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PubMed1991

Abnormal eating attitudes and body image in older undernourished individuals.

An anorexia nervosa-like syndrome has been reported in older persons. To gain additional insight into this condition, a questionnaire designed to assess the severity of eating disorders (the EAT-26) was administered to 183 male outpatients. Thirty-four subjects were found to be undernourished by midarm circumference measurement and 21 by weight adjusted for age-sex-height. Approximately 60% of malnourished subjects acknowledged inappropriate self-control around food, up to 26% described other unsuitable eating attitudes, and 3% to 52% evidenced various forms of distorted body image. They scored high on EAT-26 Oral Control subscale but low to normal on Dieting and Bulimia and Food Preoccupation subscales. These results indicate that abnormal eating attitudes and body image occur in an important minority of undernourished elderly males, but the pattern of abnormalities differs from that seen in classical anorexia nervosa. This association deserves additional investigation, with special attention to the psychopathology producing high Oral Control responses and to females as well as males. In the meantime, clinicians need to consider anorexia-like attitudes when caring for malnourished seniors.

Aged↗

PubMed2006

Item analysis of the NHANES ADL instrument in a sample of patients reporting frequent severe headaches.

BACKGROUND AND PURPOSE: The National Health and Nutrition Examination Surveys (NHANES) activity of daily living (ADL) instrument is a 16-item questionnaire designed to represent the internal latent construct of activities of daily living. The purpose of the present study was to measure selected psychometric properties (dimensionality, internal consistency and individual item response) of the NHANES ADL instrument on a population of patients who reported frequent severe headaches. METHOD: The study group consisted of 672 attendees of a traditional medical appointment with a report of severe headaches. Data analyses included exploratory factor analysis, internal consistency measures and graded item response theory. RESULTS: The NHANES ADL instrument is a uni-dimensional and internally consistent measure of activities of daily living. Graded item response theory analyses indicated that all 16 single items were sensitive measures of the latent construct of activities and daily living. Selected items demonstrated high discrimination while others demonstrated moderate discrimination among responses. CONCLUSION: Individual use of selected items of the NHANES ADL instrument may further improve the capacity of the healthcare provider in measuring and recording dysfunction associated with headaches.

Activities of Daily Living↗

PubMed1987

Validity of clinical symptoms in benign esophageal disease, assessed by questionnaire.

A questionnaire designed to test the value of questions identifying benign esophageal disease was sent to patients representing four well-defined entities: angina pectoris (n = 30), benign esophageal disease (n = 25), gastroduodenal ulcer or former gallstones (n = 27) and normal subjects (n = 38). By means of logistic regression, three key-questions were selected. A combination of an affirmative answer to "difficulty in swallowing solid food" and to "pain in the chest" or "heartburn at night" or both did not occur in the group of normal subjects, while occurring in 68% of the patients with esophageal diseases. The combination occurred in only 10% of the patients with angina pectoris and 15% of those suffering from gastroduodenal ulcer or gallstones. The predictive accuracy of the combination of the three questions is estimated for various hypothetic prevalences of esophageal disease. These questions appear to identify approximately two-thirds of individuals with esophageal disease with acceptable false-positive rates and can therefore be used in epidemiological studies.

Adult↗

PubMed1994

Determinants of physician ordering of preoperative autologous donations.

Preoperative autologous donation (PAD) is frequently utilized to reduce infectious disease transmission risks, but it is an expensive form of hemotherapy that is not always closely matched with the needs of the patients. We compared the use of PAD in an academic medical center with patient needs and then investigated the efficacy of a simple intervention to promote targeting of PAD toward patients most likely to benefit from having PADs available. Over a 3-month period, surgeons whose patients received allogeneic components were asked to complete a questionnaire designed to identify reasons for not ordering PAD. PAD units were used in 14 (11%) of 124 cases, accounting for 6% of perioperative red cell use. The responses (46, 42% of the surveys sent) stated that PAD had not been ordered because of time constraints (39%), medical problems (26%), anemia (15%), and lack of expectation of blood use (24%). Chart review documented the presence of cited conditions in 88% of cases. Logistic and cost concerns were not evident. However, only 8% of the 176 PAD units collected in that period were transfused. Following dissemination of PAD ordering guidelines, this proportion rose to 52% without a reduction in the proportion of elective surgical cases utilizing autologous transfusion. This improvement in ordering practice was maintained over at least in 5-month period. Thus we were able to improve the efficiency of PAD application (reducing over-ordering) through a simple feedback to surgeons that assisted them in targeting PAD toward patients most likely to need transfusion.

Academic Medical Centers↗

PubMed2004

Pubovaginal cutaneous fascial sling procedure for stress urinary incontinence: 10 years' experience.

OBJECTIVES: There is a considerable lack of consensus regarding indications and long-term efficacy of the many techniques for treating urinary stress incontinence. We report the long-term results of a modified pubovaginal sling procedure. METHODS: From 1989 to 1998, 129 consecutive patients underwent a pubovaginal sling by two urologists. 86 of the subjects (67%) replied to a questionnaire designed to assess the outcome of the procedure and the subjective satisfaction with the operative result. During surgery we performed a modified sling procedure using a cutaneous strip strengthened by rectus fascia and placed with almost no tension. Special care was taken not to lacerate or damage but support the urethral musculature. We routinely did an anterior vaginoplasty, and posterior vaginoplasty if necessary. RESULTS: Mean patient age was 56.8 years, mean follow-up 39 months, mean parity 2.1, previous surgery 0.4. Improvement rates were determined as follows ('Are you satisfied with the operation?'): Significantly reduced incontinence (i.e. 50-100% improvement) was found in 65.2%, slight reduction (10-40% improvement) in 15.2%, no change in 17.4% and worsening in 2.2% of all 103 cases. The majority of all complications were wound infections. CONCLUSION: Despite the considerable failure rate, the substantial improvement in the quality of life of almost two thirds of the patients during a 3-year follow-up recommends a pubovaginal sling as a treatment option for urinary incontinence.

Fasciotomy↗

PubMedDate not supplied

Correlates of life satisfaction for old Libyans compared with the judgments of Libyan youth.

Two hundred fifteen Libyans-106 young male and female undergraduate students and 109 aged male and female relatives--responded to a questionnaire designed to measure correlates of life satisfaction in old age. It was predicted that current cultural and social changes associated with the industrialization of Libya would result in significant differences in responses between young and old men and women. The young Libyan men rated close ties with their children, social relationships with individuals outside the family, and having basic physical needs met as more important than did the old Libyan men who considered social prestige, living with their spouse, and independence as more important for satisfaction in old age. The young Libyan women also considered social relationships outside the family and having basic physical needs met in old age as more important than did their older counterparts. Health and adequate living conditions were rated more highly by the young Libyan women than by the old. All participants rated social prestige equally high, but old women rated it higher than any other aspect except belief in God and self-understanding. Findings and implications for services to Libya's elderly are discussed.

Adolescent↗

PubMed2005

Research involvement, specialty choice, and emigration preferences of final year medical students in croatia.

AIM: To explore involvement in scientific research, choice of specialty, and readiness to emigrate among graduating medical students in Croatia. METHODS: A total of 312 out of 408 (76%) final year medical students of all Croatian Medical Schools (Zagreb, Rijeka, Osijek, and Split) graduating in 2004 answered a questionnaire designed for this study, including questions on scientific involvement, desired specialty, and emigration preferences. RESULTS: During undergraduate study, 71 (23%) students have been involved in scientific projects. However, only 27 of them (38%) succeeded in publishing their results. Students identified poor project management as the most common reason for publication failure. Specialty choice varied among the four medical schools in Croatia but internal medicine, pediatrics, and surgery were usually highly preferred in all schools. If they failed to get the desired specialty, 104 (33%) students would consider emigration. CONCLUSION: There is a clear need for improvement in the management of students' research projects in Croatia, enabling enthusiastic medical students to publish the results of their work and retain their interest in science. The analysis of change of the desired specialties throughout the undergraduate study suggests an increased interest in the "controllable lifestyle" specialties. Failure to get the desired specialty would result in emigration for many students.

Adult↗

PubMed1997

[Frequency of Helicobacter pylori infection in symptomatic patients in Senegal].

This prospective study was carried out in Dakar, Senegal, to assess the prevalence of Helicobacter pylori infection in symptomatic patients undergoing endoscopy and to evaluate the factors of risk for infection by this type of bacteria in the population. From October to December 1995, 134 patients were included in this study and replied to a standardized questionnaire designed to determine socioeconomic level and living conditions. Diagnosis of Helicobacter pylori infection was based on the combined results of the urea breath test (Clo-test) and histological findings. Helicobacter pylori infection was detected in 82.8% of patients with no significant difference according to sex, age, ethnic group, or living environment (urban or rural). The incidence of infection was also the same in all socioeconomic groups. It was already high in the age group between 11 and 20 years (90.9%). Helicobacter pylori was identified in 76.2% of patients with normal endoscopic findings and in 100% presenting ulcers, erosions, or gastritis. This study shows that the incidence of Helicobacter pylori infection is extremely high regardless of socioeconomic level and that infection begins at a young age. These findings are consistent with the poor hygiene of most people in Senegal.

Adolescent↗

PubMed1997

Standardization of a questionnaire for neurotoxic symptoms.

A new version of the "Psychological-Neurological Questionnaire," designed for screening purposes, was investigated concerning its sensitivity to detect early signs of occupational exposure to potential neurotoxicants. A study population of 361 subjects was stratified into four age groups (<34, 35-44, 45-54, and >54 years) and three exposure groups (no, low, and high). According to dose and exposure history, workers exposed to dioxins and furans in combustion products, to volatile organic compounds, and to chromates were classified as low exposure. Workers exposed to alkyl lead, single solvents, and solvent mixtures were classified as high exposure. Only the group with the oldest age and highest exposure could be separated clearly from other groups, indicating an interaction effect between exposure and age. The low-exposure group could not be separated from the nonexposed controls. The most effective discriminators were neurologic symptoms. Psycho- and neurovegetative lability and irritative disturbances contributed less to the differentiation. Gastrointestinal and sleep disorders, as well as alcohol intolerance, showed no differentiation quality. The observed type of interaction effect fits models of delayed neurotoxicity.

Adult↗

PubMed1997

Bias in interpretation of ambiguous scenarios in eating disorders.

Eating disorders appear to be associated with biased information processing, particularly in judgments involving the self. This study investigated three possible biases. Patients with anorexia nervosa, patients with bulimia nervosa and female controls completed questionnaires designed to assess interpretation of ambiguous scenarios with either a negative or positive outcome. When events had a negative outcome the patients responded spontaneously to open-ended questions with a weight and shape interpretation. Later, in a forced-choice format, they selected the weight and shape interpretation in preference to interpretations not connected to weight and shape. In both open-ended and forced-choice format this bias was specific to judgments involving the self. When events had a positive outcome the bias was reversed and, in the two formats, it was found only in judgments involving others. In both cases, i.e. for negative self-referent events and for positive other-referent events, patients predicted that weight and shape explanations were more likely. Both groups of patients estimated that negative outcomes involving the self would be more costly. The patients with bulimia nervosa also estimated that positive outcomes involving the self would be more beneficial. Theoretical explanations and clinical implications are discussed.

Adult↗

PubMed2001

Group learning factors in a problem-based course in oral radiology.

OBJECTIVES: To assess the development of group dynamics in students who participated in a problem-based learning (PBL) course in oral radiology and to evaluate the influence of the facilitators' experience. METHODS: At the beginning and end of the course, students in three consecutive years (1997, 1998 and 1999) responded to a group learning factor questionnaire designed to measure group dynamics (engagement, interpersonal relationships, lack of commitment and disruptive behaviour, interpersonal learning and self-presentation). The answers were analysed with paired t-test and the effects of the facilitator's seniority, expertise in oral radiology, experience of PBL and single or rotating facilitators assessed. RESULTS: Most groups in the three years reported above average group dynamic scores. There were significant changes in group dynamics. In the 1997 class, interpersonal relationships improved (P=0.014). In the 1998 class, interpersonal learning (P=0.021) and engagement (P=0.009) increased significantly, while disruptive behaviour decreased (P=0.031). In the 1999 class, lack of commitment and disruptive behaviour decreased (P=0.014). Groups led by a junior faculty member with no previous experience of PBL show less commitment and more disruptive behaviour. CONCLUSIONS: More commitment and less disruptive behaviour and improved engagement, interpersonal relationships and self-presentation were found in a PBL course in oral radiology. Facilitators should have prior exposure to PBL to avoid disruptive behaviour among the students.

Education, Dental↗

PubMedDate not supplied

The impact on factory workers of health risk appraisal and counseling in health promotion.

One hundred thirty-six subjects employed at a textile plant in eastern North Carolina participated in a voluntary health risk appraisal (HRA) administration and health screening at the work site. The subjects consisted of 74 whites (73% women and 27% men) and 62 blacks (98% women and 2% men). Six weeks after the HRA administration and health screening, participants received their results at individual counseling sessions conducted by health educators and registered nurses, who presented prevention recommendations derived from HRA and screening results related to select physiological indices and lifestyle behaviors. Six months following the initial intervention, we conducted an identical follow-up screening. Eight months following the initial intervention, we administered a health behavior questionnaire designed to determine the impact of the HRA on select health-related behaviors and subjects' recall level of HRA recommendations. Results of this study indicate that changes in subjects' self-reported health behaviors were related to recommendations presented at counseling sessions. The majority of the subjects accurately recalled HRA recommendations eight months after HRA administration. Ninety-three percent of the employees indicated making at least one positive lifestyle behavioral change, and 50% of the subjects who were referred to a doctor or health professional based on HRA recommendations reported doing so. Risk age did not appear to influence the individual's likelihood of attending the second health screening. Ninety-eight percent of the subjects indicated that they would like a yearly HRA or health screening conducted at the work site, and 88% of the subjects indicated that the HRA results encouraged them to continue practicing healthy behaviors.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2000

School health education and gender: an interactive effect?

Post-primary school students (n = 2407) and young adults (n = 477) participated in a cross-sectional evaluation of a health education programme for schools. The Lifeskills programme is based on a philosophy of student empowerment, and aims to teach knowledge and skills relevant to health promoting behaviour. School students were recruited in schools, while young adults were opportunistically recruited in workplaces, training centres and on public transport. Those who attended schools where Lifeskills had been taught and who remembered such lessons were conservatively classified as the intervention group, while those who attended other schools and did not remember such lessons were classified as the comparison group. Participants completed questionnaires designed to collect data on health-related behaviours, indicators, knowledge and psychological health. School-level factors were employed as covariates in subsequent analyses of covariance. Amongst younger pupils, females reported more positive health behaviours but lower levels of psychological well-being and more symptoms. The impact of the programme became evident at ages 13-15. Those involved drank less and reported more positive adjustment to school. However, sex differences remained, with females reporting more health-promoting behaviour and more symptoms, and lagging behind males in self-esteem and general well-being. An interaction between gender and the intervention was identified among senior pupils. Exposure was especially beneficial for females. However, as young adults, the two main effects of gender and programme participation re-emerged as the most important independent variables, and the interaction between them was not significant. This pattern has implications for the interpretation of evaluations conducted on short-term interventions as well as for short-term impact evaluations.

Adolescent↗

PubMed2006

Measuring behavioural susceptibility to obesity: validation of the child eating behaviour questionnaire.

The Child Eating Behaviour Questionnaire (CEBQ; [Wardle, J., Guthrie, C.A., Sanderson, S., & Rapoport, L. (2001). Development of the children's eating behaviour questionnaire. Journal of Child Psychology and Psychiatry, 42, 963-970]) is a parent-report questionnaire designed to assess eating styles related to obesity risk. It has been shown to have a robust factor structure and good internal reliability, but has not been validated against behavioural measures of eating. In the present study, associations were examined between three CEBQ scales (Satiety Responsiveness, SR; Food Responsiveness, FR; Enjoyment of Food, EF) and four aspects of eating behaviour (eating without hunger, caloric compensation, eating rate and energy intake at a meal) aggregated across up to five occasions, in a sample of 4-5-year olds. In multiple regression, the aggregated behavioural measures of eating explained 56% of the variance in SR, 33% of the variance in FR and 40% of the variance in EF. These findings support the validity of the CEBQ as a parent-report instrument to assess 'obesogenic' eating behaviours in children. An easily-administered measure such as the CEBQ will be valuable in gathering data on the scale required to study the behavioural phenotype associated with obesity risk.

Child, Preschool↗

PubMed1993

Development of level of institutionalization scales for health promotion programs.

This study was conducted to test an instrument for measuring the level of institutionalization (LoIn) of health promotion programs. Institutionalization occurs when a program becomes an integral part of an organization, and the LoIn instrument is a beginning effort to measure the extent of program integration into organizations. The instrument is based on theory that holds that organizations are composed of production, maintenance, supportive, and managerial subsystems. Institutionalization occurs when a program becomes imbedded into these subsystems. A questionnaire designed to test this construct was mailed to 453 administrators in 141 organizations that operate health promotion programs. Based on 322 usable responses (71%), a confirmatory factor analysis was conducted. The results support the hypothesis of an eight-factor model: four factors concern how routinized the program was in each subsystem and four factors concern the degree of program saturation within each subsystem. Correlations of the eight factors with the number of years the programs had been in operation, and managers' perceptions of program permanency, indicated that the four routinization factors were more highly correlated with program longevity than the four niche saturation factors, and the niche saturation factors were more highly correlated with managers' perceptions of program permanence than the routinization factors. The instrument, which is available from the authors, may be used as both a research instrument and a diagnostic tool in assessing the institutionalization of health promotion programs.

Community Health Services↗

PubMed2005

Tutoring in problem-based learning medical curricula: the influence of tutor background and style on effectiveness.

BACKGROUND: Evidence for the superiority of particular characteristics in PBL tutors in medical curricula is generally inconclusive. Most studies have investigated the effectiveness of content experts compared with that of non-experts as measured either by student satisfaction or academic achievement. A few have compared academic staff tutors with student tutors. The purpose of this study was to investigate the relationship between students' perception of overall tutor effectiveness, particular tutor behaviours, clinical qualifications and academic appointment. METHOD: A questionnaire designed to evaluate particular aspects of PBL tutoring technique, related either to subject-matter knowledge or to process-facilitation skill, as well as overall effectiveness, was distributed to students in first year of a PBL medical program at the end of each of three tutor terms. A total of 76 tutor terms were included in the study. Data analysis compared clinical with non-clinical tutors, and staff with non-staff tutors. RESULTS: Clinically qualified tutors used their subject-matter knowledge significantly more than non-clinical tutors and were seen as being more empathic with their students. Staff tutors placed more emphasis on assessment than non-staff tutors and were seen as having greater skill in establishing and maintaining an environment of cooperation within their PBL groups than non-staff tutors. CONCLUSION: These results suggest that both subject-matter knowledge and process-facilitation skills are necessary but not individually sufficient characteristics of effective tutors.

Analysis of Variance↗

PubMed1995

Development and initial validation of a scale to measure self-efficacy beliefs in patients with chronic pain.

The present study describes the development of the Chronic Pain Self-Efficacy Scale (CPSS), a 22-item questionnaire designed to measure chronic pain patients' perceived self-efficacy to cope with the consequences of chronic pain. The CPSS and other measures of psychosocial functioning were administered to 141 consecutive patients who were referred to an outpatient multidisciplinary pain treatment program. An exploratory factor analysis of the CPSS responses identified 3 factors: self-efficacy for pain management (PSE), self-efficacy for coping with symptoms (CSE), and self-efficacy for physical function (FSE). The CPSS then was administered to a replication sample of 136 chronic pain patients. Factor analysis confirmed the 3-factor structure of the CPSS. The subscale scores derived from the factor analysis were significantly correlated with measures of depression, hopelessness, somatic preoccupation, and adaptation to the chronic pain experience. Multiple regression analyses provided further support for the concurrent and construct validity of the CPSS. The scale may aid in the evaluation of the self-efficacy beliefs of chronic pain patients.

Adaptation, Psychological↗

PubMed1999

Sexual behavior, contraception, and risk among college students.

PURPOSE: To characterize the differences and similarities among college freshmen, sophomores, juniors, and seniors regarding their sexual behavior including contraception choices and human immunodeficiency virus (HIV) risk. METHODS: A 41-item sexual behavior questionnaire designed for this study was administered to a convenience sample (N = 797) of a college population. RESULTS: Levels of sexual activity were found to be comparable to other college-based surveys. Notable trends included an increased level of oral contraceptive use among partners reported by seniors, as compared to freshmen, without a corresponding increase in condom use; an increased reliance among seniors, as compared to freshmen, on women to provide contraception; and a low level of self or partner HIV testing either before or after initiating sexual intercourse. Gender differences also revealed greater partner relationship duration, intensity, and communication prior to initiating sexual intercourse among women versus men (p < or = .001). CONCLUSIONS: Sexual behavior among college students differs across the 4 years with regard to rates of intercourse, contraception choice, and responsibility, as well as HIV testing and partner trust. University- and college-based health care programs should address sexual behavior with an awareness of the differences that exist in the four cohorts of students.

Adult↗