Uncertainty, symptoms, and quality of life in persons with chronic hepatitis C.

BACKGROUND: Chronic hepatitis C (CHC) is the most common blood-borne infection in the United States, but little is known about illness uncertainty in these patients. OBJECTIVE: The authors examined the constructs of illness uncertainty. METHOD: In this cross-sectional study, Mishel's Uncertainty in Illness Scale was used to examine these constructs (ambiguity, complexity, inconsistency, unpredictability) and their relationships with fatigue, pain, depressive symptoms, comorbidity, and quality of life (QOL) in 126 CHC patients undergoing a watchful-waiting protocol. RESULTS: The Ambiguity subscale had the strongest relationships with depressive symptoms, QOL, and fatigue, and three of the four subscales were significantly correlated with pain. CONCLUSION: The results suggest targets for patient self-management interventions.

Medical students' attitudes toward pregnant women with substance use disorders.

OBJECTIVE: The objective of this study was to determine whether medical students' attendance at a clinic designed for pregnant substance users would yield changes in their attitudes toward the special needs of this population. STUDY DESIGN: This prospective study involved 104 consecutive third-year students rotating on our obstetrics-gynecology clerkship. Students were assigned to attend either a half day prenatal clinic designed specifically for women with substance use disorders during the first 4 weeks (study group) or during the second 4 weeks (control group). Each answered a confidential 24-question survey (using a 5-point scale from "strongly agree" to "strongly disagree"), dealing with comfort levels and attitudes, at the beginning and midway points of the 8-week clerkship. Student t tests were used for comparisons of averaged scores. RESULTS: At the beginning of the clerkship, no differences were found between the study (n = 52) and control groups (n = 52) in their responses to the survey. Regardless of gender, students who attended the clinic reported they became more comfortable in talking with patients about their substance use (P < .001) and more nonjudgmental in treating these patients (P < .02). Compared with before the clerkship, the control group became less comfortable in talking with these patients about their habits (P < .01), less aware about the prevalence of substance abuse during pregnancy (P < .02), and less aware about the efficacy of counselors (P < .05). CONCLUSION: Medical students became more comfortable and better informed about pregnant women with substance use disorders after attending a clinic dedicated toward this population's special needs.

Impact of a Diabetes Risk Score on Lifestyle Education and Patient Adherence (IDEA) in Prediabetes: A Multisite Randomized Controlled Trial.

BACKGROUND: To evaluate whether knowledge of a personalized Diabetes Risk Score (DRS) improved performance in a 12-week lifestyle change program for prediabetes. METHODS: Randomized subjects at four clinics provided samples for a DRS at baseline, 12, and 24 weeks. The intervention group received scores at each point, whereas the control group only received this information at 12 and 24 weeks. Outcomes included attendance and changes in weight, abdominal circumference, blood pressure, fasting glucose, hemoglobin A1c, cholesterol, and risk score. RESULTS: Baseline characteristics were similar in the groups (n = 192) and within risk-stratified subgroups. At 12 weeks, there were no differences in outcomes, with mean weight loss of 4.61 kg in the intervention group and 4.43 kg in the control group (p = 0.79). Both groups were given 12-week risk scores, with previously unseen baseline scores for the control group. The control group continued to lose additional weight (1.21 kg) by 24 weeks, whereas the intervention group regained previously lost weight (0.33 kg) (p = 0.04). CONCLUSIONS: The knowledge of a single baseline personalized DRS did not affect performance in a lifestyle modification program. However, the knowledge of an improvement in risk score, and the timing of this information, may impact further adherence.