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PubMed2000

Social factors influencing the acquisition of antibiotics without prescription in Kerala State, south India.

We investigated the magnitude of self-medication with antibiotics in a peri-urban area of Southern Kerala State, India and factors influencing this practice. First, a random sample of 400 households was surveyed in one primary health centre area near Trivandrum. We found 69.3% (95% CI = 64.8-73.8) of households had at least one person using a pharmaceutical product during the two-week recall period; antibiotics formed almost 11% of the medicines consumed. Next, pharmacy based interview and observation data were collected from 405 antibiotic purchasers sampled from 11 out of the 12 private pharmacies in the area. Seventy-three of these 405 customers purchased antibiotics without a prescription (18%; 95% CI = 14.3-21.7). By combining the household survey and pharmacy observations, we estimate that almost half of 1% (0.41%; 95% CI = 0.24-1.16) of the population, or four people per 1000, is engaged in self-medication using antibiotics in Kerala in any two-week period. Our data show that people least likely to follow this practice are from higher income families, having more education and higher status occupations and receiving the benefits of medical insurance. Conversely, logistic regression analysis indicated that risk of buying antibiotics without a script was associated with education at secondary level or below, the perception that it is expensive to consult a doctor and low satisfaction with medical practitioners. Keralites' self-medication patterns are interpreted broadly using social, cultural, historical and economic perspectives. Solutions to the problem of antibiotic misuse are suggested, proceeding on several fronts: among practitioners, suppliers and marketeers of medicines, and among the population of pharmaceutical consumers themselves.

Aged↗
PubMed2001

Comorbidity of pain-associated disability and depressive symptoms in connection with sociodemographic variables: results from a cross-sectional epidemiological survey in Hungary.

The purpose of this study was to investigate the prevalence of pain symptoms causing disabilities in every-day activities and their possible connection to depressive symptomatology. A representative sample of 12640 adults from the Hungarian population participated in a door-to-door survey about demographic variables, pain-associated disability, and depressive symptomatology. The overall prevalence of pain-associated disability was 32.7%, significantly lower in men, showing a significant increasing trend with age. A decreasing tendency in prevalence rates was observed in connection with higher educational and occupational status. Results revealed a 30.2% prevalence of depressive symptomatology among interviewees reporting pain-associated disabilities. The co-prevalence of depressive symptoms revealed a significant increasing trend with age and lower educational level. No significant gender difference was found in the co-occurrence of depressive symptoms. This survey concludes that pain symptoms constitute a substantial public health problem in the Hungarian population in forms of emerging disabilities and depression. Epidemiological studies offer a better understanding of sociodemographic differences in health status, and serve the better allocation of professional and economic resources.

Adolescent↗
PubMed1999

Patients with suicidal burns and accidental burns: a comparative study of socio-demographic profile in India.

This is a prospective study of 50 consecutive admissions to the burns unit. The socio-demographic data was collected using special proforma and interviewing the patients and relatives. All patients were administered the presumptive stressful life event scale (PSLES). Depending on the presence or absence of suicidal intent, patients were divided into two groups. The two groups were then compared with regards to their socio-demographic profile using the unrelated t-test and the Fisher's exact test. The two groups did not differ significantly with regards to age, sex, education, marital status, occupation or monthly per capita income. The patients who had suicidal intent came from joint family, had more stressful life events and suffered larger burns injuries compared with those who experienced accidental burn injuries. The majority of the patients were below the age of 35, unemployed and females outnumbered males in both the groups.

Accidents↗
PubMed2003

Proximal row carpectomy: a minimum 10-year follow-up study.

PURPOSE: To assess the long-term clinical and radiographic results after a proximal row carpectomy (PRC). METHODS: Twenty patients with various degenerative and posttraumatic disorders of the wrist were evaluated. The evaluation consisted of a physical examination, plain radiographs, and completion of a questionnaire that assessed patient satisfaction, return to work status, occupational and recreational activities and restrictions, and pain level. RESULTS: Two patients (10%) had persistent pain after a PRC requiring a radiocapitate arthrodesis. The remaining 18 patients were evaluated at an average follow-up of 13.1 years (range, 10.0-17.2 y). The average wrist range of motion was 63% and the average maximal grip strength was 83% of the opposite extremity, respectively. Seventeen patients were satisfied with their outcome. One patient complained of persistent pain and was not satisfied but did not want further surgery. All but 2 patients returned to their original occupation and activity level including all 5 patients involved in workers' compensation. Follow-up radiographs showed flattening of the proximal capitate in 6 patients. Radiocapitate arthrosis was absent/minimal in 13 patients and moderate/severe in 4 patients. The presence of radiographic changes did not correlate with patient satisfaction or degree of wrist pain. CONCLUSIONS: Proximal row carpectomy is a dependable and durable procedure that results in satisfactory pain relief in the majority of patients, maintenance of functional wrist motion and grip strength, high patient satisfaction, and ability to return to work. Progressive symptomatic deterioration of the radiocapitate articulation was not observed.

Adult↗
PubMed1997

Estimating measurement error in alcohol dependence symptomatology: findings from a multisite study.

Inter-rater test-retest reliability of alcohol diagnoses and symptom ratings, made by means of a modified version of the Structured Clinical Interview for DSM-III-R (SCID), were evaluated in the context of a multisite clinical trial of alcoholism treatment. Reliability coefficients for the subject's 'worst period' and the 'current period' were compared. The results show that with proper training, reliable diagnostic classification can be achieved across multiple sites. Symptom reliabilities for the current period were higher than the worst period. Respondents with higher discrepancies between test and retest tended to drink more on each drinking occasion, reported more medical detoxifications, changed residence more often, had lower occupational status and were rated by the interviewer as less attentive, motivated and intelligent. Methods to monitor and improve the reliability of diagnostic interviews in addiction research, particularly in multisite studies, are discussed in relation to the findings.

Adult↗
PubMed2000

Perceptual-motor, visual and cognitive ability in very low birthweight preschool children without neonatal ultrasound abnormalities.

Thirty-six children born preterm with very low birth weight without neonatal brain disorders and normal cerebral ultrasound findings were examined at pre-school age: visual, perceptual motor, attention, behaviour and cognitive assessments were performed in the study group as well as in a control group of term children matched for age, sex and parental educational and occupational status. The results showed a significant lower scoring in perceptual motor skills in the study group, associated with a defect of accuracy in spatial attention and a higher incidence of stereopsis impairment related with perceptual motor disabilities. Behavioural disorders, in terms of emotional maturation and hyperactivity, were significantly more frequent in the study group. To prevent behavioural and learning problems at school, a complete longitudinal assessment including visual functions and perceptual motor abilities seems mandatory in preterm born children, even in the absence of neonatal brain disorders including abnormal cerebral ultrasound findings.

Attention↗
PubMed2004

A survey of pregnant smokers' interest in different types of smoking cessation support.

The aim of this study was to survey pregnant smokers' interest in different types of smoking cessation support. Interest in cessation support was assessed via telephone interviews with women identified as smokers at their first antenatal visit. Of 206 pregnant smokers interviewed, 87% (179/206) reported wanting to stop smoking, of whom 69% (124/179) expressed an interest in receiving help with stopping. Interest was highest for behavioural support (82%, 102/124) and self-help materials (77%, 95/124). There was a significant preference for individual versus group appointments, for 'buddying' among those not in professional/managerial occupations versus those in professional/managerial occupations, and for behavioural support among non-Caucasians versus Caucasians. These findings highlight the high level of interest expressed in support with stopping smoking among pregnant smokers. Smoking cessation services may benefit through offering a range of interventions for pregnant smokers, through considering ethnic and occupational status, and through routinely offering individual appointments.

Adolescent↗
PubMed2004

Triglyceride and coronary heart disease mortality in a 24-year follow-up study in Xi'an, China.

PURPOSE: To study whether serum triglyceride (TG) was associated with coronary heart disease (CHD) mortality. METHODS: A cohort analytic study carried out in a machinery factory in Xi'an, China on 1696 subjects aged 35 years or above (1124 men and 572 women) examined in 1976 and followed up till 2000. RESULTS: At baseline, the mean serum total cholesterol (TC) and triglyceride (TG) was 4.64 and 1.16 mmol/L in men, 4.62 and 1.10 mmol/L in women, respectively. Three hundred six (239 men, 67 women) had died within 37,781 person-years of follow-up, with 49 CHD deaths (36 male, 13 female). The relative risk (95% confidence interval) of CHD mortality per mmol/L increase in TG was 2.13 (1.46-3.17) after adjusting for age, marital status, occupation, education, systolic blood pressure and TC. Dose-response relationship between TG levels by tertiles and CHD risk was found. Stratified analyses showed TG was an independent predictor for CHD mortality in subjects with lower or higher TC. CONCLUSIONS: Chinese had lower levels of TC and TG than Western populations. This study provides new evidence that TG is an independent risk factor of CHD in subjects with lower or higher TC levels, and supports the lowering of cut-off value for elevated triglyceride.

Adult↗
PubMed2006

A life-course approach to the aetiology of late-onset dementias.

Substantial progress has been made in the understanding of the neurobiology of dementias, but comprehensive causal models are not available. Genetic and environmental factors probably interact to determine vulnerability to the dementias. The life-course approach to age-related diseases, when systematically applied to the dementias, provides opportunities to identify the nature and timing of environmental contributions. We discuss the relevance of the fetal origins of adult disease hypothesis to the dementias. Associations between the dementias (most often described as Alzheimer's disease) and ischaemic heart disease, obesity, hypertension, hyperlipidaemia, and non-insulin-dependent diabetes mellitus are set against associations between dementias and childhood intelligence, low educational attainments, low socioeconomic status, occupation, and lifetime dietary history. Biological mechanisms that explain how fetal development might influence the risk of adult disease may be relevant to many age-related diseases including the dementias and, possibly, to the biology of ageing.

Age Factors↗
PubMed1989

How does gender influence age at first hospitalization for schizophrenia? A transnational case register study.

Numerous studies have reported a lower mean age at first hospitalization for schizophrenia in males than in females. For this finding not only a gender difference in age at first onset of schizophrenia, but also other factors can be responsible. With the aim of providing a comprehensive analysis of gender differences in onset, symptomatology and course of schizophrenia, we started by testing the hypothesis postulating a gender difference in mean age at first hospitalization. By using the Danish and the Mannheim psychiatric case registers we analysed all hospital admissions for schizophrenia and related diagnoses and all previous admissions for other diagnoses of the Danish population in 1976 and those of the inhabitants of the German city of Mannheim in the period of 1978-80. Artefacts were controlled for systematically. The impact of intervening variables such as selection factors as well as the influence of gender on the ascription of a diagnosis of schizophrenia for the first time were assessed. We found a mean difference of 5 to 6 years in age at first hospitalization between males and females in both countries when a broad definition of the diagnosis was used and of 4 to 5 years when a restrictive definition was applied. The higher mean age at first hospitalization among females is not attributable to artefacts, diagnostic procedures or to any essential extent to gender differences in help-seeking behaviour or occupational status. When a distinction was made between 'single' and 'married', the significant difference in age at first hospitalization between the sexes disappeared in singles. With case register data and without knowing the chronological order of marriage and onset of the disease, it remains an open question whether this finding can be explained by purely correlative associations between sex, marital status and age of onset or by causal effects.

Adolescent↗
PubMed1991

Factors influencing compulsory admission of psychiatric patients.

From 1 January 1984 until 30 June 1986 all 517 compulsorily admitted psychiatric patients of a well-defined mixed rural-urban catchment area in Baden-Württemberg, a southern State of the German Federal Republic, were compared with all 10,232 voluntarily admitted patients. Because of the very low frequency of compulsory admissions this population can be regarded as a 'core group' of committed patients. In a logit analysis the characteristics distinguishing involuntary from voluntary patients can be reduced to three main factors: the diagnosis 'schizophrenia/paranoid disorder', 'masculine gender' and the compound indicator 'not owning a home', the latter being mainly associated with youth, masculine gender and low occupational status. The strong association of these characteristics with the criteria 'severity of disease' and 'danger to oneself and others', both pre-requisites for compulsory admission according to the laws of most countries, is discussed.

Adult↗
PubMed1984

The effect of a mental hospital strike on general hospital psychiatric services.

Data collected from 6043 psychiatric in-patient records were analysed to assess the impact of a strike at a mental hospital on in-patient services in general hospital psychiatric units in St John's, Newfoundland, Canada. As a whole, during the strike general hospital units showed an increase in the number of involuntary admissions, the number of prior mental hospital admissions of patients, and indications of violent or suicidal behaviour; and a decrease in the occupational status of patients admitted and the prescription of minor tranquillizers. There was also evidence of considerable variation between general hospitals in the extent to which their admission pattern changed during the strike and the permanence of some of the strike effects. The data indicate that all patients showing violent or suicidal behaviour who would normally have been admitted to the mental hospital were treated in the general hospital units during the strike. On the other hand, a large number of patients diagnosed with schizophrenia, personality disorder or mental retardation, who normally would have been admitted to the mental hospital, apparently went without hospitalization during the strike. A substantial proportion of this latter group would usually have been admitted involuntarily.

Delivery of Health Care↗
PubMed2004

Higher socio-economic status of parents may increase risk for bipolar disorder in the offspring.

BACKGROUND: There are conflicting data regarding the socio-economic risk factors for bipolar disorders. The aim of the present study was to explore the association between the socio-economic status of an individual or the parent and the risk for bipolar disorder. METHOD: Two Danish registers were merged. From the data source, we extracted those born in 1960 or later, and those with a first-ever admission to, or contact with, Danish psychiatric facilities during 1981-1998 with a diagnosis of bipolar disorder. Fifty time-matched controls per case were chosen by the incidence-density sampling method. Effects of marital status, occupation, education, income, and wealth, of both subjects and the parents, were estimated using conditional logistic regression. RESULTS: A total of 947 cases were matched to 47 350 controls. Those at high risk of bipolar disorders were: single subjects, those in receipt of social assistance, pension or sickness payments, unemployed, subjects with a shorter educational history, and subjects with lower income. Conversely, parental higher education and higher level of paternal wealth were associated with increased risk. These associations remained significant after adjustment for gender, family history of psychiatric diagnoses, and other socio-economic variables, and are unlikely to be explained by known biases. CONCLUSIONS: The associations of lower socio-economic indices of subjects may be explained as a consequence of the disease. The association of higher socio-economic indices of parents may be explained by socio-economic achievement in the family of origin.

Adolescent↗
PubMed2006

Psychological factors in people at ultra-high risk of psychosis: comparisons with non-patients and associations with symptoms.

BACKGROUND: There have been recent advances in the ability to identify people at high risk of developing psychosis. This has led to interest in the possibility of preventing the development of psychosis and provides the opportunity to investigate psychological mechanisms that may confer vulnerability to psychosis. METHOD: Fifty-eight patients at ultra-high risk of developing a first episode of psychosis were compared with 56 non-patients matched for age and occupational status on measures of meta-cognition, schizotypal traits, dysfunctional attitudes and distress. RESULTS: Analyses of covariance revealed that people at high risk of developing psychosis scored higher on measures of cognitive vulnerability, including negative meta-cognitive beliefs, beliefs about rejection and criticism from others, and discrepancies in self-perception, schizotypal traits and general mental distress. Correlational analyses revealed that negative meta-cognitive beliefs, dysfunctional attitudes and beliefs about rejection and criticism from others were positively associated with several dimensions of symptomatology in at-risk mental states (ARMS) patients. CONCLUSIONS: Cognitive and personality factors appear to characterize people at high-risk of developing psychosis and are associated with their distressing experiences. The clinical implications of these findings are discussed.

Adult↗
PubMedDate not supplied

[Decision making process for compulsory admission: study of a group of psychiatrists of Sardinia, Italy].

OBJECTIVE: The aim of the study was to investigate the attitudes in the decision making process for admitting patients compulsorily under the Italian Law 180/78. SETTING: A group of psychiatrists (n = 81) working in the area of Cagliari (Sardinia, Italy). MAIN OUTCOME MEASURES: Three case-vignettes describing different hypothetical clinical situations: 1) a man with depression and psychotic symptoms; 2) a woman with a possible first episode of psychosis; and 3) a man with a history of substance abuse and bipolar disorder. Each vignette was followed by a list of 11 factors reported in the literature as important in the decision to admit compulsorily (current mental state, severity of the disease, dangerousness to self or others, psychiatric history, likely response of the mental state to the medical treatment, age and gender of the patient, owning a home, occupational status, social support available). Psychiatrists were asked: a) whether they would admit the patient compulsorily; and b) to rate 11 factors from the most to the least important in their decision. RESULTS: We obtained responses from 57 psychiatrists (26 males and 31 females). The most important factors for deciding to detain a patient compulsorily were: current mental state, diagnosis, severity of the illness and possible contribution of medical treatment. Perceived dangerousness to self and others was considered the most important factor by 23% of the sample. CONCLUSIONS: Our results confirm that, in three different hypothetical situations, there is agreement in the factors perceived as the most important in the decision to admit compulsorily, although their application is highly subjective. The factors correspond to those recommended by the Italian Law 180. The need for protection of the patient or others has an important role in the decision and may take precedence over the current mental state of the patients [corrected].

Adult↗
PubMed2000

[Personality disorders and psychiatric morbidity in adolescent anorexia nervosa. Results of a prospective 10 year catamnesis].

The aim of the current prospective study was to examine at regular intervals the course of the eating disorder symptoms and the psychiatric (co-) morbidity including personality disorders among juvenile patients who fulfilled the DSM-III-R criteria for anorexia nervosa. Ten years after release from hospital all 39 patients (100%), as well as a control group parallelized for age, gender and occupational status were personally followed-up. Symptoms of eating disorders were documented by means of the Standardized Interview for Anorexia and Bulimia nervosa (SIAB, Fichter et al., 1991), the Composite International Diagnostic Interview (WHO, 1990) was applied to diagnose psychiatric (co-) morbidity, and the Structured Clinical Interview (SKID-II, Spitzer et al., 1993) to assess personality disorders. Compared to the control group, at the time of follow-up a significantly greater number of patients were suffering from a psychiatric disorder, primarily an anxiety disorder, an affective disorder or from drug, respectively alcohol abuse. Personality disorders, chiefly anxious-avoidant types on the DSM-III-R were diagnosed among almost one-fourth of the patients. Our findings indicate that anorexia nervosa is not a developmental disorder limited to puberty but a disorder associated both cross-sectionally as well as longitudinally with other psychiatric disorders.

Adult↗
PubMed2004

[Autonomy and informed consent in surgical care-patients' and staff perceptions].

The aim of this study was to describe autonomy and informed consent in surgical care. The study is a part of the international BIOMED 2 project "Patients' Autonomy and Privacy in Nursing Interventions" (BIOMED2, BMH4-CT98-3555; 1998-2001) supported by the European Commission. For this study, data of patients (n = 254) and nurses (n = 205) in eleven Berlin hospitals and three hospitals outside Berlin were collected by means of a structured questionnaire. The findings of the study indicate, that information-giving was more positive than decision-making. Patients perceived they were more frequently informed about their surgery than about their care. According to the perceptions of nurses the case was reversed. The perceptions of both groups differed, since from the point of view of nurses, patients' autonomy was more frequently heeded and their consent was sought more often than from the point of view of the patients. Patients admitted as emergencies and in multi-bed rooms perceived their autonomy more negatively than those with a planned surgery or in single rooms. Elderly nurses were more frequently than younger nurses of the opinion to grant patients autonomy. Nurses with a longer working experience in nursing care perceived that patients were more frequently asked their consent. Further, nurses with a higher educational qualification and with a higher occupational status perceived decision-making more negatively. The findings of the present study give implications for clinical practice, nursing education, and for further research.

Adolescent↗
PubMed2000

Medication adherence in psychosis: predictors and impact on outcome. A 2-year follow-up of first-admitted subjects.

OBJECTIVE: To assess the baseline characteristics predicting poor medication adherence following a first admission for psychosis, and the impact of poor medication adherence on outcome. METHOD: First-admitted subjects with psychosis (n = 65) were assessed at 6-month intervals over a 2-year follow-up. Medication adherence was assessed using multiple sources of information. RESULTS: Baseline lower occupational status, alcohol misuse and the intensity of delusional symptoms and suspiciousness predicted poor medication adherence during the 2-year follow-up. Over this period, subjects with poor medication adherence presented more frequently with an episodic course of illness and were more frequently readmitted, especially with regard to involuntary readmission. CONCLUSION: In naturalistic conditions one out of two subjects with psychosis interrupts his/her treatment in the months following his/her first discharge from hospital. Therapeutic programmes aimed at improving medication adherence should be implemented early in the course of psychosis to reduce the deleterious consequences of poor medication adherence on clinical outcome.

Adolescent↗