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PubMed1996

Quality of life following transplantation of the heart, liver, and lungs.

The purpose of this study was to describe the quality of life of patients who have received a transplant of the heart, liver, and lungs. We wished to document how the different patient groups fared in relation to each other with respect to physical, psychological, and social functioning, as well as in relation to published normative data. We also wished to identify factors that contribute to better functioning. We sent out a questionnaire by mail and received responses from 55 heart, 149 liver, and 59 lung transplant recipients (82% response rate). Measures included the SF-36, Mental Health Inventory, the State Anxiety Inventory, the UCLA Loneliness Scale-Revised, a quality of life measure that rated degree of improvement since transplantation, a measure of degree of difficulty in following medical and lifestyle regimens, sleep disturbance, and the Illness Intrusiveness Rating Scale. Results indicated that lung transplant patients reported better functioning than heart or liver transplant patients in all three domains of physical, psychological, and social functioning. Lung patients' level of functioning was equivalent to or better than published norms for the SF-36. Heart and liver recipients reported equivalent functioning to published norms in some domains, but reported impairment in the areas of physical and social functioning. Heart patients especially reported greater intrusiveness of their illness on their daily lives and indicated more difficulty complying with their lifestyle regimen. In all three groups, a large majority of patients reported feeling that life had improved since transplant with respect to health, energy level, activity level, and overall quality of life. Fewer patients reported improvements in the areas of sex life, marriage, family relationships, and social relationships. Where there were differences among the three patient groups, again it was the lung patients who reported more improvement in life since transplantation. Patients with better physical functioning tended to have more energy and pep, to be younger, to see themselves as being in better health, to feel less intrusion on their lives of their illness, and to be employed. Those with better psychological functioning tended to report less sleep disturbance, less loneliness, better social functioning, more vitality, and to be older. Better social functioning was associated with better mental health, less illness intrusiveness, and less role impairment as a result of physical or emotional factors. Relatively few patients-roughly a quarter of the total sample-reported that they were working either full or part time. We conclude that transplantation results in improved quality of life overall, but that problems persist for some patients in their physical and social functioning. Interventions aimed at improving rehabilitation in specific targeted areas may enable patients to resume a more fulfilling lifestyle posttransplant.

Activities of Daily Living↗

PubMed2001

A prospective analysis of work in schizophrenia.

This study examined the longitudinal course of competitive employment in patients with schizophrenia following treatment for an acute exacerbation, and prospectively predicts work approximately 2 years later from sociodemographic and clinical characteristics. A sample of 528 patients was assessed at baseline, and 313 were followed up 1 and 2 years later. Assessments included sociodemographic characteristics, premorbid functioning, work history, symptoms, social functioning, recent efforts to find work, and interest in work. Analyses examined changes in competitive work from baseline to the followups, the correlates of work history, the prospective prediction of work at the 1- and 2-year followup assessments, and correlates of competitive work. Competitive employment increased significantly from 10 percent at baseline to 23 percent and 21 percent at the 1- and 2-year followups, respectively. At baseline, among patients who were not competitively working, 61 percent reported interest in working. Patients who were not competitively employed at baseline but reported making recent efforts to find work were more likely to be working at the followups than other not employed patients. Work at the 1- and 2-year followups was predicted by prior work experience, patient and mother's educational level, cognitive impairment, and social functioning. Similar correlates of current work status were found. Interventions may need to target educational level, cognitive impairment, and social competence and functioning in order to improve the competitive employment outcomes of persons with schizophrenia.

Adolescent↗

PubMed1999

Comorbid social anxiety and body dysmorphic disorder: managing the complicated patient.

Patients with body dysmorphic disorder (BDD) have an obsessive preoccupation with an imagined defect in appearance or, if a slight physical abnormality exists, a grossly excessive concern with it. This preoccupation causes significant distress or impairment of social, occupational, or other functioning. Social anxiety is a prominent component of BDD, and social avoidance resulting from BDD symptoms may markedly impair social functioning. In severe cases, avoidance of social situations in combination with occupational and academic impairment may result in patients becoming housebound. The prevalence of BDD is 1% to 2% in the U.S. population and 11% to 12% in patients with social anxiety disorder. Behaviors associated with BDD include mirror checking, physician visits, hair grooming, use of cosmetics, and social avoidance. Distress over BDD may lead patients to undergo repeated cosmetic surgeries in futile attempts to conceal or correct perceived defects. Additionally, depression and suicide are frequent complications of BDD. Pharmacologic and nonpharmacologic treatments for the management of BDD with coexisting social anxiety are presented in this article.

Adolescent↗

PubMed2003

Quality of life in patients with non-metastatic differentiated thyroid cancer under thyroxine supplementation therapy.

GOALS: When thyroid and other cancers are "cured" it is often assumed that the patients are able to resume their normal lives. This was a cross-sectional study to evaluate health-related quality of life (HRQOL) and to identify rehabilitation needs of patients with non-metastatic thyroid cancer under thyroxine supplementation therapy. PATIENTS AND METHODS: Included in the study were 150 consecutive patients with differentiated thyroid cancer (age 52 +/- 14 years, range 25-83 years; male/female 39/111). All patients had a history of total thyroidectomy followed by radioiodine ablation, were free of metastatic disease and under levothyroxine treatment. The mean period since the diagnosis of thyroid cancer was 5.5 +/- 6 years (range 0-23 years). Health-related quality of life was evaluated using the SF-36 Health Survey. The findings were compared with sex- and age-matched reference values. RESULTS: "Role-emotional" and "Vitality" were significantly lower ( P<0.001 and P<0.005, respectively) in the group as a whole ( n = 150). In the subgroup of patients with a recent (less than 1 year) diagnosis of thyroid cancer ( n = 51), however, the following subscales were significantly lower: "Mental Health" ( P<0.01), "Role-emotional" ( P<0.001), "Role-physical" ( P<0.005), "Social functioning" ( P<0.005) and "Vitality" ( P<0.001). Multiple regression analysis identified a significant positive correlation between "Mental Health", "Physical functioning", "Vitality", "Role-emotional" and "Social functioning" with the time since initial diagnosis, and there was also a positive correlation between "Physical functioning", "Bodily pain" and "Role-emotional" with male gender. CONCLUSIONS: These findings indicate that "Vitality", "Role-physical", "Mental Health", "Role-emotional" and "Social functioning" are significantly impaired during the first year after diagnosis. Thereafter, quality of life improves correlating with the time since initial diagnosis. However, "Vitality" and "Role-emotional" remain permanently impaired in thyroid cancer patients. A multidisciplinary rehabilitation concept should include psychological support and an early start to exercise to improve physical performance of these patients leading to better HRQOL and to help them fulfill their social role earlier.

Adult↗

PubMed1996

The long-term outcome in men with exstrophy/epispadias: sexual function and social integration.

PURPOSE: We evaluated the long-term outcome of social integration and sexual function in 29 men with bladder exstrophy and epispadias. MATERIALS AND METHODS: Four men with epispadias and 25 with bladder exstrophy were available for long-term followup. Patients were interviewed by telephone regarding sexual history and social integration. Semen analyses were obtained in 8 cases. RESULTS: Patient assessment of genital appearance was good or fair in 71%. Potency was present in all patients, and erections were straight in 66% and curved in 34% with no curvature so severe as to prevent sexual intercourse. Semen analysis showed a normal sperm count in 63% of the men and no azoospermia. Social integration was satisfactory: 100% of the men attended high school, 55% have a college education and all who are not attending school have full-time jobs. CONCLUSIONS: Our long-term review demonstrates that despite what appears to be a significant sexual handicap, patients with exstrophy/epispadias can have adequate sexual function and overall successful social integration.

Bladder Exstrophy↗

PubMed2001

Social patterns of substance use among people with dual diagnoses.

An ethnography, part of the larger New Hampshire Dual Diagnosis Study, discovered in a small subsample (n = 16) that clients participated in 1 (or sometimes 2) of 4 distinct and different social patterns of substance-use. These 4 patterns, (1) "the lone user," (2) "the small, closed social clique," (3) "the large, open user syndicate," and (4) the "entrepreneurial drug provider," manifest important social functions of such substance-use. These social functions need to be taken into account as case managers attempt to persuade clients to abstain from using substances, because changing one's substance-use immediately affects one's participation in these user networks. Case managers can understand the social pressures toward certain patterns of substance-use by attending to the social patterning of that use. Many social functions provided by these social patterns must be continued by other means if clients, once persuaded to attempt abstinence, are to be effectively supported in their sobriety.

Diagnosis, Dual (Psychiatry)↗

PubMed1986

Personality, functioning and symptomatology.

A random sample of 200 people selected from urban and rural communities was assessed using structured interview schedules to measure the prevalence of personality disorder and psychiatric illness and their relation to social functioning. Explosive personality disorder was the most prevalent type of abnormal personality. Social functioning was significantly worse in those with personality disorder than those with normal personality but there was no difference between the various diagnostic categories of abnormal personality. Social functioning differed between some PSE diagnostic categories. An assessment was made of the variables contributing to mean social functioning score, of the interactions between them, and of the correlation between social functioning symptomatology.

Adult↗

PubMed2000

Correlations with patients' perspectives of the result of lower-extremity amputation.

BACKGROUND: Patients' perceptions of the result of lower-extremity amputation vary widely, yet the factors associated with this variability are not well understood. Our objective was to identify important correlations with the perceived result that may help to indicate the factors that deserve particular emphasis in the management of patients who have had an amputation. METHODS: In this retrospective study, 148 patients who had had a major lower-extremity amputation completed a standardized questionnaire designed to assess the demographic characteristics, comorbidities, amputation characteristics, prosthetic function, and social function at a mean of seven years after surgery. We correlated each of these variables with four result metrics: general satisfaction, quality of life, freedom from frustration, and walking distance. RESULTS: The four result metrics were significantly and strongly correlated with (1) the comfort of the residual limb; (2) the condition of the contralateral limb; (3) the comfort, function, and appearance of the prosthesis; (4) social factors; and (5) the ability to exercise recreationally (p < 0.0001). Interestingly, the level and laterality of the amputation were not significantly correlated with the patients' perceived result. CONCLUSIONS: The perceived result of amputation is not associated with the amount of the limb that was amputated but rather with factors that may be optimized by surgical, prosthetic, and social management.

Amputation, Surgical↗

PubMed1980

Psychosocial disability in physically restored long-term stroke survivors.

Three parameters of social function-socialization in the home, socialization outside to the home, and hobbies and interests--were analyzed to determine social reintegration of long-term survivors of documented completed stroke, who had already achieved satisfactory levels of physical function as measured by the Kenny self-care evaluation. A significant proportion of survivors manifested social disability, despite complete physical restoration. Much of this disability cannot be accounted for by age, physical impairment or specific neurologic deficits. The distribution of functional disabilities documented suggests that psychosocial factors, as well as organic deficits, are major determinants.

Activities of Daily Living↗

PubMed2005

Social and visual function in nystagmus.

AIM: To investigate the influence of nystagmus on visual and social function and determine if parents are able to assess visual and social function in children with nystagmus. METHOD: A postal questionnaire comprising 14 questions related to visual function (VF-14) and questions pertaining to social function were sent to all 1013 members of the Nystagmus Network-a UK based organisation for nystagmus sufferers and their families. Visual and social function scores were compared by regression analysis. RESULTS: 180 adult, 233 parent, and 124 child questionnaires were returned. Idiopathic nystagmus was the most common cause. In adults the mean VF-14 score indicated very low visual function, in the same range as patients assessed in low vision services. Children's visual function scored better than adults, between scores of patients with age related macular disease and corneal grafts. There was a strong correlation between perceived visual and social function for adults (p<0.001) and parental assessment of their children (p<0.001), but not between child self assessment of visual and social function. There was strong correlation between parental and child assessment of visual and social function (p<0.001, p<0.001) CONCLUSION: Questionnaires indicated that nystagmus is associated with very low visual function. There is a strong correlation between visual and social impairment. The authors have shown for the first time in an ophthalmic disease that parents are able to estimate the impact of nystagmus on their child both in terms of visual and social functioning, although they underestimate the impact of nystagmus on emotional aspects of wellbeing.

Adolescent↗

PubMed2005

A randomized, controlled trial of cognitive behavioral social skills training for middle-aged and older outpatients with chronic schizophrenia.

OBJECTIVE: The number of older patients with chronic schizophrenia is increasing. There is a need for empirically validated psychotherapy interventions for these patients. Cognitive behavioral social skills training teaches cognitive and behavioral coping techniques, social functioning skills, problem solving, and compensatory aids for neurocognitive impairments. The authors compared treatment as usual with the combination of treatment as usual plus cognitive behavioral social skills training. METHOD: The randomized, controlled trial included 76 middle-aged and older outpatients with chronic schizophrenia, who were assigned to either treatment as usual or combined treatment. Cognitive behavioral social skills training was administered over 24 weekly group sessions. Blind raters assessed social functioning, psychotic and depressive symptoms, cognitive insight, and skill mastery. RESULTS: After treatment, the patients receiving combined treatment performed social functioning activities significantly more frequently than the patients in treatment as usual, although general skill at social functioning activities did not differ significantly. Patients receiving cognitive behavioral social skills training achieved significantly greater cognitive insight, indicating more objectivity in reappraising psychotic symptoms, and demonstrated greater skill mastery. The overall group effect was not significant for symptoms, but the greater increase in cognitive insight with combined treatment was significantly correlated with greater reduction in positive symptoms. CONCLUSIONS: With cognitive behavioral social skills training, middle-aged and older outpatients with chronic schizophrenia learned coping skills, evaluated anomalous experiences with more objectivity (achieved greater cognitive insight), and improved social functioning. Additional research is needed to determine whether cognitive insight mediates psychotic symptom change in cognitive behavior therapy for psychosis.

Activities of Daily Living↗

PubMed2003

Do age and social relations moderate the relationship between self-rated health and mortality among adult Danes?

It is well established that self-rated health (SRH) predicts mortality even after controlling for a wide range of factors. We explored the extent to which age and social relations (structural and functional) influenced the relationship between SRH and mortality (after 13 years follow-up) in a representative sample of adult Danes (N=6693). After controlling for socioeconomic status, illness, and lifestyle variables, we found that age moderated the SRH-mortality relationship such that it was present for respondents under 55 but absent for respondents over 56. In addition, weaker structural (but not functional) social relations increased mortality directly but neither structural nor functional social relations moderated the SRH-mortality relationship. We discuss the theoretical and practical implications of these findings.

Adolescent↗

PubMed1998

Predictors of health status and life satisfaction in spinal cord injury.

OBJECTIVE: To analyze relationships between injury-related variables, demographic variables, functional health status, and life satisfaction of people with spinal cord injury (SCI). DESIGN: Cross-sectional survey. SETTING: A community in the Netherlands. SUBJECTS: Three hundred eighteen people with SCI, aged 18 to 65 years. Mean age was 39.4 years and mean time after injury was 3.6 years. MAIN OUTCOME MEASURES: Health status was measured with the SIP68. Its six scales were aggregated to three dimensions, measuring physical, psychologic, and social functioning. Life satisfaction was measured with the Life Satisfaction Questionnaire. Data were analyzed by path analysis using LISREL V8. RESULTS: Obtained scores showed that respondents suffered from serious limitations in physical functioning and social functioning, had only a few limitations in psychologic functioning, and were satisfied with their lives in general and with most life domains. Physical functioning was accurately predicted by injury-related variables, but psychologic functioning was not. Next to level and completeness of the injury, the number of secondary complications turned out to be a predictor of functional health. In a path model that had a close fit with the data, injury-related variables were related to health status but not to life satisfaction. Social functioning (-.48), marital status (-.38), psychologic functioning (-.19), and age (-.16) were significant predictors of life satisfaction (total R2=.44). CONCLUSIONS: This study points out the high prevalence of secondary complications and their importance to the health status of people with SCI. Level of social and psychologic functioning are more important predictors of life satisfaction than the seriousness of the injury.

Adolescent↗

PubMed1998

Social anxiety among adolescents: linkages with peer relations and friendships.

This study examined the utility of modifying the Social Anxiety Scale for Children-Revised (SASC-R) for use with adolescents, and examined associations between adolescents' social anxiety (SA) and their peer relations, friendships, and social functioning. Boys (n = 101) and girls (n = 149) in the 10th through 12th grades completed the Social Anxiety Scale for Adolescents (SAS-A) and measures of social support, perceived competence, and number and quality of their best friendships. Factor analysis of the SAS-A confirmed a three-factor structure: Fear of Negative Evaluation, Social Avoidance and Distress in General, and Social Avoidance Specific to New Situations or Unfamiliar Peers. Girls reported more SA than boys, and SA was more strongly linked to girls' social functioning than boys'. Specifically, adolescents with higher levels of SA reported poorer social functioning (less support from classmates, less social acceptance), and girls with higher levels of SA reported fewer friendships, and less intimacy, companionship, and support in their close friendships. These findings extend work on the SASC-R to adolescents, and suggest the importance of SA for understanding the social functioning and close friendships of adolescents, especially girls.

Adolescent↗

PubMed2004

Characterization of dopamine D1 and D2 receptor function in socially housed cynomolgus monkeys self-administering cocaine.

RATIONALE: Social rank has been shown to influence dopamine (DA) D(2) receptor function and vulnerability to cocaine self-administration in cynomolgus monkeys. The present studies were designed to extend these findings to maintenance of cocaine reinforcement and to DA D(1) receptors. OBJECTIVE: Examine the effects of a high-efficacy D(1) agonist on an unconditioned behavior (eyeblinking) and a low-efficacy D(1) agonist on cocaine self-administration, as well as the effects of cocaine exposure on D(2) receptor function across social ranks, as determined by positron emission tomography (PET). METHODS: Effects of the high-efficacy D(1) agonist SKF 81297 and cocaine (0.3-3.0 mg/kg) on spontaneous blinking were characterized in eight monkeys during 15-min observation periods. Next, the ability of the low-efficacy D(1) agonist SKF 38393 (0.1-17 mg/kg) to decrease cocaine self-administration (0.003-0.1 mg/kg per injection, IV) was assessed in 11 monkeys responding under a fixed-ratio 50 schedule. Finally, D(2) receptor levels in the caudate and putamen were assessed in nineteen monkeys using PET. RESULTS: SKF 81297, but not cocaine, significantly increased blinking in all monkeys, with slightly greater potency in dominant monkeys. SKF 38393 dose-dependently decreased cocaine-maintained response rates with similar behavioral potency and efficacy across social rank. After an extensive cocaine self-administration history, D(2) receptor levels did not differ across social ranks. CONCLUSIONS: These results suggest that D(1) receptor function is not substantially influenced by social rank in monkeys from well-established social groups. While an earlier study showed that dominant monkeys had higher D(2) receptor levels and were less sensitive to the reinforcing effects of cocaine during initial exposure, the present findings indicate that long-term cocaine use changed D(2) receptor levels such that D(2) receptor function and cocaine reinforcement were not different between social ranks. These findings suggest that cocaine exposure attenuated the impact of social housing on DA receptor function.

Analysis of Variance↗

PubMed2026

Early-stage trajectories of social-occupational functioning and long-term functional outcome prediction in early psychosis: A 12-year follow-up of the randomized controlled trial on extended early intervention.

BACKGROUND: Functional impairment in psychosis often persists despite symptomatic remission. There is a paucity of research examining early-course psychosocial functioning trajectories, and none has been conducted to examine relationship between the trajectories and prospective long-term functional outcomes in early psychosis sample. METHODS: We conducted 12-year follow-up of a randomized controlled trial on extended early intervention for first-episode psychosis to identify early-course social-occupational functioning trajectories and their baseline predictors and associations with 12-year outcomes. Participants who completed Social and Occupational Functioning Scale (SOFAS) scores at three or more timepoints between baseline and 3-year follow-up were included in the study. Premorbid adjustment, illness characteristics, symptom severity, functioning, and treatment profiles were assessed. Latent growth mixture modeling was employed to derive early-course social-occupational functioning trajectories based on SOFAS scores over 3-year follow-up. RESULTS: A total of 148 participants were included in this study, with 106 patients having completed the 12-year follow-up. Our results identified four distinct trajectories, including persistently-good class, gradually-improved class, suboptimal-stable class, and persistently-poor class. Patients in persistently-poor class had more severe negative symptoms at baseline compared to patients in persistently-good class. Patients with persistently-poor trajectory had worse long-term outcomes than those with other classes in the majority of functional measures at 12-year follow-up. CONCLUSIONS: The majority of patients were classified in early-stage suboptimal or poor functional trajectories. Above one-fourth of the participants exhibited persistently-poor social-occupational functioning trajectory, which predicted worse functional outcomes at 12-year follow-up. These findings highlighted the importance of tracking functional changes during the initial years of illness.

Humans↗

PubMed1996

Fine motor outcomes in preschool children who receive occupational therapy services.

OBJECTIVE: This study examined preschool children's acquisition of fine motor skills and functional performance when occupational therapy services are included as part of the educational program. It also investigated the relationships among fine motor skills and functional performance in self-care, mobility, and social function. METHOD: Twenty-six preschool children who received weekly occupational therapy were studied. Measurements of their in-hand manipulation, tool use, eye-hand coordination, grasping strength, and functional performance in self-care, mobility, and social function were taken at the beginning and end of the school year. RESULTS: Raw and scaled scores showed significant improvements in all skill areas; standard scores showed slight improvement in eye-hand coordination and mobility function. Correlations of the motor skill tests with the functional performance scales using year-end data revealed significant correlations for in-hand manipulation, eye-hand coordination, and grasping strength with self-care function and mobility. CONCLUSIONS: The results demonstrate the level of change that occurs in fine motor skill and self-care, mobility, and social function during the course of the school year for preschoolers with moderate fine motor delays. The relationships found in the year-end testing imply that performance in underlying fine motor skills as the focus of occupational therapy intervention is associated with self-care and mobility function.

Achievement↗

PubMed2001

Short-term durability and improvement of function in traumatic brain injury: a pilot study using the Paediatric Evaluation of Disability Inventory (PEDI) classification levels.

PRIMARY OBJECTIVE: To describe the short-term durability and improvement of functional outcomes for children and adolescents with traumatic brain injury (TBI) up to 6 months after discharge from inpatient rehabilitation. RESEARCH DESIGN: Retrospective, descriptive. METHODS AND PROCEDURES: Twenty-five (28.1%) of 89 children discharged from inpatient rehabilitation were available for outpatient follow-up within 6 months. The Paediatric Evaluation of Disability Inventory (PEDI) functional skill classification levels in the domains of self-care, mobility, and social function, recorded at discharge and follow-up, were examined using the Wilcoxon matched pairs signed rank test (two-tailed). MAIN OUTCOMES AND RESULTS: Most (64-80%) of the children sustained the outcome level achieved at hospital discharge in one or more of the three domains. Significant differences (p < 0.05) from discharge to follow-up were detected in mobility and social function levels. Differences between children with and without follow-up were non-significant in all but one variable (social function level at hospital discharge). CONCLUSIONS: The results of this study suggest that children after TBI sustain outcomes achieved during inpatient rehabilitation and make significant gains in mobility and social function skills within 6 months of returning home. More research is needed to predict those children who will continue to recover and to identify factors that facilitate recovery in the community setting.

Activities of Daily Living↗