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PubMed2001

[Quality of life of severely injured patients 1 year after trauma. A matched-pair study compared with a healthy control group].

PURPOSE: Severe trauma is accompanied not only with functional disabilities, but also with pain, social and psychological problems of the patient. Those four aspects are important components of the construct quality of life (QoL). The purpose of this study was to evaluate different questionnaires and to compare results between multiply injured patients and healthy controls. METHODS: A group of 43 severely injured patients was matched according to age, gender, educational status and family life situation to 43 persons who had never experienced a severe injury. For the assessment of all four aspects of QoL the patients completed validated questionnaires: Beck-Depression-Inventory (BDI), Short Form Health Survey (SF-36), State-Trait Anxiety Inventory (STAI), a questionnaire for locus of control (KKG), and a questionnaire for social support (SOZU). RESULTS: Patients and the control group showed remarkable differences: 22 of 43 trauma patients suffered from bad health perception (subscale of SF-36) (8/43 control persons), 21 trauma patients reported moderate to severe pain (5/43 control persons), 11 of 43 trauma patients suffered from anxiety (4/43 control persons) and 10 of 43 trauma patients complained about depressive symptoms (2/43 control persons). CONCLUSION: One year after trauma, patients suffer from severe impairments, some even in all four aspects of QoL. The questionnaires used are very well applicable to patients after severe injuries. A trauma-specific Quality of Life Instrument is lacking--and is currently developed by the german trauma registry group.

Adaptation, Psychological↗
PubMed1998

Survival of elderly Finns suffering from dysthymic disorder: a community study.

The survival of aged Finns suffering from dysthymic disorder (DSM-III criteria) was assessed in two cohorts (60+ yrs and 65+ yrs) in a longitudinal epidemiological study conducted in Ahtäri in western Central Finland from 1984 onwards. The mortality of dysthymic persons (N = 214 and N = 115) was compared to that of the non-depressed population living in the same municipality (N = 982 and N = 853). Two follow-up periods (6 yrs and 11.5 yrs) were used for the first cohort, and one (6 yrs) for the second cohort. The Kaplan-Meier procedure and Mantel-Cox statistics followed by Cox proportional hazards models were used in the analyses. The occurrence of dysthymic disorder in men was related to higher mortality in both cohorts during all follow-up periods. In women, the occurrence of dysthymic disorder was related to higher mortality in the first cohort during the follow-up of 11.5 years, and in the second during the follow-up of 6 years. When age, sex, marital status, education, smoking, physical health and functional abilities were taken into account in the Cox proportional hazards models, high age, male sex, smoking, low educational level, the use of more than two medicines and lowered functional abilities emerged as predictors of mortality in the first cohort during both follow-up periods. In the second cohort, high age male sex, smoking, poor physical health and lowered functional abilities emerged as predictors. The results suggest that the higher mortality of the aged suffering from dysthymic disorder is explained by the high occurrence of somatic diseases and disabilities in dysthymic persons. They do not suggest that there might exist biochemical factors in the aetiology of dysthymic disorders that would increase mortality. Nor do they give any evidence to suggest that dysthymic disorders might be precursors of somatic diseases increasing mortality.

Aged↗
PubMed2001

Drug use during early pregnancy. The impact of maternal illness, outcome of prior pregnancies and socio-demographic factors.

OBJECTIVE: Socio-demographic factors have been associated with drug use in pregnancy. However, information on maternal illness has rarely been included in previous studies. The aim of this study was therefore to estimate the impact of maternal illness and prior pregnancy outcome on the use of analgesics/antipyretics, anti-infectives and antihistamines in early pregnancy controlling for socio-demographic factors. METHODS: One thousand nine-hundred and forty-five parous pregnant women from Norway and Sweden were included in an interview study. Information on drug use, obstetric history, maternal illness and socio-demographic factors was collected by specially trained midwives at gestational week 17 and form the basis for the present analyses. RESULTS: After control for socio-demographic factors, reported illness was associated with the use of analgesics/antipyretics, anti-infectives and antihistamines during early pregnancy. The use of analgesic/antipyretic and anti-infective drugs differed between study sites. Sociodemographic factors such as age, parity, marital status, education, occupation and smoking habits did not influence drug use in the multivariate analysis. CONCLUSION: Maternal illness during pregnancy was associated with drug use in early pregnancy. When studying factors related to drug use during pregnancy, it is important to include information on maternal illness. Socio-demographic factors may be confounders and lead to erroneous conclusions about the factors related to drug use.

Adult↗
PubMed2004

Laparoscopic cholecystectomy: is it a conscious preference among Turkish patients with symptomatic gallstones?--prospective study.

Laparoscopic cholecystectomy (LC) has the advantages of early return to full daily activity, early return to work, and better cosmetic result, as well as quickly resolving pain. Yet how this information about the procedure influences a patient's attitude toward laparocopy is not known. In this study we analyzed the factors that play role in the decision-making process of patients who choose laparoscopic surgery, and we also evaluated patients' knowledge of laparoscopy and their expectations. A questionnaire was used in evaluating 98 patients suffering from symptomatic cholelithiasis scheduled for elective laparoscopic cholecystectomy between January 2001 and January 2002. Females constituted 81% of the study population. Most of the patients (56%) were housewives. While 45% of the patients had an educational status of primary school degree only, 14% had graduated from a university. Forty-three patients described their level of knowledge about laparoscopy as "low" (had only heard about laparoscopy). In 61% of the patients the surgeon was the sole decision maker about the type of the operation. Almost none of the patients had a preference for the time of discharge from the hospital after surgery, and only three of the actively working patients offered a time interval for return to work. From this study we concluded that most patients have inadequate information about laparoscopic surgery, that the type of operation is dictated mostly by the surgeon, and that early discharge and early return to work are not important for many patients.

Aged↗
PubMed2003

[Changes in the quality of life of cerebral stroke patients in the first year after rehabilitation].

The aim of the study was to identify and analyze significant changes in the quality of life of elderly persons in the first year after rehabilitation from cerebral stroke. Data of 138 geriatric patients investigated on admission in a stationary rehabilitation program and one year later at home were used for this analysis. Multivariate logistic modelling tested differences between first investigation and follow-up in several domains: IADL functionality, subjective well-being, locus of control, subjective coping with stroke, stroke-related quality of life, social support. Age, gender, living alone and educational status were used as control variables. Compared to first investigation, subjects on follow-up showed an increased IADL functionality (OR = 1.40) but a decline in subjective well-being (OR = 0.91) and a more external locus of control (OR = 0.57). Coping with stroke has ameliorated (OR = 1.82), while stroke-related quality of life in six life domains was more negatively presented (OR = 0.82). Marked modifications in social exchange were found: the quantity of social contacts increased (OR = 4.70), while their variety reduced (OR = 0.38), significant others became more important (OR = 7.42) while the respondents' importance as a significant person for others diminished (R = 0.20). The findings suggest that recovery in IADL functionality after rehabilitation does not ensure a subsequent improvement in the subjective well-being nor does a positive trend in coping with stroke impede declines in stroke-related quality of life. Increased social exchange, which becomes more concentrated and less reciprocal, indicates a growing need of receiving social support. The findings are commented and implications for rehabilitation are mentioned.

Activities of Daily Living↗
PubMed2002

Relation between mood, social support and the quality of life in patients with laryngectomies.

Two hundred laryngectomized members of the Norwegian Society of Laryngectomies (NSL), a subsidiary of the Norwegian Cancer Society, were invited to answer the EORTC QLQ-C30 (version 3.0) and QLQ-H&N35 QOL questionnaires to assess their quality of life (QOL). The Beck Depression Inventory (BDI) scores, their levels of social support and their marital and educational statuses were also determined. In addition, the activity levels of each patient within the NSL were assessed. The questionnaires were returned anonymously by 104 patients. The results of this sample were compared with the responses to the EORTC QLQ C30/H&N35 by all of the survivors of treatment for head and neck squamous cell carcinoma (HNSCC) in western Norway between 1992 and 1997. This sample included 96 of 106 eligible patients. The QLQ-C30 symptom scores include, e.g., dyspnea, smell and taste. However, neither the QLQ-C30 functional scores nor the disease-specific scores of the people with laryngectomies differed from the general HNSCC-treated population. The level of social support by family, friends and neighbors was not associated with the QOL, whereas high BDI scores were associated with reduced QOL by most measured indexes. Furthermore, a positive association was determined between the level of activity within the NSL and QOL. This relation was to some extent secondary to differential BDI scores. In conclusion, the QOL of people with laryngectomies is relatively similar to a general population of patients treated because of HNSCC, is related to the activity level within a patient interest organization and is associated with a lower mood level.

Activities of Daily Living↗
PubMed2006

Predictors of uptake of obesity genetic testing among affected adults.

Given that a large number of candidate genes coding for a tendency toward obesity have been identified and some findings have been replicated, we explored characteristics of those who would be most likely to obtain future genetic testing for this tendency. During a series of focus groups, obese respondents rated their likelihood of obtaining testing under conditions in which either genetically-targeted drug treatment would be available, a positive test would be associated with a prognosis for developing diabetes, or neither of these. Interest in testing was greater given the first two scenarios than the third. Older age and belief that genetics were an important cause of obesity were associated with greater interest. For the first two scenarios, higher educational status was associated with greater interest, while for the third, respondents who said emotional issues caused overweight and those who crash-dieted intermittently were more likely to want genetic testing. Although further research is required to validate these findings, this study is the first published report of respondents' ratings of likelihood to obtain genetic testing for propensity to obesity, and suggests strong interest in genetic testing among some people, even in the absence of further treatment implications of the test.

Adult↗
PubMed1999

[The prevalence of pain in the German population: results of population-based studies with the Giessen Subjective Complaints List (Giessener Beschwerdebogen GBB)].

OBJECTIVE: Pain is one of the most frequent physical complaints worldwide. Empirical data on the prevalence of chronic pain is considerable. However, compared with the large number of epidemiological studies published in North America, Great Britain and particularly in Scandinavia, there has been relatively little equivalent research in Germany to date. METHODS: In two separate population-based cross-sectional studies conducted in 1975 (n=1.597, 18-60 years) and 1994 (n=2.148, 18-60 years) using the Giessen Subjective Complaints List (Giessener Beschwerdebogen GBB), data was collected on current pain in various parts of the body (limbs, back, neck, head, stomach). RESULTS: The frequency scores for pain varied according to localization between 32.4% (stomach pains 1975) and 67.3% (headaches 1994). Between the two measurement dates there was an increase in overall prevalence particularly for pains in the neck, head and limbs. At the same time we found a decrease in the proportion of severe pain symptoms. There were also considerable variations in pain experience according to age and gender: the frequency of pain increases with age (especially in limbs, back and neck). Women register more pain than men (particularly in head and neck), although the influence of gender decreases from 1975 to 1994. There are other sociodemographic variables like marital status, educational level, occupation or living in East/West Germany which influence the pain prevalence. CONCLUSIONS: Pain in differing parts of the body is a serious problem in the German population. However, the prevalence of pain is strongly dependent on sociodemographic factors (especially age, gender and living in East/West Germany), the localization of pain in the body and the grading of pain. Future epidemiological research should take these differential aspects into account.

English Abstract↗
PubMed2004

Depression and the use of complementary medicine among breast cancer patients.

This was a cross-sectional study to examine the association between anxiety, depression and quality of life and the use of complementary and alternative medicine. Anxiety and depression was measured using the Hospital Anxiety and Depression Scale (HADS), and quality of life was measured using the global quality of life subscale selected from the European Organization for Treatment and Research of Cancer (EORTC) quality of life core questionnaire (QLQ-C30). In all, 177 breast cancer patients were studied, and 32% (n=57) reported that they used or were using complementary medicine. Users and nonusers did not differ significantly in almost all variables studied, with the exception of duration of their diagnosis. The most commonly used complementary medicine was prayer and spiritual healing (n=45, 73.8% of responses). Performing the logistic regression analysis controlling for age, marital status, educational level, knowledge of diagnosis, time since diagnosis, global quality of life, depression, and anxiety scores, the results indicated that the use of complementary medicine among breast cancer patients was associated with sever depression (odds ratio 2.49, 95% CI 1.06-5.89, P 0.04). The other variables studied did not show any significant results. The study findings confirm that the use of complementary medicine is more common among depressed breast cancer patients and might be a marker of greater psychological distress in this group of patients.

Adult↗
PubMed2005

Mothers' mental distress and parenting practices with infants and toddlers.

The purpose of this study was to examine whether maternal mental distress affects parenting practices related to monitoring activities (i.e. daily routines, enrichment activities). The nationally representative sample consisted of 1638 mothers. Maternal mental distress was assessed by the 5-item Mental Health Index (MHI). Logistic regression models were conducted, controlling for covariates (e.g. marital status, education level, etc.). Approximately 14% of the women reported high levels of mental distress and 25% of the women failed to engage in enrichment activities or consistent daily routines with their children. There was a significant adverse relationship between mental distress and routines, with women who were mentally distressed being more likely to not engage in daily routines. There was no significant relationship between mental distress and enrichment activities. Race differentials were evident among these relationships. These findings highlight the prevalence of maternal mental distress and its deleterious effects on select parenting behaviors.

Child, Preschool↗
PubMed2003

[Differential and common characteristics of patients with atypical facial pain and craniomandibular dysfunction].

BACKGROUND: Craniomandibular disorders (CMD) and atypical facial pain (AFP) represent a clinical challenge. Whereas CMD patients respond to somatic approaches, somatization should be strictly avoided in AFP. The aim of this study was to establish prognostic criteria to identify an aggravated risk of a chronic course in CMD and AFP. METHOD: A total of 124 consecutive patients with CMD ( n=108) or AFP ( n=16) were examined by two interdisciplinary academic pain centers. Psychometric evaluation was conducted with standardized questionnaires (SCL-90R, STAXI, modified SBAS-IV). All patients were clinically assessed by a maxillofacial surgeon or specialized dentist. RESULTS: The following variables proved to be significant: age (risk for AFP vs CMD increased by 6% p.a.), decreased dysfunction index (13% higher risk for AFP vs CMD), and low scores concerning outwardly directed anger (12% higher risk for AFP vs CMD). There was no correlation between initial pain intensity and somatic parameters of disease as assessed by the standardized clinical examination. Low educational status proved to be the best predictor ( p<0.001) for patients presenting high initial pain with a marked discrepancy between somatic findings and subjective status. CONCLUSIONS: CMD patients differ from AFP patients regarding age, psychosocial isolation, outwardly directed anger, and a decreased dysfunction index. Additionally, initial pain intensity in patients presenting indistinct CMD/AFP can be considered as a valid predictor for a chronic course in pain.

Adolescent↗
PubMed2003

Risk factors of multiple sclerosis: a case-control study.

We assessed the risk of multiple sclerosis (MS) associated with a series of putative risk factors. We studied 140 patients (90 women) with MS (mean age, 42.1 years; SD= 10.2 years; disease duration, 10.9 years, SD= 7.5 years) and 131 sex-and age-matched controls. Using a structured questionnaire, we collected information related to demographic data, socio-economic status, education, ethnicity, changes of domiciles, migration, occupation, environmental, nutritional and hormonal factors, exposure to various bacterial and viral agents, vaccinations, and family history of diseases. In multiple logistic regression analysis, we found independent risk factors of MS to be: familiarity for MS (OR= 12.1; 95% CI, 1.3-110.7), autoimmune diseases (OR= 3.8; 95% CI, 2.0-7.1) and migraine (OR= 8.7; 95% CI, 1.0-75.4); comorbidity with autoimmune disease (OR= 6.8; 95% CI, 1.4-32.0) and migraine (OR= 13.5; 95% CI, 1.5-116.6); and vaccination against measles (OR= 92.2; 95%, 12.1-700.2). Familial susceptibility to MS, autoimmune diseases and migraine, and vaccination to measles are associated with an increased risk of MS. The data collected in this study are confirmatory and support the hypothesis that etiology of MS constitutes the effect of interplay between genetic and environmental risk factors. However, the relatively small number of cases and controls prevents firm conclusions.

Adolescent↗
PubMed2026

Development and Validation of a Predictive Model for Identification of Cognitive Impairment Risk in Older Adults with Subjective Cognitive Decline&#xff1a;A Longitudinal Study.

BACKGROUND: Subjective cognitive decline (SCD) is a transitional state between objective cognitive impairment and cognitively intact mental status, providing a critical window for implementing preventive interventions to delay objective cognitive decline. AIMS: We aimed to develop a predictive model for SCD progression in older adults with mild cognitive impairment (MCI). This model will facilitate the identification of risk factors and establishment of targeted interventions for community-based SCD management. METHODS: Data from the China Health and Retirement Longitudinal Study (CHARLS) was utilized in this study, extracting 18 indicators. Potential predictors selected through univariate Cox regression and LASSO regression analyses were sequentially incorporated into a multivariable Cox regression model. A nomogram was constructed to establish a predictive model. Model validation encompassed Area Under Curve (AUC) metrics for discriminative capacity, complemented by quantitative assessments using calibration curve analysis for precision verification and decision curve analysis (DCA) for clinical utility evaluation. RESULTS: A total of 1099 older adults with SCD were included in the final analysis, of whom 114 (10.3%) developed MCI. Multivariable Cox regression identified residence, marital status, educational level, social participation, gait speed, and baseline cognitive function. The model demonstrated time-dependent AUC values of 0.885, 0.830, 0.839, and 0.836 in the training set when evaluating discriminative capacity at 2-, 4-, 7-, and 9-year, respectively. The predictive model showed excellent predictive ability according to AUC, calibration curve, and DCA. CONCLUSIONS: A predictive model was created to estimate the risk of developing MCI in older individuals with SCD, offering clinician-actionable intervention benchmarks for preventive care.

Humans↗
PubMed2005

Factors associated with intention to breastfeed among low-income, inner-city pregnant women.

OBJECTIVES: To examine the relationship between sociodemographic factors, maternal characteristics, and intention to breastfeed among low-income, inner-city pregnant women. METHODS: English and Spanish speaking low-income women recruited from local Philadelphia health centers were surveyed at the time of their first prenatal care visit. At the time of the visit, respondents were asked whether or not they planned to breastfeed their infant. The responses of 2,690 women were included in these analyses. Multivariate logistic regression was used to assess the independent associations of race/ethnicity, nativity status, education, and other factors on the odds of intending to breastfeed. RESULTS: About half (53%) of the respondents reported that they intended to breastfeed their infant. In adjusted logistic regression models, immigrant black (adjusted OR [aOR] 5.82; 95% confidence interval [CI] 3.86, 8.77), other Hispanic (who were predominantly foreign-born) (aOR 6.05; 95% CI 3.92, 9.33), and island-born Puerto Rican (aOR 3.48; 95% CI 2.04, 5.95) women were significantly more likely to report that they intended to breastfeed than non-Hispanic whites. Somewhat surprisingly, non-Hispanic, US-born African Americans in this low-income sample were more likely to report that they intended to breastfeed than non-Hispanic white respondents (aOR 1.59; 95% CI 1.20, 2.11). Lower education, not living with the baby's father, multiparous pregnancy, and smoking were negatively and independently associated with intention to breastfeed. Maternal age, household income, public housing, and depressive symptoms were not significant predictors of breastfeeding intention in adjusted multivariate models. CONCLUSIONS: Significant differences were documented in breastfeeding intention in our sample of low-income, inner-city women. Most notable was the higher likelihood of anticipated breastfeeding among our immigrant sub-groups when compared with non-Hispanic white women. An unexpected finding was the higher likelihood of anticipated breastfeeding among native-born, non-Hispanic African American women than among non-Hispanic white respondents. Because intentions are important predictors of future behavior, more focus needs to be directed towards breastfeeding promotion during the prenatal period and towards a better understanding of why some mothers intend to breastfeed while others do not.

Adolescent↗
PubMed2006

Impact of prenatal care on infant survival in Bangladesh.

Despite improvements in public health in recent decades, levels of infant and child mortality remain unacceptably high, particularly in developing countries where primary healthcare services including prenatal care services are not universally available. Using information on 7,001 childbirths in five years preceding the 2004 Bangladesh Demographic and Health Survey, this study examined the relationship between receiving prenatal care during pregnancy and infant mortality using multivariate survival analysis. The results are presented in hazard ratios (HR) with 95% confidence intervals (95% CI). Results indicate that children of mothers who did not receive prenatal care during pregnancy were more than twice as likely to die during infancy as children whose mothers received prenatal care during pregnancy (HR=2.40, 95% CI: 1.74, 3.31) independent of child's sex, delivery assistance, birth order; mother's age at child birth, nutritional status, education level; household living conditions, and other factors. Children born to older mothers living in households without safe drinking water were at an increased risk. The study concludes that prenatal care is strongly negatively associated with infant mortality in Bangladesh independent of other risk factors. The results suggest that improving prenatal care services at the community level is key to improving child survival in Bangladesh.

Adolescent↗
PubMed2005

The Chinese Medical Interview Satisfaction Scale-revised (C-MISS-R): development and validation.

BACKGROUND: The Medical Interview Satisfaction Scale (MISS) measures patient consultation satisfaction. We validated a translated short-form of the original MISS on Hong Kong Chinese women with breast cancer. METHODS: The four highest scoring MISS Cognitive and Affective sub-scales items were administered in Chinese (C-MISS) to 224 female out patients. Phrasing revisions (C-MISS-R) were tested on 82 women. Random split tested factor structure stability. Convergent, divergent and criterion validation against other instruments was performed on 405 women. RESULTS: Two-factors accounted for 61.7% of variance but factor loadings differed from the original. Phrasing revision increased Affective sub-scale item-item correlations exceeding 0.3-64%. Two factors matching those of the original MISS, accounting for 65.2% of variance, explained 36.6% (Cognitive) and 28.8% (Affective) of variance, respectively. Alpha was 0.84,0.74 and 0.83 for the Cognitive and Affective sub-scales and total respectively. Correlations of difficulties with treatment decision making (r = -0.298), Self-efficacy (r = 0.194), optimism (r = 0.33), psychological morbidity (r = -209), marital status, education and age indicated acceptable validity. Test-retest reliability was 0.410. DISCUSSION: The Chinese MISS-Revised (C-MISS-R) has suitable factor structure and psychometric properties for use in consultation studies among Chinese female populations. Further validation is needed for males.

Aged↗
PubMed2005

Quality of life in Indian patients with rheumatoid arthritis.

PURPOSE OF STUDY: Rheumatoid arthritis (RA) is a multisystem disease with various extra-articular manifestations (EAMs). Health-related quality of life (HRQOL) issues are assuming increasing importance in chronic rheumatic diseases like RA. No data on QOL in RA is available from the Indian subcontinent. There is also a paucity of literature on the impact of EAMs on HRQOL in RA. The objective of this study was to address these lacunae. METHODS: The study group comprised 81 patients with RA from a rheumatology clinic in India. Quality of life was estimated by the generic HRQOL measure: World Health Organization quality of life instrument (WHOQOL-Bref). Disease activity in RA was measured by calculating Disease Activity Score-28 (DAS28). RESULTS: The mean HRQOL scores of the patients were 12.0+/-2.8, 13.2+/-2.7, 14.4+/-2.9 and 13.3+/-2.6 in the physical, psychological, social, and environmental domains of the WHOQOL-Bref respectively. Age, gender, disease duration, educational status, constitutional symptoms, rheumatoid factor positivity, erosions and deformities did not influence HRQOL. Disease activity had a negative influence on the physical and psychological domains. Patients with EAMs had significantly higher DAS28 scores compared to patients without EAMs. Even after adjustment for disease activity, patients with EAMs had lower HRQOL scores than patients without these features (statistically significant for physical domain). CONCLUSIONS: The physical domain of HRQOL is most affected in Indian patients with RA. Increasing disease activity and presence of EAMs worsens the quality of life.

Adult↗
PubMed2004

Menopausal hormone therapy: is there evidence for cardiac protection?.

Menopausal hormone therapy currently has no evidence-based role in the primary or secondary prevention of cardiovascular disease in women. Repeat analysis of the observational data that corrected for socioeconomic status, educational level, and coronary risk factors; as well as information from randomized clinical trials of menopausal hormone therapy both for healthy women and for women with established coronary heart disease and stroke support this statement. This approach is corroborated by recommendations from the US Food and Drug Administration and the recently released Guidelines for Cardiovascular Prevention for Women of the American Heart Association. The latter Guidelines display the lifestyle and pharmacologic interventions that are appropriate for cardiovascular disease risk reduction for women.

Cardiovascular Diseases↗