PubMed Health⌕ Search

Biomedical subjects

D Streiner

Publications and source records attributed to D Streiner.

At least 19 recordsLinked to original sources
PubMed2002

Characterising doctor-parent communication in counselling for impending preterm delivery.

OBJECTIVE: To examine the counselling of women admitted to hospital in preterm labour. Such women and their partners are often asked to participate in difficult decisions including mode of delivery, fetal monitoring, and resuscitation. STUDY DESIGN: Questionnaire based descriptive study. STUDY SETTING: A tertiary level perinatal referral centre. PATIENTS: Forty-nine women in preterm labour at 22-30 weeks gestation, admitted in two separate periods between March 1997 and May 1999. INTERVENTION AND OUTCOME MEASURE: Within 24 hours of counselling, parents were asked to complete a questionnaire assessing recall of the management plan, desire for involvement in decision making, anxiety, and feelings of control over their health. A parallel questionnaire was completed by the clinicians. RESULTS: Parents and clinicians on recall agreed well about obstetric issues but poorly about neonatal issues. Overall 27% of parents felt: "I would prefer to have the doctors advise me, rather than asking me to decide". In 79% of cases, clinicians believed parents preferred advice rather than to make decisions, but in 45% of these, they misidentified those who wished to make their decisions. Anxiety levels for one third of the mothers were high, and associated with poorer concordance of recall between parents and clinicians. CONCLUSIONS: Serious deficiencies exist in parent-clinician encounters during extremely preterm labour. Concordance between parents and clinicians is poor and anxiety very high. A quarter of parents appear to prefer to relinquish decision making autonomy, but clinicians cannot correctly identify this subgroup. Standardised counselling in the perinatal period, using formal decision aids, should be investigated.

Communication↗
PubMed2001

Relationship of psychosis to aggression, apathy and function in dementia.

BACKGROUND: Psychosis has been associated with aggression in dementia, but the nature of this relationship has been unclear. There has been very little research into the relations between apathy and functional status to psychosis in dementia. The purpose of this study is to investigate the relationship between psychosis and aggression, apathy, and functional status in outpatients with dementia. METHODS: The presence of psychosis was assessed by clinical interview and two scales: the Neuropsychiatric Inventory and the Columbia University Scale for Psychopathology in Alzheimer's Disease. The maximum likelihood estimation technique was used to determine the best estimate of the presence of psychosis. Aggression, apathy, and functional status (activities of daily living: ADLs) were measured using structured instruments. RESULTS: Sixty-one subjects were included. The CUSPAD and NPI provided low false positive and negative rates. ANCOVA analyses showed that psychosis was significantly associated with aggression, even when controlling for apathy, depression, and ADLs. Psychosis was related to apathy only when depression was controlled for. Hallucinations were related to impaired basic ADLs, even when depression and apathy were controlled for. CONCLUSIONS: Relationships were found between psychotic symptoms in dementia and aggression as well as apathy and impaired functional status. These relationships suggest pathophysiologic mechanisms and have possible treatment implications.

Activities of Daily Living↗
PubMed2001

Relationship between nurses' pain knowledge and pain management outcomes for their postoperative cardiac patients.

Nurses' knowledge and perceived barriers related to pain management have been examined extensively. Nurses have evaluated their pain knowledge and management practices positively despite continuing evidence of inadequate pain management for patients. However, the relationship between nurses' stated knowledge and their pain management practices with their assigned surgical cardiac patients has not been reported. Therefore, nurses (n=94) from four cardiovascular units in three university-affiliated hospitals were interviewed along with 225 of their assigned patients. Data from patients, collected on the third day following their initial, uncomplicated coronary artery bypass graft (CABG) surgery, were aggregated and linked with their assigned nurse to form 80 nurse-patient combinations. Nurses' knowledge scores were not significantly related to their patients' pain ratings or analgesia administered. Critical deficits in knowledge and misbeliefs about pain management were evident for all nurses. Patients reported moderate to severe pain but received only 47% of their prescribed analgesia. Patients' perceptions of their nurses as resources with their pain were not positive. Nurses' knowledge items explained 7% of variance in analgesia administered. Hospital sites varied significantly in analgesic practices and pain education for nurses. In summary, nurses' stated pain knowledge was not associated with their assigned patients' pain ratings or the amount of analgesia they received.

Adult↗
PubMed2001

Measles immunization acceptance in Southeast Asia: past patterns and future challenges.

Despite substantial increases in immunization rates, measles remains a major health problem in developing countries of Southeast Asia. The authors of this paper undertook separate investigations which examined factors influencing measles immunization acceptance in the rural Philippines, Central Java, Indonesia, and an impoverished neighborhood in Bangkok, Thailand. We briefly summarize the findings of our three field investigations before presenting a synthesizing analysis of the psychosocial and demographic factors which affect measles immunization. We then review trends influencing measles acceptance in industrialized countries to anticipate possible future challenges to measles immunization acceptance in Southeast Asia in an era of increasing globalization and information transfer. We suggest that parental perceptions of the risks and benefits of immunization, philosophical and religious convictions and state and social regulatory policies will profoundly influence measles immunization in the new millennium.

Asia, Southeastern↗
PubMed2000

Family intervention for schizophrenia.

BACKGROUND: It has been showed that people with schizophrenia from families that express high levels of criticism, hostility, or over involvement, have more frequent relapses than people with similar problems from families that tend to be less expressive of their emotions. Psychosocial interventions designed to reduce these levels of expressed emotions within families now exist for mental health workers. These interventions are proposed as adjuncts rather than alternatives to drug treatments, and their main purpose is to decrease the stress within the family and also the rate of relapse. OBJECTIVES: To estimate the effects of family psychosocial interventions in community settings for the care of those with schizophrenia or schizophrenia-like conditions compared to standard care. SEARCH STRATEGY: Electronic searches of the Cochrane Library (Issue 2, 1998), the Cochrane Schizophrenia Group's Register (June 1998), EMBASE (1981-1995) and MEDLINE (1966-1995) were undertaken and supplemented with reference searching of the identified literature. SELECTION CRITERIA: Randomised or quasi-randomised studies were selected if they focused on families of people with schizophrenia or schizoaffective disorder and compared community-orientated family-based psychosocial intervention of more than five sessions to standard care. DATA COLLECTION AND ANALYSIS: Data were reliably extracted, and, where appropriate and possible, summated. Peto odds ratios (OR), their 95% confidence intervals (CI) and number needed to treat (NNT) were estimated. The reviewers assume that people who died or dropped out had no improvement and tested the sensitivity of the final results to this assumption. MAIN RESULTS: Family intervention may decrease the frequency of relapse (one year OR 0.57 CI 0.4-0.8, NNT 6.5 CI 4-14). The trend over time of this main finding is towards the null and some small but negative studies may not have been identified by the search. Family intervention may decrease hospitalisation and encourage compliance with medication but data are few and equivocal. Family intervention does not obviously effect the tendency of individuals/families to drop out of care. It may improve general social impairment and the levels of expressed emotion within the family. This review provides no data to suggest that family intervention either prevents or promotes suicide. REVIEWER'S CONCLUSIONS: Clinicians, researchers, policy makers and recipients of care cannot be confident of the effects of family intervention from the findings of this review. Further data from already completed trials could greatly inform practice and more trials are justified as long as their participants, interventions and outcomes are generalisable to routine care.

Family Therapy↗
PubMed2000

A cross-cultural consumer-based decision aid for screening mammography.

BACKGROUND: "Women should have mammograms" is the usual perspective of educational interventions about screening. The perspective that "women should be informed" about potential risks and benefits so they can make value- and evidence-integrated personal decisions has recently been advocated. However, this perspective has not previously been operationalized. We developed an evidence-based cross-cultural mammography decision aid (MDA), for European American and Mexican American women who are 50-70 years old, at average risk of breast cancer, of varying educational levels, and English- or Spanish-speaking. METHODS: MDA development included: (1) content development by a multidisciplinary team and lay women and (2) testing for validity and reliability. Four parts include: (1) introduction; (2) information about logistics (cost, time, discomfort) and risks (sequelae of false-positive or negative results; (3) probability of developing breast cancer; and (4) benefit of mammography regarding breast cancer outcomes (e.g., death and recurrence). We assessed reliability (stability of decisions with the same information) after 1-2 weeks. We assessed validity (comprehension of information) quantitatively (probabilities were changed to see whether preferences changed predictably) and qualitatively (focus groups, standardized probes for comprehension). Subjects were a convenience sample of 49 European American (50-81 years old) and 54 Mexican American (49-89 years old) women from administrative staff at a medical school, the waiting room of an indigent primary care clinic, and a community center. RESULTS: Reliability was 100%. In quantitative validity testing, 22 of 28 women (89%) changed preference as predicted with changed probabilities. Comprehension was confirmed qualitatively in all phases of testing with both Spanish and English versions. CONCLUSION: The decision aid is valid and reliable in English and Spanish for southwestern Mexican American and European American women at average risk of breast cancer, including those of low educational levels.

Aged↗
PubMed2000

Impact of extreme prematurity on families of adolescent children.

OBJECTIVES: To compare the impact of burden of illness on families of teenaged children who were extremely low birth weight (ELBW) with that of members of a term control group (C) and to determine whether the attitudes toward active treatment of very immature infants differ between the 2 cohorts. DESIGN: In a cross-sectional survey, parents of 145 (86%) of 169 members of an ELBW cohort and 123 (85%) of 145 members of a control cohort completed a 23-item self-completed questionnaire encompassing occupational, marital, and family-related issues and attitudes toward treatment of infants of borderline viability. RESULTS: Both positive (P =.0003) and negative (P <.005) effects on marriage were higher in parents of the ELBW group; although more parents in the ELBW group felt that their child had brought their families closer together (P =.0001), their child's health had adversely affected their emotional health (P =.02) and that of other children in the family (P =.003). Despite this result, a significant proportion of parents from both cohorts supported saving all infants (ELBW 68%; C 58%) and favored the role of parents in decision making (ELBW 98%; C 97%). CONCLUSIONS: In the long term, it appears that parents of ELBW children have adjusted fairly well to their work and family life. Although some negative effects were identified, there was still considerable support for active treatment of infants of borderline viability.

Adaptation, Psychological↗
PubMed1999

Defining morning stiffness in rheumatoid arthritis.

OBJECTIVE: Morning stiffness is a common and clinically important symptom in patients with rheumatoid arthritis (RA); however, it has not performed well as a classification criterion, perhaps due to poor definition. This qualitative study was carried out to identify the characteristics of morning stiffness through the self-reports of patients with RA in order to develop a new patient centered definition. METHODS: Personal interviews with 24 patients with RA were analyzed independently by 2 reviewers using a grounded theory approach. A mail-out questionnaire was used to validate the information summarized from the interviews. RESULTS: These findings resulted in the following definition of morning stiffness in RA: slowness or difficulty moving the joints when getting out of bed or after staying in one position too long, which involves both sides of the body and gets better with movement. CONCLUSION: This new patient centered definition of morning stiffness may allow more precise classification of patients with RA.

Adult↗
PubMed1998

Predictive validity of the emergency physician and global job satisfaction instruments.

OBJECTIVE: To evaluate the predictive validity of the Emergency Physician Job Satisfaction (EPJS) and Global Job Satisfaction (GJS) instruments. METHODS: Prospective mail survey of 223 Canadian emergency physicians (EPs) using a 42-item questionnaire, including 14 items evaluating their reasons for leaving emergency medicine (EM). Original (1990) EPJS and GJS scores were analyzed using 1-way ANOVA and Scheffe's test comparing the physicians who left EM with those still in their original jobs, and those who had left their original jobs but who stayed in EM. Mean scores on the 14 "reason for leaving" items were compared with scores from an earlier sample of U.S. physicians using a t-test for independent means. Criteria for statistical significance were set at alpha = 0.05 for all analyses. RESULTS: The response rate for the primary study questions was 99.1%. Of the respondents, 29.4% had left their original jobs, and 10.4% had left EM altogether. The GJS scores for the physicians who left EM were significantly different from those for the physicians who stayed (p = 0.004). The EPJS scores for the physicians who left EM were not significantly different from those for the physicians who stayed (p = 0.56). There was no significant difference in scores between the Canadian and U.S. physicians' reasons for leaving EM (all p-values > 0.05). Shiftwork scored the highest as a reason to leave EM. CONCLUSIONS: A low GJS score is associated with physicians' leaving EM, but not with changing jobs. The EPJS instrument was not associated with either outcome. Canadian and U.S. EPs place similar levels of importance on potential reasons for leaving EM.

Analysis of Variance↗
PubMed1997

Effect of fluoxetine on menstrual cycle length in women with premenstrual dysphoria.

OBJECTIVE: To examine whether changes in menstrual cycle length occurred in women who received 20 mg of fluoxetine per day and women who received 60 mg of fluoxetine per day as compared with women who received placebo. METHODS: A two-cycle, single-blind placebo phase was followed by a six-cycle double-blind phase. Only placebo nonresponders were randomized to one of three treatment arms: placebo, fluoxetine 20 mg/day, or fluoxetine 60 mg/day. Cycle length was established using a prospective daily calendar. Cycle-length data from women who completed at least three treatment cycles were used in this analysis. Cycle-length change was defined a priori as cycle lengthening or shortening of 4 days or more (1 or more standard deviations from the mean change between baseline cycles). RESULTS: Eleven of the 62 women receiving 60 mg of fluoxetine per day and seven of the 70 women receiving 20 mg of fluoxetine per day but only one of the 61 women in the placebo group demonstrated cycle-length change at the end of the first treatment cycle (P = .011). In total, 15% of the women in the fluoxetine 60 mg/day group demonstrated a cycle-length change during two of the three observed cycles compared with 6% of the women in the fluoxetine 20 mg/day group and 3% of the women in the placebo group (P = .048). Women with cycle-length changes demonstrated either shortening or lengthening only. There were no differences between the number of women with changes in either direction. CONCLUSION: Cycle-length change occurred more frequently in the fluoxetine 60 mg/day group than in the fluoxetine 20 mg/day or placebo groups. The effects of selective serotonin reuptake inhibitors on menstrual cycle length are mostly unknown and warrant careful monitoring in women of reproductive age, who are the prime consumers of these medications.

Adult↗
PubMed1996

Review of applicability of existing functional status measures to the study of workers with musculoskeletal disorders of the neck and upper limb.

Both epidemiologic studies of the factors that contribute to the development of work-related musculoskeletal disorders of the neck and upper limb and intervention studies that test the effectiveness of workplace ergonomic and organizational changes are needed to provide empiric evidence for preventive strategies. This study reviews the relevance and comprehensiveness of existing functional status instruments for epidemiologic studies of work-related neck and upper limb disorders. Twelve domains were identified as the major areas of life affected by workers' neck and upper extremity disorder(s): work, household and family responsibilities, self-care, transportation/driving, sexual activity, sleep, social activities, recreational activities, mood, self-esteem, financial effects, and iatrogenic effects of assessments and treatment. Fifty-two functional status instruments were identified. Of these, 21 met the specified criteria as potentially relevant and were rated on the 3-point scale for relevance and comprehensiveness for each domain. None of the instruments covered all 12 domains adequately.

Arm Injuries↗
PubMed1996

Antidepressant treatment of depression: a metaanalysis.

OBJECTIVE: To carry out a metaanalysis of antidepressant studies to calculate the effect sizes for antidepressant effect in depressive disorder. METHOD: A metaanalysis of all antidepressant studies that included an active comparison drug as well as placebo was used to calculate the effect size. Articles were selected from a MEDLINE search for the period January 1966 to June 1995. Forty-nine studies were included in the metaanalysis. RESULTS: The effect sizes for antidepressant treatment are moderately larger than for placebo. A larger effect size was observed in studies where objective diagnostic criteria for depression were used. CONCLUSIONS: We conclude that the superior efficacy of antidepressants over placebo can be demonstrated.

Antidepressive Agents↗
PubMed1995

Fluoxetine in the treatment of premenstrual dysphoria. Canadian Fluoxetine/Premenstrual Dysphoria Collaborative Study Group.

BACKGROUND: Premenstrual dysphoria shares certain features with depression and anxiety states, which have been linked to serotonergic dysregulation. We evaluated the efficacy and safety of fluoxetine (which selectively inhibits the reuptake of serotonin) in the treatment of premenstrual dysphoria. METHODS: The trial consisted of a single-blind, placebo washout period lasting two menstrual cycles, followed by a randomized, double-blind, placebo-controlled trial of fluoxetine at a dose of either 20 mg or 60 mg per day or placebo for six menstrual cycles. Healthy women meeting criteria for what was then called late-luteal-phase dysphoric disorder were recruited at seven university-affiliated women's health clinics in Canada. The primary outcome measure consisted of visual-analogue scales for tension, irritability, and dysphoria during the late luteal phase of each cycle. RESULTS: Of 405 women enrolled in the placebo washout period, 313 subsequently entered the randomized phase of the study, which lasted six menstrual cycles, and 180 completed it. Fluoxetine at a dose of 20 or 60 mg per day was significantly superior to placebo in reducing symptoms of tension, irritability, and dysphoria, as measured by the visual-analogue scales (P < 0.001). The women who received 60 mg of fluoxetine per day reported significantly more side effects than those who received 20 mg per day or placebo (P < 0.001). CONCLUSIONS: Fluoxetine is useful in the treatment of premenstrual dysphoria. Treatment with fluoxetine at a dose of 20 mg per day reduces the potential for side effects while maximizing therapeutic efficacy.

Adolescent↗
PubMed1995

The effectiveness and efficiency of health promotion in specialty clinic care.

Chronic illnesses make up the majority of health problems in North America. Many chronically ill persons adjust over time to their illnesses; however, there remains a small but important group of those less adjusted, who are concentrated in specialty clinics and are high users of health care resources. This randomized clinical trial investigated the impact of health promotion interventions in the form of problem-solving counseling or phone support that augmented conventional clinic medical care. Chronically ill, poorly adjusted outpatients (n = 293) attending clinics were randomly assigned to receive additional problem-solving counseling, phone call support, or neither. Psychosocial adjustment to illness, utilization, and expenditures of health services were the main outcomes measured. There were no overall significant differences between groups in their change in psychosocial adjustment and expenditures for health and social care. However, interaction analyses (P < 0.05) gave an indication of who might benefit from these interventions. Those who lived alone and infrequently used problem-solving behaviors to cope with their illness significantly improved their adjustment to illness and had fewer health service expenditures if they received problem-solving counseling. Supportive telephone calls were most effective for those who lived with someone and frequently used problem-solving coping behaviors. These findings suggest that health promotion services should be targeted to outpatients described by specific social support and coping characteristics.

Adaptation, Psychological↗
PubMed1995

Assessing the economic value of a new antidepressant. A willingness-to-pay approach.

Using the method of willingness to pay (WTP), this study assesses the value of a new antidepressant, moclobemide, relative to that of tricyclic antidepressants (TCAs), which have equivalent efficacy but less favourable adverse effect profiles. From a published meta-analysis of controlled clinical trials, we identified 7 adverse effects, the risk of which differed significantly between moclobemide and TCAs. We obtained risk reduction data and descriptions of adverse effects from interviews with 95 individuals who had mild to moderate depression and who had been taking one or more TCAs in the previous year. Using a visual analogue scale, respondents ranked and rated each adverse effect. Participants were then asked (using the scenario of additional out-of-pocket drug payment) to quantify the maximum amount that they would pay for a new drug that reduced each adverse effect by the specified probability. Blurred vision and tremor were ranked and rated as the most bothersome adverse effects, with dry mouth being the least bothersome. On average, respondents were willing to pay an additional $Can22 per month [95% confidence interval (CI) 16-28] to reduce the risk of blurred vision from 10 to 5%. The lowest WTP value was for reducing the risk of dry mouth from 40 to 15%, at $Can11 per month (95% CI 8-15). Although not measured directly, we derived 2 estimates of WTP for multiple (i.e. all 7) risk reductions. We obtained upper and lower WTP limits of $Can118 and $Can36 per month, respectively, depending upon aggregation assumptions. Compared with the TCAs amitriptyline and imipramine, the net cost of moclobemide is greater, but the overall net benefit (WTP minus cost) is ambiguous given uncertainty about WTP aggregation over adverse effects. However, compared with the TCAs desipramine and clomipramine, the net benefit of moclobemide is unambiguously positive. We conclude that the WTP approach is a potentially valuable tool that requires more development for use in healthcare economic evaluation.

Adult↗
PubMed1995

Profile of mood states and cardiac rehabilitation after acute myocardial infarction.

Following an acute myocardial infarction, evaluation of a patient's own perceptions of health, including mood state, provides useful information about the efficacy of rehabilitation when data are available for patients randomized to both control and intervention. Data are presented on the Profile of Mood States (POMS) in 187 patients, with mild to moderate scores for Spielberger state anxiety and/or Beck depression, who were randomized within 6 wk of acute myocardial infarction to usual care or to brief cardiac rehabilitation lasting 8 wk and who were followed-up during the 12 months following the acute event. Repeated measures multivariate analysis of covariance identified significant main as well as time effects in POMS scores over 12 months. Repeated measures analysis of variance over the 12 months demonstrated significant improvement for both depression and anxiety in both groups. At 8 wk, improvement was greater in the rehabilitation patients than usual care patients but only in the tension-anxiety, depression-dejection and vigor-activity dimensions of POMS and only in anxiety in those patients with above mean anxiety scores. Overall, rehabilitation and control patients showed similar and significant improvements in anxiety, depression and in mood states over the duration of the 12-month trial.

Adult↗