Relationships between various attitudes towards self-determination in health care with special reference to an advance directive. (1/1152)

OBJECTIVES: The subject of patient self-determination in health care has gained broad interest because of the increasing number of incompetent patients. In an attempt to solve the problems related to doctors' decision making in such circumstances, advance directives have been developed. The purpose of this study was to examine relationships between public attitudes towards patient autonomy and advance directives. SUBJECTS AND MAIN OUTCOME MEASURES: A stratified random sample of 600 adults in northern Sweden was surveyed by a questionnaire with a response rate of 78.2%. The subjects were asked about their wish for control of their health care, their concerns about health care, their treatment preferences in a life-threatening situation (both reversible and irreversible), and their attitudes towards the application of advance directives. RESULTS: Numerous relationships between various aspects of self-determination in health care (desire for control, fears of over-treatment, and choice of treatment level) in general and advance directives, in particular, were found. Those who wanted to have a say in their health care (about 94%) also mainly supported the use of an advance directive. CONCLUSIONS: The fact that almost 30% of the respondents were undecided concerning their personal use of advance directives points to a lack of knowledge and to the necessity of education of the public on these issues.  (+info)

Quality of life associated with varying degrees of chronic lower limb ischaemia: comparison with a healthy sample. (2/1152)

OBJECTIVES: To assess quality of life in patients with varying degrees of ischaemia in comparison with controls, and to determine whether the degree of lower limb ischaemia and sense of coherence were associated with quality of life. MATERIALS AND METHODS: 168 patients, including 93 claudicants and 75 patients with critical ischaemia and 102 controls were studied. Quality of life was assessed using the Nottingham Health Profile in addition to the Sense of Coherence scale. MAIN RESULTS: Patients with lower limb ischaemia scored significantly reduced quality of life in all aspects compared to controls. Pain, physical mobility and emotional reactions were the significant independent factors when using logistic regression analysis. The grade of disease and low sense of coherence were significantly associated with low quality of life. Increasing lower limb ischaemia significantly conferred worse pain, sleeping disturbances and immobility. CONCLUSION: This study showed that the quality of life was impaired among patients with lower limb ischaemia, in all investigated respects. The degree to which quality of life was affected seems to represent an interplay between the grade of ischaemia and the patient's sense of coherence. This suggests the need for a multidimensional assessment prior to intervention.  (+info)

Lifetime low-level exposure to environmental lead and children's emotional and behavioral development at ages 11-13 years. The Port Pirie Cohort Study. (3/1152)

The Port Pirie Cohort Study is the first study to monitor prospectively the association between lifetime blood lead exposure and the prevalence of emotional and behavioral problems experienced by children. Lead exposure data along with ratings on the Child Behavior Checklist were obtained for 322 11-13-year-old children from the lead smelting community of Port Pirie, Australia. Mean total behavior problem score (95% confidence interval (CI)) for boys whose lifetime average blood lead concentration was above 15 microg/dl was 28.7 (24.6-32.8) compared with 21.1 (17.5-24.8) in boys with lower exposure levels. The corresponding mean scores (95% CI) for girls were 29.7 (25.3-34.2) and 18.0 (14.7-21.3). After controlling for a number of confounding variables, including the quality of the child's HOME environment (assessed by Home Observation for Measurement of the Environment), maternal psychopathology, and the child's IQ, regression modeling predicted that for a hypothetical increase in lifetime blood lead exposure from 10 to 30 microg/dl, the externalizing behavior problem score would increase by 3.5 in boys (95% CI 1.6-5.4), and by 1.8 (95% CI -0.1 to 11.1) in girls. Internalizing behavior problem scores were predicted to rise by 2.1 (95% CI 0.0-4.2) in girls but by only 0.8 (95% CI -0.9 to 2.4) in boys.  (+info)

Coping with refractory epilepsy. (4/1152)

We investigated the coping behaviour and its correlation with demographic and illness-related data, depression, locus of control and psychosocial adaptation in 40 patients with intractable epilepsy with primarily or secondarily generalized tonic-clonic seizures. Three standardized self-reporting questionnaires were applied, which are the Freiburg Questionnaire of Coping with Illness (FKV), the von Zerssen Depression Scale (D-S), and the IPC-questionnaire measuring generalized locus of control beliefs; the Social Interview Schedule (SIS), a semi-structured interview, was used to measure the psychosocial adaptation. Active, problem-focused and compliance strategies were predominantly used and regarded as most helpful. Hence, the epileptic patients use similar coping patterns reported in patients with other non life-threatening chronic diseases. The level of depression was moderate and in the range of other chronic somatic diseases. The use of coping patterns, which are regarded as maladaptive, was correlated with distinct depression, a small degree of internal locus of control beliefs and poor psychosocial adaption. These results indicate the possibility to improve psychosocial adjustment by supporting effective strategies.  (+info)

'Fatalism', accident causation and prevention: issues for health promotion from an exploratory study in a Yoruba town, Nigeria. (5/1152)

As countries experience the 'epidemiological transition' with a relative decline in infectious diseases, accident rates tend to increase, particularly road traffic accidents. The health promotion interventions intended to prevent or minimize the consequences of accidents have been developed in predominantly Western, industrialized countries. Although some of these solutions have been applied with success to less developed countries, there are also good reasons why such solutions are ineffective when tried in a different context. Health promotion as developed in the West has a particular ideological bias, being framed within a secular, individualist and rationalist culture. Different cosmologies exist outside this culture, often described as 'fatalist' by Western commentators and as obstructing change. Changing these cosmologies or worldviews may not fit with the ethic of paying due respect to the cultural traditions of the 'target group'. Health promotion is therefore faced with a dilemma. In addition to different worldviews, the different levels of development also mean that solutions formulated in richer countries do not suit poorer countries. This paper uses a small exploratory study in a Yoruba town in Nigeria to examine these points. Interviews with key informants were held in March 1994 in Igbo-Ora and data were extracted from hospital records. Levels of accidents from available records are noted and people's ideas about accident prevention are discussed. Recommendations as to the way forward are then proposed.  (+info)

Dependence, locus of control, parental bonding, and personality disorders: a study in alcoholics and controls. (6/1152)

Personality traits, socio-cultural factors, and dysfunctional family systems are considered to be important in the aetiology and clinical development of alcoholism. Particularly, conflict and issues involving psychological (emotional) dependence have long been associated with alcohol addiction. The present work, part of a more extensive study to validate a new rating scale to measure emotional dependence, the Dependence Self-rating Scale (DSRS), assesses dependence, orientation of locus of control, parental bonding perceptions, and personality disorders (PDs) in alcoholic and non-alcoholic samples. The alcoholics showed a prevalence of PDs of 31.3%. The most frequent is the Schizoid PD (40%) followed by the Dependent PD (20%). Subjects with antisocial PD were not included in our selection criteria. The alcoholics scored higher on the DSRS than the controls, but this difference was not statistically significant. By making a comparison between subjects with and without PDs, the DSRS scores were significantly higher in alcoholics with PDs. No significant differences between alcoholics and non-alcoholics in the parental perceptions and locus of control were seen. These findings are sufficiently coherent to encourage further studies on psychological emotional dependence in alcoholics using the DSRS.  (+info)

How ageing and social factors affect memory. (7/1152)

OBJECTIVES: To explore the relationships between lifestyle and memory, and determine whether social factors influence memory. METHODS: the relationship between memory and lifestyle was examined in 497 adults aged 25-80 years, using the Mectamemory in Adulthood questionnaire. We asked about sports activity and perceived activity, participation in voluntary organizations and social contacts. RESULTS: Activity and frequent contact with friends and family were related to higher memory capacity scores. Those with higher capacity scores were also younger, had better health and a stronger internal locus of control. In contrast, people with higher anxiety scores had more symptoms and less education, and were more externally oriented. CONCLUSIONS: people who consider themselves socially and physically active also consider their memory capacity to be good and are less anxious about their memory than less socially and physically active people. Perceived memory change appears to be predominantly influenced by ageing, whereas memory capacity and memory anxiety are more influenced by social factors.  (+info)

Carer distress in the general population: results from the Sydney Older Persons Study. (8/1152)

OBJECTIVE: To assess distress in a sample of carers who were selected from a community survey rather than recruited via community-service agencies. METHODS: A community survey was carried out on 630 people aged 75 or over living in Sydney, Australia. Informants nominated by these elderly people were divided into full carer (n = 21), partial carer (n = 187) and non-carer groups (n = 344). Informants completed the General Health Questionnaire (a continuous measure of psychiatric symptoms), the life satisfaction index (a measure of well-being) and the interpersonal bonding measure (a measure of quality of the relationship with the elderly person). Elderly participants had a medical examination, were assessed for disability and were questioned about use of services. RESULTS: Elderly people who had a full carer were more disabled and had more medical diagnoses. Full, but not partial, carers reported more psychiatric symptoms and lower life satisfaction. In multivariate analysis, the main determinant of carer distress was a relationship in which the carer felt controlled by the elderly person. CONCLUSION: When carers are selected from a population-based sample, only those who are full carers are more distressed. However, relationship factors are the most important determinant of distress.  (+info)