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PubMed2002

Coping and HIV infection in African-American women.

HIV is impacting African-American women at alarming rates. Many of these women are poor and socially disadvantaged, resulting in a combination of stressors that impacts the quality of their lives. This study investigated whether coping style (i.e., problem-focused, emotion-focused) varies as a function of HIV status or stage of HIV-related illness. Secondly, we examined whether the use of a particular style is associated with three areas of functioning among HIV-infected women: general psychological distress, depressive symptomatology, and physical symptomatology. Ninety-nine HIV-infected women and 143 noninfected women completed measures assessing coping styles and functioning. No significant differences emerged in coping styles between the HIV-infected and noninfected women or for the groups when symptomatic women were examined separate from asymptomatic women. Greater emotion-focused coping was associated with less general psychological distress and depression specifically. Problem-focused coping interacted with illness stage to predict all areas of functioning. By identifying effective coping strategies among African-American women with HIV, mental health professionals can design empirical interventions that can help improve quality of life for these women.

Adaptation, Psychological↗

PubMed1997

Impact of a history of diabetes mellitus on quality of life after coronary artery bypass grafting.

AIM: To describe the improvement in various aspects of quality of life (QoL) after coronary artery bypass grafting (CABG), in relation to a previous history of diabetes mellitus. PATIENTS: All patients from western Sweden who underwent CABG between 1988 and 1991 without simultaneous valve surgery. METHODS: Patients were approached with three questionnaires: The Physical Activity Score, the Nottingham Health Profile and the Psychological General Well-being Index prior to surgery and 3 months, 1 and 2 years thereafter. RESULTS: All three questionnaires already showed a significant improvement in QoL after 3 months, remaining at a similar level 1 and 2 years after the operation. In terms of Physical Activity Score improvement was of similar magnitude in diabetic and non-diabetic patients. In terms of the Psychological General Well-Being Index significant and similar improvements were found in diabetic and non-diabetic patients at each evaluation. In terms of the Nottingham Health Profile there was a significant improvement both in diabetic and non-diabetic patients 3 months, 1 and 2 years after the operation. However, improvement was more marked in diabetic than in non-diabetic patients at each evaluation. CONCLUSION: For 3 months, 1 and 2 years after CABG various aspects of QoL as estimated with three different instruments, improved significantly both in diabetic and in non-diabetic patients compared with the situation prior to the operation. However, the three instruments differed somewhat. Thus, whereas in the Physical Activity Score, diabetic patients tended to improve less markedly than non-diabetic patients, the opposite was found in the Nottingham Health Profile.

Coronary Artery Bypass↗

PubMed1988

Effect of catheter ablation of the atrioventricular junction on quality of life and exercise tolerance in paroxysmal atrial fibrillation.

The effect of catheter ablation of the atrioventricular junction (AV) and implantation of a rate-adaptive pacemaker on quality of life and exercise capacity was evaluated prospectively in 12 consecutive patients with paroxysmal atrial fibrillation (AF). All patients had been demonstrated to have paroxysmal AF that was refractory to medical therapy over a long period of time (mean 9 +/- 7 years). Patients performed a symptom-limited treadmill exercise test on the day before catheter ablation and 6 weeks after hospital discharge. Quality of life was measured using the physical dimension of the McMaster Health Index Questionnaire and the Psychological General Well-Being Index before and 6 weeks after ablation. There were no serious complications related to catheter ablation or permanent pacemaker implantation. All patients remain in complete AV block with a completely paced rhythm at a mean follow-up of 8 +/- 2 months. The McMaster Health Index scores increased from a mean of 0.69 +/- 0.20 before to 0.92 +/- 0.14 after ablation (p = 0.002). The mean Psychological General Well-Being score improved from 59.8 +/- 14.8 at baseline to 84.9 +/- 13.6 6 weeks after discharge (p = 0.001). Treadmill exercise duration increased from 6.4 +/- 4.6 to 9.9 +/- 2.6 minutes (p = 0.03) and correlated strongly with changes in functional capacity measured with the McMaster Health Index (r = 0.70, p = 0.03). These results suggest that catheter ablation of the AV junction and implantation of a rate-adaptive pace-maker significantly improve the quality of life and exercise capacity of patients with paroxysmal AF refractory to medical therapy.

Aged↗

PubMed1997

Prediction and course of grief four years after perinatal loss due to congenital anomalies: a follow-up study.

The emotional reactions of women (N = 29) after perinatal loss were evaluated over a four-year period by means of standardized questionnaires and a semi-structured interview. Eleven women (38 per cent) displayed a level of general psychological distress which is clinically significant. Grief reactions declined significantly during this period, except for difficulties with coping and despair concerning the loss, and a quarter of the women still showed a clinically significant high level of distress for intrusive images. The disposition for feelings of inadequacy (i.e. feeling anxious, insufficient, depressed and having low self-esteem) was strongly and positively related to the intensity of stress, grief and general psychological distress after four years. Our findings emphasize the importance of psychosocial screening of those women identified as showing signs of inadequacy in the face of (threatened) pregnancy loss with the objective to offer them additional psychological support.

Abnormalities, Multiple↗

PubMed2004

International validation of ReQuest in patients with endoscopy-negative gastro-oesophageal reflux disease.

BACKGROUND: Reflux Questionnaire (ReQuest), a newly developed gastro-oesophageal reflux disease-sensitive scale, can be used to reliably evaluate the effect of treatment on gastro-oesophageal reflux disease symptoms. AIM: International validation of this scale, in patients suffering from endoscopy-negative gastro-oesophageal reflux disease. METHODS: In this open, multicentre and multinational clinical trial 840 endoscopy-negative gastro-oesophageal reflux disease patients received pantoprazole 20 mg daily for 28 days. The long and short versions of ReQuest were completed both in the pre-treatment and treatment phases. For scale development an item reduction analysis was performed. Internal consistency, test-retest reliability and responsiveness were calculated for psychometric analysis. Construct validity was evaluated by comparison with the Gastrointestinal Symptom Rating Scale and the Psychological General Well-being questionnaire by means of correlation coefficients. RESULTS: Factor analyses confirmed the content validity of both long and short version of ReQuest. Psychometric calculations proved high internal consistency (Cronbach's alpha: 0.9), test-retest reliability [Intraclass Correlation Coefficient: 0.9 (long vs. long) and 0.8 (short vs. short)], and responsiveness (Responsiveness Index 320.3) of the scale, for which also good construct validity was achieved (correlation coefficient: Gastrointestinal Symptom Rating Scale -0.6; Psychological General Well-being -0.4). CONCLUSION: ReQuest proved valid, reliable, and responsive in this multinational clinical trial to evaluate treatment response in endoscopy-negative gastro-oesophageal reflux disease patients.

Adult↗

PubMed1991

Clinical psychology and general practice.

General practitioners who secure the collaboration of a clinical psychologist in treating patients, especially in a community setting, are likely to benefit the patients and themselves. Transfer of skills may be an important way for the two professions to collaborate. Health promotion could be a fruitful field for collaboration but has so far been little explored.

Family Practice↗

PubMed2000

Transdermal testosterone treatment in women with impaired sexual function after oophorectomy.

BACKGROUND: The ovaries provide approximately half the circulating testosterone in premenopausal women. After bilateral oophorectomy, many women report impaired sexual functioning despite estrogen replacement. We evaluated the effects of transdermal testosterone in women who had impaired sexual function after surgically induced menopause. METHODS: Seventy-five women, 31 to 56 years old, who had undergone oophorectomy and hysterectomy received conjugated equine estrogens (at least 0.625 mg per day orally) and, in random order, placebo, 150 microg of testosterone, and 300 microg of testosterone per day transdermally for 12 weeks each. Outcome measures included scores on the Brief Index of Sexual Functioning for Women, the Psychological General Well-Being Index, and a sexual-function diary completed over the telephone. RESULTS: The mean (+/-SD) serum free testosterone concentration increased from 1.2+/-0.8 pg per milliliter (4.2+/-2.8 pmol per liter) during placebo treatment to 3.9+/-2.4 pg per milliliter (13.5+/-8.3 pmol per liter) and 5.9+/-4.8 pg per milliliter (20.5+/-16.6 pmol per liter) during treatment with 150 and 300 microg of testosterone per day, respectively (normal range, 1.3 to 6.8 pg per milliliter [4.5 to 23.6 pmol per liter]). Despite an appreciable placebo response, the higher testosterone dose resulted in further increases in scores for frequency of sexual activity and pleasure-orgasm in the Brief index of Sexual Functioning for Women (P=0.03 for both comparisons with placebo). At the higher dose the percentages of women who had sexual fantasies, masturbated, or engaged in sexual intercourse at least once a week increased two to three times from base line. The positive-well-being, depressed-mood, and composite scores of the Psychological General Well-Being Index also improved at the higher dose (P=0.04, P=0.03, and P=0.04, respectively, for the comparison with placebo), but the scores on the telephone-based diary did not increase significantly. CONCLUSIONS: In women who have undergone oophorectomy and hysterectomy, transdermal testosterone improves sexual function and psychological well-being.

Administration, Cutaneous↗

PubMed2005

Are there differences in the attitudinal body image between adolescent anorexia nervosa and bulimia nervosa?

OBJECTIVE: Body image dissatisfaction is as well a risk factor for eating disorders (ED) and a central feature of ED. The exact nature of body image in adolescent ED is still debated. This study examined attitudinal body image in adolescent anorexia nervosa (AN) and bulimia nervosa (BN), and the association of age, maturational timing, duration of eating disorder, actual weight and general psychological distress with the attitudinal body image in ED. METHODS: The study group consisted of an outpatient clinical sample of adolescents attending for assessment because of eating disorders. The attitudinal body image of 57 adolescents (girls) aged 14-21 years was studied at the beginning of the treatment. The attitudes to body shape, body size, appearance, tone and femininity were studied by a Likert format scale and by the body dissatisfaction (BD) and drive for thinness scales (DT) from EDI-2 inventory. RESULTS: Bulimics reported more body image dissatisfaction than anorectics. In multivariate analyses BN and higher general psychological distress had strong associations with body image dissatisfaction. Longer duration of ED and earlier menarche were also associated with negative body image. DISCUSSION: Attitudinal body image differs between adolescent AN and BN. The psychological distress has a great impact on body image in ED, which should be taken into account in assessment and in treatment interventions.

Adolescent↗

PubMed2002

Randomized clinical trial of laparoscopic versus open fundoplication: evaluation of psychological well-being and changes in everyday life from a patient perspective.

BACKGROUND: The laparoscopic approach in antireflux surgery might have an impact on the patient's daily activities and well-being. METHODS: Sixty patients were randomized to laparoscopic or open 360 degrees fundoplication. Data were collected by questionnaires and interviews preoperatively, 1 month and 6 months after operation. RESULTS: Five patients in the laparoscopic group were converted to open surgery. Psychological general well-being increased after surgery and reached norm values in both study groups. No significant differences were found between the two types of surgery in the per protocol analysis, while the domain self-control was significantly better after open surgery in the intention-to-treat analysis. There was improvement of diet and sleep in both study groups; after 6 months, disturbed sleep was significantly more uncommon after open surgery. Dysphagia and flatulence were new symptoms that were reported after surgery. Overall perception of the results of the operation did not differ between the groups. CONCLUSIONS: Psychological general well-being, diet and sleep improved after both laparoscopic and open surgery. There were only small differences between the groups, but in some respects the results were better after open surgery.

Adult↗

PubMed1998

Quality of life during acute and intermittent treatment of gastro-oesophageal reflux disease with omeprazole compared with ranitidine. Results from a multicentre clinical trial. The European Study Group.

AIMS: To investigate quality of life in patients with gastro-oesophageal reflux disease. PATIENTS: A series of 704 patients were randomised to treatment with ranitidine 150 mg bd, omeprazole 10 mg om or omeprazole 20 mg om for 2 weeks. Asymptomatic/mildly symptomatic patients were followed for 12 months. METHODS: The Psychological General Well-Being index and the Gastrointestinal Symptom Rating Scale were completed before and during short-term and intermittent treatment. RESULTS: The quality of life response rate was > 80%. The majority of the patients receiving omeprazole 20 mg om (55%) had symptom relief after 2 weeks despite the fact that more patients on ranitidine required 4 weeks' treatment and an increased dose. There was no difference in the reflux dimension of Gastrointestinal Symptom Rating Scale between treatments in the initial treatment phase, but the total Gastrointestinal Symptom Rating Scale score improved significantly more on omeprazole 10 mg om than on ranitidine 150 mg bd (p = 0.006). Both doses of omeprazole improved the total Psychological General Well-Being score more than ranitidine (omeprazole 10 mg om versus ranitidine 150 mg bd, p = 0.005, omeprazole 20 mg om versus ranitidine 150 mg bd, p = 0.031). During follow-up, relapsing patients returned to pre-treatment symptom and well-being scores, but these dimensions were restored after treatment. CONCLUSION: The quality of life is impaired in patients presenting with reflux symptoms. Irrespective of whether the patients presented with endoscopy positive or endoscopy negative reflux disease, treatment on demand improved the quality of life.

Adolescent↗

PubMedDate not supplied

Effects of aromatase inhibition on sexual function and well-being in postmenopausal women treated with testosterone: a randomized, placebo-controlled trial.

OBJECTIVE: The extent to which aromatization of testosterone (T) to estradiol is required for the observed effects of testosterone therapy on sexual function and well-being are not known. Therefore, the authors investigated the effects of aromatase enzyme inhibition on sexual function, well-being, and mood in estrogen- and T-replete postmenopausal women in a double-blind, randomized, placebo-controlled study. DESIGN: Postmenopausal women using transdermal estrogen therapy for at least 8 weeks and reporting low sexual satisfaction (score <42 for the Sabbatsberg Sexual Self-rating Scale [SSS]) with a total T value of less than 1.2 nmol/L were treated with 400 muL of a 0.5% T gel (total dose 2 mg) and were randomly assigned to receive treatment with either 2.5 mg/day of letrozole or an identical placebo tablet. Women were assessed at baseline (week -2) and at 0, 4, 8, and 16 weeks. Sexual function was assessed with the SSS, well-being was assessed with the Psychological General Well-being Index, and mood was assessed with the Beck Depression Inventory at 0 and 16 weeks. Eighty-one women were screened, 76 were randomly assigned to a treatment group, and 30 in each group completed the study. Because this was a mechanistic study, only the 60 women who completed the study per protocol were included in the final analysis. RESULTS: Total T and calculated free T increased from baseline in both groups, with no difference between groups. At 16 weeks, estradiol, sex hormone-binding globulin, fasting lipids, lipoprotein(a), and C-reactive protein did not differ from baseline or between groups. Significant increases in total Sabbatsberg Sexual Self-rating Scale scores, total Psychological General Well-being Index scores, and a reduction in Beck Depression Inventory scores from baseline to 16 weeks was seen for both treatment groups, with no effect of treatment allocation. No adverse treatment effects were reported. CONCLUSIONS: Increases in total and free T in the physiologic range in postmenopausal women were associated with improved sexual satisfaction, well-being, and mood. In this study, aromatase inhibition did not influence any of these outcomes. Short-term transdermal T therapy did not modify fasting lipids, lipoprotein(a), or C-reactive protein.

Administration, Cutaneous↗

PubMed1992

Quality of life with three antihypertensive treatments. Cilazapril, atenolol, nifedipine.

A multicenter, randomized double-blind study of 6 months' duration was performed in 540 patients (average age 54 years, 57% male) with mild-to-moderate essential hypertension to determine the relative effects on quality of life of cilazapril, atenolol, and nifedipine retard. Quality of life was assessed by using both a self-administered and an interviewer-administered questionnaire; the assessment included a complaint score (symptoms checklist), Health Status Index, assessment of work satisfaction, Psychological General Well-being Index, Profile of Mood States subscales, and life satisfaction assessment. Psychomotor function was measured by the Reitan Trail Making test B. At the end of the trial, diastolic blood pressure had fallen by an average of 15 mm Hg in all three groups, but significantly (p = 0.01) more patients taking cilazapril required the addition of a diuretic (36%) compared with those taking atenolol (25%) or nifedipine retard (24%). No significant differences in quality of life were observed between cilazapril and atenolol during the trial. Symptomatic complaints increased on nifedipine retard (p = 0.02) and contributed to a higher discontinuation rate (21% discontinued treatment compared with 13% and 14% taking atenolol and cilazapril, respectively, p = 0.04). However, a possible improvement in the fatigue subscale (p = 0.04) was also observed on nifedipine retard. The 95% confidence intervals showed that none of the drugs in this trial produced an effect equivalent to that previously reported between captopril and methyldopa in the Psychological General Well Being Index or between captopril and methyldopa or propranolol in Trail Making test B.(ABSTRACT TRUNCATED AT 250 WORDS)

Angiotensin-Converting Enzyme Inhibitors↗

PubMed1999

The lifetime of automatic semantic priming effects may exceed two seconds.

The N400 component of event-related potentials (ERPs) was obtained in a modified version of the Neely [J.H. Neely, Semantic priming and retrieval from lexical memory: Roles of inhibitionless spreading activation and limited-capacity attention, Journal of Experimental Psychology: General, Vol. 106 (1977), pp. 226-254.] paradigm which permits unconfounding of semantic priming effects due to automatic and attentional processes. It was found that a short stimulus onset asynchrony (SOA) of 250 ms between the prime and the target was associated with automatic but not expectancy effects on the amplitude of N400. At a long SOA of 2000 ms between prime and target, semantic priming effects on N400 were obtained associated with both automatic and expectancy processes. Moreover, there was no significance difference in the magnitude of the automatic effects at the two SOAs, suggesting that automatic processing had not decayed within the 2000 ms interval between the prime and target. The results support the two-processing interpretation of semantic priming advanced by Posner and Synder [M.I. Posner, C.R.R. Snyder, Attention and cognitive control, in: R.L. Solso (Ed.), Information Processing and Cognition: The Loyola Symposium, Erlbaum, Hillsdale, NJ (1975).] and concur with the results of Neely [J.H. Neely, Semantic priming and retrieval from lexical memory: Roles of inhibitionless spreading activation and limited-capacity attention, Journal of Experimental Psychology: General, Vol. 106 (1977), pp. 226-254], with the exception of indicating a longer persistence of automatic processes.

Adult↗

PubMed2006

Nonoperative treatment for adolescent idiopathic scoliosis: a 10- to 60-year follow-up with special reference to health-related quality of life.

STUDY DESIGN: Retrospective study on patients 10 to 60 years of age after nonoperative treatment for adolescent idiopathic scoliosis (AIS). OBJECTIVES: To investigate long-term outcome with regard to pain, disability, psychological disturbance, and health-related quality of life (HRQOL) in nonoperatively treated patients with AIS. SUMMARY OF BACKGROUND DATA: Only little is known on the long-term quality of life and disability in patients nonoperatively treated for AIS. A detailed knowledge of the nonoperative treatment results is important when advising patients for surgery. METHODS: A total of 135 nonoperatively treated AIS patients with a minimum follow-up of 10 years were included in this investigation, 121 of whom responded to a questionnaire containing questions on pain, disability (Oswestry Disability Index [ODI], Hannover Functional Ability Questionnaire [HFAQ], psychological general well-being [PGWB], and health-related quality of life [WHOQOLBREF]). Eighty-one patients participated in a clinical/radiologic follow-up examination. Nonoperative treatment consisted of bracing (n = 60), physiotherapy (n = 59), and electrical stimulation (n = 2). The overall follow-up rate was 89.6%. The mean age at follow-up was 38.0 years (range, 20-73 years.). RESULTS: In general, patients achieved a satisfactory outcome 10 to 60 years (mean, 23 years) after nonoperative treatment with regard to pain, disability, and HRQOL. The average curve at first diagnosis measured 29.5 degrees (range, 15 degrees -59 degrees ) for the thoracic spine, 21.3 degrees (range, 15 degrees -28 degrees ) for the thoracolumbar spine, and 26.8 degrees (10 degrees -44 degrees ) for the lumbar spine. Thirteen patients showed a substantial change in curve size (+/-10 degrees ) between first diagnosis and end of growth: 11 curves progressed more than 10 degrees showing an average increase of 19.0 degrees (range, 12 degrees -30 degrees ) and 2 patients presented with less severe curves at follow-up (-10 degrees and -13 degrees ). After end of growth, 7 patients showed a substantial average increase of 16.3 degrees (range, 10 degrees -31 degrees ). Five of eight patients with thoracic curves greater than 80 degrees had restrictive pulmonary disease. Patients with curves greater than 45 degrees reported significantly higher pain levels than those with smaller curves. Patients only showed a minimal absolute disability (Oswestry and HFAQ), and no significant correlation was found between curve size and curve type, respectively. Compared with a healthy control group that was matched for age and gender, no significant differences were found in terms of HRQOL as assessed by the WHOQOLBREF questionnaire. No significant differences in pain, disability, or HRQOL were found between patients with and without brace treatment. CONCLUSIONS: Although pain, disability, HRQOL, and psychological general well-being are quite satisfactory on an absolute level, curve size was found to be a significant predictor for pain in a long-term follow-up.

Adolescent↗

PubMed1964