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PubMed2002

The comparability of quality of life scores. a multitrait multimethod analysis of the EORTC QLQ-C30, SF-36 and FLIC questionnaires.

This study investigates whether similarly named subscales of three quality of life questionnaires, the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC QLQ-C30), the Medical Outcome Study Quality of Life Questionnaire Short Form 36 (SF-36) and the Functional Living Index Cancer questionnaire (FLIC) assess similar aspects of the patients' quality of life. A multitrait multimethod analysis on the answers of 234 cancer patients showed that subscale correlations as indicators of convergent validity significantly exceed corresponding correlations of discriminant validity in five of the seven dimensions analysed (physical functioning, emotional functioning, pain, fatigue/vitality and nausea/vomiting). The results of the social functioning and overall health subscales are less clear. Content analysis of the social functioning scales reveals that this domain is differently operationalised in the three questionnaires. Linear regressions of the overall health subscales suggest that patients interpret overall health questions of the three questionnaires differently. The results show that overall health subscales of these three questionnaires cannot be equated, while most specific subscales provide valid results.

Female↗
PubMed1999

The role of depression in pain, psychophysiological syndromes and medically unexplained symptoms associated with chronic fatigue syndrome.

BACKGROUND: The association between depression and pain, function, medically unexplained symptoms and psychophysiological syndromes such as irritable bowel syndrome has not been explored before in chronic fatigue syndrome. METHODS: Cross-sectional controlled study of the current prevalence of psychophysiological syndromes, pain, function and lifetime prevalence of medically unexplained symptoms in 77 out-patients with chronic fatigue syndrome (CFS) without DSM-III-R depression, 42 CFS out-patients with DSM-III-R depression and 26 out-patient with primary DSM-III-R depression. RESULTS: Both CFS groups differed significantly from the primary depression group but not each other in the prevalence of tension headaches (P < 0.001), reporting of widespread bodily pain (P < 0.001) and the number of lifetime medically unexplained symptoms (P < 0.001). The three groups did not significantly differ in the prevalence of irritable bowel syndrome or fibromyalgia. CFS patients with depression were more impaired in social function than other CFS patients. CONCLUSION: Depression is not associated with the reporting of pain, psychophysiological syndromes and medically unexplained symptoms in CFS patients. Depression is associated with decreased social function in CFS patients. LIMITATIONS: Study depended on recall of symptoms, not confirmed by medical records and current investigations. Patients with depression were taking antidepressants. CLINICAL RELEVANCE: Treating depression in chronic fatigue syndrome is unlikely to diminish reporting of pain and medically unexplained symptoms but may improve social function.

Adult↗
PubMed2005

Dopamine D3 receptor Ser9Gly polymorphism and risperidone response.

Risperidone is an atypical antipsychotic agent with efficacy for both positive and negative symptoms of schizophrenia. Risperidone is a potent dopamine D3 antagonist and agonism at D3 sites induces behavioral suppression in rodents. We thus hypothesized that D3 antagonism may contribute to response to risperidone in negative symptoms. This study aimed to explore the influence of the Ser9Gly polymorphism of the dopamine D3 receptor (DRD3) gene on response to risperidone after controlling for nongenetic factors. One hundred twenty-three Han Chinese patients with acutely exacerbated schizophrenia were given risperidone monotherapy for up to 42 days. Clinical manifestations were measured biweekly with Positive and Negative Syndrome Scale and Nurses' Observation Scale for Inpatients Evaluation (for assessment of social functioning). For adjusting the within-subject dependence over repeated assessments, multiple linear regression with generalized estimating equation methods was used to analyze the effects of Ser9Gly polymorphism and other covariates on clinical performance. Compared with patients with the Gly9Gly genotype, those with either Ser9Ser or Ser9Gly had better performance on negative symptoms after control for other prognostic factors (P = 0.0002 and 0.0092, respectively). Patients with the Ser9Ser genotype had better social functioning than those with Gly9Gly (P = 0.0029). The Ser9Gly polymorphism, however, did not significantly affect positive symptoms. Male gender, fewer previous hospitalizations, and higher risperidone dose also predicted better treatment response. These data suggest that the DRD3 Ser9Gly polymorphism or, alternatively, another genetic variation that is in linkage disequilibrium, may influence response to risperidone in negative symptoms and social functioning.

Adult↗
PubMed2005

Health-related quality of life of mothers of children with leukemia in Japan.

OBJECTIVE: The study compared the health-related quality of life (HRQOL) of Japanese mothers of children with leukemia to that of mothers of children without leukemia. METHOD: We used the Medical Outcomes Study 36-item Short-Form (SF-36) to measure the HRQOL of 97 mothers of children (average age 6.2, range 0-14) with leukemia diagnosed between 1999 and 2000, and compared their scores to those of 240 mothers of children without leukemia matched to the children with leukemia. MAIN RESULTS: Of the eight unadjusted domain scores of the SF-36, five were significantly low among mothers of children with leukemia compared to mothers of children without leukemia: 'role-physical functioning' (RP), 'general health perception' (GH), 'vitality' (VT), 'social functioning' (SF) and 'mental health' (MH). Their SF-36 domain scores, when adjusted for demographic and clinical factors were also significantly low in RP, GH, VT, SF, RE and MH. The MH and SF scores in mothers of children with leukemia requiring hospital care were, respectively, approximately 20 points (1 standard deviation (SD), p < 0.0001) and 30 points (1.5 SD, p < 0.0001) lower than that of mothers of children without leukemia. CONCLUSION: Mothers of children with leukemia requiring hospital care have poor HRQOL, particularly with regard to mental health and social functioning, and are at a greater risk for depression. These results suggest that the current system for treating leukemic diseases of children in Japan should also include close monitoring of mothers' mental health, and provision of appropriate treatment and psycho-social support.

Adolescent↗
PubMedDate not supplied

An evaluation of a hybrid occupational therapy and supported employment program in Japan for persons with schizophrenia.

OBJECTIVE: A vocational rehabilitation program (occupational therapy and supported employment) for promoting the return to the community of long-stay persons with schizophrenia was established at a psychiatric hospital in Japan. The purpose of the study was to evaluate the program in terms of hospitalization rates, community tenure, and social functioning with each individual serving as his or her control. METHODS: Fifty-two participants, averaging 8.9 years of hospitalization, participated in the vocational rehabilitation program consisting of 2 to 6 hours of in-hospital occupational therapy for 6 days per week and a post-discharge supported employment component. Seventeen years after the program was established, a retrospective study was conducted to evaluate the impact of the program on hospitalizations, community tenure, and social functioning after participants' discharge from hospital, using an interrupted time-series analysis. The postdischarge period was compared with the period from onset of illness to the index discharge on the three outcome variables. RESULTS: After discharge from the hospital, the length of time spent by participants out of the hospital increased, social functioning improved, and risk of hospitalization diminished by 50%. Female participants and those with supportive families spent more time out of the hospital than participants who were male or came from nonsupportive families. CONCLUSION: A combined program of occupational therapy and supported employment was successful in a Japanese psychiatric hospital when implemented with the continuing involvement of a clinical team. Interventions that improve the emotional and housing supports provided to persons with schizophrenia by their families are likely to enhance the outcome of vocational services.

Adult↗
PubMed2005

Heroin maintenance for chronic heroin dependents.

BACKGROUND: Many medications have been used for stabilizing heroin users: Methadone, Buprenorphine and LAAM. The present review focus on the prescription of heroin to heroin dependents. OBJECTIVES: To assess the efficacy and acceptability of heroin maintenance versus methadone or other substitution treatments for opioid dependence, in retaining patients in treatment; reducing the use of illicit substances and improving health and social functioning. SEARCH STRATEGY: The Cochrane Central Register of Trials (CENTRAL) issue 1, 2005; MEDLINE 1966-2005, EMBASE 1980-2005 and CINAHL till 2005 (on OVID) were searched. There was no language or publication year restrictions. Many researchers were contacted for information. SELECTION CRITERIA: Randomised controlled trials of heroin (alone or combined with methadone) maintenance treatment compared with any other pharmacological treatments for heroin dependents. DATA COLLECTION AND ANALYSIS: The trials were independently assessed for inclusion and methodological quality by the reviewers. Data were extracted independently and double checked. Studies were not pooled together because of heterogeneity. MAIN RESULTS: 2400 references were obtained and 20 studies were eligible, 4 met the inclusion criteria for a total of 577 patients. The studies could not be analysed cumulatively because of heterogeneity of interventions and outcomes. Retention in treatment: no groups difference was found in two studies; one study (N=96) found RR=2.82 (95% CI 1.70-4.68) favouring heroin; one study (N=235) found RR 0.79 (95%CI 0.68-0.90) favouring methadone. Relapse to illegal heroin use (self- reported): in one study people using heroin in treatment was 64% (heroin group)and 59% (methadone group); in the other study the RR of heroin use was 0.33 (95%CI 0.15-0.72) favouring heroin. Criminal offence: one study showed the potential of heroin prescription in reducing the risk of being charged RR 0.32 (95% CI 0.14-0.78). Social functioning: two studies did not show statistical difference between intervention groups, and two studies considered criminal offence and social functioning as part of a multidomain outcome measure showing improvements among those treated with heroin plus methadone over those on methadone only. AUTHORS' CONCLUSIONS: No definitive conclusions about the overall effectiveness of heroin prescription is possible. Results favouring heroin treatment come from studies conducted in countries where easily accessible Methadone Maintenance Treatment at effective dosages is available. In those studies heroin prescription was addressed to patients who had failed previous methadone treatments. The present review contains information about ongoing trials which results will be integrated as soon as available.

Heroin↗
PubMed1998

Clinicometabolic dissociation of cognitive functions and social behavior in frontal lobe lesions.

OBJECTIVE/BACKGROUND: Case studies suggest a dissociation between cognitive functions that have been impaired after damage to the dorsolateral prefrontal cortex and social skills disturbed when the ventromedial prefrontal areas are affected. Because this dissociation had not been confirmed in a clinical setting, clinicometabolic correlations were sought in 13 patients with various lesions of the prefrontal cortex. DESIGN/METHODS: The clinical assessment included extensive testing of executive functions and evaluation of behavioral abnormalities based on an informant questionnaire. Regional cerebral glucose metabolism (rCMRGlu) was measured with [l8F] fluorodeoxyglucose ([18F] FDG) and 31-slide high-resolution PET. RESULTS: Executive-function test performance was significantly correlated with rCMRGlu in the dorsolateral prefrontal cortex (Brodmann's areas 8, 9, 45, 46, and 47) and anterior cingulate cortex (Brodmann's areas 24 and 32). Behavioral scores were significantly correlated with rCMRGlu in the frontopolar (Brodmann's area 10) and orbitofrontal cortex (Brodmann's areas 11, 12, 13, and 14). CONCLUSION: These results show that impaired executive functions and serial skill deficits are associated with distinct metabolic patterns in patients with frontal lobe pathology. In agreement with activation studies in normal subjects, our data suggest the existence of a modular organization of the frontal cortex in humans, as previously reported in nonhuman primates.

Adult↗
PubMed1997

A comparison of surgeon's assessment to patient's self analysis (short form 36) after far lateral lumbar disc surgery. An outcome study.

STUDY DESIGN: Between 1984 and 1994, 170 patients had surgery for far lateral discs. Patients were assessed by the surgeon as having poor (no improvement, increased deficit), fair (mild improvement, moderate residual deficit), good (moderate improvement, mild residual deficit) or excellent (marked improvement, no deficit) physical outcomes. The Medical Outcome Trust's SF-36 survey was completed by 76 (45%) patients, using one interviewer. OBJECTIVES: Patient-based outcome studies are becoming increasingly important. A surgeon's assessment of outcome was compared with the patients' self assessment (Short Form 36) after far lateral lumbar disc surgery. SUMMARY OF BACKGROUND DATA: The SF-36 survey provides measures on eight dimensions: physical function, role physical, bodily pain, general health, vitality, social function, role-emotional, and mental health. METHODS: Patients averaged 60.1 years of age, and included 43 men and 33 women. Patients were last examined an average of 9.1 months after their surgery, and were interviewed by telephone an average of 2.8 years later. RESULTS: Patients completing the survey were evaluated on their last visit to the surgeon as having excellent (32 patients), good (24), fair (12), and poor (8) outcomes. Overall correlations between the surgeon's assessment and all 76 patients' SF-36 scores were modest. However, for those patients examined within 4.5 years of the surgeon's assessment (n = 56), correlations were statistically significant for 6 of the SF-36 measures. Only general health and social function showed correlations less than 0.25. CONCLUSIONS: The surgeon's assessment was a particularly good predictor of SF-36 measures if the surgeon assessed the patient within the past 4.5 years. The SF-36 should be useful for large-scale outcome studies.

Aged↗
PubMed2006

Training patients with schizophrenia with the community re-entry module: a controlled study.

BACKGROUND: There is increasing evidence indicating that the Community Re-entry Module (CRM), a brief, structured instrument, could guide an effective intervention for patients with schizophrenia. This study evaluated the effectiveness of the Chinese version of the CRM with respect to improvement in psychiatric symptoms, social functioning as well as relapse and re-hospitalization rates in comparison with a supportive counseling (SC) intervention. METHOD: Ninety-six outpatients with DSM-IV schizophrenia were randomly allocated to either CRM (N=48) or an equally intensive intervention of SC (N=48). The CRM was composed of 16 one-hour sessions, which were conducted with groups of 6-8 patients on a twice-a-week schedule. The two groups received routine psychiatric outpatient care during the intervention. Participants were assessed on an intention-to-treat basis with the Positive and Negative Syndrome Scales (PANSS), with the Social Disability Screening Schedule (SDSS) by two independent raters before and immediately after intervention, and at 6-month follow-up. The number of relapse and re-hospitalization were also documented. RESULTS: The CRM group significantly improved in terms of psychiatric symptoms and social functioning compared with the SC group. Rates of relapse and re-hospitalization in the CRM group were lower although the difference between the two groups was not statistically significant. CONCLUSIONS: The study supports the feasibility and effectiveness of the Chinese version of the CRM as an effective psychosocial intervention for Chinese patients with schizophrenia to improve psychopathology, social functioning and relapse and re-hospitalization rates.

Adolescent↗
PubMed2006

The concepts of remission and recovery in schizophrenia.

OBJECTIVE: To examine the past and current research into the concepts of remission and recovery in schizophrenia. DATA SOURCES: An electronic literature search of studies published between January 1990-April 2005 examining the concepts of remission and recovery in schizophrenia and the treatment of schizophrenia with antipsychotic agents was performed using Medline and EMBASE. Primary research parameters were 'schizophrenia', 'remission', 'recovery', 'meta-analysis', 'antipsychotics', 'atypicals', 'conventional', 'cognition', 'function' and 'quality of life'. STUDY SELECTION: English language articles, original research articles, reviews and other articles of interest were reviewed. DATA EXTRACTION: Data quality was determined by publication in the peer-reviewed literature and the most important information was identified. DATA SYNTHESIS: A number of different definitions of remission and recovery have been previously used, which has made comparison of study results problematic. Recently, the first operational definition of remission, based on Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria (DSM-IV) for schizophrenia, was developed. It is hoped that this will provide a standard tool for assessing the effectiveness of treatments for schizophrenia. Recovery, which encompasses both symptom remission and more functional aspects of patient's well being, such as cognition, social functionality and quality of life, is still to be satisfactorily defined. Although recent studies on new generation antipsychotics have examined some proxy outcomes related to recovery, further research is required. CONCLUSIONS: Until the definition for 'recovery' is further elucidated, factors such as symptom control and remission, and functional aspects of recovery such as improvements in cognition and social functioning, which are quantifiable, should be used as measures of treatment outcome and markers of recovery.

Antipsychotic Agents↗
PubMed1999

Randomised controlled trial of efficacy of teaching patients with bipolar disorder to identify early symptoms of relapse and obtain treatment.

OBJECTIVE: To determine the efficacy of teaching patients with bipolar disorder (manic-depressive psychosis) to identify early symptoms of relapse and seek prompt treatment from health services. DESIGN: Single blind randomised controlled trial with matching on four baseline variables using a minimisation algorithm. SETTING: Mental health services in four NHS trusts (one teaching, three non-teaching). SUBJECTS: 69 patients with bipolar disorder who had had a relapse in the previous 12 months. INTERVENTIONS: Seven to 12 individual treatment sessions from a research psychologist plus routine care or routine care alone. MAIN OUTCOME MEASURES: Time to first manic or depressive relapse, number of manic or depressive relapses, and social functioning examined by standardised interviews every six months for 18 months. RESULTS: 25th centile time to first manic relapse in experimental group was 65 weeks compared with 17 weeks in the control group. Event curves of time to first manic relapse significantly differed between experimental and control groups (log rank 7.04, df=1, P=0.008), with significant reductions in the number of manic relapses over 18 months (median difference 30% (95% confidence interval 8% to 52%), P=0.013). The experimental treatment had no effect on time to first relapse or number of relapses with depression, but it significantly improved overall social functioning (mean difference 2.0 (0.7 to 3.2), P=0.003) and employment (mean difference 0.7 (0.1 to 1.3), P=0.030) by 18 months. CONCLUSION: Teaching patients to recognise early symptoms of manic relapse and seek early treatment is associated with important clinical improvements in time to first manic relapse, social functioning, and employment.

Adolescent↗
PubMed2004

Trauma, change in strength of religious faith, and mental health service use among veterans treated for PTSD.

One of the most pervasive effects of traumatic exposure is the challenge that people experience to their existential beliefs concerning the meaning and purpose of life. Particularly at risk is the strength of their religious faith and the comfort that they derive from it. The purpose of this study is to examine a model of the interrelationships among veterans' traumatic exposure, posttraumatic stress disorder (PTSD), guilt, social functioning, change in religious faith, and continued use of mental health services. Data are drawn from studies of outpatient (N = 554) and inpatient (N = 831) specialized treatment of PTSD in Department of Veterans Affairs programs. Structural equation modeling is used to estimate the parameters of the model and evaluate its goodness of fit to the data. The model achieved acceptable goodness of fit and suggested that veterans' experiences of killing others and failing to prevent death weakened their religious faith, both directly and as mediated by feelings of guilt. Weakened religious faith and guilt each contributed independently to more extensive use of VA mental health services. Severity of PTSD symptoms and social functioning played no significant role in the continued use of mental health services. We conclude that veterans' pursuit of mental health services appears to be driven more by their guilt and the weakening of their religious faith than by the severity of their PTSD symptoms or their deficits in social functioning. The specificity of these effects on service use suggests that a primary motivation of veterans' continuing pursuit of treatment may be their search for a meaning and purpose to their traumatic experiences. This possibility raises the broader issue of whether spirituality should be more central to the treatment of PTSD, either in the form of a greater role for pastoral counseling or of a wider inclusion of spiritual issues in traditional psychotherapy for PTSD.

Ambulatory Care↗
PubMed2002

Group-based parent-training programmes for improving emotional and behavioural adjustment in 0-3 year old children.

BACKGROUND: Mental health problems in children are common. Research suggests that parenting has an important role to play in helping children to become well adjusted adults, and that the first few months and years of a child's life are especially important in establishing patterns of emotional, cognitive and social functioning which will in turn influence the child's future development and in particular, their mental health. Parenting programmes may therefore have a role to play in improving the mental health of infants and toddlers. OBJECTIVES: The objectives of this review are as follows: a) To establish whether group-based parenting programmes are effective in improving the mental health of children less than three years of age b) To assess the role of parenting programmes in the primary prevention of mental health problems SEARCH STRATEGY: A range of biomedical and social science databases were searched including MEDLINE, EMBASE, CINAHL, PsychLIT, Sociofile, Social Science Citation Index, ASSIA, the Cochrane Library including SPECTR, CENTRAL, National Research Register (NRR) and ERIC. SELECTION CRITERIA: Only randomised controlled trials were included and studies had to include at least one standardised instrument measuring some aspect of infant mental health. DATA COLLECTION AND ANALYSIS: The treatment effect for each outcome in each study was standardised by dividing the mean difference in post-intervention scores for the intervention and treatment group, by the pooled standard deviation, to obtain an effect size. The results for each outcome in each study have been presented with 95% confidence intervals. Where appropriate the results have been combined in a meta-analysis using a random effect model. MAIN RESULTS: A total of five studies were included in the review. The 5 included studies provided a total of 36 assessments of infant and toddler mental health including emotional and behavioural adjustment, and sleep patterns. All of the results apart from 6 showed positive findings favouring the intervention group. While some of findings were non-significant, most of the effect sizes were large and the wide confidence intervals crossing the zero that were obtained in a number of the studies, were very probably due to small sample sizes. There was sufficient data from four studies to combine the results in a meta-analysis. The results of the meta-analysis show a significant difference in children's emotional and behavioural adjustment favouring the intervention group. Overall, the limited follow-up data provide equivocal evidence concerning the maintenance of these effects over time. REVIEWER'S CONCLUSIONS: The results of this review suggest that parenting programmes can be effective in improving the mental health of infants and toddlers. There is, however, insufficient evidence to reach any firm conclusions regarding the role that such programmes might play in the primary prevention of mental health problems. Furthermore, there is insufficient evidence to know whether the short-term benefit of these programmes is maintained over time, and further research is required.

Child Development↗
PubMed2004

The efficacy of short-term psychodynamic psychotherapy in specific psychiatric disorders: a meta-analysis.

BACKGROUND: The efficacy of psychodynamic therapy is controversial. Previous meta-analyses have reported discrepant results. OBJECTIVE: To test the efficacy of short-term psychodynamic psychotherapy (STPP) in specific psychiatric disorders by performing a meta-analysis of more recent studies. We assessed outcomes in target problems, general psychiatric symptoms, and social functioning. DESIGN: We identified studies of STPP published between January 1, 1970, and September 30, 2004, by means of a computerized search using MEDLINE, PsychINFO, and Current Contents. Rigorous inclusion criteria, included randomized controlled trials, use of treatment manuals and insurance of treatment integrity, therapists experienced or specifically trained in STPP, treatment of patients with specific psychiatric disorders, reliable and valid diagnostic measures, and data necessary to calculate effect sizes. Studies of interpersonal therapy were excluded. Seventeen studies fulfilled the inclusion criteria. The information was extracted by 3 raters. Effect sizes were calculated for target problems, general psychiatric symptoms, and social functioning using the data published in the original studies. To examine the stability of outcome, we assessed effect sizes separately for end of therapy and follow-up assessment. The effect sizes of STPP were compared with those of waiting-list control patients, treatments as usual, and other forms of psychotherapy. RESULTS: Short-term psychodynamic psychotherapy yielded significant and large pretreatment-posttreatment effect sizes for target problems (1.39), general psychiatric symptoms (0.90), and social functioning (0.80). These effect sizes were stable and tended to increase at follow-up (1.57, 0.95, and 1.19, respectively). The effect sizes of STPP significantly exceeded those of waiting-list controls and treatments as usual. No differences were found between STPP and other forms of psychotherapy. CONCLUSIONS: Short-term psychodynamic psychotherapy proved to be an effective treatment in psychiatric disorders. However, further research of STPP in specific psychiatric disorders is needed, including a study of the active ingredients of STPP. Effectiveness studies should be included.

Follow-Up Studies↗
PubMed2002

Interpersonal psychotherapy delivered over the telephone to recurrent depressives. A pilot study.

Rates of recurrent depression peak among women in their childbearing years, yet a large number of these women are not treated or do not seek maintenance treatment between episodes. Barriers to treatment include time constraints, demands of child care, and finances. A method for improving access to treatment of depression may be delivery of psychotherapy over the telephone. A 12-week pilot controlled clinical trial with random assignment was conducted to test the feasibility and efficacy of Interpersonal Psychotherapy delivered over the telephone (IPT-T) for depression in women (N=15 IPT-T and N=15 no treatment) with a life-time history of recurrent depression and low rates of previous treatment. Patients were interviewed at baseline and at 12 weeks by a blind and independent clinical evaluator to assess their symptom level and social functioning. IPT-T as compared to no treatment was significantly better in lowering symptoms of depression as measured by the Hamilton Rating Scale for Depression (p<.02), improving global functioning (GAS) (p<.02), and improving work and social functioning (p<.03-.05, respectively). These preliminary findings support the feasibility and helpfulness of IPT-T in preventing an increase in depressive symptoms among women with recurrent depression but current mild to moderately levels of depression.

Adult↗
PubMed2005

Eating behavior affects quality of life in type 2 diabetes mellitus.

We evaluated the prevalence of disordered eating behavior in 168 unselected outpatients with type 2 diabetes mellitus (T2DM) and the effects on the health related quality of life (HRQL). Subjects in generally good glycemic control, treated by diet or oral hypoglycemic agents (58% M; 63.8+/-SD 10.1 years; BMI, 29.7+/-5.9 kg/m2) completed self-administered questionnaires for HRQL (SF-36) and eating behavior [(Three-Factor Eating Questionnaire (TFEQ); Binge Eating Scale (BES)]. Data on HRQL were computed as effectsizes in comparison to population norm. The prevalence of altered TFEQ scales was not different between genders, and varied between 22.1% (disinhibition) and 41.4% (restriction), but only 6.7% had a positive BES score. Age (OR, 0.58 for decade; 95% CI, 0.39-0.87), duration of diabetes (OR, 1.33 for 5 years; 1.01-1.74) and BMI (OR, 1.11; 1.04-1.18) were predictive for the presence of disinhibition. BMI also predicted hunger (OR, 1.16; 1.08-1.25). SF36 domains were not different in relation to positive BES. Disinhibition at TFEQ was significantly associated with poor social functioning (p=0.018) and role-emotional (p=0.022), whereas hunger was associated with poor physical functioning (p=0.010), role-physical (p=0.0014), social functioning (p=0.015) and role-emotional (p=0.0001). Metabolic control, duration of diabetes, and the presence of complications were not associated with HRQL. A disordered eating behavior may be present in T2DM patients, and is associated with poor HRQL. This condition must be considered for an olistic approach to weight control.

Aged↗
PubMed2002

Morphology of the ventral frontal cortex in schizophrenia: relationship with social dysfunction.

BACKGROUND: Studies have reported premorbid as well as postonset social dysfunction in schizophrenia. This impairment has also been observed to emerge after lesions in the ventral aspect of the frontal cortex (i.e., straight gyrus and orbitofrontal cortex). METHODS: Magnetic resonance imaging scans were obtained from 45 male patients with schizophrenia and 45 matched control subjects. Cortical gray matter volume and surface area were determined for the ventral frontal cortex (VFC), subdivided into the orbitofrontal cortex (OFC) and the straight gyrus (SG). RESULTS: The global measures of gray matter volume and surface area in the VFC was not significantly different between patients and control subjects; however, there was a regional difference, with the right SG volume and surface area being smaller in patients compared with control subjects. Volume of the VFC had an inverse correlation with measurements of both premorbid and postdiagnosis social function. The smaller the gray matter in these regions, the greater the social dysfunction. There was no relationship between morphology of this brain region and any other clinical variable. CONCLUSIONS: Morphology of the VFC is directly related to abnormal social function in schizophrenia, including measures of social dysfunction that predate the onset of illness.

Adult↗
PubMed1992

Health-related quality of life outcomes of pancreas transplant recipients.

The health status and quality of life outcomes of 131 patients who were 1 to 11 years post-pancreas transplant were studied. Patients were compared based on the current status of their pancreas graft, i.e. whether or not their grafts were successful in maintaining an insulin-independent state, and according to recipient category (pancreas alone vs kidney and pancreas). For this study, quality of life was defined as patients' perceptions of their well-being and ability to function in six areas: physical and mental health, social functioning, role (work and home) functioning, overall health perceptions, and physical pain. Patient self-report questions from the Medical Outcome Study were used to provide a score scaled from 0 to 100, for each area. Health status was assessed by sick days, hospitalizations, and emergency room visits. Patients with a successful pancreas graft (N = 65) reported significantly more positive health perceptions (51.9 vs 28.9), less pain (33.9 vs 45.3), and greater ability to function socially (84.9 vs 71.3) than did patients whose pancreas grafts were not successful. In addition, patients with successful pancreas grafts rated their ability to perform routine activities as nearer to normal on the Karnofsky Index (2.82 vs 3.63) and were more likely to view themselves as healthier since the pancreas transplant than were patients whose pancreas grafts were not successful. These effects persisted after statistical adjustment for recipient category and case-mix factors of age, sex, education, and length of time since pancreas transplant.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗