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PubMed2003

Cognitive impairment in hip fracture patients: timing of detection and longitudinal follow-up.

OBJECTIVES: To examine the prevalence, incidence, persistence, predictors, and outcomes of cognitive impairment after hip fracture. DESIGN: Longitudinal cohort study. SETTING: Eight hospitals in Baltimore, Maryland. PARTICIPANTS: Six hundred seventy-four hip fracture patients aged 65 and older living in the community before fracture. MEASUREMENT: Delirium at admission and postsurgery, Mini-Mental State Examination (MMSE) scores postsurgery, and prefracture proxy ratings of MMSE and dementia. Follow-up measures at 2 and 12 months postfracture included mortality, MMSE, physical activities of daily living (PADLs), instrumental activities of daily living (IADLs), social functioning, and the Center for Epidemiologic Studies-Depression Scale. RESULTS: Overall, 28% had prefracture dementia or MMSE impairment, 8% had cognitive impairment first detected presurgery, 14% had impairment first detected postsurgery, and 50% were not impaired before or during hospitalization. Incident cognitive impairment was more likely in patients who were older, male, and less educated and had more prefracture PADL impairment, intertrochanteric fractures, and higher anesthesia risk ratings. Presurgery incident cases did not differ significantly from those detected postsurgery in functional outcomes or in persistence of cognitive impairment. Cognitive impairment first noted in the hospital persisted through 2 and 12 months in more than 40% of patients. Those with cognitive impairment persisting through 2 months had poorer 12-month PADLs and social functioning. CONCLUSION: Prefracture cognitive impairment and incident cognitive impairment during hospitalization are risk factors for poor functional outcomes. Many incident cognitive problems persisted over 2 to 12 months, and per-sistence predicted later functional and social impairment.

Activities of Daily Living↗
PubMed2004

Impaired health-related quality of life in Romanian patients with chronic viral hepatitis before antiviral therapy.

BACKGROUND AND AIM: Chronic hepatitis is a disabling condition leading to impairment of a patient's quality of life. We investigated the impact of chronic viral hepatitis on health-related quality of life. The relationship between transaminase level and score in the quality-of-life questionnaire was also investigated. METHODS: We studied 66 patients with chronic viral hepatitis (27 with hepatitis B, 38 with hepatitis C, 1 with hepatitis B+C; 32 men, 34 women) naive to any previous antiviral therapy. All had high levels of transaminases. Patients with chronic disease or those using drugs to modify their quality of life were discarded. The control group consisted of 36 healthy volunteers (17 men, 19 women). Both groups completed the Short Form 36 health survey, with the exception of the items concerning bodily pain. RESULTS: Significant differences between the two groups for every domain of quality of life (physical functioning, role physical, mental health, role emotional, social functioning, vitality and general health) were recorded. We found no significant correlation between the level of transaminases and any item of the health-related quality-of-life questionnaire. In hepatitis B patients, several quality-of-life scores (general health, social functioning, mental health) were better than in hepatitis C patients. CONCLUSIONS: Patients with chronic viral hepatitis not receiving antiviral therapy have an impaired quality of life as estimated by the Short Form 36 health survey.

Adult↗
PubMed2006

Health-related quality of life and appropriateness of knee or hip joint replacement.

BACKGROUND: We studied the association between explicit appropriateness criteria for total hip joint replacement (THR) and total knee replacement (TKR) with changes in health-related quality of life of patients undergoing these procedures. METHODS: Prospective observational study of 1576 consecutive patients with diagnoses of osteoarthritis on waiting lists to undergo THR or TKR. Explicit appropriateness criteria using the RAND appropriateness method were applied. Patients completed 2 questionnaires that measured health-related quality of life, the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), before the procedure and 6 months afterward. RESULTS: Patients who were considered appropriate candidates for these procedures had greater improvements than those who were considered inappropriate candidates in all 3 WOMAC domains (pain, functional limitation, and stiffness; THR: 43.0, 40.6, and 40.4 vs 14.7, 19.1, and 15.9; TKR: 34.9, 32.5, and 30.2 vs 23.2, 18.9, and 17.1; P<.001 for all comparisons). Patients who underwent THR and were judged to be appropriate candidates had greater improvements in the physical function, role-physical, bodily pain, and social function domains of the SF-36 than those judged to be inappropriate candidates (34.4, 35.1, 33.1, and 26.6 vs 19.6, 9.2, 5.7, and 7.0; P = .04, P = .03, P < .001, and P < .001, respectively). Appropriate candidates for TKR demonstrated greater improvement in the social function domain of the SF-36 after the procedure than those deemed inappropriate candidates (19.9 vs 7.9; P = .004) but not in the other domains of functional status. CONCLUSIONS: These results suggest a direct relationship between explicit appropriateness criteria and better health-related quality-of-life outcomes after THR and TKR surgery. Our results support the use of these criteria for clinical guidelines or evaluation purposes.

Activities of Daily Living↗
PubMed2005

Does a patient's self-reported health-related quality of life predict survival beyond key biomedical data in advanced colorectal cancer?

The purpose of this study was to determine whether baseline patients' self reported health-related quality of life (HRQOL) parameters could predict survival beyond key biomedical prognostic factors in patients with metastatic colorectal cancer. The analysis was conducted on 299 patients. HRQOL baseline scores were assessed using the European Organisation for Research and Treatment of Cancer, Quality of Life Questionnaire-Core30 (EORTC QLQ-C30). The Cox proportional hazards regression model was used for both univariate and multivariate analyses of survival. In addition, a bootstrap resampling technique was used to assess the stability of the outcomes. The final multivariate Cox regression model retained four variables as independent prognostic factors for survival: white blood cell (WBC) count with a hazard ratio (HR) of 1.961 (95% CI, 1.439-2.672; P<0.001), alkaline phosphatase with HR=1.509 (95% CI, 1.126-2.022; P=0.005), number of sites involved with HR=1.108 (95% CI, 1.024-1.198; P=0.01) and the patient's score on the social functioning scale with HR=0.991 (95% CI, 0.987-0.996; P<0.001) which translates into a 9% decrease in the patient's hazard of death for any 10 point increase. The independent prognostic importance of social functioning and the stability of the final Cox regression model were also confirmed by the additional bootstrap model averaging analysis, based on 1000 bootstrap-generated samples. The results suggest that social functioning, acts as a prognostic measure of survival beyond a number of previously known biomedical parameters.

Adult↗
PubMed2006

Treatment of patients with first-episode psychosis: two-year outcome data from the Danish National Schizophrenia Project.

First episode psychosis interventions have been in focus in the last two decades in an attempt to improve the course and outcome of schizophrenic disorders. The Danish National Schizophrenia Project began in 1997 its intake of patients, aged 16-35, with a first psychotic episode of a schizophrenic spectrum disorder, diagnosed by ICD-10 (F20-29). The study was carried out as a prospective, longitudinal, multicentre investigation, encompassing 16 centres, spread all over the country. The sample consists of 562 patients consecutively diagnosed during two years. Patients were treated with "supportive psychodynamic psychotherapy as a supplement to treatment as usual", "integrated, assertive, psychosocial and educational treatment programme", or "treatment as usual". Data on symptoms and social function and sociodemographic data were obtained at inclusion, and at year 1 and 2. The three sub-cohorts did not differ at baseline. After one year, the total sample of patients improved significantly concerning symptoms and social function. The significance of the improvement remained after two years. After one year, patients in the two intervention groups improved more concerning symptoms and social function than patients in the treatment-as-usual group. Improvement in the intervention groups continued into the second year. Patients receiving integrated assertive treatment faired better than those being treated with the less intensive method of supportive psychodynamic psychotherapy, and the latter group improved more than the treatment-as-usual group.

Journal Article↗
PubMed2000

Causes and consequences of duration of untreated psychosis in schizophrenia.

BACKGROUND: It is unclear what determines duration of untreated psychosis (DUP) in schizophrenia and why long DUP predicts poor outcome. AIMS: First, to test the hypothesis that specific patterns of symptoms and social functioning acting before treatment prolong DUP. Second, to clarify the mechanisms linking DUP with recovery after treatment. METHOD: Two hundred and forty-eight consecutive first admissions with schizophrenia were interviewed to assess DUP, symptoms and social functioning at admission, and symptoms were re-assessed after 6-12 weeks. RESULTS: Median DUP was 12 weeks. Long DUP was predicted by poor insight, social isolation and preserved coping skills, but not by demographic factors. Even allowing for all these variables, long DUP predicted poor outcome. CONCLUSIONS: Longer DUP results partly from a pattern of symptoms and social functioning which reduces concern by the sufferer and relevant others. DUP's relationship to outcome is strongest in the initial months of psychosis. This has implications for targeting early intervention.

Adolescent↗
PubMed2005

The course of cognitive functioning in first episode psychosis: changes over time and impact on outcome.

This three year longitudinal study examined the cognitive performance of 247 individuals who recently presented with a first episode of psychosis. Using a comprehensive battery of cognitive tests, we assessed cognition at baseline, 1 year and 2-year follow-ups. Assessments also included positive and negative symptoms, depression, social outcome and substance use. There were several significant improvements in cognition over the two-year period which were usually matched by improvements in a matched non-psychiatric control group. Regression analyses demonstrated that after controlling for symptoms cognitive impairment accounted for 4-6% of the variance in social functioning. Our results suggest that impaired cognition exists in the very early stages of a psychotic illness and that there is no decline over time. Secondly, our results suggest that, although related, poor social functioning deficits may be independent of cognitive impairment. Finally there are implications for improved methodology in the assessment of both cognitive and social functioning.

Adolescent↗
PubMed2007

Concurrent validity and clinical usefulness of several individually administered tests of children's social-emotional cognition.

In this study, the validity of 5 tests of children's social-emotional cognition, defined as their encoding, memory, and interpretation of social information, was tested. Participants were 126 clinic-referred children between the ages of 5 and 17. All 5 tests were evaluated in terms of their (a) concurrent validity, (b) incremental validity, and (c) clinical usefulness in predicting social functioning. Tests included measures of nonverbal sensitivity, social language, and social problem solving. Criterion measures included parent and teacher report of social functioning. Analyses support the concurrent validity of all measures, and the incremental validity and clinical usefulness of tests of pragmatic language and problem solving.

Adolescent↗
PubMed1990

Emotional and social reactions of children to epilepsy in a parent.

This study examined the emotional and social reactions of children to epilepsy in a parent. Clinical impression and previous research suggests that these children have special psychosocial problems. Fifteen families, randomly selected from outpatient clinics, were evaluated using an open interview, standardized inventories and a personality test. The results showed that the investigated families had acceptable levels of communication about the epilepsy. The majority of children were informed about the parent's epileptic condition before they witnessed a seizure. An overall judgement of social functioning showed that the children had sufficient social adaptation. Analysis of the personality inventories revealed no signs of serious personality disorders in the children. Closer inquiry into the results showed that, despite the availability of information, misconceptions about the epilepsy and associated fears existed. In particular, extreme denial of somatic complaints was observed in a subgroup. Associated problems in the area of social functioning concerned a defensive attitude towards inviting friends home, increased feeling of responsibility for the parents and academic problems at school.

Adaptation, Psychological↗
PubMedDate not supplied

Health-related quality of life using the SF-36 in patients with bipolar disorder compared with patients with chronic back pain and the general population.

BACKGROUND: The purpose of this study was to assess and compare the health-related quality of life of patients with bipolar disorder and chronic back pain and, in turn, to compare these results with those previously generated for the general population. METHODS: Subjects were patients with bipolar disorder (n=44), a comparison group of chronic back pain patients (n=30), and a population-based control sample (n=2,474). Health-related quality of life was assessed using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), a self-administered questionnaire in which lower scores are indicative of greater impairment. RESULTS: Patients with bipolar disorder had lower mean scores than the general population on all scales except Physical Functioning. Bipolar patients had significantly higher scores than chronic back pain patients in the categories of Physical Functioning, Role Limitations--Physical, Bodily Pain, and Social Function. There were no significant differences between bipolar disorder and chronic back pain groups in the Mental Health and Role Limitations - Emotional categories. LIMITATIONS: The results of the study are limited by the relatively small sample sizes of the bipolar and back pain patient groups. CONCLUSIONS: Patients with bipolar disorder had substantial impairment in health-related quality of life in comparison with the general population. Bipolar patients were less compromised in areas of physical and social functioning than chronic back pain patients but had similar impairment in mental health.

Adult↗
PubMed2002

Cumulative failure rate of ileal pouch-anal anastomosis and quality of life after failure.

PURPOSE: The aim of the study was to calculate the cumulative occurrence of pouch failure among 486 patients who had undergone proctocolectomy and ileoanal anastomosis for ulcerative colitis or familial adenomatous polyposis. The other goal was to compare the quality of life in the failure group of 21 patients, the successful group, and the healthy population. METHODS: Data were collected from patient histories, with the probability of pouch failure being calculated by the Kaplan-Meier method. Patients with pouch failure and controls were sent a Short-Form 36-item quality-of-life questionnaire, and data were analyzed with paired -test. RESULTS: The overall failure rate was 5.3 percent (26), including 24 pouch excisions and 2 early deaths (0.4 percent). Cumulative probabilities of pouch failure were 1, 5, and 7 percent at 1, 5, and 10 years, respectively. Neither pouchitis, gender, nor diagnosis correlated with pouch failure, but fistula formation ( p< 0.001) did. Patients with failure had lower quality-of-life scores for physical function (p < 0.02), social function ( p< 0.04), energy ( p< 0.02), and physical role function ( < 0.03) than the healthy population. Scores for physical function ( p< 0.01), energy ( p< 0.01), and physical role function ( p< 0.05) were also lower than those of control patients. CONCLUSIONS: The most common cause of pouch failure is fistula, whereas pouch excision is rarely caused by pouchitis. The impaired quality of life of patients in the failure group was caused by impairment of physical function and restrictions in social life.

Adenomatous Polyposis Coli↗
PubMed1993

Quality of life of persons with onychomycosis.

Onychomycosis is a fungal infection of the nails which, although unsightly in appearance, is often considered to be a cosmetic problem. This research reports on the development and performance of a quality-of-life instrument to measure the impact of this disease on the patients' mental and general health, social functioning, pain, and self-confidence. In telephone interviews, 680 members of a health maintenance organization (299 with onychomycosis and 381 without) were asked a battery of items regarding quality of life (mental and social functioning, self-esteem, pain) and specific problems and symptoms related with one's nails. Persons with onychomycosis had significantly poorer ratings compared with the healthy persons with respect to general health (p = 0.02) and bodily pain p < 0.001). Persons with onychomycosis also had significantly (p < 0.05) poorer ratings for mental health, social functioning, health concern, physical appearance, and functional limitations associated with activities involving standing on one's feet or working with one's fingers. This study is the first to document the impact of onychomycosis on an individual's quality of life. Persons with onychomycosis may adapt to this condition, but they continue to experience embarrassment and discomfort that reduces their quality of life.

Adolescent↗
PubMed2005

Promoting positive adult functioning through social development intervention in childhood: long-term effects from the Seattle Social Development Project.

OBJECTIVE: To examine the long-term effects of the Seattle Social Development Project intervention in promoting positive adult functioning and preventing mental health problems, crime, and substance use (including tobacco, alcohol, and other drugs) at 21 years of age. DESIGN: This nonrandomized controlled trial followed up participants to 21 years of age, 9 years after the intervention ended. We compared the following 3 intervention conditions: a full 6-year intervention (grades 1 through 6); a late 2-year intervention (grades 5 and 6 only); and a no-treatment control condition. SETTING: Eighteen public elementary schools serving diverse neighborhoods, including high-crime neighborhoods, of Seattle, Wash. PARTICIPANTS: A sex-balanced, multiethnic sample of 605 participants across the 3 conditions who completed interviews at 21 years of age (94% of the original sample in these conditions). INTERVENTIONS: Teacher training in classroom instruction and management, child social and emotional skill development, and parent training. MAIN OUTCOME MEASURES: Self-reports of functioning in school and work, emotional and mental health, and crime and substance use at 21 years of age and official court records. RESULTS: Broad significant effects on functioning in school and work and on emotional and mental health were found. Fewer significant effects on crime and substance use were found at 21 years of age. Most outcomes had a consistent dose effect, with the strongest effects in subjects in the full-intervention group and effects in the late-intervention group between those in the full-intervention and control groups. CONCLUSIONS: A theory-guided preventive intervention that strengthened teaching and parenting practices and taught children interpersonal skills during the elementary grades had wide-ranging beneficial effects on functioning in early adulthood.

Adolescent↗
PubMed2004

Anti-social welfare functions: a reply to Hansen et al.

We could reasonably expect society to give at least the same weight to the marginal utility of the poor as to the rich, and to the marginal utility of the ill as compared to the healthy. Whilst Hansen et al. [Journal of Health Economics (2004)], may be said to link CEA and CBA within a welfarist framework, the assumptions they require are inconsistent with these types of ethical preferences. Thus, the degree to which they employ a reasonable social welfare function is doubtful. This paper argues that any link between CEA and CBA will occur not within a welfarist framework but instead within a non-welfarist one in which it is unlikely that CBA results could be easily transformed into cost-effectiveness ratios.

Attitude to Health↗
PubMed2003

Childhood antecedents of avoidant personality disorder: a retrospective study.

OBJECTIVE: To explore potential risk factors and early manifestations of avoidant personality disorder (AVPD) by examining retrospective reports of social functioning and adverse childhood experiences. METHOD: Early social functioning and pathological childhood experiences were assessed using the Childhood Experiences Questionnaire-Revised. The responses of 146 adults diagnosed with primary AVPD were compared with a group of 371 patients with other personality disorders as a primary diagnosis and a group of 83 patients with current major depression disorder and no personality disorders, using chi2 analyses. Diagnoses were based on semistructured interviews by trained reliable clinicians. RESULTS: Adults with AVPD reported poorer child and adolescent athletic performance, less involvement in hobbies during adolescence, and less adolescent popularity than the depressed comparison group and the other personality disorder group. Reported rates of physical and emotional abuse were higher than the depressed group, but this result was influenced by comorbid diagnoses. CONCLUSIONS: These results suggest that early manifestations of AVPD are present in childhood but that various forms of abuse are not specific to the disorder.

Adolescent↗
PubMed2005

The use and impact of assistive devices and other environmental modifications on everyday activities and care in young children with cerebral palsy.

PURPOSE: The study describes use of assistive devices and other environmental modifications, and their impact on everyday activities and care in young children with cerebral palsy (CP). METHOD: Ninety-five children (55 boys, 40 girls; mean age 58 months, SD 18 months) and their parents were studied using a cross-sectional design. The Pediatric Evaluation of Disability Inventory (PEDI) was applied to assess daily activities using the three measurement scales: functional skills, caregiver assistance, and modifications of the environment. Use of modifications was described related to the five severity levels of the Gross Motor Function Classifications System (GMFCS). Impact was rated on the Caregiver Assistance scale of the PEDI and on a five-point Likert scale. RESULTS: Out of the 1075 provided environmental modifications, 980 were in regular use to support mobility, self-care and social function among 84 children. The number increased with GMFCS levels; children at levels IV and V used 80% of the modifications, with large variations between the children at same level. Adaptations of housing and transportation facilitated effective use of assistive devices. Half of the parents rated the modifications to have moderate to very large effect on the child's mobility, 25% on self-care skills, and 20% on social function. Furthermore, 65% reported that the modifications lightened the caregiving for mobility, 75% for self-care and 25% for social function. Functional independence and care demands often benefited from different types of modifications. CONCLUSION: The variations in use and benefits of environmental modifications indicate need of comprehensive assistive technology assessments, including child factors, family factors, technology factors and service system factors.

Activities of Daily Living↗
PubMed1995

The Edinburgh Primary Care Depression Study: personality disorder and outcome.

BACKGROUND: Little is known about the impact of personality pathology on the treatment outcome of major depressive illness in primary care in the UK. METHOD: Patients meeting criteria for DSM-III major depressive disorder were randomly allocated to one of four treatments each lasting 16 weeks, then followed up for 18 months. Assessments were made of depressive symptoms, personality and social functioning. Personality was assessed at maximum improvement or 16 weeks. RESULTS: The prevalence of personality disorder (PD) in the sample of 113 patients was 26%. Patients with a PD were significantly younger and rated more depressed at entry than patients with no personality disorder (NoPD). On completion of treatment patients with a PD were significantly more depressed and had poorer social functioning than the NoPD group. After 18 months there were no differences in ratings of depression or social functioning between the groups. CONCLUSIONS: There was substantial improvement in both the PD and NoPD groups. The presence of personality pathology delays recovery from major depressive illness.

Adolescent↗
PubMed2002

Quality of life in long-term, disease-free survivors of breast cancer: a follow-up study.

BACKGROUND: Women with breast cancer are the largest group of female survivors of cancer. There is limited information about the long-term quality of life (QOL) in disease-free breast cancer survivors. METHODS: Letters of invitation were mailed to 1336 breast cancer survivors who had participated in an earlier survey and now were between 5 and 10 years after their initial diagnosis. The 914 respondents interested in participating were then sent a survey booklet that assessed a broad range of QOL and survivorship concerns. All P values were two-sided. RESULTS: A total of 817 women completed the follow-up survey (61% response rate), and the 763 disease-free survivors in that group, who had been diagnosed an average of 6.3 years earlier, are the focus of this article. Physical well-being and emotional well-being were excellent; the minimal changes between the baseline and follow-up assessments reflected expected age-related changes. Energy level and social functioning were unchanged. Hot flashes, night sweats, vaginal discharge, and breast sensitivity were less frequent. Symptoms of vaginal dryness and urinary incontinence were increased. Sexual activity with a partner declined statistically significantly between the two assessments (from 65% to 55%, P =.001). Survivors with no past systemic adjuvant therapy had a better QOL than those who had received systemic adjuvant therapy (chemotherapy, tamoxifen, or both together) (physical functioning, P =.003; physical role function, P =.02; bodily pain, P =.01; social functioning, P =.02; and general health, P =.03). In a multivariate analysis, past chemotherapy was a statistically significant predictor of a poorer current QOL (P =.003). CONCLUSIONS: Long-term, disease-free breast cancer survivors reported high levels of functioning and QOL many years after primary treatment. However, past systemic adjuvant treatment was associated with poorer functioning on several dimensions of QOL. This information may be useful to patients and physicians who are engaging in discussion of the risks and benefits of systemic adjuvant therapy.

Breast Neoplasms↗