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PubMed2002

Validity of patient-supplied medical history data comparing two medical questionnaires.

In many European countries there has been a significant shift in the age structure of the population, resulting in a marked rise in the number of elderly, medically compromised patients. Early identification of possible medical risk factors is therefore increasingly gaining in importance in the treatment of dental patients. It was the aim of the present study to evaluate two different patient-administered questionnaires with a view to both the validity of medical history data supplied by the patients and the identification of a possible risk potential. A comprehensive form (A, specially designed for treatment under general anaesthesia, 50 questions) and a shorter form (B, for routine use in general dental practices, 37 questions) were randomly distributed to patients of two dental practices (n = 194). Data supplied by the patients were checked against those provided by the general practitioners and risk assessment was performed based on the American Society of Anaesthesiologists (ASA) physical status classification system. A total of 161 medical history forms were evaluated (A: 81 test persons, B: 80 test persons). A close relationship was observed between increased age and higher ASA classification. The evaluation of the two history forms yielded an overall sensitivity of 80% for form A and of 61% for form B (specificity 96% and 98%, respectively). With both forms, agreement between the data supplied by the patients and by the dental practitioner was highest for ASA Grade I patients (A: 88%, B:02%). However, agreement between patient and general practitioner-supplied data was lower for ASA Grade III patients with both forms (A: 92%, B: 72%). Risk overestimation with form A occurred in 6 % and with form B in 5% of cases, while the medical risk was underestimated with form A in 5% and with form B in 11% of cases. Although results of the present study emphasise the need for meticulous and thorough history taking, neither the more concise form B nor the more comprehensive and detailed form A was able to exclude the occurrence of false-positive or false-negative answers. Particularly the lack of validity observed for patient-supplied data, which resulted in higher medical risk classifications despite the use of a comprehensive medical history questionnaire, mandates the improvement and possible reorientation of interdisciplinary co-operation between the dentist and the general practitioner.

Adult↗
PubMed1975

Face validity of test and acceptance of generalized personality interpretations.

After students in different groups took one of four "personality tests" that varied in face validity, they received a generalized personality interpretation. Even though the test lowest in face validity merely required the subject to circle digits, judged accuracy of the interpretation (a) was high for all tests (76-87% of the ratings in the various test groups were good or excellent) and (b) was independent of type of test upon which the interpretation was purportedly derived. From 46-60% of the subjects in the various groups "definitely liked" or "liked" the interpretation; likability was independent of face validity of the test. Judged accuracy and likability of the interpretation correlated positively and significantly. The willingness of individuals to accept generalized statements about themselves is a researchable problem area suggested by the present research.

Adolescent↗
PubMed1978

Applicability of the Group Personality Projective Test within a prison population.

Administered the Group Personality Projective Test (GPPT) to 60 male offenders incarcerated in a state penitentiary. A board of 10 prisoners selected inmates who clearly had demonstrated one of three patterns of assaultive behavior: undercontrolled aggressives, overcontrolled aggressives, and over controlled psychopaths. A control group was chosen randomly from the prison population, as well. Results failed to support the hypothesis that GPPT scores significantly differ among relatively homogeneous prisoner subgroups or between these groups and the control group of non-assaultive prisoners.

Aggression↗
PubMed2004

Personality and emotion: test of Gray's personality theory by means of an fMRI study.

Although it is known that there are fundamental personality differences in the behavioral responses to emotional stimuli, traits have scarcely been investigated in this context by means of functional imaging studies. To maximize the variance with respect to personality, the authors tested 12 control subjects and 12 subjects who had sadomasochistic experiences with respect to the relationship between J. A. Gray's (1970) personality dimensions, the behavioral approach system (BAS) and the behavioral inhibition system (BIS), and brain activity in regions of interest. The BIS was associated with activity in numerous brain areas in response to fear, disgust, and erotic visual stimuli, whereas few associations could he detected between the BAS and brain activity in response to disgust and erotic stimuli.

Adult↗
PubMed1999

Bridging activity as a mode of stress testing for persons with hemiplegia.

OBJECTIVE: To establish a stress testing protocol for hemiplegic persons using graded bridging activity at the rates of 3 to 24 repetitions per minute. DESIGN: Paired comparisons of exercise parameters and admission and discharge data between hemiplegic and control groups. SETTING: Inpatient rehabilitation program of a tertiary rehabilitation center in Japan. PATIENTS: (1) Preliminary study: five hemiplegic patients. (2) Comparison with normal subjects: 39 hemiplegic patients and 10 age-matched controls. (3) Study of reproducibility: five hemiplegic patients and five controls. (4) Longitudinal changes: 30 hemiplegic patients. MAIN OUTCOME MEASURES: Oxygen consumption (VO2), heart rate (HR), and HR oxygen coefficient (regression coefficient between HR and VO2). RESULTS: The testing protocol was applicable to 88.6% of hemiplegic patients. The relationship between HR and VO2 was linear, and HR oxygen coefficient was significantly lower in hemiplegic patients than the controls. The intraclass correlation coefficients were greater than 0.7 for VO2, HR, and HR oxygen coefficient, indicating satisfactory reproducibility. HR decreased longitudinally for the same stress levels and the HR oxygen coefficient increased, indicating improved fitness level. CONCLUSIONS: The bridging activity protocol is a useful mode for stress-testing hemiplegic persons. The linearity between HR and VO2 with this protocol allows us to use the indices of fitness obtainable from this relationship.

Activities of Daily Living↗
PubMed1976

[Carbohydrate tolerance and behavior of insulin in the glucose infusion test in persons with normal weight with prediabetic suspicion].

In altogether 289 persons with normal weight with suspicion of the existence of a prestage of diabetes the 2 hour's glucose infusion test was carried out. In these cases 61% of the test persons showed a normal, 8% a critical, 26% a pathological and 5% a manifest diabetic metabolic condition. A reduction of the initial and late phase of the insulin secretion provable with deterioration of the carbohydrate tolerance must be regarded as cause of metabolic disturbances. The lack of a significant relation between diabetic heredofamiliality and carbohydrate tolerance indirectly refers to the importance of the environmental factors which on the basis of a genetic defect have a decisive influence of the morbidity caused by diabetes. The reduction of the initial phase which is provable already in potential diabetes, particularly clearly it is to be demonstrated in pathological and manifest diabetic metabolic situation, may be regarded as an early symptom of diabetes. Carbohydrate tolerance and preparation of insulin were reduced in decenniums of older age.

Adult↗
PubMed1989

Two-year follow-up study of coronary bypass surgery. Psychologic status, employment status, and quality of life.

This study is a prospective report of the cases of 135 patients who were slated for coronary artery bypass grafting and selected according to designated criteria. Patients received, in addition to an interview, a comprehensive cognitive, neuropsychologic, and personality assessment 2 weeks before operation and 3, 12, and 24 months after operation. Of the available sample, 82.3% completed the full study. There was no evidence of intellectual or neuropsychologic impairment after operation. Most patients returned to preoperative status 3 months after bypass grafting. Further improvement may continue 12 and 24 months after operation. The personality tests revealed that anticipation of the operation resulted in signs of emotional arousal and distress, which dissipated after a successful surgical outcome. Similarly, return to work and quality of life was enhanced. The current study represents the first systematic, longer-term follow-up of the psychologic and social consequences of coronary artery bypass grafting operations. The findings of this study are discussed within a model of social reconstitution after the successful resolution of a life-threatening medical condition.

Adult↗
PubMed1978

[Cardiovascular x-ray findings, changes of the thoracic aorta, electrocardiographic and clinical parameters in hypertension. 1. Cardiovascular x-ray findings in hypertension].

We examined 142 hypertensive patients of special consulting hours for hypertension. In a subdivision into 3 degrees of severity of hypertension and into the age groups less than or equal to 50 years and greater than 50 years X-ray findings on the heart and on the large vessels near the heart were made. Patients with blood pressure values RRs greater than or equal to 160 Torr and RRd greater than or equal to 95 Torr had these findings in 78%. 56% of the test persons with a heart affected in the left ventricle (R1) were found and 23% of the test persons with left-prevailing heart affected on the two sides (R3). The positive correlation between age of the patients with hypertension, duration of hypertension and frequency of the heart deformation in the sense of the left-ventricularly affected heart and the left-prevailing heart affected on the two sides could statistically be ascertained. 62% of the patients less than or equal to 50 years and 89% of the patients greater than 50 years had these findings. In a duration of hypertension less than or equal to 5 years 64% had these findings, in a duration of hypertension greater than 5 years 64%. The total number of findings increases with the degree of severity of hypertension. In test persons with degree II of severity of hypertension (RRs 160-200 Torr, RRd greater than or equal to 95 Torr) 73% had these findings, in test persons with degree III (RRs greater than Torr, RRd greater than or equal to Torr) 86%. The relation of the heart deformation in the sense of the left-prevailing heart affected on the two sides between degree II and III of the severity of hypertension was contradictory. In hypertension II and duration of hypertension greater than 5 years the percentage of the test persons with left-prevailing heart affected on the two sides was 42%, in hypertension III and duration of hypertension greater than 5 years 19%.

Adult↗
PubMed1998

Attitudes of oncologists, family doctors, medical students and lawyers to euthanasia.

The purpose of this survey was to define attitudes and opinions of two types of physicians, medical students and lawyers in the area of euthanasia and related issues and problems. A questionnaire was used as the source of data. There were four groups of test persons: oncologists, home care physicians (family doctors), third-year medical students and lawyers. The questionnaire included 22 questions, 4 of which concerned general characteristics of tested persons (including religious belief), while 18 referred to the problems of euthanasia. The total number of tested persons was 123, 55 men and 68 women with a median age of 38 +/- 11 years ( +/- SD). There were 30 test persons in the group of oncologists, 31 in the group of family doctors, 31 in the group of third-year students, and 31 in the group of lawyers. Between 97% and 100% of individuals gave scored responses to most items. More than half of the individuals (57%) were against euthanasia, and 61% are against the legalization of euthanasia. The views of doctors and medical students were similar (2/3 against) and significantly different from the view of lawyers (2/3 for, P < 0.01). The legalization of euthanasia is favored by 61% of lawyers, in contrast to 43%, 30% and 23% of oncologists, family doctors and medical students, respectively. Overall, 31% sais they would apply euthanasia if they were asked for it, and 36% that would if it had been legalized. Lawyers are twice as willing to perform euthanasia as students or physicians. The least ready to apply euthanasia are physicians working as oncologists (only 1 in 5). Compared with oncologists, one-third of home-care physicians would perform euthanasia anyway, whether legalized or not. Most of the test persons were of the opinion that euthanasia should be performed in the case of children born with a severe anomaly. None of the tested groups considered invalidity or being a burden to the family important reasons for the termination of somebody's life. Approximately 40% of responders believed that the decision for euthanasia should be made by the patient alone. Only lawyers were of the opinion that the misuse of euthanasia could be controlled. Our study shows that it is probably more important to determine factors associated with behavior pertaining to euthanasia in physicians working closely with suffering patients. Reducing suffering and launching a hospice movement and palliative care services might be the most appropriate way to deal with the problem of euthanasia.

Adult↗
PubMed1998

Impact of a child first aid wall calendar on lay people's skills and knowledge of infant CPR.

The aim of the study was to evaluate whether mass-mailing of a 12-month wall calendar which focused on child and infant safety and first aid treatment had any educational effect on lay people. The calendar included algorithms for removal of a foreign body from the airways and infant and child CPR. The knowledge and skills in these procedures were tested in two groups using a previously validated check-list before and after the introduction of the calendar. One group received the calendar by mass mailing, free-of-charge. Six months after calendar distribution the mean result for 52 persons tested was 18% correct, not different from the 19% correct for 65 persons tested before calendar distribution. The other group received the calendar as part of an internal company campaign focusing on infant and child safety with a possibility for borrowing a baby manikin, but with no instruction involved. In this group the mean result improved significantly from 27% precalendar (n = 57) to 47% (n = 125) (P < 0.001) 1 week after calendar distribution with a significant reduction to 38% (n = 52) (P = 0.004) 6 months later, still significantly better than precalendar (P = 0.004). Test persons younger than 50 years old scored better than those older than 50 years (39 vs. 22%, P < 0.001), and the test persons scored better if they had been tested previously (44 vs. 35%, P = 0.04) or had practised with a baby manikin (45 vs. 35%, P = 0.02). Whether the test persons had children 0-8 years old or not, did not affect the results. In conclusion the calendar had no educational effect when distributed by mail, but a safety campaign which included distribution of the calendar and a possibility to borrow a manikin had a positive influence on the first aid skills and knowledge of lay people. Mass mailing of CPR or other first aid material free-of-charge does not seem to further the goal of increasing the rate and proficiency of bystander interventions to save lives.

Adult↗
PubMed1978

[The effect of diphenylhydantoin on the automatism of the sinus node and on the sino-atrial conduction time in patients with and without sick sinus syndrome].

In 30 test persons (15 patients with disturbed function of the sino-auricular node, 9 of them with classical sick-sinus-syndrome as well as 15 test persons without disturbance of the sino-auricular node, of them 7 healthy ones) the influence of diphenylhydantoin on the function of the sino-auricular node was tested. By means of atrial stimulation the so-called sino-atrial conduction time, the recreation time of the sino-auricular node as well as the duration of the sinus period before and after intravenous application of 250 mg of diphenylhydantoin was estimated. The auricular stimulation was carried out either through an oesophageal electrode probe or usually through an electrode catheter directly placed in the right atrium. In the entire collective the sino-atrial conduction time did prolong itself statistically not significantly by 2 +/- 5ms (x +/- 2 s), in which cases there was not to be observed a different behaviour between test persons with a healthy rhythm and patients with disturbed function of the sino-auricular node. In 2 patients with sick-sinus-syndrome, however, after diphenylhydantoin and individual atrial stimulation in each case sino-atrial blockings of higher degree developed. The maximum absolute and corrected recovery time of the sino-auricular node prolonged itself in patients with syndrome of the sino-auricular node by on an average 1406 +/- 2120 ms or 1378 +/- 2338 ms, in which cases in 1 test person a threatening prolongation of the poststimulation pause to 10 s developed. In another patient after application of diphenylhydantoin an atrial arrest was observed. The automatism of the sino-auricular node of test persons with healthy rhythm was not influenced.

Arrhythmia, Sinus↗
PubMed2001

Use of microalbuminuria testing in persons with type 2 diabetes: are the right patients being tested?

OBJECTIVE: Our goal was to determine whether adult patients with type 2 diabetes who had gross proteinuria or were already taking angiotensin-blocking drugs were screened for microalbuminuria. STUDY DESIGN: This was a retrospective cross-sectional study. POPULATION: We included a total of 278 adult patients with type 2 diabetes seen during 1998 and 1999 at the family medicine practices of the Medical University of South Carolina. OUTCOMES MEASURED: The outcomes were microalbuminuria testing during either 1998 or 1999 and the initiation of medication if the screening test result was positive. RESULTS: We found that patients who could derive the greatest benefit from testing (ie, those without preexisting proteinuria or who were not receiving an angiotensin-blocking drug) were no more likely to be screened for microalbuminuria than those with existing proteinuria (16% vs 18%, P=.84) or those who were already being treated with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker (16% vs 16%, P=.83). Also, when the microalbuminuria test result was positive, only 40% of the patients were placed on angiotensin-blocking drugs. CONCLUSIONS: Physician use of microalbuminuria screening does not follow established guidelines. The test appears to be used for many patients who might not need to be screened, and it is not always used for patients who should be screened. Consideration should be given to other strategies to prevent nephropathy in persons with type 2 diabetes.

Albuminuria↗
PubMed1999

[Toxoplasmosis-antibody seroprevalence in Mecklenburg-Western Pomerania].

OBJECTIVE: The aim of this study was to get a general idea of the antibody prevalence of toxoplasmosis within the different agegroups of the population of Mecklenburg-Western Pomerania. 4854 serums (collected between 1994 and 1996) from different institutions of the federal state were investigated with the "Toxo-Competitions Test LTXC)" at the Mini-Vidas divice (bio Merieux). MATERIAL AND METHODS: An antibody prevalence rate of 59% was found. As expected, with rising age a continuing increase was recognisable. The antibody prevalence rate with the male test persons amounted to 58.5%, with the female test persons to 59.3%, and within the pregnant women 63.2%. RESULTS: Therefore 36.8% of pregnant women have got no toxoplasmosis antibodies, i.e. they are exposed to the danger of a primary infection. Within pregnant women aged between 20 and 40 an increase of antibody prevalence of 1% per year of age was recognisable. There was only a small share of pregnant women (10.5%), but they confirm the facts known from literature. CONCLUSIONS: More than 1/3 of our test persons hadn't had toxoplasmosis antibodies. Therefore in order to reduce the danger of a primary infection in pregnant women a screening before pregnancy in recommendable.

Adolescent↗
PubMed1976

[Contribution to the continuous indirect blood pressure measurement].

The plethysmanometer described follows the principle of the relaxed wall of the vessel. Here the pressure is adjusted in a finger cuff and by means of a pneumatic regulation is varied in such a way that the light plethysmogram of the adequate finger does not show any more pulsations. Thus the pressure effected on the finger above the cuff corresponds to the pressure in the finger arteries and is to be registered in mm Hg. When the course is measured in the same test person with changing of the arterial pressure (e.g. absolute arrhythmia or compressed-air pressure experiment) the blood pressure of the aorta measured when a heart catheter is diagnostically indicated shows a very close correlation to the unbloodily registered pressure of the finger arteries. On the other hand, greater varieties of the correlation coefficient which can be proved from test person to test person at present do not yet allow a formula obligatory in general, in order to tansfer the value unbloodily measured into the adequate bloody one. Nevertheless, already nowadays great ranges of application are possible for the progressing measuring of the blood pressure.

Blood Pressure Determination↗
PubMed1984

[Psychological and physical performance standards of borderline hypertensive patients before and during treatment with propranolol].

On 47 borderline hypertensives discriminative reaction tests (17 test persons) and ergometries (30 test persons) were carried out. It could be proved that both in psychic and in physical demand by beta-blocker therapy heart rate and blood pressure significantly remained below the initial value. The calculation of the interior heart work resulted in an economization of the heart work. By means of the beta-blocker therapy of the borderline hypertensives a more favourable situation in an increased functional demand and a decreased reaction of the blood pressure on psychic stress was achieved.

Adult↗
PubMed1976

EOG: light test and dark test.

The EOG test is divided into two parts: a light and a dark test. The adaptation period is extended to 30 min. During this adaptation period the luminance in the cabin decreases (or increases) slowly to the starting value of the light or dark step. In a model, we studied the influence of this ramplike luminance course on the results. Standard values for the test were calculated with 30 test persons. Our test results show a lower relative standard deviation (V = 10%) compared with earlier published results.

Adaptation, Ocular↗
PubMed1995

Prevalence of tuberculosis in a rural area by an alternative survey method without prior radiographic screening of the population.

SETTING: Mass miniature radiography (MMR) is the usual tool for population screening in tuberculosis case prevalence surveys. However, this facility is not available at most centres in India. OBJECTIVE: The feasibility of conducting a survey without MMR screening was therefore investigated. DESIGN: The study was carried out in Bangalore rural district during 1984-1986. The area was the same as for six earlier prevalence surveys conducted since 1961. The population aged up to 44 years was tuberculin tested. Persons with test induration size of > or = 10 mm were eligible for sputum examination, besides all those aged over 45 years who were eligible without discrimination. RESULTS: Reduction of workload was not adequately achieved through screening, as 78.4% of the registered population (29,400) was still eligible for sputum examination. The changed screening procedure in this survey also made comparison with earlier data difficult. In spite of more liberal and comprehensive screening, the observed prevalence rate of cases (438/100,000 population aged 10+ years) was similar to earlier surveys. The prevalence rate of smear-positive cases, however, was much lower (68/100,000 population aged 10+ years). CONCLUSION: In conclusion, the candidate screening procedure was not suitable. The findings nevertheless conformed to the overall declining trend for the area, as reported earlier.

Adolescent↗