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PubMed1995

A survey of new long-stay hospital patients in an Irish health board area.

OBJECTIVES: The aims of this study were to determine the number and rate of accumulation of new long-stay hospital patients in one of Ireland's eight health board areas, to describe their demographic and clinical features, and to assess their needs in relation to possible community placement. METHODS: Demographic and clinical information was obtained on all patients over age 17 who had been continuously hospitalized in area hospitals for more than one year and less than six years on the census day of March 1, 1992. The Community Placement Questionnaire was used to rate the patients' social functioning, problem behavior, physical disability, social contact, and needs for accommodation and day care. RESULTS: The survey identified 175 new long-stay patients, mainly middle aged to elderly. Schizophrenia was the most common psychiatric diagnosis. The bed occupancy rate for these patients was 14 per 100,000 population, and the annual accumulation rate was 2.3 per 100,000 population. CONCLUSIONS: New long-stay patients were chronically ill with significant psychiatric and social disabilities. Involuntary patients were overrepresented in the group. Two-thirds could be placed in the community if facilities were available and had sufficiently high staffing levels.

Activities of Daily Living↗
PubMed1996

Quality of life of long-stay patients discharged from two psychiatric institutions.

OBJECTIVE: The study compared the quality of life of long-stay psychiatric patients after they had been discharged to community residences for one year with that of long-stay patients who remained hospitalized. METHODS: Long-stay patients (that is, those with stays of at least one year) who were discharged from two psychiatric hospitals in London were closely matched with patients likely to stay in the hospital for another year. Baseline (in-hospital) and one-year follow-up assessments were conducted using six instruments to measure factors related to quality of life such as problems in social functioning and size of the social network. RESULTS: A total of 494 discharged patients were compared with 279 patients who remained in the hospital. The death rate did not differ between the two groups. Only six discharged patients became vagrants, and only two were imprisoned, one briefly. Discharged patients were living under much less restrictive conditions, they preferred their life in the community, and the number of their friends increased, as did the number of acquaintances in the community such as neighbors. No adverse effects of discharge on mental state or social behavior were noted. CONCLUSIONS: The results indicate that community care is a beneficial alternative to long-term care in psychiatric hospitals for the majority of patients, provided it is well planned and adequate resources are available.

Activities of Daily Living↗
PubMed2005

Home-based video CBT for comorbid geriatric insomnia: a pilot study using secondary data analyses.

Two recent studies showed that cognitive-behavioral treatment (CBT) is efficacious in treating insomnia in older adults with comorbid medical conditions. The authors extended these findings by comparing 12 older adults with comorbid insomnia who received a home-based video CBT program to the authors' previously published data on 24 participants who received classroom CBT or no treatment. All 36 participants were initially randomized within the same protocol, but the video arm was conducted 7 months after completion of the other two study arms. Compared to controls, the video CBT group demonstrated significant changes in five of eight self-report measures of sleep at posttreatment, including sleep latency, time awake after sleep onset, total time in bed, overall sleep quality, and dysfunctional beliefs and attitudes about sleep. Compared to controls, the video CBT group also had posttreatment improvements in daytime functioning, including mood, pain perception, social functioning, and energy-vitality. Although video CBT was not significantly different from classroom CBT on self-report measures, the attrition rate was higher (27% vs. 19%) and the number of participants who achieved clinically significant change was lower (50% vs. 73%). These preliminary findings suggest that delivering CBT in a home-based video format has the potential to serve as a first-line, cost-effective treatment for comorbid insomnia.

Aged↗
PubMed1997

Quality-of-life outcomes and the use of antihistamines in a French national population-based sample of patients with perennial rhinitis.

Our primary objective in designing the first large-scale nationwide population-based survey in France was to assess the impact of perennial rhinitis on quality of life. Our secondary objective was to describe the use of drug treatment, including histamine H1 antagonists, in that population. A pollbase of 20,000 households was screened for symptoms of rhinitis. 16,786 households responded, including 35,615 patients aged over 15 years, giving an overall response rate of 84%. Using an algorithm, 1367 patients with probable perennial rhinitis were selected for a cross-sectional collection of data about the history of their condition, comorbidity, use of medical resources, sick leave and nasal symptom-related quality of life [according to the Medical Outcomes Study 36-Item Short-Form Questionnaire (SF-36)]. Finally, multivariate regression techniques were used to describe the relationship between quality-of-life scores and treatment subgroups, controlling for some other confounding factors. The point prevalence of perennial rhinitis was estimated to be 4.1% [95% confidence interval (CI): 3.9 to 4.3%]. Association of perennial rhinitis with a history of asthma was highly significant (13.4% in those with perennial rhinitis vs 3.8% in those without; odds ratio 3.26; p < 0.001). 38% of the patients with perennial rhinitis reported having taken regular medication during the last 3 months. Antihistamine use was associated with use of decongestant or topical nasal products in about one-third of patients. Four SF-36 dimensions (physical functioning, role physical, bodily pain, social functioning) showed significantly higher mean scores (indicating better quality of life) in patients receiving non-anticholinergic histamine H1 antagonist therapy, relative to those receiving other treatments, a difference that was maintained after controlling for gender, age, level of nasal symptoms, medical history of asthma and number of general practitioner visits. These results established the long term impact of perennial rhinitis on quality of life (generic and specific), and raised questions about appropriate therapy, since a positive association between current use of non-anticholinergic antihistamines with improvements on some SF-36 dimensional scores in patients with perennial rhinitis was observed.

Adult↗
PubMed2000

Pool exercise combined with an education program for patients with fibromyalgia syndrome. A prospective, randomized study.

OBJECTIVE: To evaluate the effects of 6 months of pool exercise combined with a 6 session education program for patients with fibromyalgia syndrome (FM). METHODS: The study population comprised 58 patients, randomized to a treatment or a control group. Patients were instructed to match the pool exercises to their threshold of pain and fatigue. The education focused on strategies for coping with symptoms and encouragement of physical activity. The primary outcome measurements were the total score of the Fibromyalgia Impact Questionnaire (FIQ) and the 6 min walk test, recorded at study start and after 6 mo. Several other tests and instruments assessing functional limitations, severity of symptoms, disabilities, and quality of life were also applied. RESULTS: Significant differences between the treatment group and the control group were found for the FIQ total score (p = 0.017) and the 6 min walk test (p < 0.0001). Significant differences were also found for physical function, grip strength, pain severity, social functioning, psychological distress, and quality of life. CONCLUSION: The results suggest that a 6 month program of exercises in a temperate pool combined with education will improve the consequences of FM.

Adult↗
PubMedDate not supplied

Rett syndrome as a minicolumnopathy.

OBJECTIVE: Rett syndrome is a progressive neurological disorder affecting primarily females. It is characterized by the early regression of acquired language, cognitive functions, social skills, and purposeful hand function. Patients with Rett syndrome are often misdiagnosed as autistic. Recent reports of minicolumnar abnormalities in the brains of autistic and Asperger's syndrome prompted us to search for similar pathology in Rett syndrome. MATERIAL: The patient population consisted of 5 Rett syndrome patients (mean age = 14.4 +/- 4.0 years) and 17 controls (mean age = 14.6 +/- 9.5 years). Tissue was celloidin embedded, sectioned at 35 um and Nissl stained. Images (100x) were taken from Brodmann's areas 9, 21, and 22 from layer III of the left hemisphere. METHOD: Columnar width measurements for these images were obtained with computerized image analysis using previously published algorithms. Each area was analyzed separately with univariate ANOVA, including diagnosis as a fixed factor and age (linear and quadratic terms), and sex as covariates. RESULTS: Diagnosis dependent effects were statistically significant only in area 21 (p = 0.009) even when taking into account a Bonferroni correction for the multiple comparisons. CONCLUSION: Both the regional nature of the changes as well as differences in mean cell spacing differentiates the abnormal minicolumnar morphometry of Rett syndrome from that of autism.

Adolescent↗
PubMed2003

The long-term psychosocial effects of haematopoetic stem cell transplantation.

The purpose of this study was to identify long-term psychosocial effects of allogenic, syngenic and autologous haematopoetic stem cell transplantation (HSCT) on relevant parameters (physical performance, role and sexual functioning, intimate relationships, professional and social rehabilitation). A total of 163 patients, who had undergone an autologous (11.6%), syngenic (3.1%) or allogenic (85.3%) HSCT at the Department of Internal Medicine III, Ludwig-Maximilians-University, during a preceding 16-year period, were asked to complete the Herschbach Questionnaire on Stress in Cancer Patients in order to evaluate their current psychosocial distress status. An additional questionnaire for demographic data was used. Reduced quality of life as a result of HSCT is restored to its pre-HSCT level by most patients within 2 years after transplantation (no differences between groups transplanted 2-5, 6-9 or >10 years ago). The majority of patients had serious problems with "fitness" (24%), followed by problems with "pain" (17.2%) and "fear/emotional stress" (14.1%). Professional reintegration is an important factor in patients' well-being. However, 30.7% of these patients did not return to work at all. Unemployed patients had significantly higher scores for pain, anxiety, sleep disorders, depression, impairments in social functioning, partnership and family life. Only 9.8% of all patients took part in a psychotherapeutic programme and 39.3% in a rehabilitation programme. Identifying strategies for risk patients (e.g. lower education and married) need to be developed in order to optimize support for this group. Although some patients show a higher distress score in anxiety/fear and psychophysical performance, only 9.8% of all patients took advantage of available psychotherapy.

Adult↗
PubMed1992

Nutrition related resource use in urban areas.

Current social organization of cities is unable to respond to increases in the population fast enough to ensure adequate physical and social functioning of all inhabitants. New social structures in the organization of cities is changing the situation of disadvantaged and malnourished people by changing their access to resources. Resources include a number of non-economic ones that can contribute to improve health and nutritional status. The use of these resources depends on individual choices by people. The nature of basic needs predisposes these choices to include ones that are economically irrational and an inefficient use of resources from economic standpoints. The combination of restricted access to resources and inherent inefficiencies in their use determine the health and nutritional situation of people. Indicators of change in the number of choices and the elasticities of benefits associated with them would recognise both the non-competitive and the market aspects of the new urban social organization. Indicators of the number and type of choices available to people, associated with the nutritional and health benefits derived from those choices may be tools for use in urban planning to support new initiatives for groups in fast growing areas where malnutrition is prevalent.

Asia, Southeastern↗
PubMed2002

[Stressors in the teacher's workplace].

Psychosocial stressors are common problem affecting social functioning and health in many social groups. A great variety of stressors affect people working in auxiliary professions. Those stressors may induce professional burnout. The article outlines differences and similarities between Maslach burnout construct and a few concepts of stress. It also gives the literature review concerning job stressors in teachers. A wider view on teaching profession from the perspective of social sciences aims at deepened diagnosis and therapy in the context of psychiatric disturbances and constitutes the basis for planing and implementing environmental programmes of health promotion for this profession. Such perspective is consistent with the latest decisions of European Union.

Adaptation, Psychological↗
PubMed2006

[The value of SF-36 questionnaire for the measurement of life quality in chronic obstructive pulmonary disease].

This study was performed in chronic obstructive pulmonary disease (COPD) patients to compare the SF-36 questionnaire with pulmonary function tests and non-functional parameters. Fourty-five COPD patients diagnosed according to GOLD 2004 criteria were included in the study. The stable patients were evaluated by spirometry, static lung volumes, diffusion capacity, 6 MWD, BORG scale, MMRC dyspnea measurement and SF-36 life questionnaire performed on the same day. The mean age of the patients was 66 +/- 10 years and the female/male ratio was 4/41. The mean FEV1/FVC ratio was 0.49 (moderate COPD n = 18, severe COPD n = 27). The RV/TLC ratio was 0.52. Walking distance was less than normal, with a mean of 375 +/- 119 m. All the SF-36 scale except pain index are low compared to normal. General health perceptions, physical functioning, role physical, role emotional, social functioning, energy and mental health index are as follows: 47 +/- 24, 50 +/- 30, 35 +/- 38, 49 +/- 37, 63 +/- 33, 49 +/- 20, 59 +/- 20, respectively. When the general health scale compared with FVC and FEV1 revealed moderate correlation was found (r = 0.56, r = 0.55, respectively). Physical functioning compared with FVC, FEV1, RV/TLC and IC revealed moderate correlation (r = 0.62, r = 0.67, r = -0.54, r = 0.65, respectively). General health and physical functioning scales correlated with the non-functional parameters (MMRC, 6 MWD) (r = -0.51, r = 0.53, r = -0.61, r = 0.64 respectively). The SF-36 general quality of life questionnaire is a useful measurement instrument for the evaluation of therapeutic efficiency and follow up of COPD patients.

Adult↗
PubMedDate not supplied

[Depressive symptoms during treatment with interferon alpha for HCV infection--preliminary report].

BACKGROUND: Interferon alpha, used in hepatitis C virus (HCV) infection causes many neuropsychiatric side effects: emotional disturbances, chronic fatigue, cognitive impairment, and psychotic states. They overlap with emotional disturbances and cognitive impairment caused by chronic HCV infection. AIM: To assess prevalence and severity of depressive symptoms in patients treated with interferon alpha due to HCV infection. METHODS: A total of 44 persons (27 men, 17 women) aged from 21 to 61 years old (median 45 years) treated due to chronic hepatitis were examined. They were treated with pegylated interferon alfa 2a and ribavirin. All of them underwent liver biopsy to assess liver inflammation, fibrosis, and steatosis as well as completed Eysenck's neuroticism questionnaire. Then, before treatment and after 12 weeks, they underwent biochemical and psychiatric examination. Biochemical examination included aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transpeptidase (G-GT), and HCV RNA. Psychiatric examination included Beck Depression Inventory (BDI), Hamilton Depressive Rating Scale (HAMD), Montgomery-Asberg Depression Rating Scale (MADRS), and the SF-36 questionnaire. Diagnoses of depression were made basing on PSE questionnaire from Schedules of Clinical Assessment in Neuropsychiatry (SCAN version 2.0). RESULTS: Depressive disorders were diagnosed in 3 (6.8%) subjects before treatment and in 5 (11.4%) subjects after 12 weeks of treatment. A statistically significant increase of depressive rates was observed (medians: HDRS 6/11.5; MADRS 4/10; BDI 8/10.5). Quality of life dropped significantly in some SF - 36 scales: physical functioning, general health, vitality, and social functioning. Depressive ratings were independent of biochemical parameters (AST, ALT, G-GT), HCV RNA, liver inflammation, fibrosis, steatosis level, and HCV genotype. Ratings of neuroticism highly influenced all depressive ratings. Rise of depressive ratings was independent of neither any initial biochemical parameters nor the neuroticism level. CONCLUSIONS: Interferon alpha increases the severity of depressive symptoms. The rise is probably caused by biological activity of interferon and independent of initial ratings of depression.

Adult↗
PubMed2006

[Investigation and analysis of the self-esteem level and social adaptation ability of hospitalized burn patients].

OBJECTIVE: To investigate the self-esteem level and social adaptation ability of hospitalized burn patients in our burn ward. METHODS: One hundred and twenty hospitalized burn patients in our burn ward were enrolled in the study and evaluated according to their sex, severity of burn injury and education level. Their self-esteem level and social adaptation ability were scored with the Felling of Inadequacy Scale and Abbreviated Burn Specific Health Scale. RESULTS: The general score of self-esteem of the patients with mild burns( 183+/-23) was obviously lower than that with moderate and severe burns (167+/-21 and 154 +/-24) , ( P <0.01). The self-esteem level of burn patients was different in different sex and education level. Among the self-esteem scores, male burn patients presented evidently higher scores of self evaluation, social ability, appearance, as well as the general score than those in the female ( P < 0.05). Moreover, the self evaluation score and study ability was higher in those with higher education level than those with lower education. Furthermore, the score of social adaptation ability was higher in the patients with mild burns than that in patients with moderate and severe burns ( P < 0. 01). The social adaptation ability and psychological function were much higher in male patients than those in female patients, but the former were weaker than the latter in regard to the body function. The psychological function, social relationship and general condition of the patients with lower education were better than those with higher education ( P <0. 05 ). CONCLUSION: There existed difference in the self-esteem and social adaptation ability in different burn patients during different periods.

Adolescent↗
PubMedDate not supplied

Physiologic and psychologic factors related to depression in patients after myocardial infarction: a pilot study.

OBJECTIVE: To examine physiologic and psychologic factors contributing to depression in patients one year after myocardial infarction. DESIGN: Convenience, correlational design. SETTING: A university-affiliated cardiology clinic, a health maintenance organization, and a private cardiology group in a southwestern city. SUBJECTS: Fifteen men and six women 10 to 14 months after myocardial infarction. OUTCOME MEASURES: Oxygen saturation, somatic symptoms, and functional status in three areas (social, physical, and emotional) were correlated to depression scores by use of the Zung Self-rating Depression Scale (SDS) and the Symptom Questionnaire (SQ). RESULTS: Spearman rho correlations showed that depression measured with the Zung SDS and SQ depression subscale were inversely related to somatic symptoms, social function, physical function, emotional function, and total function. There was a significant inverse relationship between depression 9as measured by the Zung SDS) and both oxygen saturation and physical function. Although there was an inverse relationship between depression (as measured by the SQ subscale) and both oxygen saturation and physical function, it was not statistically significant. A Mann-Whitney U test for differences showed that mean SDS scores for Hispanic subjects (n = 5) and white subjects (n = 16) differed significantly. Stepwise multiple regression showed that overall functional status accounted for 56% of the variance for depression in the SDS and for 59% in the SQ depression subscale. Oxygen saturation accounted for less than 1% of the variance in both depression scales. CONCLUSIONS: The results of this study indicate that depression is negatively correlated with overall functional status in a select group of patients one year after myocardial infarction. A moderate negative correlation was also found between depression and hypoxia. Hispanic subjects had significant differences in their mean Zung SDS scores as compared with white subjects.

Depression↗
PubMed1998

Burden of illness of multiple sclerosis: Part II: Quality of life. The Canadian Burden of Illness Study Group.

OBJECTIVE: To measure the quality of life (QoL) of multiple sclerosis (MS) patients in Canada using a generic QoL instrument, the SF-36. METHODS: QoL was assessed in 198 MS patients, recruited from 14 MS Clinics in Canada, and stratified into three levels of disease severity, based on their Expanded Disability Status Scale (EDSS) score. Statistical tests were used to compare QoL scores between severity groups and to identify possible relationships between QoL and patient sociodemographic, clinical and economic parameters. RESULTS: QoL scores for all eight scales of the SF-36 were substantially reduced early in the disease. Compared to the normal population, QoL scores for patients with mild MS were on average 30% lower for all SF-36 scales. With EDSS progression a statistically significant decrease in three of the SF-36 domains (physical function, role-physical, and social function) was observed. There were no significant correlations between patient parameters considered and QoL scores. CONCLUSIONS: QoL of MS patients collapses early in the disease. With EDSS progression, physical functioning scales show further decreases in QoL. The absence of further changes in the mental SF-36 scales may be a reflection of patient adaptation to the disease and/or effective support care. However, the SF-36 instrument may be insensitive to some of the QoL changes in MS and a disease-specific instrument may provide additional information on QoL, particularly at later stages of the disease. This study provides a basis for future research aimed at improving management of MS.

Adult↗
PubMed1998

Health status of refugees from former Yugoslavia: descriptive study of the refugees in the Netherlands.

AIM: To describe the health status of formally recognized refugees from the former Yugoslavia in the Netherlands, and analyze the relationship between experienced traumatic events and health status. METHODS: A random sample of refugees was taken from randomly selected municipalities. One hundred and two persons received a postal questionnaire. Forty percent filled out the questionnaire completely. Well-validated self-assessment scales were used to measure six dimensions of health status. Traumatic experiences were assessed by the Harvard Trauma Questionnaire. Physical aspects of health status were measured by the three dimensions of the Medical Outcome Study (MOS) Short-form General Health Survey (SF-20) which consisted of the dimensions "physical functioning", "subjective health", and "pain". Social health was measured by the two dimensions of the SF-20, "role fulfilling" and "social functioning". RESULTS: The refugees showed vulnerable health. A significant group had an accumulation of health problems. These were mostly unrelated to sociodemographic variables. Many of the refugees experienced several traumatic events. These experiences were clearly related to all health problems. CONCLUSIONS: The refugees from the former Yugoslavia scored low on standardized health measurement scales. This was primarily due to their traumatic experiences in combination with their refugee status. There is a need for health services to prevent the accumulation of (future) health problems.

Adult↗
PubMed2005

Reciprocal relationship between pain and depression in elderly Chinese primary care patients.

BACKGROUND: Pain and depression are common in old age but the reciprocal relationship between pain and depression has not been established in a single study. Moreover, few studies have addressed this issue in a primary care setting. The purposes of this study were to examine the reciprocal relationship between pain and depression and to identify whether social support, functional disability or social functioning mediated the link between pain and depression among Hong Kong Chinese elderly primary care patients. METHOD: Subjects were 318 patients assessed by a trained assessor with MDS-HC at baseline and these subjects were randomly selected from attendants of three randomly selected elderly health centers in Hong Kong. These patients were re-assessed one year after baseline evaluation. RESULTS: Multiple regression analyses revealed that pain at baseline significantly predicted depression at 12-month follow-up assessment when age, gender, martial status, education, and depression at baseline were adjusted for, but depression at baseline was not associated with pain at 12-months after baseline measure while controlling for age, gender, martial status, education, and pain at baseline. However, depression did predict the onset of pain. Moreover, social support, physical disability or social functioning did not mediate the impact of pain on depression. CONCLUSIONS: These data suggest that pain is an important predictor of depression in elderly primary care patients. Therefore, aged care service practitioners must take this risk factor into consideration in their preventive intervention and treatment for psychological well-being.

Activities of Daily Living↗
PubMed1995

[Disorders of assertiveness and social anxiety].

Assertiveness is a multidimensional concept use to describe individual's social functioning, from normal adaptation to pathological worries of social inefficacy. Several psychological impairments are evoked in assertiveness disorders, leading to the discussion of cognitive and emotional functioning in such pathology. These pathologies are represented by the social anxiety spectrum, an heterogeneous syndrome from shyness to social phobia in which functional dysregulation are discussed to explain the missadaptation. Experimental approach are developed to test the cognitive hypothesis proposed in assertiveness and social anxiety, and to discuss the clinical and psychopathological status of assertiveness disorders.

Adaptation, Psychological↗
PubMed2004

Health-related quality of life in Italian patients with narcolepsy: the SF-36 health survey.

OBJECTIVE: To evaluate the psychometric performances of the 36-item short form (SF-36), a tool measuring health-related quality of life (HRQoL) in patients with narcolepsy or other sleep disorders, presenting excessive daytime sleepiness (EDS) as the main symptom. To compare the HRQoL of patients with narcolepsy with the Italian norm. To disclose the clinical predictors influencing the HRQoL. PATIENTS AND METHODS: One hundred and eight adults with narcolepsy, 115 with obstructive sleep apnea syndrome (OSAS) and 42 with idiopathic hypersomnia (IH) enrolled for a multicentric cross-section study employing self-administered questionnaires investigating the HRQoL (SF-36), EDS and cataplexy. A psychometric analysis and the standardized scoring of the 8 scales of the SF-36 were performed. The correlation between SF-36 scales and clinical features of narcolepsy was measured by a multiple linear regression analysis. RESULTS: SF-36 satisfied the recommended psychometric standards. Patients with narcolepsy had all domains except Bodily Pain lower than the Italian norm. Some of the variance of Physical Functioning (R(2) 0.07), Role functioning-Physical (R(2) 0.31), General Health (R(2) 0.15), Vitality (R(2) 0.10), Social Functioning (R(2) 0.21) and Role functioning-Emotional (R(2) 0.15) was explained both by EDS (inverse correlation) and disease duration (direct correlation). CONCLUSIONS: The SF-36 form is a reliable outcome measure for hypersomniac disorders. Narcolepsy seriously impacts patients' HRQoL in terms of physical and mental well-being and impairs physical and emotional functions, restricting social life. EDS is the main symptom determining this impairment. However, disease duration plays a role in counterbalancing this feature, probably by means of adaptation.

Activities of Daily Living↗