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Biomedical subjects

A Finset

Publications and source records attributed to A Finset.

At least 19 recordsLinked to original sources
PubMed2005

Activity limitations and participation restrictions in women with hand osteoarthritis: patients' descriptions and associations between dimensions of functioning.

OBJECTIVE: To describe the functional consequences of hand osteoarthritis, and analyse associations between personal factors, hand impairment, activity limitations, and participation restrictions within the framework of the International Classification of Functioning (ICF). METHODS: 87 women with hand osteoarthritis completed a clinical examination including recording of sociodemographic data, measures of hand impairment, and completion of self reported health status measures. The function subscale of the AUSCAN Osteoarthritis Hand Index was used as a measure of hand related activity limitations, while the Canadian Occupational Performance Measure (COPM) was used to describe and measure activity limitations and participation restrictions as perceived by the individual. The study variables were categorised using the dimensions in the ICF framework and analysed using bivariate and multivariate statistical approaches. RESULTS: The patients described problems in many domains of activity and participation. The most frequently described hand related problems were activities requiring considerable grip strength combined with twisting of the hands. On the impairment level, the patients had reduced grip force and joint mobility in the hands, and resisted motion was painful. Regression analyses showed that hand related activity limitations were associated with measures of hand impairment, while activity and participation (as measured by the COPM) were more strongly associated with personal factors than with hand impairment. CONCLUSIONS: Hand osteoarthritis has important functional consequences in terms of pain, reduced hand mobility and grip force, activity limitations, and participation restrictions. Rehabilitation programmes should therefore be multidisciplinary and multidimensional, focusing on hand function, occupational performance, and coping strategies.

Activities of Daily Living↗
PubMed2005

Seven year changes in health status and priorities for improvement of health in patients with rheumatoid arthritis.

OBJECTIVES: To examine possible changes in priorities for improvement in health and health status from 1994 to 2001 within the setting of the Oslo Rheumatoid Arthritis (RA) Register, which provides representative data for the entire RA population in the county. METHODS: All living patients in the Oslo RA Register area received a postal questionnaire in 1994 and 2001, including the Arthritis Impact Measurement Scales 2 (AIMS2), Short Form-36, the modified Health Assessment Questionnaire, and pain and fatigue visual analogue scales (VAS). Priorities for improvement in health were examined through question 60 in AIMS2, where patients are asked to indicate three of 12 areas of health where they would most like to see improvement. RESULTS: The number of respondents aged 20-79 years in 1994/2001 was 932/830, with similar demographic characteristics (78.8/78.3% were female, mean age 60.6/60.8, and disease duration 12.6/13.9 years). Health status was improved in all dimensions, with statistical improvement for the physical dimension, global health and pain, from 1994 to 2001. The profile of priorities remained mostly unchanged. Improvement in pain had the highest priority in both cohorts. Both symptom modifying and disease modifying drugs were more extensively used in 2001. CONCLUSIONS: Health status had improved from 1994 to 2001, probably because of access to better and more aggressive treatments. Pain remained the area of highest priority for improvement among patients with RA-despite an improved level of pain in 2001.

Adult↗
PubMed2003

Sex-sensitive cognitive performance in untreated patients with early onset gender identity disorder.

BACKGROUND: We explored whether the cognitive performance of gender identity disorder patients (GID) was comparable to that of their biological sex or skewed towards that of their gender identity. METHOD: We tested four potentially sex-sensitive cognitive factors (rotation, visualization, perception, and verbalization) as well as two neutral factors (logic and arithmetic) in GID patients from Norway (GID-N, n = 33) or the USA (GID-US, n = 19) and in a control group (C, n = 29). The testing was undertaken prior to cross sex hormone treatment. Four-way ANOVA was applied in the final analysis of the cognitive performance and its dependency on different predictors (age, biological sex, education, group). RESULTS: In both GID groups as well as in the control group (C) males excelled in visualization and rotation, also when controlling for potential confounders (biological sex, group, age and education). No female advantage was detected. Furthermore, no interaction between biological sex and group assignment was revealed in the samples. CONCLUSION: In this study the cognitive pattern of GID patients is consistent with that of their biological sex and not that of their gender identity.

Adult↗
PubMed2002

Gendered personality dispositions, hormone values, and hot flushes during and after menopause.

The study aim was to test the relationship between gendered personality dispositions (GPD), sex hormones, and vasomotor complaints in the menopausal transition. Fifty-seven healthy women (mean age 51.1 years, standard deviation 2.0) were drawn from a population registry. At enrollment all women were menstruating regularly, and all women reached menopause in the course of the study. Questionnaire data and blood samples were collected once a year over a period of five years. GPD scores (based on the Bem Sex-Role Inventory, BSRI), frequencies of hot flushes and hormone data (estradiol, follicle-stimulating hormone, luteinizing hormone, testosterone, androstendione and dehydroepiandrostendione sulfate) were determined. Subjects were placed into four categories based on the BSRI: masculine, feminine, androgynous and undifferentiated. GPD did not change during the menopausal transition. Testosterone and androstendione were related to GPD in that testosterone and androstendione were higher in the sex typed categories (masculine and feminine) than in the non sex-typed categories (androgynous and undifferentiated). GPD are related both to androgens and to vasomotor complaints such as hot flushes during the menopausal transition, but the mechanisms of these relationships are not known.

Androgens↗
PubMed2001

Learning to have less pain - is it possible? A one-year follow-up study of the effects of a personal construct group learning programme on patients with chronic musculoskeletal pain.

A randomised controlled study with the objective to explore the effects of a group learning programme based on a phenomenological epistemology and personal construct theory. Main outcome measures were: experienced pain, pain coping strategies, absenteeism, disability pension and health care consumption. One hundred and twenty-one patients with chronic musculoskeletal pain and high absenteeism were included in this study. The intervention group (n=77) consisted of nine smaller groups with 6-10 persons in each and were counselled by health personnel with special training. The control group consisted of 44 persons. The learning programme emphasised awareness, possible relations between bodily symptoms, emotions, mind and life situation, and change of focus from pain and disability to resources and potentials. One year after the end of the learning programme (T3), patients in the intervention group reported significant pain reduction, increased pain-coping abilities and a higher reduction of health care consumption than the control group (P<0.05). Absenteeism was not significantly reduced compared to the control group, but there were fewer persons receiving disability pension in the intervention group at T3 (38 versus 59%) (P<0.05). This group-learning programme should be considered an important adjunct to the therapy of patients with chronic muscular pain.

Absenteeism↗
PubMed2001

A new, brief questionnaire (PEQ) developed in primary health care for measuring patients' experience of interaction, emotion and consultation outcome.

BACKGROUND: A deepened understanding of patients' perspectives is essential in order to improve medical communication. By changing focus from patient satisfaction to patient experiences, more immediate, personal and affective responses may be captured. OBJECTIVE: Our aim was to develop a new consultation-specific questionnaire on patient experiences. METHODS: The questionnaire was developed in Norwegian primary care in three main phases. Phase 1: focus groups with patients in order to identify important aspects of patients' experiences, and their words and language when describing such experiences. Phase 2: a questionnaire survey with 110 items including 660 patients. Extensive testing resulted in a reduction to 25 items on six dimensions. Phase 3: a questionnaire survey with 25 items including 1092 patients. Psychometric analyses and feedback from patients and physicians involved dimensionality and tests of validity and reliability. RESULTS: A final questionnaire was produced with 18 items on five dimensions: communication; emotions; short-term outcome; barriers; and relations with the auxiliary staff. The validity and reliability estimates were highly satisfactory. Three scales were skewed while two were more equally distributed. Forty-eight per cent of the patients described less than optimal communication experiences; some communication barriers were detected in 70% of the visits and less helpful experiences with the staff were reported in 55% of the visits. Twenty-four per cent of patients left with no positive feelings, and 48% scored low on the outcome scale (knowledge, perceived result). CONCLUSIONS: The patient experience questionnaire (PEQ) emphasizes what patients value the most, i.e. interaction, emotions and outcome, and may represent a valuable tool for doctors who want feedback from their patients on the function of their doctor-patient relationships.

Adolescent↗
PubMed2000

[What is the most important for the patient in the meeting with a general practitioner?].

Efficient medical communication depends on an understanding of the patient perspective. The purpose of this study was to characterise the most important consultation elements as perceived by primary care patients. The experience of 31 patients regarding their most recent medical encounter were recorded in six focus groups. All groups were audiotaped and analysed by qualitative methodology. Five consultation themes emerged spontaneously in all groups: Interaction between doctor and patient (e.g. communication, emotional experiences, and personal relationship with the doctor) and consultation outcome were the most important elements. Information, continuity of care, and time with the doctor were considered reasonably important. Six other themes received limited attention in a few groups only (e.g. availability, doctor's gender, time in the waiting room, auxiliary personnel, the clinical examination, and technical skills). Patients value the personal, attentive, and listening doctor. The feeling of not having to hurry during the consultation is more important than the actual number of minutes. Patients' level of emotional involvement and their specific expectations are often undisclosed. There are large individual differences with regard to the meaning of and need for information.

Communication↗
PubMed2000

[Words and language used by patients when describing consultation with general practitioners].

Increased knowledge of how patients express their experiences may help physicians to capture their patients' perceptions and agenda. The aim of the present study was to examine words and language used by patients when describing specific primary care consultation experiences. Six focus group sessions with a total of 31 patients were conducted shortly after a general practice consultation. All group sessions were audiotaped and analysed by qualitative ethnographic methodology. Seven distinct grammatical and verbal characteristics were found: The consultations were recited in the first person with little recollection of the doctors' talk or actions. Subjectivity was constantly underlined by the verbs "feel" or "think". When expressing negative emotions, the personal pronoun constantly was changed from the personal singular to the impersonal or plural form. Language tended to be evasive in connection with possible criticism. Negative emotions were diminished by the use of limiting expressions and modest wording. Non-committal expressions, with a wide range of possible meanings, were frequent, and were possible to decipher only by close attention to non-verbal cues. We conclude that doctors may capture more of their patients' hidden emotional messages in the consultation by increased awareness of specific verbal characteristics and non-verbal cues.

Communication↗
PubMed2000

Coping strategies in patients with acquired brain injury: relationships between coping, apathy, depression and lesion location.

Coping strategies in individuals suffering severe traumatic brain injury (TBI), cerebrovascular accidents (CVA), or hypoxic brain injury (HBI) were investigated in relation to apathy, depression, and lesion location. Seventy patients (27 with TBI, 30 with CVA, and 13 with HBI) filled in a coping questionnaire (COPE) and were evaluated with respect to apathy and depression. A comparison sample of 71 students also filled in COPE. Patients coping strategies were similar to the comparison group, but patients tended to display less differentiated coping styles. A factor analysis indicated two dimensions of coping in the patient sample; approach oriented and avoidance oriented coping. Approach and avoidance coping sum scores, based on subscales from the two factors, were positively correlated in the patient sample, but not in the comparison group. Lack of active approach oriented coping was associated with apathy, whereas avoidant coping was associated with depression. Coping styles were not related to lesion location. Apathy was related to subcortical and right hemisphere lesions. In bivariate analyses, depression was unrelated to lesion location, but, in a MANCOVA, avoidant coping, apathy and lesion location (left hemisphere lesions) contributed to the variance in positive depressive symptoms. The consistent relationships between coping strategies and neuropsychiatric symptoms were interpreted as two dimensions of adaptational behaviour: an active vs. passive dimension and a depression--distress-avoidance dimension.

Adaptation, Psychological↗
PubMed2000

Social network size of female patients with rheumatoid arthritis compared to healthy controls.

UNLABELLED: To estimate how rheumatoid arthritis (RA), the disease duration, and level of physical disability, influence the total size of patients' social network and the size of different subsets. Two hundred sixty four female patients (mean age 57 yrs) with RA of more than 6 yrs duration (mean 20 yrs) were compared to 61 healthy controls matched for sex, age, and residential area. Network size was measured by Social Network Delineation Questionnaire (SNDQ), physical disability by Health Assessment Questionnaire (HAQ). RA patients had a significantly smaller total network compared to the healthy controls (RA: 15.8 persons; CONTROLS: 18.1), mostly due to a significant difference in the subset of important others in favour of the controls (RA: 1.1; CONTROLS: 2.3). There were no significant differences regarding the network size of family, friends, and neighbours. The same results remained after statistical control for sociodemographic variables. Neither disease duration nor physical disability had any significant association with network size. The interaction analysis did, however, show that non-working patients with long disease duration (> 15 yrs) had fewer important others than occupationally active patients. Furthermore, a high degree of physical disability was related to a smaller number of friends for patients > 57 yrs than for equally disabled patients below this age. Most patients with RA seem to maintain contact with the family network-members, despite the challenges connected with chronic disease.

Adult↗
PubMed2000

Agency orientation and chronic musculoskeletal pain: effects of a group learning program based on the personal construct theory.

OBJECTIVE: This study evaluated the effects of a group learning program on patients with chronic musculoskeletal pain and high absenteeism and investigates what characterizes those patients who may benefit from such a program. The learning program was based on personal construct theory. The theory included the following: (1) participation in an educational program is related to a favorable outcome across the outcome measures (pain, pain coping, management of daily life, absenteeism, and use of health care), (2) patients with high agency orientation (i.e., inner-directed) cope with their pain and manage daily life in a better manner than do patients with low agency orientation (i.e., outer-directed), and (3) patients with high personal control, measured in terms of agency orientation, in terms of health locus of control, or in both terms, will benefit more from the educational program than will patients with low personal control. DESIGN: The study was a randomized controlled study. PATIENTS: One hundred and sixteen patients with chronic musculoskeletal pain and high absenteeism answered a questionnaire before and after the intervention program. The intervention group (n = 61) consisted of nine subgroups geographically spread through the eastern part of Norway and met for four hours every 2 weeks from February 1997 to October 1997. A total of 12 meetings were held. RESULTS: The intervention group reported a significantly higher score for the variable "management of everyday life" (p <0.005) and for the variable "health care consumption" (p <0.001) than did the control group. Patients with high agency orientation benefited more from the program with regard to pain reduction and improved pain coping than did those patients with low agency orientation (p <0.05). Patients with high agency orientation also reported less absenteeism than did those patients with low agency orientation (p <0.05).

Absenteeism↗
PubMed1999

Apathy and depressed mood in acquired brain damage: relationship to lesion localization and psychophysiological reactivity.

BACKGROUND: Apathy is a frequent neurobehavioural sequel in patients with acquired brain damage and it may seriously affect outcome of rehabilitation. METHODS: Patients with traumatic brain injury, cerebrovascular insults and hypoxic brain injury, categorized into four lesion localization groups: left hemisphere damage (LHD); right hemisphere damage (RHD); bilateral hemispheric damage (BHD); and subcortical damage (SCD) were assessed with the Apathy Evaluation Scale (AES) and Montgomery and Asberg Depression Rating Scale (MADRS). Heart rate and electrodermal activity were recorded in an experimental situation that exposed the patients to mental stressors in order to measure psychophysiological reactivity. RESULTS: Significant differences in level of apathy were found between diagnostic groups as well as between localization subgroups. SCD and RHD patients displayed most apathy. Factor analysis of MADRS revealed a three-factor solution; depressed mood, somatic symptoms and negative symptoms. Apathy was significantly correlated with negative symptoms in all localization subgroups, except among the BHD patients. Apathy was not correlated with depressed mood or somatic symptoms. Moreover, apathy was significantly correlated with heart rate reactivity, but not with electrodermal reactivity. CONCLUSION: Apathy is common, its severity depending on diagnosis and localization of lesion. Apathy and depression in brain damaged patients share common features, but may be differentiated. The significant relationship between apathy and heart rate may provide a psychophysiological correlation of the disengagement, lack of interest and absence of emotional responsivity typically seen in apathy. The results have implications for the theoretical understanding of apathy and related negative symptoms, and for rehabilitation practice.

Adolescent↗
PubMed1999

Emotional activation during therapeutic interaction in traumatic brain injury: effect of apathy, self-awareness and implications for rehabilitation.

Apathy and reduced self-awareness are frequent occurring neurobehavioural sequelae following traumatic brain injury (TBI). Apathy, in terms of reduced goal directed activity and lowered motivation, and reduced self-awareness have a negative impact on the rehabilitation process. In this study, 30 patients suffering severe TBI were clinically rated for apathy and monitored for cardiovascular and electrodermal reactivity during baseline, neutral speech and therapeutic interaction. Applying a cut-off score criterion, two thirds of the TBI sample were classified as apathetic. The apathetic patients showed less psychophysiological reactivity from neutral speech to therapeutic interaction, compared to non-apathetic patients. They also reported less perceived emotional discomfort in the therapeutic situation measured with a visual analogue scale. Moreover, reduced self-awareness was associated with low autonomic reactivity. The results suggest that the reduced psychophysiological reactivity in apathetic patients may be a correlate to the lack of emotional responsivity, disengagement, lack of insight and concern about their own situation. Clinically, these results may have implications for psychotherapeutic intervention aimed at improving self-awareness. Recording psychophysiological responses during therapeutic interaction may serve as a method for monitoring emotional involvement during psychotherapy with TBI patients.

Adolescent↗
PubMed1998

[The emotions of physicians. Significance of physicians' emotional reactions to the patients].

During the last thirty years there has been a growing interest in research into physician-patient interaction. This article highlights the research which concerns the physician's countertransference feelings. The concept of countertransference is described and a classification with relevance for physicians in general is explained. The existing research into the incidence and consequences of countertransference is examined. Examples are given of categories of patients, who often evoke specific countertransference feelings in the physician. The consequences of the countertransference feelings for the physician himself are discussed and examples are given of particular situations where countertransference feelings could be of importance. Finally, the existing possibilities to learn about handling countertransference feelings are surveyed and the authors emphasize the need for more research in this particular field.

Countertransference↗
PubMed1998

Heart rate and skin conductance reactivity to brief psychological stress in brain-injured patients.

Autonomic reactivity in response to two mentally challenging tasks was studied in 74 patients with traumatic brain injury (TBI; n=33), cerebrovascular insults (CVA; n=27), and hypoxic brain damage (n = 14). Heart rate, skin conductance level, and number of spontaneous skin conductance responses were recorded during baseline and two problem-solving stress conditions consisting of Raven progressive matrices and mental arithmetic. CVA and TBI patients with focal right hemisphere injury showed significantly reduced stress reactivity compared to patients with focal left hemisphere injury. This right-left hemisphere difference was maintained when controlled for diagnosis, gender, sex, age, and stressor task performance and involvement. The results indicate that lateralization of lesion rather than diagnosis or etiology is the critical factor in autonomic stress hyporeactivity in brain-injured patients. The results are discussed in relation to brain lateralization of autonomic reactivity and possible clinical consequences of autonomic hyporeactivity for rehabilitation of patients with acquired brain injury.

Adolescent↗
PubMed1998

Complex health problems in general practice: do we need an instrument for consultation improvement and patient involvement? Theoretical foundation, development and user evaluation of the Patient Perspective Survey (PPS).

BACKGROUND AND OBJECTIVES: Many patients in general practice present with complex health problems. It is argued that the GP who is in a prime position to counsel patients with such problems, will, however, often perceive a lack of tools to manage them. The aim of the present study was to develop a novel instrument in terms of a patient-administered questionnaire, the Patient Perspective Survey (PPS), designed to enhance the quality of clinical communication in the consultation. It is based on a biopsychosocial patient perspective, patient centredness, patient resources, involvement and coping, and quality of life orientation. METHODS: Development of the PPS has included comprehensive literature research, discussions and advice, during several phases, from groups of GPs, patients, broad panels of experts and testing in pilot studies. After many revisions, a 102-item version, consisting of a main somatic, mental and social domain axis, was evaluated by GPs and patients in 213 consultations. RESULTS: The basic idea, theoretical elements and purpose of the PPS appeared in general to be well accepted. Seventy-five to eighty-five per cent of the patients found the questions relevant and easy to understand and there were high positive scorings regarding influence on the doctor-patient relationship, communication, resource and coping aspects, occurrence of new information and general satisfaction with the consultation. Similar scorings were obtained from the GPs' evaluation. Both parties agreed that there is a need for a shorter and more specific PPS version, and that the resource and coping dimension should be even more extended. CONCLUSIONS: We consider it well documented that there is a need for this new instrument to deal with complex health problems in general practice, and that it has promising potentials for consultation improvement.

Attitude of Health Personnel↗