PubMed Health⌕ Search

Biomedical subjects

M M Chren

Publications and source records attributed to M M Chren.

At least 19 recordsLinked to original sources
PubMed2006

Age, gender, quality of life and psychological distress in patients hospitalized with psoriasis.

BACKGROUND: Psoriasis has a great impact on the quality of life of patients, and the ageing population is an important public health issue. OBJECTIVES: To investigate whether older patients with psoriasis have a different impairment in quality of life compared with younger patients, considering level of severity, duration of disease, gender and psychological distress. METHODS: The study was performed between February 2000 and February 2002 at the inpatient wards of the Dermatological Institute IDI-IRCCS, Rome, Italy, in the framework of a large project on clinical, epidemiological, emotional and quality of life aspects of psoriasis (IMPROVE study). This is a hospital-based cross-sectional study, with measures of quality of life (Skindex-29, Dermatology Life Quality Index and Psoriasis Disability Index) and of psychological distress, generic (12-item General Health Questionnaire) and psoriasis-related (Psoriasis Life Stress Inventory), all self-assessed by patients. We compared the mean scores of each quality of life instrument in patients aged < 65 years and >/= 65 years, in subsets of patients based on clinical and sociodemographic characteristics. RESULTS: We analysed 936 patients hospitalized at IDI-IRCCS with a diagnosis of psoriasis. Quality of life was significantly more impaired in the older group for all the Skindex-29 scales, and psychological distress was higher in older patients. In particular, older women suffering from anxiety or depression had the greatest impairment in quality of life. The results were somewhat different using the other quality of life instruments. CONCLUSIONS: These results should alert dermatologists that similar levels of clinical severity in psoriasis may be associated with different levels of quality of life and psychological distress of patients. Particular attention should be devoted to older patients, and especially to older women.

Adolescent↗
PubMed2001

Measurement properties of Skindex-16: a brief quality-of-life measure for patients with skin diseases.

BACKGROUND: An accurate, sensitive, but brief quality-of-life outcomes measure is needed for studies of dermatologic care. OBJECTIVE: To construct a single-page version of Skindex (a dermatologic quality-of-life instrument) that would have two new features compared with the current 29-item version: (1) fewer items to which a majority of patients choose the same response, and (2) measurement of bother rather than frequency of patient experiences. METHODS: Random samples of patients waiting for dermatology appointments in clinics of Veterans Affairs hospitals and in private dermatology practices completed questionnaires; 692 patients responded to the parent instrument and 541 additional patients responded to the brief version. Reproducibility, internal consistency reliability, validity, and responsiveness of the brief version of Skindex were determined. RESULTS: For 16 items of the current 29-item version (55%), more than 50% of patients responded "Never." After an explicit process of item analysis and elimination, a single-page 16-item version was composed that asks patients about bother from their experiences; responses are reported as three scales, Symptoms, Emotions, and Functioning. For 6 items of the 16-item version (38%), more than 50% of patients responded "Never." Scale scores were reproducible after 72 hours (r = 0.88-0.90) and were internally reliable (Cronbach's alpha = 0.86-0.93). The instrument demonstrated both content and construct validity: Most patients' responses to an open-ended question about their skin disease was addressed by the items; patients with inflammatory dermatoses had higher scores than those with isolated lesions; and in an exploratory principal axes factor analysis with an oblique rotation, 74% of the common variance was explained by three factors that correlated with the a priori scales. Mean scale scores stayed the same or changed in the expected direction in patients who reported that their skin was the same or had improved. CONCLUSION: This brief single-page version of Skindex accurately and sensitively measures how much patients are bothered by their skin conditions.

Activities of Daily Living↗
PubMed2001

Psychological stress perturbs epidermal permeability barrier homeostasis: implications for the pathogenesis of stress-associated skin disorders.

BACKGROUND: A large number of skin diseases, including atopic dermatitis and psoriasis, appear to be precipitated or exacerbated by psychological stress. Nevertheless, the specific pathogenic role of psychological stress remains unknown. In 3 different murine models of psychological stress, it was recently shown that psychological stress negatively impacts cutaneous permeability barrier function and that coadministration of tranquilizers blocks this stress-induced deterioration in barrier function. OBJECTIVES AND METHODS: The relationship between psychological stress and epidermal permeability barrier function was investigated in 27 medical, dental, and pharmacy students without coexistent skin disease. Their psychological state was assessed with 2 well-validated measures: the Perceived Stress Scale and the Profile of Mood States. Barrier function was assessed simultaneously with the stress measures at periods of presumed higher stress (during final examinations) and at 2 assumed, lower stress occasions (after return from winter vacation [approximately 4 weeks before final examinations] and during spring vacation [approximately 4 weeks after final examinations]). RESULTS: The subjects as a group demonstrated a decline in permeability barrier recovery kinetics after barrier disruption by cellophane tape stripping, in parallel with an increase in perceived psychological stress during the higher vs the initial lower stress occasions. During the follow-up, presumed lower stress period, the subjects again displayed lower perceived psychological stress scores and improved permeability barrier recovery kinetics, comparable to those during the initial lower stress period. Moreover, the greatest deterioration in barrier function occurred in those subjects who demonstrated the largest increases in perceived psychological stress. CONCLUSION: These studies provide the first link between psychological status and cutaneous function in humans and suggest a new pathophysiological paradigm, ie, stress-induced derangements in epidermal function as precipitators of inflammatory dermatoses.

Adult↗
PubMed2001

Strategies of coping and quality of life in women with alopecia.

BACKGROUND: Measurements of the quality of life (QoL) have recently become an integral part of dermatological studies. Our hypothesis is that QoL in patients with certain diseases can be affected by strategies of coping behaviour, as well as by personality traits. OBJECTIVES: The aim of this study was to explore the particular correlation between QoL and strategies of coping in female patients with alopecia. PATIENTS: Fifty female patients, diagnosed with either diffuse or androgenetic alopecia, were evaluated by the use of Hairdex, an instrument developed to measure QoL in patients with hair loss. Most patients also underwent additional psychological assessments. RESULTS: Findings indicated that patients with highly visible hair loss reported a more negative impact on four Hairdex dimensions (functioning, emotions, self-confidence and stigmatization) than patients whose hair loss was only slightly visible. However, a subgroup of patients, with non-visible symptoms of hair loss, showed striking signs of psychological disturbance. These disturbed patients displayed either dysmorphophobic or affective disorder tendencies. CONCLUSIONS: Future studies using QoL as an instrument in research on patients with alopecia should consider that in cases of female alopecia these measurements may be affected by psychological disturbances.

Adaptation, Psychological↗
PubMed2000

The Spanish version of Skindex-29.

BACKGROUND: Most currently available dermatologic quality-of-life measures were originally created in English, and must be translated and adapted for use in other cultures. Our purpose was to translate and adapt culturally into Spanish a skin-related quality-of-life measure, Skindex-29, and to begin preliminary assessments of its reliability and validity. METHODS: Transcultural adaptation and cross-sectional questionnaire studies were performed. One hundred and fourteen adult persons (patients and healthy people) responded to the Spanish version of Skindex-29. Evaluations of the semantic equivalence of back-translated items, reliability, construct validity, and content validity of the Spanish version were the main outcome measures. Comparison between Spanish and American responses was also performed. RESULTS: Six problematic items required a second translation and back-translation to achieve satisfactory agreement with the original instrument. The final Spanish version of Skindex-29 was internally reliable (range of Cronbach alpha for the scales, 0.70-0.87). The instrument demonstrated both construct and content validity. As hypothesized, scores for dermatologic patients were higher than those for healthy persons (mean global scores 21 vs. 5, P < 0.01) and scores for patients with inflammatory diseases were higher than those for persons with isolated skin lesions (mean global scores 32 vs. 11, P < 0.01), indicating a poorer quality of life. In addition, most patients' responses to an open-ended question about their skin disease were addressed by items in the instrument. Skindex scale scores of American and Spanish respondents were similar. CONCLUSIONS: We have developed a semantically equivalent translation of Skindex-29 into Spanish. Our preliminary evaluation of its measurement properties suggests that it is a reliable and valid measure of the effects of skin disease on the quality of life in Spanish patients.

Adult↗
PubMed2000

Differences in patient-reported processes and outcomes between men and women with myocardial infarction.

OBJECTIVE: Previous research measuring differences in the care between men and women with myocardial infarction has focused on differences in procedure use and mortality. However, little is known about differences in processes and outcomes that are reported by patients, such as interpersonal processes of care and health status. Our goal was to measure differences in patient-reported measures for men and women who recently were hospitalized with myocardial infarction. PARTICIPANTS AND SETTING: We surveyed by mail patients with myocardial infarction discharged to home from one of 27 Cleveland area hospitals 3 months following discharge; 502 (64%) of 783 patients responded. The mean age of subjects was 65 years and 40% were women. MEASUREMENTS: Process measures included the quality of communication during the hospitalization and at time of discharge and reports of health education discussions during hospitalization. Outcome measures included physical and mental health component scores of the Medical Outcomes Study 36-Item Short-Form Health Survey, change in work status, and days spent in bed because of ill health. We compared processes and outcomes in men and women using multivariate analyses that adjusted for age, other demographic characteristics, comorbid conditions, severity of the myocardial infarction, and premorbid global health status. MAIN RESULTS: In multivariate analyses, women were as likely as men to report at least one problem with communication during the hospitalization (odds ratio [OR] 0.86; 95% confidence interval [95% CI] 0.56 to 1. 33) or at time of discharge (OR 1.24; 95% CI, 0.82 to 1.89) and to report that they were given dietary advice before discharge (OR 0. 60; 95% CI, 0.36 to 1.01), were told what to do if they developed chest pain (OR 1.21; 95% CI, 0.66 to 2.23), or, if they smoked cigarettes, given advice about how to stop smoking (OR 0.64; 95% CI, 0.26 to 1.58). However, 3 months after discharge, women reported worse physical health (P <.05) and mental health (P <.05), were more likely to report spending time in bed because of ill health (OR 1. 80; 95% CI, 1.06, 3.05), and were more likely to report working less than before their myocardial infarction (OR 4.02; 95% CI, 1.58 to 10. 20). CONCLUSIONS: In terms of processes of care measured with patient reports, women with myocardial infarction reported their quality of care to be similar to that of men. However, 3 months following myocardial infarction, women reported worse health status and were less likely to return to work than men.

Age Factors↗
PubMed2000

Report of having slowed down: evidence for the validity of a new way to inquire about mild disability in elders.

BACKGROUND: Mild disability in elderly persons may be detected by eliciting reports of modified task performance, even in the absence of reported difficulty. This study provides evidence for the validity of one type of task modification. namely, slowing, as a measure of mild walking disability. METHODS: Community-dwelling elders (N = 287) were questioned about whether they were walking indoors as quickly as they had 1 year before and 10 years before. Construct validity was assessed by the degree to which responses to these two questions were logically consistent with a general decline in walking speed, and by determining whether reported slowing was associated with concurrent reports of difficulty walking and with measured gait speed. Predictive validity in subjects without reported difficulty walking was gauged by the association of reported slowing with adverse walking outcomes at 1-year follow-up. RESULTS: Reports of slowing over 10- and 1-year periods were almost uniformly consistent with a general decline in speed. Reported slowing was significantly associated with reported difficulty walking and with slower gait speed. In the subgroup of elders initially reporting no difficulty walking, reported slowing significantly predicted incident difficulty walking at follow-up, as well as other adverse walking outcomes. For example, among elders who reported slowing, 7%, 10%, and 19% developed new difficulty walking indoors, new difficulty walking outdoors, or stopped walking for pleasure, compared with 0%, 0%, and 3% for those who had not reported slowing (p < .05). CONCLUSIONS: This study provides evidence for the construct and predictive validity of one type of task modification, namely, slowing in indoor walking. This work contributes to the development of new methods for measuring mild disability, which may in turn form the basis for clinical interventions based on the early identification of functional problems.

Aged↗
PubMed2000

Functional status before hospitalization in acutely ill older adults: validity and clinical importance of retrospective reports.

OBJECTIVES: Retrospective reports of patients' functional status before hospital admission are often used in longitudinal studies and by clinicians caring for hospitalized patients. However, the validity of these reports has not been established. Our aim was to examine the validity of retrospective reports by testing hypotheses about the relationships these measures would have with other clinical measures if they were valid. DESIGN: A prospective cohort study. PARTICIPANTS AND SETTING: A total of 2877 older patients (mean age 81, 36% women) hospitalized on the general medical service at two hospitals. For 1953 of the subjects, the patient was the primary respondent, whereas for 924 subjects, a surrogate was the primary respondent. MEASUREMENTS: Shortly after hospital admission, patients or surrogates reported whether the patient was independent in each of five activities of daily living (ADLs) on admission and at baseline 2 weeks before admission. Outcome measures included reported independence in each ADL 3 months after the hospitalization and survival to 1 year. RESULTS: Patients' retrospective reports of their ADL function 2 weeks before admission had a clinically plausible relationship with ADL function at the time of admission, in that patients independent in an ADL on admission rarely reported they were dependent in that ADL 2 weeks before admission (range 2-6%). Surrogates were somewhat more likely than patients to report that patients independent on admission were dependent 2 weeks before admission (range 5-14%). Retrospective reports of prehospitalization ADL function demonstrated strong evidence of predictive validity for both patients' and surrogates' reports. For example, among patients dependent in bathing on admission, patients who were reported as independent 2 weeks before admission were much more likely than those reported as dependent 2 weeks before admission to be independent 3 months after hospitalization (68% vs 20%, P < .001 for patient respondents; 30% vs 5%, P < .001 for surrogate respondents). Similarly, among patients dependent in bathing on hospital admission, survival 1 year after hospitalization was much higher in patients who were independent in bathing 2 weeks before admission than patients who were dependent 2 weeks before admission (76% vs 59%, P < .001 for patient respondents; 60% vs 45%, P < .001 for surrogate respondents). Results were similar for each of the other four ADLs. In a logistic regression model controlling for the number of ADLs reported as dependent on admission, the number of ADLs reported as dependent 2 weeks before admission was significantly associated with 1-year mortality among both patient (odds ratio (OR) = 1.39 per dependent ADL, 95% confidence interval (CI) - 1.26-1.54) and surrogate (OR = 1.14, 95% CI = 1.06-1.24) respondents. CONCLUSIONS: Hospitalized patients' assessments of their ability to perform ADLs before their hospitalization have evidence of face and predictive validity. These measures are strong predictors of important health outcomes such as functioning and survival. In particular, among patients dependent in ADL function on hospital admission, these results highlight the prognostic importance of inquiring about the patient's functional status before the onset of the acute illness.

Activities of Daily Living↗
PubMed1999

When doctors marry doctors: a survey exploring the professional and family lives of young physicians.

BACKGROUND: Soon, half of all physicians may be married to other physicians (that is, in dual-doctor families). Little is known about how marriage to another physician affects physicians themselves. OBJECTIVE: To learn how physicians in dual-doctor families differ from other physicians in their professional and family lives and in their perceptions of career and family. DESIGN: Cross-sectional survey. SETTING: Two medical schools in Ohio. PARTICIPANTS: A random sample of physicians from the classes of 1980 to 1990. MEASUREMENTS: Responses to a questionnaire on hours worked, income, number of children, child-rearing arrangements, and perceptions about work and family. RESULTS: Of 2000 eligible physicians, 1208 responded (752 men and 456 women). Twenty-two percent of male physicians and 44% of female physicians were married to physicians (P < 0.001). Men and women in dual-doctor families differed (P < 0.001) from other married physicians in key aspects of their professional and family lives: They earned less money, less often felt that their career took precedence over their spouse's career, and more often played a major role in child-rearing. These differences were greater for female physicians than for male physicians. Men and women in dual-doctor families were similar to other physicians in the frequency with which they achieved career goals and goals for their children and with which they felt conflict between professional and family roles. Marriage to another physician had distinct benefits (P < 0.001) for both men and women, including more frequent enjoyment from shared work interests and higher family incomes. CONCLUSIONS: Men and women in dual-doctor families differed from other physicians in many aspects of their professional and family lives, but they achieved their career and family goals as frequently. These differences reflect personal choices that will increasingly affect the profession as more physicians marry physicians.

Child↗
PubMed1999

Understanding research about quality of life and other health outcomes.

BACKGROUND: Papers reporting studies of health outcomes, particularly patients' perceptions, are becoming more common. Understanding the characteristics of tools used to measure these health outcomes is important for interpreting these studies accurately and applying them to clinical care. OBJECTIVE: The purpose of this article is to describe important features of the measurement of patient-perceived health outcomes, and to illustrate how a consideration of these features can help in applying study results to individual patients. CONCLUSION: Understanding the principles of measurement is particularly important for interpreting studies of dermatological care, in which patients' perceptions are a crucial outcome.

Health Status↗
PubMed1998

Acne vulgaris and the quality of life of adult dermatology patients.

OBJECTIVE: To determine the effects of acne vulgaris on the quality of life of adult dermatology patients. DESIGN: Cross-sectional and longitudinal questionnaire study. PATIENTS: Sixty patients with acne vulgaris attending appointments with their dermatologists. MAIN OUTCOME MEASURES: Findings using Skindex, a validated 29-item instrument to measure the effects of skin disease on patients' quality of life. Results are reported as 3 scale scores (functioning, emotions, and symptoms) and a composite score (average scale score). In addition, dermatologists rated the clinical severity of patients' skin disease, and patients responded to a global question about how they are bothered by acne. Higher Skindex scores indicate greater effects on quality of life. RESULTS: Patients with acne experienced functioning and emotional effects from their skin disease comparable with those of patients with psoriasis, but experienced fewer symptoms (for patients with acne and psoriasis, respectively, Skindex functioning scores of 14.9 and 22.8 [P=.08]; emotion scores, 39.2 and 38.9 [P=.95]; and symptoms scores, 29.5 and 42.1 [P<.05]). Skindex scores were higher in older patients than in younger patients, and patients aged 40 years or older were less likely to report improvement in their acne after 3 months (43% vs 85%; P<.05). Among patients reporting no improvement in their acne, older patients reported greater effects of their acne on their quality of life. Furthermore, in multivariate analyses, older adults reported more effects of acne on their quality of life than younger adults, even after controlling for sex and acne severity as judged by the dermatologist. CONCLUSIONS: Acne vulgaris significantly affects patients' quality of life. Regardless of the severity of acne, older adults were more affected by their acne.

Acne Vulgaris↗
PubMed1998

Reports by patients and dermatologists of skin cancer preventive services provided in dermatology offices.

OBJECTIVE: To learn how often patients receive skin cancer preventive services in dermatologists' offices. DESIGN: Survey of dermatology patients and dermatologists. SETTING: Dermatology practices of full-and part-time faculty at a midwestern medical school. PARTICIPANTS: Patients were randomly selected from clinical sessions of 11 dermatologists. Of 200 patients enrolled, 162 (81%) responded to the survey. Ten (91%) of the dermatologists responded, and 4 additional dermatologists from the faculty were also surveyed. MAIN OUTCOME MEASURES: Patients' and dermatologists' reports of the provision of skin cancer prevention counseling and screening for skin cancer. RESULTS: Most patients (93%) had been informed about the risks of sun exposure, but for only 27% was a dermatologist the main source of information. Although 76% of patients had seen a dermatologist at least twice in the last 5 years, only 34% reported that they had ever received a total-body screening examination for skin cancer. Most patients (55%) would like to learn more about skin cancer prevention, and responded that they would learn best from a brochure (43%) or from a dermatologist (42%). All dermatologists believed that some skin cancer preventive services should be provided to each patient, but they varied widely in the proportion of their white adult patients to whom they provided such services. For example, with respect to counseling about sunscreens, the same number of dermatologists (4 [29%]) responded that they counsel 25% or less of their patients, and more than 75% of their patients. CONCLUSION: There is wide variation in how often skin cancer preventive services are provided in dermatologists' offices.

Adult↗
PubMed1998

The relation between health status changes and patient satisfaction in older hospitalized medical patients.

OBJECTIVE: To examine the relation between two patient outcome measures that can be used to assess the quality of hospital care: changes in health status between admission and discharge, and patient satisfaction. DESIGN: Prospective cohort study. SETTING AND PATIENTS: Subjects were 445 older medical patients (aged > or =70 years) hospitalized on the medical service of a teaching hospital. MEASUREMENTS AND MAIN RESULTS: We interviewed patients at admission and discharge to obtain two measures of health status: global health and independence in five activities of daily living (ADLs). At discharge, we also administered a 5-item patient satisfaction questionnaire. We assessed the relation between changes in health status and patient satisfaction in two sets of analyses, that controlled for either admission or discharge health status. When controlling for admission health status, changes in health status between admission and discharge were positively associated with patient satisfaction (p values ranging from .01 to .08). However, when controlling for discharge health status, changes in health status were no longer associated with patient satisfaction. For example, among patients independent in ADLs at discharge, mean satisfaction scores were similar regardless of whether patients were dependent at admission (i.e., had improved) or independent at admission (i.e., remained stable) (79.6 vs 81.2, p = .46). Among patients dependent in ADLs at discharge, mean satisfaction scores were similar regardless of whether they were dependent at admission (i.e., remained stable) or independent at admission (i.e., had worsened) (74.0 vs 75.7, p = .63). These findings were similar using the measure of global health and in multivariate analyses. CONCLUSIONS: Patients with similar discharge health status have similar satisfaction regardless of whether that discharge health status represents stable health, improvement, or a decline in health status. The previously described positive association between patient satisfaction and health status more likely represents a tendency of healthier patients to report greater satisfaction with health care, rather than a tendency of patients who improve following an interaction with the health system to report greater satisfaction. This suggests that changes in health status and patient satisfaction are measuring different domains of hospital outcomes and quality. Comprehensive efforts to measure the outcomes and quality of hospital care will need to consider both patient satisfaction and changes in health status during hospitalization.

Aged↗
PubMed1998

What patients should ask of consumers' guides to health care quality.

Consumers' guides that profile the quality of care of individual health care providers may be influential in shaping health care markets. We propose four simple questions that can be used to evaluate such guides: (a) Does the guide measure distinct and important domains of health care quality? (b) Are the individual measures of quality described simply and precisely? (c) Do the measures take into account relevant differences between patients? (d) Are the ratings of quality presented fairly? Using these four questions, we examine the validity of one prominent guide that annually identifies America's best hospitals and present a set of recommendations for the design of future guides. Although the evaluation of health care quality is undoubtedly complex, the four questions that we pose provide a basis for developing a more rational approach to informing the public about health care quality.

Consumer Advocacy↗
PubMed1997

Convergent and discriminant validity of a generic and a disease-specific instrument to measure quality of life in patients with skin disease.

Skindex is a quality-of-life instrument for skin diseases. To determine its convergent validity and its advantage relative to a generic measure, we compared responses of 132 dermatology patients to Skindex and the Medical Outcomes Study 36-item Short-Form Survey (SF-36). We hypothesized that (i) correlations between similar scales would be strong but not redundant (r = 0.5-0.6), and (ii) Skindex scores would correlate more highly with responses about skin disease-related aspects of health, and SF-36 scores would correlate more highly with responses concerning general health. As measured by the SF-36, patients reported general health status similar to the normal population, and SF-36 scores did not correlate with dermatologists' judgments about the severity of skin disease. Correlations between the same scales of the two instruments were as hypothesized (range of r, 0.44-0.56), and patients with low, medium, or high responses to Skindex differed similarly in SF-36 scores. On the other hand, some patients who reported on the SF-36 that they were free of physical symptoms (37% of patients) or social effects (54%) on Skindex, reported such effects from their skin disease. Also, responses about skin-related health aspects correlated more highly with Skindex than SF-36 (for skin condition, mean r = 0.42 vs 0.28; for disfigurement, 0.38 vs 0.24). Conversely, responses concerning general health correlated more highly with SF-36 than Skindex (for self-reported health status, mean r = 0.28 vs 0.16; for co-morbidity, 0.48 vs 0.37). This study further supports the validity of Skindex and also suggests that both generic and disease-specific health status measures can contribute to the assessment of patients with skin diseases.

Adult↗