Biomedical subjects

M Eisemann

Publications and source records attributed to M Eisemann.

At least 19 recordsLinked to original sources

PubMed2001

Conduct problems in Russian adolescents: the role of personality and parental rearing.

The purpose of the present study was 1) to assess the predictive value of conduct problems prior to the age of 12 for the severity of antisocial behaviour during adolescence, and 2) to investigate the relationships between personality traits/parental rearing and childhood conduct problems/teenage antisocial behaviour. A group of 193 delinquents was assessed by means of the Antisocial Behavior Checklist (ABC), the Retrospective Childhood Problems (RETROPROB), the Temperament and Character Inventory (TCI) and the EMBU questionnaire on parental rearing. The extreme groups of delinquents as defined by childhood conduct problems, differed significantly on the experience of a rejecting father and a self-directed character. Furthermore, some specific predictive patterns for current antisocial behaviour by childhood conduct disorder and both personality dimensions and parental rearing factors emerged. The findings are discussed in the light of the interactive nature of relations between personality and parental rearing in the development of antisocial behaviour among adolescents.

Adolescent↗

PubMed2001

The short-EMBU in East-Germany and Sweden: a cross-national factorial validity extension.

The factorial stability and reliability of the 23-item s(hort)-EMBU previously demonstrated to be satisfactory in samples of students from Greece, Guatemala, Hungary and Italy, were extended with 791 students from East-Germany and Sweden. Previous findings on factorial validity, internal reliability and correlations among scales were replicated. The 23-item form thus continues to be recommended as a reliable functional equivalent to the early 81-item EMBU, when the clinical and/or research context does not adequately permit application of time-consuming test batteries.

Adolescent↗

PubMed2001

Vulvar vestibulitis: a multi-factorial condition.

OBJECTIVE: To study differences in somatic symptoms and personality dimensions between women with vulvar vestibulitis and a non-symptomatic control group. DESIGN: A case-control study conducted in 1998. SETTING: Two clinics in northern Sweden. SAMPLE: Thirty-eight women, 18-25 years of age, suffering from vulvar vestibulitis, and 70 healthy controls. METHODS: The women completed two questionnaires: the temperament and character inventory to study personality aspects, and the Giessen subjective complaints list, which is a checklist of subjective bodily complaints. RESULTS: Regarding personality aspects the women with vulvar vestibulitis scored significantly higher than the control group, on exclusively one out of seven subscales of the temperament and character inventory (i.e. harm avoidance). This trait is considered to be partly inherited and stable throughout life, and to give the person a tendency to react to problems with pessimistic thoughts, increased anxiety and fatigue. On the Giessen subjective complaints list the women with vestibulitis reported a significantly higher number of somatic complaints in several areas. CONCLUSIONS: The findings that women suffering from vulvar vestibulitis have more bodily complaints than the controls is interpreted as an indication of a psychosomatic element in their illness, which could be primary or secondary. Furthermore, these women are characterised by a particular personality trait, and it is suggested that this trait might influence their experience and management of pain and stress. A multi-factorial origin of vulvar vestibulitis is advocated and a multimodal interdisciplinary treatment approach is suggested. To elucidate further the mechanisms behind this health problem, prospective controlled studies are urgently needed.

Adolescent↗

PubMed2001

Doctors' authoritarianism in end-of-life treatment decisions. A comparison between Russia, Sweden and Germany.

OBJECTIVES: The study was performed in order to investigate how end-of-life decisions are influenced by cultural and sociopolitical circumstances and to explore the compliance of doctors with patient wishes. PARTICIPANTS AND MEASUREMENT: Five hundred and thirty-five physicians were surveyed in Sweden (Umeå), Germany (Rostock and Neubrandenburg), and in Russia (Arkhangelsk) by a questionnaire. The participants were recruited according to availability and are not representative. The questionnaire is based on the one developed by Molloy and co-workers in Canada which contains three case vignettes about an 82-year-old Alzheimer patient with an acute life-threatening condition; the questionnaire includes different levels of information about his treatment wishes. We have added various questions about attitudes determining doctors' decision making process (legal and ethical concerns, patient's and family wishes, hospital costs, patient's age and level of dementia and physician's religion). RESULTS: Swedish physicians chose fewer life-prolonging interventions as compared with the Russian and the German doctors. Swedish physicians would perform cardiopulmonary resuscitation (CPR) in the event of a cardiac arrest less frequently, followed by the German doctors. More than half the Russian physicians decided to perform CPR irrespective of the available information about the patient's wishes. Level of dementia emerged as the most powerful determining attitude-variable for the decision making in all three countries. CONCLUSIONS: The lack of compliance with patient wishes among a substantial number of doctors points to the necessity of emphasising ethical aspects both in medical education and clinical practice. The inconsistency in the treatment decisions of doctors from different countries calls for social consensus in this matter.

Advance Directives↗

PubMed2000

Temperament and character during the course of unipolar depression among inpatients.

Cloninger has developed a novel approach concerning relationships between psychopathological syndromes and personality by his biosocial theory. Increased levels of harm avoidance (HA) were consistently found in unipolar disorders. The present study was conducted to cross-validate, in part, previous findings that high harm avoidance (HA) persisted in the course of disorder and to explore the distinct role of character dimensions. One hundred and twenty-six inpatients with an unipolar depressive disorder and 126 healthy controls, strictly matched for age and gender have been included in the study. Our findings underline that higher harm avoidance among unipolar depressives compared to healthy controls persisted after treatment even if a significant reduction could be observed. Recurrent disorders and comorbidity with anxiety disorders seem to be related to a relatively immature character in terms of consistently lower scores for the character dimensions (e.g. self-directedness and cooperativeness) of the patients classified into these groups both at admission and at discharge compared with their healthy counterparts.

Adult↗

PubMed1999

[Decisions and attitudes in treatment of incompetent, chronically ill, aged patients. A comparison between nurses and physicians: why does no one ask the nurse?].

Health care decision making in incompetent severely ill patients presents many difficult medical, ethical, and legal problems for the physician. At the same time nurses represent the group of medical professionals who have the closest contact with the patient and who have to carry out most of the decisions and instructions. Treatment decisions and their determinants have been assessed by means of a questionnaire based on three case scenarios offering three different levels of available information of the patient's wishes (no information, DNR-order, advance directive). Responses of 191 doctors and 182 nurses have been analyzed. In both groups ethical factors and patient wishes were regarded as the most important. With an increasing level of information about the patient's will the compliance increased in both groups, being more pronounced among the nurses. The more important the will of the patient was estimated, the less difficult were the decisions, the less aggressive was the treatment level chosen, the less frequent rescuscitation was made, and the more helpful the information on patient's will were experienced. These important relationships occurred mainly in the nurses. Furthermore, age and level of dementia were related with the decisions though with less importance. The more legal aspects were regarded the more aggressive treatment options were chosen. Hospital cost were less important and did not influence the decision making. The results indicate that a more frequent use of advance directives would foster patient autonomy and at the same time lessen the burden on the medical staff. A comprehensive education of both the medical professions and the general public seems warranted.

Adolescent↗

PubMed1999

Social interaction and support related to mood and locus of control in cervical and endometrial cancer patients and their spouses.

The purpose of the study was to investigate possible relationships between quantitative and qualitative social support measures and mood in cervical (n = 30) and endometrial (n = 30) cancer patients and their spouses before and after treatment. Furthermore, the experience of locus of control was studied in light of mood and social support in women after treatment. The first interview with the patients was conducted on the day before the women started treatment, a second interview, 6 months later and a third one, 12-15 months after the initiation of treatment. The interviews with the spouses were conducted on the telephone before the initiation of their partners' treatment and 12-15 months later. Social support was assessed by the Interview Schedule for Social Interaction (ISSI), the Beck Depression Inventory (BDI) was used to measure the level of depressive symptomatology, and the locus of control orientation was assessed by the Locus of Control (LOC) scale. Women with cervical cancer reported BDI values that were significantly higher than in the endometrial group both before and after treatment. Women with cervical cancer also showed a significantly higher level on the BDI score on both occasions than did the corresponding group of spouses. The scores for ISSI were within normal limits in both groups of women. Furthermore, LOC was significantly correlated with adequacy of social interaction in women when controlled for social desirability, whereas LOC was unrelated to BDI. No significant correlations were found among the spouses concerning social network variables and dysphoric mood. The necessity of developing models for the psychological and behavioural risk assessment and for the elaboration of adequate treatment strategies is emphasized.

Adult↗

PubMed1999

Physicians' decision-making in incompetent elderly patients: a comparative study between Austria, Germany (East, West), and Sweden.

In order to investigate to what extent various determinants in the decision-making process for the treatment of severely ill incompetent patients are influenced by cultural and sociopolitical factors, 540 physicians in Austria, Germany (East and West), and Sweden, countries representing different healthcare systems, were surveyed using a self-administered questionnaire. It provided three case vignettes with different levels of information about the patient's treatment wishes in case of incompetence in a life-threatening situation. We found a general trend to a lower level of treatment in line with the patient's wishes when the information provided was more detailed. Remarkably, a substantial number of doctors did not comply with the patient's wishes. Ethical concerns and patient's wishes appeared as the most important factors whereas religious beliefs of the physician and hospital costs scored lowest. Because of the variability of treatment decisions and the importance of various factors determining the decision-making, an advance directive may be a feasible way of reducing the number of conflicts in critical situations. We recommend that ethical issues of clinical practice should be emphasized in the medical curriculum and in the training of physicians.

Adult↗

PubMed1999

Psychosocial determinants of well-being in gynecologic cancer patients.

The purpose of this study was to investigate the well-being of women with endometrial versus cervical cancer before treatment, and its determinants at 12 to 15 months follow-up. The subjects were interviewed before treatment, then 6 and 12 to 15 months after initiation of treatment. Simultaneously, they completed questionnaires on psychological symptoms and social support. It appeared that well-being at baseline and at the follow-ups were highly correlated. Furthermore, cervical cancer patients reported significantly more symptoms on all occasions. After discriminant function analysis, the following three variables remained in the analysis: (a) well-being before treatment, (b) diagnosis, and (c) children at home. This allowed 81% of the patients to be classified as having a favorable versus an unfavorable outcome. The results of this study highlight the importance of well-being before treatment as a predictor of well-being after treatment. The necessity of individualized intervention measures is warranted.

Adaptation, Psychological↗

PubMed1999

Relationships between various attitudes towards self-determination in health care with special reference to an advance directive.

OBJECTIVES: The subject of patient self-determination in health care has gained broad interest because of the increasing number of incompetent patients. In an attempt to solve the problems related to doctors' decision making in such circumstances, advance directives have been developed. The purpose of this study was to examine relationships between public attitudes towards patient autonomy and advance directives. SUBJECTS AND MAIN OUTCOME MEASURES: A stratified random sample of 600 adults in northern Sweden was surveyed by a questionnaire with a response rate of 78.2%. The subjects were asked about their wish for control of their health care, their concerns about health care, their treatment preferences in a life-threatening situation (both reversible and irreversible), and their attitudes towards the application of advance directives. RESULTS: Numerous relationships between various aspects of self-determination in health care (desire for control, fears of over-treatment, and choice of treatment level) in general and advance directives, in particular, were found. Those who wanted to have a say in their health care (about 94%) also mainly supported the use of an advance directive. CONCLUSIONS: The fact that almost 30% of the respondents were undecided concerning their personal use of advance directives points to a lack of knowledge and to the necessity of education of the public on these issues.

Adult↗

PubMed1998

Parental rearing and problem behaviours in male delinquent adolescents versus controls in northern Russia.

The purpose of this study was to investigate possible relationships between parental rearing practices and problem behaviours in a sample of male delinquent adolescents versus controls. A total of 133 subjects from a juvenile correction centre and 108 matched school-children in the Arkhangelsk region, Russia, were assessed by means of the EMBU questionnaire and Youth Self-Report. Delinquents were more severely treated by parents and had more pronounced problem scores. Furthermore, problem scores were found to be highly correlated with parental rejection and lack of emotional warmth in both delinquents and controls. Parental rearing practices may influence the development of problem behaviours. The implications of these findings with regard to preventive measures are discussed.

Adolescent↗

PubMed1998

Illness behavior in the acute phase of motor disability in neurological disease and in conversion disorder: a comparative study.

Sixty patients with a sudden onset of motor disability were assessed for illness behavior and depression. In 30 of the patients, etiology was attributed to a definite structural lesion. The remaining 30 patients were diagnosed as having conversion disorder. The Illness Behaviour Questionnaire (IBQ) and the Hamilton Rating Depression Scale (HRDS) were used as instruments for assessment. The mean HRDS score was significantly higher in the conversion group, indicating a higher degree of affective disease in these patients. According to the results of the IBQ, the patients with conversion disorder showed a higher degree of irritability, disease conviction, and phobic preoccupation, and also, to a greater extent, rejected psychological explanations for their symptoms. Denial was high in both patient groups, coexisting with affective symptoms in the conversion patients but not in the neurological patients. Although valuable information could be extracted from the IBQ, it was not found to be a reliable instrument for distinguishing between psychogenic and organic causes of motor disability.

Acute Disease↗

PubMed1998

Juvenile male rape victims: is the level of post-traumatic stress related to personality and parenting?

OBJECTIVE: The purpose of this study was to assess the level of post-traumatic stress in juvenile male rape victims and to test for its relationships with perceived parental rearing and personality dimensions. METHOD: Fifteen subjects (mean age of 16 years) were recruited from a correctional camp for juvenile criminals in Arkhangelsk, Russia. They were investigated by means of the "Revised Impact of Event Scale," the "Child Self-Report Post-Traumatic Stress Reaction Index," the "Hospital Anxiety and Depression Scale," the "EMBU" (perceived parental rearing) and the "Temperament and Character Inventory" (TCI). RESULTS: The level of post-traumatic stress, in most cases moderate to high, correlated with the temperament dimensions of harm avoidance and reward dependence. As concerns parental rearing, the total level of post-traumatic stress reaction was negatively correlated with paternal emotional warmth and positively with paternal rejection. CONCLUSIONS: The experience of post-traumatic stress is influenced by temperamental characteristics as well as by perceived parental rearing practices. Assumingly, these factors also play a role in becoming a rape victim, which deserves further investigation.

Adolescent↗

PubMed1998

Behaviour/emotional problems in male juvenile delinquents and controls in Russia: the role of personality traits.

Recent studies based on the psychobiological theory of personality by Cloninger postulate a relationship between certain personality traits and various psychopathological manifestations. To test this theory, we administered the Temperament and Character Inventory and the Youth Self-Report to 188 male delinquents from a juvenile correction centre in Northern Russia, and to 111 age-matched male controls recruited from among schoolchildren. As assumed by previous studies, psychological symptoms were primarily positively correlated with harm avoidance and negatively correlated with self-directedness. At the same time, the higher levels of aggressive and delinquent behaviour were positively correlated with novelty-seeking and negatively correlated with co-operativeness. The possible mechanisms underlying these findings are discussed.

Adolescent↗

PubMed1998

Childhood experiences and personality traits in patients with motor conversion symptoms.

A total of 30 patients with newly diagnosed motor conversion disorder were consecutively investigated by means of a Swedish self-rating inventory designed to assess perceived parental rearing practices (EMBU), and the Karolinska Scale of Personality (KSP). DSM Axis I and II psychopathology was assessed using a Structured Clinical Interview (SCID), and comparisons were made with 30 age- and sex-matched in-patients with motor symptoms due to a neurological disorder. Depression, the presence of a personality disorder and also poor schooling proved to be significantly associated with motor conversion disorder. The index patients perceived a high degree of parental rejection as well as low levels of affection and emotional warmth during childhood, but contrary to most previous studies, childhood physical and/or sexual abuse was not found to be associated with motor conversion disorder.

Adolescent↗

PubMed1998

Predictive factors for the outcome of a multidisciplinary pain rehabilitation programme on sick-leave and life satisfaction in patients with whiplash trauma and other myofascial pain: a follow-up study.

OBJECTIVE: To evaluate the effects of a multidisciplinary rehabilitation programme on sick-leave, coping resources and life satisfaction in whiplash patients and other pain patients. SUBJECTS: Forty patients suffering from symptoms after whiplash trauma and 33 patients with musculoskeletal pain in the neck or back were recruited for this study. Ninety-seven consecutive patients admitted to the Department of Neurosurgery with cervical pain, cervical disc herniation or symptomatic spondylosis served as a control group. RESULTS: Decreased coping resources and poorer life satisfaction were observed for whiplash subjects at the beginning of the rehabilitation programme compared to the control group from the Department of Neurosurgery. After the rehabilitation period 49% of the patients had improved their coping resources totalling to 63% after 2 years. At that follow-up 46% of patients had increased their life satisfaction. Furthermore, the group with whiplash injury showed a significant increase in sick absenteeism whereas the group without whiplash trauma had decreased their sick-leave. Eighty-eight per cent of the subjects could be correctly classified according to their vocational outcome by means of discriminant function. The elapse of time since working, low life satisfaction, lack of increase in coping resources during the rehabilitation programme, ethnic origin of the patient and living in the countryside predicted poor vocational outcome. CONCLUSION: Our results suggest variables from the social environment and coping resources as useful predictors for treatment outcome.

Adaptation, Psychological↗

PubMed1998

[Decisions and attitudes of nurses in the care of chronically ill elderly patients].

Data of 182 nurses from two teaching hospitals regarding their attitudes to determinants of the decision-making process in elderly patients in general and decisions in the treatment of an moderately demented, incompetent elderly man with a potentially reversible life-threatening illness using a scenario were analyzed. 68.1 percent complied to the patient's will when an advance directive existed. One fifth reported that the patient's directive was supportive for the decision. The more important the wishes of the patients were evaluated, the more frequent a less aggressive treatment choice was preferred and the less frequent the decision was for resuscitation in the case of a cardiac arrest. The increased use of advance directives is desirable to reduce the number of conflicts in decision-making for healthcare professionals and to reduce the patients' fears of over- or undertreatment and for increasing their possibilities of self-determination. A more intensive integration of topics such as death and dying, treatment of the chronically ill elderly as well as possibilities and limitations of patient directives and their use in the education of nurses is required.

Advance Directives↗

PubMed1997

[Physicians' attitude in the treatment of incompetent patients. Comparison between East and West Germany].

BACKGROUND: Health care decision-making in incompetent severely ill patients presents a number of difficult medical, ethical and legal problems for the physician. The factors and the degree to which various factors contribute to such decisions have rarely been investigated. SUBJECTS AND METHODS: 310 physicians from the state of Baden-Württernberg (Western Germany) and the state of Mecklenburg (eastern Germany) were asked by means of a questionnaire to rate the importance of eight factors in their health care decisions in the elderly. RESULTS: Both, ethical concerns and patients' wishes emerged as the most important factors for decisions in both subsamples. However, significant differences in the degree to which the factors hospital costs, patients' and family wishes, the level of dementia and the patients' age contribute to their decisions could be found between the answers of the doctors of the two lands. CONCLUSIONS: The socialization of the physicians in different health care and social systems seems to be one of the most important reasons for different health care decisions in old and incompetent patients.

Adult↗