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PubMed1998

Intraindividual comparison of the bone-anchored hearing aid and air-conduction hearing aids.

BACKGROUND: Some patients have to stop using their air-conduction hearing aid(s) because it causes or exacerbates chronic otitis. Then, a solution is the use of a bone-conduction hearing aid such as the percutaneous bone-anchored hearing aid (BAHA). OBJECTIVE: To compare patients' performance with their previous air-conduction hearing aid(s) and their BAHA using audiometric tests and a questionnaire. DESIGN: Prospective clinical evaluation in a single subject design. PATIENTS: The results of 34 consecutive patients from the Nijmegen, the Netherlands, BAHA series were included. The patients had bilateral conductive or mixed hearing loss and chronic ear problems. Before the BAHA was fitted, the patients used air-conduction hearing aids. RESULTS: The results of the speech recognition in noise test showed a small but significant improvement with the BAHA. This improvement was related to the size of the air-bone gap. The greater the air-bone gap, the poorer the results with the air-conduction hearing aid(s). The questionnaire demonstrated that the majority of patients preferred the BAHA; diminished occurrence of ear infections played a significant role. The patients did not express an evident preference concerning speech recognition. CONCLUSIONS: In patients with chronic ear problems a BAHA is an acceptable alternative if an air-conduction hearing aid is contraindicated. Preoperative assessment of the size of the air-bone gap is of some help to predict whether speech recognition may improve or deteriorate with the BAHA compared with the air-conduction hearing aid.

Adult↗
PubMed1998

Measuring health status in older patients. The SF-36 in practice.

OBJECTIVE: To examine the use of the Medical Outcomes Study short form 36-item (SF-36) health status measure in older patients receiving health care; to explore the influence of age and physical and cognitive status on response to and completion of the SF-36 questionnaire. DESIGN: Prospective observational study. SETTINGS: Hospital and ambulatory patients aged 65 years and over in the medical and surgical wards and outpatient department of a teaching hospital and a local general practitioner's surgery. SUBJECTS: 1014 hospital inpatients, 80 hospital outpatients and 40 patients attending their general practitioner's surgery. MAIN OUTCOME MEASURES: Response rates, overall rates of completion (sufficient to calculate a valid SF-36 score) and completion of individual questions. RESULTS: 37 out of 40 ambulatory patients in general practice (93%) and 71 out of 80 outpatients (89%) returned a self-completed questionnaire. In hospital inpatients the overall response rate was only 46% (369 of 802). This was improved by interview administration to 77.4% (164 of 212). Logistic regression analysis revealed that self-completion, cognitive dysfunction, disability and age were all independently associated with poor overall response rates. Among those patients who returned a completed questionnaire, completion of individual questions sufficient to calculate a valid score was variable. Only 62.5% of inpatients who self-completed a questionnaire gave sufficient response to calculate a score on the mental health subscale, compared with 93.7% of general practice patients. CONCLUSION: The self-administered questionnaire is unacceptable for older hospital inpatients. Use of an interviewer improves response, but factors which influence health status, such as physical and cognitive dysfunction, have a significant effect on response rates. Therefore the utility of the SF-36 in its present form as a routine health status measure for use in older hospital inpatients is questioned.

Aged↗
PubMed2002

Appraisal and psychological distress six months after diagnosis of breast cancer.

OBJECTIVES: Four in ten women with breast cancer experience high levels of anxiety or depression, despite advances in oncology treatments. The study investigates the role of psychosocial, disease and treatment characteristics, and appraisal processes to better understand factors contributing to this high psychological morbidity. DESIGN: A postal survey was employed to observe psychological morbidity in women 2 and 6 months after initial diagnosis and treatment of breast cancer. The study was conducted as an adjunct to an Australian multi-centre feasibility study of an evidence-based specialist breast nurse (SBN) model of care. METHODS: In total, 195 women with a new diagnosis of early or locally advanced breast cancer completed the data collection relating to this study. Psychosocial, disease and treatment information for each woman at diagnosis was recorded in research logs. Women completed the GHQ-12 questionnaire 2 months after diagnosis, and at 6 months they completed the GHQ-12 and an appraisal process questionnaire designed by the National Breast Cancer Centre (NBCC). Bivariate and multiple regression analyses were undertaken to build a statistical model to account for GHQ-12 scores at 6 months. RESULTS: According to the GHQ-12, 43% of women had a likely affective disorder at either 2 or 6 months after diagnosis. Point prevalence decreased from 2 to 6 months yet remained substantial compared with general population statistics. Psychological functioning in women with breast cancer is related to a woman's psychiatric history, grade of tumour, and her appraisal processes. Most importantly, improved psychological functioning from 2 to 6 months after diagnosis is related to a woman having a lower primary appraisal of threat and a greater secondary appraisal of self-efficacy in terms of having confidence in her own ability to cope with concerns associated with the illness. CONCLUSION: Appraisal processes play a significant role in psychological adjustment to breast cancer. Adjustment may be facilitated by ensuring that the treatment team responds to shortfalls in a woman's appraisal of her illness and her perceived ability to cope, especially where a difficult prognosis is evident.

Journal Article↗
PubMed2003

Development of the York Angina Beliefs Questionnaire.

It is known that people who have suffered a heart attack can hold misconceived or maladaptive beliefs and that these can have a deleterious effect on quality of life and functioning. It has also been noted that clinicians do not routinely elicit these maladaptive beliefs. It is probable that angina sufferers also hold such beliefs. As angina is a great burden in the western world, with over two million people with angina in the UK alone, there may be large numbers of people who suffer from these frightening and unhelpful misconceptions. We believe that there is a need for a simple questionnaire that could assist the delivery of tailored education directed at dispelling common misconceptions. This article details the development and psychometric properties of just such a brief questionnaire, designed for use both in research and in clinical practice.

Activities of Daily Living↗
PubMedDate not supplied

[Knowledge about infant asthma in medical students of Mérida, Yucatán, México].

146 undergraduate medical students at the Universidad Autónoma de Yucatán completed a questionnaire designed to measure knowledge about childhood asthma. Knowledge about asthma increased over each of the 7 years of the medical course, but the global qualification was lower their 60 points. The results suggest the necessity of implementation an educational program about childhood asthma.

Asthma↗
PubMed1994

Improving the quality of teaching: staff responses to students' views.

This paper describes the use of a questionnaire designed to enable students to comment on aspects of the teaching they received from their tutor during the preclinical course in Conservative Dentistry. The information was subsequently used by the teachers themselves, to modify their performance.

Analysis of Variance↗
PubMed2003

Prison wardens' perception of psychosocial and service needs of incarcerated women.

Wardens and administrators of 77 women's correctional facilities were mailed a questionnaire designed to assess the psychosocial and service needs of incarcerated female inmates nationally. 35 completed surveys were returned. Representativeness of the sample is discussed. Analysis identified attitudes about recent correctional trends perceived by wardens, including concerns about child care while incarcerated.

Adult↗
PubMedDate not supplied

Perceptions of contradictory communication from parental figures by adults with borderline personality disorder: a preliminary study.

This study investigated a hypothesized correlation between contradictory responses from parental figures perceived in present-day interactions by adult subjects and the diagnosis of borderline personality disorder (BPD). One hundred subjects were given a questionnaire designed to assess the frequency of perceived parental response patterns divided into appropriate, conflicting, polarized, and neglectful categories. The BPD and a group subthreshold for the disorder endorsed significantly more conflicting and fewer appropriate responses for the first parental figure rated than did both patient control subjects and normal control subjects without BPD; a trend toward similar results was found for the second parental figure also. The frequency of polarized and neglectful responses was not significantly different among the groups. There was indirect evidence that BPD subjects did not engage in the defense mechanism of "splitting" when filling out the questionnaire. These results suggest that contradictory family communication patterns might be considered in models of ongoing reinforcement for dysfunctional BPD behavior.

Adult↗
PubMedDate not supplied

CDC's Model Performance Evaluation Program: assessment of the quality of laboratory performance for HIV-1 antibody testing.

In 1986, the Centers for Disease Control (CDC) implemented the Model Performance Evaluation Program (MPEP) to evaluate the performance of laboratories that test for antibody directed against human immunodeficiency virus type 1 (HIV-1). The impetus for developing this program came from the recognition of a need to assess the quality of existing and changing laboratory technology and to ensure that the quality of testing was sufficient to meet medical and public health needs. To develop the program, CDC chose HIV-1 antibody testing as the first specific application for assessing the quality of laboratory performance because (a) of the importance of accurate and reproducible test results for acquired immunodeficiency syndrome (AIDS) surveillance, prevention, and treatment programs; (b) HIV-1 testing technology is new to many laboratories; and (c) HIV-1 testing practices and applications continue to evolve. Unlike proficiency testing programs, the MPEP is not limited to assessing quality in the analytical step, alone. It will also assess quality in the preanalytical and postanalytical steps of the testing process, that is, from the time a test is requested until the clinician who ordered the test takes an action based on the test result. The participating laboratories furnish the information needed for the performance evaluation program by (a) completing questionnaires designed to describe HIV-1 testing laboratories and their testing practices, (b) analyzing specially prepared sample panels for HIV-1 antibody reactivity, and (c) reporting results to CDC.

AIDS Serodiagnosis↗
PubMed1993

The effect of psychosocial stress and risk factors for ischaemic heart disease on the plasma fibrinogen concentration.

OBJECTIVES: To assess the effect on the fibrinogen concentration of sleep disturbance and mental stress, taking into account the effect of 21 other variables related to the risk of cardiovascular disease. DESIGN: A cross-sectional study on men threatened by redundancy, and controls. SETTING: A health screening programme in Malmö, Sweden. SUBJECTS: Four hundred and eighty five workers in a shipbuilding yard, scheduled for closure, and 190 age-matched men. The subjects were randomly selected from a larger group of shipyard workers and controls invited to a health screening programme. Mean age was 51.6 years (range 38-62 years). MAIN OUTCOME MEASURES: Plasma fibrinogen concentration, serum cortisol concentration, body composition, blood pressure, heart rate, blood lipids, platelet number and size, white blood cell count, haemoglobin concentration, vital capacity, liver enzymes, blood glucose concentration fasting and after an oral glucose tolerance test. Questionnaire designed to evaluate muscle tension, sleep disturbance, anxiety, depression, job stress, alcohol and smoking habits and perceived health. RESULTS: In stepwise regression analysis fibrinogen concentration was found to be correlated to white blood cell count, muscle tension, heart rate, body mass index, age and serum cholesterol concentration in non-smokers, which together explained 14.9% of the variation in fibrinogen concentration. In smokers, platelet count, heart rate, serum triglyceride concentration, age and fasting glucose explained 22.5% of the variation in fibrinogen concentration. The fibrinogen concentration was inversely correlated to the psychological variables, but unrelated to the serum cortisol concentration or to factors connected with the job situation, and it was decreased in moderate alcohol consumers. CONCLUSIONS: Our interpretation of the findings is that an increase in the plasma fibrinogen concentration reflects the presence of a low-grade inflammatory process, and poor physical fitness.

Adult↗
PubMed2006

Development and psychometric validation of an eating disorder-specific health-related quality of life instrument.

OBJECTIVE: Health-related quality of life (HRQOL) has been used increasingly as an outcome measure in clinical research. Although the generic quality of life instruments has been used in previous research, disease-specific instruments offer greater sensitivity and responsiveness to change than generic instruments. No such disease-specific instrument is currently available that applies to eating-disordered samples. METHOD: The current article reports on the development and validation of the Eating Disorders Quality of Life (EDQOL) instrument, a disease-specific HRQOL self-report questionnaire designed for disordered eating patients. RESULTS: The EDQOL demonstrates excellent psychometric properties. CONCLUSION: The application of the EDQOL as an outcome measure in eating disorder research is considered.

Adolescent↗
PubMed2002

An evaluation of quality of life in patients who underwent orthotopic bladder replacement after cystectomy: comparison of ileal neobladder versus colon neobladder.

OBJECTIVE: The objective of this study was to determine whether the quality of life (QOL) in patients who underwent orthotopic bladder replacement after radical cystectomy was affected by the intestinal segment used for the creation of a neobladder. MATERIALS AND METHODS: A total of 52 patients who underwent radical cystectomy for bladder cancer were included in this study; i.e., 24 patients with an ileal neobladder and 28 patients with a sigmoid neobladder. QOL was evaluated using the SF-36 health-related QOL survey and a questionnaire designed to evaluate the continent status. RESULTS: The mean follow-up periods for patients with an ileal and a sigmoid neobladder was 40.2 and 43.1 months, respectively. The SF-36 survey revealed that patients with colon neobladder had a significantly higher score for role-emotional functioning than those with ileal neobladder, while there was no significant difference in the remaining seven scores between patients with ileal and colon neobladders; however, general health and social functioning in patients with both types of neobladder appeared to be significantly lower than those in the general population in the United States. The results of the questionnaire analyzing the continent status were also similar between these two groups, including the desire to urinate, the incidence of both day- and nighttime urinary leakage, the frequency of pad exchange, and the concern of urine odor. CONCLUSIONS: Six of the eight scales concerning health-related QOL were favorable with both patients with ileal and colon neobladders, and the health-related QOL in orthotopic neobladder patients except for role-emotional functioning was not affected by the segment of the intestine used for neobladder construction. Moreover, no significant differences were observed in the QOL associated with continent status between these two groups. Therefore, patients with both types of orthotopic neobladder were generally satisfied with their health-related as well as disease-specific QOL.

Adaptation, Physiological↗
PubMed1994

Cognitive and affective reactions of black urban South Africans towards tuberculosis.

SETTING: The core concepts of tuberculosis (TB) control programmes are case-finding (voluntary presentation) and case-holding (compliance for both patient and system). Voluntary presentation and compliance are complex behaviours that depend upon symptom recognition and evaluation, cultural and social influences and enabling factors such as time, money, skills and appropriate/accessible health services. It was hypothesised that cognitive and affective reactions towards TB were based on perceived prevalence, perceived seriousness and perceived social stigma. OBJECTIVES: To ascertain the underlying dimensions that are used when people react cognitively and emotionally to TB, and to determine possible restricting social influence factors on voluntary presentation and case-holding. DESIGN: A questionnaire was designed to obtain information on background details, perceptions of TB (transmission, prevention, diagnosis and treatment), and a 19-item cognitive/affective scale. 19 trained interviewers administered the questionnaire. Interviews were conducted with 487 black adults (67 TB patients on ambulatory therapy and 420 non-TB community members), from two urban townships in the Transvaal, South Africa. RESULTS: The majority of respondents were aware of the infectious nature of TB, that it could be cured and the length of treatment. The most problematic issues were isolation for TB sufferers and the harm TB sufferers do to others. Cognitive/affective reactions were similar for TB patients and community members. 10 items out of the 19-item cognitive/affective scale had communality estimates > or = 0.30. 3 factors were extracted. The first factor seemed to combine personal threat (high personal and family risk) with social rejection by the immediate family and community for TB sufferers. Factor 2 had strong overtones of social stigma, with its emphasis on dirt, poverty and poor nutrition. Factor 3 rejected alcohol and tobacco consumption as causal agents of TB. CONCLUSIONS: The predominant cognitive/affective reactions towards TB were personal threat, social rejection and social stigma, providing partial support for the hypothesis. The powerful force of social rejection and social stigma cannot be underestimated. These inhibiting factors require urgent attention to improve voluntary presentation and compliance behaviour.

Adolescent↗
PubMed2000

Validity of the Migraine Disability Assessment (MIDAS) score in comparison to a diary-based measure in a population sample of migraine sufferers.

The Migraine Disability Assessment (MIDAS) questionnaire is a brief, self-administered questionnaire designed to quantify headache-related disability over a 3 month period. The MIDAS score has been shown to have moderately high test-retest reliability in headache sufferers and is correlated with clinical judgment regarding the need for medical care. The aim of the study was to examine the validity of the MIDAS score, and the five items comprising the score, compared to data from a 90 day daily diary used, in part, to record acute disability from headache. In a population-based sample, 144 clinically diagnosed migraine headache sufferers were enrolled in a 90 day diary study and completed the MIDAS questionnaire at the end of the study. The daily diary was used to record detailed information on headache features as well as activity limitations in work, household chores, and non-work activities (social, family and leisure activities). The MIDAS score was the sum of missed work or school days, missed household chores days, missed non-work activity days, and days at work or school plus days of household chores where productivity was reduced by half or more in the last 3 months. Validity was assessed by comparing MIDAS items and the MIDAS score with equivalent measures derived from the diary. The MIDAS items for missed days of work or school (mean 0.96, median 0) and for missed days of household work (mean 3.64, median 2.0) were similar to the corresponding diary-based estimates of missed work or school (mean 1.23, median 0) and of missed household work (mean 3.93, median 2.01). Values for missed days of non-work activities (MIDAS mean 2.6 and median 1 versus diary mean 2.22 and median 0.95) were also similar. Responses to MIDAS questions about number of days where productivity was reduced by half or more in work (mean 3.77, median 2.00) and in household work (mean 3.92, median 2.00) significantly overestimated the corresponding diary-based measures for work (mean 2.94, median 1.06) and household work (mean 2.22, median 0.98). Nonetheless, the overall MIDAS score (mean 14.53, median 9.0) was not significantly different form the reference diary-based measure (mean 13.5, median 8.4). The correlation between the MIDAS summary score and an equivalent diary score was 0.63. The group estimate of the MIDAS score was found to be a valid estimate of a rigorous diary-based measure of disability. The mean and median values for the MIDAS score in a population-based sample of migraine cases were similar to equivalent diary measures. The correlation between the two measures was in the low moderate range, but expected given that two very different methods of data collection were compared.

Absenteeism↗
PubMed1980

Teaching family planning management and evaluation skills.

In the last several years the need for training schemes in family planning programme administration has become increasingly apparent with the rapid growth of family planning services throughout the world. This paper reports on the development and use of a series of 16 practical classroom training exercises designed for teaching planning, management and evaluation skills. Each exercise can be introduced, worked and discussed in a morning or an afternoon. It is available in an individual booklet, which contains worksheets, blank tables and step-by-step instructions for working the exercise, along with a discussion of the skills being taught. Topics covered include demographic rates and concepts, the Dryfoos-Polgar-Varkey formula, risk factor analysis, target-setting, case load forecasting, service statistics, contraceptive supplies, manpower planning, couple-year of protection, cost-effectiveness, contraceptive use-effectiveness, life table techniques, numerator analysis, fertility pattern method, sampling methods and questionnaire design. These curriculum materials concentrate on imparting through the medium of actual experience a series of specific management techniques of a quantitative nature that will enhance the ability of the trainees to plan, administer and evaluate any family planning programme anywhere in the world. The exercises in this series have been tested in the family planning training programmes at Columbia University and at Downstate Medical Center in New York. They have also been used in WHO workshops in Thailand and Tanzania and in training programmes in France, Kenya and Nicaragua.

Family Planning Services↗
PubMedDate not supplied

Are health risks related to medical care charges in the short-term? Challenging traditional assumptions.

PURPOSE: This study examines the association between self-reported health risks and short-term use of medical resources. DESIGN: Cross-sectional study comparing responses from a mailed survey with medical encounter and expenditure data. Bivariate analyses and multivariate linear and logistic regressions controlling for age, gender, and health status were conducted to illustrate the relationship between selected risk factors and resource use. SETTING: A group network model health maintenance organization (HMO) in Minneapolis, Minnesota. SUBJECTS: The study population was comprised of a randomly selected sample of nonsenior adults (18 to 64 years old, n = 3825) and seniors (65 years and older, n = 1955) who were enrolled in an HMO. The response rate was 72%. MEASURES: Five independent variables: smoking, alcohol use, obesity, lack of physical activity, and unhappiness were derived from a questionnaire designed to assess health status and health risks. Outcome measures were medical care charges and use of hospital services. RESULTS: Obesity, physical inactivity, and unhappiness were related to higher charges among seniors. These relationships dissipated to some degree after controlling for age, gender, and health status. Unexpected differences were found for alcohol use among both age groups, with those considered to be "not at risk" accruing higher charges and demonstrating a higher likelihood of using inpatient hospital services than those defined to be at risk. CONCLUSIONS: Bivariate and multivariate regression results demonstrated that traditional risk factors are weak and inconsistent predictors of short-term medical charges. Charging smokers and other high risk individuals a higher annual insurance premium than is offered for those at low risk raises questions about fairness when such risk factors are not necessarily good predictors of short-term resource use. The rationale for insurance cost-shifting should be supported with reliable data connecting risks to charges.

Adult↗
PubMed1995

Prevalence of smoking among adult American Indian clinic users in northern California.

BACKGROUND: The American Indian Cancer Control Project is a 5-year program funded by the National Cancer Institute designed to promote smoking cessation among adult Indians living in Northern California. This article describes the result of our smoking prevalence survey. Our Indian-specific program combines the physician's anti-smoking message with the efforts of Indian Community Health Representatives, who have access to the Indian patients' families and communities. The study sites consist of 4 urban and 14 rural American Indian clinics in Northern California. This article reports on the results of the smoking prevalence study conducted in the first phase of the project. METHODS: A total of 1,369 adult Northern California Indian patients at 18 Indian health clinics completed a questionnaire designed to assess smoking rates and patterns as well as health problems. Participants were adult American Indians attending 1 of 18 Indian health care clinics in Northern California during 1991. The participants included patients waiting for appointments with the clinic physician, dentist, and nurses. RESULTS: Forty percent (37.35, 42.64; 95% confidence interval) of the adult population in the sample smoke cigarettes; they hold lenient attitudes toward smoking and began smoking at an early age. These patients rate obesity as the No. 1 health problem, followed by high blood pressure, arthritis/rheumatism, and problems with alcohol. The survey also found that the highest smoking rate was among the Sioux (62%), a non-California tribe. This was followed by high rates among native California tribes: Maidu (46%), Pit River (39%), Pomo (38%), Hupa (37%), and Yurok (32%).

Adult↗
PubMed1982

Retromammary versus retropectoral breast augmentation-a comparative study.

Repeated postaugmentation capsular formation following retromammary silicone implantation led surgeons to seek an alternative procedure. In 1968 Dempsey and Latham first reported the "subpectoral" route for location of the implant. Since then little data has been published comparing retromammary and retropectoral breast augmentation. The aim of this study is to compare the two procedures in terms of various factors affecting the physical and emotional well-being of the breast-augmented patient; breast firmness (according to Baker's classification), patient approval, the surgeon's judgment, and the husband's or partner's evaluation are all weighed. The study included 40 patients, 20 of whom underwent retromammary augmentation, the remaining 20 retropectoral augmentation. All 40 responded to a questionnaire designed to elicit comparative data. A detailed analysis of the results was made, leading to the following conclusions: first, patient approval was largely the same in the two groups, although slightly higher in the retropectoral group. However, both surgeons and husbands preferred the retropectoral method of prosthesis insertion.

Breast↗