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Biomedical subjects

N G Kutner

Publications and source records attributed to N G Kutner.

53 records · Page 3Linked to original sources
PubMed1985

Assessing depression and anxiety in chronic dialysis patients.

One hundred and twenty-eight patients on chronic dialysis were studied by the Zung Self-Rating Depression Scale and Self-Rating Anxiety Scale, the Differential Emotion Scale (DES), the Test of Emotional Styles (TES), and the Social Dysfunction Rating Scale (SDRS). As measured by the Zung scales, approximately half of the sample manifested depression and anxiety symptoms at clinically relevant levels. The data suggested an inverse correlation between depression and anxiety levels and patients' total length of time on dialysis, which may explain some of the variation in depression and anxiety results obtained with different samples. Depression and anxiety scores were correlated with related DES and SDRS factors, but patients' scores on the DES, TES, and SDRS generally indicated positive mood and functioning. Scales containing disease-related somatic items may yield exaggerated depression and anxiety scores for dialysis patients. It may be useful to assess patients' psychological functioning with several different instruments.

Anxiety↗
PubMed1985

Status of life-areas: congruence/noncongruence in ESRD patient and spouse perceptions.

Perceptions of ESRD patients' satisfaction with, and abilities in, 13 life-areas were assessed in 50 patients and their spouses by means of a series of linear rating scales. Patient and spouse views were congruent on 10 dimensions. Noncongruence existed only on perception of the patient's satisfaction with his/her medical situation, perception of the patient's ability to care for self, and perception of the patient's satisfaction with feelings about self. This noncongruence was especially pronounced in certain patient subgroups, and explanations related to the nature of ESRD and its treatment are suggested. We recommend that future studies examine not only perceptions of patients' satisfaction but also perceptions of the spouse's own satisfaction with various life-areas.

Activities of Daily Living↗
PubMed1985

Disability labeling vs. rehabilitation rhetoric for the chronically ill: a case study in policy contradictions.

Among persons with chronic renal disease, limited encouragement to use self-care treatment options and easy access to disability income benefits tend to reinforce the concept of disability rather than foster rehabilitation goals. More than 80% of all chronic renal disease patients on dialysis therapy receive treatment in facilities at which they become highly dependent on medical staff, and estimates of unemployment among persons aged 21-59 years suffering from this disease range from 60% to 75%. The authors' data indicate that patients who receive dialysis treatment within facilities experience negative effects on their perceived health status and health locus of control as compared to patients who practice self-care dialysis at home. Although many factors contribute to unemployment among dialysis patients, the availability of disability income benefits seems to act as the most important deterrent to employment. Increasing the emphasis on the rehabilitation of this chronically ill population will require a movement away from disability labeling by providers of care and the patients themselves, as well as adjustment in the dialysis reimbursement system and in the eligibility requirements for disability compensation.

Health↗
PubMed1984

Women with disabling health conditions: the significance of employment.

This study investigated employment status, desire to return to work, and health outlook among 148 women and 184 men with major disabling health conditions. Disabled women's need for job retraining and the importance of improved employer education about disability were recurrent themes during the interviews. No significant differences were found in women's and men's return to work or in desire for job retraining following disability onset. Perceived health status was significantly higher among employed women than among non-employed women, and the data suggest that employment contributes to improved health outlook among disabled women.

Adult↗
PubMed1983

Spatial rearrangement. Its effect on social environment in a renal dialysis clinic.

There has been little research on social environments created by spatial arrangements in health care and how these social environments may affect the nature of health care. This article describes changes in the social environment of a renal dialysis clinic that were created by an alteration in the spatial arrangements. It was found that changes occurred in the communication between staff and patients, the communication among patients, and the communication between patients and visitors. These changes in turn raised questions about the quality of care available to patients.

Color↗
PubMed1982

Assessment of rehabilitation outcomes among chronic dialysis patients.

The physical status of 137 chronic dialysis patients was assessed by both objective and subjective measures; education and employment statuses were also determined. Below normal grip strength characterized the majority of patients; slowed nerve conduction and subjective fatigue were also observed among a subset of patients. However, patients demonstrated good to normal muscle strength and relatively normal pinch strength, and activities of daily living presented no problems for the large majority of patients. Employment probability was directly related to educational status. Despite dialysis requirements and other employment disincentives, 42% of non-diabetic men aged 21-59 were employed.

Adolescent↗
PubMed1982

The problem of fatigue in dialysis patients.

137 patients on maintenance dialysis were studied. All but 2 patients were ambulatory, and all patients demonstrated good to normal strength on manual motor tests. With the exception of systemic lupus erythematosus, no correlation was found between primary diagnosis and patients' fatigue ratings. Laboratory studies of hematocrit, BUN, creatinine, calcium, and phosphorus did not correlate with fatigue ratings for the majority of patients. Fatigue appeared more problematic for patients who had been dialyzing for less than 4 years. Depression was pronounced among patients who reported feeling fatigued upon arising.

Activities of Daily Living↗
PubMed1981

Rehabilitation status of chronic renal disease patients undergoing dialysis: variations by age category.

Medical, vocational and psychological indicators of rehabilitation status were examined for 137 patients undergoing chronic dialysis therapy. Patients were evaluated by means of a semi-structured interview, self-ratings of satisfaction and depression and assessments of physical strength and cognitive-motor skills. Patients aged 25 to 34 years old were found to have the best overall adjustment to chronic dialysis therapy. The data indicate a need for improved vocational counseling for patients under age 25 and for increased concern with sources of depression among patients 55 and older.

Adolescent↗
PubMed1979

Race and sex as variables affecting reactions to disability.

Several aspects of reaction to disability were compared across samples of rehabilitation patients which differed in race and sex. Subjects included 28 black men, 14 white men, 19 black women, and 19 white women who had a range of different disabilities and who were patients at a large public hospital and a small rehabilitation center in a southeastern metropolis. Losses attributed to disability were found to vary for men and women, except that inability to work was missed most by all subjects. Only black men emphasized themselves, their jobs, and other persons as reasons for their disability. All subjects were most likely to cite mystical causes for their disability and to believe that mystical sources would most help them to improve.

Black or African American↗
PubMed1978

Medical students' orientation toward the chronically ill.

Medical students receive little training specifically directed toward care of chronically ill persons, and physicians, therefore, tend to have little knowledge of alternative long-term care arrangements. Moreover, the negative attitudes toward chronic patients which were observed by Becker in the 1950s still seem prevalent among medical students. Little interest is expressed by medical students in fields which focus on the chronically ill or aged. Restructuring of medical education is necessary in order to promote more concern among physicians with the needs of the chronically ill.

Attitude to Health↗
PubMedDate not supplied

Improving compliance in dialysis patients: does anything work?

Noncompliance with prescribed therapy significantly impacts dialysis patient care and outcome. At least one-half of hemodialysis (HD) patients are likely to be noncompliant with some part of their treatment regimen, and one-third of peritoneal dialysis (PD) patients are believed to miss prescribed exchanges. Psychosocial issues, younger age, and smoking behavior have been linked with compliance problems in multiple studies. Few interventions have been rigorously tested, but patient education and/or individualized attention, supervision, encouragement, and support are widely advocated strategies to improve patient compliance. Areas in need of continued study include psychosocial determinants of compliance in PD as well as HD patients, compliance behavior patterns over time, and the parameters within which dialysis compliance can vary and still achieve specified treatment goals.

Humans↗
PubMedDate not supplied

Measuring the quality of life of the elderly in health promotion intervention clinical trials.

The Multicenter Trials of Frailty and Injuries: Cooperative Studies of Intervention Techniques (FICSIT) is a series of clinical trials of biomedical, behavioral, and environmental interventions to reduce the risks of frailty and injury among the elderly. Reliable assessment of the quality of life reported by the subjects is a central issue in evaluating the interventions. An intervention may have a significant impact on an elderly person's sense of well-being, even though significant improvement is not observed in selected physical outcome measures. Elderly persons' compliance with particular intervention regimens may be influenced by the quality of life effects that they perceive in relation to the intervention. The researchers review the definition and measurement of quality of life in the trials, with particular attention to issues in determining common measures used at all study locations. Practical considerations in the selection and use of quality of life measures in both community and institutional populations are addressed. Topics discussed include the interrelation of aging, functional capacities, and quality of life; the multi-dimensionality of quality of life in relation to differential intervention effects; and age-related issues in the collection of quality of life data. Preliminary observations are reviewed, and potential contributions of FICSIT to intervention-sensitive quality of life assessments among the elderly are noted.

Activities of Daily Living↗