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Good inter-rater reliability of the Frenchay Activities Index in stroke patients.

OBJECTIVE: To assess inter-rater reliability of the Frenchay Activities Index (FAI) when used by occupational therapists in stroke patients. DESIGN: Independent administration of the FAI by occupational therapists in 45 stroke outpatients. SETTING: Outpatient departments of two Dutch rehabilitation centres. STATISTICS: Agreement between pairs of raters was assessed at item level using weighted Kappa and the percentage absolute agreement and for the total score using intra-class correlations (ICC), Bland-Altman plots and computation of the smallest real difference (SMR). RESULTS: ICC of the total score was good (0.90; 95% confidence interval (95% CI): 0.82-0.94). The Bland-Altman plot did not reveal relationships between agreement and height of scores. Reliability at item level was good (kappa >0.60) in 11 out of 15 items. The item 'gainful work' showed high agreement but a low kappa due to an extremely skewed score distribution. Reliability was insufficient in three items: 'local shopping', 'social occasions' and 'actively pursuing hobby'. Clarification of scoring instructions of these items might further improve the inter-rater reliability of the FAI. CONCLUSION: The FAI is a reliable instrument to measure outcomes of outpatient rehabilitation in patients with stroke.

Activities of Daily Living↗

Further evidence for the agreement between patients with stroke and their proxies on the Frenchay Activities Index.

OBJECTIVE: To determine item, subscale and total score agreement on the Frenchay Activities Index (FAI) between stroke patients and proxies six months after discharge from rehabilitation. DESIGN: Prospective study design. SETTING/SUBJECTS: Fifty patient-proxy pairs, interviewed separately, in the patient's residence. MAIN OUTCOME MEASURES: Modified FAI using 13 items. Individual FAI items, subscales and total score agreement as measured by weighted kappa and intraclass correlation coefficients (ICC). RESULTS: Excellent agreement was found for the total FAI (ICC 0.87, 95% confidence interval (CI) 0.78-0.93), and domestic (ICC 0.85, 95% CI 0.73-0.91) and outdoor (ICC 0.87, 95% CI 0.78-0.95) subscales, with moderate agreement found for the work/leisure subscale (ICC 0.63, 95% CI 0.34-0.78). For the individual FAI items, good, moderate, fair and poor agreement was found for five, three, four and one item, respectively. The best agreement was for objective items of preparing meals, washing-up, washing clothes, shopping and driving. The poorest agreement was for participation in hobbies, social outings and heavy housework. Scoring biases associated with patient or proxy demographic characteristics were found. Female proxies, and those who were spouses, scored patients lower on domestic activities; male patients, and those who were younger, scored themselves higher on outdoor activities and higher patient FIM scores were positively correlated with higher FAI scores. CONCLUSIONS: While total and subscale agreement on the FAI was high, individual item agreement varied. Proxy scores should be used with caution due to bias.

Activities of Daily Living↗

Forced collectionism after orbitofrontal damage.

A collector is a person who collects things on purpose, either as a hobby or business, or for personal satisfaction, e.g., stamp, coin, or art collector. In such instances, the act of collecting things represents voluntary, controlled, goal-directed, selective searching. Pathologic patterns of collecting have been observed following brain damage, particularly frontal lobe damage, ranging from a tendency to grasp (prehension behavior) to an irrepressible need to seize surrounding objects and store them (hoarding behavior). These adnormal behaviors express an excessive adherence to environmental stimuli but in no way express a planned process directed toward specific items. In this article, we describe an unusual pattern of pathologic collecting behavior due to frontal lobe damage: involuntary irrepressible collecting that is goal-directed and selective. The authors report a patient who collected specifically household electrical appliances following a bilateral damage of orbito- and polar-prefrontal cortex. The patient had involuntary irrepressible collecting that was goal-directed and selective. This "forced collectionism" is different from that of the usual collectionism encountered in patients with frontal lobe lesions, as the latter is in no way a planned process directed toward specific items.

Adult↗

[A study of preventive medicine in relation to mental health among middle-management employees (Part 1)--Relationship between lifestyles and working-life satisfaction].

This study examined the cross-sectional relationship between health practices and working-life satisfaction, which we used as a subjective index of Quality of Life (QOL), based on data obtained from a survey of 3,928 middle-management employees (1,026 department chiefs and 2,902 section chiefs) in 110 major companies in 1990. The results are summarized as follows. (1) The section chiefs had more poor health practices than the department chiefs. The section chiefs appeared to have significantly more poor habits in terms of cigarette smoking, eating breakfast, nutritional balance, working hours, snacking, salt consumption, obesity, enjoying hobbies and physical status than the department chiefs. Surprisingly, 66% of department chiefs and 77% of section chiefs worked more than 10 hours per day. (2) Both the Health Practice Index (HPI) and working-life satisfaction tended to be higher as their ages were higher. (3) The department chiefs who had a poor nutritional balance, did not maintain an adequate stress level, had poor eating habits, poor sleeping habits and physical inactivity appeared to have lower working-life satisfaction. (4) The working-life satisfaction of the management staff was significantly affected by health practices, occupational stress, physical health status and position after controlling simultaneously for the other potential confounders. From these results, it may be concluded that the behavioral lifestyle change of the middle-management employee is an important factor to promote mental health as evaluated by working-life satisfaction.

Adult↗

[A study of preventive medicine in relation to mental health among middle-management employees (Part 2)--effects of long working hours on lifestyles, perceived stress and working-life satisfaction among white-collar middle-management employees].

Recently, we have introduced the holistic method into health care of workers and aimed at improvement of Quality of Life (QOL). It has been made clear that primary prevention of diseases needs lifestyle appraisal. Therefore, we studied the daily working hours and the effects of long working hours on lifestyles, perceived stress and working-life satisfaction, which we used as a subjective index of Quality of Life (QOL), based on data obtained from a survey of 1,026 department chiefs and 2,902 section chiefs in 110 large companies in Japan in 1990. The results are summarized as follows. (1) The percentage of those working 10 hours per day was 41.6% for department chiefs and 40.4% for section chiefs, and for 11 or more working hours it was 24.1% in department chiefs and 30.9% in section chiefs. The younger both department and section chiefs, the longer their working hours. (2) Both department and section chiefs had a significant relationship between long working hours and poor sleeping habits, poor physical exercise, feeling busy, irregularity of daily life and irregularity of daily meals. The department chiefs had a significant relationship between long working hours and unbalanced nutrition or no hobbies. The section chiefs had a significant relationship between long working hours and drinking many cups of tea or coffee, taking a lot of salt or ill physical condition during the past six months.

Female↗

[An epidemiological study regarding the hearing acuity of residents in the area with high level of aircraft noise: results of hearing tests conducted in the vicinity of Kadena Air Base].

Hearing tests, primary and secondary, were conducted in two communities vicinal to Kadena US Air Base in Okinawa from May 1996 to July 1998. The noise exposure expressed in WECPNL as designated by the Defense Facilities Administration Agency ranged from 85 to 95 and above. A total of 2035 subjects aged between 25 and 69 years inclusive were considered eligible for inclusion in this study and among them 137 males and 206 females underwent the primary test. Before the test, subjects were asked about hearing difficulty, tinnitus, otological anamnesis and past experience of noise exposure at work and/or hobbies. The primary test was a pure tone audiometry using the ascending method of limits with 5 dB step at 7 test frequencies of 0.5 to 8 kHz. Forty individuals who were judged to have possible noise induced hearing loss were sent to Okinawa Chubu Hospital as subjects for the secondary test. The secondary test consisted of pure tone audiometry with 1 dB step at 9 test frequencies with the addition of 3 kHz and 6 kHz to the primary test frequencies, a Short Increment Sensitivity Index (SISI), test, tympanometry and audioscan audiometry. Based on test findings 12 subjects were considered to have noise induced hearing loss. The examiners interviewed the 12 subjects again to confirm that they had not experienced habitual or repeated intense noise exposure other than aircraft noise exposure around their homes. The geographical distribution of the subject's residences showed their proximity to the airfield, which strongly suggests that the cause of hearing loss may be exposure to aircraft noise from Kadena Air Base.

Adult↗

The status of indoor air pollution.

Indoor air pollution, specifically restricted in its meaning to chemicals in home indoor air environment, presents a new and probably an important challenge to the researchers of the air pollution field. The general overview of this topic suggests that the voluminous data generated in the past ten or so years have only defined the rudiments of the problem, and significant areas of research still exist. Among the important areas where information is lacking, the exposures to contaminants generated by the use of consumer products and through hobbies and crafts represent perhaps the most urgent need for substantial research.

Air Pollution↗

Behavioral changes following participation in a home health promotional program in King County, Washington.

This study examined behavioral changes in households after participation in a home environmental assessment. Home assessment visits by a trained coach, which involved a walk-through in the home with the home residents, were conducted in 36 homes. The walk-through included a list of recommended behavioral changes that the residents could make to reduce their exposures to home pollutants in areas such as dust control, moisture problems, indoor air, hazardous household products, and hobbies. Recruited households were surveyed 3 months after the home assessment to evaluate their implementation of the recommendations. Following the home visits, 31 of 36 households reported making at least one behavioral change, and 41% of the recommendations made by the volunteer coaches were implemented. In conclusion, this study found that the majority of the households who participated in the home assessment reported implementing at least one recommendation. This home health promotional method was effective in influencing behavioral changes.

Feedback↗

Management of leisure time by prospective nurses.

A focus on the importance of leisure in the development of student nurses has been neglected in the 1990s. This study considers 444 prospective nurses on conventional, diploma and degree courses in two areas of England. It examines their activities associated with socializing, their social support networks and their use of clubs, sports and hobbies before entering nursing. It is evident that students enter nurse training with a wide variety of leisure experiences. Changing recruitment patterns and the structure of nurse training has an effect on the leisure needs of prospective nurses which must be addressed.

Adult↗

Lecture versus Web tutorial for pharmacy students' learning of MDI technique.

OBJECTIVE: To compare pharmacy students' acquired knowledge and ability to assess metered-dose inhaler (MDI) technique after a traditional lecture versus a Web-based MDI technique tutorial. METHODS: All 42 third-year PharmD students completed a baseline MDI technique knowledge test and were then randomized into 1 of 3 groups. The Web group completed the tutorial on the college dispensing laboratory computers; the lecture group participated in the MDI technique excerpt of the asthma therapeutics lecture; and the control group participated in a 15-minute discussion of participants' hobbies. Afterward, participants in each group completed an identical MDI technique knowledge posttest. Students then observed a standardized mock patient perform MDI technique, documenting steps that were conducted incorrectly. MDI technique knowledge test and MDI technique evaluation test scores were compared between groups using repeated measures ANOVA. RESULTS: There was no significant difference in the baseline MDI technique knowledge test scores between groups. The post-MDI technique knowledge test scores for the Web and lecture groups did not differ significantly (p = 0.38), and both were significantly different from the control group (p < 0.001). MDI technique knowledge scores increased significantly for the Web and lecture groups from pre- to post-assessment, but did not change for the control group. A 2-way repeated measures ANOVA analysis demonstrated no significant interaction of subject and group characteristics. The MDI technique evaluation scores for the Web and lecture groups were not significantly different (p = 0.50), and both were significantly different from the control group (p </= 0.001). CONCLUSIONS: The Web-based MDI technique tutorial was as effective as the standard lecture format in pharmacy students acquiring knowledge of MDI technique and in evaluating a mock-patient exhibiting incorrect MDI technique. Further testing is required to assess the longitudinal effect of the program.

Curriculum↗

A survey of retired dentists in the United States. Council on Dental Practice.

This paper reports on the results of a national survey of retired dentists carried out in the winter and spring of 1984. More than eight in ten of the respondents were general practitioners. Most retirees are between the ages of 60 and 69, married, and report their overall health at retirement to be excellent or good. As do retired scientists, dentists find intrinsic gratification in the work role, but apparently accept retirement as part of the life cycle. Retired dentists have income substantially greater than retirees in general. As is the case for the greater majority of older Americans, Social Security provides an important income support for respondent dentists. However, the primary source of retirement income for dentists comes from savings and investments. One of three retired dentists reports net worth in 1984 as between $200-$499,999. Retired dentists are well adjusted to retirement. Overall, most dentists report high satisfaction with retirement to date. Additional leisure time for hobbies, flexibility in owning one's time, and social activities with family and friends seem the main contributors to this satisfaction. Investment planning, health assessment, enthusiasm for outside interests, and personal preparation for retirement with a spouse are reported as important in retirement planning. Retirement is not a satisfying experience for all dentists. Some do report experiencing uselessness and depression. A still smaller proportion report feelings of loneliness and inadequacy. As is the case for older people in general, solitary activities including reading, watching television, and gardening are important for retired dentists. Most older people attempt to retain activity patterns and preferences developed earlier in life.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗

Sources and assessment of occupational stress in the police.

The role of the police in Western society is undergoing a transformation that reflects the economic social and technological changes in the community and the assertion of individual rights within a democracy. The aim of this study is to evaluate level of stress among a group of French policemen and to examine the association between policing, potential stressors and stress levels. The sample is drawn from a large metropolitan police force (n=617). The population extends from the first line policeman to top senior management. Each policeman is matched for age (more or less five years) and sex, to a control. Policemen and controls complete a self administered questionnaire including demographic, occupational and health characteristics, and a stress level assessment with the help of a visual analogue scale. The average age of the two groups is 40 yr. Eighty-four percent are men. The total score for average sources is not statistically significantly different for policemen and controls. Comparison of a police group with a high stress level to a police population with a low and moderate stress level is made. The comparison is done first only with men, and second with the whole population. Policemen with a high stress level (same results only for men and the whole population) belong to the following groups: more than 15 yr service, sergeant, officer and administrative employee rank, divorced experience, age over 30, no leisure-time activities and no hobbies. Multivariate analysis shows that the two last parameters are bound to the stress level. For the whole population, age over 30 has to be added, and for the group of men, length of service over five years should be noted. Stress at work is an ill-health provoking factor. Police from minority groups such as ageing subjects or police officers have been reported to experience greater stress. This population is adversely affected by lack of available manpower and long working hours. In fact sources of stress in the police population are found both in the weariness of the job and private life planning.

Adult↗

[Epidemiologic study on physical conditions related to work among the elderly].

The present study was conducted in order to examine the epidemiologic factors related to work capacity among the elderly. As study area, Ogimi Village in Okinawa Prefecture was selected by reason of the long life expectancy of the inhabitants. Medical examination and interview were conducted on 756 inhabitants aged 65 yr and older. Working status was classified into two groups, that is, working group and non-working group. The association between working status and related factors was examined by using multiple logistic regression analysis. The examined factors were as follows: sex, age, history of apoplexy, history of being down, history of falls, history of fracture, chewing ability, pain, exercise habit, hobby, education, number of family members, alcohol, smoking, food intake frequencies and medical indicators (blood pressure, ECG, Quetlet index, skinfold thickness, grip strength, one-leg test with eyes opened, albumin, total cholesterol, hemoglobin and HDL-cholesterol). The results of the analysis revealed that grip strength and one-leg test with eyes opened had a statistically significant correlation with working status (p < 0.01). From the results, maintenance of muscle strength and equilibrium function were found to be the physical conditions related to work among the elderly in the agricultural area.

Aged↗

[Health appraisal for work adjustment of freshmen employees--information on health checkup just after entering the corporation and condition in the next fiscal year].

In 1990, 365 (males: 197, females: 168) freshmen employees at the headquarters of a large corporation were examined just after being hired in order to observe their health status. We collected (1) data of physical examinations and questionnaires for symptoms as an ordinary health checkup, (2) information on work adjustment, life patterns, and personal characteristics through interviews conducted by ten public health nurses, and (3) personal records, e.g. birth year. Statistical analyses revealed some notable findings as follows: (1) subjects with higher blood pressure had higher scores of extrovert personality among males, (2) female subjects with greater body mass index had higher scores in such manifestations of personal characteristics such as aggression and discontent with superiors, (3) higher scores of personal characteristics were noted among female subjects working in technical sections, (4) positive correlation between the scores of work adjustment and personal characteristics, (5) higher scores of undesirable life patterns among males and of work maladjustment among elder females, (6) unbalanced meal quality of subjects from rural areas, (7) higher mental tension among younger males from rural areas, and (8) higher scores of dependency and lower morale among younger female subjects. Information on health problems was collected over the 1.5 yrs that followed. More problems were detected among females than among males and among younger females than among elder females. Longitudinal analysis was carried out from just after entry into the company for approximately 1.5 yrs. Health problems in females could be predicted by the data on personal characteristics and work adjustment just after entry. Risk of health problems in male freshmen employees with hobbies and unhealthy drinking habits over the 1.5 yrs that followed was higher than in others. It was concluded that a health interview for freshmen employees by public health nurses is valuable for health care, obtaining information regarding work adjustment, life patterns, and personal characteristics.

Adult↗

Evaluation of risk assessment questions used to target blood lead screening in Illinois.

OBJECTIVE: Beginning in 1995, Illinois law permitted targeted-as opposed to universal-blood lead screening in low-risk areas, which were defined by ZIP code characteristics. State guidelines recommended specific lead risk assessment questions to use when targeting screening. This study was designed to evaluate the sensitivity and specificity of Illinois lead risk assessment questions. DESIGN: Parents bringing their 9- or 10- or 12-month and 24-month-old children for health supervision visits at 13 pediatric practices and parents of children (aged 6 through 25 months and who needed a blood lead test) receiving care at 5 local health departments completed a lead risk assessment questionnaire concerning their child. Children had venous or capillary blood lead testing. Venous confirmation results of children with a capillary level >/=10 micrograms/dL were used in analyses. CHILDREN: There were 460 children with both blood and questionnaire data recruited at the pediatric practices (58% of eligible) and 285 children (51% of eligible) recruited at local health departments. Of the 745 children studied, 738 provided a ZIP code that allowed their residence to be categorized as in a low-risk (n = 456) or high-risk (n = 282) area. RESULTS: Sixteen children (3.5%) living in low-risk areas versus 34 children (12.1%) living in high-risk areas had a venous blood lead level (BLL) >/=10 micrograms/dL; 1.8% and 5.3%, respectively, had a venous BLL >/=15 micrograms/dL. For children living in low-risk areas, Illinois mandated risk assessment questions (concerning ever resided in home built before 1960, exposure to renovation, and exposure to adult with a job or hobby involving lead) had a combined sensitivity of.75 for levels >/=10 micrograms/dL and.88 for levels >/=15 micrograms/dL; specificity was.39 and.39, respectively. The sensitivity of these questions was similar among children from high-risk areas; specificity decreased to.27 and.28, for BLLs >/=10 micrograms/dL and >/=15 micrograms/dL, respectively. The combination of items requiring respondents to list house age (built before 1950 considered high risk) and indicate exposure to renovation had a sensitivity among children from low-risk areas of.62 for BLLs >/=10 micrograms/dL with specificity of.57; sensitivity and specificity among high-risk area children were.82 and.36, respectively. For this strategy, similar sensitivities and specificities for low and high-risk areas were found for BLLs >/=15 micrograms/dL. CONCLUSIONS: The Illinois lead risk assessment questions identified most children with an elevated BLL. Using these questions, the majority of Illinois children in low-risk areas will continue to need a blood lead test. This first example of a statewide screening strategy using ZIP code risk designation and risk assessment questions will need further refinement to limit numbers of children tested. In the interim, this strategy is a logical next step after universal screening.

Child, Preschool↗

Pain experience of children with headache and their families: A controlled study.

OBJECTIVE: This study reports the pain sensitivity of children with headache and their family members, as well as the prevalence of recurring aches, psychosocial life, and family environment of children with headache at preschool age. DESIGN: A representative population-based sample of 1443 families expecting their first child were followed over 7 years. A screening questionnaire relating to the child's headache was sent to parents of a representative sample of 1132 6-year-old children. Of 144 children suffering from headache, 106 (76%) were examined and interviewed clinically. Ninety-six children with primary headache (58 migraine and 38 tension-type headache children) and matched controls (n = 96) were included in further examinations. RESULTS: Children with headache were more often extremely sensitive to pain according to their parents, were more excited about physical examinations, cried more often during blood sampling or vaccination, avoided play or games more often because they were afraid of hurting themselves, and had recurring abdominal and growing pains more often than did control children. The fathers of children with headache were more often extremely sensitive to pain. Children with headache reacted with somatic symptoms, usually with pain and functional intestinal disorders in stress situations, felt more tired, and had more ideations of death during the previous month. They had also had more problems in day care and fewer hobbies such as scout or club meetings than did control children. More mothers of tension-type headache children than those of migraine children reported that they were considerably sensitive to pain. Tension-type headache children also had a poorer family environment; the family atmosphere was more often unhappy and the relationship between the parents was more often distant than in the families of children with migraines. CONCLUSIONS: In addition to somatic factors, it is important to consider the child's pain sensitivity, reaction to various stress situations, and family functioning when studying childhood headache. The child's coping mechanisms can be supported by information given by the parents. School entry can be considered a suitable period for careful investigation into possible occurrence of headache and also for giving information about headache and its management.

Child↗

Behavioral and emotional adjustment of teenagers in mainstream school who were born before 29 weeks' gestation.

OBJECTIVES: To investigate behavioral and emotional problems and positive adjustment of 15-to 16-year-olds who were born at extremely low gestational age (ELGA), from the perspective of parents, teachers, and teenagers. METHODS: Prospective follow-up was conducted of birth cohorts, with classroom control subjects. All infants who were born before 29 weeks in 1983-1984 (mean gestational age: 27 weeks) to mothers who resided in 3 regions of the United Kingdom were studied. A total of 82% (179 of 218) of survivors were traced at age 15 to 16. The 150 in mainstream school were compared with age- and gender-matched classroom control subjects (n = 108). Behavioral and emotional problems, delinquency, peer relations, self-esteem, and hobbies, were assessed by standardized, well-validated instruments, including the Strengths and Difficulties Questionnaire, administered by mail to parents, teenagers, and teachers. RESULTS: Parents were more likely to rate ELGA teenagers than control subjects as in the "abnormal" range for hyperactivity (8% vs 1%; difference: 7%; (95% confidence interval [CI]: 2-12), peer relationship problems (19% vs 5%; difference: 14%; 95% CI: 6-21), and emotional problems (18% vs 7%; difference: 11%; 95% CI: 3-19), but not conduct problems (10% vs 5%; difference: 5%; 95% CI: -1 to 12)). Teachers reported a similar pattern. In contrast, compared with control subjects, ELGA teenagers did not rate themselves as having more problems with peers, hyperactivity, conduct, depression, or low self-esteem. They reported more emotional problems but less delinquency, alcohol, cannabis, and other drug use. CONCLUSIONS: Compared with mainstream classmates, children who are born extremely early continue to have higher levels of parent- and teacher-reported emotional, attentional, and peer problems well into their teens. However, despite these problems, they do not show signs of more serious conduct disorders, delinquency, drug use, or depression.

Adolescent↗