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PubMed1996

Effect of blood pressure control and antihypertensive drug regimen on quality of life: the African American Study of Kidney Disease and Hypertension (AASK) Pilot Study.

The African American Study of Kidney Disease and Hypertension (AASK) Pilot Study evaluated the feasibility of carrying out a randomized, multicenter, 7-year clinical trial to determine the effects of two goal levels of blood pressure control and three antihypertensive drug regimens on decline in glomerular filtration rate in African Americans with clinically diagnosed hypertensive nephrosclerosis. Participants were randomized to either a usual mean arterial blood pressure (MAP) goal group (102-107 mm Hg) or a low-MAP goal group (< or = 92 mm Hg) and to a drug regimen (initial therapy with either atenolol, amlodipine, or enalapril). Quality of life was assessed by the Medical Outcomes Short-Form 36 (MOS SF-36) at baseline and the last follow-up visit for 84 of the 94 participants of the AASK Pilot Study. Symptoms were assessed at baseline and throughout the course of therapy by participant self-report. Mean SF-36 scores increased significantly on physical functioning (9.2), role limitations (physical) (19.0), social functioning (9.0), and vitality dimensions (5.6) from baseline to the last follow-up visit in the usual MAP goal group. Scores for the eight health dimensions assessed by the MOS SF-36 did not change significantly during the same time period either in the low-MAP goal group or in any of the drug regimens. The mean score for general health perception was significantly lower at the last follow-up visit in the enalapril drug regimen (49.9) compared to drug regimens with atenolol (65.4) or amlodipine (63.9). Physical functioning, role limitations (emotional), social functioning, mental health, vitality, and general health perception scores were negatively correlated with self-reported symptoms during treatment. We conclude that selected dimensions of quality of life improved during the AASK Pilot Study only in participants randomized to the usual MAP goal group. Significant differences between MAP goal groups and drug regimens at the end of follow-up were observed for only a few health dimensions.

Adult↗
PubMed2005

Relationship between cognition and work functioning among patients with schizophrenia in an urban area of India.

OBJECTIVE: Employment rates and work functioning are poor among patients with schizophrenia and are related to cognitive dysfunction. This study examined the relationship between work functioning and cognition, other clinical and demographic variables, and measures of social functioning among patients with schizophrenia in an urban area of India. METHODS: This study evaluated cognitive dysfunction and work functioning among 88 patients with chronic schizophrenia. Attention, executive function, and memory were tested with a battery of neuropsychological tests. Work and social functions were evaluated with standardized instruments. RESULTS: Fifty-nine patients (67 percent) were employed, most in a mainstream environment. Moderate to significant work dysfunction was present among 21 patients (24 percent). When multivariate analysis was performed, cognitive deficits did not relate significantly to current employment status or to level of performance at work. Negative symptoms predicted employment status, and poor social functioning predicted poor work performance. CONCLUSIONS: The relationship between work and cognitive status in schizophrenia was not as strong as has been previously reported in this population. It was speculated that social factors, such as the compelling need to be employed, a supportive work environment, and the number of years of formal education, were factors underlying the high level of work functioning in this group despite cognitive deficits.

Adult↗
PubMed1990

Function and social status 10 years after hip fracture. Prospective follow-up of 103 patients.

Function and social outcome for 103 consecutive patients, mean age 75 years, admitted from their own homes after a hip fracture were studied during a 10-year period. Within 4 months after the fracture, 81 patients had returned home, and the percentage of survivors living at home from then on was then fairly constant. At 10 years after fracture, 31 patients were living at home, 6 were in institutions, and 66 were dead. ADL, walking ability, and household activities remained at the level already achieved within 4 months after fracture during the 10-year period. The need for social services help did not increase; about one third of the survivors had communal home help throughout the 10-year period. Patients who before fracture were healthy and living with someone and within 2 weeks after the fracture could walk with a four-legged aid or better had a good prognosis for living in their own home. The hip fracture did not effect their subsequent fate.

Activities of Daily Living↗
PubMed2000

[Effectiveness of home help service for psychiatric patients. The results of a model project in S city].

PURPOSE: The purpose of this study was to evaluate the effectiveness of a home help service project for psychiatric patients in S city. METHODS: To assess the effectiveness of the home help service, home help service providers at S city in 1997 were invited to hearings and the transcripts were examined qualitatively. Based on the results, interview questions were developed. We then interviewed 28 home help providers who were providing or had completed the service project, as well as care managers as of July 1998. Home help providers divided their patient stories retrospectively into three time frames: before starting home care, one month after starting providing care and at the present. Amount of care provided and patients' self care level were scored and averages ere compared for the three time frames. RESULTS: The analysis of the hearing data revealed parameters for the effectiveness of home help service for psychiatric patients to be as follows: 1) enhanced ability of daily living, such as taking meals, maintaining hygiene and shopping, (primary effectiveness: 5 items); and 2) developing social function, such as being motivated, maintaining personal relationship, extending social life, and decreasing family burden, (secondary effectiveness: 9 items). The amount of care needed was found to be significantly decreased and social function was significantly enhanced on comparisons between before starting home care and one month later, as well as between before starting home care and the present. DISCUSSION: Home help service for psychiatric patients is not only useful for enhancing patients' ability to succeed in daily living tasks, but also for developing their social functioning. Effectiveness was also identified in the level of patients' behavior. The results provide reasonable grounds for extended use of the home help service.

Home Care Services↗
PubMed1991

Working group recommendations: measuring outcomes of care in geriatric evaluation and management units.

Issues related to measuring outcomes of care in geriatric evaluation and management (GEM) units were identified by the outcomes working group of the GEM evaluation conference. GEM units have as a major goal the improvement or maintenance of both physical and psychosocial function. Suggested outcome measures for physical health included survival, restricted activity days, general health perceptions, comprehensive physical function, and miscellaneous specific types of functioning. In the area of psycho-social function, the working group suggested measuring cognitive function, affect/life satisfaction, social function, and satisfaction with care. The patient's caregiver (eg, spouse or child) is often an important target of GEM care, and the group suggested measuring caregiver burden, life satisfaction, and assessment of patient behavior problems. While the primary goal of GEM units is to improve health status, their effects on the utilization and cost of health care are important to decisions about wide-spread implementation and funding. The group therefore suggested a comprehensive assessment of these outcomes. Among the large array of recommended outcomes, the most important were thought to be mortality, function, and cost.

Activities of Daily Living↗
PubMed2001

Subjectively perceived quality of life after coronary artery bypass surgery.

BACKGROUND: Judgment of quality of life after coronary artery bypass surgery is usually based on objective measures of cardiovascular status. Quality of life cannot be determined solely objectively because such indicators do not explain how persons perceive and experience their lives. OBJECTIVES: To assess the quality of life and mood state over time in patients undergoing coronary artery bypass grafting and to improve understanding of subjective perceptions of well-being and how these perceptions change over time. METHODS: Three questionnaires, the Quality of Life Index, the Medical Outcomes Study 36-Item Short-Form Health Survey, and the Profile of Mood States, were administered at 3 different times (before surgery, 6 weeks after surgery, and 3 months after surgery) to a convenience sample of hospitalized adults undergoing coronary artery bypass surgery for treatment of coronary artery disease. RESULTS: For all 3 questionnaires, responses differed significantly over time. Mean scores were significantly different over time for total mood disturbance (P = .03), the socioeconomic domain of the Quality of Life Index (P = .02), and the physical functioning (P = .004), vitality (P = .007), and social functioning (P = .002) dimensions of the 36-item short-form survey. CONCLUSIONS: Subjective perceptions of physical and psychological well-being changed significantly from before surgery to 3 months after surgery. Measures of mood state, physical functioning, vitality, and social functioning improved significantly over time. However, satisfaction with the socioeconomic domain decreased significantly from before surgery to 3 months after surgery.

Adult↗
PubMed2006

Nurses' collaboration with physicians in managing medication improves patient outcome in acute psychiatric care.

The aim of the present paper was to examine the impact of nurses' collaboration with physicians in medication management on patient outcome in acute psychiatric care. Data for 143 patients with schizophrenia were assessed based on information given by nurses and physicians in charge. Twenty-two patients were defined as a collaborative group when physicians changed medication after receiving reports that nurses perceived the necessity to change. A control group was formed from the 50 patients when nurses perceived the necessity to change medication but did not tell physicians, or nurses advised of the necessity to physicians but medication was not changed. Physicians retrospectively evaluated patients' social functioning and acceptance of medication at admission and discharge. Social functioning was measured by Global Assessment of Functioning (GAF), and acceptance of medication by a single item using Japanese version of Schedule for Assessment of Insight (SAI-J). Changes in the scores from admission to discharge on GAF and acceptance of medication were defined as outcome measures. Nurses recognized the necessity to change medication for patients with frequent aggressive behavior and younger age. Compared with the control group, the collaborative group had less instruction for use of drugs, and more perceived necessity to decrease the current dose or the number of drugs because of stable symptoms. The collaborative group demonstrated significantly greater improvement in social functioning. The collaborative group improved acceptance of medication, although there were no significant differences between the two groups. Nurses' collaboration with physicians in medication management improved patient outcome in acute psychiatric care.

Acute Disease↗
PubMed1993

Executive function and social communication deficits in young autistic children.

Preschool-aged, autistic children were compared with both developmentally delayed children of similar non-verbal mental age and normally developing children of similar verbal skill on measures of executive function and social communication skills. Autistic children exhibited significantly more perseverative responses on a test of executive function when compared to both comparison groups. Autistic children also exhibited significantly fewer joint attention and social interaction behaviors. Moreover, a significant relationship was found between executive function skill and the two social communication skills, which was independent of group membership or verbal ability. Competing hypotheses to account for the relationship between executive function deficits and social communication deficits in autism are discussed.

Attention↗
PubMed2000

Functional assessment of a multicenter very low-birth-weight cohort at age 5 years. Newborn Lung Project.

BACKGROUND: Very low-birth-weight newborns (birth weight < or = 1500 g) experience serious neonatal complications, but long-term outcomes are not completely known. Most studies reflect an era of neonatal care that was fundamentally different from the present. OBJECTIVES: To compare the functional level of very low-birth-weight children before and after surfactant introduction and to relate functional level to clinical and socioeconomic factors. DESIGN: Inception cohort followed up from birth to an average age of 5 years. SETTING: Six regional neonatal intensive care units in a contiguous geographic area. PARTICIPANTS: Four hundred twenty-five very low-birth-weight children, born between August 1, 1988, and June 30, 1991, of 438 located among 626 whose parents provided follow-up information before neonatal intensive care unit discharge. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Diagnosis of cerebral palsy and standardized scores for self-care, mobility, and social function from the Pediatric Evaluation of Disability Inventory. RESULTS: Cerebral palsy was present in 12.6% of the children, with no change after surfactant introduction. Intraventricular hemorrhage (odds ratio, 2.3 per grade; 95% confidence interval, 1.8-2.8) and bronchopulmonary dysplasia (odds ratio, 2.3; 95% confidence interval, 1.2-4.6) were independently predictive of cerebral palsy and of functional outcome. For self-care, mobility, and social function, 11.7%, 29.5%, and 10.7% of the children, respectively, scored at least 2 SDs below the normative means. Social function was 0.25 to 0.50 normative SDs lower after general surfactant availability than before general surfactant availability. CONCLUSIONS: While there was no increase in major disability after surfactant introduction, there may have been a decrease in social function associated with the lower neonatal mortality. Most very low-birth-weight children functioned within the normal range in everyday tasks. Several predictors of outcome were identified.

Bronchopulmonary Dysplasia↗
PubMed1980

Costs of treatment of hip fractures. A calculation of the consumption of the resources of hospitals and rehabilitation institutions.

A series of 518 patients with hip fractures and a median age of 78 years was followed for 6 months. On admission to hospital the patients were assessed and were found to be evenly distributed among four social function groups according to their level of dependence on the social welfare system. At the 6 months follow-up the mortality rate was about 16 per cent, leaving 437 patients for a reassessment of social function. The average hospitalization time was 23 days; thus 17 per cent of all orthopaedic hospital beds in the area were occupied by patients with hip fractures. Patients staying the longest time in hospital were those waiting for discharge to a nursing home. The average stay in rehabilitation institutions was 71 days. The total rehabilitation course was longest for the most dependent patients. The risk of death or deterioration of social function among patients admitted from home was 48 per cent. In the case of social deterioration or technical failure following the fracture treatment the total rehabilitation course was considerably prolonged. The resources required for the treatment of hip fractures in a suburban area of 500,000 inhabitants were calculated to the 32 hospital beds, 43 rehabilitation beds and at least 21 nursing home beds.

Adult↗
PubMed1997

Posttraumatic stress, family functioning, and social support in survivors of childhood leukemia and their mothers and fathers.

Psychological sequelae are examined in 130 former childhood leukemia patients and 155 comparison participants and their parents. The major dependent variables are symptoms of anxiety and posttraumatic stress, family functioning, and social support. Multivariate analyses of covariance indicated significantly more posttraumatic stress symptoms in mothers and fathers of childhood leukemia survivors (p < .001) and no differences between survivors and peers. There were no significant group differences for family functioning or social support, although they were associated with anxiety and posttraumatic stress outcomes. Current child age, age at diagnosis, and months off treatment were not significantly correlated with outcome. These findings document the long-term impact of childhood cancer treatment on parents. The lack of significant differences for survivors argues for further attention to the relevance of posttraumatic stress disorder for childhood cancer survivors. The clinical implications are that psychological interventions are needed during and after cancer treatment.

Adolescent↗
PubMed2003

Perceived functional impact of abnormal facial appearance.

Functional facial deformities are usually described as those that impair respiration, eating, hearing, or speech. Yet facial scars and cutaneous deformities have a significant negative effect on social functionality that has been poorly documented in the scientific literature. Insurance companies are declining payments for reconstructive surgical procedures for facial deformities caused by congenital disabilities and after cancer or trauma operations that do not affect mechanical facial activity. The purpose of this study was to establish a large, sample-based evaluation of the perceived social functioning, interpersonal characteristics, and employability indices for a range of facial appearances (normal and abnormal). Adult volunteer evaluators (n = 210) provided their subjective perceptions based on facial physical appearance, and an analysis of the consequences of facial deformity on parameters of preferential treatment was performed. A two-group comparative research design rated the differences among 10 examples of digitally altered facial photographs of actual patients among various age and ethnic groups with "normal" and "abnormal" congenital deformities or posttrauma scars. Photographs of adult patients with observable congenital and posttraumatic deformities (abnormal) were digitally retouched to eliminate the stigmatic defects (normal). The normal and abnormal photographs of identical patients were evaluated by the large sample study group on nine parameters of social functioning, such as honesty, employability, attractiveness, and effectiveness, using a visual analogue rating scale. Patients with abnormal facial characteristics were rated as significantly less honest (p = 0.007), less employable (p = 0.001), less trustworthy (p = 0.01), less optimistic (p = 0.001), less effective (p = 0.02), less capable (p = 0.002), less intelligent (p = 0.03), less popular (p = 0.001), and less attractive (p = 0.001) than were the same patients with normal facial appearances. Facial deformity caused by trauma, congenital disabilities, and postsurgical sequelae present with significant adverse functional consequences. Facial deformities have a significant negative effect on perceptions of social functionality, including employability, honesty, and trustworthiness. Adverse perceptions of patients with facial deformities occur regardless of sex, educational level, and age of evaluator.

Adolescent↗
PubMedDate not supplied

The social and functional consequences of stroke for elderly patients.

This study sought to answer questions about the social and functional consequences of stroke for elderly patients (greater than or equal to 65 years of age). Survivors of acute stroke were retrospectively identified, and hospital records were reviewed. One year after discharge, follow-up interviews were conducted with families of surviving patients. Most patients were discharged to home (82%) and remained there. Independent functional status was the single predictor of discharge to home (p less than 0.01). By the time of followup, less than half of the surviving patients were functionally independent (42%). Stroke is an important cause of functional dependence among the elderly. Attention should be focused on minimizing the effects of persisting dysfunction on them and their families.

Activities of Daily Living↗
PubMed2001

Disability as a function of social networks and support in elderly African Americans and Whites: the Duke EPESE 1986--1992.

OBJECTIVES: We examined the association of structural and functional aspects of social relationships with change in disability, and the degree to which race modifies these associations. METHODS: Data are from a population-based sample of 4,136 African Americans and Whites aged > or = 65 living in North CAROLINA: Disability data were collected during seven consecutive yearly interviews and summarized in two outcome measures. Measures of social relationships included five measures representing network size, extent of social interaction, and specific type of relationships, as well as instrumental and emotional support. Weighted proportional odds models were fitted to model disability as a function of baseline social network and support variables, and the interaction of each variable with follow-up time. RESULTS: Network size and social interaction showed significant negative associations with disability risks, which did not vary by race, or as a function of time. Social interaction with friends was associated with a reduced risk for disability, but social interaction with children or relatives was not related to disability. Instrumental support was associated with a significantly increased disability risk, with a greater adverse effect among Whites than African AMERICANS: Emotional support was not associated with disability, but a protective effect for ADL disability was found after controlling for its intercorrelation with instrumental support. DISCUSSION: The findings provide further evidence for the role of social relationships in the disablement process, although not all types of social relationships may be equally beneficial. Furthermore, these associations may be more complex than simple causal effects. There were few racial differences in the association of social relationships with disability, with the possible exception of instrumental support, which may allude to possible sociocultural differences in the experience of instrumental support exchanges.

Activities of Daily Living↗
PubMed2000

The persistent impact of breast carcinoma on functional health status: prospective evidence from the Nurses' Health Study.

BACKGROUND: Although physical and emotional function after the diagnosis of breast carcinoma have been described in clinic populations, to the authors' knowledge no previous study has measured change from the preillness level of functional health status in community-dwelling women. METHODS: The authors conducted a 4-year (1992-96) prospective study of functional recovery after breast carcinoma in a large sample of women, aged 54-73 years. They collected multidimensional measures of self-reported functional health status in 1992, before diagnosis of breast carcinoma, and again in 1996, to examine the risk of decline associated with incident breast carcinoma. RESULTS: After adjustment for age, baseline functional health status, and multiple covariates, women who developed incident breast carcinoma were more likely to have experienced reduced physical function, role function, vitality, and social function and increased bodily pain compared with women who remained free of breast carcinoma. Risk of decline was attenuated with increasing time since diagnosis. Risk of decline in physical function was evident across all stages of breast carcinoma, even after adjustment for women undergoing treatment for persistent or recurrent disease. We found evidence that the risk of decline among breast carcinoma cases compared with healthy women was largest among those who were most socially isolated. CONCLUSIONS: Breast carcinoma results in persistent declines in multiple dimensions of functional health status. These prospective data suggest that previous studies reporting no difference in physical function among breast carcinoma cases compared with disease free women underestimated the deleterious effect of the disease on function. Socially isolated women are an especially vulnerable group.

Adult↗
PubMed2006

Patient functioning and family burden in a controlled, real-world trial of family psychoeducation for schizophrenia.

OBJECTIVE: This study explored the effectiveness of a psychoeducational family intervention for schizophrenia on patients' personal and social functioning as well as on relatives' burden and perceived support. METHODS: Thirty-four mental health professionals from 17 public mental health centers in Italy selected 71 families of consumers with schizophrenia. Forty-two families were randomly assigned to a group that received the intervention for six months, and 29 families were assigned to a waiting list for six months. At baseline and six months later, validated tools were used to assess patients' clinical status, personal and social functioning, and social network as well as relatives' burden, social resources, and perception of professional support. RESULTS: In the intervention group the number of patients with poor or very poor global personal and social functioning decreased significantly, from 17 (47 percent) at baseline to nine (25 percent) at follow-up. A significant improvement was found for the intervention group in patients' social relationships, interests in obtaining a job, maintenance of social interests, and management of social conflicts. Twenty-seven patients (74 percent) reported that their social relationships had improved during the six-month period. For both the intervention and control groups, family burden significantly improved. Relatives' social contacts and perception of professional support significantly increased only in the intervention group. CONCLUSIONS: The results suggest that a psychoeducational family intervention may have a significant impact on functional outcomes of schizophrenia when provided to patients and caregivers in real-world settings.

Adult↗
PubMed2002

A 12-month quality of life assessment of cardiac arrest survivors treated with or without an implantable cardioverter defibrillator.

BACKGROUND: Previous studies indicate that the implantable cardioverter defibrillator (ICD) has a large impact on the quality of life of patients. The effects of having an ICD over longer periods of times has been less studied. OBJECTIVE: To assess the quality of life and well-being of cardiac arrest survivors who have received an implantable cardioverter defibrillator (ICD) or other treatment. METHODS: 168 patients were monitored for 1 year and completed four questionnaires. RESULTS: No differences were found between the two treatments regarding quality of life (except for pain, ICD patients perceived less pain) and well-being. A significant improvement in physical and social function, and in mental health was found in the first 6 months. Older patients (60 years or older) perceived less improvement in their health than younger patients. Women reported having poorer social function. The prevalence of anxiety and probable depression was high irrespective of the treatment received: anxiety and depressive symptoms did not change significantly between 1 and 12 months after discharge. Patients with higher anxiety scores experienced less improvement in health and patients with more depressive symptoms experienced poorer social function. CONCLUSIONS: The prevalence of anxiety and probable depression was high in cardiac arrest survivors. Probable depression affected social function. Those patients who felt anxious experienced less health improvement. Quality of life and well-being were not affected by the type of treatment. We conclude that surviving an out-of-hospital cardiac arrest has a greater impact on patients than the treatment received.

Adult↗
PubMed1987

The antecedents and benefits of achieving abstinence in opioid addicts: a 2.5-year follow-up study.

This report examines long-term and short-term benefits of achieving abstinence from opioids in a sample of opioid addicts who were reevaluated 2.5 years following seeking treatment. Extensive assessment of drug use history and drug-associated problems had been obtained when the subjects applied for treatment. At follow-up evaluations, detailed information was obtained on intervening course of drug use, treatment, legal problems, psychological problems, social functioning, occupational functioning, and medical status. The results were as follows: (1) Achieving abstinence from illicit opioids was associated with concurrent improvement in other aspects of functioning including reduction of criminal activity, improved medical status, improved social functioning, and reduced abuse of other psychoactive substances. However, many of these improvements were reversed immediately if relapse to opioid use occurred. (2) Achieving abstinence was associated with being in drug treatment, especially treatment in a methadone maintenance program. (3) Achievement of abstinence was not successfully predicted by client characteristics measured at entrance into treatment. (4) Long-range benefits of abstinence were detectable in social functioning even for those who had relapsed at the time of follow-up reevaluation.

Adult↗