Characteristics of discrepancies between self-reported visual function and measured reading speed. Salisbury Eye Evaluation Project Team.
PURPOSE: Visual impairment is a risk factor for morbidity in the elderly and is often screened for by self-report. This study evaluates whether there are subsets for whom there is a discrepancy between self-reported and measured function. METHODS: The prevalence of a discrepancy between self-reported difficulty reading a newspaper and measured reading speed was determined in 2520 community-based men and women, aged 65 to 84 years, and the discrepant group characterized by polychotomous regression. RESULTS: Of subjects who reported minimal difficulty reading a newspaper, 10.8% (227/2107) read newsprint-sized text (0.21 degrees) more slowly than 80 words/min, a level previously shown to be necessary for sustained reading. Poor visual acuity, presence of psychiatric symptoms, and less satisfaction with vision were associated with being in the group that read slowly and reported difficulty with reading. Better cognition, better visual acuity, more years of education, white race, and fewer psychiatric symptoms were associated with being in the group that read more quickly and reported minimal difficulty. When reading the text size at which subjects read their fastest, only 2.6% of those with minimal difficulty remained discrepant. These individuals were more likely to have less education, be male, be African American, and have poorer cognitive status than those who did not remain discrepant. CONCLUSIONS: A subset of the elderly population have a substantial discrepancy between self-reported reading difficulty and measured reading speed. In some, this discrepancy may be based on underlying expectations and experiences, and in others it may represent a transition from no visual impairment to visual impairment. (+info
Prevalence of hepatitis C in prisons: WASH-C surveillance linked to self-reported risk behaviours.
We used cross-sectional willing anonymous salivary hepatitis C (WASH-C) surveillance linked to self-completed risk-factor questionnaires to estimate the prevalence of salivary hepatitis C antibodies (HepCAbS) in five Scottish prisons from 1994 to 1996. Of 2121 available inmates, 1864 (88%) participated and 1532/1864 (82%) stored samples were suitable for testing. Overall 311/1532 (20.3%, prevalence 95% CI 18.3-22.3%) were HepCAbS-positive: 265/536 (49%, 95% CI 45-54%) injector-inmates but only 27/899 (3%, 95% CI 2-4%) non-injector-inmates. Among injectors, HepCAbS positivity was only slightly higher (p = 0.03) in those who had injected inside prison (53%, 162/305) than in those who had not (44%, 98/224). Those who began injecting in 1992-96 were much less likely to be HepCAbS-positive than those who started pre-1992 (31%, 35/114 vs. 55%, 230/422; p < 0.001). Even with injectors who began in 1992-96 but had never injected inside prison, the prevalence of hepatitis C carriage was 17/63 (95% CI 16-38%). The prevalence and potential transmissibility of hepatitis C in injector-inmates are both high. Promoting 'off injecting' before 'off drugs' (both inside and outside prison), methadone prescription during short incarcerations, alternatives to prison, and support of HepCAbS-positive inmates in becoming eligible for treatment, all warrant urgent consideration. (+info
Telling the story: parents' scripts for donor offspring.
This study documents experiences of parents who chose to disclose, and intended to disclose to their children, information about the donor involvement, and children's responses when they received this information. Of the 181 parents who responded, 30% (n = 54) gave their children information about their conception (34 families). Couples chose to tell when 'it just seemed right' or when they believed their children could understand their stories. The stories shared concerned the parents' inability to have children together, and the need for spermatozoa and specialist attention, and the families reading a book about donor insemination. There appeared to be an advantage in giving children this information at a young age, at which the information was processed in a factual, non-emotional way. Any questions asked by the children related to practical issues. These parents reported that it gave them opportunities gradually to introduce information as the children's understanding progressed. Of the parents who had not told (n = 127), 77% (n = 98) intended to disclose information in the future. This group gave their child's age and inability to understand as their main reasons for choosing to wait. Some 17% (n = 22) of parents who had not told chose not to disclose. There were no significant differences between the responses of mothers and fathers. (+info
Self-reporting versus parental reporting of acute respiratory symptoms of children and their relation to pulmonary function and air pollution.
BACKGROUND: Studies of acute effects of outdoor air pollution on acute respiratory symptoms in children generally rely on reports by parents. Little is known about the validity of parental reporting of symptoms of their children. We therefore compared symptoms reported by the parents with self-reported symptoms and measured pulmonary function of 741 7-11-year-old Dutch children. We also analysed the association of symptoms reported by the child or parent and outdoor air pollution. METHODS: The parents of the children completed a daily diary of symptoms of their children for about 3 months. The children reported presence of acute respiratory symptoms in the preceding week before a pulmonary function test was conducted (6-10 test days). RESULTS: Children reported between 80% and 220% more acute respiratory symptoms than their parents for them in the same period. The agreement between symptom reports by the parent and the child was low to moderate (Kappa between 0.22 for eye irritation and 0.43 for fever). Presence of cough reported by child or parent was associated with similar small decrements in forced vital capacity (FVC), forced expiratory volume in one second (FEV1.0) and especially peak expiratory flow (PEF) and maximal mid-expiratory flow (FEF25-75). The largest pulmonary function decrements were found when symptoms were reported by both parent and child. Symptoms reported by either child or parent were not associated with air pollution. CONCLUSIONS: Symptom reports of the children were more prevalent but did not agree well with parental reports. The similar association with pulmonary function suggested that self-reported symptoms were neither superior nor inferior to symptoms reported by the parents. (+info
Follow-up of psychogenic, non-epileptic seizures: a pilot study - experience in a Dutch special centre for epilepsy.
A follow-up study was performed in 33 patients with proven (ictal EEG-CCTV) psychogenic, non-epileptic seizures (PNES). These patients received a questionnaire to evaluate seizures, treatment and rehabilitation. The response group consisted of 21 females (80% response) and seven males (100% response). Follow-up after diagnosis varied from 23-67 months. Seven patients (25%) reported that seizures had ceased and of the patients not seizure-free seven did report a seizure-free period after diagnosis of an average 6.7 months. Eight patients were on antiepileptic drugs again. Of 13 patients referred for psychotherapy, who also did receive treatment, six became free of seizures and seven did not. Of seven patients also referred, but who did not receive psychotherapy, all continued to have seizures. On a self-rating scale to compare "overall function" at the time of diagnosis and follow-up, 75% considered themselves to have "improved", but no improvement could be detected in psychosocial functioning. (+info
Projective identification, self-disclosure, and the patient's view of the object: the need for flexibility.
Certain patients, through projective identification and splitting mechanisms, test the boundaries of the analytic situation. These patients are usually experiencing overwhelming paranoid-schizoid anxieties and view the object as ruthless and persecutory. Using a Kleinian perspective, the author advocates greater analytic flexibility with these difficult patients who seem unable to use the standard analytic environment. The concept of self-disclosure is examined, and the author discusses certain technical situations where self-disclosure may be helpful. (The Journal of Psychotherapy Practice and Research 1999; 8:225-233) (+info
Mental health consumers' experience of stigma.
The extent to which mental health consumers encounter stigma in their daily lives is a matter of substantial importance for their recovery and quality of life. This article summarizes the results of a nationwide survey of 1,301 mental health consumers concerning their experience of stigma and discrimination. Survey results and followup interviews with 100 respondents revealed experience of stigma from a variety of sources, including communities, families, churches, coworkers, and mental health caregivers. The majority of respondents tended to try to conceal their disorders and worried a great deal that others would find out about their psychiatric status and treat them unfavorably. They reported discouragement, hurt, anger, and lowered self-esteem as results of their experiences, and they urged public education as a means for reducing stigma. Some reported that involvement in advocacy and speaking out when stigma and discrimination were encountered helped them to cope with stigma. Limitations to generalization of results include the self-selection, relatively high functioning of participants, and respondent connections to a specific advocacy organization-the National Alliance for the Mentally Ill. (+info
Improving the health behaviours of elderly people: randomised controlled trial of a general practice education programme.
OBJECTIVES: To establish the effect of an educational intervention for general practitioners on the health behaviours and wellbeing of elderly patients. DESIGN: Randomised controlled trial with 1 year follow up. SETTING: Metropolitan general practices in Melbourne, Australia. SUBJECTS: 42 general practitioners and 267 of their patients aged over 65 years. INTERVENTION: Educational and clinical practice audit programme for general practitioners on health promotion for elderly people. MAIN OUTCOME MEASURES: Patients' physical activity, functional status, self rated health, immunisation status, social contacts, psychological wellbeing, drug usage, and rate of influenza vaccination. Primary efficacy variables were changes in outcome measures over 1 year period. RESULTS: Patients in the intervention group had increased (a) walking by an average of 88 minutes per fortnight, (b) frequency of pleasurable activities, and (c) self rated health compared with the control group. No change was seen in drug usage, rate of influenza vaccination, functional status, or psychological wellbeing as a result of the intervention. Extrapolations of the known effect of these changes in behaviour suggest mortality could be reduced by 22% if activity was sustained for 5 years. CONCLUSIONS: Education of the general practitioners had a positive effect on health outcomes of their elderly patients. General practitioners may have considerable public health impact in promotion of health for elderly patients. (+info