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PubMed1983

Communicating probability in clinical reports: nurses' numerical associations to verbal expressions.

Verbal estimates of probability (such as likely or certain) commonly used in laboratory, radiological, and clinical reports may be a barrier to effective communication between health care professionals. In this study the investigators sought to determine whether a consensus of numerical meaning existed in a sample of nurses for each of 30 widely used verbal expressions of probability. Seventy female nurses enrolled in a graduate course were surveyed by means of a test-retest procedure using a questionnaire designed to elicit assignments of numerical probability (0% to 100%). The results showed wide inconsistency both between subjects and within subjects.

Communication↗
PubMed2002

Patient variables associated with expectations for prescriptions and general practitioners' prescribing behaviour: an observational study.

OBJECTIVES: To determine patients' needs and expectations for prescriptions as a function of demographic and illness-associated variables versus outcome of consultation. DESIGN: Questionnaire study consisting of patient interview before and after consultation with general practitioner. SETTING: A total of 618 consecutive patients in the waiting room of nine general practices in Germany (Hesse). MAIN OUTCOME MEASURES: Patient needs and expectations for prescriptions and agreement between expected outcome and prescriptions received. RESULTS: As their top priority for consultation (33% of group), patients expected to receive information about their illness. Their needs for prescriptions (26%) and expectations of receiving them (41%) were clearly lower than physician prescribing (56%). Marked interpatient differences emerged with regard to need/expectation for medication according to age, minor versus chronic illness, duration of treatment, and first-time attendance, but this was not reflected in how often physicians prescribed. A total of 85% of patients expecting a prescription received one; 44% not expressing a need for medication were issued one. Although only 4% of patients would want a drug with questionable effectiveness, doctors wrote such prescriptions to no less than 21% of patients--and especially to those with minor, newly arisen ailments (33%). Nevertheless, patient satisfaction with their visit was very high (98%). CONCLUSIONS: In Germany, patient needs and expectations for medication are clearly lower than prescribing tendencies, and marked differences between patient groups in their needs or expectations for prescriptions are not reflected in the rates of prescriptions received. Above all, patients with minor illnesses wish to receive information about their illness, and they do not expect prescriptions of drugs with questionable effectiveness.

Adult↗
PubMed1997

Psychological impact of screening for familial ovarian cancer: reactions to initial assessment.

OBJECTIVES: To assess the psychological impact on women attending a familial ovarian cancer screening clinic. STUDY METHODS: 157 women referred for screening completed an investigator designed questionnaire, the Spielberger State Trait Anxiety Scale and the Centre for Epidemiological Studies Depression Scale prior to the screening interview and an eight-item questionnaire post-assessment. RESULTS: 95.4% saw the screening as valuable. Thirty-one point four percent of all patients scored about the cutoff point for depression. Sixteen percent exhibited high levels of anxiety. Fifty-six point four percent of patients accurately perceived their risk. Twenty-one point five percent of those who accurately perceived themselves as being at high risk had high anxiety and 40.6% reported significant depressive symptoms. Of the 26.5% of patients who overestimated their risks, 40.0% reported significant depressive symptoms and 22.6% were anxious. Of the 17.1% who minimized their risk, none were anxious (0.0%), and only 15.8% were depressed. CONCLUSION: Attendees at a familial ovarian cancer screening clinic may have high levels of depression and anxiety.

Adult↗
PubMed1998

An analysis of approaches to the management of endometrial cancer in North America: a CTF study.

OBJECTIVE: The aim of this study was to define the clinical-therapeutical approach to endometrial cancer now being followed in some of the most important centers of reference for gynecological cancer in North America by means of a questionnaire. STUDY DESIGN: The questionnaire focused on four principal areas: (1) surgical staging and therapy; (2) adjuvant treatment; (3) treatment modifications; and (4) management of advanced stages (FIGO III-IV). RESULTS: There were 48 evaluable responses (77%) received by the end of December 1994 which were considered for this analysis. Lymphadenectomy is utilized routinely in 26/48 centers (54.2%) and in selective clinical-pathological conditions in another 21/48 centers (43.5%). In the majority of centers (31/48; 64.6%) radical surgery is utilized for selected indications such as cervical involvement. Only 3/48 (6.2%) centers consider the vaginal approach totally inappropriate. The great majority (40/48; 83.3%) of the centers considered postsurgical adjuvant therapy to be necessary in FIGO Stage Ic. Brachytherapy is routinely performed in 3 centers (6.2%) in postsurgical management of Stage I endometrial cancer, while the majority of the centers (31/48; 64.6%) perform brachytherapy of the vaginal vault in certain clinical-pathological conditions. A wide variety of treatments are used for advanced stages (FIGO III-IV). CONCLUSIONS: It emerges that some controversial aspects exist on endometrial cancer treatment, and these conflicting data need a large-scale multicenter randomized clinical trial.

Adult↗
PubMed1999

A longitudinal study of psychological adjustment to familial genetic risk assessment for ovarian cancer.

OBJECTIVES: To evaluate the psychological adjustment of women during initial genetic ovarian cancer risk assessment and at clinic follow-up, 6-12 months later. METHODS: Sixty-five subjects were assessed with the Centre for Epidemiological Studies Depression Scale (CESD), Spielberger's State Anxiety Inventory, and an 18-item, investigator-designed questionnaire yielding self-report on screening responses, worry about increased risk, identification of cancer-related deaths in relatives, worry about future cancer risks of daughters, alteration of future plans as a result of ovarian cancer risk, etc. RESULTS: Thirty-three percent of subjects had CESD scores above the established cutoff for depression at baseline and 38% had scores above cutoff at follow-up. Sixteen percent of subjects had state scores on the State-Trait Anxiety Inventory higher than 1 standard deviation above average (norm) at baseline, while only 6% had scores higher than 1 SD above average at follow-up. CONCLUSION: To identify factors associated with self-reported depression at follow-up, a series of demographic and self-reported variables (e.g., presence of identified problems in family, impact of genetic risk information, concern for daughter in the future) were entered in a multiple regression analysis with the CESD follow-up score as the dependent variable. Only one predictor accounted for a significant amount of variance in depression scores. Concern for daughter's risk in the future was associated with higher depression scores at follow-up (R = 0.33, P<0.02, R(2) = 11%).

Adaptation, Psychological↗
PubMed1999

Investigating the role of alienation in a multicomponent model of juvenile delinquency.

Research findings indicate that there are multiple causal pathways to delinquency. A multicomponent model of delinquency was developed to explore systematically the interrelationships of psychosocial variables and their relationships to delinquent behaviour. Most importantly, alienation was tested for its ability to act as a core mediating predictor variable. One hundred and fifty-two adolescents, 78 females and 74 males, completed a battery of questionnaires designed to assess each of the variables in the proposed model. Several salient pathways to delinquency were identified. They include environmental and person-centred factors. Alienation, when operationalized as a general construct, was not found to be a necessary mediating predictor variable. "Societal" alienation, on the other hand, was shown to have important explanatory power. Re-examining the model within a large-scale, time-extended study could inform programmes for the prevention and early intervention of delinquent behaviour.

Adolescent↗
PubMed1994

Correlates of healthy eating habits in low-income black women and Latinas.

BACKGROUND: Few factors related to healthy or unhealthy eating habits in low-income, ethnic minority groups have been identified. In this study, factors associated with healthy and unhealthy eating habits and intent to change eating habits were examined in a sample of low-income Black and Latino women. METHODS: Survey questionnaires designed to identify correlates of healthy eating habits were administered to 243 Black and Latino women whose children were enrolled in Head Start programs in South Central Los Angeles. RESULTS: Having health insurance, lower perceived susceptibility to cancer, and higher levels of social support were significantly related to healthy eating habits. Exposure to domestic violence, lower income and knowledge of risk factors, and lower perceived efficacy in changing health outcome were associated with lower levels of intent to change eating habits. CONCLUSIONS: Economic factors such as insurance coverage and level of social support should be considered in evaluating and addressing eating habits in low-income, ethnic minority women. Exposure to domestic violence and self-efficacy may also be related to intent to change eating habits in these groups.

Adult↗
PubMed2001

Problem drinking, health services utilization, and the cost of medical care.

The purpose of this study was to examine the relationships between problem drinking, health services utilization, and the cost of medical care in a community-based setting. In addition to descriptive analyses, these relationships were estimated with multivariate regression models. Data were collected in 1996 and 1997 through a standardized self-administered questionnaire designed to obtain important information on demographics, health status, morbidity, health care utilization, drug and alcohol use, and related lifestyle behaviors. The survey instrument also included the 10-item Michigan Alcoholism Screening Test (MAST-10), which was used to identify problematic alcohol users (PAUs). The empirical findings indicated that PAUs had a significantly higher number of outpatient visits, more emergency room episodes, and more admissions to a hospital than a combined group of nondrinkers and nonproblematic alcohol users (NPAUs). Analyses of total health care cost showed that the estimated differential in total cost for PAUs during the past year, including the interaction effect with problematic drug use, was $367. The total cost (full effect) for PAUs was composed of a main effect ($984) and an interaction effect (-$617). These findings have implications for substance abuse interventions and health care policy.

Adult↗
PubMed2001

Epidemiology of breast-feeding in Italy.

To evaluate the prevalence of breast-feeding in Italy and to describe the social and environmental factors associated with its practice, 1601 mothers were systematically recruited as representative of deliveries across all regions of Italy during November 1995. They were interviewed in March, June, and September of 1996. Interviews were conducted by telephone using a standardized questionnaire designed for computer scanning. The results indicated that 85% of mothers breast-fed their infants. The rates of breast-feeding at 3, 6, and 9 months were, respectively, 51%, 32%, and 19%. Among the 830 lactating mothers at 3 months, 72% practiced breast-feeding "on demand." Pediatricians, midwives, and gynecologists were the main sources of information about breast-feeding, but 43% of the mothers did not receive any information. Media (radio, TV) were mentioned as sources of information by only 2% of the mothers. Maternal factors significantly associated with breast-feeding and its duration were: a) having been breast-fed as infants, b) being nonsmokers, and c) being given information about lactation at the time of discharge from their hospital ward. Maternal characteristics (age, weight, and height), parental socioeconomic indicators (profession and education), and neonatal care (rooming-in practice) were not significantly associated with breast-feeding. Our results show that in Italy a fairly high percentage of mothers start breast-feeding and that both maternal factors (history and habits) and good information may support its duration.

Breast Feeding↗
PubMed1996

How informed general practitioners manage mild hypertension: a survey of readers of drug bulletins in 7 countries. International Society of Drug Bulletins (ISDB).

OBJECTIVE: To determine whether general practitioners (GP) who are readers of independent drug bulletins can be used as an international epidemiological observatory of the criteria adopted by "well informed" doctors in various countries in the management of mild hypertension. DESIGN: Questionnaire study of GPs' diagnostic criteria for mild hypertension, routine investigation and management of patients with this diagnosis. PARTICIPANTS: 206 GPs readers of independent drug bulletins in 7 countries, comprising 95 known systematic readers of a local bulletin and 111 randomly selected regular subscribers. MAIN OUTCOME MEASURES: Response rate to the questionnaire. Diagnostic criteria, routine investigations, and treatment used for patients with mild hypertension. RESULTS: The study required two months for planning and implementation. Four countries out of eleven had a response rate < or = 50% and were excluded; the frequency of responses from other countries was 69%. The average diastolic blood pressure (DBP) considered diagnostic of mild hypertension range from 94 mm Hg (lower threshold) to 106 (upper threshold). A minority (17%) of GPs routinely request the minimum recommended laboratory tests to assess patients. GPs routinely advise non-drug measures before starting a drug. Most would not start drug treatment in patients without other risk factors and a DBP below 100 mmHg. The top first choice drugs were diuretics and beta-adrenoceptor blockers. Half of the doctors were able to quote some published guide to the management of mild hypertension, and 18% cited a relevant trial. Attitudes in diagnosing and treating mild hypertension differed widely between GPs and countries. CONCLUSIONS: GP readers of drug bulletins can be used quickly and inexpensively to assess the extent to which recommended diagnostic and therapeutic practices are accepted by "well informed" doctors. The results suggest that attitudes in managing mild hypertension vary widely among GPs and countries and differ remarkably from the recommendations of published guidelines.

Adrenergic beta-Antagonists↗
PubMed1996

Psychosocial problems and adjustment of children with beta-thalassemia and their families.

This study explores the psychosocial problems experienced by families with children aged 6 to 14 years suffering from beta-thalassemia major (N = 188). The psychosocial problems and the family's adjustment to the effects of the illness were compared across a number of cultures where the disease is prevalent, namely Cyprus, Greece, and Italy. A small number of migrant children in the United Kingdom was also included in the study. Semi-structured interviews were conducted with parents who also completed the Rutter Parental Questionnaire and the Goldberg General Health Questionnaire. Teachers were asked to complete a Children's Behaviour Questionnaire designed by Rutter. In all countries the disease seemed to have a binding effect on the family, thus mobilizing adaptive mechanisms. Father's low education level and the presence of major medical complications were predictors of poor family adjustment. Differences between and within countries may well reflect differences in health policies, existing level of socio-economic development, and in the cultural patterns in coping with a chronic illness.

Adaptation, Psychological↗
PubMed1998

Affective disorders and multiple sclerosis: a controlled study on 65 Italian patients.

A high prevalence of major mood disorders in multiple sclerosis (MS) patients has been reported. In this study, we investigated the frequency of previous or present major mood disorders in 65 patients with clinically definite multiple sclerosis (Poser criteria) and in 31 polyneuropathy (PNP) patients. All patients underwent a questionnaire designed after DSM-IV definitions for major mood disorders. A higher lifetime risk for development of a major mood disorder was evident in MS patients (log rank test, p<0.001). Of all MS patients with a major mood disorder, at least 34% had one first-degree relative affected by a mood disorder, while the corresponding figure was 14% among PNP cases. Our data confirm the high lifetime risk for depression in MS patients and suggest that, at least in a subset of MS patients with depression, the genetic basis for depression operates with similar mechanisms as those at work in families with primary depression. However, this is not necessarily true for other subsets of depressed MS patients' families.

Adolescent↗
PubMed1978

Self-disclosure in relation to psychotherapist expertise and ethnicity.

The self-disclosure styles of Mexican Americans and their possible role in the limited participation of Mexican Americans in mental health services were explored. Ninety-four Mexican American and 93 Anglo American junior college students listened to one of four therapist introductions, then responded to questionnaires designed to measure self disclosure and self acceptance. Both groups indicated a substantial willingness to disclose about themselves to therapists. Mexican Americans proved lower in self-disclosure scores than Anglo Americans. Mexican Americans were found to disclose less to Mexican American therapists than did Anglo Americans to Anglo American therapists. Sex differences in self-disclosure were negligible. Both Mexican Americans and Anglo Americans scored in the direction of high self-acceptance. The findings held for comparable socioeconomic levels.

Educational Status↗
PubMed1984

Self-reported physical stress reactions: first- and second-order factors.

Stress Inventory-6, a 72-item self-report questionnaire designed to tap 18 factors of physical stress reactions, was subjected to factor analysis. The instrument was given to 474 students (254 females, 206 males, and 14 who failed to indicate their gender). The final factor solution identified 16 first-order and 4 second-order factors. The first-order solution replicated most of the factors identified in a previous study and defined factors in terms of organ system, muscle group, and simple content. In the second-order solution, Factors I, III, and IV include symptoms that are immediate and direct, appear to be related to arousal of the somatic and sympathetic nervous system, and are marked prominently by cardiorespiratory activity. In contrast, Factor II includes symptoms that are indirect and often delayed consequences of sustained arousal (Fatigue and Lack of Energy, Headaches, Backaches, etc.). A major distinction can be made between stress arousal Factors I and III. Factor III appears to be a simple "fight or flight" arousal pattern characterized by fairly direct manifestations of striated muscle tension as well as cardiorespiratory activity. In contrast, Factor I is a complex arousal pattern characterized by diffuse autonomic arousal, self-directed attention, and possibly low self-esteem. The results of this study draw into question the extent to which popular stress inventories tap a representative sample of stress symptoms. Clinical implications are discussed.

Adolescent↗
PubMed1982

Incestuous experiences within homosexual populations: a preliminary study.

The incidence, frequency rates, and effects of both homosexual and heterosexual incestuous experiences within lesbian and male homosexual populations are examined. Twenty-nine female homosexuals and 54 male homosexuals from diverse demographic backgrounds were administered a 16-page anonymous questionnaire designed to capture a wide range of demographic, personality, life history, and attitudinal information. Differences in family characteristics that exist between individuals who have experienced nuclear family incest, extended family incest, and those who have never experienced incest are investigated. Differences that exist between the two populations, incest and nonincest, were also studied.

Adult↗
PubMed1981

The pre- and post-therapy measurement of communication skills of couples undergoing sex therapy at the Masters & Johnson Institute.

A battery of five paper and pencil questionnaires designed to measure empirically 10 specific skills hypothesized to be involved in effective interpersonal communication was employed to assess the pre- and post-therapy levels of these skills in couples undergoing treatment for sexual dysfunction at the Masters & Johnson Institute in St. Louis, Missouri. The females exhibited significant increases across the 2-week period of therapy for the following skills: positive assertion in intimate heterosexual peer relationships, assertiveness, verbal expression of feelings, and nonmaterial support and evidence of love. For the males significant increases in the following skills were obtained: assertiveness, verbal expression of feelings, self-disclosure, and tolerance of the less pleasant aspects of the loved one. A significant decrease was observed for the skill entitled feelings not expressed verbally to the loved one. Thus, both the females and males became more assertive and more able to express their feelings openly and thus more able to share more of themselves with their partners as a result of the therapy. These results lend empirical support to Masters and Johnson's theoretical model of communication and to the view that much more than simple behavior therapy is involved in a successful sex therapy program.

Adult↗
PubMed1990

Attitudinal and experiential correlates of anorgasmia.

Twenty-four orgasmic and 10 anorgasmic women, ages 21-40, provided continuous self-report measures of sexual arousal while viewing explicit videotape segments depicting a variety of sexual activities. They also completed several questionnaires designed to assess sexual attitudes, knowledge, and guilt. As compared to the orgasmic women, the anorgasmic women reported (i) greater discomfort in communicating with a partner regarding only those sexual activities involving direct clitoral stimulation, (ii) more negative attitudes toward masturbation, (iii) greater endorsement of sex myths, and (iv) greater sex guilt. Contrary to expectations, the groups failed to differ significantly on either the frequency of use of any of the sexual activities depicted or on arousal to viewing these activities. The theoretical and clinical implications of these findings are explored.

Adult↗
PubMed1993

Orgasm in the postoperative transsexual.

The dearth of information regarding organism in postoperative transsexuals prompted the authors to study its prevalence. The sample consisted of 14 male-to-female (M-F) and 9 female-to-male (F-M) postoperative transsexuals. The relationship of orgasm to sexual and general satisfaction was explored via a specially designed questionnaire. Orgastic capacity declined in the M-F group and increased in the (F-M) group. Despite the decrease in orgasm in the M-F group, satisfaction with sex and general satisfaction with the results of surgery were high in both groups. General satisfaction of 86% replicates other studies. Frequency of sex increased by 75% in the M-F group and by 100% in the F-M group. A phalloplasty does not appear to be a critical factor in orgasm or in sexual satisfaction. The general conclusion is reached that it is possible to change one's body image and sexual identity and be sexually satisfied despite inadequate sexual functioning.

Adult↗