction (MI) two months previously. The purpose was to assess the layman's understanding of concepts such as social network, social support and control which are exposures commonly used or suggested for use in quantitative research in the area of social epidemiology. The validity of the instruments and the underlying concepts in assessing such exposures has important implications for the interpretation of the association between psychosocial factors and health or health behavior. The layman's understanding of social network and social support concepts seemed unproblematic, but the concept of control was understood in rather disparate ways among those interviewed. The experience of control/decision latitude in the work environment, seemed to form a model for the overall understanding of control among several of those interviewed and there also seemed to be important differences based on gender. Another impression, was that the individual's level of aspiration might be an important confounder in the assessment of control in population studies. It is therefore suggested that epidemiologcal data should be stratifyed by basic demographic variables like age, sex and social class in analyses including the control variable, to improve the valid use of this type of measure.

Psychosocial consequences of traffic accidents: a two year follow-up

The aim of the study was to assess long term outcome of injuries from traffic accidents with focus on psychosocial aspects. Eighty-four persons injured in traffic accidents and with moderate to severe injuries (ISS > or = 9) were interviewed approximately two years after the accident. We examined psychosocial consequences within eight different domains; sequelae of the injury, psychological consequences, sickness compensation received, living conditions, need of assistance, working capacity, economic situation and leisure time activity. Sixty-eight percent of the persons reported that they still suffered from physical seqelae and 57% had been or were still suffering from psychological distress after the accident. Sixty-three percent were on the sick-list for at least three months because of the accident. Fifty-eight percent needed some type of handicap aid during some time after the accident. For 29% of the professionally employed the traffic accident led to changed working conditions. The study indicates a need not only for adequate medical treatment, but also psychological and social counseling in the rehabilitation of victims of traffic accidents. Resources for crisis intervention should also be available at an early stage.