How we can better protect children from abuse and neglect.
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Biomedical subjects
Publications and source records attributed to M R Lowry.
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Spouse-assistants of patients undergoing maintenance home hemodialysis have been noted to suffer a variety of psychological problems if either the assistant or the patient is given sole responsibility for the conduct of home treatment. The current report is based on a prospective study of patients and spouses in the Iowa City Veterans Administration Hospital Home Hemodialysis Program, in which both partners are thoroughly trained in dialysis techniques (and the patient is expected to assume responsibility for his or her own home care). Data are presented from follow-up interviews with 32 patients and 29 spouses who had been in home treatment for a minimum of 6 months after the completion of home training. The data suggest that depression, anxiety, and marital problems are encountered less frequently in this group of spouse-assistants than in those described in earlier reports from programs with different training philosophies.
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Fifteen (18%) of 83 patients entering home hemodialysis training were found to suffer major depressive disorder diagnosed by rigorous clinical criteria. The diagnosis of depressive disorder was associated with a diagnosis of polycystic kidney disease. It was not, however, associated with past or family history of affective illness. Neither intellectual impairment nor chemical uremia were more pronounced in the patients with depressive disorder than in the patients without depressive disorder. Depressive symptoms almost invariably remitted during home dialysis training and had no apparent influence on outcome on the basis of a short-term (3-month) follow-up.
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Fifty-eight patients were systematically interviewed at the time of their entry into a home hemodialysis training program. The social, demographic, medical, and psychological characteristics of the sample are described. On interview, 13 (22%) of the 58 patients were found to be experiencing rigorously defined depressive disorder. The importance of further study regarding the incidence of depressive illness in similar groups of patients and the need for further research in defining adequate therapy for these patients are emphasized.
During a prospective study of 58 patients entering home hemodialysis training, systematic interviews revealed that thirteen (22 per cent) of the patients were suffering depressive disorder. Depressed patients were more likely than nondepressed patients to have experienced a decline in job performance during the previous year, applied for disability income, and reduced leisure activities after the beginning of training. Further, the only two patients complaining of "quite a lot" of anxiety during dialyses were both found to be suffering depressive disorder. Polycystic kidney disease and depressive disorder were significantly positively associated in this patient sample. Possible implications of that association are discussed.