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Psychologic adjustment to spinal cord injury during first postdischarge year.

A considerable body of clinical literature discusses patient adjustment to spinal cord injury (SCI) but there are few empirical data, particularly about postrehabilitation hospital adjustment. The present study targets changes in psychologic adjustment after initial rehabilitation hospitalization. Thirty-six persons with SCI completed a questionnaire designed to study such adjustment at 3 weeks, 3 months, and 1 year postdischarge. Twenty-nine able-bodied controls completed the same questionnaire at similar time intervals. Outcome measures used were the Beck Depression Inventory, the Wiggins Hostility Scale, and the Handicap Problems Inventory. Moderately increased depression and hostility in the SCI group compared to the able-bodied were found immediately postdischarge, but these differences were gone within a year. On a specific measure of adjustment to disability, the SCI group showed significantly increasing comfort with disability status over the same period. While there are reports of psychologic adjustment difficulties for persons with SCI postdischarge, the severity of these difficulties may have been overestimated and our findings suggest that problems appearing immediately after discharge appear to resolve rapidly.

Adjustment Disorders↗

A survey of corneal graft practice in the United Kingdom.

A questionnaire designed to survey current corneal graft practice was sent to 498 consultant ophthalmologists in the United Kingdom. Three hundred and twenty-nine completed questionnaires (66%) were returned. Seventy per cent of these were from consultants who perform corneal grafts, of whom 36% had a specialist interest in corneal surgery. The survey found that most consultants preferred to perform corneal grafts on an inpatient basis with the patient under general anaesthesia. Agreement (> 80%) was also found in the following areas: use of a hand-held trephine, concurrent cataract surgery (if indicated), post-operative immunosuppression, and refraction to assess post-operative astigmatism. There was less agreement on the choice of donor material, use of tissue matching, donor-trephine size disparity, suture technique, relative timing of trabeculectomy surgery (if required), the management of intraocular lenses during surgery for pseudophakic bullous keratopathy, timing of discharge after surgery, use of prophylactic acyclovir, management of astigmatism, routine removal of all corneal sutures, and discharge of uncomplicated cases from routine follow-up.

Anesthesia, General↗

Psychological distress and coping in sickle cell disease: comparison of British and Jamaican attitudes.

OBJECTIVE: To investigate possible differences in coping mechanisms in the painful crisis between Jamaican and London patients with homozygous sickle cell disease. DESIGN: Patients recruited from two London hospitals and the MRC Laboratories (Jamaica) at the University of the West Indies, Kingston, Jamaica were assessed using a questionnaire design. Patients with homozygous sickle cell disease were included, 30 in London and 30 in Jamaica. RESULTS: Jamaican patients in Jamaica had less general anxiety, a lower emotional response to pain, lower levels of perceived pain, and felt better able to decrease their pain. London patients believed that the disease had a more marked effect on their quality of life. CONCLUSION: Understanding the differences between patients' response to pain and their coping ability between Jamaican and UK patients may have important lessons for evolving effective management in the UK.

Adaptation, Psychological↗

Assessing women's sexuality after cancer therapy: checking assumptions with the focus group technique.

Cancer and cancer therapies impair sexual health in a multitude of ways. The promotion of sexual health is therefore vital for preserving quality of life and is an integral part of total or holistic cancer management. Nursing, to provide holistic care, requires research that is meaningful to patients as well as the profession to develop educational and interventional studies to promote sexual health and coping. To obtain meaningful research data instruments that are reliable, valid, and pertinent to patients' needs are required. Several sexual functioning instruments were reviewed for this study and found to be lacking in either a conceptual foundation or psychometric validation. Without a defined conceptual framework, authors of the instruments must have made certain assumptions regarding what women undergoing cancer therapy experience and what they perceive as important. To check these assumptions before assessing women's sexuality after cancer therapies in a larger study, a pilot study was designed to compare what women experience and perceive as important regarding their sexuality with what is assessed in several currently available research instruments, using the focus group technique. Based on the focus group findings, current sexual functioning questionnaires may be lacking in pertinent areas of concern for women treated for breast or gynecologic malignancies. Better conceptual foundations may help future questionnaire design. Self-regulation theory may provide an acceptable conceptual framework from which to develop a sexual functioning questionnaire.

Adult↗

Measuring disability of the upper extremity: a rationale supporting the use of a regional outcome measure.

OBJECTIVE: Many existing upper extremity outcome measures have been designed for a specific anatomic site (e.g., shoulder) or a specific disease entity (e.g., carpal tunnel syndrome). The purpose of this paper is to examine whether questionnaire items taken from very specific measures are considered relevant only to that specific region or are applicable to the whole extremity. METHODS: Fifteen practicing clinicians categorized a sample of 132 items from existing questionnaires according to whether the items reflected disability specific to an anatomic site or were relevant to the whole extremity. RESULTS: Seventy-two percent of the items were categorized as relevant to the extremity as a whole, while only 21% of the items were categorized as specific to an anatomic site. CONCLUSION: Items in existing specific upper extremity questionnaires are also relevant to other regions and conditions. This finding is in agreement with kinesiologic and biomechanical theories that the upper extremity acts as a single functional unit. Questionnaires designed for the whole extremity could provide a more practical and still valid measure of upper extremity disability.

Activities of Daily Living↗

A review of radiation protection facilities at the University College Hospital, Ibadan, Nigeria.

Ionizing-radiation causes health hazards to human beings if exposed to it. Observation of measures allows continued applications of radiation for whatever purpose throughout the world. There are many departments in the University College Hospital that make use of ionizing radiation in some of their services to patients. Radiation protection facilities in the departments were looked into using carefully designed questionnaires. Inadequacies in radiation protection measures were discovered and suggestions for improvements were proffered.

Hospitals, University↗

Psychometric evaluation of an inpatient psychiatric care consumer satisfaction survey.

This study assessed the psychometric properties of a questionnaire designed to measure consumer satisfaction with inpatient psychiatric care. To this end, 37 inpatient psychiatric units from across the United States agreed to participate. The questionnaire was completed by 1,351 individuals, or a responsible party, for an average response rate of 53%. The factor analysis identified six scales: Nonclinical Services, Psychiatric Care, Staff, Medical Outcome, Patient Education, and Program Components/Activities. The internal reliability of the scales was high to moderate (.88 to .74). Results of a stepwise regression model showed good criterion-related validity, explaining 58% of the variance in overall quality ratings. Little shrinkage in this variance occurred when the model was cross-validated. Also, differences in satisfaction levels were noted for select facility and consumer characteristics. Results are interpreted as providing support for the reliability and validity of a newly developed consumer satisfaction survey for use in evaluating inpatient psychiatric care.

Humans↗

Changes in French people's misconceptions about hepatitis C, 1997-2003.

OBJECTIVE: The French health authorities instituted in 1999 a campaign to educate physicians, high-risk populations, and the public about hepatitis C (HC). To what extent has knowledge about HC increased among members of the French public? METHOD: A convenience sample of 706 French adults, aged 18 to 87, completed in 2003 a questionnaire designed to assess their knowledge of HC. Their responses were compared to those in 1997 of a different group of French adults on an identical questionnaire. RESULTS: Between 1997 and 2003, knowledge significantly improved on 13 of the 26 items for which strong expert-public differences were found in 1997 and significantly worsened on 3 items. CONCLUSIONS: France's public education campaign led to only a limited increase in knowledge about HC. Further public education is needed.

Adolescent↗

[Validation of the Spanish version of the International Consultation on Incontinence Questionnaire-Short Form. A questionnaire for assessing the urinary incontinence].

BACKGROUND AND OBJECTIVE: A big proportion (40-70%) of patients with urinary incontinence (UI) do not ask for medical advice. Self-administered questionnaires may help in detecting UI. The objective of the present study was to validate the Spanish version of the questionnaire ICIQ-SF. PATIENTS AND METHOD: 500 women who consulted at a UI-specialized unit responded to the questionnaire. A urodynamic study was carried out and sociodemographic and clinical data were collected. Feasibility, validity and reliability were assessed. Sensitivity (Se), specificity (Sp) and positive (PPV) and negative (NPV) predictive values of the clinical and urodynamic study were also calculated. RESULTS: The mean time of administration was 3.5 (1.5) minutes. All patients answered all the items of the ICIQ-SF. According to the clinical diagnosis, patients with UI scored 11.6 (5.9) and patients without UI scored 4.5 (6.3) (p < 0.001). According to the urodynamic diagnosis, UI patients scored 11.1 (6.3) vs 6.2 (6.5) (p < 0.001). In patients with an urodynamic diagnosis of stress UI, a higher severity degree was associated with a higher score on the ICIQ-SF. The values of Se, Sp, PPV and NPV were 92.1%, 55.6%, 88.3% and 65.9%, respectively, regarding clinical diagnosis, and 87.7%, 40.8%, 85.1% and 46.2%, respectively, regarding the urodynamic study. CONCLUSIONS: This is the first questionnaire designed for diagnosing UI validated in Spain. The psychometric properties of the ICIQ-SF are satisfactory and allow to recommend the use of the questionnaire in the clinical practice.

Evaluation Studies as Topic↗

A tinnitus problem questionnaire in a clinic population.

OBJECTIVE: The purpose of this study was to investigate difficulties associated with tinnitus in a large sample of patients using an open-ended problem questionnaire. DESIGN: Four hundred seventy-three unselected patients referred to the Tinnitus Clinic of the Welsh Hearing Institute (1986 through 1991) completed the Tinnitus Problem Questionnaire (Tyler & Baker, 1988). Before clinical assessment, patients were invited to list problems that they associated with their tinnitus in order of importance in an open-ended questionnaire. Their responses were coded into 45 categories. The responses of 39 patients who only described their tinnitus were excluded, leaving unselected responses from 436 patients, 224 women and 212 men, whose average age was 57.1 yr. The questionnaire elicited an average 3.78 responses per patient (range 1 to 12). RESULTS: The 30 most common difficulties attributed to tinnitus are described. There was broad agreement between the problems reported in this clinic-based study and those reported by a self-help group sample (Tyler & Baker, 1983). CONCLUSIONS: Analysis of these responses into groups based on psychological (30.1%), hearing (23.5%), health (20.7%), sleep (14.6%), and situational (11.1%) difficulties highlights the need for recognition of the global consequences of tinnitus to many patients and for a broadly based tinnitus management model.

Adolescent↗

An assessment of the oral health knowledge and recall after a dental talk amongst nurses working with elderly patients: a pilot study.

OBJECTIVE: To assess the oral health knowledge amongst nurses working with elderly people in a local hospital run by a Primary Care Trust before and after a dental training talk. METHOD: Nursing staff working at Swanage Cottage Hospital completed a questionnaire designed to assess their knowledge of dental decay, periodontal disease, oral hygiene, denture care and palliative care. One month after receiving a dental talk, the questionnaire was redistributed to the participants. A t-test was used to compare the number of correct answers before and after the talk. RESULTS: Twenty members of the nursing staff completed the initial questionnaire and 14 completed it 1 month after the talk. Prior to the talk, of the 45 questions, the mean number of correct answers per member of staff was 23.95+/-3.83. One month after the talk this had risen by 25% to 34.9+/-3.83. This increase was statistically significant (p < 0.0001). CONCLUSION: A dental talk to a group of nursing staff caring for elderly people in a local hospital produced a significant increase in the level of oral health care knowledge.

Adult↗

Caregiver strain associated with tracheostomy in chronic respiratory failure.

STUDY OBJECTIVES: The aim of this study was to evaluate the psychological and psychosocial impact of tracheostomy on the caregivers of patients who have undergone tracheostomies. SETTING: Rehabilitation facility. PARTICIPANTS: Sixty-three lay caregivers of inpatients and outpatients with various underlying diseases who have undergone tracheostomies. METHODS: At the beginning of the study, the 63 caregivers completed a previously validated questionnaire designed to assess the problems related to caring for patients with chronic diseases. Approximately 1 year later, 40 of the 63 caregivers completed the same questionnaire a second time. The results were analyzed statistically in order to investigate the caregivers' perceptions of the factors associated with their own particular situation. RESULTS: The answers of the 40 subjects who completed the questionnaire twice revealed the existence of perceived strain persisting over time, which was greater in female caregivers and in those caring for patients who had had a tracheostomy for < 14 months. The younger caregivers (age < 59 years) and those caring for patients receiving nocturnal ventilation expressed a continuing need for information about the disease. Finally, the caregivers said that they, as well as their patients led very restricted personal lives. CONCLUSIONS: Tracheostomy causes a substantial amount of caregiver strain, which should be taken into account when deciding on any treatment plan.

Adult↗

Vocal attrition in teachers: survey findings.

A survey questionnaire, designed in part to assess prevalence and impact of vocal attrition, was administered to school teachers in different locations across the USA. Analysis of 237 questionnaires obtained from female teachers suggests that vocal attrition may be prevalent among teachers. The mean number of symptoms of vocal attrition reported by the teachers was 3.8. Over one half of the teachers reported multiple (3+) symptoms. A significant number of teachers, especially those with multiple symptoms, reported that their symptoms adversely affected their ability to teach effectively and that their voice was a chronic source of stress or frustration. The implications of these and other findings are discussed.

Adult↗

[The results of research on the prevalence of allergy to Hymenoptera venom in Southwestern Poland].

A questionnaire designed to estimate the prevalence of allergic reactions to Hymenoptera venom was posted to 1000 inhabitants of south west Poland. 881 persons responded to the questionnaire. 255 (28.9%) reported allergic reactions to stinging insects venom 141 persons (16%) report large local reactions (LL) and 114 (12.9%) systemic reactions (SYS) after stinging. At the second stage of the study 95 persons, out of the 255, were examined by a physician and tested with the intracutaneous skin test. Anamnesis carried out by the physician initially confirmed venom allergy in 87% of the LL group and 77.5% of the SYS group. Skin test results verified the above assessments confirming venom allergy in 38% persons initially reporting LL reactions and in 55% of those initially reporting SYS reaction.

Adolescent↗

Collection of survey data on contraception: an evaluation of an experiment in Peru.

The objective of this analysis is to compare two different approaches to the collection of information on contraceptive use. The data for this comparison are derived from the 1986 Demographic and Health Surveys (DHS) in Peru. Approximately 7,500 women were interviewed with the standard DHS questionnaire, whereas about 5,000 women received an "experimental questionnaire." The major difference between the questionnaires is the inclusion of a six-year monthly calendar in the experimental questionnaire that records pregnancies, contraceptive use, and postpartum information, in contrast to the more common tabular format of the standard questionnaire. The analysis demonstrates that although reports of contraceptive knowledge, ever-use, and current use are relatively robust to the variations in questionnaire design, estimates of past use are dependent on the survey instrument. Several different comparisons indicate that reporting of information on contraceptive histories in the experimental questionnaire is superior to that in the standard one.

Contraception Behavior↗

Pitfalls in Tay-Sachs carrier detection: physician referral patterns and patient ignorance.

Tay-Sachs carrier detection testing prior to pregnancy is more desirable than intra-pregnancy testing because it is technically easier, less expensive, and associated with less anxiety and less urgency. However, more than 80% of individuals referred for testing were pregnant women and/or their partners. The literature of the last several years has been silent on these and related issues. A questionnaire designed to determine the factors responsible for these circumstances was sent to 404 physicians (231 obstetrician/gynecologists and 173 internists and family physicians). Of the delivered questionnaires, 49.5% were completed and returned. The majority of obstetrician/gynecologists responding refer patients for Tay-Sachs carrier detection. Internists and family physicians do not, and their responses indicate a lack of pertinent knowledge. In addition, despite physician referral, patients delayed testing until pregnancy. While educational efforts have been targeted to obstetrician/gynecologists, expanded educational activities for internists, family physicians, and patients are required.

Education, Medical, Continuing↗

Management of acute coronary syndromes, a questionnaire survey of the clinical practice of cardiologists and other medical physicians belonging to west midland hospitals.

OBJECTIVE: To assess the management of acute coronary syndromes by cardiologists and other medical physicians in a clinical setting. DESIGN: Questionnaire survey consisting of 10 hypothetical clinical scenarios and four possible therapeutic options for each scenario. SETTING: Consultants and specialist registrars in Cardiology (with or without access to interventional facilities) and consultant physicians belonging to various hospitals in the west midland region of United Kingdom. MAIN OUTCOME MEASURES: Respondents' ability to recognise high risk patients and their management of the hypothetical clinical cases. To establish any differences in management strategy between cardiologists and general physicians, and whether these differences, if any, relate to access to interventional cardiac facilities. RESULTS: Overall no significant differences were found in the responses between cardiologists and general physicians with or without access to cardiac interventional facilities. However, cardiologists were more inclined to use percutaneous transluminal coronary angioplasty (PTCA) compared to other physicians (scenario 8, 18.4% vs. 6.7%, p = 0.05 and scenario 9, 44.9% vs. 26.7%, p = 0.01). In two other situations, physicians from institutions with access to interventional facilities were more inclined to use 'other' treatment strategies (intravenous nitrates, antiplatelet treatment, inotropes, Intra-aortic balloon pump) compared to their colleagues from non-tertiary hospitals with no interventional facility on site (scenario 3, 21.7% vs. 2.4%, p = 0.04) and more use of PTCA ( scenario 6, 52.2% vs. 26.8%, p = 0.04). CONCLUSIONS: The management of acute coronary syndromes in this questionnaire survey was satisfactory and evidence based. No real differences were found between the management strategies adopted by cardiologists or non-cardiologists. Physicians working in centres with interventional facilities were no more inclined towards using primary PTCA or rescue angioplasty than those working in centres without such facilities.

Acute Disease↗

TEMPS-A: validation of a short version of a self-rated instrument designed to measure variations in temperament.

OBJECTIVE: To validate a short English-language version of the Temperament Evaluation of Memphis, Pisa, Paris and San Diego-autoquestionnaire version (TEMPS-A), a self-report questionnaire designed to measure temperamental variations in psychiatric patients and healthy volunteers. Its constituent subscales and items were formulated on the basis of the diagnostic criteria for affective temperaments (cyclothymic, dysthymic, irritable, hyperthymic, and anxious), originally developed by the first author and his former collaborators. Further item wording and selection were achieved at a later stage through an iterative process that incorporated feedback from clinicians, researchers, and research volunteers. METHOD: A total of 510 volunteers (284 patients with mood disorders, 131 relatives of bipolar probands, and 95 normal controls) were recruited by advertisement in the newspapers, announcements on radio and television, flyers and newsletters, and word of mouth. All participants were interviewed using the Structured Clinical Interview for DSM-III-R, and completed the 110-item TEMPS-A and the Temperament and Character Inventory (TCI-125). The factorial structure, the alpha coefficients, and the item-total correlations coefficients of the TEMPS-A and the correlation coefficients between the dimensions of the TCI and the TEMPS-A subscales were then determined. RESULTS: A principal components analysis with a Varimax rotation found that 39 out of the 110 original items of the TEMPS-A loaded on five factors that were interpreted as representing the cyclothymic, depressive, irritable, hyperthymic, and anxious factors. Coefficients alpha for internal consistency were 0.91 (cyclothymic), 0.81 (depressive), 0.77 (irritable), 0.76 (hyperthymic), and 0.67 (anxious) subscales. We found statistically significant positive correlations between all-but the hyperthymic-subscales and harm avoidance. Positive correlations with the hyperthymic and cyclothymic, and novelty seeking and negative correlations with the remaining subscales were also recorded. Other major findings included positive correlations between the hyperthymic and reward dependence, persistence and self-directedness; positive correlation between the self-transcendence and the cyclothymic, hyperthymic and the anxious; and negative correlations between the depressive, cyclothymic, irritable, anxious and cooperativeness. LIMITATION: As the full-scale anxious temperament was added after the four scales of the TEMPS-A were developed, it has only been evaluated in 345 subjects. CONCLUSIONS: These data indicate that the TEMPS-A in its shortened version is a psychometrically valid scale with good internal consistency. The proposed five subscale structure is upheld. Concurrent validity against the TCI is shown. Most importantly, for each of the temperaments, we were able to show positive attributes which are meaningful in an evolutionary context, along with traits which make a person vulnerable to mood shifts. This hypothesized dual nature of temperament, which is upheld by our data, is a desirable characteristic for a putative behavioral endophenotype in an oligogenic model of inheritance for bipolar disorder.

Adult↗