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PubMed1998

The incidence and severity of rheumatoid arthritis, results from a county register in Oslo, Norway.

OBJECTIVE: To examine the incidence of rheumatoid arthritis (RA) in the community of Oslo, Norway; and to link the incidence to measures of disease severity. METHODS: A register for RA in the county of Oslo was validated to be 85% complete for patients between 20 and 79 years of age. The incidence of RA was calculated from this register for patients with disease onset 1988-1993 (n=550). Data on health related quality of life [Modified Health Assessment Questionnaire (MHAQ), Arthritis Impact Measurement Scale 2 (AIMS2), pain, fatigue] were obtained from a postal survey (response rate 73%). RESULTS: The overall annual incidence of RA over a 6 year period was 25.7/100,000 (females 36.7, males 13.8). The incidence increased with age, from 7.8 in the age group 20-29 to 61.0 between 70 and 79 years. After 5 year followup a clinically important effect on physical function (MHAQ > 1.5) was seen in 38% of the patients, on social functioning (AIMS2 social > 4) in 50%, on mental distress (AIMS2 affect > 4) in 27%, on pain (VAS > 40 mm) in 35%, and on fatigue (VAS > 40 mm) in 41%. CONCLUSION: The incidence of RA was 25.7/100,000 in the population of Oslo. After 5 years, 40-50% had clinically important changes in health status. The annual disease incidence with clinically important effect on physical function after 5 years was 10/100,000 individuals at risk.

Adult↗
PubMed1998

The social environment and health in rheumatoid arthritis: marital quality predicts individual variability in pain severity.

OBJECTIVE: To examine prospective relations between a wide array of measures of social functioning and pain, while controlling for disease duration and activity and functional grade. METHODS: As part of a larger study on health care utilization, longitudinal data were collected from 136 Dutch and 98 German outpatients on clinical status and pain. Social data included information on sexual handicap, spouse behavior, loneliness, daily emotional support, and the maintenance of pleasurable life domains. Pain severity was assessed at baseline and 12 months later with standard measures of pain and analyzed with hierarchical regressions. RESULTS: Social measures obtained at baseline were consistently associated with pain at followup. Depression was a moderate correlate of pain in the Dutch and German samples. The regressions revealed that patient reports of negative spouse behavior (such as avoidance and critical remarks) and baseline depression predicted worse pain outcome, and this association remained significant in analyses controlling for baseline pain. The level of formal education was a weak correlate of disability, emotional support, and pain. Daily emotional support and social life domains associated with positive affect had an indirect influence on outcome. The absence of strong rather than weak social ties was the component of the loneliness construct linked to pain. These associations between social prognostic factors and pain severity, however, were mediated by psychological functioning at baseline. CONCLUSION: The social environment was found to operate on the core health outcome, pain severity, via several pathways. Social functioning may be affected by rheumatoid arthritis (RA) progression, but it also appears to form a determinant of future health outcome. Not only the status of being married but also the quality of the relationship in terms of long-term stress and emotional support may be useful prognostic factors in RA.

Activities of Daily Living↗
PubMed2003

Acute and maintenance ECT with flupenthixol in refractory schizophrenia: sustained improvements in psychopathology, quality of life, and social outcomes.

OBJECTIVE: To determine the effects of ECT combined with antipsychotic medication therapy on psychopathology, quality of life, and social functioning in patients with refractory schizophrenia. METHOD: An open acute (Phase I) and maintenance (Phase II) study of the combination of ECT and flupenthixol in the treatment of 46 schizophrenic patients who were nonresponsive to antipsychotic medication from at least two different classes. Scales used: the Brief Psychiatric Rating Scale (BPRS), the Quality of Life Scale (QLS), Social and Occupational Functioning Assessment Scale (SOFAS), Global Assessment of Functioning (GAF), and Mini-Mental State Exam (MMSE). The duration of Phase II was 1 year. RESULTS: In Phase I, there were marked reductions in the BPRS scores, and substantial increases in the QLS, SOFAS, GAF, and MMSE scores. During Phase II, the BPRS negative symptoms worsened but remained improved from baseline. Changes in other outcome measures were negligible. CONCLUSION: ECT and MECT combined with flupenthixol were effective in improving psychopathology in patients refractory to antipsychotic medication alone. Ratings of psychopathology, quality of life, and social functioning all improved in Phase I and were generally sustained during Phase II in patients who had remitted.

Acute Disease↗
PubMed2003

Baseline personality functioning correlates with 6 month outcome in schizophrenia.

OBJECTIVE: The assessment of outcome in schizophrenic patients should consider both the response to treatment and the recovery of social skills. The aim was to evaluate the outcome and related psychostructural and clinical factors in schizophrenic patients after they underwent 6 months of residential multimodal treatment. METHOD: Fifty-two schizophrenic patients enrolled in a multimodal treatment program were included in the study. Symptomatology and social functioning were assessed with the Brief Psychiatric Rating Scale (BPRS) and the Social and Occupational Functioning Assessment Scale (SOFAS). The Karolinska Psychodynamic Profile (KAPP) was used for the psychostructural evaluation. RESULTS: After 6 months there was a significant improvement in the global scores of BPRS, SOFAS, and some areas of KAPP. The personality (KAPP) and social-occupational functioning (SOFAS) at baseline (T0) correlated with the global score of BPRS at 6 months (T6); moreover, SOFAS at T6 correlated with BPRS and KAPP at T0 and with the illness duration. CONCLUSION: The better the personality functioning in schizophrenic patients the better seems to be the response to treatment, with regard to symptoms as well as rehabilitation. Personality assessment might be useful for the individualisation of therapies, even within the context of a standardised program.

Adult↗
PubMedDate not supplied

The effect of lifestyle interventions on quality of life and patient satisfaction with health and health care.

Improvements in quality of life (QOL) and high levels of patient satisfaction are associated with cardiovascular risk reduction (CRR) programs. Understanding the influences that lifestyle change and medical management have on individuals, their families, and their environment can help target successful interventions that benefit both QOL and patient satisfaction. It is well known that multiple aspects of one's QOL can be affected by the development of coronary artery disease. Development of depressive symptoms and anxiety, along with declines in functional capacity and family and social functioning, has been reported. QOL is a dynamic continuum, relating to many aspects of one's life. Social relationships, financial situations, work-related issues, physical limitations, and intellectual challenges all play a role in determining QOL and satisfaction within the health care setting. Self-perception of how these factors negatively or positively influence one's QOL also exerts a strong influence. This article will review the influence of primary and secondary prevention programs on QOL and patient satisfaction.

Activities of Daily Living↗
PubMed2004

Duration of untreated psychosis: impact on 2-year outcome.

BACKGROUND: The duration of untreated psychosis has been postulated to be a predictor of clinical outcome in schizophrenia. Although several prospective studies support the relationship, some studies do not. These differences may be due to a number of methodological issues. The objectives of this study are: (i) to address many of the methodological limitations of earlier studies such as variations in sample size and selection, type of treatment provided, differences in measurement of DUP and outcome, and length of follow-up; and (ii) to examine the relationship between DUP and outcome in a prospective longitudinal study. METHOD: The DUP of 200 consecutive admissions to a first-episode programme was determined. The sample was followed over 2 years and pre-morbid functioning, symptoms, social and cognitive functioning and substance use were assessed longitudinally. RESULTS: Two years after admission to the programme, longer DUP was significantly associated with high levels of positive symptoms and poor social functioning. Independently of other variables, DUP predicted positive symptoms and social functioning at 1 and 2 years. CONCLUSIONS: There is evidence that long DUP continues to have an influence on outcome up to 2 years. These results support ongoing efforts for early detection and intervention.

Cognition Disorders↗
PubMed2007

Excessive alcohol consumption is associated with reduced quality of life among methadone patients.

AIM: To evaluate the impact of excessive alcohol consumption on the health-related quality of life of patients receiving methadone treatment for opioid dependence. DESIGN: A cross-sectional survey. PARTICIPANTS: One hundred and ninety-two patients attending out-patient methadone clinics in the south-east of England, United Kingdom. MEASUREMENTS: Quality of life (QoL) was assessed using the Medical Outcomes Study: General Health Survey, Short Form (SF-12). Alcohol consumption was assessed using the Alcohol Use Disorders Identification Test (AUDIT). FINDINGS: Approximately one-third of the sample (57/192) were AUDIT-positive (score > or = 8) and 20 of the 135 AUDIT-negative patients reported past history of alcohol problems. AUDIT-positive patients were less satisfied with their methadone dose than AUDIT-negative patients (P = 0.002), despite having a higher dose. AUDIT-positive patients reported more physical (P = 0.020) and psychological (P = 0.034) health problems and poorer QoL (P = 0.008) with an estimated effect size of 0.46. Lower QoL scores for AUDIT-positive patients affected both 'physical' (P = 0.009) and 'psychological' (P = 0.012) health domains with poor role functioning ('role limitation' due to physical health, P < 0.001 and to emotional health, P = 0.009), social functioning (P = 0.015) and self-perceived general health (P = 0.029). CONCLUSION: Excessive alcohol consumption may be associated with a distinctive pattern of QoL impairment in methadone patients. In addition to advising methadone patients regarding their alcohol consumption, comprehensive care plans should seek to restore normal personal, family and social role functioning through the provision of appropriate health and social care.

Adolescent↗
PubMed1994

Fear of falling and fall-related efficacy in relationship to functioning among community-living elders.

BACKGROUND: The relationships of fear of falling and fall-related efficacy with measures of basic and instrumental activities of daily living (ADL-IADL) and physical and social functioning were evaluated in a cohort of community-living elderly persons. METHODS: Sociodemographic, medical, psychological, and physical performance (e.g., gait speed, timed hand function) measures were administered, during an in-home assessment, to a probability sample of 1,103 residents of New Haven, Connecticut, who were > or = 72 years of age. Falls and injuries in the past year, fear of falling, and responses to the Falls Efficacy Scale were also ascertained. The three dependent variables included a 10-item ADL-IADL scale, an 8-item social activity scale, and a scale of relative physical activity level. RESULTS: Among cohort members, 57% denied fear of falling whereas 24% acknowledged fear but denied effect on activity; 19% acknowledged avoiding activities because of fear of falling. Twenty-four percent of recent fallers vs 15% of nonfallers acknowledged this activity restriction (chi 2 = 13.1; p < .001). Mean fall-related efficacy score among the cohort was 84.9 (SD 20.5), 79.8 (SD 23.4), and 88.1 (SD 17.9) among fallers and nonfallers, respectively (p < or = .0001). Fall-related efficacy proved a potent independent correlate of ADL-IADL (partial correlation = .265, p < .001); physical (partial correlation = .234, p < .001); and social (partial correlation = .088, p < .01), functioning in multiple regression models after adjusting for sociodemographic, medical, psychological, and physical performance covariates as well as history of recent falls and injuries. Fear of falling was only marginally related (p = .05) with ADL-IADL functioning and was not associated with higher level physical or social functioning. CONCLUSIONS: The strong independent association between self-efficacy and function found in this study suggests that clinical programs in areas such as prevention, geriatric evaluation and management, and rehabilitation should attempt simultaneously to improve physical skills and confidence. Available knowledge of the factors influencing efficacy should guide the development of these efficacy-building programs.

Accidental Falls↗
PubMed1988

Visual results and social rehabilitation after cataract surgery. A retrospective comparison of the effect of non-IOL and IOL surgery.

This report examines the changes that occurred in the post-operative visual and social function of patients with cataract when the hospital responsible for cataract treatment (roughly 1000 cataract extractions per year) shifted from non-IOL to IOL techniques. Visual function and vision-dependent social performance were compared retrospectively in 116 patients, 53 of whom had undergone cataract extraction without IOL implantation, and 63 of whom had been treated by IOL implantation. Patients with no IOL had the possibility of using extended-wear contact lenses if unable to tolerate aphakic spectacles. Visual results and social rehabilitation were good with both techniques, and there was no significant difference in vision-dependent social performance between the groups. The quality of vision and patient satisfaction with surgery were better in IOL patients. It appears that, once vision is restored by surgery and contact lenses are available, post-operative function in patients is determined by factors other than the type of cataract surgery. However, the shift to IOL surgery brings about improved quality of vision and patient satisfaction.

Aged↗
PubMed2005

Social cognitive problem-solving in schizophrenia: associations with fluency and verbal memory.

This study assessed the relationship between social functioning and neurocognitive function in individuals with schizophrenia. Social cognitive problem-solving (SCPS) is a significant contributor to social competence and is an aspect of information processing that is involved in the identification and resolution of interpersonal or social problems. We examined 49 schizophrenia patients and 28 healthy controls using the means-ends problem-solving procedure (MEPS) for SCPS, the Rey Auditory Verbal Learning Test (RAVLT), the Wisconsin Card Sorting Test (WCST), and a series of fluency tests for neurocognitive assessment, as well as the Positive and Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning (GAF). Fluency tests can be used to evaluate divergent thinking, and a qualitative analysis was done of the fluency test responses. The results suggest that patients with schizophrenia have a significantly poorer MEPS performance than normal controls. In patients with normal RAVLT scores, MEPS scores were correlated with task-modified responses on the fluency test but not with any of the WCST scores. This suggests that SCPS is related to divergent thinking that requires concept flexibility and/or the conversion of viewpoint in patients with schizophrenia in whom verbal memory function is preserved.

Adult↗
PubMedDate not supplied

Universal, developmental, and variable aspects of young children's play: a cross-cultural comparison of pretending at home.

Using longitudinal data from five Irish American families in the United States and nine Chinese families in Taiwan, in conjunction with an emerging body of evidence in the cultural psychology literature, we propose universal, culturally variable, and developmental dimensions of young children's pretend play. Possible universal dimensions include the use of objects, and the predominantly social nature of pretend play. Developmental dimensions include increases in the proportion of social pretend play initiated by the child, the proportion of partner initiations elaborated upon by the child, and caregivers' use of pretend play initiations to serve other, nonplay social functions. Culturally variable dimensions include the centrality of objects, the participation of specific play partners, the extent of child initiations of social pretend play with caregivers, the various functions of social pretend play in interaction, and specific themes. These findings raise the theoretical issue of how universal and variable dimensions of pretend play interact in specific communities to create distinctive development pathways.

Child Development↗
PubMed1999

Predictors of residential independence among outpatients with schizophrenia.

OBJECTIVE: Many outpatients with schizophrenia receive support or supervision in their place of residence, but the predictors of residential independence are not clearly understood. The purpose of this study was to identify factors that predict the degree of residential independence among outpatients with schizophrenia. METHODS: Seventy-two outpatients with schizophrenia were assigned to three groups based on their degree of residential independence. The three groups were compared on three measures of social functioning, on the Positive and Negative Syndrome Scale, and on a battery of neuropsychological tests. RESULTS: Patients' degree of residential independence was related to their frequency of family contact, hygiene skills, relative absence of negative symptoms, and participation in social activities. In a discriminant function analysis, the residential status of 78 percent of the patients was correctly classified. CONCLUSIONS: Aspects of social functioning are significantly associated with patients' independent living status. Future research is needed to determine how family contact, social activities, and hygiene skills may increase patients' degree of residential independence.

Activities of Daily Living↗
PubMed2000

Relationship of infarct artery patency and left ventricular ejection fraction to health-related quality of life after myocardial infarction: the GUSTO-I Angiographic Study experience.

BACKGROUND: Post-myocardial infarction global ejection fraction and infarct-related artery patency might be expected to be associated with health-related quality-of-life (HRQOL) outcomes, but this association has not been previously shown. The GUSTO-I Angiographic Study cohort 2-year follow-up afforded an examination of such potential relationships. METHODS AND RESULTS: A total of 1848 patients (87.7% response rate) who were enrolled in the GUSTO-I Angiographic Study were contacted for a telephone interview regarding their current HRQOL (physical function, psychological well-being, perceived health status, and social function) 2 years after MI. In multivariable models, left ventricular ejection fraction (EF) was significantly related to physical (P:=0.021) and social (P:=0.014) function, psychological well-being (P:=0.042), and perceived health status (P:=0.024). Infarct-related artery patency was not directly related to any HRQOL outcome. A decreasing EF was predictive of poorer outcomes in each HRQOL dimension. Men consistently had better outcomes in all HRQOL dimension with the exception of perceived health status. Increasing age was predictive of poorer outcomes in all dimensions of HRQOL except for psychological well-being where the inverse occurred; younger patients experienced greater depression, anxiety and worry than their older counterparts. The presence of comorbidities increased the likelihood of worse outcomes in all dimensions. CONCLUSIONS: This is the first study to demonstrate a significant relationship between EF and long-term HRQOL outcomes. This advantage in left ventricular function preservation should be added to the mortality advantage when considering the impact of treatment strategies for myocardial infarction.

Aged↗
PubMed2004

[Health problems and support from the health & welfare service in the elderly at home].

PURPOSE: This study was conducted to identify health problems and support received from the health and welfare service using MDS-HC(Minimum Data Set for Home Care) in the aged living at home. METHOD: Eighty-one elderly persons were selected from those listed in community-welfare service centers in Seoul and Kyunggi Province between December 2002 and January 2003. RESULT: Eleven health problems per elderly person on average were identified, and the frequent care needs were in order: preventive health measure, health promotion, visual function, depression & anxiety, communication disorders, social function, pain, environmental assessment, oral health, cognition and falls. The number of health problems by the level of ADL was 'ADL 1(Independence)' 9.87, 'ADL 2(Partial independence)' 12.78, 'ADL 3(Dependence)' 13.73. Utilization of formal health & welfare services among the elderly was 'meals on wheels' 40.7%, 'home helper' 38.2%, 'visiting of social welfare worker' 21.0%, 'physical therapy' 19.6%, 'day care center' 12.3%, 'volunteer's service' 9.9%, 'home visiting care' 3.7%, 'occupational therapy' 3.7%, and 'speech therapy' 2.5%. CONCLUSION: The results suggest that using the MDS-HC 2.0 is applicable to help decide criteria for both health and welfare service supplied to the elderly.

Aged↗
PubMedDate not supplied

Generalized social phobia versus avoidant personality disorder: differences in psychopathology, personality traits, and social and occupational functioning.

Four groups of patients with social phobia (SP) were compared with regard to psychopathologic characteristics, personality traits, and social and occupational functioning. Fifteen persons with discrete social phobia without any personality disorder (DSP), 28 persons with generalized social phobia (GSP) without any personality disorder, 24 persons with GSP with a single diagnosis of avoidant personality disorder (APD), and 23 persons with GSP with more than one PD were included in the present study. APD had higher levels of social phobic avoidance, depressive symptoms, neuroticism, introversion, and social and occupational impairment as compared with GSP. DSP was found to be the least severe condition. OPD was the most impaired on nearly all variables. Logistic regression analyses revealed that introversion and depressive symptoms were able to predict correctly the presence or absence of an APD in 85% of those with social phobia. These findings are discussed in the light of the severity continuum hypothesis of social phobia and APD and recommendations for future research are given.

Adolescent↗
PubMed2004

Hallucination focused integrative treatment improves quality of life in schizophrenia patients.

OBJECTIVE: Psychosocial treatment seems to be effective in the management of schizophrenia, although less in the area of quality of life and social functioning. To study the effectiveness of a hallucination focused integrated treatment with cognitive-behaviour therapy and coping training among schizophrenia patients suffering from 'hearing voices'. METHOD: In a randomized controlled trial (RCT) with 31 patients in the integrated treatment condition and 32 patients in the routine care condition, quality of life was assessed with the self-report questionnaire of the WHO (Bref), and social role functioning with an interviewer based schedule, at entry and 9 (post-treatment) and 18 months later. RESULTS: Follow-up data suggest a significant improvement of quality of life and in particular in social role functioning (effect size 0.64) in favour of the integrated treatment. CONCLUSION: The integrated treatment seems to be effective in reducing overall disability levels and number of patients with serious disabilities.

Adaptation, Psychological↗
PubMed1992

Gender differences in the clinical expression of schizophrenia.

Gender differences have been reported for a variety of clinical measures in patients with schizophrenia. Clinical characterization may be helpful in identifying symptom clusters which can then be linked to underlying brain function. In this study 74 men and 33 women meeting DSM-IIIR criteria for schizophrenia were studied off medication and rated on measures of symptom type and severity, as well as premorbid and current function. Men were more severely impaired in ratings of negative symptoms, while positive symptoms were not significantly different. There were also differences in premorbid and current functioning, with women manifesting better social functioning than men.

Activities of Daily Living↗
PubMed1988

Validity of Axis V of DSM-III and other measures of adaptive functioning.

In order to address validity issues which have not been adequately explored in the existing literature on Axis V, the authors compared ratings on this axis with ratings on three other measures of adaptive functioning (Social Competence, premorbid and present) in a diagnostically heterogeneous group of 195 referred adolescents. It was found that correlations amongst the measures were moderate, except between premorbid and present functioning, which was high. Axis V was found to be comparable with a measure of premorbid functioning while Social Competence was similar to present functioning.

Adolescent↗