Behavioral modification program equals healthy lifestyle.
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Biomedical subjects
Publications and source records attributed to J Boivin.
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The purpose of this study was to compare the psychological reactions of men undergoing intracytoplasmic sperm injection (ICSI) (n=18) or in-vitro fertilization (IVF) (n=22). Men monitored their psychological reactions daily for one complete treatment cycle from the first day of down-regulation until the outcome of treatment was known (approximately 52 days). The results showed that ICSI patients reported marginally more distress on the days prior to retrieval than the IVF patients. Other than this difference the pattern of results indicated that the psychological reactions of men undergoing ICSI or IVF were similar and that there was no need to manage these patients differently during treatment. However, ICSI patients may benefit from some reassuring comments on the days prior to retrieval when they showed more anticipatory anxiety.
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Clinical papers strongly recommend psychosocial counseling for patients attending infertility clinics. These recommendations are at odds with studies showing that very few patients actually take-up such services. The disparity between recommendation and actual use would seem to be due to the lack of distinction between the needs of the few highly distressed patients who feel overwhelmed by their infertility and those of the average infertile couple who experience distress but cope well with it. In the former case, psychosocial counseling is likely to be beneficial, while in the latter case informal sources of help, for example, that provided through documentation, are likely to be sufficient. Unfortunately, the emphasis on psychosocial counseling for highly distressed patients in the area of infertility has left the needs of less distressed patients neglected and the potential usefulness of alternative methods of intervening with these patients unexplored.
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The purpose of the study was to examine the stress associated with in-vitro fertilization (IVF) concurrently with other physical and relational variables, and to compare these reactions with those reported during a menstrual cycle without treatment. Women (n = 20) completed a daily symptom checklist for one complete menstrual cycle without treatment and one complete IVF cycle. The checklist included items related to stress, optimism, physical discomfort and marital and social relationships. Daily ratings during IVF were compared with those obtained during the no-treatment menstrual cycle. IVF was associated with more stress, optimism and physical discomfort than a menstrual cycle without treatment, and with greater changes to marital and social relationships. The pattern of results shows that the stress associated with IVF is less salient when examined in the context of reactions in other areas of functioning. The findings suggest that the emotional impact of IVF might be less pronounced during the actual treatment process than is generally assumed from studies focusing on the impact of treatment failure. Variables such as optimism and physical discomfort which have previously received less attention in the literature were significantly affected by IVF treatment.
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OBJECTIVE: To examine the relationship between stress and IVF outcome in women and to compare prospective ratings of IVF stress to retrospective ratings. DESIGN: Women completed daily stress ratings for one complete IVF cycle. Three days after the pregnancy test women completed a questionnaire that asked them to recall the stress of IVF. Based on the results of treatment, women were assigned to the nonpregnant (n = 23) or pregnant (n = 17) group and their daily stress ratings were compared. In addition, prospective and retrospective ratings were compared. RESULTS: The nonpregnant group reported more stress during specific stages of IVF and had a poorer biologic response to treatment than the pregnant group. It also was found that women recalled the stress of the waiting period as greater than their ongoing experience of it as measured by their daily ratings. CONCLUSIONS: The pattern of differences between the nonpregnant and pregnant group on stress and biologic factors indicates that stress is related to IVF outcome. Certain data suggest that negative feedback about the progress of treatment communicated to patients responding poorly to IVF (nonpregnant group) may have increased their stress level. However, the direction of causality between stress and IVF outcome remains speculative. Differences between prospective and retrospective stress ratings may reflect women's attempt to cope with the strain of the waiting period.
OBJECTIVE: To examine the relationship between amount of treatment failure and personal and marital distress. DESIGN: In this cross-sectional design, three groups of women (n = 91) with varying amounts of treatment failure experience were compared on measures of general and infertility-related distress and marital and sexual distress. RESULTS: The relationship between treatment failure experience and personal and marital distress was found to be curvilinear. The group that had a moderate amount of treatment failure experienced the most distress whereas the distress level of those without or with a high amount of treatment failure experience was comparable. The results also showed that the relationship between amount of treatment failure and distress was independent of age, years infertile, or years in treatment. CONCLUSION: The findings of this study provide support for infertility theories that suggest that infertility is a process rather than a series of independent emotional events and suggest that the distress women experience during infertility is a necessary part of their evolution toward acceptance of their infertility.
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Research has shown that infertility and its medical investigation are stressful for couples and have adverse effects on sexual functioning. The purpose of this study was to examine how female sexual functioning could influence aspects of the reproductive process. This question was examined within the context of the postcoital test (PCT) routinely performed during the infertility investigation. The sample consisted of 85 women with a mean age of 30 years (SD = 3.8 years) and a mean infertile period of 2.5 years (SD = 1.1 years). Prior to the physiological examination, women completed a battery of questionnaires about their sexual functioning during the scheduled encounter engaged in for purposes of the PCT and during other nonscheduled encounters. The results indicated that the PCT contributed to deterioration in female sexual functioning, and in turn, a poor sexual response was associated with poorer physiological results. The implications of sexual behavior influencing physiohormonal reproductive factors are discussed.
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Between 1970 and 1980, 46 resections of left ventricular aneurysm were carried out in patients with clinical evidence of heart failure but without associated septal perforation or severe mitral regurgitation. Aortocoronary bypass was simultaneously performed in 28% of the cases. The mean post-operative follow-up was 67 months. The early (1 mont) post-operative mortality rate was 15.2%. The actuarial survival rate (taking into account the early post-operative mortality rate) was 52.4% at 5 years and 32.9% at 10 years. Most early and late deaths were of cardiac origin. Among long-term survivors, 48.5% had no post-operative heart failure and 67% had no residual angina pectoris. In a statistical analysis of the factors involved in overall post-operative survival, no significant influence could be found for sex and age (within the limits of the study), risk factors associated with atheroma, duration of the myocardial necrosis responsible for the aneurysm, location of the aneurysm, time taken for the post-infarction heart failure to develop, presence of pre-operative angina on ECG, number of coronary arteries stenosed, extent of the aneurysm as determined by cineventriculography, cardiac index, left ventricular end-systolic pressure and associated aortocoronary bypass. In contrast, a significant prognostic value was demonstrated for the ejection fraction of the contractile area of the left ventricle (p less than 0.02), the maximal cardiac dysfunction observed prior to surgery (P less than 0.02), the presence of pre-operative dysrhythmias (P less than 0.1) and the quality of cardiac performance recovered immediately after the operation (P less than 0.001).
A total of 187 patients underwent isolated aorto-left anterior descending artery (LAD) bypass grafting with the internal saphenous vein (ISV) (= 65) and left internal mammary artery (IM) (n = 122). The respective indications of the two techniques were not systematized: the comparison of the main preoperative data of the two groups showed a statistically higher number of risk factors (p less than 0,01), more multivessel coronary lesions (p less than 0,02) and more patients with dyskinetic left ventricles (p less than 0,05) in the ISV bypass group. There were no statistical differences between the two groups in early postoperative mortality (IM: 0,8 p. 100, ISV: 1,5 p. 100), early postoperative infarction (IM: 2,5 p. 100, ISV: 1,5 p. 100), or late postoperative infarction (IM: 3,8 p. 100, ISV: 2,6 p. 100). The survival rates in the two groups were very similar with a global 90 p. 100 survival at 5 years and 78 p. 100 at 9 years. A comparison of the functional result in the two groups did not reveal significant difference: globally, 56 p. 100 of patients had no recurrence of angina 5 years, and 41 p. 100 after 9 years. Age, sex previous infarction, the number of cardiovascular risk factors, the technique used, had no prognostic significance on survival or on the quality of the postoperative functional results, contrary to the quality of left ventriculography and the number of coronary stenoses (83 subjects with isolated LAD disease, 104 subjects with multiple vessel disease). Nevertheless, patients with multiple coronary lesions had their vital prognosis improved (annual mortality less than 3 p. 100) compared to the spontaneous risk by isolated isolated aorto-LAD artery bypass surgery.