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At least 433 records · Page 24Linked to original sources
PubMed1998

First line treatment with omeprazole provides an effective and superior alternative strategy in the management of dyspepsia compared to antacid/alginate liquid: a multicentre study in general practice.

BACKGROUND: Many patients who present with dyspepsia are prescribed antacid/alginates as their first line and often mainstay therapy. This multicentre study was designed to assess whether early introduction of acid inhibition is an effective strategy in dyspepsia management. METHODS: Dyspeptic patients (n = 674) were randomized to receive either omeprazole 10 mg o.m. or antacid/alginate liquid 10 mL q.d.s. for 4 weeks in an open, parallel group study. RESULTS: Complete relief of the most common symptom at entry, heartburn, was greater in the omeprazole-treated group compared with the antacid/alginate-treated group (64 vs. 30%, respectively, at 4 weeks; P < 0.0001). The percentage of patients who met the stringent health target of complete relief of overall symptoms was higher in the omeprazole-treated group (41% at 4 weeks) compared with the antacid/alginate group (16% at 4 weeks; P < 0.0001). Comparisons of quality of life scores between treatments favoured the omeprazole group at 2 and 4 weeks for both the Psychological General Well-Being Index and the Gastrointestinal Symptom Rating Scale (each P < or = 0.0009). In addition, a greater proportion of patients rated omeprazole to be more effective in symptom relief and more convenient to use (each P = 0.0001) than antacid/alginate. CONCLUSION: This study demonstrates that, compared to antacid/alginate liquid 10 mL q.d.s., omeprazole 10 mg o.m. is more effective in the management of dyspepsia symptoms and is the patients' preferred treatment.

Adult↗
PubMed2003

Bariatric surgery in adolescence.

BACKGROUND/PURPOSE: Surgical treatment for morbid obesity is relatively contraindicated in patients less than 18 years of age. However, on some occasions, there is extreme obesity in this age group that does not respond to nonsurgical treatment. The aim of this study was to evaluate the surgical management of severe morbid obesity in adolescents. METHODS: During a 4-year period, the authors assessed 11 adolescent patients with severe morbid obesity. All patients underwent extensive preoperative evaluation including thorough psychological evaluation together with their families. Laparoscopic adjustable gastric banding (LAGB) was performed in all patients. Patients underwent follow-up for a mean of 23 months. RESULTS: The mean age of the 11 children in this study was 15.7 years (range, 11 to 17 years). Associated conditions included heart failure and pulmonary hypertension in one patient, amenorrhea in 2 patients, and gallstones in 1 patient. Mean preoperative body mass index (BMI) was 46.4 kg/m2 (range, 38 to 56.6). There were no operative complications. Over a mean follow-up period of 23 months (range, 6 to 36 months), the mean BMI dropped from 46.6 to 32.1 kg/m2 with marked improvement in medical conditions and general psychologic well being. No late complications developed in any patient. CONCLUSIONS: Children are routinely excluded from bariatric surgery programs because of the difficulties involved in psychologically and cognitively preparing this population for surgery. However, extreme morbid obesity rarely responds to nonsurgical therapy for any extended period. This select population will benefit from bariatric surgery if an effort is made to properly prepare patients, together with their families, for the postoperative change in lifestyle and body image.

Adolescent↗
PubMed1994

Limited effects of HIV counseling and testing for women. A prospective study of behavioral and psychological consequences.

OBJECTIVES: To assess the consequences of human immunodeficiency virus (HIV) counseling and testing for seronegative women in terms of sexual behavior and psychological outcomes. DESIGN: The design is prospective and longitudinal, using repeated measures. Participants were interviewed at recruitment, 2 weeks later (when tested women received results), and 3 months later. SETTING: Four community health clinics in southern Connecticut; all provide HIV counseling and testing and other specialized and primary health care services. STUDY PARTICIPANTS: A sequential sample of women were recruited for two study groups: those seeking HIV counseling and testing (n = 152), and a comparison group never tested for HIV (n = 78), matched by clinic, race, and age. MAIN OUTCOME MEASURES: A composite measure of sexual risk was developed, based on sexual activity, condom use, and partner risk factors. Psychometrically valid and reliable measures of general psychological functioning and acquired immunodeficiency syndrome (AIDS)--specific psychological indicators were also used. RESULTS: Average level of sexual risk was lower for tested than nontested women at all three interviews. For both groups, there was no significant change in sexual risk from baseline to 3-month follow-up. At the individual level, there was no difference in the number of women who decreased or increased sexual risk. For tested women, intrusive thoughts about AIDS and estimated chance of getting AIDS decreased after counseling and testing. CONCLUSIONS: Behavioral and psychological consequences of HIV counseling and testing for women at risk for HIV were limited. These results have implications for further prevention interventions.

AIDS Serodiagnosis↗
PubMed1987

The Memorial Pain Assessment Card. A valid instrument for the evaluation of cancer pain.

Effective evaluation and treatment of cancer pain require valid and independent measurement of pain intensity, pain relief, and psychological distress. The Memorial Pain Assessment Card (MPAC) is a simple instrument designed to provide rapid evaluation of these subjective experiences. On the 8.5 by 11 inch card are printed the eight pain intensity descriptors, and three visual analog scales which measure pain intensity, pain relief, and mood. Experienced patients can complete it in less than 20 seconds. The authors administered the MPAC to 50 hospitalized cancer patients within 48 hours of referral to the Pain Service for inadequate pain control, together with standard measures: The McGill Pain Questionnaire, Profile of Mood States, Hamilton Depression Scale, and Zung Anxiety Scale. Correlational and multiple regression analyses revealed that the MPAC can distinguish pain intensity from pain relief and from general psychological distress, and it can provide multidimensional assessment that is practically equivalent to the full assessment battery. We conclude that the MPAC is valid and effective for clinical use, and recommend it for the assessment of individual patients, and as an outcome measure in clinical trials.

Adolescent↗
PubMed2002

Addition of testosterone to estrogen replacement therapy in oophorectomized women: effects on sexuality and well-being.

OBJECTIVE: To evaluate the effect of adding testosterone undecanoate 40 mg daily to estrogen replacement on sexual function, psychological well-being and self-esteem in surgically postmenopausal women. METHODS: A letter of invitation to participate in the study was mailed to women who had undergone hysterectomy and bilateral oophorectomy for benign disorders during 1990-98. Fifty women, 45-60 years old, were consecutively recruited and randomly assigned to oral treatment with testosterone undecanoate 40 mg plus estradiol valerate 2 mg daily or placebo plus estradiol valerate 2 mg daily for 24 weeks. A double-blind design was chosen, with cross-over to the other regimen for another 24 weeks of treatment. Forty-four women completed the study. Outcome included scores on McCoy's sex scale questionnaire, the Psychological General Well-Being index and a self-esteem questionnaire, at baseline and after 24 weeks of either treatment. Serum concentrations of total testosterone, sex hormone binding globulin, free testosterone, dihydrotestosterone, androstenedione, estradiol, follicle stimulating hormone and luteinizing hormone were analyzed at baseline and after 24 weeks of both treatment regimens. RESULTS: After 24 weeks, both treatment regimens had significantly improved some of the sexual variables. The addition of testosterone had a significantly better effect on the sex variables 'enjoyment of sex', 'satisfaction with frequency of sexual activity' and 'interest in sex'. The total McCoy score was significantly increased by both treatments, but there was a stronger effect when testosterone was also given. Although both regimens improved psychological well-being and self-esteem, we found no significant differences between testosterone-estrogen or estrogen alone at 24 weeks. Serum levels of all androgens, with considerable individual variation, increased significantly from baseline after 24 weeks of testosterone-estrogen treatment. Supraphysiological levels were achieved in a significant proportion of the women. Increases in estradiol and sex hormone binding globulin were less marked when testosterone was also given. Both treatments reduced gonadotropin levels. CONCLUSIONS: The addition of testosterone undecanoate improved specific aspects of sexual function more than treatment with estrogen alone. Improvements in well-being and self-esteem were similar for both treatments. If testosterone undecanoate 40 mg daily should be used for clinical treatment, regular monitoring of androgen serum levels is needed.

Cross-Over Studies↗
PubMed2000

[Fundamentals of scientifically based ethics in the works of Eugen Bleuler].

The name Eugen Bleuler is almost exclusively linked with matters concerning the nosology of schizophrenia, general psychopathology, and the relationship of clinical psychiatry with psychoanalysis. His bibliography lists various works dealing with contemporary themes about legislation, the fight against alcoholism, and, for the most part from later years, with themes about general psychology. In this article, material from Bleuler's texts are reviewed, including some which have been inaccessible up to now, which either allow interpretative conclusions on ethical grounds or have this explicitly as a topic. In particular, the analysis focuses on Bleuler's work "The Scientific Fundamentals of Ethics", published in 1939. Written in a time widely viewed as disorientated, the author coherently and systemically comments on the issue of a 'new' ethic. The anti-religious and anti-philosophical positions already demonstrable in some of his earlier works will be shown. According to his conception of a scientifically based ethic, the idea of social suitability is of utmost importance and also recognisable in the animal world as a general principle of nature. Bleuler perceives the ethical 'instinct' as inherent; its absence characterises the image of an 'moral idiot', which was already a theme in his earlier works. His statements about matters concerning euthanasia are presented and, furthermore, it will be attempted to construct from his texts an underlying global view. Concerning these ethical issues, it also can be shown once more that the elderly Bleuler was hardly influenced by psychoanalytical perspectives.

Ethics, Medical↗
PubMed1991

The SCL-90R evaluated as an alternative to the MMPI for psychological screening of chronic low-back pain patients.

The efficacy of using the SCL-90R as an alternative measure to the MMPI in the psychological screening of chronic low-back pain (CLBP) patients was investigated. The MMPI and the SCL-90R were administered to 99 CLBP patients (63 men and 36 women) at the time of admission to a functional restoration treatment program. The SCL-90R was readministered after successful completion of the treatment program. Analyses indicated that there were significant changes on almost all SCL-90R clinical scales from pretreatment to post-treatment (P less than 0.01). Moreover, there were adequate levels of correlation between corresponding MMPI and SCL-90R scales (r ranged from 0.35 to 0.51). However, analyses of the interscale correlations of the SCL-90R indicated that it may be a single-factor instrument that assesses general psychological distress. It was suggested that the SCL-90R may be used as a screening device for psychological distress in CLBP patients, but if more detailed information about the patients' psychological condition is needed, the MMPI will be a more useful instrument.

Adult↗
PubMed1997

[Effectiveness of partial and complete instrumental masking in chronic tinnitus. Studies with reference to retraining therapy].

Jastreboff und Hazell [9] developed a neurophysiological approach to tinnitus perception, including the important role of the central nervous system in the maintenance and intrusiveness of tinnitus. They introduced tinnitus-retraining therapy, consisting of four different strategies: (1) directive and person-centered counseling; (2) hearing aids and/or noise generators and/or environmental sounds; (3) psychological therapy; (4) adjacent therapies. Tinnitus should not be masked as with a tinnitus-masker, but must be able to be heard in addition to the noise! A noise generator or hearing aid should be worn at least 6-8 h per day over a period of up to 18 months. In additions several clinical visits are required in order to reinforce the counseling. The actual results show complete tinnitus remission for about 20-30% and partial remission for 50-60% of the patients [6]. We report on a retrospective study in patients wearing hearing aids or tinnitus-maskers over a period of 3 years. We compared the results of patients using partial tinnitus masking to those using complete masking. The tinnitus-related and general psychological complaints were acquired by the 52-item tinnitus questionnaire developed by Hallam et al. [4] and modified by Goebel and Hiller [3]. To describe the dimensions of tinnitus-related distress the scales are labelled emotional distress, cognitive distress, emotional and cognitive distress, intrusiveness, auditory perceptual difficulties, sleep disturbance and somatic complaints. Positive changes for the global tinnitus questionnaire score of more than 10 points are significant in the dimensions of tinnitus-related distress and are described as partial tinnitus-reduction. The group with partial masking effects can be compared to those performing retraining therapy to day because directive and personal centered counseling were integrated for all patients. Patients reporting partial masking effects through their aids (hearing aid or noise generator) showed more effective treatment results (reduced or disappeared tinnitus) than those using complete masking effects (P < 0.05). The reported results are improved by current investigations in Germany showing about 20-30% tinnitus remission and 50-60% significant reduction after 1 year of treatment [1]. Further scientific investigations must be carried out to evaluate the appropriateness and effectiveness of the retraining therapy and with regard to unique quality standards.

Cognitive Behavioral Therapy↗
PubMed1998

Sociodemographic predictors of treatment outcome in chronic non-malignant pain patients. Do patients receiving or applying for disability pension benefit from multidisciplinary pain treatment?

The present study investigated the ability of sociodemographic variables to predict the short-term effect of multidisciplinary pain treatment in 286 chronic non-malignant pain patients consecutively referred to a Danish multidisciplinary pain centre. At inclusion and 3 and 6 months later the patients' pain and health related quality of life (HRQL) was assessed using self-administered questionnaires. Sociodemographic variables measured were: age, gender, educational level, civil status, employment status and disability pension (DP) status. Intensity of pain was measured using a VAS scale. HRQL was evaluated using the Medical Outcome Study-Short Form (SF-36) and the Psychological General Well-Being Scale (PGWB). Drop out was 30% after 6 months, leaving 170 patients for the study of treatment effects. Among the sociodemographic variables evaluated only retirement pension (RP) and DP-status seemed to be significant outcome predictors: six months after inclusion, patients on RP (patients >68 years, n = 40) reported larger pain reduction (30 mm on the VAS scale) than patients < or =68 years (8 mm on the VAS scale)(P = 0.001). Patients applying for DP-pension (n = 26) did not improve. Patients on DP (n = 54) and patients not receiving DP (n = 50) obtained moderate improvements, but the improvements were significantly larger than the improvements observed in the ApplyDP-group (P = 0.05). The same pattern was seen for changes in psychological well-being (PGWB) and social functioning (SF36-SFA). No improvements were obtained in SF36-Physical functioning scores. DP-status predicted improvement in pain and social functioning even when controlling for the effect of other demographic variables, pain intensity and HRQL at referral. The present study indicates that the multidimensional problems experienced by patients applying for DP are dominated by socioeconomic factors. Focus on solving these socioeconomic problems is important if chronic pain patients are to benefit from multidisciplinary pain treatment.

Adult↗
PubMed1997

The psychological symptoms of conjugal bereavement in elderly men over the first 13 months.

OBJECTIVE: The purpose of this study was to investigate the psychological symptoms experienced by recently widowed older men. It was hypothesized that conjugal bereavement in this group would be characterized by a mixture of depression, anxiety and loneliness. DESIGN: Double cohort study. SETTING: Suburban community population of Brisbane, Australia. PARTICIPANTS: Consecutive widowers (65+ years; N = 57) identified from official death records. Married men (65+ years; N = 57) identified from the electoral roll. Widowers interviewed at 6 weeks, 6 months and 13 months post-bereavement. Married men interviewed at similar intervals. MEASURES: Bereavement Phenomenology Questionnaire (BPQ), a 22-item self-report measure employing a four-point response scale to rate the frequency of phenomena over the previous fortnight. Zung Self-rating Depression Scale (SDS). State component of the Spielberger State/Trait Anxiety Inventory (STAI). Revised UCLA Loneliness Scale (ULS). 28-item General Health Questionnaire (GHQ). RESULTS: Widowers reported more state anxiety and general psychological distress, but not more depression or loneliness, than matched married men over the first 13 months post-bereavement. Widowers also reported more sleep disturbance and thoughts of death and suicide than married men. Level of state anxiety was strongly correlated with intensity of grief, but not with age, income, education, occupational prestige, cognitive function, duration of wife's final illness or expectedness of wife's death. CONCLUSIONS: The main hypothesis was not supported, as anxiety symptoms were the predominant clinical feature of recent conjugal bereavement among older men. The nature of these anxiety symptoms requires further investigation in recently widowed older persons.

Adaptation, Psychological↗
PubMed1993

Quality-of-life assessment in a home care program for advanced cancer patients: a study using the Symptom Distress Scale.

Quality-of-life assessment in advanced cancer patients should include the study of physical function, psychological status, social interactions, and symptoms. "Symptom distress" relates to the degree of discomfort caused by specific symptoms. A Symptom Distress Scale, which has been developed by McCorkle and Young, is a self-rating instrument that evaluates 13 symptoms. In the present study, the Italian version of the Symptom Distress Scale (SDS) was used to assess the quality of life in advanced cancer patients. The internal consistency of this version was found to be good (Cronbach's coefficient alpha = 0.78). A sample group of 43 patients treated in a home care program was asked to fill out the SDS on a weekly basis. The scores showed a reduction in symptom distress, which was primarily due to improvement in pain, nausea, and bowel pattern. Home care was less effective in improving concentration and, more generally, psychological aspects. This study confirms the validity of a quality-of-life monitoring system that uses a patient self-rating symptom assessment instrument.

Aged↗
PubMed1994

Reliability of self-rated tinnitus distress and association with psychological symptom patterns.

Psychological complaints were investigated in two samples of 60 and 138 in-patients suffering from chronic tinnitus. We administered the Tinnitus Questionnaire (TQ), a 52-item self-rating scale which differentiates between dimensions of emotional and cognitive distress, intrusiveness, auditory perceptual difficulties, sleep disturbances and somatic complaints. The test-retest reliability was .94 for the TQ global score and between .86 and .93 for subscales. Three independent analyses were conducted to estimate the split-half reliability (internal consistency) which was only slightly lower than the test-retest values for scales with a relatively small number of items. Reliability was sufficient also on the level of single items. Low correlation between the TQ and the Hopkins Symptom Checklist (SCL-90-R) indicate a distinct quality of tinnitus-related and general psychological disturbances.

Adult↗
PubMedDate not supplied

Psychological correlates of blood pressure: a closer examination of hostility, anxiety, and engagement.

Recent studies by other investigators have shown that hypertensives are more hostile and anxious than normotensives. The first part of this study examined the relationship between blood pressure measured daily over a one-week period and responses to a series of questions specifically developed to distinguish hypertensives from normotensives. Responses from this sample of undergraduates did not distinguish those with high blood pressure from those with normal values. Mean resting blood pressure was related to hostility and anxiety factor scores among males but not among females. Our second study used a sample of municipal employees and examined blood pressure as a function of comparable anxiety and hostility scores as well as a trait measure of overall "engagement-involvement." More highly engaged workers were no different in anxiety or hostility than less engaged workers. There was some evidence of more variable blood pressure for the former group. It is suggested that stable personality traits such as hostility and anxiety may both precede and follow the diagnosis of blood pressure. For nurses it is important to assess the patient's general psychological profile as well as his of her emotional state at the time of measurement. Repeated blood pressure readings are recommended especially for highly engaged individuals.

Adult↗
PubMed2005

Effect of physical training on quality of life and oxygen consumption in patients with congestive heart failure.

AIM: To assess changes in quality of life (QoL) and oxygen consumption produced by two different patterns of physical training in patients with congestive heart failure (CHF). MATERIAL AND METHODS: 42 men (mean age 55.9+/-8.1 years) with ischaemic CHF lasting 3.1+/-1.0 years. Patients were randomised into three groups each consisting of 14 men: group A--with constant workload, group B-with progressive/increasing workload, each trained up to 6 months and group C--not trained. QoL was assessed at baseline and at 6 months by means of the Psychological General Well-being Index (PGWB) and the Subjective Symptoms Assessment Profile (SSA-P). Cardiopulmonary exercise test and echocardiography were performed twice. RESULTS: At 6 months improvement in PGWB total index was observed, both in groups A and B (p<0.01). Men from groups A and B reported less cardiac symptoms (p<0.01), emotional distress (p<0.01), peripheral circulatory symptoms (p<0.01) and dizziness (p<0.01) in SSA-P. Improvement in sexual life was observed only in group B (p<0.01). Overall improvement of QoL was greater in group B than in group A as well as oxygen uptake (p<0.01). Higher QoL correlated positively with peak VO2 only in group B (r=0.56, p<0.05). CONCLUSIONS: Physical training improves QoL in men with CHF, but only progressive/increasing workload seems to markedly improve oxygen uptake. Improvement of QoL is related to psychological well-being and physical complaints associated with CHF.

Exercise Therapy↗
PubMed2003

The impact of treatment for gastro-oesophageal reflux disease on health-related quality of life: a literature review.

Gastro-oesophageal reflux disease (GORD) is common in the general population and is diagnosed based on patient-reported symptoms and clinical tests. Although clinical tests are available, significant percentages of patients report symptoms of heartburn and reflux despite negative endoscopies, and 24-hour pH tests are not often used by primary-care physicians in diagnosis. Consequently, patient-reported symptoms and health-related QOL (HR-QOL) are important in assessing treatment outcome. HR-QOL is significantly impaired in patients with GORD, and HR-QOL is associated with symptom severity and changes in GORD-related symptoms. The objective of this literature review is to examine the impact of pharmacological treatment on HR-QOL in patients with GORD. Generic and disease-specific HR-QOL measures have been used in clinical trials to evaluate the impact of GORD on patient functioning and well-being. The Psychological General Well-Being (PGWB) Index and the 36-Item Short-Form Health Survey (SF-36) have been used in several clinical trials of treatment for GORD and have consistently shown that HR-QOL improves with successful therapy. These trials have been conducted primarily with two pharmacological agents, omeprazole and ranitidine. On the Heartburn-specific Quality of Life questionnaire, patients treated with ranitidine reported better HR-QOL after treatment compared with placebo therapy. In two clinical trials where omeprazole and ranitidine were compared, patients treated with omeprazole reported significantly better HR-QOL (based on the PGWB Index) than those treated with ranitidine; however, 2 other trials did not detect significant differences between the treatments. Results from clinical trials using disease-specific measures (Gastrointestinal Quality of Life Index [GIQLI] and Heartburn-specific Quality of Life questionnaire) demonstrate similar findings, supporting the association between treatment-related symptom resolution and improvements in HR-QOL. The GIQLI was used in a trial comparing pantoprazole and ranitidine, where results favoured pantoprazole therapy. Several studies have demonstrated that resolution of GORD symptoms is associated with improvement in HR-QOL. Although there is evidence that treatment for GORD does improve symptoms and HR-QOL outcomes, further research is needed to more completely understand the value of medical therapy for GORD.

Drug Evaluation↗
PubMed2004

Is egocentric space automatically encoded?

Using the criteria defined by Hasher and Zacks [Hasher, L., & Zacks, R. T. (1979). Automatic and effortful processes in memory. Journal of Experimental Psychology: General, 108(3), 356-388], three studies examined the effects of intent of memorization, dual task interference, old age, practice and individual differences on memory for egocentric positions. Results showed that dual task interference and old age slightly influenced memory for egocentric positions. Small but significant individual differences were also observed. However, intent of memorization and practice had no influence on accuracy. The findings demonstrate that encoding of egocentric space works rather automatically but nevertheless requires minimal attentional resources.

Adult↗
PubMed1994

The phenomenology of post-traumatic stress disorder.

PTSD has been recognized for centuries, but its diagnosis is still being refined. PTSD currently refers to a person who has reacted with "intense fear, helplessness, or horror" to a major (or minor) trauma by developing (1) intrusive, re-experiencing symptoms; (2) avoidance responses to evidence of the trauma and generalized psychological numbing and isolation; and (3) widespread physiologic arousal. It can last for 1 to 3 months (acute) or more than 3 months (chronic) or develop for the first time at least 6 months after the trauma (delayed onset). Many of the long-lived symptoms of PTSD seem to have a biologic basis, even though the condition has environmental roots: It is one of the rare conditions in psychiatry for which one can create an animal model. Most patients improve, even if the trauma was severe, but some do not. With serious trauma, the lifetime prevalence rate for PTSD from most causes tends to be about 30% of those exposed, whereas the current prevalence after several years is usually below 10%. The symptoms wax and wane over months and years but can return in full force with retraumatization. A few patients, however, often with appropriate therapy, can turn PTSD into a growth experience. PTSD often grades into, or is comorbid with, disorders such as generalized anxiety disorder, panic disorder, major depression, chronic dysthymia, alcoholism, and somatoform disorders. Its development is determined both by the nature and power of the stressor as well as the intrinsic vulnerability of the patient and the treatment received by the patient after (usually soon after) the traumatic event. Although much is known about PTSD, even more remains unclear, and we can expect further refinements in our understanding of this disorder in the years to come.

Arousal↗