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A study was undertaken to investigate compliance in patients receiving growth hormone treatment. Two hundred patients completed a questionnaire designed to establish understanding about and compliance with treatment; 50% of our patients failed to comply with all aspects of their treatment. Failure to respond to treatment seems to be associated with poor compliance.
PURPOSE: We addressed the issue of the relationship between the general practitioner (GP) and the radiotherapist to improve the quality of care of cancer patients. MATERIAL AND METHODS: The study consisted in evaluating medical requests and phone interviews, with a questionnaire with yes/no and multiple choice answers to the following 5 questions: 1) Do you think a cancer diagnosis is always a hopeless death sentence? 2) Is it professionally rewarding to cure a cancer patient? 3) Are you satisfied with your relationship, as a general practitioner, with oncologic reference centers? 4) Is it more wearing for a general practitioner to manage a cancer than a noncancer patient? 5) Would you answer a questionnaire about the relationship between the general practitioner, the cancer patient and the oncologist? We evaluated 1590 medical requests and made 401 phone interviews; 255 colleagues (70%) answered the questionnaire. RESULTS: Medical requests were correctly and completely formulated by GPs in 45% of cases. A cancer diagnosis was not considered a hopeless death sentence in 90.9% of cases and 76% of GPs considered it professionally rewarding to cure a cancer patient. 75.6% of GPs considered it more wearing to manage a cancer than a noncancer patient, and female GPs felt this more strongly than their male counterparts. Irrespective of gender, GPs over 50 years of age tend to consider cancer a hopeless and fatal disease. The relationship with oncologic centers was considered satisfactory in 86.2% of cases. However, since cancer patients need greater medical care, GPs would like a closer cooperation with oncologists. DISCUSSION AND CONCLUSIONS: The great interest GPs took in this study encourages further investigation through a more in depth questionnaire designed with the help of GPs themselves and interested statisticians.
PURPOSE: To evaluate the effect of cytomegalovirus (CMV) retinitis on quality of life (QOL) in patients with the acquired immune deficiency syndrome (AIDS). DESIGN: Enrollment data from a multicenter, prospective cohort study. PARTICIPANTS: Patients >/=13 years of age with AIDS in three groups: no CMV retinitis, 709 patients; long-standing CMV retinitis (diagnosed a median of 34.5 months previously), 212 patients; and newly diagnosed CMV retinitis (diagnosed </=45 days previously), 50 patients. METHODS: Patients were enrolled at 19 centers throughout the United States. CMV retinitis status was determined by ophthalmoscopy. Vision-related QOL was assessed with a questionnaire designed for patients with CMV retinitis. General health-related QOL was evaluated with a modified version of the Medical Outcomes Survey-HIV instrument. Health utility was measured with the EuroQol instrument. MAIN OUTCOME MEASURES: Patient-reported vision-related QOL, general health-related QOL, and health utility. RESULTS: All domains of vision-related QOL were substantially lower in both the long-standing and newly diagnosed CMV retinitis groups than in the group with no CMV retinitis. The long-standing CMV retinitis group was similar to the no CMV retinitis group in most general health-related QOL domains and in health utility measures. The newly diagnosed CMV retinitis group scored substantially worse than the other groups in many of the general health-related QOL domains and in visual analog scale-measured health utility. Adjustment of selected scale scores for demographic characteristics and for CD4(+) T-cell count, human immunodeficiency virus viral load, and use of highly active antiretroviral therapy (HAART) attenuated most of the differences in general health-related QOL, except that physical function scores remained significantly lower in the newly diagnosed CMV retinitis group. Adjustment did not alter the pattern of vision-related QOL results. CONCLUSIONS: These results suggest that in the HAART era, CMV retinitis is associated with reduced vision-related QOL in patients both with newly diagnosed and with long-standing disease, even though patients with long-standing CMV retinitis seem to have general health-related QOL and health utility similar to that of patients with AIDS who do not have CMV retinitis. Newly diagnosed CMV retinitis also is associated with lower general health-related QOL in most domains and with lower health utility.
PURPOSE: We assessed the psychometric properties of the newly developed Erectile Dysfunction Effect on Quality of Life (ED-EQoL) instrument for quantifying the effect of erectile dysfunction on quality of life. MATERIALS AND METHODS: The questionnaire was assessed in a cohort of 283 men recruited from 11 centers in the United Kingdom. Internal consistency was examined by Cronbach's alpha, test-retest reliability was determined by administering the instrument on 2 occasions 2 weeks apart without treatment in the interim, construct validity was assessed by comparison with other quality of life measures and responsiveness was evaluated by comparing the change in the ED-EQoL after treatment with change in other measures. RESULTS: The ED-EQoL was simple to complete and captured wide variation in quality of life. It demonstrated good internal consistency and reliability, and generally correlated in an expected manner with other quality of life measures. Correlation with initial erectile function was relatively low but the change in function after treatment was reflected by the change in quality of life. CONCLUSIONS: When assessing erectile dysfunction in clinical practice or research, it is important to consider the effect on quality of life in addition to function. To our knowledge the ED-EQoL is the first erectile dysfunction specific quality of life instrument developed and extensively validated according to accepted principles of questionnaire design. Combined with a measure of erectile function its use is recommended in routine clinical practice and in research to provide a holistic approach to the assessment of erectile dysfunction and its treatment.
A quasi-experimental design was used to test the effects of instructor gender on knowledge, feelings, behavior and self-efficacy related to AIDS prevention education of 44 African-American women (N = 44) when such instruction was provided by male instructors as compared to their female counterparts. The groups consisting of 11 members each (n = 11) were randomly assigned to one of four instructors of which two were males and two were females (n = 2 males and n = 2 females). A pre- and post-test questionnaire designed specifically for use with African-American women was administered to determine if there was a significant difference in measured learning outcomes when AIDS education was provided by instructors based on gender to these African-American women enrolled in the study. The women who had male instructors scored significantly higher on the behavior post-test as compared to those who had female instructors. No significant differences were found for the effect of male and female instructors on the women's feelings and knowledge scores. In addition, instructor gender did not effect change in self-efficacy. AIDS prevention education significantly increased self-efficacy scores regardless of instructor gender.
OBJECTIVE: To assess the relationship between dietary factors and cardiovascular (CVD) risk factors in middle-aged men and women, in urban, rural and pastoral settings in Tanzania. DESIGN: Cross-sectional epidemiological study designed according to the protocol of the World Health Organisation (WHO) Cardiovascular Diseases and Alimentary Comparison (CARDIAC) study. SETTING: Three centres in Tanzania, namely Dar es Salaam (urban), Handeni (rural) and Monduli (pastoral population). SUBJECTS: The subjects, aged 47-57 years, were recruited randomly from administrative lists available from each centre. OUTCOME MEASURES: Blood pressure (BP) was measured using a centrally calibrated automatic BP machine (Khi machine). Dietary history of the participants was obtained using a standard questionnaire designed on the basis of a seven-day recall system. Height, weight, serum total cholesterol (TC) and high-density lipoprotein cholesterol (HDLC), haemoglobin A1c, sodium, potassium and magnesium were measured. RESULTS: The prevalence of hypertension (BP > or = 140/90 mmHg or antihypertensive drug use), obesity (body mass index (BMI) > or = 30 kg/m2) and hypercholesterolaemia (TC > 5.2 mmol/l) were lowest in the rural area. Consumption of green vegetables, milk, coconut milk, meat, and fish varied significantly between the three areas. Important determinants for BP among men were BMI (p < 0.001), and salt intake (p < 0.05). Among women, TC (p < 0.05), age (p < 0.05), BMI (p < 0.001) and coconut milk consumption (p < 0.001) were important BP determinants. Salt intake was positively associated with systolic BP (SBP) and diastolic BP (DBP) in men but not among women (both SBP and DBP p < 0.05 respectively). Dietary determinants of serum TC were meat, fish and green vegetable consumption. CONCLUSION: Differences in dietary habits contributed significantly to the urban-rural-pastoral variations in CVD risk pattern in Tanzania.
UNLABELLED: Middle ear effusion (MEE) is a common childhood disease characterized by accumulation of fluid in the middle ear. MEE treatment focuses on the resultant conductive hearing loss. Recently, researchers have investigated the potential effects of MEE on balance. PURPOSE: The purpose of this study was to compare balance of children with MEE to that of healthy children and to examine whether a relation exists between balance skills and the degree of muscle strength. METHODS: Twenty children with MEE and twenty healthy children aged 4.5 - 7.5 years underwent balance and strength sub-tests of Bruininks - Oseretsky Test of Motor Performance (BOTMP) and electronystagmography recordings (ENG). Parents completed a questionnaire designed to elicit their perceptions of their child's balance abilities in daily living activities. RESULTS: MEE children performed significantly worse than did the control group on BOTMP balance sub-test. BOTMP strength subtest indicated that children with MEE had poorer muscle strength than the control group, although the difference was not significant. ENG results showed no pathologic recordings in both study group and control group. Finally, a significant correlation was found between parents' responses on the questionnaire and their child's performance on BOTMP balance subtest. CONCLUSIONS: MEE may negatively impact children's balance, while muscle strength is less affected. Furthermore, the BOTMP appears to be a sensitive assessment of balance disturbances in children with MEE.
A multidisciplinary group has developed a health index questionnaire designed to measure the social, emotional, and physical function of free-living populations. The strategy has been found to be generally applicable, capable of application by lay interviewers, acceptable to interviewees, and amenable to index construction. Furthermore, initial evaluations of the resulting health indices suggest that they are biologically and clinically valid. These health indices have been successfully applied in a randomized trial of innovative primary care services. The comceptualization of individual sections of the health index questionnaire for each of these three functional areas, the generation of the instrument, and the evaluation of questionnaire responses for their biologic and clinical validity are summarized here.
The opinion of engine drivers concerning the design of the cab in a new engine (Rc5, ASEA, Sweden) is surveyed in the present study, which is aimed at recommendations for further improvements of the new cab. Fifty engine drivers from the northern part of Sweden (Ange, Vannas and Boden), who had been driving the new engine, were selected at random to answer a specially designed questionnaire. Most of the drivers considered the new cab as better than the old one (Rc4) in several respects. Particularly appreciated was an adjustable footrest, on which the safety regulator pedal was fitted, which enabled an individually adjusted position for driving. They also preferred the automatic brake valve located close to the driver and with its movements in a sagittal direction. A number of proposals for further improvement of the cab are presented in order to attain an optimally designed driver's cab.
This paper describes the development of a self-report questionnaire designed to assess assumptions and beliefs associated with eating disorders. Factor analyses suggested to replicable four-factor structure consisting of the following dimensions: negative self-beliefs; weight and shape as a means to acceptance by others; weight and shape as a means to self-acceptance; and control over eating. The subscales possess good psychometric properties and significant correlations were found between the subscales and other measures of the specific and general psychopathology of eating disorders. The questionnaire also distinguished two groups of patients with eating disorders from normal controls. The usefulness of the measure and implications of the findings for cognitive theories of eating disorders are briefly discussed.
Incidence of cutaneous phototoxic reactions induced by intravenous injection of Photofrin polyporphyrin was assessed in a series of 180 patients (266 injections) undergoing photodynamic therapy (PDT) at Roswell Park Cancer Institute during the period 1986-1989. In addition to the usual verbal questions regarding phototoxic reactions solicited at follow-up, forty-two patients in this group also responded to a written questionnaire designed to solicit answers to specific questions. Photofrin doses ranged from 0.5 to 2.0 mg/kg. Overall, 20-40% of patients reported some type of phototoxic response.
The objective of the present study was to assess the prevalence of asthma and asthma-related symptoms in Finland. We also wondered whether chronic cough may be an indicator of occult asthma. Prevalence and characteristics of children with doctor-diagnosed asthma and chronic respiratory symptoms were investigated in 7-12 year old school children from eastern Finland by using a questionnaire on respiratory symptoms. In addition, skin-prick tests, flow-volume spirometry, and serum total immunoglobulin E (IgE) measurements were performed in children reporting chronic respiratory symptoms. The parent-reported prevalence of doctor-diagnosed asthma was 4.4%, of wheezing 5.4%, of attacks of shortness of breath with wheezing 4.6%, and of dry cough at night 12%. Children with dry cough only (n = 195) had less frequent parental asthma, self-reported allergies, daily respiratory medication, and moisture stains or molds at home than asthmatic children (n = 180), but these findings were more frequent than among asymptomatic children (n = 2,169). The prevalence of at least one positive skin-prick test result was 79% among the asthmatic children and 55% among children with dry cough only. There were no differences between the two symptom groups in serum total IgE levels and spirometric lung functions, except in maximal mid-expiratory flow (MMEF) values, which were significantly lower among children with asthmatic symptoms. The present results support the hypothesis that chronic cough may be an indicator of occult asthma. Therefore, to improve the sensitivity of respiratory questionnaires designed to detect asthma, they should also include questions on chronic cough.(ABSTRACT TRUNCATED AT 250 WORDS)
OBJECTIVE: The aim of this study was to assess health professionals' beliefs about the helpfulness of a broad range of possible interventions for mental disorders. METHOD: The study involved a postal survey of 872 general practitioners (GPs), 1128 psychiatrists and 454 clinical psychologists. These health practitioners were presented with a vignette describing either a person with schizophrenia or one with depression. The vignettes were taken from an earlier survey of the general public. Respondents were asked to rate the likely helpfulness of various types of professional and non-professional help and of pharmacological and non-pharmacological interventions. RESULTS: Two-thirds or more of each profession agreed that the person with schizophrenia would be helped by GPs, psychiatrists, clinical psychologists, antipsychotic agents and admission to a psychiatric ward. Similarly, two-thirds agreed that the person with depression would be helped by GPs, psychiatrists, clinical psychologists, antidepressants, counselling and cognitive-behavioural therapy. However, there were also areas of disagreement. Psychiatrists were less likely than GPs and clinical psychologists to rate psychological and lifestyle interventions as helpful, while clinical psychologists were less likely to rate specifically medical interventions as helpful. Younger members of the professional groups and female members (who also tended to be younger) tended to rate a wider range of interventions for each disorder as likely to be helpful. CONCLUSIONS: Despite areas of broad agreement about treatment, health practitioners were more likely to endorse the interventions associated with their own profession. However, younger members of each profession tended take a broader view. If these age differences represent a cohort effect, health professionals may in the future show greater acceptance of the helpfulness of interventions offered outside their profession. These conclusions are limited by the methodology of the survey, which involved a questionnaire designed for the public rather than professionals.
Sixty-three family practitioners responded to a special questionnaire designed to determine their judgment of what is most important to teach medical students and those residents headed toward careers in family practice. The ranking of emphases and specific diseases should be helpful to dermatologists responsible for the instruction.
OBJECTIVE: To determine how adolescents use medication to manage menstrual discomfort. DESIGN: Survey. SETTING: Public high school. PARTICIPANTS: Convenience sample of 386 adolescent girls (80% return rate: 10 refusals and 8 exclusions). Two hundred and ninety-one cases were used for analyses (16.26+/-1.00 years [mean+/-SD]; range, 14-21 years), distributed equivalently across grades 10 through 12. Parent's socioeconomic status was predominately class III or lower on Hollingshead's Two-Factor Index of Social Status. Eighty-five percent of the subjects were English Canadian. MAIN OUTCOME MEASURES: The Menstrual Distress Management Questionnaire (designed for our study to measure disability and medication use) and the Symptom Severity Scale. RESULTS: Ninety-three percent reported menstrual discomfort during the last 3 menstruations and 70% of these had used over-the-counter (OTC) medications to manage the discomfort. Users of OTC medications reported greater symptom severity and disability than non-OTC users. Seventy-five percent of the OTC medication users took within the recommended dose of 1 to 2 pills, but 57% took medication less often than the maximum daily frequency. The size of a single dose of OTC medication was correlated with how often OTC medication was taken (r[s]=0.40, P<.001). Seventeen percent used prescription medication and reported significantly greater symptom severity and disability than nonprescription medication users. Seventy-one percent of the prescription drug users took the prescribed amount, 13% took less, and 16% took more. CONCLUSIONS: Adolescent girls frequently suffer from menstrual discomfort and use OTC medications to manage the discomfort, but they may not be using OTC medications effectively. There are possible explanations for medicating behavior and future research directions should be considered.
This report is the second in a series of investigations designed to develop a working model identifying the effects of trade-offs between selected conversational maxims on public attitudes toward augmentative and alternative communication (AAC) system users and their communication. In the current study, tradeoffs between the informativeness of a prestored message and its speed of delivery were examined. A total of 96 salesclerks participated. Sixteen scripted, videotaped conversational conditions, involving an AAC customer and a clerk at a checkout counter, were used to manipulate message informativeness and speed of message delivery. Following each assigned viewing, participants completed a questionnaire designed to assess their attitudes toward the AAC user and his or her communication. The conditions involving (a) the quickly delivered message with excessive information, (b) the slowly delivered message with adequate information preceded by a "floorholder," and (c) the slowly delivered message with adequate information without a floorholder were rated higher than (d) the quickly delivered message with inadequate information. There was no main effect for participant or AAC user gender. Implications regarding a model of conversational trade-offs and technological applications are discussed.
PURPOSE: The purpose of this study was to evaluate the effects of colostomy on the quality of life (QOL) in patients with spinal cord injury (SCI) by designing a questionnaire that used self-reported data and correlating these data with the clinical information obtained from patients' medical records. MATERIALS AND METHODS: A comprehensive QOL questionnaire was designed to specifically address the following 5 domains: physical health, psychosocial adjustment, body image, self-efficacy, and recreation/leisure. This questionnaire was completed during a telephone or an in-person interview. The subjective data derived from the questionnaire were correlated with objective medical information obtained from a review of medical records. RESULTS: The QOL improved significantly (t = 9.1 28, P < .0001) after colostomy. All 27 (100%) patients were "satisfied," and 16 (59%) of them were "very satisfied" with colostomy. Nineteen (70%) patients would have preferred to have the colostomy done earlier, and only 3 (11%) patients wished it reversed. Colostomy reduced the number of hospitalizations caused by chronic bowel dysfunction by 70.4%. After colostomy, the average amount of time spent on bowel care was reduced from 117.0 min/day to 12.8 min/day (t = 7.964, P < .0001). All patients stated that colostomy simplified bowel care routine and increased independence. Significant improvements were recorded in the areas of physical health, psychosocial adjustment, and self-efficacy. Stoma prolapse and wound dehiscence were the most common complications of stomal surgery. When compared with medical data, patients were able to reliably recall average time with bowel problems (r = .881, P < .0001) and stomal surgery complications (r = .810, P < .0001). CONCLUSION: Colostomy is a safe and effective treatment for chronic bowel dysfunction in patients with spinal cord injury. It is well accepted by the patients and significantly improves QOL and bowel management procedures. Correlation analysis indicates that subjective patient-reported data are consistent with objective data obtained from the medical records.
In a study that covered ten years a questionnaire about perceived health and use of health care services was mailed each autumn to 1/60 representative samples of the population in Sollentuna, a Swedish primary care district. The majority of respondents thought that their health was good, and only a small minority reported themselves as quite, or very sick. Those assessments were stable during the ten year period. The tendency to visit the health services increased with the degree of severity of the illness. This increase was most marked in the case of visits to emergency departments and visits by appointment at hospitals, and least in the case of visits to private doctors and company/school physicians, while visits to doctors at health centres and to district nurses occupied an intermediate position. Thus, by including a simple question about perceived health in a questionnaire designed to measure use of health care services, important information about the relations between use of health services and health conditions could be obtained.