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PubMed1994

Oral manifestations of HIV infection in homosexual men and intravenous drug users. Study design and relationship of epidemiologic, clinical, and immunologic parameters to oral lesions.

This article describes the baseline findings from a study designed to compare the oral manifestations of HIV infection in homosexual men and intravenous drug users. Both seropositive and seronegative persons were studied. A standard examination instrument was developed to record indexes of oral disease as well as to record the presence of oral lesions. The two groups differed in terms of education, race, socioeconomic status, employment status, housing, and smoking experience. The prevalence and type of oral lesions differed in the two seropositive groups. In seropositive homosexual men, white lesions on the tongue (28.4%) predominated; whereas for the seropositive intravenous drug users, oral candidiasis (43.0%) and gingival marginal erythema (33.3%) were most often detected. We also observed that seronegative intravenous drug users displayed a greater number of oral lesions than seronegative homosexual men. For seropositive homosexual men, lesion presence was significantly associated with decreased levels of CD4; positive associations were seen with current smoking, antiviral drug use, and antibiotic use, and a negative association was observed with current employment. In contrast, only exposure to antiviral drugs was significantly correlated with lesion presence for seropositive intravenous drug users. This baseline analysis from our longitudinal study suggests clear differences in oral manifestations of HIV infection between seropositive homosexual men and intravenous drug users and between seronegative homosexual men and intravenous drug users. Among other parameters, it is apparent that lifestyle, access to health care, and the condition of the oral cavity before infection influence the development of oral lesions in persons with HIV infection.

AIDS-Related Opportunistic Infections↗
PubMed1998

Changes in social roles as predictors of changes in drinking behaviour.

AIM: To assess the possible effects of changes in marital status, employment status and having children at home on alcohol consumption and the frequency of heavy drinking. With role theory as a starting point it was expected that a shift into more social roles would decrease consumption and heavy drinking while the shift away from social roles would be associated with an increase in consumption and heavy drinking. DESIGN: Prospective cohort study. SETTING: The province of Limburg, The Netherlands (1980-89). PARTICIPANTS: 1327 men and women aged 16-69 years at first measurement. MEASUREMENTS: Weekly consumption of standard units (10 g ethanol) of alcoholic beverages; frequency of drinking six units or more; self-reported social role. FINDINGS: The acquisition of a spouse role and a parental role but not an employment role was associated with a decrease in consumption or heavy drinking. The loss of the spouse role among women was associated with an increase in heavy drinking. Otherwise, losing a role was not linked with a change in consumption and heavy drinking. CONCLUSIONS: Limited support was found for the expectation that role transitions influence drinking behaviour. Our study suggests that other theories must be sought to explain social differences in drinking behaviour.

Adolescent↗
PubMed1998

Sociodemographic predictors of treatment outcome in chronic non-malignant pain patients. Do patients receiving or applying for disability pension benefit from multidisciplinary pain treatment?

The present study investigated the ability of sociodemographic variables to predict the short-term effect of multidisciplinary pain treatment in 286 chronic non-malignant pain patients consecutively referred to a Danish multidisciplinary pain centre. At inclusion and 3 and 6 months later the patients' pain and health related quality of life (HRQL) was assessed using self-administered questionnaires. Sociodemographic variables measured were: age, gender, educational level, civil status, employment status and disability pension (DP) status. Intensity of pain was measured using a VAS scale. HRQL was evaluated using the Medical Outcome Study-Short Form (SF-36) and the Psychological General Well-Being Scale (PGWB). Drop out was 30% after 6 months, leaving 170 patients for the study of treatment effects. Among the sociodemographic variables evaluated only retirement pension (RP) and DP-status seemed to be significant outcome predictors: six months after inclusion, patients on RP (patients >68 years, n = 40) reported larger pain reduction (30 mm on the VAS scale) than patients < or =68 years (8 mm on the VAS scale)(P = 0.001). Patients applying for DP-pension (n = 26) did not improve. Patients on DP (n = 54) and patients not receiving DP (n = 50) obtained moderate improvements, but the improvements were significantly larger than the improvements observed in the ApplyDP-group (P = 0.05). The same pattern was seen for changes in psychological well-being (PGWB) and social functioning (SF36-SFA). No improvements were obtained in SF36-Physical functioning scores. DP-status predicted improvement in pain and social functioning even when controlling for the effect of other demographic variables, pain intensity and HRQL at referral. The present study indicates that the multidimensional problems experienced by patients applying for DP are dominated by socioeconomic factors. Focus on solving these socioeconomic problems is important if chronic pain patients are to benefit from multidisciplinary pain treatment.

Adult↗
PubMed2003

Social factors and obesity: an investigation of the role of health behaviours.

OBJECTIVES: This study evaluated a behavioural model of the relation between social factors and obesity, in which differences in body mass index (BMI) across sociodemographic groups were hypothesized to be attributable to social group differences in health behaviours affecting energy expenditure (physical activity, diet and alcohol consumption and weight control). METHODS: A total of 8667 adults who participated in the 1995 Australian National Health and Nutrition Surveys provided data on a range of health factors including objectively measured height and weight, health behaviours, and social factors including family status, employment status, housing situation and migration status. RESULTS: Social factors remained significant predictors of BMI after controlling for all health behaviours. Neither social factors alone, nor health behaviours alone, adequately explained the variance in BMI. Gender-specific interactions were found between social factors and individual health behaviours. CONCLUSIONS: These results suggest that social factors moderate the relation between BMI and weight-related behaviours, and that the mechanisms underlying sociodemographic group differences in obesity may vary among men and women. Additional factors are likely to act in conjunction with current health behaviours to explain variation in obesity prevalence across sociodemographic groups.

Adolescent↗
PubMedDate not supplied

Determinants of alcohol use in pregnant women at risk for alcohol consumption.

The purpose of this investigation was to identify determinants of alcohol consumption based on a number of demographic and psychosocial variables in a group of pregnant women at risk for alcohol consumption. Data were collected on a sample of 232 pregnant females who agreed to participant in a multistate alcohol prevention intervention. The variables of interest included demographic measures of race, age, education, marital status, health status, employment status and if they had been involved in physical abuse during the past year. Additionally, psychosocial variables were collected on social support, family functioning, mental health and illicit drug use. The dependent variables of interest were any alcohol use during the pregnancy and an abuse measure that was based on a composite score generated from questions related to problems associated with alcohol behavior. Logistic regression analysis was conducted to see if the independent variables (demographic and psychosocial variables) were predictive of any alcohol use. Multiple linear regressions were conducted to ascertain if the independent measures were predictive of alcohol abuse. The results showed that race, age, physical abuse and to a lesser extent health were associated to any alcohol use and alcohol abuse. The findings with the psychosocial variables were not as robust. Nevertheless, problematic psychiatric and drug use composite scores were associated with alcohol abuse.

Adolescent↗
PubMed2004

Patient ratings of dialysis care with peritoneal dialysis vs hemodialysis.

CONTEXT: In light of conflicting evidence of differential effects of dialysis modality on survival, patient experience becomes a more important consideration in choosing between hemodialysis and peritoneal dialysis. OBJECTIVE: To compare patient satisfaction with hemodialysis and peritoneal dialysis in a cohort of patients who have recently begun dialysis. DESIGN AND SETTING: Cross-sectional survey at enrollment in a prospective inception cohort study of patients who recently started dialysis at 37 dialysis centers participating in the Choices for Healthy Outcomes in Caring for End-stage Renal Disease (CHOICE) study, a national multicenter study of dialysis outcomes, from October 1995 to June 1998. PATIENTS: Of 736 enrolled incident dialysis patients, 656 (89%) returned a satisfaction questionnaire after an average of 7 weeks of dialysis. MAIN OUTCOME MEASURE: Data collected from a patient-administered questionnaire including 3 overall ratings and 20 items rating specific aspects of dialysis care. RESULTS: Patients receiving peritoneal dialysis were much more likely than those receiving hemodialysis to give excellent ratings of dialysis care overall (85% vs 56%, respectively; relative probability, 1.46 [95% confidence interval, 1.31-1.57]) and significantly more likely to give excellent ratings for each specific aspect of care rated. The 3 items with the greatest differences were in the domain of information provided (average of information items: peritoneal dialysis [69% excellent] vs hemodialysis [30% excellent]). The smallest differences were in ratings of accuracy of information from the nephrologist, response to pain, amount of fluid removed, and staff availability in an emergency. Adjustment for patient age, race, education, health status, marital status, employment status, distance from the center, and time since starting dialysis did not reduce the differences between peritoneal dialysis and hemodialysis patients. CONCLUSIONS: After several weeks of initiating dialysis, patients receiving peritoneal dialysis rated their care higher than those receiving hemodialysis. These findings indicate that clinicians should give patients more information about the option of peritoneal dialysis.

Adult↗
PubMedDate not supplied

Hormone replacement therapy and glucose tolerance in EPIC-Norfolk: a population-based study.

BACKGROUND: Hormone replacement therapy (HRT) can affect glucose homeostasis in postmenopausal women but it is unclear whether long-term use is associated with changes in glucose tolerance. The objective was to examine the relationship of glycated haemoglobin (HbA(1C)) concentration with HRT use in non-diabetic postmenopausal women. METHODS: A cross-sectional analysis of baseline data on 2753 postmenopausal women, aged 45-74 years who were recruited to the EPIC-Norfolk study between 1995 and 1998 was performed. Women completed a health and lifestyle questionnaire from which information on HRT use was obtained and gave blood for HbA(1C) assay. RESULTS: Of the women, 23% were current HRT users and 14% were former users. Mean HbA(1C) was significantly lower in current users compared to former and never users. This difference was independent of age, body mass index (BMI), waist-to-hip ratio (WHR), family history of diabetes, educational status, employment status, smoking history, history of alcohol consumption, parity, known illness and hysterectomy status. Compared to never users of HRT, the unadjusted odds ratio (OR) for being in the highest quintile of HbA(1C) distribution as opposed to the lowest was 0.28 (95% CI 0.20-0.39) for current users and 0.41 (0.32-0.53) for ever users. After adjustment for confounders, the OR were 0.52 (0.34-0.79) and 0.72 (0. 51-1.03) for current and ever users, respectively. CONCLUSION: Women currently using HRT have lower HbA(1C) levels not explained by known confounders though we cannot completely exclude a healthy user effect. Nevertheless, this population study suggest that current use of HRT was not associated with impairment of glucose tolerance in postmenopausal women.

Aged↗
PubMedDate not supplied

Factors influencing referral of cardiac patients for cardiac rehabilitation.

This study asked the question: Are there differences in the characteristics and referral rates of men and women who are referred for cardiac rehabilitation? The sample consisted of 203 men (n = 148) and women (n = 55) who were hospitalized with at least one cardiac diagnosis and were eligible for Phase II cardiac rehabilitation. Hospital records were reviewed to obtain information on gender, age, ethnicity, insurance coverage, marital status, employment status, proximity to rehabilitation services, transportation availability, concurrent disease processes, domestic responsibilities, documentation of referral for cardiac rehabilitation, and the attending physician. A survey sent to the patients approximately 3 weeks after their discharge from the hospital also addressed these variables. Logistic regression analysis indicated only one predictor of referral: the gender of the physician. Male physicians were more likely to refer patients for cardiac rehabilitation. This finding must be viewed with caution because of the small number of female patients and female physicians included in the study. The current literature reflects conflicting findings about the proposed relationships; therefore, they merit further investigation.

Adult↗
PubMed2001

Outcomes and patient-based hearing status in conductive hearing loss.

OBJECTIVES/HYPOTHESIS: To study hearing status and quality of life outcomes in patients with conductive hearing loss (CHL), and to develop a prognostic disease severity staging system for use in future clinical outcomes studies in CHL. STUDY DESIGN: Clinical outcomes research study in three stages: 1) Prospective development and psychometric validation of a disease-specific hearing status outcomes instrument for CHL. 2) Prospective observational outcomes study of patient-based hearing status and quality of life (QOL) outcomes after treatment of CHL. 3) Development of a prognostic disease-severity staging system to stratify patients into groups of similar treatment outcome. METHODS: Psychometric instrument validation: assessment of test-retest reliability, internal consistency reliability, content, construct and criterion validity, and responsiveness to change. Statistical assessment of the impact of CHL on patient-based hearing status and QOL, and the change in hearing status and QOL after treatment. Using data from the prospective study and multivariate regression, identification of pretreatment independent variables, which predict good outcome after treatment, and development of a severity staging system. RESULTS: Test-retest reliability (r >0.70) and internal consistency reliability (alpha >0.70) were adequate for both subscales of the hearing status instrument. Construct validity was demonstrated by adequate convergent/divergent validity with other health status instruments on multi-item multitrait correlation matrixes. Criterion validity was demonstrated using audiometric threshold data. Responsiveness to change was demonstrated using the standardized response mean after treatment (SRM = 0.40 and 0.61 for the two subscales). Emotional hearing status and social/situational hearing status improved significantly after treatment of CHL: emotional score, 31.1 to 56.6 (P < .001); social/situational score, 56.7 to 63.7 (P = .01). Mean QOL subscale scores for patients with CHL were not significantly different from healthy populations, and global QOL scores did not change significantly after treatment of CHL. Using proportional improvement in emotional hearing status as an outcome, we identified several pretreatment factors that predicted good outcome (i.e., larger proportional improvement): level of pretreatment emotional hearing status, presence of sensorineural component of HL, and etiology of CHL (otosclerosis vs. all other causes). Some hypothesized predictive independent factors, such as bilateral HL, audiometric threshold level, pretreatment functional status, employment status, age, and duration of HL, were not identified as significant predictors of outcome in the multivariate analysis. We constructed a prognostic disease severity staging system in which the three predictor variables were each given a score of 0 or 1, and these three scores were added to obtain the disease stage (stage 0, 1, 2, or 3). Higher disease stage indicated more severe disease or a lower proportional improvement in emotional hearing status after treatment. This staging system appropriately stratified patients into groups of similar outcome after treatment (P = .02) and has significant potential use for future outcomes research on CHL. CONCLUSIONS: We have developed and validated a patient-based hearing status outcomes instrument for use in CHL. We have measured hearing status and quality of life outcomes after treatment of CHL, and we have developed a prognostic disease severity staging system that predicts the improvement in emotional hearing status after treatment of CHL.

Adaptation, Physiological↗
PubMed1983

Self-referral: social and demographic determinants of consulting behaviour.

This report, which is one of a series, is concerned with socio-demographic correlates of self-referral, and the extent to which the observed associations can be explained by variations in symptom prevalence and severity. Social class, marital status, employment status, and distance from health centre, all show small but significant associations with self-referral. For social class the effect appears to be mediated by symptoms. People in social classes IV and V, women who are widowed, divorced or separated, and people who live near the health centre are more likely to visit their general practitioner.

Female↗
PubMed1993

Gender inequalities in health: social position, affective disorders and minor physical morbidity.

Research has consistently reported a female excess of minor physical morbidity and affective disorders compared to men. Using data from a national cross sectional survey of British women and men aged 18-59, this paper explores three prominent explanations for these patterns: that the female excess is due to problems associated with menstruation and the menopause; that it is 'caused' by the social positions which women occupy in contemporary western societies; and that the excess of affective disorders is 'caused' by women's social positions but that their higher rate of physical illness is psychosomatic in origin. The analysis presented here suggests that problems with menstruation and the menopause cannot explain gender inequalities in minor illness. Similarly the argument that the female excess of minor physical illness is psychosomatic is not supported, indeed, there is evidence that women's experience of minor physical illness may 'cause' their higher rates of affective disorders. Finally, with a few exceptions, the relationship between minor illness and four dimensions of social positions--marital status, employment status, social class and income--were broadly the same for women and men but in each social position category, women report higher rates of both types of ill health than men. It is concluded that present measures of these social positions do not capture the differing experiences of women and men and that more gender sensitive measures are needed if gender inequalities in minor illness are to be understood.

Female↗
PubMed1996

Psychosocial factors of coronary heart disease in women: a review.

Although coronary heart disease is the leading cause of death in women in most industrialized countries, much less research has been carried out on this topic to date than in men. This article gives an overview of psychosocial factors of coronary heart disease in women, focussing on psychosocial risk factors for coronary heart disease in women such as socioeconomic status, employment status, chronic troubling emotions, social support and bereavement/widowhood. A second focus lies on psychosocial adjustment in women once coronary heart disease has become manifest, i.e. well-being, return to work, sexual activity and rehabilitation outcome after a myocardial infarction or coronary artery bypass grafting. Via a computerized literature research in Medline, Psychlit and Sociofile over the period 1980-1994 all studies on these topics were collected and reviewed. Comparatively more research has been undertaken on psychosocial risk factors for than on psychosocial adjustment to coronary heart disease in women. Low social class, low educational attainment, the double loads of work and family, chronic troubling emotions and lack of social support emerge as documented risk factors in women. Regarding psychosocial adjustment to coronary heart disease in women, there is a paucity of data, and studies including large samples of women and adjusting for gender are warranted. Psychosocial adjustment in women after a myocardial infarction seems to be worse than in men, whereas results on adjustment after coronary artery bypass grafting are inconclusive. Return to work rates after myocardial infarction or coronary artery bypass grafting are significantly lower in women than in men. Data on sexual activity of women after myocardial infarction or coronary artery bypass grafting are scarce, and there seems to be a complete lack of physician counseling on this topic. Studies on rehabilitation outcome report poorer programme uptake, poorer adherence and significantly higher drop-out rates for women than for men, yet those women who complete cardiac rehabilitation show the same or even greater functional improvements than men.

Adult↗
PubMed1996

Sociological and behavioural characteristics of perimenopausal women with an express attitude to hormone substitution therapy.

OBJECTIVES: The objective of the study is to demonstrate differences in behaviour and in sociological characteristics between women wanting hormone replacement therapy (HRT) and women refusing such treatment. METHODS: From a study base of 6189 women, 413 perimenopausal women with an express positive or negative attitude towards the use of HRT were interviewed on sociological and behavioural characteristics. Checks against bias were performed by analysis of reluctant participants, identified as women who either did not agree to participate until they received at least one reminder, or who dropped out immediately after the interview. RESULTS: Women wanting HRT had higher levels of education, were less often childless, and were more frequent solarium users than women refusing this treatment. There were no differences in marital status, employment status, the average tea, coffee, wine and cigarette consumption, sun exposure, frequencies of travels abroad, or number of family cars, summer houses or boats. No difference in present smoking status was demonstrated but the estrogen users were more frequently past or present smokers. CONCLUSIONS: It is suggested that lack of knowledge of HRT may sometimes be the cause of rejecting it, or may influence on the compliance regarding its use. Familiarity with the use of the health system for other reasons than disease may promote the use of HRT. It is demonstrated that the observed patterns do not originate from self-selection bias.

Attitude↗
PubMed1997

Self-care agency and factors related to this agency among patients with coronary heart disease.

The aim of this study was to assess the self-care agency and factors related to this agency among patients with coronary heart disease (N = 250) measured with a self-care inventory (Self-as-Carer Inventory, SCI). A secondary aim was to analyze the ability of the SCI inventory based on Orem's self-care deficit theory to measure the self-care agency of patients with coronary heart disease. Factor analysis yielded four factors which represent the key aspects of self-care, such as evaluation, implementation, decision-making, significance of knowledge, attitudes, motivation and physical prerequisites of self-care. The most important precondition for self-care in our study was 'appreciation and motivation to self-care'. This factor had numerous correlations with the background factors. Age, sex, socioeconomic status, employment status, health behavior, such as alcohol use and smoking, other diseases, such as diabetes, and satisfaction with sex life were related to the patients' self-care agency. It can be concluded that the self-care agency of our patients was moderate and many background factors were related to it. The SCI inventory seems to cover the self-care requirements of these patients, but the clinical use of SCI is precarious. The items are still too abstract and the questionnaire is therefore too difficult to fill in for many patients.

Adult↗
PubMed1998

A community-based study of well-being in adults reporting childhood abuse.

OBJECTIVE: This study examined well-being and satisfaction with community services in adult survivors of childhood abuse. METHOD: A community sample of 109 individuals, 34 reporting childhood abuse (sexual, physical and/or emotional), completed a questionnaire package as part of a study of community well-being. The package included measures of demographic variables, satisfaction with community services, physical well-being, consumption of drugs (including nicotine & alcohol), loneliness, depression, and life stress. RESULTS: Less than half of those reporting abuse had confided in someone about their experience and only 14.3% had discussed it with a counsellor. The abuse versus no abuse groups did not differ in terms of general living circumstances (e.g., income, marital status, employment status, quality of housing). Despite this, the abuse group reported poorer well-being on several measures. CONCLUSIONS: There are clear limitations to the present data. Nonetheless, the results suggest that those reporting childhood abuse tend to experience poorer well-being than those who do not report abuse, even when the "objective" aspects of their circumstances are similar.

Adaptation, Psychological↗
PubMed1997

Factors predictive of poor compliance with follow-up care after facial trauma: a prospective study.

We performed a prospective study of 59 consecutive patients with facial trauma who were treated at an urban public hospital. We obtained demographic and clinical data before treatment, then recorded compliance with clinic follow-up care. As expected, young, minority male patients, victims of assault, and blunt mechanisms of injury predominated in our series, and midface fractures and soft tissue injuries were most commonly seen. Thirty-one (52%) patients were admitted, and 28 (48%) were treated as outpatients. Although 66% of patients kept their initial follow-up appointment, only 46% of patients were seen to completion of the follow-up period. We used univariate and multivariate analyses to identify factors predictive of poor compliance with follow-up care. Factors predictive of poor compliance with the initial follow-up appointment identified in the multivariate analysis were orbital injury site (p < 0.001), Caucasian race (p = 0.007), and not having a telephone at home (p = 0.043). Factors predictive of poor compliance with completion of follow-up were failure to keep initial appointment (p < 0.001), and treatment with observation, suture only, or open reduction internal fixation only (p = 0.018). Age, marital status, employment status, education level, and hospital admission of the patient were not predictive of compliance with follow-up care. Because compliance with follow-up care may be poor, patients with facial trauma should be managed aggressively initially. In particular, patients with orbital fractures, and those treated with watchful waiting only may have poorer long-term compliance with follow-up care.

Adolescent↗
PubMed1999

Universal screening for intimate partner violence in the emergency department: importance of patient and provider factors.

STUDY OBJECTIVE: Screening for intimate partner violence has been widely advocated in the health care setting, but efforts to assess effectiveness and ensure adequacy of universal screening are largely untested. We sought to identify barriers to screening of female emergency department patients for intimate partner violence during the first year of implementation of a screening protocol. METHODS: A retrospective, structured medical chart review of 1,638 randomly identified visits included demographic factors of age, race, marital status, employment status, insurance status, arrival mode, mechanism of presenting complaint, severity of condition, presentation time, and nurse gender. The study was conducted an an inner-city Level I trauma center with 43,000 annual ED visits and universal procedures for screening for intimate partner violence in place since February 1994. The participants were a cohort of 1,509 female patients, 18 years of age or older, who were discharged from the ED between July 1994 and June 1995. The main outcome measure was the odds of being screened as a function of patient and provider variables. Statistical analyses involved univariate and multivariate logistic regression on screening rates (Yes/No) as derived from universal screening instrument variables. RESULTS: Of 1,638 records reviewed, 483 patients (29.5%) were screened for intimate partner violence. Univariate analyses revealed that women presenting with nonpsychiatric, less acute complaints and those who presented during daylight hours were more likely to be screened than women who presented with psychiatric or more acute complaints, or during the night shift. Male and female nurse providers were equally likely to screen for intimate partner violence. Step-down multivariate analyses agreed with these findings. CONCLUSION: In this random sample of female patients, screening rates varied by severity of the patient's condition, type of presenting complaint, and presentation time.

Adolescent↗
PubMed1999

A retrospective cohort study of post mastectomy pain syndrome.

Post mastectomy pain syndrome is a condition which can occur following breast surgery and has until recently been regarded as uncommon. Recent reports have suggested that it may affect 20% or more of women following mastectomy. The symptoms are distressing and may be difficult to treat however treatment for neuropathic pain can be successful. This paper reports a retrospective cohort of consecutive mastectomy cases over a six year period in one region of whom 511 survivors were traced and eligible for survey. A total of 408 completed a questionnaire survey which revealed that 175 (43%) had ever suffered from postmastectomy pain syndrome and 119 (29%) reported current symptoms although the majority were decreasing in intensity. A striking finding was the very high cumulative prevalence in younger women (65%) decreasing to 26% in the over 70 year group. The details of the onset, frequency and intensity of symptoms are described along with their natural history. The age effect on the frequency of the syndrome influences the marital status, employment status, housing, and educational status of those who report typical symptoms. Body weight and height are also associated with the frequency of post mastectomy pain syndrome. Relationship between the frequency of post mastectomy pain syndrome and radiotherapy, chemotherapy and the use of tamoxifen are difficult to unravel because of the combinations of pre and post operative treatments received confounded by age. The implications of a much higher frequency of post mastectomy pain are discussed with regard to management and counselling. The high frequency of the syndrome in the younger women is important and possible explanations are explored.

Adult↗