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PubMed1997

Motivational correlates of self-reported persistent pain in young adults.

OBJECTIVE: We sought to illustrate that personal goals can provide a meaningful context within which to interpret physical pain and that persistent (nonclinical) pain correlates with dysfunctional goal evaluation for young adults. DESIGN: A total of 127 college students reporting either no pain or persistent physical pain completed the Goal System Assessment Battery, a set of questionnaires designed to gauge stable and accessible representations of self-regulated goal pursuit. RESULTS: The results supported the general contention that persons experiencing persistent pain (at subclinical levels) tend to evaluate their important life goals in a "problematic" fashion. Specifically, the presence of persistent pain was associated with lower ratings of self-efficacy, self-monitoring, self-reward, and less positive arousal. CONCLUSIONS: The pattern of goal construal produced by this young and generally healthy group of college students reflects cognitive-motivational dysfunctions possibly presaging pain-schemes in later life.

Adult↗
PubMed2005

An implementation strategy for introducing an OSCE into a dental school.

INTRODUCTION: The Objective Structured Clinical Examination (OSCE) uses a series of test-stations to test clinical competencies. The introduction of an OSCE in a dental school is always a new experience for both staff and students and may result in a change in assessment methods. As resistance could develop when changes are introduced into an organisation, the use of a strategy for the implementation of such change will help to diminish opposition and may therefore result in the co-operation of staff and their departments. The objective of this study was to investigate the effectiveness of an implementation strategy by measuring attitudes of both staff and students towards the OSCE as a new form of clinical assessment in a dental school (ACTA). MATERIALS AND METHODS: 'Stepwise' behaviour change (with information, participation and commitment as tools) was used as a strategy to minimise protective behaviour to the introduction of an OSCE. After lectures on assessment, 59 staff members participated in a mini-OSCE with eight test-stations, playing both the role of a student and observer. A questionnaire, designed to test attitudes and commitment towards the new OSCE was completed after the examination. Six months later, 22 staff of all departments had developed and run a pilot OSCE for 44 students. A similar questionnaire was answered by staff and students. A year later, another OSCE for all 103 third year students was designed, organised and evaluated with full co-operation of the clinical teaching staff. RESULTS: Staff total attitude grew positively (P = 0.001). Student's total attitude was lower than staff (P < 0.001) The results of the survey after the mini-staff-OSCE and pilot and final OSCE were favourable in terms of the acceptance of use of an OSCE for the assessment of clinical competences. CONCLUSION: The implementation strategy appears to have been successful. The objective of gaining the co-operation of staff and departments and avoiding resistance to change was achieved.

Attitude↗
PubMed1999

Long-term study of quality and safety of osseointegration for the retention of auricular prostheses.

The aim of this article is to describe the safety and quality of the osseointegrated implant technique for the retention of craniofacial prostheses, to present a protocol for collection of clinical data, and to discuss the impact of the procedure on the patient quality of life. A protocol was designed and used to study patients who had received auricular prostheses consecutively since 1979 at our department. The patients were asked to answer a questionnaire designed to describe symptoms and problems specific for someone wearing an auricular prosthesis. In total, 99 patients received 107 prosthetic ears (8 patients had bilateral defects) retained on 309 implants (2 to 4 implants/ear). Patients of all ages were represented, and only 9 discontinuities were reported. Most patients (95%) wear their prosthesis every day, in most cases more than 10 hours/day. The follow-up period ranged from 1 to 12 years, giving a total of 2624 postoperative observations of implants, with a 3% incidence of significant skin reaction. We conclude that the surgical technique for auricular prostheses retained on osseointegrated implants is simple and associated with a low rate of peroperative and long-term complications. It offers a high degree of stability and aesthetic satisfaction.

Adolescent↗
PubMed2002

Job satisfaction and stress among MCH physicians in Alexandria.

Physician satisfaction with their job is a topic of importance to physicians in practice, physicians in training, health administrators, and health executives. Stress among physicians arises due to inadequate demands of the job in relation to worker's abilities, frustrated aspirations, and dissatisfaction with regard to aimed goals. The cross-sectional study design was conducted at 7 randomly selected Maternal and Child Health (MCH) centres, affiliated to seven medical zones in Alexandria. The study sample consisted of all physicians working at the studied MCH centres. A questionnaire designed for data collection was distributed to all physicians available and who accepted to participate in the study. The questionnaire included 4 sections measuring, socio-demographic characteristics, overall satisfaction and global satisfaction, an eight-dimension satisfaction scale, and a four-dimension stress scale. The questionnaire was distributed to 100 physicians out of whom 77% responded. Satisfaction scale was on a scale ranging from 6 (greatly satisfied) to 1 (greatly dissatisfied). Stress was on a scale ranging from 6 (greatly stressed) to 1 (greatly unstressed). The total mean satisfaction score for the sample under study was 3.3 +/- 0.6 with a significant difference among zones (F = 4.4, p < 0.05), and the total mean stress score for the sample under study was 3.8 +/- 0.7 with a significant difference among zones (F = 2.4, p < 0.05). It is recommended that decision makers at the MOHP find ways to raise the physicians' pay, efficient planning of resources, and find opportunities for future promotion.

Adult↗
PubMed2004

Sun awareness in Maltese secondary school students.

BACKGROUND: Studies indicate that reducing exposure to ultraviolet light during childhood and adolescence decreases the risk of skin cancer. From a young age, children need to be educated about the sun's harmful effects on the skin and how best to protect themselves. OBJECTIVE: To help in the design of school-based interventions to raise sun awareness, a school survey was carried out to identify students' stereotypes and misconceptions. STUDY DESIGN: A total of 965 students attending Maltese secondary schools in forms 1, 2 and 3 were surveyed in May 2002, using a structured questionnaire designed to examine students' sun-related attitudes and knowledge. RESULTS: A high level of sun awareness among students was demonstrated, with high scores on knowledge of the effects of the sun on the skin, knowledge of skin cancer and knowledge of sun protection. Girls were clearly more knowledgeable than boys. However, of all the students surveyed, 55% thought that a suntan made them look better and 70% thought that their friends would desire a tan. These views were commoner among the older students. Skin type and hair or eye colour had no bearing on attitudes towards tanning or sun-related knowledge. The commonest misconceptions were that 'the sun is bad for your skin only when you get sunburnt' and that 'you cannot get too much sun on a cloudy day'. Deliberate suntanning was more frequently reported by girls than by boys and by students in the higher forms. CONCLUSION: Attitude change lags behind knowledge. Future school sun awareness interventions need to take into account gender and age differences in students' attitudes and perspectives. They should aim at motivating attitude change and preventive behaviour through consistent and repeated sun-education messages that are supported by a sun-conscious school environment.

Adolescent↗
PubMed2000

Predictors of owner response to companion animal death in 177 clients from 14 practices in Ontario.

OBJECTIVE: To identify predictors of grief and client desires and needs as they relate to pet death. DESIGN: Cross-sectional mail survey. SAMPLE POPULATION: 177 clients, from 14 randomly selected veterinary practices, whose cat or dog died between 6 and 43 days prior to returning the completed questionnaire. PROCEDURE: Veterinary practices were contacted weekly to obtain the names of clients whose pets had died until approximately 200 clients were identified. Clients were contacted by telephone, and a questionnaire designed to measure grief associated with pet death was mailed to those willing to participate within 1 to 14 days of their pet's death. The questionnaire measured potential correlates and modifiers of grief and included three outcome measures: social/emotional and physical consequences, thought processes, and despair. Demographic data were also collected. RESULTS: Approximately 30% of participants experienced severe grief. The most prominent risk factors for grief included level of attachment, euthanasia, societal attitudes toward pet death, and professional support from the veterinary team. CONCLUSIONS AND CLINICAL RELEVANCE: Bivariate and multivariate analyses highlighted the impact owners' attitudes about euthanasia and professional intervention by the veterinary team had on reactions to pet death. Owners' perceptions of societal attitudes, also a predictor of grief, indicate that grief for pets is different than grief associated with other losses.

Adolescent↗
PubMedDate not supplied

Psychometric properties of a quitting time for alcohol questionnaire: factor structure, reliability, and validity.

Research into the dynamics of alcohol use has traditionally focused on etiological factors, particularly on the reasons an individual engages in drinking behaviours. Although reasons for the permanent cessation of drinking have also been well documented, little is known about the reasons for the episodic cessation of alcohol use that is characteristic of nonproblematic drinking patterns. The purpose of the present study was to develop and validate a questionnaire designed to monitor the reasons an individual temporarily stops drinking at the end of a drinking episode. A 23-item Quitting Time for Alcohol Questionnaire (QTAQ) was developed and distributed to a community based sample of 252 participants. Factor analysis revealed three conceptually distinct factors, QTAQ-IS (Internal Status) QTAQ-AA (Avoidance Adherence) and QTAQ-IC (Immediate Context), which accounted for 36.3% of the variance. Cross-validation on a large sample of undergraduate students (N = 479) confirmed the three-factor solution (accounting for 33% of the variance). Cronbach's alpha coefficients for the factors ranged from .74 to .81 for the community sample and from .62 to .78 for the student sample. The validity of the emergent factors was demonstrated by their ability to classify participants according to self-reported alcohol consumption and alcohol dependence criteria, and also by their significant predictive relationship with these criteria. The present findings suggest that the QTAQ is a useful instrument both for research and for use in clinical practice.

Adolescent↗
PubMed1997

Coming out by south Asian gay men in the United Kingdom.

The process of coming out among Western gay men and women is well described. The present study is the first to explore the experiences of coming out among gay men of South Asian origin in the U.K. South Asian is defined here as originating from the Indian subcontinent. Members of a homophile organization were given a questionnaire designed to assess the experiences of coming out to family and friends and the degree of compartmentalization in their lives. Information obtained from 52 questionnaires was supplemented by detailed interviews with 9 respondents. Families and religion played important roles in the process of coming out. Sisters were most likely to be told first. Some degree of dissonance between cultural and sexual identity was noted. In addition, each step taken in revealing one's sexual orientation to friends, family, and colleagues was dictated by the strength of the relationships and the desire for intimacy. Further areas of research are highlighted.

Adolescent↗
PubMed1996

Analgesic rebound headache in clinical practice: data from a physician survey.

BACKGROUND: Frequent, excessive use of over-the-counter or prescription analgesics may lead to analgesic rebound headache. Little is known about the magnitude of the health problem posed by analgesic rebound headache, its epidemiology, the characteristics of analgesic rebound headache sufferers, or about physicians' approaches to treatment. METHODS: Four hundred seventy-three practitioners, who had previously expressed an interest in the treatment of headache, were mailed a questionnaire designed to capture information about the frequency and management of analgesic rebound headache and about the characteristics of analgesic rebound headache sufferers. RESULTS: Completed questionnaires were returned by 174 practitioners (37%) from 40 states, the District of Columbia, and Puerto Rico. More than 40% of respondents indicated that analgesic rebound headache was present in at least 20% of their patients. On average, the physicians reported that 73% of patients with analgesic rebound headache were women. Analgesic rebound headache was most likely to occur in patients aged 31 to 40 years. No one analgesic was consistently identified as causative, although acetaminophen, butalbital + aspirin + caffeine, and aspirin were commonly used by patients. Eighty percent of respondents indicated that depression was commonly observed in analgesic rebound headache sufferers; 77% indicated that physical conditions (especially gastrointestinal symptoms) were commonly observed. A variety of therapeutic strategies, including pharmacotherapy, were used in the management of analgesic rebound headache. CONCLUSION: Analgesic rebound headache was recognized as a distinct entity and a substantive component in more than 40% of the practices of 174 surveyed practitioners. General practitioners, who see a wide variety of patient types with a spectrum of complaints, need to be able to diagnose analgesic rebound headache by taking a good history.

Adult↗
PubMed2001

Undescended testis and the risk of testicular cancer: importance of source and classification of exposure information.

BACKGROUND: The strength of the association between undescended testis and testicular cancer varies considerably across studies. Here we report the effect of various classifications of self-reported history of undescended testis and different data sources on the estimates of the risk of testicular cancer from a case-control study. METHODS: We performed a population-based case-control study including 269 testicular cancer cases and 797 controls matched on age and region. Medical history was assessed by interviews (index persons) and mailed questionnaires (mothers). We used conditional logistic regression to calculate odds ratios (OR) and kappa coefficients to assess agreement between different sources of information. RESULTS: Odds ratios for testicular cancer ranged between 2.4 and 5.4 based on the sons' self-reports and between 1.1 and 1.9 based on the mothers' reports. The agreement between the sons and mothers on undescended, gliding or retractile testis was fair (kappa 0.53) and was good when these conditions were treated by surgery (kappa 0.89). The rating of a history of undescended testis by two urologists was fair (kappa 0.54). CONCLUSIONS: The questionnaire design, the classifications of undescended testis and data sources have an important impact on the OR for the association of undescended testis and testicular cancer. These factors may partially explain the heterogeneity of the OR for this association in case-control studies relying on self-reports.

Adolescent↗
PubMed1979

Orality and smoking.

This study was designed to investigate the relation of orality and smoking, smoking motivation and anticipatory pleasure in smoking. Ninety-seven male and female subjects completed questionnaires designed to elicit information about their motivation and behaviour. Results indicated that difficulty in stopping smoking was positively related to three non-nutriment oral preoccupations. Smoking for psychological as opposed to social reasons was positively related to two-nutriment oral preoccupations. Anticipation of pleasure in smoking before becoming a smoker was negatively related to nutriment orality, positively related to smoking because of a craving, and, for females only, positively to one type of non-nutriment orality. The results are discussed in relation to the role of oral ingestion and the reaction of the central nervous system to the drug.

Adult↗
PubMed2000

Impact of managed care on scholarly activity and patient care: case study of 12 academic radiology and radiation oncology departments.

Six departments of radiology and six departments of radiation oncology from areas with low, medium, or high managed care penetration were asked to complete a questionnaire designed to address the impact of managed care on research and scholarly activity. Information, when available, was taken from fiscal years 1993 and 1998. Questionnaires were followed by site visits to the 12 departments. The study showed that departments with medium to high managed care penetration reported more dissatisfaction in their ability to remain active in their education and research goals. Results indicated that for the period surveyed, the departments needed to increase clinical time to make up for decreasing patient care revenues. In turn, this has reduced the time and money devoted to scholarly activities. Information from this study will be used to develop a trends database for all U.S. radiology and radiation oncology departments. This, together with a more comprehensive study by the RSNA, will assist in measuring the current and potential long-term impact of managed care and other system changes on the practice of radiology and radiation oncology.

Academic Medical Centers↗
PubMedDate not supplied

Vibration and its effects on the body.

OBJECTIVES: To assess the effects of machine-induced vibration on workers and to determine effective precautions for vibration-induced trauma. SUBJECTS AND METHODS: The study group consisted of 114 workers who were randomly selected: 50 rock drill workers and 64 truck heavy vehicle operators. Fifty-four office workers were designed as controls. The study and control groups were age-matched. All subjects were interviewed to determine subjective symptoms using a 38-item questionnaire designed by the Medical Committee of Vibration Disease, Japanese Association of Industrial Health. RESULTS: The complaints of pain in the fingers, sensitivity to cold, numbness and pain of fingers at night, weakness of static position, wrist-elbow pain, difficulty in bending and stretching elbow, pain in shoulder when holding up arms, lower back pain, sleeping disturbance and hearing difficulty were significantly higher in rock drillers than heavy vehicle operators and office workers (p < 0.05-0.01). CONCLUSION: Permanent vibration exposures cause negative physical effects that may lead to occupational diseases. In order to be protected against whole-body and hand-arm vibrations, technical and medical measures must be taken into account.

Adult↗
PubMed1994

Propofol and thiopental anesthesia: a comparison of the incidence of dreams and perioperative mood alterations.

The purpose of this study was to investigate perioperative mood profiles and the incidence of dreams in patients receiving anesthesia with either propofol (n = 29) or thiopental (n = 27) in combination with nitrous oxide. The study was a prospective, randomized, and double-blind investigation of female patients undergoing outpatient dilation and curettage. Recall of dreams was assessed 1 h postoperatively and the following day by using a questionnaire designed for surgical patients. Mood profiles were quantified using the Multiple Affect Adjective Check List-Revised (MAACL-R), a self-administered questionnaire which was completed preoperatively and 1 h postoperatively. Our results indicate that postoperatively, all patients were significantly less anxious than preoperatively (P < 0.0001). In the postoperative period, patients receiving propofol exhibited sensation-seeking tendencies (i.e., active, adventurous, aggressive, daring, energetic, enthusiastic, merry) when compared to the thiopental patients (P < 0.02). The incidence of dreams was small and equal in both groups. We conclude that patients anesthetized with propofol and nitrous oxide, as compared to patients anesthetized with thiopental and nitrous oxide, were more likely to demonstrate adventurous tendencies in the postoperative period.

Adult↗
PubMed2005

[Results of the INTRA-WHO survey in Chile].

BACKGROUND: The aging speed in developing countries has been faster than predicted. Thus, health care systems must adapt to face this new scenario efficiently. The WHO designed the INTRA study to assess health promotion and protection actions in primary care, for people over 50 years of age. MATERIAL AND METHODS: Questionnaires designed by WHO were applied to 1,167 subjects (aged 50-94 years, 68% female) and 117 health care professionals attending and working respectively, at 33 health care centers of the Viña-Quillota Health Service. RESULTS: Twenty percent of subjects were illiterate and 25% had less than 6 years of instruction. Forty three percent could reach the health centre by public transportation and 92% did not need to be accompanied, 39% spent more than one hour to be attended and 71% considered that the service in the centre was good. Sixty seven percent attended regular appointments, 63% did not perform any physical activity and only half of them were advised to start such activity. Weight loss was recommended to 55% but only one third has achieved such goal. Only one third of patients admitted being interrogated about their drinking habits. Among subjects in whom blood pressure was measured, one fourth had abnormal values. CONCLUSIONS: Primary health care in Chile, although having health care programs for the elderly, is loosing opportunities to improve health status and quality of life of this age group.

Aged↗
PubMed2000

Gait and function after intra-articular arthrodesis of the hip in adolescents.

BACKGROUND: Patients who have had a hip arthrodesis have been reported to have pain in the back and the knee due to an altered gait. There is little information about the specific compensatory mechanisms that are adopted when walking. The purpose of this study was to objectively define gait adaptations after an arthrodesis of the hip and to correlate the kinematic findings with pain and other patient outcomes. METHODS: Nine patients who had had an arthrodesis of the hip at an average age of thirteen years and five months (range, ten years and nine months to sixteen years and eleven months) were evaluated with gait analysis and muscle strength-testing and completed a questionnaire related to pain and function. The average duration of follow-up was eight years and ten months (range, two years and one month to thirteen years and ten months). The frequency of the postoperative visits varied. Seven patients were adults at the time of the study and were called back specifically for the study. RESULTS: All patients had decreased cadence and step lengths. The kinematic findings included decreased dorsiflexion of the ipsilateral ankle, hyperextension of the ipsilateral knee during the stance phase, and a tendency toward increased genu valgum during gait. In normal gait, there is no genu varum or valgum during the stance phase. The patients had an average (and standard deviation) of 7 +/- 4 degrees of genu valgum. Pelvic and lumbar motion in the sagittal plane was excessive in all patients. Strength-testing revealed clinically relevant weakness in the ipsilateral quadriceps in all patients, with a difference of more than 20 percent between the two extremities in six patients. The gastrocnemius. soleus muscle was stronger on the side with the fused hip in six patients. The questionnaire, designed by Harris in 1969 and completed by the patients at the time of the gait analysis, revealed back pain in seven patients. The questionnaire was administered only once. The functional outcome as measured with use of the same questionnaire worsened as the duration of follow-up increased. CONCLUSIONS: The gait analysis showed excessive motion in the lumbar spine and the ipsilateral knee in all nine patients. This abnormal motion led to pain as the duration of follow-up increased, and all patients who had been followed for four or more years after the arthrodesis complained of back pain. We hypothesized that excessive motion for an extended duration can lead to back pain. The preferred position of the hip for the arthrodesis was 20 to 25 degrees of flexion, neutral abduction-adduction, and neutral rotation.

Adolescent↗
PubMedDate not supplied

[A pilot study on training and information of workers exposed to biomechanical overload of the upper limb].

Health education (HE) is very important in the prevention of occupational diseases, particularly when exposure to risk factors can be reduced through working procedures and hygienic behaviours. This pilot study refers to a HE program for prevention of work related muscle-skeletal disorders of upper limbs, carried out in two groups of 15 and 12 workers, respectively employed in trimming and assembling of plastic and metal parts. The first phase of the program consisted of worksite inspections and video recording of working procedures, characteristics of tools and machinery. This was followed by an informative meeting with the workers, which began with the administration of a multiple choice questionnaire, designed to evaluate the baseline knowledge about risk factors, work related muscle-skeletal disorders of upper limbs, working specific procedures and preventive actions. Questionnaires and video recording were repeated after two months in the second phase of the program, as subjective and objective methods of evaluation of HE effectiveness. In both groups, the questionnaire score was significantly increased after the program and a clear improvement was shown in the correct working procedures. This HE program contributed to increase the level of knowledge of the workers and fostered the adoption of working behaviours suitable to reduce the strain for the upper limbs.

Adult↗
PubMed1989

Comparison between videotape and personalized patient education for anticoagulant therapy.

To assess the effectiveness of videotape patient education, 22 patients were randomized to receive either videotape or personalized teaching for oral anticoagulant (warfarin) therapy. Both groups scored significantly higher on a questionnaire designed to assess knowledge gained after instruction, with no significant difference between the two groups. Videotape instruction required substantially less nursing time. A second questionnaire assessed patient satisfaction with respect to both methods, which were rated equally effective and worthwhile. Videotape teaching is an effective and well-accepted alternative form of patient education requiring significantly less personnel time.

Administration, Oral↗