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PubMed1999

Evaluating cataract surgery gains by assessing patients' quality of life using the VF-7.

PURPOSE: To describe the development and performance of a questionnaire designed to measure functional impairment caused by cataract. SETTING: Department of Ophthalmology, Helsinki University Central Hospital, Helsinki, Finland. METHODS: The results of a visual-functioning index (VF-14) of 168 patients with first-eye cataract surgery were analyzed. Patients with significant comorbidity were excluded, leaving 142 patients for the final analysis. Snellen visual acuity measurements and complete preoperative and 4 month postoperative clinical status were performed by ophthalmologists. Outcome measures, including the VF-14, patient perception of trouble with vision, patient satisfaction with vision, and the cataract symptom score, were taken by nurses at the preoperative clinical examinations and at the 4 month postoperative visit. The Spearman rank correlation was used to determine which items of the VF-14 best correlated with a change in patient satisfaction. RESULTS: Seven items of the VF-14 that best correlated with patient satisfaction were selected for inclusion in a new 7-item index (the VF-7). Based on the Spearman rank correlation, the items from best to worst were nighttime driving; reading small print; watching television; seeing steps, stairs, or curbs; reading traffic, street, or store signs; cooking; and doing fine handwork. The correlation among changes in the VF-7 score and visual acuity in the operated eye was 0.17, while the correlation among changes in the VF-7 and patient satisfaction caused by cataract surgery was high (r = .56). CONCLUSION: The VF-7 was a strong predictor of change in patient satisfaction caused by cataract surgery.

Adult↗
PubMed1999

Tinnitus program at Brasília University Medical School.

Over the last 6 months, all patients seen at the otologic clinic of Brasília University Medical School answered a questionnaire designed to identify and describe the symptom of tinnitus. A total of 500 patients reported and described this symptom. They underwent physical examination, laboratory tests and audiological evaluation. In their order of frequency, presbycusis, chronic otitis media, otosclerosis, acoustic trauma, Menière's disease, ototoxicity, and vestibular schwannoma were found. Tinnitus was rated as minor in 81%, moderate in 18%, and severely disabling in 1%. Those who requested treatment for tinnitus were treated medically. Central vasodilators, vestibular suppressants, calcium channel blockers, anticholinergic drugs, anticonvulsant drugs, and gingko biloba were used with variable results. Tinnitus maskers were not used, but hearing prostheses were fitted when indicated. Treatment failed in the 1% with severe disabling tinnitus, and they were entered in a double-blind, randomized protocol for intratympanic dexamethasone injection. Under topical anesthesia, 0.2 ml of a 4-mg/ml dexamethasone solution (0.8 mg per injection) or 0.2 ml of normal saline was injected just posterior to the umbo. Patients remained supine for 20 minutes with the injected ear up and received four injections at 1-week intervals. Preliminary results are reported. Tinnitus is a very frequent symptom among our otologic patients, but most of them would not mention the symptom spontaneously, probably because for 81% it was mild. Curiously, the 5% of the severely disabling type tend to exhibit no clear cause, whereas the mild and moderate cases usually have an identifiable etiology.

Anti-Inflammatory Agents↗
PubMedDate not supplied

[Why psychotic patients are not drug compliant?].

Improving patient's compliance with antipsychotics is a major issue in psychosis management. As the point is to convince patients to take their drugs, we have to better understand why they should want or not want to do that. Compliance is actually a complex behavior, involving many psychosocial factors. Thus, we conducted a survey to assess compliance rate and to investigate determinant compliance factors of psychotic outpatients (according to CIM-10 diagnosis). Method - Investigated factors were selected according both to biomedical researches and to psychosocial theories (Health Belief Model). Around 20 influential factors, described in publication, were investigated. The questionnaire design conformed to sociological survey's rules. More, in order to promote patients frankness, the investigator was independent of the medical team. We processed the answers of 63 patients (61% men, average age 40 years), having presented with psychotic disorders for an average of 10 years, without addictive comorbidity (CIM-10). Results - The compliance rate was only 47%. Biomedical factors related to patients (sex, age, social way of life, professional state, and study level), as well as those related to treatment (complexity, duration, side effects occurring), don't affect compliance behavior. The psychosocial factors investigation reveals more interesting results. If the patient trusts his medicines, and do not subscribe to drug's negative beliefs , compliance rate is significantly improved (p=0,0062). It appears to be the survey's best factor for a good compliance, but it concerns only 29% of the investigated patients. When patients aknowledge the whole positive effects of their medicines, compliance is also inclined to improved (p=0,075). But compliance significantly decreases when patients felt that adverse effects are difficult to undergo or unbearable (p=0,04). It also inclined to decrease when family or friends have a negative opinion or are hostile to the pharmacological treatment. None of the other factors influence patient's compliance. Conclusion - These results demonstrate that convincing psychotic patients to be compliant is mandatory. As determinant compliance factors appear to be complex psychosocial ones, it also demonstrates that information procedure needs to be extensively structured.

Adolescent↗
PubMed2004

The economic impact of chronic prostatitis.

BACKGROUND: Little information exists on the economic impact of chronic prostatitis. The objective of this study was to determine the direct and indirect costs associated with chronic prostatitis. METHODS: Outcomes were assessed using a questionnaire designed to capture health care resource utilization. Resource estimates were converted into unit costs with direct medical cost estimates based on hospital cost-accounting data and indirect costs based on modified labor force, employment, and earnings data from the US Census Bureau. RESULTS: The total direct costs for the 3 months prior to entry into the cohort, excluding hospitalization, were $126 915 for the 167 study participants for an average of $954 per person among the 133 consumers. Of the men, 26% reported work loss valued at an average of $551. The average total costs (direct and indirect) for the 3 months was $1099 per person for those 137 men who had resource consumption with an expected annual total cost per person of $4397. For those study participants with any incurred costs, tests for association revealed that the National Institutes of Health Chronic Prostatitis Symptom Index (P<.001) and each of the 3 subcategories of pain (P =.003), urinary function (P =.03), and quality-of-life (P =.002) were significantly associated with resource use, although the quality-of-life subscale score from the National Institutes of Health Chronic Prostatitis Symptom Index was the only predictor of resource consumption. CONCLUSIONS: Chronic prostatitis is associated with substantial costs and lower quality-of-life scores, which predicted resource consumption. The economic impact of chronic prostatitis warrants increased medical attention and resources to identify and test effective treatment strategies.

Absenteeism↗
PubMed1992

Patients' preferences for learning the results of mammographic examinations.

The communication of diagnostic test results is an important aspect of the interaction between doctors and patients. Communication of mammogram results is of particular interest because the test is used to detect a common and potentially dangerous malignancy and because patients in the United States are able in some locations to obtain mammography at their own request, rather than being referred by a physician. We conducted a survey to learn about the preferences of a group of women at a traditional mammography center for learning the results of this commonly performed test. We asked women undergoing mammography to respond to questionnaires designed to learn: 1) How they felt about different methods of telling patients the results of mammograms; 2) How they were informed of the results of previous mammograms; 3) How they were told the results of the current mammograms. Patients indicated that if no abnormality is detected, they prefer to have their doctor call with the result, but if the study is 'abnormal' they wish to be told by their own physician in the office. Failing to notify the patient if the study is normal was the least preferred outcome. This group of patients did not express an interest in the most immediate form of notification (i.e. learning the result from the radiologist performing the test). Analysis of how patients felt about ways in which they were previously informed of the results of mammograms suggests that their reactions are influenced to a large extent by their clinical status. Patients undergoing mammography for diagnostic purposes, for example, were less pleased by a 'preferred' method (i.e. being told by their physician) than were those undergoing screening mammography. While patients have opinions about how they would prefer to be told their mammogram results, they are accepting a variety of methods of telling, if they are receiving good news. If abnormalities are found, patients prefer to be told in person by their own physician. Interpretations of surveys of patient satisfaction should be tempered by the finding that the clinical status of the patient alters their perceptions of satisfaction with this aspect of their physician's behavior. Patient preferences may change if increasing numbers of women are told their results by the radiologist.

Adult↗
PubMedDate not supplied

The value of clinical characteristics from a standard questionnaire to discriminate cardiac from neurological syncope in the elderly.

OBJECTIVES: To identify signs and symptoms to differentiate cardiac from neurological syncope in patients over 70 using a standardized questionnaire. DESIGN: Prospective cohort study. SETTING: Five short-stay units in a French university hospital. PARTICIPANTS: One hundred thirty-one in-patients with syncope aged 70 and older. MEASUREMENTS: Patients were interviewed about the signs and symptoms that had been present before, during or after syncope. When possible, a witness who had been present during syncope was also interviewed to compare theirs and the patients' answers. The sensitivity and specificity of 35 questions were calculated among 3 groups defined according to the cause of syncope: cardiac (n = 58), neurological (n = 31) and syncope of unknown origin (n = 42). Statistical analyses were performed to determine discriminating signs and symptoms among the causes and crude agreement was calculated for answers from patients and witnesses. RESULTS: Only 8 and 3 of 35 questions had a sensitivity of at least 0.5 for cardiac and neurological causes respectively. A feeling of impending syncope, thoracic oppression, recall of events preceding syncope and a history of arrhythmia were independently and significantly discriminant among groups. Recall of events preceding syncope (Odds Ratio (OR) = 7.5; 95% confidence interval (CI) = 2.2-25.3) and a personal history of arrhythmia (OR = 4.8; 95% CI = 1.6-14.2) were discriminant between cardiac and neurological causes suggesting mostly a cardiac cause. Agreement between patients and witnesses was only found for questions on the patient's medical history or the circumstances surrounding the onset of syncope. CONCLUSIONS: Recall of events preceding syncope and a history of arrhythmia are strongly suggestive of a cardiac rather than a neurological cause of syncope. Interviews of witnesses are not helpful in suggesting a cause for syncope.

Aged↗
PubMed2003

Health status of patients with juvenile rheumatoid arthritis at 1 and 5 years after diagnosis.

OBJECTIVE: To describe the health and functional status of children with juvenile rheumatoid arthritis (JRA) diagnosed in the early 1990s. METHODS: Patients were obtained from the Pediatric Rheumatology Disease Registry, a database of patients seen in pediatric rheumatology centers across the United States. Questionnaires designed to be filled out after retrospective chart review were sent to pediatric rheumatologists caring for children diagnosed with JRA between 1992 and 1997. RESULTS: We studied 703 patients -- 376 with pauciarticular onset (pauci), 232 with polyarticular onset (poly), and 95 with systemic onset JRA (systemic). At 1 year after diagnosis, half of the pauci and systemic patients no longer required medication, compared to 78% of the poly patients; 98% of the patients functioned in Steinbrocker classes I and II. Six percent of pauci, 27% of poly, and 11% of systemic patients had limitations in school function. Nearly 1/3 of poly patients already had joint space narrowing on radiograph. By 5 years after diagnosis, all pauci, 88% of poly, and 70% of systemic patients were in Steinbrocker classes I and II; but 6% of pauci, 28% of poly, and 44% of systemic patients had limitations in school function. Nearly 2/3 of poly and systemic patients had joint space narrowing. CONCLUSION: In these children treated prior to the era of biologic therapy, at 5 years after onset, > 25% of poly and nearly half of systemic patients had functional limitations that required modifications in their school schedule. Radiographically evident joint space damage was seen within a year of onset in poly patients, and by 5 years 2/3 of poly and systemic patients had damage.

Activities of Daily Living↗
PubMed2003

Development and initial validation of a measure of coordination of health care.

OBJECTIVE: To describe the development and initial validation of the self-administered Client Perceptions of Coordination Questionnaire. DESIGN: The instrument was developed between 1996 and 1997 through iterative item generation; within a framework of six domains of coordination, addressed across four sectors of health care provision. SETTING: 1193 individuals with complex and chronic health care needs as judged by their general practitioners (GPs), who were participants in a 2-year randomized controlled trial of a coordinated care intervention in Australia. Other samples were collected in one general practice (98) and from attendees of a chronic pain management course (29). MAIN MEASURES: Face and content validity, completion rates, transferability, internal consistency, and construct validity of the 32-item instrument. RESULTS: Most items achieved excellent completion and comprehension rates. The instrument was transferable to another chronically unwell population. Cronbach's alpha of the entire instrument was 0.92, and for six individual scales scores ranged from 0.31 to 0.86. The six scales based on principal components analysis were acceptability, received care, GP, nominated provider, client comprehension, and client capacity. The first four scales were satisfactory, but the client scales were inadequate with poor internal consistency, and convergent and discriminant validity. People with chronic pain syndromes had significantly worse experiences for almost all items, supporting construct validity. CONCLUSION: This instrument is one of the first to attempt to measure coordination of health care. Its strengths include ease of completion, transferability, and promising psychometric properties and construct validity. Problems capturing data about the patient's contribution to coordination highlight a lack of theoretical development in this area. A valid measure of coordination should be useful in needs assessment, program evaluation, and individual provider/practice audit, and would contribute to research into the experience and measurement of patient-focused care.

Adolescent↗
PubMed1996

Evaluation of efficacy of traditional Chinese medicines in the treatment of childhood bronchial asthma: clinical trial, immunological tests and animal study. Taiwan Asthma Study Group.

Traditional Chinese medicines (TCM) have been used to treat bronchial asthma for several centuries and a certain degree of clinical benefit has been observed; however, scientific substantiation is lacking. A multicenter, double-blind and placebo-controlled study was therefore conducted to evaluate the clinical efficacy in terms of symptom score, medication score, morning and evening PEFRs, and changes of immunoregulatory function, such as distribution of lymphocyte subsets and in vivo and in vitro production of lymphokines (IFN-gamma and IL-4) and inflammatory mediators (histamine, PGE2 and LTC4). Furthermore, the protective effect of TCM on the late asthmatic reaction (LAR) was evaluated by using asthmatic guinea pigs. Three hundred and three asthmatic children were classified by Chinese doctors, according to a standardized questionnaire designed on the basis of basic logic of Chinese medicine, into three groups of specific constitution (group A, B and C). Group A consisted of 32 herb A-treated patients and 34 placebo-treated; group B, 74 herb B-treated and 64 placebo-treated; and group C, 55 herb C-treated and 44 placebo-treated. The study period was six months. The results were: 1) Both treatment group and placebo group showed an improvement in all clinical parameters, thus demonstrating a placebo effect. However, the improvement was usually greater in the former than the latter, although only the difference in PEFR was significant; 2) Herb A could increase total T cell and decrease B cell; 3) Herb A and B enhanced production of PGE2 but not LTC4, IFN-gamma and IL-4; 4) There was a general tendency for in vivo and in vitro production of histamine to decrease at the end of study in both treatment group and placebo group; however, the decrease was significantly greater in the former than the latter; 5) In asthmatic guinea pigs, 10-day's pretreatment with Chinese herbs could reverse the decrease of sGaw, suppress eosinophilia in bronchoalveolar lavage fluid (BALF), prevent the eosinophil infiltration of airways, increase PGE2 production and decrease LTC4 production in serum and BALF. Thus, traditional Chinese medicines did show a certain degree of clinical efficacy. The decreased production of histamine and LTC4, increased production of PGE2 that were found in both asthmatic children and asthmatic guinea pigs, and prevention of occurrence of LAR by suppressing eosinophil infiltration of airways and preserving airway conductance that were observed in asthmatic guinea pigs after allergen challenge might be used to account partly for the effectiveness.

Adolescent↗
PubMed1997

SSRI-induced sexual dysfunction: fluoxetine, paroxetine, sertraline, and fluvoxamine in a prospective, multicenter, and descriptive clinical study of 344 patients.

The authors analyzed the incidence of sexual dysfunction (SD) with different selective serotonin reuptake inhibitors (SSRIs; fluoxetine, fluvoxamine, paroxetine, and sertraline) and hence the qualitative and quantitative changes in SD throughout time in a prospective and multicenter study. Outpatients (192 women and 152 men; age = 39.6 +/- 11.4 years) under treatment with SSRIs were interviewed with an SD questionnaire designed for this purpose by the authors and that included questions about the following: decreased libido, delayed orgasm or anorgasmia, delayed ejaculation, inability to ejaculate, impotence, and general sexual satisfaction. Patients with the following criteria were included: normal sexual function before SSRI intake, exclusive treatment with SSRIs or treatment associated with benzodiazepines, previous heterosexual or self-erotic current sexual practices. Excluded were patients with previous sexual dysfunction, association of SSRIs with neuroleptics, recent hormone intake, and significant medical illnesses. There was a significant increase in the incidence of SD when physicians asked the patients direct questions (58%) versus when SD was spontaneously reported (14%). There were some significant differences among different SSRIs: paroxetine provoked more delay of orgasm or ejaculation and more impotence than fluvoxamine, fluoxetine and sertraline (chi 2, p < .05). Only 24.5% of the patients had a good tolerance of their sexual dysfunction. Twelve male patients who suffered from premature ejaculation before the treatment preferred to maintain delayed ejaculation, and their sexual satisfaction, and that of their partners, clearly improved. Sexual dysfunction was positively correlated with dose. Patients experienced substantial improvement in sexual function when the dose was diminished or the drug was withdrawn. Men showed more incidence of sexual dysfunction than women, but women's sexual dysfunction was more intense than men's. In only 5.8% of patients, the dysfunction disappeared completely within 6 months, but 81.4% showed no improvement at all by the end of this period. Twelve of 15 patients experienced total improvement when the treatment was changed to moclobemide (450-600 mg/day), and 3 of 5 patients improved when treatment was changed to amineptine (200 mg/day).

1-Naphthylamine↗
PubMed2000

Survey of canine babesiosis in South Africa.

A questionnaire, designed to obtain qualitative information on a number of variables concerning canine babesiosis (biliary fever) in South Africa, was sent to 510 veterinary practices in late 1993. Of the 157 practices that responded, all were presented with cases of babesiosis and most were situated in Gauteng, the Western Cape and KwaZulu-Natal. Apart from the Western Cape, a winter-rainfall region, the prevalence of babesiosis cases in dogs was highest in summer. Most of the respondent practices treated between 1,000 and 5,000 sick dogs that included 100 to 500 babesiosis cases each year. Respondents identified cerebral babesiosis, enterorrhagia, 'red' or haemoconcentrated babesiosis, acute renal failure and pulmonary babesiosis or 'shock lung', amongst others, as the most prevalent forms of complicated ('atypical') babesiosis. Diminazene, imidocarb and trypan blue were the most popular antibabesials. Trypan blue was most often used in shocked patients, whereas diminazene and imidocarb were preferred when there was a high parasitaemia in the absence of shock. At least 19 antibabesial treatment regimens were used in practices. These comprised the use of single doses of antibabesial drugs; split doses with repeat injections, and combined drug variations, some of which are undesirable due to possible sterilisation of Babesia infection or potential toxicity. Side-effects were most commonly associated with imidocarb use. Ninety-six percent of respondents used supportive treatment (e.g. corticosteroids, vitamins and 'liver support') in all cases of babesiosis. The use of blood transfusion as supportive treatment varied according to practice and severity of the case. Most practices never cross-matched blood to be transfused, and transfusion reactions were rare. Diminazene was most frequently incriminated in cases where drug 'resistance' or relapses occurred. Cerebral and 'red' cases resulted in high mortality. Treatment of babesiosis costs the dog-owning public in South Africa more than R20 million each year. Information on the distribution and possible complicating role of Ehrlichia canis was obtained. Development of a vaccine was the first research priority identified.

Animals↗
PubMed1996

Development of a scale to measure directive guidance by pharmacists.

OBJECTIVE: To develop and test a questionnaire that can be used to measure directive guidance behaviors by pharmacists. QUESTIONNAIRE DESIGN: The Purdue Pharmacist Directive Guidance (PPDG) scale was developed based on the directive guidance dimension of socially supportive behaviors, as described by Barrera and Ainlay. The final scale consists of 10 items. SUBJECTS: Individuals on the Walker Test Crew database who were 18 years of age or older and self-reported taking medications for asthma, hypertension, and/or diabetes in the past 3 months were eligible for inclusion. All data were collected through telephone interviews. A total of 464 contacts were made, resulting in 300 responses. DATA ANALYSIS: Principal components analysis was performed to determine the construct subscales of the PPDG. Internal consistency of the PPDG and its subscales was assessed using Cronbach's alpha and corrected item-total correlations. Pearson product-moment correlations of the PPDG with measures of family and friend support (FFS) and self-reported medication adherence were used to determine convergent validity. Spearman rank-order correlations of the PPDG with the total number of prescription medications as well as those for asthma, hypertension, and diabetes taken in the past 3 months were obtained. ANOVA and Student's t-tests were used to determine differences in PPDG across demographic characteristics. RESULTS: Principal components analysis yielded two subscales for the PPDG. These were named Instruction and Feedback and Goal Setting, based on their content. The PPDG scale had good internal consistency (Cronbach's alpha = 0.86), and correlated positively and significantly with FFS (r = 0.27), giving some evidence of convergent validity. The PPDG scale and its subscales also had logically intuitive positive and significant correlations with the total number of prescription drugs taken in the past 3 months. CONCLUSIONS: The PPDG is short and easy to administer, and showed validity and reliability. The PPDG scale should be useful in developing a better understanding of the process by which pharmacists influence healthcare outcomes, assessing variations in pharmaceutical care, and as a tool in identifying means of overcoming barriers to higher levels of pharmaceutical care.

Adult↗
PubMed1988

Respiratory and allergic symptoms in wool textile workers.

An epidemiological study of 2153 workers in 15 West Yorkshire wool textile mills was conducted to determine relations between respiratory symptoms and exposure to inspirable wool mill dust. A questionnaire designed to elicit all the common respiratory symptoms was developed and tested, and administered to all workers willing to participate (85%). It was translated and administered in Urdu for the 385 workers from Pakistan whose English was not fluent. Symptoms investigated included cough and phlegm, wheezing and chest tightness, breathlessness and its variability, rhinitis, conjunctivitis, chills, nosebleeds, and chest illnesses. Additional questions were asked, where appropriate, about the times of day, days of the week, seasons, and places that the symptoms were worse or better than normal. An environmental survey was carried out at each mill, which included 629 measurements of inspirable dust, enabling estimates to be made of the airborne concentrations of inspirable dust usually experienced by each member of the workforce under current conditions. Overall symptom prevalences were: persistent cough and phlegm, 9%; wheeze, 31%; breathlessness on walking with others on level ground, 10%; persistent rhinitis, 18%; persistent conjunctivitis, 10%; persistent chills, 2%; ten or more nosebleeds a year, 2%; and three or more chest illnesses in past three years, 5%. After allowing for the effects of age, sex, smoking habit, and ethnic group, cough and phlegm, wheeze, breathlessness, rhinitis, conjunctivitis, and nosebleeds were found to be more frequent in those exposed to higher than to lower concentrations of dust. In some experiencing high concentrations (blenders and carpet yarn backwinders) cough and phlegm, wheeze, rhinitis, and conjunctivitis were related to the years worked in such jobs. Relative risks of each symptom in relation to inspirable dust concentrations were calculated by means of a logistic regression analysis. At concentrations of 10 mg/m3, the current United Kingdom standard for nuisance dusts, the risk of cough and phlegm relative to that of an unexposed worker was 1.37, that of wheeze 1.40, breathlessness 1.48, rhinitis 1.24, and conjunctivitis 1.70. Since some of these symptoms may be associated with functional impairment of the lungs, further studies of selected workers are being carried out to estimate the functional effects of exposure to dust in wool textile mills.

Adolescent↗
PubMed1996

Study of the risk factors for viral hepatitis C infection among Egyptians applying for work abroad.

The aim of this study was to identify the risk factors for viral hepatitis C infection among Egyptians. A cross-sectional study with case-control analysis was conducted including 5071 Egyptians applying to the Ministry of Health Laboratories for certification of freedom from viral hepatitis (B and C) to work abroad. A questionnaire designed to cover the most important known and suspected risk factors was filled out by physicians interviewers before blood drawing and after proper orientation of the purpose of the study. The overall seropositivity among the whole sample for HCV was 31.5% and was significantly lower among females (13.2%) than among males (34%). A consistent increase of seropositivity for HCV antibodies with age (in males and females and in urban and rural areas) was observed with a peak level of 54.9% in all individuals for the age group 45-49 years (significant trend p < 0.0001). A significant increase of seropositivity (p < 0.005) above 25 years of age (35.7%) than below this age 12.8%) was observed on examination of HCV distribution in 5-year age group. Married individuals have a significant higher seropositivity for HCV than non-married (38.2% and 20.9% respectively OR = 2.3, 95% CL 2.1-2.7). Individuals living in rural areas had significantly more HCV seropositivity than those living in urban areas (OR = 1.7, 95% CL 1.5-2.0). Also, individuals living in Cairo and seashore governorates had significantly lower seropositivity (14.7% and 12.7% respectively) than those living in governorates in upper or lower Egypt (29.4% and 36.3% respectively). Medical procedures risk factors identified to be associated with significant higher HCV seropositivity included: past history of injections for bilharziasis, use of common syringes, dental extraction, injections for urography, blood transfusions and previous hospitalizations. Multivariate logistic analysis revealed that only age, male sex, marriage, rural residence, living in upper and lower Egypt, injections for bilharziasis and urography were significant in the final equation for the whole group. Blood transfusion was significant in the final regression analysis among females in urban living and hospitalization was significant among males in urban living and females in rural living. Further research is needed to elucidate those factors prevailing in rural areas and in upper and lower Egypt associated with increased risk for HCV infection.

Adolescent↗
PubMed1994

[Expectations of the doctor in a private hospital--phase 2].

The purpose of this phase of the study was to explore and describe the expectations of the doctor in a private hospital with regard to the registered nurse's practice (phase 2). The expectations of the doctor were explored by means of a explorative and descriptive design. A questionnaire was designed as a data-gathering instrument, based on the scope of practice of the registered nurse (described in the conceptual framework). Through the use of descriptive statistics, a frequency-analysis was done and reflected through the use of percentages. The results were discussed in detail and presented in tables. To summarize the results, fifteen conclusion statements were described, out of which data for the orientation programme was inferred (phase 3).

Attitude of Health Personnel↗
PubMedDate not supplied

Adjustment of husbands and wives to breast cancer.

PURPOSE: The purpose of this descriptive study was to explore selected elements within the spousal relationship on fear of recurrence and emotional distress among women treated for breast cancer within the past 3 years and their husbands. DESCRIPTION OF STUDY: Fifty-eight married couples completed questionnaires designed to investigate the association between three relationship elements and adjustment (fear of recurrence and emotional distress) among husbands and wives. The relationship elements investigated were 1) adaptability and cohesion of the couple; 2) perceptions of support from the spouse; and 3) communication about the illness. The influence of the wife's age, treatment, and time since treatment also were considered. RESULTS: Both husbands and wives reported similar perceptions of dyadic functioning, level of support received from the spouse, and extent of communication about the illness. Interdependent elements within the couple relationship were associated with both fear of recurrence and emotional distress. Overall, the amount of communication about the illness explained the most variance in adjustment for both spouses, with communication increasing as fear of recurrence increased. There was some suggestion that current or past membership in a support group was related both to more communication by wives and to husbands' greater satisfaction with communication. For wives, age was the demographic variable most highly correlated with adjustment; the younger the wife, the greater was her fear of recurrence. Significant emotional distress was observed in a small subset of husbands. In addition, when either the husband or wife scored in the top 25% of the sample on fear of recurrence, the fear of recurrence score for the corresponding spouse was elevated in only two cases. This same pattern was true for emotional distress. CLINICAL IMPLICATIONS: This study adds to a growing body of information supporting the need to view women who have had breast cancer and their spouses as a unit. Four areas for heightened clinical assessment were noted; 1) greater fear of recurrence in younger women; 2) significant emotional distress in a small number of husbands; 3) the demonstration of compensation mechanisms by one spouse when the other is experiencing elevated fear of recurrence or emotional distress; and 4) an increased fear of recurrence in association with increased communication about the illness. Further investigation is necessary to determine whether communication between spouses is directed at problem solving or is an expression of emotional distress.

Adaptation, Psychological↗
PubMed1994

[Psychological status of patients with implantable cardioverter-defibrillators].

BACKGROUND: We assessed the psychological status of 20 patients (19 male, 1 female; mean age 61 +/- 9.3) with implantable cardioverter-defibrillator (ICD). Each patient underwent the Cognitive Behavioral Assessment adapted for Hospital use (CBA-H), and completed an ad hoc 20 item questionnaire designed to measure patients' perceptions of their health. METHODS: Psychological variables were treated as dependent variables and cardiac variables were considered independent variables in the one-way analysis of variance; when psychological and cardiac variables were discrete variables, Chi-square was used; correlations were performed by rank Spearman test. RESULTS: Indicated maladaptive behaviours in on 35% of the sample. Patients with pre-ICD Ventricular Fibrillation (VF) or Sustained Ventricular Tachycardia (SVT) and VF were the most psycho-physically distressed (p < .02). These were also the patients who reported feeling most stressed in the last three months (p < .03). I-E causal attribution is a psychological dimension related to the way of codify an event; I = internal means that subject attributes to itself the cause of what happens; E = external means that subject attributes to others, fate and environment what happens. The treatment received and the I-E causal attribution were found to correlate: Internal in patients who underwent both pacing and shock treatment (who were also those with the highest number of recurrent VT/VF episodes), External in patients who underwent one treatment or none (F3, 16 = 3.28; p < .04; I-E mean = 1 +/- .63 in pacing/shock treatment group; I-E mean = 2.5 +/- .57 in shock treatment group; I-E mean = 1.8 +/- .5 in pacing treatment group; I-E mean = 2 +/- .1 in no treatment group. The time since implantation (5-9, 10-18, 19-32 months) seemed to have an important effect, even if it reached statistical significance in only two areas, namely: family relationships which were better in patients who had the ICD for > 9 months, and adjustment to the physical condition, which was better in patients who had the ICD for 10-18 months. CONCLUSION: In the present study most of the patients with ICD proved to be fairly well-adjusted to their physical condition. The preimplantation cardiac condition, the treatment received, the number of recurrent VT/VF episodes, and the length of follow-up turned out to be the variables which most influenced the psychological status of patients with ICD.

Adult↗
PubMed2003

Which stoma works better for colonic dysmotility in the spinal cord injured patient?

BACKGROUND: The formation of an intestinal stoma is very effective in the treatment of colonic dysmotility associated with spinal cord injury (SCI). Little is known about the difference in the long-term outcome among left-sided colostomies, right-sided colostomies, and ileostomies in this patient population. METHODS: The records of 45 SCI patients with intestinal stomas at our institution were reviewed retrospectively. Operative details and preoperative colonic transit times (CTT) were recorded. Patients who were alive and available were interviewed using a questionnaire designed to assess the quality of life (QOL), health status, and time to bowel care before and after stoma formation. RESULTS: Between 1976 and 2002, 45 patients underwent a total of 48 intestinal stomas. A left-sided colostomy (LC) was formed in 21 patients, right-sided colostomy (RC) in 20, and ileostomy (IL) in 7. Three of the patients in the RC group ultimately underwent total abdominal colectomy and ileostomy. The indications for stoma formation and CTT were different in the three groups. Bloating, constipation, chronic abdominal pain, difficulty evacuation with prolonged CTT was the main indication in 95% of patients in the RC group, 43% of patients in the LC group, and 29% in the IL group. Management of complicated decubitus ulcers, perineal and pelvic wounds was the primary indication in 43% of patients in the LC group, 5% in the RC group, and none in the IL group. Preoperative total and right CTTs were longer in the RC group compared with the LC group: 127.5 versus 83.1 hours (P <0.05) and 53.7 versus 28.5 hours (P <0.05), respectively. Eighty-two percent of patients (37 of 45) were interviewed at a mean follow-up of 5.5 years after stoma formation. Most patients who were interviewed were satisfied with their stoma (RC, 88%; LC, 100%; IL, 83%) and the majority would have preferred to have the stoma earlier (RC, 63%; LC, 77%; and IL, 63%). The QOL index significantly improved in all groups (RC, 49 to 79, P <0.05; LC, 50 to 86, P <0.05; and IL, 60 to 82, P <0.05), as well as the health status index (RC, 58 to 83, P <0.05; LC, 63 to 92, P <0.05; IL, 61 to 88, P <0.05). The average daily time to bowel care was significantly shortened in all groups (RC, 102 to 11 minutes, P <0.05; LC, 123 to 18 minutes, P <0.05; and IL, 73 to 13 minutes, P <0.05.). CONCLUSIONS: Regardless of the type of stoma, most patients had functional improvement postoperatively. Patients who underwent RC had longer CTT and more chronic symptoms related to colonic dysmotility, reflecting the preoperative selection bias. The successful outcome noted in all groups suggests that preoperative symptoms and CTT studies may have been helpful in optimal choice of stoma site selection.

Colonic Diseases, Functional↗