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PubMedDate not supplied

Physiotherapists talking to patients.

An examination of the validity of Byrne and Long's communication model to analyze a sample of physiotherapists' communication behavior was undertaken. No evidence was found to support the model; instead, a two-dimensional model of communication was strongly supported by the data. It seems that physiotherapists' interactions are best described by one dimension of direction and advice giving and a second, independent dimension of a counseling type of communication.

Communication↗
PubMed2001

Clinical and genetic heterogeneity in nemaline myopathy--a disease of skeletal muscle thin filaments.

The term nemaline myopathy (NM) encompasses a heterogeneous group of disorders of primary skeletal muscle weakness characterized by the presence of nemaline rods in muscles of affected individuals. Disease severity is variable and unpredictable, with prognosis ranging from neonatal death to almost normal motor function. Recent advances in the identification of NM disease genes demonstrate that NM is a disease of the skeletal muscle sarcomere and, in particular, of the thin filaments. These findings are starting to alter the approach that neurologists and geneticists take to diagnosing and counseling patients with NM, and could lead to insights into specific directed therapies in the future.

Genetic Heterogeneity↗
PubMed1990

International relocation: womens' coping methods.

This article focuses on how corporate and military wives cope with international relocation. Specifically, the coping behaviors of women who exhibited signs of depression and anxiety and those women who did not in a convenience sample of 28 military and corporate women were studied. Six instruments were used: (a) the Relocation Survey, (b) the Beck Depression Inventory, (c) the Multiple Affect Adjective Check List, (d) the CAGE Questionnaire, (e) the Sarason Life Experience Survey, and (f) the Coping Questionnaire. Coping and adaptation formed the conceptual framework. The findings revealed that women who coped well used active coping behaviors and women who coped poorly used more passive coping behaviors. This study offers some direction for health care providers who may use anticipatory guidance and counseling for women prior to international moves.

Adaptation, Psychological↗
PubMed2005

Integrating services for injection drug users infected with hepatitis C virus with methadone maintenance treatment: challenges and opportunities.

Despite the high prevalence of hepatitis C virus (HCV) infection among drug users enrolled in methadone maintenance treatment programs, few drug users are being treated with combination therapy. The most significant barrier to treatment is lack of access to comprehensive HCV-related care. We describe a pilot program to integrate care for HCV infection with substance abuse treatment in a setting of maintenance treatment with methadone. This on-site, multidisciplinary model of care includes comprehensive screening and treatment for HCV infection, assessment of eligibility, counseling with regard to substance abuse, psychiatric services, HCV support groups, directly observed therapy, and enhanced linkages to a tertiary care system for diagnostic procedures. Our approach has led to high levels of adherence, with liver biopsy and substantial rates of initiation of antiviral therapy. Two cases illustrate the successful application of this model to patients with HCV infection complicated by active substance abuse and psychiatric comorbidity.

Adult↗
PubMedDate not supplied

Rehabilitation of hearing-handicapped elderly adults.

This paper describes procedures used in the development and implementation of an aural rehabilitation program for hearing-impaired elderly adults. Program emphasis is directed toward meeting the self-perceived needs of this population. Suggestions for ways to enhance the elderly adult's interest in self-management of hearing problems are gleaned from consumer workshop reports as well as clinical observations. Suggestions for identification of program candidates were offered with emphasis on dissemination of informational literature. Intake procedures were described with mention of the client's possible expectations from the program, as well as the program's expectations from the participants. Finally, program goals and procedures were described. Emphasis was directed toward three interrelated goal areas: amplification, communication remediation, and counseling-education. The role of the hearing aid as a critical tool in the rehabilitation process was highlighted. A controlled approach toward communication assessment was described, along with a scheme for determining remediation goals. Topics for personal and family counseling or education were listed along with suggestions for facilitating individual and group discussion.

Aged↗
PubMed2003

Spectrum of mutations in the gene for autosomal recessive polycystic kidney disease (ARPKD/PKHD1).

Autosomal recessive polycystic kidney disease (ARPKD/PKHD1) is an important cause of renal-related and liver-related morbidity and mortality in childhood. Recently mutations in the PKHD1 gene on chromosome 6p21.1-p12 have been identified as the molecular cause of ARPKD. The longest continuous open reading frame (ORF) is encoded by a 67-exon transcript and predicted to yield a 4074-amino acid protein ("polyductin") of thus far unknown function. By now, a total of 29 different PKHD1 mutations have been described. This study reports mutation screening in 90 ARPKD patients and identifies mutations in 110 alleles making up a detection rate of 61%. Thirty-four of the detected mutations have not been reported previously. Two underlying mutations in 40 patients and one mutation in 30 cases are disclosed, and no mutation was detected on the remaining chromosomes. Mutations were found to be scattered throughout the gene without evidence of clustering at specific sites. About 45% of the changes were predicted to truncate the protein. All missense mutations were nonconservative, with the affected amino acid residues found to be conserved in the murine polyductin orthologue. One recurrent missense mutation (T36M) likely represents a mutational hotspot and occurs in a variety of populations. Two founder mutations (R496X and V3471G) make up about 60% of PKHD1 mutations in the Finnish population. Preliminary genotype-phenotype correlations could be established for the type of mutation rather than for the site of the individual mutation. All patients carrying two truncating mutations displayed a severe phenotype with perinatal or neonatal demise. PKHD1 mutation analysis is a powerful tool to establish the molecular cause of ARPKD in a given family. Direct identification of mutations allows an unequivocal diagnosis and accurate genetic counseling even in families displaying diagnostic challenges.

Adolescent↗
PubMed1979

The effect of developmental disabilities on mental health.

Behavioral abnormalities in the developmentally disabled child are usually ascribed to parental mismanagement of a child perceived as abnormal. (Review of the available data points to the existence of primary behavioral abnormalities due directly to the cerebral dysfunction.) This has important implications for parental counseling and management.

Autistic Disorder↗
PubMed1996

A longitudinal study of veterinary students and recent graduates. 2. Views of the veterinary profession.

OBJECTIVE: To examine the development of attitudes and opinions relating to the veterinary profession. DESIGN: Longitudinal study. POPULATION: Students, 154 in all, who began studying veterinary science at The University of Queensland in 1985 and 1986. PROCEDURE: Questionnaires were completed in the first and fifth year of the course and in the second year after graduation. The data were analysed using the SAS System for Windows. RESULTS: Few changes in opinion over time were found on the role of the profession, or on the status and prestige of veterinarians. Changes did occur in views on the characteristics of a successful veterinarian, with increases in the perceived importance of interpersonal skills, and of the capacity to work hard, and decreases in the perceived importance of honesty and integrity, dedication and the prevention of cruelty. Attitudes hardened over time in relation to costs of treatment, non-payment of fees and availability out of hours. Individuals changed their opinion on whether to counsel or report an incompetent colleague, but the changes in one direction were approximately equal to those in the opposite direction. CONCLUSIONS: The attitudes and opinions of veterinary graduates result from experiences before and during their veterinary course. In general the perceived importance of interpersonal skills increases during the course, and the level of altruism decreases.

Animal Welfare↗
PubMed2000

The great population debates: how relevant are they for the 21st century?

Two great debates--whether population growth is a problem and how to address the problem if one exists--dominated population policy discussions in the 20th century. The debate about whether pitted those who saw rapid population growth as a problem against those who believed the cries of alarm were false. The debate about how was conducted between advocates of the direct delivery of contraceptives through family planning programs and those who counseled a broader, more holistic approach. The debate about how was largely resolved by the 1994 International Conference on Population and Development at Cairo; the debate about whether remains unresolved. Environmentalists, ecologists, and physical scientists generally support the view that rapid population growth is harmful, but economists remain largely unconvinced. Contemporary declines in fertility and the end of the population crisis mentality of the mid- to late 20th century could, ironically, diminish public support for precisely those programs that have been responsible for the rapid fertility decline of the past 3 decades--programs that will be required to complete the "demographic transition" in those parts of the developing world where fertility remains very high.

Aging↗
PubMed1996

From system changes to workplace accommodation: rehabilitation trends in training, education, and the system of professions in Australia.

The first part of this paper highlights the developments in rehabilitation education and training which have occurred as a result of system changes to workers' compensation and rehabilitation in Australia. Each system change has ushered in new responses to the question of what knowledge, attitudes and skills are required by rehabilitation service delivery personnel, responses which appear to trace an identifiable direction towards a greater concern for professional education. A more silent development, occurring in parallel to workers' compensation and rehabilitation changes and to directions in education and training, has been the emergence of rehabilitation counselling as a relatively new player in the rehabilitation field. The second part of this paper presents preliminary findings of a study which indicate a change in the division of labour in the rehabilitation field in Australia, reinforcing the importance of rehabilitation counselling activities.

Adult↗
PubMed1998

Delivery of preventive healthcare to older African-American patients: a performance comparison from two practice models.

While there is an increasing recognition by primary care providers of the importance of preventive health services (PHS), the delivery of such services has in general been substandard in many ambulatory care settings. Patient sociodemographic status and the structural and operational procedures of different clinic models are all believed to affect delivery of PHS. We conducted a 2-year, retrospective, sequentially randomized chart analysis of African-American patients above age 50, comparing primary, secondary, and tertiary PHS performance rates in two practice models: a medicine resident/faculty physician clinic (MR) and a nurse practitioner/faculty physician clinic (NP). Sociodemographics, disease profile, and PHS completion rates from 132 NP and 111 MR patient charts were abstracted. Apart from age, sociodemographic features were similar in both patient groups. While there were differences between clinics with regards to disease profiles (P < 0.05), and the higher number of diseases per patient (P < 0.0001) in the MR population, the NP collaborative practice had significantly better PHS performance. Rates of immunization (influenza/pneumococcal), pelvic/pap and prostate examinations, stool-guaiac testing, mammography, and functional assessment (activities of daily living, instrumental activities of daily living, and mental status testing) were > 90% in the NP and < 60% in MR patients. Although lower completion rates were found for dietary counseling (60%), auditory screening (36%), dental examination (41%), and obtaining advanced directives (24%) in the NP clinic, the rates were higher than those for the MR clinic. In this NP collaborative model, a high level of preventive health services was delivered while providing primary care to an older, inner city, African-American population of low socioeconomic means.

Black or African American↗
PubMed2001

[Characterization of 3 microsatellites of the cystic fibrosis gene in Argentine families].

Argentine population is highly heterogeneous for the cystic fibrosis (CF) transmembrane regulator (CFTR) gene mutations. The study of 14 more common mutations identified both mutated alleles in only 51% of patients. This study confirmed the diagnosis of cystic fibrosis in these patients and enabled the detection of asymptomatic carriers in their families. However, in the remaining patients the direct molecular assay did not provide the necessary information for genetic counselling. To establish the mutated allele transmission in the affected families, negative for the most common mutations, three microsatellites (IVS17bTA, IVS8CA and IVS17bCA) located in intronic regions of CFTR gene were studied. In the 40 CF families analyzed, different allelic variants were detected: 15 for IVS17bTA, 10 for IVS8CA and 4 for IVS17bCA. Polymorphism information content and heterozygosity were high, except for IVS17bCA. By the simultaneous analysis of the three microsatellites we could counsel 100% of the families. Ours results show that these microsatellites are an excellent group of markers for linkage studies in cystic fibrosis families of the Argentine population.

Alleles↗
PubMed1992

[Intervention against tobacco dependence in primary care. A study of 4 modalities of action].

OBJECTIVE: To study the feasibility and evaluate the outcome over a years of four methods of combatting tobacco addiction at the primary care level: one directed towards the team's staff and three aimed at patients (counselling of smokers and specific treatment with nicotine chewing-gum and group or individual support). To compare the results of group and individual support. DESIGN: Uncontrolled intervention study. SITE. Primary care. PATIENTS AND OTHER PARTICIPANTS: 19 members of the Team. 121 smoking patients who attended for consultation. 62 people who requested treatment. INTERVENTIONS: Consensus on the attitude taken to tobacco within the team. Systematic counselling to smokers. Treatment with nicotine chewing-gum and group or individual support. MAIN MEASUREMENTS AND RESULTS: Numbers of people who gave up after a year: among the 12 smokers in the team, 4 (33%); 8 out of the 103 people who received counselling (7.7%) (Cl 2.60-12.94%); zero out of the 20 people who never attended for treatment or left the course after the first interview; zero out of the 20 treated in a group; and 8 out of the 20 treated individually (40%) (Cl 18.53-61.47%, p less than 0.001 regarding the treatment in group). CONCLUSIONS: The results support the effectiveness of three of the methods of intervention at the Primary Care level: intervention within the team itself, systematic counselling to smokers and treatment using nicotine chewing-gum and individual support. Group support must be reserved for staff with a specific training on Tobacco Addiction and the dynamics of group treatment.

Chewing Gum↗
PubMed1998

Role of clinicians in cigarette smoking prevention.

Despite a gradual decrease in smoking rates among adults, the proportion of youth who smoke regularly has remained stable. Among high school students in 1997, 19.9% of white, 7.2% of African American, and 10.9% of Latino youth reported smoking during at least 20 of the previous 30 days. Ethnic differences in beliefs, attitudes, and behavior about smoking have not been systematically considered in developing prevention interventions for adolescents. Effective school-based smoking-prevention interventions have been developed, but these are usually not appropriately implemented. Policy proposals and current laws that affect the marketing of tobacco to youth need to be emphasized as evidence increases that marketing by the tobacco industry targets youth and leads to more smoking. Smoking-prevention programs have been designed to involve physicians and other health care professionals in the clinical setting, but limited data exist on their efficacy. We review the guidelines for involving the clinicians who provide care to children in preventing the onset of tobacco use, counseling parents of children who smoke, and counseling adolescents who have started smoking. Finally, we summarize the future directions of smoking-prevention research and programs.

Adolescent↗
PubMed1997

Laparoscopic sterilisation: opinion and practice among gynaecologists in Scotland.

OBJECTIVES: 1. To produce a list of evidence-based criteria for good quality care relating to female laparoscopic sterilisation. 2. To assess the level of agreement with each criterion among gynaecologists in Scotland. 3. To obtain an overview of current sterilisation practice for comparison with the agreed criteria. DESIGN: 1. Agreement with criteria assessed by questionnaire survey; 2. Overview of current practice obtained by questionnaire survey and by casenote review. SETTING: Scotland. SAMPLE: 1. Questionnaire survey: all 132 consultant gynaecologists in NHS practice. 2. casenote review: 988 consecutive women sterilised in 12 representative hospitals. RESULTS: The response rate to the questionnaire survey was 94%. A list of 15 evidence-based criteria was produced, covering patient selection, information and counselling, techniques of tubal occlusion and timing of sterilisation. All 15 suggested criteria gained an overall balance of support among responding gynaecologists. Similar impressions of current practice were gained from the questionnaire survey and from the casenote review. Aspects of practice which measured up well to the agreed criteria included: only 6% of women sterilised were younger than 25 years of age; over 85% of casenotes included clear documentation that women had been counselled regarding failure rate and intended permanency; 88% of sterilisations were performed, or directly supervised by, a gynaecologist of consultant or senior registrar status; and only 2% of sterilisations were undertaken in combination with induced abortion. Aspects of practice which compared poorly with the agreed criteria, and for which recommendations for change have been made, included: only 22% of casenotes mentioned that the option of vasectomy had been discussed; only 30% of gynaecologists indicated that they provide locally produced information leaflets as an adjunct to counselling; four methods of tubal occlusion (including unipolar diathermy) were in use; and there were wide variations among hospitals in the use of day-case care, ranging from 19% to 99%. CONCLUSIONS: A list of criteria for good quality care in relation to sterilisation has been validated by agreement among Scottish gynaecologists. Current practice (as assessed by questionnaire survey and casenote review) has been compared with the criteria and some recommendations for change in practice have been made. Following dissemination of these results and recommendations, re-audit will be undertaken in order to identify any changes.

Adult↗
PubMed1985

Counseling patients to counsel physicians on future care in the event of patient incompetence.

Physicians and patients share a common interest in clarifying and maximizing the powers and protection of advanced directives for future care in the event of patient incompetence. Although the complexity and unpredictability of health care circumstances make it impossible to guarantee complete control over therapeutic measures to be used when survival is in question, physicians should offer their patients the opportunity to reflect on their values and wishes and to express them explicitly. The ideal advanced directive should clearly state the author's intentions; contain clear documentation regarding authorship; be flexible, allowing family and caregivers to respond appropriately to changing circumstances; be available when needed; and be supported by legal powers that grant patients the right of enforcement and grant health care providers protection from liability. Advanced directives can be set as instruction directives or proxy directives, each form having advantages and disadvantages.

Attitude to Health↗
PubMedDate not supplied

Residents' attitudes towards and skills in counseling: using undetected standardized patients.

OBJECTIVE: To identify the frequency and quality of certain prevention-oriented counseling skills of resident physicians and to compare these skills with the residents' attitudes towards and knowledge about primary prevention. DESIGN: Longitudinal descriptive study. PATIENTS/PARTICIPANTS: 54 PGY-1-3 internal medicine and family practice residents enrolled in three training programs affiliated with Michigan State University's College of Human Medicine. INTERVENTION: Trainees' attitudes towards and knowledge about certain prevention activities were captured by an instrument designed for this study using 127 Likert scales. Counseling skills were assessed with one of two standardized patients. Residents were unaware of the simulation, which occurred in their routinely scheduled ambulatory care setting. Audiotapes of the interactions were rated by blinded, independent raters. Residents had strong positive beliefs about the role of primary care physicians in counseling patients, high levels of knowledge about what the counseling should entail, and high self-assessment about the frequency and quality of their own counseling interventions. Skill levels, however, were at or below a level defined as minimally acceptable. CONCLUSION: Resident physicians' skill levels, as measured in this study, are inadequate to accomplish routine counseling interventions in the primary care setting. These results suggest that more reliance should be placed on direct observation of physicians, ideally in nonreactive settings, for purposes of drawing conclusions about physician performance. Further, these results have implications for the training of students and residents in the area of counseling for prevention.

Attitude of Health Personnel↗