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PubMed1997

Quality of life and functional outcome following brachial plexus injury.

Thirty-two patients (3 women, 29 men) participated in a mailed questionnaire survey to evaluate long-term subjective, employment, and functional outcome following surgical treatment for brachial plexus injury. The mean age was 37 years and mean postinjury time was 7 years. The main outcome measures were overall life satisfaction, employment status, and the impact of the brachial plexus injury on life domains. Quality-of-life questions were adapted from the interviewer form of the U.S. General Social Survey. Considering overall life satisfaction, 25 patients (78%) reported at least moderate satisfaction and no patients reported extreme dissatisfaction. Ten patients reported that their injury did affect to a great deal their overall quality of life and slightly more than half the patients were employed at the time of the study. These outcomes were not affected by such patient factors as coverage by workers' compensation, litigation, pain, marital status, number of children, educational status, and the degree of functional recovery. These patient factors also did not alter the impact of the injury on overall life satisfaction. In spite of the devastating nature of these injuries, this patient population for the most part reported good quality of life with employment status predicted within the first year following injury.

Adult↗
PubMed2006

Urbanization and obesity in The Gambia: a country in the early stages of the demographic transition.

OBJECTIVE: To investigate the distribution of overweight and obesity and its relationship with socio-economic and behavioural factors in a developing-country population undergoing rapid nutritional transition. DESIGN: Cross-sectional house-to-house survey in urban Gambia. SUBJECTS: Four groups of 50 subjects were sampled as follows: young men (YM, 14-25 years), young women (YW, 14-25 years), older men (OM, 35-50 years) and older women (OW, 35-50 years). MEASUREMENTS: Several socio-economic and behavioural factors were investigated. Composite indices for socio-economic status, education, healthy lifestyle and western influences were created. Body weight, height, waist and hip circumferences were measured and body mass index (BMI) was calculated. Body composition was assessed by leg-to-leg bioimpedance. Overweight was defined as BMI=25.0-29.9 kg/m(2) and obesity as BMI>or=30.0 kg/m(2). RESULTS: There were highly significant gender and age differences in overweight (YM=0%, YW=10%, OM=6% and OW=34%) and obesity (YM=0%, YW=4%, OM=6% and OW=50%). Only 16% of OW were neither overweight nor obese compared to 88% of OM. OW had a higher fat mass percent (38.4%) than other groups, while fat-free mass (kg) was significantly higher in males than females with YW having the lowest value. Young generations were more educated and more influenced by western ideals than OM and OW. Weight gain was not always associated with weight concern and many overweight/obese subjects did not perceive themselves as overweight. CONCLUSION: Social and behavioural changes are already creating a perceptible 'generational gap' among this population undergoing rapid transition. The improved education and current lean status of the younger adults offers opportunities for preventative interventions. These need to be specially targeted at women.

Adolescent↗
PubMed2006

The relationship of suicide attempt history with childhood abuse and neglect, alexithymia and temperament and character dimensions of personality in substance dependents.

The aim of this study was to evaluate the prevalence of suicide in Turkish male substance dependents, and to investigate the relationship of suicide attempt history with childhood abuse and neglect, alexithymia, and temperament and character dimensions of personality. Participants were 154 consecutively admitted male substance dependents. Patients were investigated with the Childhood Abuse and Neglect Questionnaire, Toronto Alexithymia Scale (TAS-20) and Temperament and Character Inventory (TCI). Among substance-dependent patients, 28.6% was considered a group with suicide attempt history (SAH). Current age was lower and rate of being single was higher in the group with SAH. There were no significant differences between groups in terms of employment, educational status and duration of education. Rates of physical, emotional abuse and neglect, self-mutilation and being alexithymic were higher and ages at first substance use and regular substance use were lower in the group with SAH. Mean scores of "difficulty in identifying feelings" (DIF) and "difficulty in describing feelings" (DDF) subscale EOT of the TAS-20 were higher in the SAH group. Among temperament and character dimensions of the TCI, only "Self-directedness" and "Cooperativeness" were lower in SAH and there were no significant differences between groups in terms of other subscales. Age and Self-directedness score of TCI were determinants for suicide attempt. In particular, young drug users with low Self-directedness scores could be the target population in order to prevent suicidal behavior. This study also suggests that in substance-dependent patients, in the background of all suicidal behavior, childhood abuse and neglect must be evaluated.

Adult↗
PubMed2001

Age-related differences in length of stays, hospitalization costs, and outcomes for an injury-matched sample of adults with paraplegia.

OBJECTIVE: To investigate the effects of age at injury on neurological and functional outcomes and hospitalization length of stays and charges following spinal cord injuries resulting in paraplegia. METHODS: Subjects were 180 adults with paraplegia who were assessed in acute care and inpatient rehabilitation as part of the National Institute on Disability and Rehabilitation Research Model Spinal Cord Injury Systems. Age differences were examined by separating the sample into 3 age groups (18-39, 40-59, and 60+ years). A matched block design was used to control for injury characteristics. Cramer's statistic was used to identify age-related differences in qualitative variables; 3 x 5 one-way analysis of variance identified the main effects of age on quantitative variables. Tukey post hoc tests were performed to identify differences between age and age x injury characteristic variable levels. OUTCOME AND TREATMENT MEASURES: American Spinal Injury Association motor index scores, Functional Independence Measure (FIM) motor scores, discharge to private residence ratios, and hospitalization length of stays and charges were outcome and treatment measures. RESULTS: Age-related differences were found for etiology and health care plan, as well as for preinjury marital status, education level, and employment status. The main effects of age at injury were found for the following treatment and outcome measures: rehabilitation length of stays, FIM motor scores at rehabilitation discharge, FIM motor improvement (change), and FIM motor daily improvement (efficiency). Tukey post hoc tests revealed that older patients had longer rehabilitation stays, lower rehabilitation discharge FIM motor scores, and showed less improvement compared with younger and middle-aged injury-matched patients. No age-related differences were found in rates of discharge disposition. CONCLUSIONS: Using a matched block design procedure, older patients are discharged with lower levels of functional independence and show lower levels of improvement despite longer rehabilitation stays when compared with younger patients. Older patients' neurological recovery appears equivocal to younger patients' recovery. In contrast to findings with a matched tetraplegia sample, older and younger patients with paraplegia are discharged to private residences at similar rates.

Activities of Daily Living↗
PubMed2005

Cataracts among cancer survivors.

OBJECTIVES: To determine the frequency of cataracts in cancer survivors and their association with patients' demographic characteristics, treatment, and cancer type and the perceived effect cancer had had on their overall health. METHODS: This was a descriptive, cross-sectional review of the results of a survey of long-term cancer survivors who had been treated at the authors' institution. RESULTS: Of 3936 respondents to the survey, 168 (4%) reported having had cataracts. Cataracts were most frequent in survivors of hematologic diseases (chronic leukemia, 17%; myeloma, 13%; acute leukemia, 9%; and lymphoma, 7%). There were no notable associations between cataracts and gender, age, ethnicity, marital status, education completed, or work status. Cancer survivors with cataracts were more likely to report that cancer had affected their overall health (56% vs 39%). There was a trend of association between cataracts and prior treatment with bone marrow transplantation, but not corticosteroids. CONCLUSION: Cataracts affect a minority of long-term cancer survivors, but those who reported them were more likely to report that cancer had had a lasting effect on their overall health. Vision evaluation for all cancer survivors is recommended.

Adrenal Cortex Hormones↗
PubMed2006

Does reduction mammaplasty improve lung function test in women with macromastia? Results of a randomized controlled trial.

BACKGROUND: To determine the effects of reduction mammaplasty on lung function in women with mammary hypertrophy (macromastia), a prospective, randomized, controlled trial was conducted at the Academic Surgery and Plastic Surgery Units, Castle Hill Hospital, Cottingham, United Kingdom. METHODS: Seventy-three women who were referred for consideration of bilateral breast reduction surgery were randomized into either an early intervention group (surgery within 6 weeks) or a control group (surgery 6 months after recruitment). Each group had two sets of lung function tests: the intervention group had one before and one 3 months after surgery and the control arm had one test initially and a second test 4 months after randomization and before surgery. The main outcome measure was the lung function test. RESULTS: Sixty-five patients completed the study. The mean age was 39 years (SD, 12 years); both groups were equally matched for age, smoking status, social class, and educational status. By independent t test, there was no significant difference in lung function in the two groups. Subgroup analysis of the intervention group demonstrated a positive correlation between specimen weight and forced expiratory volume/vital capacity, forced expiratory volume/forced vital capacity, peak expiratory flow rate, and forced vital capacity. A paired sample t test revealed a significant improvement in the percentage of forced vital capacity performed/forced vital capacity predicted. CONCLUSION: The improvement in pulmonary function following reduction mammaplasty correlates with specimen weight resected.

Adolescent↗
PubMedDate not supplied

Social network and coronary artery calcification in asymptomatic individuals.

BACKGROUND: Psychosocial factors are associated with the development of coronary artery disease. However, studies examining psychosocial factors as risk indicators for coronary artery calcification (CAC) have been inconclusive. METHODS: Seven hundred eighty-three participants (mean age 57.4 +/- 9.3 years, 47% female) underwent CAC imaging using electron beam tomography. Psychosocial measures included social network (number of people in the household, marital status), socioeconomic status (education, income, and work status), history of depression, and current depressive symptoms as assessed with the Center for Epidemiologic Studies Depression (CES-D) scale. Assessments were also made for lipid profile, blood glucose, blood pressure, and health behaviors (smoking status, exercise, and diet). RESULTS: Calcification was present in 351 (44.8%) participants (CAC score range 0-3022; mean 111.5 +/- 307.2). Indicators of social isolation (being single or widowed) were independently associated with elevated risk for the presence of CAC, even after adjustment for age, sex, systolic blood pressure, blood glucose, and low-density lipoprotein (adjusted odds ratios 1.80, 95% confidence interval [CI] = 1.05-3.10, and 2.48, 95% CI = 1.02-6.03, respectively). By contrast, health behaviors, socioeconomic status, and depressive symptoms were not related to CAC. CONCLUSIONS: Social network indices such as being single or widowed are associated with CAC, independent of age and coronary risk factors. Because coronary calcification has been identified as a potential marker of early atherosclerosis, these findings may partially explain the predictive value of limited social networks for future adverse cardiovascular health outcomes.

Aged↗
PubMed2001

Impact of induced abortions on subsequent pregnancy outcome: the 1995 French national perinatal survey.

OBJECTIVE: To study the impact of previous induced abortions on preterm delivery, small for gestational age and low birthweight in subsequent pregnancies. DESIGN: Survey of a national sample of births in France in 1995. SETTING: All public and private maternity hospitals in France. POPULATION: 12,432 women who had a singleton live birth during one week. METHODS: Data were collected during the women's postpartum stay in hospital, partly obtained by interview and partly abstracted from hospital medical records. Rates of preterm delivery, small for gestational age and low birthweight were compared according to existence and number of previous induced abortions. Maternal age, parity, history of previous adverse pregnancy outcome, maternal weight before pregnancy, marital status, educational level, maternal employment status during pregnancy, nationality, smoking during the third trimester of pregnancy and antenatal care were controlled for using multiple logistic regression and polytomous logistic regression. RESULTS: Twelve percent of women reported one previous induced abortion, and 3% two or more. Previous induced abortion was associated with an increased risk of preterm birth (OR 1.4; 95% CI 1.1-1.8); the risk of preterm delivery increased with the number of previous induced abortions (OR 1.3; 95% CI 1.0-1.7 for one previous abortion and OR 1.9; 95% CI 1.2-2.8 for two or more). The relationship was the same for very preterm and moderately preterm deliveries and for spontaneous and indicated preterm deliveries. After controlling for potential confounders, the association between previous induced abortions and small for gestational age and low birthweight infants was no longer significant. CONCLUSION: This study suggests that a history of induced abortion increases the risk of preterm delivery, particularly for women who have had repeated abortions. The respective role of the surgical and medical techniques used for induced abortions needs to be explored.

Abortion, Induced↗
PubMed2006

[Screening for factors relating to the development of mental disorders in the geriatric population (PSICOTARD)].

OBJECTIVES: To detect the physical, psychological, social-demographic, and functional factors that may involve risk of developing mental disorder in the elderly, to determine the magnitude of each factor and to do the groundwork for a future longitudinal study that will enable us to define the elderly with psychological fragility in the autonomous region and to design predictive models for mental deterioration in the elderly. DESIGN: Descriptive study based on personal interviews by professionals using a standardised method. SETTING: Twenty-eight primary care health centres in the province of Huesca, Spain, with an ageing rate over 24.6%. PARTICIPANTS: Three-hundred and twenty-six patients over 64 years and resident in the province of Huesca, Spain. INTERVENTION: Personal interview conducted by health professionals (30 family doctors and a trainee psychologist). The following will be appraised: the presence of cognitive impairment (Mini-Mental State Examination), depression (Yesavage Geriatric Depression Scale), anxiety (Goldberg Scale of Anxiety), and presence of delusions, hallucinations, obsessions and hypochondria (Geriatric Mental State-GMS). MAIN MEASUREMENTS: The prevalence of the risk factors will be calculated: social and demographic variables (age, sex, marital status, education, living alone), functional status (Barthel index), the severity of physical disability (Cumulative Illness Rating Scale), pathological records (somatic and psychological), and stressful life events in the preceding year. A logistical regression model will be calculated to determine the weight of the effect of each factor adjusted for all the rest. Individual risk will be calculated for the development of each mental disorder (depression, anxiety, cognitive deterioration/dementia, psychotic symptoms, obsessions). DISCUSSION: The reliability of the questionnaire is ensured by use of diagnostic tests of proven validity and reliability, prior training of researchers and use of a data-gathering pilot study.

Aged↗
PubMedDate not supplied

Depressive symptoms lead to impaired cellular immune response.

BACKGROUND: The association between depression and immune response is not yet clear. The biological mechanisms by which depression alters the immune system is not yet understood. The purpose of this study was to investigate the longitudinal relationship between depressive symptoms and cellular immune response. METHODS: A cohort study with a baseline measurement and three annual health assessments was set up in a residential home for elderly people in Rome, Italy. A total of 166 residents aged 65 years and older, mean age 81 years, were interviewed and blood samples were collected at each annual assessment. Percentage changes in lymphocytes and T-cell subsets related to depressive symptoms were estimated over a period of 4 years, using regression models for repeated measurements. RESULTS: Elderly people with seven or more symptoms of depression, according to the Geriatric Depression Scale, had a lower percentage of CD4+DR+ T-cells over 4 years [beta = -20.2; 95% confidence interval (CI) = -33.0 to -4.9] and CD8+DR+ T-cells (beta = -26.9; 95% CI = -42.5 to -7.0) than elderly with less than seven symptoms of depression, after adjusting for confounding factors (sex, age, marital status, education, smoking habit, nutritional status, chronic diseases, disability and the use of benzodiazepines). CONCLUSION: The results of this study suggest an adverse effect of depressive symptoms on immune response. It remains to be determined whether these depression-associated immune changes are related to the onset or course of physical illness and the increased mortality observed in depressed old people.

Aged↗
PubMed1997

A consumer-constructed scale to measure empowerment among users of mental health services.

OBJECTIVE: A scale to measure the personal construct of empowerment as defined by consumers of mental health services was developed and field tested. METHODS: After extensive development, pilot testing, and analyses, a 28-item scale to measure empowerment was tested on 271 members of six self-help programs in six states. Factor analyses were used to identify the underlying dimensions of empowerment. To establish the scale's reliability and validity, responses were factor analyzed, and other analyses were conducted. RESULTS: Analyses revealed five factors: self-efficacy-self-esteem, power-powerlessness, community activism, righteous anger, and optimism-control over the future. Empowerment was related to quality of life and income but not to the demographic variables of age, gender, ethnicity, marital status, education level, or employment status. Empowerment was inversely related to use of traditional mental health services and positively related to community activism. CONCLUSIONS: The findings set a framework for a clearer understanding of the imprecise and overused concept of empowerment. The scale demonstrated adequate internal consistency and some evidence for validity. Further testing must be done to establish whether it has discriminant validity and is sensitive to change.

Adult↗
PubMed2003

Trading nutrition for education: nutritional status and the sale of snack foods in an eastern Kentucky school.

Overweight and poor nutrition of children in the United States are becoming issues of increasing concern for public health. Dietary patterns of U.S. children indicate they are consuming too few fruits and vegetables and too many foods high in fat and sugar. Contributing to this pattern of food consumption is snacking, which is reported to be on the increase among adults and children alike. One place where snacking is under increased scrutiny, and where it is being increasingly criticized, is in U.S. schools, where snack foods are often sold to supplement inadequate budgets. This article takes a biocultural approach to understanding the nutritional status of elementary school children in a rural community in eastern Kentucky. It pays particular attention to the ways in which the school's nutrition environment shapes overweight and nutritional status for many of the children, focusing on the sale of snack foods and the reasons behind the principal's decision to sell snack foods in the school.

Anthropology, Cultural↗
PubMed1993

Some factors that influence dropping out from outpatient alcoholism treatment facilities.

Even though clients treated in an outpatient setting have been documented to have very high dropout rates, evidences of the factors that influence dropping out are fragmentary and are based on small-scale studies. In our attempt to distinguish such factors, outpatient and intensive outpatient alcoholism admissions for the State of New Jersey were analyzed. Our findings indicated that females, the young and the unskilled are at a higher risk of dropping out. We also documented that drinking status of patients, occupational status, health insurance coverage, educational status, living arrangement, duration of stay in treatment and the number of sessions of service were important factors that influenced the likelihood of dropping out. Controlling for the number of sessions revealed that the relationship between the odds of dropping out and duration in treatment was mixed. Primary drug abusers in our cohort had the highest likelihood of dropping out followed by the dually addicted. It is argued that dropping out is likely to be complicated by the inability of alcoholism treatment facilities to cope with multiple addiction problems.

Adolescent↗
PubMed1987

[Time course and prognosis of industrial workers with major depression].

To investigate the time course and the prognosis of patients with depressive disorder in industry, 60 workers with major depression (DSM-III) selected from two companies were interviewed. Average follow-up years for subjects after returning to their job was 3.5, ranging from 1 to 8. About half of the subjects relapsed and two-thirds changed their job within 5 yr after returning to their job. One case committed suicide. Subjects tended to relapse within the first 4 yr and under the same precipitating situation as at their onset phase. Fifty percent of the subjects indicated "very good" or higher social adjustment according to Axis V (DSM-III). Enough rest days at the onset and no relapse significantly correlated with higher social adjustment in the subjects within 2 yr after the return. In the subjects followed-up for 3 yr or more, marital status, education, no higher occupational status, fewer relapses, and support for them by both industrial health services and worksite supervisors were found to be significant predictors of higher adjustment. The results suggested that, in order to prevent relapses and improve social adjustment of workers with major depression, the mental health team in industry should provide continuous and careful support for them, for at least 4 yr after returning to their job.

Adult↗