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Using the Draw-A-Person (DAP) Test in sex therapy.

This paper describes eight years of experience in using the Draw-A-Person (DAP) test in sex therapy. The DAP was used as part of the initial assessment and as a source of data about change during the course of therapy and at termination. The DAP test was found to be a helpful adjunct to clinical observation with regard to both intrapsychic and interpersonal factors, and it is recommended as a tool which may be useful to other sex therapists.

Adult↗

[Effect of ergonovine and the cold stress test on time intervals of left ventricular systole and their significance for the diagnosis of coronary heart disease].

In 20 healthy test persons and 44 patients with a coronary heart disease without stenocardia at rest the ergonovine and the cold pressure test were performed. During the tests the ECG in 12 standard leads and the mechanocardiogrammes were registered, from which the time intervals of the left-ventricular systole were calculated. From the analysis of the pectanginous complaints and/or from the changes of the ST segment for the diagnosis of the coronary heart disease a sensitiveness of the ergonovine test of 40% was obtained, whereas the sensitiveness of the cold tolerance test was only 10%. In healthy test persons during the ergonovine test a shortening of Q-1, a decrease of the quotient PEP/LVET and a prolongation of LVETI were established. Apart from this, in patients with coronary heart disease also shortenings of ICT and PEP and an increase of the quotient LVET/S1S2 were made evident. During the cold tolerance test in healthy test persons, besides the prolongation of LVETI, no other changes were stated. On the other hand, in the patients a decrease of the quotient PEP/LVET and a shortening of PEP were existing. The diagnostic value of the analysis of the left-ventricular time intervals was insignificantly higher during the ergonovine test than at rest. However, during the cold pressure tests no differences were stated. The application of the analysis of the left-ventricular time intervals does not essentially enlarge the sensitiveness of the two tests in comparison to the analysis of the changes of the ST segment in the ECG.

Angina Pectoris, Variant↗

[Effect of obesity on cardiovascular performance].

On 55 healthy test persons with normal weight and 76 healthy middle-aged obese test persons the measurement of systolic time intervals was performed standing and lying. In 39 obese patients and 55 test persons with normal weight a load ergometry was carried out. No significant difference between persons with normal weight and extreme overweight was recognized with regard to the index of tension. However, there were clear differences between persons with normal and overweight as to the time of tension and left-ventricular ejection time lying and standing, independent of the behaviour of blood pressure. In persons with overweight a significantly lower cardiac output was found. The index of tension of obese persons with a degree of efficacy below 75 Watt was on an average 1.04. Only half of the persons with overweight reached a degree of efficacy of 100 Watt. In 32 obese persons with a degree of efficacy of more than 75 Watt the regulation of frequency and blood pressure did not differ from that of persons with normal weight.

Adult↗

Assessment of a man with a dual diagnosis.

This case assessment of a man with dual diagnosis exemplifies the use of recent psychological measures, computerized programs, and structured assessment, including the Reiss Screen for Maladaptive Behavior, the Psychopathology Inventory for Mentally Retarded Adults, the Apperceptive Personality Test, and the Residential Services Indicator. In this case, computerized scoring of two very different tests (the Reiss Screen and the Apperceptive Personality Test) yielded very similar results.

Adult↗

Blood pressure response to the Canadian Aerobic Fitness Test.

Persons who are normotensive or borderline hypertensive at rest but who have an exaggerated blood pressure response to exercise incur a higher risk of developing sustained hypertension. Our purpose was to develop provisional norms for immediate post-exercise blood pressure responses to the Canadian Aerobic Fitness Test (CAFT) for men and women 20-69 years and to recommend threshold values for exercise hypertension. We studied 986 males and females. Blood pressure criteria for inclusion were less than 150/100 mmHg for men and less than 160/100 mmHg for women. The blood pressure values for the 3 stages of the CAFT specific to each age group and sex were appropriately summarized for each workload. An exaggerated blood pressure to exercise was defined as the mean + 1 SD while a grossly exaggerated blood pressure was defined as the mean + 2 SD. As such, the following values are recommended as criteria for the first stage of the CAFT regardless of age: Men: exaggerated response greater than or equal to 170 mmHg, grossly exaggerated, greater than or equal to 190 mmHg; women greater than or equal to 160 mmHg and 180 mmHg respectively. The delta SBP (exercise SBP minus resting SBP) at the first stage of the CAFT could also be utilized to identify persons who demonstrate an abnormal pressure response to exercise. An increase of 10 mmHg above resting diastolic pressure at any stage of exercise should also be cause for concern and counselling.

Adult↗

Antimicrobic susceptibility testing. A personal perspective.

The development of antimicrobic susceptibility testing is outlined with particular reference to standardization of procedures and organizational developments that have led to substantially improved performance. Special problems continue to be posed by increased proportions of opportunistic pathogens and newly recognized mechanisms of resistance, and these require updating. The role of automated procedures and technical problems in MBC and serum bactericidal testing are considered.

Automation↗

[Variations of pain in the treatment of one classical acupuncture-point versus one point of Yamamoto's new scalp acupuncture].

INTRODUCTION: In an experimental design the pain reduction effect of acupuncture is studied and compared to the treatment of a classical acupuncture point and a point of the Yamamoto New Scalp Acupuncture (YNSA). METHODS: Experimental pain stimuli (32 per test person) were set in 42 test persons at the upper calcaneus edge and pain reduction was checked intra-individually by using the following variations of treatment: Acupuncture YNSA basis-point D, Acupuncture at the classical point Xiao Chang Shu = Bl 27, Acupuncture at a placebo point of the head, Acupuncture at a placebo point of the gluteal region. RESULTS: Evaluation of the data as well as a statistical investigation using a bi-factoral variance analysis with repeated measurements of 2 respectively 1 factor yielded following results: There are highly significant differences concerning pain reduction through the stimulation of the YNSA basis-point D and the acupuncture at the classical point Bl 27 (p < 0,0007). There are also highly significant differences concerning the verum and the placebo treatment (p < 0,00006). Further hypothesis of controlling the experimental design were tested. CONCLUSIONS: On the whole, the investigation shows that there is a marked difference between the verum and placebo treatment as well as a difference between the acupuncture of the YNSA basis-point D and the classical acupuncture point Xiao Chang Shu (Bl 27) with regard to pain reduction induced by experimental stimuli at the calcaneus. These differences are significant.

Acupuncture Analgesia↗

Selected metabolic results of the Leipzig gerontological longitudinal study.

The results of the longitudinal study show a gradual development of the overweight of young obese women. The decrease of weight in middle aged obese women is likely to be influenced by additional therapeutic measures by the physicians. It is interesting to note that men and women of normal weight do not develop overweight over a ten-years-span. Serum cholesterol increased in all age and weight groups within a ten-years-interval. The changes of the shares of total fatty acids were especially characterized by the decrease of palmitic acid and the increase of linoleic acid in the ten-years-interval. However age, weight and sex differences were present. The increase of uric acid level occurred with all test persons independent of sex. With test persons above 45 years a significant sex difference was noticed.

Adult↗

[Therapy of obesity--effectiveness of calorie-reducing diets with various basic nutritional relations].

Within the research project nutrition and performance on altogether 80 test persons during a three weeks' test period the problem was examined, whether the relations of the basal nutrients have an influence on the effectiveness of a diet with an only moderate reduction of calories. The relations of the nutrients were tested in four variants. The daily caloric intake orients at the optimum weight of the test person: 30 kcal/kg optimum weight a day. It was shown that the so-called optimum weight caloric diet led to a sufficient continuous decrease of weight without disturbances of the general state of health. The variation of the relations of the basal nutrients had no decisive influence on the effectiveness.

Adult↗

Linking clients from HIV antibody counseling and testing to prevention services.

The effectiveness of HIV antibody counseling and testing as a prevention intervention is limited: persons testing seronegative do not usually change their risk behaviors, some actually increase their risk behaviors, and decreases in risk behaviors are usually short-lived. Referrals to additional prevention and other needed services are therefore recommended, although the extent and determinants of referral provision for persons testing seronegative are unknown. We assessed the prevalence of referrals and the association between risk behaviors and prevention referrals among seronegatives. We reviewed HIV testing and referral data on all persons receiving confidential seronegative test results in San Francisco (SF) in the first 10 months of 1995 (n = 5,595), and gathered more detailed referral information at the municipal STD clinic from November 1995 through May 1996 (n = 747). The overall prevalence of referrals was low: a referral was given to 19.1% of the SF sample and 10.6% of the STD clinic sample; 15.4% of the SF sample and 5.9% of the STD clinic sample received a prevention referral. Injection drug users (IDUs) were the most likely to receive a prevention referral (48.5% of SF IDUs, 36.4% of STD clinic IDUs); men having sex with men and women with high-risk partners were also more likely to get a prevention referral than others. For SF IDUs, unsafe sex and needle sharing were not associated with an increased likelihood of receiving a prevention referral. Opportunities to link high-risk clients from counseling and testing to HIV prevention services are being missed. The referral component of HIV counseling and testing should be improved.

AIDS Serodiagnosis↗

[Visual classification of erythrocytes in blood smears from normal subjects and patients].

Erythrocytes on specially prepared and coloured blood smears can be classified not only by idcture analysis but also by phase contrast microscopy. Parameters of change for the peripheral zone area and pallor area (phase contrast value PW and index of erythrocyte changes Ev-I) serve as classificators of visual technique. 449 blood smears of the same number of male and female grown-up persons, whose diagnosis was unknown at the time of evaluation, were used for evaluation. In 145 cases these were healthy test persons in clinical and laboratory respect (group I). 163 test persons were ill, but without any malignous neoplasias (group II), and in 141 patients an ensured malignous neoplasia could be found (group III). From those 308 test persons or patients respectively in group I + II 11 blood smears were falsely classified as positive (= 3.6%). In 5 from 141 cases in group III blood smears were falsely evaluated as negative (= 3.6%). The findings were statistically ensured by the t-test. Clinical parameters of evaluation gained with visual techniques of classification are in accordance with those gained with automatic picture analysis. The reasons for the good separating ability of PW and Ev-I are discussed. Visual techniques of classification are suitable for institutions of all grades of equipment.

Adult↗

[The Six Factor Test--a personality questionnaire for clinical practice and research].

BACKGROUND: The Six factor Test (SFT) is a personality questionnaire for assessment of the "big five" (neuroticism, extraversion, conscience, aggressivity, openness to experiences) and piety in patients with mental disorders and healthy subjects. METHODS: In a study of 360 probands (125 depressive and bipolar patients, 150 first-degree relatives of these patients, and 85 controls), the reliability and validity of the SFT was examined. Thirty-five controls and 79 relatives were reinvestigated after around 6.5 years. RESULTS: The factorial structure could be replicated, and the concurrent validity was moderate to high. Acceptable internal consistency was observed, with the exceptions of "openness" and "agreeableness". The retest reliability was high, with the exception of "openness". Patients differed from controls in neuroticism and "openness". These factors were also predictive for the first onset of psychiatric disorders in controls and relatives, respectively. CONCLUSION: The SFT is a short und simple instrument for the assessment of personality in clinical samples and controls. Reliability and validity of the three main scales (neuroticism, extraversion, and conscience) were acceptable. The corresponding coefficients of the three shorter scales, in particular of openness, were partly much lower.

Adult↗

Predictive testing for Huntington's disease: relationship with partners after testing.

This study focuses on the partner relationship of tested persons, 5 years after their predictive test result for Huntington's disease (HD). We describe changes in marital status, quality of the relationship, and perceived changes in the relationship. Twenty-six carriers, 14 of their partners, 33 non-carriers, and 17 of their partners participated in the study. Qualitative and quantitative methods were used. For the majority of tested persons (about 70%), the marital status was unchanged 5 years post test. Overall, carriers rated the quality of the relationship higher than their partners did and they perceived more positive changes. Qualitative data show that a test result leading to changed roles may induce significant marital distress. Another consequence of the test may be the changes in dynamics in asymptomatic carrier couples. A pre-test discussion of the possible impact of the test result on the relationship should result in a better preparation for and more understanding of the reactions after testing. Counselling after testing should stimulate an open communication between partners with consideration of needs and anxieties of both partners.

Adult↗

[Modified moisture chamber].

BACKGROUND: Moisture chambers can protect the eye in corneal lubrication or eyelid closure disorders. However, in cases with protrusio bulbi or pronounced chemosis conjunctivae direct damaging contact of the cornea or conjunctiva on the one hand and the inside of the moisture-chamber-bandage on the other hand are possible. Since commercial moisture-chamber-bandages are not available with different internal radii, new methods are necessary to increase the distance between the bandage and the eye. MATERIAL AND METHODS: A special pressure relieving foam dressing used in the therapy and prophylaxis of decubitus was prepared in such a way that a periocular attachment was enabled and an opening for the eye was left blank. This central opening was covered with a commercial moisture-chamber-bandage. Five test persons and two ventilated patients with protrusio bulbi and manifest lagophthalmus were treated with the modified moisture chamber. The relative humidity within the bandage was measured. RESULTS: The modified moisture chamber allows an individual adaptation to the periocular shape of the face and rises the level of the monoculus for about 7 mm. The internal relative humidity was for eight hours at 98% in both test persons and patients. All test persons felt more comfortable with the modified moisture chamber on their skin. CONCLUSIONS: The presented modified moisture chamber is a derivative of the commercial monoculus bandage for patients with sensitive protrusio bulbi.

Adult↗

Development of an interactive multimedia-CBT-program for dental implantology and using tests of a program prototype.

The aim of the study was the development of a teaching program for dental implantology designed to improve student education as well as further training in this area. Initially, the computer equipment of German dentists was evaluated. Then, the contents of a teaching program "implantology interactive" were defined. A fully functional program prototype was developed in co-operation with a medical publishing house. Subsequently, the program was tested and statistically evaluated by 70 dental students and 40 dentists for the purpose of quality assurance. The program received extremely positive ratings with regard to design and functionality. Furthermore it was found to be clearly arranged and easy to comprehend. Even computer illiterate test persons had no problem working with the program. The biggest problem discovered during the test run was that 21% of the test persons lost their orientation while working with the program. The results of the study were used to optimize the program. For example, a graphic orientation tree was integrated, thereby improving the orientation within the program. The extremely positive reactions of the test persons leads us to expect that the introduced CBT-project will be successful. The use of the program in the student education in the dental clinic in Heidelberg and a publication in a medical publishing house are to be expected in the near future.

Attitude of Health Personnel↗

[Biological availability of digoxin from a combination drug].

In a randomized cross-over study with 14 voluntary test persons the absolute biological availability of digoxin in Card-Dusodril 1/8 and 1/4 respectively was investigated. 6 test persons received 4 drag. Card-Dusodril 1/8 (= 0.5 mg digoxin), 8 test persons 4 drag. Card-Dusodril 1/4 (= 1 mg digoxin) orally, in comparison to the corresponding group with intravenously applied digoxin as standard. Based on the cumulative digoxin excretion in the urine an absolute biological availability of Card-Dusodril 1/8 of 79%, of Card-Dusodril 1/4 of 76% could be demonstrated. With regard to an average resorption of oral digoxin preparations of approx. 70%, the present values, which correspond in direct comparison to those of acetyl digoxin, can be considered good. Maximum serum levels were achieved after 86 +/- 6.8 minutes which also indicates a quick resorption.

Administration, Oral↗

Effects of spouses on distress experienced by BRCA1 mutation carriers over time.

Concerns about psychological distress have arisen regarding genetic testing for susceptibility to late-onset diseases such as breast and/or ovarian cancer. Early results do not show large-scale psychological distress among those tested; therefore, research is now focusing on identifying subgroups that may be at risk for negative outcomes. Social support has been shown to buffer both negative physical and psychological outcomes in health research. The role of spouses as part of the tested person's social support system is shown to be significant in a sample of 57 BRCA1 mutation carriers. Separately, the tested person's perception of his/her spouse's anxiety and his/her perception of the spouse's support at the time of testing are predictive of the tested person's psychological distress up to 2 years after testing. The interaction of the two variables is even more predictive. For those tested who perceived their spouse to be both anxious and nonsupportive at the time of testing, distress levels reached clinically significant levels 1 week after results were received and remained above clinical threshold measured 4 months, 1 year, and 2 years after testing. While the effects were greatest for women, they were significant for both male and female carriers. These findings are an important addition to the literature and will augment clinicians' ability to identify individuals potentially at risk for negative responses to adverse genetic test results.

Concept Formation↗

[Genetic factors in anti-D-antibody formation].

The blood group specific artificial immunization for producing anti-D-antibodies in Rh-negative persons ("de-novo immunization") is scarcely successful at present and involves risks of health for test persons. With the justified suggestion that the antibody development is genetically influenced even in man, those serological features were being searched for which might reveal a good anti-D-formation, viz. AB0-blood group, HLA antigens and serum groups Hp, Gm and Km. 134 men de-novo immunized were examined. In those persons forming anti-D with a high titre ("high responders") blood group A will be encountered more frequently. Blood group B will frequently occur in "non-responders". In 78 test persons examined in the HLA system was no correlation between the features of the HLA system and the formation of anti-D. The serum features investigated in 71 test persons did not allow any correlation to anti-D formation to be recognized in the Hp, Gm and Km system. It seems reasonable to continue the investigation for relationships between antibody development and certain hereditary characteristics in the human blood, including HLA-DR gene place.

ABO Blood-Group System↗