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PubMed2000

Impact of a history of hypertension on symptoms and quality of life prior to and at five years after coronary artery bypass grafting.

AIM: To describe symptoms and other aspects of health-related quality of life (QoL) prior to and 5 years after coronary artery bypass grafting (CABG) in relation to a history of hypertension. METHODS: Patients who underwent CABG in western Sweden were approached prior to surgery and 5 years after the operation. Health-related QoL was estimated with the Physical Activity Score, the Nottingham Health Profile and the Psychological General Well-Being Index. RESULTS: In patients with a history of hypertension (n = 740) the 5-year mortality was 16.9% versus 12.4% among patients with no history (n = 1257; p = 0.004). Of 1717 patients available for the survey, 876 (51%) responded both prior to and 5 years after CABG. Of these, 36% had a history of hypertension. Compared with the situation prior to surgery there was an improvement in both hypertensive and non-hypertensive patients in terms of physical activity, symptoms of dyspnea and chest pain and other estimates of health-related QoL. However, physical activity and dyspnea improved less in hypertensive than in non-hypertensive patients. CONCLUSION: Five years after CABG, a marked and significant improvement in terms of symptoms and other aspects of health-related QoL was observed among both hypertensive and non-hypertensive patients. However, improvement in physical activity was less marked in patients with a history of hypertension. Overall, a history of hypertension seemed to have a minor impact on improved well-being 5 years after coronary surgery. However, because of the limited response rate the results may not be applicable in a non-selected CABG population.

Adaptation, Psychological↗

PubMed1987

Developmental aspects of memory for spatial location.

The purpose was to show whether or not the encoding of location met criteria defining an automatic process (L. Hasher & R. T. Zacks, 1979, Journal of Experimental Psychology: General, 108, 356-388; 1984, American Psychologist, 39, 1372-1388). Among other criteria, automatic processes are not expected to show developmental changes beyond an early age, to be unrelated to intelligence level, and to be unaffected by instructions. In the first experiment preschool through sixth-grade children were compared on a 40-picturebook task following incidental (remember the names of pictures) or intentional (remember location) instruction. Subjects viewed and named pictures in sets of four, arranged in quadrants in the opened book, and then attempted to recall names of the objects pictured and to relocate pictures on blank pages. In the second experiment, second and sixth graders, college students, elderly persons, and mentally retarded persons were compared on a 60-picturebook task following either incidental or semantic incidental instructions (give the function of objects pictured). Memory for location was invariant across age groups and intelligence level. The only exception was that 3 and 4 year olds were more accurate following intentional instructions. Otherwise there were no differences between intentional and incidental instructions. Semantic instructions resulted in slightly more accurate locations. The results were interpreted as supportive of the Hasher and Zacks' automaticity hypothesis.

Child↗

PubMed2002

Psychological evaluation test after the use of assisted reproduction techniques.

PURPOSE: The emotional changes provoked by the use of assisted reproduction techniques (ART) may trigger important psychological reactions. The objective of the present study was to develop a psychological evaluation test (PET-ART) in order to identify the occurrence of psychological problems and to facilitate their treatment. METHODS: A total of 128 women were submitted to PET-ART of the Center for Human Reproduction, "Sinhá Junqueira" Maternity Foundation, after application of IVF/ICSI program at least once. The causes of infertility were male-related in 45% of cases, female-related in 48%, and both male- and female-related in 7%. Infertility was primary in 79% of cases and secondary in 21%. The mean age of the women was 34.5 +/- 5.2 years and the mean age of the men was 37.9 +/- 6.8 years. The PET-ART was evaluated using a questionnaire with 15 questions selected in order to detect emotional reactions caused by infertility. The responses were assigned four grades with respect to intensity (1 = mild intensity; 2 = medium intensity; 3 = high intensity; and 4 = maximum or unbearable intensity). The sum of the responses corresponded to PET-ART score ranging from 15 to 60 points. The reliability of the questionnaire was evaluated by the alpha coefficient of Cronbach. RESULTS: The PET-ART identified five questions receiving 50% or more responses of the high/maximum intensity type (sum of the percentages of responses with a score of 3 and 4). The questions were the following: 1--The waiting time before being submitted to a pregnancy test (82.8% of the patients); 2--A negative result of the pregnancy test (77.3% of the patients); 3--The degree of anxiety in a new attempt to obtain pregnancy (76.5% of the patients); 4--Finding the money necessary for the repetition of the IVF/ICSI techniques (66.4% of the patients); 5--The possibility of collecting few eggs, or of forming or not an embryo in the laboratory is an expectation that makes me anxious (57.8% of the patients). The mean PET-ART was 33 +/- 6. The alpha coefficient of Cronbach was 0.757. CONCLUSIONS: The PET-ART was an efficient tool for the identification of women with emotional changes provoked by the application of ART and for the planning of their treatment. However, a general psychological approach was developed for each emotional factor regardless of PET-ART.

Adult↗

PubMed2000

Effectiveness and costs of omeprazole vs ranitidine for treatment of symptomatic gastroesophageal reflux disease in primary care clinics in West Virginia.

OBJECTIVE: To compare clinical, health-related quality of life (HRQL), and medical cost outcomes in patients with symptomatic gastroesophageal reflux disease (GERD) receiving omeprazole sodium or ranitidine hydrochloride treatment. METHODS: A multicenter, randomized, open-label, medical effectiveness trial conducted in 5 university-based family medicine clinics. Two hundred sixty-eight patients with GERD were recruited and randomly assigned to omeprazole sodium, 20 mg once daily, or ranitidine hydrochloride, 150 mg twice daily, for up to 6 months. Main outcome assessments included the Gastrointestinal Symptom Rating Scale (GSRS) Reflux score, Psychological General Well-Being Index, and Short-Form-36 Health Survey administered at baseline and 2, 4, 12, and 24 weeks. Medical resource use and cost data were collected. RESULTS: More omeprazole-treated patients reported improved heartburn resolution at 2 weeks (49.0% vs 33.3%; P=.007) and 4 weeks (58.6% vs 35.0%; P<.001) compared with ranitidine-treated patients. The GSRS Reflux scores across 3 months showed overall differences between omeprazole (mean, 2.67) and ranitidine (mean, 2.95) groups (P=.04). Mean total 6-month medical costs were $915 lower ($8371 vs $9286; P=.64), and no difference in mean outpatient medical costs ($1198 vs $1158; P=.76) were observed in the omeprazole group compared with the ranitidine group. A post hoc secondary analysis showed that, at 12 and 24 weeks, patients treated with omeprazole for 8 weeks or more reported greater heartburn resolution (ie, 24 [43%] of 56 patients at both intervals) than patients treated with ranitidine for 8 weeks or more (12 [24%] and 13 [26%] of 50 patients, respectively; P=.001). CONCLUSIONS: Ranitidine and omeprazole were both effective at improving heartburn symptoms; however, omeprazole provided greater resolution of heartburn symptoms at 2 and 4 weeks. Despite omeprazole's higher acquisition cost, there were no significant differences in total or outpatient costs between groups.

Adult↗

PubMed2002

A randomized comparison of group cognitive-behavioral therapy and group interpersonal psychotherapy for the treatment of overweight individuals with binge-eating disorder.

BACKGROUND: Cognitive-behavioral therapy (CBT) has documented efficacy for the treatment of binge eating disorder (BED). Interpersonal psychotherapy (IPT) has been shown to reduce binge eating but its long-term impact and time course on other BED-related symptoms remain largely unknown. This study compares the effects of group CBT and group IPT across BED-related symptoms among overweight individuals with BED. METHODS: One hundred sixty-two overweight patients meeting DSM-IV criteria for BED were randomly assigned to 20 weekly sessions of either group CBT or group IPT. Assessments of binge eating and associated eating disorder psychopathology, general psychological functioning, and weight occurred before treatment, at posttreatment, and at 4-month intervals up to 12 months following treatment. RESULTS: Binge-eating recovery rates were equivalent for CBT and IPT at posttreatment (64 [79%] of 81 vs 59 [73%] of 81) and at 1-year follow-up (48 [59%] of 81 vs 50 [62%] of 81). Binge eating increased slightly through follow-up but remained significantly below pretreatment levels. Across treatments, patients had similar significant reductions in associated eating disorders and psychiatric symptoms and maintenance of gains through follow-up. Dietary restraint decreased more quickly in CBT but IPT had equivalent levels by later follow-ups. Patients' relative weight decreased significantly but only slightly, with the greatest reduction among patients sustaining recovery from binge eating from posttreatment to 1-year follow-up. CONCLUSIONS: Group IPT is a viable alternative to group CBT for the treatment of overweight patients with BED. Although lacking a nonspecific control condition limits conclusions about treatment specificity, both treatments showed initial and long-term efficacy for the core and related symptoms of BED.

Adult↗

PubMed1997

Comparison of men and women with binge eating disorder.

OBJECTIVE: This study examined gender differences in individuals with binge eating disorder (BED) on eating-related psychopathology and general psychological functioning. METHOD: Subjects were age-matched men (n = 21) and women (n = 21) with BED who were administered the Eating Disorders Examination (EDE), the Structured Clinical Interview for DSM-III-R (SCID) and SCID II, and who completed the Emotional Eating Scale (EES) and other questionnaires regarding psychological functioning. RESULTS: Men and women did not differ on measures of eating disturbance, shape and weight concerns, interpersonal problems, or self-esteem, but more men than women met criteria for at least one Axis I diagnosis and had a lifetime diagnosis of substance dependence. Women were more likely to report eating in response to negative emotions, particularly anxiety, anger and frustration, and depression. DISCUSSION: Results from our study suggest that while men and women presenting for treatment for BED are very similar, males may have more Axis I psychiatric disturbance and less emotional eating than their female counterparts. These findings are discussed in terms of the role of gender in BED and possible treatment implications are explored.

Adult↗

PubMed1979

Sex of client as a factor in preference for an approach to counseling.

In a reversed order, 90 Ss, from a general psychology course, in two groups of equal size, viewed two audiovisual tapes of a simulated first counseling session. The same counselor, same client, and same presenting concern of a vocational-educational nature were portrayed as representative of a client-centered and a behavioral approach to counseling. The Ss were asked to identify which film they preferred and why. A chi square analysis showed no difference between males and females. However, there was a statistically significant preference for the behavioral approach by both males and females. The major factor in the preference appeared to be the "structure" of the behavioral approach.

Behavior Therapy↗

PubMed1981

Diagnosis of clinical depression on four source trait dimensions -U.I. 19, U.I. 20, U.I. 25, and U.I. 30--from the O.A. Kit.

Describe four personality factors with preliminary indications of distinguishing depressed patients from normals, namely those indexed in the O-A Kit as U.I. 19, U.I. 20, U.I. 25 and U.I. 30. Thirty-one clinically depressed Ss--22 inpatients and 9 outpatients--were administered the O-A (Objective-Analytic) battery for these four and the scores compared with those of 30 demographically matched controls. From earlier research and the general psychological theory that concerned these source traits it was hypothesized that depressed Ss would deviate negatively on U.I. 19 and U.I. 25 and positively on U.I. 20 and U.I. 30. A comparison of means that used a one-tailed t-test showed significant differences on two of the factors, U.I. 19 and U.I. 20, at p less than level of significance, and on U.I. 25 and U.I. 30 at p less than .05 significance level. Thus, the clinical sample showed the hypothesized directions of divergence from the control sample on all four of the factors. Later use of a discriminant function on this pattern of deviations shows a high degree of patient-control separation (Price, Cattell, & Patrick, Note 1).

Adult↗

PubMed1990

Luria Memory Words Test and Wechsler Memory Scale: comparison of utility in discriminating neurologically impaired from controls.

Memory deficits are among the most common initial complaints of patients who are suffering from neurological disorders. The present study compared the relative clinical utility of the Wechsler Memory Scale and the Luria Memory Words Test in differentiating brain-damaged (N = 60) from non-brain-damaged patients (N = 60). Separate stepwise regression analyses selected five variables from each test that accounted for the greatest between-group variance. Separate discriminant functions then were computed that used the WMS and the Luria Words variables selected through the regression analyses. The WMS correctly classified 72% of the subjects, whereas the Luria Words correctly classified 76% of the subjects. A final discriminant function was computed that used all 10 variables and resulted in a classification accuracy of 86%, with 6% false positives and 6% false negatives. Results are discussed relative to the use of each instrument in both a general psychological assessment situation and when specific memory functioning is in question.

Brain Damage, Chronic↗

PubMed1994

Validation of the Inventory of College Students' Recent Life Experiences in an American college sample.

The factor structure and psychometric properties of the Inventory of College Students' Recent Life Experiences (ICSRLE; Kohn, Lafreniere, & Gurevich, 1990) were investigated in a sample of 216 college undergraduates. LISREL confirmatory factor analyses supported the generalizability of the 49-item one-factor and 37-item seven-factor solutions to our undergraduate sample. The coefficients alpha for the ICSRLE subscales were satisfactory. Multivariate analysis of variance was used to examine gender differences on the ICSRLE items and subscale scores. Concurrent validity evidence was shown by the positive and significant correlations of the ICSRLE subscales with related measures of daily hassles. Correlational analyses, LISREL confirmatory factor analysis, and exploratory maximum-likelihood factor analyses revealed that the ICSRLE subscales may not be contaminated by general psychological symptoms.

Adolescent↗

PubMedDate not supplied

Contemporary work characteristics, stress, and ill health.

This study investigates the relationship between work and ill health resulting from stressors originating in the work environment. The association between work and health has been well-documented. Factors in the work environment leading to ill health have included generalized psychological stress and/or specific physical environmental characteristics. Data for this study come from a 1998 telephone survey, the Indiana Survey of Work in a Polarized Economy, under the auspices of the Center for Survey Research at Indiana University. The dependent variable is an index that measures ill health among workers; control variables include sociodemographic and lifestyle characteristics of these workers as well as their job characteristics; and the four key independent variables are occupational status, organizational disruption, layoff experience, and educational discordance of the workers. Multiple regression analysis on the entire sample (n = 919) demonstrates that occupational status is negatively associated with ill health, while organizational disruption, layoff experience, and educational discordance are positively associated with it. Separate analyses for male (n = 474) and female (n = 445) respondents find significant sex differences in the effects of the key variables: for males, organizational disruption is positively related to ill health while for women occupational status is negatively related and layoff experience and educational discordance are positively related to ill health. The findings from the present research provide insight into the interrelationship of occupational environment and health within the framework of evolutionary medicine.

Adult↗

PubMed1998

Validation of questionnaire-based response criteria of treatment efficacy in the fibromyalgia syndrome.

OBJECTIVE: To compare the validity of self-reported questionnaires as response criteria of treatment efficacy in patients with fibromyalgia syndrome. METHOD: At the beginning of the treatment period, 70 fibromyalgia patients, randomly allocated to electro-acupuncture or placebo, underwent a clinical evaluation by rheumatologists and answered 1) a generic quality of life questionnaire--the Psychological General Well-Being Index (PGWB), 2) a specific function and symptom questionnaire, and 3) a pain questionnaire--the Regional Pain Score (RPS). The same evaluation was repeated at the end of the treatment period. Severity of the condition was assessed by a composite outcome score, a combination of different clinical outcome measures forming a clinical severity index. The variations between these questionnaire scores before and after treatment and the variations between the clinical severity indices estimated by clinicians were used as measures of the treatment impact. The first rationale for the validation was a positive correlation between clinical and questionnaire score changes. Another rationale for validation of the new instruments was the ability to identify the different treatment interventions. RESULTS: The correlation between the clinical severity index and the RPS was good (r = 0.62). Moreover, the RPS demonstrated a good discriminant power in detecting patients with effective treatment: it showed a specificity of 74% and a sensitivity of 75%. The PGWB correlated less well with the clinical score and was less discriminant. The specific function and symptom questionnaire showed little additional validity. CONCLUSIONS: Outcomes of syndrome severity such as pain and subjective well-being, as measured by self-reported questionnaires, can be valid instruments to evaluate treatment efficacy in short-term clinical trials. In the current study, the RPS proved to be particularly useful to assess the widespread tenderness of fibromyalgia and demonstrated high discriminative power.

Activities of Daily Living↗

PubMed2005

Randomized clinical trial of laparoscopic Nissen fundoplication compared with proton-pump inhibitors for treatment of chronic gastro-oesophageal reflux.

BACKGROUND: Both laparoscopic Nissen fundoplication (LNF) and proton-pump inhibitor (PPI) therapy are established in the treatment of gastro-oesophageal reflux disease (GORD). The aim of this study was to compare these two treatments in a randomized clinical trial. METHODS: Between July 1997 and August 2001, 340 patients with a history of GORD for at least 6 months were investigated by endoscopy, 24-h pH monitoring and manometry. Of these, 217 were randomized, 109 to LNF and 108 to PPI therapy. The two groups were well matched for age, sex, weight and severity of reflux. Twenty-four-hour pH monitoring and manometry were performed 3 months after treatment, and quality of life was assessed in both groups using the Psychological General Well-being Index and the Gastrointestinal Symptom Rating Scale at 3 and 12 months after treatment. RESULTS: At 3 months there was an improvement in lower oesophageal sphincter pressure from 6.3 to 17.2 mmHg in the LNF group but no change in the PPI group (8.1 and 7.9 mmHg before and after treatment respectively) (P < 0.001). The mean DeMeester acid exposure score improved from 42.7 to 8.6 (P < 0.001) in the LNF group and from 36.9 to 17.7 in the PPI group (P < 0.001). The mean gastrointestinal symptom and general well-being scores improved from 31.7 and 95.4 respectively before treatment to 37.0 and 106.2 at 12 months after LNF, compared with changes from 34.3 and 98.5 to 35.0 and 100.4 respectively in the PPI group. The differences in both of these scores were significant between the two groups at 12 months (P = 0.003). CONCLUSION: LNF leads to significantly less acid exposure of the lower oesophagus at 3 months and significantly greater improvements in both gastrointestinal and general well-being after 12 months compared with PPI treatment.

Adult↗

PubMed2006

Randomized clinical trial of day-care versus overnight-stay laparoscopic cholecystectomy.

BACKGROUND: Laparoscopic cholecystectomy has been performed as a day-care procedure for many years. Few studies have been conducted with primary focus on patient acceptance and preferences in terms of quality of life for this practice compared with overnight stay. METHODS: Data from 100 patients with symptomatic gallstones randomized to laparoscopic cholecystectomy performed either as a day-care procedure or with overnight stay were analysed. Complications, admissions and readmissions, quality of life and health economic aspects were assessed. Two instruments were used to assess quality of life, the Hospital Anxiety and Depression Scale (HADS) and the Psychological General Well-Being Index (PGWB). RESULTS: Forty-eight (92 per cent) of 52 patients in day-care group were discharged 4-8 h after the operation. Forty-two (88 per cent) of 48 in the overnight group went home on the first day after surgery. The overall conversion rate was 2 per cent. Two patients had complications after surgery, both in the day-care group. No patient in either group was readmitted. There was no significant difference in total quality of life score between the two groups. The mean direct medical cost per patient in the day-care group (3085 Euros) was lower than that in the overnight group (3394 Euros). CONCLUSION: Laparoscopic cholecystectomy can be performed as a day-case procedure with a low rate of complications and admissions/readmissions. Patient acceptance in terms of quality of life variables is similar to that for cholecystectomy with an overnight stay. The day-care strategy is associated with a reduction in cost.

Adolescent↗

PubMed1991

The relationship between exercise tolerance and quality of life in angina pectoris.

The relationship between exercise tolerance assessed by a conventional exercise stress test using a standard Bruce protocol and quality of life (QoL) was studied in 50 patients with stable angina pectoris (AP). Before the exercise test, patients completed three self-administered QoL questionnaires, the Psychological General Well-Being Index, an Angina-Specific QoL Questionnaire, and Jenkins' Sleep Dysfunction Scale. Total exercise time (r = -0.40) and time until onset of pain (r = -0.44) were significantly correlated with perceived physical limitations. Somatic symptoms were related to total time (r = -0.38). Apart from a significant correlation between depressed mood and total exercise time (r = 0.36), there was no corresponding correlation with well-being and sleep disturbance. These results suggest that exercise stress tests do not reflect quality of life in patients with AP.

Activities of Daily Living↗

PubMed2001

Relief of symptoms and improvement of health-related quality of life five years after coronary artery bypass graft in women and men.

BACKGROUND: Severe coronary artery disease can be successfully treated with coronary artery bypass graft (CABG), with considerable improvement in the symptoms of angina pectoris. Approximately three of four patients are free of ischemic events for 5 years; however, increased survival is demonstrated only in selected subgroups with advanced coronary artery disease, and this effect has not been established in elderly patients. HYPOTHESIS: The study was undertaken to determine the relief of symptoms and improvement in other aspects of health-related quality of life (QoL) during 5 years after CABG in women and men. METHODS: Patients who underwent CABG in western Sweden were approached prior to and 5 years after surgery. Health-related QoL was estimated with Physical Activity Score (PAS), Nottingham Health Profile, and Psychological General Well-Being Index. RESULTS: Women (n = 381) had a 5-year mortality of 17% compared with 13% for men (n = 1,619; NS). After 5 years, 1,719 patients (survivors) were available for the survey; of these, 876 (51%) answered the inquiry both prior to and after 5 years. Both women and men improved markedly and highly significantly, both with respect to symptoms and other aspects of health-related QoL. Women suffered more than men in terms of limitation of physical activity, dyspnea, chest pain, and others aspects of health-related QoL. There was a significant interaction between time and gender, with more improvement in men with regard to chest pain when walking uphill or quickly on level ground, when walking on level ground at the speed of other persons their own age, when under stress, and in windy and cold weather. For those parameters as well as for PAS, improvement was more marked in men than in women. In the other aspects of health-related QoL, there was no interaction between time and gender. CONCLUSION: Five years after CABG, limitation of physical activity, symptoms of dyspnea, and chest pain were reduced, and various aspects of health-related QoL had improved in both women and men. In general, women suffered more than men both prior to and after CABG; however, in some aspects the improvement was more pronounced in men. Because of the limited response rate, the results may not be applicable to a nonselected population who had undergone CABG.

Coronary Artery Bypass↗

PubMed2002

Impulsive behaviors in bulimic patients: relation to general psychopathology.

OBJECTIVE: At a general level, impulsivity is related to both bulimic and general psychopathology. However, it is a complex construct, and the specific role of different forms of impulsivity in psychopathology remains to be determined. The present study of bulimic outpatients examined the association of internally and externally directed impulsive behaviors with general and bulimic psychopathology. METHODS: Thirty female bulimic outpatients completed standardized measures of bulimic attitudes/behaviors, general psychopathology and impulsive behaviors. RESULTS: While general psychopathology was associated with internally directed impulsive behaviors (e.g., self-harm), bulimic pathology was more specifically linked with externally directed impulsivity (e.g., theft; reckless driving). DISCUSSION: The results indicate that the bulimia-impulsivity link in eating disordered patients is not simply a by-product of the broader association of impulsivity with psychopathology. Therefore, bulimic pathology does not seem to be just a manifestation of general psychological disturbance. Further research is suggested to test these results and potential clinical implications are outlined.

Adult↗

PubMed2006

Body Checking Questionnaire: psychometric properties and clinical correlates in obese men and women with binge eating disorder.

OBJECTIVE: Body checking is considered a behavioral manifestation of the overevaluation of shape and weight, which is characteristic of patients with eating disorders. We examined the initial psychometric properties of the Body Checking Questionnaire (BCQ) and the frequency and nature of body checking behaviors in obese men and women with binge eating disorder (BED). METHOD: Participants were a consecutive series of 73 (22 men, 51 women) treatment-seeking obese adults who met research criteria for BED as defined in the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994). Participants were administered measures to assess body checking, body image concerns, and the core psychopathology of eating disorders, and general psychological functioning. Semistructured interviews were used to establish the diagnosis of BED. RESULTS: Psychometric evidence was found to support the reliability and validity of the BCQ in patients with BED. Women reported significantly greater levels of body checking than men. Participants with greater body dissatisfaction reported more frequent checking than participants with less dissatisfaction. Among women, the frequency of checking was related to younger age, lower body mass index (BMI), body dissatisfaction, overevaluation of body shape and weight, greater depression, and lower self-esteem. CONCLUSION: There exist significant gender and age-related differences in both the frequency and correlates of body checking behaviors. Among obese women with BED, body checking is related to the overevaluation of shape as well as with associated psychopathology.

Body Image↗