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At least 631 records · Page 35Linked to original sources
PubMed2004

An analysis of risk factors for biochemical progression in patients with seminal vesicle invasion: validation of Kattan's nomogram in a pathological subgroup.

OBJECTIVE: To assess the ability of a recently published nomogram to predict failure after radical retropubic prostatectomy (RRP) in a cohort of patients with seminal vesicle invasion (SVI) of the resected specimen, widely regarded as a very poor prognostic factor in patients with prostate cancer. PATIENTS AND METHODS: Men with SVI after RRP were analysed retrospectively; patients with positive lymph nodes, adjuvant radiotherapy or hormone therapy were excluded. Age, race, baseline prostate specific antigen (PSA) level, clinical stage, Gleason score, margin status, perineural invasion, capsular invasion, laterality and route of invasion were recorded. Biochemical recurrence was defined as one PSA measurement of 0.4 ng/mL. Biochemical disease-free survival probability was plotted using the Kaplan-Meier method. Kattan's nomogram was applied to each patient and a receiver-operator characteristic (ROC) curve produced to assess the test's reliability. RESULTS: In all, 67 patients with SVI were identified (mean age 64.6 years, sd 5.9; median follow-up 30.5 months). Biochemical disease-free survival was significantly better for men with negative margins, unilateral SVI and perineural invasion. No other significant factors were detected. The median (95% confidence limit) area under the ROC curve was 0.739 (0.604-0.847). CONCLUSION: There were significant prognostic differences for three of the factors assessed. Although components of the Kattan nomogram were not significant in this group its predictive value approached that found originally, suggesting that it can be applied to patients with SVI in helping to direct adjuvant therapy and guide postoperative counselling.

Disease Progression↗
PubMed1984

Modifying and developing health behavior.

The literatures on both behavior modification and behavioral development have engendered innovations in public health programs, addressing problems of patient adherance to preventive and therapeutic regimens, delay in seeking diagnosis of illness symptoms, risk-taking behavior, and other aspects of lifestyle associated with health. Because most of this literature derives from psychology, there has been a distinct bias in the construction of interventions, pointing them directly at individuals, usually in a counseling or small group mode of delivery. These developments served public health well enough during a decade or so when the preoccupation was with utilization of health services and medical management of chronic diseases. With the publication of the Lalonde Report in Canada in 1974, the passage of Public Law 94-317 in 1976 in the United States, and similar initiatives in other English-speaking and European countries, the recognition of the greater complexities of lifestyle development and modification in the absence of symptoms has taken hold. Policy makers and public health workers seek a more efficient and equitable set of strategies to meet the behavioral health challenges of modern society without placing the entire weight of responsibility for behavior on the individual or on therapeutic practitioners. Concurrently, on a more global scale and in the developing countries, a concern has emerged for strategies that give individuals, families, and communities a greater role in deciding their own health priorities. The convergence of these two trends--one seeking to distribute responsibility for lifestyle more equitably and the other seeking to distribute responsibility for planning health programs more equitably --calls for policies, strategies, and interventions that will place similar emphasis on health education and organizational, economic, and environmental supports for health behavior. The combination of these elements of support for behavior calls, in turn, for research and more inventive applications of theory from sociology, political science, economics, and anthropology. Public health workers will need to become more conversant and facile in these social sciences, as they have in psychology and its applications in the recent past.

Adolescent↗
PubMed1985

Marriages of bisexual men.

This study examined the marriages of 26 couples in which the husband was bisexual. The subjects were a non-clinical sample married for at least two years and intending to continue their marriages. The sample was, overall, highly educated and earned concomitantly high incomes. Subjects were administered the Klein Sexual Orientation Grid and a research questionnaire to determine successful or problematic aspects of their marriages. Subjects were, for the most part, satisfied with the quality of their marriages, sexually active within the marriages, and open about the husband's homosexual behavior. A high-level of sexual activity within the marriage, open and direct communication, a valued friendship, previous counseling or psychotherapy, cognitive flexibility, and financial independence contributed to the success of these marriages. The husbands reported a great deal of ambiguity about their homosexual behavior, and the couples reported intense conflict dealing with their open marriage styles.

Adult↗
PubMed2003

Rapid detection of intron 22 inversions of the factor VIII gene in Chinese patients with severe hemophilia A.

BACKGROUND: Hemophilia A is caused by mutations in the gene for coagulation factor VIII. Recently, it has been reported that about half of the patients with severe hemophilia A have a large genomic inversion of the factor VIII gene. We tried to use a rapid method to detect this important mutation in the Chinese hemophiliacs. METHODS: Based on amplification of the leaky mRNA of factor VIII gene in peripheral blood lymphocytes, a reverse-transcription polymerase chain reaction (RT-PCR) method was applied to detect the inversion of intron 22 in the Chinese patients with severe hemophilia A. RESULTS: This mutation was detected in 7 of 20 (35%) severe hemophilia A patients from unrelated families. The mutation was not found in 3 patients of non-severe hemophilia A and 4 normal controls. Family history of bleeding tendency could not be traced in 3 of the 7 patients with intron 22 inversion. CONCLUSIONS: Intron 22 inversion of the factor VIII gene is the major genetic mutation for severe hemophilia A in Taiwan. There is a high probability of de novo mutation for this genetic change. The results were consistent with the concept that intron 22 inversion will always result in severe deficiency of factor VIII. Rapid detection of this common mutation can helpfully guide the direction of molecular study in genetic counselling.

Adolescent↗
PubMed2003

Factors affecting unsuccessful referral by the Lady Health Workers in Karachi, Pakistan.

OBJECTIVE: To estimate the proportion of patient referral and to identify the factors associated with unsuccessful referral in Karachi, Pakistan. METHODS: In a cross-sectional survey, a total of 347 patients referred to different health care facilities by the LHWs were interviewed. Data was collected using a structured questionnaire, on demographic characteristics of patients (age, sex, income etc) and potential factors (seriousness of medical condition, distance of health facility, attitude of health center staff etc) that can affect patient referral outcome. RESULTS: An overall referral rate of 55% was found in this study. Out of a total of 347 patients interviewed, 265 (76.4%) were successful while 82 (23.6%) were unsuccessful referrals. Multivariate logistic regression analysis showed that objection to referral (Adjusted OR, 2.96; CI: 1.44-5.52), never referred before (Adjusted OR, 1.25; CI: 1.34-6.90), not visited the referral site before (Adjusted OR, 4.04; CI: 2.50-6.08) and no knowledge of who to meet at the referral site (Adjusted OR, 1.30; CI: 1.01-2.96) were the factors associated with unsuccessful referral. Other factors found significant were duration of the illness of the patient, anyone not known at the referral site and failure of LHW to follow up. CONCLUSION: Our study found that a significant proportion of patients seen by the LHWs are referred to different health facilities. Improved management skills of LHWs for simple medical problems would probably reduce the number of referrals. Efforts should also be directed to enhance the communication and counseling skills of LHWs, which may reduce a significant proportion of unsuccessful referrals.

Communication↗
PubMed1995

Pediatrician involvement in breast-feeding promotion: a national study of residents and practitioners.

OBJECTIVE: Physician support for breast-feeding mothers has been shown to improve breast-feeding rates, but no evaluation of the adequacy of physicians' breast-feeding-related training has been conducted. This study was designed to assess pediatricians' knowledge, attitudes, training, and activities related to breast-feeding promotion. METHODS: Surveys were mailed to a national random sample of pediatric residents (n = 999) and practitioners (n = 610) who were board certified within the previous 3 to 5 years. RESULTS: Response rates were 74% for residents and 69% for practitioners. Although more than 90% of respondents agreed that pediatricians should be involved in breast-feeding promotion, their clinical knowledge and experience did not suggest a high degree of competency. For example, practitioners were only slightly more aware of breast-feeding's protective effect against otitis media (71% vs 60%), and more than one quarter of both groups did not agree that exclusive breast-feeding is the most beneficial form of infant nutrition. Clinical advice often included inappropriate recommendations for breast-feeding termination or formula supplementation; only 64% of practitioners and 52% of residents knew that supplementing during the first few weeks of life may cause breast-feeding failure. For both groups, prior personal breast-feeding experience (ie, respondent or spouse had breast-fed an infant for 2 or more weeks) was a major determinant of improved clinical knowledge, more frequent activity, and greater self-confidence and perceived effectiveness in the area of breast-feeding promotion. Residents reported that the breast-feeding instruction provided during training was primarily in lecture format, with limited clinical opportunities to practice skills needed to assist breast-feeding mothers. Reflecting on their own training, more than 70% of practitioners recommended that more time be devoted to direct patient interaction and practice of counseling and problem-solving skills. CONCLUSIONS: These results indicate that residency training does not adequately prepare pediatricians for their role in breast-feeding promotion. Improvements in residency training and innovative continuing education programs should be implemented to help pediatricians meet the needs of their breast-feeding patients.

Breast Feeding↗
PubMed1996

[Questionnaire to assess perception of chronic disease in couples. Perceptual pattern in coronary patients and their partners].

103 male patients with coronary heart disease and their partners filled out the Questionnaire about the Perception of an Illness and its Consequences (Fragebogen zur Wahrnehmung der Krankheit und ihrer Folgen, FWKF) which is available for both the patient and his partner. Factor analyses were done separately for the items of both FWKF versions, which examine with the consequences of coronary heart disease. Four interpretable factors were calculated, which are highly congruent in both versions: "dependency vs. independency", "resignation vs. hope regarding the physical condition", "positive vs. negative anticipation regarding social resonance" and " self and partner orientation vs. achievement". Four scales were derived which enable a diagnosis of the perception and coping modi of the patient and his partner and to draw conclusions about the partner interaction. Couples could be identified where both partners take similar extreme positions. They thus leave themselves little room for development. The significance of these results for more well-directed and therefore more improved psychosocial counselling of coronary patients and their partners is discussed.

Adaptation, Psychological↗
PubMedDate not supplied

Automated interviewing for hepatitis B risk assessment and vaccination referral.

INTRODUCTION: This study describes a convenient, anonymous, and private method to assess risk for hepatitis B and recommend vaccination for those determined to be at risk. METHODS: We used an automated telephone interview and computerized risk assessment to inform callers of their hepatitis B risk status and direct those at risk for testing, counseling, and vaccination. The project's efficacy was compared to previously reported projects, and the expense was compared to estimates assuming universal vaccination. RESULTS: This pilot project found that 63% of completed interviews indicated risk. Of those at risk, 47% reported for testing, and 89% of those tested required vaccination. Of those requiring vaccine, 75% (32% of at-risk callers) completed the three-dose series. Of those tested, 9% previously had natural infections and 2% were carriers. CONCLUSIONS: Until adolescents are universally vaccinated, computerized hepatitis B risk assessment can facilitate prevention and decrease vaccination program costs. Privacy and anonymity may increase participation of groups difficult to reach before the onset of risky behaviors that results in treatment for STDs and drug abuse.

Adult↗
PubMed1998

The controversy of hormone-replacement therapy in breast cancer survivors.

PURPOSE/OBJECTIVES: To review literature about hormone-replacement therapy (HRT) for breast cancer survivors, including potential risks and benefits, long-term health outcomes, research directions, and nursing's role in counseling these patients. DATA SOURCES: Journal articles, abstracts, text excerpts. DATA SYNTHESIS: HRT after menopause delivers proven benefits, including decreased risk of cardiovascular disease and osteoporosis and improved quality of life (QOL). As more women survive breast cancer, health risks resulting from treatment-induced menopause must be considered. Breast cancer survivors traditionally have not been offered HRT out of fear of cancer reactivation. This prohibition is being reexamined as data accumulate about estrogen's benefits. CONCLUSION: Further prospective research is needed to develop criteria for the prudent use of HRT after breast cancer. IMPLICATIONS FOR NURSING PRACTICE: Nurses can develop standards for patient education about HRT options and, when they are prescribed, design appropriate tools to measure HRT's impact on QOL, symptom relief, and long-term health outcomes.

Breast Neoplasms↗
PubMed1998

Let the patients speak.

The 1997 Texas Legislature directed the Office of Public Insurance Counsel (OPIC) to issue annual report cards comparing Texas health maintenance organizations (HMOs). OPIC released its first statewide consumer survey in August, conducted by The University of Texas Office of Survey Research.

Data Collection↗
PubMed1988

[Gene technology from the viewpoint of genetic counseling].

Gentechnology detects genetic defects at the DNA level. Direct analysis, which may be performed without family investigations, is the most reliable and therefore the most desirable means of detection. Indirect analysis on the other hand-using restriction fragment length polymorphisms (RFLP) - requires family investigations and the pedigrees are not always informative; furthermore, meiotic recombination may occur leading to erroneous conclusions. Pre-symptomatic diagnosis of a severe disease may cause serious psychical and ethical problems. Prenatal diagnosis by gentechnology may be made after amniocentesis or chorionic villi sampling.

Adult↗
PubMedDate not supplied

Genetic counseling in psychiatry.

While psychiatrists may commonly discuss family history in clinical practice, there has been little systematic research documenting the role and effectiveness of genetic counseling for psychiatric disorders. In the coming years, the expected identification of susceptibility genes for psychiatric disorders may bring new opportunities and expectations from patients and families for the clinical translation of research findings in psychiatric genetics. We review evidence for possible increasing demand for genetic counseling, particularly if specific genes related to psychiatric disorders are identified. We then explore both the potential role of genetic counseling for psychiatric disorders and the issues involved in conveying genetic information in the clinical setting. Further research regarding the effectiveness of counseling interventions, as well as additional efforts directed at genetics education for clinicians, will be needed if emerging advances in genetic research are to be incorporated into clinical practice.

Genetic Counseling↗
PubMed2002

Models of genetic counseling and their effects on multicultural genetic counseling.

This theoretical paper examines challenges to multicultural genetic counseling, counseling between culturally different clients and counselors, in the context of Kessler's typology of models of genetic counseling (Kessler S (1997) J Genet Counsel 6:287-295). It is suggested that challenges such as resistance to multicultural genetic counseling education may be due to conceptions about genetic counseling as a biomedical field that transcends questions of culture as well as lack of multicultural training or prejudice. Directions for future research and recommendations for multicultural genetic counseling education are briefly explored.

Cultural Diversity↗
PubMed1998

Prenatal smoking cessation counseling by Texas obstetricians.

BACKGROUND: Smoking during pregnancy causes 20 to 30 percent of low birthweight and 10 percent of infant mortality in the United States. Brief counseling can reduce rates of smoking. The study objectives were to describe Texas obstetricians' pregnancy smoking cessation counseling activity and to identify attributes associated with consistent, effective counseling. METHODS: A survey was mailed to a random sample of Texas obstetricians. RESULTS: A response rate of 44 percent (n = 204) was attained. A counseling coverage-effectiveness index was created based on the percentage of smokers counseled and use of specific techniques. Almost all respondents reported asking about smoking; fewer, however, reported counseling smokers. Physicians with low index scores, indicating inconsistent coverage, ineffective counseling, or both were dissatisfied with their current counseling, did not perceive counseling to decrease smoking, were not aware of the risks of smoking, and were unfamiliar with expert reports and recommendations for prenatal care. CONCLUSIONS: Obstetricians who are not reached by expert reports and guidelines from groups outside their specialty or who do not perceive the seriousness of maternal smoking are less likely to counsel consistently and to use the most effective techniques. Continuing medical education at local, state, and national levels should be directed toward increasing knowledge and skills about smoking cessation counseling of pregnant women.

Adult↗
PubMed1993

The use of large-loop excision of the transformation zone in an inner-city population.

OBJECTIVE: To determine whether large-loop excision of the transformation zone (LLETZ) can be used in our population to treat patients in a routine colposcopy clinic without diminishing the capability to see the large number of patients who require care, and to compare these results to our previous experience with laser surgery. METHODS: Patients found to have squamous intraepithelial lesions on colposcopically directed biopsies were offered treatment with LLETZ during counseling regarding their biopsy findings. Procedures included "ablation equivalents" and "cone biopsy equivalents" using local anesthesia. Follow-up examinations were used to determine cure and included cytology, colposcopy, and directed biopsies when indicated. The cure rate was compared to our previous experience with laser surgery. RESULTS: Two hundred thirty-six patients were treated in the colposcopy clinic without diminishing the capability to see all patients requiring care. Complications were few. The mean (+/- standard deviation) follow-up period was 50.7 +/- 25.3 weeks. The overall cure rate of 91.3% (95% confidence interval [CI] 87.1-95.5) was not influenced by the severity of the disease, but positive endocervical margins significantly lowered the cure rate to 69.2% compared with those who had negative margins. Before this series, only 73.1% of our patients scheduled for laser surgery returned for treatment. Assuming a 90% cure rate among those who returned, this means that the actual cure rate was only 65.8%. The likelihood of cure was 1.37 times greater (95% CI 1.27-1.52; P < .0001) using LLETZ in the clinic at the time the patient was counseled regarding her biopsy findings than using laser at a later date. In 33 patients, the LLETZ specimen showed no evidence of disease. The relative risk of negative histology was 3.31 (95% CI 1.78-6.13; P < .001) when LLETZ was done for a discrepancy between cytology and histology as opposed to any other indication. Cancer was found on the LLETZ specimen in four patients (two microinvasive, two frankly invasive), but was not suspected preoperatively in any of the patients. CONCLUSION: In our inner-city clinic, treatment with LLETZ at the time the patient was counseled regarding her biopsy findings improved the actual cure rate. The LLETZ procedure can be done safely in a clinic setting without diminishing the capability to care for a large number of patients.

Adolescent↗
PubMedDate not supplied

[Utilization and effectiveness of short-term counseling in child guidance].

UNLABELLED: This study investigates the utilization and effectiveness of short-term counseling in child guidance. For this purpose a comparison was made between short-term and long-term counseling (each N = 89) and a catamnestic telephone interview of the parents who had had short-term counseling was conducted (N = 70). RESULTS: 1. The rate of short-term counseling amounts to 39%. 2. The individuals seeking short-term counseling are significantly less burdened with problems. 3. In stating the reason for a short-term counseling, 58% of the individuals concerned claim that the number of counseling sessions held had been sufficient, that there had been an improvement with regard to the problems, or that according to the counselor there had been no need for further activity; 24% were dissatisfied with the counseling and for this reason broke it off; 10% were directed to other institutions. 4. On the whole the persons seeking advice evaluated the short-term counseling mainly positively. The evaluation of satisfaction and success corresponds with the evaluation commonly gained in educational guidance: 70% of the individuals seeking counseling were satisfied with the results, 44% reported positive changes due to the advice they received, and 66% seem to have gained a better understanding for their children. 5. The good relationship between the counselor and the person seeking advice appeared to be particularly important.

Adolescent↗