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PubMed1998

[Psychological stress factors in erectile dysfunctions. Causal models and empirical results].

In this paper the role of psychosocial factors in erectile dysfunction is examined in two different ways: (1) Current approaches to the causation of psychogenic erectile dysfunctions are reviewed and discussed. (2) Empirical results from a large unselected sample of sexually dysfunctional men are presented and compared to a sample of functional men. Concerning etiological models the traditional unidimensional dichotomous concepts (psychogenic versus organic) of erectile dysfunction have to be abandoned and replaced by two-dimensional models that are able to take the clinical reality into account that many patients have both significant psychological and organic factors in their disorder. The main causes of psychogenic erectile disorders can be divided into three groups, each belonging to a different phase of time: (i) immediate factors (performance anxiety), (ii) antecedent life events from recent history, (iii) developmental vulnerabilities from childhood and adolescence. The specific interplay as well as the importance of the different groups is different in primary and secondary erectile disorders. The empirical results presented here are based on a sample of 751 patients from our interdisciplinary outpatient unit for sexually dysfunctional men and a group of 55 sexually functional men. Both groups completed a self-developed, multidimensional questionnaire addressing a variety of psychosocial and descriptive factors concerning erectile disorders. The results prove the heterogeneity of patients and their respective erectile problems and show a number of highly significant group differences. The frequent comorbidity of erectile disorders and premature ejaculation and disorders of desire is worth mentioning as well as the high prevalence of depression and the extreme extent of performance anxiety in the patient group. The results are discussed with respect to future treatment strategies. The necessity of combined psychosomatic approaches optimizing the efficacy of all available therapeutic options is particularly stressed.

Adolescent↗
PubMed2003

Patients' and their relatives' causal explanations of schizophrenia.

BACKGROUND: Previous studies with schizophrenia patients and their relatives which have been carried out in the western part of Germany and in Austria have demonstrated a strong tendency towards assuming psychosocial stress as a cause of schizophrenia. The question arises as to whether patients with schizophrenia and their relatives in the eastern part of Germany (former German Democratic Republic) share these beliefs. METHODS: Problem-centered interviews were conducted with 100 schizophrenia patients living in the catchment area of the university hospital who were in psychiatric outpatient treatment. Thirty-six relatives were also interviewed at the same time. RESULTS: Both patients and relatives most frequently reported psychosocial stress as a cause of the illness. Sixty-two per cent of the patients and 86 % of the relatives reported more than one cause. However, the majority of them did not explicitly link these causes to one another. DISCUSSION: Similarities between the results of this study and those of previous studies prevail. However, there are some differences with regard to the role attributed to socialisation and society. Whereas there is a stronger tendency to hold the family responsible for the illness in the West, in the East the social conditions are more frequently considered to be of etiological relevance. Inconsistencies between patients' and relatives' beliefs and the results of psychiatric research on the causes of schizophrenia suggest a need to provide specific psychoeducation for both.

Adolescent↗
PubMed2004

Acquired rectal fistula in human immunodeficiency virus-positive children: a causal or casual relationship?

Acquired rectal fistula in human immunodeficiency virus (HIV)-positive children is a new and worrisome entity. The aim of this paper is to highlight the relationship between HIV infection and acquired rectal fistula (RF) in children in order to create awareness among clinicians who attend to children. Over a 1-year period, 11 girls aged 4 weeks-11 months (median 5 months) with acquired RF were managed at our institution. Ten were HIV-positive by enzyme-linked immunosorbent assay and confirmed by Western blot test. One child defaulted before the test. All the mothers and three fathers of the 10 children were seropositive for HIV. Bronchopneumonia, otitis media, oral thrush, diarrhoea, and lymphadenopathy were common associations. Treatment was essentially conservative because the result of surgical intervention was disappointing. Two of the infants and one of the fathers are now dead from full-blown acquired immunodeficiency syndrome. Acquired RF seems to be a sign of HIV infection in children. It will be necessary to screen any child presenting with acquired RF for HIV infection.

Causality↗
PubMed2004

Legionella in two splenectomized patients. Coincidence or causal relationship?

We describe two splenectomized patients admitted with pneumonia. The course in one was complicated by overwhelming multiorgan failure when the only indicative laboratory result was seropositivity for Legionella hackeliae and Legionella longbeachae. He was initially treated with ceftriaxone and roxithromycin, followed by levofloxacin as well as intensive supportive treatment, and survived. The second patient was seroreactive for Legionella micdadei. In some cases of pneumonia in splenectomized patients tentatively considered to be caused by Streptococcus pneumoniae, the causative agent might have, in fact, been Legionella. We suggest that splenectomy be considered a possible predisposing factor for Legionella pneumonia. Since prompt diagnosis of Legionella infection, especially the non- pneumophila species, is extremely difficult, alertness to this diagnostic option and early empirical initiation of appropriate aggressive antibiotic treatment may be of critical importance.

Adult↗
PubMed1999

Differences in causality factors for single and multi-vehicle crashes on two-lane roads.

Past research has found a non-linear relationship between traffic intensity or level of service (LOS) and highway crash rates. This paper investigates this relationship further by including the effects of site characteristics and estimating Poisson regression models for predicting single and multi-vehicle crashes separately. Analysis focuses on rural two-lane highways, with hourly LOS, traffic composition, and highway geometric characteristics as independent variables. The resulting models for single and multi-vehicle crashes have different explanatory variables. Single-vehicle crash rates decrease with increasing traffic intensity (lower LOS), shoulder width and sight distance. Multi-vehicle crash rates increase with the number of signals, the daily single-unit truck percentage, and the shoulder width, and decreased on principal arterials compared to other roadway classes. LOS does not significantly explain variation in the number of multi-vehicle crashes. Ongoing research by the authors is aimed at identifying other site factors, such as driveway density and intersection LOS, that can better explain the differing effects reported here and predict crash rates of both types better.

Accidents, Traffic↗
PubMed2000

Hemostatic effects of third- and second-generation oral contraceptives: absence of a causal mechanism for a difference in risk of venous thromboembolism.

Some observational studies have found a difference in the risk of nonfatal venous thromboembolism (VTE) with low-dose, oral contraceptives (OCs) containing desogestrel (DSG) or gestodene (GSD) and those containing levonorgestrel (LNG). However, this does not agree with current pathophysiological concepts. This review compares all 17 comparative studies on the hemostatic effects of DSG/GSD- and LNG- or norgestimate (NGM)-containing OCs, and comments on two recent cross-sectional studies on the effects of third- and second-generation OCs on activated protein C (APC) sensitivity. In the comparative studies, the only difference in hemostatic parameters between DSG/GSD- and LNG- or NGM-containing OC users was a tendency towards higher factor VII (FVII) levels with DSG/GSD OCs. Differential effects on APC sensitivity were observed with the endogenous thrombin generation potential (ETP) assay, but not with the classical APC resistance test. FVII is not a risk marker for VTE, but is affected by dietary fat, estrogens and androgens and may interfere with the ETP assay. As no differences in established VTE risk markers were observed, there is no plausible reason for a differential risk of VTE with DSG/GSD- and LNG-containing OCs. In fact, the lack of differences with regard to established risk markers of VTE gives further support to the findings of the most recent epidemiological studies, which have not found any difference in the risk of VTE between third- and second-generation OCs.

Causality↗
PubMed2003

New graduate perception of clinical competence: testing a causal model.

The purpose of this study was to test relationships among variables hypothesized to affect new graduate perceptions of clinical competence. The proposed model was developed based on several theories in sociology, education and nursing. Seven variables were selected for their potential contributions to graduates' perceptions of clinical competence. The sample included 468 new graduates from six baccalaureate nursing programs in Thailand. Path analysis indicated that student effort, perception of clinical learning environment (CLE) and program grade point average had direct effects on perception of clinical competence whereas hardiness had an indirect effect on the outcome variables through its impacts on student effort, perception of CLE and perception of student-faculty relationship. The model explained 8-12% of variance in the subscales of clinical competence.

Adult↗