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Quality of life during and between hemodialysis treatments: role of L-carnitine supplementation.

End-stage renal disease affects every aspect of a patient's life, including perception of health and quality of life. It is likely that a hemodialysis patient's perceptions of health-related quality of life directly influence compliance with medical, nursing, and nutritional prescriptions. Because L-carnitine supplementation is known to enhance muscle strength and energy in hemodialysis patients, we hypothesized that L-carnitine supplementation would enhance a hemodialysis patient's perception of health-related quality of life. To test this hypothesis, 1 g L-carnitine or placebo was administered orally to 101 patients immediately before and after every hemodialysis treatment for 6 months. To assess health-related quality of life from the patient's perspective, the Medical Outcomes Study Short Form 36 instrument was administered before the study and at 1.5-month intervals for the duration of the study. In addition, a 10-item questionnaire designed to assess common intradialytic symptoms was administered at the end of each dialysis treatment. Other parameters analyzed included Kt/V(urea) and level of nutrition. In the 6-month group, oral L-carnitine supplementation had an early positive effect on general health (P < 0.02) and physical function (P < 0.03), but the perceived effect was not sustained throughout the 6 months of the study. In the 3-month group, L-carnitine supplementation improved vitality (P < 0.02) and general health (P < 0.01). There was no association between Kt/V(urea) and perceived health-related quality of life. Serum albumin concentration was directly correlated to how patients perceived the quality of their lives.

Administration, Oral↗

How should we train physicians for remote and rural practice? What the present incumbents say.

OBJECTIVE: To obtain the views of the current remote and rural consultant physicians with regards to their opinion on components of an ideal training programme for an aspirant remote and rural physician. DESIGN: A questionnaire was designed to elicit information in three main areas: experience and training prior to appointment, current pattern of service provision and opinions on components of an ideal training programme for remote and rural physicians. SETTING: Five Scottish rural hospitals in Shetland, Wick, Stornoway, Fort William and Oban. SUBJECTS: Thirteen consultant physicians based in the five rural hospitals chosen. RESULTS: The response rate to the questionnaire was 85%. All had previous experience in acute general medicine, and most in one of a variety of subspecialties. Each physician had developed interests and skills in other branches of medicine following appointment in order to meet local service needs. Most felt that there was a need for expansion of consultant numbers in the future, 45% citing the European Working Time Directive as the major reason. There was an encouraging degree of commonality between the current consultants as to what they felt should be included in a training programme for remote and rural physicians. CONCLUSION: There are challenges in meeting training needs for consultant physicians intending to work in a remote setting. Development of broader-based training than offered by most current dual training programmes is essential. Only imaginative approaches to training will produce physicians who are fit for purpose.

Attitude of Health Personnel↗

Postgraduate education expectations: a survey of Hong Kong graduate nurses.

Tertiary education for nurses in Hong Kong is in its early development. With many overseas universities competing to secure Asian students, the need for locally developed programmes to meet Hong Kong's needs can be overlooked. In this survey 705 nurses with degree level qualifications working for the major public and private employing agencies completed a questionnaire designed to obtain details of postgraduate study plans and preferences for the type, focus and mode of postgraduate programmes. Analysis of responses showed 50% of the graduates surveyed intended to pursue further study in the next two years with a clear preference for course work masters, degree programmes (55%), studies with a specialist (71%) rather than a generalist focus, and programmes offered locally (85%) on a part-time basis (86%). Future educational needs were also found to vary according to gender, marital status, place of employment and nursing post. The findings from this survey have considerable implications for educational and professional nursing developments and planning to meet the future health care needs of Hong Kong. In addition, the information may inform the planning of other countries newly embarked on tertiary education for nurses.

Adult↗

The informationist in Australia: a feasibility study.

OBJECTIVES: A clinical informationist could provide the best available published evidence in response to clinicians' questions identified during the process of care. This study sought to assess the feasibility of an informationist service and to propose a model for its delivery in an Australian teaching hospital. Whilst similar services are increasing in the UK, with a long history in the USA, this is the first Australian study in an acute public hospital. METHODS: The views of 40/49 (82%) medical staff at the Daw Park Repatriation General Hospital, South Australia were canvassed using a questionnaire designed to address key issues relating to a proposed service. RESULTS: Doctors were receptive to its potential benefits, perceived it as relevant and likely to be used, and were interested in a pilot. They typically indicated a required response time of 24 h. They expressed limited concerns other than a likely high workload for such a service, and reported currently searching infrequently for evidence in response to clinical questions, citing time issues and unavailability of computers as current key barriers to pursuing clinical questions. CONCLUSIONS: An informationist service is feasible. Results suggest that a pilot could be run in an area of acute medicine where questions about therapy and diagnosis are likely to proliferate, and the informationist should attend consultant ward rounds and clinical meetings, aiming to provide a response within 24 h.

Attitude of Health Personnel↗

Sonotubometry findings in children at high risk from middle ear effusion.

The functioning of the eustachian tube has an important role to play in the development of middle ear disease. It would be useful if a clinical test could assist in the identification of eustachian tube dysfunction, particularly if this is shown to be an indicator of persistent middle ear effusion. The aim of this study was to compare the results of sonotubometry using the MMS-10 instrument in children at high risk from middle ear effusion with a group of normal subjects. Forty-one subjects (age range 5-6 years) were allocated to one of two groups (experimental group, 21 subjects; control group 20 subjects) based on a questionnaire designed to identify subjects at high risk from middle ear effusion. The test protocol allowed each subject to swallow three times for each of two pure-tones (7 and 8 kHz) delivered by the nasal probe. Sonotubometry indicated opening of the eustachian tube on swallowing in around 80% of subjects. The incidence of positive findings varied greatly amongst subjects across both groups. In the control group, the mean increase in sound pressure level on swallowing was 11.5 dB (+/- 4.3) and 9.8 dB (+/- 2.5) for 7 and 8 kHz, respectively. The corresponding means for duration were 118 ms (+/- 47.9) and 137 ms (+/- 61.8). Sonotubometry failed to demonstrate a difference between the two groups of subjects. Hence, the clinical application of sonotubometry to identify subjects at high risk from middle ear effusion is not supported.

Atmospheric Pressure↗

[Damage caused by wearing contact lenses throughout the day].

Seventy-eight contact lens patients issued with soft HEMA lenses were examined in order to establish reasons for intolerance. The examination was carried out in conjunction with a questionnaire designed to furnish information about the habits of the contact lens patients. Less than 50% of the patients had been advised to have their lenses checked. Almost all the patients wore their contact lenses all day without interruption. On average they had been wearing the lenses for up to 17 hours per day over a 3.3 year period. In approximately 2/3 of the cases the eye had suffered some damage and in approximately 1/3 of the cases the effects were more serious. Patients who had worn their lenses for even longer periods of time had suffered still more severe eye damage. However, microbiological findings, allergies to the cleaning fluids, reduced tear production, incorrect lens fit and severe deterioration of the lens material were not found to be the prime causes of intolerance. Photographs shot by SEM showed evidence of defects of the corneal surface after the HEMA lens had been worn 18 hours.

Adolescent↗

Examination of the factor structure of the Ways of Coping Questionnaire with clinical populations.

The purpose of this study was to examine the construct validity of the Ways of Coping Questionnaire in a clinical population. The questionnaire, designed to measure coping behaviors in a community-residing well population, contained eight empirically constructed factors. Confirmatory factor analysis with LISREL was used to validate this original eight-factor model with 655 community-residing adults with multiple sclerosis or a spinal cord injury. The hypothesized model was not a good fit to the data. Subsequent analyses, using both exploratory and confirmatory factor analysis procedures, identified three different coping factors: Cognitive Reframing, Emotional Respite, and Direct Assistance. These factors appeared to have greater applicability to people with chronic conditions. The kinds of coping behaviors used to manage stressful situations by individuals who are well may be quite different from those used by community-residing populations with long-term chronic conditions.

Adaptation, Psychological↗

A single session of reassurance can acutely improve the self-perception of impairment in patients with IBS.

OBJECTIVE: The aim of this study was to determine the reported frequency and self-perceived importance of factors related to health care seeking by irritable bowel syndrome (IBS) patients and the effect of reassurance on these factors. METHODS: Fifty-five IBS patients, consulting for the first time, answered a questionnaire designed to evaluate these factors (FRQ), measurements of anxiety, depression, and quality of life (QoL). A thorough explanation of the disease and reassurance were given, and the FRQ was answered again. RESULTS: The frequency of factors was: pain/discomfort, 78%; cancer fear, 11%; daily function impairment, 33%; symptoms stressfulness, 60%; and none, 2%. Pain/discomfort and symptom stressfulness were considered the most important ones. Cancer fear and symptom stressfulness correlated with anxiety (P=.003, .042), depression (P=.038, .019), and daily function impairment with depression (P=.05). Cancer fear, daily function impairment, and symptom stressfulness impacted on QoL. Reassurance acutely decreased the self-perception of daily function impairment (P=.003), independent of the patient's educational level. CONCLUSIONS: Reassurance during the first consultation for IBS decreased the self-perception of impairment in daily function.

Adult↗

Group therapy for women sexually abused as children: mental health before and after group therapy.

Forty-five female outpatients sexually abused in childhood were offered a 2-year phase-divided group therapy. Before and after treatment and at 12 months follow-up, they answered questionnaires designed to elicit responses concerning psychological symptoms (Symptom Checklist; SCL-90) and sense of coherence (SOC). Symptoms for posttraumatic stress disorder (PTSD) were assessed before and after treatment. Inpatient days and sick listing days were assessed during 2 years before and 2 years after treatment. The psychological and PTSD symptoms were significantly reduced after treatment, and the SOC was increased as well. Inpatient days were decreased, and sick listing days increased but not significantly. Compared to a similar short-term focused therapy group and a waiting-list group there were no significant differences between the groups. Trauma-focused group therapy for women who were sexually abused in childhood seems to have promising effects on mental health, both concerning long-term and short-term approaches.

Adult↗

[Family response and alcohol consumption].

The present study has its main objective the analysis of family responses to excessive alcohol consumption. For this we used data derived from a cross-sectional epidemiological community survey directed to investigate, in a random sample of 1.800 persons of 18 to 65 years of age and representative of the population of Cantabria community responses to alcohol consumption. We applied, among other instruments, a questionnaire designed by the WHO for exploring alcohol consumption, and which has being extensively used in other settings. We found, among other things, that: i) The concern about parents excessive alcohol consumption has different repercussions depending of the sex of their children, thus producing more alcohol related problems in males; ii) The concern for the alcohol consumption of ones partner is more often seeing in females, thus females tend to be more sensitive to these problems, and also they tend to detect them earlier and be more tolerant to them; iii) Persons who worry for the alcohol consumption of their partners usually have also had parents with such sort of problems; iv) And lastly about 11% of males and 13% of females with adolescent children tend to worry about the children' excessive alcohol consumption.

Adolescent↗

Burden of alcohol use in the Uganda Police in Kampala District.

BACKGROUND: Alcohol dependence is one of the leading causes of the global burden of disease. Among members of the Uganda Police Force, alcohol dependence has been a major contributor of poor mental health, poor work output and forced retirement. OBJECTIVE: This study was carried out to determine the prevalence of alcohol dependence and associated psychosocial problems in the Uganda Police Force in Kampala District. METHODS OF STUDY: A sample of police officers selected by systematic sampling strategy from two large barracks in Kampala District participated. A semi-structured questionnaire designed to elicit information on the perceived impact of alcohol use was used. Prevalence rate was derived from ICD-10 criteria for alcohol dependence, and psychosocial problems in alcohol dependence. RESULTS: Twenty respondents (19.2%) met criteria for alcohol use disorder, 26.0% met criteria for alcohol use problems and 9.6% reported that their health was poor. Alcohol use disorder or problems were significantly associated with lack of job satisfaction, poor health, problems in implementing personal plans, disciplinary problems, inability to save from personal earnings, debts, and absenteeism from work. CONCLUSION: One in five police officers met criteria for alcohol use disorder while one in four experienced psychosocial problems related to alcohol use. The results suggest serious implications for the quality of services provided by the Uganda Police. There is a need to establish measures to provide services for those affected, and a further need to establish preventative measures against alcohol dependence in the police force.

Adult↗

Adult onset of major depressive disorder in relation to early life violent victimisation: a case-control study.

BACKGROUND: Major depressive disorder is a significant cause of morbidity among women in the USA. Women are twice as likely as men to be diagnosed with major depressive disorder, yet no known risk factors can account for this sex difference. We aimed to assess violent victimisation as a risk factor for depression in women. METHODS: We undertook a case-control study to assess the association between violent victimisation early in life and major depressive disorder in women. We randomly selected a population-based sample of women, aged 36-45 years, from the greater Boston area. In 1999, 236 cases and 496 controls (n=732) completed a self-administered questionnaire designed to ascertain a lifetime history of exposure to violent victimisation. Our main outcome measure was major depressive disorder, assessed by structured clinical interview for Diagnostic Statistical Manual IV (DSM-IV) criteria. FINDINGS: 363 (50%) of 732 respondents reported experience or fear of abuse as a child or adolescent. 68 were excluded because they reported violence as an adult only. Compared with women who reported no abuse, risk of depression was increased in women who reported any abuse as a child or adolescent (relative risk 2.5, 95% CI 1.9-3.0), physical abuse only (2.4, 1.8-3.0), sexual abuse only (1.8, 1.2-2.8), and both physical and sexual abuse (3.3, 2.5-4.1). Severity of abuse had a linear dose-response relation with depression. INTERPRETATION: Our results suggest a positive association between violent victimisation early in life and major depressive disorder in women.

Adult↗

Quality of life and longevity: a study of centenarians.

OBJECTIVE: Interest in centenarians has focused on two particular aspects: the antecedents of extreme old age and the psychophysical well-being of the very old. Our study deals with the latter aspect and aims to assess the quality of life of Italian centenarians. METHOD: Using data collected using two questionnaires designed to investigate quality of life in elderly people, three groups of 38 elderly subjects were compared: centenarians and subjects aged between 75 and 85 years and 86 and 99 years. RESULTS: The centenarians complained less spontaneously about their health (maintained in part by medical treatments), but declared having greater functional disability. Their cognitive function appears to be reasonably well preserved and they have lower scores for anxiety and depression than the subjects in the two younger groups. They consider themselves religious, satisfied with their financial situation but no longer interested in sex or involved in recreational activities. They report greater satisfaction with life and with social and family relations than do less elderly individuals. CONCLUSIONS: The centenarians we interviewed seem to be well adapted to their lives and to maintain a more positive attitude than the subjects in the two younger groups.

Adaptation, Psychological↗

Utility and validity of the eating behavior inventory in clinical obesity research: a review of the literature.

The Eating Behavior Inventory (EBI) is a questionnaire designed to assess behaviours associated with weight loss and weight management. In the 25 years since it was first published, the EBI has been used to examine weight management behaviours of adults and children in more than 20 weight loss investigations. This paper systematically reviews the use of the EBI in these studies. Results indicate that baseline EBI scores have remained quite consistent over time and are generally not influenced by patient variables. The EBI has also been shown to be consistently sensitive to behavioural weight management interventions, but it appears that the amount of change in EBI scores has decreased slightly over time. Finally, the amount of change in EBI score with treatment typically correlates positively with the amount of weight subjects lose. Overall, the research that has used the EBI has provided solid and consistent evidence of the utility of the EBI as a valid tool for assessing weight management behaviours.

Behavior Therapy↗

[The effect of social support on women's perception of global stress and health status].

Social support is considered to be an essential factor in the perception of global stress, as it reduces the impact of the stressors (and thereby protects against excessive stress), a well as reduces the detrimental effects of stress. The purpose of the study was to determine the level of social support received by women in two essential areas: family life and occupational work, and to estimate the relationships between the support level and stress perception by women and the condition of their health (estimated with the use of the Goldberg General Health Questionnaire). The APGAR questionnaire designed by G. Smilkstein was used to estimate the support. This was the first instance of the application of the method in a Polish study--with prior written consent of the author of the method. The study involved 98 women in four occupational groups (physicians, nurses, spinning machine operators, and employees of financial department of an industrial plant). The results of the study indicate that the situation of the women in respect of the received social support differs, to a statistically significant degree depending on the occupational group to which they belong. The evaluations of the support are also, significant correlated with the evaluations of global stress in the whole population test--higher results with respect to the support are correlated with the lower degree of stress. The support from the family shows higher degree of correlation with the level of the perceived stress than the support received at the place of employment.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Registered nurse empowerment. Model testing and implications for nurse administrators.

OBJECTIVE: The author developed and tested a model formulated to determine what combination of organizational, leadership, and personal characteristics maximize the prediction of registered nurse empowerment in an acute care hospital. BACKGROUND: Recent innovations in patient care delivery and nursing governance are more successful with an empowered nursing staff. However, the contexts for empowerment and management practices that foster empowerment are poorly understood. Previous empowerment studies suggest that personal characteristics such as age, experience, and education are related to empowerment. Additionally, specific leadership practices and organizational cultures have been shown to foster empowerment. METHODS: Registered nurses (N = 113) who were employed in an academic health center participated in the study. Participants completed measures of organizational culture, connective leadership, empowerment, and a demographic questionnaire designed to elicit the personal characteristics included in the model. RESULTS: Regression analysis identified constructive organizational culture and connective leadership as positive predictors of empowerment, whereas defensive culture was a negative predictor. The three variables combined to explain 45% of the variance in empowerment (P < 0.001). Personal characteristics were not significant predictors, but education and position level were significantly related to connective leadership (P < 0.01). CONCLUSIONS: The Registered Nurse Empowerment Model can serve as a framework for identifying and targeting areas requiring organizational change. The quantitative measures for organizational culture, connective leadership, and empowerment provide practical assessment and evaluation tools for data-based change. Education programs for nurses at all levels should address the behaviors and strategies that promote constructive cultures and connective leadership, minimize defensive cultures, and thus, foster empowerment of nursing staff.

Academic Medical Centers↗

The influence of various fluoride exposures on the prevalence of esthetic problems resulting from dental fluorosis.

OBJECTIVES: This study sought to determine the prevalence of esthetic problems due to dental fluorosis, and determine the relationship of different fluoride exposure histories to the occurrence of these problems. METHODS: In 1993-94 2,715 children in grades 2 and 3 and 3,297 adolescents in grades 8 and 9 were examined by four dentists. Questionnaires detailing exposures to various fluoride technologies were collected from 3,022 of these study participants. Esthetic ratings of the participants' maxillary anterior teeth were made by the examiners, the participants themselves, and their parents using questionnaires designed for this purpose. RESULTS: Data indicate that 46 percent of the participants had dental fluorosis. Only 40 percent had fluorosis on anterior maxillary teeth. The prevalence of esthetic problems ranged from about 1 percent to 4 percent, depending on how an esthetic problem was defined. Esthetic problems as defined by the participant were more prevalent for the "over 11" age group. Logistic regression results demonstrated significant associations between several of the classifications of esthetic problems and the use of fluoride supplements and dentifrices, and exposure to fluoridated water during the third year of life. CONCLUSIONS: Results suggest that the prevalence of esthetic problems is low in the communities surveyed, and that exposure to any number of fluoride technologies in the third year of life can increase a child's risk for this problem.

Adolescent↗

A study of reasons of non-compliance to psychiatric treatment.

BACKGROUND: This study was carried out with an objective to find out the frequency of different reasons of non-compliance to treatment in a sample of out door psychiatric patients. METHODS: This study was conducted at Psychiatry department, Pakistan Institute of Medical Sciences, Islamabad, from Aug. 2001 to Jan. 2002. Data from a non-probability sample of two hundred follow up patients with a definite psychiatric illness was collected. A questionnaire designed for this purpose was administered by a consultant psychiatrist to the patients. The data was categorized into different causes of discontinuation of treatment accordingly. RESULTS: The commonest reasons for non-compliance were unawareness of the benefits of treatment (43%), nonaffordability of drugs (33.5%), physical side effects (28.5%), no awareness given by the doctor (03%) and unfriendly attitude of doctors (02%). The commonest illnesses leading to non-compliance were major depressive disorder (31.5%), schizophrenia (19.5%) and bipolar affective disorder (19%). CONCLUSION: Non-compliance is quite common in Pakistan like any other society. Medical practitioners need to be aware of it and address this problem because compliance is directly related to the prognosis of the illness. It is recommended that all efforts should be exerted to improve the compliance of psychiatric patients by eliminating the factors leading to non-compliance.

Adult↗