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Biomedical subjects

C M Mitchell

Publications and source records attributed to C M Mitchell.

32 records · Page 2Linked to original sources
PubMed1990

Sexual and physical abuse in women with functional or organic gastrointestinal disorders.

STUDY OBJECTIVES: To determine the prevalence of a history of sexual and physical abuse in women seen in a referral-based gastroenterology practice, to determine whether patients with functional gastrointestinal disorders report greater frequencies of abuse than do patients with organic gastrointestinal diseases, and to determine whether a history of abuse is associated with more symptom reporting and health care utilization. DESIGN: A consecutive sample of women seen in a university-based gastroenterology practice over a 2-month period was asked to complete a brief questionnaire. MEASUREMENTS: The self-administered questionnaire requested information about demographics, symptoms, health care utilization, and history of abuse. Physicians indicated the primary diagnosis for each patient and whether she had ever discussed having been sexually or physically abused. RESULTS: Of 206 patients, 89 (44%) reported a history of sexual or physical abuse in childhood or later in life; all but 1 of the physically abused patients had been sexually abused. Almost one third of the abused patients had never discussed their experiences with anyone; only 17% had informed their doctors. Patients with functional disorders were more likely than those with organic disease diagnoses to report a history of forced intercourse (odds ratio, 2.08; 95% CI, 1.03 to 4.21) and frequent physical abuse (odds ratio, 11.39; CI, 2.22 to 58.48), chronic or recurrent abdominal pain (odds ratio, 2.06; CI, 1.03 to 4.12), and more lifetime surgeries (2.7 compared with 2.0 surgeries; P less than 0.03). Abused patients were more likely than nonabused patients to report pelvic pain (odds ratio, 4.05; CI, 1.41 to 11.69), multiple somatic symptoms (7.1 compared with 5.8 symptoms; P less than 0.001), and more lifetime surgeries (2.8 compared with 2.0 surgeries; P less than 0.01). CONCLUSIONS: We found that a history of sexual and physical abuse is a frequent, yet hidden, experience in women seen in referral-based gastroenterology practice and is particularly common in those with functional gastrointestinal disorders. A history of abuse, regardless of diagnosis, is associated with greater risk for symptom reporting and lifetime surgeries.

Abdominal Pain↗
PubMed1989

Health-related quality of life in inflammatory bowel disease. Functional status and patient worries and concerns.

The assessment of health-related quality of life may be an adjunct to understanding the chronic illness experience and its effects on health outcomes. In this study, we evaluated health-related quality of life of 150 patients with inflammatory bowel disease (63 ulcerative colitis, 87 Crohn's disease). We used a standardized measure, the Sickness Impact Profile, and a questionnaire we developed that elicits and prioritizes the disease-related worries and concerns of patients with IBD. Our preliminary data indicate that: (1) IBD patients experience moderate functional impairment more in the social and psychological than in the physical dimensions; (2) Crohn's disease patients report psychosocial dysfunction to a greater degree than ulcerative colitis patients; (3) IBD patients report greatest concerns about having surgery, degree of energy, and body image issues such as having an ostomy bag; and (4) functional status and patient concerns correlate better with other measures of health status and previous health care utilization than the physician's rating of disease activity. We believe that questionnaires measuring health-related quality of life (HRQOL) can be used in research and patient care to extend the clinical assessment of patients with IBD. Further work is needed to determine the role of HRQOL relative to disease activity and other physician-based assessments in predicting health outcomes.

Adult↗
PubMed1988

Psychosocial factors in the irritable bowel syndrome. A multivariate study of patients and nonpatients with irritable bowel syndrome.

In this multivariate analysis of the irritable bowel syndrome (IBS) we describe the symptomatic and psychologic features of the condition and their possible contributions to health care seeking. We studied 72 IBS patients, 82 persons with IBS who had not sought medical treatment, and 84 normal subjects. All subjects received complete medical evaluation, diary card assessment of abdominal pain and stool habit, and standard psychologic tests of pain, personality, mood, stressful life events, illness behavior, and social support. Pain and diarrhea were the most important symptoms associated with patient status. When controlling for these symptoms we found that (a) IBS patients have a higher proportion of abnormal personality patterns, greater illness behaviors, and lower positive stressful life event scores than IBS nonpatients (p less than 0.001) and normals (p less than 0.001); (b) IBS nonpatients, although psychologically intermediate between patients and normals, are not different from normals (p less than 0.21); and (c) IBS nonpatients have higher coping capabilities, experience illness as less disruptive to life, and tend to exhibit less psychologic denial than patients. These factors may contribute to "wellness behaviors" among people with chronic bowel symptoms. We conclude that the psychologic factors previously attributed to the IBS are associated with patient status rather than to the disorder per se. These factors may interact with physiologic disturbances in the bowel to determine how the illness is experienced and acted upon.

Adult↗
PubMed1986

A retrospective evaluation of psychosocial impact of long-term growth hormone therapy.

Fifty-eight growth hormone (hGH) deficient adults who had received long-term hGH therapy and their families were contacted to assess their past and current status regarding peer relationships, educational and vocational achievements, and self-concepts. Both heterosexual and same-sex peer relationships were reported as troublesome; most reported problems with having been treated as younger than their chronologic ages. The majority reported average or above average academic performance; there were no significant differences between academic achievements of the expatients and their siblings; the greatest portion of the sample were employed at least part-time and were satisfied with their employment status. On self-concept measures, the sample rated themselves higher in self-satisfaction, personal work, and sociality, but lower on physical self and self-criticism than norms; most of the parents reported no significant differences between the patients' adjustment and that of their siblings. In addition, the recommendations from the group to others considering hGH treatment and to medical personnel working with such families are noted; implications for hGH intervention are discussed.

Adolescent↗
PubMed1985

Nonprofessional counselors: revisiting selection and impact issues.

This study examined two issues related to the use of nonprofessional counselors (n = 159) within the context of a diversion program for juvenile offenders. First, the relationship of the nonprofessionals' personality traits and general attitudes to client outcome was examined. No statistically significant correlations were observed. Second, the differential impact of various training and supervision factors was examined in terms of nonprofessional satisfaction, attitudes, and locus of control. Results suggested that training intensity, training content, and supervision setting may influence nonprofessionals' attitudes towards various social groups and their satisfaction with the nonprofessional experience.

Adolescent↗
PubMed1985

Intervention orientation: quantification of "person-blame" versus "situation-blame" intervention philosophies.

Almost from its inception at the Swampscott conference in 1965, community psychology has criticized interventions focusing solely on "person variables" or "blaming the victim." In order to begin to explore this orientation more scientifically, these studies created a measure to tap person- and situation-blame orientations of service providers working with adolescents in legal jeopardy. Its reliability and construct validity were examined; implications for other social problem areas and for further research questions are explored.

Adolescent↗
PubMed1983

The dissemination of a social intervention: process and effectiveness of two types of paraprofessional change agents.

This study was a beginning step in the dissemination of a successful intervention into delinquency which had previously used only university undergraduates as paraprofessional change agents. The interventions implemented and the comparative effectiveness of community college and university undergraduate paraprofessionals were examined using both process and outcome data. It was found that in general the community college paraprofessionals did fewer purposeful activities with their youth, but there were no differences in impact on areas such as youth's perceived positive change at home and school, self-reported delinquency, and amount and frequency of recidivism. In fact, both groups had positive impact on rate of recidivism which surpassed a treatment-as-usual comparison group. Implications for the dissemination of such programs were discussed.

Adolescent↗
PubMedDate not supplied

The rating form of IBD patient concerns: a new measure of health status.

Health status assessment for persons with chronic illness includes not only symptoms, but also an appraisal of the psychosocial concomitants of illness. In this national study of persons with inflammatory bowel disease (IBD), we standardized a disease-specific 25-item measure of perceived health status: the Rating Form of IBD Patient Concerns (RFIPC). Factor analysis yielded four indices: a) impact of disease (e.g., being a burden, loss of energy, loss of bowel control); b) sexual intimacy; c) complications of disease (e.g., developing cancer, having surgery, dying early); and d) body stigma (e.g., feeling dirty or smelly). A higher level of IBD concerns was associated with greater disease severity, female gender, and lower educational status. When controlling for these factors, as well as disease type and age, we found that concerns about: a) impact of disease was positively associated with poorer perception of health and well-being, greater psychological distress (SCL-90), and poorer daily function (Sickness Impact Profile) (p less than 0.0001); b) sexual intimacy was related to poorer psychologic function (p less than 0.01); and c) complications of disease was related to several measures of poorer daily function (p less than 0.0001 to 0.01). This standardized measure of the worries and concerns of persons with IBD may be used in clinical care and research to evaluate the effects of interventions on IBD patient outcomes.

Activities of Daily Living↗
PubMedDate not supplied

Impact of community-based diabetes education on program attenders and nonattenders.

This study reports on the differential impact of a moderately intensive diabetes education program on program attenders and dropouts. Sixty-one individuals with diabetes mellitus participated in a diabetes education program to increase knowledge, self-care, and metabolic control. Program attenders demonstrated a significant increase in diabetes knowledge and foot care irrespective of whether they attended the control or education groups. A discriminant analysis suggested that the nonattenders were more poorly educated, had less income, were younger, had had diabetes twice as long, reported more barriers to self-care, and were in poorer health than attenders. These results suggest that patients who attend interventions may be able to benefit from even minimal levels of intervention, while program dropouts may need special assistance to overcome obstacles to program participation.

Adult↗