Hirschsprung's disease: functional and psychological follow up comparing total colonic and rectosigmoid aganglionosis.
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AIMS: To compare the long term functional and psychosocial outcomes following surgical treatment for total colonic aganglionosis (TCA) with those in an age and gender matched group of patients with rectosigmoid aganglionosis (RSA). METHODS: Fifteen patients with TCA matched for age and gender with 15 patients with RSA were studied 7-17 years after the definitive operation. The internal and external sphincters were examined using anal endosonography. Functional outcome (faecal continence) was assessed by a surgeon not involved in the patients' care, and by a research psychologist in separate assessment sessions. The behavioural and emotional status of the patients was also assessed. RESULTS: Based on the surgeon's assessment, 6/15 TCA and 7/15 RSA patients were continent. In comparison, based on the psychological interview, 2/15 TCA and 6/15 RSA patients were continent. The TCA patients reported significantly more behavioural/emotional problems and lower levels of self esteem than the RSA patients. The parent and teacher assessments of psychosocial status revealed no differences between the groups. There was no association between incontinence and psychosocial adjustment in either group. There was no association between the assessments of functional outcome and the endosonographic appearance of the anal sphincters. CONCLUSIONS: The proportion of patients with faecal incontinence 7-17 years after definitive surgery was high in both groups, but no association was found between incontinence and the psychosocial outcome measures. TCA patients perceived themselves as less well adjusted than their matched pairs. Differences between the groups in length of hospitalisation and severity of illness, especially in infancy and early childhood, may account for these differences. (+info)
International business travel: impact on families and travellers.
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OBJECTIVES: Spouses and staff of the World Bank Group (WBG) were questioned about the impact of international business travel on families and travellers. Dependent variables were self reported stress, concern about the health of the traveller, and negative impact on the family. We hypothesised that several travel factors (independent variables) would be associated with these impacts. These travel factors had to do with the frequency, duration, and predictability of travel and its interference with family activities. METHODS: Survey forms were developed and distributed to all spouses of travelling staff as well as a small sample of operational staff. Kendall's tau b correlation coefficients of response frequencies were computed with the data from scaled items. Written responses to open ended questions were categorised. RESULTS: Response rates for spouses and staff were 24% and 36%, respectively. Half the spouse sample (n=533) and almost 75% of the staff sample (n=102) reported high or very high stress due to business travel. Self reported spouse stress was associated with six out of eight travel factors. Female spouses, those with children, and younger spouses reported greater stress. Self reported staff stress was significantly associated with four out of nine travel factors. Further insight into how business travel affects families and staff (including children's behavioural changes) and how families cope was gained through responses to written questions. CONCLUSIONS: The findings support the notion that lengthy and frequent travel and frequent changes in travel dates which affect family plans, all characteristic of WBG missions, negatively affects many spouses and children (particularly young children) and that the strain on families contributes significantly to the stress staff feel about their travel. Policies or management practices that take into consideration family activities and give staff greater leeway in controlling and refusing travel may help relieve stress. (+info)
Identifying mothers at risk for postnatal emotional distress: further evidence for the validity of the perinatal posttraumatic stress disorder questionnaire.
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OBJECTIVE: We evaluated the construct validity of the Perinatal Posttraumatic Stress Disorder Questionnaire. STUDY DESIGN: Using a convergent/divergent validity design and two data sources (traditional survey and World Wide Web), 121 high-risk and 52 low-risk mothers answered four questionnaires. RESULTS: High-risk mothers scored higher than low-risk mothers on all measures of emotional distress. There were significant positive correlations among the convergent measures of emotional distress, which were significantly larger than any correlation of the divergent measure with a convergent measure. Scores on the Perinatal Posttraumatic Stress Disorder Questionnaire were positively related to mothers seeking formal psychotherapy for their childbirth experiences. Questionnaire responses were not related to data source. CONCLUSION: The Perinatal Posttraumatic Stress Disorder Questionnaire is a useful tool for identifying significant emotional distress in mothers during the postnatal period. (+info)
Comparison of psychopathology in the mothers of autistic and mentally retarded children.
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The aim of this study was to evaluate anxiety, depression, alexithymia, and general psychological symptoms in the mothers of autistic children in comparison with those in the mothers of mentally retarded children. Forty mothers of autistic children and 38 mothers of mentally retarded children were included in the study. After a clinical interview, psychometric tests were performed for depression, anxiety, alexithymia, and Symptom Distress Check List (SCL-90) for general psychological symptoms. Non-depression rates was 27.5% in the mothers of autistic children whereas the rate was 55.3% in the mothers of mentally retarded children. There was no difference regarding anxiety and alexithymia between the two groups. The psychopathology in the mothers of autistic children was more frequent than in those of mentally retarded children in all sub-scales of SCL-90 (somatization obsessive-compulsive, interpersonal sensitivity, depression, anxiety, anger-hostility, phobic anxiety, paranoid thought, psychotism, and extra scale). The mothers of autistic children experienced more psychological distress than those of mentally retarded children. Our findings indicates that the assessment of autistic and mentally retarded children should include psychological assessment of their mothers. (+info)
The predictive value of the Toronto Alexithymia Scale among patients with asthma.
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OBJECTIVE: The present study examines how alexithymia, self-report of symptoms, and pulmonary function are related to each other among a sample of patients with asthma. The goal was to extend previous research showing that alexithymia may complicate treatment of asthma. METHODS: Seventy-four participants with asthma completed the Toronto Alexithymia Scale (TAS), Asthma Symptom Checklist (ASC), Taylor Manifest Anxiety Scale (TMAS), and spirometry testing. RESULTS: The "Difficulty identifying feelings" subscale (IDE) of the TAS was associated with increased report of emotional symptoms (panic-fear) as well as physical symptoms (fatigue) during the past week, but not pulmonary function on the day of testing. This relationship appeared to be influenced by trait anxiety. The "Difficulty communicating feelings" subscale (COM) was correlated with decreased pulmonary function, but not report of emotional or physical sensations experienced during the prior week. The "Externally oriented thinking" subscale (EOT) was not related to any of the dependent measures. CONCLUSION: These data suggest that alexithymia may complicate optimal management of asthma and this relationship is best studied by examining the subscales of the TAS separately. (+info)
Low back pain in schoolchildren: the role of mechanical and psychosocial factors.
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BACKGROUND: Low back pain (LBP) in schoolchildren with no apparent clinical cause is known to be a common problem, but considerably less is understood regarding the aetiology of such pain. AIM: To assess the role of both mechanical and psychosocial factors (including emotional and behavioural problems and other somatic pain complaints) in childhood LBP. METHODS: A cross sectional study was carried out in a population of 1446 schoolchildren aged 11-14 years. Information on these potential risk factors for LBP was sought using a self complete questionnaire and a five day bag weight diary. RESULTS: Mechanical factors such as physical activity and school bag weight were not associated with LBP. However, strong associations with LBP were observed for emotional problems, conduct problems, troublesome headaches, abdominal pain, sore throats, and daytime tiredness. CONCLUSION: Results suggest that psychosocial factors rather than mechanical factors are more important in LBP occurring in young populations and could possibly be a reflection of distress in schoolchildren. (+info)
Clinical effects of sexual abuse on people with learning disability: critical literature review.
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BACKGROUND: There are few publications concerning the psychological reactions of people with learning disabilities to sexual abuse. Most significantly, there are no controlled studies and few which demonstrate a systematic approach to documenting the sequelae of trauma. AIMS: To critically review the published research in this field. METHOD: A literature search in peer-reviewed psychiatry, psychology, nursing and social care journals for the years 1974 to 2001 was conducted and 25 studies were reviewed. RESULTS: Several studies suggest that, following sexual abuse, people with learning disabilities may experience a range of psychopathology similar to that experienced by adults and children in the general population. However, because of methodological limitations, these results are not conclusive. CONCLUSIONS: Whether people with learning disabilities experience reactions to sexual abuse similar to the general population has yet to be explored by systematic research. (+info)
Medically unexplained symptoms in patients referred to a specialist rheumatology service: prevalence and associations.
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OBJECTIVES: To determine the prevalence of medically unexplained rheumatic symptoms amongst patients newly referred to a rheumatology out-patient service and to examine their relationship with pain, disability, socioeconomic factors and the presence of emotional disorders (anxiety, depression and panic). METHODS: A sample of newly referred consecutive patients to a hospital-based, regional rheumatology service was administered a questionnaire for assessment of emotional disorders, pain, health status and socioeconomic factors. Rheumatologists rated the degree to which patients' symptoms were explained by organic disease (organicity rating). RESULTS: Two hundred and fifty-six patients were eligible and 203 (79%) participated. The sample included 69% females and mean age was 50 yr. Ninety-three (46%) had symptoms that were completely explained, 52 (26%) largely explained, 41 (20%) somewhat explained and 17 (8%) not at all explained by organic disease. Patients whose symptoms were of "low organicity" (somewhat or not at all explained) were more likely to be female [relative risk (RR) 1.8, 95% confidence interval (CI) 1.0-3.1], younger (mean age 44 vs 52 yr, P<0.001) and to report more somatic symptoms (median 2 vs 1, P=0.021). On univariate analysis they were more likely to be experiencing financial hardship (RR 1.7, 95% CI 1.1-2.6) and work dissatisfaction (RR 1.6, 95% CI 1.0-2.4) and to live in rented housing (RR 1.8, 95% CI 1.2-2.8) or with dependent relatives (RR 1.6, 95% CI 1.0-2.5). Logistic regression showed that female gender and living in rented housing were the significant independent predictors of low organicity. Organicity ratings were not associated with pain severity, disability, physical and mental health status or the presence of emotional disorders. CONCLUSIONS: Twenty-nine per cent of patients newly referred to rheumatology clinics had symptoms that were poorly explained by identifiable rheumatic disease. Having unexplained symptoms was associated with socioeconomic factors but not levels of pain, disability or emotional disorders. (+info)