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PubMed1997

[Body image concerns and behavioral responses in a patient with cerebellopontine angle tumor].

This case report investigates the behavioral responses of body image change of a cerebellopontine angle tumor patient. Twelve process recordings obtained from a field study comprised the data for analysis. The dimensions of the subject's body image change were body structure, body function, body sensation, and social function change. Two types of behavioral response were delineated and categorized as the following: (1) Identifying the individual's body image change, such as seeking information, seeking reassurance, and comparative behavior. (2) Maintaining the integrity of individual's body image, such as rationalizing behavior, maintenance behavior, cooperative behavior and seeking religious support. This paper reports how the investigators used nursing interventions to help the subject gradually get through the process and adapt to the body image changes properly.

Adaptation, Psychological↗
PubMed1997

[The relationship of the compliance with medical drug treatment to social and functional factors and to the cognitive status of the elderly population seeking care].

OBJECTIVE: We try to relate the compliance to sociodemographic factors as well as with the cognitive, functional and sensorial status; and with characteristics of the medication to take. DESIGN: Descriptive, cross-sectional study with a month observational window. SITE: Our primary care health district. PATIENTS: We admitted elders who came to our primary care set, aged 70 or more, random-selected and stratified for age and sex. We exclude those who were travellers in our district and those included in home-care program. MEASUREMENTS AND RESULTS: We measured medication compliance using pill counts, in those medicines in regular regime for a month or more. We measured as compliance index a mean of the deviation of the different adherence index from one, scoring good adherence when that index was < or = 0.1. Non-compliance was mainly related to cognitive impairment (p = 0.0008). CONCLUSIONS: Patients with poor functional status are at high potential risk coming from polypharmacy. We need much medication control and compliance assessment in these patients.

Aged↗
PubMed1998

Long-term quality of life after kidney and simultaneous pancreas-kidney transplantation.

We are using a validated questionnaire (SF-36) to annually assess health-related quality of life (QOL) in kidney and pancreas-kidney transplant recipients. The SF-36 consists of eight scales to assess physical functioning, general health, and mental functioning. Norms and 95% confidence intervals (C.I.) have been developed for the US population. At present, 1138 recipients with functioning grafts (520 Type I diabetic; 618 nondiabetic) 1-10 yr post-transplant have completed the questionnaire. Of the recipients, 446 completed the questionnaire once; 632 twice; and 53 three times (305 after 1 yr; 266 after 2 yr; 256 after 3 yr; 206 after 4 yr; 192 after 5 yr; 150 after 6 yr; 130 after 7 yr; 138 after 8 yr; 125 after 9 yr; 92 after 10 yr). For both diabetic and nondiabetic recipients, there was little change in average scores for each scale between years (p = NS). In relation to the US population, average scores for nondiabetics were below the 50th percentile on all 8 scales; for diabetics < 25th percentile on the physical functioning and vitality scales, < 50th percentile on all others. For both diabetic and nondiabetic recipients, average scores were higher than reported norms for patients with CHF, COPD, or depression but were similar to those with Htn or recent MI. Individual scores were then compared with age-matched means (+/- 2 SEMs) (95% C.I.) for the US population. At each year post-transplant, up to 40% of nondiabetic and up to 65% of diabetic recipients had scores below the 95% C.I. on individual scales (particularly the physical functioning and general health scales)--e.g. over 30% nondiabetic and up to 60% diabetic recipients had scores on the physical functioning scales below the 95% C.I. More diabetic recipients (vs. nondiabetics) reported poor QOL on the physical functioning, general health and social functioning scales. There was little difference in the mental health scales. For those with Type I diabetes, a similar percentage of kidney and K/P recipients reported QOL below the 95% C.I. for the age-matched population, except on the GH scale (better QOL for K/P recipients). We conclude that successful transplant recipients report health-related QOL below that of the age-matched general population but similar to those with other chronic diseases. Diabetic and nondiabetic recipients have similar scores on the mental health scales; nondiabetic recipients score better on the general health and physical functioning scales.

Adult↗
PubMed2006

Social cognition in nursing home residents with and without cognitive impairment.

Dementia affects the specific cognitive abilities underlying social functioning in ways that are just beginning to be understood. This pilot study compared the performances of 15 nursing home residents with cognitive impairment and 25 without cognitive impairment on a broad range of measures of social-cognitive functioning. The cognitively impaired group scored significantly lower than the unimpaired group on tests of face processing, person perception, and social reasoning but not on tests of affect recognition and the representation of social situations. Individuals' deficits in working memory and executive function did not fully account for their impaired performance on tests of social cognition. An improved understanding and assessment of the basic cognitive mechanisms underlying the ability of persons with dementia to interact with others would inform the design of interventions to optimize their social functioning.

Aged↗
PubMed1998

Illness perceptions, coping and functioning in patients with rheumatoid arthritis, chronic obstructive pulmonary disease and psoriasis.

The present cross-sectional study analyzed the extent to which illness perceptions and coping strategies (as measured by the Illness Perception Questionnaire and the Utrecht Coping List, respectively) are associated with levels of daily functioning, as indicated by the Medical Outcomes Study SF-20, and disease-specific measures in 244 adults: 84 with rheumatoid arthritis (RA); 80 with chronic obstructive lung disease (COPD); and 80 with psoriasis. The results of stepwise regression analyses indicated that a strong illness identity, passive coping, belief in a long illness duration, belief in more severe consequences, and an unfavorable score on medical variables were associated with worse outcome on disease-specific measures of functioning and on general role and social functioning. Coping by seeking social support and beliefs in controllability/curability of the disease were significantly related to better functioning. The implications of these findings for future interventions and research are discussed.

Activities of Daily Living↗
PubMed2003

[Profile and risk of mental illness in caregivers for home care patients].

OBJECTIVES: To determine the profile of caregivers for patients in home hospitalization, and to investigate morbidity and strain in caregivers. DESIGN: Descriptive, cross-sectional study based on personal interviews.Setting. Health area in the community (autonomous region) of Valencia (Eastern Spain). PARTICIPANTD: Systematic sampling was used to select 215 caregivers who took care of home-hospitalized patients during the year 2001. MEASURES: Personal interview at home with a questionnaire that contained items on descriptive variables, psychological well-being (Goldberg Anxiety and Depression scale), social support (Duke-UNC Functional Social Support Questionnaire), caregiver strain index and profile of the care receiver. RESULTS: The typical caregiver was a 55-year-old woman who was a first-degree relative of the patient, with primary level education, who formed part of a normally functional family and who received good social support. Anxiety was found in 32%, depression in 22% and a high strain index in 11%. The patient was typically a 70-year-old man with chronic disease, a high degree of dependence and good mental status. Correlation analysis showed that the risk of anxiety, depression and strain in caretakers increased with the patient's degree of physical dependence and mental deterioration, and with lower degrees of social support and longer periods devoted to caregiving. The risk of anxiety and depression increased as the strain index and familial dysfunction increased. Strain index was the factor that explained most of the variability in anxiety and depression. CONCLUSIONS: Feelings of psychological distress (anxiety and depression) and strain were common among caregivers. Care for caregivers should form part of the measures to provide care to patients.

Aged↗
PubMed2000

Social and psychiatric functioning in adolescents with Asperger syndrome compared with conduct disorder.

Lack of standardized phenotypic definition has made outcome studies of Asperger syndrome (AS) difficult to interpret. This paper reports psychosocial functioning in 20 male adolescents with AS, defined according to current ICD-10 criteria, and a comparison group of 20 male adolescents with severe conduct disorder. Subjects were gathered from clinical referral. Evaluation used standardized interviewer rated assessments of social functioning and psychiatric morbidity. The AS group showed severe impairments in practical social functioning despite good cognitive ability and lack of significant early language delay. High levels of anxiety and obsessional disorders were found in AS; depression, suicidal ideation, tempers, and defiance in both groups. Results are compared with those from other studies. Relevance to clinical ascertainment and treatment is discussed.

Adaptation, Psychological↗
PubMed1987

The impact of rheumatoid arthritis on the homemaker.

Few current studies of the effects of chronic conditions on social functioning examine the effects of disease on the role of homemaker. A major problem confronting researchers in this area is the difficulty in operationalizing dysfunction in social roles other than work roles. In this study we have developed a measure of homemaker functioning based on conceptualizing the homemaker role on two dimensions: the instrumental functions associated with meeting the physical needs of the household and the nurturant dimension concerned with meeting the expressive needs of the household. We used our measure of homemaker functioning to study the effects of rheumatoid arthritis on 142 women, whether employed outside the home or not, between the ages of 21 and 65, all living with husband and/or children at the time of disease onset. The disease significantly limited both instrumental and nurturing functions associated with managing a household. The more strenuous instrumental functions were more likely to be limited, although women in our study experienced serious limitations in nurturant role functions, as well. Limitations in functioning along the nurturant dimension were surprisingly high and previously undocumented. Comparisons between women employed outside the home and those not employed found few differences between the groups in social functioning on either dimension of the homemaker role. Employed women were somewhat less physically disabled than the unemployed, but both groups of homemakers continued to assume major responsibility for homemaking. Assessing functioning in social roles other than work, and functioning in nurturant as well as instrumental areas, is especially important in evaluating the effects on women of a chronic disease such as rheumatoid arthritis.

Adult↗
PubMed2001

[Steps in development of social and hygienic monitoring].

A new function--social and hygienic monitoring--is actively being put into activities of State Sanitary and Epidemiologic Service of Russian Federation. System of the monitoring is formed stepwise, with development of methodic, informational, material, technic and stuff resources in federal, regional and municipal establishments. Results of social and hygienic monitoring are used for better sanitary conditions, health care and environmental protection with consideration of regional features of sanitary and epidemiologic circumstances in territories of Russian Federation.

Adolescent↗
PubMed2000

Hip fracture outcomes: quality of life and functional status in older adults living in the community.

BACKGROUND: People who return to living in the community after a hip fracture are considered to have the best outcome. However, their quality of life (QOL) and its relationship with function over the longer term have not been fully assessed. AIMS: This case control study of community dwelling subjects six to 12 months post hip fracture aims to investigate their QOL and functional independence. METHOD: The Short Form-36 (SF-36) was utilised to measure QOL. The Modified Barthel Index (MBI), the Frenchay Activities of Daily Living Index (FAI), the Timed 'Up & Go' (TUG), and the Berg Balance Scale (Berg) were used to measure functionality. RESULTS: Ninety-two subjects and 92 controls were recruited. Despite being age and gender matched, the hip fracture subjects scored significantly (p<0.05) worse than the controls in all measures of function. The fracture group was slower on the TUG (19 vs 10.5 seconds), had more difficulties with balance (46 vs 54 out of 56), and was less active and more dependent than the control group (FAI 24 vs 31 out of 42). The SF-36 has eight domains: physical function, role physical, bodily pain, mental health, role emotional, social function, general health and vitality. The control group had a higher (p<0.05) perception of their QOL in all domains. CONCLUSION: The effects of impaired balance and mobility along with reduced functional and social independence are reflected in the diminished QOL perceived by the fracture group. This indicates that many do not return to their pre-fracture lifestyle.

Activities of Daily Living↗
PubMed1999

Quality of life in patients with vertebral fractures: validation of the Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO). Working Party for Quality of Life of the European Foundation for Osteoporosis.

Vertebral fractures may be minor or lead to pain, decreased physical function, immobility, social isolation and depression, which together contribute to quality of life. A Working Party of the European Foundation for Osteoporosis has developed a specific questionnaire for patients with vertebral fractures. This questionnaire, QUALEFFO, includes questions in the domains pain, physical function, social function, general health perception and mental function. QUALEFFO was validated in a multicenter study in seven countries. The study was done in 159 patients aged 55-80 years with clinical osteoporosis, i.e., back pain and other complaints with at least one vertebral fracture and lumbar bone mineral density T-score <-1. Patients with a recent vertebral fracture were excluded because of unstable disease. Controls were age- and sex-matched, and did not have chronic back pain or vertebral fractures. Subjects with conditions exerting a major influence on quality of life were excluded. The QUALEFFO was administered twice within 4 weeks and compared with a generic questionnaire, the Short Form 36 of the Medical Outcomes Study (SF-36). Standard spinal radiographs were made for assessment of vertebral height. Seven questions were removed from the analysis because of low response rate, linguistic ambiguities or redundancy. The 41 remaining questions were analyzed for repeatability, internal consistency and the capacity to discriminate between patients with vertebral fractures and controls. Comparison with the SF-36 was performed within similar domains by conditional logistic regression and by receiver operating characteristic (ROC) curves. The repeatability of QUALEFFO was good (kappa statistics 0.54-0.90) and 26 of 41 questions had a kappa score >/=0.70. The internal consistency of the five domains was adequate, with Crohnbach alpha around 0.80. All except five questions discriminated significantly between patients and controls. The median scores of QUALEFFO were significantly higher in patients with vertebral fractures than in controls in all five domain (p<0. 001), which is consistent with decreased quality of life in patients with osteoporosis. Spinal radiographs were assessed using the McCloskey-Kanis algorithm. According to this, 124 patients (78%) had vertebral fractures of >/=3 SD severity, in contrast with 7 controls (4%). Significant correlations existed between scores of similar domains of QUALEFFO and the SF-36, especially for pain, physical function and mental function. All five domains within each questionnaire discriminated significantly between fracture cases and controls. The odds ratios for pain and social function were greater for QUALEFFO, while general health perception was more discriminating using the SF-36. The ROC curve analysis of QUALEFFO indicated that all five domains were significantly predictive of vertebral fractures. When comparing similar domains of the two questionnaires, QUALEFFO domains demonstrated significantly better performance for pain, physical function and social function. The QUALEFFO total score and SF-36 physical composite score showed similar performance. In conclusion, QUALEFFO is repeatable, coherent and discriminates well between patients with vertebral fractures and control subjects. The results of this study confirm the decreased quality of life in patients with vertebral fractures.

Aged↗
PubMed2003

Predictors of emergency medical services utilization by elders.

OBJECTIVE: Elders (age > or = 65 years) frequently use emergency medical services (EMS) for care. Understanding reasons for EMS use by elders may allow better management of EMS demand. To the best of the authors' knowledge, no studies have identified patient characteristics associated with EMS use by elders. This study aimed to identify patient attributes associated with elder EMS users. METHODS: This was a prospective cohort study of non-institutionalized elders presenting to an urban university hospital emergency department. Nine hundred thirty elder patients completed the survey. The authors asked patients about access to care, health beliefs, and reasons for requesting EMS assistance. Univariate and logistic regression were used to identify predictors of EMS use. RESULTS: The sample had a mean age of 76 years; 37% were male; 79% were African American. Thirty percent arrived via EMS. Sixty-five percent of those transported and 46% of those not transported by EMS were admitted to the hospital (p < 0.001). Reported reasons for using EMS transport included immobility (33%), illness (22%), request by others (21%), instruction from health care providers (10%), and lack of transportation (10%). Logistic regression identified symptom onset within four hours of seeking care (OR = 3.1), age > or = 85 years (OR = 1.63), increased deficiencies in activities of daily living (OR = 1.40 per deficiency), worse physical functioning (OR = 1.14/10 points), and worse social functioning (OR = 1.06/10 points) as factors associated with EMS use. CONCLUSIONS: Elders report using EMS because of immobility, perceived medical needs, or requests by others. Similarly, the presence of acute illness symptoms, older age, and poor social and physical function, rather than health beliefs, predict EMS use among elders. These factors must be considered when managing the demand for EMS services.

Academic Medical Centers↗
PubMed2006

Brain morphometry and cognitive performance in detoxified alcohol-dependents with preserved psychosocial functioning.

The extent of structural brain damage and related cognitive deficits has been little described in alcohol-dependent individuals with preserved social functioning. Thus, we investigated the relationship between regional alterations, executive performance, and drinking history. Volumes of gray and white matter were assessed using magnetic resonance imaging voxel-based morphometry in healthy men and in detoxified alcohol-dependent men with good psychosocial functioning. Their executive performance was assessed using neuropsychological tests. Regression analyses were carried out in the regions in which volume differences were detected. Decreases in gray matter were detected bilaterally in alcohol-dependents in the dorsolateral frontal cortex (up to 20% lower), and to a lesser extent in the temporal cortex, insula, thalamus, and cerebellum. Decreases in white matter volume were widespread, being up to 10% in corpus callosum. The degradation of neuropsychological performance correlated with gray matter volume decreases in the frontal lobe, insula, hippocampus, thalami and cerebellum, and with white matter decrease in the brainstem. An early age at first drinking was associated with decreased gray matter volumes in the cerebellum, brainstem (pons), and frontal regions. Regional alteration in gray and white matter volume was associated with impairment of executive function despite preserved social and somatic functioning in detoxified patients. Besides involving frontal regions, these findings are consistent with a cerebello-thalamo-cortical model of impaired executive functions in alcohol-dependent individuals.

Alcoholism↗
PubMed2004

Comparative study of early childhood high-function autism and developmental mixed receptive-expressive language disorder.

Verbal cognitive profile and general social functioning were compared between two groups of children aged 5 to 7 years, one with high-function autism and the other with developmental mixed receptive-expressive language disorders. The two groups, totaling 50 children, were matched for age and non-verbal IQ (mean, 90). Both groups had impaired verbal cognitive profile and social adaptive functioning, with no statistically significant differences between the two groups. The implications of our findings are discussed. Current preschool and early childhood medical-educational intervention programs in Taiwan must design and implement curricula in which children with language delay, whether autistic or/not, can develop essential social skills.

Autistic Disorder↗
PubMed2002

Quality of life in patients with postural tachycardia syndrome.

OBJECTIVES: To quantify quality of life and identify demographic and clinical correlates of functioning in a well-characterized sample of patients with postural tachycardia syndrome (POTS). PATIENTS AND METHODS: Prospective patients were those seen at the Mayo Clinic Autonomic Disorders Laboratory from September 2000 to June 2001. Neurologists made diagnoses of POTS according to established criteria. Patients completed a questionnaire packet that included measures of quality of life (36-Item Short-Form Health Survey [SF-36]) and symptom severity (Autonomic Symptom Profile). Additional clinical information was abstracted from medical records. RESULTS: Ninety-four patients (89% female; mean age, 34.2 years) were enrolled in the study. Patients with POTS reported impairment across multiple domains on the SF-36. Physical functioning, role functioning, bodily pain, general health, vitality, and social functioning were all significantly impaired compared with a healthy population (P<.01 for all) and similar to that reported by patients with other chronic, disabling conditions. Hierarchical regression analyses revealed that symptom severity (beta = -.36, P<.001) and disability status (beta = -36, P<.001) were independent predictors of SF-36 physical component scores, with the full model accounting for 54% of the variance (P<.001). None of the variables examined accounted for a significant amount of the variance in SF-36 mental component scores. CONCLUSIONS: Patients with POTS experience clear limitations across multiple domains of quality of life, including physical, social, and role functioning. Treatment should address the multiple and varied impairments experienced by these patients and may require a multidisciplinary approach. Future research must further delineate factors, both disease related and psychosocial, that predict functioning and adjustment in this population.

Activities of Daily Living↗
PubMed1997

Relationships of quality-of-life measures to long-term lifestyle and drug treatment in the Treatment of Mild Hypertension Study.

OBJECTIVES: To compare 5 antihypertensive drugs and placebo for changes in quality of life (QL). To assess the relationship of lifestyle factors and change in lifestyle factors to QL in participants with stage I diastolic hypertension. METHODS: The Treatment of Mild Hypertension Study (TOMHS) was a randomized, double-blind, placebo-controlled clinical trial with minimum participant follow-up of 4 years. It was conducted at 4 hypertension screening and treatment academic centers in the United States. The cohort consisted of 902 men and women with hypertension, aged 45 to 69 years, with diastolic blood pressures less than 100 mm Hg. Informed consent was obtained from each participant after the nature of the procedures had been fully explained. Sustained nutritional-hygienic intervention was administered to all participants to reduce weight, to reduce dietary sodium and alcohol intake, and to increase physical activity. Participants were randomized to take (1) acebutolol (n = 132); (2) amlodipine maleate (n = 131); (3) chlorthalidone (n = 126); (4) doxazosin mesylate (n = 134); (5) enalapril maleate (n = 135); or placebo (n = 234). Changes in 7 QL indexes were assessed based on a 35-item questionnaire: (1) general health; (2) energy or fatigue; (3) mental health; (4) general functioning; (5) satisfaction with physical abilities; (6) social functioning; and (7) social contacts. RESULTS: At baseline, higher QL was associated with older age, more physical activity, lower obesity level, male gender, non-African American race, and higher educational level. Improvements in QL were observed in all randomized groups, including the placebo group during follow-up; greater improvements were observed in the acebutolol and chlorthalidone groups and were evident throughout follow-up. The amount of weight loss, increase in physical activity, and level of attained blood pressure control during follow-up were related to greater improvements in QL. CONCLUSIONS: In patients with stage I hypertension, antihypertensive treatment with any of 5 agents used in TOMHS does not impair QL. The diuretic chlorthali-done and the cardioselective beta-blocker acebutolol appear to improve QL the most. Success with lifestyle changes affecting weight loss and increase in physical activity relate to greater improvements in QL and show that these interventions, in addition to contributing to blood pressure control, have positive effects on the general well-being of the individual.

Aged↗
PubMed2002

The development and psychometric properties of a measure of social and adaptive functioning for children and adolescents.

Developed, piloted, and examined the psychometric properties of the Child and Adolescent Social and Adaptive Functioning Scale (CASAFS), a self-report measure designed to examine the social functioning of young people in the areas of school performance, peer relationships, family relationships, and home duties/self-care. The findings of confirmatory and exploratory factor analysis support a 4-factor solution consistent with the hypothesized domains. Fit indexes suggested that the 4-correlated factor model represented a satisfactory solution for the data, with the covariation between factors being satisfactorily explained by a single, higher order factor reflecting social and adaptive functioning in general. The internal consistency and 12-month test-retest reliability of the total scale was acceptable. A significant, negative correlation was found between the CASAFS and a measure of depressive symptoms, showing that high levels of social functioning are associated with low levels of depression. Significant differences in CASAFS total and subscale scores were found between clinically depressed adolescents and a matched sample of nonclinical controls. Adolescents who reported elevated but subclinical levels of depression also reported lower levels of social functioning in comparison to nonclinical controls.

Adaptation, Psychological↗
PubMed2004

Here's looking at you, kid: neural systems underlying face and gaze processing in fragile X syndrome.

BACKGROUND: Children with fragile X syndrome (fraX) are at risk for manifesting abnormalities in social function that overlap with features of autism and social anxiety disorder. In this study, we analyzed brain activation in response to face and gaze stimuli to better understand neural functioning associated with social perception in fraX. METHODS: Eleven female subjects with fraX, aged 10 to 22 years, were compared with age-matched female control subjects. Photographs of forward-facing and angled faces, each having direct and averted gaze (4 types of stimuli), were presented in an event-related design during functional magnetic resonance imaging. Subjects were instructed to determine the direction of gaze for each photograph. Activation in brain regions known to respond to face and gaze stimuli, the fusiform gyrus (FG) and superior temporal sulcus (STS), were compared between groups to isolate neural abnormalities in the perception of directed social stimuli. RESULTS: The fraX subjects had decreased accuracy in determining the direction of gaze compared with controls. Region of interest analysis of the FG revealed a significant interaction between diagnostic group and face orientation. Specifically, control subjects had greater FG activation to forward than to angled faces, whereas fraX subjects had no difference in FG activation to forward and angled faces. Controls showed greater left STS activation to all stimuli compared with fraX subjects. CONCLUSIONS: Our results suggest that gaze aversion in fraX subjects is related to decreased specialization of the FG in the perception of face orientation. Decreased STS activation in fraX suggests aberrant processing of gaze. These data suggest that gaze aversion in fraX may be related to dysfunction of neural systems underlying both face and gaze processing.

Adolescent↗