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Psychological Morbidity (psychological + morbidity)
Selected AbstractsIncreasing oncologists' skills in eliciting and responding to emotional cues: evaluation of a communication skills training program,PSYCHO-ONCOLOGY, Issue 3 2008Phyllis Butow Abstract Purpose: Psychological morbidity in cancer patients is common, but often undetected and untreated. We developed a communication skills training (CST) program targeting this issue, and evaluated its impact on doctor behaviour. Patients and Methods: Thirty of 35 oncologists from six teaching hospitals in six Australian cities, participated. The CST was a 1.5-day intensive face-to-face workshop incorporating presentation of principles, a DVD modelling ideal behaviour and role-play practice, followed by four 1.5 h monthly video-conferences incorporating role-play of doctor-generated scenarios. Doctors were randomized to receive the CST or not. Simulated patient interviews were videotaped and coded at baseline, after CST and 6 months later. Doctors completed questionnaires assessing stress and burnout at the same time points. Results: Doctors in the intervention group displayed more creating environment and fewer blocking behaviours at both follow-ups; however, these differences did not reach statistical significance. Intervention doctors valued the training highly, but did not report substantial reductions in stress and burnout. Conclusions: This short training programme demonstrated a positive effect on aspects of doctor behaviour. Video-conferencing after a short training course may be an effective strategy for delivering CST. Copyright © 2007 John Wiley & Sons, Ltd. [source] Quality of life issues for South Africans with acne vulgarisCLINICAL & EXPERIMENTAL DERMATOLOGY, Issue 1 2005A. Mosam Summary The adverse effects of acne on the psyche have been established in patients from ,first world' countries. There has been no in depth study in predominantly black patients from Africa addressing this issue. This was a prospective cross-sectional study of acne patients attending a dermatology unit in KwaZulu-Natal, South Africa. A questionnaire was completed and acne graded by the Global Acne Grading scale. Psychological morbidity and quality of life (QOL) were assessed by the General Health Questionnaire and Dermatology Specific Quality of Life Questionnaires, respectively. We found that clinical severity was not associated with patient perception or psychological distress. The QOL measures such as feelings, social activities, performance at work or school, activities of daily living and overall mental health were found to be associated with distress with associated P -values of 0.0002, 0.0168, 0.0032, 0.033 and <,0.0001, respectively. The severity of acne was not associated with psychological distress. Painful and bleeding lesions were associated with distress levels; P = 0.042 and P = 0.019, respectively. In conclusion, South African patients with acne vulgaris suffer significant psychological distress, which affects the quality of their lives. [source] Acne's relationship with psychiatric and psychological morbidity: results of a school-based cohort study of adolescentsJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 1 2010PJ Magin Abstract Background, There is a considerable number of studies linking acne with psychological and psychiatric morbidities, although this literature is not entirely consistent and is largely cross-sectional in methodology. Objective, This study aims to establish the relationship of acne and psychological and psychiatric morbidity in adolescents in a community setting and, via a longitudinal methodology, provide evidence for causality in the relationship. Methods, The study was a 12-month cohort study. Two hundred and forty-four students in Years 8, 9 and 11 (ages 14,17) at four Australian high schools were assessed at baseline 6 months and 12 months. Presence and severity of acne were assessed, along with a number of psychological and psychiatric morbidities and personality traits (depression, anxiety, overall psychiatric morbidity, self-consciousness, neuroticism and introversion/extraversion) and other demographic variables. Results, Of the 244 participating students, 209 (86%) completed all three rounds of data collection. A further 26 (11%) completed two rounds. The study failed to demonstrate an association of the presence of acne or of acne severity with the examined measures of psychological and psychiatric morbidity, and no evidence for an effect of acne in their causation. Conclusion, The relationship of acne and psychological morbidities found in previous health care settings was not found in this community sample. This may be due to differences between community and clinical acne populations. Other possible reasons for this finding are attenuation of psychological morbidity in subjects in this study by successful acne treatment, and the role of personality traits in the complex relationship between acne and psychological morbidities. It is suggested that this relationship would be best investigated by means of longer-term cohort studies enlisting subjects at an zearly age, prior to the onset of acne. [source] The Mental Health of Expatriate and Kosovar Albanian Humanitarian Aid WorkersDISASTERS, Issue 2 2005Barbara Lopes Cardozo The mental health consequences of exposure to traumatic events and the risk factors for psychological morbidity among expatriate and Kosovar Albanian humanitarian aid workers have not been well studied. In June 2000, we used standardised screening tools to survey 285 (69.5%) of 410 expatriate aid workers and 325 (75.8%) of 429 Kosovar Albanian aid workers from 22 humanitarian organizations that were implementing health programmes in Kosovo. The mean number of trauma events experienced by expatriates was 2.8 (standard deviation: 2.7) and by Kosovar staff 3.2 (standard deviation: 2.8). Although only 1.1% of expatriate and 6.2% of Kosovar aid workers reported symptoms consistent with the diagnosis for post-traumatic stress disorder, 17.2% and 16.9%, respectively, reported symptoms satisfying the definition of depression. Regression analysis demonstrated that the number of trauma events experienced was significantly associated with depression for the two sets of workers. Organisational support services may be an important mediating factor and should be targeted at both groups. [source] Injecting and non-injecting cocaine use in Sydney, Australia: physical and psychological morbidityDRUG AND ALCOHOL REVIEW, Issue 4 2004SHARLENE KAYE Abstract This study aimed to examine the physical and psychological harms of cocaine use and investigate the role of injecting versus non-injecting routes of administration in the severity of such harms. Two hundred and twelve cocaine users from inner-city and southwestern Sydney were administered a structured interview containing sections on demographics, drug treatment history, drug use history, cocaine use patterns, cocaine dependence and physical and psychological problems associated with cocaine use. Serious physical and psychological symptoms were prevalent among both injecting and non-injecting cocaine users. The prevalence and extent of symptoms was greater among injecting cocaine users, however route of administration did not prove to be a significant independent predictor of harm when other factors, such as frequency of use and level of dependence, were taken into account. While the level of physical and psychological harm was greater among cocaine injectors, it would appear that factors engendered by injecting, such as more frequent use and higher levels of dependence, result in higher levels of harm, rather than the route of administration per se. Physical and psychological problems were also reported among infrequent users, suggesting that cocaine can cause harm irrespective of frequency or method of use. Harm reduction initiatives should be targeted towards all cocaine users, not just those who seek treatment for dependence or present with acute medical complications. [source] Prevalence and correlates of eating disorders in Latinos in the United StatesINTERNATIONAL JOURNAL OF EATING DISORDERS, Issue S3 2007Margarita Alegria PhD Abstract Objective: To present national estimates and correlates of lifetime and 12-month DSM-IV eating disorders for Latinos. Method: Data come from the National Latino and Asian American Study (NLAAS), a national epidemiological household survey of Latinos in the United States. Results: Latinos have elevated rates of any binge eating and binge eating disorder but low prevalence of anorexia nervosa and bulimia nervosa. The US born and those living a greater percentage of their lifetime in the US evidenced higher risk for certain eating disorders while severe obesity and low levels of education were significant correlates. Rates of treatment utilization were exceedingly low. Conclusion: Standard eating disorder criteria may not be appropriate for understanding psychological morbidity of eating disorders for Latinos, particularly less acculturated Latinos, due to cultural differences in the presentation of eating disorder symptoms. Criteria for disturbed eating patterns that are more reflective of the illness experience of Latinos should be developed. © 2007 by Wiley Periodicals, Inc. [source] A systematic review of intervention studies about anxiety in caregivers of people with dementiaINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 3 2007Claudia Cooper Abstract Background There is considerable literature on managing depression, burden and psychological morbidity in caregivers of people with dementia (CG). Anxiety has been a relatively neglected outcome measure but may require specific interventions. Objective To synthesise evidence regarding interventions that reduce anxiety in CGs. Methods Twenty-four studies met our inclusion criteria. We rated the methodology of studies, and awarded grades of recommendation (GR) for each type of intervention according to Centre for Evidence Based Medicine guidelines, from A (highest level of evidence) to D. Results Anxiety level was the primary outcome measure in only one study and no studies were predicated on a power calculation for anxiety level. There was little evidence of efficacy for any intervention. The only RCT to report significantly reduced anxiety involved a CBT and relaxation-based intervention specifically devised to treat anxiety, and there was preliminary evidence (no randomised controlled trials) that caregiver groups involving yoga and relaxation without CBT were effective. There was grade B evidence that behavioural management, exercise therapies and respite were ineffective. Limitations Many interventions were heterogeneous, so there is some overlap between groups. Lack of evidence of efficacy is not evidence of lack of efficacy. Conclusions CBT and other therapies developed primarily to target depression did not effectively treat anxiety. Good RCTs are needed to specifically target anxiety which might include relaxation techniques. Some of the interventions focussed on reducing contact with the care recipients but caregivers may want to cope with caring and preliminary evidence suggests strategies to help CGs manage caring demands may be more effective. Copyright © 2006 John Wiley & Sons, Ltd. [source] Nurse-led vs. conventional physician-led follow-up for patients with cancer: systematic reviewJOURNAL OF ADVANCED NURSING, Issue 4 2009Ruth Lewis Abstract Title.,Nurse-led vs. conventional physician-led follow-up for patients with cancer: systematic review. Aim., This paper is a report of a systematic review of the effectiveness and cost-effectiveness of nurse-led follow-up for patients with cancer. Background., As cancer survivorship increases, conventional follow-up puts a major burden on outpatient services. Nurse-led follow-up is a promising alternative. Data sources., Searches were conducted covering a period from inception to February 2007 of 19 electronic databases, seven online trial registries, five conference proceedings reference lists of previous reviews and included studies. Review methods., Standard systematic review methodology was used. Comparative studies and economic evaluations of nurse-led vs. physician-led follow-up were eligible. Studies comparing different types of nurse-led follow-up were excluded. Any cancer was considered; any outcome measure included. Results., Four randomised controlled trials were identified, two including cost analyses. There were no statistically significant differences in survival, recurrence or psychological morbidity. One study showed better HRQL measures for nurse-led follow-up, but one showed no difference, two showed a statistically significant difference for patient satisfaction, but two did not. Patients with lung cancer were more satisfied with nurse-led telephone follow-up and more were able to die at home. Patients with breast cancer thought patient-initiated follow-up convenient, but found conventional follow-up more reassuring. One study showed the cost of nurse-led follow-up to be less than that of physician-led follow-up, but no statistical comparison was made. Conclusion., Patients appeared satisfied with nurse-led follow-up. Patient-initiated or telephone follow-up could be practical alternatives to conventional care. However, well-conducted research is needed before equivalence to physician-led follow-up can be assured in terms of survival, recurrence, patient well-being and cost-effectiveness. [source] Meta-Analysis of Psychosocial Interventions for Caregivers of People with DementiaJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2003FRACP, FRANZCP, Henry Brodaty MD OBJECTIVES: To review published reports of interventions for caregivers (CGs) of persons with dementia, excluding respite care, and provide recommendations to clinicians. DESIGN: Meta-analytical review. Electronic databases and key articles were searched for controlled trials, preferably randomized, published in English from 1985 to 2001 inclusive. Thirty studies were located and scored according to set criteria, and the interventions' research quality and clinical significance were judged. SETTING: Home or noninstitutional environment. PARTICIPANTS: Informal CGs,persons providing unpaid care at home or in a noninstitutional setting. MEASUREMENTS: The primary measures were psychological morbidity and burden. Other varied outcome measures such as CG coping skills and social support were combined with measures of psychological distress and burden to form a main outcome measure. RESULTS: The quality of research increased over the 17 years. Results from 30 studies (34 interventions) indicated, at most-current follow-up, significant benefits in caregiver psychological distress (random effect size (ES) = 0.31; 95% confidence interval (CI) = 0.13,0.50), caregiver knowledge (ES = 0.51; CI = 0.05,0.98), any main caregiver outcome measure (ES = 0.32; CI = 0.15,0.48), and patient mood (ES = 0.68; CI = 0.30,1.06), but not caregiver burden (ES = 0.09; CI = ,0.09,0.26). There was considerable variability in outcome, partly because of differences in methodology and intervention technique. Elements of successful interventions could be identified. Success was more likely if, in addition to CGs, patients were involved. Four of seven studies indicated delayed nursing home admission. CONCLUSION: Some CG interventions can reduce CG psychological morbidity and help people with dementia stay at home longer. Programs that involve the patients and their families and are more intensive and modified to CGs' needs may be more successful. Future research should try to improve clinicians' abilities to prescribe interventions. [source] Prevalence, morbidity and service need among South Asian and white adults with intellectual disability in Leicestershire, UKJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 4 2002C. W. McGrother Abstract Background Previous reports have suggested that South Asian and white UK populations have different prevalences of intellectual disability (ID), related psychological morbidity and service use. The aim of the present study was to compare these rates among South Asian and white adults in Leicestershire, UK. Method This cross-sectional study is comprised of two parts. The analysis of prevalence is based on data from all South Asian and white adults known to the Leicestershire Learning Disabilities Register in 1991, with population denominators being drawn from the 1991 census. The other analyses use data collected from the most recent semi-structured home interviews, carried out between 1987 and 1998, with 206 South Asian and 2334 white adults. Results The prevalence of ID in adults in Leicestershire is 3.20 per 1000 in South Asians and 3.62 per 1000 in whites. Among adults with ID, South Asians have similar prevalences of disabilities to whites and significantly lower skill levels. South Asians show similar levels of psychological morbidity, but make significantly lower use than whites of psychiatric services, residential care and respite care. South Asians use community services as extensively as whites, but feel that they have a substantially greater unmet need, especially with regard to social services. Conclusion South Asian and white populations have similar prevalences of ID and related psychological morbidity. Culturally appropriate services for South Asian adults may need to focus on skill development and community care. [source] Acne's relationship with psychiatric and psychological morbidity: results of a school-based cohort study of adolescentsJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 1 2010PJ Magin Abstract Background, There is a considerable number of studies linking acne with psychological and psychiatric morbidities, although this literature is not entirely consistent and is largely cross-sectional in methodology. Objective, This study aims to establish the relationship of acne and psychological and psychiatric morbidity in adolescents in a community setting and, via a longitudinal methodology, provide evidence for causality in the relationship. Methods, The study was a 12-month cohort study. Two hundred and forty-four students in Years 8, 9 and 11 (ages 14,17) at four Australian high schools were assessed at baseline 6 months and 12 months. Presence and severity of acne were assessed, along with a number of psychological and psychiatric morbidities and personality traits (depression, anxiety, overall psychiatric morbidity, self-consciousness, neuroticism and introversion/extraversion) and other demographic variables. Results, Of the 244 participating students, 209 (86%) completed all three rounds of data collection. A further 26 (11%) completed two rounds. The study failed to demonstrate an association of the presence of acne or of acne severity with the examined measures of psychological and psychiatric morbidity, and no evidence for an effect of acne in their causation. Conclusion, The relationship of acne and psychological morbidities found in previous health care settings was not found in this community sample. This may be due to differences between community and clinical acne populations. Other possible reasons for this finding are attenuation of psychological morbidity in subjects in this study by successful acne treatment, and the role of personality traits in the complex relationship between acne and psychological morbidities. It is suggested that this relationship would be best investigated by means of longer-term cohort studies enlisting subjects at an zearly age, prior to the onset of acne. [source] Psoralen and ultraviolet A and narrow-band ultraviolet B in inducing stability in vitiligo, assessed by vitiligo disease activity score: an open prospective comparative studyJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 10 2007A Bhatnagar Abstract Background Vitiligo is a common pigmentary disorder with great cosmetic and psychological morbidity and an unpredictable course. No treatment available is a definitive cure. Systemic psoralen and ultraviolet A (PUVA) has been the mainstay of treatment. Narrow-band UVB (NBUVB) was later introduced. In this study, we have compared the phototherapy modalities PUVA and NBUVB in inducing stability in vitiligo, assessed by using vitiligo disease activity score (VIDA), for the first time. Aims To investigate the position of NBUVB vis-à-vis PUVA in terms of stability achieved during therapy as indicated by the VIDA scores. Subjects and methods It was an open, prospective study of 50 patients divided equally in PUVA and NBUVB groups. The study period was from January 2004 to June 2005. This study was done as a part of a larger project to compare the efficacy of mentioned modalities in degree of repigmentation. Results In the NBUVB group, disease activity was present in 40% patients before commencement of therapy, which was reduced to 16% at the end of therapy (statistically significant, P = 0.049). In the PUVA group, similar figures were 20% and 16%, respectively. In the NBUVB group, 50% of patients whose disease was active prior to commencement of therapy had less than 50% repigmentation, whereas an equal number of patients had repigmentation of more than 50%. Almost an equal number of stable patients had less than and more than 50% repigmentation. In the PUVA group, 4 of the 5 (80%) patients who had active disease had less than 50% repigmentation, whereas only 1 patient (20%) with active disease obtained more than 50% repigmentation. The time to attain stability was 3.6 ± 2.1 months in the NBUVB group and 3.22 ± 3.1 months in the PUVA group. Eight of the 10 (80%) patients with unstable disease in the NBUVB group achieved stability, whereas 2 of the 5 (40%) patients of similar pre-treatment status in the PUVA group achieved stability. Conclusion NBUVB was in a more statistically advantageous position vis-à-vis PUVA, in respect to stability achieved and efficacy in both active and stable disease in a comparable time period. [source] Significant psychological morbidity occurs in irritable bowel syndrome: a case-control study using a pharmacy reimbursement databaseALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 4 2009J. B. CANAVAN Summary Background, Psychological problems are associated with IBS but the strength of this association is unclear. Aim, To assess co-prescribing of antispasmodic and CNS-acting drugs through a nested case-control study. Methods, A national dispensing database identified patients who were first dispensed antispasmodic medicines for a continuous 3-month period or more during 2006, using 2005 as a run-in period. Each patient was matched with four control patients and excluded if they received drugs indicated for IBD. Results, Four hundred and seven patients commenced antispasmodic drugs during 2006. These patients were matched with 1628 controls. In 2005, patients subsequently prescribed antispasmodics were 2,3 times more likely to receive CNS-acting drugs than controls. In the year following commencement of IBS therapy, patients were 2,4 times more likely than controls to be prescribed CNS-acting drugs including antidepressants (35.4% vs. 9.3%), anxiolytics (27.8% vs. 8.8%), antipsychotics (9.8% vs. 3.3%) and hypno-sedatives (32.7% vs. 11.3%; P < 0.0001). The adjusted OR (95% CI) for antidepressant, anxiolytic, hypnosedative and antipsychotic prescribing in IBS patients were 3.81 (2.79,5.20), 2.84 (2.12,3.81), 2.62 (1.91,3.60) and 2.58 (1.80,3.66), respectively. Conclusions, Patients prescribed ongoing therapy for presumed IBS are 2,4 times more likely to be prescribed CNS-acting drugs than controls, providing evidence of psychological comorbidity in IBS. [source] Asymptomatic individuals at genetic risk of haemochromatosis take appropriate steps to prevent disease related to iron overloadLIVER INTERNATIONAL, Issue 3 2008Katrina J. Allen Abstract Background/Aims: If community screening for hereditary haemochromatosis is to be considered, compliance with preventative measures and absence of significant psychological morbidity must be demonstrated. Methods: Workplace screening for the HFE C282Y mutation and then clinical care for C282Y homozygotes was instituted. Data were collected on understanding of test results, perceived health status and anxiety for C282Y homozygotes compared with controls. Uptake of clinical care, compliance and response to treatment and changes in diet were monitored for up to 4 years for C282Y homozygotes. Results: After 11 307 individuals were screened, 40/47 (85%) newly identified C282Y homozygotes completed questionnaires 12 months after diagnosis compared with 79/126 (63%) of controls. Significantly more C282Y homozygotes correctly remembered their test result compared with controls (95 vs 51%, P<0.0001). No significant difference in perceived health status was observed within or between the two groups at 12 months compared with baseline. Anxiety levels decreased significantly for C282Y homozygotes at 12 months compared with before testing (P<0.05). Forty-five of the 47 (95.8%) C282Y homozygotes accessed clinical care for at least 12 months. All 22 participants requiring therapeutic venesection complied with treatment for at least 12 months (range 12,47 months). Conclusion: Individuals at a high genetic risk of developing haemochromatosis use clinical services appropriately, maintain their health and are not ,worried well'. Population genetic screening for haemochromatosis can be conducted in the work place in a way that is acceptable and beneficial to participants. [source] School re-entry of the pediatric heart transplant recipientPEDIATRIC TRANSPLANTATION, Issue 8 2006Constance M. Weil Abstract:, Pediatric cardiac transplant has become increasingly frequent in the last decade and survival rates have improved remarkably. Outcome research on this population suggests that the majority of children have the capacity for healthy adaptation although 25,40% have been shown to have some type of psychiatric difficulties. As school plays a major role in these children's lives, early intervention and close liaison with schools is indicated to reduce psychological morbidity, enhance adaptation within the school environment and enhance overall adjustment. This paper proposes a model for a school re-entry program for this population. The school re-entry program is aimed at children who are undergoing cardiac transplant and will be entering or re-entering the school system. They may range in academic age from preschool to college level and have been attending private or public schools with placements in regular education programs, regular education programs with resource support, special education programs, and alternative school programs. Others may not have been attending school because of the severity of their medical condition and have been receiving in-home tutoring. Each child is offered school re-entry assistance by a multi-disciplinary team composed of members from the Cardiology Transplant Service. The re-entry program includes cognitive and psychosocial assessment, liaison with the child's school pre- and post-transplant, academic planning and provision of academic, emotional, and behavioral support before, during, and immediately after transplant, a school re-entry visit, and an ongoing school consultation. The goal is to address issues necessary for a successful school re-entry including appropriate academic placement and support, psychosocial adjustment, education of school personnel and ongoing health needs of the student. The next step is to formally evaluate the efficacy of this program in successful school re-entry. [source] Measuring psychological morbidity for diabetes commissioningPRACTICAL DIABETES INTERNATIONAL (INCORPORATING CARDIABETES), Issue 1 2010A cross-sectional survey of patients attending a secondary care diabetes clinic Abstract The aim of this study was to investigate the prevalence of psychological morbidity in the local secondary care population of people with type 1 diabetes or type 2 diabetes (T1DM or T2DM) in order to determine appropriate treatment provision. Four hundred patients seen in diabetes outpatient clinics were sent a number of standardised and validated questionnaires designed to measure: diabetes related distress; anxiety and depression; disordered eating behaviours; and borderline personality disorder. A response rate of 52.7% was achieved, providing a total of 211 completed questionnaires (111 T1DM, 100 T2DM) for analysis. This study has demonstrated a high prevalence of psychological morbidity in the local secondary care population of people with diabetes, with as many as half of those surveyed (52%) reporting some level of psychological disturbance. After controlling for age, gender and diabetes type, few differences in levels of psychological dysfunction were identified between the T1DM and T2DM cohorts. The exception to this was disinhibited eating behaviours: 22% of people with T2DM had severe levels of disinhibited eating, twice that recorded in the T1DM population. Overall, 36% (n=76) of study participants had moderate,severe levels of depression, anxiety or both, and 9.5% (16 of 168) had scores suggestive of borderline personality disorder. Copyright © 2010 John Wiley & Sons. [source] Long-term psychological consequences of pregnancy termination for fetal abnormality: a cross-sectional studyPRENATAL DIAGNOSIS, Issue 3 2005M. J. Korenromp Abstract Objective We examined women's long-term psychological well-being after termination of pregnancy (TOP) for fetal anomaly in order to identify risk factors for psychological morbidity. Methods A cross-sectional study was performed in 254 women, 2 to 7 years after TOP for fetal anomaly before 24 weeks of gestation. We used standardised questionnaires to investigate grief, posttraumatic symptoms, and psychological and somatic complaints. Results Women generally adapted well to grief. However, a substantial number of the participants (17.3%) showed pathological scores for posttraumatic stress. Low-educated women and women who had experienced little support from their partners had the most unfavourable psychological outcome. Advanced gestational age at TOP was associated with higher levels of grief, and posttraumatic stress symptoms and long-term psychological morbidity was rare in TOP before 14 completed weeks of gestation. Higher levels of grief and doubt were found if the fetal anomaly was presumably compatible with life. Conclusion Termination of pregnancy for fetal anomaly is associated with long-lasting consequences for a substantial number of women. Clinically relevant determinants are gestational age, perceived partner support, and educational level. Copyright © 2005 John Wiley & Sons, Ltd. [source] Acne: guide to features and recommended managementPRESCRIBER, Issue 15-16 2009Edward Seaton MA Acne typically presents during puberty and can cause significant psychological morbidity and facial scaring. Our Drug review describes the underlying aetiology of acne development and the available treatments, followed by a review of the prescription data and sources of further information. Copyright © 2009 Wiley Interface Ltd [source] The Cancer Coping Questionnaire: A self-rating scale for measuring the impact of adjuvant psychological therapy on coping behaviourPSYCHO-ONCOLOGY, Issue 4 2003Stirling Moorey The Cancer Coping Questionnaire is a brief, self-rating scale designed to measure coping strategies taught in Adjuvant Psychological Therapy. This paper describes the development of the 21 item Cancer Coping Questionnaire (CCQ) in a sample of 201 patients with mixed cancers. The construct validity and reliability of the instrument are reported from work on 3 samples (a mixed cancer group, n=42; women with breast cancer, n=50; and a group of patients referred for psychological help, n=48). The CCQ showed very good internal reliability and test,retest reliability. As hypothesised cancer patients with more psychological morbidity demonstrated lower CCQ scores, and the CCQ correlated with measures of adjustment to cancer. Compared with an established coping inventory (the Coping Responses Indices; CRI) the CCQs overall individual scale (items 1,14) assessed similar coping areas, particularly in relation to the CRIs foci of coping. The CCQ correlated with Active Behavioural Coping methods on the CRI. The study did not demonstrate sufficiently consistent results concerning the Interpersonal Scale of the CCQ to confirm its validity. Further psychometric work is needed, but the study demonstrated the reliability and validity of the CCQ, supporting the view that change in CCQ scores with cognitive therapy indicates improvement in coping. Copyright © 2003 John Wiley & Sons, Ltd. [source] Frequency and Correlates of Sexual Dysfunction in Women with Diabetes MellitusTHE JOURNAL OF SEXUAL MEDICINE, Issue 12 2009Anthonia Okeoghene Ogbera MPH, FACP ABSTRACT Introduction., Sexual dysfunction (SD) in women with diabetes mellitus (DM) is an important but understudied aspect of DM complications in women with DM. Aim., This report is an attempt to document the prevalence, clinical correlates, and determinants of SD in a cross sectional study of women with diabetes mellitus (DM). Main Outcome Measures., The main outcome measures were demographic, clinical parameters, psychological morbidity, and frequency of SD. Methods., A total of 58 married women with type 2 DM and 30 age-matched women who did not have DM had their sexual function and psychological status assessed using the Female Sexual Function Index (FSFI) and General Health questionnaires (GHQ 12) respectively. Glycemic control was assessed using glycosylated hemoglobin. Results., The prevalence of SD in women with DM and in the control population was 88% and 80%, respectively. The mean (standard deviation) FSFI score in the women with DM was significantly lower than that of the control group (16.2 [9.5] vs. 21 [8.5], P = 0.02). Women with DM attempted sex less frequently than those in the control group. Poor mental health status which was found to be associated with SD was noted more in women with DM than those in the control group. Conclusions., SD is high in women with and without DM. A possible determinant of SD in women with DM is psychological morbidity. Ogbera AO, Chinenye S, Akinlade A, Eregie A, and Awobusuyi J. Frequency and correlates of sexual dysfunction in women with diabetes mellitus. J Sex Med 2009;6:3401,3406. [source] Women who miscarry: The effectiveness and clinical utility of the Kessler 10 questionnaire in screening for ongoing psychological distressAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 1 2010Helen M. STALLMAN Background:, Early pregnancy loss has been linked to enduring psychological morbidity. Aims:, This study aimed to investigate the utility of the Kessler 10 (K10) questionnaire as a brief screening instrument to identify women at risk for the development of psychiatric diagnoses three months post-miscarriage. Method:, Participants were 117 consecutive women presenting at a public hospital emergency department and receiving a diagnosis of miscarriage. Main outcome measures:, K10 screen for psychological distress and the Structured Clinical Interview for DSM Disorders to determine psychiatric diagnoses. Results:, A majority of women (81.2%) experienced elevated levels of distress initially, 24.8% in the very high range. They were not at increased risk of psychiatric diagnoses at three months compared with the general population; however, they were significantly more likely to report subsyndromal symptoms at this time compared with the general population. The baseline K10 score was the only significant predictor of distress at follow-up (r = 0.45, P < 0.001). The receiver operating characteristic curve shows that a cut-off of 14 on the K10 has suitable sensitivity (97%) and specificity (82%) for predicting ongoing psychological distress in women who miscarry. Conclusions:, The K10 is effective in identifying women at risk for ensuring psychological symptoms following miscarriage. [source] A randomised controlled trial of cytological surveillance versus patient choice between surveillance and colposcopy in managing mildly abnormal cervical smearsBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 1 2004H.C. Kitchener Objective To determine whether choice of colposcopy or six month cytological surveillance would be beneficial to women with mildly abnormal smears when compared with the national policy of six months surveillance in terms of psychological morbidity. Design A randomised trial based on the Zelen design. Setting A hospital-based research clinic. Population Four hundred and seventy-six women who had had a recurrent borderline or mildly dyskaryotic smear on routine cervical screening in primary care. Methods Women were randomised either to six months cytological surveillance or to make a choice between that or colposcopy and were followed up for 1 year. Main outcome measures The primary outcome measure was caseness (score ,4) on the General Health Questionnaire at 12 months follow up. Other measures were the Spielberger State and Trait scores, default rates and cytology/colposcopy outcomes. Results There was no significant difference between the arms for General Health Questionnaire (GHQ) scores and Spielberger State and Trait at 12 months. There was a significant reduction in psychometric morbidity between baseline and 12 months in both arms. Overall rates of default from the protocol were the same in both arms, but default that led to uncertain ascertainment of cervical pathology was greater in the no-choice arm. Conclusions This trial indicates that having choice did not impact favourably or harmfully on anxiety or feelings of wellbeing. If a patient is anxious, allowing the patient to choose immediate colposcopy may be preferable because it will improve ascertainment of underlying disease in a group who are more likely to default. [source] Comparison of potassium titanyl phosphate vascular laser and hyfrecator in the treatment of vascular spiders and cherry angiomasCLINICAL & EXPERIMENTAL DERMATOLOGY, Issue 6 2003G. Dawn Summary Patients with vascular spiders and angiomas, especially on exposed sites, demonstrate considerable psychological morbidity and therefore request treatment. Traditionally, electrosurgical modalities have been used to treat such lesions, but more recently lasers have been introduced. This open study assesses the efficacy of these two treatment modalities, scoring patients' preference and psychological morbidity before and after treatment. All patients had two vascular spiders or angiomas. One lesion was randomized for treatment with the hyfrecator, whilst the other lesion was treated with the potassium titanyl phosphate (KTP) vascular laser. The end-point of the study was either clearance of lesions or a maximum of three treatments at 2-month intervals. In this first comparative study, we demonstrate that both therapeutic modalities were effective in treating these lesions and in significantly reducing the post-treatment psychological morbidity score. However, on average, only one treatment with the KTP laser was required to achieve clearance compared with two treatments with the hyfrecator. This would result in less clinic visits. In addition, patients favoured the KTP laser because of the lack of side-effects. Both the KTP vascular laser and the hyfrecator were able to clear vascular spiders and angiomas, but the KTP laser was superior as fewer treatment episodes were required and patients preferred this treatment modality because of the lack of side-effects. [source] Psychological aspects of adductor spasmodic dysphonia: a prospective population controlled questionnaire studyCLINICAL OTOLARYNGOLOGY, Issue 1 2010A.A. Kaptein Clin. Otolaryngol. 2010, 35, 31,38. Objective:, To examine psychosocial concomitants, illness perceptions, and treatment perceptions in patients with adductor spasmodic dysphonia. Design:, Prospective controlled cohort study. Setting:, A tertiary care facility. Participants:, Forty-nine out-patients (38 women, 11 men; average age of 52 years) with adductor spasmodic dysphonia completed a battery of reliable and validated psychometric assessment instruments. Control patients' data were derived from scores in questionnaires by samples in the formal Manuals of the questionnaires used. Main outcome measures:, Psychosocial functioning, illness perceptions, and treatment perceptions. Results:, Scores on psychosocial measures were elevated in male patients especially, indicating levels of psychological morbidity significantly above those seen in the general population. Assessments of illness perceptions and treatment perceptions indicated that patients perceive that they have a very low degree of control over the disorder, and experience a high emotional impact from it. Voice Handicap Index scores illustrated substantial degrees of perceived handicap. Conclusions:, Adductor spasmodic dysphonia is associated with significant negative psychosocial concomitants, coupled with low perceived control over the condition. Future research should elucidate the implications of illness perceptions and treatment perceptions for the biopsychosocial care of persons with adductor spasmodic dysphonia in order to improve self-management and enhance quality of life. [source] | |||||||||||||||||||||||||||||||