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PubMed1997

Health outcomes by self-report: validity of the SF-36 among Australian hospital patients.

This paper examines the performance of the SF-36 as a self-reported outcome measure in a diverse sample of Australian hospital in-patients. The data derive from the Care Continuum and Health Outcomes Project with a total of 2088 randomly selected patients, yielding a response rate of 80%. Distributions, completion rates and, in particular, correlates of measures were used to investigate the validity of the SF-36 according to clinical and psychometric criteria. Physical functioning, bodily pain, role limitations-physical, general health and vitality scales better represented physical than mental health, with the relative strength decreasing in that order; while mental health, role limitations-emotional and social functioning scales better represented mental health, with the relative strength decreasing in order. A cultural dimension was a strong independent correlate of all scales. While the SF-36 performed satisfactorily, there were weaknesses: the social functioning scale was too narrow to cover social health, both role limitations scales had crude response categories and particular subgroups, the frail elderly and those with complex health conditions, required measures with finer gradings for scales such as physical functioning and bodily pain. Further testing is needed to develop self-reports for use in hospital outcomes measurement which is already proposed in Australia.

Adult↗
PubMed2000

Cognitive and behavioural functioning in men with schizophrenia both before and shortly after first admission to hospital. Cross-sectional analysis.

BACKGROUND: The extent of premorbid changes associated with the onset of schizophrenia are debated. AIMS: The study examined cognitive and behavioural functioning prior to, and after, first hospitalisation for schizophrenia. METHOD: Data from the Israeli Draft Board Register of intelligence, social functioning and behaviour testing for all Israeli males aged 16-17 was linked with data from the National Psychiatric Hospitalisation Case Register. This identified 692 men who had been admitted to hospital for schizophrenia. Cases and non-cases matched on age and school were compared, as were cases aggregated by the time that had elapsed between testing and first admission to hospital. RESULTS: Cases performed worse than non-cases on all measures. On Social Functioning and on Raven's Progressive Matrices-R, differences between cases and non-cases were progressively greater for cases admitted closer to the time of testing. These differences were greatest for persons tested after first psychiatric hospitalisation. CONCLUSIONS: The results confirm premorbid deficits associated with schizophrenia and support the hypothesis that decline is progressive.

Adolescent↗
PubMed1995

The health impact of chronic sinusitis in patients seeking otolaryngologic care.

Although chronic sinusitis is an increasingly common diagnosis in the United States, the health burden of this disorder relative to the general population and to other chronic diseases has not been previously evaluated. One hundred fifty-eight patients with chronic sinusitis and no prior surgery underwent cross-sectional evaluation by use of the Medical Outcome Study Short-form 36-Item Health Survey. These patients were all referred for otolaryngologic care, and more than 80% subsequently underwent sinus surgery. Mean scores were compared from the eight subscales of general health assessment with similarly derived data for the United States general population. Significant differences (p < 0.05) were seen in several domains, including bodily pain, general health, vitality, and social functioning. Comparisons with other chronic diseases revealed significantly lower scores (p < 0.05) in measures of bodily pain and social functioning for sinusitis patients than in patients with congestive heart failure, angina, chronic obstructive pulmonary disease, and back pain. These findings suggest that the national health impact of chronic sinusitis is far greater than is currently appreciated.

Adolescent↗
PubMed2003

Factors that contribute to quality of life outcomes prioritised by people with multiple sclerosis.

The aim was to investigate factors associated with depression and social function, two outcomes identified as important by people with multiple sclerosis (MS) and to identify underlying dimensions of psycho-social well-being that may be useful as outcome measures. People with MS in eight randomly selected health authorities/boards in England and Scotland completed a postal questionnaire relating to preferences and needs for their health and social care, along with the Beck Depression Inventory and the SF-36. Responses to 10 of the original items were subjected to factor analysis. These and other explanatory variables were entered into multivariable regression models for the two outcomes. The factor analysis resulted in three dimensions representing different aspects of psycho-social well-being; one of these (representing autonomy) was associated with improvements in both outcomes, as was the SF-36 emotional role limitation score. Three other SF-36 dimensions and lack of contact with a health professional in the last year were related just to social function. The regression models emphasise the value of enabling autonomy and self-reliance amongst people with MS, as well as more general measures of emotional health. The present work identifies specific questions that could be used to measure pivotal aspects of an individual's psycho-social well-being. While these findings warrant replication for people with MS, they may have relevance to those with other long-term illnesses.

Adult↗
PubMed1983

The quality of maintenance therapy for end-stage renal disease. A review of social adjustment and rehabilitation.

Prior to 1972, ESRD patients selected for maintenance dialysis or renal transplantation were generally young, emotionally and socially well-adjusted, and physically healthy except for their renal disease. Following the enactment of Public Law 92-603 (1972), which extended Medicare coverage to virtually all ESRD patients, the criteria for the selection of patients were substantially liberalized. During the past decade, maintenance therapy has increasingly been provided for severely debilitated ESRD patients whose reported levels of rehabilitation have been less than desired. While the majority of the current ESRD patient population have not been restored to their premorbid levels of individual and social functioning, recent studies suggest this may be the result of initiating rehabilitation efforts too late in the disease process. For optimal social functioning to be achieved by ESRD patients, it is concluded that psychosocial intervention and support must be initiated at the time ESRD is diagnosed and be focused on the maintenance, rather than rehabilitation, of the patient's functioning.

Humans↗
PubMed1999

Functional outcome of internal fixation for pelvic ring fractures.

OBJECTIVE: Evaluation of the functional outcome after unstable pelvic ring fractures stabilized with internal fixation. METHODS: Between January 1, 1990, and September 1, 1997, 37 patients were treated with internal fixation for unstable pelvic fracture. Demographic data, type of accident, Hospital Trauma Index-Injury Severity Score, and fracture type according to Tile classification were scored. One patient died the day after the accident from neurologic injury. A Short Form-36 health questionnaire and a form regarding functional result after pelvic trauma, adapted from Majeed et al., were returned by 31 of 36 patients (86%). Twenty-eight patients (78%) were seen for physical and radiologic examination. RESULTS: Twenty-six men and 11 women, with an average age of 34.7 years (range, 15-66 years) were included. The mean Injury Severity Score reached 30.4 (range, 16-66). According to the Tile classification, there were 16 type B fractures and 21 type C fractures. Seven patients were treated with open reduction and internal fixation of the pubic arch, 10 patients were treated with a combination of anterior open reduction and internal fixation with additional external fixation to increase the stability of the posterior ring. Nineteen patients underwent internal fixation of both anterior and posterior arch. In the remaining case, percutaneous posterior screw fixation was combined with anterior external fixation, because of estimated infectious risk. The average follow-up time was 35.6 months. Patients scored 78.6 of 100 on the Majeed score. Remarkable was the reported change in sexual intercourse in 12 patients (40%). Only 12 patients (40%) did not have complaints when sitting. On the SF-36 scales physical and social functioning, role limitations due to physical problems and vitality were limited compared with the averages for the Dutch population. Patients treated with combined anterior and posterior internal fixation scored significantly better on both the Majeed score and on the categories physical functioning, pain, general health and social functioning compared with patients with similar fractures treated with a combination of anterior internal fixation with external fixation. At the physical examination, 11 of 28 patients (39%) did not have any abnormality. Nineteen patients (68%) were back at their original job, which was physically demanding in 9 cases. There was a suspicion of nonunion of the posterior arch in two patients, which could be confirmed with a computed tomographic scan. CONCLUSION: In general, limitations in functioning are reported, even after long-term follow-up. In partially unstable fractures, solitary anterior fixation gives good results. In completely unstable fractures, patients treated with combined internal fixation anterior as well as posterior scored a better outcome compared with combined internal and external fixation. Therefore, this technique is recommended as treatment of first choice in completely unstable fractures.

Activities of Daily Living↗
PubMed2006

Reactive attachment disorder--a theoretical model beyond attachment.

Despite its importance in public health, reactive attachment disorder (RAD) is an under-researched and little used clinical category. Abnormalities of social relatedness have long been documented in children who have been abused, neglected or institutionalised, but there have been more recent efforts to define these behaviours within the psychiatric nosology. There has been an implicit assumption that the central deficit in RAD is in the attachment system, but this has caused controversy and may have blocked research. We propose that RAD is better construed within the framework of intersubjectivity, which has a central role in the development of core brain and social functions and may also have had an important role in the evolution of a key human characteristic-complex social functioning. This broader framework may potentially explain apparently diverse symptoms such as indiscriminate friendliness and negative or unpredictable reunion responses. Finally, we suggest that a change of name may be useful in progressing the field, but accept that this may be difficult until there is better agreement in the clinical and scientific communities about the core features and aetiology of this disorder.

Child↗
PubMed2003

Enhancing behavioral and social skill functioning in children newly diagnosed with attention-deficit hyperactivity disorder in a pediatric setting.

The objective of this study was to evaluate the effectiveness of an 8-week behavioral and social skill (BSS) class for children newly diagnosed with attention-deficit hyperactivity disorder (ADHD) and their parents, initiating stimulant treatment in primary care. The subjects were 100 children, aged 5 to 12 years, recently diagnosed with ADHD and treated with stimulant medication, and their parents or guardians. Eligible families were randomly assigned to an intervention group (IG: n = 59) or control group (CG: n = 41). The BSS function of each child was assessed using DuPaul's ADHD Parent Rating Scale (18-item) and Child Attention Profile (12-item) during blinded baseline and follow-up interviews. Parent discipline practice was assessed using a five-item inventory based on Likert-scale ratings during identical periods. Computerized pharmacy records were used to track psychostimulant use over time. IG children exhibited significantly lower parent-rated ADHD symptoms, whereas IG parents reported significantly better and more consistent discipline practices compared with CG parents across time. No significant differences were found between groups in Child Attention Profile scores across time. Psychostimulant use did not significantly differ between groups across time. BSS training was well accepted and seemed to significantly improve BSS functioning among IG children in the home setting only.

Attention Deficit Disorder with Hyperactivity↗
PubMedDate not supplied

Psychopathology, treatment completion and 5 years outcome. A prospective study of drug abusers.

Two hundred Norwegian drug abusers who consecutively applied for treatment in a Phoenix-House-type of therapeutic community, were interviewed in intake and personally followed up, on average, 5 years after (response rate 79%). The year prior to follow-up, 20% had no/light use of substances and 56% heavy abuse, including the deceased (12.4%). Personality disorders and psychopathology at application did not directly predict either substance abuse problems nor level of social functioning, but were mainly related to the risk of death. Treatment completion was positively related to the 5-year outcome of social functioning, but not to substance abuse problems. Our findings indicate the need for more systematic training in how to control the use of substances in the Phoenix House model. One should also offer a more longstanding outpatient programme of social skills training, aiming at following these clients for years.

Adolescent↗
PubMed1992

Effects of epilepsy on daily functioning in northern Ecuador: summary of findings of a population-based research project.

215 patients with epilepsy and 125 healthy controls were questioned on the effects of epilepsy on social functioning as part of a population-based study of epilepsy in Northern Ecuador. 144 of these patients and 98 of the controls were followed, over a period of 1 year during an intervention study and their response to treatment assessed. Economic, intellectual and social functioning were examined. In the patient group, function was affected in important areas, most clearly, work. The low opinion the community had of the intellectual and physical abilities of patients might affect a patient's own view of themselves and sometimes diminish their opportunity for development. At 12 months, as a result of treatment, a significantly lower level of patients reported effects on function in some areas, though control individuals' views of their functional impairment had not shifted to any extent. Moreover, despite improvement, more patients at 12 months acknowledged fear of seizures, especially their unpredictability, as a handicapping factor, particularly in working outside or away from home. This seems to indicate that even when seizures are controlled, for many patients, the uncertainties of the condition remain and continue to affect their view of their capabilities.

Activities of Daily Living↗
PubMed2006

Mental health and health-related quality of life in Croatian island population.

AIM: To explore differences in self-perceived health as an indicator of health status and mortality, in six isolated populations from Croatian islands and to compare the results with control from general Croatian population obtained through the National Health Survey. METHOD: Health-related quality of life was measured using the Short Form Health Status Questionnaire (SF-36). The questionnaire was administered to 600 participants, inhabitants of 6 villages: Rab, Barbat, Lopar, and Supetarska Draga on island Rab, and Komiza and Vis, on island Vis, and to control group of 600 participants from the general Croatian population matched by age and gender to islanders. RESULTS: The islanders scored higher than controls on 3 out of 8 health dimensions, physical functioning (80.1+/-22.4 vs 73.2+/-24.8, P<0.001), vitality (61.0+/-20.3 vs 55.7+/-19.9, P<0.001), and pain (70.1+/-28.0 vs 65.9+/-26.5, P=0.008). Social functioning of islanders was significantly lower than in control group (73.4+/-18.6 vs 77.6+/-23.4, P=0.001). There was also a significant variation in health status among the islanders according to the isolation level, with the largest differences in general health perception and mental health. High isolation group reported the lowest score of all groups on mental health (P=0.018), physical functioning (P=0.045), general health (P=0.001), and vitality dimension (P=0.027). CONCLUSION: Inhabitants of Croatian islands in general showed better health-related functioning on the most of the health dimensions than general population. Islanders scored lower than controls only on social functioning which can be explained by their geographical isolation and small population. Low mental health score of islanders in the highly isolated group should be taken in account in planning health services for islands.

Croatia↗
PubMed1985

Survivors of severe traumatic brain injury in childhood. II. Late residual disability.

36 survivors of very severe traumatic childhood brain injury have been followed for a median period of 48 months after injury. One remains in a vegetative state and 35 have been discharged. 34 regained ambulation, and motor function became essentially normal in 14 of them. Ataxia and movement disorders were as common among the residua as was spasticity. Only one child remained aphasic, but 14 showed dysarthria. Six of the 36 showed major dementia and most of the rest showed very significant new impairment of cognitive and social function. This impairment was greater than expected from changes in the I.Q. Motor and speech function showed prolonged recovery while learning ability and social function did not. The overall degree of recovery seems not much better in these children than in adults.

Adolescent↗
PubMed1994

Psychosocial functioning of young adults after surgical correction for congenital heart disease in childhood: a follow-up study.

To investigate the long-term psychosocial outcome of congenital heart disease, the emotional, intellectual and social functioning of 288 (young) adult patients was assessed with standardized assessment procedures 9-23 years (mean follow-up interval: 16 years) after surgical correction for congenital heart disease in childhood, and compared with that of reference groups. With respect to emotional functioning, the patients reported significantly fewer feelings of hostility, fewer neurotic complaints and a better self-esteem than reference subjects. Overall, the results concerning social functioning showed favourable outcomes on daily activities (school, employment) and leisure-time activities for (young) adults with congenital heart disease. No significant differences were found between scores of different cardiac diagnostic groups on hostility, neuroticism, self-esteem and leisure-time activities. The possibility whether the 'denial'-mechanism might have contributed to the positive outcomes is discussed.

Activities of Daily Living↗
PubMed2004

Circumferential cervical surgery for ossification of the posterior longitudinal ligament: a multianalytic outcome study.

STUDY DESIGN: Three outcome measures, Nurick grades, Odom's criteria, and the Short Form (SF-36) were analyzed following circumferential cervical surgery in 47 patients. OBJECTIVES: To analyze three outcome measures following circumferential surgery. SUMMARY OF BACKGROUND DATA: Few studies use multiple outcome criteria to assess circumferential surgery. METHODS: Patients averaged 54 years of age and exhibited severe myelopathy (Nurick grade 3.6). Corpectomies of 2.6 vertebrae (on average) were followed by posterior fusions (C2-T1) with halo stabilization. Initial fixed-plates (n = 28) and subsequent dynamic ABC plates (Aesculap, Tuttlingen, Germany) (n = 19) were applied, Fusion was confirmed on dynamic radiographs and two-dimensional CT studies 3, 6, and up to 12 months after surgery. Nurick grades and Odom's criteria were evaluated 1 and 2 years after surgery. Results of SF-36 questionnaires, obtained before surgery, 6 weeks, 3 months, 6 months, 1 year, 2 years after surgery, were calculated. RESULTS: Neurodiagnostic studies confirmed fusion on average 5.0 months after surgery. One and 2 years after surgery, mean Nurick grades were 0.8 (+2.8 points) and 0.4 (+3.2 points), respectively. One year (2 years) postoperative Odom's criteria revealed excellent 26 (30), good 14 (11), fair 6 (5), and poor 1 (1) patient outcomes. Comparing preoperative with 1-year postoperative SF-36 questionnaires revealed moderate improvement on 5 health scales: Social Function (+19.9), Bodily Pain (+19.6), Role-Physical (+18.8), Physical Function (+12.5), and Role-Emotional (+11.1). Minimal additional improvement occurred over the second year: Role-Physical (+21.6), Social Function (+16.4), Bodily Pain (+13.4), Physical Function (+12.8), and Role Emotional (+9.5). CONCLUSION: Based on three outcome measures, the greatest improvement occurs 1 year following circumferential surgery.

Adult↗
PubMed2005

Psychiatric treatment of the homeless in a group-based therapeutic community: a preliminary field investigation.

This preliminary study investigated the effectiveness of a group-based therapeutic community for the homeless. Thirty-seven individuals residing at a homeless shelter participating in a therapeutic community were assessed across time on several variables: psychiatric symptoms, social functioning, and substance abuse. Significant initial improvements in overall distress, psychiatric symptoms, and substance abuse were found. Improvements in social functioning were exhibited in the therapeutic community participants after six months.

Female↗
PubMed2000

The Croatian Health Survey--SF-36: I. General quality of life assessment.

The objective of the Croatian Health Survey was the assessment of population health related quality of life in the transitional environment of Croatia. Health status measures incorporate dimensions such as physical, psychological, and social functioning, role performance and perception of wellbeing. In order to assess health status, "The medical outcome study 36-item short-form health survey (SF-36) model" was used. A total sample of 5048 inhabitants (1983 males and 3065 females), 18 years and over, represents approximately 1% of the general population of Croatia. Mean scores were as follows: physical functioning (PF) 69.94, role-physical (RP) 63.01, bodily pain (BP) 64.51, general health (GH) 53.40, vitality (VT) 51.85, social functioning (SF) 72.96, role-emotional (RE) 72.42, mental health (MH) 61.71 and health transition (HT) 44.79. Results of the SF-36 health survey in Croatia are very much like the results in other European countries with indication that general quality of life is lower in Croatia.

Adolescent↗
PubMed2003

[Quality of life assessment with the use of the SF-36 in patients with nasal polyposis: correlations with clinical and laboratory findings].

OBJECTIVES: We evaluated the quality of life of patients with nasal polyposis and sought correlations between clinical and laboratory parameters and quality of life. PATIENTS AND METHODS: Thirty-two patients (8 females, 24 males; mean age 43 years; range 15 to 68 years) with nasal polyposis were evaluated by history, physical examination, endoscopy, computed tomography (CT), nasal smear, and skin prick tests. Quality of life was assessed using the Medical Outcomes Study Short Form 36 (SF-36). RESULTS: The mean CT score showed a weak correlation with symptom and endoscopic scores (p<0.05), whereas the latter two scores were not correlated. All the SF-36 scales were adversely influenced, particularly including the scores for role limitation caused by emotional problems, general perception of health, vitality, and role limitation caused by physical problems. An inverse correlation was found between increasing age and complaints of pain (p<0.05). Symptom scores were correlated only with role limitation caused by emotional problems (p<0.05). Duration of nasal symptoms was correlated with increased scores for role limitation caused by physical problems, mental health, social functioning, and pain (p<0.05). Computed tomography stage was correlated with role limitation caused by emotional problems, pain, and social functioning, whereas CT scores showed correlation only with pain (p<0.05). The presence of asthma adversely influenced general perception of health scores (p<0.05). CONCLUSION: Nasal polyposis adversely affects the quality of life of patients, the extent of deterioration being more prominent in certain subscales.

Adolescent↗
PubMed2002

Motivation to serve in the military influences vulnerability to future posttraumatic stress disorder.

High motivation and belief in a cause have been reported to be protective against posttraumatic stress disorder (PTSD), while below-average intellectual functioning and poor educational achievements have been reported to increase vulnerability to PTSD. The main goal of this study was to assess the effect of education, and intellectual and behavioral functioning on the risk for future PTSD. Data collected before exposure to trauma, on intellectual and behavioral functioning, and educational achievements of 901 male Israeli adolescents who had performed pre-induction screening tests by the Israeli Draft Board, and were later diagnosed with PTSD, were compared with a control group of adolescents who were not later diagnosed with PTSD. Future PTSD patients had significantly lower intelligence, fewer years of formal education and lower scores on a scale assessing motivation to serve in the military, in comparison with the control group, with effect sizes (ES) ranging from 0.14-0.34. In contrast, future PTSD patients scored significantly higher on a scale assessing social functioning, ES=0.13. However, when controlling for the differences in motivation to serve, all of these differences disappeared. In this cohort, although slightly below average intellectual functioning and formal education, and better social functioning, independently increased vulnerability to suffer from PTSD, these associations disappeared when the future PTSD patients' lower motivation to serve in the military was included in the analysis. This suggests that low motivation to serve in the military might increase vulnerability for PTSD.

Adolescent↗