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PubMed1990

Comparisons of five health status instruments for orthopedic evaluation.

This study represents a long-term effort to find optimal techniques for evaluating outcome in patients who have undergone total joint arthroplasty. Sensitivity of five health status questionnaires was studied in a longitudinal evaluation of orthopedic surgery. The questionnaires (Arthritis Impact Measurement Scales [AIMS], Functional Status Index [FSI], Health Assessment Questionnaire [HAQ], Index of Well Being [IWB], and Sickness Impact Profile [SIP]) were administered to 38 patients with end-stage arthritis at three points in time: two weeks before hip or knee arthroplasty, and at three-month and 12- to 15-month follow-up. Response values (i.e., changes within patients) were calculated on four scales: global health, pain, mobility, and social function. By the three-month follow-up, most instruments detected large mean responses in global health, pain scores, and mobility. Smaller changes on these scales were found between three and 12 to 15 months. Social function showed small to modest gains at successive follow-ups. Standardized response means were calculated to assess sensitivity to detect change. Confidence intervals for these indices were constructed using a jackknife procedure, and significance tests were performed by pairing selected indices. Finally, the study projected sample sizes required to assess a new therapy, using each response. These statistical tools facilitated comparisons among instruments and may prove useful in other settings.

Aged↗
PubMed1984

The longitudinal course of schizoaffective disorders. A prospective follow-up study.

To study whether outcome of schizoaffective psychosis is more similar to that of schizophrenia, or major affective disorders, or whether it shows an intermediate pattern between these two disorders, we conducted a prospective follow-up study of 167 patients from two hospitals. Thirty-nine schizoaffective patients, 47 schizophrenic patients, 33 manic patients, and 48 patients with major depressive disorders were assessed during hospitalization and then followed up 1 year after hospital discharge. Standardized assessments were conducted of patients' work functioning, social adjustment, symptom outcome, rehospitalization, treatment at follow-up, and their overall posthospital adjustment. The data indicated the following: a) On both major scales of overall outcome, schizoaffective patients' posthospital adjustment was significantly poorer than that of patients with major affective disorders (p less than .01), and showed a nonsignificant tendency to be better than that of schizophrenics. Only 10 per cent of the schizoaffective patients had very favorable outcomes. b) There were no significant differences in overall outcome between schizoaffective patients who were manic vs. depressed, or mainly affective vs. mainly schizophrenic (p greater than .20). c) Both the schizoaffective and affectively disordered patient groups had significantly better posthospital work functioning than did the schizophrenic patients (p less than .05). d) However, both the schizoaffective and schizophrenic groups had significantly poorer posthospital social functioning than did the affectively disordered patients. Overall, the data suggest that outcome of schizoaffective disorders differs in some ways from that of both schizophrenia and affective disorders.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Longitudinal study on the Quality of Life of symptomatic HIV-infected patients in a trial of zidovudine versus zidovudine and interferon-alpha.

OBJECTIVES: To compare the effect of treatment with zidovudine (ZDV) or a combination of ZDV and interferon-alpha (IFN-alpha) on patient Quality-of-Life (QoL); and to document changes over time in QoL. DESIGN: This study is part of a longitudinal, randomized, controlled clinical trial comparing the efficacy and tolerance of ZDV monotherapy and ZDV plus IFN-alpha. Patients were followed-up for 1 year. SETTING: Seven academic or general medical hospitals. PARTICIPANTS: Thirty-six symptomatic HIV-infected patients (Centers for Disease Control and Prevention stage IV) with a CD4+ count > or = 150 x 10(6)/l and Karnofsky Performance Status score > or = 60, who had not received ZDV or IFN-alpha before. METHODS: QoL was assessed using two self-report questionnaires (the European Organization for Research and Treatment of Cancer Core Quality-of-Life Questionnaire and an AIDS-specific questionnaire), administered before and every 3 months after the start of the treatment. RESULTS: There were no significant differences in QoL between the two treatment groups over a 1-year period. Emotional, cognitive and social functioning improved in the entire group, and patients reported fewer symptoms (for example, shortness of breath, nausea and vomiting, influenza-like symptoms, diarrhoea, lack of appetite, taste disturbances, dizziness, weight loss, trouble in vision) and a better overall QoL until month 9. Thereafter, emotional, cognitive and social functioning and overall QoL deteriorated and patients reported more symptoms. Major complaints at baseline and follow-up were associated with fatigue and emotional functioning: patients reported a strong need to rest, and felt very tired, worried, tense and irritable. CONCLUSIONS: These results show that both treatments may have a temporary beneficial effect on patient QoL. QoL research may contribute to evaluation of clinical trials and provide patients with information about the effects of treatment on their QoL, thus enabling them to make informed decisions.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Health-related quality of life and appropriateness of cholecystectomy.

OBJECTIVE: To evaluate the relationship among appropriateness of the use of cholecystectomy and outcomes. SUMMARY BACKGROUND DATA: The use of cholecystectomy varies widely across regions and countries. Explicit appropriateness criteria may help identify suitable candidates for this commonly performed procedure. This study evaluates the relationship among appropriateness of the use of cholecystectomy and outcomes. METHODS: Prospective observational study in 6 public hospitals in Spain of all consecutive patients on waiting lists to undergo cholecystectomy for nonmalignant disease. Explicit appropriateness criteria for the use of cholecystectomy were developed by a panel of experts using the RAND appropriateness methodology and applied to recruited patients. Patients were asked to complete 2 questionnaires that measure health-related quality of life-the Short Form 36 (SF-36) and the Gastrointestinal Quality of Life Index (GIQLI)-before the intervention and 3 months after it. RESULTS: Patients judged as being appropriate candidates for cholecystectomy, using the panel's explicit appropriateness criteria, had greater improvements in the bodily pain, vitality, and social function domains of the SF-36 than those judged to be inappropriate candidates. They also demonstrated improvements in the GIQLI's physical impairment domain. Interventions judged as inappropriate were performed primarily among patients without symptoms of cholelithiasis. Those asymptomatic had a lower improvement in the bodily pain, social functioning, and physical summary scale of the SF-36 and in the symptomatology, physical impairment, and total score domains of the GIQLI. CONCLUSIONS: These results suggest a direct relationship between the application of explicit appropriateness criteria and better outcomes, as measured by health-related quality of life. They also indicate that patients without symptoms are not good candidates for cholecystectomy.

Aged↗
PubMed1997

Self-esteem, behavior, and concerns surrounding epilepsy in siblings of children with epilepsy.

Researchers document the emotional impact of epilepsy on the child with seizures. Minimal data are available examining the effects of epilepsy on the siblings of children with seizures. Twenty children whose siblings had either frequent seizures or infrequent seizures were matched by age, gender, and birth order to control subjects with no chronic illness. These three groups were compared. Self-esteem, behavioral and social functioning, and family stress were measured by the Piers-Harris Self-Concept Scale, Child Behavior Checklist, and Family Inventory of Life Events. The siblings of children with epilepsy completed the Sibling Concern About Seizure Scale to define and measure their concerns surrounding epilepsy. There is no statistical difference in self-esteem or social functioning among the three groups. There is a trend toward increased incidence of externalizing behavior in siblings of children with frequent seizures. Data indicate a trend toward siblings of children with frequent seizures having more concerns about epilepsy than siblings of children with infrequent seizures. There is significantly more stress in families of children with frequent seizures compared to families of children with infrequent seizures and families of children with no chronic illness. Although there were no significant differences in the self-esteem, behavior, socialization, and concerns between the siblings in the family when compared to the control group or to each other, there were trends in the results that may be of clinical significance. These issues, along with the level of family stress, should be considered when coordinating and providing care to families of children with intractable epilepsy.

Child↗
PubMed1979

Day treatment and psychotropic drugs in the aftercare of schizophrenic patients. A Veterans Administration cooperative study.

Schizophrenic patients referred for day treatment at the time of discharge from ten hospitals were randomly assigned to receive day treatment plus drugs or to receive drugs alone. They were tested before assignment and at 6, 12, 18, and 24 months on social functioning, symptoms, and attitudes. Community tenure and costs were also measured. The ten day centers were described on process variables every six months for the four years of the study. Some centers were found to be effective in treating chronic schizophrenic patients and others were not. All centers improved the patients' social functioning. Six of the centers were found to significantly delay relapse, reduce sumptoms, and change some attitudes. Costs for patients in these centers were not significantly different from the group receiving only drugs. More professional staff hours, group therapy, and a high patient turnover treatment philosophy were associated with poor-result centers. More occupational therapy and a sustained nonthreatening environment were more characteristic of successful outcome centers.

Adult↗
PubMed2002

A randomised controlled trial of enhanced key-worker liaison psychiatry in general practice.

BACKGROUND: Despite much interest in the development of liaison psychiatry in general practice there is no clear evidence that any form of intervention is effective. We carried out a pilot randomised controlled trial, the first we believe into this type of care, of one such model; enhanced liaison with individual patients by key workers, in general practices in Paddington and North Kensington in London. METHODS: All patients referred from primary to secondary psychiatric care from four general practices over a 10-month period, and still in contact with services, were eligible to be included in the study. The practices were allocated in a constrained randomised procedure to either normal care or enhanced key-worker liaison. The latter involved encouraging individual key workers to adopt improved communication between primary and secondary care. Baseline assessments of symptomatology and social functioning were made before randomisation and after 6 months by an independent researcher. RESULTS: Of the 84 eligible patients, 43 were seen at baseline and 34 re-assessed after 6 months. There was no difference between the clinical outcomes in the two groups but self-rated social function was significantly improved in the enhanced liaison service compared with standard care (adjusted P = 0.05). Costs were similar but somewhat more expensive for enhanced liaison. Less than half (42 %) of all key workers in the enhanced liaison arm felt they had involved the primary health care team more in the care of their patient, with 21 % of these altering their practice markedly during the study. CONCLUSIONS: It is concluded that without additional resources enhanced key-worker liaison for psychiatry in primary and secondary care has limited benefits although this does not necessarily apply to other forms of liaison practice.

Adult↗
PubMed2002

Pain behaviour in young immigrants having chronic pain: an exploratory study in primary care.

Pain behaviour can hamper rehabilitation. The aim of this study was to explore the phenomenon of pain behaviour in an unselected group of immigrant patients on >6 weeks of sick leave before and after a transcultural treatment programme in primary care. Anxiety about pain and pain behaviour-i.e. > or = 1.5 points on the University of Alabama in Birmingham (UAB) scale with scores of 0-10-were noted before and after treatment. The sex-adjusted odds ratios (OR) for pain behaviour, before and after the treatment, were calculated using logistic regression with 95% confidence intervals (95% CIs). Forty-nine men and 102 women having a mean age of 38 years participated. Their mean sick leave was 46 weeks. All reported psychosocial stress, one-quarter were depressed and social functioning was generally low. The pain was mostly caused by muscular insertion lesions (entesopathies). The frequency of pain behaviour and anxiety about pain declined after treatment (from 68% to 54% and from 76% to 50% respectively). Duration of full-time sick leave and among men also decreasing social functioning were correlated with the UAB score. Those who reported persistent anxiety about pain, or men who were depressed, had higher scores. Only persons on full-time sick leave >1 year had a significant OR for pain behaviour before treatment (OR 3.23; 95% CI 1.17-8.85, adjusted for sex). After treatment, only persons reporting persistent anxiety about pain showed a significant OR for pain behaviour (OR 3.05; 95% CI 1.49-6.23, adjusted for sex). In conclusion, pain behaviour was common in this group of immigrant patients < or = 45 years of age on long-term sick leave. Anxiety about pain and full-time sick leave for more than 1 year significantly predicted pain behaviour.

Adult↗
PubMed1995

Predicting the one-year course of adolescent major depression.

OBJECTIVE: To identify specific clinical and social functioning variables that predict persistence of major depression over a 1-year period of follow-up. METHOD: The sample consisted of 67 adolescents with major depression, drawn from consecutive referrals to psychiatric clinics in a defined, geographic catchment area. Clinical interviews and questionnaires measuring behaviors, symptoms, and social functioning were administered to both the adolescent and a parent at inception and at follow-up. Discriminant function analyses were used to identify inception variables that predicted clinical course independent of severity of depressive symptoms and global functioning. RESULTS: At 1-year follow-up, major depression remitted in 66% of subjects. Persisters were characterized at inception as older, more likely to have substance use or anxiety disorders, less involved with fathers, and less responsive to mother's discipline compared with remitters. The effect of these prognostic factors was independent of symptom severity and global functioning. CONCLUSION: These variables appear to reflect perpetuating and ameliorating factors influencing the short-term course of major depression. The findings suggest that treatments for adolescent depression that aim to enhance parent-adolescent relationships, and that specifically target coexisting disorders, should be evaluated for effectiveness.

Adolescent↗
PubMed1994

The outcome of training community psychiatric nurses to deliver psychosocial intervention.

BACKGROUND: A prospective quasi-experimental design was used to evaluate the effect of training CPNs to undertake psychosocial intervention with families caring for a relative with schizophrenia. METHOD: Patients meeting predetermined criteria were allocated to either an initial waiting-list control group or a delayed intervention group. The CPNs were trained to offer family interventions to a total target group of 48. Treatment was eventually accepted by 85%, of whom 81% (n = 34) were followed-up for 12 months. Families received a weekly mean session of 47 minutes (compared with 33 minutes in the controls). The main outcome measures are frequency and severity of symptoms (KGV), social functioning (SFS) and days in hospital. Carers' minor psychiatric morbidity (GHQ) and knowledge (KASI) are also reported. RESULTS: In the patient group both the positive and negative symptoms of schizophrenia improved significantly (P < or = 0.001 and P < or = 0.01 respectively) to 12-month follow-up, as did a global measure of social functioning (P < or = 0.001). Tentative evidence was also collected that family intervention reduced in-patient episodes. Benefits for relatives included a decrease in minor psychiatric morbidity (P < or = 0.05) and an increase in knowledge about neuroleptic drugs (P < or = 0.001). CONCLUSIONS: The study offers some evidence that CPNs can be taught to improve the outcome for families who care for a relative with schizophrenia.

Activities of Daily Living↗
PubMed2001

Maintaining contact with people with severe mental illness: 5-year follow-up of assertive outreach.

BACKGROUND: Assertive outreach is a central strand of Government mental health policy in England. Are different long-term models of mental health care which include assertive outreach associated with different service user outcomes and cost? METHOD: We conducted a multi-site 5-year follow-up study of people with severe mental illness. From 0 to 18 months all three sites had Intensive Case Management (ICM) teams practising assertive outreach. From 18 to 60 months one team sustained ICM, one team merged and another was disbanded. All 131 original ICM team clients were the study participants. Outcome was measured in terms of sustained engagement with statutory mental health services, psychiatric symptoms, social functioning, resource use and cost. RESULTS: All 120 live participants were traced. Only four people had no service contact; when contacted by a researcher they appeared to be coping well. No incidents of serious violence were discovered. No differences existed between teams in the mean total symptom or total social functioning change scores at follow-up, after controlling for baseline differences. No differences existed in mean cost between teams during the first 18 months. Mean (standard deviation) annualised costs varied considerably in the 18-60 month period: sustained team Pound Sterling13,734 (10,820); integrated team Pound Sterling11,037 (13,603); disbanded team Pound Sterling5,742 (7,007) (F=4.4, 105 df, p=0.015). CONCLUSION: Continued specialist assertive outreach service models have higher costs than non-specialist services for no apparent benefit. In the long term new assertive outreach services should have procedures in place to transfer people to lower intensity and lower cost care.

Case Management↗
PubMed1996

Interpersonal psychotherapy for depressed adolescents: a one-year naturalistic follow-up study.

OBJECTIVE: To report on a 1-year naturalistic follow-up study of 14 depressed adolescents who were treated for 3 months with interpersonal psychotherapy adapted for depressed adolescents (IPT-A). METHOD: The 14 depressed adolescents were contacted approximately 1 year after completion of 3 months of IPT-A to participate in an evaluation of depressive symptomatology, social functioning, and life events. Both self-report and clinician-rated measures were administered. RESULTS: Ten adolescents participated in the follow-up evaluation. Only one of them met criteria for an affective disorder. The majority of subjects reported few depressive symptoms and had maintained their improvements in social functioning since completion of treatment for depression. The life events survey suggested that the subjects had experienced a significant number of negative life events during their lifetime. There were no reported hospitalizations, pregnancies, or suicide attempts since completion of treatment, and all were attending school regularly. CONCLUSIONS: Despite the limitations of a naturalistic follow-up and the small sample size, the results suggest that the adolescents maintained their state of recovery from depression until 1 year after completing treatment with IPT-A.

Adolescent↗
PubMed2006

Is clozapine-aripiprazole combination a useful regime in the management of treatment-resistant schizophrenia?

Around 40-70% patients with treatment-resistant schizophrenia fail to respond to clozapine. Though combining antipsychotics is commonly practised with non-responders, there is little evidence for its use.We carried out a retrospective review of case notes of patients with treatment-resistant schizophrenia on clozapine-aripiprazole combination at our clozapine clinic. We report changes in psychotic symptoms, social function, weight, total cholesterol, serum glucose, HDL, CGI and GAF score pre- and post-aripiprazole augmentation. Clozapine-aripiprazole combination was associated with 22% reduction of clozapine dose. Eighteen out of 24 (75%) lost a mean weight of 5.05 kg. There was improvement in positive and negative symptoms, social functions, weight loss and a moderate increase in HDL. Our findings suggest that clozapine-aripiprazole is a safe and tolerable combination; however, control trials are needed to validate our findings.

Adult↗
PubMed1990

Social consequences of pediatric conditions: fertile area for future investigation and intervention.

Very little systematic research has examined the peer relations and social functioning of youngsters with chronic illness. In order to stimulate empirical and clinical interest in this potentially important area of pediatric psychology, the present paper discusses several pertinent tissues. These include (a) the role of peers in disease adaptation and treatment management, (b) specific aspects of diseases or treatments that are likely to have implications for youngsters' social functioning, (c) guidelines for further investigation in this area, and (d) suggestions for incorporating peer/social issues into educational programs and intervention efforts for youngsters with chronic disease. Throughout the discussion, the complex interplay between peer relations and adaptation to chronic illness is highlighted.

Child↗
PubMed1989

[Homes for the aged: a source of increasing concern (4). The evaluation of a group care program].

In 1983 an intervention program was initiated in the old people's home 'De Oldenhaag' for those residents whose condition indicated admission to a nursing home for psychogeriatric patients. This program appeared to halt any further decline both in mental and in social functioning. In addition residents who showed less serious cognitive problems did not decline after participation in a similar group. The program also seemed to have had its effects on the entire population of 'De Oldenhaag'. As a whole the residents of the old people's home did not show a decline in physical, mental and social functioning. In order to achieve such results it is important that the project is supported by all staff members and that it is part of the daily routine in the old people's home. Finally, it is necessary for the project to be successful that both target group and aims are well defined.

Activities of Daily Living↗
PubMed2003

An interpersonal analysis of adult attachment style: circumplex descriptions, recoiled developmental experiences, self-representations, and interpersonal functioning in adulthood.

Previous research suggests that the structure of adult attachment is dimensional, but the specific dimensions remain unclear. Given its relational nature, studies should examine attachment structure in association with conceptually related interpersonal constructs. The interpersonal model (Kiesler, 1996) provides an integrative framework to examine this structure and associations between dimensions of attachment security (i.e., Anxiety and Avoidance) and: 1) the dimensions of the interpersonal circumplex, 2) the five-factor model of personality, 3) recollections of mothers and fathers, and 4) current self-processes and adult social functioning. In two samples of undergraduates, the Anxiety and Avoidance dimensions were associated with a hostile-submissive interpersonal style. Canonical correlation analyses revealed that dimensions representing combinations of Anxiety and Avoidance, and roughly corresponding to the dimensions from Secure (i.e., low Anxiety and Avoidance) to Fearful (i.e., high Anxiety and Avoidance) attachment and from Preoccupied (i.e., high Anxiety and low Avoidance) to Dismissive (i.e., low Anxiety and high Avoidance) attachment related to the interpersonal constructs. The Secure to Fearful dimension (i.e., overall attachment security) seemed to share relatively more variance with the interpersonal constructs. These dimensions were associated with theoretically consistent characteristics, recollections of early experiences with parents, self-representations, and social functioning.

Adolescent↗
PubMedDate not supplied

Implication of base heart rate in autonomic nervous function, blood pressure and health-related QOL.

Increased resting heart rate (HR) and increased sympathetic nervous activity are independent risk factors for cardiovascular disease. Recently, base heart rate (HRo: minimum stable HR during sleep) has been reported to relate to cardiac stroke volume and age. However, little is known about the relevance of HRo. The aim of our study was to evaluate how HRo is associated with HR variability (HRV), blood pressure and health-related quality of life (HRQOL) in healthy subjects. A total of 139 volunteers participated in this study that measured 24-hr HR, HRV, and blood pressure. HRo was estimated from the trendgram and the histogram of HR during the nighttime (sleep) period, and calculated as the 1% lowest value of its integral. HRQOL was assessed by Medical Outcome Study Short-Forum 36-Item Health Survey. Sympathetic nervous activity (ratio of low frequency to high frequency component: LF/HF) and parasympathetic nervous activity (high frequency component: HF) were calculated by ECG monitoring. HRo was positively correlated with 24-hr LF/HF and nighttime LF/HF. HRo was negatively correlated with 24-hr HF and nighttime HF. Moreover, HRo was positively correlated with the scores of social functioning and role-physical. Using multivariate analysis, HRo is related to LF/HF, body mass index, and the score of social functioning (HRQOL). HRo may be a useful indicator for assessing sympathetic nervous activity and HRQOL in normotensive healthy subjects.

Adult↗