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PubMed2001

Insomnia screening in postacute traumatic brain injury: utility and validity of the Pittsburgh Sleep Quality Index.

OBJECTIVE: To assess insomnia in a rehabilitation population, the authors examined the utility and validity of the Pittsburgh Sleep Quality Index (PSQI). The assessment of insomnia is relevant to the treatment of traumatic brain injury at the postacute level and routine screening for insomnia may be enhanced by the availability of a standardized, conveniently used, self-report sleep questionnaire. DESIGN: The authors prospectively studied 91 consecutive patients with traumatic brain injury who were admitted to an outpatient neurorehabilitation program. Besides administering the PSQI, Beck Depression Inventory, Epworth Sleepiness Scale, and Multidimensional Pain Inventory, sleep diary and interview data were obtained and used to divide subjects into insomnia and noninsomnia groups according to the criteria established by the Diagnostic and Statistical Manual of Mental Disorders, ed 4. RESULTS: Sensitivity and specificity rates to the clinical diagnosis of insomnia were 93% and 100%, respectively, for a PSQI Global Score of >8, and 83% and 100% for a diagnosis of insomnia based exclusively on PSQI-derived sleep variable data. Sleep diary data provided concurrent validity for PSQI estimates of sleep-onset latency, sleep duration, and sleep efficiency. The Beck Depression Inventory, Epworth Sleepiness Scale, and Multidimensional Pain Inventory established concurrent validity for individual PSQI items pertaining to mood, hypersomnia, and pain disturbance. CONCLUSION: The PSQI was demonstrated to be a valid and useful screening tool for assessing insomnia among postacute patients with traumatic brain injury.

Adolescent↗
PubMed1994

Sexual adjustment after spinal cord injury-comparison of partner experiences in pre- and postinjury relationships.

This study compared the emotional and sexual aspects of relationships before and after spinal cord injury, from the partner's point of view. In addition, the personality characteristics of the partners were investigated. Twenty-six relationships were established before the injury and 23 after. The couples in preinjury relationships had been married or cohabiting for 3.5-51 years (median 24 years), while postinjury relationships ranged from 1 to 8 years (median 2 years). There were substantial differences in age between preinjury and postinjury partners, 21-79 years (median 51 years) and 18-45 years (median 28 years), respectively. Data collection included an 80-item questionnaire, designed to determine different aspects of sexuality, a visual analogue scale Quality of Life (VAS QL) measure and an established inventory of personality characteristics, the Karolinska Scales of Personality (KSP). Eighty-eight per cent of the partners in preinjury and 86% in postinjury relationships considered their overall relationship to be satisfactory. Concerning the sexual aspects of the relationships, several differences were revealed, all favouring postinjury relationships. Some of these held true even when age was treated as a significant factor and statistically controlled. Although the frequency of sexual activity and the variety of sexual expressions used were lower in the preinjury relationships, and perceived deterioration of sex life due to the injury was higher among preinjury partners, there was no significant difference between the two groups in satisfaction with current sex life. Thus, age seems to be a more important factor for sexual adjustment after a spinal cord injury, rather than whether the relationship is established before or after injury. The partners' personality characteristics differed only slightly from those of a sex and age matched reference group and not at all between partners in pre- and postinjury relationships.

Adaptation, Psychological↗
PubMed2000

Assessment of education and counselling offered by a familial colorectal cancer clinic.

We have evaluated whether or not client expectations, in terms of education and information needs, have been met by a multi-disciplinary familial colorectal cancer clinic. The study used a pre- and post-clinic questionnaire design and 126 (84 women, 42 men) clients of the clinic participated. The most common reason for coming to the clinic is to 'find out whether there is a gene for colorectal cancer in the family', followed by 'to reduce risk for bowel cancer' and 'concern for children's risk'. Clients would have preferred to receive more information before attendance at the clinic to help with preparation. Information given during the clinic increased knowledge of bowel cancer genetics and had a positive effect on the accuracy of some clients' perceptions of their risk of developing cancer. In multivariate analysis, higher risk perceptions, higher education level and greater baseline knowledge predicted post-clinic knowledge of bowel cancer genetics and an increase in knowledge. Client reports of the presence of a genetic counsellor or medical geneticist in the session also predicted post-clinic knowledge and an increase in knowledge. Most participants felt they received enough information during the clinic session on various aspects of familial colorectal cancer, but the desire for more written information on prevention, including lifestyle actions, was expressed by many.

Adult↗
PubMed1996

Physical activity and cardiovascular risk factors among elderly men in Finland, Italy, and the Netherlands.

Physical activity pattern and its relation with cardiovascular risk factors was investigated in 1,402 men aged 69-90 years who participated in the 30-year follow-up survey of the Finnish (Eastern and Western Finland), Italian (Montegiorgio and Crevalcore), and Dutch (Zutphen) cohorts of the Seven Countries Study. Physical activity was assessed with a validated self-administered questionnaire designed for retired men. Total physical activity varied largely within cohorts. Median total reported physical activity ranged from 50 minutes/day in Montegiorgio to 89 minutes/day in Crevalcore. Walking, gardening, and bicycling together contributed more than 70% of total physical activity in all cohorts. Depending on the definition of physical inactivity, the estimated prevalence of inactivity varied between 5% and 33% in Zutphen and between 18% and 68% in Montegiorgio. Total physical activity was inversely associated with resting heart rate (r= -0.11, p < 0.001) and was positively associated with high density lipoprotein (HDL) cholesterol (r = 0.08, p < 0.01) in pooled data. These associations remained statistically significant after adjustment for age, cohort, smoking, body mass index, and alcohol intake. Total activity was not associated with total cholesterol, non-HDL cholesterol, blood pressure, or body mass index. The authors conclude that physical activity may have a beneficial effect on HDL cholesterol levels in elderly men. Walking, gardening, and bicycling contribute substantially to their physical activity pattern.

Aged↗
PubMed2001

Journal provision and the prevalence of journal clubs: a survey of physiotherapy departments in England and Australia.

BACKGROUND AND PURPOSE: Evidence-based journal clubs can promote evidence-based practice and continuing professional development (CPD). Although studies have evaluated the impact of journal clubs in medical and nursing departments, there is little information concerning journal clubs or journal provision in physiotherapy departments. The present survey was conducted to address this deficit. METHOD: A postal questionnaire, designed to ascertain the type and extent of journal provision, and prevalence and attributes of journal clubs in physiotherapy departments, was distributed to physiotherapy managers in 150 facilities in England and in south-east Australia. Sixty-two per cent of facilities approached in England and 55% of those approached in Australia responded to the survey. RESULTS: The provision of journals in physiotherapy departments was limited, and alternative access to physiotherapy journals was generally poor. Certain facilities were innovative in providing additional journal literature for physiotherapy staff. Physiotherapy journal clubs existed in 42% of responding facilities in England and 18% of those surveyed in Australia. Several facilities provided alternative forms of journal review as part of in-service training. Relatively few journal clubs utilized a 'problem-based' format, which fosters the teaching of critical appraisal skills. Evidence of enthusiasm emerged in some facilities, but in contrast, barriers and a degree of apathy were also revealed in others. CONCLUSIONS: Physiotherapy managers, hospital administrators and academic institutions should jointly agree a strategy to both promote evidence-based journal clubs and to facilitate journal provision within physiotherapy departments.

Australia↗
PubMed2001

Patient reluctance toward tamoxifen use for breast cancer primary prevention.

BACKGROUND: The National Surgical Adjuvant Breast and Bowel Project (NSABP) P-1 trial demonstrated that tamoxifen reduces the incidence of new breast cancers by 49% in women at increased risk for breast cancer development. Tamoxifen does have side effects, however, including marginally increased risks of endometrial cancer and thromboembolic events. In this study, women at increased risk for breast cancer development were offered tamoxifen. Their knowledge of tamoxifen as a chemopreventive agent was assessed, and factors influencing their acceptance of tamoxifen and willingness to take it were determined. METHODS: Forty-three patients were identified who qualified to take tamoxifen for primary prevention. Patients qualified by having at least a 1.7% 5-year risk of developing breast cancer, the criteria for entry into the NSABP P-1 trial. Patients initially completed questionnaires designed to assess their knowledge of tamoxifen and its associated risks and benefits. Patients were then provided neutral educational sessions and literature delineating the actual risks and benefits of tamoxifen. Subsequently, patients' decisions regarding taking tamoxifen were reassessed. RESULTS: Mean patient age was 52.8 years, with a range of 39 to 74 years. Ten patients (23.2%) qualified based on the presence of lobular carcinoma in situ (LCIS), seven patients (16.3%) qualified based on increased risk secondary to age >60 years, and 26 patients (60.5%) age range 35 to 59 qualified based on risk profiles demonstrating significantly increased risk. Of the total 43 patients, two (4.7%) elected to start taking tamoxifen. Fifteen patients (34.8%) declined immediately, and 26 patients (60.5%) were undecided initially but ultimately declined. Educational sessions did not influence patients' decisions. Fear of side effects, including endometrial cancer, thromboembolic events, and menopausal symptoms, was the most commonly cited reason for declining to take tamoxifen. CONCLUSIONS: In this study, the vast majority of patients at increased risk for breast cancer perceived that the risks of taking tamoxifen outweighed the benefits and declined to take it.

Adult↗
PubMed2003

Human leukocyte antigen class II genes and Helicobacter pylori infection: does genotype overwhelm environmental exposure?

OBJECTIVE: We investigated associations between human leukocyte antigen class II genes, environmental exposures, and Helicobacter pylori infection. METHODS: Sixty-eight subjects with histologically confirmed H. pylori and intestinal metaplasia (cases) and 70 healthy subjects without H. pylori (controls) matched for age, sex, and year of birth were included in this study. All patients answered a detailed questionnaire designed to collect sociodemographic characteristics, smoking, alcohol drinking, and dietary habits. Human leukocyte antigen class II genes were typed with genomic DNA. The cytotoxins CagA and VacA were investigated with serology. Odds ratios and corresponding 95% confidence intervals were estimated from multivariate conditional logistic regression. Multiple correspondence analysis was used to represent the interrelationships of a multiple contingency table. RESULTS: Human leukocyte antigen DRB1, DQA1, and DQB1 genotypes were not significantly associated with H. pylori infection and intestinal metaplasia. No significant association with blood group or Lewis antigen system was found. However, multiple correspondence analysis clearly associated H. pylori with environmental exposure: the control group largely consumed olive oil, fresh fruits, and vegetables and histories of never or formerly smoking and the case group (those positive for H. pylori and metaplasia) largely consumed eggs, meat and butter and had histories of smoking cigarettes. CONCLUSIONS: These findings suggested that H. pylori infection is not influenced by a genetic compound and confirmed the relevance of environmental exposure.

Adult↗
PubMed1992

Antibiotic-impregnated cement use in U.S. hospitals.

The results of a survey of the use of antibiotic-impregnated bone cement and cement beads in U.S. hospitals are reported. A random sample of hospitals was selected from all hospitals registered with the American Hospital Association. A questionnaire designed to characterize the extent of use of the products and the degree of pharmacy involvement was mailed to the pharmacy directors at 547 hospitals nationwide. The response rate was 61.7% (336 evaluable returns). Ninety hospitals (26.9%) reported using antibiotic-impregnated bone cement or cement beads. Product use was significantly greater in urban hospitals, hospitals larger than 200 beds, teaching hospitals, and hospitals with pharmaceutical services in the operating rooms. Most facilities using the products were community hospitals. Total hip arthroplasty, total knee arthroplasty, and chronic osteomyelitis were the most common indications for use. Systemic antibiotics were also administered in the great majority of hospitals reporting use of the products. The products were generally used in fewer than one procedure per month. Aminoglycosides and various cephalosporins were the antibiotics most commonly used; most have not been adequately studied for this use. Although nearly all the hospital pharmacies purchased antibiotics for these products, none mixed cement and only two premanufactured antibiotic beads. About one fourth of the hospitals surveyed reported using antibiotic-impregnated bone cement and cement beads, although the total number of patients being treated was small.

Anti-Bacterial Agents↗
PubMed2002

A questionnaire assessment of nutrition knowledge--validity and reliability issues.

OBJECTIVE: This study describes an evaluation of validity and reliability measures in a questionnaire designed to assess knowledge of applied nutrition in children participating in an after-school care dietary intervention programme being undertaken in an area of high social disadvantage. DESIGN: Three domains were assessed: Knowledge of Applied Nutrition (KN), Knowledge of Food Preparation (KP) and Perceived Confidence in Cooking Skills (PC). Four pilot studies were undertaken to determine item reliability, test-retest reliability, discrimination and difficulty indices, and content, cognitive and face validity. SETTING: Primary schools in Dundee, Scotland and Newcastle upon Tyne, England. SUBJECTS: Ninety-eight children aged 11 years. RESULTS: The final instrument comprised 36 questions (18 KN items, 9 KP items and 9 PC items) presented on four sides of paper, which could be self-completed in less than 15 minutes. Question formatting included open and closed structures (KP) and multiple choice (KN and PC) items. All knowledge questions could be answered correctly by 5 to 95% of the target population, with discrimination scores ranging from 0.06 to 0.83. Retest reliability scores were significant (KN 0.458, KP 0.577, PC 0.381, ) and internal reliability (Cronbach's alpha) of each component was also significant. CONCLUSION: The test meets basic psychometric criteria for reliability and validity and forms a suitable instrument for measuring changes associated with intervention work aimed at improving food and dietary knowledge.

Child↗
PubMedDate not supplied

[Adolescence at risk: a health survey among pre-university students].

The present study investigates the level of health education in a representative sample of 804 pre-university Asturian students, randomly selected from the official list of the Ministry of Education and Science. We used a questionnaire (designed by us) in order to measure the knowledge, attitudes and behaviour related to some of the most important health determining factors. The survey was carried out by interviewing small groups of students in the classroom situation. Although it was found that the majority perceived themselves as healthy or very healthy, these young people are widely exposed to risk factors: 12% have suffered from more than 25 episodes of drunkenness during the previous year; 43.53% smoked to some extent and only 3.86% identified the days of maximum risk of pregnancy in a supposed menstrual cycle, although 31% maintained sexual relationships. Theoretically, 92% selected health as the most important factor among the three most fundamental values for life. They also think that illegal drugs are the most important health problem at present for young people. There is a contradiction between the high theoretical importance given to health, the good self-qualification of it, and the observed presence of important risk factors. A certain failure of the educational system with respect to primary prevention can be claimed.

Adolescent↗
PubMed1993

A study on existing knowledge about AIDS among undergraduates of a Nigerian University.

This study, carried out during August-October, 1991, involved 236 respondents to a questionnaire designed to determine awareness and attitudes to AIDS and the consequent effect of such awareness on their sexual behaviour. Almost all the medical students were aware of the existence of the disease, while a few (3.8 per cent) of the non-medicos believed that it had not yet reached Nigeria. Most students i.e. 98 per cent and 97 per cent of these respective groups were aware of carrier state of the disease. Only a small percentage of students, mostly medics knew about the exact signs and symptoms of clinical AIDS. The level of knowledge about the modes of transmission of AIDS was found to be adequate. With regard to the effect of this awareness on their behaviour, it was known that a good number of medics (30.37) per cent and non-medics (28.88) per cent had started using condoms. About 40 per cent medicos, and 45 per cent non-medicos revealed an aversion to sit near a person with AIDS thus emphasizing the stigma associated with the disease. Regarding control of AIDS, many felt there should be strict isolation of HIV positive individuals along with a ban on prostitution and homosexuality.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Survey of post-operative patients' pain management.

Although effective pain treatment is available for both cancer-related pain and acute post-operative pain, many patients suffer unnecessarily. The aim of this study was to evaluate post-operative patients' pain management. A descriptive survey study was conducted in a 460-bed acute hospital in the southwestern part of Sweden. One hundred post-operative inpatients, on their second post-operative day, took part in the study. They were consecutively selected from six surgical wards. Data were collected using an interview questionnaire designed by the American Pain Society and analysed by descriptive and inferential statistics. At the time of the interview, 29 of the patients reported moderate to severe pain. Regarding the patients' worst pain experienced during the last 24 h, 79 of them reported moderate to very severe pain. Significant correlations were found between reported poor pain relief after pain medication and high intensity of pain both within the last 24 h and at the time of the interview. Eighty-three patients were satisfied with the way nurses treated their pain, while 64 patients were satisfied with the way physicians treated their pain. However, the higher the pain intensity experienced by the patients the less satisfied they were. The fact that patients do not know what kinds of relief are available may be one reason for the patients expressing satisfaction despite being in pain, another that the patients judge the kindness of the staff rather than their way of treating the pain. The field of pain management is rapidly changing requiring professional knowledge and experience in order to ensure pain management of good quality.

Adult↗
PubMed1997

Prevalence of symptomatic bronchiectasis in patients with rheumatoid arthritis.

OBJECTIVE: To evaluate the prevalence of symptomatic bronchiectasis in patients with rheumatoid arthritis. METHODS: Cross-sectional retrospective study of 453 rheumatoid arthritis patients. All patients completed a questionnaire designed to detect manifestations of bronchiectasis and had a chest film taken. Computed tomography of the chest was performed in those patients whose chest film was normal. RESULTS: Thirteen patients (2.9%), all female, had symptoms that met Walker's criteria for definite (n = 7) or probable (n = 6) bronchiectasis. Symptom onset was during childhood or adolescence in 69% of cases and antedated the first symptoms of rheumatoid arthritis in all patients but one. Six of the 13 patients (46%) had chest film abnormalities suggestive of bronchiectasis, and three of the remaining seven patients had abnormal computed tomography findings, yielding a total of nine cases of bronchiectasis confirmed by imaging studies among the 13 patients with suggestive symptoms (69%). This proportion rose to 90% when the three patients who failed to come to their computed tomography appointment were excluded. CONCLUSION: Using a methodological approach similar to that previously used by pneumologists, we found a 2.9% prevalence of symptomatic bronchiectasis in a population of hospitalized rheumatoid arthritis patients, which is higher than the 0.03% prevalence previously reported in the population at large.

Adolescent↗
PubMed2006

Obstetrician-gynecologists' practice and knowledge regarding spina bifida.

The purpose was to assess practicing obstetrician-gynecologists' knowledge about the prenatal diagnosis and postnatal prognosis of spina bifida. Written questionnaires designed to assess practicing obstetrician-gynecologists' knowledge of spina bifida were mailed to 1000 randomly selected American College of Obstetricians and Gynecologists Fellows. More than 50% did not identify many of the sonographic features indicative of an open neural tube defect in the fetus and more than one third overestimated the risks of stillbirth, whereas more than two thirds overestimated the risk for premature delivery in a pregnancy complicated by fetal spina bifida. Just more than 50% correctly estimated the 1-year survival rate and just less than 50% correctly estimated survival at 6 years. Sixty-six percent overestimated the incidence of mental retardation associated with spina bifida. Maternal-fetal medicine specialists returning the survey exhibited a much better understanding of the prenatal issues and prognostic and outcome factors related to spina bifida. There are gaps in obstetrician-gynecologists' knowledge about the diagnostic features of and prognosis for fetal spina bifida. It is important for them to take advantage of continuing medical education opportunities to learn more about the management of pregnancies complicated by fetal spina bifida and about the prognosis for affected individuals.

Adult↗
PubMed1998

Bowel dysfunction in postmenopausal women.

BACKGROUND/AIMS: The perimenopausal and postmenopausal states are frequently accompanied by a variety of symptoms of hormonal imbalance. Although vasomotor, vaginal and genitourinary symptoms prevail, gastrointestinal complaints such as abdominal bloating may occur. In this study, we investigated the nature and prevalence of gastrointestinal and irritable bowel syndrome (IBS)-type complaints in women going through their climacteric and postmenopausal periods. PATIENTS/METHODS: 228 women (170 postmenopausal and 58 premenopausal) who presented for evaluation at a primary care practice limited to women's health were evaluated prospectively by a previously validated gastrointestinal symptoms questionnaire designed to evaluate symptoms suggestive of IBS. At the time of their participation in the study, none of these women was presenting for evaluation of abdominal or genitourinary symptoms. RESULTS: Thirty-eight percent of postmenopausal women reported altered bowel function, in contrast to 14% of premenopausal ones (p < 0.001). Despite this, the two groups did not differ in regards to the occurrence of abdominal pain, diarrhea or constipation, suggestive of IBS. The prevalence of IBS-type complaints peaked to 36% during the climacteric period (40-49 years). Laxative usage (9.4% prevalence), gaseousness/excessive flatulence (48% prevalence) and heart-burn/acid regurgitation (34% prevalence) were also more common among postmenopausal women. Estrogen use did not affect gastrointestinal symptoms in any of the two groups. CONCLUSIONS: Although the possible role of aging on symptom perception-regardless of hormonal status-cannot be ruled out, these results suggest that peri- and postmenopausal women have a high prevalence of altered bowel function and IBS-like gastrointestinal complaints that should be carefully assessed. If the diagnosis of IBS is confirmed, appropriate treatment may improve patients' symptoms, although this approach requires further study.

Abdominal Pain↗
PubMed1991

Hazards of horse-riding as a popular sport.

The increasing incidence of horse-riding accidents, which are often severe in nature, prompted a pilot study of a questionnaire designed to elucidate the cause of such accidents. It was hoped that, on a larger scale, the information gleaned would highlight possible preventative measures which might improve the safety of an important recreational pursuit enjoyed by young and old from many walks of life. A retrospective study of riders sustaining serious spinal injuries admitted to Stoke Mandeville Hospital was compared with riders sustaining minor but significant injuries as the accidents came to the attention of the authors. The detailed analysis paid particular attention to the setting and to the experience and task of horse and rider. It was found that 70% of the 20 accidents could be thought attributable to the behaviour of the horse at the time, and seven of these were in the spinal injuries group. Rider error was a significant contribution in seven cases, and in two instances the rider was under instruction at the time. There was also inadequate experience of the rider in seven cases, of which five were thought to show inadequate supervision. The limited number of cases studied precludes significant observations, but, as the majority of accidents seemed preventable, a larger study has been initiated in collaboration with the British Horse Society.

Adult↗
PubMed2000

Management of terminal cancer patients: attitudes and training needs of primary health care doctors and nurses.

The objective of the study was to ascertain the attitudes and training needs of primary health care (PHC) professionals regarding the management of terminal cancer patients. A cross-sectional study involving 30 PHC teams (15 urban and 15 rural) in the health district of Majorca (Spain) was carried out. Out of the 224 doctors and 186 nurses initially included, 157 and 156, respectively, completed a questionnaire designed to elicit the participant's opinions on the role of PHC in palliative care, their needs in terms of training and their management of clinical and psychological symptoms. Forty percent of professionals considered that terminal care should be the responsibility of PHC, whereas 59.5% thought it preferable for such care to be given either in Palliative Care Units or by oncologists. All kinds of relationships between PHC professionals and specialists were highly valued. Seventy-five percent of general practitioners referred to pain control, and 83% of doctors and nurses provided emotional support. Most health professionals felt training in emotional aspects would be the most desirable. One group of professionals considered palliative care to be an asset in PHC, whereas another group thought that patient care should be provided by specialists. The majority of doctors and nurses pinpointed the need for improving co-ordination with specialists. A need for tuition in palliative care was clearly stated. In conclusion, the planning of palliative care should take into account the attitudes and opinions of PHC doctors and nurses.

Attitude of Health Personnel↗
PubMed1997

A cross sectional study of 100 athletes with jumper's knee managed conservatively and surgically. The Victorian Institute of Sport Tendon Study Group.

OBJECTIVES: Jumper's knee causes significant morbidity in athletes of all standards. However, there are few reference data on the clinical course of this condition in a large number of patients, and the aim of this study was to rectify this. METHODS: A retrospective study of the course of jumper's knee in 100 athletes who presented to a sports medicine clinic over a nine year period was carried out. Subjects completed a questionnaire designed to collect details of sport participation, symptoms, and time out of sport. Ultrasonographic results were recorded from the radiologists' reports. Histopathological results were obtained for patients who had surgery. RESULTS: Forty eight subjects recalled that symptoms of jumper's knee began before the age of 20 years. Symptoms prevented 33 from participating in sport for more than six months, and 18 of these were sidelined for more than 12 months. Forty nine of the subjects had two or more separate episodes of symptoms. Ultrasonography showed a characteristics hypoechoic region at the junction of the inferior pole of the patella and the deep surface of the patellar tendon. Histopathological examination showed separation and disruption of collagen fibres on polarisation light microscopy and an increase in mucoid ground substance consistent with damage of tendon collagen without inflammation. CONCLUSIONS: Jumper's knee has the potential to be a debilitating condition for a sports person. About 33% of athletes presenting to a sports medicine clinic with jumper's knee were unable to return to sport for more than six months.

Adolescent↗