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PubMed2003

Psychosocial burden of beta-thalassaemia major in Antalya, south Turkey.

beta-thalassaemia is a recessively inherited blood disorder characterised by chronic anaemia. It requires monthly blood transfusions and regular iron chelation. Thousands of affected children are born annually and the magnitude of the problem is most severe in developing countries. Ninety-nine children and 32 adults with thalassaemia major, and 112 parents of patients were interviewed in Antalya, south Turkey, using specifically designed questionnaires to evaluate psychosocial burden. The education of most of the thalassaemic children of school age (60%) was affected, mainly due to having to attend hospital for investigation and transfusions. A high level of parental anxiety (82%) was reported. Nearly half of the families (47%) had employment and financial problems as a result of thalassaemia, yet there was a low level of marital breakdown (1.8%). A substantial majority (93%) of the parental couples would have chosen to terminate an affected pregnancy if they had known that the foetus had thalassaemia major. The results reflect the need for a national policy for public education and screening of thalassaemia in Turkey in order to offer prenatal diagnosis for all families at risk of homozygous thalassaemia.

Adolescent↗
PubMed2001

Dominance and testosterone in women.

Fifty-two young women completed the Simple Adjective Test (a questionnaire designed to measure dominance) and at the same time provided 5 ml blood for testosterone assay. Higher dominance scores were associated with higher serum testosterone levels (t-test P<0.008).

Adult↗
PubMedDate not supplied

Health-economic analyses of subcutaneous specific immunotherapy for grass pollen and mite allergy.

OBJECTIVE: To investigate the health and monetary consequences of treating allergy with specific immunotherapy (SIT) compared with symptomatic treatment/standard care among patients with grass pollen or mite allergy. METHODS: We performed an economic analysis based on 253 grass- and/or mite allergic patients who started SIT from 1.1.1996 to 1.1.2002 at the Allergy Unit, Aarhus University Hospital and at a specialist practice in Aarhus. Relevant data were collected before, during and after SIT treatment from the national health service based on each patient's personal identification number and medical records and from a specifically designed questionnaire. A cost-benefit analysis including direct and indirect costs before, during and after SIT was performed. In addition direct costs were related to the clinical effect (improvement in well-being) in the form of a cost-effectiveness analysis. RESULTS: The direct cost per patient/year before SIT (equivalent to standard care) was DKK 2,580. The investment in SIT was DKK 27,545 (in present values) per patient over a 4-year period. After SIT the cost was reduced to DKK 1,072 per patient/year. In the long term, prospective introduction of SIT incurred additional present-value direct costs of DKK 13,676 per patient treated and DKK 2,784 per patient/year of improved well-being. However, when indirect costs were included in the economic evaluation SIT was shown to be net beneficial. CONCLUSION: This study reveals that SIT is associated with initial resource investments and subsequent resource savings in the long term compared with standard care. When all consequences are measured in monetary terms, and assuming that sick days are associated with a loss of productivity, this analysis suggests that SIT increases societal welfare. This conclusion also holds if there is no loss of productivity.

Absenteeism↗
PubMed1997

Mothers and daughters menopausal ages: is there a link?

OBJECTIVE: To confirm whether there is a familial association in menopausal age between mothers and daughters. DESIGN: questionnaire survey of women attending an osteoporosis screening programme. SUBJECTS: 551 women who fulfilled the study inclusion criteria out of a random population sample of 2399 women aged between 45 to 54 living within 32 km of Aberdeen who were selected from the community health index. RESULTS: 1758 women attended screening and completed the questionnaire. Of these only 1081 women were eligible being neither hormone replacement therapy users, nor had they had a hysterectomy. However, only 551 (51%) knew their mothers menopausal age. Women with premature (< 40 years) and early menopause (< 45 years) reported significantly lower maternal menopausal ages than women with normal menopausal ages (43.81, 45.40 and 48.38 for premature, early and normal women respectively p < 0.0001). The odds of a woman having an early or premature menopause if their mother had experienced an early menopause was 6.02 (95% confidence interval 3.39 to 10.66). CONCLUSION: There seems to be a strong relationship between mothers and daughters menopausal age.

Adult↗
PubMed1997

Meat consumption and preparation, and genetic susceptibility in relation to colorectal adenomas.

Epidemiological evidence suggests that a high meat consumption and/or animal fat intake may increase the risk of colorectal cancer. The objective of this study is to examine the role of dietary factors, in particular meat preparation and consumption, in relation to colorectal adenomas, the pattern of DNA-mutations (e.g. K-ras and p53), and genetic susceptibility (NAT2, HNPCC). In a case control study on diet and colorectal adenomas (sporadic and HNPCC), acetylator status (NAT2) of cases and controls as well as K-ras and p53 mutations in adenomas will be assessed. Consumption and preparation of meat, the primary interest of this study, will be assessed by a food frequency questionnaire designed especially for this purpose.

Adenoma↗
PubMed1999

Breakthrough pain: characteristics and impact in patients with cancer pain.

Few surveys have been performed to define the characteristics and impact of breakthrough pain in the cancer population. In this cross-sectional survey of inpatients with cancer, patients responded to a structured interview (the Breakthrough Pain Questionnaire) designed to characterize breakthrough pain, and also completed measures of pain and mood (Memorial Pain Assessment Card (MPAC)), pain-related interference in function (Brief Pain Inventory (BPI)), depressed mood (Beck Depression Inventory (BDI)), and anxiety (Beck Anxiety Inventory (BAI)). Of 178 eligible patients, 164 (92.2%) met the criteria for controlled background pain. The median age was 50.6 years (range 26 to 77 years), 52% were men, and 80.6% were Caucasian. Tumor diagnoses were mixed, 75% had metastatic disease, 65% had pain caused directly by the neoplasm, and a majority had mixed nociceptive-neuropathic pain. The median Karnofsky Performance Status score was 60 (range 40 to 90). Eighty-four (51.2%) patients had experienced breakthrough pain during the previous day. The median number of episodes was six (range 1 to 60) and the median interval from onset to peak was 3 min (range 1 s to 30 min). Although almost two-thirds (61.7%) could identify precipitants (movement 20.4%; end-of-dose failure 13.2%), pain was unpredictable in a large majority (78.2%). Patients with breakthrough pain had more intense (P < 0.001) and more frequent (P < 0.01) background pain than patients without breakthrough pain. Breakthrough pain was also associated with greater pain-related functional impairment (difference in mean BPI. P < 0.001), worse mood (mood VAS, P < 0.05; BDI, P < 0.001), and more anxiety (BAI, P < 0.001). Multivariate analysis confirmed that breakthrough pain independently contributed to impaired functioning and psychological distress. These data confirm that cancer-related breakthrough pain is a prevalent and heterogeneous phenomenon. The presence of breakthrough pain is a marker of a generally more severe pain syndrome, and is associated with both pain-related functional impairment and psychological distress. The findings suggest the need for further studies of breakthrough pain and more effective therapeutic strategies.

Adult↗
PubMed2003

Comparison of arthroplasty and arthrodesis for the rheumatoid wrist.

PURPOSE: To compare the outcomes of wrist arthrodesis and arthroplasty in the treatment of rheumatoid arthritis using validated outcome patient surveys and a review of surgical complications in 2 matched cohorts. METHODS: Forty-six patients with 51 operated wrists (24 arthrodeses and 27 arthroplasties) were reviewed retrospectively at a follow-up range of 1 to 5 years. Patients completed the Disabilities of the Arm, Shoulder and Hand (DASH) inventory, the Patient-Rated Wrist Evaluation (PRWE), and a questionnaire designed specifically for this study. Surgical complications were obtained by chart review. RESULTS: Treatment groups were well matched by patient characteristics and radiographic staging. There were no statistical differences in the survey scores between the 2 groups. Patients in the arthroplasty group, however, reported a trend toward greater ease with personal hygiene and fastening buttons. Complication rates were similar with a 56% complication rate in the arthrodesis group (22% major, 35% minor) and a 52% complication rate in the arthroplasty group (11% major, 41% minor). CONCLUSIONS: The DASH and PRWE may not be designed properly to measure impairment caused by wrist disease in patients with generalized arthritis. The results show that patients with rheumatoid arthritis can and do accommodate to a wrist arthrodesis. It should not be construed, however, that patients with rheumatoid arthritis would not prefer or obtain greater benefit from a wrist arthroplasty [corrected].

Arthritis, Rheumatoid↗
PubMed1997

Clinical shock tolerability and effect of different right atrial electrode locations on efficacy of low energy human transvenous atrial defibrillation using an implantable lead system.

OBJECTIVES: The objectives of this study were 1) to evaluate the effect of different right atrial electrode locations on the efficacy of low energy transvenous defibrillation with an implantable lead system; and 2) to qualitate and quantify the discomfort from atrial defibrillation shocks delivered by a clinically relevant method. BACKGROUND: Biatrial shocks result in the lowest thresholds for transvenous atrial defibrillation, but the optimal right atrial and coronary sinus electrode locations for defibrillation efficacy in humans have not been defined. METHODS: Twenty-eight patients (17 men, 11 women) with chronic atrial fibrillation (AF) (lasting > or = 1 month) were studied. Transvenous atrial defibrillation was performed by delivering R wave-synchronized biphasic shocks with incremental shock levels (from 180 to 400 V in steps of 40 V). Different electrode location combinations were used and tested randomly: the anterolateral, inferomedial right atrium or high right atrial appendage to the distal coronary sinus. Defibrillation thresholds were defined in duplicate by using the step-up protocol. Pain perception of shock delivery was assessed by using a purpose-designed questionnaire; sedation was given when the shock level was unacceptable (tolerability threshold). RESULTS: Sinus rhythm was restored in 26 of 28 patients by using at least one of the right atrial electrode locations tested. The conversion rate with the anterolateral right atrial location (21 [81%] of 26) was higher than that with the inferomedial right atrial location (8 [50%] of 16, p < 0.05) but similar to that with the high right atrial appendage location (16 [89%] of 18, p > 0.05). The mean defibrillation thresholds for the high right atrial appendage, anterolateral right atrium and inferomedial right atrium were all significantly different with respect to energy (3.9 +/- 1.8 J vs. 4.6 +/- 1.8 J vs. 6.0 +/- 1.7 J, respectively, p < 0.05) and voltage (317 +/- 77 V vs. 348 +/- 70 V vs. 396 +/- 66 V, respectively, p < 0.05). Patients tolerated a mean of 3.4 +/- 2 shocks with a tolerability threshold of 255 +/- 60 V, 2.5 +/- 1.3 J. CONCLUSIONS: Low energy transvenous defibrillation with an implantable defibrillation lead system is an effective treatment for AF. Most patients can tolerate two to three shocks, and, when the starting shock level (180 V) is close to the defibrillation threshold, they can tolerate on average a shock level of 260 V without sedation. Electrodes should be positioned in the distal coronary sinus and in the high right atrial appendage to achieve the lowest defibrillation threshold, although other locations may be suitable for certain patients.

Adult↗
PubMedDate not supplied

Effect of dopamine receptor antagonists on cocaine subjective effects: a naturalistic case study.

Schizophrenic patients on neuroleptic medications abuse cocaine and report cocaine-induced euphoria. This study was undertaken to provide better clinical characterization of these phenomena by administering the POMS and a custom-designed questionnaire. A group of heavy cocaine users who were not mentally ill served as the control group. The results clearly suggest that schizophrenic patients report cocaine-induced euphoria and post-use craving despite being treated with therapeutic doses of haloperidol or fluphenazine. The responses of the control group were similar to that of the schizophrenic group except that the latter subjects reported a greater degree of anxiety. These results suggest that blockade of D2 receptors is not sufficient to block cocaine-induced subjective effects in humans.

Adult↗
PubMed2003

Signs and symptoms of saphenous nerve injury after greater saphenous vein stripping: prevalence, severity, and relevance for modern practice.

PURPOSE: Saphenous nerve injury has long been recognized as a risk of greater saphenous vein stripping, and it has been suggested by some authors as a reason to avoid stripping below the knee. The rate of injury reported in the literature is extremely variable, with no study adequately addressing the effect of these injuries on patient quality of life. We undertook this study to measure the prevalence of these injuries and quantify their impact on quality of life. METHODS: A cross-sectional study of patients who had undergone primary greater saphenous vein stripping to the ankle was performed. Patients who had undergone this procedure, performed in a downward manner by a single surgeon over a 12-year period, were contacted and asked to return for a follow-up examination. Subjects completed the Aberdeen Varicose Vein Symptom Severity Score as well as a questionnaire designed to identify symptoms of saphenous nerve injury and any effects on quality of life. They were then evaluated for saphenous nerve deficits with simple neurologic tests. Charts were reviewed to determine preoperative CEAP classification. Results were analyzed for statistically significant differences between groups. RESULTS: Out of 111 patients (127 legs) who had undergone the procedure, 38 (34%) agreed to participate in the study. Three of these patients were ultimately excluded because of an inability to obtain a reliable neurologic examination of the legs, leaving 35 patients with a total of 45 legs operated. Participants did not differ from the potential study population in demographic data, follow-up interval, or preoperative CEAP classification. Median time since operation was 4.5 years (range, 8 months to 10.75 years). Overall, 40% of patients reported symptoms consistent with saphenous nerve injury at some time after operation, but these symptoms affected quality of life in only 6.7%. Symptoms persisted at evaluation in 17.8%, and only one patient (2.3%) reported any negative effect on quality of life at the time of examination. Saphenous nerve deficits were identified in 58% of patients. Patients with deficits had no statistically significant differences from those without deficits in terms of demographic data, follow-up interval, preoperative CEAP class, or Aberdeen score. CONCLUSIONS: Signs and symptoms of saphenous nerve injury are common at long-term follow-up after greater saphenous vein stripping to the ankle. However, there appears to be little, if any, significant resultant morbidity. The risk of saphenous nerve injury should therefore not be considered a reason to avoid stripping of the greater saphenous vein to the ankle.

Adult↗
PubMed2000

[Information and anesthesia: what does the patient desire?].

OBJECTIVE: The aim of the study was to assess the patient's desire for information regarding their preoperative care and to assess the anaesthetists' perception of that desire. STUDY DESIGN: Questionnaire. METHODS: The question: "Would you like to be fully informed about" 13 topics of the perioperative management was asked to 106 patients at the time of the preoperative visit. Two answers were possible: Yes I want to know; No I don't want to know. 22 senior anaesthesists were also interviewed and were asked to speculate about the patients response to each item. Data were compared with those of a similar questionnaire used in different countries. RESULTS: One hundred patients who underwent general, orthopaedic, urologic surgery were interviewed. Patients sought information most frequently concerning: postoperative pain and postoperative recovery (88%), time for ambulation (83%), duration of anaesthesia (77%) and different methods of anaesthesia (77%). Only 63% patients desired to be informed about all possible complications of anaesthesia. Senior anaesthesists had a correct perception of patients desire for information about the 4 important items but not for the complications of anaesthesia. CONCLUSION: Our study suggests that an exhaustive information about anaesthesia is not wished by every patients.

Age Factors↗
PubMedDate not supplied

A profile of patients with adhesive capsulitis.

The purpose of this descriptive study is to develop a profile of patients with adhesive capsulitis and to describe the patients' perceived clinical progression. A total of 32 patients diagnosed with adhesive capsulitis and 31 control subject completed anonymous questionnaires designed to elicit demographic data as well as medical information. The adhesive capsulitis and control samples were selected from the same facilities in an effort to reduce bias. Data comparing the adhesive capsulitis group with the control group was analyzed using the Odds Ratio and Taylor Series Confidence Interval for Odds Ratio. Twenty-seven patients (84.4%) diagnosed with adhesive capsulitis fell within the age range of 40-59 years. Diabetes and heart disease appeared to be more prevalent in patients diagnosed with adhesive capsulitis as compared with the control group and general population. The majority of patients with adhesive capsulitis (90.6%) reported a perceived clinical progression that started with a pattern of pain followed by loss of motion. Age and concomitant medical conditions appeared to be most correlated with the occurrence of adhesive capsulitis. Possible reasons for the prevalence of diabetes and heart disease in adhesive capsulitis patients are discussed.

Adult↗
PubMedDate not supplied

Self-efficacy, standards, and abstinence violation: a comparison between newly sober and long-term sober alcoholics.

Recent theory and empirical data suggest that self-efficacy plays an important role in resistance to relapse for substance abusers. Another key in the relapse process, according to Marlatt and Gordon (1985), is the abstinence violation effect, which comprises self-attribution for failure and affective reaction to violation of self-imposed standards. The combination of unrealistically high standards and low self-efficacy for following those standards may potentiate the risk for relapse. A 25-item questionnaire designed to assess self-efficacy and standards was administered to alcoholics newly admitted to an inpatient treatment program and alcoholics who had been sober for at least 1 year. The groups did not differ with regard to having high standards, but the successfully abstinent alcoholics had significantly higher self-efficacy expectations than the newly sober alcoholics. These results suggest that treatment programs may need to include interventions which decrease unrealistic standards as well as those designed to increase self-efficacy expectations.

Adult↗
PubMed1998

Is early adulthood a critical developmental stage for psychosis proneness? A survey of delusional ideation in normal subjects.

It has been hypothesized that late adolescence and early adulthood might be a brain developmental stage favoring the clinical expression of psychotic symptoms in psychiatric or neurological diseases. The aim of the present survey was to examine the relationship between age and delusional ideation in a sample of subjects with no psychiatric disorder. The survey was carried out with the Aquitaine Sentinel Network of general practitioners. Consecutive practice attenders were invited to complete the PDI-21 (Peters Delusional Inventory 21 items), a self-report questionnaire designed to measure delusional ideation in the normal population. The study concerned 444 patients who had no lifetime history of psychiatric disorder and who completed the PDI-21. A principal component analysis of the PDI-21 items was performed in order to identify delusional dimensions. An age-related decrease in the likelihood to report delusional ideas was found, younger subjects scoring higher on most dimensions of delusional ideation, such as 'persecution', 'thought disturbance', 'grandiosity' and 'paranormal beliefs'. 'Religiosity' was the only dimension positively associated with age. The results suggest that there may be a physiological neurodevelopmental stage favouring the expression of psychosis proneness in normal subjects, and support the hypothesis that the association between age and positive psychotic symptoms in functional and organic psychoses may be linked to the interaction between normal brain maturational processes and cerebral abnormalities involved in the aetiology of functional and organic psychoses.

Adolescent↗
PubMed1994

The prevalence of menopausal symptoms in patients treated for breast cancer.

A survey has been performed to discover the prevalence of menopausal symptoms in 108 patients successfully treated for breast cancer. Patients were assessed by them answering a custom designed questionnaire, and the use of the Hospital Anxiety and Depression (HAD) scale and the Greene Climacteric Scale. During the first year after treatment 70% of women suffered such symptoms; overall 60% of women surveyed were affected. Adjuvant hormonal treatment was the largest contributing factor in the development of symptoms. There was a relationship with borderline cases of anxiety, but not with definite cases of anxiety, as measured by the HAD scale. The high proportion of women shown to be affected means that treatment of menopausal symptoms should be incorporated into randomized trials of adjuvant therapy.

Adult↗
PubMed1992

Treatment and planning decisions in non-small cell carcinoma of the lung: an Australasian patterns of practice study.

Fourteen practising radiation oncologists were surveyed to assess their treatment and planning habits utilizing six sample cases of non-small cell carcinoma of the lung. Respondents were first given a general questionnaire, designed to evaluate their theoretical treatment and planning recommendations based on various tumour and patient related variables. Respondents then undertook a practical planning exercise utilizing planning CT and simulator radiographs for each of the six sample cases. Each case was accompanied by a brief history and report outlining specific tumour stage and non-stage related variables. The practical planning exercise was repeated on the second day of the survey utilizing different non-stage related variables but identical radiology and stage-related information. This design enabled firstly, a comparison of clinicians' intended policy and planning methods with actual policy and planning decisions, and secondly, an assessment of intra-clinician variability in decision making and planning practice. Good agreement was evident among clinicians with respect to general, non-case specific treatment policies; however, very significant variation occurred at an inter- and intra-clinician level and involved the entire treatment and planning process for individual cases. Despite identical treatment intent across identical radiological case pairings, clinicians chose widely differing margins and target volumes in their planning exercise. Treatment intent appeared to be influenced more by non-stage related variables rather than stage related information and radiological appearances per se. We have shown that experienced radiation oncologists do not adhere to stated case selection criteria and show inconsistencies in their treatment planning for non-small cell carcinoma of the lung.

Australia↗
PubMed1997

Cancellation of pediatric outpatient surgery: economic and emotional implications for patients and their families.

STUDY OBJECTIVE: To determine the cause and timing of case cancellation in a pediatric outpatient surgical population, and to examine the economic and emotional impact of such cancellations on patients and their families. DESIGN: Questionnaire survey. SETTING: Outpatient surgery unit of a large university children's hospital. PARTICIPANTS: 127 parents of children whose elective outpatient surgery had been cancelled. INTERVENTIONS: A total of 200 questionnaires were mailed to the parents of children who had their outpatient surgery cancelled. MEASUREMENTS AND MAIN RESULTS: Of those children whose surgery had been cancelled, 34.6% were due to upper respiratory infections (URIs), 30.7% for other medical reasons, and the balance for scheduling errors, because the child had not fasted, or for difficulties with transportation. The majority of surgeries (58.3%) were cancelled prior to their scheduled surgery date. However, 18.9% were cancelled on the day of surgery prior to leaving for the hospital and 22.8% were cancelled on arrival at the outpatient surgery clinic. Of those patients whose surgeries were not cancelled until they arrived at the hospital, 38.5% of mothers and 50.0% of fathers missed a day of work and, of these, 53.3% and 42.1%, respectively, went unpaid for the work day missed. The mean number of miles driven (round trip) to the hospital for a cancelled operation was 158.8 miles (range 8 to 1,350 miles). Additional testing and new appointments were ordered in 25.2% of the cancelled cases. 45% of parents and 16% of children were disappointed by the cancellation; 16% of parents were frustrated by the cancellation and 3.3% were angry. CONCLUSIONS: This study suggests that last-minute cancellation of surgery has an important impact on patients and their families and suggests a need to review present protocols for screening patients prior to surgery.

Adolescent↗
PubMed1999

Age and anesthetic practice: a regional perspective.

STUDY OBJECTIVE: To obtain information about practitioners' behaviors, perceptions, and perspectives concerning issues related to advancing age and anesthetic practice. DESIGN: Questionnaire survey mailed to 1,208 active and retired American Society of Anesthesiologists (ASA) members in Northern New England. Topics included hours worked, practice policies, stress level of activities, observed in colleagues and personally perceived errors and problems associated with performance, and plans, preparation, and reasons for retirement. SETTING: Practicing respondents worked in academic, community, or federal hospitals, and in ambulatory surgical facilities. MEASUREMENTS AND MAIN RESULTS: For descriptive analysis, counts and frequency distributions were calculated for each question. Statistical methods were used to test differences across age groups and to identify sources of differences. Approximately 40% of respondents in each age group worked an average work week of 50 to 59 hours. Respondents aged 40 to 49 years worked the longest work weeks and duty periods and were more concerned about liability issues than other age groups. Respondents age 60+ tended to work shorter average and maximum work weeks, although 5% of them continued to work 70- to 79-hour weeks. There was no statistically significant difference in hours worked among men and women. Approximately 20% to 30% of respondents relieved older colleagues of late night or call duties, and asked them to restrict or to stop practice out of concern for patient safety. Night call was equally stressful for all age groups. Economic uncertainty, production pressure, and interpersonal relations were more stressful for younger respondents. In preparation for retirement, shifting away from complex cases and phased reduction in clinical activity were increasingly prevalent with each advancing age group. Important reasons for retirement included attitude changes, physical limitations, and declining health. CONCLUSIONS: Despite modest age-associated trends, chronological age per se is not a strong correlate of an individual's practice pattern, behaviors, or perceptions about performance.

Adult↗