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Psychosocial factors are linked to functional gastrointestinal disorders: a population based nested case-control study.

BACKGROUND: It is widely accepted based on volunteer studies that levels of psychological distress are similar in those with functional gastrointestinal (GI) disorders and health in the community, while increased psychological distress in outpatients is largely explained by health-care seeking. AIMS: To determine if psychological distress, life event stress, or social support is associated with functional GI disorders in a population-based study. METHODS: A nested case-control study was performed by first mailing a self-report bowel disease questionnaire to a random sample of Olmsted County, Minnesota, aged 20-50 yr. All persons who reported symptoms of nonulcer dyspepsia (NUD) or irritable bowel syndrome (IBS) (cases), or an absence of GI symptoms (controls), were invited to complete a series of validated questionnaires designed to measure psychological distress, life event stress, social support, current symptoms, and physician visits. RESULTS: 103 subjects with functional GI disorders and 119 controls participated (85% of eligible). Functional GI disorders were more likely to be reported by those with higher scores on each of the nine SCL-90-R scales used to measure psychological distress (except phobic anxiety), and those with more negative and total life event stress. In a multiple logistic regression model (including age and gender), somatization, interpersonal sensitivity, and total life event stress were independently associated with functional GI disorders. Findings were similar when subjects with the IBS and NUD were analyzed separately compared to controls. CONCLUSIONS: Contrary to current dogma, psychosocial factors were significantly associated with functional GI disorders in this community sample. This suggests that these factors may be involved in the etiopathogenesis rather than just driving health-care utilization.

Adult↗

The association between attitudes toward suicide and suicidal ideation in adolescents.

The aims of this study were to determine whether adolescent attitudes to suicide could be grouped into distinct factors, and then to examine the relationship between these factors and the psychosocial parameters known to be associated with suicide, and between attitudes towards suicide and suicidal ideation. A questionnaire designed to assess attitudes to suicide was distributed to a total of 525 Israeli adolescents. Statistical analysis indicated that the attitude items could be grouped into four distinct factors: the right of society to prevent suicide; suicide as a symptom of mental illness; the right of the individual to talk about suicide; and taking suicidal behaviour seriously. Each factor was differentially associated with the various psychosocial parameters examined. The association between the attitude factors and subjects' suicidal ideation was significant and at least as strong as that of the psychosocial parameters normally associated with adolescent suicide, namely gender and exposure to suicide. A generally approving attitude towards suicide was correlated with a high level of suicidal ideation.

Adolescent↗

Swedish and Finnish dental practitioners' opinions of their undergraduate education.

Recently qualified dentists from a dental school in Stockholm, Sweden (n = 259) and the dental school in Kuopio, Finland (n = 103) were sent a questionnaire designed to obtain information concerning the perceived relevance of their undergraduate education to the practice of dentistry. The response rate was 71% for Stockholm and 82% for Kuopio. Except for minor differences, probably mainly due to economic resources and traditions in choice of treatment, the graduates in the two countries had comparable views of their basic education. In general, clinical dental subjects were highly valued, while basic science subjects but also subjects in medical and behavioral sciences were given low values. Our results indicate that, although prevention and behavioral sciences are stressed more and more in undergraduate education, the practice of clinical dentistry remains essentially unchanged and restorative dentistry is still very highly valued among recent graduates of these two dental schools.

Adult↗

How Swedish dental hygienists apply their training program in the field.

The purpose of this study was to evaluate how clinical practice by Swedish dental hygienists was related to type of dental delivery system, period of training, educational institution attended and patient category. Dental hygienists from 14 different dental hygiene schools were represented. Of these schools, 11 are still in operation. A specially designed questionnaire was posted to all dental hygienists in Sweden (n = 1857). A total of 1399 questionnaire (75.3%) were completed and returned, providing data on 15,546 dental appointments. 37.2% of the Swedish dental hygienists are presently working in private practices, 45.8% in the public dental health service and 6.2% in both. Of the patients treated by hygienists, 88.7% were adults: 99.5% in private practice and 78.4% in the public dental health service. 42.0% of all dental hygienists were trained in 1980-84. The mean treatment time per appointment in private practice was 49.7 min and 45 min in the public dental health service. Scaling, root-planning and removal of overhangs took 27 min per visit in private practice and 22 min in the public dental health service. However, there were no significant differences in methods in the two delivery systems with respect to examinations, self-care training, professional mechanical toothcleaning (PMTC), topical fluoride application, or salivary and oral microbiology tests. The adult patient categories were periodontal risk (45.1%), caries risk (9.1%) and hygiene (34.6%). In periodontal risk patients, scaling, root-planning and removal of overhangs took 28 min per appointment and 14 min in caries risk patients.

Adolescent↗

Student and staff opinion of electronic capture of data related to clinical activity.

OBJECTIVE: To seek the opinion of staff and students of a new electronic method for collection of data related to student clinical activity. DESIGN: Questionnaire survey. SETTING: Staff and students in the Department of Child Dental Health, Dental School, Cardiff, and staff in the Community Dental Service who undertake clinical supervision. METHOD: A questionnaire was circulated to all 2nd and 3rd clinical year dental undergraduate students seeking their opinion on a range of issues associated with the recently introduced bar code system of data gathering of their clinical activity and achievement. A similar questionnaire was circulated to staff who have responsibility for clinical supervision of these students. RESULTS: A total of 102 replies were received. With the exception of 2 aspects, there was no disagreement between staff and students. An overall majority preferred the use of bar codes to other methods of data collection; bar codes were perceived to be more accurate and reliable than other methods; students were satisfied with the method of quality assessment; staff were dissatisfied (P < 0.05). Staff were strongly in favour of extension of the use of bar codes to other clinics, whereas students were less strongly in favour (P < 0.001); there was little enthusiasm to extend bar codes for recording attendance at lectures, seminars and other such activity. CONCLUSION: The new system has been accepted by staff and students alike. It has proven to be satisfactory for its intended purpose. As a result of this survey, minor adjustments to procedures will take place, and the method of assessment of clinical work will be reconsidered.

Attitude of Health Personnel↗

Dental student assessment of learning programmes.

OBJECTIVES: To compare relevance, accessibility, role in the teaching-learning process, and user preference, of identical case-study-based teaching programmes in CAL and booklet format. DESIGN: Questionnaire assessment. SUBJECTS AND SETTING: Dental students at Sheffield Dental School. METHODS: 54 5th-year dental students were self-grouped as computer novice (n = 26) or proficient (n = 23) and sub-groups of 12 randomly selected from each. Half of each sub-group tested the CAL programme first and half the booklet-based programme, with cross-over, after 6 weeks. Assessment of packages was carried out immediately after use, and 2 weeks after completion, a further assessment was made on the basis of preference and value as a teaching medium. RESULTS: All subjects thought both packages relevant to clinical practice and written at an appropriate level, and the majority found the text, illustrations and tasks clear. Both groups competed the CAL package more quickly. Students asked to use such packages in the future,viewing them as support for, rather than replacement of, present teaching. The majority of computer-proficient students preferred CAL, considering it the superior teaching medium. CONCLUSIONS: Both CAL and booklet case-study materials were considered useful in addition to, rather than as a replacement for, other teaching methods. Most considered the CAL superior and preferred it. Nevertheless, while past computer experience determined preference for the format, it did not influence ability to access the medium. Future use of such materials is probably best in relation to preparation for tutorials and clinics. A key role is its availability as a revision aid.

Chi-Square Distribution↗

Use of miswak versus toothbrushes: oral health beliefs and behaviours among a sample of Jordanian adults.

OBJECTIVE: This descriptive survey aimed at determining the perceived relationship among miswak, the toothbrush, and toothbrush-plus-miswak usage on oral health beliefs and behaviours of Jordanian adults, 18-60 years old, seeking dental care in the city of Irbid, northern Jordan. METHODS: Patients (n = 138) voluntarily completed a self-designed questionnaire prior to their dental appointments at public and private clinics. RESULTS: Overall, the level of oral health knowledge was low; of 71 people who attempted to define dental plaque, only 26% knew the meaning of dental plaque. While 12% have never been to a dentist, and 12% visit the dentist on a regular basis, the majority (63.2%) of the respondents reported that they visit the dentist only when they have pain. The majority (72%) use the toothbrush, 20.5% use the toothbrush-plus-miswak and only 3% use miswak alone. Toothbrush users believe that using the toothbrush-plus-miswak is most effective in reducing mouth debris (chi2 = 32.069, d.f. = 16, P = 0.01); and level of education is significantly associated with the type of oral cleaning device used (chi2 = 25.817, d.f. = 12, P = 0.05). There was no significant difference between toothbrush users and toothbrush-plus-miswak users in terms of how they perceive their oral health status. About 19% of the study participants use dental floss, 60.9% use mouth rinses and 8.3% use inter-dental brushes. Educated people (baccalaureate or associate degrees) tended to use toothbrushes and toothbrush-plus-miswak. The toothbrush-plus-miswak users are most likely to spend 1-2 min each day cleaning their teeth (chi2 = 34.9, d.f. = 20, P = 0.02) than those using other devices. Respondents who use the toothbrush are most likely to visit the dentist when they have pain (chi2 = 34.02, d.f. = 12, P = 0.00) than those using other devices. CONCLUSION: The oral health awareness level among Jordanian adults is poor and needs to be improved. Evidence-based and community-based dental health education and a philosophical change from disease-oriented and pain management care to primary preventive care are highly recommended for the Jordanian population.

Adolescent↗

Familial hypercholesterolaemia: a pilot study of parents' and children's concerns.

OBJECTIVE: To assess psychosocial concerns of families with familial hypercholesterolaemia. METHODS: One-hundred-and-fifty-four single or pairs of parents of children age 6 - 16 years responded to a specifically designed questionnaire. One child from each family was interviewed. RESULTS: Eleven percent of parents thought that their quality of life would have been better had they not known about the disease. None agreed totally that they wished the diagnosis had not been made. However, 20% reported familial conflicts and 8% that their child's emotional or social life had been adversely affected. Conflicts and adverse effects were associated with higher scores on the Child Behaviour Checklist (CBCL). Among the children, worry about cardiovascular disease (affirmed by 22%) was related to male sex and CBCL score. RELEVANCE: Most families do not indicate that they have experienced psychosocial problems due to familial hypercholesterolaemia. Parental ratings of the child's behavioural adjustment may identify vulnerable children.

Adolescent↗

Prevalence of use, epidemiology and toxicity of 'herbal party pills' among those presenting to the emergency department.

The aim of the present study was to establish the prevalence of use, epidemiology and toxicity of 'herbal party pills' in ED presenters. This was an analytical cross-sectional survey of patients and relatives presenting to a large tertiary ED. Consenting participants completed a specifically designed questionnaire. A total of 1043 people completed the questionnaire (participation rate of 97.2%). One hundred and twenty-five (11.9%) had taken herbal party pills and subgroup analysis showed that use was most prevalent in those aged 14-25 years (30%). The majority had taken pills between two and five times (56%). Eighty-three (66.4%) had been drinking alcohol when they first took party pills. Only 80 (64%) had read the product directions, and 48 (38.4%) had, at some stage, taken more pills than recommended. One hundred and six (84.8%) had felt effects from party pills, but only 63 (59% of those feeling effects or 50.4% of total) described these as 'good'. Six (5.7% of those with effects or 4.8% of total) had sought medical attention for effects. Seventy-four (59.2%) would take herbal party pills again. In conclusion, the use of herbal party pills is common in presenters to the ED, particularly in those aged 14-25 years. These people are at risk for toxicity from the pills because there is a tendency for them not to read the instructions before ingestion, to take more pills than recommended and to coingest alcohol. Emergency physicians need to be aware of the use and potential adverse effects of herbal party pills to enable them to recognize signs of toxicity in ED presenters and thus provide appropriate supportive care.

Cross-Sectional Studies↗

The pleasure of your company: attitudes and opinions of preceptors toward nurse practitioner preceptees.

PURPOSE: To survey the attitudes and opinions of preceptors about their experiences with nurse practitioner students. DATA SOURCES: Original research using a mailed questionnaire designed by the researchers to 196 physician and nurse practitioner preceptors (23% response rate). CONCLUSIONS: Preceptors desired faculty support and feedback, wanted involvement in shaping the curriculum, and had strong opinions about the precepting experience. IMPLICATIONS FOR PRACTICE: The attitudes and opinions of preceptors are extremely important to the availability of a qualified and motivated pool of preceptors, the clinical growth of the students, the quality of the student's learning experience, and the survival of nurse practitioner programs.

Adult↗

The mental health needs of elementary schoolchildren.

More than 500 elementary school personnel from a large Colorado school district provided perceptions of the unmet mental health needs of their students, the likely causes of the needs, and suggestions about solutions or programs to meet the needs. The district's definition of "mental health"--positive self-image, healthy interrelationships with peers and adults, and acquisition of school skills and competencies--guided the questionnaire design. Respondents perceived numerous unmet mental health needs, most involving about 15% of the student population. The most frequently perceived problems were poor decision-making and problem-solving skills, poor self-image, low self-confidence, inability to resolve interpersonal conflicts, depression/unhappiness, low motivation, and various conduct disorders. Further, most respondents believed children's unmet mental health needs are increasing, and the causes for most problems are family-and home-related, but most suggested solutions were school-based. Recommendations include increasing the involvement of school nurses in programs aimed at improving children's mental health.

Child↗

Current distribution of sarcoptic mange in wombats.

OBJECTIVE: To determine the distribution and prevalence of sarcoptic mange in wombats, particularly the common wombat (Vombatus ursinus). DESIGN: Questionnaire survey in two parts. PROCEDURE: Questionnaires were distributed to biologists, rangers, animal carers and naturalists. Part 1 of the questionnaire aimed to determine the present distribution of sarcoptic mange in wombats (103 responses). Part 2 invited respondents to assess the prevalence of sarcoptic mange in wombats over a 3 month period (four responses). Information on wombats from 66 localities was received. Each locality represented an area of about 2500 km2. RESULTS: Mange was observed at 93% of localities surveyed and Sarcoptes scabiei was present in common wombats at 52% of localities. Sarcoptic mange was highly prevalent (22%) in two common wombat populations in Victoria. Anecdotal evidence suggested that mange epizootics are sporadic, cause significant morbidity and mortality and have a substantial effect on local abundance. The respondents did not report sarcoptic mange in either northern hairy-nosed wombats (Lasiorhinus krefftii) or southern hairy-nosed wombats (Lasiorhinus latifrons). CONCLUSIONS: Sarcoptic mange occurs in common wombat populations throughout the range of the common wombat including Tasmania and Flinders Island. While mange epizootics are sporadic, they have the potential to threaten the long-term survival of small, remnant populations.

Alopecia↗

Criteria used by employers to select new graduate employees.

OBJECTIVE: To find out what criteria and methods are used by Australian employers to select new graduates to work in their practices. DESIGN: Questionnaires were completed by 258 employers and the responses were analysed using the SAS system. RESULTS: During selection, employers placed most reliance on formal interviews or visits to the practice. These occasions were used to assess the applicant's personal qualities including their ability to interact effectively with clients and colleagues. Employers used resumes mainly in selection of applicants to interview and many discounted nominated referees as being insufficiently critical. Academic knowledge was regarded as less important than personal qualities and very few employers reported using gender as a basis for selection. CONCLUSIONS: Senior veterinary students need to be aware of the importance placed by employers on interpersonal skills and personal qualities and should make every effort to engage in practical work, paid work and other activities that will help develop these attributes. They should be conscious that practitioners with whom they work may be contacted by potential employers and they should learn to present themselves realistically in a resume.

Australia↗

Teaching of posterior composite restorations in Japanese dental schools.

AIM: This study was conducted to assess the teaching programmes for Class I and II composite restorations in Japanese dental schools to obtain an overview of what is being taught, the relative teaching volume, the criteria for the provision of posterior composite restorations and the placement techniques taught. DESIGN: Questionnaire forms mailed to the operative dentistry teaching departments in all 29 Japanese dental schools. RESULTS: The response rate was 93 per cent, with replies from 27 of the 29 dental schools. Twenty-five (93 per cent) responding schools taught the use of Class I and two schools stated that they did not teach the use of posterior composite restorations. One of the two schools had no plan to teach posterior composites within the next five years. The other school did not answer this question. Most schools anticipated that the proportion of teaching time devoted to posterior composite restorations would increase within the next five years. Diversities and similarities between teaching programmes were noted between Japanese, North American and European dental schools, the Japanese programmes being closer to those in Europe than those in North America. CONCLUSION: The diversities in the teaching of posterior composite restorations in Japanese dental schools are as great as in other parts of the world. Such diversities must affect the overall quality of restorations in general practice.

Bicuspid↗

Cognitive processes in dental anxiety.

While waiting for treatment in a dental hospital clinic, 146 patients completed questionnaires designed to measure their anxiety and cognitions about dental treatment. Both attendance pattern (regular versus irregular) and anxiety levels were related to the patients' perceptions of the likelihood of negative events, and highly anxious patients saw positive events as being less likely than did patients with low anxiety. It also seems that irregular attenders are more anxious than regular attenders because they believe that they will require more extensive treatment and not because they have a greater fear of dentistry per se. The results indicate that a cognitive approach to dental anxiety can explain why high anxiety is maintained despite repeated pain-free experiences and suggests methods of treatment.

Anxiety↗

Planning for community care: the Community Placement Questionnaire.

The article reviews methodological issues relating to planning surveys of long-stay populations and describes the development of an assessment instrument, the Community Placement Questionnaire, designed to aid planning for long-stay patients resident in hospitals scheduled for rundown or closure. Reliability and validity data are presented and the advantages and limitations of the instrument are discussed.

Adult↗

Psychotic patients' attributions for mental illness.

The study examined the attributions concerning mental illness of young psychotic out-patients participating in a rehabilitation programme. The sample consisted of 50 men and 33 women (mean age 26 yrs) diagnosed by their treating psychiatrist as psychotic, with main symptoms: hallucinations (59 per cent), depression (12 per cent), non-specific (29 per cent). Subjects replied to a personally administered questionnaire, designed to obtain ratings of importance for several causes of mental illness, and a measure of how optimistic they felt about their future psychological health. Factor analysis of the subjects' ratings revealed three factors: 'Family - Relationships', 'Personal Inadequacy' and 'Chance', accounting for 48 per cent of the variance. Except for gender, demographic variables (age, educational level, social class) and variables specific to the sample in question (type of symptoms, length of participation in the programme) did not differentiate significantly subjects' beliefs about their illness. However, the findings suggest that lower ratings of personal inadequacy may be associated with increased optimism about subjects' future mental health.

Adult↗

Health beliefs, locus of control, emotional control and women's cancer screening behaviour.

Improvements in women's cancer-screening behaviours can lead to a reduction in the incidence of breast and cervical cancer. This paper considers the utility of three social psychological models as predictors of such behaviours. Almost 400 women throughout Northern Ireland completed a questionnaire designed to measure the extent of their cancer-screening behaviour, their health beliefs about cancer, their health locus of control and their emotional control. It was found that several components of the health belief model and of locus of control were predictors of the behaviours. The most important predictor of breast self-examination was confidence in how to practise BSE while the most important predictor of attendance for cervical smears was lack of fear of the consequences of the investigation. The findings are discussed with reference to attempts to promote these practices.

Adolescent↗