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Psychosocial Outcomes (psychosocial + outcome)
Selected AbstractsLong-term Prognosis and Psychosocial Outcomes after Surgery for MTLEEPILEPSIA, Issue 12 2006Sophie Dupont Summary:,Purpose: To assess the seizure-freedom rates and self-perceived psychosocial changes associated with the long-term outcome of epilepsy surgery in patients with refractory medial temporal lobe epilepsy associated with hippocampal sclerosis. Methods: A standard questionnaire was given to 183 patients who underwent surgery between 1988 and 2004, and 110 were completed. Results: The mean duration of follow-up after surgery was 7 years, with a maximum of 17 years. The probability that patients were seizure-free after surgery was dependent on the definition of the seizure freedom. For the patients who were seizure-free since surgery (Engel's class Ia), the probability was 97.6% at 1 year after surgery, 85.2% at 2 years after surgery, 59.5% at 5 years after surgery, and 42.6% at 10 years after surgery. For the patients who still experienced rare disabling seizures after surgery but were seizure-free at least 1 year before the time of assessment, the probability was of 97.6% at 1 year after surgery, 95% at 2 years after surgery, 82.8% at 5 years after surgery, and 71.1% at 10 years after surgery. The psychosocial long-term outcome, as measured by indices of driving, employment, familial and social relationships, and marital status, was similar to the psychosocial short-term outcome. It did not depend on seizure freedom or on follow-up time interval and was not influenced statistically by seizure frequency in cases of persisting seizures. Most but not all patients noticed a substantial overall improvement in their psychosocial condition; 48% drove (increased by 7%), 47% improved (14% worsened) in their employment status, and 68% improved (5% worsened) in their familial and social relationships. Overall, 91% of patients were satisfied with the surgery, and 92% did not regret their decision. Conclusions: The results of this study suggest that temporal lobe surgery has real long-term benefits. Two specific conclusions emerge: (a) the long-term rates of freedom from seizure depend on how seizure freedom is defined, and (b) the psychosocial long-term outcome does not change dramatically over years and does not depend on seizure freedom. [source] Family Relationships and Adolescent Psychosocial Outcomes: Converging Findings From Eastern and Western CulturesJOURNAL OF RESEARCH ON ADOLESCENCE, Issue 4 2004Julia Dmitrieva This study investigated the role of parent,adolescent relationships in mediating the association between family-related negative life events and adolescent depressive symptoms and problem behaviors among 1,696 eleventh graders from the United States (n=201), China (n=502), Korea (n=497), and Czech Republic (n=496). Results indicated that perceived parental involvement and parent,adolescent conflict mediated the link between family-related life events and adolescent depressed mood. The path from family-related life events to adolescent problem behaviors was mediated by perceived parental involvement, parent,adolescent conflict, and perceived parental sanctions of adolescent misconduct. With the exception of minor cross-cultural differences in the magnitude of associations among variables, this study revealed considerable similarity in the association of family factors with adolescent internalizing and externalizing symptomatology. The findings contribute to the growing literature on culture-general developmental processes. [source] ORIGINAL RESEARCH,ED PHARMACOTHERAPY: Psychosocial Outcomes and Drug Attributes Affecting Treatment Choice in Men Receiving Sildenafil Citrate and Tadalafil for the Treatment of Erectile Dysfunction: Results of a Multicenter, Randomized, Open-Label, Crossover StudyTHE JOURNAL OF SEXUAL MEDICINE, Issue 4 2006FRCGP, John Dean MBBS ABSTRACT Introduction., Although sildenafil citrate (sildenafil) and tadalafil are efficacious and well-tolerated treatments for erectile dysfunction (ED), preference studies have shown that patients may favor one medication over the other. Aim., To determine whether psychosocial outcomes differed when men with ED received tadalafil compared with sildenafil. Main Outcome Measures., Measures included a treatment preference question, Psychological and Interpersonal Relationship Scales (PAIRS), and Drug Attribute Questionnaire. Methods., Randomized, open-label, crossover study. After a 4-week baseline, men with ED (N = 367; mean age = 54 years; naïve to type 5 phosphodiesterase inhibitor therapy) were randomized: tadalafil for 12 weeks then sildenafil for 12 weeks or vice versa (8-week dose optimization/4-week assessment phases). During dose optimization, patients started with 10 mg tadalafil, or 25 or 50 mg sildenafil and could titrate to their optimal dose (10 or 20 mg tadalafil; 25, 50, or 100 mg sildenafil). Medications were taken as needed. Patients completing both 12-week periods chose which medication to continue during an 8-week extension. Results., Of 291 men completing both treatment periods, 71% (N = 206) chose tadalafil and 29% (N = 85) chose sildenafil (P < 0.001) for the 8-week extension. When taking tadalafil compared with sildenafil men had higher mean endpoint scores on PAIRS Sexual Self-Confidence (tadalafil = 2.91 vs. sildenafil = 2.75; P < 0.001) and Spontaneity (tadalafil = 3.32 vs. sildenafil = 3.17; P < 0.001) Domains and a lower mean endpoint score on Time Concerns Domain (tadalafil = 2.2 vs. sildenafil = 2.59; P < 0.001). The two most frequently chosen drug attributes to explain treatment preference were ability to get an erection long after taking the medication and firmness of erections. Tadalafil and sildenafil were well tolerated with 12 (3.3%) patients discontinuing for an adverse event. Conclusions., As measured with PAIRS, men with ED had higher sexual self-confidence and spontaneity and less time concerns related to sexual encounters when treated with tadalafil compared with sildenafil. These psychosocial outcomes may help explain why more men (71%) preferred tadalafil for the treatment of ED in this clinical trial. Dean J, Hackett GI, Gentile V, Pirozzi-Farina F, Rosen RC, Zhao Y, Warner MR, and Beardsworth A. Psychosocial outcomes and drug attributes affecting treatment choice in men receiving sildenafil citrate and tadalafil for the treatment of erectile dysfunction: Results of a multicenter, randomized, open-label, crossover study. J Sex Med 2006;3:650,661. [source] Long-term follow up of children exposed in utero to nifedipine or ritodrine for the management of preterm labourBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 3 2006BA Houtzager Objective, To compare the long-term psychosocial and motor effects on children exposed in utero to nifedipine or ritodrine for the management of preterm labour. Design, Randomised controlled trial. Setting, Multicentre study in two university and one primary hospital in the Netherlands. Population, In the original trial, 185 women were randomised to either nifedipine (n= 95) or ritodrine (n= 90). Of the 185 liveborn children, 171 survived (92%), and of these 102 (61%) were followed up at age 9,12 years. Methods, Age-specific questionnaires were administered to the parent and teacher. Additional data were obtained from medical records. Main outcome measures, Questionnaires were used to assess the child's behavioural,emotional problems, quality of life (QoL), motor functioning, parenting distress and the child's education. Results, Of the 171 eligible families, 102 (61%) agreed to participate and completed the questionnaires. Response was equal in the ritodrine group (n= 54 of 83 surviving children, 65%) compared with the nifedipine group (n= 48 of 88 surviving children, 55%). After controlling for differing perinatal characteristics at birth, no significant differences between the groups were detected with respect to long-term behaviour,emotional outcome, QoL, education, motor functioning or parenting distress. Psychosocial outcome was slightly better in the nifedipine group. Conclusions, The results do not support any differential postnatal effect of the tocolytic agents ritodrine or nifedipine on the child's long-term psychosocial and motor functioning. The slightly better outcome of children randomised in the nifedipine group is most likely due to more favourable perinatal outcomes in this group. These results merit further investigation in a larger group of survivors. [source] Psychosocial outcomes in children two years after epilepsy surgery: Has anything changed?EPILEPSIA, Issue 4 2008Irene M. Elliott Summary Purpose: We prospectively explored psychosocial outcomes in children (7,18 years) 2 years after epilepsy surgery. This study built on our previous one that examined these children 1 year after surgery. Methods: Twenty children were studied using the Child Behavior Checklist (CBCL; a parent report instrument of potential behavioral and social problems) preoperatively, 1 year and 2 years after surgery. A comparison group of 12 children with medically refractory seizures was examined at comparable times. We conducted mixed factorial ANOVAs to determine group, time, and interaction effects, and regression analyses to assess factors driving significant (p , 0.05) interactions. We also investigated the proportion of children scoring in the abnormal range over time. Results: Significant main effects of time were observed on total behavior, externalizing, aggression, and delinquent behavior scales, with both groups reporting improvement. Main effects of group were observed for withdrawn and total competence scales, with the surgical group demonstrating favorable scores. Significant group × time interactions were observed on the social and social problems subscales. On both subscales, the surgical group demonstrated improvement over time, whereas the nonsurgical group experienced decline. Fifty percent of the surgical group remained seizure-free. Seizure status and number of antiepileptic medications predicted changes in social scores. We did not observe a significant regression model for the social problems subscale. Discussion: These findings suggest that change in social function may take time to develop after surgery. Prospective studies designed for longer periods are required to determine if improvements in other psychosocial domains are seen over time. [source] Psychosocial outcomes at 15 years of children with a preschool history of speech-language impairmentTHE JOURNAL OF CHILD PSYCHOLOGY AND PSYCHIATRY AND ALLIED DISCIPLINES, Issue 8 2006Margaret J. Snowling Background:, Evidence suggests there is a heightened risk of psychiatric disorder in children with speech-language impairments. However, not all forms of language impairment are strongly associated with psychosocial difficulty, and some psychiatric disorders (e.g., attention deficit/hyperactivity disorder (ADHD)) are more prevalent than others in language-impaired populations. The present study assessed the psychosocial adjustment in adolescence of young people with history of speech-language impairment, and investigated specific relationships between language deficits and psychiatric disorders. Methods:, Seventy-one young people (aged 15,16 years) with a preschool history of speech-language impairment were assessed using a psychiatric interview (K-SADS) supplemented by questionnaires probing social encounters and parental reports of behaviour and attention. Their psycho-social adjustment was compared with that of a cross-sectional control group of age-matched controls. Results:, Overall the rate of psychiatric disorder was low in the clinical sample and children whose language delay had resolved by 5.5 years had a good outcome. For those whose language difficulties persisted through the school years, there was a raised incidence of attention and social difficulties. These difficulties were partially independent and associated with different language profiles. The group with attention problems showed a profile of specific expressive language difficulties; the group with social difficulties had receptive and expressive language difficulties; and the group with both attention and social difficulties was of low IQ with global language difficulties. Conclusions:, Amongst children with speech-language delays at 5.5 years, those with more severe and persistent language difficulties and low nonverbal IQ are at higher risk of psychiatric morbidity in adolescence. [source] ORIGINAL RESEARCH,ED PHARMACOTHERAPY: Psychosocial Outcomes and Drug Attributes Affecting Treatment Choice in Men Receiving Sildenafil Citrate and Tadalafil for the Treatment of Erectile Dysfunction: Results of a Multicenter, Randomized, Open-Label, Crossover StudyTHE JOURNAL OF SEXUAL MEDICINE, Issue 4 2006FRCGP, John Dean MBBS ABSTRACT Introduction., Although sildenafil citrate (sildenafil) and tadalafil are efficacious and well-tolerated treatments for erectile dysfunction (ED), preference studies have shown that patients may favor one medication over the other. Aim., To determine whether psychosocial outcomes differed when men with ED received tadalafil compared with sildenafil. Main Outcome Measures., Measures included a treatment preference question, Psychological and Interpersonal Relationship Scales (PAIRS), and Drug Attribute Questionnaire. Methods., Randomized, open-label, crossover study. After a 4-week baseline, men with ED (N = 367; mean age = 54 years; naïve to type 5 phosphodiesterase inhibitor therapy) were randomized: tadalafil for 12 weeks then sildenafil for 12 weeks or vice versa (8-week dose optimization/4-week assessment phases). During dose optimization, patients started with 10 mg tadalafil, or 25 or 50 mg sildenafil and could titrate to their optimal dose (10 or 20 mg tadalafil; 25, 50, or 100 mg sildenafil). Medications were taken as needed. Patients completing both 12-week periods chose which medication to continue during an 8-week extension. Results., Of 291 men completing both treatment periods, 71% (N = 206) chose tadalafil and 29% (N = 85) chose sildenafil (P < 0.001) for the 8-week extension. When taking tadalafil compared with sildenafil men had higher mean endpoint scores on PAIRS Sexual Self-Confidence (tadalafil = 2.91 vs. sildenafil = 2.75; P < 0.001) and Spontaneity (tadalafil = 3.32 vs. sildenafil = 3.17; P < 0.001) Domains and a lower mean endpoint score on Time Concerns Domain (tadalafil = 2.2 vs. sildenafil = 2.59; P < 0.001). The two most frequently chosen drug attributes to explain treatment preference were ability to get an erection long after taking the medication and firmness of erections. Tadalafil and sildenafil were well tolerated with 12 (3.3%) patients discontinuing for an adverse event. Conclusions., As measured with PAIRS, men with ED had higher sexual self-confidence and spontaneity and less time concerns related to sexual encounters when treated with tadalafil compared with sildenafil. These psychosocial outcomes may help explain why more men (71%) preferred tadalafil for the treatment of ED in this clinical trial. Dean J, Hackett GI, Gentile V, Pirozzi-Farina F, Rosen RC, Zhao Y, Warner MR, and Beardsworth A. Psychosocial outcomes and drug attributes affecting treatment choice in men receiving sildenafil citrate and tadalafil for the treatment of erectile dysfunction: Results of a multicenter, randomized, open-label, crossover study. J Sex Med 2006;3:650,661. [source] Psychosocial Adjustment Over a Two,Year Period in Children Referred for Learning Problems: Risk, Resilience, and AdaptationLEARNING DISABILITIES RESEARCH & PRACTICE, Issue 1 2003Lisa G. Sorensen Children with learning difficulties have an increased prevalence of psychosocial adjustment problems. We hypothesized that within the context of a risk and resilience model contextual variables influence adjustment, over and above any effects of academic performance. The Behavior Assessment System for Children (BASC) was used to evaluate the relationship between psychosocial adjustment, changes in academic skills, and contextual factors longitudinally over a two,year period in 100 children (ages 7 to 11) referred for learning problems. Although there was little improvement in academic skills, contextual factors contributed to observed psychosocial outcome. Different factors were salient for parents, teachers, and children. Context,derived vulnerability and protective factors can be important determinants of adjustment in children with learning problems, even though the academic difficulties can remain chronic. [source] Supportive-expressive group therapy for women with metastatic breast cancer: survival and psychosocial outcome from a randomized controlled trialPSYCHO-ONCOLOGY, Issue 4 2007David W. Kissane Abstract Background: Mixed reports exist about the impact of supportive-expressive group therapy (SEGT) on survival. Methods: From 485 women with advanced breast cancer recruited between 1996,2002, 227 (47%) consented and were randomized within an average 10 months of cancer recurrence in a 2:1 ratio to intervention with 1 year or more of weekly SEGT plus three classes of relaxation therapy (147 women) or to control receiving three classes of relaxation therapy (80 women). The primary outcome was survival; psychosocial well-being was appraised secondarily. Analysis was by intention-to-treat. Results: SEGT did not prolong survival (median survival 24.0 months in SEGT and 18.3 in controls; univariate hazard ratio for death 0.92 [95% CI, 0.69,1.26]; multivariate hazard ratio, 1.06 [95% CI, 0.74,1.51]). Significant predictors of survival were treatment with chemotherapy and hormone therapy (p<0.001), visceral metastases (p<0.001) and advanced disease at first diagnosis (p<0.05). SEGT ameliorated and prevented new DSM-IV depressive disorders (p = 0.002), reduced hopeless,helplessness (p = 0.004), trauma symptoms (p = 0.04) and improved social functioning (p = 0.03). Conclusions: SEGT did not prolong survival. It improved quality of life, including treatment of and protection against depression. Copyright © 2007 John Wiley & Sons, Ltd. [source] Quality of life in 244 recipients of allogeneic bone marrow transplantationBRITISH JOURNAL OF HAEMATOLOGY, Issue 3 2000S. Chiodi The number of long-term survivors after allogeneic bone marrow transplantation (BMT) has been increasing over the past years, and quality of life (QOL) has become an important end-point. We studied 244 patients undergoing an allogeneic BMT to identify factors and events influencing psychosocial outcome. Patients enrolled received the Psychosocial Adjustment to Illness Scale (PAIS) questionnaire assessing psychological and social adjustment to chronic illness or its sequelae. Eighty-two per cent of patients had a haematological disease. The median age was 28 years at BMT, and the median follow-up was 61 months. The median overall PAIS score for all patients was 56 (range 22,76): 25% (n = 61) of patients were considered to have a good QOL (, 25 percentile score); 44% (n = 108) of patients had an intermediate QOL (26,75 percentile score) and 31% (n = 75) had a poor QOL (> 75 percentile score). Factors associated with a poor QOL in multivariate analysis were: patients' age at BMT (> 25 years, P < 0·01); presence of long-term sequelae (P < 0·01); chronic graft-versus-host disease (GVHD) (P < 0·05); and a short interval from BMT (< 5 years; P < 0·05). The QOL improved with time: 12% of patients reported a good QOL within 5 years compared with 38% after this time point and, conversely, 38% reported a poor QOL within 5 years compared with 24% after this time point (P < 0·0001). Older patients had significantly poorer QOL compared with younger patients (, 25 years; P = 0·01). Females had significantly poorer scores when compared with males in the sexual (P < 0·0001) and psychological domains (P = 0·001). The data suggest that (i) one-third of patients undergoing allogeneic BMT report a poor QOL; (ii) factors associated with poor QOL are older age, presence of long-term sequelae, chronic GVHD and short follow-up; (iii) QOL is superior in long-term survivors; and (iv) BMT affects different aspects of life in males and females. A longitudinal study is ongoing to prove the effect of time on quality of life. [source] Impaired psychosocial outcome of donors after living donor liver transplantation: a qualitative case studyCLINICAL TRANSPLANTATION, Issue 4 2006Marc Walter Abstract:, Adult-to-adult living donor liver transplantation (LDLT) of the right hepatic lobe has been developing into an established therapy for treating pre-terminal liver diseases. There is little experience available on the psychosocial outcome of living donors. The aim of this first qualitative case study was to investigate the patterns for impaired psychosocial outcome in donors after LDLT. Donor hepatectomies were performed in 30 donors at the Charité Berlin. Six months after surgery, the six of the 30 donors with negative moods and physical complaints in psychometric monitoring were examined. The post-operative interviews were transcribed and analysed using current qualitative research methods. These six donors (20%) reported various unspecific complaints and psychological conflicts. Sadness was expressed about organ rejection and death of the recipient. Anxieties about the recipient and their own health were verbalized. Disappointment and anger refer to the experience that they were not as fully appreciated by the medical system and their social environment as expected. The negative emotions of donors with impaired psychosocial outcome could be related to a decrease in self-esteem in the post-operative course. Adequate medical and psychological treatment opportunities for these donors should be provided. [source] Increasing Self-Management Skills in Heart Failure Patients: A Pilot StudyCONGESTIVE HEART FAILURE, Issue 6 2005Kristin J. Flynn PhD Nonadherence to medical treatment among heart failure patients is high and results in frequent exacerbations and premature death. This treatment-only pilot study examined whether a year-long group-based self-management intervention is feasible and improves self-management skills in patients with mild-to-moderate heart failure (ejection fraction ,40% and New York Heart Association functional class I, II, or III). A total of 31 of 100 recruited patients (31%) agreed to participate. Twenty-six (84%) completed the year-long self-management program. Compared with baseline, the intervention was associated with an increase in overall self-efficacy in practicing self-management skills (p<0.001) and in four of five specific self-management skills. Patients and their group leaders also reported an increase in actual use of self-management skills (p<0.001) and in several psychosocial outcomes. The success of this pilot study suggests the need for a randomized clinical trial to test the efficacy of group-based self-management training on medical outcomes. [source] Psychosocial outcomes in children two years after epilepsy surgery: Has anything changed?EPILEPSIA, Issue 4 2008Irene M. Elliott Summary Purpose: We prospectively explored psychosocial outcomes in children (7,18 years) 2 years after epilepsy surgery. This study built on our previous one that examined these children 1 year after surgery. Methods: Twenty children were studied using the Child Behavior Checklist (CBCL; a parent report instrument of potential behavioral and social problems) preoperatively, 1 year and 2 years after surgery. A comparison group of 12 children with medically refractory seizures was examined at comparable times. We conducted mixed factorial ANOVAs to determine group, time, and interaction effects, and regression analyses to assess factors driving significant (p , 0.05) interactions. We also investigated the proportion of children scoring in the abnormal range over time. Results: Significant main effects of time were observed on total behavior, externalizing, aggression, and delinquent behavior scales, with both groups reporting improvement. Main effects of group were observed for withdrawn and total competence scales, with the surgical group demonstrating favorable scores. Significant group × time interactions were observed on the social and social problems subscales. On both subscales, the surgical group demonstrated improvement over time, whereas the nonsurgical group experienced decline. Fifty percent of the surgical group remained seizure-free. Seizure status and number of antiepileptic medications predicted changes in social scores. We did not observe a significant regression model for the social problems subscale. Discussion: These findings suggest that change in social function may take time to develop after surgery. Prospective studies designed for longer periods are required to determine if improvements in other psychosocial domains are seen over time. [source] Drinking patterns in mid-adolescence and psychosocial outcomes in late adolescence and early adulthoodADDICTION, Issue 12 2004J. Elisabeth Wells ABSTRACT Aims To describe the pattern of drinking at age 16 and to relate this to outcomes at 16,21 years and 21,25 years across a number of psychosocial domains. Design A prospective birth cohort study with annual follow-up until age 16 then at 18, 21 and 25 years. Setting Christchurch, New Zealand. Participants Of 1265 subjects, 953 were interviewed at age 16. Measurements Multiple measures of family background were collected from birth to 16 years. Alcohol consumption was measured in terms of frequency, usual or last quantity drunk and most drunk per occasion. Problems were also recorded. Questions about psychiatric symptoms enabled Diagnostic and Statistical Manual (DSM) criteria to be applied. Detailed reports on educational outcomes, employment, sexual behaviours and offending were collected. Findings Four latent classes were required to describe drinking at age 16, but these appeared to lie along a single dimension which strongly predicted outcomes at ages 16,21 and 21,25 across all domains (alcohol-related, substance dependence, mental health, education, sexual relationships and offending). After controlling for background and correlates only a small number of outcomes were still related consistently to drinking at age 16 over both periods: most alcohol-related outcomes, the number of sexual partners and the extent of violent offending. Conclusions Drinking at age 16 is a clear indicator of future life-course over most domains in late adolescence and early adulthood. Many of these associations are due to other covariates. Outcomes specific to drinking at age 16 are alcohol outcomes, number of sexual partners and violence. [source] The effect of tadalafil on psychosocial outcomes in Swedish men with erectile distress: a multicentre, non-randomised, open-label clinical studyINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 11 2006K. S. FUGL-MEYER Summary A multicentre, non-randomised, open-label study assessed whether personal distress caused by erectile dysfunction (ED) affected psychosocial outcomes of tadalafil treatment. Eligible Swedish men at least 18 years old reporting ,3-month history of ED were stratified into two groups (manifest or mild/no distress) based upon a distress question administered at enrolment. Tadalafil 20 mg was taken as needed for 8 weeks. The primary outcome was the difference between the two distress groups in change from baseline in the Psychological and Interpersonal Relationship Scales (PAIRS) spontaneity domain. Secondary outcome measures were PAIRS sexual self-confidence and time concerns domains, Life Satisfaction (LiSat-11) checklist and a Global Assessment of Treatment Response. The study also assessed tolerability. Of 662 men enrolled, 88% had manifest distress and 12% had mild/no distress. Baseline-to-endpoint changes for PAIRS domains were not significantly different between groups. Baseline-to-endpoint changes in LiSat-11 items were not significantly different between groups except for satisfaction with sexual life. Compared with men without ED, below normal baseline satisfaction with partner relationship and family life were normalised at endpoint. Over 90% of men reported improved erection and ability to engage in sexual activity. The most common treatment-emergent adverse events were headache, myalgia, dyspepsia, flushing and back pain. One man discontinued because of myalgia; 630 (95%) completed the study. In conclusion, erectile distress levels vary among patients with ED and distress can affect intra-familiar aspects of life, which may have implications for clinical practise. However, distress does not appear to hinder improvement in both mechanical and psychosocial outcomes of tadalafil treatment. [source] Psychosocial Functioning of Carcinoid Cancer Patients: Test of a Stress and Coping Mediated Model,JOURNAL OF APPLIED BIOBEHAVIORAL RESEARCH, Issue 3 2004Elizabeth Soliday This study examined a mediated-effects stress and coping model among cancer patients with carcinoid tumors to identify specific pathways with a view toward determining (a) which coping strategies predict more positive adjustment, (b) which strategies predict less positive adjustment, and (c) whether coping would mediate the effect of optimism on psychosocial outcomes. Coping strategies partially mediated the effects of optimism on the psychological adjustment in cancer patients with carcinoid tumors. Specifically, self-blame and active coping significantly predicted outcomes of distress. Thirty-seven percent of the respondents met criteria for elevated depressive symptoms warranting intervention. Generalizability of the mediated-effects stress and coping model and findings unique to the carcinoid population are discussed. [source] Effective Management of ICD Patient Psychosocial Issues and Patient Critical EventsJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 11 2009SAMUEL F. SEARS Ph.D. The clinical management of implantable cardioverter-defibrillator (ICD) patients involves successful medical and psychosocial care to reduce mortality and morbidity. Desirable quality of life (QoL) and psychosocial outcomes for ICD patients are achievable for a majority of ICD patients. Patient critical events, such as ICD shocks or ICD recalls, may occur that can dramatically alter the course of patient adjustment if not properly managed. Continuing care strategies that attend to patient critical events as they emerge may improve the psychosocial adjustment and improve the return to optimal daily functioning for ICD patients. This paper reviews QoL and psychosocial outcomes for ICD patients, patient critical events, and clinical implications for patient care. Patient critical events discussed in this paper include perioperative education, ICD shock events, device recalls, and end of life. The clinical management strategies for each of these patient critical events are suggested including patient education, psychosocial information provision, activity prescriptions, recall planning, and shock planning. [source] Leaving home after cancer in childhood: A measure of social independence in early adulthoodPEDIATRIC BLOOD & CANCER, Issue 1 2006Susanne Vinkel Koch MD Abstract Background Previous studies on psychosocial outcomes for childhood and adolescent cancer survivors have found diverse results concerning social independence. As a measure of social independence, we investigated whether cancer survivors displayed the same patterns of leaving home as population-based control group. Procedure We identified 1,597 patients in the Danish Cancer Register, born in 1965,1980, in whom a primary cancer was diagnosed before they reached the age of 20 in the period 1965,1995. The patients were compared with a random sample of the general population (n,=,43,905) frequency matched on sex and date of birth. By linking the two cohorts to registers in Statistics Denmark, we obtained socioeconomic data for the period 1980,1997. The relative risk for leaving home was estimated with discrete-time Cox regression models. Results The risk for leaving home of survivors of hematological malignancies and solid tumors did not differ significantly from that of the control cohort. Adjustments for possible socioeconomic confounders did not change this pattern. In contrast, survivors of central nervous system (CNS) tumors had a significantly reduced risk for leaving home, which was most pronounced for men (relative risk, men: 0.66; 95% confidence interval, 0.55,0.80; women: 0.88, 95% confidence interval, 0.80,0.97). Conclusion Overall, the psychosocial effects of cancer in childhood or adolescence and its treatment on the survivor and family did not appear to impede social independence in early adulthood, except for survivors of CNS tumors. Pediatr Blood Cancer © 2006 Wiley-Liss, Inc. [source] Defence mechanisms in schizophreniaPERSONALITY AND MENTAL HEALTH, Issue 4 2008Richard J. Shaw Aim,In this study, the aim was to conduct an empirical study of the nature of defence mechanisms in a group of subjects with schizophrenia. Methods,Forty-four clinically stable, medicated subjects with schizophrenia completed the Response Evaluation Measure (REM-71), a self-report measure used to assess defence mechanisms, and were rated with the Brief Psychiatric Rating Scale (BPRS) to assess severity of psychopathology. Responses on the REM-71 were compared with 136 age and gender-matched control subjects. Results,Subjects with schizophrenia were significantly more likely to endorse the use of immature but not mature defence mechanisms when compared with control subjects (p < 0.001). There was no relationship between responses on the REM-71 and the BPRS. Test,retest reliability of the REM-71 was supported by findings that responses by subjects with schizophrenia were unchanged when reassessed after a two-week time interval. Conclusions,Clinically stable subjects with schizophrenia are found to endorse the use of immature defence mechanisms that have been found to have associations with negative outcomes, including in the area of mood, self-efficacy and quality of life. Defence style may be an important mediator of psychosocial outcomes, and knowledge of specific defence patterns may have important clinical implications for both prognosis and treatment. Copyright © 2008 John Wiley & Sons, Ltd. [source] Exposure to Violence, Coping Resources, and Psychological Adjustment of South African ChildrenAMERICAN JOURNAL OF ORTHOPSYCHIATRY, Issue 1 2001Oscar A. Barbarin Ph.D. The effects of exposure to direct and vicarious political, family, and community violence on the adjustment of 625 six-year-old black South African children was examined. Ambient community violence was most consistently related to children's psychosocial outcomes. Resources in the form of individual child resilience, maternal coping, and positive family relationships were found to mitigate the adverse impact in all the assessed domains of children's functioning. [source] Structured extracurricular activities among adolescents: Findings and implications for school psychologistsPSYCHOLOGY IN THE SCHOOLS, Issue 1 2004Rich Gilman One factor that contributes to adolescent positive mental health is active engagement. Engagement is defined as any activity that is initiated to attain an outcome. In general, two forms of activities exist that correspond with engagement: solitary, non-structured, and non-cooperative pursuits, often without adult supervision (e.g., playing video games, watching television) and highly structured, collaborative activities that are under the guidance of a competent set of adults (i.e., structured extracurricular activities, or SEAs). Although large amounts of time spent in unstructured activities is related to negative psychosocial outcomes, participation in SEAs has been related to a variety of positive outcomes for students. This paper reviews current research regarding adolescent participation in SEAs and its effects on academic and personal-social variables (i.e., self-concept, life satisfaction), as well as potential preventive effects for youths considered to be "at-risk" for negative developmental outcomes. The paper also examines research investigating the potential benefits and shortcomings of different types of SEAs. Finally, suggestions for future research and school-based preventive intervention are presented. © 2004 Wiley Periodicals, Inc. Psychol Schs 41: 31,41, 2004. [source] Meta-analyses of the effect of false-positive mammograms on generic and specific psychosocial outcomesPSYCHO-ONCOLOGY, Issue 10 2010Talya Salz Abstract Objectives: While a previous meta-analysis found that false-positive mammography results affect women's likelihood of returning for screening, effects on well being have yet to be meta-analyzed. We investigated whether the effects of false-positive mammograms on women's well-being are limited to outcomes specific to breast cancer. Methods: We searched MEDLINE for studies of the psychosocial effects of false-positive results of routine screening mammography. We pooled effect sizes using random effects meta-analysis. Results: Across 17 studies (n=20,781), receiving a false-positive mammogram the result was associated with differences in all eight breast-cancer-specific outcomes that we examined. These included greater anxiety and distress about breast cancer as well as more frequent breast self-exams and higher perceived effectiveness of screening mammography. False positives were associated with only one of six generic outcomes (i.e. generalized anxiety), and this effect size was small. Conclusions: False-positive mammograms influenced women's well-being, but the effects were limited to breast-cancer-specific outcomes. Researchers should include disease-specific measures in future studies of the consequences of false-positive mammograms. Copyright © 2010 John Wiley & Sons, Ltd. [source] Sexual functioning in young adult survivors of childhood cancerPSYCHO-ONCOLOGY, Issue 8 2010Brad J. Zebrack Abstract Background: Studies of sexuality or sexual behavior in childhood cancer survivors tend to examine relationships or achievement of developmental milestones but not physiological response to cancer or treatment. The purpose of this study is to (1) identify prevalence and risk factors for sexual dysfunction in childhood cancer survivors, and (2) examine the extent to which sexual dysfunction may be associated with health-related quality of life (HRQOL) and psychosocial outcomes. Methods: Five hundred ninety-nine survivors age 18,39 years completed standardized measures of sexual functioning, HRQOL, psychological distress and life satisfaction. Descriptive statistics assessed prevalence of sexual symptoms. Bivariate analyses identified correlates of sexual symptoms and examined associations between symptoms and HRQOL/psychosocial outcomes. Results: Most survivors appear to be doing well, although 52% of female survivors and 32% of male survivors reported at least ,a little of a problem' in one or more areas of sexual functioning. Mean symptom score for females was more than twice that of males. Sexual symptoms were associated with reporting health problems. Significant associations between sexual functioning and HRQOL outcomes were observed, with gender differences in strengths of association suggesting that males find sexual symptoms more distressing than do females. Conclusions: While most survivors appear to be doing well in this important life domain, some young adult survivors report sexual concerns. While female survivors may report more sexual symptoms than male survivors, males may experience more distress associated with sexual difficulties. Better-specified measures of sexual function, behavior and outcomes are needed for this young adult population. Copyright © 2009 John Wiley & Sons, Ltd. [source] ORIGINAL RESEARCH,ED PHARMACOTHERAPY: Psychosocial Outcomes and Drug Attributes Affecting Treatment Choice in Men Receiving Sildenafil Citrate and Tadalafil for the Treatment of Erectile Dysfunction: Results of a Multicenter, Randomized, Open-Label, Crossover StudyTHE JOURNAL OF SEXUAL MEDICINE, Issue 4 2006FRCGP, John Dean MBBS ABSTRACT Introduction., Although sildenafil citrate (sildenafil) and tadalafil are efficacious and well-tolerated treatments for erectile dysfunction (ED), preference studies have shown that patients may favor one medication over the other. Aim., To determine whether psychosocial outcomes differed when men with ED received tadalafil compared with sildenafil. Main Outcome Measures., Measures included a treatment preference question, Psychological and Interpersonal Relationship Scales (PAIRS), and Drug Attribute Questionnaire. Methods., Randomized, open-label, crossover study. After a 4-week baseline, men with ED (N = 367; mean age = 54 years; naïve to type 5 phosphodiesterase inhibitor therapy) were randomized: tadalafil for 12 weeks then sildenafil for 12 weeks or vice versa (8-week dose optimization/4-week assessment phases). During dose optimization, patients started with 10 mg tadalafil, or 25 or 50 mg sildenafil and could titrate to their optimal dose (10 or 20 mg tadalafil; 25, 50, or 100 mg sildenafil). Medications were taken as needed. Patients completing both 12-week periods chose which medication to continue during an 8-week extension. Results., Of 291 men completing both treatment periods, 71% (N = 206) chose tadalafil and 29% (N = 85) chose sildenafil (P < 0.001) for the 8-week extension. When taking tadalafil compared with sildenafil men had higher mean endpoint scores on PAIRS Sexual Self-Confidence (tadalafil = 2.91 vs. sildenafil = 2.75; P < 0.001) and Spontaneity (tadalafil = 3.32 vs. sildenafil = 3.17; P < 0.001) Domains and a lower mean endpoint score on Time Concerns Domain (tadalafil = 2.2 vs. sildenafil = 2.59; P < 0.001). The two most frequently chosen drug attributes to explain treatment preference were ability to get an erection long after taking the medication and firmness of erections. Tadalafil and sildenafil were well tolerated with 12 (3.3%) patients discontinuing for an adverse event. Conclusions., As measured with PAIRS, men with ED had higher sexual self-confidence and spontaneity and less time concerns related to sexual encounters when treated with tadalafil compared with sildenafil. These psychosocial outcomes may help explain why more men (71%) preferred tadalafil for the treatment of ED in this clinical trial. Dean J, Hackett GI, Gentile V, Pirozzi-Farina F, Rosen RC, Zhao Y, Warner MR, and Beardsworth A. Psychosocial outcomes and drug attributes affecting treatment choice in men receiving sildenafil citrate and tadalafil for the treatment of erectile dysfunction: Results of a multicenter, randomized, open-label, crossover study. J Sex Med 2006;3:650,661. [source] PSYCHOSOCIAL INVESTIGATION OF INDIVIDUAL AND COMMUNITY RESPONSES TO THE EXPERIENCE OF OVINE JOHNE'S DISEASE IN RURAL VICTORIAAUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 2 2004Bernadette Hood Objective: This paper explores the psychosocial outcomes for individuals and communities in rural Victoria who experienced the outbreak of Ovine Johne's Disease (OJD). Design: The study uses a qualitative methodology to analyse the minutes of evidence provided by the inquiry into the control of OJD to identify the psychosocial events, experiences and outcomes associated with the control of this outbreak. The inquiry was undertaken by the Environment and Natural Resources Committee of the Victorian State Government. Setting: Public hearings were undertaken by the committee across several rural Victorian communities and the state capital, Melbourne. Subjects: The transcripts detail 136 submissions from 98 individuals and 23 organisations. Outcome measures: The analysis aimed to provide insight into the impact of the disease on individuals and communities and also to explore the factors individuals perceived as associated with these outcomes. Results: While the paper identifies that aspects of stock loss associated with the outbreak caused substantial emotional and economic distress, for farmers the most significant finding was the impact of the government control program on individuals, families and rural communities. The control program was perceived as having very limited scientific credibility and its implementation was described as heartless, inflexible and authoritarian. Involvement with the program resulted in farmers reporting emotions, such as, trauma, shame, guilt and stigma. Families became discordant and the sense of community within rural townships fragmented. Psychological outcomes of grief, depression and anxiety emerged as prevalent themes within families and communities. Conclusions: These data highlight the need for significant attention to the management of rural disasters, such as, the OJD program. [source] |