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 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In a patient population with serious, debilitating chronic disease, the present study tested the hypothesis that a significant amount of variance in patient satisfaction ratings of provider behavior would be explained by patients' current assessment of their health and their social circumstances. More favorable patient ratings of the art, technical quality and efficacy of their care givers were found to be significantly associated with more positive general health perceptions, fewer days spent in bed due to health problems and lower scores on a widely used depression scale, as well as with age and ethnic background. These data provide evidence indicating that patient satisfaction measures are sensitive to and confounded by patients' perceived health, view of life and social circumstances. It is suggested that if patient satisfaction ratings are to be used as indicators of the quality of health care delivery, there is a need to account for the variance attributable to measurable psychological, social and demographic factors.
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PMID:Patient suffering and patient satisfaction among the chronically ill. 707 98

The aim of the study was to determine whether duodenal ulcer is associated with depression. Forty-three patients with endoscopically proven symptomatic ulcers were compared with 43 control persons matched for age, sex, and social class. Depression was assessed by the Beck Inventory. Duodenal ulcer patients had a higher mean score than controls, and this difference was probably due to the possession of a chronic disease rather than typical duodenal ulcer. Only one patient showed moderate depression, and none were severely depressed.
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PMID:Chronic duodenal ulcer and depression. 738 43

Several studies have identified potential detrimental sequelae of cholesterol and fat-lowering interventions in randomized trial. Little research has been published to document changes in mental health in women as a result of fat and cholesterol lowering interventions to prevent chronic disease. This paper examines the relationships among changes in dietary fat consumption and mental health in the Women's Health Trial, a randomized, controlled trial to determine whether lowering fat consumption to 20% of daily calories could reduce the incidence of breast cancer in women ages 45-69 years. Assessments were made at baseline and at the 12-month follow-up of several aspects of quality of life, including negative and positive affect and past, present, and future perceptions of health. Mental health variables were measured by the Mental Health Inventory, a standardized scale used in the Medical Outcomes study. Dietary intake was assessed for all subjects with the use of semiquantitative food frequency questionnaires. The change in mental health values (follow-up minus baseline) was significantly different between intervention and control groups for three of the four psychological variables: (a) anxiety; (b) depression; and (c) vigor. In all three cases, the direction of the change for intervention women was positive. Neither randomization assignment nor percent of calories from fat at the follow-up visit were significant predictors of mental health at the 1-year follow-up. Cholesterol changes were not related to levels of mental health variables in a sample of the women. These data indicate that lowering fat in the diets of healthy women does not produce overall lowering of any mental health variables.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Effects of dietary fat intervention on mental health in women. 754 14

In an attempt to understand better the immunoregulatory disorders in paracoccidioidomycosis (PCM), the possible correlation between interleukin pattern, lymphoproliferation, C-reactive protein (CRP) and specific antibody levels was investigated in the polarized clinical forms of this disease. We studied 16 PCM patients, eight with the disseminated disease (four under treatment and four non-treated) and eight with the chronic disease. The patients with disseminated disease exhibited high antibody titres specific to Paracoccidioides brasiliensis antigen compared with patients with the chronic form of disease. Tumour necrosis factor (TNF), IL-1, IL-6 and CRP in the serum of non-treated disseminated PCM patients were increased, which correlated positively with the low mitogenic response of peripheral blood mononuclear cells (PBMC) to phytohaemagglutinin (PHA) (P < 0.01) and with the high antibody titres (P < 0.001) of these patients. Moreover, we found in the disseminated PCM patients positive correlations between IL-1 and IL-6 (P = 0.0007); IL-1 and TNF (P = 0.0045); IL-1 and IL-6 with the high antibody titres (P = 0.0834 and P = 0.0631, respectively); IL-1, IL-6 and TNF with CRP levels. By contrast, no correlations were found with those interleukins in the treated disseminated and chronic patients or in controls. It was interesting to find an inverse correlation between IL-4 and antibody production in non-treated disseminated PCM (r = -0.4770); moreover, a significant correlation (P = 0.0820) was found in chronic PCM patients with respect to the low level of either IL-4 and antibody titres against fungus antigen. Chronic PCM patients also had IL-2 levels inversely correlated with antibody production (r = -0.6313; P = 0.0628). Inverse correlations were also observed between IL-2 and IL-6 levels in non-treated disseminated patients (P = 0.0501) and between IL-2 and IL-4 in chronic patients (P = 0.0131). The inflammatory cytokines might have a pivotal role in the genesis and in control of some aspects of the disease, such as granulomatous reaction, hypergammaglobulinaemia and depression of T cell-mediated immunity in PCM.
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PMID:Differential correlation between interleukin patterns in disseminated and chronic human paracoccidioidomycosis. 764 15

Although both overweight and body weight fluctuation are related to chronic disease risk, little is known about the history of and reasons for body weight change in the general population. This paper reports the incidence of intentional and unintentional weight loss episodes during adulthood in a population-based sample of 26,261 women aged 55 to 69 years. Intentional weight loss episodes of each of four amounts (5-9, 10-19, 20-49, 50+ lbs.) and unintentional weight loss episodes of 20 or more lbs. were recalled for each of three age periods (18-39, 40-54, 55+ years). At least one intentional weight loss episode of 5 or more lbs. was reported by 69% of women, 46% reported at least one intentional weight loss episode of 10 or more lbs, and 25% reported at least one intentional weight loss episode 20 or more lbs. At least one unintentional weight loss episode of 20 or more lbs. was reported by 29% of the women. Reasons for weight losses of 20 or more lbs. were also recalled. Women who had intentionally lost 20 or more lbs. were more likely to report weight losses due to low-calorie diets, exercise and weight loss groups, while women who had unintentionally lost 20 or more lbs. were more likely to report weight losses due to depression or stress. These findings question the common assumption that weight losses in adult women are primarily intentional and emphasize the need to distinguish the reasons for weight loss in studies examining the relationship between body weight changes and health outcomes.
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PMID:History of intentional and unintentional weight loss in a population-based sample of women aged 55 to 69 years. 771 62

Michael Von Korff and colleagues at the Center for Health Studies, Group Health Cooperative (GHC) of Puget Sound created a measure of chronic disease status (CDS) using automated outpatient pharmacy data. They reported the measure appeared to provide a stable and valid measure of health status. The availability of such a measure could become a new tool for a variety of applications, including screening, resource allocation, and quality assurance. The measure was replicated for its reliability and construct and predictive validity in the KPNW membership using automated pharmacy data. Reliability and validity were tested using correlation and regression techniques. The CDS showed test-retest reliability over time. It showed construct validity with the RAND-36 instrument and the BSI-8 depression screener. It showed predictive validity with health care visits and hospitalizations. The results were similar to those at GHC. The findings indicated that the CDS can serve, with certain precautions, as a readily accessible low cost measure of health status.
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PMID:Replicating the chronic disease score (CDS) from automated pharmacy data. 772 53

Investigated the relationship between maternal and child emotional adaptation both across and within samples of children with cystic fibrosis (CF) and insulin-dependent diabetes mellitus (IDDM). Higher levels of maternal depression were associated with increased depression in children with IDDM. In addition, increased illness severity and greater length of time since diagnosis were related to increased depression in children with IDDM. Whereas maternal depression was related to decreased trait anxiety for children in the CF group, neither maternal anxiety or depression were associated with child depression or state anxiety. Empirical and clinical implications of a disease-specific approach to studying chronic disease in children are discussed.
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PMID:Child and maternal adaptation to cystic fibrosis and insulin-dependent diabetes mellitus: differential patterns across disease states. 776 Feb 18

Complaints of sleep disturbance increase with age. Objective sleep assessments using polysomnography reveal sleep impairments (increased wakefulness and arousal from sleep; decreased slow wave sleep) even in healthy seniors. Both polysomnographic sleep and subjective sleep worsen in the presence of health impairments related to drug use, pain, cardiovascular disease, diabetes, depression, or other emotional disorders. In addition to normal aging and chronic disease, sleep complaints can also result from poor sleep habits, specific occult disorders during sleep, or some combination of these factors. Occult disorders include sleep apnea syndrome, periodic leg movements, and restless legs syndrome during sleep. Diagnosis and treatment of these and other sleep disorders is discussed. Both pharmacological and nonpharmacological treatments are considered, with an emphasis on behavioral and educative treatment approaches.
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PMID:Sleep and sleep disorders in older adults. 779 28

Chronic pain severity, the responses of the significant other to the patient's pain, and social network relationships were investigated for their contributions to depression among patients with myofascial pain disorders (N = 67) and arthritis (N = 83). Interview data were gathered using the Beck Depression Inventory, McGill Pain Inventory, Multidimensional Pain Inventory, and Interpersonal Relationships Inventory. Patients with myofascial pain disorders reported significantly more severe depression and pain, more conflict about their pain, and more network conflict than those with arthritis. They also reported less network social support. After controlling for the type of painful chronic disorder, multiple linear regression analyses indicated that more severe depression was significantly associated with more severe pain, conflict about pain, and less network social support. Conflict about pain may increase the risk of depression for patients with chronic painful disorders. Patients with myofascial pain disorders, however, may experience more conflict about their pain because of the absence of objective physical findings that corroborate the report of pain.
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PMID:Depression in painful chronic disorders: the role of pain and conflict about pain. 785 59

Evidence that dying occurs as a natural, final event in the wholeness of human life is culturally, artistically, and scientifically persuasive. Very elderly patients eventually undergo a process of functional declines, progressive apathy, and loss of willingness to eat and drink that culminates in death, even in the absence of acute illness or severe chronic disease. Despite clinical resemblances to depression and dementia, aging itself and a loss of will to live are the most probable explanations for natural dying. Acceptance of the naturalness of dying, however, directly conflicts with the medicalization and legalization of death that characterizes modern society's treatment of dying elderly patients. We prefer instead to believe that dying results from disease and injury, which may yield to advances in medical technology. The progressive move of the dying out of the home and into acute and long-term care facilities suggests that medicalization may be an irreversible process. Viewing dying as an independent diagnosis in patients who are obviously undergoing terminal declines from aging and chronic diseases can facilitate communication about spiritual and palliative care needs, which tend to be neglected in the medicalized view of dying. Physicians and nurses may need to assume the role of medical stewardship to help prevent the overtreatment and overtesting of modern medicine's approach to the dying. The emotional burdens of caring for the dying elderly, however, must be addressed openly through collaborative work, institutional policies on limitation of treatment, and support building among physicians and other caregivers.
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PMID:The naturalness of dying. 756 50


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