The Frequency and Factors Related to Aggressive Behavior in Psychiatric Patients Controlled by a Variety of Restraint Methods

Background: Aggressive behavior of patients in psychiatric wards is one of the main challenges faced by healthcare workers. Despite the abundance of research on the frequency of aggressive behavior, not enough attention has been paid to its severity. Furthermore, limited studies have evaluated the restraint methods used to manage aggressive behaviors. Objectives: The current descriptive study aimed to compare the relationship between demographic characteristics, diagnosis of psychiatric illness, medical illness, and hospitalization characteristics with features of aggressive behavior in patients experiencing different types of restraint during hospitalization. Methods: We evaluated subjects admitted to the adult psychiatric wards of Imam Hossein and Taleghani hospitals in Tehran, Iran, in 2018. The patients were controlled by various restraint methods during hospitalization. All the patients were evaluated for the severity of aggression, which was determined utilizing the Persian version of the Modified Overt Aggression Scale (MOAS). All the data along with demographic and clinical characteristics obtained from medical records were analyzed using the Mann-Whitney and Kruskal-Wallis nonparametric test (P-value = 0.05) and Spearman correlation coefficient to describe the factors affecting the aggressive behavior of patients. Results: In this study, the prevalence of aggressive behavior was 11.7%. Among the demographic variables, gender (P-value = 0.003), education level (P-value = 0.05), and the history of aggressive behavior (P-value = 0.001) were significantly associated with the MOAS. Furthermore, as the hospitalization duration increased, the frequency of aggressive behavior decreased, and its severity intensified. Moreover, there was a significant relationship between aggression severity with admission type (P-value = 0.00), concurrent medical illness (P-value = 0.026), and substance abuse (P-value = 0.025). Conclusions: According to the obtained results, the factors affecting the aggression and early identification of patients with the potential of aggressive behavior is an effective management strategy for controlling these patients.

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Gender Moderates the Association Between Exposure to Interpersonal Violence and Intermittent Explosive Disorder Diagnosis

Journal of Interpersonal Violence ◽

10.1177/08862605211013951 ◽

2021 ◽

pp. 088626052110139

Author(s):

Lynette C. Krick ◽

Mitchell E. Berman ◽

Michael S. McCloskey ◽

Emil F. Coccaro ◽

Jennifer R. Fanning

Keyword(s):

Risk Factor ◽

Aggressive Behavior ◽

Interpersonal Violence ◽

Men And Women ◽

Affective Dysregulation ◽

Intermittent Explosive Disorder ◽

The Family ◽

History Of ◽

Clinically Significant ◽

The Relationship

Exposure to interpersonal violence (EIV) is a prevalent risk-factor for aggressive behavior; however, it is unclear whether the effect of EIV on clinically significant aggressive behavior is similar across gender. We examined whether gender moderates the association between experiencing and witnessing interpersonal violence and the diagnosis of intermittent explosive disorder (IED). We also examined potential pathways that might differentially account for the association between EIV and IED in men and women, including emotion regulation and social information processing (SIP). Adult men and women ( N = 582), who completed a semistructured clinical interview for syndromal and personality disorders, were classified as healthy controls (HC; n = 118), psychiatric controls (PC; n = 146) or participants with an IED diagnosis ( n = 318). Participants also completed the life history of experienced aggression (LHEA) and life history of witnessed aggression (Lhwa) structured interview and self-report measures of emotion regulation and SIP. Men reported more EIV over the lifetime. In multiple logistic regression analysis, experiencing and witnessing aggression within the family and experiencing aggression outside the family were associated with lifetime IED diagnosis. We found that the relationship between EIV and IED was stronger in women than in men. Affective dysregulation mediated certain forms of EIV, and this relation was observed in both men and women. SIP biases did not mediate the relation between EIV and IED. EIV across the lifespan is a robust risk factor for recurrent, clinically significant aggressive behavior (i.e., IED). However, the relationship between EIV and IED appears to be stronger in women. Further, this relation appears partially mediated by affective dysregulation.

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Clinical and demographic characteristics of psychiatric patients seropositive for Borrelia burgdorferi

European Psychiatry ◽

10.1016/j.eurpsy.2004.09.021 ◽

2006 ◽

Vol 21 (2) ◽

pp. 118-122 ◽

Cited By ~ 8

Author(s):

T. Hájek ◽

J. Libiger ◽

D. Janovská ◽

P. Hájek ◽

M. Alda ◽

...

Keyword(s):

Borrelia Burgdorferi ◽

Psychiatric Disorders ◽

Psychiatric Patients ◽

Psychiatric Morbidity ◽

Demographic Variables ◽

Healthy Controls ◽

Diagnostic Categories ◽

Potential Association ◽

History Of ◽

The Central Nervous System

AbstractPurpose.Borrelia burgdorferi (Bb) infection can affect the central nervous system and possibly lead to psychiatric disorders. We compared clinical and demographic variables in Bb seropositive and seronegative psychiatric patients and healthy controls.Method.Nine hundred and twenty-six consecutive psychiatric patients were screened for antibodies to Bb and compared with 884 simultaneously recruited healthy subjects.Results.Contrary to healthy controls, seropositive psychiatric patients were significantly younger than seronegative ones. None of the studied psychiatric diagnostic categories exhibited stronger association with seropositivity. There were no differences between seropositive and seronegative psychiatric patients in hospitalization length, proportion of previously hospitalized patients and proportion of subjects with family history of psychiatric disorders.Conclusion.These findings elaborate on potential association between Bb infection and psychiatric morbidity, but fail to identify any specific clinical ‘signature’ of Bb infection.

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HUBUNGAN ANTARA PARITAS, RIWAYAT KEHAMILAN,DAN ASUPAN KALSIUM DENGAN KEJADIAN PRE EKLAMPSIA BERAT

Jurnal Ilmu Keperawatan dan Kebidanan ◽

10.26751/jikk.v10i2.686 ◽

2019 ◽

Vol 10 (2) ◽

pp. 358

Author(s):

Diah Andriani ◽

Rusnoto Rusnoto

Keyword(s):

Pregnant Women ◽

Calcium Intake ◽

Severe Preeclampsia ◽

Influential Factor ◽

Bivariate Analysis ◽

P Value ◽

Pregnancy History ◽

History Of ◽

Relationship Of ◽

The Relationship

Latar Belakang: Preeklampsia/eklampsia merupakan salah satu penyebab utama morbiditas dan mortalitas perinatal di Indonesia. Sampai sekarang penyakit preeklamsia/eklamsia masih merupakan masalah kebidanan yang belum dapat erpecahkan secara tuntas. Preeklampsia merupakan penyakit yang angka kejadiannya di setiap negara berbeda-beda.Tujuan : Mengetahui hubungan paritas, riwayat kehamilan,dan asupan kalsium dengan kejadian pre eklampsia berat di UPT Puskesmas Jepang.Metode: Dalam penelitian ini yang menjadi populasi adalah semua ibu hamil yang melakukan ANC di Puskesmas Jepang Kecamatan Mejobo Kabupaten Kudus pada bulan Agustus 2017 sebanyak 30 ibu hamil.Sampel dalam penelitian ini adalah ibu hamil yang melakukan kunjungan ANC di Puskesmas Jepang Kecamatan Mejobo Kabupaten Kudus pada bulan Agustus 2017 sebanyak 30 orang. Analisis data menggunakan analisis univariat dan bivariat. Hasil penelitian Mayoritas responden memiliki paritas multipara sebanyak 18 orang (60%), dan yang primipara sebanyak 12 orang (40%). Mayoritas responden memiliki riwayat tidak pernah pre eklampsia berat sebanyak 16 orang (53,3%) dan yang pernah pre eklampsia berat sebanyak 14 orang (46,7%). Mayoritas responden memiliki asupan kalsium cukup sebanyak 18 orang (60%) dan yang asupan kalsium tidak cukup sebanyak 12 orang (40%). Mayoritas responden tidak pre eklampsia berat sebanyak 18 orang (60%) dan yang pre eklampsia berat sebanyak 12 orang (40%). Ada hubungan paritas dengan kejadian pre eklampsia berat di upt puskesmas jepang (p value = 0,001). Ada hubungan riwayat kehamilan dengan kejadian pre eklampsia berat di upt puskesmas jepang (p value = 0,001). Ada hubungan asupan kalsium dengan kejadian pre eklampsia berat di upt puskesmas jepang (p value = 0,009). Berdasarkan analisis regresi faktor yang paling berpengaruh dengan kejadian pre eklampsia berat adalah asupan kalsium (koefisien = 0,477). Kesimpulan Ada hubungan paritas, riwayat kehamilan dan asupan kalsium dengan kejadian pre eklampsia berat di UPT Puskesmas Jepang..Kata Kunci : Preeklampsia berat, paritas, riwayat kehamilan, asupan kalsiu ABSTRACT Background: Preeclampsia / eclampsia is one of the major causes of perinatal morbidity and mortality in Indonesia. Until now the disease of preeclampsia / eclampsia is still a matter of obstetrics that can not be eradicated completely. Preeclampsia is a disease whose number of events in each country is different. Objective: To determine the relationship of parity, pregnancy history, and calcium intake with the incidence of severe pre eclampsia Method: In this study the population is all pregnant women who do the ANC at the Health Center of Jepang District Mejobo Kudus Regency in August 2017 as many as 30 pregnant women. Samples in this study were pregnant women who visited the ANC at the Puskesmas Jepang District Mejobo Kudus District on in August 2017 as many as 30 people. Data analysis used univariate and bivariate analysis. Result of research Majority of respondents have multiparity parity as many as 18 people (60%), and primipara 12 (40%). The majority of respondents have a history of never preeclampsia as many as 16 people (53.3%) and who ever peb as many as 14 people (46.7%). The majority of respondents have enough intake of calcium as many as 18 people (60%) and who intake of calcium is not enough as many as 12 people (40%). The majority of respondents are not preeclampsia as many as 18 people (60%) and who preeclampsia as many as 12 people (40%). There is a parity relationship with the incidence of severe eclampsia in Puskesmas Jepang upt (p value = 0.001). There was a correlation of pregnancy history with severe pre eclampsia incidence at upt Puskesmas jepang (p value = 0,001). There is a correlation of calcium intake with severe pre eclampsia occurrence at UPT Puskesmas jepang (p value = 0,009). Based on regression analysis the most influential factor with severe pre eclampsia incidence was calcium intake (coefficient = 0.477). Conclusion There was a parity relationship, a history of pregnancy and calcium intake with severe preeclampsia events at the UPT Puskesmas Jepang. . Keywords: severe preeclampsia, parity, pregnancy history, calcium supplements

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HUBUNGAN KEBIASAAN MENONTON TAYANGAN KEKERASAN DI TELEVISI DENGAN PERILAKU AGRESIF PADA ANAK USIA PRA SEKOLAH

JURNAL KEPERAWATAN ◽

10.35790/jkp.v8i1.28416 ◽

2020 ◽

Vol 8 (1) ◽

pp. 91

Author(s):

Andre Ratuela ◽

Hendro Bidjuni ◽

Sefti Rompas

Keyword(s):

Aggressive Behavior ◽

School Children ◽

Violent Behavior ◽

Sampling Technique ◽

Cross Sectional Study ◽

School Age Children ◽

P Value ◽

Cross Sectional ◽

Study Approach ◽

The Relationship

Abstract: Aggressive behavior is a physical or psychological action that is intentionally carried out to hurt another child, such as hitting, pushing, fighting, humiliating, insulting, spreading false or excusing issues. Violence is one of the issues affecting the practice of early childhood education. Purpose: To determine the relationship between the habit of watching violence on television and aggressive behavior in pre-school children. Method : this study used Descriptive analytic with cross sectional study approach. 32 respondents of pre-school children participate in this study used total sampling technique. Data collection method used 2 quationnaire about the watching violance habbits on TV and aggressive behavior at child on pre-school. Date analysis used Spermen corelation test This. The Result of this study showed p value=0,04 with α<0,05. Conclusion: there was a relationship between watching violence on television with aggressive behavior in pre-school age children in GMIM Kindergarten Musafir Kleak. Suggestion: The results of this study recommend to provide benefits for parents in efforts to prevent the occurrence of violent behavior by children. Keywords: Watching Habits, Violent Impressions, Aggressive Behavior.Abstrak : Perilaku agresif adalah tindakan fisik atau psikologis yang secara sengaja dilakukan untuk menyakiti anak lain, seperti memukul, mendorong, berkelahi, mempermalukan, menghina, menyebarkan isu yang tidak benar atau mengucilkan. Kekerasan merupakan salah satu persoalan yang berpengaruh terhadap praktik pendidikan anak usia dini. Tujuan: Untuk mengetahui hubungan kebiasaan menonton tayangan kekerasan di televisi dan perilaku agresif pada anak pra sekolah di TK GMIM Musafir Kleak. Metode Penelitian : Penelitian ini menggunakan teknik Deskriptif analitik dengan pendekatan Cross Sectional. Sampel dalam penelitian ini menggunakan 32 responden dengan teknik total sampling. Pengumpulan data menggunakan 2 kuesioner yaitu kebiasaan menonton tayangan kekerasan di TV dan perilaku agresif pada anak pra-sekolah. Penelitian ini menggunakan uji Spearmen dan Hasil dari penelitian ini menunjukkan nilai p=0,04 yang berarti bahwa nilai α<0,05. Kesimpulan: Ada hubungan yang erat antara menonton tayangan kekerasan di televisi dengan perilaku agresif pada anak usia pra sekolah di TK GMIM Musafir Kleak. Hasil penelitian ini diharapkan dapat memberikan manfaat bagi orang tua dalam upaya pencegahan terjadinya perilaku kekerasan oleh anak.Kata Kunci: Kebiasaan Menonton, Tayangan Kekerasan, Perilaku Agresif

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Psychiatry as a career: A survey of factors affecting students’ interest in Psychiatry as a career

McGill Journal of Medicine ◽

10.26443/mjm.v12i1.730 ◽

2020 ◽

Vol 12 (1) ◽

Author(s):

Mubashir Aslam ◽

Tahir Taj ◽

Arif Ali ◽

Nasira Badar ◽

Farzan Saeed ◽

...

Keyword(s):

Medical Students ◽

Family History ◽

Medical School ◽

Psychiatric Illness ◽

P Value ◽

Factors Affecting ◽

Medical Graduates ◽

Significant Difference ◽

History Of ◽

Self Administered Questionnaire

The objectives of this study were to determine the characteristics of medical students and graduates interested in choosing psychiatry as a career and the obstacles in choosing this field of medicine. Two private and two public medical institutes were surveyed from June 2007 to August 2007. A self-administered questionnaire was distributed to third, fourth and final year students and to medical graduates doing their internship in these four medical institutes.A total of 909 medical students and graduates participated in the study. Seventeen percent of participants responded positively regarding their interest in psychiatry as a career. Significantly higher proportion belonged to private medical institutes (14% vs. 24%, P-value =0.001). There was no significant difference in reporting interest for psychiatry in regard to age, sex, year in medical school and whether or not the participant had done a psychiatry ward rotation. However significantly higher proportion of participants (22%, n=43) were reporting their interest in the field of psychiatry who had done more than a month long psychiatry ward rotation as compared to those participants (14%, n=54) with less than a month or no psychiatry rotation (P-value=0.01). More students were reporting their interest in psychiatry with a family history of psychiatric illness as compared to without family history (24% vs 16%, P-value=0.03). In conclusion, students and graduates with more than a month long rotation in psychiatry, studying in private medical colleges and with a family history of psychiatric illness were more interested in choosing psychiatry as a career.

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Riwayat Komplikasi Maternal terhadap Insiden Kelahiran Prematur di RSUD Dr. H. Chadan Boesoirie Ternate

Jurnal Kesehatan Terpadu (Integrated Health Journal) ◽

10.32695/jkt.v11i2.73 ◽

2020 ◽

Vol 11 (2) ◽

pp. 52-57

Author(s):

Siska Nawang Ayunda Maqfiro ◽

Irmasanti Fajrin

Keyword(s):

Premature Birth ◽

Sampling Technique ◽

Neonatal Morbidity ◽

Simple Random Sampling ◽

Total Sample ◽

P Value ◽

Cross Sectional ◽

Maternal Complication ◽

History Of ◽

The Relationship

Premature birth is one of the most important factors in neonatal morbidity and mortality. Based on the survey shows an increase in the incidence of premature birth at dr. H. Chasan Boesoirie hospital in 2015-2017. The purpose of this study was to determine the relationship between the history of maternal complication and the incidence of premature birth at dr. H. Chasan Boesoirie hospital used an analytic correlation research design with a cross-sectional approach. The population is all multiparity and grand multiparity at dr. H. Chasan Boesoirie hospital on January-December 2018, the sampling technique used simple random sampling, with the total sample are 196 respondents. The results show that 66,3% do not have the history of maternal complication and 85,7% do not have an incidence of premature birth. Then, that were analyzed using Spearman-rank. The results show that p-value is 0,001 (p-value<α). The conclusion that there is a relationship between the history of maternal complication and the incidence of premature birth at dr. H. Chasan Boesoirie hospital. So, it is necessary to provide information and education to pregnant women in order to plan their pregnancy well and build a referral system with primary care facilities.

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Anemia In Pregnancy With Stunting In Gayam Village District Gurah Kediri

Jurnal Kebidanan Midwiferia ◽

10.21070/midwiferia.v7i1.1319 ◽

2021 ◽

Vol 7 (1) ◽

pp. 81-94

Author(s):

Dewi Taurisiawati Rahayu

Keyword(s):

Sampling Technique ◽

P Value ◽

Test Results ◽

Critical Periods ◽

Mild Anemia ◽

Moderate Anemia ◽

History Of ◽

Anemia During Pregnancy ◽

Independent Variable ◽

The Relationship

The nutritional status and health of the mother during pre-pregnancy, pregnancy, and during breastfeeding was very critical periods for children's growth and development. The aim of this research was to determine the relationship between anemia during pregnancy and the incidence of stunting. The method used in this research was observational correlational analytic, which looking for the relationship between two independent and dependent variables used a cohort-retrospective approach, with the independent variable anemia during pregnancy and the dependent variable the incidence of stunting. The research was conducted from 2 July – 29 August 2020 in Gayam Village, Kediri Distric used MCH book instrument. Total population was 512 toddlers with judgement sampling technique as many as 88 toddlers consisted of 38 stunting and 50 non-stunting toddlers. Analysis used the Spearman Rho with the results of the Spearman value showed that total of 66 toddlers, 4 (6.1%) of stunting toddlers were found with no history of anemia, 13 (19.7%) of stunting toddlers with a history of mild anemia and 5 (7.6%) of stunting toddlers with a history of moderate anemia. Spearman rho test results p value = 0.000. This mean that the p value <α = 0.05, because the p-value <α, H1 accepted, that there was a relationship between a history of anemia during pregnancy and the incidence of stunting on toddlers. Anemia during pregnancy was very risky for the development of fetus and the development of baby that will beb born can caused stunting.

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HUBUNGAN KUALITAS PELAYANAN KESEHATAN TERHADAP TINGKAT KEPUASAN PASIEN PESERTA BPJS MANDIRI DI PUSKESMAS DELITUA KABUPATEN DELI SERDANG TAHUN 2018

Jurnal Penelitian Keperawatan Medik ◽

10.36656/jpkm.v1i2.146 ◽

2019 ◽

Vol 1 (2) ◽

pp. 48-52

Author(s):

Selamat Ginting ◽

Adi Arianto

Keyword(s):

Public Health ◽

Health Center ◽

The Body ◽

P Value ◽

Factors Affecting ◽

Public Health Center ◽

Level Of Satisfaction ◽

Quality Of Health Services ◽

The Relationship

Health is a prosperous state of the body, soul, and social which is very possible for every individual to live productively in a social and economic way. Tests of research are to identify the relationship between the quality of health services to the level of satisfaction of BPJS Mandiri in Public Health Center Deli Tua Kab Deli Serdang. The research method uses an analytical survey type with a sample of 95 people. The results of the study are that there is a significant relationship between Tangible, reliability, responsiveness, assurance, empathy for the satisfaction of BPJS Mandiri in Public Health Center Deli Tua Kab Deli Serdang wit p-value(0.00). The conclusion in this study is that the most dominant factors affecting patient satisfaction are direct evidence of this indicated by the highest Exp (B) of 6,374

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Hubungan Tipe Kepribadian Dengan Tingkat Interaksi Sosial Lansia Di Panti Wredha Sultan Fatah Demak

Jurnal Ilmu Kesehatan MAKIA ◽

10.37413/jmakia.v10i2.101 ◽

2020 ◽

Vol 10 (2) ◽

Author(s):

Galia Wardha Alvita ◽

Sholihul Huda

Keyword(s):

Sampling Technique ◽

The Elderly ◽

General Information ◽

Personality Types ◽

P Value ◽

Cross Sectional ◽

Diet Pattern ◽

History Of ◽

Cross Sectional Design ◽

The Relationship

ABSTRAKLatar Belakang : usia yang semakin tua pada lansia akan diikuti dengan perubahan interaksi sosial. Perubahan interaksi sosial lansia menimbulkan keterbatasan dalam berhubungan dengan orang lain dan mempengaruhi kepuasan dalam hidup. Perubahan interaksi sosial tersebut dipengaruhi pula oleh pengalaman tipe kepribadian dimasa mudanya yaitu tipe kepribadian tertutup ataupun terbuka. Penelitian ini bertujuan untuk mengetahui Hubungan Tipe Kepribadian Dengan Tingkat Interaksi sosial pada Lansia di Panti Wredha Sultan Fatah Demak.Metode : Jenis penelitian adalah deskriptif korelasi dengan rancangan cross sectional. Jumlah sampel dalam penelitian ini 30 responden dengan teknik pengambilan sampel total sampling. Analisa penelitian menggunakan Chi Kuadrat.Hasil : sebagian besar lansia mempunyai tipe kepribadian introvert yaitu 16 responden (53,3%), dan sebagian kecil lansia mempunyai tipe kepribadian ekstrovet yaitu 14 responden (46.7%). Sebagian besar lansia memiliki tingkat interaksi sosial kurang sebanyak 18 responden (60 %) dan tingkat interaksi sosial baik sebanyak 12 responden (40%) dengan nilai p-value 0,024 (p0.05).Kesimpulan : Ada Hubungan Tipe Kepribadian Dengan Tingkat Interaksi sosial pada Lansia di Panti Wredha Sultan Fatah Demak. Berdasarkan hasil analisis statistik tersebut memberikan informasi umum yang berkaitan dengan hubungan tipe kepribadian dengan bagaimana lansia dalam berinteraksi sehingga dapat merumuskan intervensi yang tepat dalam meningkatkan interaksi sosial lansia sesuai dengan tipe kepribadiannya Kata Kunci : Interaksi Sosial, Kepribadian, Lansia ABSTRACTBackground: The aging process in the elderly will be followed by psychososial changes. Psychososial changes that occur result in disruption of sosial interaction of the elderly and lead to dependence on others and satisfaction in life. Psychoanalytic changes are also influenced by the experience of personality types in his youth. This study aims to determine the relationship between the type of personality and the level of sosial interaction in the elderly at the Panti Wredha Sultan Fatah Demak.Method: The type of research is descriptive correlation with cross sectional design. The number of samples in this study were 30 respondents with a total sampling technique. Research analysis uses Chi Squares.Results: most of the elderly have introverted personality types, namely 16 respondents (53.3%), and a small portion of the elderly have extrovet personality types, namely 14 respondents (46.7%). Most of the elderly have a level of sosial interaction less than 18 respondents (60%) and a good level of sosial interaction as many as 12 respondents (40%) with a p-value of 0.024 (p 0.05).Conclusion: There is a Relationship between Personality Types and the Level of Sosial Interaction in the Elderly at the Panti Wredha Sultan Fatah Demak. Based on the results of the statistical analysis, it provides general information relating to the relationship of personality types with how the elderly interact so that they can form appropriate interventions in increasing sosial interaction of the elderly according to their personality type. Keywords : Diet pattern, History of hypertension, Elderly

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Non-Cardiopulmonary Factors Affecting the Six-Minute Walk Distance in Patients with Sickle Cell Disease: Results From the Walk-PHaSST Study

Blood ◽

10.1182/blood.v118.21.1074.1074 ◽

2011 ◽

Vol 118 (21) ◽

pp. 1074-1074 ◽

Cited By ~ 1

Author(s):

Ruchika Goel ◽

Kathryn L. Hassell ◽

Roberto F Machado ◽

Robyn J. Barst ◽

Nancy Yovetich ◽

...

Keyword(s):

Chronic Pain ◽

Sickle Cell Disease ◽

Sickle Cell ◽

P Value ◽

Cell Disease ◽

Walk Distance ◽

Factors Affecting ◽

History Of ◽

Minute Walk Distance ◽

Minute Walk

Abstract Abstract 1074 Non-Cardiopulmonary Factors Affecting the Six-Minute Walk Distance in Patients with Sickle Cell Disease: Results from the Walk-PHaSST Study. INTRODUCTION: The six-minute walk (6MW) test is frequently used to assess exercise capacity. Patients with sickle cell disease (SCD) can have decreased 6MW distance (6MWD) compared to controls. The 6MWD in conjunction with the TR-jet velocity (TRV) and NT-proBNP have recently been proposed to have a greater predictive value for screening SCD patients suspected of having pulmonary hypertension (PH) than TRV alone. (Parent et al, NEJM, 365; 1, 2011 365 (1):44–53). The American Thoracic Society guidelines recommend caution in controlling for sources of variability in the 6MWD (Am J Respir Crit Care Med 166. 111–117, 2002). Age and height are known confounders of the 6MWD. However, non-cardiopulmonary factors including skeletal-mechanics and pain may also impact the 6MWD. AIM: This study explores whether non-cardiopulmonary factors affect the 6MWD in SCD patients. METHODS: We analyzed data from subjects screened for the walk-PHaSST trial. Walk-PHaSST was a multi-center, placebo-controlled, double-blind, 16-week trial evaluating the safety and efficacy of oral sildenafil for the treatment of Doppler-defined PH (TRV '2.7m/s) in subjects with SCD aged >12 years. The primary endpoint in the trial was change in 6MWD. During screening, subjects were evaluated by self-reported medical history, physical examination, blood sampling, echocardiography and 6MWD. Univariate and multivariable linear regression was performed. A two sided p value <0.05 was considered significant. RESULTS: Of the 673 subjects screened, 671 had a 6MW test. The median (inter-quartile range) of 6MWD was 438m (503 – 381m = 122 m). On univariate analysis, there was no statistically significant effect of the SCD genotype on the 6MWD (p=0.26). Further, when combining the severe genotypes (HbSS and HbSβ0 thalassemia) vs the less severe genotypes, there was no significant difference in the 6MWD (p=0.22). By multivariable linear regression (Table 1), after adjusting for age, gender and TRV, the presence of the following (self-reported by subjects) were independently associated with an estimated decrease in the 6MWD: a) chronic pain (n = 260/671, 38.9%) by 24.3m (95% CI: 9.1–39.4m, p-value <0.01), b) history of avascular necrosis (AVN) of the hip (N =127/671, 18.9%) by 27.8m (95% CI: 9.2–46.4m, p-value <0.01), and c) osteopenia (N = 46/671,6.9% ) by 31.2m (95% CI: 2.7.-59.6m, p-value <0.05) There were no significant two-way interactions between chronic pain, AVN of the hip and/or osteopenia. History of leg ulcers, osteomyelitis and rheumatoid arthritis were not significant predictors of the 6MWD. DISCUSSION: In this multi-center study of patients with SCD, history of self-reported: 1) chronic pain 2) AVN of the hip and 3) osteopenia were independently associated with decreased functional capacity (as assessed by the 6MW test), after adjusting for age, gender, and TRV. While the 6MWD in patients with SCD is significantly related to cardiac function (i.e., PH and LV diastolic dysfunction), the potential effects of pain, osteonecrosis and osteopenia on 6MWD suggest that if using the 6MW test as the primary endpoint in future trials, one should consider documentation of the presence of these factors and use a stratified randomization based on a composite of these non-cardiopulmonary variables. Disclosures: Hassell: NIH:. Gladwin:Patents filed related to treating hemolysis.: Patents & Royalties.

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