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Biomedical subjects

D Streiner

Publications and source records attributed to D Streiner.

At least 37 records · Page 2Linked to original sources
PubMed1995

Problem-solving counselling or phone-call support for outpatients with chronic illness: effective for whom?

The purpose of this randomized controlled trial (RCT) was to determine the effectiveness of problem-solving counselling or phone-call support provided by nurses to outpatients not well adjusted to chronic illness. Subjects (N = 293) completed measures at baseline and after the six-month period of intervention for psychosocial variables including coping behaviours, purpose in life, and psychosocial adjustment to illness. Subjects receiving phone-call support from nurses demonstrated less psychological distress. Results also suggest that problem-solving counselling improves psychosocial adjustment to chronic illness for outpatients who live alone, infrequently use problem-solving coping skills, or frequently use avoidance coping methods. As well, outpatients with a low purpose in life who show infrequent use of problem-solving coping skills appear to benefit most from problem-solving counselling provided by nurses. On the other hand, those not well adjusted who frequently use problem-solving coping seem to be served more effectively by phone-call support.

Adaptation, Psychological↗
PubMed1994

Alcohol drinking in pregnancy.

Our study attempted to determine the prevalence of regular drinking during the second half of pregnancy among prenatal patients; the characteristics that differentiate drinkers from nondrinkers; and characteristics that differentiate prenatal patients who drink 7 or fewer standard drinks per week and those who drink more than 7. In our survey of consecutive English-speaking prenatal patients over 20 weeks' gestation, women self-reported on health habits from a study questionnaire and completed the General Health Questionnaire and Fetal Health Locus of Control. Eighty-three percent (466 of 561) of women provided data on alcohol intake during the second half of pregnancy: 106 (22.7%) reported regular weekly drinking in pregnancy, and the mean number of standard drinks was 1.97 (SD 9.78, range 0.5-184) per week. Thirty-eight (8.2%) women reported drinking more than seven standard drinks, and 14 (3.0%) reported more than 14 standard drinks per week. Women who drank more than seven standard drinks per week were significantly more likely to be under 21 years of age, poorly educated, unemployed, unmarried, to have unplanned pregnancies, emotional problems, eat unhealthy diets, smoke, use illicit drugs, and be physically abused. They also were more likely to meet psychiatric case status on the General Health Questionnaire (t = 3.85, p = 0.0001) and to believe that "chance" (t = 3.41, p = 0.001) rather than "internal control" (t = -3.54, p = 0.001) affected the health of their fetuses as measured by the Fetal Health Locus of Control. We concluded that pregnant women who drink alcohol often have other health risk factors.(ABSTRACT TRUNCATED AT 250 WORDS)

Alcohol Drinking↗
PubMed1994

Sertraline in social phobia.

Twenty-two patients meeting a primary DSM-III-R diagnosis of Social Phobia, entered a 12 week open trial of sertraline. Twenty patients completed at least 8 weeks of treatment. Sixteen patients (80%) were considered responders and 4 (20%) were considered non-responders. All measures of social anxiety and avoidance, depression and social functioning showed a statistically significant change from baseline to end point.

Adolescent↗
PubMed1994

Development of the emergency physician job satisfaction measurement instrument.

The objective of this study was to develop a valid and reliable instrument to measure the job satisfaction of physicians practicing emergency medicine. A prospective survey involving four separate stages (an item evaluation and reduction stage, a factor analysis stage, a construct validity stage, and a reliability stage) was distributed in Canada to full-time emergency physicians. Three separate survey instruments were administered (an initial draft instrument with 228 items, a pilot instrument with 142 items, and the final instrument with 79 items). Construct validity of the final instrument was tested by evaluating the correlation between physician scores on the instrument, and scores on two instruments measuring the same construct, and three measuring different but related constructs. A draft instrument with 228 items and six hypothetical domains was tested on 61 physicians. Evaluation for frequency endorsement, redundancy, and homogeneity reduced the item pool to 157. The remaining 157 items were used as a pilot instrument and tested on 223 physicians. Factor analysis eliminated 66 items from the pilot instrument, creating a final instrument with 79 items, 11 factors, and six domains. Cronbach's coefficient alpha for the final instrument domains is 0.81, and all domain-total correlations are greater than 0.4. All correlations between the final instrument and the construct validity instruments were statistically significant (P < .001), but not so high that they appeared to be measuring the same thing. Correlations between instruments measuring the same construct were higher than those measuring related but different constructs. Correlations between the final instrument and the CES-D scale, emotional exhaustion, and depersonalization subscales of the Maslach Burnout Inventory were negative. A test-retest reliability study on 42 physicians showed Pearson's correlation coefficients for individual domains were all greater than 0.7 and greater than 0.8 for the final instrument. This study has produced a valid and reliable instrument for measuring emergency physician job satisfaction, which is both internally consistent and stable.

Canada↗
PubMed1994

Prevalence of migraine headache in Canada: a population-based survey.

BACKGROUND: The aim of the present study was to estimate the prevalence of migraine headache among Canadian adults (aged > or = 18 years) and analyse variation by age, gender, household income and province of residence. METHODS: A population-based survey was undertaken using telephone interviews with 2922 adults who were randomly selected from households across Canada by stratified regional sampling. The questionnaire asked about frequency and characteristics of headaches experienced and other symptoms. The diagnostic criteria of the International Headache Society were used to classify people as migraineurs (with or without aura), headachers or non-headachers. RESULTS: Of 8921 random calls to households, 4235 were eligible and 2922 interviews were successfully completed (response rate 66%). The prevalence of migraineurs, headachers and non-headachers among males was 7.8%, 76.1%, 16.1% and among females was 24.9%, 65.6%, 9.4%. For females prevalence appears to increase with age, peaking at 40-44 years and declining thereafter. Sex-specific prevalence for males and females, controlling for age, was significantly lower in the province of Quebec compared to other provinces. We found no association between migraine prevalence and household income. Of 500 people classified by IHS criteria as migraineurs only 232 (46%) reported any migraine diagnosis by a physician. CONCLUSION: We estimate that 2.6 million adult females and 0.8 million adult males in Canada are migraineurs, but only half are likely to have been diagnosed by a physician. Contrary to a recent US survey, people from lower income households in Canada are not at greater risk of migraine. The lower prevalence of migraine in Quebec was unexpected and remains unexplained, but it may be influenced by language/translation problems.

Adult↗
PubMed1994

Family medicine residency programs. Evaluating the need for different third-year programs.

We asked hospital chief executive officers (CEOs) and District Health Council executive directors (DHCs) to compare third-year family medicine residency programs and judge which are more needed in their communities. Care for the elderly and emergency medicine ranked highest among CEOs, while DHCs ranked care for the elderly and mental health highest. Academic family medicine and northern programs ranked lowest for both groups.

Attitude of Health Personnel↗
PubMed1993

Demographic characteristics of full-time emergency physicians in Canada.

The objective of this study was to describe individual and practice characteristics of Canadian emergency physicians, and to determine if these characteristics varied with geographic region, type of certification, or method of reimbursement. The study took place in emergency departments across Canada, and all full-time physicians with certification in emergency medicine, and a random sample of Canadian Association of Emergency Physician members without certification were surveyed with a 23-item questionnaire. Descriptive statistics on individual and practice characteristics were outcome measures. Comparative statistics evaluating demographic characteristics by region, type of certification, and method of reimbursement were used. There were significant differences between responders and nonresponders based on certification (P < .001) and region of residence (P < .005). Most physicians are male (87.3%), married (83.3%), reimbursed on a fee for service basis (61%), work in teaching hospitals (65.8%), and participate in medical education (82.3%). On average physicians are 38 years of age, work of 14 shifts/month, 9 hours/shift, 11 nonclinical emergency related hours/week, and have 5 vacation weeks/year. More physicians with FRCP(EM) certification work in teaching hospitals (P < .00001), do nonclinical emergency related work (P < .0001), participate in medical education (P < .0001), and are involved in research (P < .001). There are significant differences by geographic region in gross annual salary (P < .00001), method of reimbursement (P < .00001), and independent hospital emergency department status (P < .00001). Fee-for-service reimbursement for clinical service provides a higher gross annual income than other methods (P = .028). Emergency medicine is an emerging clinical discipline with a strong academic focus.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

The epidemiology of psychotropic use in the city of São Paulo.

This is a cross-sectional community study conducted to assess the one-year prevalence of psychotropic use in the city of São Paulo. A representative stratified sample of the city was drawn from three sub-districts selected on the basis of their health indicators (Ramos & Goihman, 1989). The probability of a psychiatric disorder was estimated by means of the Adult Psychiatric Morbidity Questionnaire (QMPA) developed by Santana (1982). The total sample comprised 1742 subjects: 11.7% of males and 24.6% of females were probable cases in the QMPA, at the cut-off point 7/8. The overall psychotropic consumption was 101.6 persons/1000 inhabitants. The rate of psychotropic use was higher for females (142.3 persons/1000 inhabitants) than males (50.0 persons/1000), a difference statistically significant (chi(2) = 18.0, 1 df, P < 0.001). The highest rate of consumption was for tranquillizers (80.4/1000 inhabitants) and the general physician was found to be the leading prescriber (46.9%), being followed by cardiologists (15.3%). A log-linear model was constructed to study the combined effect of sociodemographic factors on the probability of being a tranquillizer user. Women were found to take more tranquillizers than men, consumption increased with age, and the positives in the QMPA were more likely to be users than were the negatives. The higher the family income per capita the higher the risk of being a tranquillizer user. These findings applied regardless of the sub-district, marital status, and migration status of the subjects. These results are discussed in the light of the alternative possible interventions by general practitioners.

Adult↗
PubMed1991

Effects on quality of life with comprehensive rehabilitation after acute myocardial infarction.

This investigation was designed to determine the impact of a brief period of cardiac rehabilitation, initiated within 6 weeks of acute myocardial infarction (AMI), on both disease-specific and generic health-related quality of life, exercise tolerance and return to work after AMI. With a stratified, parallel group design, 201 low-risk patients with evidence of depression or anxiety, or both, after AMI, were randomized to either an 8-week program of exercise conditioning and behavioral counseling or to conventional care. Although the differences were small, significantly greater improvement was seen in rehabilitation group patients at 8 weeks in the emotions dimension of a new disease-specific, health-related Quality of Life Questionnaire, in their state of anxiety and in exercise tolerance. All measures of health-related quality of life in both groups improved significantly over the 12-month follow-up period. However, the 95% confidence intervals around differences between groups at the 12-month follow-up effectively excluded sustained, clinically important benefits of rehabilitation in disease-specific (limitations, -2.70, 1.40; emotions, -4.86, 1.10, where negative values favor conventional care and positive values favor rehabilitation) and generic health-related quality of life (time trade-off, -0.062, 0.052; quality of well-being, -0.042, 0.035) or in exercise tolerance (-38.5, 52.1 kpm/min); also, return to work was similar in the 2 groups (relative risk, 0.93; confidence interval, 0.71, 1.64).(ABSTRACT TRUNCATED AT 250 WORDS)

Anxiety↗
PubMed1991

Psychosocial impacts in populations exposed to solid waste facilities.

This interdisciplinary study uses a parallel case study design to investigate psychosocial impacts in populations exposed to three solid waste facilities in Southern Ontario. Impacts are examined at three social scales: individual, social network and community levels. The objectives and design derive from a feasibility study recently completed by the same research team. A two stage approach is adopted. The first is an epidemiologic survey to determine the prevalence of psychosocial impacts in the populations within a prescribed area around each site. A disproportionate stratified (by distance) random sample of 250 households is surveyed at each site. Data on awareness, knowledge, concern and action regarding the site are also obtained. Scores on pre-validated health measurement scales will be compared with population norms to determine the frequency distribution above, within and below the range of normal. The second stage involves the use of qualitative methodologies to provide an in-depth analysis of the individual, social network and community level factors affecting psychosocial impacts and reactions to the situation. Depth interviews with a sub-sample of survey respondents explore individual perceptions, attitudes and actions. Focus groups composed of members of relevant organizations and discussion groups comprising non-members uncover social network and community perspectives in an interactional setting. Interviews and group sessions are taped and transcribed for content analysis of salient themes. Textual analysis of media reports and other relevant documentation provide insights regarding the informational environment and the community context of the issues.

Adaptation, Psychological↗
PubMed1988

Gender differences in variables associated with psychosocial adjustment to a burn injury.

The purpose of this study was to determine whether variables associated with psychosocial adjustment to a burn injury vary by gender. Male and female burned subjects (N = 260) were compared on their functional disability, disfigurement, coping responses, social resources, and psychosocial adjustment to a burn injury. Both men and women had adjusted psychosocially to their burn injury. Less functional disability (r = .57, p less than .001) for men and greater problem-solving (r = .57, p less than .001) for women were the most important variables in explaining psychosocial adjustment to a burn injury. In the future, researchers need to be cognizant of gender differences and consider men and women as separate populations.

Adaptation, Psychological↗
PubMed1985

Psychosocial adjustment of burn survivors.

The purpose of this study was to assess the magnitude and predictors of psychosocial adjustment in burn victims. It was postulated that once individuals sustain a burn, their long-term psychosocial adjustment is a function of their present coping responses, social resources, burn severity and time since burn. It was expected that these variables could also be used to identify individuals at risk for psychosocial maladjustment. A historical cohort analytical survey of 340 randomly selected adults and the mothers of 145 children who had sustained either major or minor burns during the past 12 years were administered the Coping Scale, Participation in Social and Recreational Activities Index, Social Support and the Psychosocial Adjustment to Illness Scale. The children's mothers also completed the Family Environment Scale and the Child Behaviour Checklist. In summary, the variance in psychosocial adjustment among adults was related to unemployment, loss of occupational status, avoidance coping, and little involvement in recreational activities. Together, these variables explained 40 per cent of the variance in psychosocial adjustment. Severity of the burn and time since the burn were not related to psychosocial adjustment. The prevalence of psychosocial maladjustment among the adults was 10 per cent and 15.7 per cent among children. Psychosocial adjustment among children was not related to the severity of the burn. The less adjusted children could be distinguished from adjusted children on the basis of their mothers' adjustment and methods of coping. The findings tended to refute the commonly held view that post-burn adjustment is associated with burn severity and suggests psychosocial adjustment is a function of both coping responses and social resources.

Achievement↗
PubMed1983

Follow-up of attempted suicide in Christchurch.

Ninety-eight subjects who had attempted suicide and 102 general practice controls previously interviewed were followed-up at 18-24 months. The former continued to show greater social and psychiatric disability than controls and more than one-third made repeat suicide attempts. Nevertheless, as a group, the attempted suicides showed significant improvement in mental state, and familial and interpersonal relationships, whereas controls reported little change in most measures. Persistence of suicidal ideation and repeat attempts were correlated with the diagnosis of psychosis and personality disorder and predictions about the likelihood of further suicidal activity were accurate. Although 92% of patients were referred for further treatment, 38% of these were judged to have dropped out prematurely. Completion of treatment and being in ongoing treatment were positively correlated with patients' self reports of improvement. The findings are compared to experience elsewhere and to a previous Christchurch follow-up study.

Follow-Up Studies↗
PubMed1982

Parental loss and family stability in attempted suicide.

Ninety-eight persons who had attempted suicide were compared wih 102 matched controls for the incidence of parental loss and family stability before the age of 25 years. Parental loss was significantly more common in the attempted suicides than in the controls, especially death of the father and divorce or separation of parents, reaching peaks during the age periods of 0 to 5 years and 17 to 20 years. The women within this group had experienced significantly more loss from parental death than did the men. Among attempted suicides, there was also a high incidence of family instability, whether or not a loss had occurred. The degree of instability, however, was significantly less among those from intact homes. Suicidal ideation was strongly correlated with family instability in both groups.

Adolescent↗
PubMed1982

Early parental loss and suicidal ideation in university students.

This study examined the relationship of early parental loss to suicidal ideation and suicide attempts in a group of university students attending a university mental health clinic. Seventy-five subjects with a history of parental loss before the age of 16 were compared to a control group of 61 subjects from intact homes for the presence of suicidal ideation and overt suicidal behaviour. Subjects with a history of early loss demonstrated significantly more suicidal ideation and more had made suicide attempts than had subjects from intact homes, and this relationship was even more marked when the consequences of the loss in terms of the subsequent family environment were considered. Where the loss resulted in the long-term disruption of family life, suicidal trends were prominent; where the family life stabilized, they were minimal. Suicidal ideation and suicide attempts occurred significantly more often among female subjects than males, and the loss of father and both parents was in excess of loss of mother among those with significant suicidal ideation. The findings support the hypothesis that early parental loss, under certain conditions, is a significant variable in the predisposition to suicidal behaviour and suggest avenues for further research.

Adolescent↗
PubMed1980

Cross-sectional studies of grammatical morphemes in autistic and mentally retarded children.

The frequency of occurrence of functors in obligatory contexts was studied in verbal autistic and mentally retarded children matched for nonverbal mental age, and the percentages of correct use of functors were rank-ordered. The grammatical complexity of their language was also described using a transformational grammar. The data were compared to those obtained in a normal group matched for mental age and to the data presented by Brown (1973) and deVilliers and deVilliers (1973) in younger children. The autistic subjects omitted functors frequently and independently of the grammatical complexity of their language. The rank ordering of morphemes was consistent within both the autistic and mentally retarded groups but showed no correlation between the two groups or to the rank ordering described by deVilliers and deVilliers. It is suggested that functors in autistic subjects may develop in an atypical but consistent order and that this may be due to specific semantic deficits, particularly in the areas of person and time deixis.

Autistic Disorder↗
PubMed1976

Phonological investigation of verbal autistic and mentally retarded subjects.

A review of the pertinent literature indicates that autistic children are likely to show normal but delayed development of speech sounds. In contrast, atypical phonological development is suggested by experiments demonstrating that autistic subjects are deficient in their ability to extract the components of structured auditory input. A systematic investigation of the speech sound systems of verbal autistic and mentally retarded children reveals a delay in phoneme acquisition, as well as a relative uniformity of error types in both groups. The autistic subjects, however, differ significantly from the mentally retarded in the phonemic substitutions which they make. Autistic subjects are also characterized by a high correlation between frequency of phonological errors and level of overall language development. The findings are interpreted as supporting the hypothesis that the autistic group shows a more global delay in language development.

Adolescent↗