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PubMed1997

The acoustic reflex in adults with histories of otitis media in childhood.

OBJECTIVE: To investigate the effects of a history of otitis media (OM) in childhood on the acoustic reflex threshold (ART) in young adults. DESIGN: Questionnaire responses on childhood ear and hearing problems were obtained from populations of university students. In Study 1, 31 students reporting histories of persistent childhood OM and 34 students with no known OM histories were identified. They received pure-tone audiometry, otomicroscopy, and measurement of ARTs for a 500 Hz pure tone. In Study 2, 20 students with OM histories and 20 students with no known OM histories received pure-tone audiometry, otomicroscopy, and measurement of ARTs for a broadband noise. RESULTS: Subjects with OM histories had higher ARTs than did subjects with no known OM histories. Multiple regression analyses showed that the main variables contributing to elevated reflex thresholds were raised hearing thresholds on the activator ear and tympanic membrane abnormalities on the probe ear. CONCLUSIONS: The elevated ARTs in adults with histories of childhood OM result from peripheral sequelae of OM. Further evidence is required to determine any functional significance of these raised reflex thresholds.

Acoustic Impedance Tests↗
PubMed1988

Self-assessment of selected interpersonal abilities in hard of hearing and deaf adolescents.

An understanding of the ability of persons with hearing impairments to interact socially needs to consider the impact of their disabilities on communication with non-disabled persons. This study examined the responses of 197 hard of hearing and deaf adolescents and a control group of 53 non-disabled young people between 14 and 18 years of age to statements in a questionnaire designed to elecit how they might behave in different contexts, with additional, independent assessment of the subjects by teachers and other educational staff. Results suggest that biological differences alone do not account for differences in self-conception found between those with hearing disabilities and those without, nor between different subgroups of those with hearing disabilities. Other cognitive, emotional, motivational and social factors also play a part. This opens up the possibility of developing new rehabilitation and training programmes to help young people with hearing disabilities acquire more positive self-assessments.

Adolescent↗
PubMed1996

Transition from school to work of students with developmental disabilities and mental retardation: an Israeli perspective.

The present research was conducted in four special education schools for students with developmental disabilities and mental retardation in the Haifa area. The total number of subjects was 72. There were 45 (63%) males and 27 (37%) females. The mean age was 18.1 years (range: 16-19.5). The mean IQ (WISC) was 66.3 points (range: 40-85). The vocational placement at the end of 6 months after leaving school was recorded for each school graduate. A total of 53 teachers--school principles, counsellors, specialized teachers and speech and occupational therapists--filled out specially designed questionnaires covering three areas: (1) students' work programme experience; (2) teachers' ratings of final year students on: academic studies, social behaviour, independence and vocational skills as well as teachers' recommendations, given towards the end of the final year at the school, for the immediate plan of action for each of the graduating students; (3) teachers' ratings of parental involvement with the educational programme of each student. Background variables included IQ, age and gender. The major finding was that 6 months after graduation, one-third of special school graduates were not working, were not enrolled in any formal programme and were idle at home. The variables that were found to correlate with successful placement were students' prior work experience, teachers' ratings of students achievements and their recommendations for each student, and parental involvement.

Adolescent↗
PubMed2003

Return to work after lower limb amputation.

This study investigated the proportion of patients who returned to work following amputation and the factors that influenced a positive or negative outcome. One hundred patients of working age who had sustained unilateral lower limb amputation at least 1 year previously and who were established prosthesis users participated in the study. A specially designed questionnaire similar to a guided interview was administered by the rehabilitation physician at the patients' routine follow-ups. The questionnaire yielded a unique score dependent on whether return to work (or a different or preferred occupation) had been achieved with good or reduced productivity. All patients were eligible for mobility benefit, including schemes to purchase suitably adapted vehicles if necessary. However, no vocational rehabilitation was available. Sixty-six per cent of patients returned to employment and this was related to mobility, time since amputation and Handicap Scale scores. Age, socket comfort, level and cause of amputation, type of previous work or the presence of other medical problems did not differ between those who did and did not return to work. The Employment Questionnaire showed good correspondence with the London Handicap Scale, indicating some concurrent validity, although future development might include consideration of psychological factors, which could explain more of the reasons for continued unemployment.

Adult↗
PubMedDate not supplied

Psychosocial sequelae of pediatric burns involving 80% or greater total body surface area.

Important questions for pediatric burn care specialists relate to the quality of life for those children who survive the most severe burn injuries. This study examines the psychological adjustment of 25 children who survived injuries > or = 80% total body surface area and the impact of such injury on the families. Data were analyzed from the most recent assessment, with the Child Behavior Checklist, Teacher Report Form, Piers-Harris Children's Self-Concept Scale, Parenting Stress Index, and a parental questionnaire designed by the authors. As a group, the children's behavioral problems as reported by both parents and teachers were within normal limits. Measures of parental stress, however, clearly differentiated the burn population. These parents attributed more stress to characteristics of their children. Children with > or = 80% TBSA burns develop positive feelings about themselves and appear no more troubled than a comparable group of nonburned children. The impact on the families is significant, however, and must be considered of consequence in the rehabilitation of the burned child.

Adaptation, Psychological↗
PubMed1998

Early detection of social interaction problems: development of a social interaction instrument in young children.

Children with developmental or psychiatric disorders often have problems with social interaction. This study reports on the development of the Ghuman-Folstein Screen for Social Interaction (SSI), a parent/caregiver questionnaire designed to measure the capacity for basic social interaction skills across a variety of contexts in preschool children. The SSI was administered to 51 clinically referred children with a high probability of deficits in social interaction and 60 healthy control subjects to establish reliability and validity. The children were 24 to 61 months of age, with diverse ethnic and socioeconomic backgrounds. Strong internal consistency, significant correlation for test/retest reliability, moderate correlation for interrater reliability and support for external validity of the SSI was established. The SSI scores differentiated between the clinically referred subjects and healthy control subjects and between children with pervasive developmental disorder (PDD) of the autistic type and other non-PDD developmental disorders. The SSI is a relatively simple, efficient, reliable, and valid measure for the capacity for basic social interaction skills in children 24 months to 5 years of age. The SSI has a potential to be useful in primary health care settings to identify children at risk who may need tracking and/or further evaluation and treatment services.

Child Behavior↗
PubMedDate not supplied

Assessment of fatigue and psychologic disturbances in patients with hepatitis C virus infection.

BACKGROUND: It is a common clinical impression that fatigue is a frequent, and often debilitating, symptom in patients with chronic hepatitis C virus (HCV) infection. However, despite its obvious clinical importance, several aspects of fatigue, including its relationship with the underlying liver disease and the presence of psychologic disturbances, have not been well examined. GOALS: The current study was carried out to assess these issues. STUDY: A total of 149 subjects were included in the study and were assigned to one of the following study groups: healthy controls (31), chronic HCV infection (24), combined HCV infection and chronic alcohol abuse (32), alcoholic liver disease (22), and chronic non-liver diseases (40). All subjects were administered investigator-assisted questionnaires designed to analyze the presence and severity of fatigue and psychologic abnormalities. RESULTS: The mean (+/-SD) fatigue scores in patients with chronic HCV infection (140 +/- 22.9; p = 0.002), alcoholic liver disease (127 +/- 31.4; p < 0.001), mixed (HCV/alcoholic) liver disease (131 +/- 29.0; p < 0.001), and chronic non-liver diseases (128 +/- 35.9; p = 0.004) were significantly greater compared to with healthy subjects (101 +/- 31.8). The total fatigue scores were higher in HCV-infected subjects compared with the other patient groups, but the differences failed to reach statistical significance. Moreover, the fatigue experienced by patients with HCV did not improve with rest as effectively as in the other study groups. All patient groups had higher scores for psychologic disturbances compared with healthy subjects. CONCLUSIONS: The current study shows that fatigue and psychologic disturbances occur frequently in chronic diseases. The fatigue experienced by patients with HCV infection is more severe and intransigent and responds poorly to relieving factors. Moreover, patients with HCV infection are more depressed and harbor greater feelings of anger and hostility compared with those with non-liver chronic diseases. These observations are important because proper management of the psychologic symptoms may have a favorable impact on the quality of life of patients with HCV infection.

Adult↗
PubMed1980

Chronographic speech patterns of acutely psychotic patients. A preliminary note.

This study was a preliminary attempt to explore the likelihood that, for psychiatric patients, amount of vocal activity (relative to silence) reflects degree of psychopathology and change with treatment. Five acute schizophrenic patients (two men and three women) were each seen in three interviews by one of two interviewers. After each interview, the interviewer evaluated the extent of his patient's pathology in terms of the Brief Psychiatric Rating Scale, and he and the patient separately completed a questionnaire designed to elicit their perceptions of the interview. The results reveal that the relative amounts of the patients' vocal activity were negatively related to the interviewers' ratings of their general level of psychopathology and were also related to several aspects of their perceptions and the interviewers' perceptions of the interview. However, the number of interviews per patient was too few to permit an evaluation of treatment effects.

Adult↗
PubMed1994

Parents' perceptions of nursing support following neonatal loss.

This retrospective descriptive study evaluated the perceptions of a convenience sample of 23 grieving parents who were members of Resolve Through Sharing in the southcentral United States. Data from two investigator-designed questionnaires were analyzed with descriptive statistics. Categories utilized were: acknowledgment of baby, education/information/written material, and general emotional support (communication/interventions). Interventions dealing with acknowledgment of the infant were reported as most beneficial. Others were rated as beneficial to varying degrees. It is imperative that nurses provide parents with research-based support to assist them in beginning a healthy grieving process.

Adult↗
PubMed1988

The role of three-dimensional computed tomography in the management of maxillofacial trauma.

Open reduction and internal fixation of facial fractures demand a detailed understanding of the three-dimensional pattern of injury. This is difficult if not impossible to obtain with present radiographic methods. The purpose of this study was to define the role of three-dimensional computerized tomography (3DCT) in surgical management of facial fractures. The two-part investigation: 1) compared the diagnostic accuracy of 3DCT with conventional CT and plain film studies; and 2) examined the clinical usefulness of 3DCT to surgeons. Twenty-four acute trauma patients suspected of having facial fractures were examined radiographically with analysis of every facial bone and specific facial regions. Particular attention was directed to the course of the fracture lines and the number, size, and displacement of fracture fragments. The surgeons were then asked to conceptualize the reported and the personally observed radiographic information and document their impressions on preprinted diagrams of the facial skeleton. They also completed questionnaires designed to indicate whether patient management would be influenced by the 3DCT. The radiographic findings were correlated with intraoperative observations. The 3DCT provided superior definition of fracture lines (especially horizontal) and the extent of comminution was better appreciated. This additional information improved the surgeons' ability to plan placement of interfragmentary wires and/or plates. Surgeons were also able to more accurately predict those patients requiring immediate bone grafting. Large, life-size 3D images of the facial skeleton made intraoperative conceptualization of the injury pattern easier. The accuracy of the 3DCT images corroborated the intraoperative findings in all cases. The following conclusions are offered: 1) The diagnosis of most mandibular fractures can be made equally well with conventional and 3DCT techniques. 2) Improved diagnosis of fracture lines and the specific patterns of comminution in midface fractures is made possible with 3DCT. 3) If open reduction and internal fixation is the mode of treatment, 3DCT is desirable because the added information makes preoperative planning more accurate and thereby facilitates surgical intervention.

Facial Injuries↗
PubMed1999

Breaking the bad news of cancer: the patient's perspective.

OBJECTIVE: Head and neck cancers present a special challenge to the patient and the physician because they affect the quintessential aspects of living such as breathing, eating, and speaking. Numerous articles have described how the physician should perform the difficult task of conveying bad news, but only a small number of articles specifically assess the patients' perceptions when being told of a serious diagnosis. The purpose of this survey was to evaluate the thoughts and concerns of patients receiving diagnoses of head and neck cancer. STUDY DESIGN: Questionnaire survey. METHODS: A 41-item questionnaire was sent to head and neck cancer patients who have been treated for and remain free of disease for at least 2 years. RESULTS: All of the respondents felt that their diagnosis was adequately explained to them and that no further explanations were necessary. Eighty-one percent of the respondents did not wish to have anyone else present at the time of diagnosis. Additionally, 75% of the respondents did not want the physician to touch their hands or hug them when given the bad news. Only 63% of the respondents had further discussions with family, friends, or other physicians after being told of their diagnosis. CONCLUSION: When patients are told of the diagnosis of head and neck cancer, they want their physician to be truthful, caring, and compassionate. The patients want their diagnosis in simple and direct terms without the incorporation of complex medical terminology. The results of this survey can provide insightful information to physicians when they are undertaking the difficult task of conveying bad news to their patients.

Communication↗
PubMed1982

Measurement of task delegations among nurses by nominal group process analysis.

Task delegations among different nursing skill levels (RNs, LPNs, NAs) are empirically measured in this study by performing a nursing activity analysis. Instead of relying on conventional techniques of time study and work sampling, this study incorporates Nominal Group Process and specially designed questionnaires for analyzing nursing activities. Approximately 100 nurses from a 193-bed short-term general hospital participated in the study. The resulting task delegation rates are compared with hospital policy, and a comparison is also made between different nursing units.

Delphi Technique↗
PubMedDate not supplied

Are nurses acting as role models for the prevention of SIDS.

PURPOSE: To examine nurses' knowledge, attitude, and practice in positioning healthy newborns for sleep in the hospital setting. DESIGN AND METHODS: A cross-sectional descriptive design was used to survey a convenience sample of practicing maternal child nurses in 58 Missouri hospitals. A 24-item investigator designed questionnaire was developed with input from SIDS Resources in Missouri. RESULTS: A total of 528 surveys were analyzed. These nurses reported no longer placing infants in the prone position for sleep, but almost 75% of those answering the survey used either the side-lying position or a mixture of side and back positioning, even though 96% of the nurses said they were aware of the AAP Guidelines recommending "back to sleep." Forty-five percent of the nurses thought the infant would be at risk for aspiration if only placed on his/her back. Only 53% of the nurses knew their hospital's policy about newborn positioning; 80% of those who knew about the policy said it included the lateral position as being acceptable practice. CLINICAL IMPLICATIONS: Nurses are the role models for new parents regarding newborn sleep position, and are in a unique position to influence parents' decisions about how to place their infants for sleep at home. Because nurses continue to worry about aspiration when newborns are placed on their backs, it is clear that more education is needed for hospital nurses about newborn sleep position and hospital policies, as well as AAP Guidelines.

Adult↗
PubMed2002

Physical activity and glucose tolerance in elderly men: the Zutphen Elderly study.

PURPOSE: To determine whether physical activity is associated with glucose tolerance in the elderly. METHODS: We examined current and 5-yr change in physical activity in relation to glucose tolerance in 424 randomly selected male inhabitants of the Dutch town Zutphen, aged 69-89 yr, without known diabetes mellitus. Physical activity was assessed by a validated questionnaire designed for retired men. Glucose intolerance was assessed by an oral glucose tolerance test and defined as impaired glucose tolerance or diabetes mellitus. RESULTS: Men with 30 min x d(-1) or more of physical activity of at least moderate intensity had a lower prevalence of glucose intolerance as compared to men without these activities (age-adjusted odds ratio 0.32; 95% CI, 0.18-0.57). Adjustment for family history of diabetes, smoking, alcohol intake, dietary factors, body mass index, and subscapular skin-fold thickness or exclusion of men with cardiovascular diseases or disabilities did not substantially change the results. With specific activities modeled simultaneously, bicycling (P for trend = 0.01) and gardening (P for trend = 0.02) were inversely associated with glucose intolerance. Men whose amount of physical activity had decreased during the past 5 yr had significantly higher age-adjusted 2-h glucose concentrations as compared with men who remained at least as active (difference 0.7 mmol x L(-1); 95% CI, 0.1-1.3). CONCLUSION: These findings suggest that common types of physical activity such as bicycling and gardening may contribute to the prevention of glucose intolerance in elderly men

Aged↗
PubMed1983

Patients' perceptions of the cosmetic impact of melanoma resection.

This study investigated the relationship between primary versus grafted closure for melanoma and the cosmetic impact on the patient of the resulting scar. A total of 176 patients with melanoma completed a multiple-choice questionnaire designed for this study. Two factors were significantly related to negative cosmetic impact: severity of scar indentation (but not scar length) and the extent to which patients were unprepared for the actual size of their scars. Patients whose scars were deeply indented as well as those whose scars were larger than anticipated displayed greatest distress about their appearance. Cosmetic impact was greater for women than for men. These observations suggest that primary closures, rather than closures requiring skin grafts, have important psychological benefits for patients and that physicians can assist postoperative adjustment by giving patients accurate information about the expected appearance of their scars.

Body Image↗
PubMed1999

A retrospective study of changes in physical symptoms and body image after reduction mammaplasty.

Reduction mammaplasty is performed typically to alleviate the painful physical symptoms of macromastia. Women who suffer from macromastia also frequently present to the plastic surgeon with heightened body image dissatisfaction and maladaptive behavioral changes in response to their breast size. Numerous investigations have demonstrated improvement in physical symptoms after breast reduction surgery. Studies have also suggested that psychological improvement occurs postoperatively; however, they have not used well-validated, standardized psychological measures. The present study is a retrospective analysis of the physical and psychological status of women who underwent reduction mammaplasty. One hundred ten patients who underwent a reduction mammaplasty between 1982 and 1996 were mailed a packet of questionnaires designed to assess current physical symptoms and body image. Sixty-one of the 110 patients (55 percent) responded. The vast majority reported substantial improvement or elimination of neck, back, shoulder, and breast pain, grooving from bra straps, poor posture, skin irritation, and social embarrassment. In addition, they reported significantly less dissatisfaction with their breasts as compared with a sample of breast reduction patients assessed preoperatively. Symptom relief and improved body image occurred independently of preoperative body weight, as we found few significant differences between obese and non-obese women concerning the resolution of physical symptoms or improvement in body image. Results provide further evidence of the efficacy of reduction mammaplasty not only for relief of physical symptoms but also for alleviation of body image dissatisfaction.

Adult↗
PubMed2000

Current practice of patient follow-up after potentially curative resection of cutaneous melanoma.

Follow-up care for patients who have undergone potentially curative resection of cutaneous melanoma varies widely among physicians, and the underlying rationale has not been assessed. To quantify current practice patterns and to discern motivation, a custom-designed questionnaire was mailed to U.S. and non-U.S. surgeons, all of whom were members of the American Society of Plastic and Reconstructive Surgeons (ASPRS). Surveys were mailed to 3,032 ASPRS members, chosen randomly from a total of 4,320 members. Of the 1,142 questionnaires that were returned, 395 were evaluable. Nonevaluability was usually due to lack of melanoma patients receiving follow-up in the surgeons' practices. Surveillance of patients after resection of melanoma relies most heavily on office visit, chest x-ray, complete blood count, and liver function tests. There was surprisingly little influence of elective node dissection on follow-up practices. Imaging tests such as computed tomography, magnetic resonance imaging, and position emission tomography scan were rarely employed. Surveillance is motivated by many factors, particularly early detection of recurrence of the index melanoma and second primary melanomas. This survey provides information regarding current follow-up strategies recommended by ASPRS surgeons after potentially curative resection of cutaneous melanoma. There is considerable variation in surveillance intensity and in motivation among practitioners, thus representing a lack of consensus.

Adult↗
PubMedDate not supplied

Prognosis of chronic fatigue in a community-based sample.

OBJECTIVE: This study examined predictors of fatigue severity and predictors of continued chronic fatigue status at wave 2 follow-up within a random, community-based sample of individuals previously evaluated in a wave 1 prevalence study of chronic fatigue and chronic fatigue syndrome that originally took place between 1995 and 1997. METHODS: Wave 1 data were from a larger community-based prevalence study of chronic fatigue syndrome. In the present study, a second wave of data were collected by randomly selecting a sample of participants from the wave 1 sample of 18,675 adults and readministering a telephone screening questionnaire designed to assess symptoms of chronic fatigue syndrome. RESULTS: Findings revealed that wave 1 fatigue severity was a predictor of fatigue severity at wave 2 in the overall sample of individuals with and without chronic fatigue. In the smaller sample of individuals with chronic fatigue, wave 1 fatigue severity, worsening of fatigue with physical exertion, and feeling worse for 24 hours or more after exercise significantly predicted continued chronic fatigue status (vs. improvement) at wave 2 follow-up. CONCLUSIONS: These findings underscore the prognostic validity of postexertional malaise in predicting long-term chronic fatigue and also highlight the importance of using population-based, representative random samples when attempting to identify long-term predictors of chronic fatigue at follow-up.

Adolescent↗