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PubMed2004

Psychological status at the menopausal transition: an Italian epidemiological study.

OBJECTIVES: To provide epidemiological data about psychological symptoms derived from a large Italian non-clinical sample, and to investigate the correlation with psychosocial factors. METHODS: The study design was a cross-sectional postal survey of a sample of menopausal women recruited from the General Registry Office in Ferrara's province. Four thousands and seventy-three women were sent a questionnaire designed on the basis of the Women Health Questionnaire (WHQ). Together with the WHQ, women were asked to fill out a personal file to define social status, cultural level, family's characteristics, recent menstrual cycles, gynaecological history and operations, drug's assumption, life events in the last year and lifetime depression. RESULTS: Factor analysis resulted in eight clusters of symptoms. Among psychiatric symptoms, three different clusters were identified: depressive symptoms, depressed mood with anxiety symptoms, and anxiety. The cluster "depressive symptoms" was more evident in the postmenopausal period with respect to the premenopausal one. CONCLUSION: The cluster "depressive symptoms" is significantly different in the premenopausal group with respect to the postmenopausal group, with greater levels of symptomatology in the postmenopausal group. On the contrary, the factor "depressed mood with anxiety symptoms" is present to the same extent in the pre-, peri- and postmenopausal groups. Prior depression is the most predictive variable of subsequent depression in postmenopausal women. Factors related to more pronounced depressive symptoms are number of life events, postmenopausal status, place of residence in rural areas and lower cultural level.

Cross-Sectional Studies↗
PubMed2005

Emotional distress and coping in the early stage of recovery following acute traumatic hand injury: a questionnaire survey.

BACKGROUND: Emotional distress is frequent in patients with acute traumatic hand injury during the first weeks after the accident. Knowledge of coping in relation to emotional distress could help to identify those who need support. OBJECTIVES: To describe the different kinds of coping used by patients in the early stage of recovery following an acute traumatic hand injury and to investigate differences in coping patterns in patients with and without symptoms of emotional distress. DESIGN: Questionnaire survey with a descriptive and comparative design. SETTING/PARTICIPANTS: A total of 112 patients with acute traumatic hand injury requiring inpatient treatment at the hand surgical clinic. Those with injuries caused by a suicide attempt or with known drug abuse were excluded. Method/main outcome measures: The patients answered a postal questionnaire at home 1-2 weeks after the accident. Emotional distress was assessed with the Hospital Anxiety and Depression scale. Coping was measured with the Jalowiec Coping Scale-40. RESULTS: Coping by "trying to keep the situation under control" and "trying to look at the problems objectively and see all sides" were most frequent. These strategies are typical for the confrontive coping style, which dominated in the actual illness-situation. Symptoms of emotional distress occurred in 32% of the patients. These patients used significantly more kinds of coping strategies and used confrontive and emotive coping strategies more often than the others. Coping by "hoping for improvement", "working tension off with physical activity", "trying to put the problem out of one's mind", "worrying", "getting nervous or angry" and "taking off by one self" were associated with emotional distress. Coping by "accepting the situation as it is" and "thinking that it is nothing to worry about" were more frequent in patients without emotional distress. CONCLUSIONS: Observations of the coping strategies associated with emotional distress in this study could help to identify patients in clinical practice that need nursing support. Coping associated with less emotional distress should be encouraged.

Activities of Daily Living↗
PubMed2000

Drug utilization pattern of antiepileptic drugs and traditional Chinese medicines in a general hospital in Taiwan - a pharmaco-epidemiologic study.

OBJECTIVE: Studies on antiepileptic drug utilization are important for the optimization of drug therapy and drug control. The present study was to evaluate the drug utilization pattern of standard antiepileptic drugs and traditional Chinese medicines (TCMs) in the treatment of different types of epilepsy in a general hospital in Taiwan. METHOD: The epileptic patients under antiepileptic drug treatment at Veterans General Hospital-Taipei were considered in the analysis. Current diagnosis was obtained by the neurologist in charge of the patient. All patients were interviewed by standard questionnaire designed to provide specific information on the types of antiepileptic drugs and details of their use. The questionnaire also sought to determine whether TCMs were used, and whether patients were using TCMs in combination with hospital standard treatment. The results were analysed by descriptive statistics. RESULTS: 729 patients with epilepsy definitely diagnosed were analysed in the study. 445 patients (61.04%) were prescribed with one antiepileptic drug. Combinations of two antiepileptic drugs were prescribed to 261 patients (35.80%), and combinations of three or more antiepileptic drugs to 23 patients (3.16%). A total of 1039 antiepileptic drugs was prescribed, corresponding to an average 1.42 drugs per patient. The most frequently prescribed antiepileptic drug was carbamazepine (56.93%), followed by phenytoin (31.96%), valproate (30.73%) and clonazepam (14.13%). Among the 729 epileptic patients, 83.68% used standard antiepileptic drugs alone, 16.32% used antiepileptic drugs in combination with TCMs. CONCLUSION: Monotherapy is the type of therapy most frequently used in all types of seizures. The selection of antiepileptic drugs is based on efficacy for specific seizure types and epileptic syndromes. The most frequently prescribed antiepileptic drug was carbamazepine, followed by phenytoin, valproate and clonazepam. As some of the patients used TCMs for treatment of epilepsy even when scientific medicine has been provided, further studies on the possible interactions between TCMs and antiepileptic drugs are in progress.

Adult↗
PubMed1980

Medical students' attitudes toward cancer.

The purpose of this study was to determine whether or not attitudes of medical students toward the cancer patient are as negative as their attitudes toward the chronically ill patient. A questionnaire designed to measure student attitudes toward cancer was administered to 122 medical students. Two versions of the questionnaire were developed. One version referred specifically to attitudes toward cancer patients while the second version assessed attitudes toward patients in general. Significant differences were found between student attitudes toward cancer patients and patients in general. Support was found for the existence of negative attitudes in the treatment of cancer patients. Implications of these findings and teaching modifications are discussed.

Attitude↗
PubMed1990

Patterns of vocational interests and work motivation among mentally retarded adults attending vocational rehabilitation centres.

The present study describes a survey of the vocational interests and work motivation of trainees attending vocational rehabilitation centers for the mentally retarded in Israel. A random sample of 152 subjects was chosen from a total of 1,509 trainees. Two sets of questionnaires were applied: (1) the Illustrated Vocational Inventory (IVI) (Whelan and Reiter, 1980); and (2) a specially designed questionnaire on work motivation based on Herzberg's model (Herzberg et al., 1959). The most significant finding of the study was that several consistent patterns of vocational knowledge, vocational interests and motivational factors emerge with regard to mentally retarded clients attending vocational rehabilitation centers; and this lends strong support to the view that such people can be placed in employment on the open labour market.

Adolescent↗
PubMed2003

Psychiatric disorders and psychiatric consultation in a general hospital: a case- control study.

INTRODUCTION: Psychiatric consultation (PC) has been considered an efficient tool to develop research, to track and to give assistance benefiting patients, health professionals and the institution. However, it has not been much used in Brazil. Although 30 to 50% of general hospital (GH) inpatients may present a psychiatric disorder, only 1 to 12% of them are referred to assessment. The aims of this study were: to assess mental disorders in a GH; to identify which of these patients are sent to psychiatric care; to verify alleged reasons for referral to psychiatric consultation, and to examine the relationship between PC and psychiatric learning (during medical school and residence). METHODS: A case-control patient study was conducted (47 cases and 94 controls) to analyze in detail the following variables: socio-demographic; clinical; degree of information (about the disease and diagnostic/therapeutic procedures), and relationship between patient and health team. Psychiatric diagnoses were made according to the ICD-10 criteria. The Self Report Questionnaire (SRQ), the CAGE and Brief Psychiatric Rating Scale (BPRS) were used as well as a specifically designed questionnaire to collect clinical and demographic data. RESULTS: Behavioral alterations, either of elation or of depression, were the main for requesting a PC; 95.8% of the cases and 27.7% of the controls had a mental disorder. Organic mental disorders and alcohol-related disorders were the most frequent diagnoses in group I (cases), while anxiety, depressive and alcohol-related disorders were predominant in group II (controls). Control group patients were better informed and more able to establish an appropriate relationship with the health team than case patients. The logistic regression showed CAGE-positive patients having 12.85 times greater risk of being referred to PC, followed by unemployed patients (2.44 times more PC referrals). DISCUSSION: The SRQ and CAGE were quite useful in the screening of possible patients and might be important for medical students to learn and use as generalists. Further research is needed to verify if and how the newly-established service will improve the diagnostic and treatment skills of our students.

Adult↗
PubMed2002

Internal consistency and reliability of a questionnaire assessing organizational innovation in two schools of dentistry.

The objective of this study was to test the internal consistency and test-retest reliability of a questionnaire designed to assess the status of and factors associated with organizational innovation in schools of dentistry. The questionnaire included thirty-three questions that assessed the following six domains: innovation/environment, innovation/leadership, innovation/personal, feedback/environment, feedback/personal, and feedback/interpersonal. A seventh domain, evidence-based learning, assessed the reaction of dental faculty to a scenario where the scientific evidence found a current treatment to be ineffective in improving the health status of patients. The questionnaire was mailed three times to a systematic sample of fifty-six dental faculty working at a research-intensive dental school (RES) and all thirty-nine dental faculty working at a dental school where the emphasis is on clinical education (CL). The two U.S. dental schools had similar numbers of students; however, they differed significantly in their research portfolios. The response rate was 70.5 percent. The seven domains had alpha coefficients ranging between 0.60 and 0.89. The test-retest reliability for the seven domains ranged between 0.65 and 0.92. Dental faculty of the RES school had significantly higher average scores than faculty of the CL school on innovation/leadership, innovation/environment, feedback/environment, and feedback/personal domains. Regression analyses found no differences between the two schools in innovation/environment scores. The innovation/environment scores were significantly associated with innovation/leadership, feedback/environment, feedback/interpersonal, and age. The evidence-based learning domain was negatively associated with the innovation/environment domain, indicating that faculty who were willing to abandon teaching of a treatment found to be ineffective felt that their school environment was not highly innovative. In conclusion, this preliminary study found that the questionnaire reliably assessed six domains representing innovation and feedback. This preliminary study also found that an innovative environment in two schools of dentistry is associated with presence of leaders who promote change and innovation, an environment that encourages feedback, and faculty members who value interpersonal feedback.

Age Factors↗
PubMedDate not supplied

Development and content validation of family practice residency recruitment questionnaires.

BACKGROUND AND OBJECTIVES: The residency recruitment process involves a substantial time and financial commitment on the part of medical students and residency programs. This paper describes the development and content validation process of two written questionnaires designed to assess the application and interview process at our family practice residency program. METHODS: Two written questionnaires were developed after completion of a literature review and from areas deemed important by our academic faculty. Drafts of each questionnaire were sent to nine jurors to assess content validity. Content reviewers provided both a qualitative and a quantitative assessment of each questionnaire. RESULTS: The inclusion of both open- and closed-ended questions/items was deemed necessary and appropriate by the panel of content jurors. Assessing faculty, residents, curriculum, program's reputation, geographic location, and spouse/family influence were considered the most important factors to include on the questionnaires when assessing a family practice residency program. CONCLUSIONS: With increasing pressure to fill positions across many family practice residency programs, it is important for faculty involved in the recruitment process to recognize that both factors within and out of their control contribute to the selection process.

Family Practice↗
PubMed2003

Counseling adolescents with hearing loss with the use of self-assessment/significant other questionnaires.

After adapting a pair of adult Self-Assessment/Significant Other questionnaires, the first author explored the value of the modified questionnaires in providing counseling to adolescents with hearing loss. Twenty adolescents with hearing loss served as subjects; peers with normal hearing were selected as their Significant Other to capitalize on the importance of peer relationships and opinions during adolescence. Each dyad completed a 12-item questionnaire designed to explore the communicative, emotional, and social impact of hearing loss. Responses to each pair of questionnaires were reviewed by the adolescent and the audiologist and served as a basis for counseling. Subsequent dialogues revealed recurring themes as the teens attempted to face age-appropriate developmental challenges as individuals with hearing loss. Based on their responses to a follow-up questionnaire, most of the adolescents found the counseling process beneficial.

Adolescent↗
PubMed2006

Cultural variability in the effects of question design features on respondent comprehension of health surveys.

PURPOSE: The aim is to identify the characteristics of common health survey questions that may be associated with cross-cultural variability in question comprehension. METHODS: Interviews with respondents representing four cultural subgroups in the United States were analyzed through behavior coding to identify survey question characteristics that may be associated with cross-cultural variability in comprehension. Using survey responses as the unit of analysis, nested within survey respondents and survey questions, hierarchical linear modeling was used to examine the effects of four questionnaire design features on cultural variations in comprehension difficulties. RESULTS: Respondent culture was found to moderate the effects of response format, question length, and reading levels. CONCLUSIONS: Several question design strategies that reduce overall comprehension difficulty appear to also increase cross-cultural disparities.

Cognitive Science↗
PubMed2004

Underreporting of energy intake among Japanese women aged 18-20 years and its association with reported nutrient and food group intakes.

OBJECTIVES: To evaluate the ratio of energy intake to basal metabolic rate (EI/BMR) among young female Japanese adults, and to compare the lifestyle and dietary characteristics between relatively low and high reporters. DESIGN: Dietary intakes were assessed over a 1-month period with a validated, self-administered, diet history questionnaire, and lifestyle variables were assessed by a second questionnaire designed for this survey. The ratio of EI/BMR was calculated from reported energy intake and estimated basal metabolic rate. SUBJECTS: In total, 1889 female Japanese university students aged 18-20 years who were enrolled in dietetics courses. RESULTS: Ninety-five per cent of the subjects were classified into a non-obese group (body mass index (BMI) <25 kg m(-2); mean+/-standard deviation (SD): 20.8+/-2.6 kg m(-2)). EI/BMR was 1.43+/-0.40 (mean+/-SD). Sixty-eight per cent of the subjects showed an EI/BMR level below the possibly balanced value of 1.56, 37% showed EI/BMR below the minimum survival value of 1.27 and 2% of the subjects showed EI/BMR exceeding the maximum value for a sustainable lifestyle of 2.4. BMI, body weight and BMR decreased significantly with the increase in EI/BMR (P<0.001). The percentage of energy from carbohydrate was significantly higher, whereas those from fat and protein were significantly lower, among the lower EI/BMR groups. As for food groups, a significantly declining trend from the lowest to the highest EI/BMR groups was observed for cereals. CONCLUSION: Underreporting, rather than overreporting, of energy intake was predominant in this relatively lean Japanese female population. BMI was the most important factor affecting the reporting accuracy of energy intake.

Adolescent↗
PubMed2001

Consequences of non-vascular trans-femoral amputation: a survey of quality of life, prosthetic use and problems.

Individuals with unilateral trans-femoral amputations due to non-vascular causes were studied in a mailed survey designed to investigate health-related quality of life (HRQL), prosthetic use and problems. The Swedish SF-36 Health Survey and a structured questionnaire designed for trans-femoral amputees were used. The series consisted of 97 subjects (60 men, 37 women), aged 20 to 69 years with a mean of 22 years since the amputation. Trauma was the cause of amputation in 55%, tumour in 35% and other causes in 10%. Ninety-two (92) subjects (95%) had a prosthesis and 80 (82%) used it daily. General HRQL was significantly lower than Swedish age- and gender-matched norms in all dimensions as measured by SF-36. Most frequently reported problems that had led to reduction in quality of life were heat/sweating in the prosthetic socket (72%), sores/skin irritation from the socket (62%), inability to walk in woods and fields (61%) and inability to walk quickly (59%). Close to half were troubled by stump pain (51%), phantom limb pain (48%), back pain (47%) and pain in the other leg (46%). One fourth considered themselves to have a poor or extremely poor overall situation. Transfemoral amputation, due to non-vascular causes, has an evident impact on quality of life and there are considerable problems related to the amputation and the prosthesis. Efforts to improve the physical and the psychological well-being for this group, with a long life expectancy, are needed.

Activities of Daily Living↗
PubMed1999

Workplace bullying in NHS community trust: staff questionnaire survey.

OBJECTIVES: To determine the prevalence of workplace bullying in an NHS community trust; to examine the association between bullying and occupational health outcomes; and to investigate the relation between support at work and bullying. DESIGN: Questionnaire survey. SETTING: NHS community trust in the south east of England. SUBJECTS: Trust employees. MAIN OUTCOME MEASURES: Measures included a 20 item inventory of bullying behaviours designed for the study, the job induced stress scale, the hospital anxiety and depression scale, the overall job satisfaction scale, the support at work scale, and the propensity to leave scale. RESULTS: 1100 employees returned questionnaires-a response rate of 70%. 421 (38%) employees reported experiencing one or more types of bullying in the previous year. 460 (42%) had witnessed the bullying of others. When bullying occurred it was most likely to be by a manager. Two thirds of the victims of bullying had tried to take action when the bullying occurred, but most were dissatisfied with the outcome. Staff who had been bullied had significantly lower levels of job satisfaction (mean 10.5 (SD 2. 7) v 12.2 (2.3), P<0.001) and higher levels of job induced stress (mean 22.5 (SD 6.1) v 16.9 (5.8), P<0.001), depression (8% (33) v 1% (7), P<0.001), anxiety (30% (125) v 9% (60), P<0.001), and intention to leave the job (8.5 (2.9) v 7.0 (2.7), P<0.001). Support at work seemed to protect people from some of the damaging effects of bullying. CONCLUSIONS: Bullying is a serious problem. Setting up systems for supporting staff and for dealing with interpersonal conflict may have benefits for both employers and staff.

Adolescent↗
PubMed1989

Technical training in surgery: the trainee's view.

A questionnaire designed to investigate the technical training of general surgical trainees was distributed throughout Scotland. A total of 222 questionnaires were sent out and 179 (81 per cent) were returned. Of the responders, 38 per cent felt that the overall operative workload was too small and the majority thought that there was too little emphasis on supervised operating. Two-thirds of trainees were generally satisfied with the amount of unsupervised operating, although a substantial proportion (21 per cent) sometimes felt out of their depth when performing delegated emergency operations. Few had attended craft workshops or travelled to other centres, but of those who had, most considered both activities to be very useful. Photographic atlases and videos were not generally felt to be of great value by those who had used them. The majority of trainees did not believe that research activity had interfered excessively with their technical training.

Attitude of Health Personnel↗
PubMed1988

Communication of adults with learning disabilities: self and others' perceptions.

This study investigated perceptions of the communication performance of 31 young adults with severe learning disabilities enrolled in a vocational-education program. Communication assessment questionnaires, designed to rate communication skills of these students, were completed by the students themselves and vocational educators. These questionnaires included items in the areas of comprehension, verbal expression, social communication, and problem solving. Overall, the students' perceptions of their own communication performance were remarkably similar to those of the vocational educators. However, students perceived their communicative performance as less problematic than did others. Of the four areas pertinent to communication, students and vocational educators perceived problem solving as most difficult. Implications of these findings are discussed with reference to the development of assessment procedures for adults with learning disabilities.

Adolescent↗
PubMed1994

Patient-based health status measurements in pediatric dialysis: expanding the assessment of outcome.

Children with end-stage renal disease (ESRD) are now long-term survivors of dialysis and transplantation. To define and provide optimal care for these children, clinicians must assess and appreciate the impact of renal disease and its treatment on their patients' quality of life. The purpose of this pilot project was to examine the correlates of health, family cohesion, and compliance in adolescents with ESRD. Twenty adolescents with ESRD were asked to respond to a generic self-report questionnaire designed to measure self-perceived physical and psychosocial health and family life. A separate, clinician-reported questionnaire was used to assess compliance with the therapeutic regimen. Results indicated that adolescents with ESRD report their general health to be poor. In addition, patients described as less compliant reported poorer health, less family cohesion, and less participation in family activities than their more compliant peers. Although caution must be observed in interpreting our clinical findings, this initial investigation of the health and well-being of an adolescent ESRD population underscores the important relationship between compliance, perceived health status, and family cohesion.

Adolescent↗
PubMed2001

Knowledge levels and attitudes of staff nurses in Israel towards complementary and alternative medicine.

AIMS: The purpose of this study was to determine the knowledge level and attitudes of Israeli nurses towards complementary and alternative medicine and what factors are related to these variables. BACKGROUND: Over recent years there has been increased interest among the lay public and health care professionals in complementary and alternative medicine (CAM). Previous studies have shown that several variables such as education, income, age, perceived health status and satisfaction with medical therapy are associated with use of CAM. Conflicting reports were found with respect to the relationship between health locus of control and the use of CAM. Israel is a small country comprised mostly of immigrants from vastly differing cultures with differing beliefs about health and health care. Nurses whose origins are similar to the general population are also caregivers who are used to integrating diverse therapies into the plan of care devised with the client. No study was found which investigated these issues among Israeli nurses. DESIGN/METHODS: A systematic random sample of 369 staff nurses working at a major academic medical centre in Jerusalem, Israel were invited to participate in the study. Informed consent was obtained. Four self-administered, pencil and paper, questionnaires were distributed to the study participants: a questionnaire designed by the authors to determine the level of knowledge and attitudes towards complementary and alternative medicine; a questionnaire which measured satisfaction with the patient-physician relationship; a questionnaire which measured health locus of control; and a demographic questionnaire. Participants received a packet containing the questionnaire and a note explaining the study. The anonymous questionnaires were collected by the ward secretaries and sent in bulk to the researchers. RESULTS: Results demonstrated that nurses in this sample perceived that they had little knowledge of complementary and alternative medicine but were very interested in learning more. Few used complementary and alternative medicine in their nursing practice but levels of personal use were similar to that of the general population. Nurses who used complementary and alternative medicine were satisfied with their care. CONCLUSIONS: In general, nurses tended to be wary of the use of complementary and alternative medicine. Nurses were also not satisfied with their relationships with their physicians. Those of middle age were more likely to use complementary and alternative medicine but no other demographic characteristics were associated with knowledge or attitudes towards complementary and alternative medicine. Nurses had higher levels of internal health locus of control which was associated with more positive attitudes and knowledge levels of complementary and alternative medicine.

Adult↗
PubMed1998

Verbal autopsies for adult deaths: their development and validation in a multicentre study.

BACKGROUND: Verbal autopsy (VA) has been widely used to ascertain causes of child deaths, but little is known about the usefulness of VA for adult deaths. This paper describes the process used to develop a VA tool for adult deaths and the results of a multicentre validation of this tool. METHODS: A mortality classification was developed by including causes of death that might be arrived at by VAs and causes that are responsive to public health interventions. An algorithm was designed for each cause in the classification, based on classifying symptoms into essential, supportive and differential. A structured questionnaire designed to elicit information on these symptoms was developed in English translated into the local languages. The tool was validated on deaths occurring at hospitals in Tanzania (315 deaths), Ethiopia (249) and Ghana (232). Hospital records of all adult deaths occurring at the study hospitals from June 1993 to April 1995 were collected prospectively. Non-medical interviewers with at least 12 years of formal education conducted VA interviews. Causes of death were diagnosed by a panel of physicians and by a computerized algorithm. The validity of the VA was assessed by comparing the VA diagnoses with hospital diagnoses. RESULTS: Specificity of VAs by physicians fell below 95% only for acute febrile illness (AFI) and TB/AIDS. Sensitivity and positive predictive value (PPV), however, varied widely both across the sites and between causes. Sensitivity was > 75% for tetanus, rabies, direct maternal causes, injuries and TB/AIDS and ranged between 60% and 74% for diarrhoea, acute abdominal conditions and AFI. The PPV was > 75% for tetanus, rabies, hepatitis and injuries and ranged between 60 and 74% for meningitis, AFI, TB/AIDS and direct maternal causes. When the communicable diseases were combined in a single group, the sensitivity was 82%, specificity 78% and PPV 85%. For the group of noncommunicable diseases the corresponding sensitivity, specificity and PPV were 71%, 87% and 67%, respectively. Use of an algorithm resulted in lower sensitivity, specificity and PPV than the VAs by physician. CONCLUSION: VAs by a panel of physicians performed better than an opinion-based algorithm. The validity of VA diagnosis was highest for AFI, direct maternal causes, TB/AIDS, tetanus, rabies and injuries.

Adult↗